SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
Hills & Dales General Hospital Inc
 
Employer identification number

38-1619577
Return Reference Explanation
Form 990, Part III, line 2 Telehealth virtual visits
Form 990, Part III, line 3 Physical Therapy services in the Ubly, Michigan location COVID-19 Pandemic: During 2020, the world-wide coronavirus pandemic impacted national and global economies. The Organization is closely monitoring its operations, liquidity and capital resources and is actively working to minimize the current and future impact of this unprecedented situation. The current and future full impact to the Organization is not known.
Form 990, Part VI, Section A, line 1 There shall be an Executive Committee of the Board, consisting of the Chair, Vice Chair, Secretary, Treasurer, the President/CEO, ex-officio without vote, and such other number of Directors who may be nominated by the Chair and approved by the Board of Directors: Provided, however, that in no event shall the Executive Committee constitue a majority of the Board of Directors. The Executive Committee shall meet at the call of the Chair, and exercise such functions and powers as the Board of Directors may provide. The Executive Committee shall keep records of its proceedings, and shall report on its actions to the Board of Directors as its next meeting. The Executive Committee shall possess and exercise all of the powers and authority of the Board of Directors, to the extent permitted by law, and shall manage the affairs of the Corporation between meetings of the Board of Directors. Notwithstanding anything which may be expressed in, or implied from this Section, the Executive Committee shall not have the power or authority to: A. Amend the Articles of Incorporation; B. Adopt an agreement of merger or consolidation; C. Approve the sale, lease, or exchange of all or substantially all of the Hospital's property and assets; D. Approve a dissolution of the Corporation or revocation of a dissolution; E. Amend these Bylaws; F. Fill vacancies on the Board and/or appoint officers; G. Modify the purpose of the Corporation; or H. Approve the incurrence of any long-term debt, or the capital and/or operating budgets of the Corporation.
Form 990, Part VI, Section A, line 6 The Corporation shall have two classes of members (A) Active Members, and (B) Honorary Members. Only Active Members of the Corporation shall have equal rights, privileges, duties, liabilities, limitations and restrictions.
Form 990, Part VI, Section A, line 7a The Board of Trustees shall consist of not less than six persons, nor more than 15 persons as determined by the Board of Trustees, a majority of whom shall be members of the Board of Trustees of Hills & Dales Healthcare Corporation
Form 990, Part VI, Section A, line 7b The following actions may be taken by the organization only upon written approval of the Board of Trustees of Hills & Dales Healthcare Corporation: A: Adoption, amendment, or other modification of the Bylaw or Articles of Incorporation; B: Any mergers, consolidation, reorganization, other change in the corporate structure or the creation of any corporate subsidiary; C: Participation in any partnership, limited partnership, corporation, association or other form of joint venture or shared service with any other party; D: Creation, incurrence, or assumption of indebtedness, commitments, or any contractual obligations with respect to borrowed money, guarantees, endorsements, leases, or other type of direct contingent liabilities, in excess of $150,000 for any one item; E: Creation, incurrence, or assumption of any mortgage, pledge, security agreement, encumbrance, or other lien of any kind in any property or assets of the organization; F: Acquisitions, by purchase, lease or by any other method of real estate, capital improvements, or equipment in excess of value of $150,000 for any such item; G: Any change in the services of programs of the organization, including the termination of existing services, the addition of new services, or any major expansion or contraction of existing services or programs; H: Adoption, amendment or modification of the annual operating and capital budgets of the corporations; or I: Adoption, amendment or modification of the mission and goals of the corporation, and its long-range and short-range strategic plans.
Form 990, Part VI, Section B, line 11b The 990 was reviewed by the CFO . A copy was then provided to the Trustees for review at the next board meeting.
Form 990, Part VI, Section B, line 12c The conflict of interest form is completed annually and monitored for compliance by the CEO and the Chairman of the Board. When a conflict exists, the Board member notifies the rest of the Board of the Conflict. The Board member is allowed to discuss the matter at hand, however, the member with the conflict is not allowed to vote on any conflicted issue. This policy covers all Board members, officers, administrative staff members and Medical Staff members with administrative responsibilities.
Form 990, Part VI, Section B, line 15 The salary of the CEO is determined by three Board members from the Hills & Dales General Hospital, Inc. Board of Trustees. All other employees report to the CEO. The wages and/or salaries of the employees are reviewed by the CEO and other Officers of the hospital. Compensation is reviewed annually.
Form 990, Part VI, Section C, line 19 The organization does not make its governing documents, conflict of interest policy, and financial statements available to the general public.
Form 990, Part IX, line 11g Professional Fees: Program service expenses 1,466,144. Management and general expenses 84,000. Fundraising expenses 0. Total expenses 1,550,144. Contracted Services: Program service expenses 1,571,887. Management and general expenses 145,191. Fundraising expenses 0. Total expenses 1,717,078. Contracted Physicians: Program service expenses 879,179. Management and general expenses 0. Fundraising expenses 0. Total expenses 879,179. Other Fees: Program service expenses 33,009. Management and general expenses 174,764. Fundraising expenses 0. Total expenses 207,773.
Form 990, Part XI, line 9: Change in Value of Beneficial Interest in Assets Held by Hills & Dales Fdtn -91,542.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2019


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