Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
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|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public Support (Subtract line 7c from line 6.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | ||||||




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | 10000128 |
| Software Version: | v2010.1.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| NUMBER OF EMPLOYEES | FORM 990, PART I, LINE 5 AND FORM 990, PART V, LINE 2A | TAXPAYER HAS INDIRECT EMPLOYEES WHO ARE LEASED TO THE ORGANIZATION BY ONE OF THE MEMBER ORGANIZATIONS. AMOUNTS PAID FOR INDIRECT EMPLOYEES IS PURSUANT TO A MANAGEMENT SERVICES CONTRACT AND IS INCLUDED ON LINES 5-10 OF PART IX. |
| NUMBER REPORTED IN BOX 3 OF FORM 1096 | FORM 990, PART V, LINE 1 | PURSUANT TO A MANAGEMENT SERVICES CONTRACT WITH A MEMBER ORGANIZATION, TAXPAYER'S VENDORS ARE PROCESSED AND PAID. AMOUNTS PAID TO THE MEMBER ORGANIZATION BY THE TAXPAYER ARE INCLUDED ON LINES 11 - 24 OF PART IX. |
| Classes of members or stockholders | Form 990, Part VI, Section A, Line 6 | THE TAXPAYER HAS FOUR MEMBERS/STOCKHOLDERS AS FOLLOWS: -SPECTRUM HEALTH HOSPITALS (EIN 38-1360529), A MICHIGAN NONPROFIT CORPORATION. -HOLLAND COMMUNITY HOSPITAL (EIN 38-2800065), A MICHIGAN NONPROFIT CORPORATION. -NORTH OTTAWA COMMUNITY HOSPITAL (EIN 38-3330803), A MICHIGAN NONPROFIT CORPORATION. -ZEELAND COMMUNITY HOSPITAL (EIN 38-1411184), A MICHIGAN NONPROFIT CORPORATION. |
| Members or stockholders electing members of governing body | Form 990, Part VI, Section A, Line 7a | THE MEMBER(S) (SEE FORM 990, PART VI, LINE 6) OF THE TAXPAYER APPOINTS ALL MEMBERS OF THE BOARD OF DIRECTORS. NO INDIVIDUAL PERSON SHALL BE ELIGIBLE TO BECOME A MEMBER OF THE CORPORATION, AND NO CORPORATION OR OTHER ENTITY SHALL BE ELIGIBLE TO BECOME A MEMBER IN THE CORPORATION UNLESS SUCH CORPORATION OR ENTITY IS AN ACUTE CARE HOSPITAL LOCATED IN KENT, ALLEGAN, OTTAWA, OR MUSKEGON COUNTIES, MICHIGAN. ADDITIONAL MEMBERS MAY BE ADMITTED TO THE CORPORATION UPON THE APPROVAL OF THE EXISTING MEMBERS HOLDING AT LEAST 80% OF THE PERCENTAGES STATED AS FOLLOWS: SPECTRUM HEALTH HOSPITALS - 35% HOLLAND COMMUNITY HOSPITAL - 35% NORTH OTTAWA COMMUNITY HOSPITAL - 15% ZEELAND COMMUNITY HOSPITAL - 15% THE BUSINESS AND AFFAIRS OF THE TAXPAYER SHALL BE MANAGED EXCLUSIVELY BY A BOARD OF DIRECTORS. THERE SHALL BE EIGHT DIRECTORS OF THE CORPORATION. EACH OF THE FOUR MEMBERS OF THE CORPORATION SHALL SELECT TWO DIRECTORS. THE WEIGHTED VOTES OF EACH PAIR OF DIRECTORS MAY BE CAST BY ONLY ONE OF THE PAIR IF BOTH ARE NOT PRESENT AT A MEETING OF THE BOARD. IF BOTH ARE PRESENT AT A MEETING OF THE BOARD, THEY SHALL EACH HAVE A VOTE EQUAL TO ONE-HALF OF THE PERCENTAGES SET FORTH ABOVE. EACH DIRECTOR SHALL HOLD OFFICE UNTIL HIS DEATH, RESIGNATION, INCAPACITY TO ACT, OR REMOVAL. IN THE EVENT ANY VACANCY SHALL OCCUR ON THE BOARD OF DIRECTORS, SUCH VACANCY SHALL BE FILLED BY THE MEMBER OF THE CORPORATION WHICH HAD ORIGINALLY APPOINTED THAT DIRECTOR. |
| Decisions requiring approval by members or stockholders | Form 990, Part VI, Section A, Line 7b | THE MEMBERS (SEE FORM 990, PART VI, LINE 6) OF THE TAXPAYER HAVE THE RESERVED POWERS SET FORTH BELOW, AND SHALL NOT BE DEEMED AUTHORIZED UNLESS AND UNTIL APPROVED BY AT LEAST 80% OF THE WEIGHTED VOTES (SEE FORM 990, PART VI, LINE 7A) OF THE MEMBERS: -ALL MATTERS REQUIRING MEMBERSHIP ACTION UNDER MICHIGAN LAW; -AMENDMENT OF THE ARTICLES OF INCORPORATION OR BYLAWS OF THE TAXPAYER; -RATIFICATION OF THE MISSION, ROLE, AND GOALS OF THE TAXPAYER; -ADOPTION, APPROVAL, REVOCATION, OR ABANDONMENT OF ANY PLAN OF DISSOLUTION OF THE TAXPAYER; AND -ADOPTION, APPROVAL, REVOCATION, OR ABANDONMENT OF ANY PLAN OF MERGER, CONSOLIDATION, SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS AND PROPERTY OF THE TAXPAYER. |
| Review of form 990 by governing body | Form 990, Part VI, Section B, Line 11a | A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. THE REVIEW PROCESS FOR THIS FORM 990 IS AS FOLLOWS: 1. PREPARATION OF THE RETURN IS SUPERVISED AND REVIEWED BY A MEMBER ORGANIZATION'S CORPORATE TAX DEPARTMENT. 2. A SECOND REVIEW IS PERFORMED BY AN EXTERNAL CPA FIRM WITH EXPERTISE IN TAX-EXEMPT RETURN PREPARATION. 3. THE RETURN IS REVIEWED BY THE ORGANIZATION'S TREASURER AND SECRETARY AND SHARED WITH THE MEMBERS OF THE BOARD OF DIRECTORS. |
| Conflict of interest policy | Form 990, Part VI, Section B, Line 12c | MANY STAFF MEMBERS OF LAROC ARE LEASED FROM A MEMBER ORGANIZATION. THE MEMBER ORGANIZATION MONITORS, ENFORCES AND ESTABLISHES THE POLICIES DISCUSSED IN THESE QUESTIONS OF THIS TAX RETURN. |
| Public Disclosure | Form 990, Part VI, Section C, Line 19 | THE ORGANIZATION'S ARTICLES OF INCORPORATION HAVE BEEN PROVIDED TO THE STATE OF MICHIGAN AND ARE AVAILABLE TO THE PUBLIC ON THE STATE'S WEBSITE. THE ORGANIZATION'S BYLAWS AND INTERNAL POLICIES ARE GENERALLY NOT MADE AVAILABLE TO THE PUBLIC. AT THE TIME OF THIS FILING, THE FINANCIAL STATEMENTS HAVE NOT BEEN AVAILABLE TO THE PUBLIC BUT ARE REPRESENTED IN PARTS VIII, IX, AND X OF THIS FORM 990. |
| POLICIES | FORM 990, PART VI, SECTION B, LINES 13-15B | MANY STAFF MEMBERS OF LAROC ARE LEASED FROM A MEMBER ORGANIZATION. THE MEMBER ORGANIZATION MONITORS, ENFORCES AND ESTABLISHES THE POLICIES DISCUSSED IN THESE QUESTIONS OF THIS TAX RETURN. |
| Average hours worked per week for related organization | Form 990, Part VII, Section A, Column B | HENRY VEENSTRA - 0 RICHARD FUNNELL - 0 BRENDA WINN - 0 JONATHAN BERENDS - 0 DAVE NEWTON - 0 MARK PAWLAK - 0 DONALD LONGPRE - 0 DARRYL BOLIN - 0 GEORGE SMART - 0 DAVID DEBOODE - 0 |
| COMPENSATION | FORM 990, PART VII, LINE 1A | COMPENSATION AND BENEFITS ARE REPORTED USING THE MOST RECENT CALENDAR YEAR COMPENSATION DATA. THE COMPENSATION FIGURES REPORTED IN THESE SECTIONS ARE FOR THE YEAR ENDED DECEMBER 31, 2010. |
| Other changes in net assets or fund balances | Form 990, Part XI, Line 5 | MEMBER DISTRIBUTIONS - -1820000; |
| Software ID: | 10000128 |
| Software Version: | v2010.1.0 |