2018-01-29T15:20:42-06:00 2016-12-31 990 2016-01-01 592951990 MEMORIAL HOSPITAL FLAGLER INC MEMO 3865862000 60 MEMORIAL MEDICAL PARKWAY PALM COAST FL 32164 Lynn C Addiscott ASSISTANT SECRETARY 4079751492 2018-01-10 204.139.85.142 2018-01-10 15:42:13 ES P C18440E83583A01A3D3F74DEBC89B245B68C7147 F7F973113C6C6A5F5987F0EC85E73F6D0608CD2F 2016 2021-01-29 14:40:06Z Florida Hospital Flagler Ron Jimenez 60 MEMORIAL MEDICAL PARKWAY PALM COAST FL 32164 189069779 0 X WWW.floridahospital.com/flagler X 1989 FL The provision of medical care to the community through the operation of a 99 bed hospital. 18 10 1271 254 260653 169667 40960 57222 183891770 185214037 -2610337 1313848 281709 126660 181604102 186711767 91779 114725 0 0 58010873 61723354 0 0 0 93182233 99074014 151284885 160912093 30319217 25799674 320581611 319475362 89369916 84126883 231211695 235348479 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 150337025 114725 185080044 PROVISION OF MEDICAL CARE TO BOTH INPATIENTS AND OUTPATIENTS. DURING THE CURRENT YEAR, THE HOSPITAL HAD 7,839 PATIENT ADMISSIONS WHICH RESULTED IN 34,006 PATIENT DAYS AND 151,869 OUTPATIENT VISITS. THE HOSPITAL IS A 99-BED ACUTE CARE HOSPITAL LOCATED IN FLAGLER COUNTY, FLORIDA. 150337025 1 1 0 1 0 0 1 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 1 0 0 0 0 0 1 1 1 0 0 1 X 0 0 1271 1 1 1 0 0 0 0 0 0 0 0 0 X 18 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 FL X CORY DOMAYER 3865864200 60 MEMORIAL MEDICAL PARKWAY PALM COAST FL 32164 X Fulbright Robert Chairman/Dir 8.50 41.50 X 0 790357 149702 Alter MD Dennis DirECTOR 50.00 0.00 X 0 1031894 25968 Chiumento Michael DIRECTOR 0.20 0.00 X 330 0 0 Deininger Robert DirECTOR (Beg 2/16) 0.20 50.00 X 330 333020 55339 Fowler David DIRECTOR 0.20 0.00 X 330 0 0 Hamilton MD Ted DiRECTOR 0.20 50.00 X 330 743790 66204 Jimenez MD Ronald Director/CEO (Beg 5/16) 50.00 0.00 X X 330 470583 77410 Johnson Sandra K DirECTOR 0.20 50.00 X 0 962268 119004 Leverton Roger DirECTOR 0.20 0.00 X 0 0 0 Mattison Kenneth R Director/CEO (End 5/16) 50.00 0.00 X X 0 671433 88933 McCabe MD Kristin DirECTOR 0.20 0.00 X 330 0 0 Moorman Holsey DirECTOR 0.20 0.00 X 330 0 0 Noseworthy Gordon Edward DirECTOR 0.20 50.00 X 0 989896 110560 Papandrea Tony DirECTOR 0.20 0.00 X 330 0 0 Revels Barbara DirECTOR 0.20 0.00 X 330 0 0 Seifert Lewis DirECTOR (End 8/16) 0.20 50.00 X 0 827748 155209 Sowers Scott DirECTOR 0.20 0.00 X 330 0 0 Sword Raven DirECTOR 0.20 0.00 X 330 0 0 Thomas Debora H DirECTOR 8.50 41.50 X 0 519963 82914 Zimmet DO Glenn DirECTOR 0.20 0.00 X 330 0 0 Bucknor Jermaine CFO (END 1/16) 50.00 0.00 X 0 334125 61380 DoMayer Cory CFO (Beg 2/16) 50.00 0.00 X 0 218754 50039 King Joanne COO 50.00 0.00 X 0 198084 54323 Thomas MD Ronald CMO 50.00 0.00 X 0 426359 67454 Davis Robert CNO 50.00 0.00 X 0 228745 49005 Celano Patricia CCO 8.50 41.50 X 0 435454 63299 Roy Tapash K Oncology Radiation Therapist 60.00 0.00 X 174538 0 25354 Cole Rema Hospice Administrator 50.00 0.00 X 146649 0 17555 Subers John Foundation administrator 50.00 0.00 X 141327 0 24513 McFadden Karen E Home Health Administrator 50.00 0.00 X 129132 0 17402 Wagner Guy W Pharmacist 60.00 0.00 X 123932 0 14462 Ottati David Former CEO 0.00 50.00 X 0 562973 106254 Ziesmer Valerie Former CFO 0.00 50.00 X 0 301794 37924 719538 10047240 1520207 21 1 1 0 PT Solutions Holdings LLC PO Box 441146 Kennesaw GA 30160 Physical Therapy Services 5350724 MedPartners Locum Tenens LLC PO Box 4729 Winter Park FL 32793 Hospitalists 2557267 GE Healthcare - Apt PO BOx 96483 Chicago IL 60693 Biomed Maintenance 1853579 SHERIDAN HEALTHCorp Inc PO Box 452197 SUNRISE FL 333232197 ANESTHESIA SERVICES 1713638 Batson-Cook Company 800 North Magnolia Avenue Suite 60 Orlando FL 32803 Design/Construction Services 1089006 62 X 57222 57222 Net patient revenue 622110 183653903 183393250 260653 Medical office building 622110 959523 959523 Cafeteria revenue 622110 556140 556140 44471 44471 185214037 3665723 3665723 6137 2358012 0 -2358012 6137 -2351875 -2351875 EHR Revenue 622110 126660 126660 126660 186711767 185080044 260653 1313848 X 114725 114725 3327055 3327055 42980378 42980378 1725920 1696650 29270 9698111 9698111 3991890 3924192 67698 105174 105174 71462 71462 943119 943119 45289227 41826121 3463106 151050 151050 3194984 2330001 864983 4483376 3907432 575944 3561699 3561699 549893 89 549804 51115 51115 2178210 2178210 7732740 7732740 2377767 2301541 76226 Income Tax Expense 18900 18900 Medical Supplies 22928712 22928712 Repairs & maintenance 3261030 3261030 State Tax Indigent Asse 1885113 1885113 290443 10281 280162 160912093 150337025 10575068 0 4042 3601 202553069 185921212 22009849 23277908 2812668 2977110 3207598 6649555 164344600 79466021 75037641 84878579 50000 50000 14522088 14522088 384656 1195309 320581611 319475362 9202793 8239743 161356 216008 80005767 75671132 89369916 84126883 X 231208240 235233024 3455 115455 231211695 235348479 320581611 319475362 X 25799674 3937987 -25600877 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5375 5375 0 Part II-B, Line 1: AMERICAN HOSPITAL ASSOCIATION and FLORIDA HOSPITAL ASSOCIATION DUES. X 1 0 0.00 0 0 7311502 7311502 58188691 21397937 36790754 79357981 54078962 25279019 19486426 3989122 15497304 84878579 Credit balances in A/R 1034026 Interco. Alloc. of TE Bond Proceeds 65610453 Due to related 4682723 Payable to third parties 4174500 Other liabilities 169430 75671132 X Part II, Line 9: The filing organization has recorded the land conservation easement on its financial statements as a Property, Plant, and Equipment Asset. The conservation easement generates no revenue and the filing organization did not incur any expense related to the maintenance and monitoring of the conservation easement. 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 5937094 5937094 0.03690 14903941 8298790 6605151 0.04100 20841035 8298790 12542245 0.07790 711437 711437 0.00440 5810 5810 0.00000 717247 717247 0.00440 21558282 8298790 13259492 0.08230 75813 75813 0.00050 30694 30694 0.00020 106507 106507 0.00070 1 10299075 1017958 58628510 47712365 10916145 X 1 1 1 1 FLORIDA HOSPITAL - FLAGLER 60 Memorial Medical Parkway Palm Coast FL 32164 www.floridahospital.com/flagler 4465 X X X Memorial Hospital Flagler Inc 1 0 0 1 X X X X X X X X X 16 1 1 1 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 Memorial Hospital Flagler, Inc. Part V, Section B, Line 5: Memorial Hospital Flagler, Inc., d/b/a Florida Hospital Flagler (FHF or the Hospital), operates a 99-bed acute-care hospital in Flagler County, Florida. The primary service area of the Hospital includes most of Flagler County. In 2016, the Flagler County population was 82.1% white, 10.8% African-American, 10.2% Hispanic, and 7.1% other races. FHF partnered with the Florida Department of Health - Flagler, Halifax Health, and Flagler Cares (an informal coalition of public and private organizations providing health and related support services) to create the Flagler Community Health Needs Assessment and Planning Partnership. The Partnership created a collaborative, countywide Community Health Needs Assessment in 2016. The 2016 Community Health Needs Assessment was built on input from people representing the broad community, as well as low-income, minority, and other medically underserved populations. Input was solicited throughout 2016, and was gathered and considered in multiple ways. FHF and the Flagler County Community Health Needs Assessment and Planning Partnership created a multi-tiered approach to stakeholder involvement. The plan included the formation of a Leadership Council that included 27 leaders from 18 organizations representing key sectors of the public health system and safety net, including organizations representing low income, minority and other underserved populations. The community engagement process also included community health surveys and facilitated community meetings. The Leadership Council of the Flagler County Community Health Needs Assessment and Planning Partnership includes representatives from the Flagler County Department of Health, United Way of Flagler/Volusia Counties, Stewart-Marchman-Act Behavorial Healthcare, Azalea Health, a federally qualified health center, the Flagler Free Clinic, the Family Life Center, Healthy Start of Flagler/Volusia, and the Florida State Department of Children and Families. These organizations represented the needs of low-income, minority, and other medically underserved populations. Memorial Hospital Flagler, Inc. Part V, Section B, Line 6a: Halifax Health Memorial Hospital Flagler, Inc. Part V, Section B, Line 6b: Flagler Department of Health Memorial Hospital Flagler, 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. Memorial Hospital Flagler, 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.Florida Hospital Flagler (FHF) is part of the East Florida Region of Florida Hospital. The Region includes six hospital facilities. This is the third-year update for Florida Hospital Flagler's 2013-2016 Community Health Plan/Implementation Strategy. Florida Hospital Flagler (FHF or "the Hospital") developed this Plan and posted it no later than May 15, 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 Flagler made a particular 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 give an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing. Florida Hospital Flagler is located in Palm Coast, Florida. The Hospital is located in the less populated western part of the city. Bunnell, FL is the (Flagler) county seat and is included in the Hospital's service area. In general, the 2,000 Bunnell residents have lower income and education levels than much of Palm Coast. Florida Hospital Flagler's 2013 Community Health Needs Assessment identified high cholesterol, obesity/nutrition, smoking, and chronic disease (heart disease, diabetes and cancer) as key health issues. Many of these conditions are related to lifestyle and to access to health/community resources. In 2015 and 2016, the Hospital provided multiple community health education programs and seminars, and tripled attendance in most of them over the past years. Efforts included work with low income populations. Some efforts, such as Change Your Life and CREATION Health, were aligned with similar efforts at four other Florida Hospital facilities in adjacent Volusia County. Priority Issue: Prompting Health & Wellness - Heart Disease, Diabetes and Wellness/Lifestyle 2013 Description of the Issue: The age-adjusted death rate for cardiac disease in Flagler County is 12.6 per 100,000 compared to 7.8 per 100,000 for the rest of Florida. Needs Assessment findings attribute the higher rate to several factors: the aging population, lifestyle factors and access/understanding of the community's health and community resources. The County's rates of diabetes and obesity are also slightly higher than the state average. 2016 Update: In 2016, over 1,300 people were enrolled in the Change Your Life lifestyle membership program. In support of the Change Your Life program, the Hospital implemented CREATION Health: an education program focused on a healthy lifestyle built around the eight core principles of CREATION Health (choice, rest, environment, activity, trust, interpersonal relationships, outlook and nutrition). 82 individuals participated in CREATION Health classes during 2014-2016 and over 70% of participants reported an increased understanding of these principles. The Hospital invested $5,550 in the program and over 829 volunteer hours to implement the program.Through a variety of outreach efforts, including Change Your Life and CREATION Health, the Hospital provided 2,935 people (including low-income groups) with important health screenings (including cholesterol and HbA1C blood sugar screenings) and over 5,321 individuals with weekly blood pressure screenings. People whose screenings were abnormal were referred to their family doctors or other affordable sources of care.In addition to these educational and screening efforts, Florida Hospital Flagler held 45 educational seminars during 2014-2016 that engaged over 2,350 people. The Hospital also hosted or provided meeting space to community groups for support and education programs that addressed not only health issues, but social conditions. Programs included diabetes education, prostate cancer, breast cancer, head & neck cancer, cancer caregivers, lupus, stroke, step-parents, domestic violence, multiple myeloma survivors, Parkinson's disease, Gamblers Anonymous and Overeaters Anonymous. Priority: Access to Health Care Services2013 Description of the Issue: Access to health care emerged as a priority for our Community Benefit plans because data showed high rates of residents without access to health care (especially primary care) and residents without insurance. Limited access to health care services can aggravate other issues identified through our research including chronic disease, mental health issues, and maternal and child health. In 2013, the community had a free clinic but lacked a Federally Qualified or Rural Health Center. 2016 Update: Florida Hospital Flagler worked with community partners to bring Azalea Health, a multi-location FQHC, to Palm Coast. The new center offers affordable primary care services to Palm Coast and the surrounding area. The FQHC sees patients with Medicaid and Medicare, and sees uninsured patients on a sliding fee scale. In addition, the Hospital provided over 950 lab vouchers to the Flagler Free Clinic.Priority: Access to Health and Community Resources 2013 Description of the Issue: At the time of the 2013 Assessment, the County's 2-1-1 community resource line was sorely out-of-date, and lacked listings for health and wellness resources. 2016 Update: Florida Hospital Flagler worked with community partners to update the 2-1-1 service. The 2016 goals and achievements were threefold: 1) increase the number of health and wellness resources listed in the county's 2-1-1 database 2) increase referrals by staff to health and wellness resources and 3) increase the number of web referrals for health and wellness resources from 0. Through an investment of $9,052 the database was increased to include 147 new health and wellness resources, over 2,900 staff referrals to health and wellness resources and 6,500 web referrals to health and wellness resources.Priority: Adult Tobacco Use and Abuse programs2013 Description of the Issue: The rate of smoking in Flagler County adults (2010) falls in the third quartile in the state. 2016 Update: 408 people completed smoking cessation classes offered by Florida Hospital Flagler during 2014-2016. The "Tools to Quit" smoking cessation program was offered on campus and in underserved areas though a Hospital investment of $3,000. The Hospital is also a supporter of the Tobacco Free Flagler County Partnership, a community coalition whose goal is to prevent youth initiation and reduce the use of tobacco products.**See Continuation 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://floridahospital.com/patient-resources/billing/financial-assistanceThe Financial Assistance Policy application can be found at:https://floridahospital.com/patient-resources/billing/financial-assistanceThe plain language summary is available at:https://floridahospital.com/patient-resources/billing/financial-assistance 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. Part V, Section B, Line 11: **ContinuationPriorities Considered but Not Selected The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else - or multiple groups - in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? Based on this prioritization process, the Hospital did not choose the following community issues: Communicable DiseasesFlorida Hospital Flagler did not select Communicable Disease as a priority at this time. We determined that there are groups already addressing this issue: The Health Department, Diggs Miracle Care and the Outreach Community Care Network. In addition, the Hospital does not have the capacity to effectively address this issue. InjuriesWe also determined we are not the best community partner to address Injury, which was identified as a top priority through secondary data. Multiple community groups are working on issues like unintentional injury, violence, and domestic violence in our community. These groups include the school systems, domestic abuse shelters, and governmental groups.Maternal and Child Health Maternal and child health issues were not selected as a direct effort. We believe our efforts around health and wellness and increasing health care access should have a positive impact on these issues. The Hospital Maternity program offers new mother and parent support and education. The Health Department offers prenatal care for low-income women, and the Healthy Start Coalition of Volusia/Flagler offers support programs, especially for high-risk mothers. The Teen Outreach Program (TOP) in the County school system - a positive youth development curriculum that encourages Healthy Behavior, Life Skills and a Sense of Purpose - has a goal of reducing teen pregnancies. 48 1 - Florida Hospital Flagler Town Center Sur 120 Cypress Edge Drive Suite 102 Palm Coast FL 32164 Surgical services 2 - Palm Coast Parkway MRI 120 Cypress Edge Drive Palm Coast FL 32164 Imaging Services 3 - Palm Coast Parkway Laboratory 120 Cypress Edge Drive Palm Coast FL 32164 Laboratory Services 4 - Palm Coast Parkway CT 120 Cypress Edge Drive Palm Coast FL 32164 CT Services 5 - Florida Hospital Memorial Hospice dba Ho 770 W Granada Blvd Suite 304 Ormond Beach FL 32174 Hospice Administrative Office 6 - Florida Hospital Memorial Home Health 770 W Granada Blvd Suite 319 Ormond Beach FL 32174 Home care services 7 - Florida Hospital Flagler Hospitalist 60 Memorial Medical Parkway Palm Coast FL 32164 Hospitalist 8 - Palm Coast Parkway Radiology 120 Cypress Edge Drive Palm Coast FL 32164 Radiology Services 9 - HCP - Alter Gay and Keen MD 21 Hospital Drive Suite 110 Palm Coast FL 32164 Orthopedic Services 10 - Palm Coast Parkway Physical Therapy 120 Cypress Edge Drive Palm Coast FL 32164 Physical Therapy 11 - Palm Coast Parkway Ultrasound 120 Cypress Edge Drive Palm Coast FL 32164 Ultrasound Services 12 - Florida Hospital Hospice - Memorial 301 Memorial Medical Parkway Daytona Beach FL 32117 Hospice care services 13 - HCP - McKinley Joseph MD 3 Pine Cone Circle Suite 105 Palm Coast FL 32137 Gastroenterology Services 14 - HCP - Joiner Thomas A MD 61 Memorial Medical Parkway Suite 2811 Palm Coast FL 32164 Family Practice Services 15 - Stuart F Meyer Hospice House 150 Memorial Parkway Palm Coast FL 32164 Hospice care services 16 - Prompt Care 120 Cypress Edge Drive Suite 102 Palm Coast FL 32164 Urgent Care & Family Practice 17 - HCP - Bower Steven C MD 61 Memorial Medical Parkway Suite 3807 Palm Coast FL 32164 Surgical services 18 - Florida Hospital Flagler Intensivist 60 Memorial Medical Parkway Palm Coast FL 32164 Intensivist 19 - Palm Coast Parkway Women's Center 120 Cypress Edge Drive Palm Coast FL 32164 Women's Health Services 20 - HCP - Combs Wallace MD 120 Pinnacles Drive Suite 1 Palm Coast FL 32164 Gastroenterology Services 21 - HCP - Kurian Kizhake MD 61 Memorial Medical Parkway Suite 3808 Palm Coast FL 32164 Cardiology Services 22 - HCP - Bolla John D MD 61 Memorial Medical Parkway Suite 3803 Palm Coast FL 32164 Family Practice Services 23 - Florida Hospital Hospice - Fish 190 N Charles Richard Beall Blvd Debary FL 32713 Hospice Administrative Office 24 - HCP - Davis Michael DO dba Pediatrics 61 Memorial Medical Parkway Suite 3811 Palm Coast FL 32164 Pediatric Services 25 - HCP - Cascone John MD 61 Memorial Medical Parkway Suite 3805 Palm Coast FL 32164 Surgical services 26 - HCP - Garcia-Guerra Jose MD 61 Memorial Medical Parkway Suite 2808 Palm Coast FL 32164 Neurological Services 27 - HCP - Rosenbaum Corey MD 21 Hospital Drive Suite 110 Palm Coast FL 32164 Orthopedic Services 28 - HCP - Turchin Sergey MD 120 Cypress Edge Drive Suite 209 Palm Coast FL 32164 Internal Medicine Services 29 - HCP - Ceballos Jecebu MD 61 Memorial Medical Parkway Suite 2806 Palm Coast FL 32164 Family Practice Services 30 - HCP - Ward Jeffery J DO 61 Memorial Medical Parkway Suite 3813 Palm Coast FL 32164 Family Practice Services 31 - HCP - Ahmed Tanam MD 120 Cypress Edge Drive Suite 207 Palm Coast FL 32164 Family Practice Services 32 - HCP - Blair-Britt Loray MD 61 Memorial Medical Parkway Suite 3802 Palm Coast FL 32164 Family Practice Services 33 - HCP - Oglesby Allan C MD 61 Memorial Medical Parkway Suite 3805 Palm Coast FL 32164 Internal Medicine Services 34 - HCP - Karraffa David MD 120 Cypress Edge Drive Suite 206 Palm Coast FL 32164 Nephrology Services 35 - HCP - Maclsaac Gregory MD 120 Cypress Edge Drive Suite 210 Palm Coast FL 32164 Family Practice Services 36 - HCP - Screnock Jonathan MD 120 Cypress Edge Drive Suite 204 Palm Coast FL 32164 Family Practice Services 37 - HCP - Hoskote Jaideep MD 120 Cypress Edge Drive Suite 201 Palm Coast FL 32164 Nephrology Services 38 - HCP - Millan Pinzon Sonia MD 120 Cypress Edge Drive Palm Coast FL 32164 Family Practice Services 39 - HCP - Nanavati Amit MD 61 Memorial Medical Parkway Ste 1-800B Palm Coast FL 32164 Cardiology Services 40 - HCP - Siddiqui Rehana MD 61 memorial Medical Parkway Suite 3812 Palm Coast FL 32164 General Practice Services 41 - HCP - Cooper Sharrell MD 120 Cypress Edge Drive Suite 202 Palm Coast FL 32164 Family Practice Services 42 - HCP - Iheme Chiamaka MD 120 Cypress Edge Drive Suite 202 Palm Coast FL 32164 Family Practice Services 43 - HCP - Nasr Issam MD 61 Memorial Medical Parkway Suite 2815 Palm Coast FL 32164 gastroenterology Services 44 - HCP - Melo Haroldo MD 42A Caroline Street Bunnell FL 32110 Internal Medicine Services 45 - Palm Coast Parkway Occupational Therapy 120 Cypress Edge Drive Palm Coast FL 32164 Occupational Therapy 46 - HCP - Walsh John A MD 61 Memorial Medical Parkway Ste 1-800B Palm Coast FL 32164 Surgery, Cardiovascular/Thoracic Services 47 - HCP - Shams Safwan MD 61 Memorial Medical Parkway Suite 1800- Palm Coast FL 32164 Gastroenterology Services 48 - HCP - Palm Coast Family PracticePlantat 42A Caroline Street Bunnell FL 32110 Family Practice Services 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: Memorial Hospital Flagler, Inc. (the Hospital) is involved with and supportive of various other community agencies in its service area that work collaboratively to help those in need and to improve the health and safety of the residents of the community. The Hospital participates with a number of other community organizations to address the healthcare needs of the community. The Hospital provides supplies and cash donations to a local community free clinic organization. The Hospital also participates in community events, such as the Rely for Life, American Cancer Society, and Heartwalk.The costs of community building activities reported on Part II of Schedule H also 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 page 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. Part III, Line 9b: The hospital filing organization's collection practices are in conformity with the requirements set forth in the 2014 Final Regulations regarding the requirements of Internal Revenue Code Section 501(r)(4) - (r)(6). No extraordinary collection actions (ECA's) are initiated by the hospital filing organization in the 120-day period following the date after the first post-discharge billing statement is sent to the individual (or, if later, the specified deadline given in a written notice of actions that may be taken, as described below). Individuals are provided with at least one written notice (notice of actions that may be taken) and a copy of the filing organization's Plain Language Summary of the Financial Assistance Policy that informs the individual that the hospital filing organization may take actions to report adverse information to credit reporting agencies/bureaus if the individual does not submit a Financial Assistance Application Form (FAA Form) or pay the amount due by a specified deadline. The specified deadline is not earlier than 120 days after the first post-discharge billing statement is sent to the individual and is at least 30 days after the notice is provided. A reasonable attempt is also made to orally notify an individual about the filing organization's Financial Assistance Policy and how the individual may obtain assistance with the Financial Assistance application process. If an individual submits an incomplete FAA Form during the 240-day period following the date on which the first post-discharge billing statement was sent to the individual, the hospital filing organization suspends any reporting to consumer credit reporting agencies/bureaus (or ceases any other ECA's) and provides a written notice to the individual describing what additional information or documentation is needed to complete the FAA Form. This written notice contains contact information including the telephone number and physical location of the hospital facility's office or department that can provide information about the Financial Assistance Policy, as well as contact information of the hospital facility's office or department that can provide assistance with the financial assistance application process or, alternatively, a nonprofit organization or governmental agency that can provide assistance with the financial assistance application process if the hospital facility is unable to do so. If an individual submits a complete FAA Form within a reasonable time-period as set forth in the notice described above, the hospital filing organization will suspend any adverse reporting to consumer credit reporting agencies/bureaus until a financial assistance policy eligibility determination can be made. 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: Memorial Hospital Flagler (the Hospital) is a 99-bed acute care facility that provides quality health care services to the residents of Palm Coast and surrounding Flagler County in the State of Florida. The Hospital is the sole provider of emergency hospital services in Flagler County. The Hospital is located in a rural community located between two larger cities. The Hospital is a crucial community and regional asset. Medicare has designated Florida Hospital Flagler as a Medicare Dependent Hospital as it is located in a rural area. The nearest other hospital is 15 miles away and this facility is owned by an affiliate. The Hospital currently offers most hospital services including cancer, home health and hospice programs. The Hospital is also the third largest employer in Flagler County.The Hospital's primary service area has a population of approximately 104,571, with an estimated 30,020 over the age of 65. High school graduates make up 84.4% of Flagler county with 21.7% of the population holding a bachelor's degree or higher. The median household income, based on population, in Flagler county is approximately $46,939. In 2015, Flagler county had an unemployment rate of 6.2%.Approximately 61.5% of the Hospital's patients during 2016 were Medicare patients, about 8.4% were Medicaid patients, about 6.2% were self-pay patients, and the remaining percentage were patients covered under commercial insurance. In 2016, about 88.7% of the hospital's in-patients were admitted through the hospital's Emergency Department. Part VI, Line 5: The provision of community benefit is central to Memorial Hospital Flagler'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 $179,917 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 $17,573,678 in new capital improvements. As a faith-based mission-driven community hospital, the Hospital is continually involved in monitoring its community, identifying unmet health care needs and developing solutions and programs to address those needs. In accordance with its conservative approach to fiscal responsibility, surplus funds of the Hospital are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its community. Part VI, Line 6: The filing organization is a part of a faith-based healthcare system of organizations whose parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). The system is known as 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 hospital and other health care organizations, the filing organization benefits from reduced costs due to system efficiencies, such as large group purchasing discounts, and the availability of internal resources such as internal legal counsel. Each 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 Palm Coast Seventh Day Adventist Church 5650 Belle Terre Parkway Palm Coast FL 32137 590806975 501(c)(3) 50000 General Support Flagler County Education Direct-Support Organization Inc 1769 E Moody Blvd Building 2 Bunnell FL 32110 593006312 501(c)(3) 5250 General Support PDA Florida Inc PO Box 352493 Palm Coast FL 32135 593758112 501(c)(3) 7750 General Support The Flagler Auditorium Governing Board Inc PO BOX 755 Bunnell FL 32110 593079371 501(c)(3) 11250 General Support American Heart Association 237 E Marks St Orlando FL 32803 135613797 501(c)(3) 14438 General Support Flagler County Free Clinic Inc PO BOX 863 Bunnell FL 32100 205036975 501(c)(3) 25000 General Support 6 0 Part I, Line 2: Grants are generally made only to related organizations that are exempt from federal income tax under IRC Section 501(c)(3), or to other local charitable community organizations, or to other 501(c)(3) organizations that are a part of the group exemption ruling issued to the General Conference of Seventh-Day Adventists. Accordingly, the filing organization has not established specific procedures for monitoring the use of grant funds in the United States as the filing organization does not have a grant making program that would necessitate such procedures. X X X 1 1 0 1 0 0 0 0 0 0 0 Fulbright Robert Chairman/Dir 0 553740 0 139180 0 97437 0 100584 0 49118 0 940059 0 62736 Alter MD Dennis DirECTOR 0 513412 0 475484 0 42998 0 14388 0 11580 0 1057862 0 0 Deininger Robert DirECTOR (Beg 2/16) 0 275628 0 29254 330 28138 0 14387 0 40952 330 388359 0 0 Hamilton MD Ted DiRECTOR 0 422542 0 104995 330 216253 0 14388 0 51816 330 809994 0 0 Jimenez MD Ronald Director/CEO (Beg 5/16) 0 354676 0 66568 330 49339 0 33037 0 44373 330 547993 0 16665 Johnson Sandra K DirECTOR 0 497740 0 169032 0 295496 0 68651 0 50353 0 1081272 0 42991 Mattison Kenneth R Director/CEO (End 5/16) 0 385104 0 99849 0 186480 0 50595 0 38338 0 760366 0 35440 Noseworthy Gordon Edward DirECTOR 0 404665 0 98618 0 486613 0 73574 0 36986 0 1100456 0 45135 Seifert Lewis DirECTOR (End 8/16) 0 567366 0 148759 0 111623 0 103910 0 51299 0 982957 0 80118 Thomas Debora H DirECTOR 0 360181 0 98402 0 61380 0 35287 0 47627 0 602877 0 22121 Bucknor Jermaine CFO (END 1/16) 0 266800 0 41723 0 25602 0 19778 0 41602 0 395505 0 0 DoMayer Cory CFO (Beg 2/16) 0 190781 0 14469 0 13504 0 11152 0 38887 0 268793 0 0 King Joanne COO 0 171051 0 19964 0 7069 0 10561 0 43762 0 252407 0 0 Thomas MD Ronald CMO 0 305493 0 52482 0 68384 0 14388 0 53066 0 493813 0 0 Davis Robert CNO 0 176826 0 31386 0 20533 0 11657 0 37348 0 277750 0 0 Celano Patricia CCO 0 320064 0 55823 0 59567 0 28179 0 35120 0 498753 0 25724 Roy Tapash K Oncology Radiation Therapist 172818 0 111 0 1609 0 5764 0 19590 0 199892 0 0 0 Cole Rema Hospice Administrator 128079 0 10714 0 7856 0 7314 0 10241 0 164204 0 0 0 Subers John Foundation administrator 120008 0 9614 0 11705 0 4077 0 20436 0 165840 0 0 0 Ottati David Former CEO 0 403475 0 87689 0 71809 0 63196 0 43058 0 669227 0 43411 Ziesmer Valerie Former CFO 0 239058 0 36216 0 26520 0 24860 0 13064 0 339718 0 3542 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, 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 ------------------------------------------------------- Ted Hamilton, MD $ 63,522 $ 63,522 $ 96,118 $ 0 Sandra Johnson $ 72,263 $ 42,629 $209,450 $ 0 Kenneth Mattison $ 54,207 $ 34,953 $ 54,723 $ 0 Edward Noseworthy $ 59,186 $ 45,393 $181,066 $ 0 David Ottati $ 48,808 $ 44,756 $ 0 $ 0 Lewis Seifert $ 89,523 $ 80,183 $ 0 $ 0 Debora Thomas $ 38,900 $ 22,133 $ 0 $ 0 Ronald Thomas, MD $ 35,014 $ 35,014 $ 0 $ 0 Valerie Ziesmer $ 28,472 $ 3,542 $ 0 $ 0 Robert Fulbright $ 86,197 $ 62,771 $ 0 $ 0 Jermaine Bucknor $ 14,934 $ 0 $ 0 $ 0 Robert Deininger $ 17,071 $ 0 $ 0 $ 0 Ronald Jimenez, MD$ 36,649 $ 16,674 $ 0 $ 0 Patricia Celano $ 40,723 $ 25,424 $ 0 $ 0 *Including Investment Earnings Dennis Alter MD PA dba Alter Orth 100% owned by board member 208290 Office Space Lease 0 Part V, Line 1a The parent corporation and sole top-tier member of Memorial Hospital Flagler, 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. The filing organization has entered "0" in Part V, Line 1a because the filing organization no longer issues Form 1099 returns, rather, all such returns are filed by and under the name and EIN of AHSSHC as the payor subject to the information reporting requirements of Section 6041. Form 990, Part VI, Section A, line 6 Memorial Hospital - Flagler, Inc. (the filing organization) has one member. The sole member of the filing organization is Memorial Health Systems, Inc. Memorial Health Systems, Inc. (MHS) 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 MHS. The Board of Directors of the filing organization are appointed by the sole member, MHS, 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 MHS, as the sole member of the filing organization, has certain reserved powers as set forth in the Bylaws of the filing organization. These reserved powers include the following: a) to approve and disapprove the executive and/or administrative leadership of the filing organization, and their salaries; b) to adopt, amend, restate, and repeal the Bylaws of the filing organization; c) to set limits and terms for the borrowing of funds in excess of an established amount; d) to approve or disapprove material changes in services offered and/or purchase or sale of personal property or real property equal to or in excess of an established amount; e) to approve or disapprove the annual operating and capital budgets of the filing organization; f) to direct the placement of funds and capital of the filing organization; g) to establish general guiding policies, to implement quality assessment, improvement and case management; h) to approve the appointment of an auditing firm and election of the fiscal year for the filing organization; and i) to establish a process for addressing patient grievances. 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 7,458,704. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,458,704. Professional Fees : Program service expenses 1,482,040. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,482,040. Purchased Medical Services : Program service expenses 20,879,121. Management and general expenses 0. Fundraising expenses 0. Total expenses 20,879,121. Environmental Services : Program service expenses 608,873. Management and general expenses 0. Fundraising expenses 0. Total expenses 608,873. Transcription Services : Program service expenses 107,077. Management and general expenses 0. Fundraising expenses 0. Total expenses 107,077. Recruiting : Program service expenses 49,001. Management and general expenses 0. Fundraising expenses 0. Total expenses 49,001. Food Service Contracts : Program service expenses 321,173. Management and general expenses 0. Fundraising expenses 0. Total expenses 321,173. Miscellaneous Purchased Services : Program service expenses 10,920,132. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,920,132. AHS Management Fees : Program service expenses 0. Management and general expenses 3,256,049. Fundraising expenses 0. Total expenses 3,256,049. Billing & Collection Services : Program service expenses 0. Management and general expenses 163,937. Fundraising expenses 0. Total expenses 163,937. EHR Management Fees : Program service expenses 0. Management and general expenses 43,120. Fundraising expenses 0. Total expenses 43,120. Form 990, Part XI, line 9: Allocation from tax-exempt parent with respect to debt 45,192. Transfer to/from affiliate -22,567,624. Transfer to tax-exempt parent -3,190,446. Gifts 112,000. 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 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 Memorial Hospital-Flagler Inc C 238573 90207 0.91280 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 MHS MHF MHWV or SWVHC C 23265 101782 0.25000 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 1 1 1 1 1 0 Memorial Health Systems Inc P 10328916 Cost Memorial Health Systems Inc Q 10780761 Cost Florida Hospital Medical Group Inc Q 139204 Cost Florida Hospital Medical Group Inc P 629058 Cost Adventist Health SystemSunbelt Inc dba Florida Hospital P 232970 Cost Adventist Health System Sunbelt Healthcare Corporation M 2939533 % of facility's operating exp. Adventist Health System Sunbelt Healthcare Corporation dba AHS IS M 4086190 % of facility's operating exp. Adventist Health System Sunbelt Healthcare Corporation-Shared Services M 1379908 % of facility's Operating exp. Adventist Health System Sunbelt Healthcare Corporation P 7835704 Cost Adventist Health SystemSunbelt Inc M 43120 % of facility's EHR revenue SunSystem Development Corporation dba Florida Hospital Flagler Foundation O 332965 Cost Florida Memorial Health Network Q 6266143 Cost Memorial Hospital - West Volusia Inc dba Florida Hospital DeLand Q 140315 Cost Memorial Hospital - West Volusia Inc dba Florida Hospital DeLand P 138250 Cost Southwest Volusia Healthcare Corporation dba Florida Hospital Fish Memorial Q 1439143 Cost Southwest Volusia Healthcare Corporation dba Florida Hospital Fish Memorial P 1433286 Cost Florida Hospital Healthcare Partners Inc N 57997265 Cost Adventist Health System Sunbelt Healthcare Corporation C 57222 Actual Amount Received SunSystem Development Corporation dba Florida Hospital Flagler Foundation C 112000 Actual Amount Received Adventist Health System Sunbelt Healthcare Corporation B 3190446 Actual Amount Given Southeast Volusia Healthcare Corporation dba Florida Hospital New Smyrna B 21962125 Actual Amount Given Memorial Health Systems Inc R 605499 actual Amount Given