2022-11-14T09:20:04-06:00 2022-03-31 382492570 BEENE GARTER 56 GRANDVILLE AVE SW STE 100 GRAND RAPIDS MI 49503 990 2022-01-01 200602574 HOLLAND COMMUNITY HEALTH CENTER HOLL 6163943788 336 S RIVER AVE HOLLAND MI 494233326 CARRIE LOMBARDI BOARD MEMBER 6163943788 2022-09-09 1 CARRIE LOMBARDI 999009999 HOWARD L CUTLER CPA P00292927 6162355200 2022-09-09 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z CARRIE LOMBARDI 336 S RIVER AVE HOLLAND MI 494233326 499097 0 X N/A X 2004 MI TO PROVIDE ACCESS TO QUALITY PRIMARY HEALTH CARE FOR ALL MEMBERS OF THE COMMUNITY WITH BOTH RESPECT AND COMPASSION. 7 6 0 50 0 0 694697 106253 1400457 392838 0 0 479 6 2095633 499097 0 0 0 0 0 0 0 0 0 2095633 499097 2095633 499097 0 0 787916 655155 787916 655155 0 0 TO IMPROVE THE HEALTH OF THE PATIENTS IN THE HOLLAND COMMUNITY BY PROVIDING QUALITY HEALTH CARE REGARDLESS OF LANGUAGE, FINANCIAL OR CULTURAL BARRIERS; THEREBY ASSURING THAT PRIMARY HEALTH CARE IS ACCESSIBLE TO ALL RESIDENTS OF THE AREA. 0 0 476985 392844 PROVIDED PATIENT HEALTH CARE VISITS TO APPROXIMATELY 2,755 PATIENTS. 476985 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 1 0 1 1 0 1 0 0 0 0 1 1 1 1 1 0 0 0 MI X JIM JUNEWICK 6164866708 4420 44TH ST SE KENTWOOD MI 49512 X X DALE SOWDERS CHAIR 1.00 X X 0 0 0 SAMIR RAJANI MD DIRECTOR 1.00 X 0 0 0 JEAN MARTIN DIRECTOR 1.00 X 0 0 0 SUE FROST TREASURER/SECRETARY 40.00 X X 0 0 0 ALLISON RUND MD DIRECTOR 1.00 X 0 0 0 PATTI VANDORT VICE CHAIR 1.00 X X 0 0 0 CARRIE LOMBARDI DIRECTOR 1.00 X 0 0 0 0 0 0 0 0 0 0 SPECTRUM HEALTH MEDICAL GROUP 648 MONROE NW SUITE 300 GRAND RAPIDS MI 49503 SEE SCHEDULE O 474406 1 106253 106253 PATIENT FEES 621400 292791 292791 PHYSICIAN INCENTIVES 621400 100047 100047 392838 MISCELLANEOUS REVENUE 623990 6 6 6 499097 392844 0 0 X 18750 18750 414887 414887 29590 29590 25429 25429 650 650 495 495 4304 4304 BANK SERVICE CHARGE 3362 3362 MISCELLANEOUS 1444 1444 OUTSIDE SERVICE 186 186 499097 476985 22112 0 699819 558216 79517 88854 19799 11714 8580 8085 787916 655155 752399 619638 35517 35517 787916 655155 X 0 0 787916 655155 0 0 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 19799 11714 8085 8085 DR RAJANI DR RUND S FROST AND EMPLOYEES OF SHMG AND BOARD MEMBERS/OFFICERS OF HCHC 474406 SHMG IS REIMBURSED FOR EXPENSES THEY PAY ON BEHALF OF HCHC. 0 DALE SOWDERS PATTI VANDORT EMPLOYEES OF HOLLAND HOSPITAL AND BOARD MEMBER/OFFICER OF HCHC 24692 HH LEASES FACILITY TO HCHC 0 SCHEDULE L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF INTERESTED PERSON: DR. RAJANI, DR. RUND, S. FROST, AND C. LOMBARDI.(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: EMPLOYEES OF SHMG AND BOARD MEMBERS/OFFICERS OF HCHC(C) DESCRIPTION OF TRANSACTION: SHMG IS REIMBURSED FOR EXPENSES THEY PAY ON BEHALF OF HCHC.(A) NAME OF INTERESTED PERSON: DALE SOWDERS AND PATTI VANDORT(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: EMPLOYEES OF HOLLAND HOSPITAL AND BOARD MEMBER/OFFICER OF HCHC (C) DESCRIPTION OF TRANSACTION: HH LEASES FACILITY TO HCHC FORM 990, PART VI, SECTION A, LINE 4 EFFECTIVE APRIL 3, 2022, SPECTRUM HEALTH MEDICAL GROUP WITHDREW AS MEMBER OF HOLLAND COMMUNITY HEALTH CENTER. HOLLAND HOSPITAL REMAINS THE SOLE MEMBER OF HOLLAND COMMUNITY HEALTH CENTER AND HAS CHANGED HOLLAND COMMUNITY HEALTH CENTERS YEAR END FROM DECEMBER 31 TO MARCH 31. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION SHALL HAVE TWO CLASSES (CLASS H AND CLASS P) OF MEMBERS. THERE SHALL BE ONE CLASS H MEMBER, HOLLAND COMMUNITY HOSPITAL, A MICHIGAN NONPROFIT CORPORATION, OF HOLLAND, MICHIGAN. THE CLASS P MEMBERS SHALL BE LIMITED TO MICHIGAN NONPROFIT CORPORATIONS ORGANIZED AND OPERATED FOR THE EMPLOYMENT OF PHYSICIANS, PHYSICIAN-OWNED PROFESSIONAL CORPORATION OR LIMITED LIABILITY COMPANIES, OR OTHER PHYSCIAN GROUPS PRACTICING IN THE HOLLAND, MICHIGAN AREA. APPLICATION FOR MEMBERSHIP SHALL BE SUBMITTED ON FORMS APPROVED BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS SHALL APPROVE OR REJECT APPLICATIONS FOR MEMBERSHIP; PROVIDED, HOWEVER, THAT IF A VOTE ON ANY SUCH MATTER RESULTS IN A TIE, THE CLASS H MEMBER SHALL HAVE THE RIGHT TO MAKE THE FINAL DECISION ON THE ADMISSION OF THE NEW MEMBER. MEMBERSHIP IN THE CORPORATION SHALL BE PERPETUAL FROM THE DATE OF ACCEPTANCE OF THE MEMBER'S APPLICATION FOR MEMBERSHIP, UNLESS THE MEMBER RESIGNS, DISSOLVES, OR IS EXPELLED. ANY SUCCESSOR ORGANIZATION BY WAY OF A MERGER OR OTHER REORGANIZATION OF A MEMBER SHALL CONTINUE AS A MEMBER OF THE CORPORATION AUTOMATICALLY WITHOUT FURTHER ACTION ON THE PART OF THE MEMBER OR THE CORPORATION. A MEMBER MAY BE EXPELLED BY ACTION OF THE BOARD OF DIRECTORS, WITH OR WITHOUT CAUSE; PROVIDED, HOWEVER, THAT IF THE VOTE ON ANY SUCH MATTER RESULTS IN A TIE, THE CLASS H MEMBER SHALL HAVE THE RIGHT TO MAKE THE FINAL DECISION ON THE EXPULSION OF ANY MEMBER. EACH MEMBER SHALL BE ENTITLED TO VOTE ON ANY MATTER FALLING UNDER THE AUTHORITY OF THE MEMBERS AS ESTABLISHED BY THE ARTICLES OF INCORPORATION, THE BY-LAWS OF THE CORPORATION, OR BY LAW. ON ANY MATTER ON WHICH THE MEMBERS ARE VOTING, THE CLASS H MEMBER SHALL HAVE ONE VOTE AND THE CLASS P MEMBERS SHALL COLLECTIVELY HAVE ONE VOTE, SUCH VOTE TO BE DETERMINED BY MAJORITY VOTE AMONG THE CLASS P MEMBERS WITH EACH CLASS P MEMBER HAVE A NUMBER OF VOTES EQUAL TO THE NUMBER OF FULL TIME EQUIVALENT PHYSICIANS EMPLOYED BY OR OWNERS (PARTNERS, CO-MEMBERS, OR SHAREHOLDERS) OF THE CLASS P MEMBER AND PRACTICING IN THE HOLLAND, MICHIGAN AREA. IN ALL OTHER RESPECTS, EACH MEMBER SHALL HAVE IDENTICAL RIGHTS AND PRIVILEDGES, WITHOUT RESPECT TO CLASS, EXCEPT AS MAY BE PROVIDED FOR IN THE BY-LAWS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS SHALL ELECT THE BOARD OF DIRECTORS. THE BOARD SHALL AT ALL TIMES CONSIST OF SIX DIRECTORS, THREE OF WHOM SHALL BE ELECTED BY THE CLASS H MEMBER AND THREE OF WHOM SHALL BE ELECTED BY THE CLASS P MEMBERS BY A COLLECTIVE VOTE AMONG THE CLASS P MEMBERS. THE TERM OF EACH DIRECTOR SHALL BE PERPETUAL, SUBJECT TO THE RESIGNATION AND REMOVAL PROVISIONS PROVIDED FOR. A DIRECTOR MAY RESIGN BY WRITTEN NOTICE TO THE CORPORATION SECRETARY. THE MEMBERS WHO APPOINTED OR ELECTED A DIRECTOR MAY REMOVE THE DIRECTOR WITH OR WITHOUT CAUSE UPON THE SAME VOTE REQUIRED FOR ELECTION. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITHIN THE GOVERNING BODY FORM 990, PART VI, SECTION B, LINE 11B CARRIE LOMBARDI (BOARD MEMBER) AND JAMES JUNEWICK (FINANCIAL REPORTING MANAGER) REVIEW THE FORM PRIOR TO FILING. THE COMPLETED AND FILED FORM 990 IS PRESENTED TO THE BOARD, HOWEVER, THERE IS NO REVIEW PROCESS BY THE ENTIRE BOARD OF DIRECTORS OF THE FORM 990 PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE BOARD MEMBERS SIGN THE CONFLICT OF INTEREST FORMS. THE COMPLETED FORMS ARE SENT TO SPECTRUM HEALTH'S RISK AND COMPLIANCE DEPARTMENT WHICH REVIEWS THE FORMS FOR ANY POTENTIAL ISSUES THAT MAY ARISE. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST FORM 990, PART VI, SECTION B, LINE 13-14 HCHC DOES NOT HAVE A FORMAL WRITTEN WHISTLEBLOWER POLICY OR WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. THEY ADHERE TO THE POLICIES THAT HAVE BEEN SET FORTH BY SPECTRUM HEALTH MEDICAL GROUP. FORM 990, PART VII, SECTION A, LINE 1 DALE SOWDERS RECEIVES COMPENSATION FOR HIS WORK AT HOLLAND HOSPITAL, WHICH IS A FOUNDING MEMBER OF HOLLAND COMMUNITY HEALTH CENTER, BUT IS NOT COMPENSATED FOR HIS TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. ALLISON RUND, M.D. RECEIVES COMPENSATION FOR HER WORK AT SPECTRUM HEALTH MEDICAL GROUP, WHICH IS A MEMBER OF HOLLAND COMMUNITY HEALTH CENTER, BUT IS NOT COMPENSATED FOR HER TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. SAMIR RAJANI, M.D. IS COMPENSATED FOR HIS WORK AT SPECTRUM HEALTH MEDICAL GROUP, WHICH IS A MEMBER OF HOLLAND COMMUNITY HEALTH CENTER, BUT IS NOT COMPENSATED FOR HIS TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. SUE FROST IS COMPENSATED BY SPECTRUM HEALTH MEDICAL GROUP FOR HER WORK AT HOLLAND COMMUNITY HEALTH CENTER. SPECTRUM HEALTH MEDICAL GROUP IS A MEMBER OF HOLLAND COMMUNITY HEALTH CENTER. SUE IS NOT COMPENSATED FOR HER TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. CARRIE LOMBARDI IS COMPENSATED FOR HER WORK AT SPECTRUM HEALTH MEDICAL GROUP, WHICH IS A MEMBER OF HOLLAND COMMUNITY HEALTH CENTER, BUT IS NOT COMPENSATED FOR HER TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. FORM 990, PART VII, SECTION B, LINE 1(B) SPECTRUM HEALTH MEDICAL GROUP PAYS ALL OPERATING EXPENSES OF HCHC AND IS REIMBURSED BY HCHC. FORM 990, PART IX, LINE 11G PROVIDER AND CLINIC SUPPORT SERVICES: PROGRAM SERVICE EXPENSES 414,887. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 414,887. HOLLAND COMMUNITY HOSPITALS 602 MICHIGAN AVENUE HOLLAND MI 49423 382800065 HEALTH CARE NEEDS OF THE HOLLAND COMMUNITY MI 501(C)(3) 3 N/A 0 SPECTRUM HEALTH PRIMARY CARE PARTNERS DBA SPECTRUM HEALTH MEDICAL GROUP 648 MONROE NW SUITE 300 GRAND RAPIDS MI 49503 381358164 TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. MI 501(C)(3) 3 N/A 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 SPECTRUM HEALTH MEDICAL GROUP M 433673 COSTS PAID HOLLAND COMMUNITY HOSPITAL C 106253 PAYMENTS RECEIVED AND DUE