2013-02-15T15:09:11-06:00 2012-03-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2011-04-01 382800065 HOLLAND COMMUNITY HOSPITAL HOLL 6163925141 602 MICHIGAN AVENUE HOLLAND MI 49423 DALE SOWDERS 6163925141 2013-02-15 1 CAROL LALONDE CPA P00181637 2695674500 2011 2016-03-07 17:11:31Z HOLLAND HOSPITAL DALE SOWDERS 602 MICHIGAN AVENUE HOLLAND MI 49423 202197710 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 12 2205 500 1760166 336851 878365 884900 175390965 181622226 -1249481 8486656 8221281 10308678 183241130 201302460 770803 783048 0 0 91784339 98382164 0 0 0 80341780 85272690 172896922 184437902 10344208 16864558 355240131 363026744 90524801 88435689 264715330 274591055 X TO CONTINUOUSLY IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE IN THE SPIRIT OF HOPE, RESPECT, COMPASSION AND DIGNITY. 0 0 152297005 783048 181622226 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' SEVEN YEARS AND COUNTINGFOR SEVEN YEARS IN A ROW, HOLLAND HOSPITAL HAS BEEN SELECTED AS ONE OF THE NATION'S 100 TOP HOSPITALS. THOMSON REUTERS ANNUALLY CONDUCTS AN INDEPENDENT REVIEW OF NEARLY 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 2012.TOP 4 PERCENT FOR 'BEST PRACTICES'"PROCESS OF CARE MEASURES" (OR "CORE MEASURES") 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 PLACE HOLLAND HOSPITAL AT THE 96TH PERCENTILE - MEANING WE'RE IN THE TOP 4 PERCENT OF HOSPITALS NATIONWIDE IN MEETING PROCESS OF CARE MEASURES. WE ARE ALSO AMONG THE FIRST HOSPITALS TO LEAD THE WAY IN PATIENT SAFETY THROUGH 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. MANY LAKESHORE RESIDENTS ARE BENEFITING FROM OUR RECENT FACILITY IMPROVEMENTS AS WELL AS SUCH CUTTING-EDGE TECHNOLOGIES AS DAVINCI ROBOT-ASSISTED SURGERY, DIGITAL MAMMOGRAPHY AND INTERVENTIONAL RADIOLOGY. DURING FISCAL YEAR 2012, HOLLAND HOSPITAL'S 320-MEMBER MEDICAL STAFF, 1,900 EMPLOYEES AND 500 VOLUNTEERS SERVED THE COMMUNITY BY PROVIDING:PATIENT DAYS 30,100DISCHARGES 7,300BIRTHS 1,700SURGERIES 17,300OUTPATIENT VISITS 395,000EMERGENCY ROOM VISITS 42,000URGENT CARE VISITS 33,200HOME HEALTH VISITS 42,300LAB TESTS 645,000RADIOLOGY PROCEDURES 102,300BEDS 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 25,000 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 OFFERS A WEALTH OF EDUCATIONAL CLASSES AND PRESENTATIONS FOR CHILDREN, ADULTS AND SENIORS. IN FY 2012, THE CENTER OFFERED 700 CLASSES AND EVENTS WITH APPROXIMATELY 13,577 PARTICIPANTS. RECENTLY, IN RESPONSE TO TODAY'S EMPHASIS ON IMPROVING WORKER HEALTH TO BOOST EFFECTIVENESS AND REDUCE HEALTH CARE COSTS, THE CENTER JOINED FORCES WITH MANY AREA BUSINESSES TO TAKE ITS WORKSITE WELLNESS PROGRAM DIRECTLY TO EMPLOYEES.SERVING THE UNDERSERVED WITH THE FACE OF HOLLAND PROJECTIN OTTAWA COUNTY, THE CHALLENGING ECONOMIC TIMES HAVE LEFT OVER 13% OF ADULTS AND CHILDREN WITH NO OR INSUFFICIENT HEALTH INSURANCE TO COVER THEIR FAMILY'S MEDICAL EXPENSES. IN RESPONSE, HOLLAND HOSPITAL FUND DEVELOPMENT INTENSIFIED ITS EFFORTS TO "SERVE THE UNDERSERVED" BY FOCUSING FINANCIAL SUPPORT ON 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 $50,000 PER SCHOOL YEARLY SERVING OVER 8,000 AREA STUDENTS. FUND DEVELOPMENT CONTRIBUTED $790,000 TO THE OPERATION OF THE HOLLAND COMMUNITY HEALTH CENTER PROVIDING PRIMARY HEALTH CARE TO OVER 4,900 COMMUNITY MEMBERS ANNUALLY. 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 (BY ABOUT 800 PATIENTS PER YEAR) FOR SERVICES OF THE HOLLAND COMMUNITY HEALTH CENTER, WHICH PROVIDES HEALTH CARE FOR PEOPLE WHO ARE UNDER INSURED AND UNINSURED. IN 2011, THE COMMUNITY HEALTH CENTER SERVED CLOSE TO 5,000 PATIENTS, NEARLY HALF OF THEM CHILDREN, WITH 10,724 VISITS. MOST OF THESE VISITS FOCUSED ON WOMEN'S AND CHILDREN'S HEALTH CARE NEEDS, DIABETES MANAGEMENT AND ELDER CARE. EACH YEAR THE COMMUNITY HEALTH CENTER 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 2011-2012 THEY SERVICED 8,000 STUDENTS, 36,021 HEALTH OFFICE VISITS, ADMINISTERED 12,402 MEDICATIONS AND REFERRED 391 STUDENTS FOR MEDICAL, DENTAL, VISION, OR SOCIAL CONCERNS. THEY PROVIDED 200 EDUCATIONAL SESSIONS.UNCOMPENSATED MEDICAL COSTS OUR COMMITMENT TO CARING FOR MEMBERS OF OUR COMMUNITY WHO ARE UNINSURED OR UNDERINSURED CONTINUES TO BE ONE OF THE BIGGEST FINANCIAL CHALLENGES FOR THE HOSPITAL. IN FY 2012, HOLLAND HOSPITAL PROVIDED UNREIMBURSED CARE TO OUR PATIENTS AT A COST OF $35.2 MILLION, A 9 PERCENT INCREASE OVER THE PREVIOUS YEAR. BAD DEBT ALONE STAYED CONSISTENT DURING 2012 AND 2011, ROSE OVER 30 PERCENT IN 2010 AND 50 PERCENT IN 2009 - A REFLECTION OF THE CONTINUED ECONOMIC ENVIRONMENT AND GROWTH IN UNEMPLOYMENT.HOLLAND HOSPITAL TAKES ITS FIDUCIARY RESPONSIBILITY SERIOUSLY, AND WORKS VERY HARD TO BALANCE THE CURRENT HEALTH CARE NEEDS OF THE COMMUNITY WITH OUR RESPONSIBILITY TO REMAIN FINANCIALLY VIABLE FOR GENERATIONS TO COME. COMMUNITY OUTREACH IS AN IMPORTANT PART OF OUR MISSION AND IT TAKES GREAT EFFORT TO FREE UP RESOURCES TO BE ABLE TO INVEST IN THESE PROGRAMS AND COVER INCREASING COSTS FROM UNCOMPENSATED CARE.2012 COMMUNITY BENEFIT SUMMARY - $35.2 MILLION TOTAL COMMUNITY BENEFITUNPAID COST OF MEDICAID $9,100,000UNPAID COST OF MEDICARE $8,400,000CHARITY CARE $1,800,000 BAD DEBT $10,200,000OTHER COMMUNITY BENEFITS (NOTE A) $5,700,000NOTE A - OTHER COMMUNITY BENEFITS INCLUDE: COMMUNITY EDUCATION & OUTREACH PROGRAMS CASH, IN-KIND DONATIONS & CONTRIBUTIONS HOLLAND COMMUNITY HEALTH CENTER HEALTH PROFESSIONAL EDUCATION & RESEARCH 152297005 1 1 0 0 0 1 0 0 0 0 1 1 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 0 0 0 0 0 1 1 1 1 0 0 1 161 0 1 2205 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 X 14 12 1 0 0 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 1 1 MI X TERRY STEELE 6163925141 602 MICHIGAN AVE HOLLAND MI 49423 DALE M SOWDERS 40.00 X X 674822 0 145058 LESLIE BROWN 1.00 X 0 0 0 BARBARA DEPREE MD 30.00 X 0 0 0 CHUCK DEPREE 1.00 X 0 0 0 BECCA DERNBERGER 1.00 X 0 0 0 WILLIAM FRAUENHEIM MD 1.00 X X 0 0 0 ROGER GAMACHE 1.00 X 0 0 0 DON KOMEJAN 1.00 X X 0 0 0 KRIS MANOS 1.00 X 0 0 0 GREG MAYBURY 1.00 X X 0 0 0 DAWN GARCIA WARD 1.00 X 0 0 0 JANE CLARK 1.00 X 0 0 0 JAMES STROOP 1.00 X 0 0 0 MARK STID 5.00 X X 0 0 0 TERRY L STEELE 40.00 X 333293 0 62134 CHARLES D KOHLRUSS 40.00 X 251358 0 48319 PATTI VANDORT 40.00 X 249705 0 47618 MARK L PAWLAK 40.00 X 234018 0 45831 WILLIAM L VANDERVLIET MD 20.00 X 0 0 0 ROBERT J BATES MD 40.00 X 586327 0 29991 MICHAEL A TRAVER MD 40.00 X 498306 0 29097 CARL H WIERKS MD 40.00 X 561314 0 30844 JOHN K LUDLOW MD 40.00 X 470716 0 30489 DERICK JOHNSON 40.00 X 558344 0 19671 4418203 0 489052 82 0 1 0 ARAMARK CORPORATION 12483 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 CONTRACTED SERVICES 3554032 ELZINGA AND VOLKERS INC 86 E 6TH ST HOLLAND MI 49423 CONSTRUCTION 3240744 WARNER NORCROSS AND JUDD 900 FIFTH THIRD CTR 111 LYON ST NW GRAND RAPIDS MI 49503 LEGAL 843653 ECG MANAGEMENT CONSULTANTS 1111 3RD AVE STE 2700 SEATTLE WA 98101 CONSULTING 842810 LAKESHORE CAMPUS LLC 161 OTTAWA AVENUE NW STE 104 GRAND RAPIDS MI 49503 LANDLORD - RENT 833034 47 125304 759596 884900 NET PATIENT REVENUE 621110 181622226 181622226 181622226 9335736 9335736 282670 0 282670 282670 282670 14750 863830 -849080 -849080 -849080 9675 125304 9675 0 19570 21745 -2175 -2175 MISCELLANEOUS REVENUE 900099 5439797 5439797 FOUNDATION INCOME 990009 1891284 1891284 PHO/LAB ACTIVITY 621500 1760166 1760166 936936 936936 10028183 201302460 181622226 1760166 17035168 783048 783048 2124368 2124368 75198764 63948775 11249989 1351054 1270390 80664 14240465 11591876 2648589 5467513 4624023 843490 911102 911102 113220 17305 95915 487037 487037 1114828 1114828 1414865 61603 1353262 1059165 604864 454301 2573627 2573627 2853634 2837316 16318 328591 307197 21394 387246 238088 149158 2011534 2011534 11511567 9818744 1692823 343623 85767 257856 SUPPLIES 28741394 28592479 148915 CONTRACT LABOR 13037041 7552282 5484759 PROVISION FOR BAD DEBTS 10273359 10273359 UTILITIES 2600064 2122784 477280 5510793 4440743 1070050 184437902 152297005 32140897 0 16963554 14399755 7398459 5691754 27719373 33314016 3404455 3489031 1925640 1661053 195651619 81259553 117034740 114392066 158892019 165974730 19938178 19786344 1963713 4317995 355240131 363026744 14250975 11766598 66245245 64199089 10028581 12470002 90524801 88435689 X 264019339 273898423 295991 292632 400000 400000 264715330 274591055 355240131 363026744 X 16864558 -6988833 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 33 438922 443802 292632 1 1 6436125 6436125 92168608 25518231 66650377 3007685 806576 2201109 86601998 54934746 31667252 7437203 7437203 114392066 INVESTMENTS IN AFFILIATED ENTITIES 2848152 F INVESTMENT IN JOINT VENTURE 16938192 F 19786344 PROFESSIONAL LIABILITY INSURANCE 2576890 COST REPORT SETTLEMENT PAYABLE 1467924 OTHER LONG-TERM LIABILITIES 684262 INTEREST PAYABLE 415769 LOSSES IN EXCESS OF INVESTMENT IN AFFILIATES 7325157 12470002 201302460 184437902 16864558 -4661380 -2327453 -6988833 9875725 199254462 -4661380 14819001 10157621 189096841 487037 11718582 12205619 201302460 189378737 17146454 17146454 172232283 487037 11718582 12205619 184437902 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 8 - OTHER ADJUSTMENTS: UNREALIZED LOSS IN AFFILIATES -2,327,453. PART XII, LINE 2D - OTHER ADJUSTMENTS: ELIMINATE INCOME FROM INVESTMENT IN JOINT VENTURE 14,787,581. FUNDRAISING EXPENSE 31,420. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFY BAD DEBT NETTED AGAINST REVENUE 10,273,359. RECLASSIFY FOUNDATION EXPENSES 1,445,223. PART XIII, LINE 2D - OTHER ADJUSTMENTS: ELIMINATE EXPENSE FROM INVESTMENT IN JOINT VENTURE 17,115,034. FUNDRAISING EXPENSE 31,420. PART XIII, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFY FOUNDATION EXPENSES 1,445,223. RECLASSIFY BAD DEBT NETTED AGAINST REVENUE 10,273,359. CULINARY CABARET 134979 125304 9675 9675 134979 125304 9675 9675 9675 0 19570 15025 6720 1 0.95000 19570 15025 6720 21745 -2175 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 1 X 1 X 1 1 1 0 1 1 1968490 1968490 0.01130 23032437 16870725 6161712 0.03540 25000927 16870725 8130202 0.04670 241842 96256 145586 0.00080 185545 185545 0.00110 335981 426064 -90083 0.00000 3745235 3745235 0.02150 4508603 522320 3986283 0.02340 29509530 17393045 12116485 0.07010 3 8552 8552 0.00000 1 797028 253955 543073 0.00310 5 383772 383772 0.00220 9 1189352 253955 935397 0.00530 0 10276799 3881302 22243070 27132227 -4889157 X 1 1 1 1 HOLLAND HOSPITAL

602 MICHIGAN AVE HOLLAND MI 49423

X X X X HOLLAND COMMUNITY HOSPITAL 1 1 X X X X X X X X X 11 1 1 1 X X X X X X X X X 1 1 1 200.000000000000 1 300.000000000000 1 X X X X 1 1 X X X 1 0 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 HH SERVICES - HOLLAND PROFESSIONAL SERVI

602 MICHIGAN AVE HOLLAND MI 49423

PHYSICIAN OFFICE HOLLAND HOSPITAL PHYSICIAN CLINIC

602 MICHIGAN AVE HOLLAND MI 49423

NOT ACTIVE 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 $ 10276799. PART II: THE HEALTH OF OUR COMMUNITY IS SIMPLY A REFLECTION OF THE HEALTH OF EACH INDIVIDUAL WITHIN OUR COMMUNITY. TO ACHIEVE THE HIGHEST LEVEL OF PERSONAL HEALTH, INDIVIDUALS MUST HAVE ACCESS TO THE APPROPRIATE TOOLS, BEST HEALTH INFORMATION AND LOCAL MEDICAL EXPERTISE. OUR OUTREACH TO THE COMMUNITY PROVIDES ACCESS TO THESE VITAL COMPONENTS. FROM HEALTH SCREENINGS AND COMMUNITY PRESENTATIONS TO CHARITABLE CARE FOR THE UNINSURED/UNDERINSURED, OUR GOAL IS TO HELP EACH INDIVIDUAL REACH HIS/HER MAXIMUM PERSONAL HEALTH POTENTIAL AND, IN THE PROCESS, CREATE AN OVERALL HEALTHIER COMMUNITY. PART III, LINE 4: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. TO DETERMINE BAD DEBTS AT COST, THE COST TO CHARGE RATIOS FROM THE 3/31/11 MEDICARE COST REPORT FOR IP, OP AND PSYCH WERE APPLIED TO EACH OF THE RESPECTABLE BAD DEBT TOTALS FROM WORKSHEET E FROM THE COST REPORT AND AN AVERAGE COST TO CHARGE RATIO DERIVED. THIS RATIO THEN WAS APPLIED TO THE TOTAL BAD DEBT (NOT INCLUDING CHARITY CARE) EXPENSE FROM THE TRIAL BALANCE TO COME UP WITH AN ESTIMATION OF BAD DEBTS AT COST.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. THE HOSPITAL ALSO MAINTAINS RECORDS OF THE COST OF SERVICES PROVIDED TO MEDICARE AND MEDICAID RECIPIENTS NOT COVERED BY GOVERNMENTAL REIMBURSEMENT AS WELL AS THE COST OF OTHER PROGRAMS DESIGNED TO PROMOTE COMMUNITY HEALTH NOT COVERED BY INSURANCE. TRADITIONAL CHARITY CARE COVERS SERVICES PROVIDED TO PEOPLE WHO CANNOT AFFORD TO PAY. CHARITY CARE IS DETERMINED BASED ON ESTABLISHED POLICIES, USING PATIENT INCOME AND ASSETS TO DETERMINE PAYMENT ABILITYTHERE 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 GET WRITTEN OFF TO BAD DEBTS INSTEAD. THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS APPROXIMATELY $727,000. 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 AND THEN APPLYING THE COSTING METHODOLOGY DISCUSSED ABOVE. 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 180 DAYS FROM DISCHARGE. AT THIS TIME THE ACCOUNT IS ELIGIBLE AND WILL BE REVIEWED TO BE SENT TO A COLLECTION AGENCY. 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 SUBGOUPS WITHIN THE POPULATION. IDENTIFIED AREAS FOR OPPORTUNITIES INCLUDED ACCESS TO HEALTHCARE FOR THOSE WITH PUBLIC HEALTH INSURANCE AND IMPROVED CARE FOR THOSE WITH CHRONIC DESEASE 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 13G: 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 ASSISSMENT 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. WE ALSO SERVE RESIDENTS IN OUR EXTENDED SERVICE AREA (ESA) WHICH TOGETHER WITH THE PSA COMPRISES A TOTAL POPULATION OF NEARLY 250,000. OUR PSA POPULATION COMPRISES ALL AGE GROUPS, SKEWING OLDER IN THE CITY OF HOLLAND AND YOUNGER IN THE GROWING AREAS OUTSIDE THE CITY. THE AREA ALSO ENCOMPASSES A WIDE RANGE OF RACIAL AND ETHNIC BACKGROUNDS. THE CITY OF HOLLAND DIFFERS SUBSTANTIALLY FROM THE SURROUNDING COUNTIES IN RACIAL/ETHNIC COMPOSITION. OVER 22% OF HOLLAND CITY RESIDENTS ARE HISPANIC/LATINO, CONTRASTED WITH ABOUT 6-8% IN OTTAWA AND ALLEGAN COUNTIES. HOLLAND ALSO SHOWS A GREATER PERCENTAGE OF ASIAN RESIDENTS (3.6%) THAN OTHER AREAS OF THE STATE AND PROPORTIONALLY MORE BLACK/AFRICAN AMERICANS (2.5%) LIVE IN HOLLAND THAN IN ADJACENT COUNTIES. PART VI, LINE 5: HOLLAND HOSPITAL, ALONG WITH OTHER MICHIGAN HOSPITALS, PROVIDES DIRECT PATIENT CARE TO THOSE WHO CANNOT AFFORD IT. THOUGH THE AMOUNT OF CHARITABLE CARE AND BAD DEBT HAS RISEN STEEPLY IN THE PAST FEW YEARS DUE PRIMARILY TO A STRUGGLING ECONOMY, HOLLAND HOSPITAL HAS REMAINED TRUE TO ITS MISSION TO CONTINUALLY IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE IN THE SPIRIT OF HOPE, COMPASSION, RESPECT AND DIGNITY. AROUND-THE-CLOCK MEDICAL CARE IS AVAILABLE TO ALL IN NEED. ADDITIONAL URGENT CARE SERVICES HAVE BEEN ADDED AND COMMUNITY HEALTH OUTREACH EFFORTS HAVE BEEN INCREASED. ALL OF THIS HAS BEEN DONE TO ENHANCE THE WELL BEING OF THE COMMUNITY, WITH LITTLE OR NO COST TO THOSE WE SERVE. REPORTS FILED WITH STATES PART VI, LINE 7 MI 1 COMMUNITY HEALTH CENTER 602 MICHIGAN AVENUE HOLLAND MI 49423 200602574 501(C)(3) 754508 N/A N/A OPERATIONAL CASH FLOW TO BREAK-EVEN LAKESHORE ADVANTAGE CORP 201 W WASHINGTON ZEELAND MI 49464 061708014 501(C)(3) 10000 N/A N/A FINANCIAL CONTRIBUTIONS 2012 MHA HEALTH FOUNDATION 6215 WEST ST JOSEPH HWY LANSING MI 48917 386091188 501(C)(3) 5790 N/A N/A FINANCIAL CONTRIBUTIONS 2012 3 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE HOSPITAL RECIEVES THEIR MONTHLY INTERNAL FINANCIALS AND A COPY OF THE AUDITED STATEMENTS ANNUALLY. X 1 1 X X X 0 0 0 0 0 0 0 0 0 DALE M SOWDERS 399309 0 133942 0 141571 0 84997 0 60061 0 819880 0 0 0 TERRY L STEELE 228742 0 61383 0 43168 0 22256 0 39878 0 395427 0 0 0 CHARLES D KOHLRUSS 181866 0 48803 0 20689 0 19700 0 28619 0 299677 0 0 0 PATTI VANDORT 176110 0 47259 0 26336 0 22100 0 25518 0 297323 0 0 0 MARK L PAWLAK 174939 0 46944 0 12135 0 21444 0 24387 0 279849 0 0 0 ROBERT J BATES MD 575016 0 0 0 11311 0 0 0 29991 0 616318 0 0 0 MICHAEL A TRAVER MD 462580 0 0 0 35726 0 0 0 29097 0 527403 0 0 0 CARL H WIERKS MD 523899 0 0 0 37415 0 0 0 30844 0 592158 0 0 0 JOHN K LUDLOW MD 388003 0 0 0 82713 0 0 0 30489 0 501205 0 0 0 DERICK JOHNSON 523899 0 0 0 34445 0 0 0 19671 0 578015 0 0 0 PART I, LINE 1A THE CEO, DALE SOWDERS, RECEIVES A COUNTRY CLUB MEMBERSHIP. MICHIGAN STATE HOSPITAL FINANCE AUTHORTIY 382889417 59465E7A5 2004-08-01 21744478 CONSTRUCTION OF NEW BUILDING 0 0 0 MICHIGAN STATE HOSPITAL FINANCE AUTHORTIY 382889417 59465E7A5 2004-08-01 22000000 CONSTRUCTION OF NEW BUILDING 0 0 0 MICHIGAN STATE HOSPITAL FINANCE AUTHORITY 800596186 NONEAVAIL 2010-08-11 23500000 CONSTRUCTION OF NEW BUILDING 0 0 0 22000000 1722767 250000 22000000 2008 0 0 1 1 22000000 225000 22000000 2008 0 0 1 1 23500000 14123420 139505 9376581 2011 1 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 BARBARA DEPREE, A BOARD MEMBER AND EMPLOYEE, IS CHUCK DEPREE'S SISTER-IN-LAW. CHUCK DEPREE IS ALSO A BOARD MEMBER. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE 990 IS PROVIDED TO CFO PRIOR TO CEO SIGNING. 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 ABSITINENCE 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 EACH 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 WAS UNDERTAKEN WAS FISCAL YEAR 2012. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -4,661,380. UNREALIZED LOSS IN AFFILIATES -2,327,453. TOTAL TO FORM 990, PART XI, LINE 5: -6,988,833. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM PRIOR YEAR. HH SERVICES - BATES ET AL LLC 602 MICHIGAN AVENUE HOLLAND MI 49423 260396104 UROLOGY PHYSICIAN OFFICE MI -800864 2822996 HOLLAND COMMUNITY HOSPITAL HH SERVICES - HOLLAND PROFESSIONAL SERVICES LLC 602 MICHIGAN AVENUE HOLLAND MI 49423 262764668 WOMENS MIDLIFE PHYSICIAN OFFICE MI 267456 HOLLAND COMMUNITY HOSPITAL HH SERVICES ORT LLC 602 MICHIGAN AVENUE HOLLAND MI 49423 264606759 ORTHOPEDIC PHYSICIAN OFFICE MI -1295761 199450 HOLLAND COMMUNITY HOSPITAL HOLLAND HOSPITAL PHYSICIAN CLINIC 602 MICHIGAN AVENUE HOLLAND MI 49423 263479537 NOT ACTIVE MI 0 0 HOLLAND COMMUNITY HOSPITAL LAKESHORE HEALTH PARTNERS - FM LLC 602 MICHIGAN AVENUE HOLLAND MI 49423 272647439 FAMILY MEDICINE PHYSICIAN OFFICE MI -815211 146299 HOLLAND COMMUNITY HOSPITAL HOLLAND SC LLC DBA SURGERY CENTER OF WEST MICHIGAN 602 MICHIGAN AVENUE HOLLAND MI 49423 203200415 OUTPATIENT SURGERY CENTER 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 11A, I HOLLAND COMMUNITY HOSPITAL 1 HOLLAND COMMUNITY HOSPITAL AUXILIARY 602 MICHIGAN AVENUE HOLLAND MI 49423 382139025 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 11A, I HOLLAND COMMUNITY HOSPITAL 1 LAKESHORE HEALTH PARTNERS 602 MICHIGAN AVENUE HOLLAND MI 49423 263518481 ENDOSCOPY SERVICES MI HOLLAND COMMUNITY HOSPITAL C -2076500 1878458 1.00000 HH SERVICES - SOUTH WASHINGTON 602 MICHIGAN AVENUE HOLLAND MI 49423 270795175 MEDICAL CLINIC MI HOLLAND COMMUNITY HOSPITAL C -250953 986386 1.00000 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 0 0 0 LAKESHORE HEALTH PARTNERS L 2130400 CONTRACTS AND TIME TRACKING HOLLAND COMMUNITY HEALTH CENTER I 58680 RENTAL AGREEMENT