2018-02-12T14:45:51-06:00 2017-03-31 381357951 PLANTE & MORAN PLLC 600 E Front St Ste 300 Traverse City MI 49686 990 2016-04-01 382800065 HOLLAND COMMUNITY HOSPITAL HOLL 6163925141 602 MICHIGAN AVENUE HOLLAND MI 49423 DALE SOWDERS PRESIDENT & CEO 6163925141 2018-02-06 1 OLIVER JURKOVIC P00433694 2319477800 2018-02-05 67.59.56.32 2018-02-06 08:02:21 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 EBB51160BF2136090E0706D858221EDFD566B897 2016 2021-01-29 14:40:06Z Holland Hospital DALE SOWDERS 602 MICHIGAN AVENUE HOLLAND MI 49423 324711394 0 X WWW.HOLLANDHOSPITAL.ORG X 1985 MI TO CONTINUOUSLY IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE IN THE SPIRIT OF HOPE, COMPASSION, RESPECT AND DIGNITY. 13 8 2475 388 1189613 -19656 617866 1089812 226864141 252694487 5260609 6610216 1080884 1169230 233823500 261563745 666778 713660 0 0 116990404 140004391 0 0 941369 102256149 108013666 219913331 248731717 13910169 12832028 431505023 477189556 104441433 129154222 327063590 348035334 X TO CONTINUOUSLY IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE IN THE SPIRIT OF HOPE, COMPASSION, RESPECT AND DIGNITY. 0 0 204654511 713659 256752647 The employees, medical staff and volunteers of Holland Community Hospital remain committed to the hospital's mission: to continually improve the health of the communities we serve in the spirit of hope, compassion, respect and dignity. Our vision is to be the preeminent stand-alone hospital in West Michigan as measured by benchmark customer service, business growth, financial performance and clinical excellence. We measure our achievements against five organizational strategic essentials: financial strength, growth, quality, superior service and superior workforce.Nationally Recognized QualityHolland Hospital's commitment to quality has earned it numerous national honors. The Hospital has received Truven 100 Top Hospitals recognition for 12 consecutive years. Healthgrades has honored Holland Hospital with its America's 50 Best Hospitals Award three years in a row. In 2016, the Centers for Medicare & Medicaid Services unveiled an Overall Hospital Quality Star Ratings system that summarizes 64 quality measures into a unified rating of one to five stars. Holland Hospital is one of only 102 hospitals to achieve a 5-star rating of the 3,617 reviewed nationwide.Workplace ExcellenceHolland Hospital was named a West Michigan's Best and Brightest Companies to Work For by the Michigan Business and Professional Association (MBPA) for a 15th consecutive year. According to MBPA, winning companies practice innovative strategies and represent best practices in human resources. The Hospital received high scores from employees on compensation, benefits and employee solutions; employee enrichment, engagement and retention; employee education and development; recruitment, selection and orientation; employee achievement and recognition; communication and shared vision; diversity and inclusion; and work-life balance.Superior ServicesHolland Hospital's clinical excellence can be found across its service lines.Orthopedics-America's 100 Best Hospitals for Joint Replacement for 4 Years in a Row (2014-2017) -Orthopedic Surgery Excellence Award for 4 Years in a Row (2014-2017) -Top 5% in the Nation for Joint Replacement for 4 Years in a Row (2014-2017)-Top 10% in the Nation for Overall Orthopedic Services for 4 Years in a Row (2014-2017)Cardiopulmonary-Five-Star Recipient for Treatment of Stroke for 11 Years in a Row (2007-2017)-Pulmonary Care Excellence Award for 3 Years in a Row (2015-2017)-DNV Primary Stroke Certification-2009-2016 Gold Performance Achievement Award for heart attack careUrology-Prostate Surgery Excellence Award for 2 Years in a Row (2016-2017)Critical Care-2017 Critical Care Excellence Award Gastroenterology-National Certificate of Recognition by the American Society for Gastrointestinal Endoscopy Breast Care-ACR Accreditation for Breast Ultrasound American College of RadiologyLeading Edge TechnologyPercutaneous Coronary Intervention Percutaneous coronary intervention (PCI) is a procedure that restores blood flow through blocked or narrowed heart vessels. Emergency PCI for patients having a heart attack has been performed at Holland Hospital since May of 2005 with exceptional life-saving results. Based on changes in state regulations, Holland Hospital's cardiovascular team can now perform PCI for patients who are at high risk for a future heart event, but are not currently experiencing heart attack so-called elective PCI.3D Gait Analysis Holland Hospital's Sports Medicine specialists now offer 3D gait analysis to scientifically evaluate a patient's personal running form. The analysis can identify the risk of injury based on biometric data. 3D gait analysis uses 3D cameras to precisely measure movement patterns and compares a patient's gait to athletes of all levels from around the globe.Summary of EffortsDuring fiscal year 2017, Holland Hospital's 440-member medical staff, 2,050 employees and 300 volunteers served the community by providing:-Patient Days 31,000-Discharges 8,700-Births 1,800-Surgeries 15,900-Outpatient Visits 509,200-Emergency Room Visits 41,100-Urgent Care Visits 41,000-Home Health Visits 41,500-Lab Tests 672,300-Radiology Procedures 109,200-Beds 189Community Outreach ProgramsHolland Hospital holds to the core belief that all members of the community should have access to high quality, affordable health care services. For individuals and families who are at risk, the Community Outreach Committee of the Hospital Board of Directors placed high priority on four community outreach efforts. Holland Community Health CenterThe Holland Community Health Center (HCHC) provides primary health care services for people who are under-insured and uninsured. Over 5,600 patients received their primary medical care at the HCHC. The majority of visits focus on women's and children's health care needs, chronic disease management and elder care. School Nursing ProgramSchool Nurses provide preventive and treatment services to students in the Holland Public, Holland Christian, West Ottawa Public, Fennville Public and Hamilton school districts. In the last school year, the school nurses served 12,450 students. The majority of visits to the nurse's office were for medication administration, with the greatest percentage being psychotropic medications. Faith Community NurseThe Faith Community Nurse at the Holland Rescue Mission provided approximately 650 one-on-one client engagements last year, offering basic health information, assessment or ongoing education for health issues as well as referrals for medical, dental, mental, and other kinds of care. The nurse brings health care services and spiritual counseling to one of the community's most vulnerable populations: homeless women and children. Breast Care FundIt is estimated that 1 in 8 women will develop invasive breast cancer in their lifetime. Early detection provides the best opportunity to treat breast cancer and reduce the risk of recurrence. The Breast Care Fund provides financial support for breast health services for women who otherwise would not be able to afford basic breast screening and diagnostic services. Community Health and Wellness The Center for Good Health (CFGH) offers a variety of educational classes and presentations for children, adults and seniors. In FY 2017, the center offered 453 classes and events with 6,672 participants. In addition to classes and educational programs for the general public, the CFGH also works with many area businesses to provide prevention and disease management programs directly to employees.Funding Access to Health Care Services for Our CommunityThe Fund Development office at Holland Hospital raises financial support for four important community outreach efforts: the Holland Community Health Center, the School Nursing Program, the Faith Community Nurse and the Breast Care Fund. In fiscal year 2017, the Fund Development office raised $507,908.12 to support these efforts.Uncompensated Medical Costs Holland Hospital remains committed to caring for members of our community who are uninsured or under-insured. In FY 2016, Holland Hospital provided un-reimbursed care to our patients at a cost of $47.5 million, a 6.5 percent increase over the previous year.The state of Michigan, including the hospital's service area, has many health challenges to address according to the findings of the United Health Foundation: -Percentage of adults physically inactive: 25.5% -Percentage of adults smoking: 20.7% -Percentage of adults with obesity: 31.2% -Percentage of adults with excessive drinking: 20.0% -Percentage of children in poverty: 21.1% -Percentage of children aged 19 to 35 months immunized: 67.6% -Percentage of population lacking insurance: 7.3%These behavioral issues will continue to put pressure on Holland Hospital and the state's health care system to find more effective and efficient ways to provide medical services and initiate preventive health care programs.2017 Community Benefit Summary $49.6 Million Total Community Benefit-Unpaid Cost of Medicaid $13,927,000-Unpaid Cost of Medicare $18,674,000-Charity Care (at cost) $1,096,000 -Bad Debt $10,582,000-Other Community Benefits (note A) $5,357,000Note A Other Community Benefits include: -Community Education & Outreach Programs -Cash, In-kind Donations & Contributions -Holland Community Health Center -Student Nursing Program -Health Professional Education & Research 204654511 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 0 1 145 0 1 2475 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 X 13 8 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 X TERRY STEELE 6163925141 602 MICHIGAN AVE HOLLAND MI 49423 DALE M SOWDERS PRESIDENT & CEO 40.00 1.00 X X 731670 0 25098 JAMES STROOP SECRETARY 1.00 1.00 X X 0 0 0 JANE CLARK CHAIR 1.00 1.00 X X 0 0 0 PHIL KONING TREASURER 1.00 1.00 X X 0 0 0 KRIS DEPREE MD TRUSTEE 1.00 1.00 X 0 0 0 ROGER GAMACHE TRUSTEE 1.00 1.00 X 0 0 0 MARK STID MD TRUSTEE, PHYSICIAN 40.00 1.00 X 218470 0 19529 MABEL CASEY TRUSTEE 1.00 1.00 X 0 0 0 TONY YASICK MD TRUSTEE, MEDICAL DIRECTOR 1.00 1.00 X 14188 0 0 DOUG HOEY MD TRUSTEE, CHIEF OF STAFF-PARTIAL YEAR 1.00 1.00 X 0 0 0 DAWN GARCIA WARD TRUSTEE 1.00 1.00 X 0 0 0 DAVE MASON TRUSTEE 1.00 1.00 X 0 0 0 JUANITA BOCANEGRA TRUSTEE 1.00 1.00 X 0 0 0 CHRIS WEDEVEN TRUSTEE, CHIEF OF STAFF 1.00 1.00 X 10000 0 0 TERRY L STEELE VP, FINANCE & CFO 40.00 1.00 X 361236 0 21809 PATTI VANDORT SVP, CNO, REHAB SERV, MARKETING 40.00 0.00 X 352840 0 16696 MICHAEL W MATTHEWS VP, MEDICAL GROUPS & HR 40.00 0.00 X 302016 0 22263 MARK L PAWLAK SVP, QUALITY, IS & HOSP OP 40.00 0.00 X 364059 0 14757 WILLIAM VANDERLIET VP, MEDICAL AFFAIRS 24.00 0.00 X 202441 0 4940 JOSEPH K POSTMA PHYSICIAN 40.00 0.00 X 806882 0 24925 Kristen M Murphy PHYSICIAN 40.00 0.00 X 543601 0 14883 DERICK M JOHNSON DO PHYSICIAN 40.00 0.00 X 648648 0 24988 STEPHEN MAUGER DO PHYSICIAN 40.00 0.00 X 787260 0 19971 Sanjeev Mathur PHYSICIAN 40.00 0.00 X 514455 0 20465 5857766 0 230324 116 0 1 0 CERNER PO BOX 412702 KANSAS CITY MO 64141 SOFTWARE - PURCHASED MAINTENANCE 5175490 ARAMARK CORPORATION 12483 COLLECTIONS CENTER DR CHICAGO IL 60693 HOUSEKEEPING 4634786 LAKEWOOD ELZINGA A JOINT VENTURE 86 E 6TH ST HOLLAND MI 49423 CONSTRUCTION 2026545 presidio networked solutions 12120 SUNSET HILLS ROAD STE 202 RESTON VA 20190 software- purchased maintenance 691892 holland 1 medical properties 3290 N Welllness Dr Holland MI 49424 Rent 629180 47 135710 64644 889458 1089812 NET PATIENT SERVICE REVENUE 622110 243554232 242364632 1189600 OTHER RELATED REVENUE 900099 4935954 4935954 EHR MEANINGFUL USE REVENUE 622110 2297344 2297344 PHARMACY SALES UNDER SEC. 340B 446110 1906957 1906957 252694487 2203132 13 2203119 1064834 224158 840676 840676 840676 67292639 62706329 179226 4586310 -179226 4407084 4407084 23155 135710 8996 14159 14159 23155 28940 -5785 -5785 CAFETERIA AND HOME MEALS 722210 320180 320180 320180 261563745 256752647 1189613 2531673 713660 713660 111917808 91410834 19654468 852506 2540876 2011096 529780 18257701 14673489 3565779 18433 7288006 5818978 1469028 283883 283883 111540 9490 102050 15392917 11414137 3969340 9440 1128119 90534 1037585 1248292 661878 586414 5982637 5982637 5559536 5513979 41221 4336 296904 231111 26435 39358 455287 325360 127005 2922 2259116 2259116 15244800 11456039 3788310 451 1050901 825859 225042 MEDICAL SUPPLIES & DRUG 43151493 42955731 194281 1481 PROVISION FOR BAD DEBTS 10660226 10660226 FOOD 1424374 1258628 165716 30 DUES, LICENSE & SUBS 798522 486257 310394 1871 2965119 1878109 1076469 10541 248731717 204654511 43135837 941369 49882219 56976201 783538 144702 26174266 19098582 6023862 6435143 4140333 4270555 275078832 127611713 147876441 147467119 172017267 208346321 21488948 31308900 3118149 3142033 431505023 477189556 20556666 21251807 220890 474136 77710042 97579166 5953835 9849113 104441433 129154222 X 326039249 347036910 439341 413424 585000 585000 327063590 348035334 431505023 477189556 X 12832028 8156922 -17206 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13029 13029 0 Part II-B, Line 1: THE HOSPITAL PAYS DUES TO THE MICHIGAN HOSPITAL ASSOCIATION AND AMERICAN MEDICAL GROUP ASSOCIATION, A PORTION OF WHICH GOES TOWARDS LOBBYING ACTIVITIES. 628248 19874 648122 599573 28675 628248 585000 14573 599573 585000 585000 0.00000 1.00000 0.00000 0 0 8299427 8299427 126872149 48700850 78171299 3705256 1812728 1892528 121622165 77098135 44524030 14579835 14579835 147467119 INVESTMENTS IN AFFILIATED ENTITIES 14370708 F INVESTMENT IN JOINT VENTURE 16938192 F 31308900 PROFESSIONAL LIABILITY INSURANCE 2054896 OTHER LONG-TERM LIABILITIES 3087034 INTEREST PAYABLE 974783 COST REPORT SETTLEMENT PAYABLE 3732400 9849113 Part V, Line 4: EARNINGS FROM THE PERMANENT ENDOWMENTS ARE INTENDED FOR GENERAL PURPOSES OF THE HOSPITAL. CULINARY CABARET 158865 135710 23155 8996 158865 135710 23155 8996 8996 14159 23155 22190 6750 1 0.95000 23155 22190 6750 28940 -5785 MI 1 0 1 0 1.00000 COLLEEN PERDOK 602 MICHIGAN AVE HOLLAND MI 49423 0 COLLEEN PERDOK 0 FUND DEVELOPMENT COORDINATOR X 0 SCHEDULE G, PART III, LINE 16: INCLUDED IN COLLEEN PERDOK'S RESPONSIBILITIES IS THE ROLE OF GAMING MANAGER; HOWEVER, THE AMOUNT OF COMPENSATION ALLOCATED TO THIS ROLE IS MINIMAL. 1 1 X 1 X 1 X 1 1 0 1 1 1025935 1025935 0.00430 32498871 19042781 13456090 0.05640 33524806 19042781 14482025 0.06070 1825142 573090 1252052 0.00520 389167 389167 0.00160 883453 883453 0.00370 3097762 573090 2524672 0.01050 36622568 19615871 17006697 0.07120 3 6459 6459 0.00000 6 8 9819 9819 0.00000 1 713668 713668 0.00300 10 8 729946 729946 0.00300 0 10129031 2090024 38234277 41976731 -3742454 X 1 1 1 HOLLAND PHO COORD. RESOURCES FOR ITS MEMBERS FOR THE DELIVERY OF QUALITY HEALTH CARE. 0.50000 0.00000 0.50000 1 1 HOLLAND COMMUNITY HOSPITAL 602 MICHIGAN AVE HOLLAND MI 49423 WWW.HOLLANDHOSPITAL.ORG 1060000036 X X X HOLLAND COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X X 15 1 1 1 1 X FULL WEBSITE LISTED IN PART V SECTION C X FULL WEBSITES LISTED IN PART V SECTION C X X 1 16 1 FULL WEBSITE LISTED IN PART V SECTION C 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X https://www.hollandhospital.org/hh/financial-information.aspx X https://www.hollandhospital.org/hh/financial-information.aspx X https://www.hollandhospital.org/hh/financial-information.aspx X X X X X X X 1 X 0 X X X 1 X 0 0 HOLLAND COMMUNITY HOSPITAL Part V, Section B, Line 3j: THE NEEDS ASSESSMENT DESCRIBED THE COMMUNITIES STRENGTHS AND OPPORTUNITIES REGARDING QUAILITY OF LIFE, OVERALL HEALTH, HEALTH BEHAVIORS, AND HEALTH CARE. THE TWO BROAD THEMES WHICH EMERGED FROM THE REPORT WERE THE DIRECT RELATIONSHIP BETWEEN HEALTH OUTCOMES AND INCOME/EDUCATION, AND THE EXISTANCE OF CHALLENGED SUBGROUPS WITHIN THE POPULATION. IDENTIFIED AREAS FOR OPPORTUNITIES INCLUDED ACCESS TO HEALTHCARE FOR THOSE WITH PUBLIC HEALTH INSURANCE AND IMPROVED CARE FOR THOSE WITH CHRONIC DISEASE, ESPECIALLY DIABETES. HOLLAND COMMUNITY HOSPITAL Part V, Section B, Line 5: DATA WAS OBTAINED FROM MULTIPLE SOURCES INCLUDING; KEY STAKEHOLDERS (EXECUTIVE DIRECTORS OF HOSPITALS, CLINICS AND PUBLIC HEALTH) VIA TELEPHONE INTERVIEWS, KEY INFORMANTS (PHYSICIANS, NURSES, DENTISTS, PHARMACISTS AND SOCIAL WORKERS) VIA ONLINE SURVEY, COMMUNITY RESIDENTS- 2,008 ADULTS VIA A TELEPHONE SURVEY, AND 285 VULNERABLE AND UNDERSERVED COMMUNITY RESIDENTS VIA A PAPER SURVEY. HOLLAND COMMUNITY HOSPITAL Part V, Section B, Line 6a: NORTH OTTAWA COMMUNITY HEALTH SYSTEM & SPECTRUM HEALTH ZEELAND COMMUNITY HOSPITAL HOLLAND COMMUNITY HOSPITAL Part V, Section B, Line 6b: OTTAWA COUNTY DEPARTMENT OF PUBLIC HEALTH, COMMUNITY MENTAL HEALTH OF OTTAWA COUNTY, & GREAT OTTAWA COUNTY UNITED WAY HOLLAND COMMUNITY HOSPITAL Part V, Section B, Line 7d: http://www.hollandhospital.org/Uploads/Public /Documents/Community/2016_2017_OCCHNA_2.pdfhttp://www.miottawa.org/Health/OCHD/pdf/2016_2017_OCCHNA.pdfhttp://www.noch.org/uploadedFiles/2014_2016_CHNA%20Summary_05212017.pdfhttp://www.spectrumhealth.org/documents/healthiercomm/SH%20Zeeland%20% 28Ottawa%20County%29%202016%20CHNA.pdfAVAILABLE UPON REQUEST FROM THE HOSPITAL FACILITY. PRINT COPIES WERE MADE AVAILABLE TO VARIOUS LOCATIONS AND INDIVIDUALS INCLUDING THE COMMUNITY OUTREACH COMMITTEE OF THE HOLLAND HOSPITAL BOARD.PART V, SECTION B, LINE 10A:http://www.hollandhospital.org/Uploads/Public/Documents/Community/CHIP.pdf HOLLAND COMMUNITY HOSPITAL Part V, Section B, Line 11: Ottawa County Community Health Improvement Plan was initiated by the partners of the CHNA and community members. The CHIP identifies 3 health priority areas including; Access to Health Care, Mental Health, and Healthy Behaviors. Holland Hospital is an active partner serving on the Community Health Improvement Steering Committee. HOLLAND COMMUNITY HOSPITAL Part V, Section B, Line 13b: Number in household (including dependents under the age of 18 yrs. old), gross income level and asset level. HOLLAND COMMUNITY HOSPITAL Part V, Section B, Line 16j: The financial Assistance policy, application and plain language summary is posted on the Hospital's website (English and Spanish). Patients may also obtain a financial assistance application by calling the Customer Service Line. Information on how to obtain an application is also available on our billing statements, posted in the facility's waiting rooms, as well as outlined on a business card and plain language summary which is offered to all patients at registration, admission and available at discharge. HOLLAND COMMUNITY HOSPITAL Part V, Section B, Line 20e: Financial assistance is discussed and offered to patients via our Patient Financial Service Customer Service Representatives, Patient Advocates, In-house Medicaid Vendor , Pre-collect and Collection agencies. 4 1 - LAKESHORE HEALTH PARTNERS 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE 2 - HH SERVICES-BATES ET AL LLC 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE 3 - LAKESHORE HEALTH PARTNERS FM LLC 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE 4 - HH SERVICES - ORT LLC 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE Part I, Line 3c: FAMILY INCOME 200 TO 300 PERCENT OF THE FEDERAL POVERTY GUIDELINES QUALIFY FOR DISCOUNTED CARE ON A RATED SCALE. Part I, Line 7: A COST-TO-CHARGE RATIO WAS USED TO COMPLETE THE CHARITY CARE (LINE 7A) AND MEANS-TESTED GOVERNMENT PROGRAMS (LINE 7B). THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 THAT ACCOMPANIES THE INSTRUCTIONS TO THE SCHEDULE.THE HOSPITAL'S COST ACCOUNTING RECORDS WERE USED TO COMPLETE THE COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS (LINE 7E), HEALTH PROFESSIONS EDUCATION (LINE 7F), AND CASH AND IN-KIND CONTRIBUTIONS (LINE 7I).A DIRECT COST AND STEP-DOWN APPROACH WAS USED TO COMPLETE THE SUBSIDIZED HEALTH SERVICES PROGRAMS (LINE 7G). Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 10,129,062. Part II, Community Building Activities: HOLLAND HOSPITAL IS COMMITTED TO SERVING THE RESIDENTS OTTAWA COUNTY AND NORTHERN ALLEGAN COUNTY WITH A BROAD RANGE OF ACCESSIBLE, LEADING-EDGE HEALTH CARE SERVICES. THESE SERVICES ARE DESIGNED TO REACH PATIENT POPULATIONS THAT ARE DIVERSE IN SIZE, DEMOGRAPHIC MAKEUP AND SOCIO-ECONOMIC LEVELS. IN ADDITION TO THE HEALTH CARE SERVICES, HOLLAND HOSPITAL OFFERS SCREENINGS, COMMUNITY EDUCATION, AND FOLLOW UP SUPPORT. FOR THOSE MOST AT RISK IN OUR SERVICE AREAS, HOLLAND HOSPITAL'S COMMUNITY OUTREACH PROGRAMS PROVIDE A LEVEL OF SECURITY AND STABILITY. THESE OUTREACH EFFORTS INCLUDE THE HOSPITAL'S SCHOOL NURSING PROGRAM, SUPPORT OF THE HOLLAND COMMUNITY HEALTH CENTER, FAITH COMMUNITY NURSE AT THE HOLLAND RESCUE AT THE HOLLAND RESCUE MISSION AND THE HOSPITAL'S BREAST CARE FUND. COMBINED, THESE PROGRAMS IMPROVE THE LIVES OF MORE THAN 17,000 INDIVIDUALS EACH YEAR. TO ASSURE THAT WE ARE ADDRESSING EXISTING AND EMERGING COMMUNITY NEEDS, THE HOSPITAL PARTICIPATES IN A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS WHICH INCLUDES THE CREATION AND IMPLEMENTATION OF A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THIS ASSESSMENT IS DONE IN PARTNERSHIP WITH TWO OTHER LOCAL HOSPITALS, THE OTTAWA COUNTY PUBLIC HEALTH DEPARTMENT AND OTTAWA COUNTY COMMUNITY MENTAL HEALTH. Part III, Line 2: THIS IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX. Part III, Line 3: THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. THERE IS A POTENTIAL THAT SOME ACCOUNTS WRITTEN OFF AS BAD DEBTS COULD HAVE BEEN ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, HOWEVER, DUE TO INADEQUATE APPLICATIONS FILED OR NEVER RETURNED THEY GET WRITTEN OFF TO BAD DEBTS INSTEAD. THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS APPROXIMATELY $2,090,024. THIS WAS DERIVED BY REVIEWING NOTES ON FILES FOR POTENTIAL CHARITY CARE CASES FOR THE LAST QUARTER OF THE YEAR AND APPLYING THAT AVERAGE TO THE TOTAL POPULATION. Part III, Line 4: ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA RELATED TO THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. Part III, Line 8: COSTING METHODOLOGY IS A COST TO CHARGE RATIO AS DEFINED BY THE IRS 990 INSTRUCTIONS. THE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT DUE TO ITS REPRESENTATION OF COST OF A PORTION OF SERVICES PROVIDED TO THE COMMUNITY WITHOUT PAYMENT. Part III, Line 9b: Any balance deemed patient responsibility (after insurance payment/determination and after any applicable discount or charity), if not paid, will receive a minimum of 2 statements. At day 60, an early out agency works the account for Holland Hospital a minimum of 90 days. The account will be held on Holland Hospital's "books" until it has aged to a minimum of 150 days from discharge. At this time the account is eligible and will be reviewed to be sent to a collection agency. SCHEDULE H, PART III, LINES 5 AND 6: AS PER THE INSTRUCTIONS, SCHEDULE H, PART III, LINES 5 AND 6 ARE DERIVED DIRECTLY FROM THE MEDICARE COST REPORT. THOSE MEDICARE COSTS NOT INCLUDED IN THE MEDICARE COST REPORT (MEDICARE ADVANTAGE AND FEE FOR SERVICE PHYSICIANS) ARE SUMMARIZED AS FOLLOWS:TOTAL COST: $2,308,755TOTAL REIMBURSEMENT: $2,491,077REIMBURSEMENT IN EXCESS OF COST: $ 182,322 Part VI, Line 2: IN COLLABORATION WITH THE OTTAWA HEALTH DEPARTMENT, THE UNITED WAY, AND SEVERAL OTHER LOCAL ENTITIES A COMMUNITY ASSESSMENT IS PERFORMED. THE UNITED WAY PUBLISHES THEIR ASSESSMENT EVERY 5 YEARS (LAST ONE IN 2012) AND THE OTTAWA COUNTY HEALTH DEPARTMENT PUBLISHES THEIR YOUTH ASSESSMENT EVERY 2 YEARS (LAST ONE IN 2015) AND EVERY 3 YEARS FOR ADULTS (LAST ONE IN 2015). THE CHNA COLLABORATIVE CONSISTED OF NORTH OTTAWA, SPECTRUM ZEELAND HOSPITALS AND THE OTTAWA COUNTY HEALTH DEPARTMENT. Part VI, Line 3: OUR FINANCIAL ASSISTANCE POLICY IS LOCATED ON OUR WEBSITE. AT THE POINT OF REGISTRATION, A PATIENT IS OFFERED A BUSINESS CARD WITH INFORMATION ABOUT OUR FINANCIAL ASSISTANCE PROGRAM. ALSO, OUR COLLECTORS, CUSTOMER SERVICE EMPLOYEES, OR ANY OTHER HOLLAND HOSPITAL EMPLOYEE WITH WHOM THE PATIENT MIGHT HAVE CONTACT, OUR MEDICAID ELIGIBILITY VENDOR, AND THE EARLY OUT AGENCIES INFORM PATIENTS OF THE FINANCIAL ASSISTANCE POLICY. ALL OF THE ABOVE MENTIONED SOURCES MAIL FINANCIAL ASSISTANCE APPLICATIONS TO THE PATIENTS FOR CONVENIENCE UPON REQUEST. INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN THE FACILITY'S WAITING ROOMS. Part VI, Line 4: HOLLAND HOSPITAL'S PRIMARY SERVICE AREA (PSA) CONSISTS OF EIGHT ZIP CODES THAT FALL WITHIN ALLEGAN AND OTTAWA COUNTIES OF WEST MICHIGAN. US CENSUS BUREAU ESTIMATES FOR 2016 SHOW THE FOLLOWING POPULATION DEMOGRAPHICS FOR OTTAWA AND ALLEGAN COUNTIES:(OTTAWA COUNTY) POPULATION ESTIMATE:282,250. ETHNIC ORIGIN: BLACK OR AFRICAN AMERICAN (1.8%), AMERICAN INDIAN AND ALASKAN NATIVE (0.6%), ASIAN (2.9%), HISPANIC OR LATINO (9.5%), WHITE, NOT HISPANIC OR LATINO (84.2%). INCOME & POVERTY: MEDIAN HOUSEHOLD INCOME ($58,989), PERSONS IN POVERTY (8.6%). (ALLEGAN COUNTY) POPULATION ESTIMATE: 115,548. ETHNIC ORIGIN: BLACK OR AFRICAN AMERICAN (1.4%), AMERICAN INDIAN AND ALASKAN NATIVE (0.7%), ASIAN (0.8%), HISPANIC OR LATINO (7.3%), WHITE, NOT HISPANIC OR LATINO (88.7%). INCOME & POVERTY: MEDIAN HOUSEHOLD INCOME ($54,264), PERSONS IN POVERTY (11.2%).ACCORDING TO THE MOST RECENTLY COMPLETED OTTAWA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (2014):- 1 IN 10 ADULTS IN OTTAWA COUNTY DO NO HAVE HEALTH CARE- 11.4% OF THE GENERAL POPULATION IN OTTAWA COUNTY DO NOT HAVE A PRIMARY CARE PHYSICIAN- THE LACK OF AFFORDABLE AND ACCESSIBLE PRIMARY CARE IS IDENTIFIED AS ONE OF THE MOST PRESSING ISSUES IN OTTAWA COUNTY. ALTHOUGH OTTAWA COUNTY CONSISTENTLY RANKS AMONG THE HEALTHIEST COUNTIES IN THE STATE OF MICHIGAN, THERE CONTINUES TO BE INDIVIDUALS WHO DO NOT HAVE ACCESS TO BASIC HEALTH SERVICES OR WHO HAVE FINANCIAL BARRIERS PREVENTING THEM FROM RECEIVING THOSE SERVICES. Part VI, Line 5: HOLLAND HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF REPRESENTATIVES FROM DIFFERENT GEOGRAPHIC SECTORS OF THE HOSPITAL'S PRIMARY SERVICE AREA (PSA), AS WELL AS REPRESENTATIVES FROM BUSINESS AND INDUSTRY, MEDICAL STAFF, AND AT-LARGE MEMBERS. THE HOSPITAL BOARD AND MEDICAL STAFF LEADERSHIP, USING AN ONBOARDING PROCESS, CONSIDERS ALL REQUESTS FROM NEW AND ACTIVE PHYSICIANS SEEKING PRIVILEGES TO PRACTICE AT HOLLAND HOSPITAL. THE HOSPITAL'S INVESTMENT TO IMPROVE PATIENT CARE TAKES SEVERAL FORMS. HOLLAND HOSPITAL CONTRIBUTES MORE THAN $1.4 MILLION IN FINANCIAL SUPPORT TO ITS COMMUNITY OUTREACH PROGRAMS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. THESE EFFORTS ARE SUPPLEMENTED THROUGH UNDERWRITING AND SPONSORSHIP SUPPORT OF COMMUNITY WIDE EVENTS, HEALTH FAIRS, EDUCATIONAL LECTURES, FREE HEALTH SCREENINGS AND HEALTH PROMOTIONS. ON A WEEKLY BASIS, HOSPITAL PHYSICIANS AND CLINICIANS SHARE ADVICE WITH THE GENERAL PUBLIC THROUGH RADIO AND PRINT INTERVIEWS. MEMBERS OF THE HOSPITAL'S LEADERSHIP TEAM SERVE ON LOCAL AGENCY BOARDS AND COMMUNITY EVENT STEERING COMMITTEES. FREE SCREENING CLINICS FOR MENTAL HEALTH ISSUES ARE OFFERED DAILY WITHOUT AN APPOINTMENT. THE HOSPITAL ALSO WELCOMES TOURS BY HIGH SCHOOL AND COLLEGE STUDENTS INTERESTED IN PURSUING HEALTHCARE DEGREES. Part VI, Line 6: NOT AFFILIATED. Part VI, Line 7, Reports Filed With States MI 1 COMMUNITY HEALTH CENTER 602 MICHIGAN AVENUE HOLLAND MI 49423 200602574 501(c)(3) 663660 N/A N/A OPERATIONAL CASH FLOW TO BREAK-EVEN MSU BIOECONOMY INSTITUTE 242 HOWARD AVE HOLLAND MI 49424 386005984 115 50000 N/A N/A RESEARCH FUNDS Part I, Line 2: THE HOSPITAL RECEIVES THEIR MONTHLY INTERNAL FINANCIALS AND A COPY OF THE AUDITED STATEMENTS ANNUALLY. HOLLAND HOSPITAL IS FUNDING, IN PART, THE OPERATIONS OF THE ABOVE MENTIONED CLINIC, WHICH IS A SIGNIFICANT COMMUNITY BENEFIT X X X 0 1 0 0 0 1 0 0 0 DALE M SOWDERS PRESIDENT & CEO 545085 0 138747 0 47838 0 7950 0 17148 0 756768 0 0 0 MARK STID MD TRUSTEE, PHYSICIAN 180005 0 32315 0 6150 0 2621 0 16908 0 237999 0 0 0 TERRY L STEELE VP, FINANCE & CFO 279000 0 52605 0 29631 0 7950 0 13859 0 383045 0 0 0 PATTI VANDORT SVP, CNO, REHAB SERV, MARKETING 250123 0 47009 0 55708 0 5193 0 11503 0 369536 0 0 0 MICHAEL W MATTHEWS VP, MEDICAL GROUPS & HR 229597 0 43290 0 29129 0 5495 0 16768 0 324279 0 0 0 MARK L PAWLAK SVP, QUALITY, IS & HOSP OP 250123 0 47009 0 66927 0 7789 0 6968 0 378816 0 0 0 WILLIAM VANDERLIET VP, MEDICAL AFFAIRS 174246 0 0 0 28195 0 4875 0 65 0 207381 0 0 0 JOSEPH K POSTMA PHYSICIAN 275018 0 469756 0 62108 0 7950 0 16975 0 831807 0 0 0 Kristen M Murphy PHYSICIAN 200013 0 286363 0 57225 0 7950 0 6933 0 558484 0 0 0 DERICK M JOHNSON DO PHYSICIAN 638611 0 0 0 10037 0 7950 0 17038 0 673636 0 0 0 STEPHEN MAUGER DO PHYSICIAN 285002 0 470676 0 31582 0 3698 0 16273 0 807231 0 0 0 Sanjeev Mathur PHYSICIAN 220002 0 284201 0 10252 0 3948 0 16517 0 534920 0 0 0 Part I, Line 4b DALE SOWDERS PARTICIPATED IN A 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. 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 2016. Part I, Line 6 MANAGEMENT BONUSES ARE BASED 20% ON WHETHER OPERATING MARGIN TARGETS ARE REACHED AND 80% ON WHETHER QUALITY PATIENT SATISFACTION AND ACHIEVEMENT OBJECTIVES ARE MET. A MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 800596186 59447ptk7 2016-10-06 41320000 CONSTRUCTION OF NEW BUILDING and DEFEASANCE OF 2004B BONDS 0 0 0 B MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 800596186 NONEAVAIL 2010-08-11 23500000 CONSTRUCTION OF NEW BUILDING 0 0 0 C MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 800596186 59447PTK7 2013-02-20 39641117 CONSTRUCTION OF NEW BUILDING AND DEFEASANCE OF 2004A BONDS 0 0 0 A 44193387 573771 21796000 21823616 2016 0 1 0 1 B 23500000 9376581 14123419 2011 1 0 1 1 C 39641117 512903 20471662 18656552 2015 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 B 0 0 1 0 0 0 0 0 1 C 0 0 0 0 0 0 0 0 1 A 0 B 0 C 0 SCHEDULE K, PART I, ISSUER NAME: THE MICHIGAN FINANCE AUTHORITY IS THE SUCCESSOR IN INTEREST TO THE MICHIGAN STATE HOSPITAL FINANCE AUTHORITY (EIN: 38-2889417), PURSUANT TO MICHIGAN EXECUTIVE ORDER 2010-2. EFFECTIVE MAY 30, 2010, ALL THE POWERS, RIGHTS, RESPONSIBILITIES AND DUTIES OF THE MICHIGAN STATE HOSPITAL FINANCE AUTHORITY WERE TRANSFERRED TO THE MICHIGAN FINANCE AUTHORITY PURSUANT TO MICHIGAN EXECUTIVE ORDER 2010-2. LAKEWOOD ELZINGA A JOINT VENTURE BOARD MEMBER JAMES STROOP OWNS GREATER THAN 35% OF THE ORGANIZATION 2026545 GENERAL CONTRACTOR FEES AND CONSTRUCTION SERVICES 0 Form 990, Part VI, Section B, line 11b HOLLAND COMMUNITY HOSPITAL'S CEO AND CFO REVIEW THE FORM 990 PRIOR TO FILING. THE CEO 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 B, line 15 The organization uses consultants to review the exectutive compensation program annually and recommend updates/increases as dictated by the market. Compensation is set for each position with established targets using national and regional data for similiar hospitals. This policy is board approved and has an ongoing review process which is comparative and data-driven. the most recent year this process has been undertaken in October 2016. The board documents its conclusion in writing. None of the interested parties are present for this discussion. Form 990, Part VI, Section C, line 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. Form 990, Part XI, line 9: Unrealized Loss in affiliates 140,953. LOSS ON EXTINQUISHMENT OF DEBT -158,159. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR. HOLLAND HOSPITAL PHYSICIAN CLINIC 602 MICHIGAN AVENUE HOLLAND MI 49423 263479537 NOT ACTIVE MI 0 0 HOLLAND COMMUNITY HOSPITAL HOLLAND SC LLC DBA SURGERY CENTER OF WEST MICHIGAN 602 MICHIGAN AVENUE HOLLAND MI 49423 203200415 NOT ACTIVE MI 0 0 HOLLAND COMMUNITY HOSPITAL 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 HOLLAND COMMUNITY HOSPITAL AUXILIARY 602 MICHIGAN AVENUE HOLLAND MI 49423 382139025 SUPPORTING ORGANIZATION MI 501(C)(3) Line 12c, III-FI N/A 0 HEALTH POINTE 602 MICHIGAN AVENUE HOLLAND MI 49423 474398187 HEALTH CARE MI 501(C)(3) Line 3 HOLLAND COMMUNITY HOSPITAL 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0