2019-11-14T20:44:29-06:00 2018-12-31 990 2018-01-01 593149293 SOUTHWEST VOLUSIA HEALTHCARE CORPORATION SOUT 3869175000 1055 SAXON BOULEVARD ORANGE CITY FL 32763 LYNN C ADDISCOTT ASSISTANT SECRETARY 4073572317 2019-11-08 204.139.85.141 2019-11-08 08:32:46 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 6F248CD6EFF84B1BE2234CC43AB797AE6C4F0CE1 2018 2020-03-31 21:24:44Z ADVENTHEALTH FISH MEMORIAL ROBERT DEININGER 1055 SAXON BOULEVARD ORANGE CITY FL 32763 169788947 0 X WWW.ADVENTHEALTH.COM/HOSPITAL/ X 1992 FL THE PROVISION OF MEDICAL CARE TO THE COMMUNITY SERVED THROUGH THE OPERATION OF A 179 BED HOSPITAL. 15 8 1252 97 83330 0 0 50000 159529619 166692733 4758949 1935217 38432 0 164327000 168677950 99689 84948 0 0 62393513 63391816 0 0 0 81575596 88765743 144068798 152242507 20258202 16435443 196271257 205894748 67915470 69304272 128355787 136590476 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 140621795 84948 166609403 THE ORGANIZATION'S EXEMPT PURPOSE INCLUDES THE PROVISION OF MEDICAL CARE TO THE SURROUNDING COMMUNITY THROUGH THE OPERATION OF A 179-BED INPATIENT FACILITY & A RELATED OUTPATIENT FACILITY PROVIDING AMBULATORY SURGERY, DIAGNOSTIC RADIOLOGY, (INCLUDING MRI AND CT SCANNERS), LABORATORY SERVICES AND PHYSICAL THERAPY. THERE WERE 9,694 PATIENT ADMISSIONS, 43,225 PATIENT DAYS, 90,544 OUTPATIENT VISITS, AND 65,984 PHYSICIAN PRACTICE PATIENT VISITS DURING THE CURRENT YEAR. 140621795 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 1 1 1 1 0 0 1 X 0 0 1252 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X ERIC OSTARLY 3869175017 1055 SAXON BOULEVARD ORANGE CITY FL 32763 X OTTATI DAVID A DIR/CHAIRMAN/REGION CEO 6.00 44.00 X 0 943603 169932 AHUJA MD RATAN DIRECTOR (END 12/18) 0.80 0.10 X 3363 0 0 BANKS DAVID P DIRECTOR 0.30 50.00 X 0 1385185 179844 BIRI ABEL DIRECTOR 0.30 50.00 X 0 453528 77520 BROWN LORENZO DIRECTOR 0.30 50.00 X 0 382035 82956 CALLA MD SHRISH DIRECTOR (BEG 3/18) 0.30 50.00 X 0 420397 36093 DEININGER ROBERT DIRECTOR/PRESIDENT/SEC 50.00 0.10 X X 0 468948 69729 DESAI MD ROHAN DIRECTOR 0.30 0.10 X 538 0 0 FOLEY DOUG DIRECTOR 0.30 0.10 X 538 0 0 GUPTA MD VISHAL DIRECTOR (END 12/18) 0.50 0.10 X 1738 0 0 NORTHEY PATRICIA DIRECTOR 0.30 0.10 X 538 0 0 PATTERSON PAT DIRECTOR 0.30 0.10 X 538 0 0 RETZER GORDON DIRECTOR 0.30 2.10 X 538 13200 0 RITCHEYJEFF DIRECTOR 0.30 0.10 X 538 0 0 WANAMAKER JOHN DIRECTOR 0.30 0.10 X 538 0 0 OSTARLY ERIC M CFO 50.00 0.00 X 0 297828 66041 THOMAS DEBORA H REGIONAL CFO 6.00 44.00 X 0 796853 116839 CELANO PATRICIA REGIONAL CCO 6.00 44.00 X 0 476945 96038 JOHNSON DANIELLE C COO 50.00 0.00 X 0 367069 69999 SMITH MD LEIGHTON CMO 50.00 0.00 X 0 461005 44472 JOHNSON MICHELE CNO 50.00 0.00 X 0 213558 34648 LEE KATHERYN ASSISTANT NURSE MANAGER 55.00 0.00 X 162193 0 23579 ALFORD MARY DIRECTOR-INPATIENT NURSING 55.00 0.00 X 144709 0 18477 WILSON MAMIE PHARMACIST 50.00 0.00 X 143319 0 14456 LEAVERTON JENNIFER ASSISTANT NURSE MANAGER 55.00 0.00 X 141795 0 21342 LAZARUS JOHN SERVICE LINE DIRECTOR 50.00 0.00 X 138349 0 18672 NOSEWORTHY G EDWARD FORMER CEO 0.00 50.00 X 0 907402 109090 739232 7587556 1249727 33 1 1 0 ROGERS LOVELOCK & FRITZ INC 4750 NEW BROAD STREET ORLANDO FL 32814 DESIGN SERVICES 3257727 CROTHALL HEALTHCARE INC 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 CLEANING & BIO MED MAINTENANCE SERVICES 1835380 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 BIOMED MAINTENANCE & CLEANING SERVICES 1276844 DIVERSIFIED CLINICAL SERVICES INC 28525 NETWORK PL CHICAGO IL 60673 WOUND CARE STAFFING 1182630 ALL STAR RECRUITING LOCUMS LLC 6119 LYONS RD COCONUT CREEK FL 33073 LOCUM TENENS COVERAGE 857573 25 X 50000 50000 NET PATIENT REVENUE 622110 164968867 164885537 83330 CAFETERIA REVENUE 622110 678822 678822 REIMB OF EXP- TE AFFILIATE 622110 540034 540034 GIFT SHOP REVENUE 622110 227153 227153 HOUSEKEEPING REVENUE 622110 97505 97505 180352 180352 166692733 3003705 3003705 42509 1110997 0 -1110997 42509 -1068488 -1068488 168677950 166609403 83330 1935217 X 84948 84948 2409347 2409347 44993787 44993787 1729569 1684213 45356 10812525 10506218 306307 3446588 3356205 90383 824435 824435 62801 62801 568373 568373 31374618 27358051 4016567 663338 663338 4481399 3722094 759305 5573198 4800796 772402 4523195 4523195 134912 134912 63224 63224 1557673 1557673 5891683 5891683 1015159 603376 411783 UBI TAXES 5000 5000 MEDICAL SUPPLIES 25872869 25872869 REPAIRS & MAINTENANCE 3672906 3672906 STATE TAX INDIGENT ASSE 1990753 1990753 490207 3028 487179 152242507 140621795 11620712 0 3275 3141 97520633 106602726 22249725 21649510 2629016 2930129 3804122 4228492 179405123 109660743 66653693 69744380 147469 131963 3263324 604407 196271257 205894748 7529690 8721697 60385780 60582575 67915470 69304272 X 128331430 136566119 24357 24357 128355787 136590476 196271257 205894748 X 16435443 -4496896 -3703858 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6608 6608 0 PART II-B, LINE 1: AMERICAN HOSPITAL ASSOCIATION DUES AND FLORIDA HOSPITAL ASSOCIATION DUES 20134565 20134565 86594613 55364970 31229643 58291839 48735616 9556223 14384106 5560157 8823949 69744380 DUE TO RELATED 3400411 PAYABLE TO THIRD PARTIES 5543802 CREDIT BALANCES IN A/R 543753 OTHER DEFERRED REVENUE 121250 INTERCO. ALLOC. OF TE BOND PROCEEDS 50870697 OTHER LIABILITIES 102662 60582575 X PART X, LINE 2: THE HOSPITAL IS PART OF A CONSOLIDATED AUDITED FINANCIAL STATEMENT. THE CONSOLIDATED AUDITED FINANCIAL STATEMENT INCLUDES THE FOLLOWING FIN 48 (ASC 740) FOOTNOTE - THE DIVISION FOLLOWS THE INCOME TAXES TOPIC OF THE ACCOUNTING STANDARDS CODIFICATION (ASC) (ASC 740) WHICH 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, 2018. 1 1 X 1 X 0 1 1 0 1 0 6557246 6557246 0.04310 17991014 8436810 9554204 0.06280 24548260 8436810 16111450 0.10590 410487 410487 0.00270 170560 170560 0.00110 581047 581047 0.00380 25129307 8436810 16692497 0.10970 9919 9919 0.00010 9919 9919 0.00010 1 16622321 1309046 35565353 36164871 -599518 X 1 1 1 ORANGE CITY SURGICAL LLC OUTPATIENT SURGICAL CENTER 0.25000 0.00000 0.75000 1 1 ADVENTHEALTH FISH MEMORIAL 1055 SAXON BLVD ORANGE CITY FL 32763 WWW.ADVENTHEALTH.COM/HOSPITAL/ADVENTHE 4408 X X X ADVENTHEALTH FISH MEMORIAL 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X SEE PART V, PAGE 8 X X 1 17 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 ADVENTHEALTH FISH MEMORIAL PART V, SECTION B, LINE 5: SOUTHWEST VOLUSIA HEALTHCARE CORPORATION, D/B/A ADVENTHEALTH FISH MEMORIAL, (AHFM OR THE HOSPITAL) OPERATES A HOSPITAL IN VOLUSIA COUNTY, FLORIDA WITH A TOTAL OF 179 LICENSED BEDS. FOR PURPOSES OF ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL DEFINED ITS COMMUNITY AS ALL OF VOLUSIA COUNTY, FLORIDA. VOLUSIA COUNTY, FLORIDA HAS A TOTAL POPULATION OF OVER 500,000. ABOUT 18% OF THE POPULATION WAS UNDER AGE 18 AND 23% OF THE POPULATION WAS 65 YEARS OR OLDER. AHFM JOINED WITH ITS FOUR AFFILIATED HOSPITALS IN VOLUSIA COUNTY AND WITH HALIFAX HEALTH, AN UNRELATED GOVERNMENTAL HOSPITAL IN VOLUSIA COUNTY, AND WITH THE VOLUSIA COUNTY DEPARTMENT OF HEALTH TO CONDUCT A COUNTY-WIDE COMMUNITY HEALTH NEEDS ASSESSMENT IN 2015-2016. ADDITIONALLY, THE HOSPITAL CONTRACTED WITH ONE VOICE FOR VOLUSIA, A LOCAL NON-PROFIT ORGANIZATION TO ASSIST IN PRIMARY DATA COLLECTION, COMPILATION AND ANALYSIS AND FACILITATION OF THE REVIEW AND PRIORITIZATION PROCESS FOR IDENTIFIED COMMUNITY HEALTH NEEDS. AS A PART OF ITS EFFORTS TO ENSURE BROAD COMMUNITY-BASED INPUT INTO THE CHNA PROCESS, THE HOSPITAL ESTABLISHED A LEADERSHIP TEAM THAT INCLUDED 45 LEADERS FROM 15 ORGANIZATIONS REPRESENTING KEY SECTORS OF THE PUBLIC HEALTH SYSTEM AS WELL AS LOW-INCOME, MINORITY AND OTHER UNDERSERVED POPULATIONS. IN ADDITION TO THE LEADERSHIP TEAM, THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS INCLUDED INPUT FROM PEOPLE REPRESENTING THE BROAD COMMUNITY, INCLUDING LOW-INCOME, MINORITY, AND OTHER MEDICALLY UNDERSERVED POPULATIONS. THIS INPUT WAS GATHERED THROUGH COMMUNITY SURVEYS (INTERNET AND PAPER) THAT REACHED 2,003 CONSUMERS AND STAKEHOLDERS AND TWO COMMUNITY MEETINGS THAT ENGAGED 120 COMMUNITY MEMBERS AND STAKEHOLDERS. THE FOLLOWING COMMUNITY-BASED ORGANIZATIONS WERE PARTICIPANTS ON THE LEADERSHIP TEAM. THESE ORGANIZATIONS SPECIFICALLY REPRESENTED THE NEEDS OF LOW-INCOME, MINORITY AND MEDICALLY UNDERSERVED POPULATIONS. THE VOLUSIA COUNTY HEALTH DEPARTMENT,THE JESUS CLINIC - A CLINIC PROVIDING FREE HEALTHCARE TO FAMILIES THAT DO NOT QUALIFY FOR MEDICAID AND ARE UNINSURED,FAMILY HEALTH SOURCE MEDICAL CENTERS,LUTHERAN SERVICES FLORIDA HEALTH SYSTEMS,VOLUSIA COUNTY SCHOOLS,STETSON UNIVERSITY,COUNCIL ON AGING,CAREER SOURCE FLAGLER/VOLUSIA,HEALTHY START COALITION OF FLAGLER AND VOLUSIA,EASTER SEALS,BETHUNE-COOKMAN UNIVERSITY,UNITED WAY OF VOLUSIA-FLAGLER COUNTIES; ANDSTEWART MARCHMAN ACT BEHAVIORAL HEALTHCARE - RECOVERY FOR MENTAL ILLNESS AND ADDICTION. ADVENTHEALTH FISH MEMORIAL PART V, SECTION B, LINE 6A: THE FILING ORGANIZATION PARTICIPATED IN A JOINT REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT INCLUDED THREE RELATED HOSPITAL ORGANIZATIONS, AN UNRELATED HOSPITAL ORGANIZATION, THE VOLUSIA COUNTY HEALTH DEPARTMENT AND A COMMUNITY NON-PROFIT ORGANIZATION. THESE COLLABORATORS ALL CONSIDERED VOLUSIA COUNTY TO BE THE PRIMARY SERVICE AREA FOR PURPOSES OF THE JOINT CHNA. ALL COLLABORATORS IN THE JOINT REGIONAL CHNA WERE AS FOLLOWS:RELATED COLLABORATORS:MEMORIAL HOSPITAL WEST VOLUSIA, INC., DBA ADVENTHEALTH DELANDSOUTHWEST VOLUSIA HEALTHCARE CORPORATION, DBA ADVENTHEALTH FISH MEMORIALSOUTHEAST VOLUSIA HEALTHCARE CORPORATION, DBA ADVENTHEALTH NEW SMYRNA BEACH, ANDMEMORIAL HEALTH SYSTEMS, INC., DBA ADVENTHEALTH DAYTONA BEACH.UNRELATED COLLABORATORS:HALIFAX HEALTH MEDICAL CENTER;THE VOLUSIA COUNTY HEALTH DEPARTMENT; AND ONE VOICE FOR VOLUSIA. ADVENTHEALTH FISH MEMORIAL PART V, SECTION B, LINE 6B: THE FILING ORGANIZATION PARTICIPATED IN A JOINT REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT INCLUDED THREE RELATED HOSPITAL ORGANIZATIONS, AN UNRELATED HOSPITAL ORGANIZATION, THE VOLUSIA COUNTY HEALTH DEPARTMENT AND A COMMUNITY NON-PROFIT ORGANIZATION. THESE COLLABORATORS ALL CONSIDERED VOLUSIA COUNTY TO BE THE PRIMARY SERVICE AREA FOR PURPOSES OF THE JOINT CHNA. ALL COLLABORATORS IN THE JOINT REGIONAL CHNA WERE AS FOLLOWS:RELATED COLLABORATORS:MEMORIAL HOSPITAL WEST VOLUSIA, INC., DBA ADVENTHEALTH DELANDSOUTHWEST VOLUSIA HEALTHCARE CORPORATION, DBA ADVENTHEALTH FISH MEMORIALSOUTHEAST VOLUSIA HEALTHCARE CORPORATION, DBA ADVENTHEALTH NEW SMYRNA BEACH, ANDMEMORIAL HEALTH SYSTEMS, INC., DBA ADVENTHEALTH DAYTONA BEACH.UNRELATED COLLABORATORS:HALIFAX HEALTH MEDICAL CENTER;THE VOLUSIA COUNTY HEALTH DEPARTMENT; AND ONE VOICE FOR VOLUSIA. ADVENTHEALTH FISH MEMORIAL 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. ADVENTHEALTH FISH MEMORIAL PART V, SECTION B, LINE 11: THE INFORMATION PROVIDED BELOW EXPLAINS HOW THE HOSPITAL FACILITY ADDRESSED IN 2018 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. SOUTHWEST VOLUSIA HEALTHCARE CORPORATION, D/B/A ADVENTHEALTH FISH MEMORIAL, WILL BE REFERRED TO IN THIS DOCUMENT AS ADVENTHEALTH FISH MEMORIAL OR "THE HOSPITAL".IN JANUARY OF 2019, EVERY WHOLLY-OWNED ENTITY ACROSS OUR ORGANIZATION ADOPTED THE ADVENTHEALTH SYSTEM BRAND. OUR IDENTITY HAS BEEN UNIFIED TO REPRESENT THE FULL CONTINUUM OF CARE OUR SYSTEM OFFERS. THROUGHOUT THIS REPORT, WE WILL REFER TO OUR HOSPITAL BY ADVENTHEALTH FISH MEMORIAL. ANY REFERENCE TO OUR 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) OR 2017 COMMUNITY HEALTH PLAN (CHP) WILL UTILIZE OUR NEW NAME FOR CONSISTENCY.ADVENTHEALTH FISH MEMORIAL IS PART OF THE CENTRAL FLORIDA DIVISION - NORTH REGION OF ADVENTHEALTH. THE ADVENTHEALTH CENTRAL FLORIDA DIVISION NORTH REGION INCLUDES SIX HOSPITAL FACILITIES.THIS IS THE SECOND-YEAR UPDATE FOR ADVENTHEALTH FISH MEMORIAL'S 2017-2019 COMMUNITY HEALTH PLAN (IMPLEMENTATION STRATEGY). ADVENTHEALTH FISH MEMORIAL 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 FISH MEMORIAL 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 SECOND-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 FISH MEMORIAL CHOSE FIVE AREAS OF FOCUS FOR THEIR 2017-2019 COMMUNITY HEALTH PLAN: 1. ADULT BEHAVIORAL HEALTH2. YOUTH BEHAVIORAL HEALTH3. CARDIOVASCULAR AND DIABETES4. HEALTH EATING AND PHYSICAL ACTIVITY5. BARRIERS TO ACCESSING HEALTH CAREPRIORITY 1: ADULT BEHAVIORAL HEALTH2016 DESCRIPTION OF THE ISSUE: BEHAVIORAL HEALTH IS A TERM THAT COVERS THE FULL RANGE OF MENTAL AND EMOTIONAL WELL-BEING - FROM COPING WITH DAILY LIFE CHALLENGES TO THE OFTEN-COMPLEX TREATMENT OF MENTAL ILLNESSES, SUCH AS DEPRESSION OR PERSONALITY DISORDER, AS WELL AS SUBSTANCE USE DISORDER AND OTHER ADDICTIVE BEHAVIORS. NOW MORE THAN EVER, HEALTH EXPERTS ACROSS ALL FIELDS ARE RECOGNIZING THE IMPORTANT LINK BETWEEN GOOD BEHAVIORAL HEALTH AND GOOD OVERALL HEALTH. ACCORDING TO THE 2000+ RESPONDENTS OF THE VOLUSIA/FLAGLER COMMUNITY HEALTH SURVEY, BEHAVIORAL HEALTH RELATED ISSUES WERE THE TOP THREE UNHEALTHY BEHAVIORS. VOLUSIA COUNTY RESIDENTS WERE MOST CONCERNED ABOUT DRUG ABUSE (56 PERCENT), MENTAL HEALTH/STRESS (47 PERCENT) AND ALCOHOL ABUSE (45 PERCENT). INJURIES AND DEATHS FROM ALCOHOL-SUSPECTED MOTOR VEHICLE CRASHES WERE HIGHER THAN THE FLORIDA RATES. DEATH RATES FROM CHRONIC LIVER DISEASE AND CIRRHOSIS HAVE INCREASED FOR ALL VOLUSIA RESIDENTS (15.4 PER 100,000 IN 2012-14). THE PERCENTAGE OF VOLUSIA RESIDENTS WHO SELF-REPORTED BEING CURRENT SMOKERS WAS 10.7 PERCENT HIGHER THAN THE FLORIDA PERCENTAGE. THE HIGHEST PERCENTAGE OF SMOKERS WERE ADULTS WITH LESS THAN A HIGH SCHOOL EDUCATION AND THE LOWEST WAS ADULTS AGED 65 AND OLDER. THE PERCENTAGE OF VOLUSIA RESIDENTS WHO REPORTED HAVING "POOR MENTAL HEALTH DAYS" ON 14 OR MORE OF THE PAST 30 DAYS WAS HIGHER THAN THE FLORIDA PERCENTAGE. WOMEN REPORTED A HIGHER PERCENTAGE OF THESE DAYS THAN MEN. ACCORDING TO THE 2000+ RESPONDENTS OF THE VOLUSIA/FLAGLER COMMUNITY HEALTH SURVEY, "MENTAL HEALTH/COUNSELING AND "SUBSTANCE ABUSE SERVICES-DRUG AND ALCOHOL" WERE THE TOP TWO HEALTH SERVICES THAT WERE DIFFICULT TO OBTAIN IN VOLUSIA COUNTY.2018 UPDATE: MANY PARTNER ORGANIZATIONS FOCUSED ON ADULT MENTAL HEALTH STRATEGIES AS PART OF THE COUNTYWIDE COMMUNITY HEALTH IMPROVEMENT PLAN. ADVENTHEALTH FISH MEMORIAL IMPLEMENTED TWO STRATEGIES FOCUSED ON ADULT BEHAVIORAL HEALTH: SMOKING CESSATION CLASSES AND LOW DOSE COMPUTED TOMOGRAPHY (CT) SCREENINGS FOR LUNG CANCER. SMOKING CESSATION CLASSES WERE HOSTED AT THE HOSPITAL THROUGHOUT THE YEAR. TOOLKITS WERE DISTRIBUTED WITH EDUCATION FOR PROVIDERS AND PATIENTS, WHICH INCLUDED SMOKING CESSATION CLASS INFORMATION. THIRTY-ONE ADULTS COMPLETED SMOKING CESSATION EDUCATION CLASSES IN 2018 WHICH WAS SLIGHTLY FEWER THAN THE ANTICIPATED GOAL OF 60. ONE OF THE BIGGEST CHALLENGES TO INCREASING PARTICIPATION IS RAISING AWARENESS OF THE AVAILABILITY OF THIS PROGRAM AS WELL AS IDENTIFYING PARTICIPANTS WILLING AND READY TO ADDRESS AND CHANGE THEIR BEHAVIOR. THE CENTER FOR DISEASE CONTROL (CDC) RECOMMENDS LOW DOSE CT SCREENINGS FOR EARLY DETECTION OF LUNG CANCER. ONE HUNDRED AND THIRTY-NINE INDIVIDUALS WERE SCREENED THROUGH THE LOW DOSE CT PROGRAM IN 2018. THE MAJORITY OF PEOPLE ENTER THE LOW DOSE CT SCREENING WITH A PHYSICIAN REFERRAL. PHYSICIAN SUPPORT AND ENGAGEMENT IS IMPORTANT. PHYSICIANS CAN EFFECTIVELY IDENTIFY INDIVIDUALS WHO ARE SMOKERS AND MAY BE GOOD CANDIDATES FOR THE LOW DOSE CT SCREENING. THE PROGRAM IS PROMOTED TO THE COMMUNITY THROUGH DIGITAL MARKETING AND EVENTS ARE HOSTED TO EDUCATE THE COMMUNITY ABOUT THE IMPORTANCE OF FINDING LUNG CANCER EARLY. AN ONGOING CHALLENGE IS THE NEED FOR CONTINUED EDUCATION TO RAISE AWARENESS OF THE IMPORTANCE OF LOW DOSE CT SCREENINGS. THE HOSPITAL HAS PUT IN PLACE STRATEGIES TO INCREASE THE VOLUME OF LOW DOSE CT SCREENINGS WHICH WILL ENGAGE PHYSICIANS AND THE COMMUNITY. ADVENTHEALTH FISH MEMORIAL WILL CONTINUE TO PROVIDE BOTH SERVICES IN 2019 TO MEET THE NEEDS OF OUR COMMUNITY. THE PRIMARY CHALLENGE WITH RESPECT TO THE LOW DOSE CT SCREENING PROGRAM IS THE NEED FOR INCREASED EDUCATION AWARENESS OF THE BENEFITS OF THE LOW DOSE CT SCREENINGS. STRATEGIES WERE PUT IN PLACE FOR INCREASING VOLUMES IN THE LOW DOSE CT SCREENING PROGRAM, INCLUDING DIRECT TO PHYSICIAN STRATEGIES. PRIORITY 2: YOUTH BEHAVIORAL HEALTH2016 DESCRIPTION OF THE ISSUE: IT IS ESTIMATED THAT 50 PERCENT OF MENTAL HEALTH CONDITIONS MANIFEST THEMSELVES DURING ADOLESCENCE. PREVENTING MENTAL AND/OR SUBSTANCE USE DISORDERS AND RELATED PROBLEMS IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS IS CRITICAL TO AMERICANS' BEHAVIORAL AND PHYSICAL HEALTH. IN 2012-14 THE VOLUSIA SUICIDE RATE WAS 8.5 PER 100,000--HIGHER THAN THE STATE RATE OF 4.9. DESPITE A DECLINE IN HIGH SCHOOL STUDENTS USING ALCOHOL IN THE LAST 30 DAYS, VOLUSIA'S RATE HAS BEEN CONSISTENTLY HIGHER THAN THE STATE RATE WITH 29.6% OF HIGH SCHOOLERS REPORTING ALCOHOL USE. VOLUSIA COUNTY RATES FOR SMOKING AND MARIJUANA USE ARE ALSO CONSISTENTLY HIGHER THAN THE STATE RATE.2018 UPDATE: AS WITH ADULT BEHAVIORAL HEALTH, YOUTH BEHAVIORAL HEALTH IS BEING ADDRESSED BY OTHER COMMUNITY PARTNERS SUPPORTING THE COUNTYWIDE COMMUNITY HEALTH IMPROVEMENT PLAN. ADVENTHEALTH FISH MEMORIAL IMPLEMENTED ONE PREVENTION-ORIENTED STRATEGY FOCUSED ON SCHOOL-AGED YOUTH IN PARTNERSHIP WITH THE AMERICAN DIABETES ASSOCIATION. INCREASED PHYSICAL ACTIVITY IS A PROVEN STRATEGY TO IMPROVE BOTH PHYSICAL AND MENTAL HEALTH. THE MORNING MILE PROGRAM WAS DESIGNED TO ENCOURAGE PHYSICAL ACTIVITY AMONG YOUTH. ADVENTHEALTH FISH MEMORIAL PARTNERED WITH A LOCAL SCHOOL DURING THE 2017-18 SCHOOL YEAR TO INITIATE THIS PROGRAM. SEVENTY-FOUR STUDENTS PARTICIPATED IN THE PROGRAM IN 2018. THIS PROGRAM WILL CONTINUE IN 2019. THE TIME OF DAY WHEN MORNING MILE PROGRAM IS OFFERED AT ORANGE CITY ELEMENTARY WAS CHANGED FOR 2018-2019. ORANGE CITY ELEMENTARY WAS CHALLENGED WITH THE EARLY MORNING TIME WHEN MORNING MILE PROGRAM WAS TAKING PLACE AND CHILDREN WERE NOT PARTICIPATING. THE MORNING MILE PROGRAM WAS CHANGED TO AFTER-SCHOOL HOURS IN THE 2018-2019 SCHOOL YEAR AND THERE HAS BEEN AN INCREASE IN STUDENT PARTICIPATION. SEE CONTINUATION SCHEDULE H, PART V, SECTION B, LINE 7A: THE CHNA REPORT FOR ADVENTHEALTH FISH MEMORIAL CAN BE FOUND AT URL:HTTPS://WWW.ADVENTHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS SCHEDULE H, PART V, SECTION B, LINE 10A: THE HOSPITAL'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 THE HOSPITAL CAN BE FOUND AT URL:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCETHE FINANCIAL ASSISTANCE POLICY APPLICATION FOR THE HOSPITAL CAN BE FOUND AT:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCETHE PLAIN LANGUAGE SUMMARY FOR THE HOSPITAL IS AVAILABLE AT:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 11 CONTINUATION: PRIORITY 3 & 4: CARDIOVASCULAR AND DIABETES AND HEALTHY EATING AND PHYSICAL ACTIVITY2016 DESCRIPTION OF THE ISSUE: CARDIOVASCULAR AND DIABETESCHRONIC DISEASES AND CONDITIONS--SUCH AS HEART DISEASE, STROKE, CANCER, AND DIABETES--ARE AMONG THE MOST COMMON, COSTLY, AND PREVENTABLE OF ALL HEALTH PROBLEMS. THESE CONDITIONS SHORTEN LIVES, REDUCE QUALITY OF LIFE, AND CREATE CONSIDERABLE BURDEN FOR CAREGIVERS. IN 2013, THE PERCENTAGE OF VOLUSIA ADULTS SELF-REPORTING THAT THEY HAD EVER BEEN TOLD THEY HAD HIGH BLOOD CHOLESTEROL WAS HIGHER THAN THE FLORIDA PERCENTAGE. THE VOLUSIA RATE FOR HOSPITALIZATIONS FROM STROKES (274.0 PER 100,000) DECREASED SLIGHTLY OVER THE LAST FIVE YEARS REPORTED BUT RATES FOR AFRICAN-AMERICANS REMAINED HIGH. THE AGE-ADJUSTED DIABETES DEATH RATE FOR VOLUSIA COUNTY (27.4 PER 100,000) INCREASED OVER THE REPORTED YEAR AND WAS CONSISTENTLY HIGHER THAN THE FLORIDA RATE. HEALTHY EATING AND PHYSICAL ACTIVITYREGULAR PHYSICAL ACTIVITY AND HEALTHY EATING CAN HELP PEOPLE MANAGE THEIR WEIGHT AS WELL AS REDUCE THEIR RISK FOR CHRONIC DISEASE. THE PERCENTAGE OF VOLUSIA ADULTS WHO SELF-REPORTED EATING FIVE OR MORE SERVINGS OF FRUITS AND VEGETABLES PER DAY WAS LOWER THAN THE FLORIDA PERCENTAGE IN 2013. FORTY-NINE PERCENT OF ADULTS SELF-REPORTED BEING INACTIVE OR INSUFFICIENTLY ACTIVE--WITH OVER 33.7 PERCENT OF THE POPULATION BEING OVERWEIGHT AND 24.4 PERCENT BEING OBESE. EIGHTY-TWO PERCENT OF VOLUSIA ADULTS REPORTED THAT THEIR OVERALL HEALTH WAS "GOOD OR "EXCELLENT". 2018 UPDATE: ADVENTHEALTH FISH MEMORIAL IMPLEMENTED SEVERAL DISTINCT STRATEGIES FOCUSED ON THE PRIORITIES OF CARDIOVASCULAR DISEASE, DIABETES AND HEALTHY EATING AND PHYSICAL ACTIVITY. CREATION HEALTH, AN EIGHT-WEEK, FAITH-BASED WELLNESS PLAN WITH LIFESTYLE SEMINARS AND TRAINING BASED ON 8 PRINCIPLES: CHOICE, REST, ENVIRONMENT, ACTIVITY, TRUST, INTERPERSONAL RELATIONS, OUTLOOK AND NUTRITION, WAS PROVIDED TO 120 INDIVIDUALS IN 2018. ADVENTHEALTH FISH MEMORIAL ALSO PROVIDED EDUCATIONAL SEMINARS COVERING OTHER HEALTH TOPICS OF INTEREST TO 577 INDIVIDUALS. OUTREACH ACTIVITIES REACHED 33,677 INDIVIDUALS AND OVER 1,831 INDIVIDUALS RECEIVED FREE HEALTH SCREENINGS SUCH AS CHOLESTEROL AND HBA1C (BLOOD SUGAR) SCREENINGS AND BLOOD PRESSURE SCREENINGS. ONE EDUCATION AND OUTREACH PROGRAM, CHANGE YOUR LIFE, WAS DISCONTINUED DURING 2018 BUT ADDITIONAL FOCUS WAS PLACED ON THE REMAINING STRATEGIES. ADVENTHEALTH FISH MEMORIAL ALSO SUCCESSFULLY IMPLEMENTED COMMUNITY CARE, A COMMUNITY-BASED CARE COORDINATION PROGRAM FOR HIGH RISK PATIENTS WITH A HISTORY OF PREVENTABLE EMERGENCY DEPARTMENT (ED) VISITS AND INPATIENT ADMISSIONS. THE PROGRAM TARGETS THE UNDERSERVED PATIENTS IN THE COMMUNITY TO INCREASE QUALITY AND COORDINATION OF CARE TO HELP IMPROVE HEALTH OUTCOMES. FIFTY-SEVEN NEW INDIVIDUALS WERE ENROLLED AND SERVED THROUGH COMMUNITY CARE--EXCEEDING THE 2018 TARGET FOR THIS PROGRAM. ADVENTHEALTH FISH MEMORIAL RECOGNIZES THE BENEFIT OF INDIVIDUALIZED COORDINATION OF CARE TO IMPROVE HEALTH OUTCOMES FOR THE UNDERSERVED. AN ONGOING CHALLENGE WILL BE TO CONTINUE FINDING CREATIVE WAYS TO MEET INDIVIDUALS' NEEDS WITH LIMITED RESOURCES. CURRENTLY THERE IS NOT ONE SYSTEM TO TRACK WHAT PROGRAMS ARE CURRENTLY AVAILABLE IN THE COMMUNITY, CHANGES TO FUNDING, OR QUALIFICATIONS FOR SPECIFIC PROGRAMS. THIS LEADS TO ADDITIONAL CHALLENGES WHEN CONNECTING THE UNDERSERVED TO THE NECESSARY RESOURCES.PRIORITY 5: BARRIERS TO ACCESSING HEALTH CARE SERVICES2016 DESCRIPTION OF THE ISSUE: ACCESS TO COMPREHENSIVE QUALITY HEALTH CARE SERVICES IS IMPORTANT FOR THE ACHIEVEMENT OF HEALTH EQUITY AND FOR INCREASING THE QUALITY OF A HEALTHY LIFE FOR EVERYONE. ACCORDING TO THE VOLUSIA/FLAGLER COMMUNITY HEALTH SURVEY, THE TOP 3 BARRIERS TO GETTING HEALTH CARE WERE: LACK OF EVENING AND/OR WEEKEND SERVICES (22.6 PERCENT), INABILITY TO PAY FOR DOCTOR/HOSPITAL VISITS (21.8 PERCENT), AND LONG WAITS FOR APPOINTMENTS (21.3 PERCENT). IN 2013, 79.8 PERCENT OF VOLUSIA ADULTS HAD SOME TYPE OF HEALTH CARE COVERAGE AND 74.8 PERCENT REPORTED HAVING A PERSONAL DOCTOR.2018 UPDATE: TO ADDRESS ACCESS TO HEALTH CARE SERVICES, ADVENTHEALTH FISH MEMORIAL IMPLEMENTED SEVERAL STRATEGIES FOCUSED ON INDIVIDUALS RESIDING IN THE HOSPITAL'S AT-RISK ZIP CODES. ADVENTHEALTH FISH MEMORIAL OFFERED 30 SCHOLARSHIPS FOR NEWBORN AND LACTATION EDUCATION CLASSES IN 2018. ADDITIONALLY, THE HOSPITAL PROVIDED FREE MEETING SPACE TO EIGHT SUPPORT GROUPS OPERATING IN THE COMMUNITY. IN 2018, ADVENTHEALTH FISH MEMORIAL PARTNERED WITH UNITED WAY OF VOLUSIA AND FLAGLER COUNTIES TO INCREASE ACCESS TO HEALTH RESOURCE INFORMATION THROUGH PROMOTION OF THE 2-1-1 CALL CENTER/WEBSITE RESOURCE. THERE WERE OVER 2,400 WEB HITS FOR HEALTH OR WELLNESS RESOURCES IN 2018. INCREASING AWARENESS OF THE NEWBORN AND LACTATION EDUCATION CLASSES TO THE TARGET POPULATION HAS PROVEN TO BE ONE OF THE BIGGEST CHALLENGES. UNITED WAY HAS CONTINUED TO WORK ON THE 2-1-1 SYSTEM IMPROVEMENTS WITH A FOCUS ON HEALTH AND WELLNESS RESOURCES.COMMUNITY NEEDS NOT CHOSEN BY ADVENTHEALTH FISH MEMORIAL: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:-- AGING-RELATED ISSUES: DUE TO THE COUNCIL ON AGING HAVING A STRONG APPROACH TO SERVING VULNERABLE SENIORS THROUGHOUT VOLUSIA COUNTY, THE ISSUE WAS NOT CHOSEN BY THE HOSPITAL. -- CHILD/ADOLESCENT ISSUES: VOLUSIA COUNTY SCHOOLS, IN PARTNERSHIP WITH OTHER ORGANIZATIONS, IMPLEMENT STRATEGIES TO ENSURE YOUTH IN THE K-12 EDUCATION SYSTEM ARE HAVING THEIR HEALTH NEEDS MET. -- CHRONIC DISEASE: CANCER/RESPIRATORY DISEASES: THE DATA REVIEWED DID NOT SUPPORT THE PRIORITIZATION OF CANCER OR RESPIRATORY DISEASES AND INSTEAD A FOCUS WAS PLACED ON STRATEGIES TO IMPACT CARDIOVASCULAR DISEASES AND DIABETES. MANY OF THOSE STRATEGIES IMPLEMENTED, ALONG WITH STRATEGIES TO PROMOTE HEALTHY EATING AND PHYSICAL ACTIVITY, WILL ALSO HAVE A POSITIVE EFFECT ON ALL CHRONIC DISEASES.-- COMMUNICABLE & INFECTIOUS DISEASES: THE DATA TRENDS AND COMPARISON TO THE STATE RATES DID NOT WARRANT PRIORITIZATION OF THIS ISSUE. THE FLORIDA DEPARTMENT OF HEALTH-VOLUSIA TAKES A LEADERSHIP ROLE IN COMMUNICABLE AND INFECTIOUS DISEASE PREVENTION AND SURVEILLANCE.-- CRIME, DOMESTIC VIOLENCE & EARLY CHILDHOOD CHILD ABUSE: SIGNIFICANT COMMUNITY INSTITUTIONS FOCUS ON THESE SOCIAL DETERMINANTS OF HEALTH, SO THE ISSUE WAS NOT PRIORITIZED FOR ADVENTHEALTH FISH MEMORIAL STRATEGIES. -- EARLY CHILDHOOD: THE EARLY LEARNING COALITION OF FLAGLER AND VOLUSIA COUNTIES, IN PARTNERSHIP WITH EARLY STEPS AND OTHER COMMUNITY PROGRAMS, HAVE COMPREHENSIVE STRATEGIES IN PLACE TO ENSURE CHILDREN UNDER AGE FIVE ARE HEALTHY AND READY TO ENTER KINDERGARTEN. THIS ISSUE WAS NOT SELECTED AS A COMMUNITY PRIORITY FOR ADDITIONAL FOCUS.-- WOMEN'S HEALTH, PRENATAL CARE AND BIRTH OUTCOMES: ALTHOUGH SOME OF THE DATA REVIEWED WAS CONCERNING, THE HEALTHY START COALITION OF FLAGLER AND VOLUSIA COUNTIES HAS DEVELOPED STRATEGIES TO IMPACT THIS POPULATION. -- SOCIAL AND ECONOMIC ISSUES: ALTHOUGH THIS ISSUE WAS NOT IDENTIFIED AS A PRIORITY ISSUE, ALL STRATEGIES IMPLEMENTED ARE VIEWED THROUGH THE LENS OF SOCIAL DETERMINANTS OF HEALTH TO ENSURE THAT VULNERABLE POPULATIONS HAVE ACCESS TO RESOURCES OFFERED OR ARE THE TARGET POPULATION FOR SERVICES AND RESOURCES. 13 1 - ORANGE CITY SURGICAL LLC DBA BLUE SPRING 1053 MEDICAL CENTER DRIVE 201 ORANGE CITY FL 32763 OUTPATIENT SURGERY CENTER JOINT VENTURE 2 - ADVENTHEALTH MEDICAL GROUP FAMILY MEDICINE 1061 MEDICAL CENTER DR 305 ORANGE CITY FL 32763 PHYSICIAN HOSPITALIST FAMILY MEDICINE 3 - ADVENTHEALTH MEDICAL GROUP FAMILY MEDICINE 1565 SAXON BLVD 102 DELTONA FL 32725 PHYSICIAN OFFICE - FAMILY PRACTICE 4 - ADVENTHEALTH MEDICAL GROUP PRIMARY CARE AT 915 DOYLE ROAD 306 DELTONA FL 32738 PHYSICIAN OFFICE - INTERNAL MEDICINE 5 - ADVENTHEALTH MEDICAL GROUP PLASTIC & RECON 934 WILLISTON PARK POINT 1028 LAKE MARY FL 32746 PHYSICIAN OFFICE - PLASTIC & RECONST SURGERY 6 - ADVENTHEALTH MEDICAL GROUP FAMILY MEDICINE 190 N CHARLES RICHARD BEALL BLVD 103 DEBARY FL 32713 PHYSICIAN OFFICE - FAMILY MEDICINE 7 - ADVENTHEALTH MEDICAL GROUP FAMILY MEDICINE 1061 MEDICAL CENTER DR 212 ORANGE CITY FL 32763 PHYSICIAN OFFICE - FAMILY MEDICINE 8 - ADVENTHEALTH MEDICAL GROUP FAMILY MEDICINE 1035 TOWN CENTER DR ORANGE CITY FL 32763 PHYSICIAN OFFICE - FAMILY PRACTICE 9 - ADVENTHEALTH MEDICAL GROUP ENDOCRINOLOGY 1081 TOWN CENTER DR ORANGE CITY FL 32763 ENDOCRINOLOGIST 10 - ADVENTHEALTH MEDICAL GROUP VASCULAR SURGER 1061 MEDICAL CENTER DR 102 ORANGE CITY FL 32763 PHYSICIAN OFFICE - VASCULAR CENTER 11 - ADVENTHEALTH MEDICAL GROUP PSYCHIATRY AT O 1061 MEDICAL CENTER DR 205 ORANGE CITY FL 32763 PHYSICIAN OFFICE - PSYCHIATRY 12 - ADVENTHEALTH MEDICAL GROUP GASTROENTEROLOG 1061 MEDICAL CENTER DR 102 ORANGE CITY FL 32763 PHYSICIAN OFFICE - GASTROENTEROLOGY 13 - ADVENTHEALTH MEDICAL GROUP ENDOCRINOLOGY A 2885 WELLNESS AVE ORANGE CITY FL 32763 PHYSICIAN OFFICE - ENDOCRINOLOGY 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 24 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS AND A NUMBER OF OTHER HEALTH CARE FACILITIES THAT OPERATED IN 10 STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS "ADVENTHEALTH".ALL HOSPITAL ORGANIZATIONS WITHIN ADVENTHEALTH COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. ADVENTHEALTH ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. ADVENTHEALTH HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. EACH ADVENTHEALTH HOSPITAL FACILITY REPORTS THEIR COMMUNITY BENEFITS TO THEIR BOARD OF DIRECTORS AND STRIVES TO COMMUNICATE THEIR COMMUNITY BENEFITS TO THEIR LOCAL COMMUNITIES. ADDITIONALLY, THE FILING ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY CAN BE ACCESSED ON THE FILING ORGANIZATION'S WEBSITE. PART I, LINE 7: THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON LINE 2 OF SECTION A OF PART III IS RECORDED IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO REVENUE, NOT BAD DEBT EXPENSE. PART III, LINE 3: METHODOLOGY FOR DETERMINING THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT MAY REPRESENT PATIENTS WHO COULD HAVE QUALIFIED UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY:SELF-PAY PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE BY COMPLETING A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM). IF AN INDIVIDUAL DOES NOT SUBMIT A COMPLETE FAA FORM WITHIN 240 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL, AN INDIVIDUAL MAY BE CONSIDERED FOR PRESUMPTIVE ELIGIBILITY BASED UPON A SCORING TOOL THAT IS DESIGNED TO CLASSIFY PATIENTS INTO GROUPS OF VARYING ECONOMIC MEANS. THE SCORING TOOL USES ALGORITHMS THAT INCORPORATE DATA FROM CREDIT BUREAUS, DEMOGRAPHIC DATABASES, AND HOSPITAL SPECIFIC DATA TO INFER AND CLASSIFY PATIENTS INTO RESPECTIVE ECONOMIC MEANS CATEGORIES. INDIVIDUALS WHO EARN A CERTAIN SCORE ON THE SCORING TOOL ARE CONSIDERED TO QUALIFY AS ELIGIBLE FOR THE MOST GENEROUS FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. AS DETERMINED BY THE FILING ORGANIZATION, A NOMINAL AMOUNT OF SUCH A PATIENT'S BILL IS WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED NON-STATE CHARITY. THE AMOUNT WRITTEN OFF AS BAD DEBT EXPENSE FOR THOSE PATIENTS WHO POTENTIALLY QUALIFY AS NON-STATE CHARITY USING THE SCORING TOOL IS THE AMOUNT SHOWN ON LINE 3 OF SECTION A OF PART III. RATIONALE FOR INCLUDING CERTAIN BAD DEBTS IN COMMUNITY BENEFIT:THE FILING ORGANIZATION IS DEDICATED TO THE VIEW THAT MEDICALLY NECESSARY HEALTH CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS SHOULD BE ACCESSIBLE TO ALL, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, CULTURAL BACKGROUND, PHYSICIAN MOBILITY, OR ABILITY TO PAY. THE FILING ORGANIZATION TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THE AVAILABILITY OF THIRD-PARTY COVERAGE. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE FILING ORGANIZATION IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. AS A 501(C)(3) HOSPITAL ORGANIZATION, THE FILING ORGANIZATION MAINTAINS A 24/7 EMERGENCY ROOM PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION CANNOT BE MADE BASED UPON INFORMATION SUPPLIED BY THE INDIVIDUAL. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGE 7-8. 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 THAN 120 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL AND IS AT LEAST 30 DAYS AFTER THE NOTICE IS PROVIDED. A REASONABLE ATTEMPT IS ALSO MADE TO ORALLY NOTIFY AN INDIVIDUAL ABOUT THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FAA FORM DURING THE 240-DAY PERIOD FOLLOWING THE DATE ON WHICH THE FIRST POST-DISCHARGE BILLING STATEMENT WAS SENT TO THE INDIVIDUAL, THE HOSPITAL FILING ORGANIZATION SUSPENDS ANY REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS (OR CEASES ANY OTHER ECA'S) AND PROVIDES A WRITTEN NOTICE TO THE INDIVIDUAL DESCRIBING WHAT ADDITIONAL INFORMATION OR DOCUMENTATION IS NEEDED TO COMPLETE THE FAA FORM. THIS WRITTEN NOTICE CONTAINS CONTACT INFORMATION INCLUDING THE TELEPHONE NUMBER AND PHYSICAL LOCATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY, AS WELL AS CONTACT INFORMATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS OR, ALTERNATIVELY, A NONPROFIT ORGANIZATION OR GOVERNMENTAL AGENCY THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS IF THE HOSPITAL FACILITY IS UNABLE TO DO SO. IF AN INDIVIDUAL SUBMITS A COMPLETE FAA FORM WITHIN A REASONABLE TIME-PERIOD AS SET FORTH IN THE NOTICE DESCRIBED ABOVE, THE HOSPITAL FILING ORGANIZATION WILL SUSPEND ANY ADVERSE REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS UNTIL A FINANCIAL ASSISTANCE POLICY ELIGIBILITY DETERMINATION CAN BE MADE. SUPPLEMENTAL SCHEDULE TO SCHEDULE H, PART III, SECTION B, LINE 8 RECONCILIATION OF SCHEDULE H REPORTED MEDICARE SURPLUS/(SHORTFALL) TO UNREIMBURSED MEDICARE COSTS ASSOCIATED WITH THE PROVISION OF SERVICESTO ALL MEDICARE BENEFICIARIES:THE MEDICARE REVENUE AND ALLOWABLE COSTS OF CARE REPORTED IN SECTION B OF PART III OF SCHEDULE H ARE BASED UPON THE AMOUNTS REPORTED IN THE FILING ORGANIZATION'S MEDICARE COST REPORT IN ACCORDANCE WITH THE IRS INSTRUCTIONS FOR SCHEDULE H. ON AN ANNUAL BASIS, THE FILING ORGANIZATION ALSO DETERMINES ITS TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS. UNREIMBURSED COSTS ARE CONSIDERED A COMMUNITY BENEFIT TO THE ELDERLY AND ARE COMBINED INTO AN ANNUAL COMMUNITY BENEFIT STATEMENT PREPARED BY ADVENTHEALTH. THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO ALL MEDICARE PATIENTS ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ ( 599,518)- DIFFERENCE IN COSTING METHODOLOGY: (1,360,112)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (329,017) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITYBENEFIT REPORTING $ (2,288,647)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 CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) DURING 2013 AND 2016. IT'S 2016 CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2016, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S 2016 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 FISH MEMORIAL IS A FAITH-BASED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION WITH A MISSION OF EXTENDING THE HEALING MINISTRY OF CHRIST WITH SKILL AND COMPASSION. IT IS A 179-BED FULL-SERVICE HOSPITAL PROVIDING INPATIENT AND OUTPATIENT SERVICES AS WELL AS 24-HOUR EMERGENCY AND CRITICAL CARE. IT IS A MEMBER OF ADVENTHEALTH, THE LARGEST PROTESTANT NOT-FOR-PROFIT HOSPITAL SYSTEM IN THE NATION AND WORKS TO PROVIDE EXCEPTIONAL, PATIENT-FOCUSED CARE TO THE DEBARY, DELTONA, ORANGE CITY AND SANFORD COMMUNITIES. THE HOSPITAL IS FULLY ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS. THE HOSPITAL HAS BEEN RECOGNIZED BY FMQAI - THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION FOR FLORIDA WITH THE FMQAI PERFORMANCE ACHIEVEMENT AWARD. THIS HONOR RECOGNIZES ADVENTHEALTH FISH MEMORIAL ON ITS WORK TO IMPROVE THE QUALITY OF HEALTH CARE FOR MEDICARE BENEFICIARIES DURING THE LAST THREE YEARS. THE HOSPITAL HAS ALSO BEEN RECOGNIZED FOR THE NINTH CONSECUTIVE YEAR AMONG THE 2013 ORLANDO SENTINEL'S TOP 100 COMPANIES FOR WORKING FAMILIES.IN 2012, THE HOSPITAL WAS AWARDED A THREE-YEAR TERM IN BOTH THE ACR GOLD STANDARD OF ACCREDIATION IN BREAST MAGNETIC RESONANCE IMAGING (MRI) AND THE AMERICAN ASSOCIATION OF CARDIOVASCULAR & PULMONARY REHABILITATION RECERTIFICATION FOR THEIR PULMONARY REHAB PROGRAM. ADDITIONALLY, THE HOSPITAL ADDED A THIRD HYPERBARIC OXYGEN CHAMBER TO MEET THE GROWING PATIENT DEMAND FOR TREATMENT AND IMPLEMENTED MEDICATION POSITIVE PATIENT IDENTIFICATION TO PROVIDE A SAFER AND MORE ACCURATE PROCESS FOR ADMINISTERING MEDICATION TO PATIENTS.ORANGE CITY, FLORIDA IS LOCATED IN VOLUSIA COUNTY. THE VOLUSIA COUNTY MARKET HAS A POPULATION OF OVER 500,000, WITH AN ESTIMATED 23.2% OF THE POPULATION OVER THE AGE OF 65. THE MEDIAN HOUSEHOLD INCOME, BASED ON POPULATION, IN VOLUSIA COUNTY IS APPROXIMATELY $40,818. HIGH SCHOOL GRADUATES ACCOUNT FOR APPROXIMATELY 89% OF VOLUSIA COUNTY, WITH AN ESTIMATED 22.5% HAVING A BACHELOR'S DEGREE OR HIGHER. IT IS ESTIMATED THAT 12% OF THE FAMILIES RESIDING IN VOLUSIA COUNTY LIVE BELOW THE POVERTY LEVEL AND THE UNEMPLOYMENT RATE IS ABOUT 5%. APPROXIMATELY 57.3% OF THE HOSPITAL'S PATIENTS DURING 2018 WERE MEDICARE PATIENTS, ABOUT 11% WERE MEDICAID PATIENTS, ABOUT 7.5% WERE SELF-PAY PATIENTS, AND THE REMAINING PERCENTAGE WERE PATIENTS COVERED UNDER COMMERCIAL INSURANCE. IN 2018, ABOUT 89.5% 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 ADVENTHEALTH FISH MEMORIAL'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 $316,190 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 $8,982,369 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: THE FILING ORGANIZATION 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 44 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 11 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AS THE PARENT ORGANIZATION OF ADVENTHEALTH, AHSSHC PROVIDES EXECUTIVE LEADERSHIP AND OTHER PROFESSIONAL SUPPORT SERVICES TO ITS SUBSIDIARY ORGANIZATIONS. PROFESSIONAL SUPPORT SERVICES INCLUDE AMONG OTHERS IT, CORPORATE COMPLIANCE, LEGAL, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. CERTAIN SUPPORT SERVICES, SUCH AS HUMAN RESOURCES, PAYROLL, A/P, AND SUPPLY CHAIN MANAGEMENT ARE PROVIDED PURSUANT TO A SHARED SERVICES MODEL BY AHSSHC TO ITS SUBSIDIARY ORGANIZATIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH ADVENTHEALTH SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. EACH ADVENTHEALTH 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. 1 SUNSYSTEM DEVELOPMENT CORP DBA ADVENTHEALTH FISH MEMORIAL FOUNDATION 1055 SAXON BLVD ORANGE CITY FL 32763 592219301 501 (C)(3) 79322 BOOK GENERAL ADMINISTRATIVE SUPPORT PROVISION OF GENERAL ADMINISTRATIVE SUPPORT 1 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 X 1 1 0 1 0 0 0 0 0 0 0 OTTATI DAVID A DIR/CHAIRMAN/REGION CEO 0 648153 0 203790 0 91660 0 120077 0 49855 0 1113535 0 48808 BANKS DAVID P DIRECTOR 0 666542 0 353663 0 364980 0 125352 0 54492 0 1565029 0 87082 BIRI ABEL DIRECTOR 0 342913 0 62638 0 47977 0 27448 0 50072 0 531048 0 9531 BROWN LORENZO DIRECTOR 0 296813 0 63461 0 21761 0 32770 0 50186 0 464991 0 8012 CALLA MD SHRISH DIRECTOR (BEG 3/18) 0 263172 0 145809 0 11416 0 14849 0 21244 0 456490 0 0 DEININGER ROBERT DIRECTOR/PRESIDENT/SEC 0 339397 0 95877 0 33674 0 25866 0 43863 0 538677 0 0 OSTARLY ERIC M CFO 0 243482 0 42176 0 12170 0 25586 0 40455 0 363869 0 0 THOMAS DEBORA H REGIONAL CFO 0 423518 0 166200 0 207135 0 64588 0 52251 0 913692 0 20900 CELANO PATRICIA REGIONAL CCO 0 354377 0 82134 0 40434 0 46847 0 49191 0 572983 0 22723 JOHNSON DANIELLE C COO 0 272037 0 47170 0 47862 0 14849 0 55150 0 437068 0 0 SMITH MD LEIGHTON CMO 0 350238 0 59985 0 50782 0 14849 0 29623 0 505477 0 0 JOHNSON MICHELE CNO 0 180451 0 24552 0 8555 0 10813 0 23835 0 248206 0 0 LEE KATHERYN ASSISTANT NURSE MANAGER 70455 0 2303 0 89435 0 8340 0 15239 0 185772 0 0 0 ALFORD MARY DIRECTOR-INPATIENT NURSING 128741 0 11629 0 4339 0 7035 0 11442 0 163186 0 0 0 WILSON MAMIE PHARMACIST 116322 0 1517 0 25480 0 6914 0 7542 0 157775 0 0 0 LEAVERTON JENNIFER ASSISTANT NURSE MANAGER 70071 0 7382 0 64342 0 6750 0 14592 0 163137 0 0 0 LAZARUS JOHN SERVICE LINE DIRECTOR 122370 0 10889 0 5090 0 6603 0 12069 0 157021 0 0 0 NOSEWORTHY G EDWARD FORMER CEO 0 437739 0 129642 0 340021 0 78927 0 30163 0 1016492 0 59186 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 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 44 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-12 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 CEO FOR ADVENTHEALTH'S CENTRAL FLORIDA DIVISION NORTH REGION IS A MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION. THE REGIONAL CEO IS CONSIDERED A COMMON LAW EMPLOYEE OF AND IS 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: A NOMINAL DISCRETIONARY SPENDING AMOUNT WAS PROVIDED IN THE CURRENT YEAR TO ALL ELIGIBLE EXECUTIVES WHO ATTEND THE ANNUAL ADVENTHEALTH PRESIDENT'S COUNCIL BUSINESS MEETING ($500 PER EXECUTIVE) OR THE ANNUAL ADVENTHEALTH CFO CONFERENCE OR CMO/CNO BUSINESS MEETING ($300 PER EXECUTIVE). OTHER DISCRETIONARY SPENDING ACCOUNTS MAY BE PROVIDED IN CONNECTION WITH OTHER ADVENTHEALTH SPONSORED CONFERENCES BUT TYPICALLY DO NOT EXCEED $200 PER PARTICIPANT. THE PAYMENT PROVIDED TO EACH EXECUTIVE WAS CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. PART I, LINE 3 THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) FOR THAT INDIVIDUAL'S ROLE IN SERVING AS THE CEO. COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC HAS TAKEN STEPS TO ENSURE THAT PROCESSES ARE IN PLACE TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS STANDARD AS SET FORTH IN TREASURY REGULATION 53.4958-6 WITH RESPECT TO ITS ACTIVE EXECUTIVE-LEVEL POSITIONS. THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE) SERVES AS THE GOVERNING BODY FOR ALL EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE IS COMPOSED OF CERTAIN MEMBERS OF THE BOARD OF DIRECTORS (THE BOARD) OF AHSSHC. VOTING MEMBERS OF THE COMMITTEE INCLUDE ONLY INDIVIDUALS WHO SERVE ON THE BOARD AS INDEPENDENT REPRESENTATIVES OF THE COMMUNITY, WHO HOLD NO EMPLOYMENT POSITIONS WITH AHSSHC AND WHO DO NOT HAVE RELATIONSHIPS WITH ANY OF THE INDIVIDUALS WHOSE COMPENSATION IS UNDER THEIR REVIEW THAT IMPACTS THEIR BEST INDEPENDENT JUDGMENT AS FIDUCIARIES OF AHSSHC. THE COMMITTEE'S ROLE IS TO REVIEW AND APPROVE ALL COMPONENTS OF THE EXECUTIVE COMPENSATION PLAN OF AHSSHC. AS AN INDEPENDENT GOVERNING BODY WITH RESPECT TO EXECUTIVE COMPENSATION, IT SHOULD BE NOTED THAT THE COMMITTEE WILL OFTEN CONFER IN EXECUTIVE SESSIONS ON MATTERS OF COMPENSATION POLICY AND POLICY CHANGES. IN SUCH EXECUTIVE SESSIONS, NO MEMBERS OF MANAGEMENT OF AHSSHC ARE PRESENT. THE COMMITTEE IS ADVISED BY AN INDEPENDENT THIRD PARTY COMPENSATION ADVISOR. THIS ADVISOR PREPARES ALL THE BENCHMARK STUDIES FOR THE COMMITTEE. COMPENSATION LEVELS ARE BENCHMARKED WITH A NATIONAL PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS OF SIMILAR SIZE AND COMPLEXITY TO ADVENTHEALTH AND EACH OF ITS AFFILIATED ENTITIES. THE FOLLOWING PRINCIPLES GUIDE THE ESTABLISHMENT OF INDIVIDUAL EXECUTIVE COMPENSATION: - THE SALARY OF THE PRESIDENT/CEO OF ADVENTHEALTH WILL NOT EXCEED THE 50TH PERCENTILE OF COMPARABLE SALARIES PAID BY SIMILARLY SITUATED ORGANIZATIONS; AND - OTHER EXECUTIVE SALARIES SHALL BE ESTABLISHED USING MARKET MEDIANS. THE COMPENSATION PHILOSOPHY, POLICIES, AND PRACTICES OF AHSSHC ARE CONSISTENT WITH THE ORGANIZATION'S FAITH-BASED MISSION AND CONFORM TO APPLICABLE LAWS, REGULATIONS, AND BUSINESS PRACTICES. AS A FAITH-BASED ORGANIZATION SPONSORED BY THE SEVENTH-DAY ADVENTIST CHURCH (THE CHURCH), AHSSHC'S PHILOSOPHY AND PRINCIPLES WITH RESPECT TO ITS EXECUTIVE COMPENSATION PRACTICES REFLECT THE CONSERVATIVE APPROACH OF THE CHURCH'S MISSION OF SERVICE AND WERE DEVELOPED IN COUNSEL WITH THE CHURCH'S LEADERSHIP. PART I, LINE 4B AS DISCUSSED IN LINE 1A ABOVE, EXECUTIVES ON THE FILING ORGANIZATION'S MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF 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 $250,000. 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 SEDB CY EMPLOYER CY CONTRIB./ DISTR.* DISTR. CONTRIB. DISTR.* PAYMENT --------------------------------------------------------------------------- OTTATI, DAVID $105,873 $ 62,888 $ 0 $ 0 $ 0 BANKS, DAVID $110,503 $ 88,189 $235,945 $ 0 $ 0 BIRI, ABEL $ 29,599 $ 9,643 $ 0 $ 0 $ 0 BROWN, LORENZO $ 17,921 $ 8,104 $ 0 $ 0 $ 0 DEININGER, ROBERT $ 29,517 $ 0 $ 0 $ 0 $ 0 THOMAS, DEBORA $ 49,739 $ 21,143 $159,175 $ 0 $ 0 CELANO, PATRICIA $ 37,498 $ 25,598 $ 0 $ 0 $ 0 JOHNSON, DANIELLE $ 13,978 $ 0 $ 0 $ 0 $ 0 SMITH, LEIGHTON $ 43,016 $ 43,016 $ 0 $ 0 $ 0 NOSEWORTHY, EDWARD $ 64,078 $ 70,922 $235,726 $ 0 $ 0 OSTARLY, ERIC $ 11,549 $ 0 $ 0 $ 0 $ 0 * INCLUDING INVESTMENT EARNINGS PART V, LINE 1A: THE PARENT CORPORATION AND SOLE TOP-TIER MEMBER OF SOUTHWEST VOLUSIA HEALTHCARE CORPORATION (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 JEFF RITCHEY AND VISHAL GUPTA, MD - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 SOUTHWEST VOLUSIA HEALTHCARE CORPORATION (SVHC) HAS ONE MEMBER. THE SOLE MEMBER OF SVHC IS ADVENTIST HEALTH SYSTEM SUNBELT, INC. ADVENTIST HEALTH SYSTEM SUNBELT, INC. (AHSS) IS A FLORIDA, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN SVHC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF SVHC IS AHSS. THE BOARD OF DIRECTORS OF SVHC ARE APPOINTED BY THE SOLE MEMBER, AHSS, WHO HAS THE RIGHT TO ELECT, APPOINT OR REMOVE ANY MEMBER OF THE BOARD OF DIRECTORS OF SVHC. FORM 990, PART VI, SECTION A, LINE 7B AHSS, AS THE SOLE MEMBER OF THE FILING ORGANIZATION, HAS CERTAIN RESERVED POWERS AS SET FORTH IN THE BYLAWS OF THE FILING ORGANIZATION. THESE RESERVED POWERS INCLUDE THE FOLLOWING: A) TO APPOINT AND REMOVE THE DIRECTORS AND ALL OFFICERS AND ADMINISTRATORS OF THE FILING ORGANIZATION, AND THEIR SALARIES; B) TO ADOPT, AMEND, RESTATE, AND REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS OF THE FILING ORGANIZATION AND THE MEDICAL STAFF BYLAWS; C) TO SET LIMITS AND TERMS FOR THE BORROWING OF FUNDS; D) TO APPROVE OR DISAPPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION; E) TO DIRECT THE PLACEMENT OF FUNDS AND CAPITAL OF THE FILING ORGANIZATION; F) TO APPROVE OR DISAPPROVE CERTAIN PURCHASES OR SALES OF PERSONAL PROPERTY OR REAL PROPERTY EQUAL TO OR IN EXCESS OF ESTABLISHED DOLLAR THRESHOLDS; G) TO ESTABLISH GENERAL GUIDING POLICIES, TO IMPLEMENT QUALITY ASSESSMENT, IMPROVEMENT AND UTILIZATION REVIEW PROGRAMS; AND H) TO APPROVE THE APPOINTMENT OF AN AUDITING FIRM AND ELECTION OF THE FISCAL YEAR FOR 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, BOARD FINANCE COMMITTEE CHAIR, CEO AND BY THE CFO PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND THE CFO DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR ANY PRINCIPAL OFFICER OF THE FILING ORGANIZATION (I.E. INTERESTED PERSONS) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION'S CEO, OTHER OFFICERS AND 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 (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 AS AN EMPLOYEE OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION. 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, LINE 7C: THE AMOUNT SHOWN IN PART VIII, LINE 7C(I) OF THE FORM 990 REPRESENTS AN ALLOCATED SHARE OF CAPITAL GAIN/(LOSS) FROM A SYSTEM WIDE, CORPORATE ADMINISTERED, INVESTMENT PROGRAM. FORM 990, PART IX, LINE 11G PAYMENTS TO HEALTHCARE PROFESSIONALS: PROGRAM SERVICE EXPENSES 6,136,736. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,136,736. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 308,997. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 308,997. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 11,986,627. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,986,627. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 36,902. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,902. TRANSCRIPTION SERVICES: PROGRAM SERVICE EXPENSES 105,294. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 105,294. RECRUITING: PROGRAM SERVICE EXPENSES 58,017. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 58,017. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 8,725,478. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,725,478. AHS MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,152,783. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,152,783. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 515,722. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 515,722. AHS SHARED SERVICE FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,348,062. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,348,062. FORM 990, PART XI, LINE 9: ALLOCATION TO TAX-EXEMPT PARENT WITH RESPECT TO DEBT -178,482. TRANSFER TO TAX-EXEMPT PARENT -1,480,683. TRANSFER TO TAX-EXEMPT TOP-TIER PARENT -2,044,695. ROUNDING 2. PART X, LINE 2: THE AMOUNTS SHOWN ON LINE 2 OF PART X OF THIS RETURN INCLUDES 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. WEST VOLUSIA FLORIDA PROPERTIES LLC 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 812513648 INACTIVE FL 0 0 SOUTHWEST VOLUSIA HEALTHCARE CORPORATION 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 UNIVERSITY INC FKA ADV UNIV OF HLTH SCIENCES 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 RANSOM MEMORIAL INC (619-123118) 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 ADVENTIST BOLINGBROOK HOSPITAL 500 REMINGTON BLVD BOLINGBROOK IL 60440 651219504 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST MIDWEST HEALTH 1 ADVENTIST CARE CENTERS - COURTLAND INC 730 COURTLAND STREET ORLANDO FL 32804 205774723 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC 1 ADVENTIST GLENOAKS HOSPITAL 701 WINTHROP AVENUE GLENDALE HEIGHTS IL 60139 363208390 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST MIDWEST HEALTH 1 ADVENTIST HLTH MID-AMERICA INC 9100 W 74TH STREET SHAWNEE MISSION KS 66204 521347407 SUPPORT OF AFFILIATED HOSPITAL KS 501(C)(3) LINE 12C, III-FI ADVENTIST HLTH SYSTEMSUNBELT INC 1 ADVENTIST HLTH PARTNERS INC 2601 NAVISTAR DR BLDG 4 FINANCE LISLE IL 60532 364138353 OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES IL 501(C)(3) LINE 3 AHS MIDWEST MANAGEMENT INC 1 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 592170012 MANAGEMENT SERVICES FL 501(C)(3) LINE 12A, I N/A 0 ADVENTIST HLTH SYSTEM GEORGIA INC 1035 RED BUD ROAD CALHOUN GA 30701 581425000 OPERATION OF HOSPITAL & RELATED SERVICES GA 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 ADVENTIST HLTH SYSTEMSUNBELT INC 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 591479658 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 ADVENTIST HLTH SYSTEMTEXAS INC 11801 S FREEWAY BURLESON TX 76028 742578952 LEASING PERSONNEL TO AFFILIATED HOSPITAL TX 501(C)(3) LINE 12C, III-FI ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 ADVENTIST MIDWEST HEALTH 120 NORTH OAK STREET HINSDALE IL 60521 362276984 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 AHP SPECIALTY CARE NFP 2601 NAVISTAR DR BLDG 4 FINANCE LISLE IL 60532 811105774 OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES IL 501(C)(3) LINE 3 AHS MIDWEST MANAGEMENT INC 1 AHS MIDWEST MANAGEMENT INC 2601 NAVISTAR DR BLDG 4 FINANCE LISLE IL 60532 363354567 OPERATION OF PHYSICIAN PRACTICE MGMT IL 501(C)(3) LINE 12A, I ADVENTIST MIDWEST HEALTH 1 AHSCENTRAL TEXAS INC 1301 WONDER WORLD DRIVE SAN MARCOS TX 78666 742621825 PROVIDE OFFICE SPACE - MEDICAL PROFESSIONALS TX 501(C)(3) LINE 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