2014-02-14T09:49:50-06:00 2013-03-31 381357951 PLANTE & MORAN PLLC 600 E FRONT ST SUITE 300 TRAVERSE CITY MI 49686 990 2012-04-01 382800065 HOLLAND COMMUNITY HOSPITAL HOLL 6163925141 602 MICHIGAN AVENUE HOLLAND MI 49423 DALE SOWDERS 6163925141 2014-02-14 1 SUSAN MIENCIER P00842339 2319477800 2012 2015-11-30 17:44:51Z HOLLAND HOSPITAL DALE SOWDERS 602 MICHIGAN AVENUE HOLLAND MI 49423 328969739 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. 14 9 2335 400 1458291 249797 884900 947167 181622226 197954717 8486656 4474152 10308678 4358372 201302460 207734408 783048 743560 0 0 98382164 104787162 0 0 689527 85272690 87403738 184437902 192934460 16864558 14799948 363026744 404640320 88435689 110485817 274591055 294154503 X TO CONTINUOUSLY IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE IN THE SPIRIT OF HOPE, RESPECT, COMPASSION AND DIGNITY. 0 0 156661262 743560 199814792 HOLLAND COMMUNITY HOSPITAL OPENED ITS DOORS TO THE FIRST PATIENT IN 1917. TODAY, THANKS TO THE VISION AND HARD WORK OF STAFF, COMMUNITY MEMBERS AND MEDICAL PROFESSIONALS, WE HAVE GROWN TO BECOME THE LEADING PROVIDER OF HEALTH CARE SERVICES IN THE WEST MICHIGAN LAKESHORE REGION. OUR MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. THIS UNWAVERING COMMITMENT TO PROVIDE EXCELLENT, COMPASSIONATE AND INCREASINGLY ADVANCED HEALTH CARE REGARDLESS OF PATIENTS' ABILITY TO PAY CONTINUES UNABATED.FIRST-RATE QUALITY HOLLAND HOSPITAL'S ONGOING COMMITMENT TO EXCELLENCE IS DEMONSTRATED IN PHYSICIAN EXPERTISE, THE HIGHEST STANDARDS OF PATIENT CENTERED CARE AND DNV ISO CERTIFICATION. WE ARE ONE OF THE FEW HOSPITALS IN THE COUNTRY TO ACHIEVE THE INTERNATIONAL STANDARD FOR QUALITY: ISO 9001-2008 CERTIFICATION. THIS UNIVERSAL BENCHMARK DEMONSTRATES OUR COMMITMENT TO ORGANIZATIONAL EXCELLENCE AND SYSTEMATIC QUALITY IMPROVEMENT RESULTING IN IMPROVED OUTCOMES AND HIGHER PATIENT SATISFACTION.'TOP 100 HOSPITALS' EIGHT YEARS AND COUNTINGFOR EIGHT YEARS IN A ROW, HOLLAND HOSPITAL HAS BEEN SELECTED AS ONE OF THE NATION'S 100 TOP HOSPITALS. TRUVEN HEALTH ANALYTICS (FORMERLY THOMSON REUTERS) ANNUALLY CONDUCTS AN INDEPENDENT REVIEW OF APPROXIMATELY 3,000 HOSPITALS AND RECOGNIZES THOSE DEMONSTRATING SUPERIOR PERFORMANCE. THE VALUATION IS BASED ON PATIENT CARE FACTORS SUCH AS SAFETY AND SATISFACTION AND FINANCIAL INDICATORS SUCH AS EXPENSES AND PROFITABILITY. HOLLAND HOSPITAL IS THE ONLY MEDIUM-SIZED HOSPITAL IN MICHIGAN TO MAKE THE LIST 2006 THROUGH 2013.TOP 3 PERCENT FOR 'BEST PRACTICES'HOLLAND HOSPITAL'S 'CORE MEASURES' THE PROCESSES WE USE TO MEASURE OUR QUALITY OF CARE - ARE PROVEN BEST-PRACTICE STANDARDS FOR TREATING PATIENTS WITH CERTAIN MEDICAL CONDITIONS. HOW WELL EACH HOSPITAL APPLIES THESE LIFE-SAVING MEASURES IS TRACKED BY THE U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES AND CAN BE VIEWED AT WWW.HOSPITALCOMPARE.HHS.GOV.RECENT DATA PLACED HOLLAND HOSPITAL AT THE 97TH PERCENTILE MEANING WE'RE IN THE TOP 3PERCENT OF HOSPITALS NATIONWIDE IN MEETING PROCESS OF CORE MEASURES. WE ALSO RANKED AMONG THE LEADING HOSPITALS IN PATIENT SAFETY AS DETERMINED BY THE MICHIGAN HEALTH & HOSPITAL ASSOCIATION KEYSTONE CENTER FOR PATIENT SAFETY & QUALITY. LEADERS IN INNOVATIVE PRACTICESTHE HOSPITAL CONTINUES TO MEET THE GROWING HEALTH CARE NEEDS OF THE COMMUNITY BY PROVIDING EXPERIENCED SPECIALISTS, LEADING-EDGE TECHNOLOGY AND EXCEPTIONAL PATIENT CARE. ALTHOUGH THE HEALTH CARE LANDSCAPE CONTINUES TO CHANGE, HOLLAND HOSPITAL REMAINS AHEAD OF THE CURVE WITH FISCAL DISCIPLINE, EFFICIENT USE OF RESOURCES, AND WISE INVESTMENT IN NEW TECHNOLOGIES. PATIENTS WITHIN OUR SERVICE AREA AND BEYOND ARE BENEFITING FROM OUR RECENT FACILITY IMPROVEMENTS INCLUDING OUR NEWLY OPENED ORTHOPEDIC AND SPINE UNIT. DURING FISCAL YEAR 2013, HOLLAND HOSPITAL'S 330-MEMBER MEDICAL STAFF, 2,000 EMPLOYEES AND 400 VOLUNTEERS SERVED THE COMMUNITY BY PROVIDING:PATIENT DAYS 29,900DISCHARGES 8,100BIRTHS 1,700SURGERIES 15,800OUTPATIENT VISITS 440,200EMERGENCY ROOM VISITS 44,100URGENT CARE VISITS 32,600HOME HEALTH VISITS 39,000LAB TESTS 656,000RADIOLOGY PROCEDURES 102,000BEDS 189INNOVATIVE OUTREACH PROGRAMSIMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE MEANS TAKING OUR SERVICES INTO THE COMMUNITY TO OFFER RESIDENTS CONVENIENT ACCESS TO HEALTH PROGRAMS AND EDUCATION. MORE PROGRAMS AND SERVICES ARE REACHING BEYOND HOSPITAL WALLS INTO THE COMMUNITY, WHETHER AT SCHOOLS, NEIGHBORHOODS OR BUSINESSES. RESIDENTS AND EMPLOYEES ALIKE CAN TAKE ADVANTAGE OF NUMEROUS PREVENTION AND WELLNESS OFFERINGS.HEALTH EDUCATION AND SERVICESRECOGNIZING THAT MEN AND WOMEN HAVE UNIQUE HEALTH NEEDS, HOLLAND HOSPITAL HAS RESPONDED TO THE COMMUNITY'S REQUEST FOR PROGRAMS THAT ADDRESS GENDER-RELATED HEALTH CONCERNS. OUR WOMEN'S MIDLIFE SERVICES IS DEVOTED ENTIRELY TO ADDRESSING THE PHYSICAL AND EMOTIONAL ISSUES OF MATURE WOMEN. CREATED BY WOMEN FOR WOMEN AND DIRECTED BY A CERTIFIED MENOPAUSE PRACTITIONER, WOMEN'S MIDLIFE SERVICES OFFERS THE LATEST INFORMATION ON MENOPAUSE AND RELATED ISSUES. INTERPRETATION SERVICESOUR ON-SITE INTERPRETERS, SPECIALLY TRAINED IN MEDICAL CONDITIONS IN ACCORDANCE WITH THE NATIONAL COUNCIL ON INTERPRETING IN HEALTH CARE, ARE AVAILABLE 24 HOURS A DAY TO FACILITATE COMMUNICATION BETWEEN PATIENTS AND PROVIDERS. IN THE PAST YEAR, STAFF HANDLED MORE THAN 28,000 INTERPRETATION REQUESTS. VIDEO CONFERENCING SYSTEMS AT THE OFF-SITE URGENT CARE CENTER, BREAST AND BONE HEALTH CENTER AND HOLLAND HOSPITAL MEDICAL BUILDING CONNECT PATIENTS FACE-TO-FACE WITH HOSPITAL INTERPRETERS IN MINUTES ELIMINATING DELAYS DUE TO TRAVEL TIME.DIABETES EDUCATION DIABETES IS A MAJOR HEALTH EPIDEMIC THAT WE CONTINUE TO ADDRESS THROUGH OUR DIABETES SELF-MANAGEMENT EDUCATION PROGRAM. WE ASSIST THOSE WITH DIABETES BY OFFERING INDIVIDUAL CONSULTATIONS AS WELL AS GROUP CLASSES. PARTICIPANTS LEARN ABOUT DIET AND NUTRITION, HOW TO TEST THEIR BLOOD SUGAR, AND MANAGING THE DISEASE WITH MEDICATION. COMMUNITY OUTREACH PROGRAMS THE CENTER FOR GOOD HEALTH (CFGH) OFFERS A VARIETY OF EDUCATIONAL CLASSES AND PRESENTATIONS FOR CHILDREN, ADULTS AND SENIORS. IN FY 2013, THE CENTER OFFERED 656 CLASSES AND EVENTS WITH APPROXIMATELY 10,258 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 COMMUNITYTHE FUND DEVELOPMENT OFFICE AT HOLLAND HOSPITAL FOCUSES ON RAISING FINANCIAL SUPPORT FOR THREE VITAL PROGRAMS: THE HOLLAND COMMUNITY HEALTH CENTER, THE SCHOOL NURSING PROGRAM AND THE FAITH COMMUNITY NURSE. FUND DEVELOPMENT IS THE SOLE SOURCE OF FUNDING FOR THE SCHOOL NURSING PROGRAM, INVESTING $500,000 PER YEAR TO SERVE OVER 9,600 AREA STUDENTS. FUND DEVELOPMENT CONTRIBUTED $750,000- $850,000 TO THE OPERATION OF THE HOLLAND COMMUNITY HEALTH CENTER WHICH PROVIDES PRIMARY HEALTH CARE TO OVER 4,900 COMMUNITY MEMBERS WHO ARE EITHER UNINSURED OR UNDER-INSURED. FUND DEVELOPMENT COVERS THE ENTIRE $35,000 COST OF THE FAITH COMMUNITY NURSE AT THE HOLLAND RESCUE MISSION TO ENSURE THAT OVER 1,700 RESIDENTS ARE GIVEN ACCESS TO A MEDICAL PROFESSIONAL WHILE STAYING AT THE MISSION.HOLLAND COMMUNITY HEALTH CENTERDEMAND IS RISING DRAMATICALLY FOR SERVICES OF THE HOLLAND COMMUNITY HEALTH CENTER (HCHC), WHICH PROVIDES HEALTH CARE FOR PEOPLE WHO ARE UNDER INSURED AND UNINSURED. IN 2012, 617 NEW PATIENTS WERE SERVED AT THE HCHC. MOST OF THESE VISITS FOCUSED ON WOMEN'S AND CHILDREN'S HEALTH CARE NEEDS, DIABETES 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 PROGRAMSCHOOL NURSING PROVIDES SERVICES TO HOLLAND, WEST OTTAWA AND HAMILTON PUBLIC SCHOOLS. SCHOOL YEAR 2012-2013 THEY SERVICED 9,674 STUDENTS, 34,086 HEALTH OFFICE VISITS, ADMINISTERED 10,748 MEDICATIONS AND REFERRED 400 STUDENTS FOR ADDITIONAL MEDICAL, DENTAL, VISION, OR SOCIAL CONCERNS. 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 2013, HOLLAND HOSPITAL PROVIDED UN-REIMBURSED CARE TO OUR PATIENTS AT A COST OF $37.8 MILLION, A 7 PERCENT INCREASE OVER THE PREVIOUS YEAR. OUR LEVEL OF BAD DEBT IS A DIRECT REFLECTION OF THE STATE OF OUR LOCAL ECONOMY. BAD DEBT ROSE 50 PERCENT IN 2009 AND CLIMBED ANOTHER 30 PERCENT IN 2010 AS THE AVERAGE UNEMPLOYMENT LEVELS IN OTTAWA COUNTY REACHED 12.3% AND 11% IN RESPECTIVELY. IN 2011 AND 2012, OUR BAD DEBT STAYED CONSISTENT AS UNEMPLOYMENT LEVELS DROPPED TO 8.3% IN 2011 AND 6.4% IN 2012. HOWEVER, BAD DEBT ROSE OVER 9% IN 2013 AS UNEMPLOYMENT INCHED BACK UP TO 6.7% AND THE LOCAL ECONOMIC RECOVERY CONTINUED TO STRUGGLE. (UNEMPLOYMENT FIGURES: MICHIGAN DEPARTMENT OF TECHNOLOGY, MANAGEMENT, AND BUDGET.)2012 COMMUNITY BENEFIT SUMMARY $37.8 MILLION TOTAL COMMUNITY BENEFITUNPAID COST OF MEDICAID $9,400,000UNPAID COST OF MEDICARE $11,700,000CHARITY CARE $2,100,000 BAD DEBT $11,200,000OTHER COMMUNITY BENEFITS (NOTE A) $3,400,000FINANCE COMMENT: CHARITY IS NOW BEING REPORTED AT COST, IN THE PAST IT HAD BEEN REPORTED AT WHAT GROSS CHARGES WOULD HAVE BEEN. NOTE A OTHER COMMUNITY BENEFITS INCLUDE:-COMMUNITY EDUCATION & OUTREACH PROGRAMS-CASH, IN-KIND DONATIONS & CONTRIBUTIONS-HOLLAND COMMUNITY HEALTH CENTER-HEALTH PROFESSIONAL EDUCATION & RESEARCH 156661262 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 1 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 140 0 1 2335 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 X 14 9 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 X DALE M SOWDERS 40.00 1.00 X X 624126 0 124160 LESLIE BROWN 1.00 1.00 X X 0 0 0 BARBARA DEPREE MD 30.00 1.00 X 159830 0 17392 BECCA DERNBERGER 1.00 1.00 X 0 0 0 WILLIAM FRAUENHEIM MD 1.00 1.00 X X 29750 0 0 ROGER GAMACHE 1.00 1.00 X 0 0 0 DON KOMEJAN 1.00 1.00 X X 0 0 0 GREG MAYBURY 1.00 1.00 X 0 0 0 DAWN GARCIA WARD 1.00 1.00 X 0 0 0 JANE CLARK 1.00 1.00 X 0 0 0 JAMES STROOP 1.00 1.00 X 0 0 0 MARK STID 5.00 36.00 X 188305 0 17702 PHIL KONING 1.00 1.00 X 0 0 0 ELIZABETH ROLINSKI 1.00 1.00 X 0 0 0 KRIS MANOS 1.00 1.00 X 0 0 0 PATTI VANDORT 40.00 0.00 X 257191 0 43352 MARK L PAWLAK 40.00 0.00 X 241810 0 38745 WILLIAM L VANDERVLIET MD 20.00 0.00 X 0 0 0 TERRY L STEELE 40.00 1.00 X 339397 0 38659 CHARLES D KOHLRUSS 40.00 0.00 X 282731 0 23862 MICHAEL W MATTHEWS 40.00 0.00 X 74546 0 2243 ROBERT J BATES MD 40.00 0.00 X 578914 0 20017 MICHAEL A TRAVER MD 40.00 0.00 X 413866 0 22257 CARL H WIERKS MD 40.00 0.00 X 550093 0 21711 JOHN K LUDLOW MD 40.00 0.00 X 444004 0 22257 DERICK M JOHNSON DO 40.00 0.00 X 550093 0 17880 4734656 0 410237 57 0 1 0 LAKEWOOD ELZINGA A JOINT VENTURE 86 E 6TH ST HOLLAND MI 49423 CONSTRUCTION 4461206 ARAMARK CORPORATION 12483 COLLECTIONS CENTER DR CHICAGO IL 60693 HOUSEKEEPING 3632321 ELZINGA AND VOLKERS INC 86 E 6TH ST HOLLAND MI 49423 CONSTRUCTION 1104446 CSMC 2006-C4 PO BOX 3125 ANN ARBOR MI 481063125 RENT/SERVICES 1065397 MATTHEI AND COLIN ASSOCIATES 332 S MICHIGAN AVE SUITE 614 CHICAGO IL 60604 ARCHITECT 972814 54 137681 88985 720501 947167 NET PATIENT SERVICE REVENUE 622110 195507120 195507120 EHR MEANINGFUL USE REVENUE 622110 2447597 2447597 197954717 2947858 2947858 331421 187473 143948 143948 63100 80848 122537470 5500 120116826 899850 2420644 -894350 1526294 1526294 9168 137681 9168 0 19560 22014 -2454 -2454 OTHER RELATED REVENUE 900099 1796975 1796975 PHO/LAB ACTIVITY 621500 1458291 1458291 CAFETERIA AND HOME MEALS 722210 961612 961612 4216878 207734408 199814792 1458291 5514158 743560 743560 2579330 412979 2166351 79542913 66791828 12285945 465140 1452723 1356455 96268 15478148 11362832 3980425 134891 5734048 4760428 973620 272730 272730 112421 14671 97750 517796 517796 15184780 9311005 5836228 37547 982102 81174 900928 1021266 660959 360307 3160386 3160386 4780947 4407407 373540 324712 297781 23964 2967 173972 99696 73330 946 1763447 1763447 11433929 9856452 1572889 4588 306482 85599 220883 SUPPLIES 30965047 30794722 169581 744 PROVISION FOR BAD DEBTS 11352828 11352828 FOOD 1240929 1151994 88822 113 DUES, LICENSE & SUBCRIP 520225 285589 233546 1090 3289739 1069856 2178382 41501 192934460 156661262 35583671 689527 14399755 14322804 5691754 604225 33314016 38064742 3489031 3794569 1661053 2705225 213388416 88207779 114392066 125180637 165974730 193637244 19786344 19703439 4317995 6627435 363026744 404640320 11766598 15805587 0 205000 64199089 79834864 12470002 14640366 88435689 110485817 X 273898423 293412406 292632 342097 400000 400000 274591055 294154503 363026744 404640320 X 14799948 9394935 -4631435 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 19896 19896 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE HOSPITAL PAYS DUES TO THE MICHIGAN HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH GOES TOWARDS LOBBYING ACTIVITIES. 692632 503956 454490 742098 695991 438922 442281 692632 696468 640725 641202 695991 681023 519647 504202 696468 759350 617613 695940 681023 0.00000 0.54000 0.46000 0 0 7556948 7556948 93490772 28980751 64510021 2738885 763186 1975699 94338412 58463842 35874570 15263399 15263399 125180637 PROFESSIONAL LIABILITY INSURANCE 2767976 COST REPORT SETTLEMENT PAYABLE 70538 OTHER LONG-TERM LIABILITIES 1648599 INTEREST PAYABLE 317744 LOSSES IN EXCESS OF INVESTMENT IN AFFILIATES 9835509 14640366 X 210809994 9394935 39041 9433976 201376018 517796 5840594 6358390 207734408 191246546 8354352 8354352 182892194 517796 9524470 10042266 192934460 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: EARNINGS FROM THE PERMENANT ENDOWMENTS ARE INTENDED FOR GENERAL PURPOSES OF THE HOSPITAL. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: OTHER INCOME 39,041. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -187,473. INCOME FROM DISREGARDED ENTITY - HH SERVICES-BATES 2,861,988. INCOME FROM DISREGARDED ENTITY - LHP-FM 1,765,993. INCOME FROM DISREGARDED ENTITY - HH SERVICES-ORTHO 2,294,436. LOSS ON SALE OF FIXED ASSETS -894,350. PART XII, LINE 2D - OTHER ADJUSTMENTS: OTHER INCOME 56,448. RENTAL EXPENSES 187,473. CAPITAL CONTRIBUTION TO AFFILIATE 901,943. LOSS ON DEFEASANCE OF DEBT 1,451,934. LOSS ON SALE OF FIXED ASSETS 894,350. EARNINGS OF EQUITY INVESTMENTS 4,862,204. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES FROM DISREGARDED ENTITY - HH SERVICES-BATES 3,745,858. EXPENSES FROM DISREGARDED ENTITY - LHP-FM 2,275,738. EXPENSES FROM DISREGARDED ENTITY - HH SERVICES-ORTHO 3,502,874. CULINARY CABARET 146849 137681 9168 9168 146849 137681 9168 9168 9168 0 19560 15294 6720 1 0.95000 19560 15294 6720 22014 -2454 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 1 0 1 1 2145297 2145297 0.01180 23745260 16573242 7172018 0.03950 25890557 16573242 9317315 0.05130 256178 24863 231315 0.00130 321886 321886 0.00180 273008 240186 32822 0.00020 1707684 1707684 0.00940 2558756 265049 2293707 0.01270 28449313 16838291 11611022 0.06400 3 5593 5593 0.00000 1 723660 254355 469305 0.00260 5 108855 108855 0.00060 9 838108 254355 583753 0.00320 0 11352828 2214204 32102314 34999867 -2897553 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

X X X HOLLAND COMMUNITY HOSPITAL 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X 1 1 X X X 1 0 X X 1 X 0 0 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 - SOUTH WASHINGTON

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 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 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 7G: INCLUDED IN SUBSIDIZED HEALTH SERVICES ARE: MIDLIFE, SCHOOL NURSING, PARISH NURSING, AND CONGESTIVE HEART. PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $11,352,828. PART II: HOLLAND HOSPITAL TAKES PRIDE IN ITS LEVEL OF COMMUNITY INVOLVEMENT. KEY MEMBERS OF THE HOSPITAL ADMINISTRATION PARTICIPATE ON PLANNING AND IMPLEMENTATION BOARDS INCLUDING THE CHAMBER OF COMMERCE AND THE HOLLAND COMMUNITY HEALTH CENTER. THE HOSPITAL ENGAGES IN FORMAL AND INFORMAL COMMUNITY INITIATIVES, PARTNERING WITH LOCAL NON-PROFIT ORGANIZATIONS, PUBLIC HEALTH ORGANIZATIONS, LOCAL MUNICIPALITIES, LONG TERM CARE FACILITIES, LAW ENFORCEMENT, CHURCHES AND SCHOOL DISTRICTS. THE HOSPITAL PLANS AND CONDUCTS EMERGENCY PREPAREDNESS DRILLS LOCALLY AND REGIONALLY. OUR COMMUNITY OUTREACH EFFORTS INCLUDE HEALTH EDUCATION AND ADVOCACY WITHIN AREA SCHOOL DISTRICTS, THE HOLLAND CITY RESCUE MISSION, AND THROUGH THE PROVISION OF PRIMARY HEALTH CARE FOR PATIENTS OF THE HOLLAND COMMUNITY HEALTH CENTER. HOLLAND HOSPITAL IS A SIGNIFICANT SUPPORTER OF PROGRAMMING FOR AT-RISK POPULATIONS. THE HOSPITAL PROVIDES BOTH FINANCIAL AND IN-KIND SUPPORT OF AGE 0-5 CHILD SCHOOL READINESS PROGRAMS, FREE SCREENING FOR MENTAL HEALTH/SUBSTANCE ABUSE PROBLEMS, AND MONTHLY EDUCATIONAL PROGRAMMING FOR AREA SENIORS. 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 EVALULATING 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. 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 ORGANIZATIONS 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 $2,214,204. 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.THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2, IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX. 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. FORM 990, PART III, SECTION B: AS PER THE INSTRUCTIONS, SCHEDULE H, PART III, LINES 5 AND 6 ARE DERIVED DIRECTLY FROM THE MEDICARE COST REPORT. THOSE MEDICARE SERVICES NOT INCLUDED IN THE MEDICARE COST REPORT (MEDICARE ADVANTAGE AND FEE FOR SERVICE PHYSICIANS) HAVE A COST IN EXCESS OF REIMBURSEMENT OF $744,020. HOLLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 1J: 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 3: 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 4: NORTH OTTAWA COMMUNITY HEALTH SYSTEM & SPECTRUM HEALTH ZEELAND COMMUNITY HOSPITAL HOLLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 5C: SURVEYS OF THE COMMUNITY WERE HELD TO DISCUSS THE NEEDS ASSESSMENT. HOLLAND COMMUNITY HOSPITAL PART V, SECTION B, LINE 14G: THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE ALONG WITH A FINANCE 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 VI, LINE 2: IN COLLABORATION WITH THE OTTAWA COUNTY HEALTH DEPARTMENT AND THE UNITED WAY, 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 2012) AND EVERY 3 YEARS FOR ADULTS (LAST ONE IN 2012). 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 MICHIGAN. THIS AREA REPRESENTED JUST OVER 150,000 RESIDENTS IN 2012. OVERALL, THE PSA POPULATION IS EXPECTED TO GROW BY NEARLY 2% OVER THE NEXT FIVE YEARS, INCREASING BY APPROXIMATELY 3,000 RESIDENTS FOR A TOTAL OF ALMOST 153,000 RESIDENTS BY 2017. THIS POPULATION COMPRISES ALL AGE GROUPS, SKEWING OLDER IN THE CITY OF HOLLAND AND YOUNGER IN THE GROWING AREAS OUTSIDE THE CITY. WE ALSO SERVE RESIDENTS IN OUR EXTENDED SERVICE AREA (ESA) WHICH TOGETHER WITH THE PSA COMPRISES A TOTAL POPULATION OF NEARLY 250,000. THE MOST RECENT RACIAL DEMOGRAPHIC BREAKOUT FOR OTTAWA COUNTY SHOWS WHITE 93.3%, BLACK OR AFRICAN AMERICAN 1.7%, AMERICAN INDIAN OR ALASKA NATIVE 0.6%, ASIAN 2.8%, NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER 0.0%, TWO OR MORE RACES 1.7%, HISPANIC OR LATINO 9.0% AND WHITE (NOT HISPANIC OR LATINO) 85.2% AGE DEMOGRAPHICS FOR OTTAWA COUNTY SHOW YOUNGER THAN FIVE YEARS 6.4%, YOUNGER THAN EIGHTEEN YEARS 25.4%, AGE 65 OR OLDER 12.5% WITH THE REMAINING POPULATION BETWEEN THE AGES OF 18 AND 65 FROM A TOTAL POPULATION OF 269,099. 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 MEDICAL STAFF, AREA EMPLOYERS AND AT-LARGE MEMBERS. THE HOSPITAL ACTIVELY RECRUITS PRIMARY AND SPECIALTY CARE PHYSICIANS AND CLINICAL SUPPORT STAFF BASED ON THE HEALTH NEEDS WITHIN THE PSA. HOLLAND HOSPITAL IS ACCESSIBLE 24/7 FOR ALL PERSONS IN NEED OF MEDICAL CARE REGARDLESS OF THEIR ABILITY TO PAY. THE AMOUNT OF CHARITABLE CARE AND BAD DEBT IS IN THE TENS OF MILLIONS OF DOLLARS AND INCREASING ANNUALLY. WORKING UPSTREAM, HOLLAND HOSPITAL PROVIDES APPROXIMATELY $800,000 IN ANNUAL SUPPORT OF THE HOLLAND COMMUNITY HEALTH CENTER WHICH PROVIDES PRIMARY HEALTH CARE SERVICES, WELLNESS CHECKS AND FAMILY CARE FOR THE UNINSURED AND UNDER-INSURED. WITHOUT THIS SERVICE, THESE INDIVIDUALS WOULD UTILIZE THE HOSPITAL'S EMERGENCY DEPARTMENT FOR BASIC CARE. FREE SCREENING PROGRAMS, ONGOING FREE COMMUNITY EDUCATION, AND ONLINE HEALTH INFORMATION ARE ALSO A PART OF HOLLAND HOSPITAL'S CONTRIBUTION TO THE HEALTH OF THE COMMUNITIES IT SERVES. PART VI, LINE 6: NOT AFFILIATED. REPORTS FILED WITH STATES PART VI, LINE 7 MI 1 COMMUNITY HEALTH CENTER 602 MICHIGAN AVENUE HOLLAND MI 49423 200602574 501(C)(3) 720861 0 N/A N/A OPERATIONAL CASH FLOW TO BREAK-EVEN LAKESHORE ADVANTAGE CORP 201 W WASHINGTON ZEELAND MI 49464 061708014 501(C)(3) 12000 0 N/A N/A FINANCIAL CONTRIBUTIONS 2013 COMMUNITY FOUNDHOLLAND ZEELAND 70 W 8TH STREET SUITE 100 HOLLAND MI 49423 386095283 501(C)(3) 1500 0 N/A N/A FINANCIAL CONTRIBUTIONS 2013 HOLLAND AREA CHAMBER OF COMMERCE 272 E 8TH STREET HOLLAND MI 49423 380655230 501(C)(6) 5400 0 N/A N/A FINANCIAL CONTRIBUTIONS 2013 CITY OF ZEELAND 21 S ELM ST ZEELAND MI 49464 386004744 N/A 1000 0 N/A N/A ZEELAND FIRE-RESCUE COMMUNITY EDUCATION PROGRAMS 3 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE HOSPITAL RECEIVES THEIR MONTHLY INTERNAL FINANCIALS AND A COPY OF THE AUDITED STATEMENTS ANNUALLY. X X X 0 1 0 0 0 0 0 0 0 DALE M SOWDERS 424989 0 133114 0 66023 0 102638 0 21522 0 748286 0 0 0 BARBARA DEPREE MD 159830 0 0 0 0 0 0 0 17392 0 177222 0 0 0 MARK STID 188305 0 0 0 0 0 0 0 17702 0 206007 0 0 0 PATTI VANDORT 187547 0 46967 0 22677 0 26376 0 16976 0 300543 0 0 0 MARK L PAWLAK 185372 0 46656 0 9782 0 23841 0 14904 0 280555 0 0 0 TERRY L STEELE 239702 0 61000 0 38695 0 22012 0 16647 0 378056 0 0 0 CHARLES D KOHLRUSS 190332 0 48502 0 43897 0 5518 0 18344 0 306593 0 0 0 ROBERT J BATES MD 578914 0 0 0 0 0 0 0 20017 0 598931 0 0 0 MICHAEL A TRAVER MD 413866 0 0 0 0 0 0 0 22257 0 436123 0 0 0 CARL H WIERKS MD 550093 0 0 0 0 0 0 0 21711 0 571804 0 0 0 JOHN K LUDLOW MD 444004 0 0 0 0 0 0 0 22257 0 466261 0 0 0 DERICK M JOHNSON DO 550093 0 0 0 0 0 0 0 17880 0 567973 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 2012. A MICHIGAN STATE HOSPITAL FINANCE AUTHORTIY 382889417 59465E7A5 2004-08-01 21744478 CONSTRUCTION OF NEW BUILDING 1 0 0 B MICHIGAN STATE HOSPITAL FINANCE AUTHORTIY 382889417 59465E7A5 2004-08-01 22000000 CONSTRUCTION OF NEW BUILDING 0 0 0 C MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 800596186 NONEAVAIL 2010-08-11 23500000 CONSTRUCTION OF NEW BUILDING 0 0 0 D MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 382889417 59447PTG6 2013-02-20 37010000 CONSTRUCTION OF NEW BUILDING AND DEFEASANCE OF 2004A BONDS 0 0 0 A 22000000 1722767 250000 22000000 2008 0 0 1 1 B 22000000 225000 22000000 2008 0 0 1 1 C 23500000 14123419 139505 9376581 2011 1 0 1 1 D 39641117 3056775 18656552 243926 20471662 2015 1 0 0 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 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 1 0 0 0 0 0 B 1 1 0 0 0 0 C 0 1 0 0 0 0 0 0 0 D 0 1 0 0 1 0 0 0 0 A 0 B 0 C 0 D 0 LAKEWOOD CONSTRUCTION BOARD MEMBER JAMES STROOP IS AN OWNER OF LAKEWOOD CONSTRUCTION. 139662 LAKEWOOD CONSTRUCTION WAS SELECTED AS GENERAL CONTRACTOR FOR A HOSPITAL PROJECT AND THE PAYMENTS TO LAKEWOOD CONSTRUCTION RELATE TO CONSTRUCTION SERVICES, INCLUDING PAYMENTS TO SUBCONTRACTORS AS WELL AS THE GENERAL CONTRACTOR FEE. 0 LAKEWOOD ELZINGA A JOINT VENTURE BOARD MEMBER JAMES STROOP IS AN INDIRECT OWNER OF LAKEWOOD ELZINGA JV. 5679758 LAKEWOOD ELZINGA A JOINT VENTURE WAS SELECTED AS GENERAL CONTRACTOR FOR SEVERAL HOSPITAL PROJECTS. THE PAYMENTS TO LAKEWOOD ELZINGA A JOINT VENTURE RELATE TO CONSTRUCTION SERVICES, INCLUDING PAYMENTS TO SUBCONTRACTORS AS WELL AS THE GENERAL CONTRACTOR FEE. 0 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 2013. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, COLUMN D: WILLIAM FRAUENHEIM, BOARD MEMBER, ALSO SERVED AS MEDICAL DIRECTOR FOR THE CARDIAC SERVICE LINE. A THIRD PARTY, WEST MICHIGAN HEART, WAS COMPENSATED $29,750 FOR THESE MEDICAL DIRECTOR SERVICES. THE $29,750 HAS BEEN REPORTED ON FORM 990, PART VII, COLUMN D. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: UNREALIZED LOSS IN AFFILIATES -2,277,558. HH SERVICES-SOUTH WASHINGTON CAPITAL CONTRIBUTION -901,943. LOSS ON EXTINGUISHMENT OF DEBT -1,451,934. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR. HH SERVICES ORT LLC 602 MICHIGAN AVENUE HOLLAND MI 49423 264606759 ORTHOPEDIC PHYSICIAN OFFICE MI -1208438 234205 HOLLAND COMMUNITY HOSPITAL 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 HH SERVICES - BATES ET AL LLC 602 MICHIGAN AVENUE HOLLAND MI 49423 260396104 UROLOGY PHYSICIAN OFFICE MI -866463 1120402 HOLLAND COMMUNITY HOSPITAL LAKESHORE HEALTH PARTNERS - FM LLC 602 MICHIGAN AVENUE HOLLAND MI 49423 272647439 FAMILY MEDICINE PHYSICIAN OFFICE MI -509745 173398 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 11A, I HOLLAND COMMUNITY HOSPITAL 1 HOLLAND COMMUNITY HOSPITAL AUXILIARY 602 MICHIGAN AVENUE HOLLAND MI 49423 382139025 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 11C, III-FI N/A 0 LAKESHORE HEALTH PARTNERS 602 MICHIGAN AVENUE HOLLAND MI 49423 263518481 ENDOSCOPY SERVICES MI 501(C)(3) LINE 3 HOLLAND COMMUNITY HOSPITAL 1 HH SERVICES - SOUTH WASHINGTON 602 MICHIGAN AVENUE HOLLAND MI 49423 270795175 MEDICAL CLINIC MI HOLLAND COMMUNITY HOSPITAL C 892356 1.00000 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 LAKESHORE HEALTH PARTNERS M 1553386 CONTRACTS AND TIME TRACKING HOLLAND COMMUNITY HOSPITAL AUXILIARY C 78485 ACTUAL AMOUNTS PAID HH SERVICES - SOUTH WASHINGTON B 901943 ACTUAL AMOUNTS PAID