2020-11-06T14:14:34-06:00 2019-12-31 990 2019-01-01 363208390 ADVENTIST GLENOAKS HOSPITAL ADVE 6305458000 701 WINTHROP AVE GLENDALE HEIGHTS IL 60139 LYNN C ADDISCOTT ASSISTANT SECRETARY 4079751492 2020-11-06 204.139.85.142 2020-11-06 12:56:50 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 12841AD40E8BDE8F2A214B1E8B2FAB2FB37BA08E 2019 2021-01-29 14:40:06Z BRUCE CHRISTIAN 701 WINTHROP AVE GLENDALE HEIGHTS IL 60139 99232004 0 X WWW.AMITAHEALTH.ORG X 1982 IL THE PROVISION OF MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF A 143 BED HOSPITAL. 18 9 709 74 23748 16047 121087 106645 95826397 99115483 17877 1696 3388 -1348 95968749 99222476 238520 184626 0 0 42175342 41182933 0 0 0 50262319 51400349 92676181 92767908 3292568 6454568 63173541 64154017 40995086 36306706 22178455 27847311 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 78028763 184626 99091735 THE FILING ORGANIZATION DOES BUSINESS UNDER THE NAME AMITA HEALTH ADVENTIST MEDICAL CENTER GLENOAKS (AMITA HEALTH GLENOAKS, OR THE HOSPITAL). THE HOSPITAL, WHICH IS PART OF ADVENTHEALTH, IS A 143-BED ACUTE-CARE HOSPITAL IN GLENDALE HEIGHTS, ILLINOIS, THAT HAS SERVED THE HEALTHCARE NEEDS OF THE GLENDALE HEIGHTS COMMUNITY AND SURROUNDING AREAS SINCE 1980. LOCATED AT 701 WINTHROP AVENUE, THE HOSPITAL IS A FULL-SERVICE HOSPITAL THAT INCLUDES THE LAGATTUTA CENTER FOR HEALTH (THE CENTER), A TWO-STORY FACILITY THAT PROVIDES OUTPATIENT AND ONCOLOGY SERVICES. THE CENTER HOUSES TIME-SHARE PHYSICIAN OFFICES, ALLOWING THE HOSPITAL TO PROVIDE SUBSPECIALTY CARE ON ITS CAMPUS. SPECIALTY CARE AND OTHER SERVICES AVAILABLE AT THE HOSPITAL INCLUDE BEHAVIORAL HEALTHCARE, CARDIAC CATHETERIZATION, CARDIAC ELECTROPHYSIOLOGY, CARDIOLOGY/HEARTCARE, DIAGNOSTIC IMAGING, DIALYSIS, DIGITAL MAMMOGRAPHY, EMERGENCY MEDICAL CARE, GASTROENTEROLOGY, INTERVENTIONAL RADIOLOGY, LABORATORY, OBSTETRICS, OCCUPATIONAL AND PHYSICAL THERAPIES, ONCOLOGY, OPHTHALMOLOGY, ORTHOPEDICS, OUTPATIENT PHARMACY, PAIN MANAGEMENT, PODIATRY AND SURGERY. IN PARTNERSHIP WITH PT SOLUTIONS, THE HOSPITAL ALSO OPERATES THREE OUTPATIENT PHYSICAL REHABILITATION SITES IN BLOOMINGDALE, GLENDALE HEIGHTS AND WHEATON, ILLINOIS. IN 2018, THE HOSPITAL OPENED A HEPATITIS-C CLINIC DEDICATED TO THE DIAGNOSIS AND TREATMENT OF THE DISEASE, WHICH KILLS TENS OF THOUSANDS OF PEOPLE A YEAR.FROM NEW TECHNOLOGIES AND AESTHETIC UPDATES TO ALL-PRIVATE PATIENT ROOMS IN THE HOSPITAL'S MEDICAL/SURGICAL UNITS, RECENT RENOVATIONS AT THE HOSPITAL HAVE PLACED WORLD-CLASS MEDICAL SERVICES IN AN ENVIRONMENT CONDUCIVE TO PATIENTS' COMFORT AND CARE. THE RENOVATIONS ALSO HAVE RAISED THE HOSPITAL'S RECOGNITION LEVEL IN THE COMMUNITY AND HAVE ENHANCED THE HOSPITAL'S ABILITY TO ATTRACT HIGH-QUALITY PHYSICIANS.THE HOSPITAL'S ONGOING COMMITMENT TO SERVING COMMUNITY NEEDS IS BEST EXEMPLIFIED BY ITS THERAPEUTIC DAY SCHOOL (THE SCHOOL), WHICH WORKS WITH LOCAL SCHOOL DISTRICTS TO PROVIDE ACADEMIC EDUCATION AND THERAPIES AT THREE LOCATIONS (GLENDALE HEIGHTS, GLEN ELLYN, ILLINOIS, AND NORTH AURORA, ILLINOIS) FOR MORE THAN 200 THIRD- TO 12TH-GRADE STUDENTS WITH EMOTIONAL DISORDERS. THE SCHOOL ALSO OFFERS A TRANSITION PROGRAM FOR ITS GRADUATES AS THEY PREPARE FOR COLLEGE OR THE WORKFORCE. FOUNDED IN 1994, THE PROGRAM IS ONE OF THE MOST RESPECTED ALTERNATIVE SCHOOLS IN THE CHICAGO AREA.THE MODERNIZATION AND PERFORMANCE OF AMITA HEALTH GLENOAKS HAVE CAUGHT THE ATTENTION OF HEALTHCARE AUTHORITIES WHO MEASURE HOSPITAL QUALITY AND SAFETY. THE HOSPITAL IS CERTIFIED AS A PRIMARY STROKE CENTER BY THE JOINT COMMISSION AND THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION AND HAS RECEIVED NATIONAL QUALITY APPROVAL FROM THE JOINT COMMISSION. THE HOSPITAL ALSO HAS BEEN DESIGNATED AS A BLUE DISTINCTION CENTER+ BY THE BLUE CROSS AND BLUE SHIELD ASSOCIATION FOR DELIVERING SAFE, HIGH-QUALITY AND COST-EFFICIENT MATERNITY CARE. IN 2018, CRIBS FOR KIDS CERTIFIED THE HOSPITAL AS A GOLD SAFE SLEEP CHAMPION FOR ITS COMMITMENT TO REDUCING INFANT SLEEP-RELATED DEATHS THROUGH INFANT-SAFE-SLEEP BEST PRACTICES AND EDUCATION. ALSO IN 2018, AMINO, A SAN FRANCISCO-BASED HEALTHCARE DATA COMPANY, RANKED AMITA HEALTH GLENOAKS FOURTH IN THE COMPANY'S RANKINGS OF THE TOP FIVE LEAST-EXPENSIVE HOSPITALS IN THE CHICAGO AREA.IN 2019, THE HOSPITAL TREATED 5,654 INPATIENTS, PERFORMED 440 INPATIENT SURGERIES AND DELIVERED 364 BABIES. THE HOSPITAL'S MEDICAL STAFF INCLUDES OVER 300 PHYSICIANS REPRESENTING MORE THAN 27 MEDICAL AND SURGICAL SPECIALTIES.THE HOSPITAL PROVIDES CARE FOR ALL, INCLUDING THE FINANCIALLY DISADVANTAGED, UNINSURED, UNDERINSURED, HOMELESS AND THOSE WHO RECEIVE PUBLIC AID. IN 2019, THE HOSPITAL PROVIDED $3,276,335 OF CHARITY CARE AT COST. THIS WAS IN ADDITION TO $838,605 IN OTHER COMMUNITY BENEFITS SERVICES.ABOUT ADVENTIST MIDWEST HEALTHTHE HOSPITAL IS A SUBSIDIARY ORGANIZATION OF ADVENTIST MIDWEST HEALTH (AMH), A NETWORK OF FOUR NOT-FOR-PROFIT HOSPITALS AND THEIR OUTPATIENT-BASED HEALTHCARE FACILITIES IN CHICAGO'S WESTERN SUBURBS. AMH TAKES A HOLISTIC APPROACH TO WELLNESS, ADDRESSING THE PHYSICAL, MENTAL, SOCIAL AND SPIRITUAL NEEDS OF THE PEOPLE IT SERVES. AMH'S HOSPITALS AND OTHER FACILITIES ARE INTEGRAL TO THE FABRIC OF THEIR COMMUNITIES. AMH PARTNERS WITH LOCAL CIVIC ORGANIZATIONS AND BUSINESSES TO BRING STATE-OF-THE-ART TREATMENTS AND PREVENTIVE HEALTHCARE SERVICES CLOSE TO WHERE PEOPLE LIVE AND WORK. AS PART OF ADVENTHEALTH, THE LARGEST, NOT-FOR-PROFIT PROTESTANT HOSPITAL SYSTEM IN THE NATION, AMH IS GROUNDED IN CHRISTIAN VALUES AND COMMITTED TO EXTENDING THE HEALING MINISTRY OF CHRIST. AMH WELCOMES PATIENTS FROM ANY RELIGIOUS DENOMINATION AS WELL AS PATIENTS WHO DO NOT ASCRIBE TO ANY RELIGION.IN FEBRUARY 2015, AMH AND ALEXIAN BROTHERS HEALTH SYSTEM (ABHS) FORMED A JOINT OPERATING COMPANY (JOC). A JOC ALLOWS SEPARATE OWNERS TO INTEGRATE OPERATIONS TO ACHIEVE A COMMON GOAL WHILE MAINTAINING SEPARATE OWNERSHIP OF ASSETS. IT ALSO ALLOWS AMH AND ABHS TO WORK IN UNISON WHILE PRESERVING THE ADVENTIST AND CATHOLIC IDENTITIES AND MISSION PRIORITIES THAT DEFINE AMH AND ABHS, RESPECTIVELY. IN APRIL 2015, ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO., D/B/A AMITA HEALTH, WAS ANNOUNCED AS THE NEW NAME OF THE JOC. THE NAME AMITA IS INSPIRED BY THE MEANING IT HAS IN SEVERAL LANGUAGES -- FRIENDSHIP IN ITALIAN, HONESTY AND TRUTH IN HEBREW, AND SPIRITUAL LIGHT AND BOUNDLESSNESS IN HINDI. THE NAME REFLECTS AMITA HEALTH'S FAITH-BASED CALL TO HEALING, ITS CORE VALUES, AND THE COMPASSION AND DEDICATION THAT ITS CAREGIVERS SHOW EVERY DAY TO PATIENTS, THEIR FAMILIES AND EACH OTHER.AMITA HEALTH GLENOAKS SERVICES DIAGNOSTIC SERVICESAMITA HEALTH GLENOAKS' DIAGNOSTIC SERVICES INCLUDE THE LATEST TECHNOLOGY AND PRACTICES, WHICH ARE ACCREDITED BY NATIONALLY AND STATE RECOGNIZED AGENCIES AND ASSOCIATIONS, SUCH AS THE ILLINOIS EMERGENCY MANAGEMENT AGENCY, THE AMERICAN COLLEGE OF RADIOLOGY, THE COLLEGE OF AMERICAN PATHOLOGISTS, THE CLINICAL LABORATORY IMPROVEMENT AMENDMENTS AND THE JOINT COMMISSION.DIAGNOSTIC SERVICES OFFERED INCLUDE:-- DIAGNOSTIC IMAGING (GENERAL X-RAY, CT, MRI, ULTRASOUND, NUCLEAR MEDICINE)-- BREAST-CARE SERVICES (SCREENING, BREAST BIOPSY ULTRASOUND, BONE DENSITOMETRY, AND GENETIC COUNSELING) -- CARDIOLOGY (CARDIAC CATHETERIZATION, ELECTROPHYSIOLOGY, ELECTROCARDIOGRAMS [EKGS], STRESS TESTING, ECHOCARDIOGRAPHY, HOLTER MONITORING OF ARRHYTHMIAS)-- PULMONARY DIAGNOSTICS (ARTERIAL BLOOD GAS ANALYSIS)-- GASTROENTEROLOGY (COLONOSCOPY, BRONCHOSCOPY)-- LABORATORY/PATHOLOGY (CHEMISTRY, MICROBIOLOGY, HEMATOLOGY, HISTOLOGY, CYTOLOGY, PHLEBOTOMY, TRANSFUSION SERVICES)EMERGENCY DEPARTMENTEMERGENCY MEDICAL CARE IS PROVIDED 24/7 FOR ALL AGES AND TYPES OF PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY FOR SUCH SERVICES.OUTPATIENT SERVICES PERFORMED IN 2019: -- 1,043 OUTPATIENT SURGERIES-- 22,282 EMERGENCY ROOM VISITS. 78028763 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 709 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 18 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X JARED BROWN 2242730191 701 WINTHROP AVENUE GLENDALE HEIGHTS IL 60139 X HAFFNER PHD RANDALL DIR/CHAIRMAN 0.10 50.00 X 0 2740749 301079 SNYDER BRENT G DIRECTOR 0.10 50.00 X 0 1313113 166868 THORDARSON THOR DIR/PRES/SEC/EVP & COO 5.00 45.00 X 0 1069460 40054 BUCHANAN HERBERT DIRECTOR (BEG 1/19) 5.00 45.00 X 62782 565034 11050 CARROLL RICHARD VP/CMO BOLINGBROOK/GLENOAK 25.00 25.00 X 0 486430 33291 CHRISTIAN BRUCE PRES/CEO BOLINGBROOK/GLENO 25.00 25.00 X 0 483030 32555 YANG MD ERIC DIRECTOR (END 12/19) 0.10 50.00 X 0 437486 15754 ROEHR RICHARD FORMER COO 25.00 25.00 X 0 329925 44978 RADIVOJEVIC VLADIMIR VP/COO BOLINGBROOK/GLENOAK & INTERIM CFO 25.00 25.00 X 0 272130 43858 PFEIFER CAROL CNO 50.00 0.00 X 217473 0 37628 ALBAUGH JOLENE RN DIR - SURGICAL SVCS 60.00 0.00 X 179056 19501 22997 DOMINGUEZ MIGUEL RN DIR-NURSING 60.00 0.00 X 158388 0 35354 DE RAMOS DO DAVID DIRECTOR (BEG 1/19) 0.10 50.00 X 0 167073 25837 PUNNOOSE BISSY RN BEHAVORIAL HEALTH 50.00 0.00 X 160335 0 24119 BROWN JARED CFO (BEG 8/19) 25.00 25.00 X 0 152807 23563 TIANGSON LETICIA RN EMERGENCY DEPT 46.00 0.00 X 149601 0 23513 GRIGSBY LISA DIR EDUCATION SVCS AMITA 60.00 0.00 X 148064 0 16538 SCHIMEROWSKI DEBORAH CFO 2.50 5.00 X 16894 33789 4031 MARTINEZ MD CARLOS DIRECTOR 0.10 4.20 X 0 25313 0 GUTH MD SCOTT DIRECTOR 0.10 3.20 X 0 19906 0 ZEISEL HENRY CFO 2.50 0.00 X 16383 0 1866 VINCENT SHERRIL INTERIM VP/CFO BOLINGBROOK(END 1/19) 25.00 25.00 X 0 4378 0 SCOTT GLYNN DIRECTOR 0.10 2.40 X 0 2499 0 VALENTINE II MDIV MAURICE DIRECTOR/VICE CHAIR 0.10 0.20 X 0 2499 0 AGUILERA RONALD DIRECTOR 0.10 0.20 X 0 1699 0 ARQUILLA VENANZIO DIRECTOR 0.10 0.20 X 0 0 0 EASTMAN LINDA DIRECTOR 0.10 0.20 X 0 0 0 GRAY JR MARSHALL DIRECTOR 0.10 0.70 X 0 0 0 HAWKINS RONNIE DIRECTOR 0.10 0.20 X 0 0 0 HOLDER BILL DIRECTOR 0.10 0.20 X 0 0 0 O'CONNOR PETER DIRECTOR 0.10 0.20 X 0 0 0 WRIGHT JONATHAN DIRECTOR 0.10 0.20 X 0 0 0 1108976 8126821 904933 54 1 1 1 COMPASS GROUP USA INC PO BOX 102289 ATLANTA GA 30368 FOOD SERVICES 3719006 PT SOLUTIONS HOLDINGS LLC PO BOX 441146 KENNESAW GA 30160 THERAPY SERVICES 1530974 SUBURBAN PULMONARY & SLEEP ASSOCIATES 700 E OGDEN AVE 205 WESTMONT IL 60559 HOSPITALIST SERVICES 1082229 TRIMEDX LLC PO BOX 636129 CINCINNATI OH 45263 CLINICAL ENGINEERING SERVICES 914902 WAUKEGAN ROOFING COMPANY INC 252 CHADDICK DRIVE WHEELING IL 60090 CONSTRUCTION SERVICES 847852 13 X 83401 23244 106645 NET PATIENT REVENUE 622110 90652165 90652165 HEALTH EDUCATION PROGRAM 622110 7982757 7982757 CAFETERIA REVENUE 622110 288631 288631 PHARMACY REVENUE 622110 131210 131210 MEDICAL OFFICE BUILDING 622110 34985 11237 23748 25735 25735 99115483 957 957 7340 8688 -1348 -1348 -1348 479 1100 0 840 479 260 739 739 99222476 99091735 23748 348 X 184626 184626 1106705 1106705 29738918 28499324 1239594 906012 844034 61978 6917970 6516190 401780 2513328 2337395 175933 41678 41678 154 154 25069538 14150051 10919487 33949 33949 1435171 1353890 81281 3177986 2790505 387481 1722970 1722970 26332 26332 49927 49927 899039 899039 2710253 2710253 1188930 1167930 21000 MEDICAL SUPPLIES 9085252 9085252 STATE INDIGENT TAX ASSE 5054684 5054684 REPAIRS AND MAINTENANCE 510762 510762 UBI TAXES 48352 48352 345372 151931 193441 92767908 78028763 14739145 0 2546 1749 0 15112984 15770023 2003714 1802999 1751267 1922980 95535874 66563975 29667287 28971899 14635743 15684367 63173541 64154017 5410834 5662701 693 35584252 30643312 40995086 36306706 X 21671288 27069462 507167 777849 22178455 27847311 63173541 64154017 X 6454568 2971 -788683 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 19310 19310 0 PART II-B, LINE 1: DUES WERE PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE ILLINOIS HOSPITAL ASSOCIATION. 978305 978305 58924779 36781347 22143432 32389541 28570039 3819502 3243249 1212589 2030660 28971899 DUE FROM RELATED 13796733 OTHER RECEIVABLES 106775 RIGHT OF USE ASSET-OPERATING LEASE 912764 OTHER ASSETS 868095 15684367 DUE TO RELATED 15381805 PAYABLE TO THIRD PARTIES 3721303 AR CREDIT BALANCES 794561 ACCRUED INTEREST PAYABLE 1586 INTERCO ALLOC OF TE BOND PROCEEDS 9772804 LEASE CLEARING AMITA 876628 OTHER LIABILITIES 94625 30643312 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, 2019 AND 2018. NAHS ALSO HAS TEMPORARY DEDUCTIBLE DIFFERENCES OF APPROXIMATELY $46,500 AND $53,000 AT DECEMBER 31, 2019 AND 2018, RESPECTIVELY, PRIMARILY AS A RESULT OF NET OPERATING LOSS CARRYFORWARDS. AT DECEMBER 31, 2019, NAHS HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $47,500, EXPIRING BEGINNING IN 2022 THROUGH 2026. DEFERRED TAXES HAVE BEEN PROVIDED FOR THESE AMOUNTS, RESULTING IN A NET DEFERRED TAX ASSET OF APPROXIMATELY $11,400 AND $13,400 AT DECEMBER 31, 2019 AND 2018, 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, 2019 AND 2018 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 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, 2019 AND 2018. 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. WHILE FINAL REGULATIONS ON THESE PROVISIONS HAVE NOT YET BEEN PROMULGATED, THE IMPACT OF THESE PROVISIONS ON THE CONSOLIDATED FINANCIAL STATEMENTS IS NOT EXPECTED TO BE SIGNIFICANT. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 3276335 3276335 0.03530 28249574 33563739 0 0.00000 31525909 33563739 3276335 0.03530 16182 16182 0.00020 40666 40666 0.00040 56848 56848 0.00060 31582757 33563739 3333183 0.03590 1 4734994 446310 21255840 21890166 -634326 X 1 1 1 1 ADVENTIST GLENOAKS HOSPITAL 701 WINTHROP AVE GLENDALE HEIGHTS IL 60139 WWW.AMITAHEALTH.ORG/LOCATIONS/HOSPITAL 0003814 X X X ADVENTIST GLENOAKS HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X SEE PART V, PAGE 8 X X 1 17 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 600.000000000000 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 X 1 X 0 X X X X 1 X 0 0 ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 5: ADVENTIST GLENOAKS HOSPITAL (AGH OR THE HOSPITAL) COLLABORATED WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS TO CONDUCT A JOINT CHNA IN 2019. ALL THE COLLABORATORS IN THE 2019 JOINT CHNA DEFINED THEIR COMMUNITY TO BE DUPAGE COUNTY, ILLINOIS. DUPAGE COUNTY, ILLINOIS HAS A POPULATION OF OVER 900,000. THE 2019 JOINT CHNA WAS A COLLABORATIVE EFFORT OF IMPACT DUPAGE. IMPACT DUPAGE IS A COALITION OF ORGANIZATIONS THAT WAS FORMED WITH THE PURPOSE OF CREATING A COMMON UNDERSTANDING OF COMMUNITY NEEDS, GAPS, AND PRIORITIES THAT WILL ADVANCE THE WELL-BEING OF THE DUPAGE COUNTY COMMUNITY. THE HOSPITAL IS A MEMBER OF THE STEERING COMMITTEE OF IMPACT DUPAGE AS A HOSPITAL ORGANIZATION OF AMITA HEALTH THAT SERVES THE RESIDENTS OF DUPAGE COUNTY. IMPACT DUPAGE UTILIZED A COMMUNITY DRIVEN, STRATEGIC PLANNING PROCESS IN DEVELOPING AND IMPLEMENTING EFFORTS AROUND THE PRIORITIZATION OF PUBLIC HEALTH ISSUES. AS A PART OF THE COMMUNITY HEALTH ASSESSMENT AND DATA COLLECTION EFFORTS, A SPECIFIC EFFORT WAS MADE TO INCLUDE INPUT FROM UNDERREPRESENTED POPULATION GROUPS AND PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. IMPACT DUPAGE CONDUCTED A SURVEY AMONG DUPAGE COUNTY RESIDENTS TO ASSESS THE COMMUNITY'S PERCEPTIONS, THOUGHTS AND OPINIONS OF HEALTH AND THE QUALITY OF LIFE IN THEIR COMMUNITY. THE SURVEY WAS OPEN TO ALL DUPAGE COUNTY RESIDENTS AND 1,577 SURVEYS WERE COLLECTED. THE SURVEY WAS CONDUCTED ONLINE AND BY PAPER. PRIOR TO THE SURVEY LAUNCH, COMMUNICATION TOOLS WERE DEVELOPED AND DISSEMINATED TO PROMOTE THE SURVEY. THE SURVEY CONTAINED QUESTIONS ON DUPAGE COUNTY'S GREATEST STRENGTHS, IMPORTANT HEALTH CONCERNS, RISKY BEHAVIORS, COMMUNITY AND PERSONAL HEALTH, AND WHERE THE COMMUNITY SHOULD FOCUS ITS ATTENTION TO MAKE THINGS BETTER IN DUPAGE COUNTY. USING ITS NETWORK OF COMMITTEE MEMBERS, INFORMATION REGARDING THE LAUNCH OF THE SURVEY WAS DISTRIBUTED TO THE FOLLOWING ORGANIZATIONS IN ORDER TO ENSURE REPRESENTATION FROM THE BROAD COMMUNITY OF DUPAGE COUNTY:ADDISON RESOURCES CONNECTBENEDICTINE UNIVERSITYDUPAGE CHIEFS OF POLICE ASSOCIATIONDUPAGE COUNTY BOARD OF HEALTHDUPAGE COUNTY HEALTH DEPARTMENT PUBLIC HEALTH CLINICSDUPAGE COUNTY JUVENILE JUSTICE COUNCILDUPAGE COUNTYDUPAGE EARLY CHILDHOOD COLLABORATIONDUPAGE MAYORS AND MANAGERS CONFERENCEFAMILY SHELTER SERVICE GLENDALE HEIGHTS YOUTH COMMISSIONHEALTHY LOMBARDIMPACT DUPAGE NETWORKSLOVE CHRISTIAN CLEARINGHOUSE NEWSLETTERMUNICIPAL PIOSNORTH CENTRAL COLLEGEOHSEM EOC TOUR GIRL SCOUT PARENTSPEOPLE'S RESOURCE CENTER WEEKLY EMAILSPREVENTION LEADERSHIP TEAMVIRTUAL BACKPACKSWALK IN MINISTRIESWEATHER SPOTTER TRAINING COURSE ATTENDEES, ANDWOODRIDGE PARK DISTRICT.PAPER SURVEYS WERE LOCATED AT MULTIPLE DUPAGE COUNTY HEALTH DEPARTMENT PUBLIC HEALTH CLINICS THROUGHOUT THE COUNTY. THE SURVEY WAS FEATURED IN VILLAGE NEWSLETTERS AND VARIOUS AGENCY WEBSITES AND SOCIAL MEDIA ACCOUNTS. ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 6A: ADVENTIST GLENOAKS HOSPITAL (AGH OR THE HOSPITAL) COLLABORATED WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS TO CONDUCT A JOINT CHNA IN 2019. ALL THE COLLABORATORS IN THE 2019 JOINT CHNA DEFINED THEIR COMMUNITY TO BE DUPAGE COUNTY, ILLINOIS. DUPAGE COUNTY, ILLINOIS HAS A POPULATION OF OVER 900,000. THE 2019 JOINT CHNA WAS A COLLABORATIVE EFFORT OF IMPACT DUPAGE, A COLLABORATION OF PARTNERS FORMED WITH THE PURPOSE OF CREATING A COMMON UNDERSTANDING OF COMMUNITY NEEDS, GAPS AND PRIORITIES THAT WILL ADVANCE THE WELL-BEING OF THE DUPAGE COUNTY COMMUNITY. THE HOSPITAL, AS A PART OF AMITA HEALTH SYSTEM, WAS A MEMBER OF THE STEERING COMMITTEE OF IMPACT DUPAGE, ALONG WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS AND INCLUDING THE DUPAGE COUNTY HEALTH DEPARTMENT. THE OTHER HOSPITAL ORGANIZATION THAT PARTICIPATED IN THE 2019 JOINT CHNA AS A MEMBER OF THE STEERING COMMITTEE OF IMPACT DUPAGE WAS ADVOCATE AURORA HEALTH CARE. ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 6B: ADVENTIST GLENOAKS HOSPITAL (AGH OR THE HOSPITAL) COLLABORATED WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS TO CONDUCT A JOINT CHNA IN 2019. ALL THE COLLABORATORS IN THE 2019 JOINT CHNA DEFINED THEIR COMMUNITY TO BE DUPAGE COUNTY, ILLINOIS. DUPAGE COUNTY, ILLINOIS HAS A POPULATION OF OVER 900,000. THE 2019 JOINT CHNA WAS A COLLABORATIVE EFFORT OF IMPACT DUPAGE, A COLLABORATION OF PARTNERS FORMED WITH THE PURPOSE OF CREATING A COMMON UNDERSTANDING OF COMMUNITY NEEDS, GAPS AND PRIORITIES THAT WILL ADVANCE THE WELL-BEING OF THE DUPAGE COUNTY COMMUNITY. THE HOSPITAL, AS A PART OF AMITA HEALTH SYSTEM, WAS A MEMBER OF THE STEERING COMMITTEE OF IMPACT DUPAGE, ALONG WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS AND INCLUDING THE DUPAGE COUNTY HEALTH DEPARTMENT. THE OTHER NON-HOSPITAL ORGANIZATIONS THAT PARTICIPATED IN THE 2019 JOINT CHNA AS MEMBERS OF THE STEERING COMMITTEE OF IMPACT DUPAGE WERE COMMUNITY CONSOLIDATED SCHOOL DISTRICT 89, DUPAGE HEALTH COALITION, DUPAGE COUNTY COMMUNITY SERVICES, DUPAGE COUNTY HEALTH DEPARTMENT, DUPAGE COUNTY PUBLIC DEFENDER'S OFFICE, DUPAGE FEDERATION ON HUMAN SERVICES REFORM, DUPAGE FOUNDATION, DUPAGE PADS, FAMILY SHELTER SERVICE, LINDEN OAKS BEHAVIORAL HEALTH, METROPOLITAN FAMILY SERVICES DUPAGE, NORTHWESTERN MEDICINE, PEOPLE'S RESOURCE CENTER, PRAIRIE STATE LEGAL SERVICES, INC., WORKNET DUPAGE - DUPAGE COUNTY WORKFORCE DEVELOPMENT, AND UNITED WAY OF METRO CHICAGO. ADVENTIST GLENOAKS 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. COPIES OF THE CHNA REPORT WERE MAILED AND/OR E-MAILED TO COMMUNITY PARTNERS WHO PARTICIPATED IN THE CHNA PROCESS. PARTNERS WERE ALSO PROVIDED LINKS TO THE WEBSITE FOR DISSEMINATION TO THEIR MAILING LISTS AND RESPECTIVE CONSTITUENTS. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE AT AMITAHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT AND IS ALSO BROADLY DISTRIBUTED WITHIN OUR COMMUNITY TO STAKEHOLDERS INCLUDING COMMUNITY LEADERS, GOVERNMENT OFFICIALS, AND SERVICE ORGANIZATIONS. ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 11: THE INFORMATION PROVIDED BELOW EXPLAINS HOW THE HOSPITAL FACILITY ADDRESSED IN 2019 THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, AND ANY SUCH NEEDS THAT WERE NOT ADDRESSED AND THE REASONS WHY SUCH NEEDS WERE NOT ADDRESSED. THE HOSPITAL FACILITY CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT BY 12/31/16 AND ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT IN 2017 PRIOR TO MAY 15, 2017. ADVENTIST GLENOAKS HOSPITAL (AGH OR THE HOSPITAL) COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2016. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED ON BEHALF OF THE FILING ORGANIZATION AS PART OF A LARGER PROJECT SPONSORED BY THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL (MCHC) AND DONE BY PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC). A COMPLETE DESCRIPTION OF SAMPLE SIZE AND SURVEY DESIGN IS AVAILABLE IN THE FULL REPORT FOUND ONLINE AT: AMITAHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFITDESCRIPTION OF CHNA DEMOGRAPHICS IN THE GLENOAKS HOSPITAL SERVICE AREA, THE POPULATION IS SLIGHTLY OLDER WITH 15.2% BEING OVER 65 AS COMPARED TO 13.9% IN ILLINOIS. THE GLENOAKS HOSPITAL REGION IS SLIGHTLY MORE DIVERSE THAN AVERAGE, 18.5% OF THE POPULATION IS HISPANIC AS COMPARED TO 16.7% IN ALL OF ILLINOIS. THE COMMUNITY'S SOCIAL DETERMINANTS ARE POSITIVE, HAVING LESS POVERTY, LESS UNEMPLOYMENT AND A BETTER EDUCATED COMMUNITY THAN AVERAGE. 6.9% OF THE POPULATION LIVES AT OR BELOW 100% OF THE POVERTY LEVEL AND 18.6% (INCLUSIVE) ARE AT OR BELOW 200% OF THE POVERTY LEVEL, REPRESENTING 168,845 INDIVIDUALS. AS NOTED IN THE HOSPITAL'S 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, IT IS MOST OFTEN THESE INDIVIDUALS THAT HAVE DIFFICULTY ACCESSING SERVICES AND HAVE POORER OVERALL HEALTH, AND SO OUR EFFORTS TO PROVIDE THE COMMUNITY WITH NEEDED SERVICES WAS DIRECTED IN MOST CASES TOWARDS THIS POPULATION. PRIORITY ISSUES ADDRESSEDMENTAL HEALTH/SUBSTANCE ABUSETHE GLENOAKS SERVICE AREA IS ABOUT AVERAGE IN TERMS OF ITS MENTAL HEALTH INDICATORS, BUT FOR LOW INCOME AND THE UNINSURED THERE IS A MARKED LACK OF ACCESSIBILITY. KEY INFORMANTS CITE LACK OF MENTAL HEALTH SERVICES AS THEIR TOP CONCERN BECAUSE OF THE RIPPLE EFFECT ON THE COMMUNITY. ACTION TAKEN:- ACTIVE PARTNERS WITH IMPACT DUPAGE AND THE HOPE TASKFORCE, AN INITIATIVE BY THE DUPAGE COUNTY HEALTH DEPARTMENT, TO REDUCE THE NUMBER OF OPIOID DEATHS IN DUPAGE COUNTY. - CONTINUED TO WORK WITH IMPACT DUPAGE TO INCREASE AMOUNTS OF MEDICATIONS ROUTED TO AND COLLECTED BY THE DUPAGE COUNTY RXBOX PROGRAM. OVER 7 TONS WAS COLLECTED THRU 2019, AS REPORTED BY DCHD ENVIRONMENTAL HEALTH SERVICES STAFF. THIS EFFORT IS ONGOING TO ENSURE UNUSED MEDICATION IS PROPERLY DISPOSED OF AND TO AVOID MISUSE OF MEDICATIONS. - AMITA HEALTH ADVENTIST MEDICAL CENTER GLENOAKS HOSTED FREE SUPPORT GROUPS WITH NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) THAT ASSISTS INDIVIDUALS WITH MENTAL ILLNESS. DIABETESTYPE II DIABETES IS MORE PREVALENT IN LOW INCOME AND UNINSURED POPULATIONS. DIABETES CONTRIBUTES TO HEART DISEASE AND STROKE AND REQUIRES ONGOING AND EXPENSIVE CARE. THIS IS CLOSELY RELATED TO OBESITY, LACK OF EXERCISE AND POOR NUTRITION. ACTION TAKEN: - AGH PROVIDED A CONTRIBUTION TO ACCESS DUPAGE (DUPAGE HEALTH COALITION) ON THE DEVELOPMENT OF A SELF-MANAGEMENT PROGRAM FOR LOW INCOME DIABETIC PATIENTS. - AGH PROVIDED NURSES AT COMMUNITY EVENTS IN 2019 TO PROVIDE GLUCOSE SCREENINGS AND DIABETIC EDUCATION. NUTRITION, PHYSICAL ACTIVITY AND WEIGHTNUTRITION, PHYSICAL ACTIVITY AND WEIGHT IS CLOSELY LINKED TO THE INCIDENCE OF TYPE II DIABETES. CURIOUSLY, ACCORDING TO THE US DEPARTMENT OF AGRICULTURE 26.7% OF INDIVIDUALS IN DUPAGE COUNTY HAVE LOW FOOD ACCESS. MORE INFORMATION IS NEEDED AND HAS BEEN REQUESTED ABOUT THIS ISSUE. ACTION TAKEN: - ACTIVE MEMBERS AND FUNDERS ($10,000 FROM GLENOAKS) OF FORWARD DUPAGE, WHICH LEADS THE HEALTHY CHILD CARE PROJECT, DESIGNED TO CREATE ENVIRONMENTS FOR STAFF, CHILDREN AND THEIR FAMILIES THAT PROMOTE HEALTHY HABITS AND THAT COMBAT CHILDHOOD OBESITY. AMITA REPRESENTATIVES ALSO SERVE ON ITS BOARD OF DIRECTORS TO HELP OVERSEE PLANNING AND INTERVENTIONS RELATED TO INCREASED PHYSICAL ACTIVITY AND NUTRITION IN THE COUNTY. - AGH PARTNERED WITH THE HOSPITAL'S MEDICAL STAFF TO OFFER A MATCHING DONATION TO TWO COMMUNITY PANTRIES IN THE GLENDALE HEIGHT COMMUNITY IN 2019. EACH PANTRY WAS GIVEN $14,400 PER YEAR FOR OPERATIONAL COSTS AND EXPANSION TO HELP FULFILL THE FOOD INSECURITY NEEDS OF THE COMMUNITY.- HOSPITAL DIETITIANS HAD A NUTRITION TABLE AT THE GLENDALE HEIGHTS HEALTH AND SAFETY FAIR WHERE EDUCATION HANDOUTS WERE PROVIDED IN BOTH ENGLISH AND SPANISH ON GENERAL, CHILD, AND VEGETARIAN NUTRITION. IN ADDITION, FRESH FRUIT AND GRANOLA BARS WERE PROVIDED, WHICH WERE SUPPLIED BY THE HOSPITAL'S FOOD AND NUTRITION DEPARTMENT (DIETARY).ACCESS TO HEALTHCARE SERVICESACCESS TO HEALTHCARE SERVICES IS MOST PROBLEMATIC FOR THOSE IN VERY LOW AND LOW INCOME CATEGORIES, THOSE WITHOUT INSURANCE AND THOSE WITH MEDICAID. THE SURVEY IDENTIFIED THAT 72% OF THOSE OVER 65 HAVE A SPECIFIC SOURCE OF ONGOING CARE, SIMILAR TO THE MCHC REGION BUT LESS THAN ILLINOIS AT 80%. THIS MAY BE A LOYALTY ISSUE, LIKELY NOT THE INABILITY TO ACCESS CARE. ACTION TAKEN: - SINCE 2017, THE HOSPITAL HAS BEEN IN A PARTNERSHIP WITH DISPENSARY OF HOPE. BY WORKING WITH THE PHARMACEUTICAL SUPPLY CHAIN, THE DISPENSARY OF HOPE SUPPORTS THE OUTPATIENT PHARMACY BY PROVIDING FREE MEDICATION TO LOW-INCOME AND CHRONICALLY ILL INDIVIDUALS WHO ARE UNDERINSURED. OUR PHARMACISTS PROVIDE FREE CONSULTATIONS AND OFFICE HOURS FOR DISPENSING THE MEDICATION.- ADVENTIST GLENOAKS HOSPITAL PROVIDED $65,378 IN FUNDING TO ACCESS DUPAGE (DUPAGE HEALTH COALITION) TO SUPPORT LOW-INCOME, UNDERINSURED COMMUNITY MEMBERS ACCESS HEALTH CARE. EACH PATIENT IS REFERRED TO A PRIMARY CARE PHYSICIAN (PCP) OR A CLINIC THAT PROVIDES ONGOING PRIMARY CARE. COPAYMENTS TEND TO COST NO MORE THAN FIFTEEN DOLLARS FOR PRIMARY CARE SERVICES. ACCESS DUPAGE HELPS SECURE SPECIALISTS FOR ALL ENROLLEES. A MAJORITY OF THE LAB AND DIAGNOSTIC SERVICES ORDERED BY PCPS OR REFERRED SPECIALISTS ARE COVERED BY THE PROGRAM AND AVAILABLE AT A LOCAL HOSPITAL FOR A FIVE-DOLLAR COPAYMENT PER TEST. PRESCRIPTIONS ORDERED BY THE PCP OR REFERRED SPECIALISTS ARE COVERED BY THE PROGRAM AND AVAILABLE AT SELECT DUPAGE COUNTY PHARMACIES FOR COPAYMENTS RANGING FROM TEN DOLLARS TO FIFTY DOLLARS. - NURSES ADMINISTERED 325 FREE FLU VACCINES TO COMMUNITY MEMBERS AT THE GLENDALE HEIGHTS HEALTH AND SAFETY FAIR AND 20 FLU VACCINES WERE ADMINISTERED AT THE ICNA RELIEF FOOD PANTRY. SEE CONTINUATION ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 16J: THE FILING ORGANIZATION USES MULTIPLE METHODS OF COMMUNICATING ITS MISSION OF PROVIDING CARE TO ALL WHO NEED IT REGARDLESS OF ABILITY TO PAY. SIGNS POSTED AT REGISTRATION CLEARLY POINT OUT THAT CHARITY CARE OR FINANCIAL ASSISTANCE IS AVAILABLE. REGISTRATION IS EDUCATED ON PROVIDING FINANCIAL ASSISTANCE POLICY INFORMATION AND FORMS TO PATIENTS. THE MAIN WEBSITE FOR ALL SYSTEM HOSPITALS FEATURES INFORMATION ON HOW TO APPLY FOR FINANCIAL ASSISTANCE ON-LINE. IN THE HOSPITAL SETTING, WE EMPLOY FINANCIAL COUNSELORS WHO ARE AVAILABLE TO WORK WITH PATIENTS AND WE ALSO HAVE MEDICAID APPLICATION SPECIALISTS TO ASSIST PATIENTS THAT MAY QUALIFY. IN ADDITION, ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING FINANCIAL ASSISTANCE. SCHEDULE H, PART V, SECTION B, LINE 11 - CONTINUATION: OTHER IDENTIFIED HEALTH ISSUESCANCERTHE AGE ADJUSTED DEATH RATE FOR FEMALE BREAST CANCER IS 24.2 AS COMPARED TO ILLINOIS AT 22.8 AND THE US AT 21.3. THE INCIDENCE IS ALSO HIGHER AT 140.6 IN THE AGH SERVICE AREA AS COMPARED TO 129.4 IN THE MCHC REGION, 127.4 IN ILLINOIS AND 122.7 IN THE US. ACTION TAKEN:- PROVIDED FREE MAMMACARE, AN INTERNATIONALLY RECOGNIZED STANDARD FOR BREAST EXAMINATION. DURING THE CLASSES, COMMUNITY MEMBERS PRACTICE ON LIFELIKE BREAST MODELS, ALLOWING THEM TO FEEL THE DIFFERENCE.HEART DISEASE AND STROKE ALTHOUGH A TOP CONCERN FOR THE KEY INFORMANTS, THE DATA DOES NOT INDICATE THAT THIS IS A PRIORITY. THE AGE ADJUSTED DEATH RATES FOR HEART DISEASE AND STROKE ARE WELL BELOW COMPARISONS. IT MAY BE THAT COMMENTERS ARE NOTING A LOGICAL INCREASE DUE TO THE AGING POPULATION. ACTION TAKEN: - THE HOSPITAL CONTINUED ITS PARTNERSHIP WITH THE DUPAGE HEALTH COALITION. PATIENTS ARE ABLE TO RECEIVE HEALTHCARE SERVICES THAT TREAT COMORBIDITIES THAT LEAD TO HEART DISEASE AND STROKE. - THROUGHOUT THE YEAR, AMITA HEALTH, INCLUDING THE HOSPITAL, PROVIDED FREE FLU VACCINES, LUNG VITAL CAPACITY ASSESSMENTS, BLOOD SUGAR CHECKS, BLOOD PRESSURE CHECKS, BODY FAT ANALYSIS AND A STROKE RISK ASSESSMENT.IMMUNIZATION AND INFECTIOUS DISEASES AMONG ADULTS AGED 65 AND OVER, 49.3% HAVE HAD FLU VACCINES AS COMPARED TO 56.6% IN THE MCHC REGION AND 58.6% IN ILLINOIS. THIS OPPORTUNITY CAN BE ADDRESSED WITHIN EMPLOYED PHYSICIAN GROUPS AS WELL AS IN THE COMMUNITY.- AGH PARTNERED WITH THE DUPAGE HEALTH COALITION IN ORDER TO PROVIDE FREE OR LOW-COST SERVICES THAT TREAT INFECTIOUS DISEASES OR PREVENT THEM THROUGH IMMUNIZATIONS.SEXUALLY TRANSMITTED DISEASESAMONG UNMARRIED ADULTS, A RISE IN THOSE WHO HAVE HAD MORE THAN THREE SEXUAL PARTNERS IN THE PAST YEAR, FROM 6.9% IN 2009 TO 16.5% IN 2015, SIGNALING A POTENTIAL NEED FOR PATIENT COUNSELING. - THE HOSPITAL CONTINUED ITS PARTNERSHIP WITH THE DUPAGE HEALTH COALITION, WHICH PROVIDES AFFORDABLE MEDICATION AND ACCESS TO PRIMARY CARE SERVICES TO TREAT STDS AND HIV/AIDS. - INJURY AND VIOLENCE VIOLENCE INTERVENTIONS ARE COMPLETED IN THE CLINICAL SETTING AS PART OF ROUTINE PATIENT ASSESSMENTS. NOT ADDRESSED: POTENTIALLY DISABLING CONDITIONS - THE HOSPITAL PROVIDES EXTENSIVE SERVICES IN A CLINICAL SETTING. ADDITIONALLY, DUE TO THE LACK OF FUNDING, THE HOSPITAL WAS NOT ABLE TO CREATE A SEPARATE COMMUNITY BENEFIT PROGRAM. - RESPIRATORY DISEASES - THE HOSPITAL IS A PART OF THE ADVENTIST CARDIOVASCULAR NETWORK'S PULMONARY REHABILITATION PROGRAM WHICH PROVIDES A PHYSICIAN-DIRECTED TEAM OF NURSES, EXERCISE PHYSIOLOGISTS AND RESPIRATORY THERAPISTS THAT SPECIALIZE IN PULMONARY DISEASE AND TREATMENTS TO EACH OUTPATIENT WHO PARTICIPATES. THE PULMONARY REHABILITATION PROGRAM IS CERTIFIED BY THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION (AACVPR). SCHEDULE H, PART V, SECTION B, LINE 7A THE CHNA REPORT CAN BE FOUND AT URL:HTTPS://WWW.AMITAHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT/AMITA-HEALTH-ADVENTIST-MEDICAL-CENTER-GLENOAKS SCHEDULE H, PART V, SECTION B, LINE 10A: THE HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND AT:HTTPS://WWW.AMITAHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT/AMITA-HEALTH-ADVENTIST-MEDICAL-CENTER-GLENOAKS SCHEDULE H, PART V, SECTION B, LINE 16A,B,C: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE AT:HTTPS://WWW.AMITAHEALTH.ORG/PATIENT-RESOURCES/PAY-YOUR-BILL/PRICE-ESTIMATES/ADVENTIST-FORMS-AND-POLICY-INFORMATION THE FINANCIAL ASSISTANCE POLICY APPLICATION CAN BE FOUND AT:HTTPS://WWW.AMITAHEALTH.ORG/PATIENT-RESOURCES/PAY-YOUR-BILL/PRICE-ESTIMATES/ADVENTIST-FORMS-AND-POLICY-INFORMATION THE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://WWW.AMITAHEALTH.ORG/PATIENT-RESOURCES/PAY-YOUR-BILL/PRICE-ESTIMATES/ADVENTIST-FORMS-AND-POLICY-INFORMATION SCHEDULE H, PART V, SECTION B, LINE 8 - 10A THE FILING ORGANIZATION ADOPTED A COMMUNITY HEALTH NEEDS ASSESSMENT REPORT BY 12/31/2019 AND WAS IN THE PROCESS OF DEVELOPING ITS COMMUNITY HEALTH NEEDS IMPLEMENTATION STRATEGY AT THAT TIME. THE FILING ORGANIZATION'S 2020-2022 COMMUNITY HEALTH NEEDS IMPLEMENTATION STRATEGY IS DOCUMENTED IN A WRITTEN REPORT CALLED THE "COMMUNITY HEALTH PLAN". THE COMMUNITY HEALTH PLAN (CHP) DESCRIBES HOW THE FILING ORGANIZATION PLANS TO MEET ITS IDENTIFIED PRIORITIZED HEALTH NEEDS OR IDENTIFIES THE HEALTH NEED AS ONE THE FILING ORGANIZATION DOES NOT INTEND TO SPECIFICALLY ADDRESS AND PROVIDES AN EXPLANATION AS TO WHY THE FILING ORGANIZATION DOES NOT INTEND TO ADDRESS THAT HEALTH NEED. THE FILING ORGANIZATION'S 2020-2022 CHP WAS ADOPTED BY MAY 15, 2020 AND IS POSTED ON THE HOSPITAL FACILITY'S WEBSITE.AS THE HOSPITAL FACILITY'S 2020-2022 COMMUNITY HEALTH NEEDS IMPLEMENTATION STRATEGY WAS NOT ADOPTED BY THE END OF THE HOSPITAL ORGANIZATION'S TAXABLE YEAR OF DECEMBER 31, 2019, SCHEDULE H, PART V, SECTION B, LINE 9 INDICATES THAT 2017 WAS THE TAX YEAR IN WHICH THE HOSPITAL FACILITY LAST ADOPTED AN IMPLEMENTATION STRATEGY. SCHEDULE H, PART V, SECTION B, LINE 10A REFLECTS THE WEBSITE ADDRESS FOR THE HOSPITAL FACILITY'S 2014-2016, 2017-2019, AND 2020-2022 IMPLEMENTATION STRATEGIES. 3 1 - THERAPEUTIC DAY SCHOOL NORTH CAMPUS 135 N BRANDON DRIVE GLENDALE HEIGHTS IL 60139 BEHAVORIAL HEALTH 2 - THERAPEUTIC DAY SCHOOL WEST CAMPUS 940 MOOSEHEART ROAD NORTH AURORA IL 60542 BEHAVORIAL HEALTH 3 - THERAPEUTIC DAY SCHOOL SOUTH CAMPUS 1N450 MAIN STREET GLEN ELLYN IL 60139 BEHAVORIAL HEALTH PART I, LINE 3C: EVERY UNINSURED PERSON, REGARDLESS OF INCOME, RECEIVES AN AUTOMATIC 15% DISCOUNT OFF OF CHARGES. PERSONS WHO EARN LESS THAN 600% OF THE FEDERAL POVERTY GUIDELINES ARE GIVEN MORE SIGNIFICANT DISCOUNTS, DEPENDING ON THEIR INDIVIDUAL SITUATIONS.FEDERAL POVERTY LEVEL - 0-200% UNINSURED PATIENT DISCOUNT - 95%FEDERAL POVERTY LEVEL - 201-300% UNINSURED PATIENT DISCOUNT - 75%FEDERAL POVERTY LEVEL - 301-600% UNINSURED PATIENT DISCOUNT - 74%FEDERAL POVERTY LEVEL - > 600% UNINSURED PATIENT DISCOUNT - 74% 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 27 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.THE FILING ORGANIZATION IS INCLUDED IN THE SUBMISSION OF THE ANNUAL NONPROFIT HOSPITAL COMMUNITY BENEFIT PLAN REPORT WITH THE ATTORNEY GENERAL'S OFFICE OF THE STATE OF ILLINOIS. THIS REPORT IS PREPARED ON A CONSOLIDATED BASIS AND INCLUDES DATA FOR ADVENTIST MIDWEST HEALTH, ADVENTIST GLENOAKS HOSPITAL, AND ADVENTIST BOLINGBROOK HOSPITAL. THESE HOSPITAL ORGANIZATIONS ARE ALL RELATED ORGANIZATIONS. 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. - CHARITY AT COST - A COST TO CHARGE METHODOLOGY BASED ON THE MOST RECENTLY FILED MEDICARE COST REPORT WAS USED TO CALCULATE COSTS. - UNREIMBURSED MEDICAID - COSTS ARE CALCULATED USING THE MOST RECENTLY FILED MEDICAID COST REPORT. - OTHER BENEFITS - COSTS ARE DETERMINED BY ACTIVITY REPORTED IN ACCORDANCE WITH GUIDELINES PUBLISHED BY THE CATHOLIC HEALTH ASSOCIATION. COSTS COULD INCLUDE THE VALUE OF HOURLY WAGES, COSTS OF MATERIALS, VALUE OF SPACE LOANED TO COMMUNITY GROUPS FOR MEETINGS, AND INDIRECT COSTS WHERE APPLICABLE. PART III, LINE 2: AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE FILING ORGANIZATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITHIN COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY AMITA HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE FILING ORGANIZATION'S POLICIES. PART III, LINE 3: THE FILING ORGANIZATION PROACTIVELY WORKS TO PRESUMPTIVELY ASSESS AND GRANT CHARITY TO ALL UNINSURED PATIENTS. THE HOSPITAL SCREENS ALL UNINSURED PATIENTS AGAINST CREDIT SCORE DATA IN ORDER TO PRESUMPTIVELY APPLY ITS FINANCIAL ASSISTANCE POLICY. BASED ON THIS PROCESS, APPROXIMATELY 96% OF THE UNINSURED PATIENT POPULATION IS DEFINED AS ELIGIBLE FOR A PARTIAL CHARITY ADJUSTMENT ON THEIR ACCOUNTS. THE AVERAGE DISCOUNT GIVEN TO THE UNINSURED PATIENT POPULATION IS 81%. IN PRIOR YEARS, PROACTIVE EFFORTS WERE LIMITED TO ONLY THOSE ACCOUNTS WITH BALANCES > $5,000. UNDER THAT SCENARIO, IT WAS ESTIMATED THAT 1/3 OF OUR BAD DEBT PLACEMENTS MAY HAVE BEEN ELIGIBLE FOR CHARITY CARE DISCOUNTS. WITH A MORE COMPREHENSIVE PRESUMPTIVE CHARITY PROGRAM, MANY MORE ACCOUNTS ARE GRANTED CHARITY EARLIER IN THE PROCESS AND PRIOR TO BAD DEBT PLACEMENT. THEREFORE, IT IS ESTIMATED THAT APPROXIMATELY 10% OF OUR CURRENT BAD DEBT PLACEMENTS WOULD BE ELIGIBLE FOR ADDITIONAL CHARITY IF A FULL PRESUMPTIVE CHARITY PROCESS WAS CONDUCTED ACROSS 100% OF OUR SELF-PAY AFTER INSURANCE ACCOUNTS.DISCOUNTS AND PAYMENTS ARE NOT INCLUDED IN BAD DEBT EXPENSE IN THE FINANCIAL STATEMENTS UNLESS THE PAYMENT IS A RECOVERY OF AMOUNTS PREVIOUSLY WRITTEN OFF AS BAD DEBT. RECOVERIES ARE CLASSIFIED AS A DECREASE TO BAD DEBT EXPENSE.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.RATIONALE FOR INCLUDING A MEDICARE SHORTFALL AS COMMUNITY BENEFIT:AS A 501(C)(3) ORGANIZATION, THE FILING ORGANIZATION PROVIDES EMERGENCY AND NON-ELECTIVE CARE TO ALL REGARDLESS OF ABILITY TO PAY. ALL HOSPITAL SERVICES ARE PROVIDED IN A NON-DISCRIMINATORY MANNER TO PATIENTS WHO ARE COVERED BENEFICIARIES UNDER THE MEDICARE PROGRAM. AS A PUBLIC INSURANCE PROGRAM, MEDICARE PROVIDES A PRE-ESTABLISHED REIMBURSEMENT RATE/AMOUNT TO HEALTH CARE PROVIDERS FOR THE SERVICES THEY PROVIDE TO PATIENTS. IN SOME CASES, THE REIMBURSEMENT AMOUNT PROVIDED TO A HOSPITAL MAY EXCEED ITS COSTS OF PROVIDING A PARTICULAR SERVICE OR SERVICES TO A PATIENT. IN OTHER CASES, THE MEDICARE REIMBURSEMENT AMOUNT MAY RESULT IN THE HOSPITAL EXPERIENCING A SHORTFALL OF REIMBURSEMENT RECEIVED OVER COSTS INCURRED. IN THOSE CASES WHERE AN OVERALL SHORTFALL IS GENERATED FOR PROVIDING SERVICES TO ALL MEDICARE PATIENTS, THE SHORTFALL AMOUNT SHOULD BE CONSIDERED AS A BENEFIT TO THE COMMUNITY. TAX-EXEMPT HOSPITALS ARE REQUIRED TO ACCEPT ALL MEDICARE PATIENTS REGARDLESS OF THE PROFITABILITY, OR LACK THEREOF, WITH RESPECT TO THE SERVICES THEY PROVIDE TO MEDICARE PATIENTS. THE POPULATION OF INDIVIDUALS COVERED UNDER THE MEDICARE PROGRAM IS SUFFICIENTLY LARGE SO THAT THE PROVISION OF SERVICES TO THE POPULATION IS A BENEFIT TO THE COMMUNITY AND RELIEVES THE BURDENS OF GOVERNMENT. IN THOSE SITUATIONS WHERE THE PROVISION OF SERVICES TO THE TOTAL MEDICARE PATIENT POPULATION OF A TAX-EXEMPT HOSPITAL DURING ANY YEAR RESULTS IN A SHORTFALL OF REIMBURSEMENT RECEIVED OVER THE COST OF PROVIDING CARE, THE TAX-EXEMPT HOSPITAL HAS PROVIDED A BENEFIT TO A CLASS OF PERSONS BROAD ENOUGH TO BE CONSIDERED A BENEFIT TO THE COMMUNITY. DESPITE A FINANCIAL SHORTFALL, A TAX-EXEMPT HOSPITAL MUST AND WILL CONTINUE TO ACCEPT AND CARE FOR MEDICARE PATIENTS. TYPICALLY, TAX-EXEMPT HOSPITALS PROVIDE HEALTH CARE SERVICES BASED UPON AN ASSESSMENT OF THE HEALTH CARE NEEDS OF THEIR COMMUNITY AS OPPOSED TO THEIR TAXABLE COUNTERPARTS WHERE PROFITABILITY OFTEN DRIVES DECISIONS ABOUT PATIENT CARE SERVICES THAT ARE OFFERED. PATIENT CARE PROVIDED BY TAX-EXEMPT HOSPITALS THAT RESULTS IN MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS PROVIDING A BENEFIT TO THE COMMUNITY AND RELIEVING THE BURDENS OF GOVERNMENT. PART III, LINE 9B: IT IS THE POLICY OF THE FILING ORGANIZATION TO OFFER PATIENTS A PAYMENT PLAN AND/OR CHARITY ASSISTANCE WHEN IT BECOMES KNOWN OR EVEN SUSPECTED THAT A PATIENT NEEDS FINANCIAL ASSISTANCE. SIGNS AND BROCHURES ARE POSTED IN FACILITY REGISTRATION AREAS. FINANCIAL COUNSELORS ARE NOTIFIED AND EVERY ATTEMPT IS MADE TO CONTACT AND WORK WITH THE PATIENT OR THEIR FAMILY TO HELP THEM COMPLETE A FINANCIAL ASSISTANCE APPLICATION WITH COMPASSION AND DIGNITY. FINANCIAL COUNSELORS WORK WITH PATIENTS TO HELP DETERMINE IF THERE ARE ANY THIRD-PARTY PAYORS WHICH MAY BE AVAILABLE TO HELP THE PATIENT MEET THEIR OBLIGATIONS. THE HOSPITAL WORKS WITH THE PATIENT TO DETERMINE IF THEY ARE ELIGIBLE FOR FEDERAL PROGRAMS INCLUDING MEDICAID, STATE FUNDED PROGRAMS INCLUDING CRIME VICTIMS, ALTERNATIVE INSURANCE INCLUDING COBRA, WORKER'S COMPENSATION AND OR OTHER SPECIALIZED GRANT PROGRAMS SUCH AS OUR MAMMOGRAPHY GRANT PROGRAM FOR LOW INCOME WOMEN. IN THE EVENT NO THIRD-PARTY PROGRAMS ARE IDENTIFIED, THE HOSPITAL THEN WORKS WITH THE PATIENT TO HELP THEM APPLY FOR FINANCIAL ASSISTANCE DISCOUNTS AND PAYMENT PLANS. IN ADDITION, ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING FINANCIAL ASSISTANCE. 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 GLENDALE HEIGHTS, ILLINOIS. IT CURRENTLY OPERATES A HOSPITAL FACILITY AND IS LICENSED FOR 143 BEDS. THE HOSPITAL PROVIDES A FULL RANGE OF SERVICES, INCLUDING EMERGENCY CARE, SURGICAL, ONCOLOGY, OBSTETRICAL, CARDIOLOGY, INTERVENTIONAL RADIOLOGY, BEHAVIORAL HEALTH AND MORE. THE HOSPITAL OPERATES A THREE-CAMPUS THERAPEUTIC DAY SCHOOL WHERE STUDENTS IN 3RD GRADE THROUGH HIGH SCHOOL ARE PROVIDED AN ENVIRONMENT THAT BLENDS ACADEMIC EDUCATION WITH THERAPIES THAT NURTURE EACH STUDENT'S EMOTIONAL GROWTH AND INDEPENDENCE. THE HOSPITAL IS AN ACCREDITED CHEST PAIN CENTER AND CERTIFIED PRIMARY STROKE CENTER. AS THE ONLY DISPROPORTIONATE SHARE HOSPITAL IN DUPAGE COUNTY, THE HOSPITAL IS A SAFETY NET FOR THE MOST VULNERABLE AND UNDERSERVED POPULATIONS - PROVIDING CARE MANY PATIENTS CANNOT ACCESS ELSEWHERE.THE ADVENTIST GLENOAKS HOSPITAL COMMUNITY CONSISTS PRIMARILY OF GLENDALE HEIGHTS AND THE SURROUNDING AREA. WE DEFINE THE PRIMARY SERVICE AREA (PSA) AS THE COLLECTION OF ZIP CODES WHERE APPROXIMATELY 75% OF HOSPITAL PATIENTS RESIDE, AND WE FOCUS OUR COMMUNITY HEALTH IMPROVEMENT ON THIS SERVICE AREA. THE SERVICE AREA INCLUDES THE FOLLOWING ZIP CODES: 60172, 60148, 60188, 60108, 60137, 60101, AND 60139 .ACCORDING TO US CENSUS DATA (2018) THE POPULATION OF THIS SERVICE AREA IS 254,741. THE AVERAGE AGE IS 38.7 YEARS WITH AN AVERAGE FAMILY INCOME OF $73,360. THE AGE SPREAD OF THE PRIMARY SERVICE AREA IS SIMILAR TO DUPAGE COUNTY AND ILLINOIS. EIGHT PERCENT OF THOSE THAT RESIDE IN THIS SERVICE AREA ARE LIVING IN POVERTY. THE PRIMARY SERVICE AREA OF ADVENTIST GLENOAKS HOSPITAL HAS A SLIGHTLY HIGHER HISPANIC/LATINO POPULATION THAN DUPAGE COUNTY AND ILLINOIS. THE HOSPITAL IS THE ONLY MEDICAID DISPROPORTIONATE SHARE HOSPITAL IN DUPAGE COUNTY, ILLINOIS. THE FACILITY SERVES A DISPROPORTIONATE NUMBER OF STATE AND FEDERALLY FUNDED PATIENTS AS WELL AS A SIGNIFICANT NUMBER OF UNINSURED PATIENTS IN COMPARISON TO OTHER HOSPITAL FACILITIES IN DUPAGE COUNTY. DURING 2019, 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 2019, ABOUT 62.8% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. - MEDICARE PATIENTS 38.5% - MEDICAID PATIENTS 28.7% - SELF-PAY PATIENTS 8.% THE DEMOGRAPHIC MAKEUP OF THE HOSPITAL'S DUPAGE COUNTY COMMUNITY IS AS FOLLOWS: - POPULATION 929,026 - POPULATION OVER 65 15.67% - POVERTY (BELOW 100% FPL) 6.8% - UNEMPLOYMENT RATE 5.2% - UNINSURED ADULTS 6.3% PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO ADVENTIST GLENOAKS 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. DURING THE CURRENT YEAR, THE HOSPITAL PROVIDED $376,422 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF A COMMUNITY HOSPITAL. 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 $2,063,217 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: ADVENTIST GLENOAKS 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 47 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 12 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. THE FILING ORGANIZATION IS ALSO A COVERED AFFILIATE OF A JOINT OPERATING COMPANY THAT DOES BUSINESS UNDER THE NAME OF AMITA HEALTH. AMITA HEALTH HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT ORGANIZATION UNDER IRC SECTION 501(C)(3). AMITA HEALTH PROVIDES VARIOUS MANAGEMENT AND EXECUTIVE SUPPORT SERVICES TO THE FILING ORGANIZATION. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AMITA HEALTH AND BY ADVENTHEALTH PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING THE 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 AS A COVERED AFFILIATE OF AMITA HEALTH AND AS PART OF A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITALS 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. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY THE FILING 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 OR OF AMITA HEALTH 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 AND TO WWW.AMITHHEALTH.ORG TO LEARN MORE ABOUT THE VISION AND SERVICES PROVIDED BY ALL ITS HOSPITAL LOCATIONS. PART VI, LINE 7, REPORTS FILED WITH STATES IL 1 DUPAGE HEALTH COALITION 511 THORNHILL DR SUITE M CAROL STREAM IL 60188 364448208 501(C)(3) 130757 GENERAL SUPPORT GLENOAKS HOSPITAL FOUNDATION 701 WINTHROP AVE GLENDALE HEIGHTS IL 60139 363926044 501(C)(3) 14038 COST GENERAL ADMINISTRATIVE SUPPORT PROVISION OF GENERAL ADMINISTRATIVE SUPPORT MIDWEST HEALTH FOUNDATION 120 N OAK STREET HINSDALE IL 60521 352230515 501(C)(3) 24831 COST GENERAL ADMINISTRATIVE SUPPORT PROVISION OF GENERAL ADMINISTRATIVE SUPPORT THE DUPAGE COMMUNITY FOUNDATION 3000 WOODCREEK DR SUITE 310 DOWNERS GROVE IL 60515 363978733 501(C)(3) 10000 GENERAL SUPPORT 4 0 PART I, LINE 2: GRANTS ARE GENERALLY MADE ONLY TO RELATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3), OR TO OTHER LOCAL CHARITABLE COMMUNITY ORGANIZATIONS, OR TO OTHER 501(C)(3) ORGANIZATIONS THAT ARE A PART OF THE GROUP EXEMPTION RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES. X X X 1 1 1 1 0 0 0 0 0 0 0 HAFFNER PHD RANDALL DIR/CHAIRMAN 0 1264609 0 491378 0 984762 0 258314 0 42765 0 3041828 0 244687 SNYDER BRENT G DIRECTOR 0 765142 0 259990 0 287981 0 142659 0 24209 0 1479981 0 118519 THORDARSON THOR DIR/PRES/SEC/EVP & COO 0 620170 0 311794 0 137496 0 15087 0 24967 0 1109514 0 73337 BUCHANAN HERBERT DIRECTOR (BEG 1/19) 47608 428469 2240 20160 12934 116405 0 0 1105 9945 63887 574979 0 0 CARROLL RICHARD VP/CMO BOLINGBROOK/GLENOAK 0 384361 0 0 0 102069 0 15087 0 18204 0 519721 0 23307 CHRISTIAN BRUCE PRES/CEO BOLINGBROOK/GLENO 0 394247 0 55930 0 32853 0 14202 0 18353 0 515585 0 0 YANG MD ERIC DIRECTOR (END 12/19) 0 240000 0 0 0 197486 0 15087 0 667 0 453240 0 0 ROEHR RICHARD FORMER COO 0 313501 0 0 0 16424 0 15087 0 29891 0 374903 0 0 RADIVOJEVIC VLADIMIR VP/COO BOLINGBROOK/GLENOAK & INTERIM 0 249606 0 10000 0 12524 0 14477 0 29381 0 315988 0 0 PFEIFER CAROL CNO 213073 0 0 0 4400 0 17600 0 20028 0 255101 0 0 0 ALBAUGH JOLENE RN DIR - SURGICAL SVCS 157056 0 20000 0 2000 19501 7779 0 15218 0 202053 19501 0 0 DOMINGUEZ MIGUEL RN DIR-NURSING 145604 0 10000 0 2784 0 7377 0 27977 0 193742 0 0 0 DE RAMOS DO DAVID DIRECTOR (BEG 1/19) 0 117545 0 0 0 49528 0 8456 0 17381 0 192910 0 0 PUNNOOSE BISSY RN BEHAVORIAL HEALTH 85123 0 4690 0 70522 0 8006 0 16113 0 184454 0 0 0 BROWN JARED CFO (BEG 8/19) 0 152702 0 0 0 105 0 7616 0 15947 0 176370 0 0 TIANGSON LETICIA RN EMERGENCY DEPT 84145 0 3398 0 62058 0 7129 0 16384 0 173114 0 0 0 GRIGSBY LISA DIR EDUCATION SVCS AMITA 144823 0 0 0 3241 0 7125 0 9413 0 164602 0 0 0 PART I, LINE 1A CERTAIN 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 THE FILING ORGANIZATION'S PARENT. THE FILING ORGANIZATION AND ITS 501(C)(3) PARENT ARE A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTHEALTH (AH). THE TOP-TIER PARENT OF ADVENTHEALTH IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AS PART OF AH, THE FILING ORGANIZATION ADHERES TO CERTAIN AHSSHC POLICIES REGARDING ITS EXECUTIVES. TRAVEL FOR COMPANIONS: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING 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: NOMINAL DISCRETIONARY SPENDING AMOUNTS ARE PERIODICALLY PROVIDED TO ELIGIBLE EXECUTIVES WHO ATTEND ANNUAL BUSINESS MEETINGS SUCH AS THE ADVENTHEALTH CFO CONFERENCE OR THE CMO/CNO BUSINESS MEETING ($300 OR LESS PER EXECUTIVE). PAYMENTS PROVIDED TO EACH EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. PART I, LINE 3 THE FILING ORGANIZATION IS A COVERED AFFILIATE OF THE JOINT OPERATING COMPANY, ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO. D/B/A AMITA HEALTH (AMITA). AMITA UTILIZES VARIOUS COMPARABILITY DATA IN ESTABLISHING COMPENSATION FOR THOSE EXECUTIVES THAT PERFORM SERVICES FOR AMITA AND FOR ONE OR MORE COVERED AFFILIATES. COMPARABILITY DATA UTILIZED INCLUDES COMPENSATION SURVEYS AND STUDIES AND THE FORMS 990 OF OTHER UNRELATED COMPARABLE ORGANIZATIONS. AMITA ALSO HAS A COMPENSATION COMMITTEE THAT APPROVES ALL RELEVANT EXECUTIVE COMPENSATION. THE COMPENSATION OF THE FILING ORGANIZATION'S CEO WAS DETERMINED AND APPROVED BY AMITA'S EXECUTIVE COMPENSATION COMMITTEE. PART I, LINES 4A-B DURING THE YEAR ENDING DECEMBER 31, 2019, JOLENE ALBAUGH RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $12,080. PURSUANT TO CORPORATE EXECUTIVE POLICIES GOVERNING EXECUTIVE SEVERANCE, SEVERANCE AGREEMENTS FOR EXECUTIVES OPERATING AT THE VICE PRESIDENT LEVEL AND ABOVE ARE ENTERED INTO UPON ELIGIBILITY TO FACILITATE THE TRANSITION TO SUBSEQUENT EMPLOYMENT FOLLOWING AN INVOLUNTARY SEPARATION FROM EMPLOYMENT. LINE 4B: CERTAIN INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A RECEIVED COMPENSATION IN 2019 FROM ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF A HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. BEGINNING IN 2018, CERTAIN EXECUTIVE EMPLOYEES WHO WERE PREVIOUSLY ON THE PAYROLL OF AHSSHC WERE TRANSFERRED TO THE PAYROLL OF THE FILING ORGANIZATION'S PARENT. CERTAIN EXECUTIVES WHO WERE PARTICIPANTS IN AHSSHC'S NON-QUALIFIED DEFERRED COMPENSATION PLAN RECEIVED TAXABLE AMOUNTS FROM THE PLAN IN 2019. A DESCRIPTION OF THE PLAN FOLLOWS. IN RECOGNITION OF THE CONTRIBUTION THAT EACH EXECUTIVE MAKES TO THE SUCCESS OF ADVENTHEALTH, ADVENTHEALTH PROVIDES TO ELIGIBLE EXECUTIVES PARTICIPATION IN THE ADVENTHEALTH EXECUTIVE FLEX BENEFIT PROGRAM (THE PLAN). THE PURPOSE OF THE PLAN IS TO OFFER ELIGIBLE EXECUTIVES AN OPPORTUNITY TO ELECT 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 PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH IS DEDUCTED THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS. THE PRE-DETERMINED BENEFITS ALLOWANCE CREDIT PERCENTAGE IS APPROVED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF AHSSHC. ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED FROM THE ANNUAL PRE-DETERMINED BENEFITS ALLOWANCE ARE CONTRIBUTED, AT THE EMPLOYEE'S OPTION, 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 DOCUMENTS DEFINE AN EMPLOYEE WHO IS ELIGIBLE TO PARTICIPATE IN THE PLAN TO GENERALLY INCLUDE THE CHIEF EXECUTIVE OFFICERS OF ADVENTHEALTH ENTITIES AND VICE PRESIDENTS OF ALL ADVENTHEALTH ENTITIES WHOSE BASE SALARY IS AT LEAST $260,000. 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 IS FORFEITED BY THE EXECUTIVE UPON A VOLUNTARY SEPARATION. IN ADDITION TO THE PLAN, ADVENTHEALTH HAS INSTITUTED 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. PARTICIPATION IN THE PLAN IS OFFERED TO ADVENTHEALTH EXECUTIVES 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) 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 THE SERP AND BY THE INDIVIDUAL'S YEAR OF ENTRY TO THE ADVENTHEALTH EXECUTIVE FLEX BENEFIT PROGRAM. ADDITIONALLY, ADVENTHEALTH HAS ADOPTED A SENIOR EXECUTIVE DEATH BENEFIT (SEDB) PLAN IN RECOGNITION OF THE CONSIDERABLE AGE AND SERVICE REQUIREMENTS IN THE SERP. THE SEDB PLAN PROVIDES A BENEFIT IN AN AMOUNT EQUAL TO THE AMOUNT THE EXECUTIVE'S BENEFIT WOULD HAVE BEEN UNDER THE SERP 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 PLAN WITH PRESENT VALUE RECOGNIZING AN EARLY BENEFIT COMMENCEMENT. 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 OF THE ELIGIBILITY REQUIREMENTS OF SERP AS OF THE EXECUTIVE'S DATE OF DEATH BUT WOULD HAVE SATISFIED ALL OF THOSE REQUIREMENTS WITHIN FIVE (5) YEARS FOLLOWING DEATH HAD THE EXECUTIVE LIVED AND CONTINUED EMPLOYMENT. THE SEDB PLAN WAS REVIEWED AND APPROVED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. FLEX PLAN FLEX PLAN/ SERP 457(B) CY CY EMPLOYER CY CONTRIB./ DISTRIBUTIONS* CONTRIB. DISTRIBUTIONS* PAYMENT ------------------------------------------------------- RICHARD CARROLL, MD $ 0 $ 23,307 $ 0 $ 0 RANDALL HAFFNER, PHD $262,228 $ 238,856 $ 657,546 $ 0 BRENT G. SNYDER $146,573 $120,434 $ 83,943 $ 0 THOR THORDARSON $ 0 $ 76,025 $ 0 $ 0 *INCLUDING INVESTMENT EARNINGS DEBORAH SCHIMEROSWKI, CFO WAS COMPENSATED BY PRESENCE CARE TRANSFORMATION CORPORATION AND HENRY ZEISEL, CFO, CAROL PFIEFER, CNO, AND HERBERT BUCHANAN, REGIONAL OFFICER WERE COMPENSATED BY ALEXIAN BROTHERS HEALTH SYSTEM IN 2019 FOR SERVICES PROVIDED TO THE FILING ORGANIZATION. PRESENCE CARE TRANSFORATION CORPORATION AND ALEXIAN BROTHERS HEALTH SYSTEM ARE AFFILIATED WITH THE FILING ORGANIZATION. PLEASE SEE OUR RESPONSE TO FORM 990, PART VI, SECTION A, LINE 7B FOR A DISCUSSION CONCERNING THE FILING ORGANIZATION'S AFFILIATION WITH ALEXIAN BROTHERS HEALTH SYSTEM THROUGH THE JOINT OPERATING COMPANY KNOWN AS AMITA HEALTH. COMPENSATION FOR THESE INDIVIDUAL'S SERVICES PROVIDED TO THE FILING ORGANIZATION IS DISCLOSED IN PART VII, LINE 1A, AND SCHEDULE J, PART II. PART V, LINE 1A: THE PARENT CORPORATION OF ADVENTIST GLENOAKS HOSPITAL (THE FILING ORGANIZATION) IS ADVENTIST MIDWEST HEALTH (AMH). AMH IS AN ILLINOIS, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). AMH HAS ESTABLISHED A SHARED SERVICE CENTER TO CENTRALIZE THE ACCOUNTS PAYABLE (A/P) FUNCTION FOR ALL AMH 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 AMH AS THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. THE FACTS AND CIRCUMSTANCES SUPPORT A POSITION THAT AMH, 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). AMH WILL NOT MERELY BE MAKING PAYMENTS AT THE DIRECTION OF ITS SUBSIDIARY ORGANIZATIONS. ACCORDINGLY, AMH IS CONSIDERED THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. FORM 990, PART VI, SECTION A, LINE 6 ADVENTIST GLENOAKS HOSPITAL (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS ADVENTIST MIDWEST HEALTH. ADVENTIST MIDWEST HEALTH IS AN ILLINOIS, 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 MEMBERS OF THE BOARD OF DIRECTORS (GOVERNING BOARD) OF THE FILING ORGANIZATION ARE APPOINTED BY THE CORPORATE MEMBER, AMH. THE CORPORATE MEMBER IS ENTITLED TO ELECT NOT LESS THAN EIGHTEEN (18) AND NO MORE THAN TWENTY THREE (23) VOTING MEMBERS TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION PURSUANT TO THE PROVISIONS OF THE BYLAWS, SUBJECT TO THE RATIFICATION OF THE AMITA HEALTH BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FILING ORGANIZATION IS A COVERED AFFILIATE OF THE JOC KNOWN AS AMITA HEALTH. THE SOLE MEMBER OF THE FILING ORGANIZATION IS AMH. AMH IS ALSO ONE OF TWO MEMBERS IN AMITA HEALTH. THE OTHER MEMBER OF AMITA HEALTH IS ALEXIAN BROTHERS HEALTH SYSTEM. THE TOP-TIER PARENT OF AMH IS AHSSHC (SPONSOR). THE GOVERNING DOCUMENTS OF THE FILING ORGANIZATION PROVIDE FOR CERTAIN RESERVED POWERS TO EXERCISE FINANCIAL, MANAGERIAL, AND OPERATIONAL AUTHORITIES OVER THE FILING ORGANIZATION BY AHSSHC, AS SPONSOR, BY AMH AS MEMBER, BY BOTH MEMBERS OF THE JOC, NAMELY, AMH AND ALEXIAN BROTHERS HEALTH SYSTEM (MEMBERS), AND BY THE BOARD OF DIRECTORS OF THE JOC. CERTAIN GOVERNANCE POWERS ARE RESERVED TO AMH AS THE MEMBER OF THE FILING ORGANIZATION. THESE RESERVED POWERS INCLUDE THE ALTERATION, RESTATEMENT OR REPEAL OF THE ARTICLES OF INCORPORATION, BYLAWS OR MISSION STATEMENT OF THE FILING ORGANIZATION, PROVIDED THAT SUCH ACTIONS ARE NOT INCONSISTENT WITH THE JOC BYLAWS OR THE AFFILIATION AGREEMENT AND THE APPOINTMENT OF THE FILING ORGANIZATION'S BOARD OF DIRECTORS, SUBJECT TO THE RATIFICATION OF THE JOC BOARD OF DIRECTORS. FINANCIAL AUTHORITIES RESERVED TO THE SPONSOR, THE BOARD OF DIRECTORS OF THE JOC, AND BY BOTH MEMBERS OF THE JOC INCLUDE THE APPROVAL OF ANY DISPOSITION OF THE FILING ORGANIZATION'S ASSETS AND ANY INTERNAL TRANSFER OF THE FILING ORGANIZATION'S ASSETS. THE SPONSOR, THE BOARD OF DIRECTORS OF THE JOC, AND BOTH MEMBERS OF THE JOC MAY APPROVE SUCH DISPOSITIONS OR TRANSFERS UP TO ESTABLISHED ASSET DOLLAR VALUES AS SET FORTH IN THE BYLAWS OF THE FILING ORGANIZATION. ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION MUST BE RATIFIED BY BOTH SPONSORS OF THE JOC. THE BOARD OF DIRECTORS OF THE JOC MUST APPROVE ANY CAPITAL EXPENDITURE TO BE MADE BY THE FILING ORGANIZATION IN EXCESS OF $10 MILLION. OPERATIONAL AUTHORITIES RESERVED TO THE BOARD OF DIRECTORS OF THE JOC INCLUDE THE DETERMINATION OF THE SERVICES TO BE PROVIDED BY THE FILING ORGANIZATION, INCLUDING THE AUTHORITY TO DIRECT THE EXPANSION, REDUCTION AND CONSOLIDATION OF CLINICAL PROGRAMS, PATIENT CARE SERVICES AND ADMINISTRATIVE CAPABILITIES OR OTHER MAJOR CHANGES IN THE OPERATION OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, CEO AND BY THE CFO PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, 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 KEY EMPLOYEES ARE NOT COMPENSATED BY THE FILING ORGANIZATION. THE COMPENSATION PACKAGE FOR THESE INDIVIDUALS IS DETERMINED BY THE JOINT OPERATING COMPANY, ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO. DBA AMITA HEALTH. AS NOTED IN OUR RESPONSE TO PART VI, SECTION A, LINE 7B, THE FILING ORGANIZATION IS A COVERED AFFILIATE OF THE JOC KNOWN AS AMITA HEALTH. THE COMPENSATION OF THE CEO, CFO, COO, CMO AND CNO ARE ESTABLISHED AND APPROVED BY AMITA HEALTH. PLEASE SEE THE DISCUSSION CONCERNING THE PROCESS FOLLOWED BY AMITA HEALTH 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 (NOT INCLUDING PHYSICIAN MEMBERS OF THE BOARD), OFFICER(S) AND KEY EMPLOYEES 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 WITHIN ADVENTHEALTH OR AMITA HEALTH. PHYSICIAN MEMBERS OF THE BOARD OF DIRECTORS RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS AS A RESULT OF PROVIDING VARIOUS MEDICAL SERVICES TO THOSE RELATED ENTITIES. PART VIII, LINES 7A, B AND C: THE AMOUNTS SHOWN IN PART VIII, LINES 7A(I) AND 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 5,903,146. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,903,146. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 235,408. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 235,408. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 493,257. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 493,257. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 1,750,640. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,750,640. RECRUITING: PROGRAM SERVICE EXPENSES 275. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 275. FOOD SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 2,407,059. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,407,059. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,360,266. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,360,266. ADVENTHEALTH MANGEMENT FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 420,951. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 420,951. REGION SUPPORT SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 10,498,536. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,498,536. FORM 990, PART XI, LINE 9: ALLOCATIONS TO TAX-EXEMPT PARENT WITH RESPECT TO DEBT -24,887. TRANSFER TO RELATED TOP-TIER TAX-EXEMPT PARENT -1,108,202. NET CHANGE IN INTEREST IN FOUNDATION 311,328. GIFTS 25,000. TRANSFER FROM RESTRICTED FOR OPERATIONS -26,040. ASC 842 LEASE ACCOUNTING ADJUSTMENTS 34,119. ROUNDING -1. ADVENTHEALTH FAMILY MEDICINE RURAL HEALTH CLINICS INC FKA HOSPICE OF THE C 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 (218-123119) 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 (218-123119) 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 FKA UNIVERSITY COMMUNITY HOSPITAL SPECIALTY CA 3100 E FLETCHER AVE TAMPA FL 33613 593231322 INACTIVE FL 501(C)(3) LINE 12A, I UNIVERSITY COMMUNITY HOSPITAL INC 1 ADVENTHEALTH OSCEOLA SOUTH INC (416-123119) 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 841817046 INACTIVE FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 ADVENTHEALTH POLK NORTH INC (418-123119) 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 (415-123119) 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 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 LAKE WINYAH DRIVE ORLANDO FL 32803 593069793 EDUCATION/OPERATION OF SCHOOL FL 501(C)(3) LINE 2 ADVENTIST HLTH SYSTEMSUNBELT INC 1 ADVENTHEALTH WEST FL AMBULATORY SVCS INC FKA WEST FL HLTH INC 14055 RIVEREDGE DRIVE TAMPA FL 33637 471881744 INACTIVE FL 501(C)(3) LINE 10 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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 FLORIDA MEMORIAL HEALTH NETWORK INC (11 - 102419) 770 W GRANADA BLVD STE 317 ORMOND BEACH FL 32174 593403558 PHYSICIAN HOSPITAL ORG. 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 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 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 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 ADVENTIST MIDWEST HEALTH Q 2504348 COST ADVENTIST MIDWEST HEALTH P 30089822 COST GLENOAKS HOSPITAL FOUNDATION B 14038 ACTUAL AMOUNT GIVEN ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION M 780973 % OF FACILITY'S OPERATING EXP. ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION P 2671898 COST ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION B 480548 ACTUAL AMOUNT GIVEN ADVENTIST HEALTH PARTNERS INC P 2912860 COST ADVENTIST BOLINGBROOK HOSPITAL P 622513 COST ADVENTIST BOLINGBROOK HOSPITAL Q 212921 COST ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION DBA AH IT M 3127369 % OF FACILITY'S OPERATING EXP. ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION-INSURANCE ALLOCATION P 627654 COST GLENOAKS HOSPITAL FOUNDATION C 40973 ACTUAL AMOUNT RECEIVED ADVENTIST HEALTH PARTNERS INC Q 136843 COST MIDWEST HEALTH FOUNDATION B 24831 ACTUAL AMOUNT GIVEN MIDWEST HEALTH FOUNDATION C 220122 ACTUAL AMOUNT RECEIVED