2018-01-30T13:48:15-06:00 2016-12-31 990 2016-01-01 591113901 University Community Hospital Inc UNIV 8139716000 3100 East Fletcher Avenue Tampa FL 33613 Lynn Addiscott Assistant Secretary 8139716000 2018-01-29 204.139.85.142 2018-01-29 15:29:15 ES P C18440E83583A01A3D3F74DEBC89B245B68C7147 F7F973113C6C6A5F5987F0EC85E73F6D0608CD2F 2016 2021-01-29 14:40:06Z Florida Hospital Tampa Brian Adams 3100 East Fletcher Avenue Tampa FL 33613 672263922 0 X www.floridahospital.com/tampa X 1966 FL The provision of medical care to the community through the operation of two hospitals and a long-term acute care facility. 21 17 5156 586 0 0 309912 604249 643743355 668777120 -2096191 866955 1605240 538905 643562316 670787229 2610874 621500 0 0 241351692 259433914 0 0 0 336409904 353880977 580372470 613936391 63189846 56850838 890936683 992668182 288253065 338851917 602683618 653816265 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 571332263 621500 669182835 Operation of Florida Hospital Tampa, a 418-bed general acute care hospital, Florida Hospital Pepin Heart Institute, a 75-bed facility, Florida Hospital Carrollwood, a 120-bed general acute care hospital, and a 50-bed Long-Term Acute Care Hospital. Combined these facilities generated 28,984 patient admissions, 161,575 patient days, and 182,030 outpatient visits during the current tax year. 571332263 1 1 0 1 0 0 0 0 0 1 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 1 0 0 0 0 0 1 1 1 1 0 0 1 X 0 0 1 5156 1 0 0 0 0 0 0 0 0 0 0 X 21 17 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X Tim Widdison 8139716000 3100 East Fletcher Avenue Tampa FL 33613 X Anderson Robert Chairman 2.00 0.00 X 0 0 0 Adams Brian S Director/CEO 50.00 0.00 X X 0 592235 114278 Berard Art Director (End 5/16) 0.00 0.00 X 0 0 0 Bronleewe MD Scott Director (End 9/16) 1.00 50.00 X 0 463765 30252 Butcher Jack Director 1.00 0.00 X 0 0 0 Cannella MD Xavier Director 1.00 0.00 X 0 0 0 Courson Jon Director 1.00 0.00 X 0 0 0 Ennis Jr Henry Director 1.00 0.00 X 0 0 0 Jimenez David Director 1.00 0.00 X 0 0 0 Joyner Arthenia Director 1.00 0.00 X 0 0 0 Lightfoot Ken Director 1.00 0.00 X 0 0 0 Mahon Mary Director 1.00 0.00 X 0 0 0 Meyer Fred Director 1.00 0.00 X 0 0 0 Muniz Tony Director (Beg 1/16) 1.00 0.00 X 0 0 0 Newman Eric Director 1.00 0.00 X 0 0 0 O'Malley MD Brendan Director 1.00 2.60 X 9504 0 0 Parker IV Thaddeus Director 1.00 0.00 X 0 0 0 Patel MD Sharad Director 1.80 36.00 X 20603 232603 17432 Pepin Tom Director (End 8/16) 1.00 0.00 X 0 0 0 Robbins Charlie Director 1.00 0.00 X 0 0 0 Scaglione Basil Director 1.00 0.00 X 0 0 0 Schultz Michael H Vice Chairman 22.00 28.00 X 0 1405614 187037 Stonesifer MD Kurt Director 1.00 0.00 X 0 0 0 Vivero Jose Director 1.00 0.00 X 0 0 0 Didenko Vadym V CFO - Medical Center (End 7/16) 48.00 2.00 X 0 442802 92099 Heinrich William CFO - Medical Center (Beg 7/16) 50.00 0.00 X 0 293595 65033 Jiang-Saldana Hui COO - Medical Center (End 12/16) 50.00 0.00 X 0 348705 79225 Torres Michael A MD CMO - Medical Center 50.00 0.00 X 0 339391 56746 Bjornstad MD Brad CMO - Medical Center/Carrollwood 50.00 0.00 X 0 436676 64542 Solomita Joy B CNO - Medical Center 50.00 0.00 X 0 295954 62892 Shaw Brigitte W CBDO - Medical Center 50.00 0.00 X 0 326596 71430 Johnson Joel D CEO - Carrollwood 50.00 0.00 X 0 455503 81801 Cox Shane H CFO - Carrollwood (End 7/16) 50.00 0.00 X 0 317204 110149 Mcguinness Robin J CNO - Carrollwood 50.00 0.00 X 0 241934 25736 Lambert MD Charles Physician 40.00 0.00 X 403132 0 19829 Widdison Timothy AVP/Controller 40.00 0.00 X 191645 0 12308 Nelson Sanidad Mary J AVP Human Resources 40.00 0.00 X 187527 0 12203 Moorman Kathleen A Pharmacist 40.00 0.00 X 185311 0 9669 Antonelli Steve Pharmacist 40.00 0.00 X 175775 0 11206 Hagensicker Janice K Former Regional CFO 0.00 50.00 X 0 748110 90014 1173497 6940687 1213881 189 1 1 0 Crothall Healthcare Inc 13028 Collections Center Dr Chicago IL 60693 Housekeeping 6965351 Morrison Healthcare PO Box 102289 Atlanta GA 30368 Food Service 4248778 Aramark Healthcare Technologies 12483 Collections Center Dr Chicago IL 60693 Service Contract - Med Equip 3198516 Cross Country Staffing Inc PO Box 404674 Atlanta GA 30384 Staffing 3185011 Sound Physicians of Florida II 1498 Pacific Ave Suite 400 Tacoma WA 98402 Medical Fees 2429049 136 X 604249 604249 Net patient revenue 622110 659320802 659320802 Cafeteria revenue 622110 2818449 2818449 Lab revenue 622110 1720323 1720323 Medical office building 622110 1198013 1198013 Management fee revenue 622110 1071510 1071510 2648023 2648023 668777120 2295640 2295640 133190 0 133190 133190 133190 48008 1476693 0 -1476693 48008 -1428685 -1428685 EHR Revenue 405715 405715 405715 670787229 669182835 0 1000145 X 621500 621500 5624003 30107 5593896 187717028 186518518 1198510 5808705 5630895 177810 44890489 44391262 499227 15393689 14922473 471216 921140 921140 186899 186899 590623 590623 95179168 76745285 18433883 5683146 5683146 16131337 12596200 3535137 22119530 19017717 3101813 9034299 9034299 716377 716377 944634 944634 6286934 6286934 41986762 41986762 3986612 3728816 257796 Medical Supplies 132390901 132390901 Repairs & maintenance 11143243 11143243 State Tax Indigent Asse 6287351 6287351 292021 292021 613936391 571332263 42604128 0 6800 11323 187386426 229141685 95307940 89225418 242969 119076 18868966 18713476 13263412 20783675 818292121 231642207 531349768 586649914 13478496 12638496 31031906 35385119 890936683 992668182 42420077 43291667 2257 1472086 245830731 294088164 288253065 338851917 X 575660166 624359784 25934289 28456481 1089163 1000000 602683618 653816265 890936683 992668182 X 56850838 2458178 -8176369 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 105868 105868 0 Part II-B, Line 1: Dues were paid to the American Hospital Association and Florida Hospital Association. 3 Outside Consultants were used during 2016 for lobbying on behalf of the filing organization with respect to legislative matters impacting the delivery of health as follows: 1. Mike Fasano - $12,000 2. Mark Sharpe - $36,000 2. RSA Consultants - $36,000 24210901 1750326 1960207 3581619 141971 24197844 19917358 408643 1086497 20907 21391591 15959081 3717574 1053087 812384 19917358 15352543 1135681 831175 1360318 15959081 16260168 982420 679929 2515974 15352543 0.60990 0.04130 0.34880 0 1 1 28620410 28620410 498337766 106512011 391825755 182916664 120177505 62739159 108417281 4952691 103464590 586649914 Due to related 15310119 Payable to third parties 3275592 Credit balances in A/R 2686996 Interco. Alloc. of TE Bond Proceeds 246318615 Due to affiliated 41965 Other liabilities 26454877 294088164 X Part V, Line 4: University Community Hospital Foundation, Inc. (UCHF), a related organization formed and maintained exclusively to further the exempt purpose of University Community Hospital, Inc. (the Hospital), held assets in temporary endowment and permanent endowment funds during the current tax year. UCHF's endowment consists of individual donor restricted endowment funds and pledges receivable where the assets have been designated for endowment. Temporarily and Permanently restricted endowment funds are intended to benefit various programs and departments of the Hospital and its patients. Endowment funds have also been designated by the Board of UCHF to support various Hospital initiatives. 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. Part V, Line 1a - column (a) Current year: Explanation for change in opening balance: During the current year, it came to the attention of the UCHF's management that certain temporarily restricted funds in the amount of $2,819,310 were incorrectly classified as unrestricted. As a result, UCHF restated the beginning endowment fund balance in its 2016 tax year. 1 1 X 1 X 0 1 1 0 1 0 28889042 28889042 0.04710 92034217 33300486 58733731 0.09570 120923259 33300486 87622773 0.14280 92974 92974 0.00020 5874219 5874219 0.00960 5967193 5967193 0.00980 126890452 33300486 93589966 0.15260 1989 1989 0.00000 2041 2041 0.00000 8360 8360 0.00000 12390 12390 0.00000 1 33381587 3804836 122640510 142257434 -19616924 X 1 1 3 1 Florida Hospital Tampa 3100 E Fletcher Avenue Tampa FL 33613 www.floridahospital.com/tampa 4035 X X X X 2 Florida Hospital Carrollwood 7171 N Dale Mabry Hwy Tampa FL 33614 www.floridahospital.com/carrollwood 4179 X X X 3 FL Hosp at Connerton LTAC Hospital 9441 Health Center Drive Land OLakes FL 34637 www.floridahospital.com/connerton 4499 X X Florida Hospital Tampa 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X See Part V, Section C X X 1 14 1 See Part V, Section C 0 1 X 200.000000000000 X X X X 1 1 X X X X 1 X https://floridahospital.com/patient-resources/billing/financial-assistance X https://floridahospital.com/patient-resources/billing/financial-assistance X https://floridahospital.com/patient-resources/billing/financial-assistance X X X X X X 1 X 0 X X X X 1 X 0 0 Florida Hospital Carrollwood 2 0 0 1 X X X X X X X X X 16 1 0 0 1 X See Part V, Section C X X 1 14 1 See Part V, Section C 0 1 X 200.000000000000 X X X X 1 1 X X X X 1 X https://floridahospital.com/patient-resources/billing/financial-assistance X https://floridahospital.com/patient-resources/billing/financial-assistance X https://floridahospital.com/patient-resources/billing/financial-assistance X X X X X X 1 X 0 X X X X 1 X 0 0 FL Hosp at Connerton LTAC Hospital 3 0 0 1 X X X X X X X X X 16 1 0 0 1 X See Part V, Section C X X 1 14 1 See Part V, Section C 0 1 X 200.000000000000 X X X X 1 1 X X X X 1 X https://floridahospital.com/patient-resources/billing/financial-assistance X https://floridahospital.com/patient-resources/billing/financial-assistance X https://floridahospital.com/patient-resources/billing/financial-assistance X X X X X X 1 X 0 X X X X 1 X 0 0 Florida Hospital Tampa Part V, Section B, Line 5: University Community Hospital, Inc. d/b/a Florida Hospital Tampa, (FHT or the Hospital) is a 493-bed hospital facility located in Hillsborough County in Florida. The Hospital's primary service area is nestled in Hillsborough County, adjacent to the University of South Florida, and is primarily comprised of seven zip codes surrounding the Hospital. Several of the primary service area zip codes include communities that are fundamentally underserved. The Hospital's primary service area includes diverse micro-communities which vary in income, education level, and living conditions and are ethnically and culturally diverse. 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, 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 Hillsborough Public Schools, the Brain Expansion Scholastic Training Program, a not-for-profit dedicated to creating a long-lasting positive impact in the lives of under-represented and disadvantaged youth, the Hillsborough County Department of Health, and the University Area Community Development Center, an organization that provides economic, education, and public services in the University of South Florida area community where 95% of the population is below the poverty level. FHT 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 Carrollwood Part V, Section B, Line 5: University Community Hospital, Inc., d/b/a Florida Hospital Carrollwood (FHCW or the Hospital), is a 120-bed community hospital specializing in Spine, Orthopedic, and Bariatric Surgery, as well as Emergency, Cardiology, and Wound Healing services. The Hospital's primary service area is comprised of 25 zip codes located within the Florida counties of Hillsborough and Pasco. The total population in the Hospital's primary service area is approximately 725,000. Approximately 20% of the individuals living in the Hospital's primary service area live in households with incomes below the Federal poverty level. 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, 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 Tampa Housing Authority, the Hillsborough County Indigent Health Plan, the Health Council of West Central Florida, Tampa Family Health Centers, Inc., a federally qualified health center, the Tampa Bay Network to End Hunger, Bethesda Ministries CDC, Inc., a not-for-profit community development organization focusing on disadvantaged residents of the community, and the Hillsborough County Department of Health. FHCW 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. FL Hosp. at Connerton LTAC Hospital Part V, Section B, Line 5: Florida Hospital Connerton is a 50-bed long-term acute care hospital to which patients are referred from 25 other hospital facilities in the state of Florida. Florida Hospital at Connerton serves patients with medically complex conditions that require additional weeks of specialized hospital care (following a hospitalization), have a history of failed treatment in a lower level of care, or have a high rate of recidivism. 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, 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. CHNAC members included patients/families, community members, community caregivers, first responders, public health, experts on aging populations, and health care providers. Key members of the CHNAC included representatives from the Pasco County Health Department, Pasco County Fire & Rescue and the St. Leo College School of Healthcare Management. FH Connerton also gathered primary data through the utilization of stakeholder surveys/interviews. A stakeholder survey was distributed to and completed by both members of the CHNAC and members of the community at large. Interviewees were chosen based upon a number of different factors, including their knowledge of the health needs of low-income, minority and other underserved populations. Various sources of secondary data were also gathered as a part of the data collection process. Florida Hospital Tampa 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 Carrollwood 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. FL Hosp. at Connerton LTAC Hospital 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 Tampa 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 Tampa (FHT or "the Hospital") is part of the West Florida Division of Florida Hospital. The Division includes nine hospital facilities. This is the third-year update for Florida Hospital Tampa's 2013-2016 Community Health Plan/Implementation Strategy. Florida Hospital Tampa (FHT or "the Hospital") developed this Plan and posted it no later than May, 2014 as part of its 2013 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, Florida Hospital Tampa worked 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. Priority: Access to Affordable Health Care2013 Description of the Issue: Four zip codes (33604, 33610, 33612 and 22613) in Florida Hospital Tampa's primary service have uninsured rates ranging from 37-44% compared to an overall county rate of about 24%. Median Household Incomes in these zip codes ranged from $29,100 to $35,500 compared to the county average of $48,600. As a result, access to timely and affordable health care is an issue for the residents of these communities. 2016 Update: Florida Hospital Tampa's efforts around health care access focused on expanding the safety net for uninsured residents of the four zip codes noted above, with a special focus on the University Area Community Development neighborhoods. In 2015, Florida Hospital Tampa renovated approximately 8,000 square feet of hospital space for use by the Tampa Community Health Center, a federally qualified health center (FQHC). In 2016, the FQHC with Tampa Family Health was opened at Florida Hospital Tampa. FQHCs see uninsured patients on a sliding fee scale basis and accept Medicaid, Medicare and private insurance and offer a permanent medical home for patients. FQHC enrollment is expected to minimize uninsured and Medicaid ER visits and make appropriate health care services more readily available to those patients with non-urgent conditions. To date, FHT has referred approximately 3,350 patients from the ED to the FQHC for care. The FQHC accepts all individuals in need of medical care. Florida Hospital Tampa continued its work with the University of South Florida Medical School's free Bridge Clinic (the Clinic); one of the locations is onsite at the Florida Hospital (Tampa) Pepin Heart Institute. The Clinic is open two additional days per month based on volume and need. FHT donated $52,432 (the goal was $42,000) in imaging services to the Judeo Christian Center free clinic. FHT also donated 30 free mammograms to uninsured women (at a charitable cost of $53,439).Transportation is an issue for many patients, FHT continued its partnership with the Hillsborough Area Regional Transit Authority (HART). Additionally, FHT vans continued to transport patients to and from FHT, particularly wound care patients. Florida Hospital Tampa established a Congregational Health Network to improve access to care for congregants. In 2016, 500 members participated in various health events. Florida Hospital Tampa continued its partnership with Gracepoint (mental and behavioral health) and in 2016 referred 1,056 total patients from the ER to Gracepoint for appropriate care (the goal in 2016 was to grow the number of referrals 15% from 2015 and we grew by 25%).Priority: Lack of Health Education & Awareness of Services 2013 Description of the Issue: Florida Hospital Tampa's 2013 Community Health Needs Assessment showed that community residents, particularly those with lower income, were unaware of the available health education and services available to them.2016 Update: Interventions included the training and deployment of Community Health Workers in the very low-income University Area Community Development Center neighborhoods (in which FHT is located). FHT also offered educational workshops and programming in cooperation with the Alliance to Benefit the Whole Child at partner school locations including Robles Elementary. As noted above, health education programming was integrated into FHT's Congregational Health Network. This community education focused on both physical and mental health resources. FHT support groups included, Lymphedema, breast cancer survivor groups and breast cancer exercise/yoga classes. Every group is free of charge or at very low cost. As noted earlier in this document, FHT provided space for a Federally Qualified Health Center. FHT helped the FQHC generate awareness of its presence in the community.Priorities: Diabetes & Obesity2013 Description of the Issue: When compared with the state of Florida, a lower percentage of the population in Hillsborough County has diabetes 8.2 % and 6.3%, respectively. The number of diabetes-related hospitalizations in the county is comparable to the statewide level; however, both rates are on the rise. African American females had the highest rates of diabetes. Obesity is a major cause of diabetes. 2016 Update: FHT held community diabetes screenings in targeted low-income zip codes and implemented educational programming. In 2016 there were 169 total education classes offered with a total of 527 enrollees of which 100 enrollees (or 18.9%) consisted of adults from targeted zip codes of 33604, 33610, 33612, 33613, and 33617. Florida Hospital Tampa provided scholarships and discounted rates to individuals who participated in the Florida Hospital Community Health Improvement Plan (CHIP) and in the fall of 2016, to participants in a one 18-week class with 10 employees from Hillsborough County Public Schools and 19 Florida Hospital Tampa employees (total of 29).Priorities 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: Maternal and Child Health: Florida Hospital Tampa currently provides OB and maternal-infant services as well as many new-mother and parent support programs. FHT is working with the FQHCs to increase the number of low-income women who receive early prenatal care, and is working with the ABC and Healthy Start programs to increase the number of women who attend prepared childbirth classes. In addition, the Needs Assessment Committee determined that multiple community partners are already working on this issue, including the Health Department, the federal Healthy Start Coalition and Maternal & Child Health Program at the University of South Florida, and the Tampa Bay Doula program.Teen Pregnancy: Teen pregnancy prevention is not a core competency of Florida Hospital Tampa or other area hospitals. FHT does provide and support the services noted above.Respiratory Diseases/Asthma: The Needs Assessment Committee determined that, while these are important health issues, FHT does not have the outreach capacity to build a new program around respiratory diseases.Heart Disease: The Pepin Heart Institute at Florida Hospital Tampa already provides heart disease treatment as well as screenings and support groups such as Mended Hearts. Florida Hospital Carrollwood Part V, Section B, Line 11: The information provided below explains how the hospital facility addressed in 2016 the significant health needs identified in its 2013 Community Health Needs Assessment, and any such needs that were not addressed and the reasons why such needs were not addressed. The hospital facility conducted a Community Health Needs Assessment in 2016 and adopted an implementation strategy to address the significant health needs identified in the 2016 Community Health Needs Assessment in 2017 prior to May 15, 2017. This is the third-year update for Florida Hospital Carrollwood's 2013-2016 Community Health Plan/Implementation Strategy. Florida Hospital Carrollwood (FHCW or "the Hospital") developed and posted this Plan in May 2014 as part of its 2013 Community Health Needs Assessment process.This assessment was based on primary data interviews and surveys; secondary data from local, regional and national health-related sources; and prevalence data that guided the Hospital in determining the health needs of the communities it serves. Florida Hospital Carrollwood made a notable effort to define the needs of low-income, minority and underserved populations in its service area. The issues identified in the Assessment were prioritized by community and hospital stakeholders, who also selected key issues for the Hospital to address in this Plan.Florida Hospital Carrollwood (FHCW) is part of the West Florida Region of Florida Hospital, which includes nine hospital facilities. This is the final year of Florida Hospital Carrollwood's 2013 Community Health Plan/Implementation Strategy. The notes below describe the issues identified in 2013 and an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing. Priority Issue: Lack of Primary Care/Access to Primary Care2013 Description of the Issue: Mirroring the decrease in primary care physicians across the country, this issue is compounded by a lack of their participation in caring for the un- and underinsured in this community. This issue also includes lack of transportation needed for access. FHCW, its community partners and the Congregational Health Network collaborated to create a new paradigm for primary care delivery. Interventions include:- Provide in-hospital services to at least 80 patients from the Judeo-Christian Coalition Clinic;- Engage up to 15 physicians to donate care to the Judeo-Christian Coalition Clinic;- Increase the availability of specialty services (at FHCW) for Judeo-Christian Coalition Clinic patients;- Expand the Congregational Health Network (clinics) from zero to two;- Implement CREATION Health programs (choice, rest, environment, activity, trust, interpersonal relationships, outlook and nutrition) at five congregations; and- Provide transportation for uninsured adults to the Judeo-Christian Coalition Clinic.2016 Update: The State of Florida did not expand Medicaid, so the numbers of uninsured individuals were still highly impacted in our community. Florida Hospital Carrollwood recruited additional primary care and specialty physicians and enrolled 30 physicians in Florida's Sovereign Immunity program. These physicians provide free care through the Judeo-Christian Network (JCN) free clinic located in the Carrollwood service area. FHCW also planned to provide in-hospital services to JCN patients (while this was included in our Charity Care numbers for 2015, our goal was to provide the "proper level of care at the proper time" for JCN patients - instead of on an emergency basis only). This program has been put on indefinite "hold" due to internal Hospital considerations. With our community partners, we successfully advocated for free door-to-door transportation for JCN patients who do not have automobiles or access to public transportation. Expansion of the Congregational Health network was a key priority throughout the three-year Plan. In 2013, when this plan was developed Florida Hospital Carrollwood and Florida Hospital Tampa were working together on this initiative. This arrangement changed in 2015; Florida Hospital Carrollwood did not have a Congregational Health Network in 2016 and so therefore could not complete this part of the Plan. CREATION Health was not implemented due to lack of the Congregational Health Network. Priority Issue: Diabetes/Food Programs2013 Description of the Issue: If not treated, poor nutrition can lead to chronic disease for those faced with lack of access to care. FHCW and Congregational Health Network collaborated to address this issue. Interventions include: - Create food programs in targeted communities for un- and underinsured residents in zip code 33607 (very low-income);- Provide diabetes education programs to align with food programs in zip code 33607 (very low-income); and- Support American Diabetes Association 5K Walk.2016 Update: Florida Hospital Carrollwood recognized that people in food deserts and low income/low access communities had a prevalence of diabetes due to inconsistent or no access to fresh, healthy food or to nutrition education. We began our Food Is Medicine (FIM) program in zip code 33607, a defined food desert. FIM's goal was to change food-related behaviors through access to appropriate food and long-term nutrition education. Participants enrolled in the program and were screened for blood sugar, blood pressure and BMI. They attended free health education classes, completed their first and last day screenings for blood sugar, BMI, and BP, completed pre-and post-behavioral checklists, and received a free $10 produce voucher at the end of class every week. The voucher was redeemed at a food produce truck that was brought to the site each week. With a goal of 20% of participants showing a drop-in blood sugar, through 2016, 43% had a reduction in blood sugar and 51% in BMI. We started with three classes in two locations; the program has grown to 32 locations in 14 targeted food deserts. Over 80 community partners are part of FIM, including hospitals outside the Florida Hospital System. FIM has become a key strategy for the Florida Hospital West Region; the program will be expanded to the Division's eight other facilities over the next year.Florida Hospital Carrollwood declined to participate in the American Diabetes Walk due to Division commitments to the area American Heart and American Cancer Society walks; therefore, this issue could not be addressed as planned.Priority Issues: Lack of Education on Health Resources; High Cholesterol/Hypertension; and Asthma/Respiratory Issues2013 Description of the Lack of Education Issue: Education about and how to access resources is not reaching those who need it the most.2016 Update: FHCW initiated community collaborations resulting in health education and access to community health and social service resources for underserved populations. Due to the lack of a Congregational Health Model, FHCW chose to complete this priority issue through its Food Is Medicine program. The FIM program provides participants with free health education classes and health screenings. 2013 Description of High/Cholesterol/Hypertension/Asthma/Respiratory Diseases: If not treated, these conditions will lead to chronic disease for those faced with lack of access to care and perpetuate usage of the ED.2016 Update: FHCW initiated community collaborations to provide health education on community health and social service resources related to respiratory conditions and high/cholesterol/hypertension. See Continuation. FL Hosp. at Connerton LTAC Hospital Part V, Section B, Line 11: Florida Hospital Connerton is part of the West Florida Region of Florida Hospital. The Region includes nine hospital facilities. This is the third-year update for Florida Hospital Connerton's 2013-2016 Community Health Plan/Implementation Strategy. Florida Hospital Connerton (FHC or "the Hospital") developed this Plan and posted it in May 2014 as part of its 2013 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, Florida Hospital Connerton made a notable effort to define and address the needs of low-income, minority and underserved populations in its service area. The 2013 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and hospital stakeholders, who then selected key issues for the Hospital to address in its 2013-2016 Community Health Plan. The three-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2013 and give an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing. FHC is a long-term acute care hospital located in rural Pasco County, Florida. When FHC conducted its most recent Community Health Needs Assessment, its Community Advisory Committee noted the unique nature of the Connerton LTAC facility. FHC does not have an Emergency Department and is not a "community" hospital with a defined geographic service area. In 2013, patient referrals came from 25 other hospitals; patients themselves came from 48 zip codes mostly in, but not limited to, Florida. This remained the case in 2016. FHC has two affiliated acute care hospitals close to it; Florida Hospital Wesley Chapel (16 miles) and Florida Hospital Zephyrhills (29 miles). Priority: Family/caregiver burnout and compassion fatigue 2013 Description of the issue: The majority of FHC patients have undergone traumatic events (such as car accidents, brain injuries, multiple organ failures and the like), and the average patient stay is nearly a month. This leads to a higher-than-average rate of patient frustration, family/caregiver burnout and family/staff compassion fatigue. 2016 Update: FHC's leadership team has been trained in Critical Incident Debriefing, and now works with patients, families and employees. The Critical Incident Debriefing service has been expanded to community caregivers and first responders in 2016. Connerton LTAC also implemented a Caring for Caregivers program for patient families, community, first responders and staff. The Hospital has allocated $14,300 to the Caring for Caregivers Program Coordinator. The goals are to help LTAC families reduce their stress levels. Program components include screening for stressors, counseling and support, and an updated reporting system for families who have concerns about their loved ones. This program has created a roving comfort cart with healthy snacks and bottled water for staff and visitors, a Recharge Room that includes soft music, aromatherapy and relaxing activities, and Zumba classes. Chaplains and other staff have had enhanced training for working with families, and the staff has created a new healing environment (music, art, etc.) that will also enhance patient and family care. The CREATION Health wellness and lifestyle program is offered to family members and staff. It focuses on eight principles: Choice, Rest, Environment, Activity, Trust in God, Interpersonal Relationships, Outlook and Nutrition.Priority: Community support and referrals for chronic disease - diabetes2013 Description of the issue: While many FHC patients have diabetes, the condition is not their primary reason for being at the Hospital, so such patients are linked with other community resources at discharge. 2016 Update: Patients and family members with diabetes are referred to community resources such as the American Diabetes Association and to other Florida Hospital locations that offer diabetes education and treatment. If they are not from the local community, they are referred to resources in their home communities. Employees and leadership provide financial support to the American Diabetes Association and support their 5K Walk. $1,931 was raised for the Heartwalk. In 2016 FHC started plans with two local schools to implement the Morning Mile program in the next school year. Priority: Community support and referrals for chronic disease - respiratory/asthma2013 Description of the issue: Chronic disease is not the patients' primary reason for being at FHC, so patients are linked with other community resources.2016 Update: Patients and family members with respiratory diseases are referred to community resources such as the American Lung Association and to other Florida Hospital locations that offer smoking cessation and education. Employees and leadership provide financial support to the American Lung Association and support their "Fight for Air" Climb. If they are not from the local community, they are referred to resources in their home communities. Priority: Transportation and lodging for LTAC families 2013 Description of the issue: Some family members of patients come from long distances in Florida or from out-of-state. They may not have rental cars, and the nearest lodging is 13 miles away. 2016 Update: Connerton LTAC provides family transportation to LTAC families without automobiles. FHC is also working with the Pasco Economic Development Commission to find lodging solutions (for families) that are closer to the Hospital.Priorities 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: - Access to primary care / un- and underinsured: no FHC capacity; not a patient need; FHC can make referrals to other Florida Hospital facilities and community resources;- Access to dental care: no FHC capacity; not a patient need; FHC can make referrals to other Florida Hospital facilities and community resources;- Cancer: no FHC capacity, not a patient need; FHC can make referrals to other Florida Hospital facilities and community resources;- Communicable diseases and communicable diseases reporting: Health Department and acute care hospital responsibility; not a patient need and community resources;- Immunizations for pre-K and general public: no FHC capacity; not a patient need;- Health literacy & education: no FHC capacity; not a patient need; FHC can make referrals to other Florida Hospital facilities and community resources;- Heart disease & stroke: no FHC capacity; not a patient need; FHC can make referrals to other Florida Hospital facilities and community resources;- Infant death & low birth weight babies: no FHC capacity; not a patient need;- Injury, violence and motor vehicle accidents: no FHC capacity for prevention;- Obesity: no FHC capacity; FHC can make referrals to other Florida Hospital facilities and community resources;- Substance abuse: no FHC capacity; not a patient need; FHC can make referrals to other Florida Hospital facilities and community resources; and- Suicide: no FHC capacity; not a patient need. Part V, Section B, Line 7a Each hospital facility's CHNA report was made widely available through the following websites:Facility 1 -- Florida Hospital Tampahttps://www.floridahospital.com/community-health-needs-assessmentsFacility 2 -- Florida Hospital Carrollwoodhttps://www.floridahospital.com/community-health-needs-assessmentsFacility 3 -- FL Hosp. at Connerton LTAC Hospitalhttps://www.floridahospital.com/community-health-needs-assessments Part V, Section B, Line 8-10a - Florida Hospital Tampa: 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. The hospital facility's most recently adopted Implemenation Strategy can be found here: https://www.floridahospital.com/community-health-needs-assessments. Part V, Section B, Line 8-10a - Florida Hospital Carrollwood: 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. The hospital facility's most recently adopted Implemenation Strategy can be found here: https://www.floridahospital.com/community-health-needs-assessments. Part V, Section B, Line 8-10a - FL Hosp. at Connerton LTAC Hospital: 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. The hospital facility's most recently adopted Implemenation Strategy can be found here: https://www.floridahospital.com/community-health-needs-assessments. Florida Hospital Carrollwood - Part V, Section B, Line 11 (Continuation): Priorities 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: Mental HealthFHCW does not provide mental health services, but has contracted with Grace Point for services, as needed. Poverty/ UnemploymentThis is not a core ability of FHCW. The Tampa Bay Workforce Alliance is the community lead on issues of unemployment.UninsuredFHCW is involved with the Hillsborough County Health Plan, providing insurance to more than 13,000 who otherwise would not have access to health care in the community. At a more general level, The University of South Florida has received federal funding for Health Navigators to help Tampa/County residents enroll in insurance offered on the Federal Insurance Marketplace. This will help increase the coverage level of our community. 3 1 - UCH Wound Healing Institute 3000 Medical Park Dr Ste 430 Tampa FL 33613 Wound Care 2 - Brandon Wound Care Clinic 205 S Moon Ave Ste 106 Brandon FL 33511 Wound Care 3 - Carrollwood Occupational Health Clinic 7001 N Dale Mabry Hwy Tampa FL 33613 Occupational Health Part I, Line 6a: The filing organization was a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) during its current tax year. During the current year, AHSSHC served as a parent organization to 22 tax-exempt 501(c)(3) hospital organizations that operated 44 hospitals in ten states within the U.S. The system of organizations under the control and ownership of AHSSHC is known as "Adventist Health System" (AHS).All hospital organizations within AHS collect, calculate, and report the community benefits they provide to the communities they serve. AHS organizations exist solely to improve and enhance the local communities they serve. AHS has a system-wide community benefits accounting policy that provides guidelines for its health care provider organizations to capture and report the costs of services provided to the underprivileged and to the broader community. Each AHS hospital facility reports their community benefits to their Board of Directors and strives to communicate their community benefits to their local communities. Additionally, the filing organizations most recently conducted community health needs assessment and associated implementation strategy are posted on the filing organization's website. Part I, Line 7: The amounts of costs reported in the table in line 7 of Part I of Schedule H were determined by utilizing a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges, contained in the Schedule H instructions. Part II, Community Building Activities: The filing organization is involved with and supportive of various other organizations in its community that work collaboratively to help those in need and to improve the health and safety of the residents of the community. The filing organization supports and participates with a number of other community organizations, such as the University Area Community Development Corporation, Inc. and the Tampa Bay Partnership for Regional Economic Development. The filing organization is supportive of other health and wellness programs in its community, such as the American Heart Association and the American Cancer Society. 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 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. 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 all Medicare patients are as follows:- Medicare surplus/(shortfall) shown on line 7 of Section B of Schedule H: $ (19,616,924)- Difference in costing methodology: (239,644)- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (40,613,541) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's communitybenefit reporting $ (60,470,109)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 three hospitals operated by the filing organization conducted community health needs assessments (CHNA) during 2013/2014 and 2016. Each hospital facility'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 CHNAs. Each 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 each of the filing organization's hospital facilities are transparent and available to all individuals served at any point in the care continuum. For each of the filing organization's hospital facilities, the FAP, FAA Form, PLS, and contact information for the hospital facility's financial counselors are prominently and conspicuously posted on each of the filing organization's hospital facility's websites. Each 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 populations). Signage is displayed in public locations of each of the filing organization's hospital facilities, including at all points of admission and registration and the Emergency Department. The signage contains each of 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 each 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. Each of 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 each 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 relevant 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 each of 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: The filing organization currently operates 3 hospital facilities, Florida Hospital Tampa, including a Heart Hospital, Florida Hospital Carrollwood, and a Long Term Acute Care Hospital on three campuses in and around the Tampa Bay Area. Combined, these facilities are a major healthcare provider caring for close to 200,000 patients each year residing in Hillsborough, Pasco and surrounding Counties. A description of each of the hospital campuses is described below. University Community Hospital, Inc. dba Florida Hospital Tampa;Florida Hospital Tampa (FHT), located in Hillsborough County in close proximity to the University of South Florida, is licensed for 418 acute-care beds. FHT is home to six Centers of Excellence that focus resources on major disease areas including cardiac treatment, women's health, stroke, pediatrics, diabetes management and orthopaedics. Florida Hospital Pepin Heart Institute (FHPHI), located adjacent to FHT, is licensed for 75 beds. This free-standing heart hospital is filled with advancements in technology, techniques, and revolutionary patient-centered care and is raising expectations when it comes to the diagnosis, treatment, and study of cardiovascular disease. Most importantly, FHPHI is filled with a team of physicians, nurses, technicians, and staff who have worked together for more than 20 years to create one of the most successful heart programs in the Tampa Bay Area. FHPHI's physicians and clinical specialists have built a comprehensive cardiovascular program with the experience of providing thousands of angioplasty procedures and open heart surgeries. Tampa, Florida is located in Hillsborough County. Florida Hospital Tampa's primary service area has a population of approximately 639,976, with an estimated 11.48% over the age of 65. The per capita income in Hillsborough County is approximately $27,148. High school graduates account for approximately 86% of the primary service area. It is estimated that 19% of the individuals residing in the primary service area live below 100% of the Federal Poverty Level and the unemployment rate is about 5.9. Approximately 44.2% of FHT's patients during the current tax year were Medicare patients, about 15.8% were Medicaid patients, about 8.2% were self-pay patients, and the remaining percentage were patients covered under commercial insurance. In 2016, about 66.3% of FHT's in-patients were admitted through the Emergency Department. University Community Hospital, Inc. dba Florida Hospital Carrollwood;Florida Hospital Carrollwood (FHCW), also located in Hillsborough County, is licensed for 120 beds and offers comprehensive medical and surgical care, many specialized services, as well as a wide range of radiological procedures available for diagnosis and treatment of injuries and illnesses. Diagnostic imaging services offered include x-rays, ultrasound, mammography, nuclear medicine, CT Scan and special procedures. FHCW's five-story medical tower also houses a six-suite surgery unit that offers advanced technologies in gynecologic, vascular surgery and joint replacement procedures.Tampa, Florida is located in Hillsborough County. Florida Hospital Carrollwood's primary service area has a population of approximately 724,918, with an estimated 11.60% over the age of 65. The median household income in Hillsborough County is approximately $50,122. High school graduates account for approximately 85% of the primary service area. It is estimated that 19.70% of the individuals residing in the primary service area live below 100% of the Federal Poverty Level. Approximately 45.0% of FHCW's patients during the current tax year were Medicare patients, about 11.8% were Medicaid patients, about 7.4% were self-pay patients, and the remaining percentage were patients covered under commercial insurance. In 2016, about 69.8% of FHCW's in-patients were admitted through the Emergency Department. University Community Hospital, Inc. dba Florida Hospital at Connerton Long Term Acute Care Hospital;Florida Hospital at Connerton Long Term Acute Care Hospital (LTAC), located in Pasco County is licensed for 50 beds. This facility is designed to serve individuals who have medically complex illnesses, requiring additional weeks of specialized hospital care. Florida Hospital Connerton LTAC (FHC or Connerton LTAC) is a long-term acute care hospital located in rural Pasco County, Florida. When FHC conducted its most recent Community Health Needs Assessment, its Community Health Needs Assessment Committee noted the unique nature of the Connerton LTAC facility. FHC does not have an Emergency Department and is not a "community" hospital with a defined geographic service area. In 2015, patient referrals came from 25 other hospitals; patients themselves came from 52 different counties mostly in, but not limited to, Florida. Approximately 77.2% of LTAC's patients during the current tax year were Medicare patients, about 2.5% were Medicaid patients and the remaining percentage were patients covered under commercial insurance. The filing organization (UCH) is a crucial community and regional asset. UCH provides necessary medical services to the already large and rapidly expanding Tampa Area. With the exception of the LTAC, each facility is located in Tampa, Florida and primarily serves patients residing in Hillsborough County which is located on the west coast of central Florida. Part VI, Line 5: The provision of community benefit is central to the filing organization's mission of service and compassion. Restoring and promoting the health and quality of life of those in the communities served by the filing organization is a function of "extending the healing ministry of Christ and embodies the filing organzation's commitment to its values and principles. The filing organization 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 information provided in Parts I, II and III of this Schedule H, the filing organization captures and reports the benefits provided to its communities 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 filing organization provided $413,049 of benefit with respect to the faith-based and spiritual needs of the community in conjunction with its operation of its community hospitals. The filing organization 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 filing organization expended $92,243,797 in new capital improvements. As faith-based mission-driven community hospitals, the filing organization is continually involved in monitoring its communities, 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 filing organization are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its communities.The filing organization values the communities it serves, and pledges to provide each community with needed educational, preventative, diagnostic, treatment and rehabilitative services. The filing organization is continually improving and updating its range of services as necessary to meet community needs. The filing organization's community outreach efforts are focused on health education, wellness information, physician referral, and screening services. Each month, the filing organization offers a variety of health and wellness classes taught by members of its medical staff and other health care professionals. The filing organization also maintains a speakers' bureau whereby qualified speakers are provided to community groups to deliver the latest information on health, wellness, and prevention. Because prevention and early detection are key components of maintaining good health for individuals of all ages, UCH regularly conducts a variety of free and low-cost health screening events. Such screenings include cholesterol, blood pressure checks, body fat and osteoporosis screenings. Part VI, Line 6: University Community Hospital, Inc. 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 communities 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 a community benefit report with any state. 1 American Heart Association PO Box 21203 St Petersburg FL 33742 135613797 501(c)(3) 20000 General Support Museum Of Science and Industry Inc 4801 East Fowler Ave Tampa FL 33617 592657399 501(c)(3) 500000 General Support Tampa Bay Partnership for Regional Economic Development 4300 W Cypress St Suite 700 Tampa FL 33607 593248071 501(c)(6) 50000 General Support Florida Health Sciences Center Inc dba Tampa General Hospital PO Box 1289 Tampa FL 33601 593458145 501(c)(3) 15000 General Support University Area Community Development Corporation Inc 14103 N 22nd St Tampa FL 33613 311624121 501(c)(3) 10000 General Support Hillsborough Education Foundation Inc 2306 N Howard Ave Tampa FL 33607 592883361 501(c)(3) 7500 General Support Florida West Coast Public Broadcasting Inc 1300 North Blvd Tampa FL 33607 590840626 501(c)(3) 5500 General Support American Cancer Society 2006 W Kennedy Blvd Tampa FL 33606 590657320 501(c)(3) 6000 General Support 7 1 Part I, Line 2: Grants are generally made only to related organizations that are exempt from Federal Income Tax under 501(c)(3), or to other non-profit community organizations. 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 X 1 1 0 1 0 0 0 0 0 0 0 Adams Brian S Director/CEO 0 438701 0 92056 0 61478 0 71961 0 42317 0 706513 0 49438 Bronleewe MD Scott Director (End 9/16) 0 460677 0 0 0 3088 0 14387 0 15865 0 494017 0 0 Patel MD Sharad Director 20603 195566 0 0 0 37037 0 12621 0 4811 20603 250035 0 0 Schultz Michael H Vice Chairman 0 723423 0 231777 0 450414 0 125789 0 61248 0 1592651 0 104861 Didenko Vadym V CFO - Medical Center (End 7/16) 0 348268 0 54576 0 39958 0 49495 0 42604 0 534901 0 26419 Heinrich William CFO - Medical Center (Beg 7/16) 0 244988 0 36125 0 12482 0 24285 0 40748 0 358628 0 0 Jiang-Saldana Hui COO - Medical Center (End 12/16) 0 287508 0 48698 0 12499 0 34428 0 44797 0 427930 0 0 Torres Michael A MD CMO - Medical Center 0 310904 0 0 0 28487 0 47083 0 9663 0 396137 0 0 Bjornstad MD Brad CMO - Medical Center/Carrollwood 0 316221 0 60323 0 60132 0 41794 0 22748 0 501218 0 23835 Solomita Joy B CNO - Medical Center 0 236715 0 39838 0 19401 0 31711 0 31181 0 358846 0 7827 Shaw Brigitte W CBDO - Medical Center 0 260915 0 33242 0 32439 0 27745 0 43685 0 398026 0 18864 Johnson Joel D CEO - Carrollwood 0 302444 0 89761 0 63298 0 36910 0 44891 0 537304 0 26703 Cox Shane H CFO - Carrollwood (End 7/16) 0 229188 0 42009 0 46007 0 25579 0 84570 0 427353 0 0 Mcguinness Robin J CNO - Carrollwood 0 196997 0 38173 0 6764 0 12677 0 13059 0 267670 0 0 Lambert MD Charles Physician 377058 0 0 0 26074 0 14387 0 5442 0 422961 0 0 0 Widdison Timothy AVP/Controller 171207 0 14272 0 6166 0 9955 0 2353 0 203953 0 0 0 Nelson Sanidad Mary J AVP Human Resources 170046 0 16328 0 1153 0 9741 0 2462 0 199730 0 0 0 Moorman Kathleen A Pharmacist 163277 0 19588 0 2446 0 9394 0 275 0 194980 0 0 0 Antonelli Steve Pharmacist 136222 0 888 0 38665 0 8926 0 2280 0 186981 0 0 0 Hagensicker Janice K Former Regional CFO 0 394666 0 103402 0 250042 0 52974 0 37040 0 838124 0 25725 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. 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. Health or social club dues or initiation fees: AHSSHC has a Corporate Executive Policy that addresses business development expenditures. Under this policy, certain AHS eligible executives may be reimbursed for member dues and usage charges for a country club or other social club upon authorization. Club memberships must be recommended by the CEO of the AHS hospital organization and approved by the Chairman of the Board of Directors of the organization. In addition, the proposed membership must be approved annually by the AHSSHC Board Compensation Committee, an independent committee of the Board of Directors of AHSSHC. Eligible executives are limited to certain senior level executives (hospital organization CEOs, the CEO of the nursing home division of AHS, senior vice presidents at three large hospital organizations, regional CEOs and CFOs and the president and senior vice presidents of AHSSHC). In the current year, for this filing organization, three executives were eligible to receive reimbursement for club fees. Each AHS executive who is approved for a club membership must submit an annual report to the AHSSHC Board Compensation Committee that describes how the membership benefited their organization during the preceding year. 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 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 $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 ------------------------------------------------------- Schultz, Michael H.$129,402 $101,026 $215,284 $ 0 Adams, Brian S. $ 57,573 $ 49,466 $ 0 $ 0 Didenko, Vadym V. $ 35,107 $ 26,261 $ 0 $ 0 Heinrich, William $ 9,897 $ 0 $ 0 $ 0 Johnson, Joel D. $ 23,723 $ 27,328 $ 15,049 $ 0 Jiang-Saldana, Hui $ 20,041 $ 0 $ 0 $ 0 Shaw, Brigitte W. $ 13,358 $ 19,159 $ 0 $ 0 Bjornstad, MD, Brad$ 45,406 $ 23,199 $ 0 $ 0 Solomita, Joy B. $ 17,324 $ 7,508 $ 0 $ 0 Cox, Shane H. $ 11,192 $ 0 $ 0 $ 0 Torres, MD, Michael A $ 50,695 $ 0 $ 0 $ 0 Hagensicker, Janice K. $ 56,586 $ 25,740 $170,808 $ 0 * Including Investment Earnings Jon L Courson III Family member of Board Member 39768 Employee Compensation 0 Part V, Line 1a The parent corporation and sole top-tier member of University Community Hospital, 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 2 Jon Courson and Eric Newman - Family Relationship Form 990, Part VI, Section A, line 6 University Community Hospital, Inc. (the filing organization) has one member. The sole member of the filing organization is Adventist Health System Sunbelt Healthcare Corporation. Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) 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 AHSSHC. AHSSHC appoints all voting members to the Board of Directors of UCH. Regular directors are nominated by the Board of Directors of UCH but must be appointed by the member. Form 990, Part VI, Section A, line 7b AHSSHC, 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: 1) The approval or disapproval of the Bylaws of the filing organization; 2) To set limits and terms for the borrowing of funds in excess of $100,000; 3) The approval or disapproval of single expenditures and/or the purchase or sale of real property in excess of one million dollars; 4) To direct the placement of funds and capital of the filing organization; 5) To establish general guiding policies; and 6) To approve the identity of an auditing firm and election of the fiscal year for the filing organization. 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 these individuals 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 (excluding Physician 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. The Physician Members of the Board receive compensation from a related tax-exempt affiliate organization for providing medical services. 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 Professional: Program service expenses 25,289,622. Management and general expenses 0. Fundraising expenses 0. Total expenses 25,289,622. Professional Fees: Program service expenses 7,931,595. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,931,595. Purchased Medical Services: Program service expenses 11,462,922. Management and general expenses 0. Fundraising expenses 0. Total expenses 11,462,922. Environmental Services: Program service expenses 2,372,534. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,372,534. Recruiting: Program service expenses 16,940,792. Management and general expenses 0. Fundraising expenses 0. Total expenses 16,940,792. Food Service Contracts: Program service expenses 919. Management and general expenses 0. Fundraising expenses 0. Total expenses 919. Miscellaneous Purchased Services: Program service expenses 12,746,901. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,746,901. AHS Management Fees: Program service expenses 0. Management and general expenses 6,121,226. Fundraising expenses 0. Total expenses 6,121,226. Billing & Collection Services: Program service expenses 0. Management and general expenses 6,948,362. Fundraising expenses 0. Total expenses 6,948,362. EHR Management Fees: Program service expenses 0. Management and general expenses 75,117. Fundraising expenses 0. Total expenses 75,117. AHS Shared Services Fees: Program service expenses 0. Management and general expenses 5,289,178. Fundraising expenses 0. Total expenses 5,289,178. Form 990, Part XI, line 9: Transfer to tax exempt parent -7,926,797. Transfer from affiliates 1,707,387. Transfer to affiliates -427,780. Allocation from tax exempt parent with respect to debt 192,479. Pension Liability Adjustment -3,773,000. Other 214. Change in Interest in Foundation 2,433,029. Safe Lifting Program Funding from tax exempt parent 98,446. Adjustment with respect to Federal Grant -480,347. 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. Boudreaux Realty LLC 401 East Jackson St Ste 2700 Tampa FL 33602 461450437 Real Estate FL University Community Hospital Inc Mason Florida Investments LLC 401 East Jackson St Ste 2700 Tampa FL 33602 591113901 Real Estate FL University Community Hospital Inc 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 N/A C 1 Florida Hosp Hlth Village Property Owner's Assoc Inc 550 E Rollins Street 7th Floor Orlando FL 32803 821748255 Condo Association FL N/A C 1 Florida Hospital Healthcare System Inc 101 Southhall Lane Ste 150 Maitland FL 32751 593215680 PHSO FL N/A C 1 Florida Medical Plaza Condo Association Inc 601 East Rollins Street Orlando FL 32803 592855791 Condo Association FL N/A C 1 Florida Memorial Health Network Inc 770 W Granada Blvd Ste 317 Ormond Beach FL 32174 593403558 Physician Hospital Org. FL N/A C 1 Kissimmee Multispecialty Clinic Condominium Association Inc 201 Hilda Street Suite 30 Kissimmee FL 34741 593539564 Condo Association FL N/A C 1 LN Health Partners Inc (815-123116) 550 E Rollins Street 6th Floor Orlando FL 32803 813556903 Inactive FL N/A C 1 Midwest Management Services Inc 9100 West 74th Street Shawnee Mission KS 66204 480901551 Inactive KS N/A C 1 North American Health Services Inc & Sub 900 Hope Way Altamonte Springs FL 32714 621041820 Lessor/Holding Co. TN N/A C 1 Ormond Prof Associates Condo Assoc'n Inc (430 year end) 770 W Granada Blvd Ste 101 Ormond Beach FL 32174 592694434 Condo Association FL N/A C 1 Park Ridge Property Owner's Association Inc 1 Park Place Naples Road Fletcher NC 28732 030380531 Condo Association NC N/A C 1 Porter Aff Hlth Svcs Inc dba Diversified Aff Hlth Svcs 2525 S Downing Street Denver CO 80210 840956175 Healthcare Services CO N/A C 1 San Marcos Regional MRI Inc 1301 Wonder World Drive San Marcos TX 78666 770597968 Holding Company TX N/A C 1 The Garden Retirement Community Inc 485 North Keller Road Ste 250 Maitland FL 32751 593414055 Real Estate Rental FL N/A C 1 Winter Park Medical Office Building I Condo Assoc Inc 601 East Rollins Street Orlando FL 32803 452228478 Condo Association FL N/A C 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 Adventist Health System Sunbelt Healthcare Corp M 11267198 % of Facility's Operating Exp. Adventist Health System Sunbelt Healthcare Corp P 28840835 Cost Adventist Health System Sunbelt Healthcare Corp-Shared Svcs M 5289178 % of Facility's Operating Exp. Adventist Health System Sunbelt Healthcare Corp dba AHS IS M 21351924 % of Facility's Operating Exp. Adventist Health SystemSunbelt Inc M 75118 % of Facility's EHR Revenue Adventist Health System Sunbelt Healthcare Corp R 3349679 Actual Amount Given Florida Hospital Physician Group Inc Q 12218242 Cost Florida Hospital Zephyrhills Inc Q 1385308 Cost Pasco-Pinellas Hillsborough Community Health System Inc Q 3983348 Cost Tarpon Springs Hospital Foundation Inc Q 5650534 Cost University Community Hospital Foundation Inc Q 1333464 Cost Florida Hospital Medical Group Inc Q 642164 Cost Pasco-Pinellas Hillsborough Community Health System Inc P 6673290 Cost Florida Hospital Zephyrhills Inc P 3629367 Cost Tarpon Springs Hospital Foundation Inc P 10197414 Cost Adventist Health SystemSunbelt Inc dba Florida Hospital Heartland Divisi P 132080 Cost Pasco-Pinellas Hillsborough Community Health System Inc S 439244 Actual Amount Received Florida Hospital Zephyrhills Inc S 474875 Actual Amount Received Tarpon Springs Hospital Foundation Inc S 365488 Actual Amount Received Adventist Health System Sunbelt Healthcare Corp B 4577118 Actual Amount Given Adventist Health System Sunbelt Healthcare Corp Q 98446 Cost University Community Hospital Foundation Inc C 427780 Actual Amount Received SunSystem Development Corp dba Florida Hospital Zephyrhills Foundation B 131660 Actual Amount Given SunSystem Development Corp dba Florida Hospital Wesley Chapel Foundation B 148060 Actual Amount Given Helen Ellis Memorial Hospital Foundation Inc B 148060 Actual Amount Given