2016-05-13T15:04:44-07:00 2015-12-31 990 2015-01-01 381366927 HOLLAND HOME HOLL 6162355034 2100 Raybrook St SE Suite 300 Grand Rapids MI 495465783 Hermina Breuker CEO 6162355000 2016-05-11 2015 2016-09-27 15:27:22Z Hermina Breuker 2100 Raybrook St SE Suite 300 Grand Rapids MI 49546 69409724 0 X www.hollandhome.org X 1892 MI Provide nursing therapy and benevolent services for aged residents in skilled nursing, dementia nursing, assisted living and independent living centers. 12 11 1444 734 -86169 0 3294775 3144724 58721435 60587159 254973 187746 138647 233091 62409830 64152720 0 0 0 0 30492911 32314718 21408 2486 592781 30800530 30953868 61314849 63271072 1094981 881648 232921073 229618100 238283217 235760458 -5362144 -6142358 In fulfilling God's calling to serve others, the organization will serve aged persons (1) with love and compassion, (2) with a commitment to excellence and (3) follow Christ's teachings and example in all that the organization does. 0 0 55955727 61007996 Provide nursing and residential care at three facilities located in Grand Rapids, Michigan to an average of 1,564 residents each day in skilled nursing (214), assisted living (383) and independent living (967). Of the 383 residents in assisted living, the organization provides financial assistance to 18% or 66 residents on average which amounts to $2.1 million in benevolence. In skilled nursing, the organization serves an average of 107 residents (50%) on Medicaid and 31 residents (15%) on Medicare. These contractural allowances cost the organization $6.3 million in 2015. The organization provides uncompensated costs of private rooms to most of the 107 residents on Medicaid. 0 0 0 55955727 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 40 0 1 1444 1 0 0 0 0 0 1 1 0 0 0 0 X 12 11 0 0 0 0 1 0 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 MI X David Tiesenga 6162355035 2100 Raybrook St SE Suite 300 Grand Rapids MI 495465783 Hermina Breuker CEO/Director 50 X X 272979 0 11910 Mark Eriks Director/Secretary 2 X X 0 0 0 Paul Farr Director 2 0 X 0 0 0 Gary Malburg Treasurer/Director 2 0 X X 0 0 0 Jean Nagelkerk Director 2 0 X 0 0 0 Bruce Neckers Director 2 0 X 0 0 0 Max Smith Director/Assistant Treasurer 2 0 X X 0 0 0 Luis Tomatis Director 2 0 X 0 0 0 James Tuinstra Director 2 0 X 0 0 0 Mary Ursul Vice Chair/Director 2 0 X X 0 0 0 Carl VerBeek Director 2 0 X 0 0 0 Susan Vogel-Vanderson Chair/Director 2 0 X X 0 0 0 David Tiesenga CFO 50 0 X 242213 0 17000 H David Claus President Emeritus 40 0 X 350960 0 18000 John Mulder Chief Medical Consultant 50 0 X 152936 0 0 Carolyn Flietstra VP Home and Community Based Services 50 0 X 152188 0 3831 Troy Vugteveen Vice President of Operations 50 0 X 136999 0 3517 Jeff Engle Vice President of Information Services 50 0 X 124606 0 3341 Catherine Vydareny Executive Director 50 0 X 114137 0 4201 1547018 0 61800 8 0 1 0 Morrison Services 39395 W 12 Mile Rd Farmington Hills MI 48331 Dietary Services 3880920 Plante Moran 27400 Northwestern Highway Southfield MI 48037 Accountants 131290 Rehab Care Group Inc PO Box 503534 St Louis MO 63150 Therapy Services 1114677 Clifton Larson Allen 101 N Tryon St Suite 1000 Charlotte NC 28246 Accountants 104389 Foster Swift Collings and Smith PC 313 S Washington Square Lansing MI 48933 Attorneys 147505 5 0 0 41225 0 0 3103499 0 3144724 HFA and Independent Living 623000 20412463 20412463 0 0 Medicare/Medicaid 623000 10861559 10861559 0 0 Skilled Nursing 623000 8869987 8869987 0 0 Amortization of Endowments 623000 6865074 6865074 0 0 Ancillary Revenue 623000 734168 734168 0 0 12843908 12930077 -86169 0 60587159 469364 0 0 469364 0 0 0 0 0 0 0 0 0 0 4780741 94128 4501241 655246 279500 -561118 -281618 0 0 -281618 333608 41225 100517 233091 0 233091 0 64152720 60673328 -86169 420837 0 0 0 0 0 0 0 0 866158 0 866158 0 0 0 0 0 25257204 22958314 1909284 389606 1436854 1172443 244515 19896 2773546 2437509 294672 41365 1980956 1740948 210464 29544 346989 162649 178840 5500 151458 0 151458 0 91520 0 91520 0 0 0 0 0 2486 2486 45106 0 45106 0 0 0 0 0 766779 0 766779 0 2605642 2384544 159277 61821 658596 58958 599638 0 0 0 0 0 5178152 4544737 633415 0 255770 204101 40914 10755 0 0 0 0 60752 40562 16825 3365 6097629 6097629 0 0 0 0 0 0 7182699 6809704 372995 0 0 0 0 0 Purchased Services 4703285 4703285 0 0 Medicaid Quality Assurance Fees 1663682 1663682 0 0 Bad Debt 157872 157872 0 0 Miscellaneous 193767 95839 96191 1737 794170 722951 44513 26706 63271072 55955727 6722564 592781 1689418 1084074 10582798 8563016 7017066 5523045 2681440 2915292 0 0 0 0 6203390 4757607 311390 280625 81142 375184 252313938 86085576 165095114 166228362 22727126 23591318 0 0 12390764 12215146 0 0 4141425 4084431 232921073 229618100 29735628 30203201 0 0 37662651 37462767 106690000 105197081 0 0 0 0 0 0 3430000 3430000 60764938 59467409 238283217 235760458 X -12379210 -11665403 7017066 5523045 0 0 -5362144 -6142358 232921073 229618100 X 881648 -965393 0 0 0 -696469 X 0 1 X 1 0 X 990202 2567214 2648707 3294775 3144724 12645622 55046905 55784173 57098358 58721435 60587159 287238030 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56037107 58351387 59747065 62016210 63731883 299883652 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 299883652 496265 495718 1009991 323090 469364 2794428 0 0 0 0 0 0 496265 495718 1009991 323090 469364 2794428 0 0 0 0 0 0 0 0 0 0 0 0 56533372 58847105 60757056 62339300 64201247 302678080 0.99077 0.98987 0.00923 0.01013 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 13971719 13971719 0 209524698 74428145 135096553 0 851128 280612 570516 0 15934699 8847023 7087676 0 12031694 2529796 9501898 166228362 Interest in Net Assets of Charitable Foundation 12215146 C 12215146 0 Mortgage Notes Payable 378844 Refundable Amounts Payable 51026704 Fair Value Interest Rate SWAPs 8061861 59467409 Christmas Dinner 374833 41225 333608 0 2485 9178 51771 6000 31083 0 0 374833 41225 333608 0 2485 9178 51771 6000 31083 100517 233091 X 0 1 X X X 0 0 0 0 0 0 0 0 0 Hermina Breuker CEO/Director 272979 0 0 0 0 0 11910 0 6698 0 291587 0 0 0 David Tiesenga CFO 242213 0 0 0 0 0 17000 0 5500 0 264713 0 0 0 H David Claus President Emeritus 350960 0 0 0 0 0 18000 0 6802 0 375762 0 0 0 John Mulder Cheif Medical Consultant 152936 0 0 0 0 0 0 0 0 0 152936 0 0 0 Carolyn Flietstra VP Home and Community Based Services 152188 0 0 0 0 0 3831 0 0 0 156019 0 0 0 Schedule J, Part I, Line 1a The CFO is reimbursed on a monthly basis for health club dues he pays for personally. Schedule J, Part I, Line 1b The CFO is reimbursed on a monthly basis for health club dues he pays for personally A Economic Development Corporation of the City of Kentwood 381844797 491740DW3 2006-08-31 50590705 See Part VI 1 0 0 B Economic Development Corporation of the City of Kentwood 381844797 491740DF0 2012-06-29 50090801 Refund Prior Bonds 8/2/00, 8/31/06, 10/3/02 0 0 0 C Michigan Strategic Fund 521417332 NoneNoneN 2014-12-11 23590000 Refund prior issue (12/18/2009) 0 0 0 A 17765000 0 52102374 3059955 0 0 1002277 68371 113697 33164503 14693567 0 2005 0 1 1 1 B 370000 0 50234595 4709530 0 0 1001816 0 0 0 45435529 0 2005 1 0 1 1 C 62917 0 23590000 0 0 0 0 0 0 0 23590000 0 2005 1 0 1 1 A 0 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 0 A 0 0 0 1 1 1 Morgan Stanley Capital Services Inc 26.2 0 1 1 Lehman Brothers 30.2 1 0 0 B 0 1 1 0 0 0 1 Wachovia 27.8 1 0 0 C 0 0 1 1 1 0 0 0 0 A 0 B 0 C 0 Schedule K, Part I, Column f-08/31/2006 50,590,705 Economic Development Corporation of the City Construction of facility, land purchase, refund prior issue (10/3/02) Schedule K, Part II, Line 3-08/31/2006 50,590,705 Economic Development Corporation of the City The total proceeds do not agree to the issue price in Part I, Column (e) due to investment earnings. Schedule K, Part II, Line 3-06/29/2012 50,090,801 Economic Development Corporation of the City The total proceeds do not equal the summation of the lines 4 - 12 due to transferred or replacement proceeds in line 4. Schedule K, Part IV, Line 2c-08/31/2006 50,590,705 Economic Development Corporation of the City Issuer name: Econ Dev Corp of the City of Kentwood; Date the Rebate Computation was Performed: 11/15/2014 Schedule K, Part IV, Line 2c-12/11/2014 23,590,000 Michigan Strategic Fund Issuer Name: Michigan Strategic Fund; Date the Rebate Computation was performed: 06/11/2015. Note regarding the 6/11/2015 rebate computation: Since the bond proceeds have been spent, a spending exception was met, and the debt service fund was operated on a bona fide basis, no further rebate calculations are necessary. Schedule K, Part IV, Line 5c-08/31/2006 50,590,705 Economic Development Corporation of the City GIC terminated in November 2011 Carl VerBeek Director 21002 Legal Services 0 Mark Eriks Secretary/Director 280342 Food/Supplies 0 Form 990, Part VI, Section A, Line 6 Pursuant to its Articles of Incorporation as amended, the corporation is organized on a "nonstock membership basis" Form 990, Part VI, Section A, Line 7b Pursuant to its Bylaws as amended, the corporation is a subsidiary of Christian Living Services and not withstanding any other provision in their Bylaws to the contrary, the approval of Christian Living Services as the member of this corporation is required to: (1) change the purpose, philosophy, core values or mission of the corporation, (2) amend the Articles of Incorporation or Bylaws of the corporation, (3) make any change to the structure of operation of the corporation which would affect its status as a nonprofit entity, exempt from taxation under Section 501(c)(3) of the Internal Revenue Code, (4) dissolve of liquidate the corporation, (5) merge or consolidate with another entity, (6) remove a Director of the corporation, (7) create or acquire a new subsidiary entity or enter into a joint venture or partnership, (8) purchase, acquire or lease any real property or sell, lease, exchange, give as security, mortgage, or dispose of any personal property owned, held or leased by the corporation, (9) purchase, lease (as lessor or lessee), sell or otherwise dispose of any personal property that would be a capital asset of the corporation under generally accepted accounting purposes,(10) borrow or enter into a guaranty, (11) adopt a budget, schedule of fees, marketing plan or long-range plan for the corporation, (12) enter into a material contract such as an employee lease arrangement or a contract to subcontract the provision of food service, facilities maintenance or janitorial service, or (13) change accountants or attorneys. Form 990, Part VI, Section B, Line 11b The Form 990 and appropriate Schedules are prepared by the organization. The completion of the Form is reported to the organization's Audit Committee. The Form 990 and appropriate Schedules to the Internal Revenue Service. Form 990, Part VI, Section B, Line 12c On an annual basis each diretor, principal officer and member of a committee with board delegated powers must complete a statement that (1) they have received a copy of the Conflict of Interest Policy, (2) they have read and understand the policy, (3) they have agreed to comply with the policy, and (4) they understand that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. Form 990, Part VI, Section B, Line 15 The organization purchases compensation surveys and bases the executive compensation on the fiftieth percentile of prevailing market rates for similar positions, market trends and the financial capabilities of the organization. The organization continuously strives to balance financial realities with the desire to pay people fairly. Then the executive pay is reviewed with a subgroup of the Board of Directors. Form 990, Part VI, Section C, Line 19 The organization does not make its governing documents of Conflict of Interest Policy available to the public. However, a summary of the annual financial statement is printed once each year in the New Horizons, a publication of the organization which is sent to residents, residents' family members and donors on a quarterly basis. A copy of the audited financial statement is available upon request and this is also communicated in the New Horizons. Form 990, Part XI, Line 9 Other Changes in Net Assets of Fund Balances: Change in Fair Market Value of Interest Rate SWAPs: $1,459,023; Change in Interest in New Asset of Foundation: -$175,618; Pension Related Changes in Other than Net Periodic Benefit Cost: -$485,866; Changes in Pledges Receivable: -$696,469. Holland Home Foundation 2100 Raybrook St SE Suite 300 Grand Rapids MI 495465783 382663466 Receive and manage funds MI 501(c)(3) 7 N/A 0 Home Health Care Agency of Holland Home 2100 Raybrook St SE Suite 300 Grand Rapids MI 495465783 382660300 Home care MI 501(c)(3) 9 N/A 0 Rehab Dimensions 2100 Raybrook St SE Suite 300 Grand Rapids MI 495465783 383337881 Rehabilitation services MI 501(c)(3) 9 N/A 0 Christian Living Services 2100 Raybrook St SE Suite 300 Grand Rapids MI 495465783 261126816 Administrative services MI 501(c)(3) 11b N/A 0 Reliance Community Care Partners 2100 Raybrook St SE Suite 203 Grand Rapids MI 495465783 382295909 Care management MI 501(c)(3) 9 N/A 0 Faith Hospice 2100 Raybrook St SE Suite 300 Grand Rapids MI 495465783 383062893 Hospice care MI 501(c)(3) 9 N/A 0 Helpers of Holland Home 2100 Raybrook St SE Grand Rapids MI 49546 271062997 Private Duty Assistance MI 501(c)(3) 11b N/A 0 EHCO Group LLC 1279 Cedar St NE Grand Rapids MI 49503 464304654 Care management MI N/A Related -77598 78034 0 0 1 0.2 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 Holland Home Foundation c 250000 Cash Receipts Faith Hospice q 4711176 Accounts Payable Faith Hospice p 231661 Accounts Payable Home Health Care Agency of Holland Home q 1390865 Accounts Payable Helpers of Holland Home q 366318 Accounts Payable Rehab Dimensions q 181918 Accounts Payable Reliance Community Care Partners q 1518055 Accounts Payable EHCO Group LLC b 88000 Accounts Payable