2018-10-24T08:39:00-05:00 2017-12-31 990 2017-01-01 592108057 FLORIDA HOSPITAL ZEPHYRHILLS INC FLOR 8137880411 7050 GALL BLVD ZEPHYRHILLS FL 33541 LYNN C ADDISCOTT ASSISTANT SECRETARY 4079751492 2018-10-02 204.139.85.142 2018-10-02 15:10:15 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 6F248CD6EFF84B1BE2234CC43AB797AE6C4F0CE1 2017 2019-02-21 02:37:17Z AMANDA MAGGARD 7050 GALL BLVD ZEPHYRHILLS FL 33541 151881473 0 X WWW.FLORIDAHOSPITAL.COM/ZEPHYRHILLS X 1998 FL PROVISION OF MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF A 149 BED ACUTE-CARE HOSPITAL. 13 10 1175 214 68564 -1644 0 20000 148228701 146980653 1556337 4714629 122184 125881 149907222 151841163 96498 269992 0 0 65117681 67781449 0 0 0 71816060 72980924 137030239 141032365 12876983 10808798 190690542 194840069 75736196 69301426 114954346 125538643 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 132315863 269992 146932266 FLORIDA HOSPITAL ZEPHYRHILLS, INC. OPERATES A 149-BED ACUTE CARE HOSPITAL IN ZEPHYRHILLS, FL. IN THE CURRENT YEAR, THERE WERE 8,339 PATIENT ADMISSIONS RESULTING IN 31,594 PATIENT DAYS, AND 56,062 OUTPATIENT VISITS. 132315863 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 1175 1 1 1 0 0 0 0 0 0 0 0 0 X 13 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X RYAN WILLIS 8137836100 7050 GALL BLVD ZEPHYRHILLS FL 33541 X BRUCE BERGHERM DIRECTOR/CHAIR (BEG 6/17) 5.60 44.40 X 0 551277 112573 IRFAN ALI MD DIRECTOR (BEG 1/17) 0.50 0.00 X 0 0 0 DENYSE BALES-CHUBB DIRECTOR 0.50 50.00 X 0 454258 103703 RANDALL BELCHER DIRECTOR 0.50 0.00 X 0 0 0 ROBERT CABOT DIRECTOR 0.50 0.00 X 0 0 0 SCOTT CAMERON DIRECTOR 0.50 0.00 X 0 0 0 LEROY HAUFF DIRECTOR 0.50 0.00 X 0 0 0 STEPHEN HERR DIRECTOR 0.50 0.00 X 0 0 0 AMANDA MAGGARD DIRECTOR/SEC/CEO (BEG 9/17) 50.00 0.00 X X 0 274756 68840 TERRI MCENDREE MD DIRECTOR (END 8/17) 0.50 0.00 X 0 0 0 RAYMOND PICHETTE DIRECTOR (BEG 9/17) 0.50 1.00 X 0 308 0 RAY POLK DIRECTOR 0.50 0.00 X 0 0 0 MICHAEL SCHULTZ DIRECTOR/CHAIR (END 6/17) 5.60 44.40 X 0 1687407 231618 JOHN SCOTT DIRECTOR 0.50 0.50 X 0 0 0 RANDALL SURBER DIRECTOR/SEC/CEO(END7/17) 50.00 0.00 X X 0 497346 95733 ROBERT WINTERS DIRECTOR 0.50 0.00 X 0 0 0 RYAN WILLIS CFO & COO 50.00 0.00 X 0 230820 38888 DIMA DIDENKO REGION CFO 5.60 44.40 X 0 529545 113905 HUGAR MCNAMEE MD CMO (END 4/17) 4.00 40.00 X 0 406536 47098 GWEN ALONSO CNO 50.00 0.00 X 0 236764 39345 ROBIN MCGUINNESS REGION CNO 5.60 44.40 X 0 295890 62569 AMIR QUEFATIEH MD PHYSICIAN 40.00 0.00 X 1258900 0 42876 BERTRAM A LEWIS JR MD PHYSICIAN 40.00 0.00 X 502084 0 42737 RALPH HIGHSHAW MD PHYSICIAN 40.00 0.00 X 422597 0 42267 MARIAN ANTONETTE SAMPSON MD PHYSICIAN 40.00 0.00 X 370662 0 22827 HARRY BLACKSTONE MD PHYSICIAN 40.00 0.00 X 224338 0 26218 WILLIAM HEINRICH FORMER CFO & COO 0.00 50.00 X 0 366419 58458 2778581 5531326 1149655 74 1 1 0 MORRISON MANAGEMENT SPECIALISTS INC PO BOX 102289 ATLANTA GA 30368 DIETARY MANAGEMENT SERVICES 1487962 ARAMARK 10510 TWIN LAKES PARKWAY CHARLOTTE NC 28289 EQUIPMENT MAINTENANCE 1344081 TAMPA BAY ANESTHESIA ASSOC LLC 3414 LOGGERHEAD WAY WESLEY CHAPEL FL 33544 ANESTHESIA SERVICES 999806 PT SOLUTIONS PO BOX 242278 MONTGOMERY AL 36124 THERAPY SERVICES 932595 BAY LINEN 11525 47TH STREET NORTH CLEARWATER FL 33762 LINEN SERVICES 611135 34 X 20000 20000 NET PATIENT REVENUE 622110 145193839 145193839 CAFETERIA REVENUE 622110 669791 669791 FITNESS CENTER REVENUE 622110 539059 474012 65047 DAYCARE REVENUE 622110 324540 324540 GIFT SHOP REVENUE 622110 192821 192821 60603 60603 146980653 2160050 2160050 149531 40310 109221 109221 3517 105704 2485955 68624 0 0 2485955 68624 2554579 2554579 EHR REVENUE 622110 16660 16660 16660 151841163 146932266 68564 4820333 X 269992 269992 1421416 1421416 50358772 50358772 1519585 1504666 14919 10728152 10702499 25653 3753524 3716672 36852 99347 99347 65608 65608 479112 479112 19685007 15633556 4051451 523158 523158 3048490 2295072 753418 5442279 4670646 771633 2193480 2193480 90070 4682 85388 20611 20611 1678614 1678614 8974465 8974465 1614023 1601814 12209 MEDICAL SUPPLIES 24101722 24101722 REPAIRS & MAINTENANCE 2915957 2915957 STATE TAX INDIGENT ASSE 1689726 1689726 UBI TAXES 4000 4000 355255 3528 351727 141032365 132315863 8716502 0 X 2984 12125 98932152 84426412 16928956 16224811 4054926 5077667 3835351 4567526 206047619 124443262 65518817 81604357 308520 409137 9328 1108836 2508706 190690542 194840069 12283340 8826052 63452856 60475374 75736196 69301426 X 114954346 125538643 114954346 125538643 190690542 194840069 X 10808798 3469100 -3693601 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 5829 5829 0 PART II-B, LINE 1: AMERICAN & FLORIDA HOSPITAL ASSOCIATION DUES. 23348901 23348901 83739579 49700651 34038928 95698569 72199632 23498937 3260570 2542979 717591 81604357 DUE TO RELATED 2850768 PAYABLE TO THIRD PARTIES 1480943 CREDIT BALANCES IN A/R 379549 INTERCO. ALLOC. OF TE BOND PROCEEDS 55243180 DUE TO AFFILIATED -1171 OTHER LIABILITIES 522105 60475374 X PART X, LINE 2: THE HOSPITAL IS PART OF A CONSOLIDATED AUDITED FINANCIAL STATEMENT. THE CONSOLIDATED AUDITED FINANCIAL STATEMENT INCLUDES THE FOLLOWING FIN 48 (ASC 740) FOOTNOTE - THE DIVISION FOLLOWS INCOME TAXES TOPIC OF THE ACCOUNTING STANDARDS CODIFICATION (ASC) (ASC 740) WHICH PRESCRIBES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAX POSITIONS RECOGNIZED IN FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN, OR EXPECTED TO BE TAKEN, IN A TAX RETURN. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2017. 1 1 X 1 X 0 1 1 1 0 1 0 6681986 6681986 0.04740 18873795 10877445 7996350 0.05670 25555781 10877445 14678336 0.10410 236557 236557 0.00170 236557 236557 0.00170 25792338 10877445 14914893 0.10580 17389 17389 0.00010 17389 17389 0.00010 1 6157310 217729 39197975 42588058 -3390083 X 1 1 1 1 FLORIDA HOSPITAL ZEPHYRHILLS 7050 GALL BLVD ZEPHYRHILLS FL 33541 WWW.FLORIDAHOSPITAL.COM/ZEPHYRHILLS 4445 X X X FLORIDA HOSPITAL ZEPHYRHILLS INC 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X SEE STATEMENT X X 1 17 1 SEE STATEMENT 0 1 X 200.000000000000 X X X X 1 1 X X X X 1 X SEE STATEMENT X SEE STATEMENT X SEE STATEMENT X X X X X X 1 X 0 X X X X 1 X 0 0 FLORIDA HOSPITAL ZEPHYRHILLS, INC. PART V, SECTION B, LINE 5: FLORIDA HOSPITAL ZEPHYRHILLS, INC., D/B/A FLORIDA HOSPITAL ZEPHYRHILLS, (FHZ OR THE HOSPITAL) IS A 149-BED REGIONAL MEDICAL CENTER LOCATED IN EAST PASCO COUNTY IN FLORIDA. FHZ SERVES THE EASTERN PORTION OF PASCO COUNTY, WHICH IS COMPRISED OF PRIMARILY THE CITIES OF ZEPHYRHILLS, DADE CITY, AND PORTIONS OF WESLEY CHAPEL. THE HOSPITAL SERVES A POPULATION THAT IS PRIMARILY WHITE, OLDER, AND UNDERINSURED. MANY RESIDENTS, PARTICULARLY IN TWO OF THE ZIP CODES THAT COMPRISE THE HOSPITAL'S PRIMARY SERVICE AREA, ARE SENIORS, WITH MORE THAN 65% OF THE RESIDENTS OVER THE AGE OF 65, MANY OF WHOM MAY HAVE CHRONIC DISEASES DUE TO AGE AND/OR LIFESTYLE. THE HOSPITAL'S PRIMARY SERVICE AREA IS COMPRISED OF FIVE ZIP CODES IN PASCO COUNTY, FLORIDA. IN CONDUCTING ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), PRIMARY AND SECONDARY HEALTH DATA WAS COLLECTED AND ANALYZED. PRIMARY DATA WAS GATHERED BASED UPON INPUT FROM INDIVIDUALS REPRESENTING THE BROAD COMMUNITY, AS WELL AS LOW-INCOME, MINORITY, AND OTHER MEDICALLY UNDERSERVED POPULATIONS. PRIMARY DATA INPUT WAS PRIMARILY GATHERED THROUGH THE ESTABLISHMENT OF A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE, COMMUNITY STAKEHOLDER SURVEYS (APPROXIMATELY 100 SURVEYS WERE CONDUCTED), AND PUBLIC HEALTH INPUT AND EXPERTISE. THE HOSPITAL FORMED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) THAT INCLUDED REPRESENTATIVES OF THE COMMUNITY AND THE HOSPITAL, WITH A SPECIAL FOCUS ON UNDERSERVED POPULATIONS. MANY OF THE CHNAC MEMBERS WERE SELECTED BECAUSE OF THEIR DIRECT TIES TO THE UNDERSERVED AND IMPOVERISHED COMMUNITIES IN THE HOSPITAL'S PRIMARY SERVICE AREA. KEY MEMBERS OF THE CHNAC INCLUDED REPRESENTATIVES FROM THE PASCO COUNTY HEALTH DEPARTMENT, PREMIER COMMUNITY HEALTHCARE, A FEDERALLY QUALIFIED HEALTH CARE CENTER, AND CHURCH OF THE NAZARENE, A LOCAL COMMUNITY CHURCH. FHZ ALSO GATHERED PRIMARY DATA THROUGH THE UTILIZATION OF A STAKEHOLDER SURVEY. THIS STAKEHOLDER SURVEY WAS DISTRIBUTED TO AND COMPLETED BY BOTH MEMBERS OF THE CHNAC AND MEMBERS OF THE COMMUNITY AT LARGE. VARIOUS SOURCES OF SECONDARY DATA WERE REVIEWED TO UNDERSTAND THE LARGER ISSUES PLAGUING THE HOSPITAL'S PRIMARY SERVICE AREA. FLORIDA HOSPITAL ZEPHYRHILLS, INC. PART V, SECTION B, LINE 7D: THE HOSPITAL HAS ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS MUST BE POSTED ON THE HOSPITAL'S WEBSITE AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE WIDELY AVAILABLE ON ITS WEBSITE ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. THE HOSPITAL WILL ALSO MAKE A PAPER COPY OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST AND WITHOUT CHARGE, AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE AVAILABLE FOR PUBLIC INSPECTION ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. FLORIDA HOSPITAL ZEPHYRHILLS, INC. PART V, SECTION B, LINE 11: THE INFORMATION PROVIDED BELOW EXPLAINS HOW THE HOSPITAL FACILITY ADDRESSED IN 2017 THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, AND ANY SUCH NEEDS THAT WERE NOT ADDRESSED AND THE REASONS WHY SUCH NEEDS WERE NOT ADDRESSED. THE HOSPITAL FACILITY CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2016 AND ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT IN 2017 PRIOR TO MAY 15, 2017. FLORIDA HOSPITAL ZEPHYRHILLS, INC. (FHZ OR THE HOSPITAL) IS PART OF THE WEST FLORIDA DIVISION OF ADVENTIST HEALTH SYSTEM WHICH INCLUDES NINE HOSPITAL FACILITIES.THIS IS THE FIRST-YEAR UPDATE FOR FLORIDA HOSPITAL ZEPHYRHILLS' 2017-2019 COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY. FHZ DEVELOPED THIS PLAN AND POSTED IT IN MAY 2017 AS PART OF ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS.FOR THE DEVELOPMENT OF BOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY, FHZ WORKED TO DEFINE AND ADDRESS THE NEEDS OF LOW-INCOME, MINORITY AND UNDERSERVED POPULATIONS IN ITS SERVICE AREA. THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT USED PRIMARY DATA INTERVIEWS AND SURVEYS; SECONDARY DATA FROM LOCAL, REGIONAL AND NATIONAL HEALTH-RELATED SOURCES; AND HOSPITAL PREVALENCE DATA TO HELP THE HOSPITAL DETERMINE THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. ONCE THE DATA WAS GATHERED, THE PRIMARY ISSUES IDENTIFIED IN THE NEEDS ASSESSMENT WERE PRIORITIZED BY COMMUNITY AND HOSPITAL STAKEHOLDERS, WHO THEN SELECTED KEY ISSUES FOR THE HOSPITAL TO ADDRESS IN ITS 2017-2019 COMMUNITY HEALTH PLAN. THE FIRST-YEAR PROGRESS ON THE COMMUNITY HEALTH PLAN IS NOTED BELOW. THIS NARRATIVE DESCRIBES THE ISSUES IDENTIFIED IN 2016 AND GIVES AN UPDATE ON THE STRATEGIES ADDRESSING THOSE ISSUES. THERE IS ALSO A DESCRIPTION OF THE IDENTIFIED ISSUES THAT THE HOSPITAL IS NOT ADDRESSING.FLORIDA HOSPITAL ZEPHYRHILLS CHOSE FIVE AREAS OF FOCUS FOR THEIR 2017-2019 COMMUNITY HEALTH PLAN: 1. OBESITY2. HEART DISEASE3. LACK OF EXERCISE4. SMOKING CESSATION5. NUTRITION/ACCESS TO HEALTHY FOODPRIORITY: OBESITY/LACK OF EXERCISE2016 DESCRIPTION OF THE ISSUE: 30.6% OF ADULTS AGE 20+ SELF-REPORT THAT THEY HAVE A BMI GREATER THAN 30 IN OUR AREA. OBESITY IS THE NUMBER ONE HEALTH PROBLEM IDENTIFIED IN OUR PRIMARY DATA COLLECTION. 23.9% OF ADULTS LIVING IN OUR PRIMARY SERVICE AREA, AGES 20 AND OLDER, SELF-REPORTED THAT THEY HAVE NO LEISURE TIME FOR ACTIVITY. 2017 UPDATE:TO ADDRESS THE OBESITY AND LACK OF EXERCISE PRIORITY, OUR PLAN IS TO INCREASE NUTRITIONAL EDUCATION AND OPPORTUNITIES TO EXERCISE TO IMPROVE CONSUMER LIFESTYLE CHOICES. OUR PLAN ALSO INCLUDED INCREASED EXERCISE OPPORTUNITIES AND EDUCATION FOR ELEMENTARY AND MIDDLE SCHOOL STUDENTS THROUGH A MORNING MILE PROGRAM WITH THE AMERICAN DIABETES ASSOCIATION (ADA). OUR WELLNESS CENTER OFFERED MULTIPLE SESSIONS OF OUR 8-WEEK CREATION HEALTH PROGRAM. THIS PROGRAM IS A FAITH-BASED WELLNESS PLAN COMPLETE WITH LIFESTYLE SEMINARS AND A SPECIAL TRAINING PROGRAM FOR THOSE WHO WANT TO LIVE HEALTHIER AND HAPPIER LIVES. IT CONSISTS OF EIGHT PRINCIPLES TO INCLUDE CHOICE, REST, ENVIRONMENT, ACTIVITY, TRUST, INTERPERSONAL RELATIONSHIPS, OUTLOOK AND NUTRITION. OUR ANNUAL GOAL WAS TO ACHIEVE 50 PARTICIPANTS AND WE SURPASSED THIS GOAL WITH 98 TOTAL PARTICIPANTS. OF THE 98 PARTICIPANTS, 78.5% REPORTED AN IMPROVED KNOWLEDGE REGARDING HEALTH AND LIFESTYLE CHOICES AS MEASURED BY PRE- AND POST- 8-WEEK SESSION SURVEYS. IN ADDITION, OUR GOAL WAS TO TRAIN FIVE ADDITIONAL FHZ'S EMPLOYEES AS CREATION HEALTH COACHES AND WE SURPASSED THIS GOAL BY TRAINING NINE OF OUR EMPLOYEES IN 2017.WE ALSO MET OUR INITIATIVE TO SPONSOR TWO LOCAL CHURCHES, SO THEY COULD PROVIDE THE CREATION HEALTH 8-WEEK PROGRAM TO THEIR PARISHIONERS, TEACHING THEM TO LIVE HEALTHY AND WHOLE. OUR SECOND INITIATIVE WAS TO PILOT IN PARTNERSHIP WITH THE ADA A MORNING MILE PROGRAM AT TWO LOCAL, TITLE 1 SCHOOLS FOR THE 2017/18 SCHOOL YEAR. THIS PROGRAM ENCOURAGES CHILDREN TO WALK EVERY MORNING BEFORE CLASSES BEGIN. UNFORTUNATELY, THIS PROGRAM DID NOT COME TO FRUITION AS THE TWO LOCAL SCHOOLS ENCOUNTERED ISSUES THAT MADE IT DIFFICULT TO SUPPORT THE PROGRAM. ONE OF THE SCHOOLS UNDERWENT CONSTRUCTION THAT MADE IT IMPOSSIBLE TO PROVIDE A WALKING COURSE WHILE THE OTHER HAD A CHANGE IN LEADERSHIP AND COULD NOT PROVIDE FACULTY SUPPORT TO IMPLEMENT THE PROGRAM.OUR PLAN IS TO REPLACE THE MORNING MILE PROGRAM WITH A TRANSITION TO WELLNESS PROGRAM. THIS PROGRAM IDENTIFIES PATIENTS AT DISCHARGE WHO ARE PREDISPOSED, HAVE BEEN DIAGNOSED, OR WHO HAVE BEEN HOSPITALIZED WITH A CHRONIC LIFESTYLE DISEASE. WITH THE HELP OF A FITNESS NURSE AND SUPPORT TEAM, WEEKLY EDUCATION AND EXERCISE WILL BE OFFERED THROUGH OUR WELLNESS CENTER. IN ADDITION, PARTICIPANTS IN THIS PROGRAM CAN BE REFERRED BY THEIR PHYSICIAN. PARTICIPANTS WILL COMPLETE A PRE- AND POST- CREATION HEALTH ASSESSMENT TO DETERMINE CURRENT AND POST LIFESTYLE CHOICES THAT AFFECT THEIR OVERALL HEALTH. THIS PROGRAM BEGINS IN AUGUST 2018 AND OUR GOAL IS TO ENROLL 10 PARTICIPANTS IN YEAR 2 AND 15 IN YEAR 3 OF OUR COMMUNITY HEALTH PLAN. PRIORITY: HEART DISEASE2016 DESCRIPTION OF THE ISSUE: 8.6% OF ADULTS AGES 18 AND OLDER ARE DIAGNOSED WITH HEART DISEASE COMPARED TO STATE RATES AT 5.6% AND NATIONAL RATES AT 4.4%.2017 UPDATE: OUR COMMUNITY HEALTH PLAN INITIATIVE INCLUDES HEART DISEASE AND NUTRITION EDUCATION AND FREE HEART SCREENINGS TO LOWER THE RISK OF HEART DISEASE IN OUR COMMUNITY. OUR GOAL WAS TO DELIVER HEART HEALTHY EDUCATION AND SCREENINGS TO 1,000 CONSUMERS VIA HEALTH FAIRS, HEALTH TALKS, ETC. WE EXCEEDED OUR GOAL, REACHING 1,200 CONSUMERS IN OUR PRIMARY SERVICE AREA. THREE YEARS AGO, WE STARTED A COMMUNITY HEALTH EDUCATION PROGRAM FOR OUR 55+ COMMUNITIES IN DADE CITY AND ZEPHYRHILLS. WE QUICKLY IDENTIFIED A TREND IN HEART DISEASE WITH 47-50% OF CHOLESTEROL AND BLOOD PRESSURE SCREENINGS BEING IN THE ABNORMAL RANGE. THROUGH CONTINUED EDUCATION TO THESE SAME COMMUNITIES, WE WATCHED OUR HEART SCREENING RESULTS DROP TO 38.6% ABNORMAL IN 2017. GIVEN THESE RESULTS, WE WILL NEED TO CHANGE OUR YEAR 2 AND 3 GOALS TO LOWER NUMBERS AS WE ARE SEEING BETTER OUTCOMES FROM THESE SCREENINGS. THE HOSPITAL ALSO PRESENTED MULTIPLE COMPLETE HEALTH IMPROVEMENT PROGRAMS (CHIP) LAST YEAR. CHIP IS A LIFESTYLE ENRICHMENT PROGRAM DESIGNED TO REDUCE DISEASE RISK FACTORS THROUGH THE ADOPTION OF BETTER HEALTH HABITS AND APPROPRIATE LIFESTYLE MODIFICATIONS. OUR GOAL WAS TO SPONSOR 30 PEOPLE AND WE SPONSORED 27 WHO NEEDED FINANCIAL ASSISTANCE IN 2017. OF THE 27 PARTICIPANTS, 76% COMPLETED THE 9-WEEK COURSE AND 68% EXPERIENCED IMPROVED BIOMETRIC INDICES SUCH AS BLOOD SUGAR LEVELS, CHOLESTEROL, BODY MASS INDEX AND WEIGHT LOSS. 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://WWW.FLORIDAHOSPITAL.COM/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE THE FINANCIAL ASSISTANCE POLICY APPLICATION CAN BE FOUND AT:HTTPS://WWW.FLORIDAHOSPITAL.COM/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE THE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://WWW.FLORIDAHOSPITAL.COM/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 11 - CONTINUATION: PRIORITY: SMOKING CESSATION2016 DESCRIPTION OF THE ISSUE: 25.7% OF ADULTS AGE 18 AND OVER SELF-REPORT THAT THEY CURRENTLY SMOKE CIGARETTES SOME DAYS OR EVERY DAY, WHICH IS 7.7% HIGHER THAN THE STATE RATE.2017 UPDATE: OUR COMMUNITY HEALTH PLAN INITIATIVE WAS TO PROVIDE SUPPORT AND EDUCATION ON SMOKING AND TOBACCO CESSATION TO DETER OR STOP TOBACCO USAGE. IN PARTNERSHIP WITH OUR LOCAL GULF COAST NORTH AHEC AND THE FLORIDA DEPARTMENT OF HEALTH, WE HOST A MONTHLY IQUIT TOBACCO PROGRAM ON THE HOSPITAL'S CAMPUS. OUR GOAL WAS TO HAVE 37% OF OUR ANNUAL ATTENDANCE REPORT THAT THEY QUIT TOBACCO. OUR ACTUAL RESULT WAS 32%. OUR GREATEST CHALLENGE IS GETTING PEOPLE TO ATTEND THIS FREE CLASS THAT OFFERS FREE NICOTINE REPLACEMENT PATCHES, GUM AND LOZENGES, IN ADDITION TO EDUCATION AND SUPPORT.WE DID NOT ACHIEVE OUR GOAL OF SUPPORTING LOCAL CHURCHES IN THE DISTRIBUTION OF SMOKING CESSATION MATERIALS FOR TEENS. THESE MATERIALS HAVE BEEN GATHERED AND WILL BE DISTRIBUTED IN 2018. PRIORITY: NUTRITION AND ACCESS TO HEALTHY FOOD2016 DESCRIPTION OF THE ISSUE: THE FOOD INSECURITY RATE FOR THE HOSPITAL'S PRIMARY SERVICE AREA IS 15.1% OF THE POPULATION AND 26.29% OF THE HOSPITAL'S PRIMARY SERVICE AREA POPULATION HAS LOW FOOD ACCESS. 2017 UPDATE:IN RESPONSE TO THIS COMMUNITY NEED, THE HOSPITAL PARTNERED WITH THE UNIVERSITY OF FLORIDA TO PRESENT SEVERAL NUTRITIONAL EDUCATION SERIES. PARTICIPANTS AT EACH SESSION RECEIVED NUTRITION EDUCATION AND A TEN-DOLLAR VOUCHER TO REDEEM AT THE HOSPITAL'S FOOD IS MEDICINE FOOD TRUCK, FILLED WITH FRESH FRUITS AND VEGETABLES. BLOOD SUGAR LEVELS WERE MEASURED FOR EACH PARTICIPANT BEFORE AND AFTER EACH EDUCATIONAL SERIES AND 58.8% OF PARTICIPANTS HAD REDUCED BLOOD SUGAR LEVELS FOLLOWING EDUCATION.OUR BIGGEST CHALLENGE WAS WHEN HURRICANE IRMA DAMAGED THE FOOD IS MEDICINE FOOD TRUCK AND IT WAS NO LONGER ABLE TO SERVE OUR CAMPUS. AS A RESULT, WE PARTNERED WITH A LOCAL PRODUCE MARKET WHERE PARTICIPANTS COULD REDEEM THEIR VOUCHERS IN RETURN FOR FRUITS AND VEGETABLES. COMMUNITY NEEDS NOT CHOSEN BY FLORIDA HOSPITAL ZEPHYRHILLS: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:ISSUES THAT WILL NOT BE ADDRESSED BY FLORIDA HOSPITAL ZEPHYRHILLS:DIABETES AND LOW-INCOME FAMILIES AND POVERTY WHILE DIABETES AND LOW-INCOME FAMILIES AND POVERTY WERE LISTED IN OUR PRIORITY AREAS OF FOCUS DEFINED BY OUR PRIMARY AND SECONDARY DATA, THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE FELT THAT THESE ISSUES WERE RELATED AND COVERED UNDER THE FIVE SELECTED PRIORITIES. THROUGH COMMUNITY EDUCATION ON HEART DISEASE, OBESITY, SMOKING CESSATION AND NUTRITION AND COUPLED WITH THE FOOD IS MEDICINE, CHIP AND CREATION HEALTH PROGRAMS AND FREE HEALTH SCREENINGS, THE COMMITTEE FELT THAT THESE WERE HEALTH RELATED ISSUES THAT WOULD BE POSITIVELY AFFECTED BY ADDRESSING THE FIVE PRIMARY ISSUES. FURTHER, THROUGH OUR PARTNERSHIP WITH PREMIER COMMUNITY HEALTHCARE GROUP (A FEDERALLY QUALIFIED HEALTH CENTER), THE HOSPITAL'S EMERGENCY ROOM IS STAFFED WITH A FULL-TIME PATIENT NAVIGATOR TO ASSIST THE UNINSURED WITH SCHEDULING FOLLOW-UP APPOINTMENTS WITH PREMIER AS WELL AS ASSISTANCE WITH MEDICATIONS TO IMPROVE OUTCOMES AND PREVENT RE-ADMISSIONS AND ER VISITS. THE HOSPITAL ALSO OFFERS COMMUNITY SCHOLARSHIPS TO COVER CO-PAYMENTS AND/OR THE COST OF ITS GESTATIONAL DIABETES EDUCATION PROGRAM. TRANSPORTATION - THIS ISSUE WAS NOT ADDRESSED AS IT IS NOT A COMPETENCY OF THE HOSPITAL. 2 2 - FAMILY PRACTICE OF DADE CITY 37740 MERIDIAN AVE DADE CITY FL 33525 FAMILY PRACTICE 3 - UROLOGY ASSOICATES OF LAND O' LAKES 7040 LAND O LAKES BLVD 103 104 LAND O LAKES FL 34638 UROLOGY PRACTICE PART I, LINE 6A: THE FILING ORGANIZATION WAS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) DURING ITS CURRENT TAX YEAR. DURING THE CURRENT YEAR, AHSSHC SERVED AS A PARENT ORGANIZATION TO 22 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS THAT OPERATED 43 HOSPITALS IN NINE STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS "ADVENTIST HEALTH SYSTEM" (AHS).ALL HOSPITAL ORGANIZATIONS WITHIN AHS COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. AHS ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. AHS HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. EACH AHS HOSPITAL FACILITY REPORTS THEIR COMMUNITY BENEFITS TO THEIR BOARD OF DIRECTORS AND STRIVES TO COMMUNICATE THEIR COMMUNITY BENEFITS TO THEIR LOCAL COMMUNITIES. ADDITIONALLY, THE FILING ORGANIZATIONS MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY ARE POSTED ON THE FILING ORGANIZATION'S WEBSITE. PART I, LINE 7: THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. PART II, COMMUNITY BUILDING ACTIVITIES: THE COSTS OF COMMUNITY BUILDING ACTIVITIES REPORTED ON PART II OF SCHEDULE H PRIMARILY REPRESENT THE COSTS ASSOCIATED WITH PROVIDING EDUCATION FOR THE FILING ORGANIZATION'S STAFF PHYSICIANS AND EMPLOYEES. THE FILING ORGANIZATION'S PROVISION OF THESE EDUCATIONAL PROGRAMS/ACTIVITIES TO STAFF PHYSICIANS AND EMPLOYEES PROVIDES AN OPPORTUNITY FOR HEALTH CARE PROFESSIONALS TO ENHANCE THEIR SKILLS AND EXPERTISE AND KEEP UP-TO-DATE WITH THE LATEST ADVANCEMENTS IN MEDICAL PROCEDURES AND TECHNOLOGY. IN ADDITION, TRAINING OPPORTUNITIES ARE OFTEN PROVIDED ON-SITE AT THE FILING ORGANIZATION'S HOSPITAL FACILITY, THEREBY ALLOWING FOR HEALTH CARE PROFESSIONALS TO BE MORE READILY AVAILABLE TO ASSIST IN MEETING IMMEDIATE PATIENT CARE NEEDS. EDUCATION AND TRAINING PROVIDED TO THE FACILITY'S WORKFORCE IS VITAL IN ASSISTING HEALTH CARE PROFESSIONALS DIRECTLY INVOLVED IN PATIENT CARE WITH KEEPING ABREAST OF THE LATEST DEVELOPMENTS IN THEIR RESPECTIVE AREAS OF EXPERTISE, LEARNING POSSIBLE NEW AND INNOVATE WAYS OF DELIVERING CARE TO PATIENTS, AND UNDERSTANDING THE NEWEST TECHNOLOGIES AVAILABLE FOR THE TREATMENT OF PATIENTS. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON LINE 2 OF SECTION A OF PART III IS RECORDED IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO REVENUE, NOT BAD DEBT EXPENSE. PART III, LINE 3: METHODOLOGY FOR DETERMINING THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT MAY REPRESENT PATIENTS WHO COULD HAVE QUALIFIED UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY:SELF-PAY PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE BY COMPLETING A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM). IF AN INDIVIDUAL DOES NOT SUBMIT A COMPLETE FAA FORM WITHIN 240 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL, AN INDIVIDUAL MAY BE CONSIDERED FOR PRESUMPTIVE ELIGIBILITY BASED UPON A SCORING TOOL THAT IS DESIGNED TO CLASSIFY PATIENTS INTO GROUPS OF VARYING ECONOMIC MEANS. THE SCORING TOOL USES ALGORITHMS THAT INCORPORATE DATA FROM CREDIT BUREAUS, DEMOGRAPHIC DATABASES, AND HOSPITAL SPECIFIC DATA TO INFER AND CLASSIFY PATIENTS INTO RESPECTIVE ECONOMIC MEANS CATEGORIES. INDIVIDUALS WHO EARN A CERTAIN SCORE ON THE SCORING TOOL ARE CONSIDERED TO QUALIFY AS ELIGIBLE FOR THE MOST GENEROUS FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. AS DETERMINED BY THE FILING ORGANIZATION, A NOMINAL AMOUNT OF SUCH A PATIENT'S BILL IS WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED NON-STATE CHARITY. THE AMOUNT WRITTEN OFF AS BAD DEBT EXPENSE FOR THOSE PATIENTS WHO POTENTIALLY QUALIFY AS NON-STATE CHARITY USING THE SCORING TOOL IS THE AMOUNT SHOWN ON LINE 3 OF SECTION A OF PART III. RATIONALE FOR INCLUDING CERTAIN BAD DEBTS IN COMMUNITY BENEFIT:THE FILING ORGANIZATION IS DEDICATED TO THE VIEW THAT MEDICALLY NECESSARY HEALTH CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS SHOULD BE ACCESSIBLE TO ALL, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, CULTURAL BACKGROUND, PHYSICIAN MOBILITY, OR ABILITY TO PAY. THE FILING ORGANIZATION TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THE AVAILABILITY OF THIRD-PARTY COVERAGE. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE FILING ORGANIZATION IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. AS A 501(C)(3) HOSPITAL ORGANIZATION, THE FILING ORGANIZATION MAINTAINS A 24/7 EMERGENCY ROOM PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION CANNOT BE MADE BASED UPON INFORMATION SUPPLIED BY THE INDIVIDUAL. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON 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.RATIONALE FOR INCLUDING A MEDICARE SHORTFALL AS COMMUNITY BENEFIT:AS A 501(C)(3) ORGANIZATION, THE FILING ORGANIZATION PROVIDES EMERGENCY AND NON-ELECTIVE CARE TO ALL REGARDLESS OF ABILITY TO PAY. ALL HOSPITAL SERVICES ARE PROVIDED IN A NON-DISCRIMINATORY MANNER TO PATIENTS WHO ARE COVERED BENEFICIARIES UNDER THE MEDICARE PROGRAM. AS A PUBLIC INSURANCE PROGRAM, MEDICARE PROVIDES A PRE-ESTABLISHED REIMBURSEMENT RATE/AMOUNT TO HEALTH CARE PROVIDERS FOR THE SERVICES THEY PROVIDE TO PATIENTS. IN SOME CASES, THE REIMBURSEMENT AMOUNT PROVIDED TO A HOSPITAL MAY EXCEED ITS COSTS OF PROVIDING A PARTICULAR SERVICE OR SERVICES TO A PATIENT. IN OTHER CASES, THE MEDICARE REIMBURSEMENT AMOUNT MAY RESULT IN THE HOSPITAL EXPERIENCING A SHORTFALL OF REIMBURSEMENT RECEIVED OVER COSTS INCURRED. IN THOSE CASES WHERE AN OVERALL SHORTFALL IS GENERATED FOR PROVIDING SERVICES TO ALL MEDICARE PATIENTS, THE SHORTFALL AMOUNT SHOULD BE CONSIDERED AS A BENEFIT TO THE COMMUNITY. TAX-EXEMPT HOSPITALS ARE REQUIRED TO ACCEPT ALL MEDICARE PATIENTS REGARDLESS OF THE PROFITABILITY, OR LACK THEREOF, WITH RESPECT TO THE SERVICES THEY PROVIDE TO MEDICARE PATIENTS. THE POPULATION OF INDIVIDUALS COVERED UNDER THE MEDICARE PROGRAM IS SUFFICIENTLY LARGE SO THAT THE PROVISION OF SERVICES TO THE POPULATION IS A BENEFIT TO THE COMMUNITY AND RELIEVES THE BURDENS OF GOVERNMENT. IN THOSE SITUATIONS WHERE THE PROVISION OF SERVICES TO THE TOTAL MEDICARE PATIENT POPULATION OF A TAX-EXEMPT HOSPITAL DURING ANY YEAR RESULTS IN A SHORTFALL OF REIMBURSEMENT RECEIVED OVER THE COST OF PROVIDING CARE, THE TAX-EXEMPT HOSPITAL HAS PROVIDED A BENEFIT TO A CLASS OF PERSONS BROAD ENOUGH TO BE CONSIDERED A BENEFIT TO THE COMMUNITY. DESPITE A FINANCIAL SHORTFALL, A TAX-EXEMPT HOSPITAL MUST AND WILL CONTINUE TO ACCEPT AND CARE FOR MEDICARE PATIENTS. TYPICALLY, TAX-EXEMPT HOSPITALS PROVIDE HEALTH CARE SERVICES BASED UPON AN ASSESSMENT OF THE HEALTH CARE NEEDS OF THEIR COMMUNITY AS OPPOSED TO THEIR TAXABLE COUNTERPARTS WHERE PROFITABILITY OFTEN DRIVES DECISIONS ABOUT PATIENT CARE SERVICES THAT ARE OFFERED. PATIENT CARE PROVIDED BY TAX-EXEMPT HOSPITALS THAT RESULTS IN MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS PROVIDING A BENEFIT TO THE COMMUNITY AND RELIEVING THE BURDENS OF GOVERNMENT. PART III, LINE 9B: THE HOSPITAL FILING ORGANIZATION'S COLLECTION PRACTICES ARE IN CONFORMITY WITH THE REQUIREMENTS SET FORTH IN THE 2014 FINAL REGULATIONS REGARDING THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(R)(4) - (R)(6). NO EXTRAORDINARY COLLECTION ACTIONS (ECA'S) ARE INITIATED BY THE HOSPITAL FILING ORGANIZATION IN THE 120-DAY PERIOD FOLLOWING THE DATE AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL (OR, IF LATER, THE SPECIFIED DEADLINE GIVEN IN A WRITTEN NOTICE OF ACTIONS THAT MAY BE TAKEN, AS DESCRIBED BELOW). INDIVIDUALS ARE PROVIDED WITH AT LEAST ONE WRITTEN NOTICE (NOTICE OF ACTIONS THAT MAY BE TAKEN) AND A COPY OF THE FILING ORGANIZATION'S PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY THAT INFORMS THE INDIVIDUAL THAT THE HOSPITAL FILING ORGANIZATION MAY TAKE ACTIONS TO REPORT ADVERSE INFORMATION TO CREDIT REPORTING AGENCIES/BUREAUS IF THE INDIVIDUAL DOES NOT SUBMIT A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM) OR PAY THE AMOUNT DUE BY A SPECIFIED DEADLINE. THE SPECIFIED DEADLINE IS NOT EARLIER THAT 120 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL AND IS AT LEAST 30 DAYS AFTER THE NOTICE IS PROVIDED. A REASONABLE ATTEMPT IS ALSO MADE TO ORALLY NOTIFY AN INDIVIDUAL ABOUT THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FAA FORM DURING THE 240-DAY PERIOD FOLLOWING THE DATE ON WHICH THE FIRST POST-DISCHARGE BILLING STATEMENT WAS SENT TO THE INDIVIDUAL, THE HOSPITAL FILING ORGANIZATION SUSPENDS ANY REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS (OR CEASES ANY OTHER ECA'S) AND PROVIDES A WRITTEN NOTICE TO THE INDIVIDUAL DESCRIBING WHAT ADDITIONAL INFORMATION OR DOCUMENTATION IS NEEDED TO COMPLETE THE FAA FORM. THIS WRITTEN NOTICE CONTAINS CONTACT INFORMATION INCLUDING THE TELEPHONE NUMBER AND PHYSICAL LOCATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY, AS WELL AS CONTACT INFORMATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS OR, ALTERNATIVELY, A NONPROFIT ORGANIZATION OR GOVERNMENTAL AGENCY THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS IF THE HOSPITAL FACILITY IS UNABLE TO DO SO. IF AN INDIVIDUAL SUBMITS A COMPLETE FAA FORM WITHIN A REASONABLE TIME-PERIOD AS SET FORTH IN THE NOTICE DESCRIBED ABOVE, THE HOSPITAL FILING ORGANIZATION WILL SUSPEND ANY ADVERSE REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS UNTIL A FINANCIAL ASSISTANCE POLICY ELIGIBILITY DETERMINATION CAN BE MADE. SUPPLEMENTAL SCHEDULE TO SCHEDULE H, PART III, SECTION B RECONCILIATION OF SCHEDULE H REPORTED MEDICARE SURPLUS/(SHORTFALL) TO UNREIMBURSED MEDICARE COSTS ASSOCIATED WITH THE PROVISION OF SERVICESTO ALL MEDICARE BENEFICIARIES:THE MEDICARE REVENUE AND ALLOWABLE COSTS OF CARE REPORTED IN SECTION B OF PART III OF SCHEDULE H ARE BASED UPON THE AMOUNTS REPORTED IN THE FILING ORGANIZATION'S MEDICARE COST REPORT IN ACCORDANCE WITH THE IRS INSTRUCTIONS FOR SCHEDULE H. ON AN ANNUAL BASIS, THE FILING ORGANIZATION ALSO DETERMINES ITS TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS. UNREIMBURSED COSTS ARE CONSIDERED A COMMUNITY BENEFIT TO THE ELDERLY AND ARE COMBINED INTO AN ANNUAL COMMUNITY BENEFIT STATEMENT PREPARED BY ADVENTIST HEALTH SYSTEM. THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO MEDICARE PATIENTS AS REPORTED IN THE AHS COMMUNITY BENEFIT REPORT ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ (3,390,083)- DIFFERENCE IN COSTING METHODOLOGY: (625,012)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITY BENEFIT REPORTING: (6,858,789) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITY BENEFIT REPORTING: $(10,873,884)AS INDICATED ABOVE, THE PRIMARY DIFFERENCES BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) REPORTED ON SCHEDULE H, PART III, SECTION B, LINE 7 AND THE FILING ORGANIZATION'S PORTION OF THE COMPANY'S ANNUAL COMMUNITY BENEFIT STATEMENT IS DUE TO A DIFFERENCE IN THE COSTING METHODOLOGY AND DIFFERENCES IN THE POPULATION OF MEDICARE PATIENTS WITHIN THE CALCULATION. THE COST METHODOLOGY UTILIZED IN CALCULATING ANY MEDICARE SURPLUS/(SHORTFALL) FOR PURPOSES OF THE ANNUAL COMMUNITY BENEFIT REPORTING IS BASED UPON THE COST-TO-CHARGE RATIO OUTLINED IN WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE SAME COST-TO-CHARGE RATIO IS USED TO DETERMINE THE COSTS ASSOCIATED WITH SERVICES PROVIDED TO CHARITY CARE PATIENTS AND MEDICAID PATIENTS AS REPORTED IN SCHEDULE H, PART I, LINE 7. IN ADDITION, THE MEDICARE COST REPORT EXCLUDES SERVICES PROVIDED TO MEDICARE PATIENTS FOR PHYSICIAN SERVICES, SERVICES PROVIDED TO PATIENTS ENROLLED IN MEDICARE HMOS, AND CERTAIN SERVICES PROVIDED BY OUTPATIENT DEPARTMENTS OF THE FILING ORGANIZATION THAT ARE REIMBURSED ON A FEE SCHEDULE. THE COMPANY'S OWN COMMUNITY BENEFIT STATEMENT CAPTURES THE UNREIMBURSED COST OF PROVIDING SERVICES TO ALL MEDICARE BENEFICIARIES THROUGHOUT THE ORGANIZATION. PART VI, LINE 2: THE HOSPITAL CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) DURING 2013 AND 2016. IT'S 2016 CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2016, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S 2016 CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN FINAL REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY.SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY. PART VI, LINE 3: THE FINANCIAL ASSISTANCE POLICY (FAP), FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM), AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) OF THE FILING ORGANIZATION'S HOSPITAL FACILITY ARE TRANSPARENT AND AVAILABLE TO ALL INDIVIDUALS SERVED AT ANY POINT IN THE CARE CONTINUUM. THE FAP, FAA FORM, PLS, AND CONTACT INFORMATION FOR THE HOSPITAL FACILITY'S FINANCIAL COUNSELORS ARE PROMINENTLY AND CONSPICUOUSLY POSTED ON THE FILING ORGANIZATION'S HOSPITAL FACILITY'S WEBSITE. THE WEBSITE INDICATES THAT A COPY OF THE FAP, FAA FORM, AND PLS IS AVAILABLE AND HOW TO OBTAIN SUCH COPIES IN THE PRIMARY LANGUAGES OF ANY POPULATIONS WITH LIMITED PROFICIENCY IN ENGLISH THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY (REFERRED TO BELOW AS LEP DEFINED POPULATIONS). SIGNAGE IS DISPLAYED IN PUBLIC LOCATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, INCLUDING AT ALL POINTS OF ADMISSION AND REGISTRATION AND THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE HOSPITAL FACILITY'S WEBSITE ADDRESS WHERE THE FAP, FAA FORM, AND PLS CAN BE ACCESSED AND THE TELEPHONE NUMBER AND PHYSICAL LOCATION THAT INDIVIDUALS CAN CALL OR VISIT TO OBTAIN COPIES OF THE FAP, FAA FORM AND PLS OR TO OBTAIN MORE INFORMATION ABOUT THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS. PAPER COPIES OF THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. PAPER COPIES ARE MADE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGES OF ANY LEP DEFINED POPULATIONS. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A PAPER COPY OF THE HOSPITAL FACILITY'S PLS WILL BE OFFERED TO EVERY PATIENT AS A PART OF THE INTAKE OR DISCHARGE PROCESS. A CONSPICUOUS WRITTEN NOTICE IS INCLUDED ON ALL BILLING STATEMENTS SENT TO PATIENTS THAT NOTIFIES AND INFORMS RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, INCLUDING THE FOLLOWING: 1) THE TELEPHONE NUMBER OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND THE FAA FORM; AND 2) THE WEBSITE ADDRESS WHERE COPIES OF THE FAP, FAA FORM AND PLS MAY BE OBTAINED. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE. COPIES OF THE PLS ARE DISTRIBUTED TO MEMBERS OF THE COMMUNITY IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. PART VI, LINE 4: FLORIDA HOSPITAL ZEPHYRHILLS (FHZ) IS A 149-BED, FULL-SERVICE ACUTE-CARE FACILITY THAT HAS BEEN PROVIDING HEALTHCARE SERVICES TO RESIDENTS IN CENTRAL AND EASTERN PASCO COUNTY SINCE 1985. FHZ IS THE ONLY HOSPITAL IN ZEPHYRHILLS, THE SECOND LARGEST CITY IN PASCO COUNTY, AND IS LOCATED JUST 25 MILES NORTHEAST OF TAMPA. AS PART OF ITS PATIENT-FIRST FOCUS, FHZ CONTINUES TO EXPAND ITS SERVICES SO THAT PATIENTS AND THEIR FAMILIES CAN RECEIVE UNPARALLELED AND COMPASSIONATE TREATMENT IN THEIR OWN COMMUNITY. A COMPETITOR HOSPITAL IS LOCATED APPROXIMATELY EIGHT MILES AWAY FROM FLORIDA HOSPITAL ZEPHYRHILLS. ALTHOUGH THE COMPETITOR HOSPITAL PROVIDES MANY OF THE SAME SERVICES AS THE HOSPITAL, FLORIDA HOSPITAL ZEPHYRHILLS IS THE ONLY HOSPITAL WITHIN 25 MILES TO PROVIDE OPEN HEART SURGERY AS WELL AS A FULL ORTHOPAEDICS PROGRAM.IN 2009, THE NEW HEART INSTITUTE OPENED. IT IS THE ONLY NATIONALLY ACCREDITED CHEST PAIN CENTER IN EAST PASCO COUNTY. THE HEART INSTITUTE IS ALSO ONE OF THE NATIONALLY ACCREDITED HEART FAILURE HOSPITALS IN THE COUNTRY.FLORIDA HOSPITAL ZEPHYRHILLS HAS EXPANDED AND UPGRADED TO AN ALL-DIGITAL EMERGENCY DEPARTMENT AND THE ED PHYSICIANS ARE ALL BOARD CERTIFIED IN EMERGENCY MEDICINE. FROM AGGRESSIVE TREATMENT IN THE ED TO REHABILITATION AND WELLNESS, THE PRIMARY STROKE CENTER EXCEEDS THE AMERICAN STROKE ASSOCIATION GUIDELINES.PASCO COUNTY, FLORIDA HAS A POPULATION OF APPROXIMATELY 498,000, WITH AN ESTIMATED 22.7% AGE 65 OR OVER THE AGE OF 65. THE MEDIAN HOUSEHOLD INCOME, IN PASCO COUNTY IS APPROXIMATELY $44,518. HIGH SCHOOL GRADUATES ACCOUNT FOR APPROXIMATELY 87.25% OF PASCO COUNTY. IT IS ESTIMATED THAT 14.7% OF THE INDIVIDUALS RESIDING IN PASCO COUNTY LIVE BELOW THE FEDERAL POVERTY LEVEL AND THE UNEMPLOYMENT RATE IS ABOUT 6.5%. THE HOSPITAL IS IDEALLY LOCATED IN THE CENTER OF ZEPHYRHILLS AND IS A SHORT DISTANCE FROM DADE CITY AND WESLEY CHAPEL, ITS PRIMARY SERVICE AREAS. IT IS CLOSE TO I-75, US301, AND HWY 54.THE HOSPITAL'S PAYOR MIX IS APPROXIMATELY 63% MEDICARE, 13% MEDICAID, 6% SELF PAY AND THE REMAINING AMOUNT IS COMMERCIAL AND OTHER PAYOR CLASSES. APPROXIMATELY 80% OF THE HOSPITAL'S IN-PATIENTS ARE ADMITTED THROUGH ITS EMERGENCY DEPARTMENT. PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO FLORIDA HOSPITAL ZEPHYRHILLS'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT AND COMMUNITY BUILDING INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, THE HOSPITAL PROVIDED $227,168 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 $25,060,338 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. PART VI, LINE 6: FLORIDA HOSPITAL ZEPHYRHILLS IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 43 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 15 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 IT, CORPORATE COMPLIANCE, LEGAL, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. CERTAIN SUPPORT SERVICES, SUCH AS HUMAN RESOURCES, PAYROLL, A/P, AND SUPPLY CHAIN MANAGEMENT ARE PROVIDED PURSUANT TO A SHARED SERVICES MODEL BY AHSSHC TO ITS SUBSIDIARY ORGANIZATIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH 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 SUNSYSTEM DEVELOPMENT CORPORATION DBA FLORIDA HOSPITAL ZEPHYRHILLS FOUND 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 592219301 501(C)(3) 232992 COST GENERAL ADMINISTRATIVE SUPPORT PROVISION OF GENERAL ADMINISTRATIVE SUPPORT UNIVERSITY COMMUNITY HOSPITAL FOUNDATION INC DBA FL HOSP TAMPA FOUNDATION 3100 EAST FLETCHER TAMPA FL 33613 592554889 501(C)(3) 22000 GENERAL SUPPORT THE GREATER DADE CITY CHAMBER OF COMMERCE 14112 8TH STREET DADE CITY FL 33525 590549446 501(C)(6) 15000 GENERAL SUPPORT 2 1 PART I, LINE 2: GRANTS ARE GENERALLY MADE ONLY TO RELATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3), OR TO OTHER LOCAL CHARITABLE COMMUNITY ORGANIZATIONS, OR TO OTHER 501(C)(3) ORGANIZATIONS THAT ARE A PART OF THE GROUP EXEMPTION RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES. X X X X 1 1 0 1 0 0 0 0 0 0 0 BRUCE BERGHERM DIRECTOR/CHAIR (BEG 6/17) 0 420074 0 78333 0 52870 0 56257 0 56316 0 663850 0 15219 DENYSE BALES-CHUBB DIRECTOR 0 342737 0 72883 0 38638 0 57141 0 46562 0 557961 0 22311 AMANDA MAGGARD DIRECTOR/SEC/CEO (BEG 9/17) 0 190285 0 22439 0 62032 0 14192 0 54648 0 343596 0 0 MICHAEL SCHULTZ DIRECTOR/CHAIR (END 6/17) 0 817653 0 228757 0 640997 0 148250 0 83368 0 1919025 0 113615 RANDALL SURBER DIRECTOR/SEC/CEO(END7/17) 0 348490 0 69448 0 79408 0 58507 0 37226 0 593079 0 35360 RYAN WILLIS CFO & COO 0 200943 0 23728 0 6149 0 12044 0 26844 0 269708 0 0 DIMA DIDENKO REGION CFO 0 418353 0 62921 0 48271 0 66043 0 47862 0 643450 0 30192 HUGAR MCNAMEE MD CMO (END 4/17) 0 287676 0 109126 0 9734 0 14562 0 32536 0 453634 0 0 GWEN ALONSO CNO 0 196531 0 32409 0 7824 0 12318 0 27027 0 276109 0 0 ROBIN MCGUINNESS REGION CNO 0 248283 0 34126 0 13481 0 43116 0 19453 0 358459 0 0 AMIR QUEFATIEH MD PHYSICIAN 443507 0 807935 0 7458 0 14562 0 28314 0 1301776 0 0 0 BERTRAM A LEWIS JR MD PHYSICIAN 482022 0 0 0 20062 0 14562 0 28175 0 544821 0 0 0 RALPH HIGHSHAW MD PHYSICIAN 415006 0 0 0 7591 0 14562 0 27705 0 464864 0 0 0 MARIAN ANTONETTE SAMPSON MD PHYSICIAN 183021 0 185367 0 2274 0 14562 0 8265 0 393489 0 0 0 HARRY BLACKSTONE MD PHYSICIAN 178548 0 18240 0 27550 0 11246 0 14972 0 250556 0 0 0 WILLIAM HEINRICH FORMER CFO & COO 0 281516 0 42797 0 42106 0 14562 0 43896 0 424877 0 0 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. AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING AHSSHC EXECUTIVE TO HAVE HIS OR HER SPOUSE ACCOMPANY THE EXECUTIVE ON CERTAIN BUSINESS TRIPS EACH YEAR. TYPICALLY, REIMBURSEMENT IS ONLY PROVIDED TO CERTAIN EXECUTIVE LEADERS AND IS USUALLY LIMITED TO ONE BUSINESS TRIP PER YEAR BEYOND THE ANNUAL 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. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES ASSISTANCE TO EXECUTIVES WHO HAVE BEEN RELOCATED BY THE COMPANY DURING THE YEAR. RELOCATION ASSISTANCE PROVIDED TO EXECUTIVES MAY INCLUDE RELOCATION ALLOWANCES TO ASSIST WITH DUPLICATE HOUSING EXPENSES. RELOCATION ASSISTANCE IS ADMINISTERED PER AHSSHC POLICY BY AN EXTERNAL RELOCATION COMPANY. ANY TAXABLE REIMBURSEMENTS MADE TO EXECUTIVES IN CONNECTION WITH RELOCATION ASSISTANCE ARE TREATED AS WAGES TO THE EXECUTIVE AND ARE SUBJECT TO ALL PAYROLL WITHHOLDING AND REPORTING REQUIREMENTS. 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 A SPLIT DOLLAR LIFE INSURANCE POLICY AND LONG-TERM CARE INSURANCE, TO INDIVIDUALLY TAILOR A BENEFITS PROGRAM APPROPRIATE TO EACH EXECUTIVE'S NEEDS. THE PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH IS DEDUCTED THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS. THE PRE-DETERMINED BENEFITS ALLOWANCE CREDIT PERCENTAGE IS APPROVED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF AHSSHC. ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED FROM THE ANNUAL PRE-DETERMINED BENEFITS ALLOWANCE ARE CONTRIBUTED, AT THE EMPLOYEE'S OPTION, TO EITHER AN IRC 457(F) DEFERRED COMPENSATION ACCOUNT OR TO AN IRC 457(B) ELIGIBLE DEFERRED COMPENSATION PLAN. UPON ATTAINMENT OF AGE 65, ALL PREVIOUS 457(F) DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT AND ANY FUTURE EMPLOYER CONTRIBUTIONS ARE MADE QUARTERLY FROM THE PLAN DIRECTLY TO THE PARTICIPANT. THE PLAN DOCUMENTS DEFINE AN EMPLOYEE WHO IS ELIGIBLE TO PARTICIPATE IN THE PLAN TO GENERALLY INCLUDE THE CHIEF EXECUTIVE OFFICERS OF AHS ENTITIES AND VICE PRESIDENTS OF ALL AHS ENTITIES WHOSE BASE SALARY IS AT LEAST $243,000. 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. ADDITIONALLY, IN 2017 AHS ADOPTED A SENIOR EXECUTIVE DEATH BENEFIT (SEDB) PLAN IN RECOGNITION OF THE CONSIDERABLE AGE AND SERVICE REQUIREMENTS IN THE SERP. THE SEDB PLAN PROVIDES A BENEFIT IN AN AMOUNT EQUAL TO THE AMOUNT THE EXECUTIVE'S BENEFIT WOULD HAVE BEEN UNDER THE SERP PLAN ASSUMING THAT, ON THE DATE OF THE EXECUTIVE'S DEATH (AND NOT BEFORE), THE EXECUTIVE SATISFIED THE LAST OF THE ELIGIBILITY REQUIREMENTS OF THE SERP PLAN WITH PRESENT VALUE RECOGNIZING AN EARLY BENEFIT COMMENCEMENT. AN ELIGIBLE EXECUTIVE BECOMES A PARTICIPANT IN THE SEDB PLAN IF THE EXECUTIVE DIES PRIOR TO TERMINATION OF EMPLOYMENT, PROVIDED THE EXECUTIVE HAS NOT SATISFIED ALL OF THE ELIGIBILITY REQUIREMENTS OF SERP AS OF THE EXECUTIVE'S DATE OF DEATH BUT WOULD HAVE SATISFIED ALL OF THOSE REQUIREMENTS WITHIN FIVE (5) YEARS FOLLOWING DEATH HAD THE EXECUTIVE LIVED AND CONTINUED EMPLOYMENT. THE SEDB PLAN WAS REVIEWED AND APPROVED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. FLEX PLAN FLEX PLAN/ SERP 457(B) CY CY EMPLOYER CY CONTRIB./ DISTRIBUTIONS* CONTRIB. DISTRIBUTIONS* PAYMENT ------------------------------------------------------- BRUCE BERGHERM $ 51,695 $ 15,951 $ 0 $ 0 DENYSE BALES-CHUBB $ 42,579 $ 24,551 $ 0 $ 0 WILLIAM HEINRICH $ 17,223 $ 0 $ 0 $ 0 MICHAEL SCHULTZ $151,688 $120,092 $369,309 $ 0 RANDY SURBER $ 43,945 $ 37,614 $ 0 $ 0 DIMA DIDENKO $ 51,481 $ 32,984 $ 0 $ 0 AMANDA MAGGARD $ 6,446 $ 0 $ 0 $ 0 ROBIN MCGUINNESS $ 28,554 $ 0 $ 0 $ 0 *INCLUDING INVESTMENT EARNINGS PART V, LINE 1A: THE PARENT CORPORATION AND SOLE TOP-TIER MEMBER OF FLORIDA HOSPITAL ZEPHYRHILLS, INC. (THE FILING ORGANIZATION) IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS A FLORIDA, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). AHSSHC HAS ESTABLISHED A SHARED SERVICE CENTER TO CENTRALIZE THE ACCOUNTS PAYABLE (A/P) FUNCTION FOR ALL AHSSHC SUBSIDIARY ORGANIZATIONS. THE FILING ORGANIZATION HAS ENTERED "0" IN PART V, LINE 1A BECAUSE THE FILING ORGANIZATION NO LONGER ISSUES FORM 1099 RETURNS, RATHER, ALL SUCH RETURNS ARE FILED BY AND UNDER THE NAME AND EIN OF AHSSHC AS THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. THE FACTS AND CIRCUMSTANCES SUPPORT A POSITION THAT AHSSHC, AS A PAYOR ON BEHALF OF ITS SUBSIDIARY ORGANIZATIONS IN A SHARED SERVICE ENVIRONMENT, WILL HAVE SUFFICIENT MANAGEMENT AND OVERSIGHT IN CONNECTION WITH THE SUBSIDIARY ORGANIZATIONS' PAYMENTS TO MEET THE STANDARD SET FORTH IN TREAS. REG. SECTION 1.6041-1(E). AHSSHC WILL NOT MERELY BE MAKING PAYMENTS AT THE DIRECTION OF ITS SUBSIDIARY ORGANIZATIONS. ACCORDINGLY, AHSSHC IS CONSIDERED THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. FORM 990, PART VI, SECTION A, LINE 2 LEROY HAUFF AND SCOTT CAMERON - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 FLORIDA HOSPITAL ZEPHYRHILLS, INC. (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS ADVENTIST HEALTH SYSTEM SUNBELT, INC. ADVENTIST HEALTH SYSTEM SUNBELT, INC. (AHSS) IS A FLORIDA, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE FILING ORGANIZATION IS AHSS. THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION ARE APPOINTED BY THE SOLE MEMBER, AHSS, WHO HAS THE RIGHT TO ELECT, APPOINT OR REMOVE ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B AHSS, AS THE SOLE MEMBER OF THE FILING ORGANIZATION, HAS CERTAIN RESERVED POWERS AS SET FORTH IN THE BYLAWS OF THE FILING ORGANIZATION. THE RESERVED POWERS INCLUDE THE FOLLOWING: A) TO APPROVE OR DISAPPROVE THE EXECUTIVE AND/OR ADMINISTRATIVE LEADERSHIP OF THE FILING ORGANIZATION; B) TO APPROVE OR DISAPPROVE THE OPERATING BYLAWS OF THE FILING ORGANIZATION; C) TO RESERVE THE RIGHT TO APPROVE OR DISAPPROVE THE MEDICAL STAFF BYLAWS, RULES AND REGULATIONS; D) TO APPROVE OR DISAPPROVE MAJOR BUILDING PROGRAMS AND THE PURCHASE OR SALE OF PERSONAL PROPERTY OR REAL PROPERTY EQUAL TO OR IN EXCESS OF $1,000,000; E) TO ESTABLISH GENERAL GUIDING POLICIES; F) TO SET LIMITS AND TERMS FOR BORROWING OF FUNDS; G) TO APPROVE OR DISAPPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS; H) TO DIRECT THE PLACEMENT OF FUNDS AND CAPITAL AND THE MAKING OF GIFTS, DONATIONS, LOANS AND TRANSFERS OF FUNDS OR OTHER ASSETS; I) TO APPROVE OR DISAPPROVE SALARY RATES FOR THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION AND THE RIGHT TO APPROVE OR DISAPPROVE SALARY RATES FOR ADMINISTRATIVE AND DEPARTMENT HEAD PERSONNEL; J) TO IMPLEMENT QUALITY ASSESSMENT, IMPROVEMENT AND UTILIZATION REVIEW PROGRAMS; K) TO APPROVE THE APPOINTMENT OF AN AUDITING FIRM FOR THE HOSPITAL; AND L) TO APPROVE THE ELECTION OF THE FISCAL YEAR FOR THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND BY THE CFO PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND THE CFO DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR ANY PRINCIPAL OFFICER OF THE FILING ORGANIZATION (I.E. INTERESTED PERSONS) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF 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 7A, B AND C: THE AMOUNT SHOWN IN PART VIII, LINE 7C OF THE FORM 990 REPRESENTS AN ALLOCATED SHARE OF CAPITAL GAIN/(LOSS) FROM A SYSTEM WIDE, CORPORATE ADMINISTERED, INVESTMENT PROGRAM. FORM 990, PART IX, LINE 11G PAYMENTS TO HEALTHCARE PROFESSIONALS: PROGRAM SERVICE EXPENSES 8,177,084. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,177,084. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,900,070. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,900,070. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 987,345. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 987,345. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 956,075. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 956,075. TRANSCRIPTION SERVICES: PROGRAM SERVICE EXPENSES 122,808. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 122,808. RECRUITING: PROGRAM SERVICE EXPENSES 29,241. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,241. FOOD SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 3,193. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,193. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,457,740. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,457,740. AHS MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,540,955. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,540,955. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,279,068. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,279,068. EHR MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 6,664. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,664. AHS SHARED SERVICE FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,224,764. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,224,764. 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. FORM 990, PART XI, LINE 9: INVESTMENT AMORTIZATION 115,404. TRANSFER TO RELATED TAX-EXEMPT TOP-TIER PARENT -3,580,126. ALLOCATION FROM TAX-EXEMPT PARENT WITH RESPECT TO DEBT -17,241. TRANSFER TO RELATED TAX-EXEMPT ORGANIZATION -208,122. SCHEDULE K-1 UBI AMOUNTS NOT RECORDED ON BOOK -3,517. ROUNDING 1. ADVENTIST BOLINGBROOK HOSPITAL 500 REMINGTON BLVD BOLINGBROOK IL 60440 651219504 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST MIDWEST HEALTH 1 ADVENTIST CARE CENTERS - COURTLAND INC 730 COURTLAND STREET ORLANDO FL 32804 205774723 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC 1 ADVENTIST GLENOAKS HOSPITAL 701 WINTHROP AVENUE GLENDALE HEIGHTS IL 60139 363208390 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST MIDWEST HEALTH 1 ADVENTIST HLTH MID-AMERICA INC 9100 W 74TH STREET SHAWNEE MISSION KS 66204 521347407 SUPPORT OF AFFILIATED HOSPITAL KS 501(C)(3) LINE 12C, III-FI ADVENTIST HLTH SYSTEMSUNBELT INC 1 ADVENTIST HLTH PARTNERS INC 2601 NAVISTAR DR BLDG 4 FINANCE LISLE IL 60532 364138353 OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES IL 501(C)(3) LINE 3 AHS MIDWEST MANAGEMENT INC 1 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 592170012 MANAGEMENT SERVICES FL 501(C)(3) LINE 12A, I N/A 0 ADVENTIST HLTH SYSTEM GEORGIA INC 1035 RED BUD ROAD CALHOUN GA 30701 581425000 OPERATION OF HOSPITAL & RELATED SERVICES GA 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 ADVENTIST HLTH SYSTEMSUNBELT INC 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 591479658 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 ADVENTIST HLTH SYSTEMTEXAS INC 11801 S FREEWAY BURLESON TX 76028 742578952 LEASING PERSONNEL TO AFFILIATED HOSPITAL TX 501(C)(3) LINE 12C, III-FI ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 ADVENTIST MIDWEST HEALTH 120 NORTH OAK STREET HINSDALE IL 60521 362276984 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 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 2601 NAVISTAR DR BLDG 4 FINANCE LISLE IL 60532 811105774 OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES IL 501(C)(3) LINE 3 AHS MIDWEST MANAGEMENT INC 1 AHS MIDWEST MANAGEMENT INC 2601 NAVISTAR DR BLDG 4 FINANCE LISLE IL 60532 363354567 OPERATION OF PHYSICIAN PRACTICE MGMT IL 501(C)(3) LINE 12A, I ADVENTIST MIDWEST HEALTH 1 AHSCENTRAL TEXAS INC 1301 WONDER WORLD DRIVE SAN MARCOS TX 78666 742621825 PROVIDE OFFICE SPACE - MEDICAL PROFESSIONALS TX 501(C)(3) LINE 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 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 381359189 INACTIVE MI 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 BOLINGBROOK HOSPITAL FOUNDATION 500 REMINGTON BLVD 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 CENTURA HEALTH CORPORATION 9100 E MINERAL CIRCLE CENTENNIAL CO 80112 841335382 JOINT OPERATING COMPANY CO 501(C)(3) LINE 12A, I N/A 0 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 DADE CITY INC (816-123117) 13100 FORT KING ROAD DADE CITY FL 33525 822567308 INACTIVE FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 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 LANE 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 OCALA INC (1214-123117) 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 824372339 INACTIVE FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 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 N/A 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 N/A 0 HINSDALE HOSPITAL FOUNDATION 120 NORTH OAK STREET 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 INACTIVE 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 305 MEMORIAL MEDICAL PKWY 212 DAYTONA BEACH FL 32117 311771522 FUND-RAISING FOR TAX-EXEMPT HOSPITAL FL 501(C)(3) LINE 7 N/A 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 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