TARPON SPRINGS HOSPITAL FOUNDATION INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- TARPON SPRINGS HOSPITAL FOUNDATION INC (EIN 59-0898901)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-10-29
- IRS object ID
- 202013039349301131
- Schema version
- 2019v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-10-29T10:05:10-05:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 590898901 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tarpon Springs Hospital Foundation Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TARP | BusinessNameControlTxt |
| Phone | 7279425006 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1395 South Pinellas Avenue | AddressLine1Txt |
| City | Tarpon Springs | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 346893790 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Lynn Addiscott | PersonNm |
| Person Title | Assistant Secretary | PersonTitleTxt |
| Phone | 4073572317 | PhoneNum |
| Signature | 2020-10-05 | SignatureDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 204.139.85.141 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-10-05 | IPDt |
| IP Tm | 11:00:33 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 12841AD40E8BDE8F2A214B1E8B2FAB2FB37BA08E | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AdventHealth North Pinellas | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jason Dunkel | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1395 South Pinellas Avenue | AddressLine1Txt |
| City | Tarpon Springs | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 346893790 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $123,947,598 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.adventhealth.com/hospital | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1970 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | The provision of medical care to the community through the operation of one general acute care hospital with a total of 168 beds. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 837 | TotalEmployeeCnt |
| Total Volunteers | 109 | TotalVolunteersCnt |
| Total Gross UBI | $2,352 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $336,698 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $117,048,573 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $123,166,024 | CYProgramServiceRevenueAmt |
| PY Investment Income | $61,735 | PYInvestmentIncomeAmt |
| CY Investment Income | $444,876 | CYInvestmentIncomeAmt |
| PY Other Revenue | $6,591 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $117,122,899 | PYTotalRevenueAmt |
| CY Total Revenue | $123,947,598 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $95,500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $72,898 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $50,388,773 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $50,859,327 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $65,456,066 | PYOtherExpensesAmt |
| CY Other Expenses | $69,636,012 | CYOtherExpensesAmt |
| PY Total Expenses | $115,940,339 | PYTotalExpensesAmt |
| CY Total Expenses | $120,568,237 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,182,560 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,379,361 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $61,843,573 | TotalAssetsBOYAmt |
| Total Assets EOY | $84,135,483 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $38,448,583 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $43,997,809 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $23,394,990 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $40,137,674 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Adventist Health System Sunbelt Healthcare Corporation and all its subsidiary organizations were established by the Seventh-Day Adventist Church to bring a ministry of healing and health to the communities served. Our mission is to extend the healing ministry of Christ.The hospital and healthcare system whose parent is Adventist Health System Sunbelt Healthcare Corporation is known as AdventHealth. AdventHealth seeks to be widely respected as a consumer-focused organization that engages individuals in their health by delivering wholistic, best practice care across a connected, comprehensive continuum of services. With Christ as our example, AdventHealth cares for and nurtures people: our employees, our communities, our healthcare professionals, and those who trust us for care and healing. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $112,121,742 | ExpenseAmt |
| Grant | $72,898 | GrantAmt |
| Revenue | $123,163,672 | RevenueAmt |
| Desc | Operation of acute care hospital totaling 168 beds with 5,784 patient admissions resulting in 30,277 patient days in the current year and 48,815 outpatient visits and 29,262 physician clinic patient visits. | Desc |
| Total Program Service Expenses | $112,121,742 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 837 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Vadym Didenko | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7279425022 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1395 South Pinellas Avenue | AddressLine1Txt |
| City | Tarpon Springs | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 346893790 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Bergherm Bruce | ||||||||||
| Dir/Chair/SEO West FL Regi | 4.88 | 45.12 | Yes (X) | Yes (X) | $0 | $1,043,562 | $124,279 | |||
| Adams Brian | ||||||||||
| Director (end 5/19) | 0.50 | 50.00 | Yes (X) | $0 | $734,618 | $112,067 | ||||
| Didenko Vadym | ||||||||||
| Dir/CFO West FL Region | 4.88 | 45.12 | Yes (X) | $0 | $709,399 | $107,808 | ||||
| Skula Erika | ||||||||||
| Director (beg 7/19) | 0.50 | 50.00 | Yes (X) | $0 | $651,754 | $53,053 | ||||
| McGuinness Robin | ||||||||||
| Region CNO - Former Key Employee | 4.88 | 45.12 | $0 | $506,282 | $89,653 | Yes (X) | ||||
| Astra MD Louis | ||||||||||
| Physician | 40.00 | 0.00 | $581,575 | $0 | $42,644 | Yes (X) | ||||
| Dunkel Jason | ||||||||||
| President/CEO | 50.00 | 0.00 | Yes (X) | Yes (X) | $0 | $382,654 | $52,472 | |||
| Kotak MD Rajesh | ||||||||||
| Physician | 40.50 | 0.00 | $364,700 | $0 | $42,282 | Yes (X) | ||||
| Miller Steve | ||||||||||
| Former CFO | 0.00 | 50.00 | $0 | $260,592 | $40,391 | Yes (X) | ||||
| Baker MD Gregory | ||||||||||
| Physician | 40.00 | 0.00 | $238,707 | $0 | $20,415 | Yes (X) | ||||
| Heinrich Caleb | ||||||||||
| CFO | 50.00 | 0.00 | Yes (X) | $0 | $232,574 | $45,447 | ||||
| Knapp-Baker MD Paula | ||||||||||
| Physician | 40.00 | 0.00 | $242,895 | $0 | $30,259 | Yes (X) | ||||
| Torres MD Jose | ||||||||||
| Physician | 40.80 | 0.00 | $254,141 | $0 | $8,349 | Yes (X) | ||||
| Segur Jennifer | ||||||||||
| CNO | 50.00 | 0.00 | $0 | $217,396 | $33,154 | Yes (X) | ||||
| Mathur DO Rajneesh | ||||||||||
| Director (end 12/19) | 1.16 | 0.00 | Yes (X) | $1,250 | $0 | $0 | ||||
| Butcher Jack | ||||||||||
| Dir/Secretary | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Carson MD Thomas | ||||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Kouskoutis N Michael | ||||||||||
| Dir/Vice Chairman | 0.50 | 0.30 | Yes (X) | $0 | $0 | $0 | ||||
| Pawson Jonathan | ||||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Schiefer Mark | ||||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Sellew Roger | ||||||||||
| Dir/Treasurer | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Arnold MD Paul | ||||||||||
| Director (beg 1/19) | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Mayo Darrell | ||||||||||
| Director (beg 7/19) | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,683,268 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,738,831 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $802,273 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 33 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Crothall Healthcare Inc | |||||
| 13028 Collections Center Drive | Chicago | IL | 60693 | Environmental Services | $1,938,872 |
| Polin Rutledge and Fischer MDPA | |||||
| 34637 US Hwy 19 North | Palm Harbor | FL | 34684 | Medical Professional Services | $1,432,487 |
| AMN Healthcare Inc | |||||
| 1905 Corporate Blvd NW | Boca Raton | FL | 33431 | Medical Professional Services | $841,564 |
| Tampa Bay Emergency Physicians | |||||
| 4535 Dressler Rd | Canton | OH | 44718 | Medical Professional Services | $711,933 |
| North Pinellas Anesthesia Assoc | |||||
| 7032 Collection Center Drive | Chicago | IL | 60693 | Medical Professional Services | $650,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 32 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
| Related Organizations | $335,698 | RelatedOrganizationsAmt |
| All Other Contributions | $1,000 | AllOtherContributionsAmt |
| Total Contributions | $336,698 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Net patient revenue | 622110 | $122,638,905 | $122,638,905 | |
| Cafeteria revenue | 622110 | $268,483 | $268,483 | |
| Reimbursement of Expenses | 622110 | $101,245 | $101,245 | |
| Medical Office Building | 622110 | $40,760 | $38,408 | $2,352 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $116,631 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $116,631 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $123,166,024 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $96,529 | TotalRevenueColumnAmt |
| Exclusion | $96,529 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $48,347 | SecuritiesAmt |
| Other | $300,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $48,347 | SecuritiesAmt |
| Other | $300,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $348,347 | TotalRevenueColumnAmt |
| Exclusion | $348,347 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $123,947,598 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $123,163,672 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,352 | UnrelatedBusinessRevenueAmt |
| Exclusion | $444,876 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,898 | TotalAmt |
| Program Services | $72,898 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,157,438 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $1,157,438 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,294,887 | TotalAmt |
| Program Services | $37,278,778 | ProgramServicesAmt |
| Management And General | $16,109 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $954,741 | TotalAmt |
| Program Services | $929,318 | ProgramServicesAmt |
| Management And General | $25,423 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,768,642 | TotalAmt |
| Program Services | $8,419,524 | ProgramServicesAmt |
| Management And General | $349,118 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,683,619 | TotalAmt |
| Program Services | $2,612,160 | ProgramServicesAmt |
| Management And General | $71,459 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,346 | TotalAmt |
| Management And General | $53,346 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,430 | TotalAmt |
| Management And General | $51,430 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,569 | TotalAmt |
| Management And General | $15,569 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,339,621 | TotalAmt |
| Program Services | $25,004,250 | ProgramServicesAmt |
| Management And General | $3,335,371 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,187,255 | TotalAmt |
| Management And General | $1,187,255 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,380,363 | TotalAmt |
| Program Services | $1,743,897 | ProgramServicesAmt |
| Management And General | $636,466 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,609,181 | TotalAmt |
| Program Services | $4,142,524 | ProgramServicesAmt |
| Management And General | $466,657 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,127,842 | TotalAmt |
| Program Services | $4,127,842 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,333 | TotalAmt |
| Program Services | $14,254 | ProgramServicesAmt |
| Management And General | $110,079 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $394,582 | TotalAmt |
| Management And General | $394,582 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $988,143 | TotalAmt |
| Program Services | $988,143 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,664,874 | TotalAmt |
| Program Services | $3,664,874 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,656,934 | TotalAmt |
| Program Services | $1,602,804 | ProgramServicesAmt |
| Management And General | $54,130 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $17,502,874 | $17,502,874 | |
| Repairs & maintenance | $2,644,086 | $2,644,086 | |
| State Tax Indigent Asse | $1,357,411 | $1,357,411 | |
| UBI taxes | $2,500 | $2,500 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $535,668 | TotalAmt |
| Program Services | $16,105 | ProgramServicesAmt |
| Management And General | $519,563 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,568,237 | TotalAmt |
| Program Services | $112,121,742 | ProgramServicesAmt |
| Management And General | $8,446,495 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $757 | BOYAmt |
| EOY | $750 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $12,099,700 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,475,730 | BOYAmt |
| EOY | $16,946,801 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $24,038 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,236,433 | BOYAmt |
| EOY | $3,589,612 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,980,060 | BOYAmt |
| EOY | $3,139,120 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $66,854,991 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $24,338,152 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,827,482 | BOYAmt |
| EOY | $42,516,839 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,926,423 | BOYAmt |
| EOY | $2,806,973 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,916,504 | BOYAmt |
| EOY | $54,814 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $480,184 | BOYAmt |
| EOY | $2,956,836 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,843,573 | BOYAmt |
| EOY | $84,135,483 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,899,476 | BOYAmt |
| EOY | $7,548,504 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $86,400 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,462,707 | BOYAmt |
| EOY | $36,449,305 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,448,583 | BOYAmt |
| EOY | $43,997,809 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,432,916 | BOYAmt |
| EOY | $37,295,050 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,962,074 | BOYAmt |
| EOY | $2,842,624 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,394,990 | BOYAmt |
| EOY | $40,137,674 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,843,573 | BOYAmt |
| EOY | $84,135,483 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,379,361 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$1,483,460 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $14,846,783 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $4,862 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,862 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | Dues paid to American Hospital Association and Florida Hospital Association. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,962,074 | BeginningYearBalanceAmt |
| Contributions | $991,915 | ContributionsAmt |
| Investment Earnings Or Losses | -$103,171 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $8,194 | OtherExpendituresAmt |
| End Year Balance | $2,842,624 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,930,341 | BeginningYearBalanceAmt |
| Contributions | $20,578 | ContributionsAmt |
| Investment Earnings Or Losses | $14,964 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $3,809 | OtherExpendituresAmt |
| End Year Balance | $1,962,074 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,407,618 | BeginningYearBalanceAmt |
| Contributions | $729,044 | ContributionsAmt |
| Investment Earnings Or Losses | -$169,524 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $36,797 | OtherExpendituresAmt |
| End Year Balance | $1,930,341 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,158,634 | BeginningYearBalanceAmt |
| Contributions | $551,642 | ContributionsAmt |
| Investment Earnings Or Losses | -$245,733 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $56,925 | OtherExpendituresAmt |
| End Year Balance | $1,407,618 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,085,241 | BeginningYearBalanceAmt |
| Contributions | $136,176 | ContributionsAmt |
| Investment Earnings Or Losses | -$33,164 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $29,619 | OtherExpendituresAmt |
| End Year Balance | $1,158,634 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,497,317 | OtherCostOrOtherBasisAmt |
| Book Value | $5,497,317 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,085,310 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,838,980 | DepreciationAmt |
| Book Value | $21,246,330 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,879,971 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,291,114 | DepreciationAmt |
| Book Value | $8,588,857 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,392,393 | OtherCostOrOtherBasisAmt |
| Depreciation | $208,058 | DepreciationAmt |
| Book Value | $7,184,335 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $42,516,839 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to related | $3,095,456 |
| Payable to third parties | $2,009,199 |
| Credit balances in A/R | $343,994 |
| Accrued interest payable | $87,249 |
| Leases payable | $5,764,820 |
| Other liabilities | $2,182,820 |
| Interco Alloc of TE Bond Proceeds | $20,865,483 |
| Operating Lease Liability | $2,100,284 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $36,449,305 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | Helen Ellis Memorial Hospital Foundation, Inc. (HEMHF), a related organization formed and maintained exclusively to further the exempt purpose of AdventHealth North Pinellas (the Hospital) held assets in temporary endowment funds during the current tax year. HEMHF's endowment consists of individual donor restricted endowment funds where the assets have been designated for endowment established to support various purposes benefiting the Hospital and its patients. |
| 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. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | 0 | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,091,121 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,091,121 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06710 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,949,629 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,084,329 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,865,300 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06520 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,040,750 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,084,329 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,956,421 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13230 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $127,154 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $127,154 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $127,154 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $127,154 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,167,904 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,084,329 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $16,083,575 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13340 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $8,265,069 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,066,501 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $27,266,622 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $30,754,583 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,487,961 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 2 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp (2 entries)
| FacilityFacilityNum | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Website AddressWebsiteAddressTxt | State LicenseStateLicenseNum | Licensed HospitalLicensedHospitalInd | General Medical And SurgicalGeneralMedicalAndSurgicalInd | Emergency Room24 HrsEmergencyRoom24HrsInd | Facility Reporting GroupFacilityReportingGroupCd |
|---|---|---|---|---|---|---|---|---|---|---|
| AdventHealth North Pinellas | ||||||||||
| 1 | 1395 South Pinellas Avenue | Tarpon Springs | FL | 34689 | www.adventhealth.com/hospital/adventhe | 4333 | Yes (X) | Yes (X) | Yes (X) | A |
| AdventHealth Palm Harbor ER | ||||||||||
| 2 | 34106 US Highway 19 North | Palm Harbor | FL | 34684 | www.adventhealth.com/hospital-and-emer | 4333 | Yes (X) | Yes (X) | A | |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Group A | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Part V, Page 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Part V, Page 8 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Part V, Page 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Part V, Page 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Part V, Page 8 | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 7a: | The CHNA report for Facility Reporting Group A can be found at URL:https://www.adventhealth.com/community-health-needs-assessments |
| Schedule H, Part V, Section B, Line 10a: | Facility Reporting Group A's most recently adopted implementation strategy can be found at:https://www.adventhealth.com/community-health-needs-assessments |
| Schedule H, Part V, Section B, Line 16a,b,c: | The Financial Assistance Policy for Facility Reporting Group A can be found at URL:https://www.adventhealth.com/legal/financial-assistanceThe Financial Assistance Policy application for Facility Reporting Group A can be found at:https://www.adventhealth.com/legal/financial-assistanceThe plain language summary for Facility Reporting Group A is available at:https://www.adventhealth.com/legal/financial-assistance |
| 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. |
| Part V, Section B | Facility Reporting Group A |
| Facility Reporting Group A consists of: | - Facility 1: AdventHealth North Pinellas, - Facility 2: AdventHealth Palm Harbor ER |
| Group A Part V, Section B, line 5: | Tarpon Springs Hospital Foundation, Inc., d/b/a AdventHealth North Pinellas (AHNP or the Hospital), operates a 168-bed hospital and a free-standing ER location in Pinellas County in Florida. AHNP primarily serves the residents in the northern part of Pinellas County and western Pasco County. CHNA data indicated that the population in the Hospital's service area is primarily Caucasian (approximately 90% of the population) and over 27% of the community's permanent residents are over the age of 65. To provide broad community input with respect to the conduct of its 2019 Community Health Needs Assessment, the Hospital formed a Community Health Needs Assessment Committee (CHNAC). The CHNAC included representatives from the Hospital, representatives from the Pinellas County Health Department, and community participants that represented low-income, minority, and underserved populations. The following is a listing of the community/governmental organizations that were represented on the Hospital's CHNAC:Shepherd Center in Tarpon Springs - a community service agency that provides programs and services to the local homeless and other underserved community members;Citizens Alliance for Progress;Pinellas Safe Harbor - an emergency homeless shelter and a jail-diversion program;St. Vincent de Paul Society - an organization providing volunteer services and a food bank;Community volunteer/activist; Pinellas County Health Department;Mt. Herman Missionary Baptist Church; St. Timothy's Lutheran Church;Methodist Church;Tarpon Springs Police Department; Gulfcoast North Area Health Education Center; Gracepoint - an organization providing mental health services;Salvation Army of Tarpon Springs; and Metropolitan Ministries.The Hospital also worked closely with the Florida Department of Health in Pinellas County to gather community input through a community-wide health survey, stakeholder interviews/surveys, and community focus groups. Community surveys were conducted in collaboration with the Pinellas County Department of Health. A total of 6,494 Pinellas County residents participated in the community survey. |
| Group A 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. |
| Group A Part V, Section B, line 11: | Tarpon Springs Hospital Foundation, Inc. d/b/a AdventHealth North Pinellas will be referred to in this document as AdventHealth North Pinellas 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 of 2019, every wholly-owned entity adopted the AdventHealth system brand. Our identify has been unified to represent the full continuum of care our system offers. Any reference to our 2016 Community Health Needs Assessment (CHNA) or 2017 Community Health Plan (CHP) will utilize our new name for consistency.AdventHealth North Pinellas is part of the West Florida Division of AdventHealth. The West Florida Division includes 11 hospital facilities.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 in 2016 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. This is the third-year update for AdventHealth North Pinellas's 2017-2019 Community Health Plan (Implementation Strategy). AdventHealth North Pinellas developed this plan and posted it by May 15, 2017 as part of its 2016 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AdventHealth North Pinellas worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2016 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 Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2017-2019 Community Health Plan. The third-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2016 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing.AdventHealth North Pinellas chose five areas of focus for its 2017-2019 Community Health Plan: Diabetes, Heart Disease, Asthma, Access to Care and Obesity.Priority 1: Diabetes2016 Description of the Issue: In the Hospital's primary service area (PSA), 8.9% of adults aged 20 and older have been diagnosed by a physician as diabetic. This is in comparison to 9.4 % in Pasco County, 8.4% in Pinellas County while the state average is 8.89%. Diabetes is a prevalent health problem in the USA, which may indicate an unhealthy lifestyle and puts individuals at risk for further health issues. While there are resources in the community and at the Hospital, this Community Health Needs Assessment Committee believes there is an opportunity to impact this prevalence in the community. 2019 Update: AdventHealth North Pinellas partnered with local community organizations to address the nutritional needs of those in communities designated as food deserts or low income/low access areas with the Food is Health Program (FiH) (formally known as Food is Medicine). The program provides educational opportunities on health and lifestyle, biometric screenings, and increased access to healthy produce and dry goods. In year three, the Hospital partnered with the University of Florida Institute of Food and Agricultural Sciences (UF/IFAS) Extension in Pinellas County to provide Adults Cooking Matters classes at Citizens Alliance for Progress, a site located within the Hospital's provider service area. A total of 51 vouchers to receive free fresh produce were distributed to participants (an increase from 19 in year two). Vouchers are worth ten dollars each and are redeemed at the on-site food truck, which is filled with fresh fruits and vegetables. In year three, we exceeded the expected outcome of 10% with 29% of FiH participants showing a reduced blood sugar level (measured by finger-sticks the first and last day of class). The third outcome to grow Divisional staff was not met in 2019, but a Community Health Coordinator was hired in May of 2020. Now that we have gained additional experience implementing our signature FiH program, we will utilize the past data trends to develop more realistic outcome goals as we continue to provide this valuable Community Benefit program to our community members. The increased success of the FiH program has been due to our active participation in maintaining community partnerships, the restructure of the program implementation strategies to reflect available resources and opportunities, and the increase of internal organizational support to hire additional coordinators to manage the program. We continue to realize that we cannot run this program without strong partnerships with health education providers, local fresh produce vendors, and other community-based organizations who are the boots on the ground addressing social determinants of health. Our West Florida Division Community Benefit team continues to manage our community partnerships by regularly attending community meetings and actively engaging with food security initiatives. In year two, we launched new strategies for marketing the free FiH classes to the community and hope to engage our community in much more effective ways to encourage participation. Examples of the marketing strategies implemented in year three include: local advertisement in community newspapers, media interviews to educate the community on the FiH program and its partnerships, internal education campaigns with Hospital team members and a collaboration with internal marketing teams to develop strategies to increase program awareness. The Hospital partnered with the American Diabetes Association (ADA) to pilot a Morning Mile Program (before-school walking program) at two Title I schools in their PSA for the 2018-2019 school year. As mentioned in year two, due to a lack of reporting of outcomes and extremely poor management of the program overall by the ADA, the contract for the program was not renewed for year three.See Continuation |
| Continuation of Part V, Section B, Line 11 for Facility Group A: | Priority 2: Heart Disease2016 Description of the Issue: The service area death rate due to coronary heart disease per 100,000 population is 160.66. Pasco County has a rate of 163.5; the Pinellas County rate is 157.1; and the state rate is 156.1. In the service area, 7.5% of adults aged 18 and older have been diagnosed by a physician with coronary heart disease or angina, the state average is only 5.6%. Heart disease is also related to high blood pressure, high cholesterol and heart attacks. In the Hospital's service area, 29.11% of adults aged 18 and older have been diagnosed by a physician with high blood pressure or hypertension. The county rates are 29.2% in Pasco County and 29% in Pinellas County; the state average is 28.3%. In the Hospital's service area, 47.59% of the adult population has been diagnosed with High Cholesterol: 48.94% in Pasco County and 45.44 % in Pinellas County; the state average is 41.90%. Of the Hospital's Self-Pay/Medicaid Emergency Department (ED) patients and for the general ED population, chest pain was one of the top 10 diagnoses in 2015. Sub Edno Infarction and Atrial Fibrillation were two of the top ten in-patient diagnosis in 2015 for the total patient population. Therefore, heart disease remains a key health problem in the Hospital's community.2019 Update: AdventHealth North Pinellas offers free blood pressure screenings at a variety of community events (onsite at the Hospital and at off-site events throughout the community). In year three, the Hospital sponsored 45 events and averaged ten screenings per event. The free events aim to increase community awareness and participation in blood pressure screenings. The Hospital offers free "Healthy Happenings" events and "Health Talks" to the uninsured and seniors with high blood pressure living in low income/low access communities throughout Pinellas and Pasco Counties, specifically in zip code areas 34652, 34683, 34684, 34689, 34690, and 34691. The free events and talks aim to provide free heart disease education to lower disease risk. In 2019, a total of 40 "Healthy Happenings" events took place, exceeding our year three goal of 15 events. In year three data was not collected regarding improved knowledge among event participants. The implementation plan originally included deployment of the Community Health Improvement Program (CHIP), a lifestyle enrichment program designed to reduce disease risk factors through better health habits and appropriate lifestyle modifications. Due to scheduling difficulties with the contracted facilitator, the program and subsequent metrics were removed in year two. Priority 3: Asthma (with a focus on tobacco cessation)2016 Description of the Issue: In our community, 15.5% of the population has been diagnosed with asthma. This indicator is relevant because it is often exacerbated by poor environmental conditions. In 2015, at the Hospital, respiratory disease-related diagnoses accounted for four of the top 10 reasons for inpatient admissions for Medicaid and Self-Pay patients.2019 Update: AdventHealth North Pinellas partnered with the Area Health Education Council (AHEC) to implement community smoking cessation classes at the Hospital. The Hospital provides the space for the classes to be hosted, in year three the outcome metric of ten was exceeded by 30 for a total of 40 classes hosted. The number of participants also exceeded the goal of 30 for a total of 33. Priority 4: Access to Care2016 Description of the Issue: In Pinellas County, 25.44% of adults aged 18-64 are uninsured. In Pasco County, the rate is 25%, and the state rate is 28.78%. A lack of insurance is a primary barrier to health care access including regular primary care, specialty care and other health services that contribute to poor health status. More than one-fifth (20.6%) of adults aged 18 and older self-report that they do not have a personal doctor or health care provider. Access to regular primary care can prevent major health issues and non-urgent emergency department (ED) visits. Urinary tract infections, upper respiratory infections and acute pharyngitis (sore throat) were three of the top ten ED diagnoses for Medicaid and Self Pay patients in 2015. These are preventable Hospital visits that could be handled with a lower level of care.To address access to primary care barriers, the Hospital is working to develop a framework for tracking referrals to and enrollment at Federally Qualified Health Centers to connect uninsured/under insured Emergency Department (ED) patients with a medical home. 2019 Update: The Hospital hired CanAide to develop a tracking system for referrals which was developed and implemented in July 2016. AdventHealth North Pinellas employees screen and submit patient's applications for Pinellas County health coverage and follow-up with them after their transition from the Hospital. Success rate is approximately 25-30% of uninsured/underinsured patients are referred and qualify. In year three there was a success rate of 40% which exceeded the expected outcome. To reduce the burden of access to other health services, the Hospital implemented, "Operation Sunshine" which includes the "Sun Spotter" truck, a mobile sun safety skin cancer screening and education program with on-site skin cancer exams for schools, businesses and community organizations in Pinellas County. The overall goal of the program is to provide free melanoma screenings to the general population. In year three, 617 uninsured/underinsured community members were screened for Melanoma and referred for follow up screening, which exceeds the expected outcome of screening 600 people. Additionally, 217 uninsured/underinsured community members received follow up screenings, which exceeds the expected outcome of 200.Initially for year three the Hospital had a goal to collaborate with three community partners who focused on serving aging populations to provide health and nutrition programs for community seniors. Due to a lack of organizations in the area with the resources to partner on this strategy, the Hospital was unable to meet the goal. In lieu of this the Hospital partnered with the University of Florida Institute of Food and Agricultural Sciences (UF/IFAS) Extension in Pinellas County and Citizens United Alliance for Progress to offer a Food is Health program series to the seniors in the surrounding Tarpon Springs community. Priority 5: Obesity2016 Description of the Issue: In the Hospital's service area, 37.8% of adults have a body mass index (BMI) between 25 and 30 (overweight), and 27.7% of adults aged 20 and older self-report that they have a BMI greater than 30% (obese). Excess weight may indicate an unhealthy lifestyle and puts individuals at risk for further health issues.2019 Update: In year one, AdventHealth North Pinellas sponsored the CREATION Health (CH) program which is a faith-based holistic (mental, physical and spiritual) wellness program with lifestyle seminars and training programs. It teaches eight universal principles of health (Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook, & Nutrition) for living a healthier and happier life. This 8-week seminar provides the best practices of whole person living based on biblical principles and is supported by evidence-based science. These seminars were hosted in two local faith congregations identified by existing professional relationships with the Chaplain at the Hospital. The outcome metrics for the number of CH seminars provided were adjusted for years two and three to zero as a result of the decision to replace the CH program with a new program that would be developed at the division level. See Continuation II |
| Continuation II of Part V, Section B, Line 11 Facility Group A: | Community Needs Not Chosen by AdventHealth North Pinellas:The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. 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:A. Low-income/Poverty - In the Hospital's community, 12.3% of the population are living in households with incomes below the Federal Poverty Level. Poverty is relevant because it creates barriers to health services access, healthy food, and other necessities that contribute to a poor health status. However, this was not chosen as a top five priority because the Hospital as an institution does not have the capability to affect the poverty level in the community.B. Cancer Incidents-Screenings - The Community Health Needs Assessment Committee agreed that the community and Hospital already had screening opportunities for low-income individuals but noted that the Hospital does not provide services for ongoing cancer care once a patient receives a positive test result. Therefore, cancer incidence will not be a focus for the Community Health Plan. |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a: | The filing organization was a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) during its current tax year. During the current year, AHSSHC served as a parent organization to 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. |
| 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 to be 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 page 8 and 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: | 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 | 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 Medicare patients as reported in the AHS Community Benefit Report are as follows:- Medicare surplus/(shortfall) shown on line 7 of Section B of Schedule H: $ (3,487,961)- Difference in costing methodology: 77,135- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (11,153,422) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's community benefit reporting: $ (14,564,248)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: | AdventHealth North Pinellas (AHNP), a 168-bed facility, situated on the west coast of central Florida along the Anclote River where the river meets the Gulf of Mexico, serves the residents of North Pinellas and surrounding communities with vital healthcare services. A Medical Staff of more than 430 physicians, including primary care and specialists, have privileges at AHNP. These doctors bring a tremendous resource of medical expertise to the hospital and the communities it serves.AdventHealth North Pinellas is a crucial community asset. In addition to operating a hospital facility, AHNP also operates 2 wound healing institutes, and 1 sleep center. AdventHealth North Pinellas also owns and operates a full service emergency room (ER) location in nearby Palm Harbor, Florida (Pinellas County). The Palm Harbor ER features 24 beds and overnight observation care, on-site imaging, lab and pharmacy services. It offers adult and pediatric emergency care. 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 77.1% of the Hospital's in-patients were admitted through the Hospital's Emergency Department. - Medicare Patients 56.2% - Medicaid Patients 10.5% - Self-Pay Patients 8.% The demographic makeup of the Hospital's service area is as follows: - Population 160,079 - Population Over 65 27.71% - Poverty (Below 100% FPL) 11.7% - Unemployment Rate 6% - Violent Crime Rate (Per 100,000 Pop.) 482.2 - Pop. Age 25+ with No High School Diploma 8.5% - Uninsured Adults 16.44% - Uninsured Children 6.64% - Food Insecurity Rate 16.2% - Pop. with Low Food Access 20.24% |
| Part VI, Line 5: | The provision of community benefit is central to AdventHealth North Pinellas'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 $170,694 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 $10,348,231 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: | AdventHealth North Pinellas 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. As the parent organization of AdventHealth, AHSSHC provides executive leadership and other professional support services to its subsidiary organizations. Professional support services include among others IT, corporate compliance, legal, reimbursement, risk management, and tax as well as treasury functions. Certain support services, such as human resources, payroll, A/P, and supply chain management are provided pursuant to a shared services model by AHSSHC to its subsidiary organizations. The provision of these executive and support services on a centralized basis by AHSSHC provides an appropriate balance between providing each AdventHealth subsidiary hospital organization with mission-driven consistent leadership and support while allowing the hospital organization to focus its resources on meeting the specific health care needs of the community it serves. The reader of this Form 990 should keep in mind that this reporting entity may differ in certain areas from that of a stand-alone hospital organization due to its inclusion in a larger system of healthcare organizations. As a part of a system of hospital and other health care organizations, the filing organization benefits from reduced costs due to system efficiencies, such as large group purchasing discounts, and the availability of internal resources such as internal legal counsel. Each AHS subsidiary pays a management fee to AHSSHC for the internal services provided by AHSSHC. As a result, management fee expense reported by an AdventHealth subsidiary organization may appear greater in relation to management fee expense that may be reported by a single stand-alone hospital. The single stand-alone hospital would likely report costs associated with management and other professional services on various expense line items in its statement of revenue and expense as opposed to reporting such costs in one overall management fee expense. As the reporting of the Form 990 is done on an entity by entity basis, there is no single Form 990 that captures the programs and operations of AdventHealth as a whole. The reader is directed to visit the web-site of AdventHealth at www.adventhealth.com to learn more about the mission and operations of AdventHealth. |
| Part VI, Line 7: | The filing organization does not file an annual community benefit report with any state agencies. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Saint Nicholas Greek Orthodox Cathedral | |||||||
| 36 N Pinellas Ave | Tarpon Springs | FL | 34689 | 830371578 | 501(c)(3) | $10,000 | General Support |
| City of Tarpon Springs | |||||||
| PO Box 5004 | Tarpon Springs | FL | 34688 | 695000437 | City of Tarpon Sprin | $40,398 | General Support |
| Boys and Girls Clubs of the Suncoast Inc | |||||||
| 4624 E Bay Dr 103 | Clearwater | FL | 33764 | 591566799 | 501(c)(3) | $5,000 | General Support |
| Greater Palm Harbor Area Chamber of Commerce | |||||||
| 1151 Nebraska Ave | Palm Harbor | FL | 34683 | 593484438 | 501(c)(6) | $7,500 | General Support |
| American Heart Association Inc | |||||||
| PO Box 4002900 | Des Moines | IA | 50340 | 135613797 | 501(c)(3) | $5,000 | General Support |
| Tarpon Springs Shepherd Center Inc | |||||||
| 304 S Pinellas Ave | Tarpon Springs | FL | 34689 | 593070882 | 501(c)(3) | $5,000 | General Support |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 5 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | Yes (X) | FirstClassOrCharterTravelInd |
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Discretionary Spending Acct | Yes (X) | DiscretionarySpendingAcctInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bergherm Bruce | ||||||||||||||
| Dir/Chair/SEO West FL Regi | $0 | $549,470 | $0 | $152,709 | $0 | $341,383 | $0 | $97,292 | $0 | $26,987 | $0 | $1,167,841 | $0 | $41,695 |
| Adams Brian | ||||||||||||||
| Director (end 5/19) | $0 | $525,143 | $0 | $116,724 | $0 | $92,751 | $0 | $71,381 | $0 | $40,686 | $0 | $846,685 | $0 | $67,282 |
| Didenko Vadym | ||||||||||||||
| Dir/CFO West FL Region | $0 | $504,495 | $0 | $114,100 | $0 | $90,804 | $0 | $66,213 | $0 | $41,595 | $0 | $817,207 | $0 | $51,481 |
| Skula Erika | ||||||||||||||
| Director (beg 7/19) | $0 | $316,654 | $0 | $47,646 | $0 | $287,454 | $0 | $30,016 | $0 | $23,037 | $0 | $704,807 | $0 | $5,449 |
| McGuinness Robin | ||||||||||||||
| Region CNO - Former Key Employee | $0 | $386,439 | $0 | $75,290 | $0 | $44,553 | $0 | $66,484 | $0 | $23,169 | $0 | $595,935 | $0 | $28,554 |
| Astra MD Louis | ||||||||||||||
| Physician | $546,787 | $0 | $0 | $0 | $34,788 | $0 | $15,087 | $0 | $27,557 | $0 | $624,219 | $0 | $0 | $0 |
| Dunkel Jason | ||||||||||||||
| President/CEO | $0 | $305,675 | $0 | $43,431 | $0 | $33,548 | $0 | $16,446 | $0 | $36,026 | $0 | $435,126 | $0 | $0 |
| Kotak MD Rajesh | ||||||||||||||
| Physician | $291,595 | $0 | $0 | $0 | $73,105 | $0 | $15,087 | $0 | $27,195 | $0 | $406,982 | $0 | $0 | $0 |
| Miller Steve | ||||||||||||||
| Former CFO | $0 | $108,108 | $0 | $24,164 | $0 | $128,320 | $0 | $7,250 | $0 | $33,141 | $0 | $300,983 | $0 | $0 |
| Baker MD Gregory | ||||||||||||||
| Physician | $218,184 | $0 | $0 | $0 | $20,523 | $0 | $12,586 | $0 | $7,829 | $0 | $259,122 | $0 | $0 | $0 |
| Heinrich Caleb | ||||||||||||||
| CFO | $0 | $198,923 | $0 | $31,201 | $0 | $2,450 | $0 | $12,044 | $0 | $33,403 | $0 | $278,021 | $0 | $0 |
| Knapp-Baker MD Paula | ||||||||||||||
| Physician | $215,245 | $0 | $0 | $0 | $27,650 | $0 | $13,004 | $0 | $17,255 | $0 | $273,154 | $0 | $0 | $0 |
| Torres MD Jose | ||||||||||||||
| Physician | $240,000 | $0 | $0 | $0 | $14,141 | $0 | $8,078 | $0 | $271 | $0 | $262,490 | $0 | $0 | $0 |
| Segur Jennifer | ||||||||||||||
| CNO | $0 | $188,684 | $0 | $28,219 | $0 | $493 | $0 | $11,238 | $0 | $21,916 | $0 | $250,550 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 1a | The filing organization is a part of the system of healthcare organizations known as AdventHealth. Members of the filing organization's executive management team that hold the position of Vice-President or above are compensated by and on the payroll of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), the parent organization of the healthcare system known as AdventHealth. AHSSHC is exempt from federal income tax under IRC Section 501(c)(3). The filing organization reimburses AHSSHC for the salary and benefit cost of those executives on the payroll of AHSSHC. At the direction of AHSSHC, and in accordance with the reserved powers in the filing organization's governing documents, the executive team listed on Part VII provides services to the filing organization. First-class or charter travel: Pursuant to the AdventHealth system-wide general policy regarding business travel, no reimbursement will be provided for any additional cost incurred with respect to first-class or charter air travel beyond the cost of a regular coach airfare. As a means of providing additional business travel reimbursement for those members of the AHSSHC senior executive management team that travel frequently on behalf of AdventHealth, a special annual travel allowance is provided for those executives. As AdventHealth operates 47 hospitals in 9 states, the senior leadership of AHSSHC travel extensively and often visit multiple hospital locations in different states as a part of a single business trip. The special travel allowance can provide reimbursements to the executive for such items as the purchase of air travel upgrade coupons, to cover the cost differential between coach and first-class travel, or to cover the cost of a charter flight. The special travel allowance benefit was originally authorized by and codified into a policy by the AHSSHC Board Compensation Committee (the Committee), an independent body of the AHSSHC Board of Directors, who also approves the annual cap on the amount of the allowance. The special travel allowance has an annual cap of $24,000 for members of the Leadership Executive Team (AdventHealth Cabinet-13 members) and $15,000 for AdventHealth Corporate Office Senior Vice Presidents, Regional CEO's and Division Chief Officers (generally 20-30 individual executives). The Regional SEO, CFO, and CNO for AdventHealth's West Florida Division are listed on Part VII of this Form 990. The three individuals are considered common law employees of and are on the payroll of AHSSHC. While the special travel allowance benefit is an AHSSHC compensation policy and practice, the cost of providing this benefit is allocated to and reimbursed in part by the filing organization. Accordingly, the filing organization has checked the box in Schedule J, Part I, line 1a for first-class or charter travel since it has partially paid for the cost of providing this benefit. Those executives who receive the special travel allowance are responsible for tracking the expenses reimbursable under the special travel allowance and must submit such expenses on their accountable plan expense report. Any taxable reimbursements made to executives under the special travel allowance arrangement are treated as taxable compensation to the executive. 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: 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. Health or social club dues or initiation fees: AHSSHC has a Corporate Executive Policy that addresses business development expenditures. Under this policy, certain AdventHealth eligible executives may be reimbursed for member dues and usage charges for a country club or other social club upon authorization. Club memberships must be recommended by the CEO of the AdventHealth hospital organization and approved by the Chairman of the Board of Directors of the organization. In addition, the proposed membership must be approved annually by the AHSSHC Board Compensation Committee, an independent committee of the Board of Directors of AHSSHC. Eligible executives are limited to certain senior level executives (hospital organization CEOs, the CEO of the nursing home region of AdventHealth, senior vice presidents at three large hospital organizations, regional CEOs and CFOs and the president and senior vice presidents of AHSSHC). In the current year, for this filing organization, one executive were eligible to receive reimbursement for club fees. Each AdventHealth executive who is approved for a club membership must submit an annual report to the AHSSHC Board Compensation Committee that describes how the membership benefited their organization during the preceding year. The Regional SEO for AdventHealth's West Florida Division is listed on Part VII of this Form 990. The individual is considered a common law employee of and is on the payroll of AHSSHC. While the club dues membership is an AHSSHC compensation policy and practice, the cost of providing this benefit is allocated to and partially reimbursed by the filing organization. Accordingly, the filing organization has checked the box in Schedule J, Part I, line 1a for health or social club dues since it has paid fully for the CEO and partially for the other individual for the cost of providing this benefit. |
| 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, Lines 4a-b | During the year ending December 31, 2019, Steve Miller received severance payments in the amount of $108,108. Pursuant to the AHSSHC Corporate Executive Policy 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 with AHSSHC. 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 a healthcare system known as AdventHealth. 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 ------------------------------------------------------- Bruce Bergherm $ 92,206 $ 42,088 $ 249,122 $ 0 Brian Adams $ 75,294 $ 68,937 $ 0 $ 0 Vadym Didenko $ 70,126 $ 56,302 $ 0 $ 0 Erika Skula $ 33,929 $ 5,505 $ 0 $ 0 Robin McGuinness $ 51,397 $ 29,014 $ 0 $ 0 Jason Dunkel $ 20,359 $ 0 $ 0 $ 0 *Including Investment Earnings |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 1a | The parent corporation and sole top-tier member of Tarpon Springs Hospital Foundation, 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 | Roger Sellew and Thomas Carson - Family Relationship Roger Sellew and Michael Kouskoutis - Family Relationship |
| Form 990, Part VI, Section A, line 4 | The Bylaws of the filing organization were amended during 2019. A summary of the significant changes made is as follows: 1) The qualifications of the Community Appointees of the filing organization's Board of Directors were changed to no longer require that a Community Appointee be a resident of the City of Tarpon Springs, Florida or any other community located in the Hospital's service area. Under the amended Bylaws, a Community Appointee must either be familiar with the communities served by the Hospital and/or be a resident of such communities. 2) Prior to the 2019 amendments, Community Appointees of the Board of Directors were nominated by Helen Ellis Memorial Hospital Foundation, Inc., a related 501(c)(3) foundation organization, and approved by the filing organization's Member. The 2019 amendments provide that the Community Appointees shall now be nominated and approved by the filing organization's Member. 3) The qualifications of the Member Appointees of the filing organization's Board of Directors were also amended to provide that individuals who serve as an officer of a medical staff of an institution in competition with the Hospital or who have an ownership interest in a healthcare facility or organization which is in direct competition with the Hospital may not serve as Board of Director members, unless specifically approved by the Member. A provision providing that one of the Member Appointees shall be the incumbent chief executive officer of the Member was also removed from the Bylaws. 4) The right to review and approve the compensation level of senior management of the filing organization was removed as a power, duty, and responsibility of the Board of Directors and as a reserved power of the Member of the filing organization. 5) Prior to amendment, the Member of the filing organization, namely University Community Hospital, Inc., was provided the reserved powers of approving the terms and conditions of the borrowing of the filing organization and the power to direct the use and application of the net income of the filing organization, including the making of gifts, capital contributions, donations, loans, investments, and other transfers. The amended Bylaws provide that these powers are now reserved to Adventist Health System Sunbelt Healthcare Corporation, the 501(c)(3) top-tier parent of the filing organization and its Member. |
| Form 990, Part VI, Section A, line 6 | Tarpon Springs Hospital Foundation, Inc., d/b/a AdventHealth North Pinellas (the filing organization) has one member. The sole member of the filing organization is University Community Hospital, Inc. (UCH). UCH is a Florida non-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) is the sole member of UCH. AHSSHC is the parent organization of a healthcare system that operates hospitals, nursing home facilities and other healthcare provider organizations. AHSSHC is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). |
| Form 990, Part VI, Section A, line 7a | The Board of Directors of the filing organization is to consist of not less than 12 members. One half of the Board of Directors shall be composed of individuals who (i) have demonstrated knowledge and/or expertise in business or health care; (ii) are familiar with the communities served by the Hospital and/or are residents of the community served by the Hospital; and (iii) have a proven history of being able to participate effectively with others in order to fulfill the general stewardship responsibilities of a Director (the "Community Appointees"). The remaining one half of the Board of Directors are appointed to the Board by UCH as the Member. |
| Form 990, Part VI, Section A, line 7b | UCH, 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) Approval of the selection of and removal of senior management of the filing organization; b) Approval of the filing organization's Articles of Incorporation; c) Approval of any material changes in services at the health care facilities; d) Approval of major building programs and purchases or sales of property in excess of $500,000 and sales/purchases of less than $500,000 when the filing organization's net revenues are not available for such purpose; e) Appointment of the Member Appointees and approval of the Community Appointees to the Board of Directors; and f) Approval of all operating and capital budgets and strategic plans of the filing organization. Adventist Health System Sunbelt Healthcare Corporation, as the 501(c)(3) top-tier member of the filing organization, has the following reserved powers: a) The authority to set limits and terms for all types of financial transactions exceeding $100,000; and b) The authority to secure naming rights and to direct the placement of funds and capital and the making of gifts, sponsorships, donations, loans, and transfers of funds or other assets by the filing organization in excess of $100,000. |
| 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 Trustees/Directors, its officers, executive employees, physician employees, and officers of the medical staff (to be known as Interested Persons). In connection with any actual or possible conflicts of interest, any member of the Board of Trustees/Directors of the filing organization or any other Interested Person of the filing organization 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 Trustees/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 Interested Person, the remaining members of the Board of Trustees/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 Trustees/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. 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 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 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 9,059,146. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,059,146. Professional Fees: Program service expenses 4,432,935. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,432,935. Purchased Medical Services: Program service expenses 1,915,618. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,915,618. Environmental Services: Program service expenses 1,854,176. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,854,176. Transcription Services: Program service expenses 32,621. Management and general expenses 0. Fundraising expenses 0. Total expenses 32,621. Recruiting: Program service expenses 1,275. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,275. Miscellaneous Purchased Services: Program service expenses 7,708,479. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,708,479. AdventHealth Management Fees: Program service expenses 0. Management and general expenses 1,373,482. Fundraising expenses 0. Total expenses 1,373,482. Billing & Collection Services: Program service expenses 0. Management and general expenses 885,284. Fundraising expenses 0. Total expenses 885,284. AdventHealth Shared Services Fees: Program service expenses 0. Management and general expenses 1,076,605. Fundraising expenses 0. Total expenses 1,076,605. |
| 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. |
| Form 990, Part XI, line 9: | Transfer to tax-exempt top-tier parent -1,519,808. Net Transfer from tax-exempt parent 15,013,016. Gifts 90,000. Transfer to tax-exempt affiliated organization -19,478. ASC 842 Lease Accounting Adjustments 402,504. Change in Foundation Interest 880,550. Rounding -1. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (111 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| AdventHealth Family Medicine Rural Health Clinics Inc 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 | Yes (1) | |
| AdventHealth Foundation Shawnee Mission | |||||||||||
| 9100 W 74th Street | Shawnee Mission | KS | 66204 | 480868859 | Fund-raising for Tax-exempt hospital | KS | 501(c)(3) | Line 7 | Shawnee Mission Medical Center Inc | Yes (1) | |
| AdventHealth Home Care East Florida LLC (218-123119) | |||||||||||
| 770 West Granada Blvd 319 | Ormond Beach | FL | 32174 | 833768458 | Inactive | FL | 501(c)(3) | Line 12a, I | Memorial Hlth Systems Inc | Yes (1) | |
| AdventHealth Hospice Care East Florida Inc (218-123119) | |||||||||||
| 770 West Granada Blvd 304 | Ormond Beach | FL | 32174 | 833748461 | Inactive | FL | 501(c)(3) | Line 12a, I | Memorial Hlth Systems Inc | Yes (1) | |
| AdventHealth North Polk Inc 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 | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
| AdventHealth Ransom Memorial Inc | |||||||||||
| 1301 S Main Street | Ottawa | KS | 66067 | 830976641 | Operation of Hospital & Related Services | KS | 501(c)(3) | Line 3 | Adventist Hlth Mid-America Inc | Yes (1) | |
| AdventHealth University Inc | |||||||||||
| 671 Lake Winyah Drive | Orlando | FL | 32803 | 593069793 | Education/Operation of School | FL | 501(c)(3) | Line 2 | Adventist Hlth SystemSunbelt Inc | Yes (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 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| AdventHealth West Florida Imaging Inc (924-123119) | |||||||||||
| 14055 Riveredge Drive Ste 250 | Tampa | FL | 33637 | 843225135 | Imaging & Testing | FL | 501(c)(3) | Line 12a, I | AdventHealth West Florida Ambulatory Services Inc | Yes (1) | |
| Adventist Bolingbrook Hospital | |||||||||||
| 500 Remington Blvd | Bolingbrook | IL | 60440 | 651219504 | Operation of Hospital & Related Services | IL | 501(c)(3) | Line 3 | Adventist Midwest Health | Yes (1) | |
| Adventist Care Centers - Courtland Inc | |||||||||||
| 730 Courtland Street | Orlando | FL | 32804 | 205774723 | Operation of Home for the Aged/Hlthcare Delivery | FL | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Adventist GlenOaks Hospital | |||||||||||
| 701 Winthrop Avenue | Glendale Heights | IL | 60139 | 363208390 | Operation of Hospital & Related Services | IL | 501(c)(3) | Line 3 | Adventist Midwest Health | Yes (1) | |
| Adventist Hlth Mid-America Inc | |||||||||||
| 9100 W 74th Street | Shawnee Mission | KS | 66204 | 521347407 | Support of Affiliated Hospital | KS | 501(c)(3) | Line 12c, III-FI | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Adventist Hlth Partners Inc | |||||||||||
| 2601 Navistar Dr Bldg 4 Finance | Lisle | IL | 60532 | 364138353 | Operation of Physician Practices & Medical Services | IL | 501(c)(3) | Line 3 | AHS Midwest Management Inc | Yes (1) | |
| Adventist Hlth System Sunbelt Hlthcare Corp | |||||||||||
| 900 Hope Way | Altamonte Springs | FL | 32714 | 592170012 | Management Services | FL | 501(c)(3) | Line 12a, I | 0 | N/A | |
| Adventist Hlth System Georgia Inc | |||||||||||
| 1035 Red Bud Road | Calhoun | GA | 30701 | 581425000 | Operation of Hospital & Related Services | GA | 501(c)(3) | Line 3 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Adventist Hlth SystemSunbelt Inc | |||||||||||
| 900 Hope Way | Altamonte Springs | FL | 32714 | 591479658 | Operation of Hospital & Related Services | FL | 501(c)(3) | Line 3 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Adventist Hlth SystemTexas Inc | |||||||||||
| 11801 S Freeway | Burleson | TX | 76028 | 742578952 | Leasing Personnel to Affiliated Hospital | TX | 501(c)(3) | Line 12c, III-FI | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Adventist Midwest Health | |||||||||||
| 120 North Oak Street | Hinsdale | IL | 60521 | 362276984 | Operation of Hospital & Related Services | IL | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| AHP Specialty Care NFP | |||||||||||
| 2601 Navistar Dr Bldg 4 Finance | Lisle | IL | 60532 | 811105774 | Operation of Physician Practices & Medical Services | IL | 501(c)(3) | Line 3 | AHS Midwest Management Inc | Yes (1) | |
| AHS Midwest Management Inc | |||||||||||
| 2601 Navistar Dr Bldg 4 Finance | Lisle | IL | 60532 | 363354567 | Operation of Physician Practice Mgmt | IL | 501(c)(3) | Line 12a, I | Adventist Midwest Health | Yes (1) | |
| AHSCentral Texas Inc | |||||||||||
| 1301 Wonder World Drive | San Marcos | TX | 78666 | 742621825 | Provide Office Space - Medical Professionals | TX | 501(c)(3) | Line 12c, III-FI | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Apopka Hlth Care Properties Inc | |||||||||||
| 305 E Oak Street | Apopka | FL | 32703 | 510605694 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Battle Creek Adventist Hospital | |||||||||||
| 900 Hope Way | Altamonte Springs | FL | 32714 | 381359189 | Inactive | MI | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Bert Fish Medical Center Auxiliary Inc | |||||||||||
| 401 Palmetto Street | New Smyrna Beach | FL | 32168 | 591054892 | Volunteer support services | FL | 501(c)(3) | Line 10 | 0 | N/A | |
| Bolingbrook Hospital Foundation (1119-62119) | |||||||||||
| 500 Remington Blvd | Bolingbrook | IL | 60440 | 900494445 | Fund-raising for Tax-exempt hospital | IL | 501(c)(3) | Line 7 | Midwest Hlth Foundation | 0 | |
| Bradford Heights Hlth & Rehab Center Inc | |||||||||||
| 950 Highpoint Drive | Hopkinsville | KY | 42240 | 205782342 | Operation of Home for the Aged/Hlthcare Delivery | KY | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Burleson Nursing & Rehab Center Inc | |||||||||||
| 301 Huguley Blvd | Burleson | TX | 76028 | 205782243 | Operation of Home for the Aged/Hlthcare Delivery | TX | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Caldwell Hlth Care Properties Inc | |||||||||||
| 1333 West Main | Princeton | KY | 42445 | 510605680 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Central Texas Hlthcare Collaborative | |||||||||||
| 1301 Wonder World Drive | San Marcos | TX | 78666 | 453739929 | Support Operation of Hospital | TX | 501(c)(3) | Line 12a, I | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Chickasaw Hlth Care Properties Inc | |||||||||||
| 250 S Chickasaw Trail | Orlando | FL | 32825 | 510605681 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Chippewa Valley Hospital & Oakview Care Center Inc | |||||||||||
| 1220 Third Avenue West | Durand | WI | 54736 | 391365168 | Operation of Hospital & Related Services | WI | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Courtland Hlth Care Properties Inc | |||||||||||
| 730 Courtland Street | Orlando | FL | 32804 | 510605682 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Creekwood Place Nursing & Rehab Center Inc | |||||||||||
| 107 Boyles Drive | Russellville | KY | 42276 | 205782260 | Operation of Home for the Aged/Hlthcare Delivery | KY | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Dairy Road Hlth Care Properties Inc | |||||||||||
| 7350 Dairy Road | Zephyrhills | FL | 33540 | 510605684 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| East Orlando Hlth & Rehab Center Inc | |||||||||||
| 250 S Chickasaw Trail | Orlando | FL | 32825 | 205774748 | Operation of Home for the Aged/Hlthcare Delivery | FL | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Emory-Adventist Inc | |||||||||||
| 900 Hope Way | Altamonte Springs | FL | 32714 | 582171011 | Inactive | GA | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Fletcher Hospital Inc | |||||||||||
| 100 Hospital Drive | Hendersonville | NC | 28792 | 560543246 | Operation of Hospital & Related Svcs | NC | 501(c)(3) | Line 3 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| FLNC Inc | |||||||||||
| 3355 E Semoran Blvd | Apopka | FL | 32703 | 205774761 | Operation of Home for the Aged/Hlthcare Delivery | FL | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Florida Hospital Dade City Inc | |||||||||||
| 13100 Fort King Road | Dade City | FL | 33525 | 822567308 | Operation of Hospital & Related Svcs | FL | 501(c)(3) | Line 3 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Florida Hospital Healthcare Partners Inc | |||||||||||
| 770 West Granada Blvd 101 | Ormond Beach | FL | 32174 | 462354804 | Operation of Physician Practices & Medical Services | FL | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Florida Hospital Medical Group Inc | |||||||||||
| 2600 Westhall Lane 4th Floor | Maitland | FL | 32751 | 593214635 | Operation of Physician Practices & Medical Services | FL | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Florida Hospital Ocala Inc | |||||||||||
| 1500 SW 1st Avenue | Ocala | FL | 34471 | 824372339 | Operation of Hospital & Related Svcs | FL | 501(c)(3) | Line 3 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Florida Hospital Physician Group Inc | |||||||||||
| 12470 Telecom Dr 100 | Tampa | FL | 33637 | 462021581 | Operation of Physician Practices & Medical Services | FL | 501(c)(3) | Line 3 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Florida Hospital Waterman Inc | |||||||||||
| 1000 Waterman Way | Tavares | FL | 32778 | 593140669 | Operation of Hospital & Related Services | FL | 501(c)(3) | Line 3 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Florida Hospital Zephyrhills Inc | |||||||||||
| 7050 Gall Blvd | Zephyrhills | FL | 33541 | 592108057 | Operation of Hospital & Related Services | FL | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Florida Radiology Imaging at Lake Mary LLC | |||||||||||
| 2600 Westhall Lane 4th Floor | Maitland | FL | 32751 | 550789387 | Imaging & Testing | FL | 501(c)(3) | Line 3 | Florida Hospital Medical Group Inc | Yes (1) | |
| Fountain Inn Nursing & Rehab Center Inc | |||||||||||
| 485 North Keller Road 250 | Maitland | FL | 32751 | 472180518 | Operation of Home for the Aged/Hlthcare Delivery | FL | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| GlenOaks Hospital Foundation (11-62119) | |||||||||||
| 701 Winthrop Avenue | Glendale Heights | IL | 60139 | 363926044 | Fund-raising for Tax-exempt hospital | IL | 501(c)(3) | Line 7 | Midwest Hlth Foundation | 0 | |
| Helen Ellis Memorial Hospital Auxiliary Inc | |||||||||||
| 1395 S Pinellas Ave | Tarpon Springs | FL | 34689 | 592106043 | Fund-raising for Tax-exempt hospital/foundation | FL | 501(c)(3) | Line 12c, III-FI | 0 | N/A | |
| Helen Ellis Memorial Hospital Foundation Inc | |||||||||||
| 1395 S Pinellas Ave | Tarpon Springs | FL | 34689 | 593690149 | Fund-raising for Tax-exempt hospital | FL | 501(c)(3) | Line 7 | 0 | N/A | |
| Hinsdale Hospital Foundation | |||||||||||
| 120 North Oak Street | Hinsdale | IL | 60521 | 521466387 | Fund-raising for Tax-exempt hospital | IL | 501(c)(3) | Line 7 | Midwest Hlth Foundation | 0 | |
| Hospice of the Comforter Inc | |||||||||||
| 480 W Central Parkway | Altamonte Springs | FL | 32714 | 592935928 | Operation of Hospice | FL | 501(c)(3) | Line 10 | The Comforter Health Care Group Inc | Yes (1) | |
| In-Motion Rehab Inc | |||||||||||
| 485 North Keller Road 250 | Maitland | FL | 32751 | 208023411 | Therapy services to tax exempt nursing homes | KS | 501(c)(3) | Line 12b, II | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| La Grange Memorial Hospital Foundation (11-62119) | |||||||||||
| 5101 S Willow Springs Rd | La Grange | IL | 60525 | 300247776 | Fund-raising for Tax-exempt hospital | IL | 501(c)(3) | Line 7 | Midwest Hlth Foundation | 0 | |
| Lake County Health Care Properties Inc | |||||||||||
| 485 North Keller Road 250 | Maitland | FL | 32751 | 813923985 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Memorial Hlth Systems Foundation Inc | |||||||||||
| 305 Memorial Medical Pkwy 212 | Daytona Beach | FL | 32117 | 311771522 | Fund-raising for Tax-exempt hospital | FL | 501(c)(3) | Line 7 | 0 | N/A | |
| Memorial Hlth Systems Inc | |||||||||||
| 301 Memorial Medical Parkway | Daytona Beach | FL | 32117 | 590973502 | Operation of Hospital & Related Services | FL | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Memorial Hospital - West Volusia Inc | |||||||||||
| 701 West Plymouth Avenue | Deland | FL | 32720 | 593256803 | Operation of Hospital & Related Services | FL | 501(c)(3) | Line 3 | Memorial Hlth Systems Inc | Yes (1) | |
| Memorial Hospital Flagler Inc | |||||||||||
| 60 Memorial Medical Parkway | Palm Coast | FL | 32164 | 592951990 | Operation of Hospital & Related Services | FL | 501(c)(3) | Line 3 | Memorial Hlth Systems Inc | Yes (1) | |
| Memorial Hospital Inc | |||||||||||
| 210 Marie Langdon Drive | Manchester | KY | 40962 | 610594620 | Operation of Hospital & Related Services | KY | 501(c)(3) | Line 3 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Merriam Hlth Care Properties Inc | |||||||||||
| 9700 West 62nd Street | Merriam | KS | 66203 | 364595806 | Lease to Related Organization | KS | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Metroplex Adventist Hospital Inc | |||||||||||
| 2201 S Clear Creek Road | Killeen | TX | 76549 | 742225672 | Operation of Hospital & Related Services | TX | 501(c)(3) | Line 3 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Metroplex Clinic Physicians Inc | |||||||||||
| 2201 S Clear Creek Road | Killeen | TX | 76549 | 113762050 | Physician Hlthcare services to the community | TX | 501(c)(3) | Line 3 | Metroplex Adventist Hospital Inc | Yes (1) | |
| Midwest Hlth Foundation | |||||||||||
| 120 North Oak Street | Hinsdale | IL | 60521 | 352230515 | Support of subsidiary foundations | IL | 501(c)(3) | Line 12b, II | 0 | N/A | |
| Mills Hlth & Rehab Center Inc | |||||||||||
| 500 Beck Lane | Mayfield | KY | 42066 | 205782320 | Operation of Home for the Aged/Hlthcare Delivery | KY | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Mission Strategies of Georgia Inc | |||||||||||
| 485 North Keller Road 250 | Maitland | FL | 32751 | 900866024 | Provision of support to the nursing home division | GA | 501(c)(3) | Line 12b, II | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Missouri Adventist Hlth Inc | |||||||||||
| 9100 W 74th Street | Shawnee Mission | KS | 66204 | 431224729 | Support Hlth Care Services | MO | 501(c)(3) | Line 12d, III-O | Adventist Hlth Mid-America Inc | Yes (1) | |
| Ormond Beach Memorial Hospital Auxiliary Inc | |||||||||||
| 301 Memorial Medical Parkway | Daytona Beach | FL | 32117 | 591721962 | Volunteer support services | FL | 501(c)(3) | Line 12c, III-FI | 0 | N/A | |
| Osceola Health Care Properties Inc | |||||||||||
| 485 North Keller Road 250 | Maitland | FL | 32751 | 813165729 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Overland Park Nursing & Rehab Center Inc | |||||||||||
| 6501 West 75th Street | Overland Park | KS | 66204 | 205774821 | Operation of Home for the Aged/Hlthcare Delivery | KS | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Paragon Hlth Care Properties Inc | |||||||||||
| 950 Highpoint Drive | Hopkinsville | KY | 42240 | 510605686 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Pasco-Pinellas Hillsborough Community Hlth System Inc | |||||||||||
| 2600 Bruce B Downs Blvd | Wesley Chapel | FL | 33544 | 208488713 | Operation of Hospital & Related Services | FL | 501(c)(3) | Line 3 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Portercare Adventist Hlth System (630 Year End) | |||||||||||
| 9100 E Mineral Circle | Centennial | CO | 80112 | 840438224 | Operation of Hospital & Related Services | CO | 501(c)(3) | Line 3 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Princeton Hlth & Rehab Center Inc | |||||||||||
| 1333 West Main | Princeton | KY | 42445 | 205782272 | Operation of Home for the Aged/Hlthcare Delivery | KY | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Princeton Professional Services Inc | |||||||||||
| 601 E Rollins Street | Orlando | FL | 32803 | 591191045 | Provision of Hlthcare Services | FL | 501(c)(3) | Line 10 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Quality Circle for Hlthcare Inc | |||||||||||
| 900 Hope Way | Altamonte Springs | FL | 32714 | 263789368 | Hlthcare Quality Services | FL | 501(c)(3) | Line 12a, I | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Resource Personnel Inc | |||||||||||
| 485 North Keller Road 250 | Maitland | FL | 32751 | 208040875 | Provide administrative support to tax exempt nursing homes | FL | 501(c)(3) | Line 12b, II | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Rocky Mountain Adventist Hlthcare Foundation (630 Year End) | |||||||||||
| 7995 E Prentice Ave 204 | Greenwood Village | CO | 80111 | 840745018 | Fund-raising for Tax-exempt hospital | CO | 501(c)(3) | Line 7 | 0 | N/A | |
| Rollins Brook Community Care Corp | |||||||||||
| 2201 S Clear Creek Road | Killeen | TX | 76549 | 461656773 | Support Operation of Hospital | TX | 501(c)(3) | Line 12a, I | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Russellville Hlth Care Properties Inc | |||||||||||
| 683 East Third Street | Russellville | KY | 42276 | 510605691 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| San Marcos Hlth Care Properties Inc | |||||||||||
| 1900 Medical Parkway | San Marcos | TX | 78666 | 510605693 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| San Marcos Nursing & Rehab Center Inc | |||||||||||
| 1900 Medical Parkway | San Marcos | TX | 78666 | 205782224 | Operation of Home for the Aged/Hlthcare Delivery | TX | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Shawnee Mission Hlth Care Inc | |||||||||||
| 6501 West 75th Street | Overland Park | KS | 66204 | 480952508 | Lease to Related Organization | KS | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Shawnee Mission Hlth Care Properties Inc | |||||||||||
| 485 North Keller Road 250 | Maitland | FL | 32751 | 813914908 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Shawnee Mission Medical Center Inc | |||||||||||
| 9100 W 74th Street | Shawnee Mission | KS | 66204 | 480637331 | Operation of Hospital & Related Services | KS | 501(c)(3) | Line 3 | Adventist Hlth Mid-America Inc | Yes (1) | |
| South Pasco Hlth Care Properties Inc | |||||||||||
| 38250 A Avenue | Zephyrhills | FL | 33542 | 510605679 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Southeast Volusia Healthcare Corp | |||||||||||
| 401 Palmetto Street | New Smyrna Beach | FL | 32168 | 473793197 | Operation of Hospital & Related Services | FL | 501(c)(3) | Line 3 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Southwest Volusia Hlth Services Inc | |||||||||||
| 1055 Saxon Blvd | Orange City | FL | 32763 | 593281591 | Medical Office Building for Hospital | FL | 501(c)(3) | Line 12a, I | Southwest Volusia Hlthcare Corp | Yes (1) | |
| Southwest Volusia Hlthcare Corp | |||||||||||
| 1055 Saxon Blvd | Orange City | FL | 32763 | 593149293 | Operation of Hospital & Related Services | FL | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Specialty Physicians of Central Texas Inc | |||||||||||
| 1301 Wonder World Drive | San Marcos | TX | 78666 | 208814408 | Physician Hlthcare services to the community | TX | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Spring View Hlth & Rehab Center Inc | |||||||||||
| 718 Goodwin Lane | Leitchfield | KY | 42754 | 205782288 | Operation of Home for the Aged/Hlthcare Delivery | KY | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Sunbelt Hlth & Rehab Center - Apopka Inc | |||||||||||
| 305 East Oak Street | Apopka | FL | 32703 | 205774856 | Operation of Home for the Aged/Hlthcare Delivery | FL | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Sunbelt Hlth Care Centers Inc | |||||||||||
| 485 North Keller Road 250 | Maitland | FL | 32751 | 581473135 | Management Services | TN | 501(c)(3) | Line 12b, II | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| SunSystem Development Corp | |||||||||||
| 900 Hope Way | Altamonte Springs | FL | 32714 | 592219301 | Fund Raising for Affiliated Tax-Exempt Hospitals | FL | 501(c)(3) | Line 7 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| Tarpon Springs Hospital Foundation Inc | |||||||||||
| 1395 S Pinellas Ave | Tarpon Springs | FL | 34689 | 590898901 | Operation of Hospital & Related Services | FL | 501(c)(3) | Line 3 | University Community Hospital Inc | Yes (1) | |
| Tarrant County Hlth Care Properties Inc | |||||||||||
| 301 Huguley Blvd | Burleson | TX | 76028 | 510605677 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Taylor Creek Hlth Care Properties Inc | |||||||||||
| 718 Goodwin Lane | Leitchfield | KY | 42754 | 510605678 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| The Comforter Health Care Group Inc | |||||||||||
| 605 Montgomery Road | Altamonte Springs | FL | 32714 | 271857940 | Lease to Related Organization | FL | 501(c)(3) | Line 12c, III-FI | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| The Volunteer Auxiliary of Florida Hospital - Flagler Inc | |||||||||||
| 60 Memorial Medical Parkway | Palm Coast | FL | 32164 | 592486582 | Volunteer support services | FL | 501(c)(3) | Line 12c, III-FI | 0 | N/A | |
| Tri-County Nursing and Rehab Center Inc | |||||||||||
| 485 North Keller Road 250 | Maitland | FL | 32751 | 472219363 | Operation of Home for the Aged/Hlthcare Delivery | FL | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Trinity Nursing & Rehab Center Inc | |||||||||||
| 9700 West 62nd Street | Merriam | KS | 66203 | 205774890 | Operation of Home for the Aged/Hlthcare Delivery | KS | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| University Community Hospital Foundation Inc | |||||||||||
| 3100 E Fletcher Ave | Tampa | FL | 33613 | 592554889 | Fund-raising for Tax-exempt hospital | FL | 501(c)(3) | Line 12a, I | 0 | N/A | |
| University Community Hospital Inc | |||||||||||
| 3100 E Fletcher Ave | Tampa | FL | 33613 | 591113901 | Operation of Hospital & Related Services | FL | 501(c)(3) | Line 3 | Adventist Hlth System Sunbelt Hlthcare Corp | Yes (1) | |
| West Florida Health Home Care Inc | |||||||||||
| 13601 Bruce B Downs Blvd Ste 110 | Tampa | FL | 33613 | 593686109 | Home Health Services | GA | 501(c)(3) | Line 10 | West Florida Health Inc | Yes (1) | |
| West Kentucky Hlth Care Properties Inc | |||||||||||
| 500 Beck Lane | Mayfield | KY | 42066 | 510605676 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Zephyr Haven Hlth & Rehab Center Inc | |||||||||||
| 38250 A Avenue | Zephyrhills | FL | 33542 | 205774930 | Operation of Home for the Aged/Hlthcare Delivery | FL | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
| Zephyrhills Hlth & Rehab Center Inc | |||||||||||
| 7350 Dairy Road | Zephyrhills | FL | 33540 | 205774967 | Operation of Home for the Aged/Hlthcare Delivery | FL | 501(c)(3) | Line 10 | Sunbelt Hlth Care Centers Inc | Yes (1) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| Clear Creek MOB Ltd (1119-3519) | |||||||
| 2201 S Clear Creek Rd | Killeen | TX | 76549 | 742609195 | Real Estate | TX | N/A |
| Florida Hospital DMERT LLC | |||||||
| 500 Winderley Place Ste 324 | Maitland | FL | 32751 | 202392253 | Medical Equipment | FL | N/A |
| Florida Hospital Home Infusion LLP | |||||||
| 500 Winderley Place Ste 226 | Maitland | FL | 32751 | 593142824 | Home Infusion Services | FL | N/A |
| Heart of Florida Surgery Center LLC | |||||||
| 410 Lionel Way 100 | Davenport | FL | 33837 | 812235296 | Surgery Center | DE | N/A |
| Functional Neurosurgical Ambulatory Surgery Ctr LLC | |||||||
| 11 W Dry Creek Circle 120 | Littleton | CO | 80120 | 464426708 | Surgery Center | CO | N/A |
| PAHS OnPoint Urgent Care LLC (382019 - 12312019) | |||||||
| 9100 E Mineral Circle | Centennial | CO | 80112 | 832465331 | Urgent Care Center | CO | N/A |
| Princeton Homecare Services LLC | |||||||
| 1050 Forrer Blvd | Kettering | OH | 45420 | 814196648 | Operation of Home Health Agency | FL | N/A |
| San Marcos MRI LP | |||||||
| 1330 Wonder World Dr Ste 202 | San Marcos | TX | 78666 | 770597972 | Imaging & Testing | TX | N/A |
| The Bariatric Center of Kansas City LLC | |||||||
| 9100 W 74th Street | Merriam | KS | 66204 | 823025378 | Surgery Center | KS | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (20 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| Altamonte Medical Plaza Condominium Association Inc | |||||||||
| 601 East Rollins Street | Orlando | FL | 32803 | 592855792 | Condo Association | FL | N/A | C | Yes (1) |
| Apopka Medical Plaza Condominium Association Inc | |||||||||
| 601 East Rollins Street | Orlando | FL | 32803 | 593000857 | Condo Association | FL | N/A | C | Yes (1) |
| CC MOB Inc | |||||||||
| 2201 S Clear Creek Road | Killeen | TX | 76549 | 742616875 | Real Estate Rental | TX | N/A | C | Yes (1) |
| Central Texas Medical Associates | |||||||||
| 1301 Wonder World Drive | San Marcos | TX | 78666 | 742729873 | Inactive | TX | N/A | C | Yes (1) |
| Central Texas Providers Network | |||||||||
| 1301 Wonder World Drive | San Marcos | TX | 78666 | 742827652 | Physician Hospital Org. | TX | N/A | C | Yes (1) |
| Florida Hospital Flagler Medical Offices Association Inc | |||||||||
| 60 Memorial Medical Parkway | Palm Coast | FL | 32164 | 262158309 | Condo Association | FL | N/A | C | Yes (1) |
| Florida Hosp Hlth Village Property Owner's Assoc Inc | |||||||||
| 550 E Rollins Street 7th Floor | Orlando | FL | 32803 | 821748255 | Condo Association | FL | N/A | C | Yes (1) |
| Florida Hospital Healthcare System Inc | |||||||||
| 101 Southhall Lane Ste 150 | Maitland | FL | 32751 | 593215680 | PHSO | FL | N/A | C | Yes (1) |
| Florida Medical Plaza Condominium Association Inc | |||||||||
| 601 East Rollins Street | Orlando | FL | 32803 | 592855791 | Condo Association | FL | N/A | C | Yes (1) |
| 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 | Yes (1) |
| Kissimmee Multispecialty Clinic Condominium Association Inc | |||||||||
| 201 Hilda Street Suite 30 | Kissimmee | FL | 34741 | 593539564 | Condo Association | FL | N/A | C | Yes (1) |
| LN Health Partners Inc | |||||||||
| 550 E Rollins Street 6th Floor | Orlando | FL | 32803 | 813556903 | Inactive | FL | N/A | C | Yes (1) |
| Midwest Management Services Inc | |||||||||
| 9100 West 74th Street | Shawnee Mission | KS | 66204 | 480901551 | Inactive | KS | N/A | C | Yes (1) |
| North American Health Services Inc & Sub | |||||||||
| 900 Hope Way | Altamonte Springs | FL | 32714 | 621041820 | Lessor/Holding Co. | TN | N/A | C | Yes (1) |
| Ormond Prof Associates Condo Assoc'n Inc (430 year end) | |||||||||
| 770 W Granada Blvd Ste 101 | Ormond Beach | FL | 32174 | 592694434 | Condo Association | FL | N/A | C | Yes (1) |
| Park Ridge Property Owner's Association Inc | |||||||||
| 1 Park Place Naples Road | Fletcher | NC | 28732 | 030380531 | Condo Association | NC | N/A | C | Yes (1) |
| Porter Affiliated Health Services Inc | |||||||||
| 2525 S Downing Street | Denver | CO | 80210 | 840956175 | Healthcare Services | CO | N/A | C | Yes (1) |
| San Marcos Regional MRI Inc | |||||||||
| 1301 Wonder World Drive | San Marcos | TX | 78666 | 770597968 | Holding Company | TX | N/A | C | Yes (1) |
| The Garden Retirement Community Inc | |||||||||
| 485 North Keller Road Ste 250 | Maitland | FL | 32751 | 593414055 | Real Estate Rental | FL | N/A | C | Yes (1) |
| Winter Park Medical Office Building I Condo Assoc Inc | |||||||||
| 601 East Rollins Street | Orlando | FL | 32803 | 452228478 | Condo Association | FL | N/A | C | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (15 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Adventist Health System Sunbelt Healthcare Corp | ||
| M | $1,000,676 | % of facility's operating exp. |
| Adventist Health System Sunbelt Healthcare Corp dba AIT | ||
| M | $4,173,338 | % of facility's operating exp. |
| Adventist Health System Sunbelt Healthcare Corp dba AIT | ||
| P | $56,412 | Cost |
| Adventist Health System Sunbelt Healthcare Corp-Shared Services | ||
| M | $1,076,605 | % of facility's operating exp. |
| Adventist Health System Sunbelt Healthcare Corp | ||
| P | $4,843,890 | Cost |
| Adventist Health System Sunbelt Healthcare Corp | ||
| B | $539,294 | Actual Amount Given |
| Adventist Health System Sunbelt Healthcare Corp - Insurance Allocation | ||
| P | $980,514 | Actual Amount Given |
| University Community Hospital Inc | ||
| S | $15,273,681 | Actual Amount Received |
| University Community Hospital Inc | ||
| R | $260,665 | Actual Amount Given |
| University Community Hospital Inc | ||
| P | $7,269,398 | Cost |
| Adventist Health SystemSunbelt Inc dba AdventHealth Sebring | ||
| Q | $227,654 | Cost |
| Florida Hospital Physician Group Inc | ||
| P | $3,972,502 | Cost |
| Adventist Health System Sunbelt Healthcare Corp | ||
| B | $1,519,808 | Actual Amount Given |
| Adventist Health SystemSunbelt Inc dba AdventHealth Orlando | ||
| P | $295,970 | Cost |
| Helen Ellis Memorial Hospital Foundation Inc | ||
| C | $425,698 | Actual Amount Received |