2018-01-30T13:48:15-06:00 2016-12-31 990 2016-01-01 592108057 Florida Hospital Zephyrhills Inc FLOR 8137880411 7050 Gall Blvd Zephyrhills FL 33541 Lynn C Addiscott Assistant Secretary 4079751492 2018-01-09 204.139.85.142 2018-01-09 13:11:44 ES P E904DE6D4998E83E456D7371406A3E618825EF48 F7F973113C6C6A5F5987F0EC85E73F6D0608CD2F 2016 2021-01-29 14:40:06Z Randy Surber 7050 Gall Blvd Zephyrhills FL 33541 151264795 0 X WWW.FHZEPH.ORG X 1998 FL PROVISION OF MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF A 139 BED ACUTE-CARE HOSPITAL. 13 9 1154 207 55983 -2362 100000 0 137290769 148228701 660220 1556337 304921 122184 138355910 149907222 647186 96498 0 0 62915471 65117681 0 0 0 71162281 71816060 134724938 137030239 3630972 12876983 180514060 190690542 79639569 75736196 100874491 114954346 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 Adventist Health System (AHS). AHS 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, AHS cares for and nurtures people: our employees, our communities, our healthcare professionals, and those who trust us for care and healing. 0 0 126486181 96498 148177782 FLORIDA HOSPITAL ZEPHYRHILLS, INC. OPERATES A 139-BED ACUTE CARE HOSPITAL IN ZEPHYRHILLS, FL. IN THE CURRENT YEAR, THERE WERE 8,260 PATIENT ADMISSIONS RESULTING IN 32,796 PATIENT DAYS, and 57,460 outpatient visits. 126486181 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 327 0 1 1154 1 1 1 0 0 0 0 0 0 0 0 0 X 13 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X Ryan Willis 8137836100 7050 GALL BLVD Zephyrhills FL 33541 X Michael Schultz Director/Chairman 5.50 44.50 X 0 1405614 187036 Denyse Bales-Chubb Director (beg 4/16) 0.50 50.00 X 0 393834 78067 Randall Belcher Director 0.50 0.00 X 0 0 0 Bruce Bergherm Director (end 4/16) 0.50 50.00 X 0 514887 113913 Robert Cabot Director 0.50 0.00 X 0 0 0 Scott Cameron Director (beg 6/16) 0.50 0.00 X 0 0 0 Leroy Hauff Director 0.50 0.00 X 0 0 0 Stephen Herr Director 0.50 0.00 X 0 0 0 Terri McEndree MD Director (beg 6/16) 0.50 0.00 X 0 0 0 William E McGavern Director (end 2/16) 0.50 0.00 X 0 0 0 Ray Polk Director 0.50 0.00 X 0 0 0 Javier Rojas MD Director (end 12/16) 3.30 0.00 X 21574 0 0 John Scott Director 0.50 0.50 X 0 0 0 Randy Surber Director/Sec/CEO 50.00 0.00 X X 0 417902 80772 ROBERT Winters Director 0.50 0.00 X 0 0 0 William Heinrich CFO & COO (end 7/16) 50.00 0.00 X 0 293595 65034 Ryan Willis CFO & COO (beg 8/16) 50.00 0.00 X 0 91145 12126 Dima Didenko Region SEO (beg 7/16) 5.00 45.00 X 0 442802 92099 Hugar McNamee MD CMO 50.00 0.00 X 0 329049 40248 Gwen Alonso CNO 50.00 0.00 X 0 214421 36869 Amir Quefatieh MD Physician 40.00 0.00 X 1330794 0 39605 Bertram A Lewis Jr MD Physician 40.00 0.00 X 567524 0 40667 Harry Blackstone MD Physician 40.00 0.00 X 313637 0 31014 Marian Antonette Sampson MD physician 40.00 0.00 X 274743 0 23619 Migdalia Merida MD Physician 40.00 0.00 X 210623 0 19021 Paul Ziegele Former CFO 0.00 0.00 X 0 106493 19507 2718895 4209742 879597 73 1 1 0 Morrison Management Specialists Inc PO BOX 102289 Atlanta GA 30368 Dietary Management Services 1067484 Aramark 10510 Twin Lakes Parkway Charlotte NC 28289 Equipment Maintenance 1000747 Tampa Bay Anesthesia Assoc LLC 3414 Loggerhead Way Wesley Chapel FL 33544 Anesthesia Services 908422 Bay Linen 11525 47th Street North Clearwater FL 33762 Linen Services 478068 PT Solutions PO BOX 242278 Montgomery AL 36124 Therapy Services 458401 32 X Net patient revenue 622110 146610162 146610162 Cafeteria revenue 622110 695111 695111 Fitness center revenue 622110 304774 253855 50919 Daycare revenue 622110 274777 274777 Gift shop revenue 622110 195584 195584 148293 148293 148228701 1914807 1914807 133490 11306 122184 122184 5064 117120 987797 1231544 114723 -1231544 873074 -358470 -358470 149907222 148177782 55983 1673457 X 96498 96498 1655242 1655242 48292777 48292777 1504921 1480869 24052 10095866 10095866 3568875 3511837 57038 211553 211553 71462 71462 492573 492573 18551821 14799495 3752326 1844918 1844918 3295213 2464270 830943 5274933 4623650 651283 2298581 2298581 125258 9571 115687 503900 503900 2134520 2134520 6779710 6779710 1271627 1255309 16318 Medical Supplies 24933862 24933862 Repairs & maintenance 2461079 2461079 State Tax Indigent Asse 1228093 1228093 UBI taxes 5000 5000 331957 20194 311763 137030239 126486181 10544058 0 4116 2984 99166839 98932152 16729665 16928956 3558449 4054926 2963087 3835351 180996749 115477932 57846661 65518817 350884 308520 -105641 1108836 180514060 190690542 12326562 12283340 67313007 63452856 79639569 75736196 X 100863571 114954346 10920 0 100874491 114954346 180514060 190690542 X 12876983 2055788 -852916 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 5665 5665 0 Part II-B, Line 1: American & Florida Hospital Association dues. 8306101 8306101 78389308 46113984 32275324 83629654 66835043 16794611 10671686 2528905 8142781 65518817 Due to related 3803371 Payable to third parties 1586587 Credit balances in A/R 368860 Interco. Alloc. of TE Bond Proceeds 57150904 Due to affiliated 100121 Other liabilities 443013 63452856 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 footnote - The Division follows ASC 740, Income Taxes, 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, 2016. 1 1 X 1 X 0 1 1 1 0 1 0 5341791 5341791 0.03900 17650699 7884199 9766500 0.07130 22992490 7884199 15108291 0.11030 626556 626556 0.00460 626556 626556 0.00460 23619046 7884199 15734847 0.11490 821074 821074 0.00600 821074 821074 0.00600 1 5962294 293901 39460479 43812631 -4352152 X 1 1 1 1 Florida Hospital Zephyrhills 7050 Gall Blvd Zephyrhills FL 33541 www.fhzeph.org 4445 X X X Florida Hospital Zephyrhills Inc 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X See Statement X X 1 14 1 See Statement 0 1 X 200.000000000000 X X X X 1 1 X X X X 1 X See Statement X See Statement X See Statement X X X X X X 1 X 0 X X X X 1 X 0 0 Florida Hospital Zephyrhills, Inc. Part V, Section B, Line 5: Florida Hospital Zephyrhills, Inc., d/b/a Florida Hospital Zephyrhills, (FHZ or the Hospital) is a 139-bed regional medical center located in East Pasco County in Florida. FHZ serves the eastern portion of Pasco County, which is comprised of primarily the cities of Zephyrhills, Dade City, and portions of Wesley Chapel. The Hospital serves a population that is primarily white, older, and underinsured. Many residents, particularly in two of the zip codes that comprise the Hospital's primary service area, are seniors, with more than 65% of the residents over the age of 65, many of whom may have chronic diseases due to age and/or lifestyle. The Hospital's primary service area is comprised of five zip codes in Pasco County, Florida. In conducting its 2016 Community Health Needs Assessment (CHNA), primary and secondary health data was collected and analyzed. Primary data was gathered based upon input from individuals representing the broad community, as well as low-income, minority, and other medically underserved populations. Primary data input was primarily gathered through the establishment of a Community Health Needs Assessment Committee, community stakeholder surveys (approximately 100 surveys were conducted), and Public Health input and expertise. The Hospital formed a Community Health Needs Assessment Committee (CHNAC) that included representatives of the community and the Hospital, with a special focus on underserved populations. Many of the CHNAC members were selected because of their direct ties to the underserved and impoverished communities in the Hospital's primary service area. Key members of the CHNAC included representatives from the Pasco County Health Department, Premier Community HealthCare, a federally qualified health care center, and Church of the Nazarene, a local community church. FHZ also gathered primary data through the utilization of a stakeholder survey. This stakeholder survey was distributed to and completed by both members of the CHNAC and members of the community at large. Various sources of secondary data were reviewed to understand the larger issues plaguing the Hospital's primary service area. Florida Hospital Zephyrhills, Inc. 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. Florida Hospital Zephyrhills, Inc. Part V, Section B, Line 11: The information provided below explains how the hospital facility addressed in 2016 the significant health needs identified in its 2013 Community Health Needs Assessment, and any such needs that were not addressed and the reasons why such needs were not addressed. The hospital facility conducted a Community Health Needs Assessment in 2016 and adopted an implementation strategy to address the significant health needs identified in the 2016 Community Health Needs Assessment in 2017 prior to May 15, 2017. This is the third-year update for Florida Hospital Zephyrhills' 2013-2016 Community Health Plan/Implementation Strategy. Florida Hospital Zephyrhills (FHZ or the Hospital) developed this Plan and posted it in May 2014 as part of its 2013 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, Florida Hospital Zephyrhills made a notable effort to define and address the needs of low-income, minority and underserved populations in its service area. The 2013 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 2013-2016 Community Health Plan. The three-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2013 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. Issue: Stroke Awareness2013 Description of the Issue: Florida Hospital Zephyrhills's service area has the fourth highest three-year, age-adjusted stroke rates in the state. The American Stoke Association and other community organizations provide outreach and educational materials on stroke prevention and warning signs. 2016 Update: FHZ has earned an Advanced Certification for Primary Stroke by the Joint Commission. A requirement for earning this certification requires a hospital to educate its community on the warning signs of a stroke. Due to the large numbers of older residents and the high rate of stroke in the community, Florida Hospital Zephyrhills invested significant time educating its community on how to recognize the warning signs of a stroke and the importance of responding quickly. The Hospital offered 42 community health talks over the past three years to 55+ communities reaching more than 960 residents. The Hospital also distributed more than 3,300 educational stroke wallet cards at community events and health fairs. In addition, FHZ provided 6,328 encounters with staff members for stroke education. The Hospital also offered a monthly Stroke Support Group at no cost to the community. Issue: Heart Disease 2013 Description of the Issue: The Pasco County three-year, age-adjusted death rate for heart disease is higher than the rest of Florida for the Caucasian population; it is the second-highest in the state for the African America population. In addition, tobacco use is higher in Pasco County (21%) than in the state of Florida (17.1%). 2016 Update: Florida Hospital Zephyrhills focused its heart disease efforts on early detection and screenings. The Hospital held community education programs related to heart disease prevention and treatment to include 49 health talks reaching 2,290 people. The Hospital also provided free heart health screenings to 2,031 people through 29 community events that included cholesterol, hypertension and EKG screenings. FHZ provided 39 heart healthy nutrition classes with 465 attendees.The Hospital also hosted its annual MEGA Heart Expo which provides heart education through multiple health talks featuring local cardiologists, electrophysiologists and primary care physicians. This expo also included an educational health fair, free heart screenings, and an inflatable, walk-through MEGA heart exhibit where a physician provides tours while discussing how the heart functions. This event drew more than 250 people.In addition, the Hospital offered a free monthly Heart Health Support Group which includes cardiologists who provide heart disease education. FHZ supports the annual AHA Heart Walk and hosts an annual 5K Run/Walk through its wellness center. Employees and the community are urged to participate. The Hospital partners with its local health department to provide a smoking cessation class. Over the past three years, the Hospital hosted 30 smoking cessation classes with 212 participants.FHZ's Life Coach and CREATION Health program for cardiac patients is open to the public and focuses on the principles of Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook and Nutrition which encourages people to make healthy lifestyle choices. Issue: Uncontrolled Diabetes2013 Description of the Issue: The age-adjusted rate for diabetes in Pasco County is higher than in the rest of the state: the county rate is 2314.8 per 100,000 vs. the state rate of 2260.3 per 100,000. Stroke and heart disease are often associated with undetected and/or uncontrolled diabetes. 2016 Update: Florida Hospital Zephyrhills offered free diabetic education classes to uninsured and low income people through its diabetic program. In three years, the Hospital delivered 85 diabetic education classes to 867 people. The Hospital also provided free blood glucose screenings to 547 people, exceeding our goal of 150 screenings. People with elevated blood sugars were referred to their family doctors and/or the Premier Community Health Care clinic (FQHC) that sees uninsured people on a sliding fee scale basis. The Hospital's monthly no-cost diabetes support group had 325 participants.The Hospital holds a partnership with Walgreens Rx for highly discounted diabetes medications and supplies. The Hospital's Life Coach and CREATION Health programs for cardiac patients are open to the public and focus on the principles of Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook and Nutrition which encourages people to make healthy lifestyle choices.Issue: Access to Health Care/Rate of Uninsured2013 Description of the Issue: The 12% unemployment rate in Pasco County is worse than the state of Florida rate of 10.5%. Our Needs Assessment cited this as the second-highest behavioral risk factor for a lack of access to affordable health care. In addition, Pasco County has many small employers who do not provide health coverage to their workers. The overall uninsured rate in the Hospital's service area is 20%.2016 Update: While the State of Florida did not expand Medicaid, Florida Hospital Zephyrhills has worked to increase the rate of insurance through inpatient and ER referrals to Marketplace Enrollment Navigators. In addition, the Hospital actively enrolled eligible patients in Medicaid, worked with the Pasco Medicaid Enrollment Office and helped eligible patients access the Pasco County Health Department.In year three of our Community Health Plan, the Hospital partnered with Premier Community Health Care (FQHC), a local clinic that sees uninsured people on a sliding fee scale basis, to provide a full-time patient navigator in the Hospital's ER. This navigator assists the uninsured with scheduling follow-up appointments, medication management and scheduling other outpatient tests. This navigator also assists in-patients as well with these same services. During the past three years, the Hospital provided free back-to-school physicals for 581 children and recruited 8 new primary care providers to the community (Pasco County is a federally designated Medically Underserved Area, as well as a Health Professionals Shortage Area). Because the unemployment rate is high in Pasco County, Hospital Leadership is active in the Pasco Economic Development Council (PEDC). The PEDC is working on large scale economic development efforts with the intent of positively impacting future employment opportunities in the county Schedule H, Part V, Section B, Line 7a: The CHNA report can be found at URL:https://www.floridahospital.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.floridahospital.com/community-health-needs-assessments Schedule H, Part V, Section B, Line 16a,b,c: The Financial Assistance Policy can be found at URL:https://www.floridahospital.com/patient-resources/billing/financial-assistance The Financial Assistance Policy application can be found at:https://www.floridahospital.com/patient-resources/billing/financial-assistance The plain language summary is available at:https://www.floridahospital.com/patient-resources/billing/financial-assistance Part V, Section B, Line 11 - continuation: Issue: Healthy Living and Obesity 2013 Description of the Issue: The number of adults who are overweight/obese is higher in Pasco County than in the state of Florida. Overweight/obesity are linked to chronic diseases including diabetes, heart disease and stroke. 2016 Update: Florida Hospital Zephyrhills offered healthy living programs to supplement the disease-specific activities noted above. During the past three years, the Hospital hosted 58 CREATION Health programs with 1,347 participants to help people choose to make healthy lifestyle choices. Over 233 CREATION Health Student Guides were distributed in local schools and CREATION Health educational materials were distributed at 115 other local events. CREATION Health teaches and encourages people to make healthy lifestyle choices so they can live long, healthy lives.The Hospital has an on-site wellness center and the Hospital's paved, walking trail is open to the public. In 2016, the Hospital added a CREATION Health Community Garden to promote healthy nutrition and to encourage the community to grow their own organic vegetables.Issues Considered, but Not AddressedThe 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 issue: CancerAlthough Cancer is the number one killer for all races and ethnicities (as noted in the three-year, age-adjusted death rate for Pasco County), and the number four health problem identified in primary research, it was not selected as a priority because Florida Hospital Zephyrhills does not provide cancer treatment services. And, while we have a Simpson Breast Health Center, it serves primarily as a diagnostic service and is not set up to manage cancer on a broader scale. We have a solid transfer agreement in place with Moffitt Cancer Center; this ensures access to cancer care for our patients. SCHEDULE H, PART V, SECTION B, LINE 8 10a The filing organization adopted a Community Health Needs Assessment Report by 12/31/16 and was in the process of developing its Community Health Needs Implementation Strategy. The filing organization's 2017 Community Health Needs Implementation Strategy will be documented in a written report called the "Community Health Plan". The Community Health Plan (CHP) will describe how the filing organization plans to meet its identified prioritized health needs or will identify the health need as one the filing organization does not intend to specifically address and provide an explanation as to why the filing organization does not intend to address that health need. In accordance with Final Regulation Section 1.501(r)-3(c)(5), the filing organization's 2017 CHP was adopted no later than May 15, 2017 and is also posted on the hospital facility's website.As the hospital facility's 2017 Community Health Needs Implementation Strategy was not adopted by the end of the hospital organization's taxable year of December 31, 2016, Schedule H, Part V, Section B, line 9 indicates that 2014 was the tax year in which the hospital facility last adopted an implementation strategy. Schedule H, Part V, Section B, Line 10a reflects the website address for the hospital facility's 2014 Implementation Strategy since this is the most recently adopted Implementation Strategy. 8 2 - Wound Care 38233 Daughtery Rd Zephyrhills FL 33540 Wound Care 3 - Medical Group of Tampa Bay Pulmonology 6747 Gall Blvd Zephyrhills FL 33541 Physician / Pulmonology 4 - Community Care Family Practice of Zephyr 38240 Daughtery Rd Zephyrhills FL 33540 Physician / Outpatient Clinic 5 - Medical Group of Tampa Bay Urology 6747 Gall Blvd Zephyrhills FL 33541 Physician / Outpatient Clinic 6 - Internal Medicine of East Pasco 37924 Medical Arts Ct Zephyrhills FL 33541 Internal Medicine 7 - Family Practice 37908 Daughtery Rd Zephyrhills FL 33541 Family Practice 8 - Family Practice of Lake Jovita 14010 21st Street Dade City FL 33525 Physician / Outpatient Clinic 9 - Family Practice of Dade City 37740 Meridian Ave Dade City FL 33525 Family Practice 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 22 tax-exempt 501(c)(3) hospital organizations that operated 44 hospitals in ten states within the U.S. The system of organizations under the control and ownership of AHSSHC is known as "Adventist Health System" (AHS).All hospital organizations within AHS collect, calculate, and report the community benefits they provide to the communities they serve. AHS organizations exist solely to improve and enhance the local communities they serve. AHS 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 AHS 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 organizations most recently conducted community health needs assessment and associated implementation strategy are posted 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 II, Community Building Activities: The costs of community building activities reported on Part II of Schedule H primarily represent the costs associated with providing education for the filing organization's staff physicians and employees. The filing organization's provision of these educational programs/activities to staff physicians and employees provides an opportunity for health care professionals to enhance their skills and expertise and keep up-to-date with the latest advancements in medical procedures and technology. In addition, training opportunities are often provided on-site at the filing organization's hospital facility, thereby allowing for health care professionals to be more readily available to assist in meeting immediate patient care needs. Education and training provided to the facility's workforce is vital in assisting health care professionals directly involved in patient care with keeping abreast of the latest developments in their respective areas of expertise, learning possible new and innovate ways of delivering care to patients, and understanding the newest technologies available for the treatment of patients. 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 pages 7. Please note that dollar amounts on the attached consolidated audited financial statements are in thousands. Part III, Line 8: Costing Methodology:Medicare allowable costs were calculated using a cost-to-charge ratio.Rationale for Including a Medicare Shortfall as Community Benefit:As a 501(c)(3) organization, the filing organization provides emergency and non-elective care to all regardless of ability to pay. All hospital services are provided in a non-discriminatory manner to patients who are covered beneficiaries under the Medicare program. As a public insurance program, Medicare provides a pre-established reimbursement rate/amount to health care providers for the services they provide to patients. In some cases, the reimbursement amount provided to a hospital may exceed its costs of providing a particular service or services to a patient. In other cases, the Medicare reimbursement amount may result in the hospital experiencing a shortfall of reimbursement received over costs incurred. In those cases where an overall shortfall is generated for providing services to all Medicare patients, the shortfall amount should be considered as a benefit to the community. Tax-exempt hospitals are required to accept all Medicare patients regardless of the profitability, or lack thereof, with respect to the services they provide to Medicare patients. The population of individuals covered under the Medicare program is sufficiently large so that the provision of services to the population is a benefit to the community and relieves the burdens of government. In those situations where the provision of services to the total Medicare patient population of a tax-exempt hospital during any year results in a shortfall of reimbursement received over the cost of providing care, the tax-exempt hospital has provided a benefit to a class of persons broad enough to be considered a benefit to the community. Despite a financial shortfall, a tax-exempt hospital must and will continue to accept and care for Medicare patients. Typically, tax-exempt hospitals provide health care services based upon an assessment of the health care needs of their community as opposed to their taxable counterparts where profitability often drives decisions about patient care services that are offered. Patient care provided by tax-exempt hospitals that results in Medicare shortfalls should be considered as providing a benefit to the community and relieving the burdens of government. Part III, Line 9b: The hospital filing organization's collection practices are in conformity with the requirements set forth in the 2014 Final Regulations regarding the requirements of Internal Revenue Code Section 501(r)(4) - (r)(6). No extraordinary collection actions (ECA's) are initiated by the hospital filing organization in the 120-day period following the date after the first post-discharge billing statement is sent to the individual (or, if later, the specified deadline given in a written notice of actions that may be taken, as described below). Individuals are provided with at least one written notice (notice of actions that may be taken) and a copy of the filing organization's Plain Language Summary of the Financial Assistance Policy that informs the individual that the hospital filing organization may take actions to report adverse information to credit reporting agencies/bureaus if the individual does not submit a Financial Assistance Application Form (FAA Form) or pay the amount due by a specified deadline. The specified deadline is not earlier that 120 days after the first post-discharge billing statement is sent to the individual and is at least 30 days after the notice is provided. A reasonable attempt is also made to orally notify an individual about the filing organization's Financial Assistance Policy and how the individual may obtain assistance with the Financial Assistance application process. If an individual submits an incomplete FAA Form during the 240-day period following the date on which the first post-discharge billing statement was sent to the individual, the hospital filing organization suspends any reporting to consumer credit reporting agencies/bureaus (or ceases any other ECA's) and provides a written notice to the individual describing what additional information or documentation is needed to complete the FAA Form. This written notice contains contact information including the telephone number and physical location of the hospital facility's office or department that can provide information about the Financial Assistance Policy, as well as contact information of the hospital facility's office or department that can provide assistance with the financial assistance application process or, alternatively, a nonprofit organization or governmental agency that can provide assistance with the financial assistance application process if the hospital facility is unable to do so. If an individual submits a complete FAA Form within a reasonable time-period as set forth in the notice described above, the hospital filing organization will suspend any adverse reporting to consumer credit reporting agencies/bureaus until a financial assistance policy eligibility determination can be made. Supplemental Schedule to Schedule H, Part III, Section B Reconciliation of Schedule H Reported Medicare Surplus/(Shortfall) to Unreimbursed Medicare Costs Associated with the Provision of ServicesTo All Medicare Beneficiaries:The Medicare revenue and allowable costs of care reported in Section B of Part III of Schedule H are based upon the amounts reported in the filing organization's Medicare cost report in accordance with the IRS instructions for Schedule H. On an annual basis, the filing organization also determines its total unreimbursed costs associated with providing services to all Medicare patients. Unreimbursed costs are considered a community benefit to the elderly and are combined into an annual Community Benefit Statement prepared by Adventist Health System. The primary reconciling items between the Medicare surplus/(shortfall) shown on line 7 of Section B of Part III of Schedule H and the filing organization's unreimbursed costs of services provided to Medicare patients as reported in the AHS Community Benefit Report are as follows:- Medicare surplus/(shortfall) shown on line 7 of Section B of Schedule H: $ (4,352,152)- Difference in costing methodology: 658,716- Unreimbursed costs incurred for services provided to Medicare patients per the filing organization's community benefit reporting: (2,535,497) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's community benefit reporting: $(6,228,933)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: Florida Hospital Zephyrhills (FHZ) is a 139-bed, full-service acute-care facility that has been providing healthcare services to residents in central and eastern Pasco County since 1985. FHZ is the only hospital in Zephyrhills, the second largest city in Pasco County, and is located just 25 miles northeast of Tampa. As part of its patient-first focus, FHZ continues to expand its services so that patients and their families can receive unparalleled and compassionate treatment in their own community. A competitor hospital is located approximately eight miles away from Florida Hospital Zephyrhills. Although the competitor hospital provides many of the same services as the Hospital, Florida Hospital Zephyrhills is the only hospital within 25 miles to provide open heart surgery as well as a full orthopaedics program.In 2009, the new Heart Institute opened. It is the only nationally accredited chest pain center in East Pasco County. The Heart Institute is also one of the nationally accredited heart failure hospitals in the country.Florida Hospital Zephyrhills has expanded and upgraded to an all-digital Emergency Department and the ED physicians are all board certified in emergency medicine. From aggressive treatment in the ED to rehabilitation and wellness, the Primary Stroke Center exceeds the American Stroke Association guidelines.Pasco County, Florida has a population of approximately 498,000, with an estimated 22.7% age 65 or over the age of 65. The median household income, in Pasco County is approximately $44,518. High school graduates account for approximately 87.25% of Pasco County. It is estimated that 14.7% of the individuals residing in Pasco County live below the federal poverty level and the unemployment rate is about 6.5%. The hospital is ideally located in the center of Zephyrhills and is a short distance from Dade City and Wesley Chapel, its primary service areas. It is close to I-75, US301, and Hwy 54.The Hospital's payor mix is approximately 62% Medicare, 12% Medicaid, 6% Self Pay and the remaining amount is commercial and other payor classes. Approximately 82% of the Hospital's in-patients are admitted through its Emergency Department. Part VI, Line 5: The provision of community benefit is central to Florida Hospital Zephyrhills'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 $140,782 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 $13,365,345 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: Florida Hospital Zephyrhills 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 Adventist Health System (AHS). AHSSHC is an organization exempt from federal income tax under IRC Section 501(c)(3). AHSSHC and its subsidiary organizations operate 44 hospitals in 10 states throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC and its subsidiaries also operate 16 nursing home facilities and other ancillary health care provider facilities, such as ambulatory surgery centers and diagnostic imaging centers. As the parent organization of the AHS system, AHSSHC provides executive leadership and other professional support services to its subsidiary organizations. Professional support services include among others corporate compliance, legal, human resources, reimbursement, risk management, and tax as well as treasury functions. The provision of these executive and support services on a centralized basis by AHSSHC provides an appropriate balance between providing each AHS 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 hospitals and other health care organizations, the filing organization benefits from reduced costs due to system efficiencies, such as large group purchasing discounts, and the availability of internal resources such as internal legal counsel. Each AHS subsidiary pays a management fee to AHSSHC for the internal services provided by AHSSHC. As a result, management fee expense reported by a AHS 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 AHS as a whole. The reader is directed to visit the web-site of AHS at www.adventisthealthsystem.com to learn more about the mission and operations of AHS. Part VI, Line 7 The filing organization does not file an annual community benefit report with any state agencies. 1 SunSystem Development Corporation dba Florida Hospital Zephyrhills Found 900 Hope Way Altamonte Springs FL 32714 592219301 501(c)(3) 86498 cost general administrative support provision of general administrative support University Community Hospital Foundation Inc dba FL Hosp Tampa Foundation 3100 East Fletcher Tampa FL 33613 592554889 501(c)(3) 10000 General Support 2 0 Part I, Line 2: Grants are generally made only to related organizations that are exempt from federal income tax under IRC Section 501(c)(3), or to other local charitable community organizations, or to other 501(c)(3) organizations that are a part of the group exemption ruling issued to the General Conference of Seventh-Day Adventists. Accordingly, the filing organization has not established specific procedures for monitoring the use of grant funds in the United States as the filing organization does not have a grant making program that would necessitate such procedures. X X X 1 1 1 1 0 0 0 0 0 0 0 Michael Schultz Director/Chairman 0 723423 0 231777 0 450414 0 125789 0 61247 0 1592650 0 104861 Denyse Bales-Chubb Director (beg 4/16) 0 292442 0 75289 0 26103 0 35569 0 42498 0 471901 0 9835 Bruce Bergherm Director (end 4/16) 0 343760 0 71309 0 99818 0 38332 0 75581 0 628800 0 30258 Randy Surber Director/Sec/CEO 0 305313 0 65998 0 46591 0 48741 0 32031 0 498674 0 29614 William Heinrich CFO & COO (end 7/16) 0 244988 0 36125 0 12482 0 24285 0 40749 0 358629 0 0 Dima Didenko Region SEO (beg 7/16) 0 348268 0 54576 0 39958 0 49495 0 42604 0 534901 0 26419 Hugar McNamee MD CMO 0 280555 0 29578 0 18916 0 14388 0 25860 0 369297 0 0 Gwen Alonso CNO 0 176350 0 30731 0 7340 0 11092 0 25777 0 251290 0 0 Amir Quefatieh MD Physician 444346 0 819968 0 66480 0 14388 0 25217 0 1370399 0 0 0 Bertram A Lewis Jr MD Physician 481661 0 37970 0 47893 0 14388 0 26279 0 608191 0 0 0 Harry Blackstone MD Physician 220826 0 31424 0 61387 0 14388 0 16626 0 344651 0 0 0 Marian Antonette Sampson MD physician 241970 0 30131 0 2642 0 14388 0 9231 0 298362 0 0 0 Migdalia Merida MD Physician 208283 0 0 0 2340 0 11034 0 7987 0 229644 0 0 0 Paul Ziegele Former CFO 0 0 0 0 0 106493 0 0 0 19507 0 126000 0 4043 Part I, Line 1a The filing organization is a part of the system of healthcare organizations known as Adventist Health System (AHS). 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 AHS. 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 that provide services and are on the management team of the filing organization. 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 Vice Presidents and above and is usually limited to one business trip per year beyond the annual AHS 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: AHS 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 of 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 AHS President's Council business meeting ($500 per executive) or the annual AHS CFO Conference or CMO/CNO business meeting ($300 per executive). Other discretionary spending accounts may be provided in connection with other AHS sponsored conferences but typically do not exceed $200 per participant. With respect to the AHS President's Council meeting, eligible executives may include AHSSHC Vice Presidents and above and all AHSSHC subsidiary organization CEOs and Regional CFOs. 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 AHS and each of its affiliated entities. The following principles guide the establishment of individual executive compensation: - The salary of the President/CEO of AHS will not exceed the 40th percentile of comparable salaries paid by similarly situated organizations; and - Other executive salaries shall be established using market medians. The compensation philosophy, policies, and practices of AHSSHC are consistent with the organization's faith-based mission and conform to applicable laws, regulations, and business practices. As a faith-based organization sponsored by the Seventh-day Adventist Church (the Church), AHSSHC's philosophy and principles with respect to its executive compensation practices reflect the conservative approach of the Church's mission of service and were developed in counsel with the Church's leadership. Part I, Lines 4a-b During the year ending December 31, 2016, Paul Ziegele received severance payment in the amount of $102,685. Pursuant to the AHSSHC Corporate Executive Policy governing executive severance, severance agreements for executives operating at the Vice President level and above are entered into upon eligibility to facilitate the transition to subsequent employment following an involuntary separation from employment with AHS. 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 Adventist Health System (AHS). In recognition of the contribution that each executive makes to the success of AHS, AHS provides to eligible executives participation in the AHS 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 deferred compensation benefits taxable under Internal Revenue Code (IRC) Section 457(f), 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 AHS 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 AHS entities and Vice Presidents of all AHS entities whose base salary is at least $236,000. 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, AHS has instituted a defined benefit, non-tax-qualified deferred compensation plan for certain executives who have provided lengthy service to AHS and/or to other Seventh-Day Adventist Church hospitals or health care institutions. Participation in the plan is offered to AHS executives on a prorata schedule beginning with 20 years of service as an employee of AHS 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 AHS 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 AHS Executive FLEX Benefit Program. Flex Plan Flex Plan/ SERP 457(b) CY CY Employer CY Contrib./ Distributions* Contrib. Distributions* Payment ------------------------------------------------------- Bruce Bergherm $ 33,945 $ 30,276 $ 0 $ 0 Denyse Bales-Chubb $ 21,182 $ 9,840 $ 0 $ 0 William Heinrich $ 9,897 $ 0 $ 0 $ 0 Michael Schultz $129,402 $101,026 $215,284 $ 0 Randy Suber $ 34,354 $ 29,487 $ 0 $ 0 Dima Didenko $ 35,107 $ 26,261 $ 0 $ 0 Paul K. Ziegele $ 0 $ 4,045 $ 0 $ 0 *Including Investment Earnings Part V, Line 1a: The parent corporation and sole top-tier member of Florida Hospital Zephyrhills, Inc. (the filing organization) is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). AHSSHC has established a shared service center to centralize the Accounts Payable (A/P), Payroll, HR, and Materials Management functions for all AHSSHC subsidiary organizations. 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. During 2016, the filing organization transitioned its A/P function to AHSSHC. Accordingly, the number entered on line 1a represents the number reported on Box 3 of Form 1096 as filed by the filing organization for 2016. Subsequent to the transition of the A/P function to the AHSSHC shared service center, the filing organization will not enter any amount on Part V, line 1a. As a result of this transition, 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. Form 990, Part VI, Section A, line 6 Florida Hospital Zephyrhills, Inc. (the filing organization) has one member. The sole member of the filing organization 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 the filing organization. Form 990, Part VI, Section A, line 7a The sole member of the filing organization is AHSS. The Board of Directors of the filing organization are appointed by the sole member, AHSS, who has the right to elect, appoint or remove any member of the Board of Directors of the filing organization. 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. The reserved powers include the following: a) to approve or disapprove the executive and/or administrative leadership of the filing organization; b) to approve or disapprove the operating Bylaws of the filing organization; c) to reserve the right to approve or disapprove the medical staff bylaws, rules and regulations; d) to approve or disapprove major building programs and the purchase or sale of personal property or real property equal to or in excess of $1,000,000; e) to establish general guiding policies; f) to set limits and terms for borrowing of funds; g) to approve or disapprove the annual operating and capital budgets; h) to direct the placement of funds and capital and the making of gifts, donations, loans and transfers of funds or other assets; i) to approve or disapprove salary rates for the Chief Executive Officer of the Corporation and the right to approve or disapprove salary rates for administrative and department head personnel; j) to implement quality assessment, improvement and utilization review programs; k) to approve the appointment of an auditing firm for the Hospital; and l) to approve the election of the fiscal year for the Corporation. 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 conflict of interests, 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 Interests 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 Adventist Health System (AHS). The audited consolidated financial statements of AHS and of the AHS "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 AHS on a consolidated basis and for the grouping of AHS subsidiaries comprising the "Obligated Group". The filing organization does not generally make its governing documents or conflict of interest policy available to the public. Part VII, Section A For those Board of Director members who devote less than full-time to the filing organization (based upon the average number of hours per week shown in column (B) on page 7 of the return) the compensation amounts shown in columns (E) and (F) on page 7 were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position within Adventist Health System. Part VIII, Lines 7b and 7c: The amounts shown in Part VIII Lines 7b and 7c of the Form 990 represent an allocated share of capital gain/(loss) from a system wide, corporate administered, investment program. Form 990, Part IX, line 11g Payments to Healthcare Professionals: Program service expenses 9,284,824. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,284,824. Professional Fees: Program service expenses 2,991,373. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,991,373. Purchased Medical Services: Program service expenses 1,187,217. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,187,217. Environmental Services: Program service expenses 801,418. Management and general expenses 0. Fundraising expenses 0. Total expenses 801,418. Transcription Services: Program service expenses 213,950. Management and general expenses 0. Fundraising expenses 0. Total expenses 213,950. Recruiting: Program service expenses 138,355. Management and general expenses 0. Fundraising expenses 0. Total expenses 138,355. Food Service Contracts: Program service expenses 15,088. Management and general expenses 0. Fundraising expenses 0. Total expenses 15,088. Other Purchased Services: Program service expenses 167,270. Management and general expenses 0. Fundraising expenses 0. Total expenses 167,270. AHS Management Fees: Program service expenses 0. Management and general expenses 1,457,365. Fundraising expenses 0. Total expenses 1,457,365. Billing & Collection Services: Program service expenses 0. Management and general expenses 1,398,894. Fundraising expenses 0. Total expenses 1,398,894. AHS Shared Service Fee: Program service expenses 0. Management and general expenses 896,067. Fundraising expenses 0. Total expenses 896,067. Form 990, Part XI, line 9: Schedule K-1 UBI amounts not recorded on book -4,409. Gift from Foundation 1,380,561. Allocation from tax-exempt parent with respect to debt -150,130. Transfer to related tax-exempt organization -474,875. Transfer to related tax-exempt top-tier parent -1,793,556. Investment Amortization 189,492. Rounding 1. Part X, Line 2 The amounts shown on line 2 of Part X of this return include the filing organization's interest in a central investment pool maintained by Adventist Health System Sunbelt Healthcare Corporation, the filing organization's top-tier parent. The investments in the central investment pool are recorded at market value. 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 3040 Salt Creek Lane Arlington Heights IL 60005 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 Adventist University of Health Sciences Inc (630 Year End) 671 Lake Winyah Drive Orlando FL 32803 593069793 Education/Operation of School FL 501(c)(3) Line 2 Adventist Hlth SystemSunbelt Inc 1 AHP Specialty Care NFP 3040 Salt Creek Lane Arlington Heights IL 60005 811105774 Operation of Physician Practices & Medical Services IL 501(c)(3) Line 3 AHS Midwest Management Inc 1 AHS Midwest Management Inc 1000 Remington Blvd Ste 200 Bolingbrook IL 60440 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 12c, III-FI Adventist Hlth System Sunbelt Hlthcare Corp 1 Apopka Hlth Care Properties Inc 305 E Oak Street Apopka FL 32703 510605694 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Battle Creek Adventist Hospital 1000 Remington Blvd Ste 200 Bolingbrook IL 60440 381359189 Inactive MI 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Bolingbrook Hospital Foundation 1000 Remington Blvd N Entrance 2nd Bolingbrook IL 60440 900494445 Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation 0 Bradford Heights Hlth & Rehab Center Inc 950 Highpoint Drive Hopkinsville KY 42240 205782342 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Burleson Nursing & Rehab Center Inc 301 Huguley Blvd Burleson TX 76028 205782243 Operation of Home for the Aged/Hlthcare Delivery TX 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Caldwell Hlth Care Properties Inc 1333 West Main Princeton KY 42445 510605680 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Central Texas Hlthcare Collaborative 1301 Wonder World Drive San Marcos TX 78666 453739929 Support Operation of Hospital TX 501(c)(3) Line 12a, I Adventist Hlth SystemSunbelt Inc 1 Chickasaw Hlth Care Properties Inc 250 S Chickasaw Trail Orlando FL 32825 510605681 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Chippewa Valley Hospital & Oakview Care Center Inc 1220 Third Avenue West Durand WI 54736 391365168 Operation of Hospital & Related Services WI 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Courtland Hlth Care Properties Inc 730 Courtland Street Orlando FL 32804 510605682 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Creekwood Place Nursing & Rehab Center Inc 107 Boyles Drive Russellville KY 42276 205782260 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Dairy Road Hlth Care Properties Inc 7350 Dairy Road Zephyrhills FL 33540 510605684 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 East Orlando Hlth & Rehab Center Inc 250 S Chickasaw Trail Orlando FL 32825 205774748 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Emory-Adventist Inc 900 Hope Way Altamonte Springs FL 32714 582171011 Inactive GA 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Fletcher Hospital Inc 100 Hospital Drive Hendersonville NC 28792 560543246 Operation of Hospital & Related Svcs NC 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 FLNC Inc 3355 E Semoran Blvd Apopka FL 32703 205774761 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Florida Hospital Healthcare Partners Inc 770 West Granada Blvd 101 Ormond Beach FL 32174 462354804 Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Florida Hospital Medical Group Inc 2600 Westhall Ln 4th Floor Maitland FL 32751 593214635 Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Florida Hospital Physician Group Inc 12470 Telecom Dr 100 Tampa FL 33637 462021581 Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Florida Hospital Waterman Inc 1000 Waterman Way Tavares FL 32778 593140669 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Florida Hospital Zephyrhills Inc 7050 Gall Blvd Zephyrhills FL 33541 592108057 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Foundation for Shawnee Mission Medical Center Inc 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 Fountain Inn Nursing & Rehab Center Inc 485 North Keller Road 250 Maitland FL 32751 472180518 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 GlenOaks Hospital Foundation 701 Winthrop Avenue Glendale Heights IL 60139 363926044 Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation 0 Helen Ellis Memorial Hospital Auxiliary Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 592106043 Fund-raising for Tax-exempt hospital/foundation FL 501(c)(3) Line 12c, III-FI 0 Helen Ellis Memorial Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 593690149 Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 7 Tarpon Springs Hospital Foundation Inc 0 Hinsdale Hospital Foundation 7 Salt Creek Lane Suite 203 Hinsdale IL 60521 521466387 Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation 0 Hospice of the Comforter Inc 480 W Central Parkway Altamonte Springs FL 32714 592935928 Operation of Hospice FL 501(c)(3) Line 10 The Comforter Health Care Group Inc 1 Hospice of the Comforter Foundation Inc 480 W Central Parkway Altamonte Springs FL 32714 271858033 Fund Raising for Affiliated Tax-Exempt Hospice FL 501(c)(3) Line 7 The Comforter Health Care Group Inc 1 In-Motion Rehab Inc 485 North Keller Road 250 Maitland FL 32751 208023411 Therapy services to tax exempt nursing homes KS 501(c)(3) Line 12b, II Sunbelt Hlth Care Centers Inc 1 La Grange Memorial Hospital Foundation 5101 S Willow Springs Rd La Grange IL 60525 300247776 Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation 0 Lake County Health Care Properties Inc 485 North Keller Road 250 Maitland FL 32751 813923985 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Memorial Hlth Systems Foundation Inc 770 West Granada Blvd Ormond Beach FL 32174 311771522 Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 7 0 Memorial Hlth Systems Inc 301 Memorial Medical Parkway Daytona Beach FL 32117 590973502 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Memorial Hospital - West Volusia Inc 701 West Plymouth Avenue Deland FL 32720 593256803 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Memorial Hlth Systems Inc 1 Memorial Hospital Flagler Inc 60 Memorial Medical Parkway Palm Coast FL 32164 592951990 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Memorial Hlth Systems Inc 1 Memorial Hospital Inc 210 Marie Langdon Drive Manchester KY 40962 610594620 Operation of Hospital & Related Services KY 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Merriam Hlth Care Properties Inc 9700 West 62nd Street Merriam KS 66203 364595806 Lease to Related Organization KS 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Metroplex Adventist Hospital Inc 2201 S Clear Creek Road Killeen TX 76549 742225672 Operation of Hospital & Related Services TX 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Metroplex Clinic Physicians Inc 2201 S Clear Creek Road Killeen TX 76549 113762050 Physician Hlthcare services to the community TX 501(c)(3) Line 3 Metroplex Adventist Hospital Inc 1 Midwest Hlth Foundation 120 North Oak Street Hinsdale IL 60521 352230515 Support of subsidiary Foundations IL 501(c)(3) Line 12b, II N/A 0 Mills Hlth & Rehab Center Inc 500 Beck Lane Mayfield KY 42066 205782320 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Mission Strategies of Georgia Inc 485 North Keller Road 250 Maitland FL 32751 900866024 Provision of support to the nursing home division GA 501(c)(3) Line 12b, II Sunbelt Hlth Care Centers Inc 1 Missouri Adventist Hlth Inc 9100 W 74th Street Shawnee Mission KS 66204 431224729 Support Hlth Care Services MO 501(c)(3) Line 12d, III-O Adventist Hlth Mid-America Inc 1 Ormond Beach Memorial Hospital Auxiliary Inc 301 Memorial Medical Parkway Daytona Beach FL 32117 591721962 Volunteer support services FL 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 0 Osceola Health Care Properties Inc (620-123116) 485 North Keller Road 250 Maitland FL 32751 813165729 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Overland Park Nursing & Rehab Center Inc 6501 West 75th Street Overland Park KS 66204 205774821 Operation of Home for the Aged/Hlthcare Delivery KS 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Paragon Hlth Care Properties Inc 950 Highpoint Drive Hopkinsville KY 42240 510605686 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Pasco-Pinellas Hillsborough Community Hlth System Inc 2600 Bruce B Downs Blvd Wesley Chapel FL 33544 208488713 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Portercare Adventist Hlth System (630 Year End) 9100 E Mineral Circle Centennial CO 80112 840438224 Operation of Hospital & Related Services CO 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Princeton Hlth & Rehab Center Inc 1333 West Main Princeton KY 42445 205782272 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Princeton Professional Services Inc 601 E Rollins Street Orlando FL 32803 591191045 Provision of Hlthcare Services FL 501(c)(3) Line 10 Adventist Hlth System Sunbelt Hlthcare Corp 1 Quality Circle for Hlthcare Inc 900 Hope Way Altamonte Springs FL 32714 263789368 Hlthcare Quality Services FL 501(c)(3) Line 12a, I Adventist Hlth System Sunbelt Hlthcare Corp 1 Resource Personnel Inc 485 North Keller Road 250 Maitland FL 32751 208040875 Provide administrative support to tax exempt nursing homes FL 501(c)(3) Line 12b, II Sunbelt Hlth Care Centers Inc 1 Rocky Mountain Adventist Hlthcare Foundation (630 Year End) 7995 E Prentice Ave 204 Greenwood Village CO 80111 840745018 Fund-raising for Tax-exempt hospital CO 501(c)(3) Line 7 0 Rollins Brook Community Care Corp 2201 S Clear Creek Road Killeen TX 76549 461656773 Support Operation of Hospital TX 501(c)(3) Line 12a, I Adventist Hlth SystemSunbelt Inc 1 Russellville Hlth Care Properties Inc 683 East Third Street Russellville KY 42276 510605691 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 San Marcos Hlth Care Properties Inc 1900 Medical Parkway San Marcos TX 78666 510605693 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 San Marcos Nursing & Rehab Center Inc 1900 Medical Parkway San Marcos TX 78666 205782224 Operation of Home for the Aged/Hlthcare Delivery TX 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Shawnee Mission Hlth Care Inc 6501 West 75th Street Overland Park KS 66204 480952508 Lease to Related Organization KS 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Shawnee Mission Hlth Care Properties Inc(98-123116) 485 North Keller Road 250 Maitland FL 32751 813914908 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Shawnee Mission Medical Center Inc 9100 W 74th Street Shawnee Mission KS 66204 480637331 Operation of Hospital & Related Services KS 501(c)(3) Line 3 Adventist Hlth Mid-America Inc 1 South Central Inc 900 Hope Way Altamonte Springs FL 32714 593689740 Management Support GA 501(c)(3) Line 12c, III-FI N/A 0 South Pasco Hlth Care Properties Inc 38250 A Avenue Zephyrhills FL 33542 510605679 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Southeast Volusia Healthcare Corp 401 Palmetto Street New Smyrna Beach FL 32168 473793197 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Southwest Volusia Hlth Services Inc 1055 Saxon Blvd Orange City FL 32763 593281591 Medical Office Building for Hospital FL 501(c)(3) Line 12a, I Southwest Volusia Hlthcare Corp 1 Southwest Volusia Hlthcare Corp 1055 Saxon Blvd Orange City FL 32763 593149293 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Specialty Physicians of Central Texas Inc 1301 Wonder World Drive San Marcos TX 78666 208814408 Physician Hlthcare services to the community TX 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Spring View Hlth & Rehab Center Inc 718 Goodwin Lane Leitchfield KY 42754 205782288 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Sunbelt Hlth & Rehab Center - Apopka Inc 305 East Oak Street Apopka FL 32703 205774856 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Sunbelt Hlth Care Centers Inc 485 North Keller Road 250 Maitland FL 32751 581473135 Management Services TN 501(c)(3) Line 12b, II Adventist Hlth System Sunbelt Hlthcare Corp 1 SunSystem Development Corp 900 Hope Way Altamonte Springs FL 32714 592219301 Fund Raising for Affiliated Tax-Exempt Hospitals FL 501(c)(3) Line 7 Adventist Hlth System Sunbelt Hlthcare Corp 1 Takoma Regional Hospital Inc (630 Year End)(7115-123116) 401 Takoma Ave Greeneville TN 37743 510603966 Operation of Hospital & Related Services TN 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Takoma Regional Hospital Foundation Inc 401 Takoma Ave Greeneville TN 37743 471334302 Fund Raising for Affiliated Tax-Exempt Hospital TN 501(c)(3) Line 7 Takoma Regional Hospital Inc 1 Tarpon Springs Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 590898901 Operation of Hospital & Related Services FL 501(c)(3) Line 3 University Community Hospital Inc 1 Tarrant County Hlth Care Properties Inc 301 Huguley Blvd Burleson TX 76028 510605677 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Taylor Creek Hlth Care Properties Inc 718 Goodwin Lane Leitchfield KY 42754 510605678 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 The Comforter Health Care Group Inc 605 Montgomery Road Altamonte Springs FL 32714 271857940 Lease to Related Organization FL 501(c)(3) Line 12c, III-FI Adventist Hlth System Sunbelt Hlthcare Corp 1 The Volunteer Auxiliary of Florida Hospital - Flagler Inc 60 Memorial Medical Parkway Palm Coast FL 32164 592486582 Volunteer support services FL 501(c)(3) Line 12c, III-FI 0 Tri-County Nursing and Rehab Center Inc 485 North Keller Road 250 Maitland FL 32751 472219363 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Trinity Nursing & Rehab Center Inc 9700 West 62nd Street Merriam KS 66203 205774890 Operation of Home for the Aged/Hlthcare Delivery KS 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 University Community Hospital Foundation Inc 3100 E Fletcher Ave Tampa FL 33613 592554889 Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 12a, I 0 University Community Hospital Specialty Care Inc 3100 E Fletcher Ave Tampa FL 33613 593231322 Inactive FL 501(c)(3) Line 12a, I University Community Hospital Inc 1 University Community Hospital Inc 3100 E Fletcher Ave Tampa FL 33613 591113901 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 West Kentucky Hlth Care Properties Inc 500 Beck Lane Mayfield KY 42066 510605676 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Zephyr Haven Hlth & Rehab Center Inc 38250 A Avenue Zephyrhills FL 33542 205774930 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Zephyrhills Hlth & Rehab Center Inc 7350 Dairy Road Zephyrhills FL 33540 205774967 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Clear Creek MOB Ltd 2201 S Clear Creek Rd Killeen TX 76549 742609195 Real Estate TX N/A Endoscopy Center at Porter LLC (11-32916) 1001 South Park Drive Littleton CO 80120 205855038 Medical Services CO N/A Florida Hospital DMERT LLC 500 Winderley Place Ste 324 Maitland FL 32751 202392253 Medical Equipment FL N/A Florida Hospital Home Infusion LLP 500 Winderley Place Ste 324 Maitland FL 32751 593142824 Home Infusion Services FL N/A Functional Neurosurgical Ambulatory Surgery Center LLC 777 S Williams St Denver CO 80209 464426708 Surgery Center CO N/A PAHSLarkin Ventures LLC 9100 E Mineral Cir Centennial CO 80112 474211060 Medical Services CO N/A PAHSUSP Surgery Centers LLC 15305 Dallas Pkwy Ste 1600 LB 28 Addison TX 75010 263057950 Medical Services CO N/A San Marcos MRI LP 1330 Wonder World Dr Ste 202 San Marcos TX 78666 770597972 Imaging & Testing TX N/A Altamonte Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 592855792 Condo Association FL N/A C 1 Apopka Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 593000857 Condo Association FL N/A C 1 CC MOB Inc 2201 S Clear Creek Road Killeen TX 76549 742616875 Real Estate Rental TX N/A C 1 Central Texas Medical Associates 1301 Wonder World Drive San Marcos TX 78666 742729873 Inactive TX N/A C 1 Central Texas Providers Network 1301 Wonder World Drive San Marcos TX 78666 742827652 Physician Hospital Org. TX N/A C 1 Florida Hospital Flagler Medical Offices Association Inc 60 Memorial Medical Parkway Palm Coast FL 32164 262158309 Condo Association FL N/A C 1 Florida Hosp Hlth Village Property Owner's Assoc Inc 550 E Rollins Street 7th Floor Orlando FL 32803 821748255 Condo Association FL N/A C 1 Florida Hospital Healthcare System Inc 101 Southhall Lane Ste 150 Maitland FL 32751 593215680 PHSO FL N/A C 1 Florida Medical Plaza Condo Association Inc 601 East Rollins Street Orlando FL 32803 592855791 Condo Association FL N/A C 1 Florida Memorial Health Network Inc 770 W Granada Blvd Ste 317 Ormond Beach FL 32174 593403558 Physician Hospital Org. FL N/A C 1 Kissimmee Multispecialty Clinic Condominium Association Inc 201 Hilda Street Suite 30 Kissimmee FL 34741 593539564 Condo Association FL N/A C 1 LN Health Partners Inc (815-123116) 550 E Rollins Street 6th Floor Orlando FL 32803 813556903 Inactive FL N/A C 1 Midwest Management Services Inc 9100 West 74th Street Shawnee Mission KS 66204 480901551 Inactive KS N/A C 1 North American Health Services Inc & Sub 900 Hope Way Altamonte Springs FL 32714 621041820 Lessor/Holding Co. TN N/A C 1 Ormond Prof Associates Condo Assoc'n Inc (430 year end) 770 W Granada Blvd Ste 101 Ormond Beach FL 32174 592694434 Condo Association FL N/A C 1 Park Ridge Property Owner's Association Inc 1 Park Place Naples Road Fletcher NC 28732 030380531 Condo Association NC N/A C 1 Porter Aff Hlth Svcs Inc dba Diversified Aff Hlth Svcs 2525 S Downing Street Denver CO 80210 840956175 Healthcare Services CO N/A C 1 San Marcos Regional MRI Inc 1301 Wonder World Drive San Marcos TX 78666 770597968 Holding Company TX N/A C 1 The Garden Retirement Community Inc 485 North Keller Road Ste 250 Maitland FL 32751 593414055 Real Estate Rental FL N/A C 1 Winter Park Medical Office Building I Condo Assoc Inc 601 East Rollins Street Orlando FL 32803 452228478 Condo Association FL N/A C 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 Sunsystem Develop Corp dba FH Zephyrhills Foundation C 1380561 ACTUAL AMOUNT Received Sunsystem Develop Corp dba FH Zephyrhills Foundation B 86498 ACTUAL AMOUNT GIVEN Adventist Health System Sunbelt Inc dba Florida Hospital M 154346 Cost Plus Appropriate Margin adventist Health System Sunbelt Healthcare Corporation M 2261492 % OF FACILITY'S OPERATING EXP. Adventist Health System Sunbelt Healthcare Corporation P 6294898 COST Adventist Health System Sunbelt Healthcare Corporation dba AHS IS M 4481778 % OF FACILITY'S OPERATING EXP. adventist Health System Sunbelt Healthcare Corporation-Shared Services M 896067 % OF FACILITY'S OPERATING EXP. adventist Health System Sunbelt Healthcare Corporation B 1793556 ACTUAL AMOUNT GIVEN University Community Hospital Inc P 3629367 COST Pasco-Pinellas Hillsborough Community Health System Inc Q 246220 COST University Community Hospital Inc Q 1385308 COST Florida Hospital Physician Group Inc P 3540757 COST University Community Hospital Inc R 474875 ACTUAL AMOUNT GIVEN