Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
Spectrum Health System Group Return
 
Employer identification number

61-1740292
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
(1) DAVID OTTENBAKER MD
  		DIRECTOR, SHMG TUITION ASSISTANCE   X 36,000 19,846   No   No Yes  
(2) JASON SLAIKEU
  		OFFICER, SHMG TUITION ASSISTANCE   X 27,000 27,845   No   No Yes  
(3) LESLIE JURECKO
  		DIRECTOR, SHMG TUITION ASSISTANCE   X 13,500 14,428   No   No Yes  
(4) BRETT ZIMMERMAN
  		DIRECTOR, SHMG TUITION ASSISTANCE   X 13,500 14,428   No   No Yes  
Total ...............Small Bullet $ 76,547
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2015
Page 2
Schedule L (Form 990 or 990-EZ) 2015
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) DR MARGARET GUSTAFSON
  		BUSINESS 375,841 SHL-See Sch L, Part V   No
(2) TIMOTHY O'CALLAGHAN
  		FAMILY 262,838 SHMG-SEE SCH L, PART V   No
(3) AMWAY HOTEL CORPORATION
  		BUSINESS 239,988 SHF-SEE SCH L, PART V   No
(4) SUSAN PHILLIPS
  		FAMILY 132,242 SHMG-SEE SCH L, PART V   No
(5) MARLENE HOLSTINE
  		FAMILY 109,099 SHZ-SEE SCH L, PART V   No
(6) JENNIFER VIPPERMAN
  		FAMILY 44,576 SHL-SEE SCH L, PART V   No
(7) KELLY JOHNSON
  		FAMILY 39,398 SHU-SEE SCH L, PART V   No
(8) LORI BRUINS
  		FAMILY 32,858 SHZ-SEE SCH L, PART V   No
(9) JENNIFER MCGRAW
  		FAMILY 31,214 SHMG-SEE SCH L, PART V   No
(10) THOMAS KNOERL II
  		FAMILY 25,121 SHRC-SEE SCH L, PART V   No
(11) JACOB SELLA
  		FAMILY 12,136 SHGM-SEE SCH L, PART V   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L, Part V SHZ FAMILY RELATIONSHIPS WITH INTERESTED PERSONS MR. STAN KONYNENBELT, A MEMBER OF SHZ'S BOARD OF DIRECTORS, HAS A SIBLING THAT IS EMPLOYED BY SHZ. (PART IV, LINE 5) MR. HENRY VEENSTRA, AN OFFICER AND MEMBER OF SHZ'S BOARD OF DIRECTORS, HAS A DAUGHTER THAT IS EMPLOYED BY SHZ. (PART IV, LINE 8)
Schedule L, Part V SHU FAMILY RELATIONSHIPS WITH INTERESTED PERSONS MR. RYAN JOHNSON, AN OFFICER OF SHU, HAS A SPOUSE THAT IS EMPLOYED BY SHU. (PART IV, LINE 7)
Schedule L, Part V SHGM FAMILY RELATIONSHIPS WITH INTERESTED PERSONS MR. JOHN SELLA, A FORMER OFFICER OF SHGM, HAS A SON THAT IS EMPLOYED BY SHGM. (PART IV, LINE 11)
Schedule L, Part V SHF BUSINESS RELATIONSHIPS WITH INTERESTED PERSONS MS. MARIA DEVOS, A MEMBER OF SHF'S BOARD OF DIRECTORS, HAS AN INDIRECT OWNERSHIP INTEREST IN A TAXABLE ENTITY THAT HAS A BUSINESS RELATIONSHIP WITH SHF. (PART IV, LINE 3)
Schedule L, Part V SHMG FAMILY RELATIONSHIPS WITH INTERESTED PERSONS MS. MARY O'CALLAGHAN, A MEMBER OF THE SHMG BOARD OF DIRECTORS, HAS A SPOUSE THAT IS EMPLOYED BY SHMG. (PART IV, LINE 2) MR. BRIAN PHILLIPS, A MEMBER OF THE SHMG BOARD OF DIRECTORS, HAS A SPOUSE THAT IS EMPLOYED BY SHMG. (PART IV, LINE 4) MR. THOMAS MCGRAW, AN OFFICER OF SHMG, HAS A DAUGHTER THAT IS EMPLOYED BY SHMG. (PART IV, LINE 9)
Schedule L, Part V SHL BUSINESS AND FAMILY RELATIONSHIPS WITH INTERESTED PERSONS DR. MARGARET GUSTAFSON, A MEMBER OF SHL'S BOARD OF DIRECTORS, HAS A BUSINESS RELATIONSHIP WITH SHL INVOLVING SALE OF BUSINESS ASSETS. (PART IV, LINE 1) MR. MARK VIPPERMAN, AN OFFICER AND MEMBER OF SHL'S BOARD OF DIRECTORS, HAS A DAUGHTER THAT IS EMPLOYED BY SHL. (PART IV, LINE 6)
Schedule L, Part V SHRC FAMILY RELATIONSHIPS WITH INTERESTED PERSONS MR. THOMAS KNOERL, AN OFFICER OF SHRC, HAS A SON THAT IS EMPLOYED BY SHRC. (PART IV, LINE 10)
Schedule L (Form 990 or 990-EZ) 2015


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Software Version: 2015v3.0