2025-02-18T15:19:54-06:00 2024-03-31 331498605 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2023-04-01 200602574 HOLLAND COMMUNITY HEALTH CENTER HOLL 6163943788 336 S RIVER AVE HOLLAND MI 49423 ALEX ROEHLING VICE PRESIDENT & CFO 6163943788 2025-02-17 1 1 DAVID LOWENTHAL P00378651 3122071040 2025-02-17 2023 2025-03-06 01:10:19Z ALEX ROEHLING 336 S RIVER AVE HOLLAND MI 49423 2568178 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. 15 12 0 12 0 0 1040148 1011439 1624845 1556739 0 0 0 0 2664993 2568178 0 0 0 0 0 0 0 0 0 2664993 2568178 2664993 2568178 0 0 290533 502665 290533 502665 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 RESIDENCE TO OF THE AREA. 0 0 2511541 1556739 PROVIDED PATIENT HEALTH CARE VISITS TO APPROXIMATELY 10,612 PATIENTS 2511541 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 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 15 12 0 0 0 0 1 1 0 1 0 0 0 0 1 1 1 1 1 0 0 0 MI X ALEXANDER ROEHLING 6163943456 602 MICHIGAN AVE HOLLAND MI 49423 DALE M SOWDERS PRESIDENT-CEO 1.00 40.00 X X 0 1011405 23572 SHELLY MACIEJEWSKI CHAIR 1.00 1.00 X X 0 0 0 GREG CHRISTIE SECRETARY 1.00 1.00 X X 0 0 0 GWEN AUWERDA TRUSTEE 1.00 1.00 X 0 0 0 MIKE NOVAKOSKI TRUSTEE 1.00 1.00 X 0 0 0 LESLIE BROWN TRUSTEE 1.00 1.00 X 0 0 0 BETH PETER TRUSTEE 1.00 1.00 X 0 0 0 BARBARA DEPREE MD TRUSTEE 1.00 40.00 X 0 196106 18245 KEN FILIPPINI TRUSTEE 1.00 1.00 X 0 0 0 MICHAEL HILL TRUSTEE 1.00 1.00 X 0 0 0 DOUG HOEY TRUSTEE 1.00 1.00 X 0 0 0 HAANS MULDER TRUSTEE 1.00 1.00 X 0 0 0 BILL VANDER VLIET MD TRUSTEE 1.00 1.00 X 0 0 0 PATTI VANDORT SVP, CNO, REHAB SERV, MARK 1.00 40.00 X X 0 673883 16691 JODI OWCZARSKI TRUSTEE 1.00 1.00 X 0 0 0 CARA WILKINSON TRUSTEE 1.00 1.00 X 0 0 0 ALEX ROEHLING VP, FINANCE & CFO 1.00 40.00 X 0 495807 9630 MARK L PAWLAK SVP, QUALITY, IS & HOSP OP 1.00 40.00 X 0 651493 18487 JOSEPH D BONELLO VICE PRESIDENT, NURSING-CN 1.00 40.00 X 0 333904 25015 0 3362598 111640 0 0 1 0 0 1011439 1011439 PATIENT FEES 621400 1280433 1280433 QUALITY INCENTIVES 621400 276306 276306 1556739 2568178 1556739 0 0 X 1876530 1849607 26923 29714 29714 350050 350050 3482 3482 9510 9510 10513 10513 MEDICAL SUPPLIES AND DR 288018 288018 BAD DEBT EXPENSE 361 361 2568178 2511541 56637 0 68967 325617 185629 150620 55864 29436 35937 26428 290533 502665 90802 92965 199731 409700 290533 502665 X 0 0 0 0 290533 502665 0 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 55864 29436 26428 26428 RELATED PARTY PAYABLE 409700 409700 0 1 0 0 0 0 0 0 0 DALE M SOWDERS PRESIDENT-CEO 0 799260 0 0 0 212145 0 9900 0 13672 0 1034977 0 0 PATTI VANDORT SVP, CNO, REHAB SERV, MARK 0 529410 0 89578 0 54895 0 9900 0 6791 0 690574 0 0 MARK L PAWLAK SVP, QUALITY, IS & HOSP OP 0 443036 0 71663 0 136794 0 9900 0 8587 0 669980 0 0 ALEX ROEHLING VP, FINANCE & CFO 0 307693 0 126059 0 62055 0 9173 0 457 0 505437 0 0 JOSEPH D BONELLO VICE PRESIDENT, NURSING-CN 0 245913 0 45896 0 42095 0 7377 0 17638 0 358919 0 0 BARBARA DEPREE MD TRUSTEE 0 159541 0 0 0 36565 0 4816 0 13429 0 214351 0 0 PART I, LINE 4B DALE SOWDERS PARTICIPATED IN A 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THROUGH A RELATED PARTY. THE SERP IS DESIGNED TO PROVIDE THE PARTICIPANT WITH A TARGET BENEFIT FOR LIFE BEGINNING AT THE PARTICIPANTS ATTAINMENT OF AGE 65 EQUAL TO 60 PERCENT OF THE PARTICIPANTS FINAL AVERAGE COMPENSATION, OFFSET BY THE PARTICIPANTS SOCIAL SECURITY BENEFIT AND 401(K) SAVINGS PLAN EMPLOYER CONTRIBUTION EQUIVALENT. CONTRIBUTIONS MADE TO THE SERP ARE INCLUDED IN PART II, COLUMN (C). NO PAYMENTS WERE MADE IN 2023. FORM 990, PART VI, SECTION A, LINE 6 HOLLAND COMMUNITY HOSPITAL IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF HOLLAND COMMUNITY HOSPITAL, THE SOLE MEMBER, WILL BE THE BOARD OF DIRECTORS OF THE ORGANIZATION. 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 HOLLAND COMMUNITY HOSPITAL'S CFO REVIEWS THE FORM 990 PRIOR TO FILING. THE CFO THEN SIGNS AND FILES THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS, ADMINISTRATION, DIRECTORS AND MANAGERS FILL OUT A CONFLICT OF INTEREST DISCLOSURE FORM ANNUALLY. THESE FORMS ARE COLLECTED BY THE COMPLIANCE OFFICE, INVESTIGATED AND THEN MAINTAINED BY HUMAN RESOURCES. THE BYLAWS SPECIFICALLY STATE THAT A BOARD MEMBER WHO HAS A CONFLICT OF INTEREST AS TO A MATTER BEFORE THE BOARD SHOULD NOT VOTE OR USE PERSONAL INFLUENCE WITH OTHER BOARD MEMBERS. THE MINUTES OF THE BOARD MEETING SHALL DISCLOSE THE MEMBER'S ABSTINENCE FROM VOTING ON THE MATTER. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST FORM 990, PART IX, LINE 11G OUTSIDE SERVIES: PROGRAM SERVICE EXPENSES 1,000. MANAGEMENT AND GENERAL EXPENSES 26,923. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 27,923. LEASED EMPLOYEES: PROGRAM SERVICE EXPENSES 1,848,607. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,848,607. 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 HOLLAND COMMUNITY HOSPITAL. HOLLAND COMMUNITY HOSPITAL 602 MICHIGAN AVENUE HOLLAND MI 49423 382800065 HOSPITAL CARE MI 501(C)(3) LINE 3 N/A 0 HOLLAND COMMUNITY HOSPITAL AUTHORITY SELF-INSURANCE TRUST FUND 602 MICHIGAN AVENUE HOLLAND MI 49423 386389385 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12A, I HOLLAND COMMUNITY HOSPITAL 1 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 HOLLAND COMMUNITY HOSPITAL C 1011439 PAYMENT RECEIVED AND DUE