2019-09-30T10:15:04-05:00 2018-12-31 346565596 ERNST & YOUNG US LLP 201 NORTH FRANKLIN STREET SUITE 2400 TAMPA FL 33602 990 2018-01-01 050615150 BAYCARE ALLIANT HOSPITAL INC BAYC 7277346782 601 MAIN STREET DUNEDIN FL 34698 MELANIE A MCPEAK FINANCE MANAGER 7277346782 2019-09-30 1 MELANIE MCPEAK P01346034 8132254800 73.184.197.104 2019-09-30 10:13:13 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 66FC02D03DBAC7EA2C5C7B5513D8D7164FCFC484 2018 2019-02-21 02:37:17Z MARCI METZLER 601 MAIN STREET DUNEDIN FL 34698 17464460 0 X SEE SCHEDULE O X 2004 FL ALLIANT HOSPITAL WILL PROVIDE EXCELLENCE IN CARE FOR PATIENTS WITH PROLONGED ILLNESSES RECOGNIZING THAT OPTIMUM HEALING REQUIRES A TEAM APPROACH TO BOTH MEDICAL AND HUMAN VALUES. 7 7 1 12 0 1741 3132 2835 19610620 17445172 0 12840 2030 3613 19615782 17464460 0 0 0 0 8391475 8750065 0 0 0 10828450 10547860 19219925 19297925 395857 -1833465 8150178 5349182 6971905 6004371 1178273 -655189 BAYCARE ALLIANT HOSPITAL, INC. WILL PROVIDE EXCELLENCE IN CARE FOR PATIENTS WITH PROLONGED ILLNESSES RECOGNIZING THAT OPTIMUM HEALING REQUIRES A TEAM APPROACH TO BOTH MEDICAL AND HUMAN VALUES. 0 0 17001751 0 17448785 BAYCARE ALLIANT HOSPITAL, INC. (BAH) IS A 48 BED, LONG-TERM ACUTE CARE HOSPITAL. DURING 2018, BAH PROVIDED INPATIENT CARE TO 361 PATIENTS AND THE AVERAGE LENGTH OF STAY WAS 28.1 DAYS. THROUGH EFFORTS OF THE MEDICAL ASSISTANCE PROGRAM AND THE HOSPITAL'S CHARITY CARE PROGRAM BAH SAW A NET COMMUNITY BENEFIT EXPENSE OF $842,403. REFER TO SCHEDULE H FOR ADDITIONAL INFORMATION. 17001751 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 X 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X MARCI METZLER FINANCE MANAGER 7277346782 2985 DREW STREET CLEARWATER FL 33759 BRUCE BOKOR TRUSTEE 1.00 0.00 X 0 0 0 KEN HAMILTON TRUSTEE 1.00 0.00 X 0 0 0 ALAN HOLDERITH TRUSTEE/CHAIRMAN 1.00 0.00 X X 0 0 0 CHARLES ROBINSON TRUSTEE/SECRETARY 1.00 0.00 X X 0 0 0 PATRICIA SIZEMORE TRUSTEE VP,PATIENT CARE SVCS TILL JULY 1.00 0.00 X 0 0 0 RONALD BEAMON TRUSTEE EFF SEP VP/CFO HOSPITAL DIV 1.00 0.00 X 0 0 0 GLENN WATERS TRUSTEE/PRES/EVP BAYCARE HOSP DIV 1.00 0.00 X 0 0 0 SU REYNARD-SURIANO TRUSTEE EFF FEBRUARY 1.00 0.00 X 0 0 0 JACQUELINE AROCHO ADMINISTRATOR ALLIANT HOSP 45.00 0.00 X 249188 0 9439 MARCI METZLER FINANCE MANAGER 45.00 0.00 X 0 0 0 249188 0 9439 1 0 1 0 MEASE DUNEDIN HOSPITAL INC 601 MAIN ST MS 403 DUNEDIN FL 34698 PHARMACY/ANCILLARY SERVICES 5184026 BAYCARE HEALTH SYSTEM INC 2985 DREW ST CLEARWATER FL 33759 MANAGEMENT FEES 1239002 DVA HEALTHCARE RENAL CARE INC PO BOX 8500-1607 PHILADELPHIA PA 19178 DIALYSIS SERVICES 368436 BAYCARE HOME CARE INC 8452 118TH AVE N LARGO FL 33773 EQUIPMENT RENTALS 227064 LEONARD J DUNN 3201 LEPRECHAUN LN PALM HARBOR FL 34683 PHYSICIAN SERVICES 140499 6 2835 2835 MEDICARE/MEDICAID PAYM 621990 12735775 12735775 HOSPITAL PATIENT CARE 621990 4709397 4709397 17445172 12840 12840 OTHER REVENUE 621990 3613 3613 3613 17464460 17448785 0 12840 258626 258626 6879591 6494698 384893 243025 229428 13597 863631 815313 48318 505192 465337 39855 900017 900017 13121 13121 9709 9709 1236 1236 978523 899480 79043 24370 24370 354501 287452 67049 40893 35928 4965 1146341 1127411 18930 64714 36587 28127 109490 109490 179053 173707 5346 154718 128347 26371 PURCHASED SERVICES 3521595 3521595 MEDICAL SUPPLIES 2239501 2239501 MISCELLANEOUS 410536 46202 364334 ASSESSMENTS 298637 298637 100905 91402 9503 19297925 17001751 2296174 0 4630706 2398108 2192843 1756483 87779 88041 1686895 745615 1070722 941280 15959 16253 32732 29458 119437 119559 8150178 5349182 262757 296550 4292189 3693279 2416959 2014542 6971905 6004371 X 1178273 -655189 1178273 -655189 8150178 5349182 X -1833465 3 X 0 1 X 1 0 X 0 1 0 0 0 0 1 6500 0 1 1236 7736 0 PART II-B, LINE 1B, 1G AND 1I LINE 1B, 1G LOBBYING ACTIVITES PERFORMED BY AN EMPLOYEE CONCERNING HEALTHCARE ISSUES. LINE 1I DUES WERE PAID TO THE NATIONAL ASSOCIATION FOR LONG TERM HOSPITALS. THIS ASSOCIATION USES A PORTION OF ITS DUES TO CONDUCT LOBBYING ACTIVITIES. 258128 54702 203426 1427327 690913 736414 1440 1440 941280 DEFERRED COMPENSATION PLAN 119559 EST THIRD PARTY SETTLEMENTS 630 DUE TO AFFILIATES 1894353 2014542 X 17376576 80 80 17376496 87964 87964 17464460 19225792 79 79 19225713 72212 72212 19297925 PART X, LINE 2: MANAGEMENT BELIEVES THAT ALL TAX POSITIONS TAKEN WITH RESPECT TO EXEMPT STATUS ISSUES AND UBTI ISSUES, IF EXAMINED BY THE IRS WITH FULL KNOWLEDGE OF ALL MATERIAL FACTS, ARE MORE LIKELY THAN NOT TO BE SUSTAINED. THEREFORE, THE FULL BENEFITS OF THE TAX POSITIONS TAKEN ARE RECOGNIZED IN THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: GRANTS 79. ROUNDING 1. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 72,210. DONATIONS 2,914. INVESTMENT INCOME 12,840. PART XII, LINE 2D - OTHER ADJUSTMENTS: GRANTS 79. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 72,210. ROUNDING 2. 1 1 1 X 250.000000000000 0 1 1 1 0 0 30048 0 30048 0.00160 1289494 564242 725252 0.03770 1319542 564242 755300 0.03930 43588 0 43588 0.00230 32420 0 32420 0.00170 466 0 466 0.00000 10629 0 10629 0.00060 87103 87103 0.00460 1406645 564242 842403 0.04390 1 72210 56016 7897167 8536954 -639787 X 1 1 1 1 BAYCARE ALLIANT HOSPITAL 601 MAIN STREET DUNEDIN FL 34698 WWW.BAYCARE.ORG/ALLIANT-HOSPITAL 4492 X ACUTE LTC HOSPITAL BAYCARE ALLIANT HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 1 0 1 X SEE PART V, PAGE 8 1 16 0 1 0 1 X 250.000000000000 0.000000000000 X X X X X X 1 1 X X X 1 X HTTPS://BAYCARE.ORG/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE X HTTPS://BAYCARE.ORG/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE X HTTPS://BAYCARE.ORG/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 0 X X 0 0 BAYCARE ALLIANT HOSPITAL PART V, SECTION B, LINE 5: TO SOLICIT INPUT FROM KEY INFORMANTS, THOSE INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY, AN ONLINE KEY INFORMANT SURVEY WAS ALSO IMPLEMENTED AS PART OF THIS PROCESS. A LIST OF RECOMMENDED PARTICIPANTS WAS PROVIDED BY BAYCARE ALLIANT HOSPITAL; THIS LIST INCLUDED NAMES AND CONTACT INFORMATION FOR PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND A VARIETY OF OTHER COMMUNITY LEADERS. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. KEY INFORMANTS WERE CONTACTED BY EMAIL, INTRODUCING THE PURPOSE OF THE SURVEY AND PROVIDING A LINK TO TAKE THE SURVEY ONLINE; REMINDER EMAILS WERE SENT AS NEEDED TO INCREASE PARTICIPATION. IN ALL, 55 COMMUNITY STAKEHOLDERS IN THE BAYCARE ALLIANT HOSPITAL SERVICE AREA TOOK PART IN THE ONLINE KEY INFORMANT SURVEY, AS OUTLINED ON PAGE 8 OF THE CHNA. SEVERAL OF THE PARTICIPANTS RESPONDING TO THE SURVEY REPRESENT ORGANIZATIONS WHICH WORK WITH LOW-INCOME, MINORITY OR OTHER MEDICALLY UNDERSERVED POPULATIONS. BAYCARE ALLIANT HOSPITAL PART V, SECTION B, LINE 6A: CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES:1. ST. ANTHONY'S HOSPITAL2. MORTON PLANT HOSPITAL ASSOCIATION3. TRUSTEES OF MEASE4. ST. JOSEPH'S HOSPITAL5. SOUTH FLORIDA BAPTIST HOSPITAL BAYCARE ALLIANT HOSPITAL PART V, SECTION B, LINE 11: WHILE 9 AREAS OF OPPORTUNITY WERE IDENTIFIED WITHIN BAYCARE ALLIANT HOSPITAL SERVICE AREA, CONCENTRATED EFFORTS WILL BE DEDICATED DURING THE 2017-2019 TIME PERIOD TO ADDRESSING THE FOLLOWING SIGNIFICANT HEALTH NEEDS OF OUR COMMUNITY AS IDENTIFIED IN THE MOST RECENT CHNA: - ACCESS TO HEALTHCARE SERVICES - DEMENTIA (INCLUDING ALZHEIMER'S DISEASE) - DIABETES - HEART DISEASE & STROKE - MENTAL HEALTH - ORAL HEALTH - POTENTIALLY DISABLING CONDITIONSPLEASE SEE THE ATTACHED IMPLEMENTATION PLAN FOR SPECIFIC ACTIVITIES THAT ARE UNDERWAY TO ADDRESS THESE SIGNIFICANT HEALTH NEEDS DURING THE 2017-2019 TIME PERIOD.BASED ON THE SCOPE/SCALE OF THE ISSUE, BAYCARE ALLIANT HOSPITAL LEADERSHIP'S PERCEIVED ABILITY TO IMPACT THE ISSUE, THE AVAILABILITY OF EXISTING COMMUNITY RESOURCES ALREADY IN PLACE TO ADDRESS THE ISSUE AND CONSIDERING COMMUNITY STAKEHOLDER FEEDBACK, THE SIGNIFICANT HEALTH NEEDS IDENTIFIED DURING THE 2016 ASSESSMENT THAT ARE NOT DIRECTLY REFERENCED IN THE 2017-2019 CHNA IMPLEMENTATION STRATEGY, ARE LISTED BELOW:CANCER WHILE NO NEW ACTIVITIES ARE NOTED WITHIN THE CYCLE-2 CHNA IMPLEMENTATION PLAN SPECIFICALLY RELATED TO CANCER, BAYCARE ALLIANT HOSPITAL REMAINS COMMITTED TO SUPPORTING THOSE AFFECTED BY CANCER. BAYCARE ALLIANT HOSPITAL'S LEADERSHIP BELIEVES THAT EXISTING HOSPITAL INITIATIVES AND NEW EFFORTS OUTLINED HEREIN TO IMPROVE ACCESS TO HEALTH SERVICES WILL HAVE A POSITIVE IMPACT ON AIDING THOSE AFFECTED BY CANCER AND THAT A SEPARATE SET OF INITIATIVES WAS NOT NECESSARY AT THIS TIME.SUBSTANCE ABUSEBAYCARE ALLIANT HOSPITAL HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS SUBSTANCE ABUSE. OTHER COMMUNITY ORGANIZATIONS (INCLUDING RESOURCES WITHIN THE BAYCARE HEALTH SYSTEM) HAVE INFRASTRUCTURE IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. BAYCARE ALLIANT HOSPITAL PART V, SECTION B, LINE 13B: PATIENTS MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE ON THE FULL BALANCE OF THEIR ACCOUNT IF THE HOSPITAL BILL EXCEEDS 25% OF THEIR ANNUAL INCOME. BAYCARE ALLIANT HOSPITAL PART V, SECTION B, LINE 18E: LIEN ACTION RELATED TO COLLECTIONS IS LIMITED TO PATIENTS INVOLVING AUTO LIABILITY INSURANCE. PART V, SECTION B, LINE 7A HTTPS://BAYCARE.ORG/HOSPITALS/BAYCARE-ALLIANT-HOSPITAL/ABOUT-US/COMMUNITY-HEALTH-NEEDS PART I, LINE 3C: PATIENTS WHO ARE UNINSURED OR UNDERINSURED AND CANNOT PAY FOR HOSPITAL SERVICES ARE ELIGIBLE FOR CHARITY CONSIDERATION. THESE PATIENTS ARE SCREENED BY DESIGNATED TEAM MEMBERS IN OUR FINANCIAL ASSISTANCE DEPARTMENT. THE AGENCY FOR HEALTH CARE ADMINISTRATION (AHCA) DEFINES CHARITY ELIGIBILITY AT 200 PERCENT OF THE FEDERAL POVERTY GUIDELINES, UNLESS THE TOTAL HOSPITAL BILL IS MORE THAN 25 PERCENT OF THE PATIENT'S ANNUAL INCOME. MEDICAID RECIPIENTS WHO HAVE EXCEEDED THEIR COVERAGE LIMITS ARE ALSO CONSIDERED FOR CHARITY CARE. BAYCARE ALLIANT HOSPITAL, INC GOES ABOVE AND BEYOND THE AHCA REQUIREMENTS BY PROVIDING ADDITIONAL "HARDSHIP" CHARITY FOR PATIENTS WHO ARE AT 250 PERCENT OF THE FEDERAL POVERTY GUIDELINES. IN ADDITION, AN UNINSURED DISCOUNT OF 40% IS AUTOMATICALLY GIVEN TO ANY PATIENT WHO DOES NOT HAVE INSURANCE COVERAGE OR BENEFITS. THERE IS NO INCOME OR ASSET TEST REQUIRED FOR THE UNINSURED DISCOUNT. PATIENTS RECEIVE AN ADDITIONAL 10% DISCOUNT IF THE ACCOUNT IS PAID WITHIN 30 DAYS. PART I, LINE 7: FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS COSTS (LINES A THROUGH D) ARE DETERMINED USING OUR COST ACCOUNTING SYSTEM, WHICH CAPTURES ALL INPATIENTS AND OUTPATIENTS, INCLUDING EMERGENCY ROOM PATIENTS. THE SYSTEM ALSO CAPTURES ALL PATIENT PAY TYPES - PRIVATE INSURANCE, MEDICARE, MEDICAID, UNINSURED AND SELF-PAY. THE COSTS HAVE BEEN OFFSET BY ANY PAYMENTS RECEIVED FROM MEDICAID OR ANY OTHER UNCOMPENSATED CARE PROGRAM. OTHER BENEFITS AT COST (LINES E THROUGH J, AS WELL AS AMOUNTS REPORTED IN PART II) WERE COMPILED BY THE COMMUNITY HEALTH DEPARTMENT USING THE CATHOLIC HEALTH ASSOCIATION GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $72,210 WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. PART III, LINE 2: BAD DEBT EXPENSE IS REPORTED AS TOTAL BAD DEBT FOR THE FACILITY. THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE IS CALCULATED AS A CHARGE RATIO, DERIVED FROM DATA SAMPLING. THE RESULTING CHARGE RATIO IS THEN APPLIED TO TOTAL BAD DEBT ACCOUNTS OF THE ORGANIZATION, WHICH CALCULATES THE BAD DEBT ATTRIBUTABLE TO FINANCIAL ASSISTANCE. THE STATE OF FLORIDA REQUIRES THE PATIENT TO PROVIDE CERTAIN DOCUMENTATION IN ORDER TO QUALIFY FOR FINANCIAL ASSISTANCE. IN CASES WHERE THE PATIENT HAS NOT RESPONDED TO HOSPITAL REQUESTS OR BILLING STATEMENT ALERTS, THOSE ACCOUNTS ARE PROCESSED AS BAD DEBT, IF UNPAID. PART III, LINE 3: SEE PART III, LINE 2 PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS INCLUDE A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE ON PAGE 8 OF THE BAYCARE ALLIANT HOSPITAL, INC. NOTES TO FINANCIAL STATEMENTS. PART III, LINE 8: COST REPORTS WERE USED TO REPORT MEDICARE ALLOWABLE COSTS. MEDICARE DEFINES ALLOWABLE COSTS AS THOSE APPROPRIATE AND HELPFUL IN DEVELOPING AND MAINTAINING THE OPERATION OF PATIENT CARE FACILITIES AND ACTIVITIES. IT SPECIFICALLY EXCLUDES CERTAIN COSTS THAT ARE NOT DIRECTLY RELATED TO PATIENT CARE. THE HOSPITAL INCURS ADDITIONAL EXPENSE RELATED TO THE PROVISION OF CARE TO MEDICARE PATIENTS THAT MEDICARE HAS DEEMED NON-ALLOWABLE. THIS ADDITIONAL EXPENSE INCLUDES COSTS OF PHYSICIAN SERVICES (EMERGENCY ON-CALL FEES, HOSPITALIST PROGRAM, RECRUITMENT, ETC.), ADVERTISING COSTS, CAFETERIA COSTS FOR MEALS SOLD TO VISITORS, ETC. THE HOSPITAL ATTEMPTS TO COLLECT COINSURANCE AND DEDUCTIBLES FROM MEDICARE BENEFICIARIES. TO THE EXTENT COLLECTION EFFORTS ARE UNSUCCESSFUL, MEDICARE REIMBURSES THE HOSPITAL AT 65% OF UNPAID AMOUNTS. THE FOLLOWING TABLE RECONCILES THE SURPLUS OR SHORTFALL FROM LINE 7 TO THE ACTUAL SURPLUS OR SHORTFALL. THE ADDITIONAL COSTS WERE ALLOCATED TO MEDICARE BASED UPON MEDICARE'S PERCENTAGE OF TOTAL ALLOWABLE COSTS. THE UNPAID COINSURANCE/DEDUCTIBLES WERE ESTIMATED USING HISTORICAL COLLECTION RESULTS. ANY SHORTFALL AMOUNTS HAVE NOT BEEN TREATED AS COMMUNITY BENEFIT. - LINE 7 SURPLUS OR (SHORTFALL) ($639,787) - ADDITIONAL NON-ALLOWABLE COSTS AND UNPAID/NON-REIMBURSED COINSURANCE/DEDUCTIBLES ($187,635) - TOTAL SURPLUS OR (SHORTFALL) ($827,422) PART III, LINE 9B: PATIENTS WHO ARE UNABLE TO PAY ARE ENCOURAGED BY BAYCARE HEALTH SYSTEM REPRESENTATIVES, VIA PERSONAL INTERVIEWS, SIGNAGE, ON PATIENT BILLING STATEMENTS, BROCHURES OR CUSTOMER SERVICE PHONE CALLS, TO SUBMIT FINANCIAL INFORMATION TO THE FINANCIAL ASSISTANCE DEPARTMENT TO DETERMINE ELIGIBILITY FOR PROGRAMS, SUCH AS COUNTY, MEDICAID, DISABILITY, VICTIMS OF CRIME, CHARITY, ETC. FOR THOSE PATIENTS WHO PROVIDE ALL THE NECESSARY DOCUMENTATION AND QUALIFY FOR CHARITY ACCORDING TO THE FINANCIAL ASSISTANCE POLICY, (DEFINED IN PART I, LINE 3C), THE PATIENT'S ACCOUNT BALANCE WOULD BE WRITTEN OFF COMPLETELY TO CHARITY AND NOT BILLED TO THE PATIENT. PART VI, LINE 2: BAYCARE ALLIANT HOSPITAL, INC IS COMMITTED TO MEETING THE NEEDS OF THE COMMUNITY IT SERVES. OUR QUALITY PHILOSOPHY IS MODELED AROUND UNDERSTANDING OUR CUSTOMERS' NEEDS IN THE COMMUNITIES IT SERVES. BAYCARE ALLIANT HOSPITAL, INC ADDRESSES COMMUNITY HEALTH STATUS ASSESSMENTS BY ACCESSING EXISTING THIRD PARTY DATABASES PROFILING HEALTH STATUSINFORMATION FOR GEOGRAPHIES IT SERVES. THE ASSESSMENTS PROVIDE A PROFILE OF HEALTH STATUS INDICATORS IN COMPARISON TO STATE AVERAGES AND, IF AVAILABLE, NATIONAL BENCHMARKS.IN ADDITION, BAYCARE ALLIANT HOSPITAL, INC CONDUCTS PHYSICIAN COMMUNITY NEED STUDIES THAT OUTLINE PHYSICIAN DEFICITS BY SPECIALTY FOR THE GEOGRAPHIC AREA SERVED. STUDIES ARE ALSO CONDUCTED TO IDENTIFY GAPS IN GEOGRAPHIC ACCESS TO SERVICES SUCH AS PRIMARY CARE, OUTPATIENT SERVICES AND INPATIENT SERVICES. ALL OF THE ABOVE PROCESSES OCCUR ON AN ONGOINGBASIS TO ASSIST BAYCARE ALLIANT HOSPITAL, INC IN DEVELOPING INITIATIVES AND PROGRAMS/SERVICES TO ADDRESS IDENTIFIED HEALTH CARE NEEDS IN THE COMMUNITIES IT SERVES. PART VI, LINE 3: BAYCARE ALLIANT HOSPITAL, INC FINANCIAL ASSISTANCE TEAM MEMBERS ARE DEDICATED TO ASSISTING PATIENTS IN OBTAINING ASSISTANCE THROUGH FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS OR THROUGH THE BAYCARE HEALTH SYSTEM, INC FINANCIAL ASSISTANCE POLICY. SIGNAGE AND BROCHURES ARE AVAILABLE, AS WELL AS TEAM MEMBERS WHOSE FULL RESPONSIBILITY IS TO ASSIST PATIENTS IN THE EMERGENCY ROOM AND ON INPATIENT UNITS. THE FINANCIAL ASSISTANCE TEAM INTERVIEWS PATIENTS FOR ALL AVAILABLE PROGRAMS, ASSISTS THE PATIENTS IN COMPLETING APPLICATIONS TO GOVERNMENT AGENCIES AND FOR HOSPITAL CHARITY CARE, ADVISES PATIENTS REGARDING AVAILABLE COMMUNITY RESOURCES FOR HEALTH CARE, REVIEWS AND APPROVES PATIENT REQUESTS FOR CHARITY CARE, AND PROVIDES EDUCATION AND SUPPORT TO THE PATIENT THROUGHOUT THE ASSISTANCE PROCESS.IN ADDITION TO THE AFOREMENTIONED COMPREHENSIVE PROCESS, BAYCARE ALLIANT HOSPITAL, INC ALSO INFORMS AND EDUCATES PATIENTS WHO MAY BE BILLED FOR PATIENT CARE, BUT MAY BE ELIGIBLE FOR CHARITY OR OTHER PROGRAMS, VIA PATIENT BILLING STATEMENTS AND CUSTOMER SERVICE REPRESENTATIVE CALLS. THE GOAL IN USING THESE VARIOUS MEANS IS TO EFFECTIVELY COMMUNICATE WITH THE ENTIRE PATIENT POPULATION SO THEY ARE INFORMED AND EDUCATED ABOUT THEIR ELIGIBILITY FOR ASSISTANCE. PART VI, LINE 4: BAYCARE ALLIANT HOSPITAL IS A LONG TERM ACUTE CARE (LTAC) FACILITY SERVING PARTS OF HILLSBOROUGH, PASCO AND PINELLAS COUNTIES. THE AVERAGE HOUSEHOLD INCOME IN THIS AREA IS $8,655 LOWER THAN THE STATE AVERAGE AND $18,399 BELOW THE NATIONAL AVERAGE. THOSE HOUSEHOLDS WITH INCOMES BELOW $15,000 REPRESENT 10.9% OF THE HOUSEHOLDS IN THE SERVICE AREA. THE POPULATION SERVED IS PREDOMINANTLY CAUCASIAN AND HIGH-SCHOOL OR HIGHER EDUCATED. HISPANICS ARE THE SECOND LARGEST ETHNIC GROUP REPRESENTING 10.8% OF THE POPULATION. BAYCARE ALLIANT HOSPITAL IS CONNECTED WITH THE BAYCARE HEALTH SYSTEM THAT SERVES WEST CENTRAL FLORIDA. THE AREA SERVED BY BAYCARE ALLIANT HOSPITAL HAS 10 ACUTE CARE HOSPITALS, 1 REHAB HOSPITAL, 1 PSYCHIATRIC HOSPITAL & 1 LONG-TERM ACUTE CARE HOSPITAL. 5 OF THE ACUTE CARE HOSPITALS ARE NOT-FOR PROFIT. THERE ARE 6 FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS/POPULATIONS IN BAYCARE ALLIANT HOSPITAL'S PRIMARY SERVICE AREA. THE POPULATION SERVED BY BAYCARE ALLIANT HOSPITAL IS EXPECTED TO GROW 5.5% IN THE NEXT 5 YEARS. THE EXPECTED GROWTH RATE FOR THE UNITED STATES IS 3.5%. THE OVER 65 POPULATION IS EXPECTED TO GROW 15.5% IN THE NEXT FIVE YEARS. BASED ON FLORIDA INPATIENT DISCHARGE DATA FOR THE PERIOD OF 10/01/17-9/30/18, THE PAYER MIX FOR THE GEOGRAPHIC AREA CONSISTS OF 55.8% MEDICARE/MEDICARE HMO, 14.0% MEDICAID/MEDICAID HMO, 18.4% COMMERCIAL INSURANCE, 8.0% SELF-PAY/NON-PAY, AND 3.9% OTHER. PART VI, LINE 5: BAYCARE ALLIANT HOSPITAL, INC. IS A 48-BED, LONG-TERM ACUTE CARE HOSPITAL (LTCH) AFFILIATED WITH BAYCARE. IT IS THE ONLY FACILITY OF ITS KIND LOCATED WITHIN A 20 MILE RADIUS OF DUNEDIN, FLORIDA. THE 27,253-SQUARE-FOOT FACILITY PROVIDES DIAGNOSTIC, MEDICAL TREATMENT AND REHABILITATION FOR PATIENTS EXPERIENCING COMPLEX MEDICAL CONDITIONS DUE TO CHRONIC DISEASE OR INJURIES. THE HOSPITAL TAKES A MULTI-DISCIPLINARY, FAMILY-CENTERED APPROACH WITH PHYSICIANS, NURSING AND OTHER HEALTH CARE SPECIALISTS WORKING TOGETHER TOWARD THE GOAL OF THE BEST POSSIBLERECOVERY FOR PATIENTS. BAYCARE ALLIANT IS LOCATED INSIDE MEASE DUNEDIN HOSPITAL. THIS PROXIMITY ENABLES BAYCARE ALLIANT TO PROVIDE THE COMMUNITY WITH ACCESS TO HIGH QUALITY PATIENT CARE AND MINIMIZES PATIENT TRANSPORTATION. LONG-TERM HOSPITALS LOCATED WITHIN GENERAL ACUTE CARE HOSPITALS ARE OFTEN REFERRED TO AS "HOSPITALS WITHIN A HOSPITAL OR"HIH'S". A TYPICAL STAY AT A LONG-TERM ACUTE CARE HOSPITAL IS 25 DAYS OR MORE. THE BOARD IS MADE UP OF COMMUNITY MEMBERS WHO WANT TO PROVIDE THE COMMUNITY WITH ACCESS TO COMPASSIONATE PATIENT CARE OF SUPERIOR QUALITY. THE HOSPITAL HAS PROVIDED EDUCATIONAL SESSIONS TO THE PHYSICIAN AND CLINICAL COMMUNITY, LECTURED TO LOCAL ORGANIZATIONS, AND SPONSORED CHARITABLE EVENTS. THERE IS A CRITICAL NEED FOR THE HOSPITAL GIVEN THAT IT IS THE ONLY LTCH WITHIN THE VICINITY, AND GIVEN THAT IT SERVES THE MOST HIGHLY ACUTE AND CHRONICALLY ILL SEGMENT OF THE COMMUNITY. PART VI, LINE 6: BAYCARE ALLIANT HOSPITAL, INC. IS AFFILIATED WITH BAYCARE HEALTH SYSTEM, INC. ("BAYCARE"), A LEADING, NOT-FOR-PROFIT HEALTH CARE SYSTEM THAT CONNECTS INDIVIDUALS AND FAMILIES TO A WIDE RANGE OF SERVICES AT 14 HOSPITALS AND HUNDREDS OF OTHER CONVENIENT LOCATIONS THROUGHOUT THE TAMPA BAY AND WEST CENTRAL FLORIDA REGIONS. INPATIENT AND OUTPATIENT SERVICES INCLUDE ACUTE CARE, PRIMARY CARE, IMAGING, LABORATORY, BEHAVIORAL HEALTH, HOME CARE AND URGENT CARE. BAYCARE'S ANNUAL "REPORT TO THE COMMUNITY" CAN BE VIEWED AT HTTPS://BAYCARE.ORG/ANNUAL-REPORT-2018.BAYCARE'S HOSPITALS ARE BARTOW REGIONAL MEDICAL CENTER, MEASE COUNTRYSIDE, MEASE DUNEDIN, MORTON PLANT, MORTON PLANT NORTH BAY, ST. ANTHONY'S, ST. JOSEPH'S, ST. JOSEPH'S CHILDREN'S, ST. JOSEPH'S WOMEN'S, ST. JOSEPH'S HOSPITAL-NORTH, ST. JOSEPH'S HOSPITAL-SOUTH, SOUTH FLORIDA BAPTIST, WINTER HAVEN AND WINTER HAVEN WOMEN'S.*BAYCARE WAS FOUNDED IN 1997 WHEN SEVERAL OF THE AREA'S NOT-FOR-PROFIT HOSPITALS CAME TOGETHER TO CREATE A HEALTH SYSTEM THAT WOULD ENSURE HIGH-QUALITY HEALTH CARE FOR EVERYONE IN THE COMMUNITY, REGARDLESS OF THEIR ABILITY TO PAY. TODAY, BAYCARE IS A $4.2 BILLION, INTEGRATED HEALTH DELIVERY SYSTEM WITH 28,400 EMPLOYEES. IT PLAYS AN IMPORTANT ROLE AS AN ECONOMIC ENGINE, ANNUALLY GENERATING A $6.62 BILLION IMPACT ON THE REGION AND THE STATE. IN 2018, BAYCARE SPENT $2.09 BILLION TO PAY FOR THE SALARY AND BENEFITS OF ITS EMPLOYEES AND INVESTED $309 MILLION IN CAPITAL RESOURCES.BAYCARE'S CENTRALIZATION OF ADMINISTRATIVE FUNCTIONS IN A NUMBER OF AREAS, INCLUDING FINANCE, BUSINESS OFFICE, INFORMATION TECHNOLOGY, HUMAN RESOURCES, PERFORMANCE IMPROVEMENT, CLINICAL OUTCOMES, CARE MANAGEMENT, PLANNING, SUPPLY CHAIN AND MARKETING/COMMUNICATIONS, HAS PROVIDED A MANAGEMENT STRUCTURE THAT HELPS ITS HOSPITALS AND SERVICE LINES OPERATE MORE EFFICIENTLY AND CONTINUE STRIVING FOR CLINICAL EXCELLENCE. BAYCARE'S FINANCIAL STABILITY ALSO HELPS ENSURE THAT ITS HOSPITALS REMAIN FOCUSED ON THEIR SHARED MISSION TO IMPROVE THE HEALTH OF ALL THEY SERVE THROUGH COMMUNITY-OWNED SERVICES THAT SET THE STANDARD FOR HIGH-QUALITY, COMPASSIONATE CARE, REGARDLESS OF PATIENTS' ABILITY TO PAY.IN 2018, BAYCARE PROVIDED $462 MILLION IN TOTAL COMMUNITY BENEFIT, 11% OF BAYCARE'S REVENUES, WHICH INCLUDES $117 MILLION IN TRADITIONAL CHARITY CARE FOR UNINSURED PATIENTS, $311 MILLION IN MEDICAID AND OTHER INCOME-BASED PROGRAMS, AND $34 MILLION IN UNBILLED COMMUNITY SERVICES. ALL OF THESE ARE MEASURED IN UNREIMBURSED COST.*IN CERTAIN CASES, HOSPITAL LOCATIONS WITH THE SAME TAX IDENTIFICATION AND STATE LICENSE NUMBER ARE LISTED AS ONE FACILITY ON FORM 990, SCHEDULE H, CONSISTENT WITH IRS REPORTING GUIDELINES. PART VI, LINE 7 BAYCARE ALLIANT HOSPITAL, INC. OPERATES IN THE STATE OF FLORIDA, WHICH DOES NOT REQUIRE A COMMUNITY BENEFIT REPORT TO BE FILED WITH THE STATE GOVERNMENT. 0 0 0 0 0 0 0 0 0 JACQUELINE AROCHO ADMINISTRATOR ALLIANT HOSP 222386 0 17949 0 8853 0 9409 0 29 0 258626 0 0 0 PART I, LINE 3 THE FILING ORGANIZATION DOES NOT USE ANY OF THE OPTIONS LISTED IN SCHEDULE J, PART I, LINE 3 TO ESTABLISH THE COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR. HOWEVER, BAYCARE HEALTH SYSTEM, INC. USES COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE AS A MEANS TO ESTABLISH THE CEO'S COMPENSATION OF THE FILING ORGANIZATION. PART V, LINE 1A EFFECTIVE 2018, THE TOTAL NUMBER FROM BOX 3 OF FORM 1096 IS REPORTED BY BAYCARE HEALTH SYSTEM, INC, EIN 59-2796965, A RELATED ORGANIZATION THAT PROCESSES FORMS 1099 FOR ITS AFFILIATES. THIS IS A CHANGE FROM THE PRIOR YEAR REPORTING AS IT BETTER ALIGNS THE FORM 1096, BOX 3 REPORTING TO THE ISSUING EIN. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF BAYCARE ALLIANT HOSPITAL, INC. IS BAYCARE HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A A. THE BOARD OF DIRECTORS SHALL BE COMPOSED OF SEVEN (7) DIRECTORS. THE DIRECTORS SHALL BE DESIGNATED AS "NUMBER 1", "NUMBER 2", "NUMBER 3", "NUMBER 4", "NUMBER 5", "NUMBER 6 AND "NUMBER 7" RESPECTIVELY. B. DIRECTOR NUMBERS 1,2,3,4 AND 5 (COLLECTIVELY, THE "SELF-PERPETUATING DIRECTORS") SHALL BE INITIALLY APPOINTED BY BAYCARE. THEREAFTER, AT THE END OF A TERM OF OFFICE OR TO OTHERWISE FILL THE VACANCY OF ANY SELF-PERPETUATING DIRECTOR, ALL THE THEN SELF-PERPETUATING DIRECTORS BY MAJORITY VOTE SHALL APPOINT A SUCCESSOR SELF-PERPETUATING DIRECTOR. NO SELF-PERPETUATING DIRECTOR MAY ALSO SERVE AS A DIRECTOR, OFFICER OR EMPLOYEE OF BAYCARE OR ANY OTHER PARTICIPANTS IN THE BAYCARE JOINT OPERATING AGREEMENT. FURTHERMORE, NO SELF-PERPETUATING DIRECTOR MAY BE A MEMBER OF THE MEDICAL STAFF OF A HOSPITAL OWNED, LEASED, MANAGED OR OTHERWISE OPERATED BY BAYCARE. C. DIRECTOR NUMBERS 6 AND 7 (COLLECTIVELY, THE "BAYCARE APPOINTEES") SHALL BE APPOINTED BY BAYCARE. AT LEASE SIXTY (60) DAYS BEFORE THE EXPIRATION OF THE TERM OF ANY BAYCARE APPOINTEE, THE BOARD OF DIRECTORS SHALL NOTIFY BAYCARE OF (I) ITS OBLIGATION TO APPOINT A SUCCESSOR TO SUCH BAYCARE APPOINTEE AND (II) THE DATE UPON WHICH TERM OF SUCH BAYCARE APPOINTEE SHALL EXPIRE. D. EACH DIRECTOR SHALL SERVE FOR A TERM OF THREE (3) YEARS, EXCEPT THAT IN ORDER TO PROVIDE FOR STAGGERED TENURES OF THE INITIAL BOARD OF DIRECTORS, DIRECTOR NUMBERS 1, 2, 5 AND 6 SHALL SERVE AN INITIAL TERM OF THREE (3) YEARS, AND DIRECTOR NUMBERS 3, 4, AND 7 SHALL SERVE AN INITIAL TERM OF TWO (2) YEARS. EACH DIRECTOR THEREAFTER APPOINTED TO FILL AN EXPIRED TERM SHALL BE APPOINTED FOR AND SHALL SERVE THE FULL TERM OF THREE (3) YEARS. E. EACH DIRECTOR SHALL SERVE UNTIL HIS OR HER SUCCESSOR IS APPOINTED AS DESCRIBED IN THIS ARTICLE. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS OF THE BOARD ARE SUBJECT TO THE MEMBER BAYCARE HEALTH SYSTEM'S APPROVAL: 1) CHANGING THE NAME OF THE CORPORATION. 2) CHANGES TO BYLAWS. 3) THE SALE OR MERGER OF THE ASSETS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE ORGANIZATION AND REVIEWED BY THE CFO, AS WELL AS THE ORGANIZATION'S PAID PREPARER. A FINAL COPY OF THE FORM 990 WAS REVIEWED BY A SUBCOMMITTEE OF THE BOARD OF DIRECTORS. PRIOR TO FILING WITH THE IRS, A FINAL COPY OF THE FORM 990 WAS PROVIDED TO THE ENTIRE BOARD. FORM 990, PART VI, SECTION B, LINE 12C BAYCARE ALLIANT HOSPITAL, INC. HAS AN AFFIRMATIVE POLICY WHICH REQUIRES THAT ALL ACTUAL OR APPARENT CONFLICTS BE DISCLOSED PROMPTLY AND FULLY TO ALL NECESSARY PARTIES AND WHICH PROHIBITS SPECIFIED INVOLVEMENT IN THE AFFAIRS OF THE CORPORATION BY PERSONS HAVING SUCH CONFLICTS. THE POLICY APPLIES TO ALL MEMBERS OF THE BOARD OF DIRECTORS AND CORPORATE OFFICERS, AGENTS AND EMPLOYEES OF THE CORPORATION, INCLUDING INDEPENDENT CONTRACTOR PROVIDERS OF SERVICES AND MATERIALS. THE CORPORATION'S MANAGEMENT HAS THE AFFIRMATIVE OBLIGATION TO PUBLICIZE PERIODICALLY THIS POLICY TO ALL PARTIES. ALL PERSONS WHOM THE POLICY APPLIES MUST PROMPTLY DISCLOSE ALL REAL AND APPARENT CONFLICTS WHICH THEY DISCOVER OR HAVE BROUGHT TO THEIR ATTENTION TO THE APPROPRIATE PERSONS IN THE FORM OF A WRITTEN DESCRIPTION OF THE FACTS COMPRISING THE REAL AND APPARENT CONFLICT. AN ANNUAL DISCLOSURE STATEMENT MUST BE CIRCULATED TO ALL PERSONS TO WHOM THIS POLICY APPLIES TO ASSIST THEM IN CONSIDERING SUCH DISCLOSURES, BUT DISCLOSURE IS APPROPRIATE WHENEVER CONFLICTS ARISE. THE WRITTEN DISCLOSURE NOTICES OF CONFLICTS MUST BE FILED ANNUALLY WITH THE PRESIDENT OF THE CORPORATION OR ANY OTHER PERSONS DESIGNATED BY HER FROM TIME TO TIME TO RECEIVE SUCH NOTIFICATIONS. ALL DISCLOSURE NOTICES RECEIVED WILL BE NOTED FOR RECORD IN THE MINUTES OF THE MEETING OF THE BOARD OF DIRECTORS. WHEN AN INDIVIDUAL DIRECTOR, OFFICER, AGENT OR EMPLOYEE BELIEVES THAT HE OR A MEMBER OF HIS IMMEDIATE FAMILY MIGHT HAVE OR DOES HAVE A REAL OR APPARENT CONFLICT, HE SHOULD IN ADDITION TO FILING THE DISCLOSURE NOTICE, ABSTAIN FROM MAKING MOTIONS, VOTING, EXECUTING AGREEMENTS, OR TAKING ANY OTHER SIMILAR DIRECT ACTION ON BEHALF OF THE CORPORATION WHERE THE CONFLICT MIGHT PERTAIN. WHEN ANY PERSON REQUESTS IN WRITING, OR UPON ITS OWN INITIATIVE, THE BOARD AT ANY TIME MAY ESTABLISH FURTHER GUIDELINES CONSISTENT WITH THE INTERESTS OF THE CORPORATION FOR THE RESOLUTION OF ANY REAL OR APPARENT CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 BAYCARE ALLIANT HOSPITAL, INC. USES NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS EVERY TWO YEARS TO ASSIST IN THE REVIEW OF COMPENSATION OF EMPLOYEES IN LEADERSHIP POSITIONS. COMPENSATION CONSULTANTS PROVIDE A REVIEW OF THE LEADERSHIP POSITIONS AT ALLIANT HOSPITAL TO DETERMINE IF COMPENSATION IS REASONABLE WHEN COMPARED AGAINST MARKET STANDARDS. THE HOSPITAL UTILIZES A COMPENSATION COMMITTEE TO FURTHER EXAMINE THE RESULTS PROVIDED BY THE COMPENSATION CONSULTANTS. THE REVIEW WAS COMPLETED IN 2017. THE HOSPITAL ALSO UTILIZES AN ANNUAL MANAGER MARKET STUDY AND A SEMI-ANNUAL NON-MANAGEMENT MARKET STUDY TO DETERMINE IF ALL OTHER POSITIONS ARE CONGRUOUS WITH MARKET STANDARDS. FORM 990, PART VI, SECTION C, LINE 19 BAYCARE ALLIANT HOSPITAL, INC. PUBLISHES ITS FINANCIAL STATEMENTS WITH THE AGENCY FOR HEALTH CARE ADMINISTRATION. GOVERNING DOCUMENTS ARE AVAILABLE VIA SUNBIZ.ORG. FORM 990, PART XI, LINE 9: ROUNDING 3. SECTION J WWW.BAYCARE.ORG/HOSPITALS/BAYCARE-ALLIANT-HOSPITAL/ABOUT-US