SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2016
Open to Public Inspection
Name of the organization
NORTH OTTAWA COMMUNITY HOSPITAL
 
Employer identification number

38-3330803
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    100,335   100,335 0.140 %
b Medicaid (from Worksheet 3, column a) . . . . .     7,712,982 1,756,327 5,956,655 8.030 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     7,813,317 1,756,327 6,056,990 8.170 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     118,800 3,376 115,424 0.160 %
f Health professions education (from Worksheet 5) . . .     112,862   112,862 0.150 %
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     54,719   54,719 0.070 %
j Total. Other Benefits . .     286,381 3,376 283,005 0.380 %
k Total. Add lines 7d and 7j .     8,099,698 1,759,703 6,339,995 8.550 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2016
Schedule H (Form 990) 2016
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members
    24,525   24,525 0.030 %
6 Coalition building     28,630   28,630 0.040 %
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     53,155   53,155 0.070 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
2,702,748
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
8,109,696
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
11,837,173
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-3,727,477
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
11 LAKESHORE HEALTHCARE LLC
 
REAL ESTATE 50.000 %   50.000 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2016
Schedule H (Form 990) 2016
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 NORTH OTTAWA COMMUNITY HOSPITAL
1309 SHELDON ROAD
GRAND HAVEN,MI49417
HTTP://WWW.NOCH.ORG/
700010
X X         X      
Schedule H (Form 990) 2016
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Schedule H (Form 990) 2016
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Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
NORTH OTTAWA COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 15
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTP://WWW.NOCH.ORG/UPLOADEDFILES/ABOUT_US/NOCHS%20CHNA%202016%20ACTION%20P
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2016
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Schedule H (Form 990) 2016
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
NORTH OTTAWA COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
HTTP://WWW.NOCH.ORG/UPLOADEDFILES/PATIENTS_AND_VISITORS/DOC001.PDF
b
HTTP://WWW.NOCH.ORG/UPLOADEDFILES/PATIENTS_AND_VISITORS/DOC002.PDF
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2016
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Schedule H (Form 990) 2016
Page 6
Part VFacility Information (continued)

Billing and Collections
NORTH OTTAWA COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2016
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Schedule H (Form 990) 2016
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
NORTH OTTAWA COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23 Yes  
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24 Yes  
If "Yes," explain in Section C.
Schedule H (Form 990) 2016
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Schedule H (Form 990) 2016
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
NORTH OTTAWA COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: THE 2015 OTTAWA COUNTY CHNA CONSISTED OF SURVEY DATA FROM ADULT RESIDENTS (INCLUDING UNDER-SERVED POPULATIONS) AND KEY INFORMANTS; IN ADDITION TO INTERVIEWS WITH KEY STAKEHOLDERS. A STEERING COMMITTEE PROVIDED GUIDANCE TO VIP RESEARCH AND EVALUATION WHEN DEVELOPING THE CHNA. MEMBERS OF THE STEERING COMMITTEE INCLUDE REPRESENTATIVES FROM: - GREATER OTTAWA COUNTY UNITED WAY - HOLLAND HOSPITAL - NORTH OTTAWA COMMUNITY HOSPITAL - OTTAWA COUNTY COMMUNITY MENTAL HEALTH - OTTAWA COUNTY DEPARTMENT OF PUBLIC HEALTH - SPECTRUM HEALTH ZEELAND COMMUNITY HOSPITALTHE ASSESSMENT PROVIDES INFORMATION ON THE COUNTY'S HEALTH STRENGTHS AND OPPORTUNITIES FOR IMPROVEMENT. THE RESEARCH INDICATES THE MOST PREVALENTHEALTH ISSUES ARE ACCESS TO HEALTH CARE, MENTAL HEALTH AND HEALTHY BEHAVIORS.
NORTH OTTAWA COMMUNITY HOSPITAL PART V, SECTION B, LINE 6A: HOLLAND HOSPITAL AND SPECTRUM HEALTH-ZEELAND COMMUNITY HOSPITAL
NORTH OTTAWA COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: GREATER OTTAWA COUNTY UNITED WAY, OTTAWA COUNTY COMMUNITY MENTAL HEALTH, AND OTTAWA COUNTY HEALTH DEPARTMENT.
NORTH OTTAWA COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: THE HEALTH NEEDS IDENTIFIED IN THE MOST RECENT CHNA WERE: ACCESS TO CARE, MENTAL HEALTH, AND HEALTHY BEHAVIORS. SINCE THESE NEEDS WERE IDENTIFIED NOCH TOOK SPECIFIC ACTIONS, WHICH INCLUDED THE FOLLOWING FOR EACH IDENTIFIED NEED. ACCESS TO CARESTRATEGY 1: IMPLEMENT COMMUNITY HEALTH WORKER MODEL- INTEGRATED EMERGENCY ROOM CAPITAL EXPANSION (OPEN FALL 2016)- PATHWAYS TO BETTER HEALTH PARTICIPATION (2016 IMPLEMENTATION)- OAISD SCHOOL NURSE INITIATIVE PARTICIPATION (2016 IMPLEMENTATION)- PCP OFFICE CARE COORDINATORS -INTEGRATE WITH ER- FOUR POINTES MASTERPIECE LIVING -CHW DIETARY EDUCATIONSTRATEGY 2: INCREASE CARE COORDINATION USE- INTEGRATED EMERGENCY ROOM CAPITAL EXPANSION (OPEN FALL 2016)- PATHWAYS TO BETTER HEALTH PARTICIPATION (2016 IMPLEMENTATION)- PCP OFFICE CARE COORDINATORS -INTEGRATE WITH ER- SPECIALTY CLINICS -ORTHOPEDICS, BARIATRICS- EMR INTEGRATION (NOCH, NOMG); GREAT LAKES HEALTH CONNECTSTRATEGY 3: INCREASE HEALTH LITERACY- INTEGRATED EMERGENCY ROOM CAPITAL EXPANSION (OPEN FALL 2016)- PATHWAYS TO BETTER HEALTH PARTICIPATION (2016 IMPLEMENTATION)- PCP OFFICE CARE COORDINATORS -INTEGRATE WITH ER- SPECIALTY CLINICS CARE COORDINATORS -ORTHOPEDICS, BARIATRICS- NOMG HEALTH TIPS -SOCIAL MEDIA STRATEGY, GHTV ON DEMAND/STREAMING CONTENT- DIABETES EDUCATION- PRESCRIPTION HEALTH GRANT --NOMG/FARMER'S MARKET - COMMUNITY-BASED INITIATIVES: - CHAMBER OF COMMERCE FARMER'S MARKET EDUCATION STATION - NORTH SHORE DUNES TRAIL SYSTEM EXPANSION - OAISD SCHOOL NURSE PROGRAM - FOUR POINTES -COMMUNITY GARDEN, MASTERPIECE LIVING DIETARY EDUCATION, RED APRON GROCERY DELIVERY MEAL PLANNINGMENTAL HEALTHSTRATEGY 1: PARTNER AND PROMOTE THE "BE NICE" CAMPAIGN- GHAPS MENTAL HEALTH TASK FORCE (INTEGRATED SCHOOL NURSE PROGRAM)- SLPS INTEGRATED SCHOOL NURSE PROGRAM- MENTAL ILLNESS TASK FORCE (NORTHERN OTTAWA COUNTY) -POSSIBLE COLLABORATIONSTRATEGY 2: TRAIN PRIMARY POINT OF CONTACT PEOPLE IN MH- INTEGRATED ER MODEL --PARTNER WITH TCM COUNSELING RE: INTERSECTION POINT STRATEGY (SEE SLIDE 17)- PCP OFFICE CARE COORDINATORS -INTEGRATE WITH ER- BARIATRIC CLINIC ASSESSMENTS- WOMEN'S HEALTH PPMD PROGRAM (REGIONAL BEST PRACTICE)STRATEGY 3: IMPROVE & PROMOTE EXISTING RESOURCESNOCHS SOCIAL WORK STAFF WILL BE CHARGED WITH KEEPING THE FOLLOWING RESOURCES UPDATED WITH NOCHS INFORMATION; AND ENSURING INTERNAL PERSONNEL HAS ACCESS TO THESE RESOURCES:- 2-1-1- THE KNOW BOOK- WHOLE FAMILY CONNECTIONHEALTHY BEHAVIORSSTRATEGY 1: SUPPORT THE OTTAWA COUNTY FOOD POLICY COUNCIL- ADDRESS THE OCFPC'S THREE MAIN THEMES OF ELIMINATING HUNGER, HEALTHY EATING BY ALL, AND LOCALLY SOURCED FOOD BY: - CHAMBER OF COMMERCE FARMER'S MARKET EDUCATION STATION - FOUR POINTES MASTERPIECE LIVING -CHW DIETARY EDUCATION - FOUR POINTES -COMMUNITY GARDEN, MASTERPIECE LIVING DIETARY EDUCATION, RED APRON GROCERY DELIVERY MEAL PLANNING - PRESCRIPTION FOR HEALTH GRANTSTRATEGY 2: SUPPORT SHAPE MICHIGAN'S EFFORTS- SHAPE MICHIGAN IS A UNITED WAY COMMUNITY PARTNERSHIP WITH COALITION MEMBERS FROM BUSINESSES, GOVERNMENT AGENCIES, NONPROFIT AND HEALTH ORGANIZATIONS AND EDUCATIONAL INSTITUTIONS. THE 5 COUNTIES (OTTAWA, KENT, MUSKEGON, NEWAYGO AND OCEANA) SET OUT TO CHANGE 5 METRICS WITHIN THE NEXT 5 YEARS.
NORTH OTTAWA COMMUNITY HOSPITAL PART V, SECTION B, LINE 13H: A PATIENT WHO IS IDENTIFIED AS "DECEASED WITH NO ESTATE" WILL QUALIFY FOR A 100% FINANCIAL ASSISTANCE DISCOUNT.
NORTH OTTAWA COMMUNITY HOSPITAL PART V, SECTION B, LINE 23: THE HOSPITAL MAKES EVERY REASONABLE EFFORT NECESSARY TO IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR CHARITY OR DISCOUNTED CARE BEFORE BILLING THEM. THE PATIENT IS RESPONSIBLE FOR PROVIDING INFORMATION THAT SUPPORTS THEIR ELIGIBILTIY FOR OUR FAP. IF THE PATIENT DOES NOT COMPLY WITH PROVIDING THIS INFORMATION IN A REASONABLE TIME FRAME, THE PATIENT WILL BE CHARGED AT GROSS CHARGES UNTIL THEY PROVIDE THE INFORMATION AND IT CAN BE ANALYZED FOR ELIGIBILTIY. AT SOME POINT THE ACCOUNT MAY GO TO A THIRD PARTY FOR COLLECTIONS. EVEN AT THIS POINT, THE COLLECTION AGENCY CAN IDENTIFY THE PATIENT AS BEING ELIGIBLITY FOR FINANCIAL ASSISTANCE, BUT ONLY IF THE PATIENT IS ABLE TO PROVIDE THE SUPPORTING DOCUMENTATION.
NORTH OTTAWA COMMUNITY HOSPITAL PART V, SECTION B, LINE 24: BEFORE MARCH 1, 2013, THE HOSPITAL APPLIED DISCOUNTS OF 25%-75% OF GROSS CHARGES FOR FAP ELIGIBLE PATIENTS. AFTER MARCH 1, 2013, THE HOSPITAL CALCULATED THE AVERAGE DISCOUNT FROM OUR LOWEST PAYING COMMERCIAL INSURANCE. THIS DISCOUNT WAS THEN APPLIED TO THE PATIENT'S ACCOUNT IF THEY MET FAP ELIGIBILTY CRITIERIA. A FURTHER DISCOUNT OF 25%-75% WAS GIVEN OFF THE ALREADY DISCOUNTED CHARGES BASED ON THEIR INCOME LEVEL. ESSENTIALLY THEN, THE DISCOUNT FOR ALL PATIENTS MEETING THE FAP CRITERIA WAS GREATER THAN THE DISCOUNT FOR THE LOWEST PAYING COMMERCIAL INSURANCE. IN ADDITION, THE HOSPITAL REVIEWED ACCOUNTS THAT WERE REWARDED DISCOUNTS FROM THE JULY 1, 2012-FEB 28,2013 TIME FRAME. THESE ACCOUNTS WERE FURTHER ADJUSTED TO THE LOWEST COMMERCIAL INSURANCE RATE. REFUNDS WERE GIVEN IF THERE WERE OVER-PAYMENTS.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2016
Page 9
Schedule H (Form 990) 2016
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?9
Name and address Type of Facility (describe)
1 1 - DUNEWOOD PHARMACY
1445 SHELDON
GRAND HAVEN,MI49417
RETAIL AND INFUSION PHARMACY
2 2 - IN HOME CARE NURSING
18525 WOODLAND RIDGE
SPRING LAKE,MI49456
HOME HEALTH AGENCY
3 3 - IN HOME CARE NURSING
18525 WOODLAND RIDGE
SPRING LAKE,MI49456
DURABLE MEDICAL EQUIPMENT RENTAL AND SALES
4 4 - WOMEN'S HEALTH
1445 SHELDON ROAD
GRAND HAVEN,MI49417
PHYSICIAN SERVICES
5 5 - DUNEWOOD INTERNAL MEDICINE
1310 WISCONSIN
GRAND HAVEN,MI49417
PHYSICIAN SERVICES
6 6 - DUNEWOOD FAMILY PRACTICE
1310 WISCONSIN
GRAND HAVEN,MI49417
PHYSICIAN SERVICES
7 7 - DR ROBERT DIXON
1310 WISCONSIN STE 200
GRAND HAVEN,MI49417
PHYSICIAN SERVICES
8 8 - NOCH CENTER FOR BARIATRICS
1445 SHELDON ROAD
GRAND HAVEN,MI49417
PHYSICIAN SERVICES
9 9 - SPORTS MEDICINE
1310 WISCONSIN
GRAND HAVEN,MI49417
PHYSICIAN SERVICES
10
Schedule H (Form 990) 2016
Page 10
Schedule H (Form 990) 2016
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART I, LINE 3C: FIRST WE DETERMINE ELIGIBILITY BASED ON INCOME UP TO 250% OF THE FPG. THEN WE CONSIDER ASSETS. THE INCOME LEVEL WRITE-OFF RATE IS ADJUSTED BY THE ASSET LEVEL WRITE-OFF RATE TO DETERMINE THE TOTAL WRITE OFF RATE. FOR EXAMPLE, FOR INCOME 150-200% OF POVERTY LEVEL, WE WRITE OFF 75%. THIS IS THEN ADJUSTED BY THE ASSET RATE. IF THE PATIENT HAS ASSETS >$35,000, THEN THE ADJUSTMENT PERCENT IS 0%. 0% ASSET RATE X 75% INCOME RATE = 0% WRITE-OFF. IF ASSETS ARE BETWEEN $20,000 - 35,000, THEN THE ADJUSTMENT FACTOR IS 75%, FOR EXAMPLE 75% INCOME RATE X 75% ASSET RATE = 56.25% WRITE-OFF. IF THE PATIENTS ASSETS TOTAL LESS THAN $20,000, THEN THE ASSET ADJUSTMENT RATE IS 100%.
PART I, LINE 7: A COST TO CHARGE RATIO WAS USED. THIS RATIO WAS DERIVED FROM INPUTS FROM THE MHA COMMUNITY BENEFIT TRACKER SOFTWARE, WHICH FOLLOWS WORKSHEET 2 OF THE IRS INSTRUCTIONS TO SCHEDULE H.
PART I, LN 7 COL(F): $2,702,748 OF BAD DEBT EXPENSE INCLUDED IN PART IX, LINE 25 WAS ELIMINATED WHEN CALCULATING THE ORGANIZATION'S PERCENTAGE OF NET COMMUNITY BENEFIT EXPENSE OF TOTAL EXPENSE.
PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL EMS DEPARTMENT IS PRESENT AT MANY COMMUNITY EVENTS AT NO CHARGE TO THE EVENT ORGANIZERS. THE EMS DEPARTMENT ATTENDS EVENTS SUCH AS LOCAL HIGH SCHOOL FOOTBALL GAMES, RUNNING EVENTS, PARADES, FIRE DEPARTMENT OPEN HOUSES, BEACH EVENTS, AND FESTIVALS. THEIR PRESENCE AT THESE EVENTS PROVIDES EDUCATION TO THE COMMUNITY, BUT MORE IMPORTANTLY AN IMMEDIATE INTERVENTION SHOULD A HEALTHCARE NEED ARISE.
PART III, LINE 4: FROM FINANCIAL STATEMENT FOOTNOTE 1 "PATIENT AND RESIDENT ACCOUNTS RECEIVABLE": PATIENT AND RESIDENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE SYSTEM 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 ABOUT 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 SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). 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 SYSTEM 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.
PART III, LINE 8: THE AMOUNTS INCLUDED IN PART III, LINES 5 AND 6 WERE GENERATED USING THE 2017 FILED MEDICARE COST REPORT. THIS RESULTED IN A SHORTFALL OF APPROXIMATELY $3,767,477. SINCE OVER 40% OF OUR PAYORS ARE EITHER MEDICARE FFS OR MEDICARE ADVANTAGE PLANS, THIS IS A SIGNIFICANT SHORTFALL FOR A COMMUNITY HOSPITAL OF OUR SIZE, THEREFORE, WE FEEL THIS AMOUNT IS CONSIDERED A COMMUNITY BENEFIT.
PART III, LINE 9B: THE HOSPITAL WORKS VERY DILIGENTLY TO DETERMINE IF A PATIENT QUALIFIES FOR CHARITY OR UNDER-INSURED DISCOUNTS. ULTIMATELY IT IS UP TO THE PATIENT TO PROVIDE THE NECESSARY PAPERWORK TO QUALIFY THEM FOR CHARITY CARE OR UNDERINSURED DISCOUNTS. IN THE EVENT THAT THE PATIENT DOES NOT RESPOND TO REQUESTS FOR INFORMATION, THEY WILL BE SENT TO AN OUTSIDE COLLECTION AGENCY. OFTEN TIMES THE COLLECTION AGENCY HAS SUCCESS IN OBTAINING THE NECESSARY PAPERWORK TO DETERIMINE IF THE PATIENT FALLS WITHIN OUR CHARITY CARE GUIDELINES. IF THE PATIENT IS COMPLIANT IN FILLING OUT THE PAPERWORK AND FOUND TO BE ELIGIBLE FOR CHARITY CARE, WE MOVE THEM FROM BAD DEBT STATUS TO ACCOUNTS RECEIVABLE, AND THEN EVENTUAL ADJUSTMENT OF THEIR BILL TO THE APPROPRIATE ADJUSTMENT CODE.
PART VI, LINE 2: NORTH OTTAWA COMMUNITY HOSPITAL HAS BEEN AN INTEGRAL PART OF THE OTTAWA COUNTY HEALTH ASSESSMENT COMMITTEE, WHICH IS LEAD BY THE OTTAWA COUNTY HEALTH DEPARTMENT. THE HOSPITAL MEETS FREQUENTLY WITH MUNICIPALITY REPRESENTATIVES TO EVALUATE HEALTH-RELATED SERVICES THAT CAN BE ENHANCED OR ADDED TO OUR FACILITY. WE CONDUCT SURVEYS, HOLD FOCUS GROUPS AND INVITE BUSINESS AND COMMUNITY GROUPS TO HELP US DETERMINE THE NEEDS OF THE COMMUNITY. WE HAVE RELATIONSHIPS WITH "SAFETY NET PROVIDERS" IN OUR LOCAL COMMUNITY THAT FURTHER ENHANCE OUR ABILITY TO PROVIDE CARE AND HEALTH RELATED PROGRAMS TAILORED TO OUR SERVICE AREA. WE ALSO USE COMMUNITY HEALTH STATUS INFORMATION (MORTALITY, MORBIDITY, DISEASE RATES, BIRTH RATES, IMMUNIZATION RATES, ETC) TO HELP US FOCUS ON LOCAL NEEDS. FINALLY, ON A REGIONAL COLLABORATIVE BASIS WE PARTICIPATE IN AH4Q-ALIGNING HEALTHCARE PROVIDERS FOR QUALITY, WHICH ASSESSES, EVALUATES AND PROMOTES BETTER CARE FOR WEST MICHIGAN CITIZENS.
PART VI, LINE 3: AS SOON AS THE HOSPITAL BECOMES AWARE THAT A PATIENT DOES NOT HAVE INSURANCE COVERAGE, OR IS UNDER-INSURED, THAT PERSON IS CONTACTED EITHER BY PHONE, MAIL, OR IN PERSON BY OUR FINANCIAL COUNSELOR. WE HAVE A NUMBER OF PAMPHLETS THAT OUTLINE OUR CHARITY CARE POLICY, AS WELL AS HELP LOANS FOR WHICH THE HOSPITAL UNDERWRITES THE INTEREST PORTION OF THE LOAN.
PART VI, LINE 4: THE HOSPITAL MAINLY SERVES THE CITIZENS OF THE ADJACENT COMMUNITIES OF GRAND HAVEN, GRAND HAVEN TOWNSHIP, FERRYSBURG, VILLAGE OF SPRING LAKE, SPRING LAKE TOWNSHIP, ROBINSON TOWNSHIP, WEST OLIVE TOWNSHIP AND CROCKERY TOWNSHIP. THE HOSPITAL SERVES PATIENTS OF ALL INCOME LEVELS.
Schedule H (Form 990) 2016
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