2021-11-10T07:34:15-06:00 2020-12-31 990 2020-01-01 391365168 CHIPPEWA VALLEY HOSPITAL AND OAKVIEW CARE CENTER INC CHIP 7156724211 1220 THIRD AVENUE WEST DURAND WI 54736 LYNN C ADDISCOTT ASST. SECRETARY 4079751492 2021-10-04 LYNN ADDISCOTT 999009999 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z ADVENTHEALTH DURAND DOUGLAS PETERSON 1220 THIRD AVENUE WEST DURAND WI 54736 15997315 0 X WWW.ADVENTHEALTH.COM/HOSPITAL/ADVENTHEALTH-DURAND X 1980 WI THE OPERATION OF A 25 BED ACUTE CARE HOSPITAL. 12 7 116 13 0 0 109715 1425242 15480970 14393470 263233 172553 0 0 15853918 15991265 29707 20862 0 0 7549853 8131961 0 0 0 6906436 7209637 14485996 15362460 1367922 628805 10918855 15158743 6002420 9472680 4916435 5686063 X 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. 0 0 13704079 20862 14393470 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. 13704079 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 116 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X HARMAT BEEBE 7852298309 1301 S MAIN STREET OTTAWA KS 66067 X HUENERGARDT SAMUEL CHAIRMAN/DIRECTOR 2.50 47.50 X X 0 896670 144180 RANDOLPH KARSTEN DIRECTOR 2.50 47.50 X X 0 564175 78496 PETERSON DOUGLAS DIRECTOR/CEO 50.00 0.00 X X 0 333224 45479 DOHLMAN MD ROBERT DIRECTOR 50.00 0.00 X 231603 0 28342 HEIKE CHARLIE DIRECTOR (BEG 5/20) 13.70 0.00 X 39617 0 0 EDGE MICHAEL VICE CHAIRMAN 1.00 1.00 X 150 3005 0 BAUER LINDA DIRECTOR 1.00 0.00 X 150 0 0 BECHEL TODD DIRECTOR 1.00 0.00 X 150 0 0 BEST ROXANNE DIRECTOR 1.00 0.00 X 150 0 0 BUHLMAN CAROL DIRECTOR 1.00 0.00 X 150 0 0 GILLES MARK DIRECTOR 1.00 0.00 X 150 0 0 HEIKE ROBERT DIRECTOR (END 2/20) 1.00 0.00 X 0 0 0 YINGST WILLIAM DIRECTOR 1.00 0.00 X 150 0 0 HARMAT BEEBE CFO (BEG 3/20) 5.00 45.00 X 0 180814 40982 RUCKER MD KENNETH PHYSICIAN 50.00 0.00 X 307909 0 32700 HUNT MD THOMAS PHYSICIAN 50.00 0.00 X 219396 0 32927 MENTELE ANTON MID-LEVEL CRNA 50.00 0.00 X 199303 0 36149 POESCHEL JANE FNPC 50.00 0.00 X 165337 0 26719 JACOBSON ANGELA DIRECTOR OF NURSING 50.00 0.00 X 119693 0 33016 1283908 1977888 498990 10 0 1 0 SACRED HEART HOSPITAL 900 W CLAIREMONT AVE EAU CLAIRE WI 54701 ED PHYSICIAN & LAB SERVICES 1150400 PHYSICAL THERAPY ASSOCIATES LTD PO BOX 173 DURAND WI 54736 PHYSICAL THERAPY SERVICES 733968 ENGIE INSIGHT SERVICES INC 1313 N ATLANTIC ST 5000 SPOKANE WA 99201 ENERGY MGMT SERVICES 222043 BARTINGALE MECHANICAL INC 213 LOUIS AVE SUITE G EAU CLAIRE WI 54703 PLUMBING & HVAC CONTRACTOR 114161 AMN HEALTHCARE INC 12400 HIGH BLUFF DRIVE SAN DIEGO CA 92130 STAFFING AGENCY 105704 6 X 1424837 405 1425242 NET PATIENT REVENUE 622110 13486193 13486193 PHARMACY 340B 622110 749187 749187 RENTAL REVENUE 622110 54591 54591 CAFETERIA REVENUE 622110 19977 19977 83522 83522 14393470 178603 178603 6050 -6050 -6050 -6050 15991265 14393470 0 172553 X 20862 20862 750799 750799 4846434 4846434 243008 234536 8472 1900798 1900798 390922 377294 13628 19844 19844 31328 31328 3701805 3395891 305914 316124 316124 547115 416853 130262 818087 769747 48340 272428 272428 18780 3780 15000 4345 4345 101754 101754 160232 160232 43291 34230 9061 MEDICAL SUPPLIES 811758 811758 REPAIRS & MAINTENANCE 318320 318320 LICENSES & PERMITS 5264 5264 39162 39162 15362460 13704079 1658381 0 5079709 7746428 1570007 1832164 123412 179990 288391 379562 1624796 338207 788506 1286589 3068830 3734010 10918855 15158743 1125587 1382505 4876833 8090175 6002420 9472680 X 4916435 5070835 615228 4916435 5686063 10918855 15158743 X 628805 248194 -107371 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1130 1130 0 PART II-B, LINE 1: MEMBER DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE WISCONSIN HOSPITAL ASSOCIATION THAT REPRESENT LOBBYING ACTIVITIES CONDUCTED BY THESE TWO ASSOCIATIONS. 76556 76556 215832 21749 194083 1191885 305217 886668 140523 11241 129282 1286589 DUE FROM RELATED 2488346 OTHER RECEIVABLES 345426 RECEIVABLE FROM THIRD PARTIES 792708 RIGHT OF USE ASSET-OPERATING LEASE 107530 3734010 DUE TO RELATED 2445360 PAYABLE TO THIRD PARTIES 774656 CREDIT BALANCES IN A/R 26562 OTHER DEFERRED REVENUE 916021 ACCRUED INTEREST PAYABLE 46 INTERCO ALLOC OF TE BOND PROCEEDS 3716903 OPERATING LEASE LIABILITY 100510 OTHER LIABILITIES 110117 8090175 X PART X, LINE 2: 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. 1 1 X 1 X 0 1 1 1 0 0 209479 209479 0.01360 1248880 573339 675541 0.04400 1458359 573339 885020 0.05760 1458359 573339 885020 0.05760 1 232102 11489 7853019 7775266 77753 X 1 1 1 1 CHIPPEWA VALLEY HOSPITAL AND OAKVIEW CARE CENTER INC 1220 THIRD AVE WEST DURAND WI 54736 WWW.ADVENTHEALTH.COM/HOSPITAL/ADVENTHE 1008 X X X X CHIPPEWA VALLEY HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X SEE PART V, PAGE 8 X X 1 20 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 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 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. X X X 1 1 0 1 0 0 0 0 0 0 0 HUENERGARDT SAMUEL CHAIRMAN/DIRECTOR 0 656404 0 186731 0 53535 0 100531 0 43649 0 1040850 0 20458 RANDOLPH KARSTEN DIRECTOR 0 400598 0 114177 0 49400 0 36310 0 42186 0 642671 0 17917 PETERSON DOUGLAS DIRECTOR/CEO 0 208176 0 55897 0 69151 0 14043 0 31436 0 378703 0 9859 RUCKER MD KENNETH PHYSICIAN 293207 0 0 0 14702 0 15320 0 17380 0 340609 0 0 0 DOHLMAN MD ROBERT DIRECTOR 223705 0 0 0 7898 0 11891 0 16451 0 259945 0 0 0 HUNT MD THOMAS PHYSICIAN 197541 0 15000 0 6855 0 11192 0 21735 0 252323 0 0 0 MENTELE ANTON MID-LEVEL CRNA 196598 0 0 0 2705 0 9927 0 26222 0 235452 0 0 0 HARMAT BEEBE CFO (BEG 3/20) 0 166119 0 13108 0 1587 0 6557 0 34425 0 221796 0 0 POESCHEL JANE FNPC 153852 0 0 0 11485 0 7884 0 18835 0 192056 0 0 0 JACOBSON ANGELA DIRECTOR OF NURSING 101363 0 9612 0 8718 0 5582 0 27434 0 152709 0 0 0 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 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. 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 1 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 592170012 MANAGEMENT SERVICES FL 501(C)(3) LINE 12A, I N/A 0 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 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 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 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 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 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 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 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 1 BATTLE CREEK ADVENTIST HOSPITAL 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 381359189 INACTIVE MI 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 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 N/A 0 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 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 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 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 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 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 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 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 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 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 1 EMORY-ADVENTIST INC 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 582171011 INACTIVE GA 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 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 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 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 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 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 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 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 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 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 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 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 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 N/A 0 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 N/A 0 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 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 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 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 N/A 0 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 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 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 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 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 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 1 MIDWEST HEALTH FOUNDATION 120 NORTH OAK STREET HINSDALE IL 60521 352230515 SUPPORT OF SUBSIDIARY FOUNDATIONS IL 501(C)(3) LINE 7 N/A 0 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 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 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 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 N/A 0 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 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 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 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 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 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 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 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 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 N/A 0 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 N/A 0 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 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 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 N/A 0 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 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 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 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 1 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 1 FLORIDA HOSPITAL HOME INFUSION LLP 500 WINDERLEY PLACE STE 226 MAITLAND FL 32751 593142824 HOME INFUSION SERVICES FL N/A 0 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 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 1 ALTAMONTE MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC 601 EAST ROLLINS STREET ORLANDO FL 32803 592855792 CONDO ASSOCIATION FL N/A C 1 APOPKA MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC 601 EAST ROLLINS STREET ORLANDO FL 32803 593000857 CONDO ASSOCIATION FL N/A C 1 CC MOB INC 2201 S CLEAR CREEK ROAD KILLEEN TX 76549 742616875 REAL ESTATE RENTAL TX N/A C 1 CENTRAL TEXAS MEDICAL ASSOCIATES 1301 WONDER WORLD DRIVE SAN MARCOS TX 78666 742729873 INACTIVE TX N/A C 1 CENTRAL TEXAS PROVIDERS NETWORK (11-3312020) 1301 WONDER WORLD DRIVE SAN MARCOS TX 78666 742827652 PHYSICIAN HOSPITAL ORG. TX N/A C 1 FLORIDA HOSPITAL FLAGLER MEDICAL OFFICES ASSOCIATION INC 60 MEMORIAL MEDICAL PARKWAY PALM COAST FL 32164 262158309 CONDO ASSOCIATION FL N/A C 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 1 FLORIDA HOSPITAL HEALTHCARE SYSTEM INC 101 SOUTHHALL LANE STE 150 MAITLAND FL 32751 593215680 PHSO FL N/A C 1 FLORIDA MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC 601 EAST ROLLINS STREET ORLANDO FL 32803 592855791 CONDO ASSOCIATION FL N/A C 1 KISSIMMEE MULTISPECIALTY CLINIC CONDOMINIUM ASSOCIATION INC 201 HILDA STREET SUITE 30 KISSIMMEE FL 34741 593539564 CONDO ASSOCIATION FL N/A C 1 LN HEALTH PARTNERS INC (11 - 9102020) 550 E ROLLINS STREET 6TH FLOOR ORLANDO FL 32803 813556903 INACTIVE FL N/A C 1 MIDWEST MANAGEMENT SERVICES INC 9100 WEST 74TH STREET SHAWNEE MISSION KS 66204 480901551 INACTIVE KS N/A C 1 NORTH AMERICAN HEALTH SERVICES INC & SUB 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 621041820 LESSOR/HOLDING CO. TN N/A C 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 1 PARK RIDGE PROPERTY OWNER'S ASSOCIATION INC 1 PARK PLACE NAPLES ROAD FLETCHER NC 28732 030380531 CONDO ASSOCIATION NC N/A C 1 PORTER AFFILIATED HEALTH SERVICES INC 2525 S DOWNING STREET DENVER CO 80210 840956175 HEALTHCARE SERVICES CO N/A C 1 SAN MARCOS REGIONAL MRI INC (11-3312020) 1301 WONDER WORLD DRIVE SAN MARCOS TX 78666 770597968 HOLDING COMPANY TX N/A C 1 THE GARDEN RETIREMENT COMMUNITY INC 485 NORTH KELLER ROAD STE 250 MAITLAND FL 32751 593414055 REAL ESTATE RENTAL FL N/A C 1 WINTER PARK MEDICAL OFFICE BUILDING I CONDO ASSOC INC 601 EAST ROLLINS STREET ORLANDO FL 32803 452228478 CONDO ASSOCIATION FL N/A C 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 SHAWNEE MISSION MEDICAL CENTER INC P 504000 COST ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION M 128886 % OF FACILITY'S OPERATING EXP. ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION DBA AIT M 556914 % OF FACILITY'S OPERATING EXP. ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION P 1021713 COST ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION B 107372 ACTUAL AMOUNT GIVEN ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION SHARED SERVICES M 138665 % OF FACILITY'S OPERATING EXP.