2020-11-06T14:14:34-06:00 2019-12-31 990 2019-01-01 651219504 ADVENTIST BOLINGBROOK HOSPITAL ADVE 6303125000 500 REMINGTON BLVD BOLINGBROOK IL 60440 LYNN C ADDISCOTT ASSISTANT SECRETARY 4073572317 2020-11-06 204.139.85.142 2020-11-06 12:52:20 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 12841AD40E8BDE8F2A214B1E8B2FAB2FB37BA08E 2019 2021-01-29 14:40:06Z BRUCE CHRISTIAN 500 REMINGTON BLVD BOLINGBROOK IL 60440 140985402 0 1071 X WWW.AMITAHEALTH.ORG X 2003 IL OPERATION OF A 138-BED ACUTE-CARE HOSPITAL SERVING RESIDENTS IN & AROUND BOLINGBROOK, IL. 18 9 823 192 0 0 251607 185808 136770107 140710575 49381 89019 0 0 137071095 140985402 160077 94920 0 0 47302717 45516007 0 0 0 84964378 85821017 132427172 131431944 4643923 9553458 110340812 112328568 107315960 101775504 3024852 10553064 X ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION AND ALL ITS SUBSIDIARY ORGANIZATIONS WERE ESTABLISHED BY THE SEVENTH-DAY ADVENTIST CHURCH TO BRING A MINISTRY OF HEALING AND HEALTH TO THE COMMUNITIES SERVED. OUR MISSION IS TO EXTEND THE HEALING MINISTRY OF CHRIST.THE HOSPITAL AND HEALTHCARE SYSTEM WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION IS KNOWN AS ADVENTHEALTH. ADVENTHEALTH SEEKS TO BE WIDELY RESPECTED AS A CONSUMER-FOCUSED ORGANIZATION THAT ENGAGES INDIVIDUALS IN THEIR HEALTH BY DELIVERING WHOLISTIC, BEST PRACTICE CARE ACROSS A CONNECTED, COMPREHENSIVE CONTINUUM OF SERVICES. WITH CHRIST AS OUR EXAMPLE, ADVENTHEALTH CARES FOR AND NURTURES PEOPLE: OUR EMPLOYEES, OUR COMMUNITIES, OUR HEALTHCARE PROFESSIONALS, AND THOSE WHO TRUST US FOR CARE AND HEALING. 0 0 110569845 94920 140710575 THE FILING ORGANIZATION DOES BUSINESS UNDER THE NAME AMITA HEALTH ADVENTIST MEDICAL CENTER BOLINGBROOK (AMITA HEALTH BOLINGBROOK, OR THE HOSPITAL). AMITA HEALTH BOLINGBROOK, WHICH IS PART OF ADVENTHEALTH, OPERATES A 138-BED ACUTE-CARE HOSPITAL IN BOLINGBROOK, ILLINOIS, THAT HAS SERVED THE HEALTHCARE NEEDS OF THE BOLINGBROOK COMMUNITY AND SURROUNDING AREAS SINCE THE HOSPITAL OPENED IN 2008. LOCATED AT 500 REMINGTON BLVD., AMITA HEALTH BOLINGBROOK IS A FULL-SERVICE HOSPITAL THAT INCLUDES TWO MEDICAL OFFICE BUILDINGS ON ITS CAMPUS IN BOLINGBROOK, AN AMBULATORY-CARE SITE IN PLAINFIELD, ILLINOIS, AND SEVEN OUTPATIENT PHYSICAL REHABILITATION SITES IN PARTNERSHIP WITH PT SOLUTIONS. SPECIALTY CARE AND OTHER SERVICES AVAILABLE AT THE HOSPITAL INCLUDE BARIATRICS, A BREAST CENTER, CANCER CARE, CARDIAC CARE, A CHRONIC DISEASE CENTER, EMERGENCY SERVICES, EXECUTIVE HEALTH, GASTROENTEROLOGY, GERIATRICS, HOME HEALTH, HOSPICE, INTERVENTIONAL RADIOLOGY, NEUROLOGY, A PAIN MANAGEMENT CENTER, PEDIATRICS, PHYSICAL REHABILITATION, RADIOLOGY, SLEEP DISORDERS, SURGICAL SERVICES, AND WOMEN'S CARE. IN 2015, THE HOSPITAL OPENED A 24-BED GEROPSYCHIATRY UNIT TO ADDRESS A GROWING COMMUNITY NEED FOR MENTAL HEALTH TREATMENT FOR OLDER ADULTS. IN 2017, AMITA HEALTH BOLINGBROOK OPENED A HEPATITIS-C CLINIC DEDICATED TO THE DIAGNOSIS AND TREATMENT OF THE DISEASE, WHICH KILLS TENS OF THOUSANDS OF PEOPLE A YEAR. THE HOSPITAL HAS EXPANDED ITS OUTPATIENT SERVICES STEADILY IN RECENT YEARS, OFFERING OUTPATIENT SERVICES SUCH AS BARIATRIC SURGERY, INTERVENTIONAL PAIN MANAGEMENT, AND A MOBILE PET/CT SERVICE. THE HOSPITAL'S AMBULATORY-CARE SITE IN PLAINFIELD, ILLINOIS, OFFERS IMAGING, LABORATORY AND REHABILITATION SERVICES. AMITA HEALTH BOLINGBROOK PLAYS AN ACTIVE ROLE IN THE COMMUNITY, SPONSORING A WIDE VARIETY OF COMMUNITY OUTREACH PROGRAMS, INCLUDING FREE HEALTH SCREENINGS AND EDUCATIONAL PROGRAMS. IN ADDITION, THE HOSPITAL PROVIDES HEALTH SERVICES TO LOCAL EMPLOYERS.AMITA HEALTH BOLINGBROOK HAS BUILT A REPUTATION FOR CLINICAL EXCELLENCE, EARNING RECOGNITION FROM SEVERAL INDEPENDENT AUTHORITIES. THE JOINT COMMISSION HAS ACCREDITED THE HOSPITAL WITH THE GOLD SEAL OF APPROVAL FOR QUALITY. THE JOINT COMMISSION AND THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION HAVE CERTIFIED THE HOSPITAL AS A PRIMARY STROKE CENTER. THE BLUE CROSS BLUE SHIELD ASSOCIATION HAS RECOGNIZED THE MEDICAL CENTER AS A BLUE DISTINCTION CENTER+ FOR DELIVERING SAFE, HIGH-QUALITY AND COST-EFFICIENT MATERNITY CARE. THE HOSPITAL'S WOMEN'S IMAGING CENTER HAS BEEN DESIGNATED BY THE AMERICAN COLLEGE OF RADIOLOGY AS A BREAST IMAGING CENTER OF EXCELLENCE, AND ITS SLEEP DISORDERS CENTER HAS BEEN ACCREDITED BY THE AMERICAN ACADEMY OF SLEEP MEDICINE. IN 2019, AMITA HEALTH BOLINGBROOK TREATED 5,782 INPATIENTS, PERFORMED 859 INPATIENT SURGERIES AND DELIVERED 861 BABIES. THE HOSPITAL'S MEDICAL STAFF INCLUDES APPROXIMATELY 480 PHYSICIANS REPRESENTING 47 MEDICAL AND SURGICAL SPECIALTIES.AMITA HEALTH BOLINGBROOK PROVIDES CARE FOR ALL, INCLUDING THE FINANCIALLY DISADVANTAGED, UNINSURED, UNDERINSURED, HOMELESS AND THOSE WHO RECEIVE PUBLIC AID. IN 2019, THE HOSPITAL PROVIDED $3,179,547 OF CHARITY CARE AT COST. THIS WAS IN ADDITION TO $639,486 IN OTHER COMMUNITY BENEFITS SERVICES, AND $7,362,665 OF UNREIMBURSED MEDICAID AT COST.ABOUT ADVENTIST MIDWEST HEALTHAMITA HEALTH BOLINGBROOK IS A SUBSIDIARY ORGANIZATION OF ADVENTIST MIDWEST HEALTH (AMH), A NETWORK OF FOUR NOT-FOR-PROFIT HOSPITALS AND THEIR OUTPATIENT-BASED HEALTHCARE FACILITIES IN CHICAGO'S WESTERN SUBURBS. AMH TAKES A HOLISTIC APPROACH TO WELLNESS, ADDRESSING THE PHYSICAL, MENTAL, SOCIAL AND SPIRITUAL NEEDS OF THE PEOPLE IT SERVES. AMH'S HOSPITALS AND OTHER FACILITIES ARE INTEGRAL TO THE FABRIC OF THEIR COMMUNITIES. AMH PARTNERS WITH LOCAL CIVIC ORGANIZATIONS AND BUSINESSES TO BRING STATE-OF-THE-ART TREATMENTS AND PREVENTIVE HEALTHCARE SERVICES CLOSE TO WHERE PEOPLE LIVE AND WORK. AS PART OF ADVENTHEALTH, THE LARGEST, NOT-FOR-PROFIT PROTESTANT HOSPITAL SYSTEM IN THE NATION, AMH IS GROUNDED IN CHRISTIAN VALUES AND COMMITTED TO EXTENDING THE HEALING MINISTRY OF CHRIST. AMH WELCOMES PATIENTS FROM ANY RELIGIOUS DENOMINATION AS WELL AS PATIENTS WHO DO NOT ASCRIBE TO ANY RELIGION.IN FEBRUARY 2015, AMH AND ALEXIAN BROTHERS HEALTH SYSTEM (ABHS) FORMED A JOINT OPERATING COMPANY (JOC). A JOC ALLOWS SEPARATE OWNERS TO INTEGRATE OPERATIONS TO ACHIEVE A COMMON GOAL WHILE MAINTAINING SEPARATE OWNERSHIP OF ASSETS. IT ALSO ALLOWS AMH AND ABHS TO WORK IN UNISON WHILE PRESERVING THE ADVENTIST AND CATHOLIC IDENTITIES AND MISSION PRIORITIES THAT DEFINE AMH AND ABHS, RESPECTIVELY. IN APRIL 2015, ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO., D/B/A AMITA HEALTH, WAS ANNOUNCED AS THE NEW NAME OF THE JOC. THE NAME AMITA IS INSPIRED BY THE MEANING IT HAS IN SEVERAL LANGUAGES -- FRIENDSHIP IN ITALIAN, HONESTY AND TRUTH IN HEBREW, AND SPIRITUAL LIGHT AND BOUNDLESSNESS IN HINDI. THE NAME REFLECTS AMITA HEALTH'S FAITH-BASED CALL TO HEALING, ITS CORE VALUES, AND THE COMPASSION AND DEDICATION THAT ITS CAREGIVERS SHOW EVERY DAY TO PATIENTS, THEIR FAMILIES AND EACH OTHER.AMITA HEALTH BOLINGBROOK SERVICES DIAGNOSTIC SERVICESTHE HOSPITAL'S DIAGNOSTIC SERVICES INCLUDE THE LATEST TECHNOLOGY AND PRACTICES, WHICH ARE ACCREDITED BY NATIONALLY AND STATE RECOGNIZED AGENCIES AND ASSOCIATIONS, SUCH AS THE ILLINOIS EMERGENCY MANAGEMENT AGENCY, THE AMERICAN COLLEGE OF RADIOLOGY, THE COLLEGE OF AMERICAN PATHOLOGISTS, THE CLINICAL LABORATORY IMPROVEMENT AMENDMENTS AND THE JOINT COMMISSION.DIAGNOSTIC SERVICES OFFERED INCLUDE: -- DIAGNOSTIC IMAGING (GENERAL X-RAY, CT, MRI [INCLUDING OPEN MRI], PET, ULTRASOUND, NUCLEAR MEDICINE)-- BREAST-CARE SERVICES (SCREENING AND 3-D DIAGNOSTIC MAMMOGRAPHY, BREAST BIOPSY ULTRASOUND, STEREOTACTIC BREAST BIOPSY, BONE DENSITOMETRY, GENETIC COUNSELING) -- CARDIOLOGY (CARDIAC CATHETERIZATION, ELECTROPHYSIOLOGY, ELECTROCARDIOGRAMS [EKGS], STRESS TESTING, ECHOCARDIOGRAPHY, HOLTER MONITORING OF ARRHYTHMIAS)-- PULMONARY DIAGNOSTICS (ARTERIAL BLOOD GAS ANALYSIS)-- GASTROENTEROLOGY (COLONOSCOPY, BRONCHOSCOPY)-- LABORATORY/PATHOLOGY (CHEMISTRY, MICROBIOLOGY, HEMATOLOGY, HISTOLOGY, CYTOLOGY, PHLEBOTOMY, TRANSFUSION SERVICES)EMERGENCY DEPARTMENTEMERGENCY MEDICAL CARE IS PROVIDED 24/7 FOR ALL AGES AND TYPES OF PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY FOR SUCH SERVICES. OUTPATIENT SERVICES PERFORMED IN 2019: -- 2,999 OUTPATIENT SURGERIES-- 36,052 EMERGENCY ROOM VISITS. 110569845 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 823 1 0 0 0 0 0 0 0 0 0 0 0 0 X 18 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X JARED BROWN 2242730191 500 REMINGTON BLVD BOLINGBROOK IL 60440 X HAFFNER PHD RANDALL DIR/CHAIRMAN 0.10 50.00 X 0 2740749 301079 SNYDER BRENT G DIRECTOR 0.10 50.00 X 0 1313113 166868 THORDARSON THOR DIR/PRES/SEC/EVP & COO 7.50 42.50 X 0 1069460 40054 BUCHANAN HERBERT DIR (BEG 1/19) REG OPERATIONS OFFICER 5.00 45.00 X 62782 565034 11050 CARROLL RICHARD VP/CMO BOLINGBROOK/GLENOAK 25.00 25.00 X 0 486430 33291 CHRISTIAN BRUCE PRES/CEO BOLINGBROOK/GLENO 25.00 25.00 X 0 483030 32555 MURRILL MICHAEL FORMER COO 0.00 50.00 X 0 435889 42112 YANG MD ERIC DIRECTOR (END 12/19) 0.10 50.00 X 0 437486 15754 ROEHR RICHARD FORMER COO 25.00 25.00 X 0 329925 44978 MURPHY MARY FORMER REGIONAL CNO 0.00 50.00 X 0 333450 25784 RADIVOJEVIC VLADIMIR VP/COO BOLINGBROOK/GLENOAK & INTERIM CFO 25.00 25.00 X 0 272130 43858 CRUZ RN OBED VP/CNO BOLINGBROOK 50.00 0.00 X 0 236651 38500 MATHIS REBECCA FORMER CFO 0.00 50.00 X 0 199380 20029 LEONARD DIANE DIR-NURSING II 60.00 0.00 X 160996 0 34468 DE RAMOS DO DAVID DIRECTOR (BEG 1/19) 0.10 50.00 X 0 167073 25837 BROWN JARED CFO (BEG 8/19) 25.00 25.00 X 0 152807 23563 SEBASTIAN BEENA PHARMACIST I 40.00 0.00 X 126152 0 31195 MICHALOWICZ CATHERINE LEAD-NURSING SUPPORT 46.00 0.00 X 145236 0 7137 SPACCAPANICCIA CASSANDRA MGR-PHARMACY 50.00 0.00 X 129162 0 23184 PONTERIO JODI MGR-PHARMACY 50.00 0.00 X 143824 0 6464 SCHIMEROWSKI DEBORAH CFO 2.50 5.00 X 16894 33789 4031 MARTINEZ MD CARLOS DIRECTOR 4.20 0.20 X 25313 0 0 GUTH MD SCOTT DIRECTOR 0.10 3.20 X 0 19906 0 VINCENT SHERRIL INTERIM VP/CFO BOLINGBROOK(END 1/19) 25.00 25.00 X 0 4378 0 SCOTT GLYNN DIRECTOR 0.10 2.40 X 0 2499 0 VALENTINE II MDIV MAURICE DIRECTOR/VICE CHAIR 0.10 0.20 X 0 2499 0 AGUILERA RONALD DIRECTOR 0.10 0.20 X 0 1699 0 ARQUILLA VENANZIO DIRECTOR 0.10 0.20 X 0 0 0 EASTMAN LINDA DIRECTOR 0.10 0.20 X 0 0 0 GRAY JR MARSHALL DIRECTOR 0.10 0.70 X 0 0 0 HAWKINS RONNIE DIRECTOR 0.10 0.20 X 0 0 0 HOLDER BILL DIRECTOR 0.10 0.20 X 0 0 0 O'CONNOR PETER DIRECTOR 0.10 0.20 X 0 0 0 WRIGHT JONATHAN DIRECTOR 0.10 0.20 X 0 0 0 810359 9287377 971791 36 1 1 1 COMPASS GROUP USA INC PO BOX 102289 ATLANTA GA 30368 FOOD & ENVIRONMENTAL SERVICES 5264502 PT SOLUTIONS HOLDINGS LLC PO BOX 441146 KENNESAW GA 30160 THERAPY SERVICES 5130001 TRIMEDX LLC PO BOX 636129 CINCINNATI OH 45263 BIOMED CLINICAL SERVICES 1246437 ADVANCE INPATIENT MEDICINE 903 COMMERCE DRIVE 333 OAKBROOK IL 60523 PHYSICIAN SERVICES 676799 DUPAGE NEONATOLOGY ASSOCIATES SC PO BOX 487 HINSDALE IL 60522 MEDICAL SERVICES 301125 18 X 163429 22379 185808 NET PATIENT REVENUE 622110 139450399 139450399 CAFETERIA REVENUE 622110 482187 482187 HEALTH EDUCATION PROGRAMS 622110 436525 436525 MEDICAL OFFICE BUILDING 622110 167555 167555 GIFT SHOP REVENUE 622110 78329 78329 95580 95580 140710575 59312 59312 29707 0 29707 29707 29707 140985402 140710575 0 89019 X 94920 94920 1202396 1202396 32472391 30959807 1512584 1078877 1002277 76600 7896900 7431249 465651 2865443 2661997 203446 73815 73815 9566 9566 36817426 20400413 16417013 58568 58568 2209714 2078375 131339 4355547 3818610 536937 2400339 2400339 23001 23001 28842 28842 2328254 2328254 5625840 5625840 2304807 2292807 12000 MEDICAL SUPPLIES 21595029 21595029 STATE TAX INDIGENT ASSE 6675910 6675910 REPAIRS & MAINTENANCE 1094531 1094531 UBI TAXES 42000 42000 177828 80645 97183 131431944 110569845 20862099 0 3440 3442 4833428 22409289 22705623 2438463 2986642 2453900 3115095 174239809 98469505 79729968 75770304 1754386 368107 1551366 2545927 110340812 112328568 7619744 7487950 143469 90208 99552747 94197346 107315960 101775504 X 1967596 10202212 1057256 350852 3024852 10553064 110340812 112328568 X 9553458 184245 -2209491 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 750 0 0 1 23031 23781 0 PART II-B, LINE 1: DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND ILLINOIS HOSPITAL ASSOCIATION, AND $750 TO WILL COUNTY CENTER FOR ECONOMIC DEVELOPMENT. 108671740 43033744 65637996 64315656 55279172 9036484 1252413 156589 1095824 75770304 DUE TO RELATED 4807841 PAYABLE TO THIRD PARTIES 12498552 AR CREDIT BALANCES 1653055 INTERCO ALLOC OF TE BOND PROCEEDS 73744214 OPERATING LEASE LIABILITY 1476274 OTHER LIABILITIES 14024 ACCRUED INTEREST PAYABLE 3386 94197346 X PART X, LINE 2: THE FILING ORGANIZATION IS A SUBSIDIARY ORGANIZATION WITHIN ADVENTHEALTH. THE CONSOLIDATED FINANCIAL STATEMENTS OF ADVENTHEALTH CONTAIN THE FOLLOWING FIN 48 (ASC 740) FOOTNOTE: PLEASE NOTE THAT DOLLAR AMOUNTS ARE IN THOUSANDS. HEALTHCARE CORPORATION AND ITS AFFILIATED ORGANIZATIONS, OTHER THAN NORTH AMERICAN HEALTH SERVICES, INC. AND ITS SUBSIDIARY (NAHS), ARE EXEMPT FROM STATE AND FEDERAL INCOME TAXES. ACCORDINGLY, HEALTHCARE CORPORATION AND ITS TAX-EXEMPT AFFILIATES ARE NOT SUBJECT TO FEDERAL, STATE OR LOCAL INCOME TAXES EXCEPT FOR ANY NET UNRELATED BUSINESS TAXABLE INCOME. NAHS IS A WHOLLY OWNED, FOR-PROFIT SUBSIDIARY OF HEALTHCARE CORPORATION. NAHS AND ITS SUBSIDIARY ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. NAHS FILES A CONSOLIDATED FEDERAL INCOME TAX RETURN AND, WHERE APPROPRIATE, CONSOLIDATED STATE INCOME TAX RETURNS. ALL TAXABLE INCOME WAS FULLY OFFSET BY NET OPERATING LOSS CARRYFORWARDS FOR FEDERAL INCOME TAX PURPOSES; AS SUCH, THERE IS NO PROVISION FOR CURRENT FEDERAL OR STATE INCOME TAX FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018. NAHS ALSO HAS TEMPORARY DEDUCTIBLE DIFFERENCES OF APPROXIMATELY $46,500 AND $53,000 AT DECEMBER 31, 2019 AND 2018, RESPECTIVELY, PRIMARILY AS A RESULT OF NET OPERATING LOSS CARRYFORWARDS. AT DECEMBER 31, 2019, NAHS HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $47,500, EXPIRING BEGINNING IN 2022 THROUGH 2026. DEFERRED TAXES HAVE BEEN PROVIDED FOR THESE AMOUNTS, RESULTING IN A NET DEFERRED TAX ASSET OF APPROXIMATELY $11,400 AND $13,400 AT DECEMBER 31, 2019 AND 2018, RESPECTIVELY. NAHS REMEASURED ITS DEFERRED TAX ASSETS AND LIABILITIES BASED ON THE RATES AT WHICH THEY ARE EXPECTED TO REVERSE IN THE FUTURE, WHICH IS GENERALLY 21%. A FULL VALUATION ALLOWANCE HAS BEEN PROVIDED AT DECEMBER 31, 2019 AND 2018 TO OFFSET THE DEFERRED TAX ASSET, SINCE HEALTHCARE CORPORATION HAS DETERMINED THAT IT IS MORE LIKELY THAN NOT THAT THE BENEFIT OF THE NET OPERATING LOSS CARRYFORWARDS WILL NOT BE REALIZED IN FUTURE YEARS. THE INCOME TAXES TOPIC OF THE ASC (ASC 740) PRESCRIBES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAX POSITIONS RECOGNIZED IN FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN, OR EXPECTED TO BE TAKEN, IN A TAX RETURN. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2019 AND 2018. ON DECEMBER 22, 2017, THE UNITED STATES ENACTED TAX REFORM LEGISLATION COMMONLY KNOWN AS THE TAX CUTS AND JOBS ACT (ACT), RESULTING IN SIGNIFICANT MODIFICATIONS TO EXISTING LAW. CERTAIN PROVISIONS IMPACT TAX-EXEMPT ORGANIZATIONS, INCLUDING REVISIONS TO TAXES ON UNRELATED BUSINESS ACTIVITIES, EXCISE TAXES ON COMPENSATION OF CERTAIN EMPLOYEES, AND VARIOUS OTHER PROVISIONS. WHILE FINAL REGULATIONS ON THESE PROVISIONS HAVE NOT YET BEEN PROMULGATED, THE IMPACT OF THESE PROVISIONS ON THE CONSOLIDATED FINANCIAL STATEMENTS IS NOT EXPECTED TO BE SIGNIFICANT. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 3179547 3179547 0.02420 29420375 22057710 7362665 0.05600 32599922 22057710 10542212 0.08020 25063 25063 0.00020 62985 62985 0.00050 88048 88048 0.00070 32687970 22057710 10630260 0.08090 1 9538247 761508 32503607 32293567 210040 X 1 1 1 1 ADVENTIST BOLINGBROOK HOSPITAL 500 REMINGTON BLVD BOLINGBROOK IL 60440 WWW.AMITAHEALTH.ORG/LOCATIONS/HOSPITAL 0005496 X X X ADVENTIST BOLINGBROOK HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X PART V, PAGE 8 X X 1 17 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 600.000000000000 X X X X 1 1 X X X X 1 X PART V, PAGE 8 X PART V, PAGE 8 X PART V, PAGE 8 X X X X X X X 1 X 0 X X X X 1 X 0 0 ADVENTIST BOLINGBROOK HOSPITAL PART V, SECTION B, LINE 5: ADVENTIST BOLINGBROOK HOSPITAL (ABH OR THE HOSPITAL) COLLABORATED WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS TO CONDUCT A JOINT CHNA IN 2019. ALL THE COLLABORATORS IN THE 2019 JOINT CHNA DEFINED THEIR COMMUNITY TO BE WILL COUNTY, ILLINOIS. WILL COUNTY, ILLINOIS HAS A POPULATION OF OVER 700,000 AND IS COMPRISED OF 23 CITIES, INCLUDING JOLIET, PLAINFIELD, BOLINGBROOK, AND ROMEOVILLE. THE 2019 JOINT CHNA WAS A COLLABORATIVE EFFORT OF THE MOBILIZING FOR ACTION IN PLANNING AND PARTNERSHIP (MAPP) COLLABORATIVE. THE HOSPITAL WAS AN EXECUTIVE COMMITTEE MEMBER OF THE MAPP COLLABORATIVE, ALONG WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS AND INCLUDING THE WILL COUNTY HEALTH DEPARTMENT. MAPP IS A COMMUNITY DRIVEN, STRATEGIC PLANNING PROCESS THAT ASSISTS COMMUNITIES IN DEVELOPING AND IMPLEMENTING EFFORTS AROUND THE PRIORITIZATION OF PUBLIC HEALTH ISSUES. AS A PART OF THE COMMUNITY HEALTH ASSESSMENT AND DATA COLLECTION EFFORTS, A SPECIFIC EFFORT WAS MADE TO INCLUDE INPUT FROM UNDERREPRESENTED POPULATION GROUPS AND PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. THE WILL COUNTY MAPP COLLABORATIVE CONDUCTED A SURVEY AMONG WILL COUNTY RESIDENTS TO ASSESS THE COMMUNITY'S PERCEPTIONS, THOUGHTS AND OPINIONS OF HEALTH AND THE QUALITY OF LIFE IN THEIR COMMUNITY. THE SURVEY WAS OPEN TO ALL WILL COUNTY RESIDENTS AND 1,688 SURVEYS WERE COLLECTED. THE MAPP COLLABORATIVE MADE A SPECIAL EFFORT TO GATHER INPUT FROM UNDERREPRESENTED POPULATIONS, INCLUDING THE FOLLOWING GROUPS: LATINO/HISPANIC, AFRICAN AMERICAN, YOUTH, AND RESIDENTS FROM CERTAIN IDENTIFIED COMMUNITY AREAS. IN ORDER TO REACH THESE POPULATIONS, PAPER COPIES OF THE SURVEY WERE DISTRIBUTED TO VARIOUS GROUPS THROUGHOUT WILL COUNTY, INCLUDING THE SPANISH COMMUNITY CENTER, NORTHERN ILLINOIS FOOD BANK MOBILE PANTRY SITES, AND YMCA SITES. SURVEYS WERE ALSO COLLECTED FROM CLIENTS OF THE WILL COUNTY COMMUNITY HEALTH CENTER IN WAITING AREAS. QUESTIONS ADDRESSING HEALTH EQUITY WERE INCLUDED IN THE SURVEY TO HELP MEASURE THE EFFECTS OF DISCRIMINATION ON HEALTH. RESPONDENTS WERE ASKED TO IDENTIFY PERCEPTIONS OF DISCRIMINATION DUE TO RACE, ETHNICITY, AND COLOR IN WILL COUNTY. ADVENTIST BOLINGBROOK HOSPITAL PART V, SECTION B, LINE 6A: ADVENTIST BOLINGBROOK HOSPITAL (ABH OR THE HOSPITAL) COLLABORATED WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS TO CONDUCT A JOINT CHNA IN 2019. ALL THE COLLABORATORS IN THE 2019 JOINT CHNA DEFINED THEIR COMMUNITY TO BE WILL COUNTY, ILLINOIS. WILL COUNTY, ILLINOIS HAS A POPULATION OF OVER 700,000 AND IS COMPRISED OF 23 CITIES, INCLUDING JOLIET, PLAINFIELD, BOLINGBROOK, AND ROMEOVILLE. THE 2019 JOINT CHNA WAS A COLLABORATIVE EFFORT OF THE MOBILIZING FOR ACTION IN PLANNING AND PARTNERSHIP (MAPP) COLLABORATIVE. THE HOSPITAL WAS AN EXECUTIVE COMMITTEE MEMBER OF THE MAPP COLLABORATIVE, ALONG WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS AND INCLUDING THE WILL COUNTY HEALTH DEPARTMENT. THE OTHER HOSPITAL ORGANIZATIONS THAT PARTICIPATED IN THE 2019 JOINT CHNA AS EXECUTIVE COMMITTEE MEMBERS OF THE MAPP COLLABORATIVE INCLUDED AMITA HEALTH SAINT JOSEPH MEDICAL CENTER, SILVER CROSS HOSPITAL, CHESTNUT HEALTH SYSTEMS, AND EDWARD HOSPITAL. ADVENTIST BOLINGBROOK HOSPITAL PART V, SECTION B, LINE 6B: ADVENTIST BOLINGBROOK HOSPITAL (ABH OR THE HOSPITAL) COLLABORATED WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS TO CONDUCT A JOINT CHNA IN 2019. ALL THE COLLABORATORS IN THE 2019 JOINT CHNA DEFINED THEIR COMMUNITY TO BE WILL COUNTY, ILLINOIS. WILL COUNTY, ILLINOIS HAS A POPULATION OF OVER 700,000 AND IS COMPRISED OF 23 CITIES, INCLUDING JOLIET, PLAINFIELD, BOLINGBROOK, AND ROMEOVILLE. THE 2019 JOINT CHNA WAS A COLLABORATIVE EFFORT OF THE MOBILIZING FOR ACTION IN PLANNING AND PARTNERSHIP (MAPP) COLLABORATIVE. THE HOSPITAL WAS AN EXECUTIVE COMMITTEE MEMBER OF THE MAPP COLLABORATIVE, ALONG WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS AND INCLUDING THE WILL COUNTY HEALTH DEPARTMENT. THE OTHER NON-HOSPITAL ORGANIZATIONS THAT PARTICIPATED IN THE 2019 JOINT CHNA AS EXECUTIVE COMMITTEE MEMBERS OF THE MAPP COLLABORATIVE INCLUDED THE WILL COUNTY HEALTH DEPARTMENT, WILL COUNTY EXECUTIVE'S OFFICE, WILL COUNTY COMMUNITY HEALTH CENTER, THE WILL COUNTY BOARD, AUNT MARTHA'S YOUTH SERVICES, GOVERNORS STATE UNIVERSITY, GREATER JOLIET YMCA, SENIOR SERVICES OF WILL COUNTY, STEPPING STONES, INC., UNITED WAY OF WILL COUNTY, CATHOLIC CHARITIES, EASTERSEALS JOLIET REGION, INC., VALLEY VIEW SCHOOL DISTRICT, AND THE WILL-GRUNDY MEDICAL CLINIC. ADVENTIST BOLINGBROOK HOSPITAL PART V, SECTION B, LINE 7D: THE HOSPITAL HAS ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS MUST BE POSTED ON THE HOSPITAL'S WEBSITE AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE WIDELY AVAILABLE ON ITS WEBSITE ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. THE HOSPITAL WILL ALSO MAKE A PAPER COPY OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST AND WITHOUT CHARGE, AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE AVAILABLE FOR PUBLIC INSPECTION ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. COPIES OF THE CHNA REPORT WERE MAILED AND/OR E-MAILED TO COMMUNITY PARTNERS WHO PARTICIPATED IN THE CHNA PROCESS. PARTNERS WERE ALSO PROVIDED LINKS TO THE WEBSITE FOR DISSEMINATION TO THEIR MAILING LISTS AND RESPECTIVE CONSTITUENTS. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE AT AMITAHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT AND IS ALSO BROADLY DISTRIBUTED WITHIN OUR COMMUNITY TO STAKEHOLDERS INCLUDING COMMUNITY LEADERS, GOVERNMENT OFFICIALS, AND SERVICE ORGANIZATIONS. ADVENTIST BOLINGBROOK HOSPITAL PART V, SECTION B, LINE 11: THE INFORMATION PROVIDED BELOW EXPLAINS HOW THE HOSPITAL FACILITY ADDRESSED IN 2019 THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, AND ANY SUCH NEEDS THAT WERE NOT ADDRESSED AND THE REASONS WHY SUCH NEEDS WERE NOT ADDRESSED. THE HOSPITAL FACILITY CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT BY 12/31/16 AND ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT IN 2017 PRIOR TO MAY 15, 2017. AMITA HEALTH ADVENTIST BOLINGBROOK HOSPITAL (ABH OR THE HOSPITAL) COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA)IN 2016. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED ON BEHALF OF THE FILING ORGANIZATION AS PART OF A LARGER PROJECT SPONSORED BY THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL (MCHC) AND DONE BY PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC). THE SERVICE AREA FOR THE HOSPITAL IS COMPRISED OF 34 RESIDENTIAL ZIP CODES BASED ON PATIENT ORIGIN. A COMPLETE DESCRIPTION OF SAMPLE SIZE AND SURVEY DESIGN IS AVAILABLE IN THE FULL REPORT FOUND ONLINE AT HTTPS://WWW.AMITAHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT/ADVENTIST-BOLINGBROOK. DESCRIPTION OF DEMOGRAPHICSIN THE BOLINGBROOK HOSPITAL SERVICE AREA, THE POPULATION IS SLIGHTLY YOUNGER THAN AVERAGE, AND ABOUT 17.7% OF THE POPULATION IS HISPANIC. THE COMMUNITY'S SOCIAL DETERMINANTS ARE POSITIVE, HAVING LESS POVERTY, LESS UNEMPLOYMENT AND A BETTER EDUCATED COMMUNITY THAN AVERAGE (2016 CHNA, PAGE 39). HOWEVER, 7.4% OF THE POPULATION LIVES AT OR BELOW 100% OF THE POVERTY LEVEL AND 19.4% ARE AT OR BELOW 200% OF THE POVERTY LEVEL, REPRESENTING 306,654 INDIVIDUALS. IT IS MOST OFTEN THESE INDIVIDUALS THAT HAVE DIFFICULTY ACCESSING SERVICES AND HAVE POORER OVERALL HEALTH, AND SO OUR EFFORTS TO PROVIDE THE COMMUNITY WITH NEEDED SERVICES WAS DIRECTED IN MOST CASES TOWARDS THIS POPULATION. PRIORITY ISSUES ADDRESSEDMENTAL HEALTH/SUBSTANCE ABUSEIN THE ABH SERVICE AREA, 22.8% OF RESIDENTS DESCRIBE THEIR MENTAL HEALTH AS FAIR OR POOR AS COMPARED TO THE MCHC REGION AT 13.2% AND THE NATION AT 11.9%. ACCESSING MENTAL HEALTH SERVICES IS PARTICULARLY DIFFICULT FOR LOW INCOME RESIDENTS AND THOSE WITHOUT INSURANCE. RELATED TO MENTAL HEALTH ACCESS ISSUES, 6.9% OF ABH RESIDENTS REPORT LIVER DISEASE AS COMPARED TO 1.6% OF THE MCHC AREA. ACTION TAKEN: - AS MEMBERS OF THE WILL COUNTY MAPP COLLABORATIVE, THE HOSPITAL PROMOTED MENTAL HEALTH FIRST AID, A PUBLIC EDUCATION PROGRAM DESIGNED TO TEACH INDIVIDUALS HOW TO INTERACT WITH AND HELP SOMEONE EXPERIENCING A MENTAL HEALTH OR ADDICTIONS CHALLENGE OR CRISIS. PARTICIPANTS LEARN MENTAL ILLNESS SIGNS AND SYMPTOMS, RISK ASSESSMENT, INTERVENTION STRATEGIES, AND EFFECTIVE COMMUNICATION SKILLS. SINCE 2014, OVER 1,200 PEOPLE HAVE BECOME MENTAL HEALTH FIRST AIDERS. - PROVIDED START-UP FUNDING TO VNA HEALTH CARE (FQHC) TO EXPAND MENTAL HEALTH SERVICES TO SERVE LOW-INCOME PATIENTS IN NEED. NUTRITION, PHYSICAL ACTIVITY AND WEIGHTTHE PERCENTAGE OF OBESITY/OVERWEIGHT IN CHILDREN IS QUITE HIGH IN THE ABH COMMUNITY. OVER 44.0% ARE OVERWEIGHT, 40.3% ARE OBESE AS COMPARED TO THE MCHC REGION AT 31.6% AND 18.1% RESPECTIVELY. ACTION TAKEN:- THE HOSPITAL PARTICIPATED IN THE WEEKLY BOLINGBROOK FARMER'S MARKETS TO PROVIDE INFORMATION ON NUTRITION AND HEALTHY EATING HABITS TO THE COMMUNITY AND PROVIDED FREE HEALTH SCREENINGS. - ABH HOSTED THE ANNUAL ST. PADDY'S HALF MARATHON AND 5K COURSE RUNS THROUGHOUT BOLINGBROOK. NEARLY 22,000 RUNNERS PARTICIPATED IN THE HALF MARATHON IN 2019. - PROVIDED AN ONSITE 24/7 EMERGENCY FOOD PANTRY OUTSIDE THE HOSPITAL EMERGENCY DEPARTMENT. THE MICRO PANTRY IS MAINTAINED AND STOCKED BY HOSPITAL STAFF AND THE COMMUNITY AT LARGE TO HELP THOSE WITH FOOD INSECURITY ISSUES. - SUPPORTED WEWILL WORKHEALTHY, A WORKSITE WELLNESS RECOGNITION PROGRAM DEVELOPED IN 2013. IT RECOGNIZES THE WORKSITES IN WILL COUNTY THAT ARE ENGAGED IN WORKSITE WELLNESS BEST PRACTICES THROUGH AN APPLICATION PROCESS. THIS APPLICATION CONSISTS OF POLICIES, PROGRAMS, AND SERVICES PERTAINING TO HEALTH PROMOTION, PHYSICAL ACTIVITY, BEHAVIORAL HEALTH, ENVIRONMENTAL HEALTH, NUTRITION, AND SAFETY. WEWILL WORKHEALTHY IS AN AWARD PROGRAM WITH LEVELS OF RECOGNITION: HONORABLE MENTION, BRONZE, SILVER, GOLD, AND THE INNOVATION AWARD. IN 2019, NINE ORGANIZATIONS HAVE RECEIVED RECOGNITION, IMPACTING MORE THAN 10,000 WILL COUNTY EMPLOYEES. - THE HOSPITAL DONATED $10K IN FUNDING TO UNITED WAY FUNDS FOR THEIR HEALTHY LIFESTYLES CATEGORY. SOME OF THE HEALTHY LIFESTYLES PROGRAMS OUR UNITED WAY INVESTS IN ARE: -- MOBILE DENTAL UNIT TO HELP CHILDREN AND ADULTS WHO NEED DENTAL CARE BUT HAVE NO INSURANCE; -- ONCOLOGY SUPPORT FOR INDIVIDUALS GOING THROUGH TREATMENT FOR CANCER AND SUPPORT TO THEIR FAMILIES; -- AUTISM SERVICES FOR CHILDREN AND SUPPORT TO THEIR FAMILIES; -- MOBILE HEARING VAN TO SCREEN CHILDREN AND ADULTS; -- RESIDENTIAL TREATMENT FOR ADULTS WHO ARE ALCOHOL OR DRUG DEPENDENT; -- TRAUMA FOCUSED MENTAL HEALTH SERVICES FOR CHILDREN WHO HAVE BEEN ABUSED; AND -- MEDICAL CARE FOR CHILDREN AND ADULTS WHO NEED MEDICAL CARE BUT HAVE NO HEALTH INSURANCE.OTHER IDENTIFIED HEALTH ISSUES ACCESS TO HEALTHCARE SERVICESOVERALL, 47.8% OF THE ABH SERVICE AREA REPORTED DIFFICULTY IN ACCESSING CARE DUE TO FINDING A DOCTOR, COST, INCONVENIENT OFFICE HOURS OR LACK OF TRANSPORTATION. OF THOSE IN THE LOWER SOCIOECONOMIC STATUS, 66.7% REPORTED DIFFICULTY ACCESSING CARE. ACTION TAKEN: - OVER THE PAST THREE YEARS, THE WILL COUNTY MAPP COLLABORATIVE, IN WHICH THE HOSPITAL IS A MEMBER, DEVELOPED A CAMPAIGN TO EDUCATE HEALTH CARE CONSUMERS ON HOW TO APPROPRIATELY UTILIZE SERVICES. THE CAMPAIGN LISTED SYMPTOMS ON WHEN TO GO TO YOUR PRIMARY CARE PROVIDER OR THE EMERGENCY ROOM, ALL THE WHILE PROMOTING THE LOCAL FQHCS.-PARTNERED WITH VNA HEALTH CARE (FQHC) TO ASSIST IN CARE COORDINATION OF EMERGENCY PATIENTS AND INPATIENTS THAT ARE IDENTIFIED AS NOT HAVING A MEDICAL HOME. HOSPITAL SOCIAL WORK AND CARE MANAGEMENT TEAMS COORDINATE WITH THE ONSITE VNA CARE COORDINATOR TO ENSURE PROPER APPOINTMENTS ARE MADE. -SINCE 2017, THE HOSPITAL HAS BEEN IN A PARTNERSHIP WITH DISPENSARY OF HOPE. BY WORKING WITH THE PHARMACEUTICAL SUPPLY CHAIN, THE DISPENSARY OF HOPE SUPPORTS THE OUTPATIENT PHARMACY BY PROVIDING FREE MEDICATION TO LOW-INCOME AND CHRONICALLY ILL INDIVIDUALS WHO ARE UNDERINSURED. OUR PHARMACISTS PROVIDE FREE CONSULTATIONS AND OFFICE HOURS FOR DISPENSING THE MEDICATION.CANCER THE AGE ADJUSTED DEATH RATE FROM FEMALE BREAST CANCER IS SLIGHTLY ABOVE NATIONAL RATES, THE INCIDENCE OF PROSTATE CANCER IS SLIGHTLY ABOVE NATIONAL RATES. ACTION TAKEN: - HOSTED THE ANNUAL PINK LIGHTING CEREMONY ON THE HOSPITAL CAMPUS, COMMEMORATING THE START OF BREAST CANCER AWARENESS MONTH. PATIENTS, SURVIVORS, THEIR FAMILIES AND STAFF GATHERED FOR MUSIC, PRAYER, A SPECIAL SPEAKER AND THE CHANCE TO PUT A RIBBON ON THE TREE IN MEMORY OF A LOVED ONE.DIABETES WHILE THE AGE ADJUSTED DEATH RATE FOR TYPE II DIABETES IS FAVORABLE IN THE ABH AREA, 14.8% OF THE POPULATION REPORTS BORDERLINE DIABETES AS COMPARED TO 6.9% OF THE MCHC POPULATION AND 5.1% OF THE NATIONAL POPULATION. THIS SERIOUS, CHRONIC DISEASE IS EXPENSIVE TO TREAT AND CLOSELY RELATED TO HEART DISEASE, STROKE, OBESITY AND NUTRITION. ACTION TAKEN: - THROUGH THE SUPPORT TO AND COLLABORATION WITH VNA HEALTH CARE, LOW INCOME COMMUNITY MEMBERS HAVE AN OPPORTUNITY TO BE SCREENED FOR PRE-DIABETES AND DIABETES CLASSES. VNA OFFERS A MULTI-DISCIPLINARY DIABETES RESOURCE TEAM TO SUPPORT PATIENTS THROUGH A STEP BY STEP DIABETES PROGRAM. THEIR RECORDS SHOW THAT OVER 60% OF THE PATIENTS REDUCED THEIR WEIGHT; 100% INCREASED PHYSICAL ACTIVITY; AND 80% OF PATIENTS HAD HEALTHIER EATING HABITS. SEE CONTINUATION ADVENTIST BOLINGBROOK HOSPITAL PART V, SECTION B, LINE 16J: THE FILING ORGANIZATION USES MULTIPLE METHODS OF COMMUNICATING ITS MISSION OF PROVIDING CARE TO ALL WHO NEED IT REGARDLESS OF ABILITY TO PAY. SIGNS POSTED AT REGISTRATION CLEARLY POINT OUT THAT CHARITY CARE OR FINANCIAL ASSISTANCE IS AVAILABLE. REGISTRATION IS EDUCATED ON PROVIDING FINANCIAL ASSISTANCE POLICY INFORMATION AND FORMS TO PATIENTS. THE MAIN WEBSITE FOR ALL SYSTEM HOSPITALS FEATURES INFORMATION ON HOW TO APPLY FOR FINANCIAL ASSISTANCE ON-LINE. IN THE HOSPITAL SETTING, WE EMPLOY FINANCIAL COUNSELORS WHO ARE AVAILABLE TO WORK WITH PATIENTS AND WE ALSO HAVE MEDICAID APPLICATION SPECIALISTS TO ASSIST PATIENTS THAT MAY QUALIFY. IN ADDITION, ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING FINANCIAL ASSISTANCE. SCHEDULE H, PART V, SECTION B, LINE 11 - CONTINUATION: FAMILY PLANNING THIS ISSUE WAS CALLED OUT AS A TOP CONCERN BY COMMUNITY STAKEHOLDERS, BUT NOT SUPPORTED BY DATA. IT IS LIKELY THAT BECAUSE LACK OF FAMILY PLANNING IS SO DETRIMENTAL TO YOUNG WOMEN, THOSE OF LOW SOCIOECONOMIC STATUS ETC. THAT ITS IMPACT IS GREATER THAN THE NUMBERS WOULD SUGGEST. ACTION TAKEN: - OFFERED FREE OR FOR A NOMINAL FEE CLASSES TO FAMILIES AND COMMUNITY MEMBERS ON TOPICS THAT INCLUDE: BABY CARE BASICS; INFANT AND CHILD CPR CLASSES; PREPARED CHILDBIRTH MARATHON; BREASTFEEDING CLASS; AND BREASTFEEDING SUPPORT GROUPS. HEART DISEASE AND STROKEBOTH OF THESE ISSUES ARE HIGHER THAN THE STATE AND NATIONAL NORMS, ALTHOUGH THE DEATH RATE FOR BOTH IS MORE FAVORABLE THAN STATE OR NATIONAL NORMS. ACTION TAKEN: - THE HOSPITAL PROVIDES ONGOING FREE FLU VACCINES, BLOOD SUGAR CHECKS, BLOOD PRESSURE CHECKS, BODY FAT ANALYSIS AND STROKE RISK ASSESSMENTS IN THE HOSPITAL AND IN THE COMMUNITY. IMMUNIZATION AND INFECTIOUS DISEASES ONLY 37.8% OF THOSE OVER 65 HAVE HAD A FLU VACCINE IN THE PAST YEAR, WELL BELOW MCHC AT 56.5% AND ILLINOIS AT 58.6%. ALL IMMUNIZATIONS ARE BELOW THE HEALTHY PEOPLE 2020 BENCHMARKS. ACTION TAKEN: - PARTNERED WITH THE VNA HEALTH CARE CENTER TO PROVIDE PRIMARY CARE SERVICES THAT INCLUDE ADMINISTERING THE REQUIRED VACCINATIONS FOR SCHOOLS AND HELPS FAMILIES STAY ON TRACK OF THE VACCINATION SCHEDULE. - PROVIDED EVERY PATIENT UPON DISCHARGE THE OPPORTUNITY TO RECEIVE A FLU VACCINE. EVERY EMPLOYEE IS REQUIRED TO HAVE A FLU VACCINE FOR THE PROTECTION OF OUR PATIENTS UNLESS THEY WERE MEDICALLY EXCUSED. - SEXUALLY TRANSMITTED DISEASES ALTHOUGH A CONCERN IN THE COMMUNITY, PATIENTS ARE REFERRED TO THE WILL COUNTY HEALTH DEPARTMENT, WHICH OFFERS FREE STD TESTING. DUE TO LACK OF FUNDING, THE HOSPITAL WAS NOT ABLE TO PROVIDE AN EXTERNAL COMMUNITY BENEFIT PROGRAM. ISSUES NOT ADDRESSED DUE TO LACK OF RESOURCES- POTENTIALLY DISABLING CONDITIONS - ALTHOUGH AN IDENTIFIED COMMUNITY NEED, THE HOSPITAL PROVIDES EXTENSIVE SERVICES IN A CLINICAL SETTING. DUE TO THE LACK OF FUNDING, THE HOSPITAL WAS NOT ABLE TO CREATE AN EXTERNAL COMMUNITY BENEFIT PROGRAM. - CHRONIC KIDNEY DISEASE - NO FURTHER PROGRAMMING WAS CREATED, AS THE HOSPITAL'S INTERNAL PLAN FOR UNDERINSURED OR UNINSURED PATIENTS WAS ADOPTED AS DESCRIBED: IF THE PATIENT IS DIAGNOSED WITH END STAGE RENAL DISEASE (ESRD) THEY BECOME ELIGIBLE FOR MEDICARE REGARDLESS OF AGE. IF FURTHER, THEY HAVE NO EMPLOYER SPONSORED PLAN THEN MEDICARE BECOMES PRIME AND COVERS DIALYSIS RIGHT AWAY AS SOON AS ALL OF THE PAPERWORK IS DONE. IF THE PATIENT IS NOT MEDICARE ELIGIBLE THEN PUBLIC AID BECOMES PRIME AND COVERS THE TREATMENTS. LASTLY IF THE PATIENT IS NOT ELIGIBLE FOR EITHER MEDICARE OR PUBLIC AID (GENERALLY ONLY UNDOCUMENTED PERSONS MEET THESE CRITERIA SO IT IS RARE) THEN USUALLY THERE ARE FUNDS AVAILABLE THROUGH THE NATIONAL KIDNEY FOUNDATION ETC. THE SOCIAL WORKERS ASSOCIATED WITH THE DIALYSIS CENTERS PROVIDE THE REFERRALS AND EDUCATION. - INJURY AND VIOLENCE - THE CHNA IDENTIFIED BICYCLE HELMET USAGE AND VIOLENT CRIME BOTH AS LOW-PRIORITY. THERE WAS NOT A PROGRAM DEVISED FOR THE HELMET USAGE DUE TO FUNDING. IN TERMS OF VIOLENT CRIME, THE HOSPITAL DECIDED TO CONTINUE THE FREE ED TRAINING TO OUR LOCAL LAW ENFORCEMENT/FIRST RESPONDERS AND NOT DEDICATE SEPARATE DOLLARS FOR VIOLENT CRIME DUE TO SHORTAGES IN FUNDING. SCHEDULE H, PART V, SECTION B, LINE 7A: THE CHNA REPORT CAN BE FOUND AT URL:HTTPS://WWW.AMITAHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT/AMITA-HEALTH-ADVENTIST-MEDICAL-CENTER-BOLINGBROOK SCHEDULE H, PART V, SECTION B, LINE 10A: THE HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND AT:HTTPS://WWW.AMITAHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT/AMITA-HEALTH-ADVENTIST-MEDICAL-CENTER-BOLINGBROOK SCHEDULE H, PART V, SECTION B, LINE 16A,B,C: THE FINANCIAL ASSISTANCE POLICY CAN BE FOUND AT URL:HTTPS://WWW.AMITAHEALTH.ORG/PATIENT-RESOURCES/PAY-YOUR-BILL/PRICE-ESTIMATES/ADVENTIST-FORMS-AND-POLICY-INFORMATIONTHE FINANCIAL ASSISTANCE POLICY APPLICATION CAN BE FOUND AT:HTTPS://WWW.AMITAHEALTH.ORG/PATIENT-RESOURCES/PAY-YOUR-BILL/PRICE-ESTIMATES/ADVENTIST-FORMS-AND-POLICY-INFORMATIONTHE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://WWW.AMITAHEALTH.ORG/PATIENT-RESOURCES/PAY-YOUR-BILL/PRICE-ESTIMATES/ADVENTIST-FORMS-AND-POLICY-INFORMATION SCHEDULE H, PART V, SECTION B, LINE 8 - 10A THE FILING ORGANIZATION ADOPTED A COMMUNITY HEALTH NEEDS ASSESSMENT REPORT BY 12/31/2019 AND WAS IN THE PROCESS OF DEVELOPING ITS COMMUNITY HEALTH NEEDS IMPLEMENTATION STRATEGY AT THAT TIME. THE FILING ORGANIZATION'S 2020-2022 COMMUNITY HEALTH NEEDS IMPLEMENTATION STRATEGY IS DOCUMENTED IN A WRITTEN REPORT CALLED THE "COMMUNITY HEALTH PLAN". THE COMMUNITY HEALTH PLAN (CHP) DESCRIBES HOW THE FILING ORGANIZATION PLANS TO MEET ITS IDENTIFIED PRIORITIZED HEALTH NEEDS OR IDENTIFIES THE HEALTH NEED AS ONE THE FILING ORGANIZATION DOES NOT INTEND TO SPECIFICALLY ADDRESS AND PROVIDES AN EXPLANATION AS TO WHY THE FILING ORGANIZATION DOES NOT INTEND TO ADDRESS THAT HEALTH NEED. THE FILING ORGANIZATION'S 2020-2022 CHP WAS ADOPTED BY MAY 15, 2020 AND IS POSTED ON THE HOSPITAL FACILITY'S WEBSITE.AS THE HOSPITAL FACILITY'S 2020-2022 COMMUNITY HEALTH NEEDS IMPLEMENTATION STRATEGY WAS NOT ADOPTED BY THE END OF THE HOSPITAL ORGANIZATION'S TAXABLE YEAR OF DECEMBER 31, 2019, SCHEDULE H, PART V, SECTION B, LINE 9 INDICATES THAT 2017 WAS THE TAX YEAR IN WHICH THE HOSPITAL FACILITY LAST ADOPTED AN IMPLEMENTATION STRATEGY. SCHEDULE H, PART V, SECTION B, LINE 10A REFLECTS THE WEBSITE ADDRESS FOR THE HOSPITAL FACILITY'S 2014-2016, 2017-2019, AND 2020-2022 IMPLEMENTATION STRATEGIES. 5 2 - PLAINFIELD IMAGING & OUTPATIENT CENTER 15728 S ROUTE 59 PLAINFIELD IL 60544 IMAGING CENTER 3 - ADVENTIST BOLINGBROOK HOSPITAL 420 REMINGTON BLVD 135 BOLINGBROOK IL 60440 OUTPATIENT REHABILITATION FACILITY 4 - WOMEN'S IMAGING CENTER 396 REMINGTON BLVD 235 BOLINGBROOK IL 60440 IMAGING CENTER 5 - MATERNAL FETAL MEDICINE DEPT 396 REMINGTON BLVD 231 BOLINGBROOK IL 60440 MATERNAL FETAL MEDICINE 6 - ADVENTIST PLAINFIELD PHYSICAL THERAPY 15728 S ROUTE 59 PLAINFIELD IL 60544 OUTPATIENT REHABILITATION FACILITY PART I, LINE 3C: EVERY UNINSURED PERSON, REGARDLESS OF INCOME, RECEIVES AN AUTOMATIC 15% DISCOUNT OFF OF CHARGES. PERSONS WHO EARN LESS THAN 600% OF THE FEDERAL POVERTY GUIDELINES ARE GIVEN MORE SIGNIFICANT DISCOUNTS, DEPENDING ON THEIR INDIVIDUAL SITUATIONS.FEDERAL POVERTY LEVEL - 0-200% UNINSURED PATIENT DISCOUNT - 95%FEDERAL POVERTY LEVEL - 201-300% UNINSURED PATIENT DISCOUNT - 75%FEDERAL POVERTY LEVEL - 301-600% UNINSURED PATIENT DISCOUNT - 74%FEDERAL POVERTY LEVEL - > 600% UNINSURED PATIENT DISCOUNT - 74% PART I, LINE 6A: THE FILING ORGANIZATION WAS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) DURING ITS CURRENT TAX YEAR. DURING THE CURRENT YEAR, AHSSHC SERVED AS A PARENT ORGANIZATION TO 27 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS AND A NUMBER OF OTHER HEALTH CARE FACILITIES THAT OPERATED IN 10 STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS "ADVENTHEALTH".ALL HOSPITAL ORGANIZATIONS WITHIN ADVENTHEALTH COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. ADVENTHEALTH ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. ADVENTHEALTH HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. EACH ADVENTHEALTH HOSPITAL FACILITY REPORTS THEIR COMMUNITY BENEFITS TO THEIR BOARD OF DIRECTORS AND STRIVES TO COMMUNICATE THEIR COMMUNITY BENEFITS TO THEIR LOCAL COMMUNITIES. ADDITIONALLY, THE FILING ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY CAN BE ACCESSED ON THE FILING ORGANIZATION'S WEBSITE.THE FILING ORGANIZATION IS INCLUDED IN THE SUBMISSION OF THE ANNUAL NONPROFIT HOSPITAL COMMUNITY BENEFIT PLAN REPORT WITH THE ATTORNEY GENERAL'S OFFICE OF THE STATE OF ILLINOIS. THIS REPORT IS PREPARED ON A CONSOLIDATED BASIS AND INCLUDES DATA FOR ADVENTIST MIDWEST HEALTH, ADVENTIST GLENOAKS HOSPITAL, AND ADVENTIST BOLINGBROOK HOSPITAL. THESE HOSPITAL ORGANIZATIONS ARE ALL RELATED ORGANIZATIONS. PART I, LINE 7: THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. - CHARITY AT COST - A COST TO CHARGE METHODOLOGY BASED ON THE MOST RECENTLY FILED MEDICARE COST REPORT WAS USED TO CALCULATE COSTS. - UNREIMBURSED MEDICAID - COSTS ARE CALCULATED USING THE MOST RECENTLY FILED MEDICAID COST REPORT. - OTHER BENEFITS - COSTS ARE DETERMINED BY ACTIVITY REPORTED IN ACCORDANCE WITH GUIDELINES PUBLISHED BY THE CATHOLIC HEALTH ASSOCIATION. COSTS COULD INCLUDE THE VALUE OF HOURLY WAGES, COSTS OF MATERIALS, VALUE OF SPACE LOANED TO COMMUNITY GROUPS FOR MEETINGS, AND INDIRECT COSTS WHERE APPLICABLE. PART III, LINE 2: AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE FILING ORGANIZATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITHIN COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY AMITA HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE FILING ORGANIZATION'S POLICIES. PART III, LINE 3: THE FILING ORGANIZATION PROACTIVELY WORKS TO PRESUMPTIVELY ASSESS AND GRANT CHARITY TO ALL UNINSURED PATIENTS. THE HOSPITAL SCREENS ALL UNINSURED PATIENTS AGAINST CREDIT SCORE DATA IN ORDER TO PRESUMPTIVELY APPLY ITS FINANCIAL ASSISTANCE POLICY. BASED ON THIS PROCESS, APPROXIMATELY 96% OF THE UNINSURED PATIENT POPULATION IS DEFINED AS ELIGIBLE FOR A PARTIAL CHARITY ADJUSTMENT ON THEIR ACCOUNTS. THE AVERAGE DISCOUNT GIVEN TO THE UNINSURED PATIENT POPULATION IS 81%. IN PRIOR YEARS, PROACTIVE EFFORTS WERE LIMITED TO ONLY THOSE ACCOUNTS WITH BALANCES > $5,000. UNDER THAT SCENARIO, IT WAS ESTIMATED THAT 1/3 OF OUR BAD DEBT PLACEMENTS MAY HAVE BEEN ELIGIBLE FOR CHARITY CARE DISCOUNTS. WITH A MORE COMPREHENSIVE PRESUMPTIVE CHARITY PROGRAM, MANY MORE ACCOUNTS ARE GRANTED CHARITY EARLIER IN THE PROCESS AND PRIOR TO BAD DEBT PLACEMENT. THEREFORE, IT IS ESTIMATED THAT APPROXIMATELY 10% OF OUR CURRENT BAD DEBT PLACEMENTS WOULD BE ELIGIBLE FOR ADDITIONAL CHARITY IF A FULL PRESUMPTIVE CHARITY PROCESS WAS CONDUCTED ACROSS 100% OF OUR SELF-PAY AFTER INSURANCE ACCOUNTS.DISCOUNTS AND PAYMENTS ARE NOT INCLUDED IN BAD DEBT EXPENSE IN THE FINANCIAL STATEMENTS UNLESS THE PAYMENT IS A RECOVERY OF AMOUNTS PREVIOUSLY WRITTEN OFF AS BAD DEBT. RECOVERIES ARE CLASSIFIED AS A DECREASE TO BAD DEBT EXPENSE.RATIONALE FOR INCLUDING CERTAIN BAD DEBTS IN COMMUNITY BENEFIT:THE FILING ORGANIZATION IS DEDICATED TO THE VIEW THAT MEDICALLY NECESSARY HEALTH CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS SHOULD BE ACCESSIBLE TO ALL, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, CULTURAL BACKGROUND, PHYSICIAN MOBILITY, OR ABILITY TO PAY. THE FILING ORGANIZATION TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THE AVAILABILITY OF THIRD-PARTY COVERAGE. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE FILING ORGANIZATION IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. AS A 501(C)(3) HOSPITAL ORGANIZATION, THE FILING ORGANIZATION MAINTAINS A 24/7 EMERGENCY ROOM PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION CANNOT BE MADE BASED UPON INFORMATION SUPPLIED BY THE INDIVIDUAL. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGES 8-9. PLEASE NOTE THAT DOLLAR AMOUNTS ON THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE IN THOUSANDS. PART III, LINE 8: COSTING METHODOLOGY: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. PART III, LINE 9B: IT IS THE POLICY OF THE FILING ORGANIZATION TO OFFER PATIENTS A PAYMENT PLAN AND/OR CHARITY ASSISTANCE WHEN IT BECOMES KNOWN OR EVEN SUSPECTED THAT A PATIENT NEEDS FINANCIAL ASSISTANCE. SIGNS AND BROCHURES ARE POSTED IN FACILITY REGISTRATION AREAS. FINANCIAL COUNSELORS ARE NOTIFIED AND EVERY ATTEMPT IS MADE TO CONTACT AND WORK WITH THE PATIENT OR THEIR FAMILY TO HELP THEM COMPLETE A FINANCIAL ASSISTANCE APPLICATION WITH COMPASSION AND DIGNITY. FINANCIAL COUNSELORS WORK WITH PATIENTS TO HELP DETERMINE IF THERE ARE ANY THIRD-PARTY PAYORS WHICH MAY BE AVAILABLE TO HELP THE PATIENT MEET THEIR OBLIGATIONS. THE HOSPITAL WORKS WITH THE PATIENT TO DETERMINE IF THEY ARE ELIGIBLE FOR FEDERAL PROGRAMS INCLUDING MEDICAID, STATE FUNDED PROGRAMS INCLUDING CRIME VICTIMS, ALTERNATIVE INSURANCE INCLUDING COBRA, WORKER'S COMPENSATION AND OR OTHER SPECIALIZED GRANT PROGRAMS SUCH AS OUR MAMMOGRAPHY GRANT PROGRAM FOR LOW INCOME WOMEN. IN THE EVENT NO THIRD-PARTY PROGRAMS ARE IDENTIFIED, THE HOSPITAL THEN WORKS WITH THE PATIENT TO HELP THEM APPLY FOR FINANCIAL ASSISTANCE DISCOUNTS AND PAYMENT PLANS. IN ADDITION, ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING FINANCIAL ASSISTANCE. PART VI, LINE 2: THE HOSPITAL CONDUCTS COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) EVERY THREE YEARS. ITS 2019 CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2019, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S 2019 CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN FINAL REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY.SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY. PART VI, LINE 3: THE FINANCIAL ASSISTANCE POLICY (FAP), FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM), AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) OF THE FILING ORGANIZATION'S HOSPITAL FACILITY ARE TRANSPARENT AND AVAILABLE TO ALL INDIVIDUALS SERVED AT ANY POINT IN THE CARE CONTINUUM. THE FAP, FAA FORM, PLS, AND CONTACT INFORMATION FOR THE HOSPITAL FACILITY'S FINANCIAL COUNSELORS ARE PROMINENTLY AND CONSPICUOUSLY POSTED ON THE FILING ORGANIZATION'S HOSPITAL FACILITY'S WEBSITE. THE WEBSITE INDICATES THAT A COPY OF THE FAP, FAA FORM, AND PLS IS AVAILABLE AND HOW TO OBTAIN SUCH COPIES IN THE PRIMARY LANGUAGES OF ANY POPULATIONS WITH LIMITED PROFICIENCY IN ENGLISH THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY (REFERRED TO BELOW AS LEP DEFINED POPULATIONS). SIGNAGE IS DISPLAYED IN PUBLIC LOCATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, INCLUDING AT ALL POINTS OF ADMISSION AND REGISTRATION AND THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE HOSPITAL FACILITY'S WEBSITE ADDRESS WHERE THE FAP, FAA FORM, AND PLS CAN BE ACCESSED AND THE TELEPHONE NUMBER AND PHYSICAL LOCATION THAT INDIVIDUALS CAN CALL OR VISIT TO OBTAIN COPIES OF THE FAP, FAA FORM AND PLS OR TO OBTAIN MORE INFORMATION ABOUT THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS. PAPER COPIES OF THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. PAPER COPIES ARE MADE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGES OF ANY LEP DEFINED POPULATIONS. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A PAPER COPY OF THE HOSPITAL FACILITY'S PLS WILL BE OFFERED TO EVERY PATIENT AS A PART OF THE INTAKE OR DISCHARGE PROCESS. A CONSPICUOUS WRITTEN NOTICE IS INCLUDED ON ALL BILLING STATEMENTS SENT TO PATIENTS THAT NOTIFIES AND INFORMS RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, INCLUDING THE FOLLOWING: 1) THE TELEPHONE NUMBER OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND THE FAA FORM; AND 2) THE WEBSITE ADDRESS WHERE COPIES OF THE FAP, FAA FORM AND PLS MAY BE OBTAINED. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE. COPIES OF THE PLS ARE DISTRIBUTED TO MEMBERS OF THE COMMUNITY IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. PART VI, LINE 4: ADVENTIST BOLINGBROOK HOSPITAL (AHH) IS A 138-BED STATE-OF-THE-ART ACUTE CARE HOSPITAL SERVING THE RESIDENTS OF THE VILLAGE OF BOLINGBROOK, ILLINOIS AND SURROUNDING COMMUNITIES. BOLINGBROOK IS LOCATED IN WILL COUNTY, ILLINOIS. PRIOR TO THE BUILDING OF THE HOSPITAL, ADVENTIST MIDWEST HEALTH, AN AFFILIATE OF THE HOSPITAL, OPERATED A FREE-STANDING EMERGENCY CENTER IN THE VILLAGE OF BOLINGBROOK. THE HOSPITAL IS MEETING A DEMAND FOR ACUTE CARE INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES IN THE COMMUNITY IT SERVES. THE HOSPITAL OFFERS THE LATEST TECHNOLOGICAL ADVANCES AND WAS DESIGNED TO OFFER ALL FAMILY-FRIENDLY PRIVATE PATIENT ROOMS. SERVICES OFFERED AT THE HOSPITAL INCLUDE CARDIAC CARE, IMAGING SERVICES, A WOMEN'S CARE CENTER, INCLUDING A MATERNAL FETAL CENTER, SURGICAL SERVICES AND INTERVENTIONAL RADIOLOGY. THE HOSPITAL OPENED A NEW WOUND CARE CENTER IN 2013 AND HAS ALSO ESTABLISHED AN AGREEMENT WITH VNA HEALTH CARE TO OFFER A FEDERALLY QUALIFIED HEALTH CENTER ON THE HOSPITAL CAMPUS TO PROVIDE CARE FOR THE UNINSURED AND UNDERINSURED.THE ADVENTIST BOLINGBROOK HOSPITAL COMMUNITY CONSISTS PRIMARILY OF BOLINGBROOK AND THE SURROUNDING AREA. WE DEFINE THE PRIMARY SERVICE AREA (PSA) AS THE COLLECTION OF ZIP CODES WHERE APPROXIMATELY 75% OF HOSPITAL PATIENTS RESIDE, AND WE FOCUS OUR COMMUNITY HEALTH IMPROVEMENT ON THIS SERVICE AREA. THE LARGEST PRIMARY SERVICE AREA RESIDES IN WILL COUNTY. A SMALL PART OF THE NORTHERN/NORTHEASTERN SERVICE AREA IS IN DUPAGE COUNTY. ZIP CODES FOR THE SERVICE AREA INCLUDED: 60517, 60440, 60439, 60490, 60446, 60544, 60403, 60435, AND 60441. ACCORDING TO US CENSUS DATA (2018) THE POPULATION OF THIS SERVICE AREA IS 300,313. THE AVERAGE AGE IS 37.9 YEARS WITH AN AVERAGE FAMILY INCOME OF $78,826. THE AGE SPREAD OF THE PRIMARY SERVICE AREA IS SIMILAR TO WILL COUNTY, DUPAGE COUNTY AND ILLINOIS. EIGHT PERCENT OF THOSE THAT RESIDE IN THIS SERVICE AREA ARE LIVING IN POVERTY. THE PRIMARY SERVICE AREA OF ADVENTIST BOLINGBROOK HOSPITAL HAS A SLIGHTLY HIGHER HISPANIC/LATINO POPULATION AND NON-HISPANIC BLACK POPULATION THAN WILL COUNTY AND DUPAGE COUNTY. DURING 2019, THE HOSPITAL'S PATIENT PERCENTAGE POPULATION WAS MADE UP OF THE BELOW PAYORS WITH THE REMAINING PERCENTAGE OF THE PATIENTS BEING COVERED UNDER COMMERCIAL INSURANCE. APPROXIMATELY 35.6% OF THE HOSPITAL'S PATIENTS WERE MEDICARE PATIENTS, ABOUT 18.5% WERE MEDICAID PATIENTS, ABOUT 5.4% WERE SELF-PAY PATIENTS. IN 2019, ABOUT 74.3% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO ADVENTIST BOLINGBROOK HOSPITAL'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT AND COMMUNITY BUILDING INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, THE HOSPITAL PROVIDED $541,107 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 $1,708,177 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. PART VI, LINE 6: ADVENTIST BOLINGBROOK HOSPITAL IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTHEALTH. AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 47 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 12 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. THE FILING ORGANIZATION IS ALSO A COVERED AFFILIATE OF A JOINT OPERATING COMPANY THAT DOES BUSINESS UNDER THE NAME OF AMITA HEALTH. AMITA HEALTH HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT ORGANIZATION UNDER IRC SECTION 501(C)(3). AMITA HEALTH PROVIDES VARIOUS MANAGEMENT AND EXECUTIVE SUPPORT SERVICES TO THE FILING ORGANIZATION. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AMITA HEALTH AND BY ADVENTHEALTH PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING THE HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION AS A COVERED AFFILIATE OF AMITA HEALTH AND AS PART OF A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITALS AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY THE FILING ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY BY ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF ADVENTHEALTH OR OF AMITA HEALTH AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEB-SITE OF ADVENTHEALTH AT WWW.ADVENTHEALTH.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF ADVENTHEALTH AND TO ACCESS WWW.AMITAHEALTH.ORG TO LEARN MORE ABOUT THE VISION AND SERVICES PROVIDED BY ALL ITS LOCATIONS. PART VI, LINE 7, REPORTS FILED WITH STATES IL 1 BOLINGBROOK HOSPITAL FOUNDATION 500 REMINGTON BLVD BOLINGBROOK IL 60440 900494445 501(C)(3) 27207 COST GENERAL ADMINSTRATIVE SUPPORT PROVISION OF GENERAL ADMINISTRATIVE SUPPORT UNITED WAY OF WILL COUNTY 54 N OTTAWA STREET 300 JOLIET IL 60432 362515625 501(C)(3) 10000 GENERAL SUPPORT MIDWEST HEALTH FOUNDATION 120 N OAK STREET HINSDALE IL 60521 352230515 501(C)(3) 37713 COST GENERAL ADMINSTRATIVE SUPPORT PROVISION OF GENERAL ADMINISTRATIVE SUPPORT BOLINGBROOK SEVENTH-DAY ADVENTIST CHURCH 301 E BOUGHTON ROAD BOLINGBROOK IL 60440 362277365 501(C)(3) 20000 GENERAL SUPPORT 4 0 PART I, LINE 2: GRANTS ARE GENERALLY MADE ONLY TO RELATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3), OR TO OTHER LOCAL CHARITABLE COMMUNITY ORGANIZATIONS, OR TO OTHER 501(C)(3) ORGANIZATIONS THAT ARE A PART OF THE GROUP EXEMPTION RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES. X X X 1 1 0 1 0 0 0 0 0 0 0 HAFFNER PHD RANDALL DIR/CHAIRMAN 0 1264609 0 491378 0 984762 0 258314 0 42765 0 3041828 0 244687 SNYDER BRENT G DIRECTOR 0 765142 0 259990 0 287981 0 142659 0 24209 0 1479981 0 118519 THORDARSON THOR DIR/PRES/SEC/EVP & COO 0 620170 0 311794 0 137496 0 15087 0 24967 0 1109514 0 73337 BUCHANAN HERBERT DIR (BEG 1/19) REG OPERATIONS OFFICE 47608 428469 2240 20160 12934 116405 0 0 1105 9945 63887 574979 0 0 CARROLL RICHARD VP/CMO BOLINGBROOK/GLENOAK 0 384361 0 0 0 102069 0 15087 0 18204 0 519721 0 23307 CHRISTIAN BRUCE PRES/CEO BOLINGBROOK/GLENO 0 394247 0 55930 0 32853 0 14202 0 18353 0 515585 0 0 MURRILL MICHAEL FORMER COO 0 362445 0 41525 0 31919 0 14230 0 27882 0 478001 0 0 YANG MD ERIC DIRECTOR (END 12/19) 0 240000 0 0 0 197486 0 15087 0 667 0 453240 0 0 ROEHR RICHARD FORMER COO 0 313501 0 0 0 16424 0 15087 0 29891 0 374903 0 0 MURPHY MARY FORMER REGIONAL CNO 0 306745 0 0 0 26705 0 15087 0 10697 0 359234 0 12629 RADIVOJEVIC VLADIMIR VP/COO BOLINGBROOK/GLENOAK & INTERIM 0 249606 0 10000 0 12524 0 14477 0 29381 0 315988 0 0 CRUZ RN OBED VP/CNO BOLINGBROOK 0 215567 0 10000 0 11084 0 12226 0 26274 0 275151 0 0 MATHIS REBECCA FORMER CFO 0 128917 0 1586 0 68877 0 6555 0 13474 0 219409 0 51928 LEONARD DIANE DIR-NURSING II 156053 0 0 0 4943 0 8242 0 26226 0 195464 0 0 0 DE RAMOS DO DAVID DIRECTOR (BEG 1/19) 0 117545 0 0 0 49528 0 8456 0 17381 0 192910 0 0 BROWN JARED CFO (BEG 8/19) 0 152702 0 0 0 105 0 7616 0 15947 0 176370 0 0 SEBASTIAN BEENA PHARMACIST I 123743 0 0 0 2409 0 6109 0 25086 0 157347 0 0 0 MICHALOWICZ CATHERINE LEAD-NURSING SUPPORT 93079 0 0 0 52157 0 6858 0 279 0 152373 0 0 0 SPACCAPANICCIA CASSANDRA MGR-PHARMACY 119423 0 0 0 9739 0 6234 0 16950 0 152346 0 0 0 PONTERIO JODI MGR-PHARMACY 143723 0 0 0 101 0 6055 0 409 0 150288 0 0 0 PART I, LINE 1A MEMBERS OF THE FILING ORGANIZATION'S EXECUTIVE MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF THE FILING ORGANIZATION'S PARENT. THE FILING ORGANIZATION AND ITS 501(C)(3) PARENT ARE A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTHEALTH (AH). THE TOP-TIER PARENT OF ADVENTHEALTH IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AS PART OF AH, THE FILING ORGANIZATION ADHERES TO CERTAIN AHSSHC POLICIES REGARDING ITS EXECUTIVES. TRAVEL FOR COMPANIONS: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING EXECUTIVE TO HAVE HIS OR HER SPOUSE ACCOMPANY THE EXECUTIVE ON CERTAIN BUSINESS TRIPS EACH YEAR. TYPICALLY, REIMBURSEMENT IS ONLY PROVIDED TO CERTAIN EXECUTIVE LEADERS AND IS USUALLY LIMITED TO ONE BUSINESS TRIP PER YEAR BEYOND THE ANNUAL ADVENTHEALTH PRESIDENT'S COUNCIL BUSINESS MEETING AND OTHER MEETINGS WHERE THE SPOUSE IS SPECIFICALLY INVITED. THE AHSSHC CORPORATE EXECUTIVE SPOUSAL TRAVEL POLICY WAS ORIGINALLY APPROVED AND REVIEWED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. ALL SPOUSAL TRAVEL COSTS REIMBURSED TO THE EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: ADVENTHEALTH HAS A SYSTEM-WIDE POLICY ADDRESSING GROSS-UP PAYMENTS PROVIDED IN CONNECTION WITH EMPLOYER-PROVIDED BENEFITS/OTHER TAXABLE ITEMS. UNDER THE POLICY, CERTAIN TAXABLE BUSINESS-RELATED REIMBURSEMENTS (I.E. TAXABLE BUSINESS-RELATED MOVING EXPENSES, TAXABLE ITEMS PROVIDED IN CONNECTION WITH EMPLOYMENT) PROVIDED TO ANY EMPLOYEE MAY BE GROSSED-UP AT A 25% RATE UPON APPROVAL BY THE FILING ORGANIZATION'S CEO AND CFO. ADDITIONALLY, EMPLOYEES AT THE DIRECTOR LEVEL AND ABOVE ARE ELIGIBLE FOR GROSS-UP PAYMENTS ON GIFTS RECEIVED FOR BOARD OF DIRECTOR SERVICES. DISCRETIONARY SPENDING ACCOUNT: NOMINAL DISCRETIONARY SPENDING AMOUNTS ARE PERIODICALLY PROVIDED TO ELIGIBLE EXECUTIVES WHO ATTEND ANNUAL BUSINESS MEETINGS SUCH AS THE ADVENTHEALTH CFO CONFERENCE OR THE CMO/CNO BUSINESS MEETING ($300 OR LESS PER EXECUTIVE). PAYMENTS PROVIDED TO EACH EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. PART I, LINE 3 THE FILING ORGANIZATION IS A COVERED AFFILIATE OF THE JOINT OPERATING COMPANY, ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO. D/B/A AMITA HEALTH (AMITA). AMITA UTILIZES VARIOUS COMPARABILITY DATA IN ESTABLISHING COMPENSATION FOR THOSE EXECUTIVES THAT PERFORM SERVICES FOR AMITA AND FOR ONE OR MORE COVERED AFFILIATES. COMPARABILITY DATA UTILIZED INCLUDES COMPENSATION SURVEYS AND STUDIES AND THE FORMS 990 OF OTHER UNRELATED COMPARABLE ORGANIZATIONS. AMITA ALSO HAS A COMPENSATION COMMITTEE THAT APPROVES ALL RELEVANT EXECUTIVE COMPENSATION. THE COMPENSATION OF THE FILING ORGANIZATION'S CEO WAS DETERMINED AND APPROVED BY AMITA'S EXECUTIVE COMPENSATION COMMITTEE. PART I, LINE 4B CERTAIN INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A RECEIVED COMPENSATION IN 2019 FROM ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF A HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. BEGINNING IN 2018, CERTAIN EXECUTIVE EMPLOYEES WHO WERE PREVIOUSLY ON THE PAYROLL OF AHSSHC WERE TRANSFERRED TO THE PAYROLL OF THE FILING ORGANIZATION'S PARENT. CERTAIN EXECUTIVES WHO WERE PARTICIPANTS IN AHSSHC'S NON-QUALIFIED DEFERRED COMPENSATION PLAN RECEIVED TAXABLE AMOUNTS FROM THE PLAN IN 2019. A DESCRIPTION OF THE PLAN FOLLOWS. IN RECOGNITION OF THE CONTRIBUTION THAT EACH EXECUTIVE MAKES TO THE SUCCESS OF ADVENTHEALTH, ADVENTHEALTH PROVIDES TO ELIGIBLE EXECUTIVES PARTICIPATION IN THE ADVENTHEALTH EXECUTIVE FLEX BENEFIT PROGRAM (THE PLAN). THE PURPOSE OF THE PLAN IS TO OFFER ELIGIBLE EXECUTIVES AN OPPORTUNITY TO ELECT FROM AMONG A VARIETY OF SUPPLEMENTAL BENEFITS, INCLUDING A SPLIT DOLLAR LIFE INSURANCE POLICY AND LONG-TERM CARE INSURANCE, TO INDIVIDUALLY TAILOR A BENEFITS PROGRAM APPROPRIATE TO EACH EXECUTIVE'S NEEDS. THE PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH IS DEDUCTED THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS. THE PRE-DETERMINED BENEFITS ALLOWANCE CREDIT PERCENTAGE IS APPROVED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF AHSSHC. ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED FROM THE ANNUAL PRE-DETERMINED BENEFITS ALLOWANCE ARE CONTRIBUTED, AT THE EMPLOYEE'S OPTION, TO EITHER AN IRC 457(F) DEFERRED COMPENSATION ACCOUNT OR TO AN IRC 457(B) ELIGIBLE DEFERRED COMPENSATION PLAN. UPON ATTAINMENT OF AGE 65, ALL PREVIOUS 457(F) DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT AND ANY FUTURE EMPLOYER CONTRIBUTIONS ARE MADE QUARTERLY FROM THE PLAN DIRECTLY TO THE PARTICIPANT. THE PLAN DOCUMENTS DEFINE AN EMPLOYEE WHO IS ELIGIBLE TO PARTICIPATE IN THE PLAN TO GENERALLY INCLUDE THE CHIEF EXECUTIVE OFFICERS OF ADVENTHEALTH ENTITIES AND VICE PRESIDENTS OF ALL ADVENTHEALTH ENTITIES WHOSE BASE SALARY IS AT LEAST $260,000. THE PLAN PROVIDES FOR A CLASS YEAR VESTING SCHEDULE (2 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT. DISTRIBUTIONS COULD ALSO BE MADE FROM THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT UPON ATTAINMENT OF AGE 65 OR UPON AN INVOLUNTARY SEPARATION. THE ACCOUNT IS FORFEITED BY THE EXECUTIVE UPON A VOLUNTARY SEPARATION. IN ADDITION TO THE PLAN, ADVENTHEALTH HAS INSTITUTED A DEFINED BENEFIT, NON-TAX-QUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN EXECUTIVES WHO HAVE PROVIDED LENGTHY SERVICE TO ADVENTHEALTH AND/OR TO OTHER SEVENTH-DAY ADVENTIST CHURCH HOSPITALS OR HEALTH CARE INSTITUTIONS. PARTICIPATION IN THE PLAN IS OFFERED TO ADVENTHEALTH EXECUTIVES ON A PRO-RATA SCHEDULE BEGINNING WITH 20 YEARS OF SERVICE AS AN EMPLOYEE OF ADVENTHEALTH AND/OR ANOTHER HOSPITAL OR HEALTH CARE INSTITUTION CONTROLLED BY THE SEVENTH-DAY ADVENTIST CHURCH AND WHO SATISFY CERTAIN OTHER QUALIFYING CRITERIA. THIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WAS DESIGNED TO PROVIDE ELIGIBLE EXECUTIVES WITH THE ECONOMIC EQUIVALENT OF AN ANNUAL INCOME BEGINNING AT NORMAL RETIREMENT AGE EQUAL TO 60% OF THE AVERAGE OF THE PARTICIPANT'S THREE, FIVE OR SEVEN HIGHEST YEARS OF BASE SALARY FROM ADVENTHEALTH ACTIVE EMPLOYMENT INCLUSIVE OF INCOME FROM ALL OTHER SEVENTH-DAY ADVENTIST CHURCH HEALTHCARE EMPLOYER-FINANCED RETIREMENT INCOME SOURCES AND INVESTMENT INCOME EARNED ON THOSE CONTRIBUTIONS THROUGH SOCIAL SECURITY NORMAL RETIREMENT AGE AS DEFINED IN THE PLAN. THE NUMBER OF YEARS INCLUDED IN HIGHEST AVERAGE COMPENSATION IS DETERMINED BY THE INDIVIDUAL'S YEAR OF ENTRY TO THE SERP AND BY THE INDIVIDUAL'S YEAR OF ENTRY TO THE ADVENTHEALTH EXECUTIVE FLEX BENEFIT PROGRAM. ADDITIONALLY, ADVENTHEALTH HAS ADOPTED A SENIOR EXECUTIVE DEATH BENEFIT (SEDB) PLAN IN RECOGNITION OF THE CONSIDERABLE AGE AND SERVICE REQUIREMENTS IN THE SERP. THE SEDB PLAN PROVIDES A BENEFIT IN AN AMOUNT EQUAL TO THE AMOUNT THE EXECUTIVE'S BENEFIT WOULD HAVE BEEN UNDER THE SERP PLAN ASSUMING THAT, ON THE DATE OF THE EXECUTIVE'S DEATH (AND NOT BEFORE), THE EXECUTIVE SATISFIED THE LAST OF THE ELIGIBILITY REQUIREMENTS OF THE SERP PLAN WITH PRESENT VALUE RECOGNIZING AN EARLY BENEFIT COMMENCEMENT. AN ELIGIBLE EXECUTIVE BECOMES A PARTICIPANT IN THE SEDB PLAN IF THE EXECUTIVE DIES PRIOR TO TERMINATION OF EMPLOYMENT, PROVIDED THE EXECUTIVE HAS NOT SATISFIED ALL OF THE ELIGIBILITY REQUIREMENTS OF SERP AS OF THE EXECUTIVE'S DATE OF DEATH BUT WOULD HAVE SATISFIED ALL OF THOSE REQUIREMENTS WITHIN FIVE (5) YEARS FOLLOWING DEATH HAD THE EXECUTIVE LIVED AND CONTINUED EMPLOYMENT. THE SEDB PLAN WAS REVIEWED AND APPROVED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. FLEX PLAN FLEX PLAN/ SERP 457(B) CY CY EMPLOYER CY CONTRIB./ DISTRIBUTIONS* CONTRIB. DISTRIBUTIONS* PAYMENT ------------------------------------------------------- RICHARD CARROLL, MD $ 0 $ 23,307 $ 0 $ 0 RANDALL HAFFNER, PHD $262,228 $ 238,856 $ 657,546 $ 0 MARY MURPHY $ 0 $ 12,621 $ 0 $ 0 BRENT G. SNYDER $146,573 $120,434 $ 83,943 $ 0 THOR THORDARSON $ 0 $ 76,025 $ 0 $ 0 REBECCA MATHIS $ 0 $ 0 $ 0 $51,928 *INCLUDING INVESTMENT EARNINGS DEBORAH SCHIMEROSWKI, CFO WAS COMPENSATED BY PRESENCE CARE TRANSFORMATION CORPORATION IN 2019 AND HERBERT BUCHANAN WAS COMPENSATED BY ALEXIAN BROTHERS HEALTH SYSTEM IN 2019 FOR SERVICES PROVIDED TO THE FILING ORGANIZATION. PRESENCE CARE TRANSFORMATION CORPORATION AND ALEXIAN BROTHERS HEALTH SYSTEM ARE AFFILIATED WITH THE FILING ORGANIZATION. PLEASE SEE OUR RESPONSE TO FORM 990, PART VI, SECTION A, LINE 7B FOR A DISCUSSION CONCERNING THE FILING ORGANIZATION'S AFFILIATION WITH ALEXIAN BROTHERS HEALTH SYSTEM THROUGH THE JOINT OPERATING COMPANY KNOWN AS AMITA HEALTH. COMPENSATION FOR THESE INDIVIDUAL'S SERVICES PROVIDED TO THE FILING ORGANIZATION IS DISCLOSED IN PART VII, LINE 1A, AND SCHEDULE J, PART II. PART V, LINE 1A: THE PARENT CORPORATION OF ADVENTIST BOLINGBROOK HOSPITAL (THE FILING ORGANIZATION) IS ADVENTIST MIDWEST HEALTH (AMH). AMH IS AN ILLINOIS, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). AMH HAS ESTABLISHED A SHARED SERVICE CENTER TO CENTRALIZE THE ACCOUNTS PAYABLE (A/P) FUNCTION FOR ALL AMH SUBSIDIARY ORGANIZATIONS. THE FILING ORGANIZATION HAS ENTERED "0" IN PART V, LINE 1A BECAUSE THE FILING ORGANIZATION NO LONGER ISSUES FORM 1099 RETURNS, RATHER, ALL SUCH RETURNS ARE FILED BY AND UNDER THE NAME AND EIN OF AMH AS THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. THE FACTS AND CIRCUMSTANCES SUPPORT A POSITION THAT AMH, AS A PAYOR ON BEHALF OF ITS SUBSIDIARY ORGANIZATIONS IN A SHARED SERVICE ENVIRONMENT, WILL HAVE SUFFICIENT MANAGEMENT AND OVERSIGHT IN CONNECTION WITH THE SUBSIDIARY ORGANIZATIONS' PAYMENTS TO MEET THE STANDARD SET FORTH IN TREAS. REG. SECTION 1.6041-1(E). AMH WILL NOT MERELY BE MAKING PAYMENTS AT THE DIRECTION OF ITS SUBSIDIARY ORGANIZATIONS. ACCORDINGLY, AMH IS CONSIDERED THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. FORM 990, PART VI, SECTION A, LINE 6 ADVENTIST BOLINGBROOK HOSPITAL (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS ADVENTIST MIDWEST HEALTH. ADVENTIST MIDWEST HEALTH (AMH) IS AN ILLINOIS, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE BOARD OF DIRECTORS (GOVERNING BOARD) OF THE FILING ORGANIZATION ARE APPOINTED BY THE CORPORATE MEMBER, AMH. THE CORPORATE MEMBER IS ENTITLED TO ELECT NOT LESS THAN EIGHTEEN (18) AND NO MORE THAN TWENTY THREE (23) VOTING MEMBERS TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION PURSUANT TO THE PROVISIONS OF THE BYLAWS, SUBJECT TO THE RATIFICATION OF THE AMITA HEALTH BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FILING ORGANIZATION IS A COVERED AFFILIATE OF THE JOC KNOWN AS AMITA HEALTH. THE SOLE MEMBER OF THE FILING ORGANIZATION IS AMH. AMH IS ALSO ONE OF TWO MEMBERS IN AMITA HEALTH. THE OTHER MEMBER OF AMITA HEALTH IS ALEXIAN BROTHERS HEALTH SYSTEM. THE TOP-TIER PARENT OF AMH IS AHSSHC (SPONSOR). THE GOVERNING DOCUMENTS OF THE FILING ORGANIZATION PROVIDE FOR CERTAIN RESERVED POWERS TO EXERCISE FINANCIAL, MANAGERIAL, AND OPERATIONAL AUTHORITIES OVER THE FILING ORGANIZATION BY AHSSHC, AS SPONSOR, BY AMH AS MEMBER, BY BOTH MEMBERS OF THE JOC, NAMELY, AMH AND ALEXIAN BROTHERS HEALTH SYSTEM (MEMBERS), AND BY THE BOARD OF DIRECTORS OF THE JOC. CERTAIN GOVERNANCE POWERS ARE RESERVED TO AMH AS THE MEMBER OF THE FILING ORGANIZATION. THESE RESERVED POWERS INCLUDE THE ALTERATION, RESTATEMENT OR REPEAL OF THE ARTICLES OF INCORPORATION, BYLAWS OR MISSION STATEMENT OF THE FILING ORGANIZATION, PROVIDED THAT SUCH ACTIONS ARE NOT INCONSISTENT WITH THE JOC BYLAWS OR THE AFFILIATION AGREEMENT AND THE APPOINTMENT OF THE FILING ORGANIZATION'S BOARD OF DIRECTORS, SUBJECT TO THE RATIFICATION OF THE JOC BOARD OF DIRECTORS. FINANCIAL AUTHORITIES RESERVED TO THE SPONSOR, THE BOARD OF DIRECTORS OF THE JOC, AND BY BOTH MEMBERS OF THE JOC INCLUDE THE APPROVAL OF ANY DISPOSITION OF THE FILING ORGANIZATION'S ASSETS AND ANY INTERNAL TRANSFER OF THE FILING ORGANIZATION'S ASSETS. THE SPONSOR, THE BOARD OF DIRECTORS OF THE JOC, AND BOTH MEMBERS OF THE JOC MAY APPROVE SUCH DISPOSITIONS OR TRANSFERS UP TO ESTABLISHED ASSET DOLLAR VALUES AS SET FORTH IN THE BYLAWS OF THE FILING ORGANIZATION. ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION MUST BE RATIFIED BY BOTH SPONSORS OF THE JOC. THE BOARD OF DIRECTORS OF THE JOC MUST APPROVE ANY CAPITAL EXPENDITURE TO BE MADE BY THE FILING ORGANIZATION IN EXCESS OF $10 MILLION. OPERATIONAL AUTHORITIES RESERVED TO THE BOARD OF DIRECTORS OF THE JOC INCLUDE THE DETERMINATION OF THE SERVICES TO BE PROVIDED BY THE FILING ORGANIZATION, INCLUDING THE AUTHORITY TO DIRECT THE EXPANSION, REDUCTION AND CONSOLIDATION OF CLINICAL PROGRAMS, PATIENT CARE SERVICES AND ADMINISTRATIVE CAPABILITIES OR OTHER MAJOR CHANGES IN THE OPERATION OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, CEO AND BY THE CFO PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, CEO AND THE CFO DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR ANY PRINCIPAL OFFICER OF THE FILING ORGANIZATION (I.E. INTERESTED PERSONS) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES ARE NOT COMPENSATED BY THE FILING ORGANIZATION. THE COMPENSATION PACKAGE FOR THESE INDIVIDUALS IS DETERMINED BY THE JOINT OPERATING COMPANY, ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO. DBA AMITA HEALTH. AS NOTED IN OUR RESPONSE TO PART VI, SECTION A, LINE 7B, THE FILING ORGANIZATION IS A COVERED AFFILIATE OF THE JOC KNOWN AS AMITA HEALTH. THE COMPENSATION OF THE CEO, CFO, COO, CMO AND CNO ARE ESTABLISHED AND APPROVED BY AMITA HEALTH. PLEASE SEE THE DISCUSSION CONCERNING THE PROCESS FOLLOWED BY AMITA HEALTH IN DETERMINING EXECUTIVE COMPENSATION IN OUR RESPONSE TO SCHEDULE J, LINE 3. FORM 990, PART VI, SECTION C, LINE 19 THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTHEALTH. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF ADVENTHEALTH AND OF THE ADVENTHEALTH "OBLIGATED GROUP" ARE FILED ANNUALLY WITH THE MUNICIPAL SECURITIES RULEMAKING BOARD (MSRB). THE "OBLIGATED GROUP" IS A GROUP OF AHSSHC SUBSIDIARIES THAT ARE JOINTLY AND SEVERALLY LIABLE UNDER A MASTER TRUST INDENTURE THAT SECURES DEBT PRIMARILY ISSUED ON A TAX-EXEMPT BASIS. UNAUDITED QUARTERLY FINANCIAL STATEMENTS PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) ARE ALSO FILED WITH MSRB FOR ADVENTHEALTH ON A CONSOLIDATED BASIS AND FOR THE GROUPING OF ADVENTHEALTH SUBSIDIARIES COMPRISING THE "OBLIGATED GROUP". THE FILING ORGANIZATION DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. PART VII, SECTION A FOR THOSE BOARD OF DIRECTOR MEMBERS (NOT INCLUDING PHYSICIAN MEMBERS OF THE BOARD), OFFICER(S) AND KEY EMPLOYEES WHO DEVOTE LESS THAN FULL-TIME TO THE FILING ORGANIZATION (BASED UPON THE AVERAGE NUMBER OF HOURS PER WEEK SHOWN IN COLUMN (B) ON PAGE 7 OF THE RETURN) THE COMPENSATION AMOUNTS SHOWN IN COLUMNS (E) AND (F) ON PAGE 7 WERE PROVIDED IN CONJUNCTION WITH THAT PERSON'S RESPONSIBILITIES AND ROLES IN SERVING IN AN EXECUTIVE LEADERSHIP POSITION WITHIN ADVENTHEALTH OR AMITA HEALTH. PHYSICIAN MEMBERS OF THE BOARD OF DIRECTORS RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS AS A RESULT OF PROVIDING VARIOUS MEDICAL SERVICES TO THOSE RELATED ENTITIES. PART VIII, LINES 7A, B AND C: THE AMOUNTS SHOWN IN PART VIII, LINES 7A(I) AND 7C(I) OF THE FORM 990 REPRESENTS AN ALLOCATED SHARE OF CAPITAL GAIN/(LOSS) FROM A SYSTEM WIDE, CORPORATE ADMINISTERED, INVESTMENT PROGRAM. FORM 990, PART IX, LINE 11G PAYMENTS TO HEALTHCARE PROFESSIONAL: PROGRAM SERVICE EXPENSES 6,235,894. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,235,894. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 414,393. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 414,393. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 6,215,723. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,215,723. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 2,567,524. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,567,524. RECRUITING: PROGRAM SERVICE EXPENSES -4,774. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -4,774. FOOD SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 2,578,941. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,578,941. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,392,712. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,392,712. ADVENTHEALTH MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 573,722. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 573,722. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 10,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,000. REGION SUPPORT SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 15,833,291. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,833,291. FORM 990, PART XI, LINE 9: TRANSFER TO TOP-TIER TAX-EXEMPT PARENT -2,084,160. ALLOCATIONS TO TAX-EXEMPT PARENT WITH RESPECT TO DEBT -187,787. NET CHANGE IN INTEREST IN FOUNDATION 57,410. ASC 842 LEASE ACCOUNTING ADJUSTMENTS 5,045. ROUNDING 1. ADVENTHEALTH FAMILY MEDICINE RURAL HEALTH CLINICS INC FKA HOSPICE OF THE C 187 PR 4060 LAMPASAS TX 76550 271858033 OPERATION OF RURAL HEALTH CLINICS & MEDICAL SERVICES FL 501(C)(3) LINE 3 METROPLEX ADVENTIST HOSPITAL INC 1 ADVENTHEALTH FOUNDATION SHAWNEE MISSION 9100 W 74TH STREET SHAWNEE MISSION KS 66204 480868859 FUND-RAISING FOR TAX-EXEMPT HOSPITAL KS 501(C)(3) LINE 7 SHAWNEE MISSION MEDICAL CENTER INC 1 ADVENTHEALTH HOME CARE EAST FLORIDA LLC (218-123119) 770 WEST GRANADA BLVD 319 ORMOND BEACH FL 32174 833768458 INACTIVE FL 501(C)(3) LINE 12A, I MEMORIAL HLTH SYSTEMS INC 1 ADVENTHEALTH HOSPICE CARE EAST FLORIDA INC (218-123119) 770 WEST GRANADA BLVD 304 ORMOND BEACH FL 32174 833748461 INACTIVE FL 501(C)(3) LINE 12A, I MEMORIAL HLTH SYSTEMS INC 1 ADVENTHEALTH NORTH POLK INC FKA UNIVERSITY COMMUNITY HOSPITAL SPECIALTY CA 3100 E FLETCHER AVE TAMPA FL 33613 593231322 INACTIVE FL 501(C)(3) LINE 12A, I UNIVERSITY COMMUNITY HOSPITAL INC 1 ADVENTHEALTH OSCEOLA SOUTH INC (416-123119) 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 841817046 INACTIVE FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 ADVENTHEALTH POLK NORTH INC (418-123119) 40100 US HIGHWAY 27 N DAVENPORT FL 33837 841793121 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 ADVENTHEALTH POLK SOUTH INC (415-123119) 410 SOUTH 11TH STREET LAKE WALES FL 33853 834672945 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 ADVENTHEALTH RANSOM MEMORIAL INC 1301 S MAIN STREET OTTAWA KS 66067 830976641 OPERATION OF HOSPITAL & RELATED SERVICES KS 501(C)(3) LINE 3 ADVENTIST HLTH MID-AMERICA INC 1 ADVENTHEALTH UNIVERSITY INC 671 LAKE WINYAH DRIVE ORLANDO FL 32803 593069793 EDUCATION/OPERATION OF SCHOOL FL 501(C)(3) LINE 2 ADVENTIST HLTH SYSTEMSUNBELT INC 1 ADVENTHEALTH WEST FL AMBULATORY SVCS INC FKA WEST FL HLTH INC 14055 RIVEREDGE DRIVE TAMPA FL 33637 471881744 INACTIVE FL 501(C)(3) LINE 10 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 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 1 ADVENTIST BOLINGBROOK HOSPITAL 500 REMINGTON BLVD BOLINGBROOK IL 60440 651219504 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST MIDWEST HEALTH 1 ADVENTIST CARE CENTERS - COURTLAND INC 730 COURTLAND STREET ORLANDO FL 32804 205774723 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC 1 ADVENTIST GLENOAKS HOSPITAL 701 WINTHROP AVENUE GLENDALE HEIGHTS IL 60139 363208390 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST MIDWEST HEALTH 1 ADVENTIST HLTH MID-AMERICA INC 9100 W 74TH STREET SHAWNEE MISSION KS 66204 521347407 SUPPORT OF AFFILIATED HOSPITAL KS 501(C)(3) LINE 12C, III-FI ADVENTIST HLTH SYSTEMSUNBELT INC 1 ADVENTIST HLTH PARTNERS INC 2601 NAVISTAR 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