2018-08-14T08:23:33-05:00 2017-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2016-10-01 590675143 FLAGLER HOSPITAL INC FLAG 9048254400 400 HEALTH PARK BLVD ST AUGUSTINE FL 32086 MURRAY S MARSH JR CFO 9048254400 2018-08-13 1 Amy Bibby P00445891 8282542254 2016 2022-09-23 18:48:47Z JOSEPH S GORDY 400 HEALTH PARK BLVD ST AUGUSTINE FL 32086 250892508 0 X WWW.FLAGLERHOSPITAL.ORG X 1906 FL PROVIDE EXCELLENT HEALTHCARE SERVICES AND BE RECOGNIZED AS A LEADING PROVIDER IN NORTHEAST FLORIDA. 15 14 2351 201 131137 30076 0 1512787 240403548 240669542 7346968 5342279 5013884 3084218 252764400 250608826 437558 288104 0 0 106612262 109957064 0 0 0 142267968 150389985 249317788 260635153 3446612 -10026327 306354650 341511188 134918256 176899461 171436394 164611727 PROVIDE THE BEST PATIENT EXPERIENCE WITH THE BEST STAFF. 0 0 239068807 288104 240538405 Since its founding in 1889, our private, not-for-profit facility has grown into a diverse clinical enterprise that is consistently recognized nationally for clinical excellence by Healthgrades, Truven, and OTHER COMPARATIVE QUALITY DATA ORGANIZATIONS.HOSPITAL SERVICES PROVIDED TO INPATIENT AND OUTPATIENT INCLUDING CHARITY CARE TO INDIGENT AND OTHER PATIENTS. PLEASE SEE SCHEDULE H FOR DETAILS ON COMMUNITY BENEFITS. 239068807 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 415 0 1 2351 1 1 1 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X MURRAY S MARSH JR - CFO 9048254400 400 HEALTH PARK BLVD ST AUGUSTINE FL 32086 MATT BAKER CHAIRMAN 1.00 X X 0 0 0 WILLIAM KOPF VICE-CHAIRMAN 1.00 1.00 X X 0 0 0 STUART SOROKA MD SECRETARY 1.00 X X 0 0 0 WILLIAM ABARE EDD DIRECTOR 1.00 X 0 0 0 TODD BATENHORST MD DIRECTOR 1.00 X 0 0 0 JAMES GRIMES MD DIRECTOR 1.00 X 0 0 0 JEFF KAMM DIRECTOR 1.00 X 0 0 0 RAY MATUZA DIRECTOR 1.00 1.00 X 0 0 0 TODD NEVILLE DIRECTOR 1.00 X 0 0 0 BRAD RUNK DIRECTOR 1.00 X 0 0 0 SUSAN PONDER-STANSEL DIRECTOR 1.00 X 0 0 0 KAREN TAYLOR DIRECTOR 1.00 X 0 0 0 LEN TUCKER DIRECTOR 1.00 1.00 X 0 1961 0 LEN WEEKS DIRECTOR 1.00 1.00 X 0 0 0 SUSAN YARIAN MD DIRECTOR 1.00 X 22500 0 0 Joseph S Gordy CEO 40.00 1.00 X 569557 0 52250 Roger D Carter CFO 40.00 1.00 X 274971 0 35674 Jason P Barrett Executive VP 40.00 1.00 X 297866 0 30578 William D Rieger CIO 40.00 X 223394 0 34224 Christopher Schmidt COO 40.00 X 276466 0 29510 Donald R Crist VP Operations 40.00 X 231358 0 32749 Jeffrey A Hurley CLO 40.00 X 239606 0 33620 Mary K Mantese CNO 40.00 X 197189 0 27160 Michael C DiBella CMO 40.00 X 381894 0 34214 Michael C Sanders Chief-Medical Informatics 40.00 X 309366 0 17250 Miguel A Machado CMO 20.00 20.00 X 295617 240000 37617 Gregory A Gibson MD 0.00 40.00 X 0 243767 24935 Brian D Raymaker MD 0.00 40.00 X 0 190594 18291 3319784 676322 408072 60 0 1 0 ALLSCRIPTS HEALTHCARE LLC 24630 NETWORK PLACE CHICAGO IL 606731246 SOFTWARE SUPPORT 1267970 BERKELEY RESEARCH GROUP LLC 220 POWELL STREET 200 EMERYVILLE CA 94608 CONSULTING 1169467 PERSHING YOAKLEY & ASSOCIATES 2220 SUTHERLAND AVE KNOXVILLE TN 37919 CONSULTING 1021569 STERICYCLE 4010 COMMERICAL AVE NORTHOBROOKE IL 60062 CONTRACT SERVICES 791392 CARDIOTHORACIC & VASCULAR SURGICAL 1824 KING STREET STE 200 JACKSONVILLE FL 32204 CONTRACT SERVICES 732744 46 1134538 378249 1512787 Net Patient Service 623000 237913336 237913336 OTHER OPERATING REVENUE 623000 2178698 2047561 131137 EHR MEANGINFUL USE 623000 577508 577508 240669542 1803543 1803543 1828461 235977 1592484 1592484 1592484 3461491 77245 0 0 3461491 77245 3538736 3538736 204811 47705 157106 157106 Food & Nutrition Sales 722210 1060493 1060493 Patient Record Transcription 900099 196405 196405 MISCELLANEOUS 900099 77730 77730 1334628 250608826 240538405 131137 8426497 X 288104 288104 2310407 2310407 86230187 81060837 5169350 2815698 2574669 241029 12057012 11024910 1032102 6543760 5983602 560158 413713 413713 589041 589041 189645 189645 151629 151629 34759687 29469911 5289776 689161 689161 4539979 3868083 671896 2859334 2859334 6381533 5760834 620699 417321 148132 269189 3186165 3186165 19157799 19157799 3844427 3844427 UBI TAX 4511 4511 Medical Supplies 49742629 49713486 29143 Bad Debt 19152192 19152192 Indigent tax 3226032 3226032 1085187 605113 480074 260635153 239068807 21566346 0 351939 2563469 49249978 30990318 26904258 1979450 2840484 6386550 6719765 3881271 2090758 388246811 243291237 142677670 144955574 87602665 83871748 12973095 6404863 1466242 -14825 10019271 10019271 8026179 5905845 306354650 341511188 35458466 33831970 3850341 3719080 90390000 136823303 5218068 2525108 1381 0 134918256 176899461 X 171436394 164611727 171436394 164611727 306354650 341511188 -10026327 3201660 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 376280 0 0 376280 0 Part II-B, Line 1: DURING THE TAX YEAR, THE ORGANIZATION ENGAGED A PROFESSIONAL LOBBYIST TO MONITOR LEGISLATION DIRECTLY AFFECTING NOT-FOR-PROFIT HOSPITALS/RURAL COMMUNITY PROVIDERS. 4009627 0 381717 4391344 3581146 225328 203153 4009627 3895387 -314241 3581146 3609062 286325 3895387 6007584 499217 2897739 3609062 1.00000 0 1 1 6172204 6172204 159316623 102609833 56706790 402364 259147 143217 208569239 134331587 74237652 13786381 6090670 7695711 144955574 X 234941976 3201660 -18868510 -15666850 250608826 0 250608826 241766643 283682 283682 241482961 19152192 19152192 260635153 Part V, Line 4: THE ORGANIZATION'S ENDOWMENT CONSISTS OF THREE INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. THE ENDOWMENTS ARE ALL DONOR-RESTRICTED AND INTERNALLY CONTROLLED. FLAGLER HEALTH CARE FOUNDATION, A RELATED ORGANIZATION, HOLDS THESE ENDOWMENTS FOR BENEFIT OF FLAGLER HOSPITAL, INC. INVESTMENTS CONTAIN AMOUNTS TO BE HELD IN PERPETUITY, THE DIVIDEND AND INTEREST INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTHCARE SERVICES, AND THE REMAINING INVESTMENT INCOME, GAINS, AND LOSSES ARE TO ADJUST THE CORPUS. Part X, Line 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE, AND IS ALSO EXEMPT FROM STATE INCOME TAXES. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE HOSPITAL'S MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE HOSPITAL HAS ANALYZED THE TAX POSITIONS AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2017 OR 2016, THERE ARE NO UNCERTAIN POSITIONS TAKEN, OR EXPECTED TO BE TAKEN, THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE HOSPITAL BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2013. Part XI, Line 2d - Other Adjustments: RENTAL EXPENSES NET WITH REVENUES 235,977. BAD DEBT NET WITH REVENUE -19,152,192. COGS NET WITH REVENUES 47,705. Part XII, Line 2d - Other Adjustments: RENTAL EXPENSES NET WITH REVENUE 235,977. COGS NET WITH REVENUES 47,705. Part XII, Line 4b - Other Adjustments: BAD DEBT NET WITH REVENUE 19,152,192. 1 1 1 X 1 X 1 1 1 0 0 9812389 550947 9261442 0.03840 25057258 14103801 10953457 0.04540 34869647 14654748 20214899 0.08380 1957175 1957175 0.00810 818582 818582 0.00340 7648478 7648478 0.03170 209841 209841 0.00090 259117 259117 0.00110 10893193 10893193 0.04520 45762840 14654748 31108092 0.12900 1 35000 35000 0.00010 3 82236 62700 19536 0.00010 1 10000 10000 0.00000 5 127236 62700 64536 0.00020 1 19152192 1011079 84678401 88699911 -4021510 X 1 1 1 OUTPATIENT SURGERY CENTER OF ST AUGUSTINE LLC ORTHOPEDIC OP SURGERY 0.10680 0.89320 1 1 FLAGLER HOSPITAL 400 HEALTH PARK BLVD ST AUGUSTINE FL 32086 X X X FLAGLER HOSPITAL 1 0 0 1 X X X X X X X X X 14 1 1 1 1 X SEE PART V X 1 14 1 SEE PART V 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X SEE PART V X SEE PART V X SEE PART V X X X X X X 1 X 0 X X X X 1 X 0 0 FLAGLER HOSPITAL Part V, Section B, Line 5: FLAGLER HOSPITAL AND THE ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL USED TWO DIFFERENT APPROACHES TO GATHER INFORMATION FROM A CROSS-SECTION OF THE COMMUNITY. THE FIRST APPROACH WAS TO CONDUCT COMMUNITY FOCUS GROUPS, AND THE SECOND APPROACH WAS TO DEPLOY A COUNTY-WIDE ASSESSMENT. FLAGLER HOSPITAL Part V, Section B, Line 6a: ANASTASIA MOSQUITO CONTROL DISTRICTAZALEA HEALTHBETTY GRIFFIN HOUSEBOYS & GIRLS CLUBS OF NORTHEAST FLORIDACLINTON HEALTH MATTERS INITIATIVENORTHEAST FLORIDA REGIONAL DIRECTORDELORES BARR WEAVER POLICY CENTEREPIC BEHAVIORAL HEALTHCAREEPISCOPAL CHILDREN'S SERVICESFIRST COAST TECHNICAL COLLEGEFLORIDA DEPT. OF HEALTH IN ST. JOHNS COUNTYGOOD SAMARITAN HEALTH CENTERSHAVEN HOSPICEHEALTHY SCHOOLSHOME AGAIN ST. JOHNSLEARN TO READ ST. JOHNSLINCOLNVILLE FARMERS MARKETMOUNT ZION AME CHURCHNEW MT. MORIAH CHRISTIAN MINISTRYNORTHEAST FLORIDA COMMUNITY HOSPICECOMMUNITY RELATIONS REPRESENTATIVEPACT PREVENTION COALITIONST. AUGUSTINE METRO TREATMENT CENTERST. JOHNS COUNTY BOARD OF COMMISSIONERSST. JOHNS COUNTY MEDICAL EXAMINERCHIEF MEDICAL EXAMINERST. JOHNS COUNTY ADMINISTRATIONST. JOHNS COUNTY COUNCIL ON AGINGST. JOHNS COUNTY EDUCATION FOUNDATIONST. JOHNS COUNTY EMERGENCY MANAGEMENTST. JOHNS COUNTY FIRE RESCUEST. JOHNS COUNTY HEALTH AND HUMAN SERVICES ADVISORY COUNCILST. JOHNS COUNTY HEALTH AND HUMAN SERVICESST. JOHNS COUNTY SOCIAL SERVICESFLORIDA DEPARTMENT OF HEALTHST. JOHNS COUNTY MEDICAL SOCIETYEXECUTIVE DIRECTORST. JOHNS COUNTY SCHOOL DISTRICT/HEAD STARTST. JOHNS COUNTY SHERIFF'S OFFICESTEWART-MARCHMAN ACT BEHAVIORAL HEALTHCARETOBACCO FREE ST. JOHNSVELO FEST COMMUNITY INITIATIVEYMCA OF FLORIDA'S FIRST COAST PART V, SECTION B, LINE 11 Flagler Hospital's Implementation of Strategic ObjectivesReduce Percentage of Low Birth Weight InfantsThe percentage of low birthweight infants in St. Johns County continues to be a disparity among community populations. For this reason, reducing the percentage of low birthweight infants in St. Johns County was selected as a Strategic Objective Critical actions include the formation of a Fetal Infant Mortality Review Team and coordinated efforts among community partners towards increasing the percentage of women receiving first trimester prenatal care. Flagler Hospital's Director of Maternity Services, Neonatal Intensive Care Manager and Maternity Coordinator continue to serve on the St. Johns Infant Mortality Task Force. The Task Force meets quarterly to analyze mortality rates for Northeast Florida and determine leading causes for low birth weight to achieve better outcomes for St. Johns County. This Task Force is part of the NE Florida Healthy Start Coalition, Inc. The Task Force is currently working to promote healthy pregnancy and pregnancy Body Mass Index levels, reduce tobacco usage among pregnant women and help increase awareness of the importance of increasing the interval time between pregnancies for healthy outcomes. Flagler Hospital offers free pre-natal yoga classes to help moms stay in optimum health for delivery (Open to all St. Johns County moms, even if they don't plan to deliver at Flagler Hospital). Reduce Chronic Disease Morbidity and MortalityChronic disease was responsible for over 55.6% of all deaths in St. Johns County in 2016. Cancer is the leading cause of death in St. Johns County, with breast, colon and lung cancer identified as being the most common types among residents. Among survey respondents, 8.4% reported cancer as the most concerning health problem, ranking second among all respondents. To raise awareness about the benefits of prevention and early detection of cancer, Flagler Hospital participated in over 30 health fairs, providing St. Johns County residents with up-to-date screening guidelines and the benefits of a healthy lifestyle. Further, a three year Flagler Cancer Institute Community Needs assessment was completed, which identified the following areas of need within the community: mammography screening rates, age-adjusted cancer death rate for black St. Johns County residents, and time between lung cancer diagnoses to treatment.Cancer prevention programs included presentations for local churches and civic groups, lung cancer awareness events, colorectal cancer prevention and awareness events and a skin cancer prevention program. In addition, Flagler Hospital partnered with other community organizations such as Good Samaritan Wildflower Clinic, American Cancer Society, Lung Cancer Alliance, Pink up the Pace and Unity Outreach to promote cancer awareness and early detection throughout the community.Breast Cancer:From 2011 to 2013, the breast cancer age-adjusted death rate was 18.3/100,000. This rate is lower than state and regional averages, and identical to the peer county state average. In order to reduce the time frame between breast cancer diagnosis and treatment, a Breast Cancer Patient Navigator (BCPN) was added to the Flagler Hospital Cancer Institute Care Team and helps patients move through the process of breast cancer all the way through diagnosis, surgery, treatment and recovery. The Breast Cancer Patient Navigator helps patients from the time there is a suspicion of breast cancer until treatment is concluded. Our patient navigator nurse is a Certified Breast Care Nurse CBCN and is dedicated to the following: providing patients with knowledgeable and compassionate support; facilitating communication between the patient and physicians in order to decrease fragmentation of care; and providing patients and family members with information on community-based resources.In this fiscal year, the BCPN guided over 136 patients through their cancer treatment. The Breast Cancer Patient Navigator participates in many community events, educating women on the benefits of early detection and the importance of performing self-examinations. Flagler Hospital continues to support local non-profit organizations that focus on the prevention and early detection of breast cancer in St. Johns County. Flagler Hospital, in partnership with the Wildflower Clinic, held a Free Mammogram Day on Saturday, June 25, 2016. This event was open to all uninsured St. Johns County women between the ages of 40-64. At this event 54 women received mammograms, health screenings, and information on available community resources. In addition, Flagler Hospital's Cancer Education and Support Center facilitates a Breast Cancer Support Group that meets on a monthly basis. Colon Cancer: The annual Colorectal Cancer Awareness Day was held on March 4, 2016. The event was coordinated with Borland-Groover Clinic and GI Associates to provide information on colorectal cancer prevention and screening strategies. This event took place in the Cancer Education and Support Center and over 100 people visited the event and answered the optional survey.The information provided was based on the National Comprehensive Cancer Network (NCCN) Colorectal Screening Guidelines.Lung Cancer: Realizing that cigarette smoking is the number one risk factor for lung cancer, Flagler Hospital continues to maintain a smoke free facility, including parking lots and leased properties. Flagler Hospital also implemented a Tobacco Screening Protocol throughout the hospital. Upon admission, each patient is asked if they smoke or use tobacco in any other form. This information is used to trigger a consult from the Cardiopulmonary Department, from a member of the "Quit Team". Quit Team members verify the patients who use tobacco and provide counseling on tobacco cessation. If the patient is interested in quitting, they are given information on free tobacco cessation programs offered through Flagler Hospital. The Quit Team also educated Flagler staff and medical personnel on the importance of the message that cessation opportunities are both valuable and efficacious. Flagler Hospital partners with Northeast Florida Area Health Education Center to provide access to the "Quit Smoking Now" smoking cessation program. Quit Smoking Now is a free course that consists of group sessions facilitated by the cardiopulmonary department and held in the Flagler Hospital Wellness Center. Classes take place one per week for 1 hour, over a six week period. During this fiscal year, 9 different Quit Smoking Now programs were offered with 99 participants. Of the participants, 57 completed the program and 44 quit smoking. In addition to the Quit Smoking Now smoking cessation program, Flagler Hospital hosted two lung cancer awareness events. Shine a Light on Lung Cancer was held in the Cancer Education and Support Center on November 17, 2016. This is a national event held at different locations across the nation. The goal is to bring attention, compassion, hope and support to all individuals impacted by Lung Cancer. Lastly, the Great American Smoke out also took place on November 17, 2016. The event was hosted by Flagler Hospital in collaboration with Tobacco Free Florida and encourages smokers to make a plan to quit smoking or pledge to help someone quit smoking.The Director of Community Health Improvement serves as the Chairman of the Tobacco Free St. Johns Partnership, which is a community-wide locally organized group collectively working towards eliminating initiation and use of tobacco among St. Johns County residents, supporting policy change and educating decision makers about the impact of tobacco on the lives of St. Johns County residents and visitors. PART V, SECTION B, LINE 11 CONTINUED Reduce Substance AbuseSubstance abuse was listed as the #1 important health problem by survey respondents in the 2014 CHNA. This includes binge drinking, underage drinking, cigarette and marijuana and other drug use. Flagler Hospital's Mental Health Director works closely with EPIC Community Services (EPIC was created to provide substance abuse prevention, intervention, outpatient treatment and aftercare services), PACT, (Prevention, Action, Choices and Teamwork) Prevention Services (which advocates for prevention for youth), Tobacco Free St. Johns and other groups such as law enforcement on this issue. St. Johns County continues to rank in the top 5 counties in Florida for binge drinking. The St. Johns County Behavioral Health Consortium continues to work towards finding a way to get these important health services available for referral in our service area. Thanks to state funding and a sizeable donation from Flagler Hospital, EPIC Behavioral Healthcare's 16-bed Detox Center opened last fiscal year.The center opened in January 2014 as the only detoxification center in St. Johns County. It offers medical detox, substance abuse residential treatment, substance abuse outpatient treatment, and medication management for people diagnosed with a co-occurring mental health disorder.The EPIC Recovery Center has become the cornerstone of the addiction treatment system of care in St. Johns County serving some of the most vulnerable Floridians uninsured, homeless, those involved in the child welfare system, criminally justice involved, and/or suffering from multiple chronic health conditions. Increase Access to Dental CareAccess to dental care has long been an issue in St. Johns County, as it is across the state. Respondents of the 2014 St. Johns County Community Health Needs Assessment reported Dental/Oral care as one of the top health serviceS that is difficult to ACCESS. A major theme of all focus groups was a need for improved access to dental care. To address this need, Flagler Hospital, the Wildflower Clinic, and the St. Johns County Health Leadership Council STUDIES 802 dental cases PRESENTING AT the Flagler Hospital Emergency Department TO IDENTIFY PATIENTS. The Good Samaritan Wildflower Clinic is the only clinic offering both free dental and free health care in St. Johns County. Flagler continues to be a major corporate sponsor of the Wildflower Clinic and works closely with the clinic to shorten the time between the initial crises (Flagler ER visit) and follow up care. With the help of grants from Flagler Hospital, and other community organizations, the Wildflower Clinic staff has begun offering regular dental walk-in clinics every week. With continued collaboration between the Wildflower Clinic and Flagler Hospital's Emergency Department on coordinating care between uninsured St. Johns County residents, Flagler Hospital emergency room visits for dental emergencies have continued to drop by over 10% each fiscal year. Furthermore, dental visits to the Wildflower Clinic have increased to over 2,500 visits. Building on this success, partners continue to optimize this transition and follow-up process from the hospital emergency room to the Wildflower Dental clinic.Increase Access to Mental Health CareWith depression and anxiety ranked as the #3 health problems in St. Johns County, the 2014 CHNA revealed that access to mental health services continues to be an issue. In addition, mental health counseling was reported to be the #2 most difficult to obtain service by survey respondents.In response to an identified critical need for outpatient mental health services in St. Johns County, Flagler Hospital introduced an Intensive Outpatient Program. This program was specifically designed to support patients after being released from inpatient care. The program's primary goal of improving quality of life and reduce symptoms to prevent relapse is accomplished through group therapy, medication and symptom management and individual psychotherapy. All new patients participate in a formal clinical evaluation performed by a multi-disciplinary team. This evaluation helps the team develop a treatment plan that reflects each patient's individual strengths, limitations and goals for treatment. Every patient's goals are reviewed and updated weekly in team meetings and individual sessions. Medical staff from the Intensive Outpatient Program attends community events to raise awareness about mental health and to inform the community on available resources. A scholarship is available for each session, to ensure that access to mental health services is never dependent upon a patient's ability to pay. Flagler Hospital is committed to collaboration with community partners to address each need identified during the 2014 CHNA. To increase access to mental health care, this collaboration centers on coordination and linkage of mental health services between Flagler Hospital and community outpatient providers. Flagler Hospital continues to work with community partners to develop a county-wide Mobile Crisis Response Team (MCRT). The team's mission will be to provide an assessment at the first signs of child behavioral risk to prevent serious mental issues from developing. The team will also provide immediate access to mental health services and allow the opportunity for families to select a solution that works best for them. The ultimate goal of the Mobile Crisis Response Team program will be to divert children from costly emergency services and establish greater coordination of care that will serve the family beyond the initial crisis. The MCRT consists of three state licensed clinicians, a certified case manager and a state licensed registered nurse. PART V, SECTION B, LINE 11 CONTINUED Leverage 2-1-1 as a Community Resource Tool Many of the organizations and providers at the forefront of providing care in St. Johns County have their own list of community providers or use printed resource guides with soon-outdated information. Never has there been a viable list of resources that is easily accessible and updatable. The Health Leadership Council convened a "Resource Tool" subcommittee to identify and evaluate program options. The Director of Community Health Improvement at Flagler Hospital serves as the chair of this subcommittee, which began meeting last fiscal year as a response to the CHNA and CHIP.The Resource Tool Subcommittee identified United Way's 2-1-1 system as the primary focus for addressing the need to increase access to available community resources. The Resource Tool Subcommittee will lead the effort to align all community resource providers using the 2-1-1 system in order to offer residents a single location for available community resources.Flagler Hospital is a major contributor to Northeast Florida Counts (www.nefloridacounts.org) which serves as a FREE online health resource for the seven county area of Northeast Florida. The site helps planners, policy makers, and community members learn about issues and identify improvements necessary for healthful outcomes. The tool is used for community assessment, strategic planning, collaboration, community capacity development, grant development, and educational and advocacy purposes.Increase Use of Available TransportationFrom the focuses groups conducted as part of the 2014 Community Health Needs Assessment, a focus of "A Need for Transportation" was observed as the primary theme from focuses groups. Furthermore, survey results showed a positive increase in the percentage of respondents that ranked transportation as a barrier to care, from 7.9% in 2011 to 9.7% in 2014.Transportation has been a focus in St. Johns County for over 15 years. The 2005 St. Johns County Community Health Needs Assessment identified improving access to health services in outlying areas of St. Johns County through coordination of public transportation as a high-priority community need. Since that time, a community-wide effort to improve public transportation in St. Johns County has picked up momentum. The St. Johns County Council on Aging, Inc. (COA) serves as the Community Transportation Coordinator for St. Johns County. The COA provides door-to-door non-emergency medical transportation services to ambulatory and wheelchair bound clients within the St. Johns County service area. The Sunshine Bus Company (a division of the COA) is St. Johns County's public bus service. Since its inception in 2006, the Sunshine Bus Company has continued to expanded services to better serve the community, with the addition of new routes and an increased number of daily trips. The 2014 St. Johns County Community Health Needs Assessment feedback showed the continued need for a focus on transportation. This year, Flagler Hospital supported the strategic objective of "Increase Use of Available Transportation Options" by partnering with the St. Johns County Health Leadership Council to provide transportation training to 14 community organizations. This education is offered to both community members, and healthcare providers, in effort to raise awareness and increase utilization. PART V, LINE 16A, FAP, APPLICATION, AND PLAIN LANGUAGE SUMMARY URL http://www.flaglerhospital.org/Financial-Services/Charity-Care-and-Financial-Assistance-Policy.aspx PART V, LINE 7, CHNA AND IMPLEMENTATION STRATEGY URL http://stjohns.floridahealth.gov/programs-and-services/community-health-planning-and-statistics/community-health-assessments/_documents/sjc_2014_health_needs_assessment.pdf 1 1 - FLAGLER OUTPATIENT LAB 156-316 ST HWY 312 260-264 ST AUGUSTINE FL 32086 OUTPATIENT LAB SATELLITE DRAW STATION Part I, Line 3c: FLAGLER HOSPITAL USES THE FEDERAL POVERTY GUIDELINES (FPG) TO DETERMINE WHETHER A PATIENT QUALIFIES FOR CHARITY. FLAGLER HOSPITAL PROVIDES FREE CHARITY CARE FOR ALL PATIENTS WITH INCOME UP TO 200% OF THE FPG. FLAGLER HOSPITAL ALSO PROVIDES SIGNIFICANT DISCOUNTS TO PATIENTS THAT MEET THE FOLLOWING:1) 200% TO 400% OF THE FPG, 2) RETIRED AGE 55-65 WITH NO INSURANCE, 3) UNINSURED WORKERS, AND 4) UNDER INSURED. ADDITIONALLY, THE HOSPITAL INCLUDES PATIENTS WITH MEDICAID AND HOMELESS PATIENTS TO BE ELIGIBLE FOR CHARITY CARE. IN ORDER TO DETERMINE A FINANCIAL NEED, OUR POLICY STATES THAT WE WILL "TAKE INTO ACCOUNT THE PATIENT'S AVAILABLE ASSETS AND ALL OTHER FINANCIAL RESOURCES AVAILABLE TO THE PATIENT". THE HOSPITAL ALSO PROVIDES DISCOUNTS FOR PROMPT PAYMENT WHICH IS REQUIRED TO BE PAID WITHIN 10 BUSINESS DAYS OF THE SERVICES BEING RENDERED. THE HOSPITAL CONTRACTS WITH A THIRD PARTY VENDOR WHO SCREENS ALL SELF PAY PATIENTS ADMITTED TO THE HOSPITAL. THE VENDOR ALSO SCREENS ER AND OUTPATIENT SURGICAL PATIENTS IN ACCORDANCE WITH THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA). THIS VENDOR ASSISTS THE PATIENT IN APPLYING FOR ANY FEDERAL, STATE, OR COUNTY PROGRAMS THEY MAY BE ELIGIBLE FOR. PATIENTS NOT SEEN BY THE VENDOR ARE SEEN BY DESIGNATED FLAGLER HOSPITAL STAFF MEMBERS THAT WORK WITH PATIENTS TO ASSIST WITH APPLYING FOR FINANCIAL ASSISTANCE. THEY DISCUSS THE INCOME DOCUMENTS NEEDED, PREPARE THE APPLICATION, AND FOLLOW UP WITH PATIENTS ON ELIGIBILITY. Additionally, the Hospital will adjust patient balances to zero as presumptive charity after 120 days has passed, three statements have been sent to the patient, and multiple phone calls with no success if the patient's income is estimated to be 200% or below the FPG utilizing third party proprietary software. Part I, Line 7: THE ORGANIZATION USED WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE FINANCIAL ASSISTANCE AND UNREIMBURSED MEDICAID AT COST FOR THE PURPOSE OF PART I, LINE 7. Part I, Line 7g: FLAGLER HOSPITAL PROVIDES ESSENTIAL FUNDING TO A LOCAL FEDERALLY QUALIFIED HEALTH CLINIC (AZALEA HEALTH) THAT PROVIDES PRIMARY CARE SERVICES TO THE UNINSURED AND MEDICAID POPULATION OF ST JOHNS COUNTY. FLAGLER HOSPITAL ALSO SUBSIDIZES MANY SUBSEQUENT PHYSICIAN REFERRAL COSTS ASSOCIATED WITH THE CONTINUATION OF CARE OF THE UNINSURED PATIENTS AND ANCILLARY TESTS PERFORMED. AMOUNTS REPORTED ON LINE 7G ALSO INCLUDE ER SPECIALTY CALL COVERAGE AND PROFESSIONAL FEES FOR INDIGENT CARE. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 19,152,192. PART I, LINE 6A FLAGLER HOSPITAL PRODUCES A NUMBER OF PUBLICATIONS THAT FEATURE MANY OF THE HEALTH IMPROVEMENT INITIATIVES THAT THE HOSPITAL HAS IMPLEMENTED THROUGHOUT ST. JOHNS COUNTY. FOR EXAMPLE, THE ANNUAL CANCER REPORT DETAILS CANCER EDUCATION AND OUTREACH ACTIVITIES, SCREENING INFORMATION, AVAILABLE SUPPORT GROUPS, CLASSES AND EVENTS. THE HOSPITAL ALSO PRODUCES A QUARTERLY MAGAZINE DEDICATED TO ADDRESSING HEALTH CONCERNS THAT PROVIDES INFORMATION ABOUT MANY OF THE HOSPITAL'S OFFERINGS AND COMMUNITY BENEFIT ACTIVITIES SUCH AS SMOKING CESSATION, FREE PHYSICALS, PRENATAL YOGA CLASSES, DIABETES EDUCATION AND THE FLAGLER HEALTH CARE ACADEMY. PART I, LINE 7, OTHER BENEFITS DESCRIPTIONS COMMUNITY BENEFIT OPERATIONSFlagler Hospital has a full time Director of Community Health Improvement to coordinate hospital-wide community benefit functions in accordance with national standards and public reporting requirements. The Director of Community Health Improvement uses CBISA software to track and report community benefit activities and provide an annual report on community benefit numbers to the Director of Accounting for the hospital's 990 H. COMMUNITY HEALTH IMPROVEMENT SERVICESIn addition to needs assessed by the Health Leadership Council, death from diabetes is on the decline, but incidence of diabetes is rising, due to obesity. During this fiscal year, Flagler Hospital partnered with the Wildflower Clinic, a non-profit dedicated to providing free medical and dental care to qualifying St. Johns County residents, to establish Wildflower Chronic Care Clinic (CCC). The Chronic Care Clinic provides invaluable care to uninsured, chronically ill, low-income residents of St. Johns County. The Flagler CCC focuses on chronic disease management, with an emphasis on diabetes management. This clinic is available to any patient with an unmanaged, chronic condition who meets the Good Samaritan Health Centers patient qualifications. Patients receive services free of charge.The Chronic Care Clinic is staffed with a nurse practitioner, who is available by phone, pager, and email, 24 hours a day/7 days a week. All chronic Care Clinic patients are provided with her contact information and instructed to contact her directly if they have any questions or concerns between visits, especially if they are not feeling well. Through telemedicine or additional visits between scheduled appointments, the nurse practitioner can add or adjust medications, order lab work, and manage any situations for which a patient may have otherwise resorted to the Flagler Hospital Emergency care Center for a non-emergent visit. By pairing 24-hour access to a nurse practitioner with access to medications that would be otherwise unaffordable and education about their chronic illnesses, the Wildflower Chronic Care Clinic has effectively kept countless patients from seeking care in the Flagler Hospital Emergency Care Center. During the last fiscal year, Flagler Hospital has provided the Wildflower Clinic $445,877 in free laboratory services and $2,914 in Chronic Care Clinic support. The Heart Center at Flagler Hospital provides a critical service to residents of St. Johns County and the surrounding areas. Flagler Hospital's state-of-the-art healthcare encompasses the entire continuum of care for heart patients, including close collaboration with St. Johns County Fire Rescue, including transmission of EKGs directly from ambulance to hospital, cardiac cath labs, world-class physicians and staff, quality assurance plans, and community outreach and education programs. Once a patient is discharged with a diagnosis of heart failure, a nurse care coordinator follows up with the patient to review discharge medications, vital signs, the importance of weight management and fluid restrictions. Once in the home, the nurse practitioner reviews the foods that are in the patient's homes and discusses how that food should be used in the diet or not used at all. She uses cups that are in the patient's house to should how much fluid should go in and how many a day should be used. This offers the patient a practical approach to caring for themselves at home. This service comes at no charge to the patient and helps them understand what the doctor expects from them. This service goes beyond hospital education and is true community/ home education. Flagler Hospital maintains a Cancer Resource Center, open to all in the community, along with a wig and prosthesis closet. There is a free computer kiosk for the dissemination of health information. It is staffed by our Cancer Education and Support coordinator and volunteers each weekday from 9:00 until 4:00.HEALTH PROFESSIONS EDUCATIONFlagler Hospital donated paid staff hours in one-on-one programs to precept nursing students and ARNP students from Jacksonville University, St. Johns River State College, University of Central Florida, University of Florida, Daytona State College. Additionally, students in the fields of EMT training, Physical Therapy, Occupational Therapy, Medical Assisting, Lab Sciences, Social Work, Health Information Management, Cardiovascular Technology, Radiology, Nuclear Medicine and Mental Health were trained with one-on-one contact with staff at Flagler Hospital.Flagler Hospital has a full time staff member dedicated to offering Continuing Medical Education to all physicians in the St. Johns County Community, regardless of their affiliation with the hospital. This helps ensure that our local residents have access to physicians who are up to date on the latest advancements in medical care. The CME Coordinator worked with physicians to present 47 programs of Grand Rounds, Medical Society meetings, webcasts, and ICD-10 trainings during this FY.RESEARCHFlagler Hospital employs two full-time employees to manage a cancer patient database, log information that can be used to detect cancer earlier, improve treatments and ultimately, increase cancer survival rate. Registrars determine a patient's eligibility for the cancer registry, record the patient's diagnosis, and track their treatment plan. By collecting, tracking and evaluating this data, we are able to advance our knowledge on risk factors for certain cancers. Because data entered in the cancer registry is available to the public, outcomes and treatment plans for patients in St. Johns County have an impact nation-wide. FINANCIAL AND IN-KIND CONTRIBUTIONSFlagler Hospital made financial and in-kind contributions totaling $259,117 to many area non-profit organizations that focus on providing health programs targeting community health needs that were identified through The St. Johns County Community Health Needs Assessment. One of the biggest determinants of health that community organizations have influence on is access to healthcare. During this last fiscal year, Flagler Hospital gave a $50,000 grant to the St. Johns Council on Aging to provide staff to assist senior citizens in St. Johns County in applying for free or reduced rate prescription drugs from pharmaceutical companies. This program continues to serve over 300 seniors. Because the grant provided paid staff to run this program, Council on Aging volunteers were able to focus over 600 volunteer hours on counseling, client notification and doctor's office visits to help expedite paperwork. Flagler Hospital also donated meeting rooms and in some cases food/catering charges for various non-profit, support and self-help groups in the community. This totaled over $3,314 using a $3/hour charge for each meeting space, a figure based on the square footage of the hospital. Part III, Line 2: Patient account balances are recognized as bad debt expense when being transferred to a collection agency. Part III, Line 3: ASSUMED A THIRD OF THE BAD DEBT ACCOUNTS COULD QUALIFY FOR FINANCIAL ASSISTANCE. APPROXIMATELY 50% OF THOSE ACCOUNTS HAVE BEEN ADJUSTED BY 50% THROUGH AN ADMIN/SELF PAY ADJUSTMENT. COST ESTIMATED USING THE COST TO CHARGE RATIO WITHIN WORKBOOK. THE ASSUMED BAD DEBT ACCOUNTS THAT COULD QUALIFY FOR FINANCIAL ASSISTANCE WAS UPDATED TO A THIRD FROM A HALF DUE TO THE IMPLEMENTATION OF A PRESUMPTIVE CHARITY POLICY. PART II, COMMUNITY BUILDING ACTIVITIES DESCRIPTION Flagler Hospital donated paid staff time for employees who served on various boards for community events and committees which offered community support, coalition building with other agencies and health and welfare providers, and community health improvements advocacy. Through its participation in the Health Planning Council of Northeast Florida, Flagler Hospital committed to support the Northeast Florida Counts website as a site sponsor, pledging $10,000 yearly. This website provides key health information to the community and addresses the issue of accessibility to data and serves as a roadmap for collaborative community improvement by highlighting where we have been, our current status and directing where we need to go. It is a free online health resource for a seven county area, which includes our own service area of St. Johns County (www.nefloridacounts.org).Through a partnership with the hospital, the St. Johns County School District created the Flagler Hospital Academy of Medical and Health Careers at Pedro Menendez High School in 2007-2008. It is open to students throughout the school system. It focuses on providing skills and experience necessary to attain entry level jobs in health, medical and related fields, and provides academic preparation to continue training through clinical experience, community college and university programs. Now in its 10th year, the academy had 42 third year students rotating through various departments at the hospital for training, for a combined total of 5040 hours. Students shadowed in the lab, radiology, pharmacy, operating room, physical and occupational therapy, in addition to multiple nursing units. ECONOMIC DEVELOPMENTFlagler Hospital is a strong supporter of the St. Johns Coutny Chamber of Commerce. In addition to financial support, Flagler Hospital plays a large role in the St. Johns County Economic Development Council. The Economic Development Council actively markets St. Johns County as a premier destination for companies prospectively considering expansion or relocation. These activities are designed to support the succes of both new and existing businesses in St. Johns County.COMMUNITY SUPPORTTO ENHANCE COMMUNITY SUPPORTS NETWORKS, MANY OF FLAGLER HOSPITAL'S STAFF, DURING PAID TIME, ARE ACTIVE IN COMMUNITY ORGANIZATION BOARDS AND EVENT PLANNING COMMITTEES SUCH AS: SCHOOL HEALTH ADVISORY COMMITTEE AND THE TRANSPORTATION DISADVANTAGED COORDINATING BOARD. COALITION BUILDINGTHROUGH PARTICIPATION IN THE HEALTH PLANNING COUNCIL OF NORTHEAST FLORIDA, FLAGLER HOSPITAL COMMITTED TO SUPPORT THE NORTHEAST FLORIDA COUNTS WEBSITE AS A SITE SPONSOR, PLEDGING $10,000 YEARLY. THIS WEBSITE PROVIDES KEY HEALTH INFORMATION TO THE COMMUNITY AND ADDRESSES THE ISSUE OF ACCESSIBILITY TO DATA AND SERVES AS A ROADMAP FOR COLLABORATIVE COMMUNITY IMPROVEMENT BY HIGHLIGHTING WHERE WE HAVE BEEN, OUR CURRENT STATUS AND DIRECTING WHERE WE NEED TO GO. IT IS A FREE ONLINE HEALTH RESOURCE FOR A SEVEN COUNTY AREA, WHICH INCLUDES OUR OWN SERVICE AREA OF ST. JOHNS COUNTY (WWW.NEFLORIDACOUNTS.ORG). Part III, Line 4: THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS WAS APPROXIMATELY $19,152,000 AND $13,913,000 FOR THE YEARS ENDED SEPTEMBER 30, 2017 AND 2016, RESPECTIVELY. THE INCREASE IN FISCAL YEAR 2017 WAS THE RESULT OF AN INCREASE IN SELF PAY ACCOUNTS RECEIVABLE.TO ESTIMATE THE AMOUNT OF BAD DEBT THAT RELATES TO PATIENTS THAT WOULD HAVE BEEN ELIGIBLE FOR CHARITY CARE, FLAGLER HOSPITAL SORTS BAD DEBTS BETWEEN PATIENTS THAT HAVE INSURANCE AND PURELY SELF PAY PATIENTS. BAD DEBTS RELATED TO PATIENTS WITH INSURANCE WERE CONSIDERED TO BE INELIGIBLE FOR CHARITY CARE EVEN THOUGH MANY HAVE HIGH DEDUCIBLE AND CO-INSURANCE PLANS AND COULD POSSIBLY QUALIFY. REMAINING BAD DEBTS REPRESENT ENTIRELY SELF PAY ACCOUNTS. THESE ACCOUNTS ARE REDUCED BY MORE THAN 50% USING A SELF PAY ADJUSTMENT CODE AND THE REMAINING AMOUNT IS WRITTEN OFF TO BAD DEBT; THEREFORE, ONLY A PORTION OF THE ACCOUNT IS INCLUDED IN THE BAD DEBT AMOUNT. WE HAVE ASSUMED THAT APPROXIMATELY 50% OF THE SELF PAY BAD DEBTS WOULD HAVE BEEN CHARITY IF THE PATIENT WOULD HAVE BEEN IN COMPLIANCE IN COMPLETING THE CHARITY APPLICATION PROCESS. THIS ESTIMATE IS CONSIDERED TO BE CONSERVATIVE AND IS BASED ON THE EXPERIENCE OF OUR COLLECTIONS STAFF. Part III, Line 8: The Medicare revenue and allowable costs on lines 5 and 6, respectively, were taken from the Medicare cost report. Total revenue received from Medicare is the reimbursement allowed, before reduction of co-pay amounts, less sequestration and any other reductions associated with value based purchasing reductions as per the cost report worksheets E Part A and B. Medicare allowable costs relating to payments are taken from the Part A and Part B expenses as determined by the cost report step down and cost apportionment methodology on worksheets D-1 and D Part V, plus the 65% reduction applied to Medicare bad debts. Part III, Line 9b: 1. FLAGLER HOSPITAL BUSINESS OFFICE STAFF REVIEW UNPAID PATIENT ACCOUNTS ON A REGULAR BASIS TO IDENTIFY THOSE ACCOUNTS THAT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. ATTEMPTS TO CLASSIFY THESE PARTICULAR INDIVIDUALS START AT THE TIME THAT THEY ARE STILL IN-HOUSE. PATIENTS ARE ALSO CONTACTED AFTER DISCHARGE THROUGH PHONE CALLS OR MAIL. COMPLIANT INDIVIDUALS WHO MEET THE HOSPITAL'S FINANCIAL ASSISTANCE GUIDELINES ARE GRANTED THE APPROPRIATE DISCOUNT BASED ON WHERE THEY FALL IN RELATION TO THE FEDERAL POVERTY GUIDELINES. MANY PATIENTS DUE TO FAILURE TO PRODUCE THE APPROPRIATE DOCUMENTATION RECEIVE A REDUCED NON-COMPLIANT HOSPITAL ADJUSTMENT. THESE PARTICULAR INDIVIDUALS MAY HAVE RECEIVED A HIGHER WRITE-OFF IF THEY WERE IN FACT COMPLIANT. 2. REGARDLESS OF THE PATIENTS FINANCIAL CLASS OR STATUS, IF A BILL REMAINS UNPAID FOR MORE THAN 120 DAYS FROM THE DATE IT WAS FIRST MAILED TO THE PATIENT, AND REASONABLE COLLECTION ATTEMPTS HAVE FAILED, THE PATIENT IS SCREENED FOR PRESUMTIVE CHARITY AT 200% OR BELOW THE FEDERAL POVERTY GUIDELINE; IF PRESUMTIVE CHARITY LEVEL IS NOT MET THE DEBT IS SENT TO A PRIMARY BAD DEBT COLLECTION AGENCY FOR FURTHER COLLECTION EFFORTS. Part VI, Line 2: St. Johns County is fortunate to have strong and proactive leadership within its public health system, and a history of successful collaboration. Championed by Flagler Hospital and the Florida Department of Health in St. Johns County, the St. Johns County Health Leadership Council was established in 2010 for the specific purpose of bringing together key leaders from the local community to assess and address the health needs of our residents. In May 2014, the St. Johns County Health Leadership Council achieved national role model status, when it was selected by the University of Kentucky (UK) College of Public Health to be included in a nation-wide study of highly successful public health collaborative. The purpose of the UK study was to identify, compare and contrast exceptional models of collaboration involving community hospitals, public health departments and other stakeholders, who share a commitment to improving community health, and to determine the key lessons learned from their experiences. The T. Johns County Health Leadership Council was one of only twelve collaborative selected by the UK Study Team from over 150 national applications. Flagler Hospital's CEO, VP of Patient Engagement and Director of Community Health Improvement, along with representatives from 41 other agencies participated in this highly collaborative effort with Flagler Hospital in the forefront of every phase from developing survey questions, creating survey tools, identifying focus groups, analyzing data, establishing action plans and reviewing results. A listing of the membership organizations and representatives is attached hereto as Attachment A.The year-long process for this assessment began in July 2013 and utilized a community-wide strategic planning process called "Mobilizing for Action through Planning and Partnerships or "MAPP", which was developed by the National Association of City and County Health Officials and the Centers for Disease Control and Prevention. The Community Health Needs Assessment (CHNA) was planned by the Health Leadership Council as a collection of data gathered to identify and analyze health status, health factors and health outcomes within the community.Using MAPP guidelines, focus groups were formed to determine how residents felt about the quality of life in St. Johns County. These focus groups were facilitated by leaders of the Health Leadership Council with the intent of covering a variety of geographic and demographic sectors of the county. Second, a survey was dispersed county-wide and made available online. This data and data from the National and State County Health Rankings and Healthy People 2020, served as a basis for the Community Health Improvement Plan (CHIP). Note: the complete "Community Health Needs Assessment and Community Health Improvement Plan" is published and available on the Flagler Hospital website: www.flaglerhospital.org. Flagler Hospital's Board of Directors approved the Community Health Needs Assessment and Community Health Improvement Plan at their meeting on March 24, 2016.To implement the findings and goals determined through the CHNA, the MAPP process uses a three year cycle with each identified need having an "owner" to track progress. While various members of the Health Leadership Council took "ownership" of various aspects of the Health Needs Assessment's implementation, Flagler Hospital participates in each part of implementation. The shared vision and common values of members provide a framework for pursuing the long range goals, so Flagler Hospital is proud to partner with many members of the Health Leadership Council, in order to broaden community participation. Flagler Hospital acknowledges and agrees with the specified goals of the CHNA. A Community Balanced Scorecard was created to track and evaluate each of the strategic objectives and acts as the Community Health Improvement Plan. The criteria and rationale for each of the objectives and goals is contained on page 116 of the published "2014 Community Health Needs Assessment and Community Health Improvement Plan". Part VI, Line 3: THE HOSPITAL COMMUNICATES ITS CHARITY CARE POLICY, OR PATIENT-FRIENDLY SUMMARY THEREOF, IN THE FOLLOWING WAYS: - POSTED ON THE FLAGLER HOSPITAL WEBSITE - POSTED AT THE RECEPTION DESKS IN ALL REGISTRATION AREAS - POSTED AT ALL FINANCIAL COUNSELORS' DESKSWHEN UNINSURED OR UNDERINSURED PATIENTS ARE ADMITTED TO THE HOSPITAL, THEY ARE SCREENED FOR FINANCIAL ASSISTANCE. AT THE TIME OF SCREENING, THE PATIENT IS PROVIDED A FINANCIAL ASSISTANCE APPLICATION TO COMPLETE. THEY ARE THEN ASKED TO SUBMIT THE REQUIRED FINANCIAL DOCUMENTS (I.E., BANK STATEMENTS, PAY STUBS, TAX RETURNS, ETC.). THOSE PATIENTS DISCHARGED PRIOR TO SCREENING ARE CALLED BY BUSINESS OFFICE AND ARE SCREENED OVER THE PHONE. THE PATIENT IS INFORMED OF THE ELIGIBILITY REQUIREMENTS AND THE FINANCIAL DOCUMENTS NEEDED FOR VERIFICATION. UNINSURED PATIENTS TREATED IN THE EMERGENCY DEPARTMENT WHO MEET CERTAIN CRITERIA ARE SCREENED BY PHONE BY THE BUSINESS OFFICE. THE PATIENT IS INFORMED OF THE ELIGIBILITY REQUIREMENTS AND THE FINANCIAL DOCUMENTS NEEDED. A SEPARATE SCREENING IS PERFORMED TO DETERMINE ELIGIBILITY FOR COUNTY PROGRAMS AND MEDICAID.IN ADDITION, THE HOSPITAL UTILIZES A THIRD-PARTY VENDOR TO SCREEN SELF PAY PATIENTS FOR POSSIBLE DISCOUNTS AND FINANCIAL ASSISTANCE OPTIONS. FOR DETAILS, PLEASE SEE THE REPONSE TO PART I, LINE 3C ABOVE. Part VI, Line 4: Flagler Hospital is the only hospital located in St. Johns County, Florida and serves as the primary health care provider for local residents. According to 2015 U.S. Census data, there are 243,812 residents in Flagler Hospital's defined community of St. Johns County. Part VI, Line 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. FORM 990, SCHEDULE H, PART VI, COMMUNITY HEALTH PROMOTION PLEASE SEE PART V LINE 11 DESCRIPTION FOR PROMOTION OF COMMUNITY HEALTH 1 COMMUNITY HOSPICE OF NE FL 4266 SUNBEAM RD JACKSONVILLE FL 32257 591940256 501(C)(3) 5000 OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE FLAGLER COLLEGE INC 74 KING ST ST AUGUSTINE FL 32084 591157081 501(C)(3) 5000 OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE INVESTING IN KIDS (INK) 40 ORANGE ST ST AUGUSTINE FL 32084 841455282 501(C)(3) 15000 OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE NORTH FLORIDA CARDIOVASCULAR 501 RIVERSIDE AVE STE 800 JACKSONVILLE FL 32202 201773470 501(C)(3) 5000 OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE PROJECT SOS INCC 4417 BEACH BLVD JACKSONVILLE FL 32207 593179894 501(C)(3) 5000 OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE ST JOHNS COUNCIL ON AGING 180 MARINE ST ST AUGUSTINE FL 32084 591525829 501(C)(3) 50000 OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE ST JOHNS COUNTY CHAMBER OF COMMERCE 1 RIBERIA ST ST AUGUSTINE FL 32084 590432275 501(C)(3) 35000 OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE UNIVERSITY OF NORTH FLORIDA FOUNDATION 1 UNF DR BLDG 39 JACKSONVILLE FL 32224 237167701 501(C)(3) 35000 OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE 8 Part I, Line 2: THE FLAGLER HEALTH CARE FOUNDATION, A SUPPORTING ORGANIZATION OF THE HOSPITAL, REPORTS ITS FINANCIAL ACTIVITIES TO THE CFO OF FLAGLER HOSPITAL. X 1 0 X X X X X 0 1 0 0 0 1 0 0 0 Joseph S Gordy CEO 480691 0 71070 0 17796 0 52250 0 0 0 621807 0 0 0 Roger D Carter CFO 258278 0 0 0 16693 0 16985 0 18689 0 310645 0 0 0 Jason P Barrett Executive VP 287697 0 0 0 10169 0 17250 0 13328 0 328444 0 0 0 William D Rieger CIO 214564 0 0 0 8830 0 13857 0 20367 0 257618 0 0 0 Christopher Schmidt COO 264947 0 0 0 11519 0 17110 0 12400 0 305976 0 0 0 Donald R Crist VP Operations 217489 0 0 0 13869 0 14060 0 18689 0 264107 0 0 0 Jeffrey A Hurley CLO 228328 0 0 0 11278 0 14931 0 18689 0 273226 0 0 0 Mary K Mantese CNO 186114 0 0 0 11075 0 11583 0 15577 0 224349 0 0 0 Michael C DiBella CMO 375876 0 0 0 6018 0 17250 0 16964 0 416108 0 0 0 Michael C Sanders Chief-Medical Informatics 308130 0 0 0 1236 0 17250 0 0 0 326616 0 0 0 Miguel A Machado CMO 293903 240000 0 0 1714 0 17250 0 20367 0 333234 240000 0 0 Gregory A Gibson MD 0 202310 0 29815 0 11642 0 12690 0 12245 0 268702 0 0 Brian D Raymaker MD 0 169449 0 20925 0 220 0 10334 0 7957 0 208885 0 0 Part I, Line 1a THE ORGANIZATION PROVIDES GROSS UP PAYMENTS FOR THE VALUE OF DISABILITY INSURANCE POLICY PREMIUMS TO CERTAIN OFFICERS, REPORTED ON THE OFFICERS' FORM W-2. Part I, Line 4b THE ORGANIZATION CONTRIBUTED $35,000 TO A 457(F) PLAN FOR JOSEPH S. GORDY. Part I, Line 6 THE ORGANIZATION PAYS A CEO BONUS ON FINANCIAL, OPERATING MARGIN, PATIENT SATISFACTION, AND QUALITY MEASURES. A sT JOHNS COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY 592146640 2012-04-04 30000000 SEE PART VI 0 0 0 B sT JOHNS COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY 592146640 2017-09-28 71400000 SEE PART VI 0 0 0 A 12000000 30000000 30000000 2012 0 0 1 1 B 71400000 338361 592158 53517222 16952259 2019 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 B 0 PART I, LINE A, COLUMN F FINANCING OF FACILITIES IMPROVEMENT PROJECTS; ACQUISITION AND INSTALLATION OF NEW ELECTRONIC MEDICAL RECORDS SYSTEM. PART I, LINE B, COLUMN F CURRENT REFUNDING OF SERIES 2010A AND SERIES 2010B BONDS; FINANCING OF FACILITIES IMPROVEMENT PROJECTS AND EQUIPMENT ACQUISITIONS. PART II, LINE 11, COLUMN B BOND PROCEEDS APPLIED TOWARD CURRENT REFUNDING OF SERIES 2012 A AND SERIES 2010B BONDS. Form 990, Part VI, Section A, line 6 COASTAL COMMUNITY HEALTH, INC. IS THE SOLE MEMBER OF THE ORGANIZATION. Form 990, Part VI, Section A, line 7a THE SOLE MEMBER HAS THE AUTHORITY TO APPOINT THE BOARD MEMBERS. Form 990, Part VI, Section A, line 7b THE SOLE MEMBER HAS THE AUTHORITY TO: 1. ADOPT OR REVISE A STRATEGIC PLAN 2. AMEND THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS 3. CONDUCT MERGERS, ACQUISITIONS AND SALES OF ALL OR SUBSTANTIAL PART OF CORPORATION'S ASSETS 4. LIQUIDATION AND DISSOLUTION 5. ELECTION AND REMOVAL OF THE CORPORATION'S OFFICERS AND DIRECTORS INCLUDING THE CHIEF EXECUTIVE OFFICER AND THE CHAIRMAN OF THE CORPORATION'S BOARD OF DIRECTORS 6. APPROVAL OF CAPITAL AND OPERATING BUDGETS 7. ANY ACTIONS AFFECTING THE CORPORATION'S TAX EXEMPT STATUS 8. FUNDAMENTAL CHANGES IN MISSION OR DIRECTION 9. ENTRY INTO A MATERIAL AGREEMENT THAT INVOLVE ANNUAL PAYMENTS THAT EXCEED 2% OF THE CORPORATION'S TOTAL ANNUAL BUDGETED OPERATING EXPENSES, A SIGNIFICANT JOINT VENTURE, PROVIDES MANAGEMENT FOR THE CORPORATION, OR INSURANCE WITH A PROJECTED ANNUAL VALUE OF 5% OR MORE OF THE CORPORATION'S ANNUAL NET PATIENT REVENUE 10. INCURRENCE, REFINANCING, PREPAYMENT OR DEFEASANCE OF DEBT IN THE EXCESS OF THE GREATER OF $10,000,000 OR 10% OF THE CORPORATION'S OUTSTANDING DEBT 11. SECURING A MORTGAGE, DEED OF TRUST, OR OTHER ENCUMBRANCE IN EXCESS OF THE GREATER OF $10,000,000 OR 10% OF THE CAPITAL BUDGET 12. INCURRENCE OF ANY UNBUDGETED CAPITAL EXPENSE IN EXCESS OF THE GREATER OF $5,000,000 OR 5% OF THE CORPORATION'S ANNUAL CAPITAL BUDGET 13. A CAPITAL EXPENDITURE OVERRUN IN EXCESS OF THE GREATER OF $5,000,000 OR 5% OF THE BUDGETED CAPITAL EXPENSE 14. INCURRENCE OF ANY UNBUDGETED OPERATING EXPENSE IN EXCESS OF 1% OF THE CORPORATION'S TOTAL ANNUAL OPERATING EXPENSES 15. SELECTION OF THE CORPORATIONS INDEPENDENT AUDITOR 16. ADOPTION OR REVISION OF CHARITABLE CARE POLICIES 17. DONATION OF MATERIAL FUNDS TO A PERSON OR ENTITY NOT AFFILIATED WITH THE SOLE MEMBER OR ANY OF ITS SUBSIDIARIES PROVIDED THAT THE SOLE MEMBER SHALL NOT BE REQUIRED TO REVIEW OR AUTHORIZE CONTRIBUTIONS TO A LOCAL CHARITY THAT DID NOT EXCEED $250,000 IN ANY YEAR. 18. FORMATION OF A NEW MATERIAL ENTITY AS A SUBSIDIARY 19. ACTIONS TAKEN TO CURE ANY BREACH OF OR FAILURE TO COMPLY WITH COVENANTS IN BOND AND OTHER DEBT AGREEMENTS Form 990, Part VI, Section B, line 11b THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTANT AND REVIEWED AND APPROVED BY INTERNAL MANAGEMENT AND SHARED WITH EACH BOARD MEMBER PRIOR TO FILING. Form 990, Part VI, Section B, line 12c THE ORGANIZATION REQUIRES COMPLETION OF A CONFLICT OF INTEREST QUESTIONNAIRE. Form 990, Part VI, Section B, line 15 THE COMPENSATION PACKAGE FOR THE CEO POSITION IS SET AND APPROVED BY THE COMPENSATION COMMITTEE, WHICH CONSISTS OF THE CURRENT AND PAST CHAIRPERSONS OF THE HOSPITAL, FLAGLER HEALTH CARE SYSTEM, AND FLAGLER HEALTH SERVICES BOARDS. INDEPENDENT SALARY SURVEYS ARE OBTAINED FROM INDUSTRY EXPERTS TO DETERMINE COMPENSATION AND BENEFITS. THOSE INDEPENDENT SALARY SURVEYS ARE ALSO USED TO DEVELOP COMPENSATION PACKAGES FOR THE SENIOR MANAGEMENT TEAM. Form 990, Part VI, Section C, line 18 PHOTOCOPIES OF THE ORGANIZATION'S FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICES. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part IX, line 11g Other fees: Program service expenses 157,890. Management and general expenses 1,483,943. Fundraising expenses 0. Total expenses 1,641,833. CONTRACT SERVICES: Program service expenses 13,280,613. Management and general expenses 2,299,343. Fundraising expenses 0. Total expenses 15,579,956. PURCHASE SERVICES: Program service expenses 3,394,325. Management and general expenses 1,365,967. Fundraising expenses 0. Total expenses 4,760,292. PROFESSIONAL FEES: Program service expenses 12,637,083. Management and general expenses 140,523. Fundraising expenses 0. Total expenses 12,777,606. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FLAGLER HEALTH CARE FOUNDATION 400 HEALTH PARK BLVD ST AUGUSTINE FL 32086 592440537 SUPPORTING ORGANIZATION FL 501(C)(3) 11 (TYPE I) FLAGLER HOSPITAL 1 COASTAL COMMUNITY HEALTH INC 841 PRUDENTIAL DR STE 1604 JACKSONVILLE FL 32207 471322041 SUPPORTING ORGANIZATION FL 501(C)(3) 11 (TYPE I) 0 OUTPATIENT SURGERY CENTER OF ST AUGUSTINE LLC 1 ORTHOPAEDIC PL STE 200 ST AUGUSTINE FL 32086 202047704 OUTPATIENT SURGERY FL N/A RELATED 174356 173234 0 1 0.10680 FLAGLER HEALTH SERVICES INC 400 HEALTH PARK BLVD ST AUGUSTINE FL 32086 592484352 REAL ESTATE LEASING FL FLAGLER Hospital INC C 2006032 3695037 1.00000 1 HEALTH PARK OWNERS ASSOCIATION 400 HEALTH PARK BLVD ST AUGUSTINE FL 32086 592869538 BUILDING ASSOCIATION FL FLAGLER Hospital INC C 61755 573638 1.00000 1 ANDERSON GIBBS CONDOMINIUM ASSOC 400 HEALTH PARK BLVD ST AUGUSTINE FL 32086 593223458 BUILDING ASSOCIATION FL FLAGLER Hospital INC C 614579 1.00000 1 1 1 1 1 0 0 0 0 0 1 0 0 1 0 1 1 1 0 0 Flagler Health Care Foundation Inc A 35030 FMV Flagler Health Services Inc J 429892 FMV Flagler Health Care Foundation Inc M 561093 FMV Flagler Health Care Foundation Inc Q 199770 FMV Flagler Health Services Inc P 58309 fMV Flagler Health Care Foundation Inc C 1134538 FMV