2016-02-04T09:48:06-06:00 2015-03-31 381357951 PLANTE & MORAN PLLC 600 E FRONT ST SUITE 300 TRAVERSE CITY MI 49686 990 2014-04-01 382800065 HOLLAND COMMUNITY HOSPITAL HOLL 6163925141 602 MICHIGAN AVENUE HOLLAND MI 49423 DALE SOWDERS PRESIDENT & CEO 6163925141 2016-02-03 1 OLIVER JURKOVIC P00433694 2319477800 2014 2016-04-25 22:37:26Z HOLLAND HOSPITAL DALE SOWDERS 602 MICHIGAN AVENUE HOLLAND MI 49423 334166862 0 X WWW.HOLLANDHOSPITAL.ORG X 1985 MI TO CONTINUOUSLY IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE IN THE SPIRIT OF HOPE, RESPECT, COMPASSION AND DIGNITY. 13 10 2250 370 1143408 43668 1264629 914695 213061896 216763943 4848427 11020629 1056378 1525485 220231330 230224752 668510 668160 0 0 113415052 113004807 0 0 851597 93229693 99369823 207313255 213042790 12918075 17181962 435874826 443584093 117860654 113604399 318014172 329979694 X TO CONTINUOUSLY IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE IN THE SPIRIT OF HOPE, RESPECT, COMPASSION AND DIGNITY. 0 0 175807946 668160 224960156 HOLLAND COMMUNITY HOSPITAL'S MISSION - TO CONTINUALLY IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE IN THE SPIRIT OF HOPE, COMPASSION, RESPECT AND DIGNITY - IS PRACTICED EVERY DAY BY THE STAFF OF 2,000 HOSPITAL EMPLOYEES AND 300+ MEMBERS OF ITS MEDICAL STAFF. WE ARE COMMITTED TO BE THE PREEMINENT STAND-ALONE HOSPITAL IN WEST MICHIGAN AS MEASURED BY BENCHMARK CUSTOMER SERVICE, BUSINESS GROWTH, FINANCIAL PERFORMANCE AND CLINICAL EXCELLENCE. WE BASE OUR EFFORTS ON OUR CORE VALUES OF CUSTOMER SERVICE, COMMUNICATION, CREATIVITY, AND COMMITMENT.FIRST-RATE QUALITY:HOLLAND HOSPITAL IS ONE OF ONLY FIVE MICHIGAN HOSPITALS TO EARN HEALTHGRADE'S 50 BEST HOSPITALS DESIGNATION. HEALTHGRADES AMERICA'S 50 BEST HOSPITALS AWARD RECOGNIZES 50 HOSPITALS AS AMONG THE TOP 1% IN THE NATION FOR CONSISTENT CLINICAL EXCELLENCE BASED ON AN ANALYSIS OF RISK-ADJUSTED MORTALITY AND COMPLICATION RATES FOR COMMON PROCEDURES AND CONDITIONS. 'TOP 100 HOSPITALS' TEN YEARS AND COUNTING:FOR A TENTH CONSECUTIVE YEAR, HOLLAND HOSPITAL EARNED A SPOT IN TRUVEN HEALTH ANALYTICS' TOP 100 HOSPITAL NATIONAL RANKINGS. TRUVEN RECOGNIZES THE 100 HIGHEST-SCORING HOSPITALS FROM A TOTAL POOL OF 2,787, INCLUDING NOT-FOR-PROFIT, FOR-PROFIT AND GOVERNMENT INSTITUTIONS. SUPERIOR HEART CARE:FOR A SEVENTH CONSECUTIVE YEAR, HOLLAND HOSPITAL HAS BEEN RECOGNIZED WITH A GOLD PERFORMANCE ACHIEVEMENT AWARD PRESENTED BY THE AMERICAN COLLEGE OF CARDIOLOGY'S NCDR ACTION REGISTRY. HOLLAND HOSPITAL IS ONE OF ONLY 78 HOSPITALS NATIONWIDE TO RECEIVE THE HONOR IN 2015. THE ACTION REGISTRY-GWTG GOLD PERFORMANCE ACHIEVEMENT AWARD RECOGNIZES HOSPITALS THAT HAVE SUSTAINED HIGH PERFORMANCE LEVELS IN THE TREATMENT OF HEART ATTACK PATIENTS FOLLOWING GUIDELINES SET BY THE AMERICAN COLLEGE OF CARDIOLOGY/AMERICAN HEART ASSOCIATION. LEADERS IN TECHNOLOGY INFRASTRUCTURE:AFTER A YEAR OF PREPARATION, HOLLAND HOSPITAL IMPLEMENTED AN ORGANIZATION-WIDE ELECTRONIC MEDICAL RECORD (EMR) SYSTEM USING CERNER SOFTWARE. THIS TRANSITION PROVIDES PATIENTS AND PHYSICIANS WITH QUICK, SECURE ACCESS TO NEEDED HEALTH INFORMATION. SPECIFICALLY WITH THE NEW SYSTEM:- ALL HEALTH RECORDS ARE IN ONE PLACE, GIVING PROVIDERS ACCESS TO THE INFORMATION THEY NEED, WHEN THEY NEED IT.- PROVIDERS CAN VIEW TEST RESULTS AND DOCUMENT VISITS IN REAL-TIME WITHOUT LEAVING THE EXAM ROOM.- PATIENT RECORDS ARE ALWAYS UP-TO-DATE. THERE IS NO NEED TO FILL OUT FORMS AT EACH VISIT.PROVIDERS CAN VERIFY PATIENT ID, MEDICATIONS, AND OTHER VITAL INFORMATION BY SCANNING THE BAR CODE ON THE PATIENT'S WRIST BAND. HEALTH INFORMATION IS SECURE AND PASSWORD-PROTECTED. EMRS ELIMINATE ERRORS THAT CAN RESULT FROM ILLEGIBLE HANDWRITING OR TRANSFERRING PAPER COPIES. SUMMARY OF EFFORTS:DURING FISCAL YEAR 2015, HOLLAND HOSPITAL'S 330-MEMBER MEDICAL STAFF, 2,000 EMPLOYEES AND 370 VOLUNTEERS SERVED THE COMMUNITY BY PROVIDING:PATIENT DAYS 29,000DISCHARGES 8,100BIRTHS 1,800SURGERIES 15,800OUTPATIENT VISITS 421,500EMERGENCY ROOM VISITS 42,400URGENT CARE VISITS 36,400HOME HEALTH VISITS 41,400LAB TESTS 632,200RADIOLOGY PROCEDURES 102,200BEDS 189COMMUNITY OUTREACH PROGRAMS:IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE MEANS TAKING OUR SERVICES INTO THE COMMUNITY TO OFFER RESIDENTS CONVENIENT ACCESS TO HEALTH PROGRAMS AND EDUCATION. AT THE DIRECTION OF THE COMMUNITY OUTREACH COMMITTEE OF THE HOSPITAL BOARD OF DIRECTORS, WE FOCUS OUR OUTREACH EFFORTS ON TARGETED AT RISK POPULATIONS INCLUDING THE UNINSURED/UNDER INSURED, STUDENTS FROM LOW-INCOME FAMILIES, AND TEMPORARILY DISPLACED INDIVIDUALS AND FAMILIES.HOLLAND COMMUNITY HEALTH CENTER:THE HOLLAND COMMUNITY HEALTH CENTER (HCHC) PROVIDES PRIMARY HEALTH CARE SERVICES FOR PEOPLE WHO ARE UNDER INSURED AND UNINSURED. OVER 5,200 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. EACH YEAR THE HCHC ACQUIRES OVER $500,000 WORTH OF FREE MEDICATIONS FOR PATIENTS WHO CANNOT AFFORD THEM. THE SCHOOL NURSING PROGRAM:SCHOOL NURSES PROVIDE SERVICES TO HOLLAND PUBLIC, HOLLAND CHRISTIAN, WEST OTTAWA PUBLIC, FENNVILLE PUBLIC AND HAMILTON COMMUNITY SCHOOLS. IN SCHOOL YEAR 2014-15 OUR NURSES SERVICED MORE THAN 11,600 STUDENTS WITH 21,144 HEALTH ROOM VISITS, GAVE 21,261 MEDICATION ADMINISTRATIONS DURING THE SCHOOL YEAR AND REFERRED 245 STUDENTS FOR ADDITIONAL MEDICAL DENTAL, VISION, OR SOCIAL CONCERN. FAITH COMMUNITY NURSE:THE FAITH COMMUNITY NURSE AT THE HOLLAND RESCUE MISSION PROVIDED APPROXIMATELY 700 ONE-ON-ONE CLIENT ENGAGEMENTS LAST YEAR, OFFERING BASIC HEALTH INFORMATION, ASSESSMENT OR ONGOING EDUCATION FOR HEALTH ISSUES AS WELL AS HELPING INDIVIDUALS ACCESS MEDICAL, DENTAL, MENTAL, AND OTHER KINDS OF CARE. THE AFFORDABLE CARE ACT, ALONG WITH MICHIGAN'S EXPANDED MEDICAID (HEALTHY MICHIGAN PLAN), ALLOWED MOST WOMEN AT THE MISSION TO GAIN ACCESS TO SOME LEVEL OF INSURANCE EVEN IF THEY WERE EMPLOYED SPORADICALLY OR PART TIME. THE FAITH COMMUNITY NURSE HELPED EXPLAIN THESE SERVICES AND HOW THEY WORK. COMMUNITY OUTREACH PROGRAMS:THE CENTER FOR GOOD HEALTH (CFGH) OFFERS A VARIETY OF EDUCATIONAL CLASSES AND PRESENTATIONS FOR CHILDREN, ADULTS, AND SENIORS. IN FY 2015, THE CENTER OFFERED 682 CLASSES AND EVENTS WITH 9,000 PARTICIPANTS. IN RESPONSE TO TODAY'S EMPHASIS ON IMPROVING WORKER HEALTH TO BOOST EFFECTIVENESS AND REDUCE HEALTH CARE COSTS, CFGH WORKS WITH MANY AREA BUSINESSES TO PROVIDE WORKSITE WELLNESS PROGRAMS DIRECTLY TO EMPLOYEES.FUNDING ACCESS TO HEALTH CARE SERVICES FOR OUR COMMUNITY:THE FUND DEVELOPMENT OFFICE AT HOLLAND HOSPITAL RAISES FINANCIAL SUPPORT FOR FOUR IMPORTANT PROGRAMS: THE HOLLAND COMMUNITY HEALTH CENTER, THE SCHOOL NURSING PROGRAM, THE FAITH COMMUNITY NURSE, AND THE BREAST CARE FUND. FUND DEVELOPMENT IS THE SOLE SOURCE OF COMMUNITY FUNDRAISING FOR THESE PROGRAMS. IN FISCAL YEAR 2015, THE FUND DEVELOPMENT RAISED $433,706.UNCOMPENSATED MEDICAL COSTS:OUR COMMITMENT TO CARING FOR MEMBERS OF OUR COMMUNITY WHO ARE UNINSURED OR UNDER-INSURED CONTINUES TO BE ONE OF THE BIGGEST FINANCIAL CHALLENGES FOR THE HOSPITAL. IN FY 2015, HOLLAND HOSPITAL PROVIDED UN-REIMBURSED CARE TO OUR PATIENTS AT A COST OF $44.6 MILLION, A 6.7 PERCENT INCREASE OVER THE PREVIOUS YEAR.IN 2014, THE STATE OF MICHIGAN EXPANDED ITS MEDICAID PROGRAM WITH THE GOAL OF REDUCING THE NUMBER OF RESIDENTS WHO WERE UNINSURED. THE EXPANSION WAS ALSO INTENDED TO REDUCE THE LEVEL OF UNCOMPENSATED CARE THAT IMPACTS HOSPITAL BUDGETS.HOWEVER, ACCORDING TO THE MICHIGAN HEALTH AND HOSPITAL ASSOCIATION, IT WILL BE ANOTHER YEAR OR MORE BEFORE HOSPITALS KNOW HOW MUCH THAT COST HAS DECREASED. IT COULD TAKE EVEN LONGER TO ASSESS WHETHER IT'S DROPPED ENOUGH TO MAKE UP FOR THE CUTS IN FEDERAL REIMBURSEMENTS THAT WERE OUTLINED IN THE AFFORDABLE CARE ACT.WITHIN HOLLAND HOSPITAL'S PRIMARY SERVICE AREA,THE 2015 OTTAWA COUNTY COMMUNITY NEEDS ASSESSMENT REVEALED: 4 IN 10 LOW INCOME HOUSEHOLDS ARE NOT CONFIDENT NAVIGATING THE HEALTH CARE SYSTEM, 6 IN 10 ADULTS ARE OVERWEIGHT (35.3%) OR OBESE (23.9%), 1 IN 10 ADULTS DO NOT HAVE HEALTH INSURANCE, 11.4% OF THE GENERAL POPULATION DOES NOT HAVE A PRIMARY CARE PHYSICIAN (33% AMONG UNDER-SERVED POPULATIONS)THESE FACTORS SET THE STAGE FOR A PATIENT POPULATION WITH SIGNIFICANT, UNTREATED CHORNIC ILLNESSES WHICH REQUIRE MEDICAL ATTENTION AT A SIGNIFICANT COST TO HOLLAND HOSPITAL.2015 COMMUNITY BENEFIT SUMMARY-$44.6 MILLION TOTAL COMMUNITY BENEFITUNPAID COST OF MEDICAID $11,700,000UNPAID COST OF MEDICARE $15,900,000CHARITY CARE $ 1,300,000 BAD DEBT $10,800,000OTHER COMMUNITY BENEFITS $ 4,900,000FINANCE COMMENT: CHARITY IS NOW BEING REPORTED AT COST, IN THE PAST IT WAS REPORTED AT WHAT GROSS CHARGES WOULD HAVE BEEN.OTHER COMMUNITY BENEFITS INCLUDE: COMMUNITY EDUCATION & OUTREACH PROGRAMS; CASH, IN-KIND DONATIONS & CONTRIBUTIONS; HOLLAND COMMUNITY HEALTH CENTER; STUDENT NURSING PROGRAM; HEALTH PROFESSIONAL EDUCATION & RESEARCH 175807946 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 143 0 1 2250 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 X 13 10 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 1.30 X X 694094 0 65732 JAMES STROOP CHAIR 1.00 1.00 X X 0 0 0 PHIL KONING TREASURER 1.00 1.00 X X 0 0 0 JANE CLARK SECRETARY 1.00 1.00 X X 0 0 0 LESLIE BROWN TRUSTEE 1.00 1.00 X 0 0 0 KRIS DEPREE MD TRUSTEE 1.00 1.00 X 0 0 0 TONY YASICK MD TRUSTEE, MEDICAL DIRECTOR 1.00 1.00 X 0 0 0 ROGER GAMACHE TRUSTEE 1.00 1.00 X 0 0 0 CLINT GRIFFIN MD TRUSTEE, CHIEF OF STAFF 1.00 1.00 X 15785 0 0 DAWN GARCIA WARD TRUSTEE 1.00 1.00 X 0 0 0 MARK STID MD TRUSTEE, PHYSICIAN 5.00 1.00 X 13051 171361 19915 ELIZABETH ROLINSKI TRUSTEE 1.00 1.00 X 0 0 0 JUANITA BOCANEGRA TRUSTEE 1.00 1.00 X 0 0 0 DAVE MASON TRUSTEE - PARTIAL YEAR 1.00 1.00 X 0 0 0 PATTI VANDORT VP, NURSING & CNO 40.00 0.00 X 296656 0 43176 MARK L PAWLAK VP, ANCILLARY SERVICES & Q 40.00 0.00 X 292403 0 37309 TERRY L STEELE VP, FINANCE & CFO 40.00 1.30 X 340680 0 34639 MICHAEL W MATTHEWS VP, MEDICAL GROUPS 40.00 0.30 X 234786 0 20524 CARL H WIERKS MD PHYSICIAN 40.00 0.00 X 600310 0 22812 DERICK M JOHNSON DO PHYSICIAN 40.00 0.00 X 599335 0 24860 STEPHEN MAUGER DO PHYSICIAN 40.00 0.00 X 543871 0 24743 MICHAEL TRAVER PHYSICIAN 40.00 0.00 X 419180 0 24743 ROBERT BATES PHYSICIAN 40.00 0.00 X 417059 0 22404 4467210 171361 340857 82 0 1 0 LAKEWOOD ELZINGA A JOINT VENTURE 86 E 6TH ST HOLLAND MI 49423 CONSTRUCTION 7648154 CERNER PO BOX 412702 KANSAS CITY MO 64141 SOFTWARE - PURCHASED MAINTENANCE 6078373 ARAMARK CORPORATION 12483 COLLECTIONS CENTER DR CHICAGO IL 60693 HOUSEKEEPING 5626982 JOHNSON CONTROLS INC PO BOX 93107 CHICAGO IL 606733107 CONSTRUCTION 2613876 QUADRAMED PO BOX 347188 PITTSBURGH PA 152514188 SOFTWARE - PURCHASED MAINTENANCE 864986 46 128013 46380 740302 914695 NET PATIENT SERVICE REVENUE 622110 207028179 207028179 OTHER RELATED REVENUE 900099 4824630 4824630 PHARMACY SALES UNDER SEC. 340B 446110 2495148 2495148 EHR MEANINGFUL USE REVENUE 622110 1272578 1272578 LAB ACTIVITY 621500 1143408 1143408 216763943 2094093 2094093 754548 257403 497145 497145 411800 85345 112538131 30200 103530291 111504 9007840 -81304 8926536 8926536 13698 128013 13698 0 25780 29214 -3434 -3434 CAFETERIA AND HOME MEALS 722210 1031774 1031774 1031774 230224752 224958871 1143408 3207778 668160 668160 2084329 2084329 89391258 75260541 13516460 614257 838935 838935 14358839 12028494 2152185 178160 6331446 5223990 1107456 259237 259237 121411 14111 107300 14788097 10441483 4342254 4360 972853 58065 914788 814768 417139 397629 4871326 4871326 5075696 4585702 486634 3360 321110 290883 26521 3706 255830 151030 102769 2031 2232631 2232631 15244933 11693785 3549403 1745 609623 63434 546189 MEDICAL SUPPLIES & DRUG 37788165 37654838 132810 517 PROVISION FOR BAD DEBTS 11096396 11096396 FOOD 1509089 1359397 148911 781 DUES, LICENSE & SUBS 659505 407477 249999 2029 2749153 1321455 1387047 40651 213042790 175807946 36383247 851597 18080957 24609432 423130 555849 42652916 44684414 4160838 4307890 2854933 4106580 255300124 103488696 150237227 151811428 192033075 188048409 20033843 19914997 5397907 5545094 435874826 443584093 18317771 14041681 220890 220890 82217911 80218738 17104082 19123090 117860654 113604399 X 317145367 329053775 283805 340919 585000 585000 318014172 329979694 435874826 443584093 X 17181962 -2594160 -2622280 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 13509 13509 0 PART II-B, LINE 1: THE HOSPITAL PAYS DUES TO THE MICHIGAN HOSPITAL ASSOCIATION, A PORTION OF WHICH GOES TOWARDS LOBBYING ACTIVITIES. 585000 309986 157018 737968 742098 185000 342098 585000 692632 503956 454490 742098 695991 438922 442281 692632 696468 640725 641202 695991 0.00000 1.00000 0.00000 0 0 8043721 8043721 113571118 37834511 75736607 3448495 1157152 2291343 118969824 64497033 54472791 11266966 11266966 151811428 PROFESSIONAL LIABILITY INSURANCE 1905721 OTHER LONG-TERM LIABILITIES 1461531 INTEREST PAYABLE 535237 LOSSES IN EXCESS OF INVESTMENT IN AFFILIATES 15220601 19123090 X PART V, LINE 4: EARNINGS FROM THE PERMANENT ENDOWMENTS ARE INTENDED FOR GENERAL PURPOSES OF THE HOSPITAL. PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE HOSPITAL, LHPFML, AND LHP ARE TAX-EXEMPT ORGANIZATIONS AS DEFINED UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN MADE IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR THE HOSPITAL, LHPFML, OR LHP. ORT AND BATES ARE SINGLE-MEMBER LIMITED LIABILITY COPRORATIONS, IN WHICH THE ACTIVITY FLOWS THROUGH TO THE HOSPITAL FOR FEDERAL INCOME TAX PURPOSES. THE HOSPITAL'S TAX RETURNS ARE NOT SUBJECT OT EXAMINATION BY TAXING AUTHORITIES FOR YEARS BEGINNING PRIOR TO MARCH 31, 2012. THE HOSPITAL HAS ADOPTED ACCOUNTING STANDARDS RELATED TO UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, REVIEWED ALL TAX POSITIONS. THE EVALUATED POTENTIAL EXPOSURE RELATED TO UNCERTAIN TAX POSITIONS WAS FOUND TO BE IMMATERIAL. CULINARY CABARET 141711 128013 13698 13698 141711 128013 13698 13698 13698 0 25780 23564 5650 1 0.95000 25780 23564 5650 29214 -3434 MI 1 0 1 0 1.00000 COLLEEN PERDOK 602 MICHIGAN AVE HOLLAND MI 49423 0 COLLEEN PERDOK 57 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 1368303 1368303 0.00680 28052014 19415931 8636083 0.04280 29420317 19415931 10004386 0.04960 1677536 521510 1156026 0.00570 449000 449000 0.00220 686221 686221 0.00340 2812757 521510 2291247 0.01130 32233074 19937441 12295633 0.06090 2 8318 8318 0.00000 3 2050 2050 0.00000 1 259213 259213 0.00130 6 269581 269581 0.00130 0 11096396 1501468 31490003 37919103 -6429100 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 14 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 14 1 FULL WEBSITE LISTED IN PART V SECTION C 0 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X HTTP://WWW.HOLLANDHOSPITAL.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE.ASPX X HTTP://WWW.HOLLANDHOSPITAL.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE.ASPX X X X X 1 0 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: EXISTING DATA WAS REVIEWED, INCLUDING THE NUMBER OF VISITS TO HEALTH CARE PROGRAMS AND FACILITIES, THE TYPES OF VISITS, POTENTIAL CAUSES, AND OTHER RELATED INFORMATION. IN ADDITION, MORE THAN 1,200 COMMUNITY MEMBERS WERE SURVEYED TO GATHER INFORMATION ABOUT THEIR PERSONAL HEALTH AND WELL-BEING, HEALTH-RELATED BEHAVIORS AND RISKS FOR DISEASES. COMMUNITY FOCUS GROUPS WERE ALSO HELD TO DISCUSS THE PERCEPTION OF NEEDS. THEY ALSO INTERVIEWED AND/OR SURVEYED 45 HEALTH CARE PROVIDERS OR KEY INFORMANTS TO PROVIDE INPUT IN REGARDS TO COMMUNITY HEALTH NEEDS. 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 7D: HTTP://WWW.HOLLANDHOSPITAL.ORG/UPLOADS/PUBLIC /DOCUMENTS/COMMUNITY/2014_2015_OCCHNA_2.PDFHTTP://WWW.MIOTTAWA.ORG/HEALTH/OCHD/PDF/2014_2015_OCCHNA.PDFHTTP://WWW.NOCH.ORG/UPLOADEDFILES/2014_2015_CHNA%20SUMMARY_05212015.PDFHTTP://WWW.SPECTRUMHEALTH.ORG/DOCUMENTS/HEALTHIERCOMM/SH%20ZEELAND%20% 28OTTAWA%20COUNTY%29%202015%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: HOLLAND HOSPITAL, IN COLLABORATION WITH THE OTHER HOSPITALS, COUNTY HEALTH DEPARTMENT, COMMUNITY MENTAL HEALTH AND DOZENS OF HEALTH & HUMAN SERVICE AGENCIES, HAS SPENT THE LAST SEVEN MONTHS DEVELOPING A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THE CHIP DOCUMENT (POSTED ON HOLLAND HOSPITAL'S WEBSITE) IS OUR STRATEGY/ACTION PLAN TO ADDRESS THE THREE MOST SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA: ACCESS TO HEALTH, BEHAVIORAL HEALTH, AND HEALTHY BEHAVIORS. THE ACTIONS STEPS OUTLINED IN THE CHIP WILL BEGIN IN JANUARY, 2016. PROGRESS WILL BE MEASURED EVERY SIX MONTHS. HTTP://WWW.HOLLANDHOSPITAL.ORG/UPLOADS/PUBLIC/DOCUMENTS/COMMUNITY/CHIP.PDF HOLLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 16I: THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE ALONG WITH A FINANCIAL ASSISTANCE APPLICATION (ENGLISH AND SPANISH). INFORMATION ON THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN THE FACILITY'S WAITING ROOMS, AS WELL AS OUTLINED ON A BUSINESS CARD GIVEN TO ALL PATIENTS AT REGISTRATION. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY HOLLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.HOLLANDHOSPITAL.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE.ASPX HOLLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: HTTP://WWW.HOLLANDHOSPITAL.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE.ASPX 7 LAKESHORE HEALTH PARTNERS 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE HH SERVICES - BATES ET AL LLC 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE HH SERVICES - ORT LLC 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE LAKESHORE HEALTH PARTNERS FM LLC 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE HOLLAND HOSPITAL PHYSCIAN CLINIC 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE HOLLAND COMMUNITY HEALTH CENTER 602 MICHIGAN AVE HOLLAND MI 49423 PHYSICIAN OFFICE LAKESHORE AREA RADIATION & ONCOLOGY CENT 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 $ 11,096,396. PART II, COMMUNITY BUILDING ACTIVITIES: HOLLAND HOSPITAL SERVES COMMUNITIES THAT ARE DIVERSE IN SIZE, DEMOGRAPHIC MAKEUP AND SOCIO-ECONOMIC LEVELS. FOR AT-RISK INDIVIDUALS AND FAMILIES, THE HOSPITAL OFFERS PRIMARY HEALTH CARE SERVICES THROUGH THE HOLLAND COMMUNITY HEALTH CENTER, HOLLAND RESCUE MISSION AND WITHIN FIVE AREA SCHOOL DISTRICTS WITH LARGE STUDENT POPULATIONS WHO QUALIFY FOR FREE OR REDUCED LUNCHES. MONTHLY EDUCATIONAL PROGRAMS PROVIDE HEALTH INFORMATION AND ADVICE TO TARGETED AUDIENCES INCLUDING WOMEN AND SENIORS. THROUGH ITS WEBSITE AND SOCIAL MEDIA TOOLS, THE HOSPITAL COMMUNICATES KEY HEALTH INFORMATION THROUGHOUT ITS ENTIRE SERVICE AREA AND BEYOND. ONGOING COMMUNITY WELLNESS CLASSES AND FREE SCREENINGS PROVIDE EASY ACCESS TO HEALTHY LIFESTYLE ADVICE AND SUPPORT. THE HOSPITAL'S PARTNERSHIPS WITH OTHER SERVICES PROVIDERS, LOCAL BUSINESSES, MUNICIPALITIES, CHURCHES AND SOCIAL AGENCIES BUILDS UPON THE HOSPITAL'S DAY-TO-DAY EFFORTS TO IMPROVE THE HEALTH THE COMMUNITIES IT SERVES. 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 $1,501,468. 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 FOR A MINIMUM OF 90 DAYS. THE ACCOUNT WILL BE HELD ON HOLLAND HOSPITAL'S "BOOKS" UNTIL IT HAS AGED TO A MINIMUM OF 180 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: $1,964,618TOTAL REIMBURSEMENT: $1,289,577COST IN EXCESS OF REIMBURSEMENT: $ 675,041 PART VI, LINE 2: THE 2015 CHNA WAS CONDUCTED IN COLLABORATION WITH GREATER OTTAWA COUNTY UNITED WAY, HOLLAND HOSPITAL, NORTH OTTAWA COMMUNITY HEALTH SYSTEM, OTTAWA COUNTY DEPARTMENT OF PUBLIC HEALTH, OTTAWA COUNTY COMMUNITY MENTAL HEALTH AND SPECTRUM HEALTH ZEELAND COMMUNITY HOSPITAL. THE METHODOLOGY USED FOR DATA COLLECTION INCLUDED: KEY STAKEHOLDER INTERVIEWS, KEY INFORMANT SURVEY, UNDERSERVED COMMUNITY RESIDENT PAPER SURVEY AND A COMMUNITY RESIDENT TELEPHONIC SURVEY. THE RESULTS OF THE CHNA ARE ON THE HOSPITAL'S WEBSITE, IN PRINT AND PRESENTED VIA A COMMUNITY FORUM. 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 (POPULATION: 150,675). OUR EXTENDED SERVICE AREA (ESA) OR SECONDARY SERVICE AREA CONSISTS OF FOUR MORE ZIPS TO THE NORTH, EAST, AND SOUTH OF THE HOSPITAL (POPULATION: 94,449). IN OTTAWA COUNTY, THE RACIAL DEMOGRAPHIC BREAK DOWN IS 85.2% (WHITE), 9.0% (HISPANIC), 2.8% (ASIAN), 1.7% (AFRICAN AMERICAN), 0.6% (NATIVE AMERICAN), AND <0.1% (PACIFIC ISLANDER). IN THE CITY OF HOLLAND WHERE HOLLAND HOSPITAL IS LOCATED, THERE IS A SIGNIFICANTLY HIGHER PERCENTAGE OF HISPANIC INDIVIDUALS WITH THE RACIAL DEMOGRAPHIC BREAK DOWN OF 68.9% (WHITE), 22.7% (HISPANIC), 3.0% (ASIAN), 3.6% (AFRICAN AMERICAN), 0.6% (NATIVE AMERICAN), AND <0.1% (PACIFIC ISLANDER). ACCORDING TO 2010 CENSUS DATA, THE POPULATION OF OTTAWA COUNTY WAS SPREAD OUT WITH 28.70% UNDER THE AGE OF 18, 11.90% FROM 18 TO 24, 29.30% FROM 25 TO 44, 20.00% FROM 45 TO 64, AND 10.10% WHO WERE 65 YEARS OF AGE OR OLDER. THE MEDIAN AGE WAS 32 YEARS. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $52,347, AND THE MEDIAN INCOME FOR A FAMILY WAS $59,896. MALES HAD A MEDIAN INCOME OF $42,180 VERSUS $27,706 FOR FEMALES. THE PER CAPITA INCOME FOR THE COUNTY WAS $21,676. ABOUT 3.10% OF FAMILIES AND 5.50% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 4.70% OF THOSE UNDER THE AGE 18 AND 4.90% OF THOSE AT AGE 65 OR OVER. 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. IN 2014, HOLLAND HOSPITAL INVESTED MILLIONS OF DOLLARS IN UPGRADES TO ITS ELECTRONIC HEALTH RECORDS SYSTEM TO IMPROVE PATIENT SAFETY AND ENHANCE THE EFFICIENCY OF RECORDING/ACCESSING OF PATIENT MEDICAL INFORMATION. ADDITIONAL, THE HOSPITAL CONSTRUCTED A MEDICAL OFFICE BUILDING TO HELP ASSURE THE ACCESSIBILITY TO CARDIOLOGISTS AND CARDIOVASCULAR CARE FOR RESIDENTS IN THE GREATER HOLLAND AREA. THE HOSPITAL CONTINUES TO CONTRIBUTE IN EXCESS OF $1 MILLION PER YEAR IN COMMUNITY OUTREACH INITIATIVES THAT BRING PRIMARY CARE SERVICES TO THE MOST AT-RISK POPULATIONS. FREE COMMUNITY EDUCATIONAL OPPORTUNITIES ARE PROVIDED ON A CONTINUAL BASIS THROUGH PHYSICIAN PRESENTATIONS, RADIO/TELEVISION/PRINT/WEB APPEARANCES, AND IN PARTNERSHIP WITH OTHER HEALTH CARE PROVIDERS. 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 1 0 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 0 1 0 0 0 0 0 0 0 DALE M SOWDERS PRESIDENT & CEO 531696 0 114059 0 48339 0 47210 0 18522 0 759826 0 0 0 MARK STID MD TRUSTEE, PHYSICIAN 3176 145390 0 16627 9875 9344 270 3395 0 16250 13321 191006 0 0 PATTI VANDORT VP, NURSING & CNO 229975 0 36319 0 30362 0 28300 0 14876 0 339832 0 0 0 MARK L PAWLAK VP, ANCILLARY SERVICES & Q 222480 0 35135 0 34788 0 28401 0 8908 0 329712 0 0 0 TERRY L STEELE VP, FINANCE & CFO 273823 0 37970 0 28887 0 23599 0 11040 0 375319 0 0 0 MICHAEL W MATTHEWS VP, MEDICAL GROUPS 190666 0 29561 0 14559 0 4861 0 15663 0 255310 0 0 0 CARL H WIERKS MD PHYSICIAN 588692 0 0 0 11618 0 6782 0 16030 0 623122 0 0 0 DERICK M JOHNSON DO PHYSICIAN 588692 0 0 0 10643 0 7800 0 17060 0 624195 0 0 0 STEPHEN MAUGER DO PHYSICIAN 270000 0 257338 0 16533 0 7800 0 16943 0 568614 0 0 0 MICHAEL TRAVER PHYSICIAN 402926 0 956 0 15298 0 7800 0 16943 0 443923 0 0 0 ROBERT BATES PHYSICIAN 402926 0 0 0 14133 0 7800 0 14604 0 439463 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 2014. A MICHIGAN FINANCE AUTHORITY 800596186 59465E7A5 2004-08-01 22000000 CONSTRUCTION OF NEW BUILDING 0 0 0 B MICHIGAN FINANCE AUTHORITY 800596186 NONEAVAIL 2010-08-11 23500000 CONSTRUCTION OF NEW BUILDING 0 0 0 C MICHIGAN FINANCE AUTHORITY 800596186 59447PTK7 2013-02-20 39641117 CONSTRUCTION OF NEW BUILDING AND DEFEASANCE OF 2004A BONDS 0 0 0 A 22000000 225000 22000000 2008 0 0 1 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 1 1 0 0 0 1 B 0 0 1 0 0 0 0 0 1 C 0 1 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. FORM 990, PART VI, SECTION B, LINE 11 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 EXECUTIVE COMPENSATION PROGRAM ANNUALLY AND RECOMMEND UPDATES/INCREASES AS DICTATED BY THE MARKET. COMPENSATION IS SET FOR THE PRESIDENT AND CEO, AND EACH VICE PRESIDENT POSITION WITH ESTABLISHED TARGETS USING NATIONAL AND REGIONAL DATA FOR SIMILAR 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 IS AUGUST 2015. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: UNREALIZED LOSS IN AFFILIATES -2,622,280. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR. 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