CHIPPEWA VALLEY HOSPITAL & OAKVIEW CARE CENTER INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- CHIPPEWA VALLEY HOSPITAL & OAKVIEW CARE CENTER INC (EIN 39-1365168)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-10
- IRS object ID
- 202113149349300211
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-10T07:34:15-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391365168 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHIPPEWA VALLEY HOSPITAL AND | BusinessNameLine1Txt |
| Business Name Line2 | OAKVIEW CARE CENTER INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHIP | BusinessNameControlTxt |
| Phone | 7156724211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1220 THIRD AVENUE WEST | AddressLine1Txt |
| City | DURAND | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54736 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LYNN C ADDISCOTT | PersonNm |
| Person Title | ASST. SECRETARY | PersonTitleTxt |
| Phone | 4079751492 | PhoneNum |
| Signature | 2021-10-04 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | LYNN | PersonFirstNm |
| Person Last | ADDISCOTT | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ADVENTHEALTH DURAND | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DOUGLAS PETERSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1220 THIRD AVENUE WEST | AddressLine1Txt |
| City | DURAND | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54736 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,997,315 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ADVENTHEALTH.COM/HOSPITAL/ADVENTHEALTH-DURAND | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1980 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | THE OPERATION OF A 25 BED ACUTE CARE HOSPITAL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 116 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $109,715 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,425,242 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,480,970 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,393,470 | CYProgramServiceRevenueAmt |
| PY Investment Income | $263,233 | PYInvestmentIncomeAmt |
| CY Investment Income | $172,553 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $15,853,918 | PYTotalRevenueAmt |
| CY Total Revenue | $15,991,265 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $29,707 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $20,862 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,549,853 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,131,961 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,906,436 | PYOtherExpensesAmt |
| CY Other Expenses | $7,209,637 | CYOtherExpensesAmt |
| PY Total Expenses | $14,485,996 | PYTotalExpensesAmt |
| CY Total Expenses | $15,362,460 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,367,922 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $628,805 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $10,918,855 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,158,743 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,002,420 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,472,680 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,916,435 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,686,063 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION AND ALL ITS SUBSIDIARY ORGANIZATIONS WERE ESTABLISHED BY THE SEVENTH-DAY ADVENTIST CHURCH TO BRING A MINISTRY OF HEALING AND HEALTH TO THE COMMUNITIES SERVED. OUR MISSION IS TO EXTEND THE HEALING MINISTRY OF CHRIST.THE HOSPITAL AND HEALTHCARE SYSTEM WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION IS KNOWN AS ADVENTHEALTH. ADVENTHEALTH SEEKS TO BE WIDELY RESPECTED AS A CONSUMER-FOCUSED ORGANIZATION THAT ENGAGES INDIVIDUALS IN THEIR HEALTH BY DELIVERING WHOLISTIC, BEST PRACTICE CARE ACROSS A CONNECTED, COMPREHENSIVE CONTINUUM OF SERVICES. WITH CHRIST AS OUR EXAMPLE, ADVENTHEALTH CARES FOR AND NURTURES PEOPLE: OUR EMPLOYEES, OUR COMMUNITIES, OUR HEALTHCARE PROFESSIONALS, AND THOSE WHO TRUST US FOR CARE AND HEALING. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $13,704,079 | ExpenseAmt |
| Grant | $20,862 | GrantAmt |
| Revenue | $14,393,470 | RevenueAmt |
| Desc | OPERATION OF A 25-BED ACUTE CARE HOSPITAL IN DURAND, WISCONSIN. DURING THE CURRENT YEAR THERE WERE 147 PATIENT ADMISSIONS RESULTING IN 768 PATIENT DAYS, 14,225 OUTPATIENT VISITS FOR THE YEAR, AND 11,755 PHYSICIAN PRACTICE PATIENT VISITS. | Desc |
| Total Program Service Expenses | $13,704,079 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 116 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HARMAT BEEBE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7852298309 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 S MAIN STREET | AddressLine1Txt |
| City | OTTAWA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66067 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| HUENERGARDT SAMUEL | ||||||||
| CHAIRMAN/DIRECTOR | 2.50 | 47.50 | Yes (X) | Yes (X) | $0 | $896,670 | $144,180 | |
| RANDOLPH KARSTEN | ||||||||
| DIRECTOR | 2.50 | 47.50 | Yes (X) | Yes (X) | $0 | $564,175 | $78,496 | |
| PETERSON DOUGLAS | ||||||||
| DIRECTOR/CEO | 50.00 | 0.00 | Yes (X) | Yes (X) | $0 | $333,224 | $45,479 | |
| DOHLMAN MD ROBERT | ||||||||
| DIRECTOR | 50.00 | 0.00 | Yes (X) | $231,603 | $0 | $28,342 | ||
| HEIKE CHARLIE | ||||||||
| DIRECTOR (BEG 5/20) | 13.70 | 0.00 | Yes (X) | $39,617 | $0 | $0 | ||
| EDGE MICHAEL | ||||||||
| VICE CHAIRMAN | 1.00 | 1.00 | Yes (X) | $150 | $3,005 | $0 | ||
| BAUER LINDA | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $150 | $0 | $0 | ||
| BECHEL TODD | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $150 | $0 | $0 | ||
| BEST ROXANNE | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $150 | $0 | $0 | ||
| BUHLMAN CAROL | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $150 | $0 | $0 | ||
| GILLES MARK | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $150 | $0 | $0 | ||
| HEIKE ROBERT | ||||||||
| DIRECTOR (END 2/20) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| YINGST WILLIAM | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $150 | $0 | $0 | ||
| HARMAT BEEBE | ||||||||
| CFO (BEG 3/20) | 5.00 | 45.00 | Yes (X) | $0 | $180,814 | $40,982 | ||
| RUCKER MD KENNETH | ||||||||
| PHYSICIAN | 50.00 | 0.00 | $307,909 | $0 | $32,700 | Yes (X) | ||
| HUNT MD THOMAS | ||||||||
| PHYSICIAN | 50.00 | 0.00 | $219,396 | $0 | $32,927 | Yes (X) | ||
| MENTELE ANTON | ||||||||
| MID-LEVEL CRNA | 50.00 | 0.00 | $199,303 | $0 | $36,149 | Yes (X) | ||
| POESCHEL JANE | ||||||||
| FNPC | 50.00 | 0.00 | $165,337 | $0 | $26,719 | Yes (X) | ||
| JACOBSON ANGELA | ||||||||
| DIRECTOR OF NURSING | 50.00 | 0.00 | $119,693 | $0 | $33,016 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,283,908 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,977,888 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $498,990 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SACRED HEART HOSPITAL | |||||
| 900 W CLAIREMONT AVE | EAU CLAIRE | WI | 54701 | ED PHYSICIAN & LAB SERVICES | $1,150,400 |
| PHYSICAL THERAPY ASSOCIATES LTD | |||||
| PO BOX 173 | DURAND | WI | 54736 | PHYSICAL THERAPY SERVICES | $733,968 |
| ENGIE INSIGHT SERVICES INC | |||||
| 1313 N ATLANTIC ST 5000 | SPOKANE | WA | 99201 | ENERGY MGMT SERVICES | $222,043 |
| BARTINGALE MECHANICAL INC | |||||
| 213 LOUIS AVE SUITE G | EAU CLAIRE | WI | 54703 | PLUMBING & HVAC CONTRACTOR | $114,161 |
| AMN HEALTHCARE INC | |||||
| 12400 HIGH BLUFF DRIVE | SAN DIEGO | CA | 92130 | STAFFING AGENCY | $105,704 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
| Government Grants | $1,424,837 | GovernmentGrantsAmt |
| All Other Contributions | $405 | AllOtherContributionsAmt |
| Total Contributions | $1,425,242 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 622110 | $13,486,193 | $13,486,193 |
| PHARMACY 340B | 622110 | $749,187 | $749,187 |
| RENTAL REVENUE | 622110 | $54,591 | $54,591 |
| CAFETERIA REVENUE | 622110 | $19,977 | $19,977 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $83,522 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $83,522 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,393,470 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $178,603 | TotalRevenueColumnAmt |
| Exclusion | $178,603 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,050 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$6,050 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$6,050 | TotalRevenueColumnAmt |
| Exclusion | -$6,050 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,991,265 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,393,470 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $172,553 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,862 | TotalAmt |
| Program Services | $20,862 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $750,799 | TotalAmt |
| Management And General | $750,799 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,846,434 | TotalAmt |
| Program Services | $4,846,434 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $243,008 | TotalAmt |
| Program Services | $234,536 | ProgramServicesAmt |
| Management And General | $8,472 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,900,798 | TotalAmt |
| Program Services | $1,900,798 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $390,922 | TotalAmt |
| Program Services | $377,294 | ProgramServicesAmt |
| Management And General | $13,628 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,844 | TotalAmt |
| Management And General | $19,844 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,328 | TotalAmt |
| Management And General | $31,328 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,701,805 | TotalAmt |
| Program Services | $3,395,891 | ProgramServicesAmt |
| Management And General | $305,914 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $316,124 | TotalAmt |
| Management And General | $316,124 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $547,115 | TotalAmt |
| Program Services | $416,853 | ProgramServicesAmt |
| Management And General | $130,262 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $818,087 | TotalAmt |
| Program Services | $769,747 | ProgramServicesAmt |
| Management And General | $48,340 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $272,428 | TotalAmt |
| Program Services | $272,428 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,780 | TotalAmt |
| Program Services | $3,780 | ProgramServicesAmt |
| Management And General | $15,000 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,345 | TotalAmt |
| Management And General | $4,345 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,754 | TotalAmt |
| Program Services | $101,754 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $160,232 | TotalAmt |
| Program Services | $160,232 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,291 | TotalAmt |
| Program Services | $34,230 | ProgramServicesAmt |
| Management And General | $9,061 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $811,758 | $811,758 | |
| REPAIRS & MAINTENANCE | $318,320 | $318,320 | |
| LICENSES & PERMITS | $5,264 | $5,264 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,162 | TotalAmt |
| Program Services | $39,162 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,362,460 | TotalAmt |
| Program Services | $13,704,079 | ProgramServicesAmt |
| Management And General | $1,658,381 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,079,709 | BOYAmt |
| EOY | $7,746,428 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,570,007 | BOYAmt |
| EOY | $1,832,164 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $123,412 | BOYAmt |
| EOY | $179,990 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $288,391 | BOYAmt |
| EOY | $379,562 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,624,796 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $338,207 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $788,506 | BOYAmt |
| EOY | $1,286,589 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,068,830 | BOYAmt |
| EOY | $3,734,010 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,918,855 | BOYAmt |
| EOY | $15,158,743 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,125,587 | BOYAmt |
| EOY | $1,382,505 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,876,833 | BOYAmt |
| EOY | $8,090,175 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,002,420 | BOYAmt |
| EOY | $9,472,680 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,916,435 | BOYAmt |
| EOY | $5,070,835 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $615,228 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,916,435 | BOYAmt |
| EOY | $5,686,063 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,918,855 | BOYAmt |
| EOY | $15,158,743 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $628,805 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $248,194 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$107,371 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $1,130 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,130 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | MEMBER DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE WISCONSIN HOSPITAL ASSOCIATION THAT REPRESENT LOBBYING ACTIVITIES CONDUCTED BY THESE TWO ASSOCIATIONS. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $76,556 | OtherCostOrOtherBasisAmt |
| Book Value | $76,556 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $215,832 | OtherCostOrOtherBasisAmt |
| Depreciation | $21,749 | DepreciationAmt |
| Book Value | $194,083 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,191,885 | OtherCostOrOtherBasisAmt |
| Depreciation | $305,217 | DepreciationAmt |
| Book Value | $886,668 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $140,523 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,241 | DepreciationAmt |
| Book Value | $129,282 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,286,589 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM RELATED | $2,488,346 |
| OTHER RECEIVABLES | $345,426 |
| RECEIVABLE FROM THIRD PARTIES | $792,708 |
| RIGHT OF USE ASSET-OPERATING LEASE | $107,530 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,734,010 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO RELATED | $2,445,360 |
| PAYABLE TO THIRD PARTIES | $774,656 |
| CREDIT BALANCES IN A/R | $26,562 |
| OTHER DEFERRED REVENUE | $916,021 |
| ACCRUED INTEREST PAYABLE | $46 |
| INTERCO ALLOC OF TE BOND PROCEEDS | $3,716,903 |
| OPERATING LEASE LIABILITY | $100,510 |
| OTHER LIABILITIES | $110,117 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $8,090,175 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE FILING ORGANIZATION IS A SUBSIDIARY ORGANIZATION WITHIN ADVENTHEALTH. THE CONSOLIDATED FINANCIAL STATEMENTS OF ADVENTHEALTH CONTAIN THE FOLLOWING FIN 48 (ASC 740) FOOTNOTE: PLEASE NOTE THAT DOLLAR AMOUNTS ARE IN THOUSANDS. HEALTHCARE CORPORATION AND ITS AFFILIATED ORGANIZATIONS, OTHER THAN NORTH AMERICAN HEALTH SERVICES, INC. AND ITS SUBSIDIARY (NAHS), ARE EXEMPT FROM STATE AND FEDERAL INCOME TAXES. ACCORDINGLY, HEALTHCARE CORPORATION AND ITS TAX-EXEMPT AFFILIATES ARE NOT SUBJECT TO FEDERAL, STATE OR LOCAL INCOME TAXES EXCEPT FOR ANY NET UNRELATED BUSINESS TAXABLE INCOME. NAHS IS A WHOLLY OWNED, FOR-PROFIT SUBSIDIARY OF HEALTHCARE CORPORATION. NAHS AND ITS SUBSIDIARY ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. NAHS FILES A CONSOLIDATED FEDERAL INCOME TAX RETURN AND, WHERE APPROPRIATE, CONSOLIDATED STATE INCOME TAX RETURNS. ALL TAXABLE INCOME WAS FULLY OFFSET BY NET OPERATING LOSS CARRYFORWARDS FOR FEDERAL INCOME TAX PURPOSES; AS SUCH, THERE IS NO PROVISION FOR CURRENT FEDERAL OR STATE INCOME TAX FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019. NAHS ALSO HAS TEMPORARY DEDUCTIBLE DIFFERENCES OF APPROXIMATELY $41,800 AND $46,500 AT DECEMBER 31, 2020 AND 2019, RESPECTIVELY, PRIMARILY AS A RESULT OF NET OPERATING LOSS CARRYFORWARDS. AT DECEMBER 31, 2020, NAHS HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $43,500, EXPIRING BEGINNING IN 2022 THROUGH 2026. DEFERRED TAXES HAVE BEEN PROVIDED FOR THESE AMOUNTS, RESULTING IN A NET DEFERRED TAX ASSET OF APPROXIMATELY $10,200 AND $11,400 AT DECEMBER 31, 2020 AND 2019, RESPECTIVELY. NAHS REMEASURED ITS DEFERRED TAX ASSETS AND LIABILITIES BASED ON THE RATES AT WHICH THEY ARE EXPECTED TO REVERSE IN THE FUTURE, WHICH IS GENERALLY 21%. A FULL VALUATION ALLOWANCE HAS BEEN PROVIDED AT DECEMBER 31, 2020 AND 2019 TO OFFSET THE DEFERRED TAX ASSET SINCE HEALTHCARE CORPORATION HAS DETERMINED THAT IT IS MORE LIKELY THAN NOT THAT THE BENEFIT OF THE NET OPERATING LOSS CARRYFORWARDS WILL NOT BE REALIZED IN FUTURE YEARS. THE INCOME TAXES TOPIC OF THE ACCOUNTING STANDARDS CODIFICATION (ASC) (ASC 740) PRESCRIBES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAX POSITIONS RECOGNIZED IN FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN, OR EXPECTED TO BE TAKEN, IN A TAX RETURN. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2020 AND 2019. ON DECEMBER 22, 2017, THE UNITED STATES ENACTED TAX REFORM LEGISLATION COMMONLY KNOWN AS THE TAX CUTS AND JOBS ACT (ACT), RESULTING IN SIGNIFICANT MODIFICATIONS TO EXISTING LAW. CERTAIN PROVISIONS IMPACT TAX-EXEMPT ORGANIZATIONS, INCLUDING REVISIONS TO TAXES ON UNRELATED BUSINESS ACTIVITIES, EXCISE TAXES ON COMPENSATION OF CERTAIN EMPLOYEES, AND VARIOUS OTHER PROVISIONS. THE IMPACT OF THESE PROVISIONS ON THE CONSOLIDATED FINANCIAL STATEMENTS IS NOT, AND IS NOT EXPECTED, TO BE SIGNIFICANT. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $209,479 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $209,479 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01360 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,248,880 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $573,339 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $675,541 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04400 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,458,359 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $573,339 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $885,020 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05760 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,458,359 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $573,339 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $885,020 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05760 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $232,102 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $11,489 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,853,019 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,775,266 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $77,753 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHIPPEWA VALLEY HOSPITAL AND OAKVIEW CARE CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1220 THIRD AVE WEST | AddressLine1Txt |
| City | DURAND | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54736 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.ADVENTHEALTH.COM/HOSPITAL/ADVENTHE | WebsiteAddressTxt |
| State License | 1008 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHIPPEWA VALLEY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, PAGE 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 20 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, PAGE 8 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, PAGE 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, PAGE 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, PAGE 8 | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CHIPPEWA VALLEY HOSPITAL | PART V, SECTION B, LINE 5: CHIPPEWA VALLEY HOSPITAL AND OAKVIEW CARE CENTER, INC., D/B/A ADVENTHEALTH DURAND, (AHD OR THE HOSPITAL) OPERATES A 25-BED CRITICAL ACCESS HOSPITAL IN PEPIN COUNTY, WISCONSIN. FOR PURPOSES OF ITS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL DEFINED ITS COMMUNITY AS ITS PRIMARY SERVICE AREA FROM WHICH 94% OF ITS PATIENTS COME. AS A PART OF ITS EFFORTS TO ENSURE BROAD COMMUNITY-BASED INPUT INTO THE CHNA PROCESS, THE HOSPITAL ESTABLISHED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) TO HELP GUIDE THE HOSPITAL THROUGH THE ASSESSMENT PROCESS. THE CHNAC INCLUDED REPRESENTATION FROM THE HOSPITAL, PUBLIC HEALTH EXPERTS AND THE BROAD COMMUNITY WITH INTENTIONAL REPRESENTATION FROM LOW-INCOME, MINORITY AND OTHER UNDERSERVED POPULATIONS. PARTICIPANTS IN THE CHNAC INCLUDED TWO REPRESENTATIVES FROM THE PEPIN COUNTY HEALTH DEPARTMENT AND TWO COMMUNITY MEMBERS WHO BOTH REPRESENTED LOW-INCOME COMMUNITIES. AS THE ONLY HOSPITAL IN PEPIN COUNTY, THE HOSPITAL WORKED WITH THE PEPIN COUNTY HEALTH DEPARTMENT TO ASSESS THE HEALTH NEEDS OF ITS COMMUNITY. AN ONLINE AND IN-PERSON SURVEY WAS DISTRIBUTED THROUGH THE PEPIN COUNTY HEALTH DEPARTMENT, THE HOSPITAL NEWSLETTER AND THOUGH A DIRECT MAILING TO MORE THAN 7,500 HOUSEHOLDS. STAKEHOLDER INTERVIEWS WERE ALSO COMPLETED BY COMMUNITY STAKEHOLDERS, HOSPITAL HEALTH CARE WORKERS, AND CHNAC MEMBERS. |
| CHIPPEWA VALLEY HOSPITAL | PART V, SECTION B, LINE 7D: THE HOSPITAL HAS ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS MUST BE POSTED ON THE HOSPITAL'S WEBSITE AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE WIDELY AVAILABLE ON ITS WEBSITE ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. THE HOSPITAL WILL ALSO MAKE A PAPER COPY OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST AND WITHOUT CHARGE, AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE AVAILABLE FOR PUBLIC INSPECTION ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. |
| CHIPPEWA VALLEY HOSPITAL | PART V, SECTION B, LINE 11: CHIPPEWA VALLEY HOSPITAL & OAKVIEW CARE CENTER, INC. D/B/A ADVENTHEALTH DURAND WILL BE REFERRED TO IN THIS DOCUMENT AS ADVENTHEALTH DURAND OR "THE HOSPITAL". THE HOSPITAL IS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS THE 501(C)(3) PARENT ORGANIZATION OF A HOSPITAL AND HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. IN JANUARY 2019, EVERY WHOLLY-OWNED ENTITY OF AHSSHC ADOPTED THE ADVENTHEALTH SYSTEM BRAND. OUR IDENTITY HAS BEEN UNIFIED TO REPRESENT THE FULL CONTINUUM OF CARE OUR SYSTEM OFFERS. ANY REFERENCES TO OUR PRIOR COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNAS) OR PRIOR COMMUNITY HEALTH PLANS (CHPS) WILL UTILIZE OUR NEW NAME FOR CONSISTENCY. ADVENTHEALTH DURAND IS PART OF THE MULTI-STATE DIVISION OF ADVENTHEALTH. THE DIVISION INCLUDES NINE HOSPITAL FACILITIES. THIS IS THE FIRST-YEAR UPDATE FOR ADVENTHEALTH DURAND'S 2020-2022 COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY. THE HOSPITAL DEVELOPED THIS PLAN AND POSTED IT IN MAY 2020 AS PART OF ITS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. FOR THE DEVELOPMENT OF BOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY, ADVENTHEALTH DURAND WORKED TO DEFINE AND ADDRESS THE NEEDS OF LOW-INCOME, MINORITY AND UNDERSERVED POPULATIONS IN ITS SERVICE AREA. THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT USED PRIMARY DATA INTERVIEWS AND SURVEYS; SECONDARY DATA FROM LOCAL, REGIONAL, AND NATIONAL HEALTH-RELATED SOURCES; AND HOSPITAL PREVALENCE DATA TO HELP THE HOSPITAL DETERMINE THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. ONCE THE DATA WAS GATHERED, THE PRIMARY ISSUES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT WERE PRIORITIZED BY COMMUNITY AND HOSPITAL STAKEHOLDERS, WHO THEN SELECTED KEY ISSUES FOR THE HOSPITAL TO ADDRESS IN ITS 2020-2022 COMMUNITY HEALTH PLAN. THE FIRST-YEAR PROGRESS ON THE COMMUNITY HEALTH PLAN IS NOTED BELOW. THE NARRATIVE DESCRIBES THE PRIORITIZED ISSUES IDENTIFIED IN 2019 AND GIVES AN UPDATE ON THE STRATEGIES ADDRESSING THOSE ISSUES. THERE IS ALSO A DESCRIPTION OF THE IDENTIFIED ISSUES THAT THE HOSPITAL DID NOT ADDRESS. ADVENTHEALTH DURAND CHOSE TWO PRIORITIES FOR ITS 2020-2022 COMMUNITY HEALTH PLAN: 1. CHRONIC DISEASE MANAGEMENT2. HEALTHY GROWTH, DEVELOPMENT AND OBESITYPRIORITY 1: CHRONIC DISEASE MANAGEMENT 2019 DESCRIPTION OF THE ISSUE:CHRONIC DISEASES ARE DEFINED BROADLY AS CONDITIONS THAT LAST ONE YEAR OR MORE AND REQUIRE ONGOING MEDICAL ATTENTION OR LIMIT ACTIVITIES OF DAILY LIVING OR BOTH. CHRONIC DISEASES SUCH AS HEART DISEASE, CANCER AND DIABETES ARE THE LEADING CAUSES OF DEATH AND DISABILITY IN THE UNITED STATES. ACCORDING TO SECONDARY DATA, 35.29% OF ADULTS IN ADVENTHEALTH DURAND'S SERVICE AREA HAVE HIGH CHOLESTEROL, WHILE 32.97% HAVE HIGH BLOOD PRESSURE. PREVENTATIVE MEASURES TO CURB CHRONIC DISEASE MAY BE IMPLEMENTED WITH RELATIVE EASE, AND THE IMPACT OF IMPLEMENTING PREVENTATIVE MEASURES IS OF HIGH VALUE BOTH TO INDIVIDUALS AND TO THE COMMUNITY AT LARGE.2020 UPDATE: RECOGNIZING THE IMPACT OF SOCIAL DETERMINANTS OF HEALTH, LIKE ACCESS TO HEALTH CARE AND HEALTH EDUCATION, ON INDIVIDUALS' HEALTH OUTCOMES, ADVENTHEALTH RECENTLY PARTNERED WITH AUNT BERTHA, A SOCIAL CARE NETWORK, TO CONNECT PATIENTS TO PROGRAMS IN THE COMMUNITIES THAT ADDRESS SOCIAL NEEDS. THIS PARTNERSHIP WILL HELP ADVENTHEALTH TEAM MEMBERS TO MORE FULLY INTEGRATE SOCIAL CARE INTO OUR WHOLE-PERSON CARE MODEL. OUR WHOLE-PERSON APPROACH TO CARE IS DESIGNED TO EMPOWER INDIVIDUALS TO TAKE THEIR HEALTH INTO THEIR OWN HANDS. THIS APPROACH IN ADDITION TO OUR PARTNERSHIP WITH AUNT BERTHA WILL ALLOW US TO CONNECT PATIENTS TO NEEDED RESOURCES, WHICH IS A KEY STEP IN CREATING HEALTHIER PEOPLE AND COMMUNITIES. THE ADVENTHEALTH DURAND COMMUNITY HEALTH PLAN HAS ONE DESIRED GOAL STATEMENT UNDER THE CHRONIC DISEASE MANAGEMENT PRIORITY. 1. IMPROVE KNOWLEDGE AROUND DIABETES AND THE IMPACT OF LIFESTYLE CHOICES ON DIABETIC CONDITIONS FOR COMMUNITY MEMBERSGOAL 1: IMPROVE KNOWLEDGE AROUND DIABETES AND THE IMPACT OF LIFESTYLE CHOICES ON DIABETIC CONDITIONS FOR COMMUNITY MEMBERS OBJECTIVE 1: THE FIRST OBJECTIVE IS TO USE CURRICULUM FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION'S (CDC) NATIONAL DIABETES PREVENTION PROGRAM TO PROVIDE 10 CLASSES FOR THE COMMUNITY BY THE END OF YEAR THREE. THE INITIATIVE IS FUNDED AND MANAGED THROUGH ADVENTHEALTH DURAND AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE INITIATIVE PROVIDES CHRONIC DISEASE EDUCATION RELATED TO DIABETES, HYPERTENSION, NUTRITION, ETC. FOR THE MEMBERS OF THE COMMUNITY. THE FIRST METRIC FOR THE OBJECTIVE WAS PROGRESSED ON, WITH 10 CLASSES SET. DUE TO COVID-19, THE INITIATIVE WAS DELAYED. HOWEVER, THE HOSPITAL WAS ABLE TO PLAN THE DETAILS OF THE CLASSES. ADDITIONALLY, A MEMBER OF THE HOSPITAL STAFF, WHO IS BOTH A REGISTERED DIETICIAN AND CERTIFIED DIABETES EDUCATOR, PROVIDED ONE-ON-ONE SESSIONS WITH 463 COMMUNITY MEMBERS DURING THIS TIME AT NO COST TO THE PARTICIPANTS. OBJECTIVE 2: THE SECOND OBJECTIVE IS TO ENGAGE AND EDUCATE 60 COMMUNITY MEMBERS USING THE CDC CURRICULUM BY THE END OF YEAR THREE. THE INITIATIVE IS FUNDED AND MANAGED THROUGH ADVENTHEALTH DURAND AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE INITIATIVE PROVIDES CHRONIC DISEASE EDUCATION RELATED TO DIABETES, HYPERTENSION, NUTRITION, ETC. FOR THE MEMBERS OF THE COMMUNITY. THE FIRST METRIC FOR THE OBJECTIVE WAS PROGRESSED ON WITH CLASSES SCHEDULED. DUE TO COVID-19, THE INITIATIVE WAS DELAYED AS A RESULT OF RESTRICTIONS ON IN-PERSON CLASSES THAT DID NOT ALLOW THE HOSPITAL TO HOST 10 CLASSES THAT WOULD ENGAGE 60 COMMUNITY MEMBERS. THE HOSPITAL IS SCHEDULED TO BEGIN THESE CLASS SESSIONS IN SEPTEMBER 2021. OBJECTIVE 3:THE THIRD OBJECTIVE IS TO PROVIDE PRE AND POST BIOMETRICS SCREENINGS FOR CLASS PARTICIPANTS TO MEASURE EFFECTIVENESS OF CURRICULUM AND LIFESTYLE CHANGES. THE INITIATIVE IS FUNDED AND MANAGED THROUGH ADVENTHEALTH DURAND AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE INITIATIVE PROVIDES SCREENINGS THAT WILL PROVIDE A BASELINE FOR THE PARTICIPANTS AND PROVIDE A WAY TO MEASURE THE EFFECTIVENESS OF THE CURRICULUM THROUGH CHANGES IN BIOMETRIC NUMBERS. THE FIRST METRIC FOR THE OBJECTIVE WAS MET BY PROVIDING 463 SCREENINGS TO COMMUNITY MEMBERS REFERRED TO THE PROGRAM AT NO CHARGE. ADDITIONALLY, THE HOSPITAL HAS BEEN ABLE TO BEGIN THE CONTINUOUS GLUCOSE MONITORING PROGRAM TO TRACK THE GLUCOSE LEVELS OF COMMUNITY MEMBERS.OBJECTIVE 4:THE FOURTH OBJECTIVE IS TO ESTABLISH TWO NEW COMMUNITY PARTNERS BY THE END OF YEAR THREE TO PARTNER WITH AS POTENTIAL SITES FOR DIABETES PROGRAMS. THE INITIATIVE IS MANAGED BY ADVENTHEALTH DURAND AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE INITIATIVE CREATES MORE ACCESS POINTS FOR DIABETES EDUCATION THROUGHOUT THE COMMUNITY BY PARTNERING WITH COMMUNITY ORGANIZATIONS THAT SERVE POPULATIONS IN NEED. THE FIRST METRIC FOR THE OBJECTIVE WAS PROGRESSED ON. THE HOSPITAL WILL CONTINUE TO BUILD A LIST OF POSSIBLE PARTNERS AND ENGAGE ORGANIZATIONS THAT COULD BE POTENTIAL SITES FOR THE DIABETES PROGRAMS.OBJECTIVE 5:THE FIFTH OBJECTIVE IS TO HOST THREE HEALTH TALKS FOCUSED ON DIABETES AND LIFESTYLE CHOICES FOR COMMUNITY MEMBERS BY THE END OF THREE YEARS. THE INITIATIVE IS FUNDED AND MANAGED THROUGH ADVENTHEALTH DURAND AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE INITIATIVE PROVIDES CHRONIC DISEASE EDUCATION RELATED TO DIABETES, HYPERTENSION, NUTRITION, ETC. FOR THE MEMBERS OF THE COMMUNITY. THESE TALKS ARE HOSTED BY A REGISTERED DIETICIAN, A PHYSICIAN OR NURSE PRACTITIONER. THE FIRST METRIC FOR THE OBJECTIVE WAS PROGRESSED ON. IN 2020, THE HOSPITAL EXPERIENCED DELAYS ON THIS INITIATIVE BECAUSE OF COVID-19 SOCIAL DISTANCING RESTRICTIONS. THE HOSPITAL WILL CONTINUE TO WORK ON THE INITIATIVE BY HOSTING THE FIRST HEALTH TALK IN SEPTEMBER 2021.SEE CONTINUATION |
| CHIPPEWA VALLEY HOSPITAL | PART V, SECTION B, LINE 13H: EFFECTIVE MARCH 1, 2020, THE FILING ORGANIZATION'S HOSPITAL FACILITY (OR FACILITIES) AUGMENTED THEIR FINANCIAL ASSISTANCE POLICY WITH A COVID-19 FINANCIAL GRACE ADDENDUM. PURSUANT TO THE COVID-19 FINANCIAL GRACE ADDENDUM, UNINSURED PATIENTS TREATED FOR COVID-19 RELATED EVALUATIONS ARE TO RECEIVE FREE OR DISCOUNTED CARE DEPENDING ON THE PATIENT'S COOPERATION IN SUBMITTING NECESSARY FINANCIAL ASSISTANCE INFORMATION. INSURED PATIENTS TESTED FOR COVID-19 ARE NOT EXPECTED TO HAVE OUT-OF-POCKET EXPENSES BASED ON INSURANCE COMMUNITY RESPONSE TO WAIVE PATIENT FINANCIAL RESPONSIBILITY. IF A PAYER UNEXPECTEDLY FAILS TO WAIVE PATIENT RESPONSIBILITY FOR COVID-19 RELATED TESTING, THE FILING ORGANIZATION WILL NOT BALANCE BILL PATIENTS FOR ANY OUT-OF-POCKET EXPENSES RELATED TO COVID-19. IN ADDITION, PATIENTS WITH EXISTING PAYMENT PLANS ARE PROVIDED OPPORTUNITIES FOR REDUCING THEIR MONTHLY PAYMENTS. |
| PART V, SECTION B, LINE 11 - CONTINUATION 2 | PRIORITY 2: HEALTHY GROWTH, DEVELOPMENT AND OBESITY 2019 DESCRIPTION OF THE ISSUE:THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) COMBINED OBESITY AND HEALTHY EATING/ACCESS TO HEALTHY FOODS INTO ONE CATEGORY IN ORDER TO FOCUS EFFORTS ON TWO ISSUES, WHICH ARE INTERCONNECTED. THE STATE OF WISCONSIN HAS SEEN AN INCREASE IN THE RATE OF OBESITY IN ADULTS FROM 26% TO 31% FROM 2008 TO 2018. OBESITY WAS RANKED AS ONE OF THE TOP TWO RISK FACTORS FOR COMMUNITY MEMBERS' HEALTH BY COMMUNITY STAKEHOLDERS IN INTERVIEWS. SECONDARY DATA ALSO SHOWED THAT 20% OF ADULTS IN THE PRIMARY SERVICE AREA RECEIVE NO LEISURE TIME PHYSICAL ACTIVITY.FACTORS WHICH HAVE SHOWN TO PROMOTE HEALTHY BEHAVIORS INCLUDE: EASY ACCESS TO NUTRITIOUS FOOD CLEAN AIR AND WATER SAFE TRANSPORTATION HEALTHY SPACES FOR WALKING, PLAYING AND SOCIALIZING SCHOOLS THAT EQUIP YOUTH WITH IMPORTANT HEALTH SKILLS HEALTH CARE THAT PREVENTS AS WELL AS TREATS REWARDS FOR HEALTHY BEHAVIORS OVER RISKY ONESTHE ABOVE FACTORS ARE DETERMINED BASED ON SHARED DECISIONS AND ACTIONS, NOT JUST INDIVIDUAL BEHAVIORS. THOSE WHO MUST HELP IMPLEMENT THESE DECISIONS WORK IN MANY FIELDS, EXTENDING FAR BEYOND THE HEALTH CARE SECTOR.2020 UPDATE: THE ADVENTHEALTH DURAND COMMUNITY HEALTH PLAN HAS TWO DESIRED GOAL STATEMENTS UNDER THE HEALTHY GROWTH, DEVELOPMENT AND OBESITY PRIORITY. 1. SPONSOR ANNUAL EVENTS FOR COMMUNITY MEMBERS THAT PROMOTE EXERCISE, ACTIVITY AND HEALTHY LIFESTYLE 2. EMPOWER COMMUNITY MEMBERS TO IMPROVE HEALTH OUTCOMES THROUGH EDUCATION GOAL 1: SPONSOR ANNUAL EVENTS FOR COMMUNITY MEMBERS THAT PROMOTE EXERCISE, ACTIVITY AND HEALTHY LIFESTYLE OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE FUNDING AND IN-KIND STAFF SUPPORT TO HOST ANNUAL "FUN RUNS" FOR CHILDREN, TEENAGERS AND ADULTS FOR A TOTAL OF THREE BY THE END OF YEAR THREE. THE INITIATIVE IS FUNDED THROUGH ADVENTHEALTH DURAND AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE HOSPITAL DID NOT MEET ITS SET METRIC IN 2020. IT ALSO DID NOT MEET THE SECOND METRIC FOR THE OBJECTIVE. DUE TO COVID-19, THE INITIATIVE WAS DELAYED AS A RESULT OF RESTRICTIONS ON IN-PERSON EVENTS. THE HOSPITAL PLANS TO CONTINUE WORK ON THIS INITIATIVE BY HOSTING THE "FUN RUN" EVENT IN JUNE 2021 AND AIMS TO PROVIDE THREE "FUN RUN" EVENTS BY THE END OF YEAR THREE. OBJECTIVE 2: THE SECOND OBJECTIVE IS TO HOST TWO HEALTH TALKS A YEAR FOCUSED ON EXERCISE, NUTRITION, AND HEALTHY COOKING FOR THE COMMUNITY FOR A TOTAL OF SIX BY THE END OF YEAR THREE. THE INITIATIVE IS FUNDED AND MANAGED THROUGH ADVENTHEALTH DURAND AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE INITIATIVE PROVIDES WELLNESS EDUCATION AT NO COST TO THE COMMUNITY. THESE HEALTH TALKS SPAN A VARIETY OF TOPICS TO ADDRESS THIS PRIORITY AREA. THE FIRST METRIC FOR THE OBJECTIVE WAS NOT MET, WITH TWO HEALTH TALKS A YEAR SET AND ZERO LECTURES HOSTED. IN 2020, THE HOSPITAL EXPERIENCED DELAYS ON THIS INITIATIVE BECAUSE OF COVID-19 SOCIAL DISTANCING RESTRICTIONS. THE HOSPITAL WILL CONTINUE TO WORK ON THE INITIATIVE BY HOSTING THE FIRST HEALTH TALK IN SEPTEMBER 2021. ALTHOUGH COVID-19 RESTRICTIONS HINDERED OUR ABILITY TO MEET OUR ANNUAL OBJECTIVES, THE HOSPITAL BELIEVES IT WILL BE ABLE TO MEET THE OVERALL OBJECTIVE OF SIX HEALTH CLASSES BY THE END OF YEAR THREE.GOAL 2: EMPOWER COMMUNITY MEMBERS TO IMPROVE HEALTH OUTCOMES THROUGH EDUCATION OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE FREE BIOMETRIC SCREENINGS FOR UP TO 100 COMMUNITY MEMBERS ANNUALLY. THE INITIATIVE IS DEPLOYED THROUGH ADVENTHEALTH DURAND AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE INITIATIVE PROVIDES WELLNESS EDUCATION AT NO COST TO THE COMMUNITY. THE HOSPITAL PLANS TO DISTRIBUTE 100 CARDS TO LOCAL COMMUNITY MEMBERS AND BUSINESSES TO SERVE AS A REFERRAL TO THE PROGRAM FOR BIOMETRIC SCREENINGS. THE FIRST METRIC FOR THE OBJECTIVE WAS NOT MET, WITH 100 COMMUNITY MEMBERS SERVED AS THE OBJECTIVE. IN 2020, THE HOSPITAL EXPERIENCED DELAYS ON THIS INITIATIVE BECAUSE OF COVID-19 SOCIAL DISTANCING RESTRICTIONS. THE HOSPITAL WILL CONTINUE TO WORK ON THE INITIATIVE BY PROVIDING BIOMETRIC SCREENINGS IN 2021.OBJECTIVE 2: THE SECOND OBJECTIVE IS TO REFER COMMUNITY MEMBERS WHEN APPROPRIATE TO FREE HOSPITAL SPONSORED CDC DIABETES PROGRAMS. THE INITIATIVE IS DEPLOYED THROUGH ADVENTHEALTH DURAND AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE INITIATIVE PROVIDES COMMUNITY MEMBERS IN NEED WITH ACCESS TO WELLNESS AND DIABETES PROGRAMMING TO EMPOWER THEM TO BETTER MANAGE THEIR CONDITION AND MAKE APPROPRIATE LIFESTYLE CHOICES. IN 2020, DUE TO COVID-19 SOCIAL DISTANCING RESTRICTIONS THE HOSPITAL WAS NOT ABLE TO PROVIDE REFERRALS AS CLASSES WERE NOT HELD IN ACCORDANCE WITH PUBLIC HEALTH GUIDELINES. COMMUNITY NEEDS NOT CHOSEN BY ADVENTHEALTH DURAND:THE PRIMARY AND SECONDARY DATA IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED MULTIPLE COMMUNITY ISSUES. THE HOSPITAL AND COMMUNITY STAKEHOLDERS USED THE FOLLOWING CRITERIA TO NARROW THE LARGER LIST TO THE PRIORITY AREAS NOTED ABOVE:1. HOW ACUTE IS THE NEED? (BASED ON DATA AND COMMUNITY CONCERN)2. WHAT IS THE TREND? IS THE NEED GETTING WORSE?3. DOES THE HOSPITAL PROVIDE SERVICES THAT RELATE TO THE PRIORITY? 4. IS SOMEONE ELSE - OR MULTIPLE GROUPS - IN THE COMMUNITY ALREADY WORKING ON THIS ISSUE? 5. IF THE HOSPITAL WERE TO ADDRESS THIS ISSUE, ARE THERE OPPORTUNITIES TO WORK WITH COMMUNITY PARTNERS? BASED ON THIS PRIORITIZATION PROCESS, THE HOSPITAL DID NOT CHOOSE THE FOLLOWING COMMUNITY ISSUES: 1. SUBSTANCE USE/ABUSE : THE CHNAC AGREED THAT THE ISSUES OF ALCOHOL ABUSE, ELECTRONIC SMOKING, ILLEGAL DRUGS AND TOBACCO USE WERE ALL IMPORTANT ISSUES BASED ON BOTH PRIMARY AND SECONDARY DATA AS WELL AS GROUP DISCUSSIONS. THE TERM SUBSTANCE USE/ABUSE WAS UTILIZED TO ENCOMPASS VARIOUS FORMS OF USE OR MISUSE. THE COMMUNITY ASSET INVENTORY IDENTIFIED EXISTING COMMUNITY-BASED EFFORTS ALREADY IN PLACE TO ADDRESS THESE ISSUES. THESE INCLUDE THE PEPIN AND BUFFALO COUNTY JUSTICE SERVICES, WHICH HELPS LOW-RISK CRIME OFFENDERS WITH ALCOHOL/SUBSTANCE ABUSE. IN ADDITION, THE PEPIN COUNTY HEALTH DEPARTMENT HAS PARTNERED WITH THE SCHOOL DISTRICT TO ADDRESS SUBSTANCE USE AND MISUSE. THE HOSPITAL WILL CONTINUE TO DIRECT COMMUNITY MEMBERS TO AVAILABLE RESOURCES IN THE COMMUNITY. 2. MENTAL HEALTH: EAU CLAIRE AND CHIPPEWA COUNTY BOTH PROVIDE INPATIENT AND OUTPATIENT MENTAL HEALTH SERVICES THROUGH CHIPPEWA COUNTY RECOVERY & WELLNESS CONSORTIUM. THE CONSORTIUM CONNECTS INDIVIDUALS EXPERIENCING A MENTAL HEALTH EMERGENCY, MENTAL ILLNESS, AND/OR SUBSTANCE USE DISORDER WITH NECESSARY SERVICES SUCH AS PSYCHIATRY, MENTAL HEALTH AND SUBSTANCE ABUSE COUNSELING, SUPPORTED EMPLOYMENT, AND INDIVIDUAL SKILL DEVELOPMENT. THE HOSPITAL FELT THAT THESE EXISTING RESOURCES AND PARTNERS WERE BETTER EQUIPPED TO ADDRESS THE ISSUE OF MENTAL HEALTH. THE HOSPITAL IS COMMITTED TO WHOLE PERSON HEALTH AND WILL CONTINUE TO DIRECT THE COMMUNITY TO AVAILABLE RESOURCES. |
| PART V, SECTION B, LINE 10A | URL FOR THE HOSPITAL FACILITY'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY: HTTPS://WWW.ADVENTHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS |
| SCHEDULE H, PART V, SECTION B, LINE 16A,B,C: | THE FINANCIAL ASSISTANCE POLICY CAN BE FOUND AT URL:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCETHE FINANCIAL ASSISTANCE POLICY APPLICATION CAN BE FOUND AT:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCETHE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCE |
| PART V, SECTION B, LINE 7A: | URL FOR THE HOSPITAL FACILITY'S MOST RECENT CHNA: HTTPS://WWW.ADVENTHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A: | THE FILING ORGANIZATION WAS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) DURING ITS CURRENT TAX YEAR. DURING THE CURRENT YEAR, AHSSHC SERVED AS A PARENT ORGANIZATION TO 29 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS AND A NUMBER OF OTHER HEALTH CARE FACILITIES THAT OPERATED IN 10 STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS "ADVENTHEALTH".ALL HOSPITAL ORGANIZATIONS WITHIN ADVENTHEALTH COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. ADVENTHEALTH ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. ADVENTHEALTH HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. EACH ADVENTHEALTH HOSPITAL FACILITY REPORTS THEIR COMMUNITY BENEFITS TO THEIR BOARD OF DIRECTORS AND STRIVES TO COMMUNICATE THEIR COMMUNITY BENEFITS TO THEIR LOCAL COMMUNITIES. ADDITIONALLY, THE FILING ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY CAN BE ACCESSED ON THE FILING ORGANIZATION'S WEBSITE. |
| PART I, LINE 7: | THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. |
| PART III, LINE 2: | THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON LINE 2 OF SECTION A OF PART III IS RECORDED IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO REVENUE, NOT BAD DEBT EXPENSE. |
| PART III, LINE 3: | METHODOLOGY FOR DETERMINING THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT MAY REPRESENT PATIENTS WHO COULD HAVE QUALIFIED UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY:SELF-PAY PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE BY COMPLETING A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM). IF AN INDIVIDUAL DOES NOT SUBMIT A COMPLETE FAA FORM WITHIN 240 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL, AN INDIVIDUAL MAY BE CONSIDERED FOR PRESUMPTIVE ELIGIBILITY BASED UPON A SCORING TOOL THAT IS DESIGNED TO CLASSIFY PATIENTS INTO GROUPS OF VARYING ECONOMIC MEANS. THE SCORING TOOL USES ALGORITHMS THAT INCORPORATE DATA FROM CREDIT BUREAUS, DEMOGRAPHIC DATABASES, AND HOSPITAL SPECIFIC DATA TO INFER AND CLASSIFY PATIENTS INTO RESPECTIVE ECONOMIC MEANS CATEGORIES. INDIVIDUALS WHO EARN A CERTAIN SCORE ON THE SCORING TOOL ARE CONSIDERED TO QUALIFY AS ELIGIBLE FOR THE MOST GENEROUS FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. AS DETERMINED BY THE FILING ORGANIZATION, A NOMINAL AMOUNT OF SUCH A PATIENT'S BILL IS WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED NON-STATE CHARITY. THE AMOUNT WRITTEN OFF AS BAD DEBT EXPENSE FOR THOSE PATIENTS WHO POTENTIALLY QUALIFY AS NON-STATE CHARITY USING THE SCORING TOOL IS THE AMOUNT SHOWN ON LINE 3 OF SECTION A OF PART III. RATIONALE FOR INCLUDING CERTAIN BAD DEBTS IN COMMUNITY BENEFIT:THE FILING ORGANIZATION IS DEDICATED TO THE VIEW THAT MEDICALLY NECESSARY HEALTH CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS SHOULD BE ACCESSIBLE TO ALL, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, CULTURAL BACKGROUND, PHYSICIAN MOBILITY, OR ABILITY TO PAY. THE FILING ORGANIZATION TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THE AVAILABILITY OF THIRD-PARTY COVERAGE. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE FILING ORGANIZATION IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. AS A 501(C)(3) HOSPITAL ORGANIZATION, THE FILING ORGANIZATION MAINTAINS A 24/7 EMERGENCY ROOM PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION CANNOT BE MADE BASED UPON INFORMATION SUPPLIED BY THE INDIVIDUAL. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. |
| PART III, LINE 4: | FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGES 8-9. PLEASE NOTE THAT DOLLAR AMOUNTS ON THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE IN THOUSANDS. |
| PART III, LINE 8: | COSTING METHODOLOGY: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. |
| PART III, LINE 9B: | THE HOSPITAL FILING ORGANIZATION'S COLLECTION PRACTICES ARE IN CONFORMITY WITH THE REQUIREMENTS SET FORTH IN THE 2014 FINAL REGULATIONS REGARDING THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(R)(4) - (R)(6). NO EXTRAORDINARY COLLECTION ACTIONS (ECA'S) ARE INITIATED BY THE HOSPITAL FILING ORGANIZATION IN THE 120-DAY PERIOD FOLLOWING THE DATE AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL (OR, IF LATER, THE SPECIFIED DEADLINE GIVEN IN A WRITTEN NOTICE OF ACTIONS THAT MAY BE TAKEN, AS DESCRIBED BELOW). INDIVIDUALS ARE PROVIDED WITH AT LEAST ONE WRITTEN NOTICE (NOTICE OF ACTIONS THAT MAY BE TAKEN) AND A COPY OF THE FILING ORGANIZATION'S PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY THAT INFORMS THE INDIVIDUAL THAT THE HOSPITAL FILING ORGANIZATION MAY TAKE ACTIONS TO REPORT ADVERSE INFORMATION TO CREDIT REPORTING AGENCIES/BUREAUS IF THE INDIVIDUAL DOES NOT SUBMIT A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM) OR PAY THE AMOUNT DUE BY A SPECIFIED DEADLINE. THE SPECIFIED DEADLINE IS NOT EARLIER THAT 120 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL AND IS AT LEAST 30 DAYS AFTER THE NOTICE IS PROVIDED. A REASONABLE ATTEMPT IS ALSO MADE TO ORALLY NOTIFY AN INDIVIDUAL ABOUT THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FAA FORM DURING THE 240-DAY PERIOD FOLLOWING THE DATE ON WHICH THE FIRST POST-DISCHARGE BILLING STATEMENT WAS SENT TO THE INDIVIDUAL, THE HOSPITAL FILING ORGANIZATION SUSPENDS ANY REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS (OR CEASES ANY OTHER ECA'S) AND PROVIDES A WRITTEN NOTICE TO THE INDIVIDUAL DESCRIBING WHAT ADDITIONAL INFORMATION OR DOCUMENTATION IS NEEDED TO COMPLETE THE FAA FORM. THIS WRITTEN NOTICE CONTAINS CONTACT INFORMATION INCLUDING THE TELEPHONE NUMBER AND PHYSICAL LOCATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY, AS WELL AS CONTACT INFORMATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS OR, ALTERNATIVELY, A NONPROFIT ORGANIZATION OR GOVERNMENTAL AGENCY THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS IF THE HOSPITAL FACILITY IS UNABLE TO DO SO. IF AN INDIVIDUAL SUBMITS A COMPLETE FAA FORM WITHIN A REASONABLE TIME-PERIOD AS SET FORTH IN THE NOTICE DESCRIBED ABOVE, THE HOSPITAL FILING ORGANIZATION WILL SUSPEND ANY ADVERSE REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS UNTIL A FINANCIAL ASSISTANCE POLICY ELIGIBILITY DETERMINATION CAN BE MADE. |
| SUPPLEMENTAL SCHEDULE TO SCHEDULE H, PART III, SECTION B, LINE 8 | RECONCILIATION OF SCHEDULE H REPORTED MEDICARE SURPLUS/(SHORTFALL) TO UNREIMBURSED MEDICARE COSTS ASSOCIATED WITH THE PROVISION OF SERVICESTO ALL MEDICARE BENEFICIARIES:THE MEDICARE REVENUE AND ALLOWABLE COSTS OF CARE REPORTED IN SECTION B OF PART III OF SCHEDULE H ARE BASED UPON THE AMOUNTS REPORTED IN THE FILING ORGANIZATION'S MEDICARE COST REPORT IN ACCORDANCE WITH THE IRS INSTRUCTIONS FOR SCHEDULE H. ON AN ANNUAL BASIS, THE FILING ORGANIZATION ALSO DETERMINES ITS TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS. UNREIMBURSED COSTS ARE CONSIDERED A COMMUNITY BENEFIT TO THE ELDERLY AND ARE COMBINED INTO AN ANNUAL COMMUNITY BENEFIT STATEMENT PREPARED BY ADVENTHEALTH. THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO ALL MEDICARE PATIENTS ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ 77,753- DIFFERENCE IN COSTING METHODOLOGY: 1,311,849- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (1,958,492) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITYBENEFIT REPORTING $ (568,890)AS INDICATED ABOVE, THE PRIMARY DIFFERENCES BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) REPORTED ON SCHEDULE H, PART III, SECTION B, LINE 7 AND THE FILING ORGANIZATION'S PORTION OF THE COMPANY'S ANNUAL COMMUNITY BENEFIT STATEMENT IS DUE TO A DIFFERENCE IN THE COSTING METHODOLOGY AND DIFFERENCES IN THE POPULATION OF MEDICARE PATIENTS WITHIN THE CALCULATION. THE COST METHODOLOGY UTILIZED IN CALCULATING ANY MEDICARE SURPLUS/(SHORTFALL) FOR PURPOSES OF THE ANNUAL COMMUNITY BENEFIT REPORTING IS BASED UPON THE COST-TO-CHARGE RATIO OUTLINED IN WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE SAME COST-TO-CHARGE RATIO IS USED TO DETERMINE THE COSTS ASSOCIATED WITH SERVICES PROVIDED TO CHARITY CARE PATIENTS AND MEDICAID PATIENTS AS REPORTED IN SCHEDULE H, PART I, LINE 7. IN ADDITION, THE MEDICARE COST REPORT EXCLUDES SERVICES PROVIDED TO MEDICARE PATIENTS FOR PHYSICIAN SERVICES, SERVICES PROVIDED TO PATIENTS ENROLLED IN MEDICARE HMOS, AND CERTAIN SERVICES PROVIDED BY OUTPATIENT DEPARTMENTS OF THE FILING ORGANIZATION THAT ARE REIMBURSED ON A FEE SCHEDULE. THE COMPANY'S OWN COMMUNITY BENEFIT STATEMENT CAPTURES THE UNREIMBURSED COST OF PROVIDING SERVICES TO ALL MEDICARE BENEFICIARIES THROUGHOUT THE ORGANIZATION. |
| PART VI, LINE 2: | THE HOSPITAL CONDUCTS COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) EVERY THREE YEARS. ITS 2019 CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2019, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S 2019 CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN FINAL REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY.SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY. |
| PART VI, LINE 3: | THE FINANCIAL ASSISTANCE POLICY (FAP), FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM), AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) OF THE FILING ORGANIZATION'S HOSPITAL FACILITY ARE TRANSPARENT AND AVAILABLE TO ALL INDIVIDUALS SERVED AT ANY POINT IN THE CARE CONTINUUM. THE FAP, FAA FORM, PLS, AND CONTACT INFORMATION FOR THE HOSPITAL FACILITY'S FINANCIAL COUNSELORS ARE PROMINENTLY AND CONSPICUOUSLY POSTED ON THE FILING ORGANIZATION'S HOSPITAL FACILITY'S WEBSITE. THE WEBSITE INDICATES THAT A COPY OF THE FAP, FAA FORM, AND PLS IS AVAILABLE AND HOW TO OBTAIN SUCH COPIES IN THE PRIMARY LANGUAGES OF ANY POPULATIONS WITH LIMITED PROFICIENCY IN ENGLISH THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY (REFERRED TO BELOW AS LEP DEFINED POPULATIONS). SIGNAGE IS DISPLAYED IN PUBLIC LOCATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, INCLUDING AT ALL POINTS OF ADMISSION AND REGISTRATION AND THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE HOSPITAL FACILITY'S WEBSITE ADDRESS WHERE THE FAP, FAA FORM, AND PLS CAN BE ACCESSED AND THE TELEPHONE NUMBER AND PHYSICAL LOCATION THAT INDIVIDUALS CAN CALL OR VISIT TO OBTAIN COPIES OF THE FAP, FAA FORM AND PLS OR TO OBTAIN MORE INFORMATION ABOUT THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS. PAPER COPIES OF THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. PAPER COPIES ARE MADE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGES OF ANY LEP DEFINED POPULATIONS. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A PAPER COPY OF THE HOSPITAL FACILITY'S PLS WILL BE OFFERED TO EVERY PATIENT AS A PART OF THE INTAKE OR DISCHARGE PROCESS. A CONSPICUOUS WRITTEN NOTICE IS INCLUDED ON ALL BILLING STATEMENTS SENT TO PATIENTS THAT NOTIFIES AND INFORMS RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, INCLUDING THE FOLLOWING: 1) THE TELEPHONE NUMBER OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND THE FAA FORM; AND 2) THE WEBSITE ADDRESS WHERE COPIES OF THE FAP, FAA FORM AND PLS MAY BE OBTAINED. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE. COPIES OF THE PLS ARE DISTRIBUTED TO MEMBERS OF THE COMMUNITY IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | THE FILING ORGANIZATION IS LOCATED IN RURAL DURAND, WISCONSIN. IT CURRENTLY OPERATES A HOSPITAL FACILITY AND IS LICENSED FOR 25 ACUTE CARE BEDS WHICH ARE APPROVED AS "SWING BEDS" FOR LONG TERM CARE. CHIPPEWA VALLEY HOSPITAL (THE HOSPITAL) IS A CRUCIAL COMMUNITY AND REGIONAL ASSET. IT IS THE ONLY HOSPITAL IN PEPIN COUNTY, WISCONSIN WITH THE CLOSEST HOSPITAL BEING 20 OR MORE MILES AWAY. DURING 2020, THE HOSPITAL'S PATIENT PERCENTAGE POPULATION WAS MADE UP OF THE BELOW PAYORS WITH THE REMAINING PERCENTAGE OF THE PATIENTS BEING COVERED UNDER COMMERCIAL INSURANCE. IN 2020, ABOUT 45.6% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. - MEDICARE PATIENTS 62.1% - MEDICAID PATIENTS 8.6% - SELF-PAY PATIENTS 2.0% THE DEMOGRAPHIC MAKEUP OF THE HOSPITAL'S SERVICE AREA IS AS FOLLOWS: - POPULATION 366,192 - POPULATION OVER 65 18.63% - POVERTY (BELOW 100% FPL) 12.6% - UNEMPLOYMENT RATE 6.6% - VIOLENT CRIME RATE (PER 100,000 POP.) 79.8 - POP. AGE 25+ WITH NO HIGH SCHOOL DIPLOMA 9.2% - UNINSURED ADULTS 7.83% - UNINSURED CHILDREN 5.45% - FOOD INSECURITY RATE 11.3% - POP. WITH LOW FOOD ACCESS 6.4% |
| PART VI, LINE 5: | THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO CHIPPEWA VALLEY HOSPITAL'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT AND COMMUNITY BUILDING INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE HOSPITAL EXPENDED $658,314 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. |
| PART VI, LINE 6: | CHIPPEWA VALLEY HOSPITAL IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTHEALTH. AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 48 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 11 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AS THE PARENT ORGANIZATION OF ADVENTHEALTH, AHSSHC PROVIDES EXECUTIVE LEADERSHIP AND OTHER PROFESSIONAL SUPPORT SERVICES TO ITS SUBSIDIARY ORGANIZATIONS. PROFESSIONAL SUPPORT SERVICES INCLUDE AMONG OTHERS IT, CORPORATE COMPLIANCE, LEGAL, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. CERTAIN SUPPORT SERVICES, SUCH AS HUMAN RESOURCES, PAYROLL, A/P, AND SUPPLY CHAIN MANAGEMENT ARE PROVIDED PURSUANT TO A SHARED SERVICES MODEL BY AHSSHC TO ITS SUBSIDIARY ORGANIZATIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH ADVENTHEALTH SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. EACH AHS SUBSIDIARY PAYS A MANAGEMENT FEE TO AHSSHC FOR THE INTERNAL SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY AN ADVENTHEALTH SUBSIDIARY ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY BY ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF ADVENTHEALTH AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEB-SITE OF ADVENTHEALTH AT WWW.ADVENTHEALTH.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF ADVENTHEALTH. |
| PART VI, LINE 7: | THE FILING ORGANIZATION DOES NOT FILE AN ANNUAL COMMUNITY BENEFIT REPORT WITH ANY STATE AGENCIES. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Discretionary Spending Acct | Yes (X) | DiscretionarySpendingAcctInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HUENERGARDT SAMUEL | ||||||||||||||
| CHAIRMAN/DIRECTOR | $0 | $656,404 | $0 | $186,731 | $0 | $53,535 | $0 | $100,531 | $0 | $43,649 | $0 | $1,040,850 | $0 | $20,458 |
| RANDOLPH KARSTEN | ||||||||||||||
| DIRECTOR | $0 | $400,598 | $0 | $114,177 | $0 | $49,400 | $0 | $36,310 | $0 | $42,186 | $0 | $642,671 | $0 | $17,917 |
| PETERSON DOUGLAS | ||||||||||||||
| DIRECTOR/CEO | $0 | $208,176 | $0 | $55,897 | $0 | $69,151 | $0 | $14,043 | $0 | $31,436 | $0 | $378,703 | $0 | $9,859 |
| RUCKER MD KENNETH | ||||||||||||||
| PHYSICIAN | $293,207 | $0 | $0 | $0 | $14,702 | $0 | $15,320 | $0 | $17,380 | $0 | $340,609 | $0 | $0 | $0 |
| DOHLMAN MD ROBERT | ||||||||||||||
| DIRECTOR | $223,705 | $0 | $0 | $0 | $7,898 | $0 | $11,891 | $0 | $16,451 | $0 | $259,945 | $0 | $0 | $0 |
| HUNT MD THOMAS | ||||||||||||||
| PHYSICIAN | $197,541 | $0 | $15,000 | $0 | $6,855 | $0 | $11,192 | $0 | $21,735 | $0 | $252,323 | $0 | $0 | $0 |
| MENTELE ANTON | ||||||||||||||
| MID-LEVEL CRNA | $196,598 | $0 | $0 | $0 | $2,705 | $0 | $9,927 | $0 | $26,222 | $0 | $235,452 | $0 | $0 | $0 |
| HARMAT BEEBE | ||||||||||||||
| CFO (BEG 3/20) | $0 | $166,119 | $0 | $13,108 | $0 | $1,587 | $0 | $6,557 | $0 | $34,425 | $0 | $221,796 | $0 | $0 |
| POESCHEL JANE | ||||||||||||||
| FNPC | $153,852 | $0 | $0 | $0 | $11,485 | $0 | $7,884 | $0 | $18,835 | $0 | $192,056 | $0 | $0 | $0 |
| JACOBSON ANGELA | ||||||||||||||
| DIRECTOR OF NURSING | $101,363 | $0 | $9,612 | $0 | $8,718 | $0 | $5,582 | $0 | $27,434 | $0 | $152,709 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTHEALTH. MEMBERS OF THE FILING ORGANIZATION'S EXECUTIVE MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF THE HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). THE FILING ORGANIZATION REIMBURSES AHSSHC FOR THE SALARY AND BENEFIT COST OF THOSE EXECUTIVES ON THE PAYROLL OF AHSSHC. AT THE DIRECTION OF AHSSHC, AND IN ACCORDANCE WITH THE RESERVED POWERS IN THE FILING ORGANIZATION'S GOVERNING DOCUMENTS, THE EXECUTIVE TEAM LISTED ON PART VII PROVIDES SERVICES TO THE FILING ORGANIZATION. TRAVEL FOR COMPANIONS: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING AHSSHC EXECUTIVE TO HAVE HIS OR HER SPOUSE ACCOMPANY THE EXECUTIVE ON CERTAIN BUSINESS TRIPS EACH YEAR. TYPICALLY, REIMBURSEMENT IS ONLY PROVIDED TO CERTAIN EXECUTIVE LEADERS AND IS USUALLY LIMITED TO ONE BUSINESS TRIP PER YEAR BEYOND THE ANNUAL ADVENTHEALTH PRESIDENT'S COUNCIL BUSINESS MEETING AND OTHER MEETINGS WHERE THE SPOUSE IS SPECIFICALLY INVITED. THE AHSSHC CORPORATE EXECUTIVE SPOUSAL TRAVEL POLICY WAS ORIGINALLY APPROVED AND REVIEWED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. ALL SPOUSAL TRAVEL COSTS REIMBURSED TO THE EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: ADVENTHEALTH HAS A SYSTEM-WIDE POLICY ADDRESSING GROSS-UP PAYMENTS PROVIDED IN CONNECTION WITH EMPLOYER-PROVIDED BENEFITS/OTHER TAXABLE ITEMS. UNDER THE POLICY, CERTAIN TAXABLE BUSINESS-RELATED REIMBURSEMENTS (I.E. TAXABLE BUSINESS-RELATED MOVING EXPENSES, TAXABLE ITEMS PROVIDED IN CONNECTION WITH EMPLOYMENT) PROVIDED TO ANY EMPLOYEE MAY BE GROSSED-UP AT A 25% RATE UPON APPROVAL BY THE FILING ORGANIZATION'S CEO AND CFO. ADDITIONALLY, EMPLOYEES AT THE DIRECTOR LEVEL AND ABOVE ARE ELIGIBLE FOR GROSS-UP PAYMENTS ON GIFTS RECEIVED FOR BOARD OF DIRECTOR SERVICES. DISCRETIONARY SPENDING ACCOUNT: OCCASIONAL DISCRETIONARY SPENDING AMOUNTS ARE PERIODICALLY PROVIDED TO ELIGIBLE EXECUTIVES WHO ATTEND ANNUAL BUSINESS MEETINGS SUCH AS THE ADVENTHEALTH PRESIDENT'S COUNCIL, CFO CONFERENCE OR THE CMO/CNO BUSINESS MEETING. PAYMENTS PROVIDED TO EACH EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. |
| PART I, LINE 3 | THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS APPOINTED AND COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC HAS TAKEN STEPS TO ENSURE THAT PROCESSES ARE IN PLACE TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS STANDARD AS SET FORTH IN TREASURY REGULATION 53.4958-6 WITH RESPECT TO ITS ACTIVE EXECUTIVE-LEVEL POSITIONS. THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE) SERVES AS THE GOVERNING BODY FOR ALL EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE IS COMPOSED OF CERTAIN MEMBERS OF THE BOARD OF DIRECTORS (THE BOARD) OF AHSSHC. VOTING MEMBERS OF THE COMMITTEE INCLUDE ONLY INDIVIDUALS WHO SERVE ON THE BOARD AS INDEPENDENT REPRESENTATIVES OF THE COMMUNITY, WHO HOLD NO EMPLOYMENT POSITIONS WITH AHSSHC AND WHO DO NOT HAVE RELATIONSHIPS WITH ANY OF THE INDIVIDUALS WHOSE COMPENSATION IS UNDER THEIR REVIEW THAT IMPACTS THEIR BEST INDEPENDENT JUDGMENT AS FIDUCIARIES OF AHSSHC. THE COMMITTEE'S ROLE IS TO REVIEW AND APPROVE ALL COMPONENTS OF THE EXECUTIVE COMPENSATION PLAN OF AHSSHC. AS AN INDEPENDENT GOVERNING BODY WITH RESPECT TO EXECUTIVE COMPENSATION, IT SHOULD BE NOTED THAT THE COMMITTEE WILL OFTEN CONFER IN EXECUTIVE SESSIONS ON MATTERS OF COMPENSATION POLICY AND POLICY CHANGES. IN SUCH EXECUTIVE SESSIONS, NO MEMBERS OF MANAGEMENT OF AHSSHC ARE PRESENT. THE COMMITTEE IS ADVISED BY AN INDEPENDENT THIRD-PARTY COMPENSATION ADVISOR. THIS ADVISOR PREPARES ALL THE BENCHMARK STUDIES FOR THE COMMITTEE. COMPENSATION LEVELS ARE BENCHMARKED WITH A NATIONAL PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS OF SIMILAR SIZE AND COMPLEXITY TO ADVENTHEALTH AND EACH OF ITS AFFILIATED ENTITIES. THE FOLLOWING PRINCIPLES GUIDE THE ESTABLISHMENT OF INDIVIDUAL EXECUTIVE COMPENSATION: - THE SALARY OF THE PRESIDENT/CEO OF ADVENTHEALTH WILL NOT EXCEED THE 50TH PERCENTILE OF COMPARABLE SALARIES PAID BY SIMILARLY SITUATED ORGANIZATIONS; AND - OTHER EXECUTIVE SALARIES SHALL BE ESTABLISHED USING MARKET MEDIANS. THE COMPENSATION PHILOSOPHY, POLICIES, AND PRACTICES OF AHSSHC ARE CONSISTENT WITH THE ORGANIZATION'S FAITH-BASED MISSION AND CONFORM TO APPLICABLE LAWS, REGULATIONS, AND BUSINESS PRACTICES. AS A FAITH-BASED ORGANIZATION SPONSORED BY THE SEVENTH-DAY ADVENTIST CHURCH (THE CHURCH), AHSSHC'S PHILOSOPHY AND PRINCIPLES WITH RESPECT TO ITS EXECUTIVE COMPENSATION PRACTICES REFLECT THE CONSERVATIVE APPROACH OF THE CHURCH'S MISSION OF SERVICE AND WERE DEVELOPED IN COUNSEL WITH THE CHURCH'S LEADERSHIP. |
| PART I, LINE 4B | AS DISCUSSED IN LINE 1A ABOVE, EXECUTIVES ON THE FILING ORGANIZATION'S MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF THE HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. IN RECOGNITION OF THE CONTRIBUTION THAT EACH EXECUTIVE MAKES TO THE SUCCESS OF ADVENTHEALTH, ADVENTHEALTH PROVIDES SUPPLEMENTAL EXECUTIVE BENEFIT PLANS TO ELIGIBLE EXECUTIVES. IN 2020, ADVENTHEALTH RESTRUCTURED ITS EXECUTIVE SUPPLEMENTAL RETIREMENT AND BENEFIT PLANS TO REDUCE COMPLEXITY, TO INCREASE PREDICTABILITY OF BENEFITS AND TO CONSOLIDATE MULTIPLE SUPPLEMENTAL EXECUTIVE BENEFIT PLANS INTO ONE PLAN. EFFECTIVE 1/1/2020, A NEW SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP III) WAS ADOPTED AND THE THREE EXISTING PLANS, DESCRIBED BELOW, WERE AMENDED AND RESTATED. THE NEWLY ADOPTED SERP III PLAN, AS WELL AS THE AMENDED AND RESTATED PLANS, WERE REVIEWED AND APPROVED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. SERP III PLAN (EFFECTIVE 1/1/2020): TO RECOGNIZE THE CONTRIBUTION EACH EXECUTIVE MAKES TO THE SUCCESS OF ADVENTHEALTH AND TO RECOGNIZE THE LIMITATIONS AVAILABLE TO EXECUTIVES IN QUALIFIED RETIREMENT PLANS DUE TO COMPENSATION LIMITS SET ON SUCH PLANS, ADVENTHEALTH ADOPTED A NEW SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP III) IN 2020. THE SERP III PLAN EFFECTIVELY REPLACES THE PRIOR SERP II PLAN, THE EXECUTIVE FLEX BENEFIT PROGRAM PLAN, AND THE SENIOR EXECUTIVE DEATH BENEFIT PLAN FOR QUALIFIED EXECUTIVES EXCEPT FOR CERTAIN GRANDFATHERED EXECUTIVE EMPLOYEES. THE SERP III PLAN PROVIDES ELIGIBLE EXECUTIVES A PERCENTAGE OF THEIR BASE PAY, WHICH IS CREDITED TO A DEFERRED COMPENSATION ACCOUNT. THE PLAN ALSO PROVIDES FOR COMPENSATION DEFERRAL AND SELECTION OF LIFE INSURANCE COVERAGE AND LONG-TERM CARE INSURANCE. TO BE ELIGIBLE TO PARTICIPATE IN THE SERP III PLAN, EXECUTIVES MUST BE ON THE AHSSHC CORPORATE PAYROLL AND BE EITHER A CEO OF AN ADVENTHEALTH ENTITY, AN AHSSHC VICE PRESIDENT (VP) OR VP OF AN ADVENTHEALTH ENTITY WITH A BASE SALARY OF AT LEAST $285,000 IN 2020 (ADJUSTED ANNUALLY BY THE SAME PERCENTAGE AS IRC SECTION 401(A)(17) LIMIT INCREASES), OR OTHER LEADER SPECIFICALLY APPROVED BY THE ADVENTHEALTH PRESIDENT. ELIGIBLE EXECUTIVES DO NOT INCLUDE GRANDFATHERED EXECUTIVES, MEANING THOSE EXECUTIVES WHO WOULD SATISFY ALL THE ELIGIBILITY REQUIREMENTS OF THE SERP II PLAN PRIOR TO DEC 31, 2027, HAD THE PLAN NOT BEEN AMENDED AND RESTATED AS OF JAN. 1, 2020. CONTRIBUTION CREDITS WILL BE ESTABLISHED AND MAINTAINED BY CLASS YEAR ACCOUNTS FOR EACH PARTICIPANT USING TIERED CONTRIBUTION CREDIT PERCENTAGES OF ANNUAL BASE COMPENSATION. CONTRIBUTION CREDIT PERCENTAGES RANGE BETWEEN 15% AND 19% OF BASE COMPENSATION. CONTRIBUTION CREDITS WILL BE MADE EACH QUARTER IN 25% INCREMENTS WITH REDUCTIONS IN CONTRIBUTIONS IF THE EXECUTIVE IS ALSO A GRANDFATHERED FLEX PARTICIPANT (SEE BELOW). SERP III PROVIDES FOR A CLASS YEAR VESTING AND PAYMENT SCHEDULE (7 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S DEFERRED COMPENSATION ACCOUNT. UPON ATTAINMENT OF A NORMAL RETIREMENT AGE (AGE 62), OR UPON CERTAIN OTHER CIRCUMSTANCES AS DEFINED IN THE SERP III PLAN DOCUMENT, ALL DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT. FOR ANY EXECUTIVES WORKING BEYOND THE NORMAL RETIREMENT AGE, FUTURE EMPLOYER CONTRIBUTIONS WILL BE MADE QUARTERLY FROM SERP III DIRECTLY TO THE PARTICIPANT AS A TAXABLE CASH BONUS. SERP II PLAN (AMENDED AND RESTATED IN 2020): IN 2020, THE SERP II PLAN WAS AMENDED AND RESTATED TO PROVIDE THAT ELIGIBLE EMPLOYEES ARE RESTRICTED TO THOSE EXECUTIVES WHO, AS OF JANUARY 1, 2020, SATISFIED, OR IF EMPLOYMENT CONTINUES, WILL SATISFY THE ELIGIBILITY REQUIREMENTS OF SERP II PRIOR TO DECEMBER. 31, 2027. THE SERP II PLAN IS A DEFINED BENEFIT, NON-TAX-QUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN EXECUTIVES WHO HAVE PROVIDED LENGTHY SERVICE TO ADVENTHEALTH AND/OR TO OTHER SEVENTH-DAY ADVENTIST CHURCH HOSPITALS OR HEALTH CARE INSTITUTIONS. UNDER THE PROVISIONS OF THE SERP II PLAN, BENEFITS ARE PROVIDED TO QUALIFYING EXECUTIVE PARTICIPANTS ON A PRO-RATA SCHEDULE BEGINNING WITH 20 YEARS OF SERVICE AS AN EMPLOYEE OF ADVENTHEALTH AND/OR ANOTHER HOSPITAL OR HEALTH CARE INSTITUTION CONTROLLED BY THE SEVENTH-DAY ADVENTIST CHURCH AND WHO SATISFY CERTAIN OTHER QUALIFYING CRITERIA. THIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP II) WAS DESIGNED TO PROVIDE ELIGIBLE EXECUTIVES WITH THE ECONOMIC EQUIVALENT OF AN ANNUAL INCOME BEGINNING AT NORMAL RETIREMENT AGE EQUAL TO 60% OF THE AVERAGE OF THE PARTICIPANT'S THREE, FIVE OR SEVEN HIGHEST YEARS OF BASE SALARY FROM ADVENTHEALTH ACTIVE EMPLOYMENT INCLUSIVE OF INCOME FROM ALL OTHER SEVENTH-DAY ADVENTIST CHURCH HEALTHCARE EMPLOYER-FINANCED RETIREMENT INCOME SOURCES AND INVESTMENT INCOME EARNED ON THOSE CONTRIBUTIONS THROUGH SOCIAL SECURITY NORMAL RETIREMENT AGE AS DEFINED IN THE PLAN. THE NUMBER OF YEARS INCLUDED IN HIGHEST AVERAGE COMPENSATION IS DETERMINED BY THE INDIVIDUAL'S YEAR OF ENTRY TO SERP II AND BY THE INDIVIDUAL'S YEAR OF ENTRY TO THE ADVENTHEALTH EXECUTIVE FLEX BENEFIT PROGRAM. FLEX PLAN (AMENDED AND RESTATED IN 2020): IN 2020, THE FLEX PLAN WAS AMENDED AND RESTATED TO EXCLUDE EMPLOYED EXECUTIVES WHO ARE HIRED OR PROMOTED AFTER A CERTAIN DATE FROM BEING ELIGIBLE TO PARTICIPATE IN THE FLEX PLAN EXCEPT FOR CERTAIN INSURANCE COVERAGE FEATURES OF THE PLAN. ADDITIONALLY, A PROVISION WAS ADDED TO PLACE A MAXIMUM LIMIT ON THE AMOUNT OF A PARTICIPANT'S ANNUAL FLEX ALLOWANCE TO NOT BE GREATER THAN A MAXIMUM DOLLAR AMOUNT OR PERCENTAGE OF COMPENSATION AS ESTABLISHED BY THE ADVENTHEALTH BENEFITS ADMINISTRATION COMMITTEE. THE FLEX PLAN WAS ORIGINALLY DESIGNED TO PROVIDE ELIGIBLE EXECUTIVES AN OPPORTUNITY TO SELECT FROM AMONG A VARIETY OF SUPPLEMENTAL BENEFITS, INCLUDING A SPLIT DOLLAR LIFE INSURANCE POLICY AND LONG-TERM CARE INSURANCE, TO INDIVIDUALLY TAILOR A BENEFITS PROGRAM APPROPRIATE TO EACH EXECUTIVE'S NEEDS. THE FLEX PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS IS DEDUCTED. THE BENEFITS ALLOWANCE CREDIT PERCENTAGE IS DETERMINED BY THE ADVENTHEALTH BENEFITS ADMINISTRATION COMMITTEE. FOR GRANDFATHERED ELIGIBLE EMPLOYEES, THE ANNUAL PRE-DETERMINED FLEX ALLOWANCE IS CONTRIBUTED AND ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED ARE, AT THE EMPLOYEE'S OPTION, CONTRIBUTED TO EITHER AN IRC 457(F) DEFERRED COMPENSATION ACCOUNT OR TO AN IRC 457(B) ELIGIBLE DEFERRED COMPENSATION PLAN. UPON ATTAINMENT OF AGE 65, ALL PREVIOUS 457(F) DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT AND ANY FUTURE EMPLOYER CONTRIBUTIONS ARE MADE QUARTERLY FROM THE PLAN DIRECTLY TO THE PARTICIPANT. THE PLAN PROVIDES FOR A CLASS YEAR VESTING SCHEDULE (2 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT. DISTRIBUTIONS COULD ALSO BE MADE FROM THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT UPON ATTAINMENT OF AGE 65 OR UPON AN INVOLUNTARY SEPARATION. THE ACCOUNT WILL BE FORFEITED BY THE EXECUTIVE UPON A VOLUNTARY SEPARATION. WITH RESPECT TO GRANDFATHERED PARTICIPANTS, THE FLEX PLAN DOCUMENTS DEFINE ELIGIBLE EMPLOYEES TO INCLUDE THE CHIEF EXECUTIVE OFFICERS OF ADVENTHEALTH ENTITIES AND VICE PRESIDENTS OF ALL ADVENTHEALTH ENTITIES WHOSE BASE SALARY WAS AT LEAST EQUAL TO THE INTERNAL REVENUE CODE SECTION 401(A)(17) COMPENSATION LIMIT EACH YEAR. SENIOR EXECUTIVE DEATH BENEFIT PLAN (SEDB) (AMENDED AND RESTATED IN 2020): THE SEDB PLAN WAS ORIGINALLY DESIGNED TO PROVIDE A BENEFIT IN AN AMOUNT EQUAL TO THE AMOUNT THE EXECUTIVE'S BENEFIT WOULD HAVE BEEN UNDER THE SERP II PLAN ASSUMING THAT, ON THE DATE OF THE EXECUTIVE'S DEATH (AND NOT BEFORE), THE EXECUTIVE SATISFIED THE LAST OF THE ELIGIBILITY REQUIREMENTS OF THE SERP II PLAN WITH PRESENT VALUE RECOGNIZING AN EARLY BENEFIT COMMENCEMENT. IN CONJUNCTION WITH THE AMENDMENT AND RESTATEMENT OF THE SERP II PLAN, THE SEDB WAS SIMILARLY AMENDED IN 2020 TO LIMIT ELIGIBLE EMPLOYEES TO ONLY THOSE WHO EITHER SATISFY THE ELIGIBILITY REQUIREMENTS OF SERP II AS OF JANUARY 1 2020, OR REMAIN IN ACTIVE EMPLOYMENT AND WILL SATISFY THOSE REQUIREMENTS PRIOR TO DECEMBER 31, 2027. AN ELIGIBLE EXECUTIVE BECOMES A PARTICIPANT IN THE SEDB PLAN IF THE EXECUTIVE DIES PRIOR TO TERMINATION OF EMPLOYMENT, PROVIDED THE EXECUTIVE HAS NOT SATISFIED ALL THE ELIGIBILITY REQUIREMENTS OF SERP II AS OF THE EXECUTIVE'S DATE OF DEATH BUT WOULD HAVE SATISFIED ALL THOSE REQUIREMENTS WITHIN FIVE (5) YEARS FOLLOWING DEATH HAD THE EXECUTIVE LIVED AND CONTINUED EMPLOYMENT. THE SEDB PLAN WILL TERMINATE AUTOMATICALLY AFTER DECEMBER 31, 2027. |
| SCHEDULE J, PART I, LINE 4B - CONTINUATION | FLEX PLAN FLEX PLAN SERP II SERP III CONTR. DISTR.* CONTR./DISTR. CONTR. HUENERGARDT,SAMUEL $ 104,711 $ 26,243 $ 0 $ 0 RANDOLPH, KARSTEN $ 40,491 $ 22,126 $ 0 $ 0 PETERSON, DOUGLAS $ 10,409 $ 13,416 $ 33,425 $ 0 *INCLUDING INVESTMENT EARNINGS |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 1A: | THE PARENT CORPORATION AND SOLE TOP-TIER MEMBER OF CHIPPEWA VALLEY HOSPITAL AND OAKVIEW CARE CENTER, INC. (THE FILING ORGANIZATION) IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS A FLORIDA, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). AHSSHC HAS ESTABLISHED A SHARED SERVICE CENTER TO CENTRALIZE THE ACCOUNTS PAYABLE (A/P) FUNCTION FOR ALL AHSSHC SUBSIDIARY ORGANIZATIONS. THE FILING ORGANIZATION HAS ENTERED "0" IN PART V, LINE 1A BECAUSE THE FILING ORGANIZATION NO LONGER ISSUES FORM 1099 RETURNS, RATHER, ALL SUCH RETURNS ARE FILED BY AND UNDER THE NAME AND EIN OF AHSSHC AS THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. THE FACTS AND CIRCUMSTANCES SUPPORT A POSITION THAT AHSSHC, AS A PAYOR ON BEHALF OF ITS SUBSIDIARY ORGANIZATIONS IN A SHARED SERVICE ENVIRONMENT, WILL HAVE SUFFICIENT MANAGEMENT AND OVERSIGHT IN CONNECTION WITH THE SUBSIDIARY ORGANIZATIONS' PAYMENTS TO MEET THE STANDARD SET FORTH IN TREAS. REG. SECTION 1.6041-1(E). AHSSHC WILL NOT MERELY BE MAKING PAYMENTS AT THE DIRECTION OF ITS SUBSIDIARY ORGANIZATIONS. ACCORDINGLY, AHSSHC IS CONSIDERED THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. |
| FORM 990, PART VI, SECTION A, LINE 2 | TODD BECHEL AND MARK GILLES - FAMILY RELATIONSHIP TODD BECHEL AND CAROL BUHLMAN - BUSINESS RELATIONSHIP CHARLIE HEIKE AND ROBERT HEIKE - FAMILY RELATIONSHIP |
| FORM 990, PART VI, SECTION A, LINE 6 | CHIPPEWA VALLEY HOSPITAL AND OAKVIEW CARE CENTER, INC. (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS ADVENTIST HEALTH SYSTEM/SUNBELT, INC. ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI) IS A FLORIDA, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN THE FILING ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER OF THE FILING ORGANIZATION IS AHSSI. THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION ARE APPOINTED BY THE SOLE MEMBER, AHSSI, WHO HAS THE RIGHT TO ELECT, APPOINT OR REMOVE ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | AHSSI, AS THE SOLE MEMBER OF THE FILING ORGANIZATION, HAS CERTAIN RESERVED POWERS AS SET FORTH IN THE BYLAWS OF THE FILING ORGANIZATION. THESE RESERVED POWERS INCLUDE THE FOLLOWING: A) TO APPROVE AND DISAPPROVE THE EXECUTIVE AND/OR ADMINISTRATIVE LEADERSHIP OF THE FILING ORGANIZATION, AND THEIR SALARIES; B) TO ADOPT, AMEND, RESTATE, AND REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS OF THE FILING ORGANIZATION; C) TO SET LIMITS AND TERMS FOR THE BORROWING OF FUNDS; D) TO APPROVE OR DISAPPROVE MAJOR BUILDING PROGRAMS AND/OR A PURCHASE OR SALE OF PERSONAL PROPERTY OR REAL PROPERTY EQUAL TO OR IN EXCESS OF ONE MILLION DOLLARS; E) TO APPROVE OR DISAPPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION; F) TO DIRECT THE PLACEMENT OF FUNDS AND CAPITAL OF THE FILING ORGANIZATION; G) TO ESTABLISH GENERAL GUIDING POLICIES; H) TO APPROVE OR DISAPPROVE OPENING OR CLOSING OF THE FACILITIES OR MAJOR CHANGES IN OPERATION; AND I) TO ESTABLISH A PROCESS FOR ADDRESSING PATIENT GRIEVANCES. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND BY THE CFO PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND THE CFO DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR ANY PRINCIPAL OFFICER OF THE FILING ORGANIZATION (I.E. INTERESTED PERSONS) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE FILING ORGANIZATION'S CEO, OTHER OFFICERS AND CERTAIN KEY EMPLOYEES ARE NOT COMPENSATED BY THE FILING ORGANIZATION. SUCH INDIVIDUALS ARE COMPENSATED BY THE RELATED TOP-TIER PARENT ORGANIZATION OF THE FILING ORGANIZATION. PLEASE SEE THE DISCUSSION CONCERNING THE PROCESS FOLLOWED BY THE RELATED TOP-TIER PARENT ORGANIZATION IN DETERMINING EXECUTIVE COMPENSATION IN OUR RESPONSE TO SCHEDULE J, LINE 3. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTHEALTH. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF ADVENTHEALTH AND OF THE ADVENTHEALTH "OBLIGATED GROUP" ARE FILED ANNUALLY WITH THE MUNICIPAL SECURITIES RULEMAKING BOARD (MSRB). THE "OBLIGATED GROUP" IS A GROUP OF AHSSHC SUBSIDIARIES THAT ARE JOINTLY AND SEVERALLY LIABLE UNDER A MASTER TRUST INDENTURE THAT SECURES DEBT PRIMARILY ISSUED ON A TAX-EXEMPT BASIS. UNAUDITED QUARTERLY FINANCIAL STATEMENTS PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) ARE ALSO FILED WITH MSRB FOR ADVENTHEALTH ON A CONSOLIDATED BASIS AND FOR THE GROUPING OF ADVENTHEALTH SUBSIDIARIES COMPRISING THE "OBLIGATED GROUP". THE FILING ORGANIZATION DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. |
| PART VII, SECTION A | FOR THOSE BOARD OF DIRECTOR MEMBERS AND OFFICER(S) WHO DEVOTE LESS THAN FULL-TIME TO THE FILING ORGANIZATION (BASED UPON THE AVERAGE NUMBER OF HOURS PER WEEK SHOWN IN COLUMN (B) ON PAGE 7 OF THE RETURN) THE COMPENSATION AMOUNTS SHOWN IN COLUMNS (E) AND (F) ON PAGE 7 WERE PROVIDED IN CONJUNCTION WITH THAT PERSON'S RESPONSIBILITIES AND ROLES IN SERVING IN AN EXECUTIVE LEADERSHIP POSITION AS AN EMPLOYEE OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION. |
| PART VIII, LINES 7A, B AND 7C: | THE AMOUNT SHOWN IN PART VIII, LINE 7C(I) OF THE FORM 990 REPRESENTS AN ALLOCATED SHARE OF CAPITAL GAIN/(LOSS) FROM A SYSTEM WIDE, CORPORATE ADMINISTERED, INVESTMENT PROGRAM. |
| FORM 990, PART IX, LINE 11G | PAYMENTS TO HEALTHCARE PROFESSIONALS: PROGRAM SERVICE EXPENSES 1,216,491. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,216,491. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,339,431. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,339,431. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 145,623. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 145,623. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 2,335. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,335. TRANSCRIPTION: PROGRAM SERVICE EXPENSES 5,977. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,977. RECRUITING: PROGRAM SERVICE EXPENSES 10,847. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,847. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 675,187. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 675,187. ADVENTHEALTH MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 127,932. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 127,932. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 36,621. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,621. ADVENTHEALTH SHARED SERVICE FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 141,361. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 141,361. |
| FORM 990, PART XI, LINE 9: | TRANSFER TO TAX-EXEMPT PARENT -107,372. ROUNDING 1. |
| FORM 990, PART XII, LINE 3B | FOR THE 2020 FISCAL YEAR ENDING DECEMBER 31, 2020, ADVENTHEALTH WAS SUBJECT TO THE SINGLE AUDIT REQUIREMENTS, AS SET FORTH IN THE REGULATIONS AT 2 CFR PART 200, SUBPART F. AS A CALENDAR YEAR TAXPAYER, THE DEADLINE TO COMPLETE AND SUBMIT THE SINGLE AUDIT REPORTING PACKAGE TO THE FEDERAL AUDIT CLEARINGHOUSE, AS REQUIRED UNDER SUBPART F OF 2 CFR 200.501, IS SEPTEMBER 30, 2021. HOWEVER, ON MARCH 19TH, 2021, THE OFFICE OF MANAGEMENT AND BUDGET (OMB) ISSUED MEMORANDUM M21-20, WHICH OUTLINED THE OMB'S EFFORTS TO SUPPLEMENT THE SUPPORT IN THE AMERICAN RESCUE PLAN ACT OF 2021 (ARP), PROMOTE PUBLIC TRUST IN THE FEDERAL GOVERNMENT'S STEWARDSHIP OF TAXPAYER RESOURCES, AND ALLEVIATE SOME OF THE ADMINISTRATIVE CHALLENGES RELATED TO THE CORONAVIRUS PANDEMIC. AS PART OF THE ADMINISTRATIVE RELIEF INCLUDED IN MEMORANDUM M21-20, THE OMB PROVIDED A SIX-MONTH EXTENSION OF TIME TO COMPLETE AND SUBMIT THE SINGLE AUDIT REPORTING PACKAGE. THE EXTENDED REPORTING DEADLINE FOR CALENDAR YEAR TAXPAYERS IS MARCH 31, 2022. |
| PART X, LINE 2 | THE AMOUNTS SHOWN ON LINE 2 OF PART X OF THIS RETURN INCLUDE THE FILING ORGANIZATION'S INTEREST IN A CENTRAL INVESTMENT POOL MAINTAINED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, THE FILING ORGANIZATION'S TOP-TIER PARENT. THE INVESTMENTS IN THE CENTRAL INVESTMENT POOL ARE RECORDED AT MARKET VALUE. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (104 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ADVENTHEALTH FAMILY MEDICINE RURAL HEALTH CLINICS INC | |||||||||||
| 187 PR 4060 | LAMPASAS | TX | 76550 | 271858033 | OPERATION OF RURAL HEALTH CLINICS & MEDICAL SERVICES | FL | 501(C)(3) | LINE 3 | METROPLEX ADVENTIST HOSPITAL INC | Yes (1) | |
| ADVENTHEALTH FOUNDATION SHAWNEE MISSION | |||||||||||
| 9100 W 74TH STREET | SHAWNEE MISSION | KS | 66204 | 480868859 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | KS | 501(C)(3) | LINE 7 | SHAWNEE MISSION MEDICAL CENTER INC | Yes (1) | |
| ADVENTHEALTH HOME CARE EAST FLORIDA LLC | |||||||||||
| 770 WEST GRANADA BLVD 319 | ORMOND BEACH | FL | 32174 | 833768458 | INACTIVE | FL | 501(C)(3) | LINE 12A, I | MEMORIAL HLTH SYSTEMS INC | Yes (1) | |
| ADVENTHEALTH HOSPICE CARE EAST FLORIDA INC | |||||||||||
| 770 WEST GRANADA BLVD 304 | ORMOND BEACH | FL | 32174 | 833748461 | INACTIVE | FL | 501(C)(3) | LINE 12A, I | MEMORIAL HLTH SYSTEMS INC | Yes (1) | |
| ADVENTHEALTH NORTH POLK INC | |||||||||||
| 3100 E FLETCHER AVE | TAMPA | FL | 33613 | 593231322 | INACTIVE | FL | 501(C)(3) | LINE 12A, I | UNIVERSITY COMMUNITY HOSPITAL INC | Yes (1) | |
| ADVENTHEALTH POLK NORTH INC | |||||||||||
| 40100 US HIGHWAY 27 N | DAVENPORT | FL | 33837 | 841793121 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| ADVENTHEALTH POLK SOUTH INC | |||||||||||
| 410 SOUTH 11TH STREET | LAKE WALES | FL | 33853 | 834672945 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| ADVENTHEALTH SENIOR CARE INC FKA AH OSCEOLA SOUTH INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 841817046 | INACTIVE | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| ADVENTHEALTH SOUTH OVERLAND PARKINC FKA MERRIAM HLTH CARE PROP | |||||||||||
| 7820 W 165TH STREET | OVERLAND PARK | KS | 66223 | 364595806 | INACTIVE | KS | 501(C)(3) | LINE 3 | ADVENTIST HLTH MID-AMERICA INC | Yes (1) | |
| ADVENTHEALTH RANSOM MEMORIAL INC | |||||||||||
| 1301 S MAIN STREET | OTTAWA | KS | 66067 | 830976641 | OPERATION OF HOSPITAL & RELATED SERVICES | KS | 501(C)(3) | LINE 3 | ADVENTIST HLTH MID-AMERICA INC | Yes (1) | |
| ADVENTHEALTH UNIVERSITY INC | |||||||||||
| 671 WINYAH DRIVE | ORLANDO | FL | 32803 | 593069793 | EDUCATION/OPERATION OF SCHOOL | FL | 501(C)(3) | LINE 2 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| ADVENTHEALTH WEST FLORIDA AMBULATORY SVCS INC | |||||||||||
| 14055 RIVEREDGE DRIVE STE 250 | TAMPA | FL | 33637 | 471881744 | OPERATION OF IMAGING CENTER & MEDICAL SERVICES | FL | 501(C)(3) | LINE 10 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| ADVENTHEALTH WEST FLORIDA IMAGING INC | |||||||||||
| 14055 RIVEREDGE DRIVE STE 250 | TAMPA | FL | 33637 | 843225135 | IMAGING & TESTING | FL | 501(C)(3) | LINE 10 | ADVENTHEALTH WEST FLORIDA AMBULATORY SERVICES INC | Yes (1) | |
| ADVENTIST BOLINGBROOK HOSPITAL | |||||||||||
| 500 REMINGTON BLVD | BOLINGBROOK | IL | 60440 | 651219504 | OPERATION OF HOSPITAL & RELATED SERVICES | IL | 501(C)(3) | LINE 3 | ADVENTIST MIDWEST HEALTH | Yes (1) | |
| ADVENTIST CARE CENTERS - COURTLAND INC | |||||||||||
| 730 COURTLAND STREET | ORLANDO | FL | 32804 | 205774723 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | FL | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| ADVENTIST GLENOAKS HOSPITAL | |||||||||||
| 701 WINTHROP AVENUE | GLENDALE HEIGHTS | IL | 60139 | 363208390 | OPERATION OF HOSPITAL & RELATED SERVICES | IL | 501(C)(3) | LINE 3 | ADVENTIST MIDWEST HEALTH | Yes (1) | |
| ADVENTIST HLTH MID-AMERICA INC | |||||||||||
| 9100 W 74TH STREET | SHAWNEE MISSION | KS | 66204 | 521347407 | SUPPORT OF AFFILIATED HOSPITAL | KS | 501(C)(3) | LINE 12C, III-FI | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| ADVENTIST HLTH PARTNERS INC | |||||||||||
| 2601 NAVISTAR DR BLDG 4 FINANCE | LISLE | IL | 60532 | 364138353 | OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES | IL | 501(C)(3) | LINE 3 | AHS MIDWEST MANAGEMENT INC | Yes (1) | |
| ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 592170012 | MANAGEMENT SERVICES | FL | 501(C)(3) | LINE 12A, I | 0 | N/A | |
| ADVENTIST HLTH SYSTEM GEORGIA INC | |||||||||||
| 1035 RED BUD ROAD NE | CALHOUN | GA | 30701 | 581425000 | OPERATION OF HOSPITAL & RELATED SERVICES | GA | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| ADVENTIST HLTH SYSTEMSUNBELT INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 591479658 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| ADVENTIST HLTH SYSTEMTEXAS INC | |||||||||||
| 11801 S FREEWAY | BURLESON | TX | 76028 | 742578952 | LEASING PERSONNEL TO AFFILIATED HOSPITAL | TX | 501(C)(3) | LINE 12C, III-FI | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| ADVENTIST MIDWEST HEALTH | |||||||||||
| 120 NORTH OAK STREET | HINSDALE | IL | 60521 | 362276984 | OPERATION OF HOSPITAL & RELATED SERVICES | IL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| AHP SPECIALTY CARE NFP | |||||||||||
| 2601 NAVISTAR DR BLDG 4 FINANCE | LISLE | IL | 60532 | 811105774 | OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES | IL | 501(C)(3) | LINE 3 | AHS MIDWEST MANAGEMENT INC | Yes (1) | |
| AHS MIDWEST MANAGEMENT INC | |||||||||||
| 2601 NAVISTAR DR BLDG 4 FINANCE | LISLE | IL | 60532 | 363354567 | OPERATION OF PHYSICIAN PRACTICE MGMT | IL | 501(C)(3) | LINE 12A, I | ADVENTIST MIDWEST HEALTH | Yes (1) | |
| AHSCENTRAL TEXAS INC (11-12142020) | |||||||||||
| 11801 S FREEWAY | BURLESON | TX | 76028 | 742621825 | PROVIDE OFFICE SPACE - MEDICAL PROFESSIONALS | TX | 501(C)(3) | LINE 12C, III-FI | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| APOPKA HLTH CARE PROPERTIES INC | |||||||||||
| 305 E OAK STREET | APOPKA | FL | 32703 | 510605694 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 12C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| BATTLE CREEK ADVENTIST HOSPITAL | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 381359189 | INACTIVE | MI | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| BERT FISH MEDICAL CENTER AUXILIARY INC | |||||||||||
| 401 PALMETTO STREET | NEW SMYRNA BEACH | FL | 32168 | 591054892 | VOLUNTEER SUPPORT SERVICES | FL | 501(C)(3) | LINE 10 | 0 | N/A | |
| BRADFORD HEIGHTS HEALTH & REHAB CENTER INC | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 205782342 | INACTIVE | KY | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| BURLESON NURSING & REHAB CENTER INC | |||||||||||
| 301 HUGULEY BLVD | BURLESON | TX | 76028 | 205782243 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | TX | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| CENTRAL TEXAS HLTHCARE COLLABORATIVE (11-3312020) | |||||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 453739929 | SUPPORT OPERATION OF HOSPITAL | TX | 501(C)(3) | LINE 12A, I | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| CHICKASAW HLTH CARE PROPERTIES INC | |||||||||||
| 250 S CHICKASAW TRAIL | ORLANDO | FL | 32825 | 510605681 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 12C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| CHIPPEWA VALLEY HOSPITAL & OAKVIEW CARE CENTER INC | |||||||||||
| 1220 THIRD AVENUE WEST | DURAND | WI | 54736 | 391365168 | OPERATION OF HOSPITAL & RELATED SERVICES | WI | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| COALITION FOR PHYSICIAN WELL-BEING INC (619 - 12312020) | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 463477012 | PROVIDE SUPPORT FOR PHYSICIAN WELL-BEING. | FL | 501(C)(3) | LINE 10 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| COURTLAND HLTH CARE PROPERTIES INC | |||||||||||
| 730 COURTLAND STREET | ORLANDO | FL | 32804 | 510605682 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 12C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| CREEKWOOD PLACE NURSING & REHAB CENTER INC | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 205782260 | INACTIVE | KY | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| DAIRY ROAD HLTH CARE PROPERTIES INC | |||||||||||
| 7350 DAIRY ROAD | ZEPHYRHILLS | FL | 33540 | 510605684 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 12C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| EAST ORLANDO HLTH & REHAB CENTER INC | |||||||||||
| 250 S CHICKASAW TRAIL | ORLANDO | FL | 32825 | 205774748 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | FL | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| EMORY-ADVENTIST INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 582171011 | INACTIVE | GA | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| FLETCHER HOSPITAL INC | |||||||||||
| 100 HOSPITAL DRIVE | HENDERSONVILLE | NC | 28792 | 560543246 | OPERATION OF HOSPITAL & RELATED SVCS | NC | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| FLNC INC | |||||||||||
| 3355 E SEMORAN BLVD | APOPKA | FL | 32703 | 205774761 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | FL | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| FLORIDA HOSPITAL DADE CITY INC | |||||||||||
| 13100 FORT KING ROAD | DADE CITY | FL | 33525 | 822567308 | OPERATION OF HOSPITAL & RELATED SVCS | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| FLORIDA HOSPITAL HEALTHCARE PARTNERS INC | |||||||||||
| 770 WEST GRANADA BLVD 101 | ORMOND BEACH | FL | 32174 | 462354804 | OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| FLORIDA HOSPITAL MEDICAL GROUP INC | |||||||||||
| 2600 WESTHALL LANE 4TH FLOOR | MAITLAND | FL | 32751 | 593214635 | OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| FLORIDA HOSPITAL OCALA INC | |||||||||||
| 1500 SW 1ST AVENUE | OCALA | FL | 34471 | 824372339 | OPERATION OF HOSPITAL & RELATED SVCS | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| FLORIDA HOSPITAL PHYSICIAN GROUP INC | |||||||||||
| 12470 TELECOM DR 100 | TAMPA | FL | 33637 | 462021581 | OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| FLORIDA HOSPITAL WATERMAN INC | |||||||||||
| 1000 WATERMAN WAY | TAVARES | FL | 32778 | 593140669 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| FLORIDA HOSPITAL ZEPHYRHILLS INC | |||||||||||
| 7050 GALL BLVD | ZEPHYRHILLS | FL | 33541 | 592108057 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| FLORIDA RADIOLOGY IMAGING AT LAKE MARY LLC | |||||||||||
| 2600 WESTHALL LANE 4TH FLOOR | MAITLAND | FL | 32751 | 550789387 | IMAGING & TESTING | FL | 501(C)(3) | LINE 3 | FLORIDA HOSPITAL MEDICAL GROUP INC | Yes (1) | |
| FOUNTAIN INN NURSING & REHAB CENTER INC | |||||||||||
| 4501 WATERMAN WAY | TAVARES | FL | 32778 | 472180518 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | FL | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| HELEN ELLIS MEMORIAL HOSPITAL AUXILIARY INC | |||||||||||
| 1395 S PINELLAS AVE | TARPON SPRINGS | FL | 34689 | 592106043 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL/FOUNDATION | FL | 501(C)(3) | LINE 12C, III-FI | 0 | N/A | |
| HELEN ELLIS MEMORIAL HOSPITAL FOUNDATION INC | |||||||||||
| 1395 S PINELLAS AVE | TARPON SPRINGS | FL | 34689 | 593690149 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | FL | 501(C)(3) | LINE 7 | 0 | N/A | |
| HINSDALE HOSPITAL FOUNDATION | |||||||||||
| 120 NORTH OAK STREET | HINSDALE | IL | 60521 | 521466387 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | IL | 501(C)(3) | LINE 7 | MIDWEST HLTH FOUNDATION | 0 | |
| HOSPICE OF THE COMFORTER INC | |||||||||||
| 480 W CENTRAL PARKWAY | ALTAMONTE SPRINGS | FL | 32714 | 592935928 | OPERATION OF HOSPICE | FL | 501(C)(3) | LINE 10 | THE COMFORTER HEALTH CARE GROUP INC | Yes (1) | |
| IN-MOTION REHAB INC | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 208023411 | THERAPY SERVICES TO TAX EXEMPT NURSING HOMES | KS | 501(C)(3) | LINE 12B, II | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| LAKE COUNTY HEALTH CARE PROPERTIES INC | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 813923985 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 12C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| MEMORIAL HLTH SYSTEMS FOUNDATION INC | |||||||||||
| 305 MEMORIAL MEDICAL PKWY 212 | DAYTONA BEACH | FL | 32117 | 311771522 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | FL | 501(C)(3) | LINE 7 | 0 | N/A | |
| MEMORIAL HLTH SYSTEMS INC | |||||||||||
| 301 MEMORIAL MEDICAL PARKWAY | DAYTONA BEACH | FL | 32117 | 590973502 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| MEMORIAL HOSPITAL - WEST VOLUSIA INC | |||||||||||
| 701 WEST PLYMOUTH AVENUE | DELAND | FL | 32720 | 593256803 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | MEMORIAL HLTH SYSTEMS INC | Yes (1) | |
| MEMORIAL HOSPITAL FLAGLER INC | |||||||||||
| 60 MEMORIAL MEDICAL PARKWAY | PALM COAST | FL | 32164 | 592951990 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | MEMORIAL HLTH SYSTEMS INC | Yes (1) | |
| MEMORIAL HOSPITAL INC | |||||||||||
| 210 MARIE LANGDON DRIVE | MANCHESTER | KY | 40962 | 610594620 | OPERATION OF HOSPITAL & RELATED SERVICES | KY | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| METROPLEX ADVENTIST HOSPITAL INC | |||||||||||
| 2201 S CLEAR CREEK ROAD | KILLEEN | TX | 76549 | 742225672 | OPERATION OF HOSPITAL & RELATED SERVICES | TX | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| METROPLEX CLINIC PHYSICIANS INC | |||||||||||
| 2201 S CLEAR CREEK ROAD | KILLEEN | TX | 76549 | 113762050 | PHYSICIAN HLTHCARE SERVICES TO THE COMMUNITY | TX | 501(C)(3) | LINE 3 | METROPLEX ADVENTIST HOSPITAL INC | Yes (1) | |
| MIDWEST HEALTH FOUNDATION | |||||||||||
| 120 NORTH OAK STREET | HINSDALE | IL | 60521 | 352230515 | SUPPORT OF SUBSIDIARY FOUNDATIONS | IL | 501(C)(3) | LINE 7 | 0 | N/A | |
| MILLS HEALTH & REHAB CENTER INC | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 205782320 | INACTIVE | KY | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| MISSION STRATEGIES OF GEORGIA INC | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 900866024 | PROVISION OF SUPPORT TO THE NURSING HOME DIVISION | GA | 501(C)(3) | LINE 12B, II | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| MISSOURI ADVENTIST HEALTH INC | |||||||||||
| 9100 W 74TH STREET | SHAWNEE MISSION | KS | 66204 | 431224729 | SUPPORT HLTH CARE SERVICES | MO | 501(C)(3) | LINE 12D, III-O | ADVENTIST HLTH MID-AMERICA INC | Yes (1) | |
| ORMOND BEACH MEMORIAL HOSPITAL AUXILIARY INC | |||||||||||
| 301 MEMORIAL MEDICAL PARKWAY | DAYTONA BEACH | FL | 32117 | 591721962 | VOLUNTEER SUPPORT SERVICES | FL | 501(C)(3) | LINE 12C, III-FI | 0 | N/A | |
| OSCEOLA HEALTH CARE PROPERTIES INC | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 813165729 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 12C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| OVERLAND PARK NURSING & REHAB CENTER INC | |||||||||||
| 6501 WEST 75TH STREET | OVERLAND PARK | KS | 66204 | 205774821 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | KS | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| PASCO-PINELLAS HILLSBOROUGH COMMUNITY HLTH SYSTEM INC | |||||||||||
| 2600 BRUCE B DOWNS BLVD | WESLEY CHAPEL | FL | 33544 | 208488713 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| PORTERCARE ADVENTIST HEALTH SYSTEM (630 YE) | |||||||||||
| 9100 E MINERAL CIRCLE | CENTENNIAL | CO | 80112 | 840438224 | OPERATION OF HOSPITAL & RELATED SERVICES | CO | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| PRINCETON HEALTH & REHAB CENTER INC | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 205782272 | INACTIVE | KY | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| PRINCETON PROFESSIONAL SERVICES INC | |||||||||||
| 601 E ROLLINS STREET | ORLANDO | FL | 32803 | 591191045 | PROVISION OF HLTHCARE SERVICES | FL | 501(C)(3) | LINE 10 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| QUALITY CIRCLE FOR HLTHCARE INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 263789368 | HLTHCARE QUALITY SERVICES | FL | 501(C)(3) | LINE 12A, I | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| RESOURCE PERSONNEL INC | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 208040875 | PROVIDE ADMINISTRATIVE SUPPORT TO TAX EXEMPT NURSING HOMES | FL | 501(C)(3) | LINE 12B, II | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| ROCKY MOUNTAIN ADVENTIST HLTHCARE FOUNDATION (630 YEAR END) | |||||||||||
| 7995 E PRENTICE AVE 204 | GREENWOOD VILLAGE | CO | 80111 | 840745018 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | CO | 501(C)(3) | LINE 7 | 0 | N/A | |
| ROLLINS BROOK COMMUNITY CARE CORP | |||||||||||
| 2201 S CLEAR CREEK ROAD | KILLEEN | TX | 76549 | 461656773 | SUPPORT OPERATION OF HOSPITAL | TX | 501(C)(3) | LINE 12A, I | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| SAN MARCOS HLTH CARE PROPERTIES INC | |||||||||||
| 1900 MEDICAL PARKWAY | SAN MARCOS | TX | 78666 | 510605693 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 12C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| SAN MARCOS NURSING & REHAB CENTER INC | |||||||||||
| 1900 MEDICAL PARKWAY | SAN MARCOS | TX | 78666 | 205782224 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | TX | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| SHAWNEE MISSION HLTH CARE INC | |||||||||||
| 6501 WEST 75TH STREET | OVERLAND PARK | KS | 66204 | 480952508 | LEASE TO RELATED ORGANIZATION | KS | 501(C)(3) | LINE 12C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| SHAWNEE MISSION HLTH CARE PROPERTIES INC | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 813914908 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 12C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| SHAWNEE MISSION MEDICAL CENTER INC | |||||||||||
| 9100 W 74TH STREET | SHAWNEE MISSION | KS | 66204 | 480637331 | OPERATION OF HOSPITAL & RELATED SERVICES | KS | 501(C)(3) | LINE 3 | ADVENTIST HLTH MID-AMERICA INC | Yes (1) | |
| SOUTH PASCO HLTH CARE PROPERTIES INC | |||||||||||
| 38250 A AVENUE | ZEPHYRHILLS | FL | 33542 | 510605679 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 12C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| SOUTHEAST VOLUSIA HEALTHCARE CORP | |||||||||||
| 401 PALMETTO STREET | NEW SMYRNA BEACH | FL | 32168 | 473793197 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| SOUTHWEST VOLUSIA HLTH SERVICES INC | |||||||||||
| 1055 SAXON BLVD | ORANGE CITY | FL | 32763 | 593281591 | MEDICAL OFFICE BUILDING FOR HOSPITAL | FL | 501(C)(3) | LINE 12A, I | SOUTHWEST VOLUSIA HLTHCARE CORP | Yes (1) | |
| SOUTHWEST VOLUSIA HLTHCARE CORP | |||||||||||
| 1055 SAXON BLVD | ORANGE CITY | FL | 32763 | 593149293 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| SPECIALTY PHYSICIANS OF CENTRAL TEXAS INC (11-3312020) | |||||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 208814408 | PHYSICIAN HLTHCARE SERVICES TO THE COMMUNITY | TX | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| SPRING VIEW HLTH & REHAB CENTER INC | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 205782288 | INACTIVE | KY | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| SUNBELT HLTH & REHAB CENTER - APOPKA INC | |||||||||||
| 305 EAST OAK STREET | APOPKA | FL | 32703 | 205774856 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | FL | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| SUNBELT HLTH CARE CENTERS INC | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 581473135 | MANAGEMENT SERVICES | TN | 501(C)(3) | LINE 12B, II | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| SUNSYSTEM DEVELOPMENT CORP | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 592219301 | FUND RAISING FOR AFFILIATED TAX-EXEMPT HOSPITALS | FL | 501(C)(3) | LINE 7 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| TARPON SPRINGS HOSPITAL FOUNDATION INC | |||||||||||
| 1395 S PINELLAS AVE | TARPON SPRINGS | FL | 34689 | 590898901 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | UNIVERSITY COMMUNITY HOSPITAL INC | Yes (1) | |
| TARRANT COUNTY HLTH CARE PROPERTIES INC | |||||||||||
| 301 HUGULEY BLVD | BURLESON | TX | 76028 | 510605677 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 12C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| THE COMFORTER HEALTH CARE GROUP INC | |||||||||||
| 605 MONTGOMERY ROAD | ALTAMONTE SPRINGS | FL | 32714 | 271857940 | LEASE TO RELATED ORGANIZATION | FL | 501(C)(3) | LINE 12C, III-FI | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| THE VOLUNTEER AUXILIARY OF FLORIDA HOSPITAL - FLAGLER INC | |||||||||||
| 60 MEMORIAL MEDICAL PARKWAY | PALM COAST | FL | 32164 | 592486582 | VOLUNTEER SUPPORT SERVICES | FL | 501(C)(3) | LINE 12C, III-FI | 0 | N/A | |
| TRI-COUNTY NURSING AND REHAB CENTER INC | |||||||||||
| 1290 CELEBRATION BLVD | KISSIMMEE | FL | 34747 | 472219363 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | FL | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| TRINITY NURSING & REHAB CENTER INC (11-91020) | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 205774890 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | KS | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| UNIVERSITY COMMUNITY HOSPITAL FOUNDATION INC | |||||||||||
| 3100 E FLETCHER AVE | TAMPA | FL | 33613 | 592554889 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | FL | 501(C)(3) | LINE 12A, I | 0 | N/A | |
| UNIVERSITY COMMUNITY HOSPITAL INC | |||||||||||
| 3100 E FLETCHER AVE | TAMPA | FL | 33613 | 591113901 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| WEST FLORIDA HEALTH HOME CARE INC | |||||||||||
| 13601 BRUCE B DOWNS BLVD STE 110 | TAMPA | FL | 33613 | 593686109 | HOME HEALTH SERVICES | GA | 501(C)(3) | LINE 10 | ADVENTHEALTH WEST FLORIDA AMBULATORY SVCS INC | Yes (1) | |
| ZEPHYR HAVEN HLTH & REHAB CENTER INC | |||||||||||
| 38250 A AVENUE | ZEPHYRHILLS | FL | 33542 | 205774930 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | FL | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| ZEPHYRHILLS HLTH & REHAB CENTER INC | |||||||||||
| 7350 DAIRY ROAD | ZEPHYRHILLS | FL | 33540 | 205774967 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | FL | 501(C)(3) | LINE 10 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| FLETCHER HOSPITAL SURGICAL VENTURES LLC | |||||||||
| 9131 ANSON WAY STE 304 | RALEIGH | NC | 27615 | 861482646 | INDIRECT INTEREST IN SURGERY CENTER | NC | N/A | 0 | 0 |
| FLORIDA HOSPITAL DMERT LLC | |||||||||
| 500 WINDERLEY PLACE STE 324 | MAITLAND | FL | 32751 | 202392253 | MEDICAL EQUIPMENT | FL | N/A | 0 | Yes (1) |
| FLORIDA HOSPITAL HOME INFUSION LLP | |||||||||
| 500 WINDERLEY PLACE STE 226 | MAITLAND | FL | 32751 | 593142824 | HOME INFUSION SERVICES | FL | N/A | 0 | Yes (1) |
| FUNCTIONAL NEUROSURGICAL AMBULATORY SURGERY CTR LLC | |||||||||
| 11 W DRY CREEK CIRCLE 120 | LITTLETON | CO | 80120 | 464426708 | SURGERY CENTER | CO | N/A | 0 | 0 |
| HEART OF FLORIDA SURGERY CENTER LLC (11 -10152020) | |||||||||
| 410 LIONEL WAY 100 | DAVENPORT | FL | 33837 | 812235296 | SURGERY CENTER | DE | N/A | 0 | Yes (1) |
| PAHS ONPOINT URGENT CARE LLC | |||||||||
| 9100 E MINERAL CIRCLE | CENTENNIAL | CO | 80112 | 832465331 | URGENT CARE CENTER | CO | N/A | 0 | 0 |
| PRINCETON HOMECARE SERVICES LLC | |||||||||
| 1050 FORRER BLVD | KETTERING | OH | 45420 | 814196648 | OPERATION OF HOME HEALTH AGENCY | FL | N/A | 0 | 0 |
| SAN MARCOS MRI LP | |||||||||
| 1330 WONDER WORLD DR STE 202 | SAN MARCOS | TX | 78666 | 770597972 | IMAGING & TESTING | TX | N/A | 0 | 0 |
| THE BARIATRIC CENTER OF KANSAS CITY LLC | |||||||||
| 9100 W 74TH STREET | MERRIAM | KS | 66204 | 823025378 | SURGERY CENTER | KS | N/A | 0 | 0 |
| URGENT CARE CENTERS OF BREVARD COUNTY LLC (14-12312020) | |||||||||
| 2600 WESTHALL LANE | MAITLAND | FL | 32751 | 844261523 | URGENT CARE CENTERS | FL | N/A | 0 | Yes (1) |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (19 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| ALTAMONTE MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC | |||||||||
| 601 EAST ROLLINS STREET | ORLANDO | FL | 32803 | 592855792 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| APOPKA MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC | |||||||||
| 601 EAST ROLLINS STREET | ORLANDO | FL | 32803 | 593000857 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| CC MOB INC | |||||||||
| 2201 S CLEAR CREEK ROAD | KILLEEN | TX | 76549 | 742616875 | REAL ESTATE RENTAL | TX | N/A | C | Yes (1) |
| CENTRAL TEXAS MEDICAL ASSOCIATES | |||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 742729873 | INACTIVE | TX | N/A | C | Yes (1) |
| CENTRAL TEXAS PROVIDERS NETWORK (11-3312020) | |||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 742827652 | PHYSICIAN HOSPITAL ORG. | TX | N/A | C | Yes (1) |
| FLORIDA HOSPITAL FLAGLER MEDICAL OFFICES ASSOCIATION INC | |||||||||
| 60 MEMORIAL MEDICAL PARKWAY | PALM COAST | FL | 32164 | 262158309 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| FLORIDA HOSP HLTH VILLAGE PROPERTY OWNER'S ASSOC INC | |||||||||
| 550 E ROLLINS STREET 7TH FLOOR | ORLANDO | FL | 32803 | 821748255 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| FLORIDA HOSPITAL HEALTHCARE SYSTEM INC | |||||||||
| 101 SOUTHHALL LANE STE 150 | MAITLAND | FL | 32751 | 593215680 | PHSO | FL | N/A | C | Yes (1) |
| FLORIDA MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC | |||||||||
| 601 EAST ROLLINS STREET | ORLANDO | FL | 32803 | 592855791 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| KISSIMMEE MULTISPECIALTY CLINIC CONDOMINIUM ASSOCIATION INC | |||||||||
| 201 HILDA STREET SUITE 30 | KISSIMMEE | FL | 34741 | 593539564 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| LN HEALTH PARTNERS INC (11 - 9102020) | |||||||||
| 550 E ROLLINS STREET 6TH FLOOR | ORLANDO | FL | 32803 | 813556903 | INACTIVE | FL | N/A | C | Yes (1) |
| MIDWEST MANAGEMENT SERVICES INC | |||||||||
| 9100 WEST 74TH STREET | SHAWNEE MISSION | KS | 66204 | 480901551 | INACTIVE | KS | N/A | C | Yes (1) |
| NORTH AMERICAN HEALTH SERVICES INC & SUB | |||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 621041820 | LESSOR/HOLDING CO. | TN | N/A | C | Yes (1) |
| ORMOND PROF ASSOCIATES CONDO ASSOC'N INC (430 YEAR END) | |||||||||
| 770 W GRANADA BLVD STE 101 | ORMOND BEACH | FL | 32174 | 592694434 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| PARK RIDGE PROPERTY OWNER'S ASSOCIATION INC | |||||||||
| 1 PARK PLACE NAPLES ROAD | FLETCHER | NC | 28732 | 030380531 | CONDO ASSOCIATION | NC | N/A | C | Yes (1) |
| PORTER AFFILIATED HEALTH SERVICES INC | |||||||||
| 2525 S DOWNING STREET | DENVER | CO | 80210 | 840956175 | HEALTHCARE SERVICES | CO | N/A | C | Yes (1) |
| SAN MARCOS REGIONAL MRI INC (11-3312020) | |||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 770597968 | HOLDING COMPANY | TX | N/A | C | Yes (1) |
| THE GARDEN RETIREMENT COMMUNITY INC | |||||||||
| 485 NORTH KELLER ROAD STE 250 | MAITLAND | FL | 32751 | 593414055 | REAL ESTATE RENTAL | FL | N/A | C | Yes (1) |
| WINTER PARK MEDICAL OFFICE BUILDING I CONDO ASSOC INC | |||||||||
| 601 EAST ROLLINS STREET | ORLANDO | FL | 32803 | 452228478 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (6 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| SHAWNEE MISSION MEDICAL CENTER INC | ||
| P | $504,000 | COST |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION | ||
| M | $128,886 | % OF FACILITY'S OPERATING EXP. |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION DBA AIT | ||
| M | $556,914 | % OF FACILITY'S OPERATING EXP. |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION | ||
| P | $1,021,713 | COST |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION | ||
| B | $107,372 | ACTUAL AMOUNT GIVEN |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION SHARED SERVICES | ||
| M | $138,665 | % OF FACILITY'S OPERATING EXP. |