2018-01-31T14:07:36-06:00 2016-12-31 990 2016-01-01 591479658 Adventist Health SystemSunbelt Inc ADVE 4073572317 900 Hope Way Altamonte Springs FL 32714 Lynn C Addiscott Asst. Secretary 4073572317 2018-01-31 204.139.85.142 2018-01-31 12:36:26 ES P C0247F8892BD8C7016DCC34A30CA09F011CB4127 2D951D70D370B284B8357A24D7DC4FA93EDF4DEB 2016 2021-01-29 14:40:06Z Terry Shaw 900 Hope Way Altamonte Springs FL 32714 3941235043 0 1071 X www.adventisthealthsystem.com X 1973 FL Operation of 11 acute-care hospitals & related healthcare services. 24 19 29312 3967 21283121 1464093 9303349 8848774 3648256768 3868669395 -25362685 20107756 11676116 8266783 3643873548 3905892708 20381036 24675655 0 0 1576273864 1678616674 0 0 0 1745242517 1830586474 3341897417 3533878803 301976131 372013905 6857582662 7155851570 4065608896 3989631837 2791973766 3166219733 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 3278591940 24675655 3854008096 Operation of 11 acute care hospitals with 155,977 patient admissions, 787,371 patient days and 1,360,426 outpatient visits in the current year. In addition to hospital operations, the corporation provides medical care through a number of other activities such as urgent care centers, physician clinics, home health services, hospice services, sleep centers, wound centers, therapy and rehab. 3278591940 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 1 0 0 0 0 1 1 1 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 2019 0 1 29312 1 1 1 0 0 0 0 0 0 0 0 0 X 24 19 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X Paul Rathbun 4073572419 900 Hope Way Altamonte Springs FL 32714 X Livesay MDiv Donald E Chairman/Director 2.00 3.00 X 0 1058 0 Brown-Fraser PhD Sherine Director 1.00 3.00 X 0 950 0 Carlson Ronald Director 1.00 3.00 X 0 1058 0 Cauley DMin Michael F Director 1.00 3.00 X 393 950 0 Craig Carlos Director 1.00 3.00 X 0 950 0 Davidson James R Director 1.00 3.00 X 393 1058 0 Griffith Jr Buford Director 1.00 3.00 X 0 1058 0 Haffner PhD Randall L Director 1.00 50.00 X 0 1707541 265682 Houmann Lars D Director 1.00 50.00 X 90 1914919 273719 Jernigan PhD Donald L Director/CEO (End 12/16) 1.00 50.00 X X 0 2240423 108696 Johnson MD Mark Director 1.00 3.00 X 0 1058 0 Knutson J Deryl Director (End 5/16) 1.00 3.00 X 0 308 0 Mack Gregory Director (Beg 9/16) 1.00 3.00 X 393 750 0 Moore MDiv Larry R Vice Chairman/Director 1.00 3.00 X 0 950 0 Morel Hubert J Director (End 6/16) 1.00 3.00 X 0 200 0 Page John Director (Beg 6/16) 1.00 3.00 X 0 750 0 Peoples Troy K Director 1.00 3.00 X 0 1058 0 Pichette Raymond Director 1.00 3.00 X 0 1058 0 Robinson Randy Director 1.00 3.00 X 393 1058 0 Scott Glynn CW Director 1.00 3.00 X 0 1058 0 Shaw EdD Kenneth Director 1.00 3.00 X 0 1058 0 Shaw Terry D Director/CFO (CEO Beg 12/16) 1.00 50.00 X X 0 1836153 277585 Smith DMin PhD Ron C Vice Chair/Sec/Director 2.00 3.00 X 393 1050 0 Thurber Gary F Vice Chairman/Director 2.00 3.00 X 0 1058 0 Valentine II MDiv Maurice R Director 1.00 3.00 X 0 1333 0 Webb Gil Director 1.00 3.00 X 0 1058 0 Werner Thomas L Director 1.00 3.00 X 0 47288 0 Bradley Kenneth W SEO/SW Mkt & Admin FH Celebration Health 50.00 0.00 X 1003 596322 96189 Dodds Sheryl D SEO/Chief Clinical Officer FH System 50.00 0.00 X 0 549127 86285 Goodman Todd A SEO/CFO FH & AHS Central FL Region 50.00 0.00 X 0 617892 107859 Harcombe Douglas W SEO/NE Mkt & Admin FH Altamonte 50.00 0.00 X 90 456140 92297 Hilliard Douglas W Sr VP/Sr Finance Officer FH Orlando 50.00 0.00 X 0 555430 105802 Moorhead MD John David SEO/Chief Medical Officer FH System 50.00 0.00 X 0 789966 68236 Owen Terry R SEO/Ambulatory & System Serv FH System 50.00 0.00 X 0 741009 101509 Reed MD Monica P SEO/Care Innovation FH System 50.00 0.00 X 1450 968827 134695 Stevens Eric A SEO/Cent Mkt & Admin FH Orl/FH Women 50.00 0.00 X 90 790376 138796 Tol Daryl L Pres/CEO FH & AHS Central FL Region 50.00 0.00 X 90 1252045 161738 Zbarschuk Amy L Sr VP/Sr Finance Officer, FH System 50.00 0.00 X 0 465877 90882 Davis Jr MD Robert Duane Physician/Dir - FH Cardio Institute 50.00 0.00 X 1303520 0 20782 Jones MD Phillip E Physician 50.00 0.00 X 1083776 0 37975 Lee MD Kathy Physician 50.00 0.00 X 1016276 0 29479 Silvestry MD Scott Phys/Dir - FH Thoracic Transplant 40.00 0.00 X 924217 0 37244 Shimshak MD Thomas M Physician 50.00 0.00 X 894406 0 40227 Banks David P Former key employee 0.00 50.00 X 0 1759438 149146 Fulbright Robert D Former key employee 0.00 50.00 X 0 790358 149703 Hagensicker Janice K Former key employee 50.00 0.00 X 0 748110 90015 Hurst Jeffery D Former key employee 50.00 0.00 X 1272 664102 55266 Paradis J Brian Former key employee 0.00 30.00 X 0 1659157 189261 Soler Eddie Former key employee 0.00 50.00 X 0 1169422 161539 5228245 22340809 3070607 1605 1 1 0 Brasfield & Gorrie LLC 941 W Morse Blvd Suite 200 Winter Park FL 32789 Design and Construction Services 90498994 Cerner Corporation PO Box 959156 Saint Louis MO 63195 Patient Records & Billing Services 16897102 CC Staffing Inc PO Box 404674 Atlanta GA 30384 Staffing Services 15139087 Koosharem Corporation Select Staffing PO Box 802015 Chicago IL 60680 Staffing Services 11667991 Barton Malow Company 5337 Millenia Lakes Blvd Orlando FL 32839 Construction Services 11339699 474 X 6480948 2190398 177428 8848774 Patient Revenue 622110 3802581478 3789731025 12850453 Cafeteria/Vending Rev. 622110 20447386 19772201 675185 Rent from Exempt Affiliates 622110 13315405 13315405 Gift Shop 622110 6384469 6353920 30549 Research 622110 4718167 4718167 21222490 13763754 7458736 3868669395 30422518 30422518 205261 205261 252568 252568 2971021 320181 1555936 74675 1415085 245506 1660591 268198 1392393 23191701 19667853 14043871 -19667853 9147830 -10520023 -10520023 Equity earnings from related enti 622110 4334026 4334026 EHR Revenue 622110 2465173 2465173 Investment in Subs 622110 -462851 -462851 17276 17276 6353624 3905892708 3854008096 21283121 21752717 X 24495993 24495993 179662 179662 8972077 8972077 1234978599 1222536115 12442484 50062972 49260717 802255 292939906 285459233 7480673 91663120 90163743 1499377 8412866 8412866 822212 822212 7866423 7866423 375851209 326106627 49744582 23401878 23401878 109754195 81537621 28216574 12791947 11333045 1458902 67705643 67705643 6666587 3676980 2989607 1725031 1025143 699888 41755070 41755070 179834578 179834578 74284254 73884005 400249 Medical Supplies 663347100 663347100 Repairs/Maintenance 87108264 87108264 Assessments 46917484 46917484 UBI Tax 630302 630302 121711431 22264917 99446514 3533878803 3278591940 255286863 0 X 113373 116869 1947033102 2079287840 581708203 622203323 80866232 92318523 21809191 17411574 4235886741 2028437594 2067130397 2207449147 6819502 6102820 32779520 31622377 2119323142 2099339097 6857582662 7155851570 273084819 257236071 3271874640 3382694759 520649437 349701007 4065608896 3989631837 X 2790708206 3164072731 1265560 2147002 2791973766 3166219733 6857582662 7155851570 X 372013905 32824081 -30592019 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 142136 142136 0 Part II-B, Line 1: The corporation reimbursed traveling expenses and paid fees to retain the services of two consulting firms which performed lobbying activities on behalf of the corporation. The two firms were Richard Crotty and Johnson & Blanton and were paid a total of $12,506 during the year. Additionaly, dues were paid to the American Hospital Association, Florida Hospital Association, Texas Hospital Association, and Association of Organ Procurement who use a portion of the dues to conduct lobbying activities. 19118543 568450 277615 573609 19390999 18008913 530000 911157 331527 19118543 17037065 976037 344211 17668891 16504372 79461 808853 355621 17037065 15644852 79402 780118 16504372 0.86110 0.13890 0.00000 0 1 1 198845032 198845032 1420572519 593548156 827024363 2328661446 1388073998 940587448 287807744 46815440 240992304 2207449147 Funds Held in Trust 8285369 Due From Related Parties and Affiliates 25286972 Long-term Investments 76208983 Other Non-Current Assets 8863635 Receivable - Interco Alloc of Tax-Exempt Bond Proceeds 1934861437 Receivable from Third Party 6153217 Other Current Receivable 25152392 Assets Held for Sale 14513959 Board Designated Funds 13133 2099339097 Payable to Third Party 62884605 Due to Related-Affiliated Entities 128589264 Other Current Liabilities 27901544 Other Non-Current Liabilities 129338810 Notes and Loans Payable 165551 Leases Payable 821233 349701007 X Part V, Line 4: All endowment funds are held by related 501(c)(3) exempt foundations. These endowment funds have been established for a variety of purposes in support of related tax-exempt hospitals. All of the foundation's permanently restricted endowment funds are required to be retained permanently either by explicit donor stipulation or by the Florida Uniform Prudent Management of Institutional Funds Act. Part V, line 1a, column (a) Prior year - Explanation for change in opening balance: During year 2015, it came to the attention of the Foundation's management that an Endowment in the amount of $340,022 was mistakenly misclassified as of December 31, 2014. As a result, the Foundation restated beginning board-designated endowment funds in its 2015 tax year. Part V, line 1c, column (a) Current year - During 2016, the Foundation agreed to a modification of a donor's endowment agreement, which resulted in an impairment of $722,928. This amount has been netted with the Foundation's current year investment return. Part X, Line 2: The filing organization is a subsidiary organization within Adventist Health System (AHS). The consolidated financial statements of AHS contain the following FIN 48 footnote: Please note that dollar amounts are in thousands. Healthcare Corporation and its affiliated organizations, other than North American Health Services, Inc. and its subsidiary (NAHS), are exempt from state and federal income taxes. Accordingly, Healthcare Corporation and its tax-exempt affiliates are not subject to federal, state or local income taxes except for any net unrelated business taxable income. NAHS is a wholly owned, for-profit subsidiary of Healthcare Corporation. NAHS and its subsidiary are subject to federal and state income taxes. NAHS files a consolidated federal income tax return and, where appropriate, consolidated state income tax returns. All taxable income was fully offset by net operating loss carryforwards for federal income tax purposes; as such, there is no provision for current federal or state income tax for the years ended December 31, 2016 and 2015. NAHS also has temporary deductible differences of approximately $59,100 and $62,700 at December 31, 2016 and 2015, respectively, primarily as a result of net operating loss carryforwards. At December 31, 2016, NAHS had net operating loss carryforwards of approximately $59,600, expiring beginning in 2022 through 2026. Deferred taxes have been provided for these amounts, resulting in a net deferred tax asset of approximately $22,500 and $23,800 at December 31, 2016 and 2015, respectively. A full valuation allowance has been provided at December 31, 2016 and 2015 to offset the deferred tax asset since Healthcare Corporation has determined that it is more likely than not that the benefit of the net operating loss carryforwards will not be realized in future years. The Income Taxes Topic of the ASC (ASC 740) 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 and 2015. 0 Central America and the Caribbean Grantmaking 64105 Central America and the Caribbean Meetings 8739 Central America and the Caribbean Program Services Provision of Supplies, Mission Trips 255303 Central America and the Caribbean Speakers 3231 East Asia and the Pacific Grantmaking 16792 East Asia and the Pacific Meetings 16468 East Asia and the Pacific Program Services Mission Trips 164847 East Asia and the Pacific Speakers 32352 Europe (including Iceland and Greenland) Meetings 34166 Europe (including Iceland and Greenland) Speakers 11498 Middle East and North Africa Meetings 336 North America (which includes Canada and Mexico, but not the U.S.) Meetings 14348 North America (which includes Canada and Mexico, but not the U.S.) Program Services Mission Trips, Recruitment 76193 North America (which includes Canada and Mexico, but not the U.S.) Speakers 1531 South America Grantmaking 21874 South America Meetings 3908 South America Program Services Medical/Dental Clinics, Mission Trips 234972 South America Speakers 9577 South Asia Speakers 4151 Sub-Saharan Africa Grantmaking 84226 Sub-Saharan Africa Program Services Mission Trips 331560 0 0 0 0 0 0 561837 828340 1390177 Sub-Saharan Africa Medical Supplies or Equipment 84166 Medical Equipment Other Central America and the Caribbean Medical Supplies or Equipment 11395 Medical Equipment Other East Asia and the Pacific Medical Supplies or Equipment 16792 Medical Equipment Other South America Medical Supplies or Equipment 5140 Medical Equipment Other Central America and the Caribbean Provision of Clothing/Food 49500 Meal Packs Other South America Medical Supplies or Equipment 11697 Medical Equipment Other 5 0 0 0 0 0 0 0 Part I, Line 2: Foreign grants are generally non-cash donations of medical equipment and supplies to assist foreign health care providers in fulfilling their mission of providing health care services to the populations they serve. The foreign health care providers are often hospitals and/or clinics operated and/or sponsored by or affiliated with the Seventh-Day Adventist Church. The foreign hospitals/clinics may be located in remote and/or underserved villages and townships of developing countries. Grants are typically made to other U.S. charitable organizations or foreign entities recognized as charitable by the foreign country in which they are located. As a result of the nature of the grants as non-cash medical equipment and supplies and the fact that most grants are made indirectly through other U.S. or foreign charitable organizations, the filing organization has not established specific procedures for monitoring the use of grant funds outside the United States. 1 1 X 1 X 0 1 1 0 0 178062168 178062168 0.05040 513860134 305410583 208449551 0.05900 691922302 305410583 386511719 0.10940 21948008 110740 21837268 0.00620 42252864 9361920 32890944 0.00930 4543785 4363110 180675 0.00010 3157911 2084655 1073256 0.00030 20335782 20335782 0.00580 92238350 15920425 76317925 0.02170 784160652 321331008 462829644 0.13110 25186201 7370626 17815575 0.00500 438944 4875 434069 0.00010 148336 148336 0.00000 25773481 7375501 18397980 0.00510 1 219252099 6287507 716246098 834973123 -118727025 X 1 1 1 San Marcos MRI LP Imaging Center 0.60000 0.00000 0.40000 2 Central Texas Ambulatory Endoscopy Endoscopy Center 0.18800 0.00000 0.81200 3 Surgical Center at Sun'N Lake LLC Ambulatory Surgery 0.50000 0.00000 0.50000 4 Surgery Management Associates of Kissimmee LLC Management/Admin 0.30000 0.00000 0.70000 11 1 Florida Hospital Orlando 601 E Rollins Street Orlando FL 32803 www.floridahospital.com/orlando 4369 X X X X X X Therapy Center, EPS Cath Lab A 2 Florida Hospital Altamonte 601 E Altamonte Drive Altamonte Springs FL 32701 www.floridahospital.com/altamonte 4369 X X X X Cancer Center, Therapy A 3 Florida Hospital Celebration Health 400 Celebration Place Celebration FL 34747 www.floridahospital.com/celebration-h 4369 X X X X Therapy Center A 4 Winter Park Memorial Hospital 200 N Lakemont Avenue Winter Park FL 32792 www.floridahospital.com/winter-park-m 4369 X X X X A 5 Florida Hospital East Orlando 7727 Lake Underhill Road Orlando FL 32822 www.floridahospital.com/east-orlando 4369 X X X X A 6 FH Heartland Medical Center 4200 Sun N Lake Blvd Sebring FL 33825 www.floridahospital.com/heartland 4171 X X X B 7 Florida Hospital Kissimmee 2450 North Orange Blossom Trail Kissimmee FL 34744 www.floridahospital.com/kissimmee 4369 X X X X A 8 Central Texas Medical Center 1301 Wonder World Drive San Marcos TX 78666 www.ctmc.org 000556 X X X A 9 Florida Hospital Apopka 201 N Park Avenue Apopka FL 32703 www.floridahospital.com/apopka 4369 X X X X A 10 FH Heartland Medical Center Lake Placid 1210 US Highway 27 North Lake Placid FL 33852 www.floridahospital.com/heartland 4171 X X X Senior Behavioral Unit, Outpatient Physical Therapy B 11 Florida Hospital Wauchula 533 W Carlton Street Wauchula FL 33873 www.floridahospital.com/heartland 4239 X X X X Skilled Nursing A GROUP A 0 0 1 X X X X X X X X X 16 1 0 0 1 X See statement X X 1 14 1 See statement 0 1 X 200.000000000000 X X X X 1 1 X X X X 1 X See statement X See statement X See statement X X X X X X 1 X 0 X X X X 1 X 0 0 GROUP B 0 0 1 X X X X X X X X X 16 1 1 0 1 X See statement X X 1 14 1 See statement 0 1 X 200.000000000000 X X X X 1 1 X X X X 1 X See statement X See statement X See statement X X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: Florida Hospital Orlando, - Facility 2: Florida Hospital Altamonte, - Facility 3: Florida Hospital Celebration Health, - Facility 4: Winter Park Memorial Hospital, - Facility 5: Florida Hospital East Orlando, - Facility 7: Florida Hospital Kissimmee, - Facility 8: Central Texas Medical Center, - Facility 9: Florida Hospital Apopka, - Facility 11: Florida Hospital Wauchula Group A-Facility 1 -- Florida Hospital Orlando Part V, Section B, line 5: Florida Hospital Orlando (FHO or the Hospital) is the flagship hospital of the seven hospital campuses that operate under a single hospital license. All seven campuses, collectively, are known as Florida Hospital. Florida Hospital's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. FHO is located in Orange County. FHO has become one of the most trusted and comprehensive hospitals in the region; as a result, the primary service area of the Orlando campus includes all of Orange, Osceola and Seminole Counties. Florida Hospital conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Florida Hospital campuses. The 2016 CHNA conducted for FHO was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.FHO had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within FHO's community/service area. The following organizations participated in FHO's CHNAC and specifically represented low-income, minority and other medically underserved populations:Second Harvest Food Bank a non-profit organization that operates a food bank throughout the six counties that make up most of Central Florida and provides a workforce development program for populations at risk for food insecurity;Aspire Health Partners a non-profit health provider that works to provide behavioral health care services to individuals experiencing mental illness and issues of substance abuse within Orange and Seminole counties;Grace Medical Home a patient-centered medical home that focuses on serving the clinically underserved through the provision of continuous and comprehensive primary care;Orange County Public Health Department, andSeminole County Health Department.To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Survey data was scanned for themes based only on the responses of those from the zip codes included in FHO's primary service area. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants. Group A-Facility 1 -- Florida Hospital Orlando 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. Group A-Facility 1 -- Florida Hospital Orlando Part V, Section B, line 11: The information provided below explains how Florida Hospital Orlando (FHO or the Hospital) 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. FHO 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 (FH) has seven acute-care hospital facilities in Orange, Seminole and Osceola Counties, FL. The tri-county area is often referred to as Central Florida. The seven FH facilities operate under one license but, due to the diverse communities served, FH conducted separate Community Health Needs Assessments and Community Health Plans (implementation strategies) for each FH campus. This narrative describes the Community Health Plan for FHO, a 1,398-bed tertiary medical center in downtown Orlando in Orange County, Florida. FHO chose three areas of focus for its 2013-16 Community Health Plan: Access to Care, Mental Health and Heart Disease/Obesity. This narrative also addresses efforts in Diabetes and Obesity/Disease Prevention. This is the third-year update for FHO's 2013-2016 Community Health Plan/Implementation Strategy. FHO 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, FHO made a notable effort to define and address the needs of low-income, minority and underserved populations in its service area. The 2013 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and hospital stakeholders, who then selected key issues for the Hospital to address in its 2013-2016 Community Health Plan. The three-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2013 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing. Priority: Access to Affordable Health Care 2013 Description of the Issue: Over 24% of people in Central Florida do not have health insurance, and the State of Florida has not accepted federal Medicaid expansion dollars. A number of FHO initiatives linked uninsured and underinsured residents with free or affordable health care. 2016 Update: FHO provided $6 million in financial support for the Primary Care Access Network (PCAN) of Orange County, a dynamic collaborative of 22 safety net providers: Orange County Government, FQHC medical homes, the Health Department, free clinics, community agencies, hospitals and social service entities. PCAN's mission is to improve the access, quality and coordination of health care services to the underinsured and uninsured populations of Orange County. Since 2001, the collaboration has grown from one FQHC medical home with 5,000 patients to 13 FQHCs with 92,000 uninsured patients. Uninsured patients are seen on a sliding fee scale basis (the FQHCs also accept Medicaid, Medicare and private insurance). In addition, 10,300 people with incomes below 125% of the federal poverty level received secondary care at the Orange County Medical Clinic. FHO also provided $100,000 each in financial support to Grace Medical Home (for chronic conditions), Health Care Center for the Homeless (a local FQHC), and Shepherd's Hope (a local free/charitable clinic). FHO operates a no-cost Community After Hours Clinic (now called the Community Medicine Clinic) that saw 3,000 uninsured patients and costs the Hospital over half a million dollars to operate. FHO financially supported the operations of Shepherd's Hope free clinics (that saw 15,000 uninsured patients), provided funding for an electronic medical records system, and recruited over 150 different Florida Hospital employees to volunteer at Shepherd's Hope clinics. FHO also provided financial support to start up the school health clinic at nearby Edgewater High School, which saw over 1300 children free of charge in 2016. FHO provided a funding match for the Healthy Start Coalition of Orange County that serves mothers and infants. FHO's mobile mammogram unit provided 979 free or very low-cost mammograms to uninsured women in 2016. To help build the local health care workforce (and ensure that Central Florida has providers in the future), FHO provided several million dollars in funding for the professional development and education of medical and nursing students from Valencia College, Seminole State College, Adventist University, the University of Central Florida (UCF), and the UCF School of Medicine. These entities also rotate students through multiple clinical departments at FHO. Priority: Mental Health 2013 Description of the Issue: While there are strong mental health and substance abuse providers in the Orange County community, funding for these services is very limited (as is the case throughout Florida). FHO has medical-psychiatric beds, and is the Baker Act Receiving Center for Orange County. 2016 Update: The Florida Hospital Outlook Clinic for Depression & Anxiety provides free comprehensive behavioral evaluation, treatment and case management for uninsured residents of Orange County. In 2016, 1,308 patients received services (the goal was 800), up from 816 in 2015. The Outlook Clinic is in partnership with Orange County Government Health Services, the Mental Health Association of Central Florida, and local universities such as the University of Central Florida and Rollins College. FHO was a co-founder of, and provides major funding for, the Orange County Central Receiving Center (CRC). The CRC provides an alternative to jail or to the Baker Act Receiving Center. Law enforcement officers can bring non-dangerous arrestees to the CRC, a short-term treatment setting for alcohol or drug-impaired arrestees. The County mental health provider, Aspire Behavioral Health Partners (Aspire), operates the CRC. FHO cared for over 2,200 Baker Act patients in 2016. FHO also provides other major funding for Aspire ($1.3 million) as well as financial support for the Mental Health Association of Central Florida ($25k). FHO has representatives working on the Orange County Government SAMHSA Wrap-Around effort to coordinate preventive mental health services for children. Priority: Heart Disease/Obesity 2013 Description of the Issue: Heart Disease is a leading cause of death in Central Florida and across the nation. Risk factors for heart disease include obesity, lack of exercise and smoking. The Florida Heart Institute at FHO offers heart transplantation, surgical and interventional cardiology programs, and a full range of pre- and post-treatment services. Obesity increases the risk for developing health conditions such as heart disease, stroke, diabetes and cancer. Additionally, being overweight or obese increases the risk of adverse health outcomes and has significant economic impacts on individuals and the community. These impacts can include a rise in health care spending over time as well as lost earnings and productivity due to illness. 2016 Update: FHO continued to fund and operate a Congestive Heart Failure (CHF) clinic serving uninsured patients, named the Trina Hidalgo Heart Clinic. It is staffed by FHO ARNPs and is co-located with the Orlando County Medical Clinic (specialty care) noted above. In 2016, the clinic served 1,333 unique patients with 3,549 visits at no cost to the patients. FHO offered many free screenings and community lectures on disease prevention and the warning signs of heart disease. For example, the Mended Hearts Cardiac Support Group held monthly is open to community members and our Distinguished Lecture Series invites the community to hear from top experts in a variety of fields, including heart disease. FHO also holds Chronic Disease Self-Management Programs, an evidenced-based program licensed through Stanford University that teaches participants how to live with chronic disease, including heart disease. FHO contributed $115,000 towards cardiac research and education through the American Heart Association, and FHO had 929 employees participate in the 2016 annual Heart Walk. **see continuation of footnote Group A-Facility 3 -- Florida Hospital Celebration Health Part V, Section B, line 5: Florida Hospital Celebration Health (FHCH or the Hospital) is one of seven campuses that operate under a single hospital license. All seven campuses, collectively, are known as Florida Hospital. Florida Hospital's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. FHCH is located in Osceola County and it primarily serves residents from Osceola County, parts of Orange, Polk, and Lake Counties. Florida Hospital conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Florida Hospital campuses. The 2016 CHNA conducted for FHCH was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.FHCH had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within FHCH's community/service area. The following organizations participated in FHCH's CHNAC and specifically represented low-income, minority and other medically underserved populations:Osceola Council of Aging a non-profit organization with a focus on providing care and essential social services to seniors and families; Healthy Start of Osceola County - an organization that assists families with access to prenatal care and services for infants that promote healthy growth and development, focusing on the socioeconomically disadvantaged and populations that experience health disparities in birth outcomes; Community Vision of Osceola County a community planning non-profit that works to convene regional stakeholders to create a shared vision for a healthy and prosperous Osceola County; Community Hope Center a social service non-profit that works to connect socioeconomically disadvantaged families to essential services with the goal of helping them to become self-sustaining; andThe Osceola County Health Department.To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Survey data was scanned for themes based only on the responses of those from the zip codes included in FHCH's primary service area. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants. Group A-Facility 3 -- Florida Hospital Celebration Health 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. Group A-Facility 3 -- Florida Hospital Celebration Health Part V, Section B, line 11: The information provided below explains how Florida Hospital Celebration Health (FHCH or the Hospital) 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. FHCH 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 (FH) has seven acute-care hospital facilities in Orange, Seminole and Osceola Counties, FL. The tri-county area is often referred to as Central Florida. The seven FH facilities operate under one license but, due to the diverse communities served, FH conducted separate Community Health Needs Assessments and Community Health Plans (implementation strategies) for each FH campus. This narrative describes the Community Health Plan for FHCH, a 237-bed community hospital in the town of Celebration in northwestern Osceola County, Florida. FHCH is 10 miles away from Florida Hospital Kissimmee. Celebration is a planned community originally developed by the Walt Disney Company in the late 1990s. The residents of Celebration are considered upper middle class, but the area around the town is home to many low-income people who work part- or full-time in the tourism industry. This is the third-year update for FHCH's 2013-2016 Community Health Plan/Implementation Strategy. FHCH 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, FHCH made a notable effort to define and address the needs of low-income, minority and underserved populations in its service area. The 2013 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2013-2016 Community Health Plan. The three-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2013 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing. FHCH chose two areas of focus for its 2013-16 Community Health Plan: Obesity/Diabetes and Maternal and Child Health. FHCH is also deeply involved in Access to Care initiatives for the County's uninsured residents. Accordingly, the narrative below describes the actions taken by FHCH with respect to Access to Care issues. Priority: Obesity/Diabetes 2013 Description of the Issue: Obesity increases the risk for developing health conditions such as heart disease, stroke, diabetes, and cancer - and the comorbidities that often accompany these diseases. Additionally, being overweight or obese increases the risk of adverse health outcomes and has significant economic impacts on individuals and the community. These impacts can include a rise in health care spending over time as well as lost earnings and productivity due to illness. Good nutrition, physical activity, and maintaining a healthy body weight can help manage/prevent obesity and promote overall health and well-being. 2016 Update: FHCH's obesity/chronic disease interventions targeted both adults and children. FHCH partnered with local organizations to deliver weekend food to children who qualify for free or reduced lunch per the school district ($40,000 in funding support in 2016). FHCH facilitated and hosted an event to package food items for children and families, and supported education initiatives around the 5-2-1-0 Let's Go campaign in Osceola County Schools. Let's Go! is a nationally recognized childhood obesity prevention effort that works with schools, child care and out-of-school programs, and community organizations. The programs promote the 5-2-1-0 formula: five or more fruits and vegetables, 2 hours less recreational screen time, 1 hour more of physical activity and 0 sugary drinks (and more water). CREATION Health lifestyle seminars and expanded programs were offered at FHCH and in community settings. CREATION Health is a faith-based wellness plan that focuses on eight principles: Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook and Nutrition. CREATION Kids is a child-friendly wellness program that stresses healthy eating and exercise in church and school settings; it reached 766 children and their parents in 2016. To increase opportunities for leisure time physical activity, FHCH sponsored several races including the Town of Celebration Marathon and half-marathon events, with proceeds going to a scholarship fund for Osceola County high school seniors ($15,000 in support in 2016). FHCH also supported the annual American Heart Association Heart Walk with a corporate sponsorship of $115,000 plus an additional $215,000 raised by employees who participated in the event (227 employees from FHCH signed up to participate). Priority: Maternal and Child Health 2013 Description of the Issue: Pre-term and low birthweight rates in Osceola County were comparable or lower than Orange and Seminole Counties, as was the rate of receiving prenatal care in the first trimester. All indicators meet the Healthy People 2020 goals. 2016 Update: While some of the babies delivered at FHCH came from middle- or upper-income families, many did not. FHCH's service area includes the rural, very low-income community of Intercession City and its surrounding area. FHCH participated in efforts to reduce cesarean births at all Florida Hospital campuses. FHCH also put a strong emphasis on increasing the number of women who are breastfeeding exclusively at the time of discharge. A wide range of parent education classes are available; most are open to the public. Florida Hospital provided a funding match for the Healthy Start Coalition that serves mothers and infants. Additionally, Florida Hospital's mobile mammogram unit provided 979 free or very low-cost mammograms to uninsured women in 2016. Staff from FHCH served on the Fetal Infant Mortality Review Committee on the Closing the Gap grant administered by the Florida Department of Health in Osceola County. The Committee studied data and proposed solutions to improve infant health outcomes for County residents. Priority: Access to Care 2013 Description of the Issue: Access to comprehensive, quality health care is important for increasing the quality of life. Osceola County has the highest rate of uninsured in Central Florida - over 30%. The County is 50% Hispanic and across the nation, Hispanics have much higher rates of being uninsured. 2016 Update: FHCH is one of the founders and active members of the Osceola Health Leadership Council sponsored by Community Vision. Since 1995, Community Vision has worked to bring public, private and faith sectors together in partnerships to create solutions for Osceola County's many challenges. Florida Hospital was a founder of Community Vision, and Florida Hospital, through its Community Health Impact Council, established an endowment that funds the agency's health leadership efforts. The Health Leadership Council members represent the four hospitals in the County (two are Florida Hospital facilities), the Health Department, free clinics, the Council on Aging and others. Their work has led to better coordination among safety net providers, the expansion of the County's network of Federally Qualified Health Centers (FQHCs), the establishment of the County's free clinics, and a specialty care referral network. FHCH and Florida Hospital Kissimmee financially supported a number of free/affordable health care resources for uninsured County residents. This included the Council on Aging free chronic care clinic (for uninsured adults of all ages), the free diabetes program at the Council on Aging clinic (109 participants in 2016), and the no-cost secondary care referral system for the County's free clinics. The Council on Aging clinic served 2,165 people in 2016; as many as 50% were of Hispanic origin. FHCH also provided financial support to help un- and underinsured people to garner referrals and enrollment assistance for the FQHC medical homes in St. Cloud, Kissimmee, Poinciana, and Intercession City (four miles from Celebration). **see continuation of footnote Group A-Facility 2 -- Florida Hospital Altamonte Part V, Section B, line 5: Florida Hospital Altamonte (FHAlt or the Hospital) is one of seven campuses that operate under a single hospital license. All seven campuses, collectively, are known as Florida Hospital. Florida Hospital's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. FHAlt is located in Seminole County and its primary service area encompasses almost all of Seminole County. Florida Hospital conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Florida Hospital campuses. The 2016 CHNA conducted for FHAlt was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.FHAlt had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within FHAlt's community/service area. The following organizations participated in FHAlt's CHNAC and specifically represented low-income, minority and other medically underserved populations:Kids House a local child abuse prevention and treatment organization that works with regional social service agencies, the criminal justice system, and local health systems to better the lives of Central Florida's children;Healthy Start of Seminole County an organization that assists families with access to prenatal care and services for infants that promote healthy growth and development, focusing on the socioeconomically disadvantaged and populations that experience health disparities in birth outcomes; Seminole Prevention Coalition a coalition of public and private stakeholders that collectively work to promote a safe and drug-free Seminole County through evidence-based prevention initiatives that focus on issues of substance abuse and mental health;True Health a multi-county Federally Qualified Health Center that provides access to care for low-income, uninsured, underinsured and underserved populations in Seminole and Orange Counties regardless of ability to pay; and The Department of Health in Seminole County. To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants. Group A-Facility 2 -- Florida Hospital Altamonte 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. Group A-Facility 2 -- Florida Hospital Altamonte Part V, Section B, line 11: The information provided below explains how Florida Hospital Altamonte (FHAlt or the Hospital) 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. FHAlt 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 (FH) has seven acute-care hospital facilities in Orange, Seminole and Osceola Counties, FL. The tri-county area is often referred to as Central Florida. The seven FH facilities operate under one license but, due to the diverse communities served, FH conducted separate Community Health Needs Assessments and Community Health Plans/Implementation Strategies for each FH campus. This narrative describes the Community Health Plan for FHAlt , a 398-bed community hospital in Altamonte Springs, a northern suburb of Orlando, Florida. FHAlt is located in Seminole County, which is more affluent than Orange and Osceola Counties (in which six other Florida Hospital facilities are located), however Seminole County still has many pockets of vulnerable populations. This is the third-year update for FHAlt's 2013-2016 Community Health Plan/Implementation Strategy. FHAlt 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, FHAlt made a particular effort to define and address the needs of low-income, minority and underserved populations in its service area. The 2013 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2013-2016 Community Health Plan. The three-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2013 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing. FHAlt chose two areas of focus for its 2013-16 Community Health Plan: Access to Care and Obesity. The Obesity effort also addresses the prevention and management of Chronic Diseases. Priority: Access to Care 2013 Description of the Issue: The state of Florida has not accepted federal Medicaid expansion dollars, leaving 17.4% of Seminole County residents without health insurance. While this is lower than the overall Central Florida rate of 24%, Seminole County has pockets of uninsured residents, particularly in Sanford, the County seat. 2016 Update: FHAlt provides financial support ($100k annually) to the Health Care Center for the Homeless (HCCH) which operates, among others, a medical and dental facility at Harvest Time International in Sanford. HCCH is a federally qualified health center (FQHC) that treats uninsured patients on a sliding fee scale basis, and accepts Medicaid, Medicare and most insurance. FHAlt also supports HCCH's HOPE van and the HOPE team which provides behavioral health services to homeless people living in camps in the woods. FHAlt has worked for many years with the True Health FQHC in Sanford on referrals between each entity and participates in their annual fundraising event at the $5k level. Florida Hospital provided financial support ($100k annually) for operations to Shepherd's Hope, which operates, among others, a free clinic in Longwood in Seminole County. This clinic is located at the Seminole Sharing Center that provides a food pantry, clothing boutique, and social services for the working poor, as well as the Oasis Center for homeless people (which includes showers and other amenities). FHAlt funds also helped Shepherd's Hope build a new electronic medical records system, and FHAlt staff recruited over 150 different Florida Hospital employees to volunteer at Shepherd's Hope clinics including the new Longwood location. Florida Hospital Orlando's Community After Hours Clinic (now called the Community Medicine Clinic), Congestive Heart Failure Clinic (now called the Trina Hidalgo Heart Clinic), Lung Clinic and Outlook Clinic for Depression & Anxiety are located adjacent to Orange County but also serve Seminole County residents. These clinics provide care at no cost to their patients. Over the period of this Health Plan, Florida Hospital spent over half a million dollars annually to operate these access to care initiatives and served over 8,000 patients. FHAlt provides leadership (via board membership) and full salary support for several clinical staff at Kids' House of Seminole and its Children's Advocacy Center. Kids' House provides services to victims of child abuse and their families, as well as prevention programs. In 2016, the Hospital helped support Kids' House with $287,000 in costs. FHAlt also provided a funding match for the Healthy Start Coalition of Seminole County that serves mothers and infants at $78,500 annually. Florida Hospital's mobile mammogram unit provided 979 free or very low-cost mammograms to uninsured women, including those in Seminole County. Florida Hospital financially supports ($50k in 2016), IDignity, a nonprofit agency that helps homeless people without identification to get IDs. IDignity serves both Seminole and Orange Counties. In order to help build the local health care workforce (and ensure that Central Florida has providers in the future), FHAlt provided funding for the professional development and education of medical and nursing students from Valencia College, Seminole State College, Adventist University, the University of Central Florida (UCF), and the UCF School of Medicine. These entities, particularly Seminole State College, rotate students through clinical departments at FHAlt. Altogether, Florida Hospital contributed $32 million in 2016 to clinical workforce development and education. Priority: Obesity / Chronic Disease Prevention 2013 Description of the Issue: Obesity increases the risk for developing health conditions such as heart disease, stroke, diabetes and cancer. Additionally, being overweight or obese increases the risk of adverse health outcomes and has significant economic impacts on individuals and the community. These impacts can include a rise in health care spending over time as well as lost earnings and productivity due to illness. Good nutrition, physical activity, and maintaining a healthy body weight can help manage/prevent obesity and promote overall health and well-being. FHAlt's obesity interventions were designed to serve both children and adults. 2016 Update: Florida Hospital partnered with the Winter Park Health Foundation to co-found "Healthy Central Florida," an initiative that promotes healthy living and influences policy changes such as smoke-free resolutions. Healthy Central Florida also offered healthy lifestyle events in Winter Park (north Orange and South Seminole Counties) and Maitland, which straddles Seminole and Orange Counties. Examples include events that promoted a healthy lifestyle, exercise, good nutrition, and the establishment of smoke-free and safe pedestrian resolutions in Winter Park and other communities. Activities included the Maitland Walks program. Altogether, Florida Hospital contributed $290,000 to Healthy Central Florida in 2016. CREATION Health lifestyle seminars and expanded programs were offered at FHAlt and in community settings. CREATION Health is a faith-based wellness plan that focuses on eight principles: Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook and Nutrition. CREATION Kids (formally called Healthy 100 Kids) is a child-friendly wellness program that stresses healthy eating and exercise in church and school settings; it reached 766 children and their parents. To increase opportunities for leisure time physical activity, FHAlt raised funds for groups such as the American Heart Association (the Heart Walk enlisted 277 FHAlt employees). As a system, Florida Hospital employees raised $215k in 2016.**see continuation of footnote Group A-Facility 5 -- Florida Hospital East Orlando Part V, Section B, line 5: Florida Hospital East Orlando (FHEO or the Hospital) is one of seven campuses that operate under a single hospital license. All seven campuses, collectively, are known as Florida Hospital. Florida Hospital's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. FHEO is located in Orange County and primarily serves the residents of eastern Orange County. Florida Hospital conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Florida Hospital campuses. The 2016 CHNA conducted for FHEO was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.FHEO had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within FHEO's community/service area. The following organizations participated in FHEO's CHNAC and specifically represented low-income, minority and other medically underserved populations:True Health - a multi-county Federally Qualified Health Center that provides access to care for low-income, uninsured, underinsured and underserved populations in Seminole and Orange Counties regardless of ability to pay;Catholic Charities of Central Florida this non-profit organization works to connect vulnerable populations to comprehensive social services;FHEO Community Advisory Council an advisory council that brings together community leaders to acquire valuable input on the region;Latino Leadership a grassroots organization dedicated to unique needs of the Hispanic community within the greater Central Florida area; andOrange County Public Health Department. To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Survey data was scanned for themes based only on the responses of those from the zip codes included in FHEO's primary service area. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants. Group A-Facility 5 -- Florida Hospital East Orlando 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. Group A-Facility 5 -- Florida Hospital East Orlando Part V, Section B, line 11: The information provided below explains how Florida Hospital East Orlando (FHEO or the Hospital) 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. FHEO 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 (FH) has seven acute-care hospital facilities in Orange, Seminole and Osceola Counties, FL. The tri-county area is often referred to as Central Florida. The seven FH facilities operate under one license but, due to the diverse communities served, FH conducted separate Community Health Needs Assessments and Community Health Plans/Implementation Strategies for each FH campus. This narrative describes the Community Health Plan for FHEO, a 295-bed community hospital on the eastern side of the Orlando metro area. FHEO is located in Orange County, which is more urban than Seminole and Osceola Counties (in which six other Florida Hospital facilities are located), thus there are many pockets of vulnerable populations. This is the third-year update for FHEO's 2013-2016 Community Health Plan/Implementation Strategy. FHEO 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, FHEO made a notable effort to define and address the needs of low-income, minority and underserved populations in its service area. The 2013 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2013-2016 Community Health Plan. The three-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2013 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing. FHEO chose five areas of focus for their 2013-2016 Community Health Plan: Obesity, Diabetes, Access to Care, Mental Health and Social Determinants of Health/Health Disparities. Priority: Obesity 2013 Description of the Issue: Obesity negatively affects people's quality of life and increases the risk for developing health conditions such as heart disease, stroke, diabetes, and cancer - and the comorbidities that often accompany these diseases. Additionally, being overweight or obese increases the risk of adverse health outcomes and has significant economic impacts on individuals and the community. These impacts can include a rise in health care spending over time as well as lost earnings and productivity due to illness. Several factors influence the likelihood of obesity including individual behavior, the social and built environment, and genetic heritability. As a result, being overweight or obese is a complex health issue to address. 2016 Update: Good nutrition, physical activity, and maintaining a healthy body weight can help manage/prevent obesity and promote overall health and well-being. FHEO 's obesity interventions target both adults and children. The interventions undertaken by FHEO include: - Implementing and supporting positive nutritional and exercise instruction within the primary service area through the Mission FIT Possible program in local schools (3,906 children completed the program in 2016); - Increasing the availability of fruits to children and through support of a mobile farmer's market that actively travels to regions identified as food deserts (9,035 customers were served in 2016); - Funding efforts to reduce heart related conditions though the funding of research and programs via financial support and board membership on the American Heart Association (Florida Hospital donated $115,000 to the American Heart Association in 2016, and our employees raised an additional $215,000 for their annual Heart Walk); and - Creation Health faith-based wellness plan that focuses on eight principles: Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook and Nutrition. CREATION Health lifestyle seminars and expanded programs are offered at all Florida Hospital locations and in community settings (The CREATION Kids program had 766 children participate in 2016). Priority: Diabetes 2013 Description of the Issue: Diabetes can lead to the development of serious and disabling complications if not properly treated. Complications include heart disease and stroke, high blood pressure, blindness, kidney disease, and limb amputation. According to the American Diabetes Association, it is possible to prevent or delay diabetic complications through a healthy diet, physical activity, and maintaining a healthy weight and glucose levels. 2016 Update: FHEO 's diabetes engagement interventions include: - Continuing to offer the Cuidate program based on the Stanford chronic disease self-management program, as the East Orlando community is nearly 50% Hispanic, the CDC-recommended classes are offered in both Spanish and English (465 community members graduated from the program in 2016); and - The Bridge Program intensive case management model that helps uninsured, high-user patients with chronic conditions was a major part of the East Orlando community health plan. The Bridge team helped patients enroll in affordable FQHC Medical Homes, compassionate drug programs, and community resources that improve health, disease management skills, and quality of life. Unfortunately, this program was cancelled due to lack of resources in March of 2016, however it is being replaced by a similar program in 2017 (44 patients were helped by the Bridge program in 2016). Priority: Access to Care 2013 Description of the Issue: Over 24% of people in Central Florida do not have health insurance, and the State of Florida has not accepted federal Medicaid expansion dollars. 2016 Update: A number of FHEO initiatives educate and link underserved community members to free or affordable health resources: - Operating the Community After Hours Clinic (now called the Community Medicine Clinic) that provides care to uninsured and underinsured people (Florida Hospital spent $536,305 operating this clinic in 2016); - Financially supporting and leading the Primary Care Access Network (PCAN) integrated system of health care for uninsured and underinsured people in Orange County (PCAN had 111,000 primary care patients in 15 FQHC medical homes in 2016); - Encouraging medical home enrollment by making appointments or referring uninsured and underinsured emergency department patients and inpatients to PCAN FQHCs (70 appointments were made at PCAN FQHCs through the Bridge Program in 2016); - Providing financial support to Shepherd's Hope free clinics ($110,000 donated in 2016); - Providing financial support for the Health Care Center for the Homeless ($100,000 donated in 2016); - Providing financial support for Grace Medical Home, a chronic care medical home for uninsured people ($100,000 donated in 2016); - Increasing the availability of free or low-cost mammograms for uninsured and underinsured women via the mobile mammogram unit and Florida Hospital diagnostics centers (979 uninsured women were given free or reduced-cost mammograms on the mobile unit in 2016); and - Supporting the education and training of medical practitioners through the FH Residency programs and Adventist University, and through partnerships with the UCF and FSU Medical Schools (185 residency slots in 2016). **see continuation of footnote Group A-Facility 4 -- Winter Park Memorial Hospital Part V, Section B, line 5: Winter Park Memorial Hospital (WPMH or the Hospital) is one of seven campuses that operate under a single hospital license. All seven campuses, collectively, are known as Florida Hospital. Florida Hospital's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. WPMH is located in Orange County and it primarily serves the residents of northwestern and central Orange County and extends into southern Seminole County. Florida Hospital conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Florida Hospital campuses. The 2016 CHNA conducted for WPMH was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.WPMH had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within WPMH's community/service area. The following organizations participated in WPMH's CHNAC and specifically represented low-income, minority and other medically underserved populations:Healthy Start of Orange County - - an organization that assists families with access to prenatal care and services for infants that promote healthy growth and development, focusing on the socioeconomically disadvantaged and populations that experience health disparities in birth outcomes; Healthy Central Florida an organization that works to promote positive behavioral and connected communities through community based partnerships and activities;Hebni Nutrition Consultants a community based organization that works to reduce health disparities through culturally appropriate nutrition education and health promotion; andOrange County Health Department.To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Survey data was scanned for themes based only on the responses of those from the zip codes included in WPMH's primary service area. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants. Group A-Facility 4 -- Winter Park Memorial 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. Group A-Facility 4 -- Winter Park Memorial Hospital Part V, Section B, line 11: The information provided below explains how Winter Park Memorial Hospital (WPMH or the Hospital) 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. WPMH 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 (FH) has seven acute-care hospital facilities in Orange, Seminole and Osceola Counties, FL. The tri-county area is often referred to as Central Florida. The seven FH facilities operate under one license but, due to the diverse communities served, FH conducted separate Community Health Needs Assessments and Community Health Plans (implementation strategies) for each FH campus. This narrative describes the Community Health Plan for WPMH, a 320-bed community hospital. WPMH is located in a suburb of Orlando, and shares much of the same service area with Florida Hospital Orlando and Florida Hospital East Orlando in Orange County. This is the third-year update for WPMH's 2013-2016 Community Health Plan/Implementation Strategy. WPMH 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, WPMH made a notable effort to define and address the needs of low-income, minority and underserved populations in its service area. The 2013 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2013-2016 Community Health Plan. The three-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2013 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing. WPMH chose three areas of focus for its 2013-16 Community Health Plan: Obesity/Chronic Disease, Access to Care and Diabetes. Priority: Obesity & Chronic Disease Prevention 2013 Description of the Issue: Obesity increases the risk for developing health conditions such as heart disease, stroke, diabetes and cancer. Additionally, being overweight or obese increases the risk of adverse health outcomes and has significant economic impacts on individuals and the community. These impacts can include a rise in health care spending over time as well as lost earnings and productivity due to illness. Good nutrition, physical activity, and maintaining a healthy body weight can help manage/prevent obesity and promote overall health and well-being. WPMH's obesity and disease prevention interventions were designed to serve both adults and children. 2016 Update: Florida Hospital partnered with the Winter Park Health Foundation to co-found "Healthy Central Florida," an initiative that supports healthy living and influences policy changes such as smoke-free resolutions. Healthy Central Florida also offers numerous community events that promote a healthy lifestyle, exercise, good nutrition, and the establishment of smoke-free and safe pedestrian resolutions in Winter Park and the community. Examples of events included Bike to Work Day, International Walk (or Bike) to School Day, Move 60 and nutrition seminars with national experts. These programs are offered at no cost. Over 1,000 Winter Park residents participated in these programs in 2016 alone. The CEO of WPMH was also the Mayor of Winter Park in 2015, so additional walking efforts included: Walk and Talk with the Mayor, Walk with a Doc, the Mayor's Sole Challenge, and Maitland Walks. The Walk and Roll (walking school bus) program reached over 2000 elementary school students in 2016. Again, there was no charge for these activities. With community partners, Florida Hospital served over 9,000 people in 2016 with a Mobile Farmers Market that offered fresh fruits and vegetables, cooking demos and nutritional educational opportunities. Most mobile visits were in identified food deserts. Florida Hospital also provided financial support to the Edible Education Experience, a local nonprofit focused on teaching kids where their food comes from, how to grow their own fruits and vegetables, and how to prepare them. CREATION Health lifestyle seminars and expanded programs were offered at WPMH and in community settings. CREATION Health is a faith-based wellness plan that focuses on eight principles: Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook and Nutrition. CREATION Kids is a child-friendly wellness program that stresses healthy eating and exercise in church and school settings; it reached 766 children and their parents in 2016. To increase opportunities for leisure time physical activity, WPMH supported the annual American Heart Association Heart Walk with a corporate sponsorship of $115,000 plus an additional $215,000 raised by employees who participated in the event (263 employees from WPMH signed up to participate). Priority Issue: Access to Care 2013 Description of the Issue: Over 24% of people in Central Florida do not have health insurance, and the State of Florida has not accepted federal Medicaid expansion dollars. A number of Florida Hospital (including WPMH) initiatives linked uninsured and underinsured residents with free or affordable health care. 2016 Update: Florida Hospital provided $6 million in financial support for the Primary Care Access Network (PCAN) of Orange County, a dynamic collaborative of 22 safety net providers: Orange County Government, FQHC medical homes, the Health Department, free clinics, community agencies, hospitals and social service entities. PCAN's mission is to improve the access, quality and coordination of health care services to the underinsured and uninsured populations of Orange County. Since 2001, the collaboration has grown from one FQHC medical home with 5,000 patients to 13 FQHCs with 92,000 uninsured patients. Uninsured patients are seen on a sliding fee scale basis (the FQHCs also accept Medicaid, Medicare and private insurance). In addition, 10,300 people with incomes below 125% of the federal poverty level received secondary care at the Orange County Medical Clinic. Florida Hospital also provided $100,000 each in financial support to Grace Medical Home (for chronic conditions), Health Care Center for the Homeless (a local FQHC), and Shepherd's Hope (a local free/charitable clinic). Florida Hospital operates a no-cost Community After Hours Clinic (now called the Community Medicine Clinic) that saw 3,000 uninsured patients and costs the hospital over half a million dollars to operate. Florida Hospital financially supported the operations of Shepherd's Hope free clinics (that saw 15,000 uninsured patients), provided funding for an electronic medical records system, and recruited over 150 different Florida Hospital employees to volunteer at Shepherd's Hope clinics. Financial support was also provided to fund the school health clinic at nearby Edgewater High School, which saw over 1,300 children free of charge in 2016. Florida Hospital provided a funding match for the Healthy Start Coalition of Orange County that serves mothers and infants. Florida Hospital's mobile mammogram unit provided 979 free or very low-cost mammograms to uninsured women in 2016. To help build the local health care workforce (and ensure that Central Florida has providers in the future), Florida Hospital provided several million dollars in funding for the professional development and education of medical and nursing students from Valencia College, Seminole State College, Adventist University, the University of Central Florida (UCF), and the UCF School of Medicine. These entities also rotate students through clinical departments at WPMH. **see continuation of footnote Group A-Facility 7 -- Florida Hospital Kissimmee Part V, Section B, line 5: Florida Hospital Kissimmee (FHK or the Hospital) is one of seven campuses that operate under a single hospital license. All seven campuses, collectively, are known as Florida Hospital. Florida Hospital's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. FHK is located in Osceola County and it primarily serves residents throughout Osceola County with a primary service area of South Orlando, Kissimmee, and Poinciana. Florida Hospital conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Florida Hospital campuses. The 2016 CHNA conducted for FHK was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.FHK had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within FHK's community/service area. The following organizations participated in FHK's CHNAC and specifically represented low-income, minority and other medically underserved populations:Osceola Council of Aging a non-profit organization with a focus on providing care and essential social services to seniors and families; Healthy Start of Osceola County - an organization that assists families with access to prenatal care and services for infants that promote healthy growth and development, focusing on the socioeconomically disadvantaged and populations that experience health disparities in birth outcomes; Community Vision of Osceola County a community planning non-profit that works to convene regional stakeholders to create a shared vision for a healthy and prosperous Osceola County; Community Hope Center a social service non-profit that works to connect socioeconomically disadvantaged families to essential services with the goal of helping them to become self-sustaining; andThe Osceola County Health Department.To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Survey data was scanned for themes based only on the responses of those from the zip codes included in FHK's primary service area. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants. Group A-Facility 7 -- Florida Hospital Kissimmee 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. Group A-Facility 7 -- Florida Hospital Kissimmee Part V, Section B, line 11: The information provided below explains how Florida Hospital Kissimmee (FHK or the Hospital) 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. FHK 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 (FH) has seven acute-care hospital facilities in Orange, Seminole and Osceola Counties, FL. The tri-county area is often referred to as Central Florida. The seven FH facilities operate under one license but, due to the diverse communities served, FH conducted separate Community Health Needs Assessments and Community Health Plans (implementation strategies) for each FH campus. This narrative describes the Community Health Plan for FHK, a 162-bed community hospital in the city of Kissimmee in north central Osceola County, Florida. FHK is 10 miles from Florida Hospital Celebration Health, also in Osceola County. Osceola County is a bedroom community to Orlando, and houses many residents who work part- or full-time in the tourism industry. Approximately 62% of Kissimmee residents are of Hispanic descent. Overall, health outcomes and income levels in Osceola County are the lowest in Central Florida. This is the third-year update for FHK's 2013-2016 Community Health Plan/Implementation Strategy. FHK 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, FHK made a notable effort to define and address the needs of low-income, minority and underserved populations in its service area. The 2013 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2013-2016 Community Health Plan. The three-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2013 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing. FHK chose three areas of focus for its 2013-16 Community Health Plan: Access to Care, Obesity/Heart Disease/Diabetes, and Violent Crime. Priority: Access to Care 2013 Description of the Issue: Access to comprehensive, quality health care is important for increasing the quality of life. Osceola County has the highest rate of uninsured in Central Florida - over 30%. The County is over 60% Hispanic and across the nation, Hispanics have much higher rates of being uninsured. 2016 Update: FHK is one of the founders and active members of the Osceola Health Leadership Council sponsored by Community Vision. Since 1995, Community Vision has worked to bring public, private and faith sectors together in partnerships to create solutions for Osceola County's many challenges. Florida Hospital was a founder of Community Vision, and Florida Hospital, through its Community Health Impact Council, established an endowment that funds the agency's health leadership efforts. The Health Leadership Council members represent the four hospitals in the County (two are Florida Hospital facilities), the Health Department, free clinics, the Osceola Council on Aging and others. Their work has led to better coordination among safety net providers, the expansion of the County's network of Federally Qualified Health Centers (FQHCs), the establishment of the County's free clinics, and a specialty care referral network. FHK and Florida Hospital Celebration Health financially supported several free/affordable health care resources for uninsured County residents. This included the Council on Aging free chronic care clinic (for uninsured adults of all ages), the free diabetes program at the Council on Aging clinic (109 participants in 2016), and the no-cost secondary care referral system for the County's free clinics. The Council on Aging clinic served 2,165 people in 2016; as many as 50% were of Hispanic origin. FHK also provided financial support to help uninsured and underinsured people to garner referrals and enrollment assistance for the FQHC medical homes in St. Cloud, Kissimmee, Poinciana, and Intercession City. FHK and Florida Hospital Celebration Health were founders of the Community Hope Center. The Hope Center serves low-income, poverty-level families who are homeless or live in motels along Highway 192 in western Osceola County. The Center is a community collaboration whose key partners include Community Presbyterian Church of Celebration, Osceola Council on Aging, Park Place Behavioral Health, Community Vision and Florida Hospital. In 2015, the Health Care Center for the Homeless (HCCH) opened a new FQHC at the Hope Center. Florida Hospital provided start-up funding for the clinic and contributes $100,000 annually to HCCH for daily operations. In addition, FHK supported the education and training of medical practitioners at UCF Medical School, the TECO (Technical Education Center of Osceola) nursing and other health professions programs, and the Valencia College Nursing program. Many of these students participated in clinical rotations at FHK and Florida Hospital Celebration Health. Florida Hospital provided a funding match for the Healthy Start Coalition that serves mothers and infants. Additionally, Florida Hospital's mobile mammogram unit provided 979 free or very low-cost mammograms to uninsured women in 2016. Priority: Chronic Disease: Obesity / Heart Disease/Diabetes 2013 Description of the Issue: FHK 's Community Health Needs Assessment showed that 31.9% of Osceola County residents are obese compared to 27.9% in Orange County and 26.4% in Seminole County. Rates of heart disease and stroke are also far higher than the rest of Central Florida, and the rate of hospitalization for diabetes is 3,273 per 100,000 (higher than Orange and Seminole Counties). Obesity increases the risk for chronic health conditions such as heart disease, stroke, diabetes and cancer - and the comorbidities that often accompany these diseases. Additionally, being overweight or obese increases the risk of adverse health outcomes and has significant economic impacts on individuals and the community. These impacts can include a rise in health care spending over time as well as lost earnings and productivity due to illness. Poverty is one of the drivers of obesity. 2016 Update: FHK 's obesity/chronic disease interventions targeted both adults and children. FHK partnered with local organizations to deliver weekend food to children who qualify for free or reduced lunch per the school district ($40,000 in funding support in 2016). FHK facilitated and hosted an event to package food items for children and families, and supported education initiatives around the 5-2-1-0 Let's Go campaign in Osceola County Schools. Let's Go! is a nationally recognized childhood obesity prevention effort that works with schools, child care and out-of-school programs, and community organizations. The programs promote the 5-2-1-0 formula: five or more fruits and vegetables, 2 hours less recreational screen time, 1 hour more of physical activity and 0 sugary drinks (and more water). CREATION Health lifestyle seminars and expanded programs were offered at FHK and in community settings. CREATION Health is a faith-based wellness plan that focuses on eight principles: Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook and Nutrition. CREATION Kids is a child-friendly wellness program that stresses healthy eating and exercise in church and school settings; it reached 766 children and their parents in 2016. **see continuation of footnote Group A-Facility 8 -- Central Texas Medical Center Part V, Section B, line 5: Central Texas Medical Center (CTMC or the Hospital) is a 178-bed hospital located in San Marcos, Texas. The Hospital's service area consists of Hay County, Caldwell County, and Comal County. 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 Hospitals' primary service area. Key members of the CHNAC included representatives from Texas State University, Student Health Center, the San Marcos Consolidated Independent School District, the San Marcos City Council, the Hays County Commission Court, EL Buen Pastor Methodist Church, and the Schieb Center, a non-profit organization providing mental health services mainly to those without insurance and those on Medicaid. CTMC also gathered primary data through focus groups, interviews, and an online survey. An external party conducted ten interviews and one focus group on behalf of the Hospital to gather input from individuals who represented the broad interests of the community. The key stakeholders included nonprofit leaders, health department authorities, public school leaders, healthcare providers or leaders, elected officials, researchers, people representing distinct geographic areas, and people representing certain ethic/racial groups. Group A-Facility 8 -- Central Texas Medical Center 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. Group A-Facility 8 -- Central Texas Medical Center Part V, Section B, line 11: The information provided below explains how Central Texas Medical Center (CTMC or the Hospital) 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. CTMC 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. CTMC is part of the Adventist Health System's Southwest Region. This is the third-year update for CTMC's 2013-2016 Community Health Plan/Implementation Strategy. CTMC 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, CTMC made a notable effort to define and address the needs of low-income, minority and underserved populations in its service area. The 2013 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and hospital stakeholders, who then selected key issues for the Hospital to address in its 2013-2016 Community Health Plan. The three-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2013 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing. A. Priority: Accessing the right level of care, in the right setting, at the right time: rate of uninsured CTMC interventions include:Live Oaks Health Partners Community Clinic (LOHP-CC or the Clinic) is CTMC's multi-specialty medical practice. It serves insured and uninsured patients at six locations. In 2016, the planned interventions included the expansion of services to uninsured patients. 1) Goal: Increase capacity at LOHP-CC so low-income patients have access to primary care services in a clinic setting vs. accessing non-urgent care via hospital emergency departments. Goal: 550 available encounters per month. - 2016 Actual: 574 encounters per month. The Clinic continues to meet the growing primary care needs of low-come, uninsured residents in the Hospital's community. The hiring of a primary care physician in 2014 has been essential to this growth. Clinic renovations and increased hours created improved workflows and enhanced patient satisfaction. We fully anticipate that our patient base will continue to expand. Cost: $2,471,553 Matching: $110,000 2) Goal: Create physician access at LOHP-CC for uninsured patients with complex medical conditions. Goal: Offer at least 30 available appointments per week. -2016 Actual: 160 available appointments per week. The number of available appointments in 2016 far exceeded expectations. The clinic's physician, who is both a family practitioner and obstetrician, limited the number of OB deliveries in 2016 so he could expand his clinic hours and availability. This positively impacted patient access. Additionally, this has enhanced the care for complex patients that need consistent follow-up access to their physician. Cost: $25,000 3) Goal: Increase the number of uninsured patients receiving prescription assistance at LOHP-CC to at least 250 patients. Goal: 310 patients enrolled. - 2016 Actual: 122 patients enrolled. We had a much lower number of patients accessing this program in 2016 and we are not sure why. In partnership with many pharmaceutical companies, this program has been instrumental to the needs of our patients, especially those with chronic conditions. This enables physicians to better manage their patients and foster better compliance. We will continue to provide this service and ensure that all eligible patients take advantage of this service. Cost: $165,895 4) Goal: Offer discounted lab and radiology diagnostic services at CTMC for LOHP-CC patients. Goal: 750 encounters. - 2016 Actual: 606 encounters. Over the three years of the plan, we continued to see steady growth in the number of patients accessing discounted diagnostic services at CTMC. In large part this is due to an increased patient panel at Live Oak Health Partners Community Clinic (LOHP-CC). This program has been critical to our physicians as patient diagnosis and/or compliance is very dependent on diagnostic tests. Cost: $71,800 5) Goal: Distribute at least 100 vouchers for free mammograms. - 2016 Actual: 54 vouchers redeemed. This initiative saw a declining trend over the plan's three years. This is partially due to a decline in referrals from a community social service agency. Additionally, our patient navigator primarily focused on assisting women with a diagnosis of breast cancer vs. community outreach promoting screening mammograms. Going forward, a plan has been re-established so our CTMC patient navigator will conduct community outreach promoting the importance of screening mammograms. Cost: $14,365 6) Goal: Recruit primary care physicians to establish practices in Hays and/or Caldwell Counties (Medically Underserved Areas that have challenges attracting new physicians). Goal: Recruit at least 1 PCP. - 2016 Actual: 1 PCP recruited. Our three-year goal was to recruit a total of 2 primary care physicians to our community. We well exceeded this goal by recruiting 4 primary care physicians over the course of the health plan. This was a critical achievement as population growth coupled with a shortage of primary care physicians has made timely access to primary care services a challenge. The addition of these physicians will be significant for our community. Cost: $1,635,332 7) Goal: Collaborate with at least two area school counselors to increase participation in the CTMC Hospital Grief Center's Camp HeartSong and Camp HeartSong Too. Goal: 61 in Camp HeartSong and 9 in Camp HeartSong Too: - 2016 Actual: 24 in Camp HeartSong/Camp HeartSong Too. In 2016 there was lack of community interest in HeartSong Too; Camp HeartSong also had a lower than anticipated participation rate. We continue to believe these are valuable programs and will work with community leaders to promote future referrals to these programs. Cost: $0. Funded through donations and corporate sponsorships. $20,000 in matching 8) Goal: Increase the number of support groups at the CTMC Hospital Grief program. Goal: Offer 9 support groups annually. - 2016 Actual: 8 groups offered. Over the course of the plan our number of support groups stayed relatively consistent. We continue to find ways to promote the value of these groups for both adults and youth so individuals are offered the tools and support to manage grief and loss. Cost: $0. Funded through Hospice Thrift Store. $24,500 B. Priority: Healthier management of lifestyle/making good choices in the areas of nutrition, weight management, exercise, smoking, alcohol use and sexually transmitted infections (STIs). CTMC interventions included efforts with community partners to promote lifestyle improvements: 1. Goal: Collaborate with churches, civic groups, schools and employers to offer CREATION Health workshops (based on principles of choice, rest, environment, activity, trust, interpersonal relationships, outlook and nutrition). Goal: Offer 6 CREATION Health workshops and completion of 300 on-line assessments. - 2016 Actual: 6 workshops and 422 on-line assessments. Over the course of the CHP, the offering of this valuable AHS program met expectations. Going forward we will continue to encourage participation in CREATION Health ideals through workshops and assessments. The program is sovaluable and offers many tools for participants to focus on 7 key principles of health. Cost: $60,665 **see continuation of footnote Group A-Facility 9 -- Florida Hospital Apopka Part V, Section B, line 5: Florida Hospital Apopka (FHApk or the Hospital) is one of seven campuses that operate under a single hospital license. All seven campuses, collectively, are known as Florida Hospital. Florida Hospital's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. FHApk is located in Orange County and its primary service area encompasses Northwest Orange County with the cities of Apopka and Zellwood as it main servicing jurisdictions. Florida Hospital conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Florida Hospital campuses. The 2016 CHNA conducted for FHApk was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.FHApk had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within FHApk's community/service area. The following organizations participated in FHApk's CHNAC and specifically represented low-income, minority and other medically underserved populations:Apopka Ministerial Alliance an alliance that brings together the leadership from the faith communities that make up Apopka;City of Winter Garden Winter Garden is adjacent to the city of Apopka;Matthew's Hope Ministries a non-profit organization that works to transform the lives of individuals experiencing homelessness; and Shepard's Hope a free and charitable clinic that provides care to the underinsured and uninsured. To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Survey data was scanned for themes based only on the responses of those from the zip codes included in FHApk's primary service area. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants. Group A-Facility 9 -- Florida Hospital Apopka 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. Group A-Facility 9 -- Florida Hospital Apopka Part V, Section B, line 11: The information provided below explains how Florida Hospital Apopka (FHApk or the Hospital) 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. FHApk 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 (FH) has seven acute-care hospital facilities in Orange, Seminole and Osceola Counties, FL. The tri-county area is often referred to as Central Florida. The seven FH facilities operate under one license but, due to the diverse communities served, FH conducted separate Community Health Needs Assessments and Community Health Plans (implementation strategies) for each FH campus. This narrative describes the Community Health Plan for FHApk, a 50-bed community hospital in Apopka, a suburb of Orlando, in Orange County, Florida. This is the third-year update for FHApk's 2013-2016 Community Health Plan/Implementation Strategy. FHApk 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, FHApk made a notable effort to define and address the needs of low-income, minority and underserved populations in its service area. The 2013 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2013-2016 Community Health Plan. The three-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2013 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing. FHApk chose two areas of focus for its 2013-16 Community Health Plan: Obesity/Chronic Disease and Access to Care. Priority: Obesity/Chronic Disease 2013 Description of the Issue: Obesity increases the risk for developing health conditions such as heart disease, stroke, diabetes, and cancer - and the comorbidities that often accompany these diseases. Additionally, being overweight or obese increases the risk of adverse health outcomes and has significant economic impacts on individuals and the community. These impacts can include a rise in health care spending over time as well as lost earnings and productivity due to illness. Several factors influence the likelihood of obesity including individual behavior, the social and built environment, and genetic heritability. As a result, being overweight or obese is a complex health issue to address. 2016 Update: Good nutrition, physical activity, and maintaining a healthy body weight can help manage/prevent obesity and promote overall health and well-being. FHApk's obesity/chronic disease interventions target both adults and children. The following programs/initiatives were conducted in order to address the issues of obesity/chronic disease. - Increase opportunities for leisure time physical activity in a social setting via annual runs/walks; (the Florida Hospital system had 3,184 employees participate in the 2016 American Heart Association Heart Walk 29 of those were from FHApk); - Provide education to increase knowledge of positive behaviors towards healthy eating and exercise via Mission Fit Possible program for Children in local schools (3,906 children completed the program in 2016); - Increase the availability of fruits to the diets of the population age 2 and older via the mobile farmers (9,035 customers were served in 2016); and - Provide support and board membership to the American Heart Association and encourage employee participation in the annual Heart Walk. (Florida Hospital donated $115,000 to the American Heart Association in 2016, and our employees raised an additional $215,000 for their annual Heart Walk. Additionally, a Florida Hospital board member has served on the AHA board every year during the time frame of this Health Plan.) Additional chronic disease interventions include: - Heart of Apopka, which uses the Stanford chronic disease self-management program for patients with chronic conditions, free of charge (571 community members graduated from the program in 2016 106 of them were from the Apopka area); - Free care for uninsured COPD and asthma patients at the Apopka Lung Clinic operated by FHApk's Respiratory Care Department (The Lung Clinic saw 616 patients in 2016 and spent over $70,000 on medication disbursements at no cost to the patients); - Increase access to medication and pulmonary care through FHApk's Pulmonary Rehab Center (FHApk secured free medications valued at over $3 million that were disbursed to patients at no charge); and - Creation Health faith-based wellness plan that focuses on eight principles: Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook and Nutrition. CREATION Health lifestyle seminars and expanded programs are offered at all Florida Hospital locations and in community settings. (The CREATION Kids program had 766 children participate in 2016). Priority: Access to Care 2013 Description of the Issue: Over 24% of people in Central Florida do not have health insurance, and the State of Florida has not accepted federal Medicaid expansion dollars. Apopka has increased problems with Access to Care because it is more rural than Orlando, with much lower access to resources. 2016 update: A number of FHApk initiatives educate and link underserved community members to free or affordable health resources: - Operate the Apopka Lung Clinic for uninsured people with chronic respiratory conditions including COPD and asthma (Florida Hospital funded the Lung Clinic $180,000 in 2016); - Operating the Community After Hours Clinic (now called the Community Medicine Clinic) that provides care to uninsured and underinsured people (Florida Hospital spent $536,305 operating this clinic in 2016); - Financially supporting and leading the Primary Care Access Network (PCAN) integrated system of health care for uninsured and underinsured people in Orange County (PCAN had 111,000 primary care patients in 15 FQHC medical homes in 2016); - Encouraging medical home enrollment by making appointments or referring uninsured and underinsured emergency department patients and inpatients to PCAN FQHCs (70 appointments were made at PCAN FQHCs through the Bridge Program in 2016); - Providing financial support to Shepherd's Hope free clinics ($110,000 donated in 2016); - Providing financial support for the Health Care Center for the Homeless ($100,000 donated in 2016); - Providing financial support for Grace Medical Home, a chronic care medical home for uninsured people ($100,000 donated in 2016); - Increasing the availability of free or low-cost mammograms for uninsured and underinsured women via the mobile mammogram unit and Florida Hospital diagnostics centers (979 uninsured women were given free or reduced-cost mammograms on the mobile unit in 2016); and - Supporting the education and training of medical practitioners through the FH Residency programs and Adventist University, and through partnerships with the UCF and FSU Medical Schools (185 residency slots in 2016). **see continuation of footnote Group A-Facility 11 -- Florida Hospital Wauchula Part V, Section B, line 5: Florida Hospital Heartland Medical Center operates one hospital facility in Wauchula in Hardee County in Florida under a single license. Florida Hospital Wauchula (FHW or the Hospital) is designated by the state of Florida as a Critical Access Hospital. The Hospitals' primary service area is comprised of three zip codes, two of which are located in Hardee County. 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 Hospitals' primary service area. Key members of the CHNAC included representatives from Central Florida Health Care, a local federally qualified health center, Nu-Hope Elder Care Services, Inc., a senior social service organization, Healthy Start Wauchula, Redlands Christian Migrant Association, an organization providing childcare and early education for children of migrant farm workers and rural, low-income families, Samaritan's Touch, a health clinic for the uninsured, Heartland Rural Health Network for low-income and minority populations, and the Hardee County Department of Health. Florida Hospital Heartland Medical Center also gathered primary data through the utilization of a stakeholder survey. This stakeholder survey was distributed to and completed by most of the 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 Hospitals' primary service area. Group A-Facility 11 -- Florida Hospital Wauchula 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. Group A-Facility 11 -- Florida Hospital Wauchula Part V, Section B, line 11: The information provided below explains how Florida Hospital Wauchula (FHW or the Hospital) 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. FHW 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. The Florida Hospital Heartland Division is comprised of three hospital facilities, all of which are part of the West Florida Region of Florida Hospital. Florida Hospital Wauchula is in Hardee County. Florida Hospital Heartland Medical Center in Sebring and Florida Hospital Lake Placid in Lake Placid are in adjacent Highlands County. This update refers to FHW. This is the third-year update for FHW's 2013 - 2016 Community Health Plan/Implementation Strategy. This Plan was developed and then posted in May 2014 as part of the 2013 Community Health Needs Assessment process. FHW is a 25-bed Critical Access Hospital in Hardee County, a small, rural county (638 square miles) with approximately 27,500 residents. Wauchula is the county seat. In FHW's primary service area, approximately 43% of the population is Hispanic or Latino. As FHW is the only hospital in Hardee County, Wauchula patients needing more critical care are often transferred to Florida Hospital Heartland Medical Center in Sebring or Florida Hospital Heartland Lake Placid. 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 determine the needs of the community it serves. FHW's Community Health Needs Assessment Committee, comprised of community members including those representing low-income, minority and other underserved populations, attempted to define and address the needs of low-income, minority and underserved populations in its service area, selecting the following four priority issues. Priority: Access to Health Care 2013 Description of the Issue: Access to health care is a major issue for Hardee County, where approximately 39% of the residents are uninsured (compared to 24% for the rest of the state). Access to care is affected by socio-economic status, health risk behaviors and limited job opportunities. The Affordable Care Act helped many people get insurance but the State of Florida did not expand Medicaid, leaving the most vulnerable without health coverage. There is a severe physician shortage in Hardee County which, per the Hardee County Health Department, ranks 56th (of 67 counties) in access to clinical care. The County has a ratio of 3,237:1 for primary care providers. Not only is there a shortage of providers, but there is a lack of education on how to access affordable health care and treatment, as well as screenings. 2016 Update: FHW set out to improve access to care by helping community primary care providers increase their capacity. FHW is a founder and an active partner in the Hardee County Primary Care Network, a public/private partnership that provides health care to the working poor whose incomes are less than 150% of the federal poverty level. FHW operates the Pioneer Medical Center (Rural Health Clinic) that accepts Medicaid and sees uninsured patients on a sliding fee scale basis. The Network also includes Central Florida Health Care, a Federally Qualified Health Center/Migrant Health Center that offers primary, dental, pediatric, and obstetrical/gynecological care. The Hardee County Health Department, FHW, and a local pharmacy complete the Network. The Network enrolled over 1,200 new patients in 2016 (the average annual enrollment is 1,200-1,300 people). All providers accept Medicaid, Medicare and some insurance. Uninsured patients are eligible for sliding scale fees, and usually pay a small co-payment for services. FHW provided medical services including labs and imaging for some uninsured patients, and actively enrolls eligible patients in Medicaid. Ten Congregational Health volunteers are members of the CREATION Health Ministry program and provided education on available health care resources, to their congregants. Priority: Cancer 2013 Description of the Issue: Cancer is the leading cause of death in Hardee County. The 2009-2011 age-adjusted death rate for all cancers for Hardee County residents is 165 per 100,000 residents compared to the State of Florida's rate of 161.1 per 100,000. For men, the three leading cancers are lung, prostate and colorectal. For women, the leading cancers are lung, breast and colorectal. Efforts to promote the importance of early detection are key to reducing the number of cases. Individuals from underserved populations are more likely to be diagnosed with late-stage cancers that might have been treated or cured if diagnosed earlier. 2016 Update: In partnership with the two other Florida Hospital Heartland facilities in the Division, several interventions included Wauchula-area patients. Efforts included smoking cessation classes that were free to uninsured/low-income residents, and held on site at FHW. FHW is also a member of the Hardee County Health Care Task Force and the Hardee Tobacco Free Partnership. Low-income and uninsured Hardee County residents also had access to mammography. Screenings and treatment for residents with incomes below 150% of the federal poverty level were provided through the Primary Care Network of Hardee County (see Access to Care). FHWs' Pink Army (Breast Cancer) sponsored education efforts about the early detection of breast cancer, and raised dollars for the County's mammography fund. Those without access to insurance were eligible to apply through Samaritan's Touch Care Center for free mammograms at FHW, funded by the Pink Army Mammogram fund. FHW does not provide cancer treatment services; patients may receive this care at Florida Hospital Heartland Medical Center in Sebring. Priority: Diabetes 2013 Description of the Issue: Hardee County has a higher than state average rate of diabetes-related hospitalizations and amputations. With diabetes self-management education below the state average, the emphasis on educating the public about management of diabetes is crucial. 2016 Update: Because FHW is so small, health educators from Florida Hospital Heartland (in Sebring) provided health education and promotion activities in Hardee County. 37% of adult residents are considered obese, so the programs promoted physical activity and weight loss for overweight or obese participants. Diabetes screenings (A1c) were offered in cooperation with the Hardee County Primary Care Network and Heartland Rural Health Network (serving five counties including Hardee). The Network serves people whose incomes are less than 150% of the federal poverty level. In addition, uninsured people with high blood sugar were referred to the Central Florida Health Care (FQHC) or the Pioneer Medical Center (RHC) that accept uninsured patients on a sliding fee scale basis. In 2016, FHW (along with Florida Hospital Heartland Medical Center Sebring and Florida Hospital Heartland Medical Center Lake Placid) worked to implement the Stanford Chronic Disease Self-Management Program (CDSMP). This included the training of facilitators, development of community and hospital partnerships, and recruitment of participants. The CDSMP, recognized by the CDC for improvement in diabetes self-management skills and reduced hospitalizations, began in the first quarter of 2016. Priority: Heart Disease and Stroke 2013 Description of the Issue: Heart Disease and Stroke are the leading cause of death in Florida, and are often related to overweight and obesity. In Hardee County, heart disease and stroke are the second highest cause of death. High cholesterol, heart attacks, angina, heart disease and hypertension rates are above the state average for all adults. Poor eating habits and economic pressure contribute to these outcomes. As with cancer, heart disease and its risk factors are not being detected early in people who do not schedule routine checkups with a physician. 2016 Update: FHW provided cardiac screenings and stroke seminars at local health fairs, as well as educational seminars on the importance of regular checkups with primary care physicians. As appropriate, uninsured patients were referred to Central Florida Health Care (FQHC) or the Pioneer Medical Center (RHC); both accept Medicaid and see uninsured patients on a sliding fee scale basis. FHW does not provide advanced cardiac treatment services, patients may receive this care at Florida Hospital Heartland Medical Center in Sebring. **see continuation of footnote Part V, Section B Facility Reporting Group B Facility Reporting Group B consists of: - Facility 6: FH Heartland Medical Center, - Facility 10: FH Heartland Medical Center Lake Placid Group B-Facility 6 -- FH Heartland Medical Center Part V, Section B, line 5: Florida Hospital Heartland Medical Center operates two hospital facilities in Highlands County under a single license, one in Sebring, Florida and one in Lake Placid, Florida (the Hospitals). The two Hospitals collaborated in 2016 to conduct a 2016 Community Health Needs Assessment as these two Hospitals share the same service area. The Hospitals' primary service area includes Highlands County and portions of Hardee County. 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 Hospitals formed a Community Health Needs Assessment Committee (CHNAC) that included representatives of the community and the Hospitals, 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 Hospitals' primary service area. Key members of the CHNAC included representatives from Central Florida Health Care, a local federally qualified health center, Nu-Hope Elder Care Services, Inc., a senior social service organization, Healthy Start-Wauchula, the Highlands County Board of County Commissioners, Redlands Christian Migrant Association, an organization providing childcare and early education for children of migrant farm workers and rural, low-income families, Samaritan's Touch, a health clinic for the uninsured, Heartland Rural Health Network for low-income and minority populations, the Highlands County Department of Health and the Hardee County Department of Health. Florida Hospital Heartland Medical Center also gathered primary data through the utilization of a stakeholder survey. This stakeholder survey was distributed to and completed by most of the 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 Hospitals' primary service area. Group B-Facility 6 -- FH Heartland Medical Center Part V, Section B, line 6a: Florida Hospital Heartland in Sebring and Florida Hospital Lake Placid collaborated in conducting their Community Health Needs Assessments (CHNA) in 2016. Group B-Facility 6 -- FH Heartland Medical Center 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. Group B-Facility 6 -- FH Heartland Medical Center Part V, Section B, line 11: The information provided below explains how Florida Hospital Heartland Medical Center (FHHMC or the Hospital) 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. FHHMC 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. The Florida Hospital Heartland Division is comprised of three hospital facilities, all of which are part of the West Florida Region of Florida Hospital. Florida Hospital Heartland Medical Center (FHH) in Sebring and Florida Hospital Lake Placid (FHLP) in Lake Placid are both located in Highlands County. Florida Hospital Wauchula (FHW) is in adjacent Hardee County. The Florida Hospital facilities in Highlands County are 16 miles apart and share the same service area. Accordingly, this response to Question 11 focuses on the two Highlands County facilities. This is the third-year update for FHH in Sebring and FHLP's 2013-2016 Community Health Plan/Implementation Strategy. This Plan was developed and then posted in May 2014 as part of the 2013 Community Health Needs Assessment process. Highlands County is a rural county with over 98,000 residents. However, the town of Sebring is home to just approximately 10,000 people and Lake Placid is home to another approximate 2,000. About a third of the residents are over 65. 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 determine the needs of the community served. FHH and FHLPs' Community Health Needs Assessment Committee, comprised of community members including those representing low-income, minority and other underserved populations, made a particular effort to define and address the needs of low-income, minority and underserved populations in its service area. FHH and FHLP selected the following four priority issues in their 2013 Community Health Needs Assessment. Priority: Cancer 2013 Description of the issue: Cancer is the second leading cause of death in the Sebring/Lake Placid community. Efforts to promote the importance for early detection are key to reducing the number of cases of cervical, breast and prostate cancer. Individuals from underserved populations are more likely to be diagnosed with late-stage cancers that might have been treated, or cured, if diagnosed earlier. 2016 Description of the issue: FHH/FHLP smoking cessation classes in 2016 were moved to our partner location at the Lake Placid SDA Church's Better Living Community Center. Classes in Sebring were also moved off-site, to the local bowling alley and South Florida State College. AHEC is now teaching these classes. The classes continue to be free to uninsured/low-income residents. FHH/FHLP's Pink Army (Breast Cancer) education efforts dropped due to the Pink Army program being phased out at the state level. A few events were held at the request of community members, and donations are still being accepted to grow the mammogram fund for uninsured residents. More than $12,000 was raised in the last three years and will continue to be available to qualified community members. Priority: Heart Disease and Stroke 2013 Description of the Issue: Heart disease and stroke are the leading cause of death in the Sebring/Lake Placid community. High cholesterol, heart attacks, angina, heart disease and hypertension rates are above the state average for all adults and for adult women. Poor eating habits and economic pressure contribute to these outcomes. As with cancer, heart disease and its risk factors are not being detected early in people who do not or cannot afford routine checkups with a physician. 2016 Update: Because much of Highlands County's population consists of older people with chronic conditions, the Stanford Chronic Disease Self-Management Program (CDSMP) was a new effort defined in our implementation strategies. The CDSMP uses pre- and post-program surveys, and has expected outcomes (defined by the CDC) around disease self-management skills and reductions in preventable hospitalizations. As in other communities, it took time to set up the program per Stanford specifications, build community partnerships, and train trainers. This work was completed in 2015 and free classes began Q1 of 2016. Twenty people participated in the CDSMP program in 2016, with no participants being readmitted within 30 days. Two lifestyle training programs addressed the prevention and lifestyle factors that impact heart disease and stroke. CREATION Health classes and programs were offered at no cost in the community and at FHH and FHLP. CREATION Health is based on the principles of choice, rest, environment, activity, trust, interpersonal relationships, outlook and nutrition. CHIP (Complete Health Improvement Program) provided classes on nutrition, exercise and stress management. CHIP's pre- and post-class biometric screenings showed that 100% of the program participants had improved biometric scores, an increased understanding of nutrition principles, and adherence to routine checkups with their physicians. Other heart disease-related community efforts included cardiac screenings at nine health fairs. 72 people participated in cardiac rehabilitation classes, and 85 attended stroke education seminars. All programs stressed the importance of regular checkups with primary care physicians. Priority: Diabetes/Chronic Disease Management 2013 Description of the Issue: There is a higher-than-state average for diabetes-related hospitalizations, including amputations, in the FHH service area. Attendance at diabetes self-management programs is also below the state average, indicating that it is important to make our community more aware of the importance of managing diabetes. An individual's socio-economic status, race and ethnicity plays a major role in access to education about diabetes and risk factors. 2016 Update: Interventions included diabetes self-management classes for 90 people, a community diabetes support group, outpatient Medical Nutrition Therapy (MNT) and gestational diabetes classes. A new free Pre-diabetes 3-hour class has been implemented this year, and is open to the public. The Stanford Chronic Disease Self-Management Program (CDSMP) also includes a program on diabetes. There will be no charge for the program. The CDSMP instructor is currently determining if there is enough interest in such a group, to be offered at a future date. Priority: Access to Health Care 2013 Description of the Issue: In addition to a lack of affordable insurance and/or health care services, access to health care can be attributed to a lack of education or understanding of the health care system and how treatment and overall care is communicated. Providing community education about access to health care and decision-making skills is important, as is information about resources for screening and intervention programs at health fairs and other events offered in the community. 2016 Update: FHH/FHLP provided $2.5 million (at cost) in vouchers for free lab and imaging services to the local free clinic for uninsured people. FHH/FHLP conducted nine health fairs for both insured and uninsured community members; uninsured participants were referred to the local Federally Qualified Health Center (FQHC). 45 Congregational Health volunteers provided education on available health care resources. 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 Hospitals did not choose the following community issues: Medical Home ShortageThe community's total number of licensed family physicians is below the state average with a ratio of 1 primary care physician to 270 people. This issue was not chosen because it is encompassed in the access to health care priority. **see continuation of footnote Group B-Facility 10 -- FH Heartland Medical Center Lake Placid Part V, Section B, line 5: Florida Hospital Heartland Medical Center operates two hospital facilities in Highlands County under a single license, one in Sebring, Florida and one in Lake Placid, Florida (the Hospitals). The two Hospitals collaborated in 2016 to conduct a 2016 Community Health Needs Assessment as these two Hospitals share the same service area. The Hospitals' primary service area includes Highlands County and portions of Hardee County. 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 Hospitals formed a Community Health Needs Assessment Committee (CHNAC) that included representatives of the community and the Hospitals, 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 Hospitals' primary service area. Key members of the CHNAC included representatives from Central Florida Health Care, a local federally qualified health center, Nu-Hope Elder Care Services, Inc., a senior social service organization, Healthy Start-Wauchula, the Highlands County Board of County Commissioners, Redlands Christian Migrant Association, an organization providing childcare and early education for children of migrant farm workers and rural, low-income families, Samaritan's Touch, a health clinic for the uninsured, Heartland Rural Health Network for low-income and minority populations, the Highlands County Department of Health and the Hardee County Department of Health. Florida Hospital Heartland Medical Center also gathered primary data through the utilization of a stakeholder survey. This stakeholder survey was distributed to and completed by most of the 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 Hospitals' primary service area. Group B-Facility 10 -- FH Heartland Medical Center Lake Placid Part V, Section B, line 6a: Florida Hospital Heartland in Sebring and Florida Hospital Lake Placid collaborated in conducting their Community Health Needs Assessments (CHNA) in 2016. Group B-Facility 10 -- FH Heartland Medical Center Lake Placid 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. Group B-Facility 10 -- FH Heartland Medical Center Lake Placid Part V, Section B, line 11: The information provided below explains how Florida Hospital Heartland Medical Center (FHHMC or the Hospital) 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. FHHMC 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. The Florida Hospital Heartland Division is comprised of three hospital facilities, all of which are part of the West Florida Region of Florida Hospital. Florida Hospital Heartland Medical Center (FHH) in Sebring and Florida Hospital Lake Placid (FHLP) in Lake Placid are both located in Highlands County. Florida Hospital Wauchula (FHW) is in adjacent Hardee County. The Florida Hospital facilities in Highlands County are 16 miles apart and share the same service area. Accordingly, this response to Question 11 focuses on the two Highlands County facilities. This is the third-year update for FHH in Sebring and FHLP's 2013-2016 Community Health Plan/Implementation Strategy. This Plan was developed and then posted in May 2014 as part of the 2013 Community Health Needs Assessment process. Highlands County is a rural county with over 98,000 residents. However, the town of Sebring is home to just approximately 10,000 people and Lake Placid is home to another approximate 2,000. About a third of the residents are over 65. 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 determine the needs of the community served. FHH and FHLPs' Community Health Needs Assessment Committee, comprised of community members including those representing low-income, minority and other underserved populations, made a particular effort to define and address the needs of low-income, minority and underserved populations in its service area. FHH and FHLP selected the following four priority issues in their 2013 Community Health Needs Assessment. Priority: Cancer 2013 Description of the issue: Cancer is the second leading cause of death in the Sebring/Lake Placid community. Efforts to promote the importance for early detection are key to reducing the number of cases of cervical, breast and prostate cancer. Individuals from underserved populations are more likely to be diagnosed with late-stage cancers that might have been treated, or cured, if diagnosed earlier. 2016 Description of the issue: FHH/FHLP smoking cessation classes in 2016 were moved to our partner location at the Lake Placid SDA Church's Better Living Community Center. Classes in Sebring were also moved off-site, to the local bowling alley and South Florida State College. AHEC is now teaching these classes. The classes continue to be free to uninsured/low-income residents. FHH/FHLP's Pink Army (Breast Cancer) education efforts dropped due to the Pink Army program being phased out at the state level. A few events were held at the request of community members, and donations are still being accepted to grow the mammogram fund for uninsured residents. More than $12,000 was raised in the last three years and will continue to be available to qualified community members. Priority: Heart Disease and Stroke 2013 Description of the Issue: Heart disease and stroke are the leading cause of death in the Sebring/Lake Placid community. High cholesterol, heart attacks, angina, heart disease and hypertension rates are above the state average for all adults and for adult women. Poor eating habits and economic pressure contribute to these outcomes. As with cancer, heart disease and its risk factors are not being detected early in people who do not or cannot afford routine checkups with a physician. 2016 Update: Because much of Highlands County's population consists of older people with chronic conditions, the Stanford Chronic Disease Self-Management Program (CDSMP) was a new effort defined in our implementation strategies. The CDSMP uses pre- and post-program surveys, and has expected outcomes (defined by the CDC) around disease self-management skills and reductions in preventable hospitalizations. As in other communities, it took time to set up the program per Stanford specifications, build community partnerships, and train trainers. This work was completed in 2015 and free classes began Q1 of 2016. Twenty people participated in the CDSMP program in 2016, with no participants being readmitted within 30 days. Two lifestyle training programs addressed the prevention and lifestyle factors that impact heart disease and stroke. CREATION Health classes and programs were offered at no cost in the community and at FHH and FHLP. CREATION Health is based on the principles of choice, rest, environment, activity, trust, interpersonal relationships, outlook and nutrition. CHIP (Complete Health Improvement Program) provided classes on nutrition, exercise and stress management. CHIP's pre- and post-class biometric screenings showed that 100% of the program participants had improved biometric scores, an increased understanding of nutrition principles, and adherence to routine checkups with their physicians. Other heart disease-related community efforts included cardiac screenings at nine health fairs. 72 people participated in cardiac rehabilitation classes, and 85 attended stroke education seminars. All programs stressed the importance of regular checkups with primary care physicians. Priority: Diabetes/Chronic Disease Management 2013 Description of the Issue: There is a higher-than-state average for diabetes-related hospitalizations, including amputations, in the FHH service area. Attendance at diabetes self-management programs is also below the state average, indicating that it is important to make our community more aware of the importance of managing diabetes. An individual's socio-economic status, race and ethnicity plays a major role in access to education about diabetes and risk factors. 2016 Update: Interventions included diabetes self-management classes for 90 people, a community diabetes support group, outpatient Medical Nutrition Therapy (MNT) and gestational diabetes classes. A new free Pre-diabetes 3-hour class has been implemented this year, and is open to the public. The Stanford Chronic Disease Self-Management Program (CDSMP) also includes a program on diabetes. There will be no charge for the program. The CDSMP instructor is currently determining if there is enough interest in such a group, to be offered at a future date. Priority: Access to Health Care 2013 Description of the Issue: In addition to a lack of affordable insurance and/or health care services, access to health care can be attributed to a lack of education or understanding of the health care system and how treatment and overall care is communicated. Providing community education about access to health care and decision-making skills is important, as is information about resources for screening and intervention programs at health fairs and other events offered in the community. 2016 Update: FHH/FHLP provided $2.5 million (at cost) in vouchers for free lab and imaging services to the local free clinic for uninsured people. FHH/FHLP conducted nine health fairs for both insured and uninsured community members; uninsured participants were referred to the local Federally Qualified Health Center (FQHC). 45 Congregational Health volunteers provided education on available health care resources. 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? **see continuation of footnote Part V, Section B, Line 7a Each hospital facility's CHNA report was made widely available through the following websites:Facility 1 -- Florida Hospital Orlandohttps://www.floridahospital.com/community-health-needs-assessmentsFacility 2 -- Florida Hospital Altamontehttps://www.floridahospital.com/community-health-needs-assessmentsFacility 3 -- Florida Hospital Celebration Healthhttps://www.floridahospital.com/community-health-needs-assessmentsFacility 4 -- Winter Park Memorial Hospitalhttps://www.floridahospital.com/community-health-needs-assessmentsFacility 5 -- Florida Hospital East Orlandohttps://www.floridahospital.com/community-health-needs-assessmentsFacility 6 -- FH Heartland Medical Centerhttps://www.floridahospital.com/community-health-needs-assessmentsFacility 7 -- Florida Hospital Kissimmeehttps://www.floridahospital.com/community-health-needs-assessmentsFacility 8 -- Central Texas Medical Centerhttp://www.ctmc.org/about-us/community-benefitFacility 9 -- Florida Hospital Apopkahttps://www.floridahospital.com/community-health-needs-assessmentsFacility 10 -- FH Heartland Medical Center Lake Placidhttps://www.floridahospital.com/community-health-needs-assessments Facility 11 -- Florida Hospital Wauchulahttps://www.floridahospital.com/community-health-needs-assessments Part V, Section B, Line 8 - 10a Each of the filing organization's hospital facilities adopted a Community Health Needs Assessment Report by 12/31/16 and was in the process of developing its Community Health Needs Implementation Strategy. Each of the filing organization's hospital facilities' 2017 Community Health Needs Implementation Strategy will be documented in a written report called the "Community Health Plan". The Community Health Plans (CHPs) will describe how each of the filing organization's hospitals plans to meet its identified prioritized health needs or will identify the health need as one the relevant Hospital facility does not intend to specifically address and provide an explanation as to why the specific Hospital facility does not intend to address that health need. In accordance with Final Regulation Section 1.501(r)-3(c)(5), each of the filing organization's hospital facilities' 2017 CHP was adopted no later than May 15, 2017 and is also posted on each hospital facility's website. As each of 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 each of the hospital facilities last adopted an implementation strategy. Schedule H, Part V, Section B, Line 10a reflects the website address for each of the hospital facility's 2014 Implementation Strategy since this is the most recently adopted Implementation Strategy. Part V, Section B, Line 10a Each hospital facility's most recently adopted implementation strategy was made widely available through the following websites:Facility 1 -- Florida Hospital Orlandohttps://www.floridahospital.com/community-health-needs-assessmentsFacility 2 -- Florida Hospital Altamontehttps://www.floridahospital.com/community-health-needs-assessmentsFacility 3 -- Florida Hospital Celebration Healthhttps://www.floridahospital.com/community-health-needs-assessmentsFacility 4 -- Winter Park Memorial Hospitalhttps://www.floridahospital.com/community-health-needs-assessmentsFacility 5 -- Florida Hospital East Orlandohttps://www.floridahospital.com/community-health-needs-assessmentsFacility 6 -- FH Heartland Medical Centerhttps://www.floridahospital.com/community-health-needs-assessmentsFacility 7 -- Florida Hospital Kissimmeehttps://www.floridahospital.com/community-health-needs-assessmentsFacility 8 -- Central Texas Medical Centerhttp://www.ctmc.org/about-us/community-benefitFacility 9 -- Florida Hospital Apopkahttps://www.floridahospital.com/community-health-needs-assessmentsFacility 10 -- FH Heartland Medical Center Lake Placidhttps://www.floridahospital.com/community-health-needs-assessments Facility 11 -- Florida Hospital Wauchulahttps://www.floridahospital.com/community-health-needs-assessments Part V, Section B, Line 16a-16C Each hospital facility's FAP, FAP application form and plain language summary of the FAP was made widely available through the following websites:Facility 1 -- Florida Hospital Orlandohttps://www.floridahospital.com/patient-resources/billing/financial-assistanceFacility 2 -- Florida Hospital Altamontehttps://www.floridahospital.com/patient-resources/billing/financial-assistanceFacility 3 -- Florida Hospital Celebration Healthhttps://www.floridahospital.com/patient-resources/billing/financial-assistanceFacility 4 -- Winter Park Memorial Hospitalhttps://www.floridahospital.com/patient-resources/billing/financial-assistanceFacility 5 -- Florida Hospital East Orlandohttps://www.floridahospital.com/patient-resources/billing/financial-assistanceFacility 6 -- FH Heartland Medical Centerhttps://www.floridahospital.com/patient-resources/billing/financial-assistanceFacility 7 -- Florida Hospital Kissimmeehttps://www.floridahospital.com/patient-resources/billing/financial-assistanceFacility 8 -- Central Texas Medical Centerhttps://www.ctmc.org/patients-visitors/after-my-stay/financial-assistanceFacility 9 -- Florida Hospital Apopkahttps://www.floridahospital.com/patient-resources/billing/financial-assistanceFacility 10 -- FH Heartland Medical Center Lake Placidhttps://www.floridahospital.com/patient-resources/billing/financial-assistanceFacility 11 -- Florida Hospital Wauchulahttps://www.floridahospital.com/patient-resources/billing/financial-assistance Part V, Section B, Line 11 Continuation of Footnote Group A-Facility 1 -- Florida Hospital OrlandoDescription of CHNA Significant Needs Continued CREATION Health lifestyle seminars and expanded programs were offered at FHO and in community settings. CREATION Health is a faith-based wellness plan that focuses on eight principles: Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook and Nutrition. CREATION Kids is a child-friendly wellness program that stresses healthy eating and exercise in church and school settings; it reached 766 children and their parents in 2016. With community partners, FHO served over 9,000 people in 2016 with a Mobile Farmers Market that offered fresh fruits and vegetables, cooking demos and nutritional educational opportunities. Most mobile visits were in identified food deserts. FHO also provided financial support to the Edible Education Experience, a local nonprofit focused on teaching kids where their food comes from, how to grow their own fruits and vegetables, and how to prepare them. Issue: Diabetes (as it relates to Obesity, aka "Diabesity") in the Town of Eatonville 2013 Description of the Issue: FHO's 2013 Needs Assessment showed that Diabetes is among the most prevalent chronic diseases in Orange County. Diabetes can lead to the development of serious and disabling complications if not properly treated. Complications include heart disease and stroke, high blood pressure, blindness, kidney disease and limb amputation. The town of Eatonville, just three miles from FHO, is the nation's oldest African-American community. The community has a 24% rate of diabetes (compared to 7.1% for the rest of Orange County). 2016 Update: "Healthy Eatonville Place" targeted the primarily African-American residents of the town of Eatonville. The program offered screenings, diabetic health risk assessments and treatment to help Eatonville residents better control their diabetes. Diabetic and pre-diabetic residents participated in the no-cost effort, and the program's retention rate was 86%. For 2016, other outcomes included: - Pre-diabetic participants who did not become diabetic: 98% (up from 66% in 2015); - Pre-diabetic participants who met their weight loss goal of >7%: 31% (down from 50% in 2015); - Pre-diabetic participants who reported nutrition and exercise changes: 85% (up from 60% in 2015); - Patients with poorly controlled diabetes who reached their blood pressure goal: 61% (down from 80% in 2015);; - Patients with poorly controlled diabetes who finished diabetes education and understood their personal goals: 85% (down from 90% in 2015); and - Patient "graduates" with poorly controlled diabetes who continued with the program's interventions and support programs: 93% (up from 75% in 2015). FHO also supports the American Diabetes Association Annual Bicycle race, Tour de Cure and other walks that provide opportunities for leisure time activity. Issue: Social Determinants of Health and Health Disparities 2013 Description of the Issue: Although specific health determinants and poverty were not selected as priorities in FHO's Community Health Needs Assessment, FHO supports "place-based" community transformation efforts that address health determinants in geographically specific areas. 2016 Update: FHO continued to be the anchor partner for the City of Bithlo Transformation Effort led by the nonprofit agency United Global Outreach (UGO). UGO and its partners are working to address multiple conditions in this very low-income community (census tract 166.22) of 8,200 people: Education, Housing, Transportation, Health Care, Environment, Basic Needs and Sense of Community. Florida Hospital provided $130,000 in direct funding. FHO also engaged community partners (colleges, businesses, community organizations, etc.) and recruited its vendors and employees to help in the effort. FHO was also a partner in LIFT Orlando, a nonprofit organization of business leaders collaborating with residents to accelerate community transformation in the primarily low-income, African-American community of Parramore in downtown Orlando. Focus areas include cradle-to-career education, mixed income housing, community health and wellness, and long-term economic viability. FHO provides funding to IDignity, a nonprofit agency that helps homeless, precariously housed and other low-income people get identification items: birth certificates, social security numbers or cards, drivers' licenses, state IDs and other personal identification. Community Needs Not Chosen by Florida Hospital Orlando: 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: Violent Crime Hospitals lack the ability to directly address violent crimes but, given the high crime rates, FHO views its active involvement in issues of awareness and prevention as especially crucial. FHO provided major funding to the Harbor House Domestic Violence Center, and provided office and (off-site) treatment space for the Orange County Victims' Services Center (VSC) and the Sexual Assault Treatment Center (SATC) of Orange County. Approximately 10 nurses were trained as Sexual Assault Nurse Examiners and are on-call for the SATC. FHO staff, particularly in the ED, were trained to screen patients for domestic violence issues. Health LiteracyHealth Literacy was not selected as a priority issue by FHO. The Adult Literacy League and others organizations including Hispanic Health Initiatives and the Center for Multicultural Wellness & Prevention provide literacy services for the community. In addition, FHO provides full translation services that assists patients for whom English is not the primary language. Motor Vehicle AccidentsThe issue of motor vehicle collision is not within the purview of community hospitals. FHO does promote and fund safe pedestrianism through its partnership with Healthy Central Florida. Single Parent HouseholdsThe issue of single parent households is not within the purview of FHO. Maternal and Child HealthBecause of its existing support of the Healthy Start Coalition and other maternal infant initiatives, FHO did not choose Maternal and Child Health as a priority area. Florida Hospital facilities (Winter Park, Orlando and Celebration) provide obstetrics services, and the Florida Hospital for Women opened in 2015. Sexually Transmitted Diseases FHO provides inpatient care but does not provide wrap-around services for HIV/AIDS or STD patients. The Health Department has STD and HIV/AIDS Clinics, and the Center for Multicultural Wellness and Prevention provides programs that screen for and treat sexually transmitted diseases. In addition, Orange County Government Health Services operates the Ryan White HIV/AIDS Program that provides services to people without sufficient health coverage or financial resources to cope with HIV/AIDS. Diabetes Diabetes is a major health concern in Central Florida, and the Florida Hospital Diabetes Institute provides treatment, education and research for the community. Rather than a global focus on diabetes, FHO is focusing on obesity because it is a risk factor for diabetes, heart disease and cancer. CancerCancer is a major cause of death in Central Florida and the U.S. FHO is not focusing on cancer and cancer prevention as a priority because of the many hospital and community resources already available. Groups like the American Cancer and Leukemia Societies provide outreach and education throughout the community - and in partnership with the hospitals. FHO receives Susan G. Komen dollars to help fund free mammograms for low-income women, and uses its mobile mammogram unit to reach out to this audience. Part V, Section B, Line 11 Continuation of Footnote Group A-Facility 3 -- Florida Hospital Celebration HealthDescription of CHNA Significant Needs Continued FHCH and Florida Hospital Kissimmee were founders of the Community Hope Center. The Hope Center serves low-income, poverty-level families who are homeless or live in motels along Highway 192 in western Osceola County. The Center is a community collaboration whose key partners include Community Presbyterian Church of Celebration, Osceola Council on Aging, Park Place Behavioral Health, Community Vision and Florida Hospital. In 2015, the Health Care Center for the Homeless (HCCH) opened a new FQHC at the Hope Center. Florida Hospital provided start-up funding for the clinic and contributes $100,000 annually to HCCH for daily operations. In addition, FHCH supported the education and training of medical practitioners at UCF Medical School, the TECO (Technical Education Center of Osceola) nursing and other health professions programs, and the Valencia College Nursing program. Many of these students participated in clinical rotations at FHCH and Florida Hospital Kissimmee. Community Needs Not Chosen by Florida Hospital Celebration Health: 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: Heart DiseaseFHCH supports chronic disease management programs at the Osceola Council on Aging Chronic Care Clinic and the Hope Clinic. In addition, the Obesity interventions noted above address many of the risk factors for heart disease. Mental Health and Substance AbuseFHCH does not offer substance abuse or behavioral/mental health services. Hospital inpatients with behavioral health co-morbidities are transferred to the Med-Psych unit at Florida Hospital Orlando campus or to Park Place Behavioral Health, Osceola's County's behavioral health provider and home of the County's Baker Act Receiving Center. Dental CareFHCH does not offer dental care but partners with the Dental Care Access Foundation that provides free and/or sliding fee scale dentistry to people who are uninsured or underinsured. Several of the five FQHCs in Osceola County provide dental services. Cancer FHCH provides cancer treatment but did not choose Cancer as a top priority community issue. FHCH does offer various cancer education programs. AsthmaFHCH does not have Asthma-specific community programming but actively supports the American Lung Association, and provides health education, disease management and stop smoking programs. Housing Affordability and HomelessnessHousing affordability is not a core competency of hospitals and other health care providers. Florida Hospital is not leading out on this issue but made a significant financial donation (that garnered a community match) to establish and expand permanent supportive housing efforts in the tri-county area. FHCH also provides leadership to two regional commissions focused on housing issues specific to vulnerable families and individuals, and is active in Habitat for Humanity. High UnemploymentHigh unemployment, while a health determinant, is not a core competency of FHCH. As a means of promoting employment, FHCH provides leadership to the regional BusinessForce, multiple Chambers of Commerce (including Kissimmee, Celebration and St. Cloud) and Economic Development Commissions (Orange and Osceola) that focus on growing a healthy business community. As a means of promoting both access to care and challenging high unemployment, FHCH supports the education and training of Certified Nursing Assistants in Osceola County through the Project OPEN initiative. Single Parent HouseholdsSingle Parent Households are not a core competency of hospitals and other health care providers. Part V, Section B, Line 11 Continuation of Footnote Group A-Facility 2 -- Florida Hospital AltamonteDescription of CHNA Significant Needs Continued Community Needs Not Chosen by Florida Hospital Altamonte: 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: Diabetes, Cancer, Heart Disease, Stroke & AsthmaFHAlt and its community partners - the Department of Health, the Area Health Education Council (AHEC), the American Heart Association, the American Cancer Society, the American Lung Association, etc. - already provide several health education and disease management programs. Marijuana Use among Youth, Mental Health & Substance AbuseFHAlt does not provide substance abuse or behavioral/mental health services. There are strong mental health and substance abuse assets in Seminole County including Aspire Behavioral Health (in- and outpatient mental health and substance abuse services) and the Orlando Health Behavioral Group, an 80-bed psychiatric hospital at South Seminole Hospital, an unrelated hospital. Maternal and Child Health FHAlt provides obstetrics services and a variety of pre- and postnatal programs and car seats for parents and children. Women and children may qualify for our Financial Assistance Program that includes charity care and/or steep discounts for low-income patients. As noted in the Access to Care section above, FHAlt provides member support to maternal and child health initiatives in Seminole County including the Healthy Start Coalition of Seminole County and Kids' House (the County's sexual abuse treatment center for children). Motor Vehicle Accidents The issue of motor vehicle collisions is not within the purview of community hospitals. Housing AffordabilityHousing affordability is a health determinant rather than a core competency of hospitals and other health care providers. FHAlt made a significant financial donation (that garnered community matches) to establish and expand permanent supportive housing efforts in Seminole County and surrounding areas. Florida Hospital also provides leadership to two regional commissions focused on issues of housing specific to vulnerable families and individuals, and is active in Habitat for Humanity. Part V, Section B, Line 11 Continuation of Footnote Group A-Facility 5 -- Florida Hospital East OrlandoDescription of CHNA Significant Needs Continued Priority: Mental Health and Substance Abuse 2013 Description of the Issue: FHEO has identified mental health as being essential to personal well-being, family and interpersonal relationships, and the ability to contribute to society. Issues of mental health such as depression and anxiety affect people's ability to participate in health-promoting behaviors. Research has shown that mental health and physical health are closely connected because mental health plays a major role in people's ability to maintain good physical health. 2016 Update: Currently, there are strong mental health and substance abuse assets in Orange County including Aspire Behavioral Health (inpatient and outpatient mental health/substance abuse services). Still, such services in Orange County can be hard to access because of funding and capacity issues. FHEO works with local providers to help expand capacity. Specifically, FHEO interventions include: - Providing major funding to Aspire Behavioral Health Center (County mental health) for inpatient and outpatient mental health and substance abuse services ($1.2 million went to Aspire in 2016); - Offering comprehensive evaluation, treatment, and case management for uninsured residents of Orange County through the Outlook Clinic for Depression & Anxiety. Florida Hospital funds the clinic in partnership with the Mental Health Association, the Orange County Medical Clinic, the UCF School of Social Work, the Primary Care Access Network (PCAN) and Walgreens (1308 patients seen at the Outlook Clinic in 2016); - Encouraging enhanced behavioral health services at FQHCs in East Orlando. Although other FQHCs are expanding their behavioral health services, the FQHC near FHEO has not chosen to do so yet; and - Supporting efforts to provide behavioral health services in low-income, underserved areas such as Bithlo, a historically depressed and impoverished community in East Orange County. Partners there include Aspire Health Partners and Florida Blue. Priority: Social Determinants of Health/Health Disparities 2013 Description of the Issues: Health disparities adversely affect people who have systematically experienced greater obstacles to health based on their: racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion. Within Orange County, black/African-American, Hispanic/Latino families, and the elderly are more than three times more likely to live in poverty than their white neighbors. Further, the FHEO community is more than 50% Hispanic and the east part of the County includes the community of Bithlo, one of the poorest communities in Florida. 2016 Update: There are several social determinant issues, as well as health disparities in East Orlando. FHEO's specific interventions to address these include: - Florida Hospital funds our partner transforming the Bithlo community, United Global Outreach (Contributed $125,000 to UGO in 2016);- Encouraging other partners to sign on to the work in the Bithlo community (150 partners helped in Bithlo in 2016); and- Support GED classes in Bithlo through Career Source (25 adults graduated with their GED in 2016). Priority: Violent Crime 2013 Description of the Issue: Orange County's rates of violent crime exceed the national average, especially in minority communities. 2016 Update: Although FHEO wanted to focus on Violent Crime as a priority, it was quickly discovered that the Hospital lacked the ability to directly address violent crimes. However, Florida Hospital has provided funding to several organizations that address the effects of violent crime. We view our active involvement in issues of awareness and prevention as especially crucial since Orange County's rates of violent crime exceed the national average. Interventions include: - Funding to Harbor House Domestic Violence Centers; - Providing office and treatment space for the Orange County Victims' Services Center; - Training FHEO staff to screen patients for domestic violence issues; and - Donating space for the Sexual Assault Treatment Center of Orange County. Community Needs Not Chosen by Florida Hospital East Orlando: 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: A. Sexually Transmitted DiseasesFHEO provides inpatient care but does not provide wrap-around services for HIV/AIDS or STD patients. The Health Department has STD and HIV/AIDS Clinics, and the Center for Multicultural Wellness and Prevention provides programs that screen for and treat sexually transmitted diseases. In addition, Orange County Government Health Services operates the Ryan White HIV/AIDS Program that provides services to people without sufficient health coverage or financial resources to cope with HIV disease. B. Maternal and Child Health FHEO does not have Maternal and Child health services, but supports the Healthy Start Coalition financially. Other Florida Hospital facilities (Winter Park, Orlando and Celebration) provide obstetrics services, and the Florida Women's Hospital opened in 2015. The Walt Disney Pavilion at Florida Children's Hospital accepts referrals from other Florida Hospital campuses and from FH's CentraCare Walk-In Urgent Care Centers. C. Cancer FHEO does not provide cancer treatment services. Patients in the East Orlando community are treated at the Cancer Institute at the main Florida Hospital campus. In addition, FHEO supports the Area Health Education Council (AHEC) and provides funding to the American Cancer Society and the American Lung Association; these partners provide health education and disease management programs throughout the County. D. Heart DiseaseHeart disease, hypertension and Congestive Heart Failure - with Diabetes - are the most common chronic conditions in the United States. Risk factors include health behaviors such as obesity and smoking. The Cuidate and Bridge programs noted above provide education and support for people with or at risk for heart disease through the Stanford Chronic Disease Self-Management Program offered in Spanish and English. Plus, several other Florida Hospital campuses focused on Heart Disease as their priority. E. Motor Vehicle CollisionsThe issue of motor vehicle collisions is not within the purview of community hospitals. FHEO promotes and funds safe pedestrianism through its partnership with Healthy Central Florida. F. Single Parent HouseholdsAgain, the issue of single parent households is not within the purview of FHEO. In financially supporting the tri-county Healthy Start Coalitions, FHEO helps expectant and new patients access health education and parenting programs. Part V, Section B, Line 11 Continuation of Footnote Group A-Facility 4 -- Winter Park Memorial HospitalDescription of CHNA Significant Needs Continued Priority Issue: Diabetes 2013 Description of the Issue: WPMH's 2013 Needs Assessment showed that Diabetes is one of the most prevalent chronic diseases in Orange County. Diabetes can lead to the development of serious and disabling complications if not properly treated. Complications include heart disease and stroke, high blood pressure, blindness, kidney disease and limb amputation. The town of Eatonville, in WPMH's service area, is the nation's oldest African American community. The community has a 24% rate of diabetes (compared to 7.1% for the rest of Orange County). 2016 Update: Florida Hospital Orlando and WPMH implemented the "Healthy Eatonville Place" program which targeted the primarily African-American residents of the town of Eatonville. The program offered screenings, diabetic health risk assessments and treatment to help Eatonville residents better control their diabetes. Diabetic and pre-diabetic residents participated in the no-cost effort, and the program's retention rate was 86%. For 2016, other outcomes included: - Pre-diabetic participants who did not become diabetic: 98% (up from 66% in 2015); - Pre-diabetic participants who met their weight loss goal of >7%: 31% (down from 50% in 2015); - Pre-diabetic participants who reported nutrition and exercise changes: 85% (up from 60% in 2015); - Patients with poorly controlled diabetes who reached their blood pressure goal: 61% (down from 80% in 2015); - Patients with poorly controlled diabetes who finished diabetes education and understood their personal goals: 85% (down from 90% in 2015); and - Patient "graduates" with poorly controlled diabetes who continued with the program's interventions and support programs: 93%. (up from 75% in 2015). WPMH also supports the American Diabetes Association Annual Bicycle race, Tour de Cure and other walks that provide opportunities for leisure time activity. Community Needs Not Chosen by Winter Park Memorial Hospital: 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: Substance Abuse and Mental Health While there are strong mental health and substance abuse providers in the Orange County community, funding for these services is very limited (as is the case throughout Florida). Florida Hospital Orlando has medical-psychiatric beds, and is the Baker Act Receiving Center for Orange County. Health LiteracyHealth Literacy was not selected as a priority issue by WPMH. The Adult Literacy League and others entities including Hispanic Health Initiatives and the Center for Multicultural Wellness & Prevention provide literacy services for the community. In addition, WPMH provides full translation services that help patients for whom English is not the primary language. Motor Vehicle Accidents The issue of motor vehicle collisions is not within the purview of community hospitals. WPMH does promote and fund safe pedestrianism through its partnership with Healthy Central Florida. Single Parent Households The issue of single parent households is not within the purview of WPMH. Maternal and Child HealthBecause of its existing support of the Healthy Start Coalition and other maternal infant initiatives WPMH did not choose Maternal and Child Health as a priority area. WPMH houses the Baby Place OB program, and the Baby Place Academy which offers multiple parent education programs. Some examples include Boot Camp for New Dads (in cooperation with the Orange County Healthy Start Coalition), Sibling Class, Infant and Child CPR, and Childbirth Preparation. Sexually Transmitted Diseases WPMH provides inpatient care but does not provide wrap-around services for HIV/AIDS or STD patients. The Health Department has STD and HIV/AIDS Clinics, and the Center for Multicultural Wellness and Prevention provides programs that screen for and treat sexually transmitted diseases. In addition, Orange County Government Health Services operates the Ryan White HIV/AIDS Program that provides services to people without sufficient health coverage or financial resources to cope with HIV/AIDS. Heart Disease/Diabetes Heart disease/Diabetes is a major health concern in Central Florida, and the Florida Hospital Diabetes Institute provides treatment, education and research for the community. Rather than a global focus on heart disease/diabetes, WPMH is focusing on obesity because it is a risk factor for diabetes, heart disease and cancer. CancerCancer is a major cause of death in Central Florida and the U.S. WPMH is not focusing on cancer and cancer prevention as a priority because of the many hospital and community resources already available. Groups like the American Cancer Society and Leukemia Societies provide outreach and education throughout the community - and in partnership with the hospitals. WPMH receives Susan G. Komen dollars to help fund free mammograms for low-income women, and uses its mobile mammogram unit to reach out to this audience. Part V, Section B, Line 11 Continuation of Footnote Group A-Facility 7 -- Florida Hospital KissimmeeDescription of CHNA Significant Needs Continued To increase opportunities for leisure time physical activity, FHK sponsored several races including the Town of Celebration Marathon and half-marathon events, with proceeds going to a scholarship fund for Osceola County high school seniors ($15,000 in support in 2016). FHK also supported the annual American Heart Association Heart Walk with a corporate sponsorship of $115,000 plus an additional $215,000 raised by employees who participated in the event (95 employees from FHK signed up to participate). Priority: Violent Crime 2013 Description of the Issue: According to the Florida Department of Law Enforcement, Osceola County's rate of violent crime exceeds the national average. While hospitals lack the ability to directly address violent crimes, FHK is engaged with organizations that address the effects of violent crime. 2016 Update: Although FHK wanted to focus on Violent Crime as a priority, it was quickly discovered that the Hospital lacked the ability to directly address violent crimes. However, Florida Hospital has provided funding to several organizations that address the effects of violent crime. We view our active involvement in issues of awareness and prevention as especially crucial since Osceola County's rates of violent crime exceed the national average. Interventions include: - Funding to Harbor House Domestic Violence Centers; - Providing office and treatment space for the Victims' Services Center; - Training staff to screen patients for domestic violence issues; and - Donating space for clinical space for Sexual Assault Nurse Examiners who work directly with victims of sexual assault. Community Needs Not Chosen by Florida Hospital Kissimmee 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 Health and Substance AbuseFHK does not offer substance abuse or behavioral/mental health services. Hospital inpatients with behavioral health co-morbidities are transferred to the Med-Psych unit at the Florida Hospital Orlando campus or to Park Place Behavioral Health, Osceola's behavioral health provider and home of the County's Baker Act Receiving Center. Dental CareFHK does not offer dental care but partners with the Dental Care Access Foundation that provides free and/or sliding fee scale dentistry to people who are uninsured or underinsured. Several of the five FQHCs in Osceola County offer dental services. Cancer FHK does not provide cancer treatment; its cancer patients are referred to Florida Hospital Celebration Health or Florida Hospital Orlando. AsthmaFHK does not have Asthma-specific community programming but actively supports the American Lung Association, and provides health education, disease management and stop smoking programs. Maternal and Child HealthFHK does not have Maternal and Child health services, but supports the Healthy Start Coalition of Osceola County financially and through Board of Director services. Other Florida Hospital facilities (Winter Park, Orlando, and Celebration) provides obstetrics services, and the Florida Women's Hospital at Florida Hospital Orlando opened in 2015. Housing Affordability and HomelessnessHousing affordability is not a core competency of hospitals and other health care providers. Florida Hospital is not leading out on this issue but made a significant financial donation (that garnered a community match) to establish and expand permanent supportive housing efforts in the tri-county area. High UnemploymentHigh unemployment is not a core competency of hospitals. FHK already supports the education and training of health care professionals through Project Open (training of homeless or precariously housed women as Certified Nursing Assistants) and at local colleges and trade schools, including the Technical Education Center of Osceola (TECO) and Valencia College in Osceola County. Single Parent HouseholdsSingle Parent households are not a core competency of hospitals and other health care providers. Part V, Section B, Line 11 Continuation of Footnote Group A-Facility 9 -- Florida Hospital ApopkaDescription of CHNA Significant Needs Continued Community Needs Not Chosen by Florida Hospital Apopka: 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: A. Stroke Stroke is among the most common chronic conditions in the United States and is frequently related to health behaviors such as obesity and smoking. FHApk and its community partners - the Department of Health, the Area Health Education Council (AHEC), the American Heart Association, the American Cancer Society, the American Lung Association, etc. - already provide health education and disease management programs. As noted above, FHApk's Obesity interventions focus on health education, exercise, nutrition, stress management, and personal accountability - factors vital to the control of diabetes, cancer, heart disease, stroke, asthma and the comorbidities that often accompany these diseases. Therefore, FHApk is addressing the risk factors for these chronic diseases by specifically addressing Obesity. B. DiabetesDiabetes can lead to the development of serious and disabling complications if not properly treated. Complications include heart disease and stroke, high blood pressure, blindness, kidney disease, and limb amputation. According to the American Diabetes Association, it is possible to prevent or delay diabetic complications through a healthy diet, physical activity, and maintaining a healthy weight and glucose levels. FHApk does not offer specific diabetes services (other than routine inpatient care), but its diabetes engagement includes the Heart of Apopka program that uses the Stanford chronic disease self-management program that includes diabetes management. Because the Apopka community is nearly 50% Hispanic, the free, CDC-recommended classes are offered in both Spanish and English. C. CancerFHApk does not provide cancer treatment services. Patients in the Apopka community are treated at the Cancer Institute at the main Florida Hospital campus. In addition, FHApk supports the Area Health Education Council (AHEC) and provides funding to the American Cancer Society and the American Lung Association; these partners provide health education and disease management programs throughout the county. D. Heart DiseaseHeart disease, hypertension and Congestive Heart Failure - with Diabetes - are the most common chronic conditions in the United States. Risk factors include health behaviors such as obesity and smoking. The Heart of Apopka program noted above provides education and support for people with or at risk for heart disease through the free Stanford Chronic Disease Self-Management Program offered in Spanish and English. Apopka residents can access the free Florida Hospital congestive heart failure clinic at the Orange County Medical Clinic. FHApk supports efforts to reduce heart related conditions through the funding of research and programs via board membership to the American Heart Association. E. Sexually Transmitted DiseasesFHApk provides inpatient care but does not provide wrap-around services for HIV/AIDS or STD patients. The Health Department has STD and HIV/AIDS Clinics, and the Center for Multicultural Wellness and Prevention provides programs that screen for and treat sexually transmitted diseases. In addition, Orange County Government Health Services operates the Ryan White HIV/AIDS Program that provides services to people without sufficient health coverage or financial resources to cope with HIV. F. Maternal and Child HealthFHApk does not offer Maternal and Child health services, but supports the Healthy Start Coalition financially and through Board of Director service. Other Florida Hospital facilities (Winter Park, Orlando and Celebration) provide obstetrics services, and the new Florida Women's Hospital opened in 2015. The Walt Disney Pavilion at Florida Children's Hospital accepts referrals from other Florida Hospital campuses and from FH's CentraCare Walk-In Urgent Care Centers. G. Mental Health and Substance AbuseFHApk does not provide mental health and substance abuse services. There are strong mental health and substance abuse assets in Orange and Seminole County including Aspire Behavioral Health (inpatient and outpatient mental health and substance abuse services) and the Orlando Health Behavioral Group, an 80-bed psychiatric hospital at South Seminole Hospital, an unrelated hospital. Additionally, the Florida Hospital Community Health Impact Council (a grant-making entity) funds innovative mental health care models. Despite not being an explicit initiative prioritized by the campus, FHApk is addressing issues of mental health by: - Offering comprehensive evaluation, treatment and case management to improve quality of life for residents with mental health diagnosis via the Outlook Clinic for Depression and Anxiety - created in partnership with the Mental Health Association, FH Behavioral Health, Orange County Medical Clinic, UCF School of Social Work and Walgreens; and - Increasing the likelihood of medication adherence among uninsured patients via free or discounted prescription medications. H. Motor Vehicle Collisions The community issue of motor vehicle collisions is a health determinant rather than a core competency of most hospitals including FHApk. I. Single Parent HouseholdsSingle Parent Households, while a community issue, are a health determinant rather than a core competency of most hospitals including FHApk. J. Health LiteracyAlthough health literacy was not an issue prioritized by the Apopka campus, the principle of health literacy is embedded into our chronic disease self-management program efforts. We also aim to strengthen the relationship with community resources including Community Health Centers, a Federally Qualified Health Center (FQHC) in Apopka that offers primary care, dental, and obstetric services. Florida Hospital is also working internally to ensure comprehensive discharge education that emphasizes patients' understanding of the nature of their condition and has piloted a health navigator program in a local FQHC to better embed the principle of health literacy into its community health planning. Part V, Section B, Line 11 Continuation of Footnote Group B-Facility 6 -- Florida Hospital Heartland Medical CenterDescription of CHNA Significant Needs Continued Motor Vehicle Deaths The community's rate of motor vehicle accidents is higher that the state average; many are related to alcohol. Motor vehicle deaths that do not involve alcohol are unintentional deaths and may be related to the rural nature of the community. Numerous local organizations are currently working to stop drinking and driving. Chronic Lower Respiratory DiseaseHospitalizations for respiratory diseases exceed the state rate. Smoking is the main cause of chronic lower respiratory disease. Florida Hospital already offers smoking cessation classes and a Better Breathers Support Group, and other organizations such as the American Lung Association focus on this disease. Need for Health Promotion Lifestyle and personal health habits are growing concerns. The community's obesity rate is higher than the expected level for students in middle and high school, as well as in adults. We are already addressing this issue in our diabetes, heart disease and chronic disease self-management efforts. In addition, ACCESS Florida offered by the Florida Department of Children and Families helps families purchase nutritional foods needed to maintain a healthy lifestyle. HIV/AIDS HIV/AIDS deaths exceed the state average. An alarming 29% of married persons still believe you get HIV from mosquitoes. This is an issue of education, which many groups are focusing on. The local Health Department cares for HIV/AIDS patients. The Highlands County Rural Health Network offers "Making a Difference!" an initiative that empowers adolescents to change their behaviors and reduce their risks of pregnancy, HIV and other sexual transmitted diseases. Maternal-Infant Pregnancy, parental care and newborn care fall in as the tenth issue. Even though teen birth rates have dropped since 2010, the area's rates are still above the average. A 15 to 20-year-old has a 57% chance of giving birth, and 30% of mothers began their prenatal care after the first trimester. FHH offers a birthing center that serves women of all incomes and ethnicities. Several community groups are working diligently on teen pregnancy prevention. Healthy Choices Education/Teen Pregnancy Prevention are current initiatives by Highlands County Rural Health Network (of which FHH is a member); their focus is helping reduce STDs and teen pregnancy within the community. PediatricsPediatric services are limited in this community, due in part to a limited demand driven by a large aging population. FHH has a pediatric unit and a pediatric hospitalist, but no specialists. Families with acute needs travel out of the community - to Tampa, Orlando or Lakeland - for specialty pediatric services. FHH has a referral agreement with Florida Hospital for Children in Orlando that provides access to 30 sub-specialties. Due to the limited demand for pediatrics in the community, FHH has no current plans to expand the existing pediatric unit. Mental Health/Substance AbuseThere is a shortage of mental health providers in the community, meaning that the ability to provide effective care is challenging. In Highlands County, the patient-to-provider ratio is four times the state average. Substance abuse is also a growing issue, especially in middle and high school aged populations. Marijuana use is above the state average. FHH does not provide mental health or substance abuse services. BALANCE Lives in Transition is an organization formed to improve treatment and quality of life for residents. Drug Free Highlands works with the Highlands County School Board and Sheriff's Office to promote a drug- free community. Part V, Section B, Line 11 Continuation of Footnote Group A-Facility 8 -- Central Texas Medical CenterDescription of CHNA Significant Needs Continued 2. Goal: Increase CREATION Health Fitness Challenge participants from 64 to 100 by adding at least one Challenge and creating a children's component. Goal: 100 participants. - 2016 Actual: 431 participants. The concept for this event was initially a fitness challenge whereby participants would compete in actual fitness events. However, to reach a larger audience, during year two of the plan this event was re-branded as Family Fitness Fun Day. The goal of this family-oriented event is to promote healthy living through many of the CREATION health ideals. This has been a huge success drawing over 400 participants in years 2 and 3 of the plan. Cost: $31,841 Matching: $7,5503. Goal: Collaborate with local community organizations to provide vouchers for free health screenings to residents of Hays and Caldwell Counties at CTMC's annual HealthCheck screening event. Goal: 200 vouchers distributed. - 2016 Actual: 305 vouchers. HealthCheck continues to be a very popular and well attended health and wellness event. Through coordination with many area social service agencies our voucher distribution well exceeded our respective annual goals. This event not only offers education but also several health screenings such as blood pressure, cholesterol with LDL and HDL breakdown, glucose, and triglycerides. Cost: $39,361 Matching: $1,557 C. Priority: Prevalence and/or enhanced outpatient management of heart disease/congestive heart failure (CHF) and related conditions/risk factors such as hypertension CTMC interventions include efforts to better manage uninsured CHF patients who come to CTMC: 1. Goal: Identify uninsured Congestive Health failure (CHF) patients at risk for preventable readmissions and provide contacts to help them manage their disease in outpatient and home settings. Goal: Provide at least one contact for 95% of target population. - 2016 Actual: Contacts provided for 90% of target population. This program saw good success in 2014 and 2015. For much of 2016 we did not have a Transitional Care Coordinator so while our contact percentage was close to our goal our overall patient denominator was low. Additionally, we shifted our focus to Medicare patients only opting to refer unfunded patients to a medical home for coordinated follow-up care. Cost: $112,188 2. Goal: Initiate referrals to a medical home for unfunded CHF patients in Hays and Caldwell Counties. Goal: 75% of all unfunded patients have a referral to a medial home prior to discharge from CTMC. - 2016 Actual: 10% of all unfunded patients received a referral to a medical home prior to discharge from CTMC. The project exceeded expectations in 2014 and 2015 but was also negatively impacted due to not having a Transitional Care Coordinator coordinating with our case managers during much of 2016. As a result, our referrals were negatively impacted. However, moving forward this program is back on track for 2017. Cost: $13,899 3. Increase capacity of outpatient cardiac rehabilitation program to provide cardiac rehab services to unfunded patients. Goal: 8 patients accepted into program. - 2016 Actual: 4 patients were accepted into the program; 2 participated at some level. During years 1 and 2 we either met or exceeded our goals. We are not certain as to why we did not meet our year 3 goal. This program does take a large commitment from patients as they are expected to participate in several sessions each week. Transportation issues can be a barrier. We will continue to work with our case managers and cardiologists to identify patients appropriate for this program. Cost: $9050 4. Goal: Develop a "Better Breathers Club" in cooperation with the American Lung Association for residents of CTMC's service area who have CHF, COPD (Chronic Obstructive Pulmonary Disease) or related conditions. - 2016 Actual: We certified one instructor and held 7 meetings during year 1 of the CHP. However, referrals and interest in BBC did not support local meetings; goal was discontinued during year 2. Cost: $210 D. Priority: Prevalence and/or enhanced outpatient management of diabetes; programs to address anticipated growth of diabetes and related conditions. CTMC interventions include community screenings and education for people with diabetes: 1. Goal: Offer monthly glucose screenings and Diabetes Risk Assessments to residents of Hays and Caldwell Counties. Goal: Average 36 screenings at CTMC; increase assessments in outlying communities by 10%. - 2016 Actual: Averaged 53 blood glucose screenings and risk assessments monthly at CTMC. Averaged 16 participants at the 4 offsite blood glucose screenings and risk assessments. Unfortunately, diabetes is very prevalent in our community. These blood glucose screenings and risk assessments consistently met expected goals. Year 2 realized a slightly lower number of screenings at CTMC but this was also the first year we provided outreach screenings. Our outreach activities met expectations. Cost: $3,328 2. Goal: At least 40% of diabetes education class participants will receive at least two follow-up visits over a 12-month period. - 2016 Actual: 43% of diabetes education class participants received at least 2 follow-up visits. We found that the success of the follow-up visits was strongly contingent upon patient compliance. While we did not meet our year 1 and 2 goals we did see a steady increase in patient compliance over the course of the CHP exceeding our goal in year 3. Cost: $3,516 3. Goal: Offer a free diabetes support group meeting every two weeks. Goal: Average 13 participants per meeting. - 2016 Actual: Averaged 9 participants per meeting. While we did not meet anticipated goals each year we do feel this support group is very valuable to the community and the patients we serve. Going forward we will focus on promoting the value of this group especially for newly diagnosed diabetics and their family members. Cost: $10,614 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: Prevalence of Respiratory Disorders including asthma and COPD and access to programs/services that reduce "rescue care". While this is an important initiative, CTMC does not currently have the infrastructure to support programs that focus on respiratory diseases. There are no engaged pulmonologists on the medical staff. Future programs could include pulmonary rehabilitation and education programs that focus on asthma and those with chronic obstructive pulmonary disease (COPD). CTMC is working with the Lung Association on the Better Breathers program. Timely access to local Mental Health Services including treatment for substance abuse. As noted in the Needs Assessment, limited resources are available for mental health services. Hill Country Mental Health and Mental Retardation (MHMR) operate the Schieb Center in San Marcos. This center offers a wide array of programs. Qualitative data suggests demand for these services outweighs access. Currently, CTMC does not have the expertise or professional staff to address mental health services. All patients who present at CTMC with behavioral health conditions, including substance abuse, are transferred to another facility once medically stabilized. In 2012, almost 10% of all transfers from CTMC were due to mental health conditions. Prevalence of some cancer-related conditions and timely access to screening services and treatment. CTMC offers screening and related services specifically for breast cancer. We do not, however, offer clinical programs for the treatment of cancer including oncology and radiation services. Significant enhancements to our medical staff membership and service lines would need to be accomplished to effectively treat cancer and cancer-related conditions. We will continue to support community screening programs, especially breast cancer screening. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote Group A-Facility 8 -- Central Texas Medical CenterDescription of CHNA Significant Needs Continued Limited transportation resources, especially transportation for healthcare and related services. Unfortunately, Hays and Caldwell Counties have no mass transportation system. There is no bus system or light rail access. The CARTS (Capital Area Rural Transportation System) addresses some transportation challenges but services must be arranged ahead of time and the wait times can be significant. CTMC does not have the infrastructure to address transportation needs that are prevalent throughout the counties we serve. A future goal would be to design targeted health care services that are offered in satellite locations throughout the service area to make access to care closer to home and lessen reliance on transportation services. Reduced Teen Pregnancy Rates; support services including healthcare for pregnant teens. CTMC has a very robust obstetrics program including a neonatal ICU. Teen mothers frequently access these services. CTMC also offers free childbirth education services including breastfeeding/lactation consultation. While we offer a reasonable array of obstetrical-related health care services CTMC is not in the best position to reduce teen pregnancy rates through education and birth control. Other community partners including the Health Departments are working on this issue. Therefore, this is not an identified CTMC priority at this time. Part V, Section B, Line 11 Continuation of Footnote Group B-Facility 10 -- Florida Hospital Heartland Medical Center Lake PlacidDescription of CHNA Significant Needs Continued Based on this prioritization process, the Hospitals did not choose the following community issues: Medical Home ShortageThe community's total number of licensed family physicians is below the state average with a ratio of 1 primary care physician to 270 people. This issue was not chosen because it is encompassed in the access to health care priority. Motor Vehicle Deaths The community's rate of motor vehicle accidents is higher that the state average; many are related to alcohol. Motor vehicle deaths that do not involve alcohol are unintentional deaths and may be related to the rural nature of the community. Numerous local organizations are currently working to stop drinking and driving. Chronic Lower Respiratory DiseaseHospitalizations for respiratory diseases exceed the state rate. Smoking is the main cause of chronic lower respiratory disease. Florida Hospital already offers smoking cessation classes and a Better Breathers Support Group, and other organizations such as the American Lung Association focus on this disease. Need for Health Promotion Lifestyle and personal health habits are growing concerns. The community's obesity rate is higher than the expected level for students in middle and high school, as well as in adults. We are already addressing this issue in our diabetes, heart disease and chronic disease self-management efforts. In addition, ACCESS Florida offered by the Florida Department of Children and Families helps families purchase nutritional foods needed to maintain a healthy lifestyle. HIV/AIDS HIV/AIDS deaths exceed the state average. An alarming 29% of married persons still believe you get HIV from mosquitoes. This is an issue of education, which many groups are focusing on. The local Health Department cares for HIV/AIDS patients. The Highlands County Rural Health Network offers "Making a Difference!" an initiative that empowers adolescents to change their behaviors and reduce their risks of pregnancy, HIV and other sexual transmitted diseases. Maternal-Infant Pregnancy, parental care and newborn care fall in as the tenth issue. Even though teen birth rates have dropped since 2010, the area's rates are still above the average. A 15 to 20-year-old has a 57% chance of giving birth, and 30% of mothers began their prenatal care after the first trimester. FHH offers a birthing center that serves women of all incomes and ethnicities. Several community groups are working diligently on teen pregnancy prevention. Healthy Choices Education/Teen Pregnancy Prevention are current initiatives by Highlands County Rural Health Network (of which FHH is a member); their focus is helping reduce STDs and teen pregnancy within the community. PediatricsPediatric services are limited in this community, due in part to a limited demand driven by a large aging population. FHH has a pediatric unit and a pediatric hospitalist, but no specialists. Families with acute needs travel out of the community - to Tampa, Orlando or Lakeland - for specialty pediatric services. FHH has a referral agreement with Florida Hospital for Children in Orlando that provides access to 30 sub-specialties. Due to the limited demand for pediatrics in the community, FHH has no current plans to expand the existing pediatric unit. Mental Health/Substance AbuseThere is a shortage of mental health providers in the community, meaning that the ability to provide effective care is challenging. In Highlands County, the patient-to-provider ratio is four times the state average. Substance abuse is also a growing issue, especially in middle and high school aged populations. Marijuana use is above the state average. FHH does not provide mental health or substance abuse services. BALANCE Lives in Transition is an organization formed to improve treatment and quality of life for residents. Drug Free Highlands works with the Highlands County School Board and Sheriff's Office to promote a drug-free community. Part V, Section B, Line 11 Continuation of Footnote Group A-Facility 11 -- Florida Hospital WauchulaDescription of CHNA Significant Needs Continued As noted above, FHW (along with Florida Hospital Heartland Medical Center in Sebring and Florida Hospital Heartland Medical Center Lake Placid) worked to implement the Stanford Chronic Disease Self-Management Program (CDSMP) in 2015 and 2016. The CDSMP is recognized by the CDC for improvement in chronic heart disease self-management skills and reduced hospitalizations, and classes began first quarter of 2016. 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: Motor Vehicle Deaths The community's rate of motor vehicle accidents is higher that the state average; many are related to alcohol. Motor vehicle deaths that do not involve alcohol are unintentional deaths and may be related to the rural nature of the community. This is not a core competency of FHW, and there are numerous community organizations working to stop drinking and driving. Chronic Lower Respiratory DiseaseSmoking falls within the education for heart disease and stroke. FHW already offers a five-week program to become tobacco free as well as a Better Breathers Club that teaches ways to cope with COPD. Health PromotionThis issue fell under the umbrella of diabetes, which is being addressed as one of the priorities. Florida Department of Children and Families offers ACCESS Florida, a program that helps individuals and families purchase nutritional foods needed to maintain and promote good health. The Hardee County Department of Health also offers a variety of health promotion programs. FHW maintains membership in the Hardee Health Care Task Force and Tobacco Free Partnership. HIV/AIDSHardee County has an average of two AIDS cases reported annually. This issue already has numerous groups and advocacies working to educate about HIV/AIDS and how they can be treated if they are diagnosed. Making a Difference! is an initiative that empowers adolescents to change their behaviors that will reduce their risks of pregnancy, HIV and other sexually transmitted diseases. Pregnancy/Prenatal Care/NewbornFHW does not offer OB services. While teen birth rates are high, there are numerous organizations trying to educate on teen pregnancies and the importance of prenatal care as well as continuing the child's health welfare after birth through regular check-ups with a pediatrician. Healthy Choices Education /Teen Pregnancy Prevention are current initiatives by the Heartland Rural Health Network (five counties including Hardee); they focus on healthy choices education to help reduce STD and teen pregnancy within the community. Healthy Start is another program promoting optimal prenatal health and developmental outcomes for all pregnant women and babies. FHW is also a member of the Teen Pregnancy Prevention Alliance in Hardee County. Pediatric ServicesFHW does not offer pediatric services. The Health Department, Florida Hospital Heartland and Central Florida Family Health Care (FQHC) offer these services. Mental Health/Substance AbuseFHW does not provide mental health services. Currently, there are several community-based substance abuse and mental health programs available to help provide stable environments and mentoring for those affected. BALANCE Lives in Transition was formed as a unique support system to improve the treatment and quality of life for residents. They are engaged in a variety of activities to create awareness about behavioral health and promote the promise of recovery for residents. ImmunizationsImmunizations are increasingly available through health departments, drug stores, the local FQHC and primary care physicians. FHW does not provide immunizations. Dental Care Dental care was not chosen as a priority due to the scope of resources available and the fact that this issue also falls into access to health care. Central Florida Health Care (FQHC) offers dental services for low-income and insured patients. 154 1 - Florida Hospital Cancer Institute 2501 N Orange Avenue Suites 139 181 33 Orlando FL 32804 Cancer Center 2 - Florida Hospital Rehabilitation and Sports 5165 Adanson Street Orlando FL 32804 Therapy Center 3 - Florida Hospital Orlando Pathology Lab 2855 N Orange Avenue Orlando FL 32803 Lab Services 4 - Florida Hospital Kissimmee Outpatient Imag 2400 N Orange Blossom Trail Suite 106 Kissimmee FL 34744 Outpatient Services 5 - Florida Hospital Winter Garden 2000 Fowler Grove Blvd Winter Garden FL 34787 Freestanding ED 6 - Florida Hospital Cancer Institute - Kissim 1300 West Oak Street Kissimmee FL 34741 Cancer Center 7 - Florida Hospital Altamonte Ambulatory Surg 661 E Altamonte Drive Suite 110 Altamonte Springs FL 32701 Outpatient Surgery Center 8 - Florida Hospital Kidney Stone Center 2501 N Orange Avenue Suite 121 Orlando FL 32804 Outpatient Services 9 - Florida Hospital Altamonte Outpatient MRI 661 E Altamonte Drive Suite 112 Altamonte Springs FL 32701 Radiology Services 10 - Family Health East Orlando Women's Pavilio 7975 Lake Underhill Road Suite 100 Orlando FL 32822 Women's Health Clinic 11 - Lake Mary Freestanding ED 950 Rinehart Road Lake Mary FL 32746 Freestanding ED 12 - AdminBHSOnsite 2600 Westhall Lane Box 300 Maitland FL 32751 Corporate Services 13 - Florida Hospital Endoscopy OP Services 2415 N Orange Avenue Suite 201 Orlando FL 32804 OP Services 14 - Florida Hospital Surgery Center East Orla 258 S Chickasaw Trail Suite 100 Orlando FL 32825 Outpatient Surgery 15 - FHCC - LAKE BUENA VISTA #2 12500 S Apopka Vineland Road Orlando FL 32836 Urgent Care Clinic 16 - Florida Hospital Transplant Center 2415 N Orange Avenue Suite 600 700 Orlando FL 32804 Organ Tissue/Transplant Center 17 - FHHMC Surgery Center 4240 Sun N Lake Blvd Sebring FL 33872 Outpatient Surgery 18 - Florida Hospital Cancer Care Center 2100 Glenwood Drive Winter Park FL 32792 Radiation Oncology 19 - FHCC - SOUTH ORANGE 2609 S Orange Avenue Orlando FL 32806 Urgent Care Clinic & Employer Onsite Clinic 20 - Florida Hospital Celebration Health Outpat 410 Celebration Place Suite 408 Celebration FL 34747 Outpatient Surgery Center 21 - Florida Hospital Medical Plaza 2501 N Orange Avenue Orlando FL 32804 Physician Clinics 22 - Florida Hospital Gamma Knife 2501 N Orange Avenue Suite 101 S Orlando FL 32804 Gamma Knife 23 - Florida Hospital Altamonte Mammography Cen 661 E Altamonte Drive Suite 130 Altamonte Springs FL 32701 Radiology Services 24 - FHCC - SANFORD 4451 West 1st Street Sanford FL 32771 Urgent Care Clinic 25 - FHCC - WATERFORD 250 N Alafaya Trail Suite 135 Orlando FL 32825 Urgent Care Clinic 26 - FHCC - WINTER GARDEN 3005 Daniels Road Winter Garden FL 34787 Urgent Care Clinic 27 - FHCC - ORANGE LAKE 8201 W Irlo Bronson Highway Kissimmee FL 34747 Urgent Care Clinic 28 - Florida Hospital Kissimee - OP Endoscopy 2400 N Orange Blossom Trail Suite 301 Kissimmee FL 34744 Outpatient Services 29 - FHHMC Cardiology Associates 4638 Sun N Lake Blvd Sebring FL 33872 Outpatient Phys Clinic 30 - Florida Hospital Center for Behavioral Hea 501 E King Street 1st Floor Orlando FL 32803 Med/Psych 31 - FHCC - WINTER PARK 3099 Aloma Avenue Winter Park FL 32792 Urgent Care Clinic 32 - Florida Hospital Apopka The Women's Cente 205 N Park Avenue Suite 108 Apopka FL 32703 Womens's services 33 - FHCC - ALTAMONTE 440 W Highway 436 Altamonte Springs FL 32714 Urgent Care Clinic 34 - Florida Hospital Rehabilitation & Sports M 8701 Maitland Summit Blvd Orlando FL 32810 Therapy Center 35 - FHCC - HUNTERS CREEK 3293 Greenwald Way North Kissimmee FL 34741 Urgent Care Clinic 36 - Loch Haven OBGyn Group 235 E Princeton Street Suite 200 Orlando FL 32804 Physician Clinics 37 - FHCC - LEE ROAD 2540 Lee Road Winter Park FL 32789 Urgent Care Clinic 38 - FHCC - MT DORA 9015 US Highway 441 Mount Dora FL 32757 Urgent Care Clinic 39 - FHCC - PORT ORANGE 1208 Dunlawton Avenue Port Orange FL 32127 Urgent Care Clinic 40 - Florida Hospital Celebration Women's Insti 410 Celebration Place Suite 201 Celebration FL 34747 Women's services 41 - Winter Park Memorial Hospital Women's Cent 100 N Edinburgh Winter Park FL 32792 Women's Health Clinic, Imaging 42 - Florida Hospital Altamonte Pain Medicine 711 E Altamonte Drive Suite 100 Altamonte Springs FL 32701 Pain Medicine 43 - FHCC - COLONIAL TOWN 630 North Bumby Avenue Orlando FL 32803 Urgent Care Clinic 44 - FHCC - CLERMONT 15701 State Road 50 Suite 101 Clermont FL 34711 Urgent Care Clinic 45 - FHCC - UNIVERSITY 11550 University Blvd Orlando FL 32817 Urgent Care Clinic 46 - FHCC - DR PHILLIPS 8014 Conroy-Windermere Road Suite 104 Orlando FL 32835 Urgent Care Clinic 47 - Cancer Institute 4420 Sun N Lake Blvd Sebring FL 33872 Oncology 48 - FHCC - AZALEA PARK 509 S Semoran Blvd Orlando FL 32807 Urgent Care Clinic 49 - FH Wauchula Pioneer Medical Center 515 Carlton Street Wauchula FL 33873 Outpatient Phys Clinic 50 - FHCC - OVIEDO 8010 Red Bug Road Oviedo FL 32765 Urgent Care Clinic 51 - FHCC - KISSIMMEE 4320 W Vine Street Kissimmee FL 34746 Urgent Care Clinic 52 - FHHMC CareNow 4421 Sun N Lake Blvd Suite B Sebring FL 33872 Outpatient Phys Clinic 53 - Florida Hospital Altamonte Imaging Center 894 E Altamonte Drive Suite 1100 Altamonte Springs FL 32701 Radiology Services 54 - Florida Hospital Rehabilitation & Sports M 711 E Altamonte Drive Suite 200 Altamonte Springs FL 32701 Therapy Center 55 - FHHMC SeaScape Imaging & Laboratory OP Cen 2950 Alt US 27 S Sebring FL 33870 Outpatient Imaging & Laboratory 56 - FHCC - BRANDON 10222 Bloomingdale Avenue Riverview FL 33578 Urgent Care Clinic 57 - FHCC - LONGWOOD 855 S US Highway 17-92 Longwood FL 32750 Urgent Care Clinic 58 - FHHMC Interventional Cardiology 4240 Sun N Lake Blvd Suite 202 Sebring FL 33872 Outpatient Phys Clinic 59 - FHCC - SAND LAKE 2301 Sand Lake Road Orlando FL 32809 Urgent Care Clinic 60 - Florida Hospital Sleep Disorder Center - W 1925 Mizell Avenue Suite 200 Winter Park FL 32792 Sleep Center 61 - Florida Hospital Laboratory - Winter Park 1925 Mizell Avenue Suite 100 Winter Park FL 32792 Lab Services 62 - Florida Hospital Center for Thrombosis 2566 Lee Road Winter Park FL 32789 Thrombosis Center 63 - FHHMC Therapy Center 6325 US Highway 27 N Sebring FL 33870 Outpatient Therapy Center 64 - CTMC Hospice 1315 IH 35 North San Marcos TX 78666 Hospice services 65 - Florida Hospital Center for Sleep Disorder 501 E King Street 2nd Floor Orlando FL 32803 Sleep Disorder Center 66 - FHCC - Carrollwood 4001 W Linebaugh Ave Tampa FL 33624 Urgent Care Clinic 67 - Florida Hospital Advanced Nuclear Imaging 328 Spruce Street Orlando FL 32803 Radiology Services 68 - Florida Hospital Rehabilitation & Sports M 7975 Lake Underhill Road Suite 345 Orlando FL 32822 Therapy Center 69 - Florida Hospital Rehabilitation & Sports M 615 E Princeton Street Suite 104 Orlando FL 32803 Therapy Center 70 - San Marcos MRI LP 1330 Wonder World Drive San Marcos TX 78666 Imaging Services 71 - Family Health Center Winter Park 2950 Aloma Avenue Suite 100 Winter Park FL 32792 Physician Clinics, Medicine Specialists, Surgical Specialists 72 - FHCC - St Cloud 4660 13th Street St Cloud FL 34769 Urgent Care Clinic 73 - FHCC - Leesburg 1103 North 14th Street Leesburg FL 34748 Urgent Care Clinic 74 - SDOC Clinic 831 Simpson Road Kissimmee FL 34744 Employer Clinic 75 - Family Health Center East 7975 Lake Underhill Road Suite 200 Orlando FL 32822 Physician Clinics 76 - FHHMC Heartland Women's Health 37 Ryant Blvd Sebring FL 33870 Outpatient Phys Clinic 77 - Florida Hospital Celebration Health Life S 410 Celebration Place Suite 302B Celebration FL 34747 Education Services 78 - Florida Hospital Cardiac Cath Lab 2501 N Orange Ave Suite 137 N Orlando FL 32804 Cardiac Cath Lab 79 - Florida Hospital Sports Medicine & Rehabil 2501 N Orange Ave Suite 137 Orlando FL 32804 Pediatric Center / Outpatient Services 80 - FHCC - CONWAY 5810 S Semoran Blvd Orlando FL 32822 Urgent Care Clinic 81 - Florida Hospital Rehabilitation & Sports M 8000 Red Bug Lake Road Suite 140 Oviedo FL 32765 Therapy Center 82 - FHCC - Daytona 1014 W International Speedway Blvd Daytona Beach FL 32114 Urgent Care Clinic 83 - FHHMC Highlands Surgical Associates 4301 Sun N Lake Blvd Suite 103 Sebring FL 33872 Outpatient Phys Clinic 84 - FHCC - Wesley Relo 1127 Bruce B Downs Blvd Wesley Chapel FL 33544 Urgent Care Clinic 85 - Florida Hospital Rehab and Sports Medicine 100 Waymont Court Suite 120 Lake Mary FL 32746 Therapy/Hearing Center 86 - Florida Hospital Rehabilitation & Sports M 201 Hilda Street Suite 12 Kissimmee FL 34741 Therapy Center 87 - Florida Hospital Rehabilitation & Sports M 2520 N Orange Avenue Suite 100 Orlando FL 32804 Therapy Center 88 - Florida Hospital Rehab and Sport Medicine 2005 Mizell Avenue Winter Park FL 32792 Therapy Center 89 - FHHMC Family Practice Center 1006 W Pleasant Street Avon Park FL 33825 Outpatient Phys Clinic 90 - FHHMC Wound Care 4143 Sun N Lake Blvd Sebring FL 33872 Wound Care 91 - FHHMC Women's Wellness Center 4240 Sun N Lake Blvd Suite 200 Sebring FL 33872 Outpatient Phys Clinic 92 - Florida Hospital Diabetes Institute 2415 N Orange Ave Suite 501 Orlando FL 32804 Diabetes 93 - FHHMC Family Medicine Specialist & OP Labo 2315 US Highway 27 N Avon Park FL 33825 Outpatient Phys Clinic & Laboratory 94 - PEDS Fairbanks 2325 W Fairbanks Ave Winter Park FL 32789 Urgent Care Clinic 95 - CTMC Rehab Services 1340 Wonder World Drive San Marcos TX 78666 OP Rehab Services 96 - Florida Hospital Laboratory - Orlando 2501 N Orange Avenue Suite 370 Orlando FL 32804 Lab Services 97 - Celebration Hand Therapy 410 Celebration Place Suite 300 Celebration FL 34747 Therapy Center 98 - Central Texas Ambulatory Endoscopy 1303 Wonder World Drive San Marcos TX 78666 Endoscopy Services 99 - Palm Coast 1270 Palm Coast Parkway NW Palm Coast FL 32137 Urgent Care Clinic 100 - Peds Lake Mary 105 South Country Club Road Lake Mary FL 32746 Urgent Care Clinic 101 - Florida Hospital Rehabilitation & Sports M 205 N Park Avenue Suite 110 Apopka FL 32703 Therapy Center 102 - FHHMC Pulmonary & Critical Care Specialist 4409 Sun N Lake Blvd Suite E Sebring FL 33872 Outpatient Phys Clinic 103 - FHCC - SOUTH TAMPA 301 North Dale Mabry Hwy Tampa FL 33609 Urgent Care Clinic 104 - Medical Plaza - Florida Hospital Kissimmee 2400 N Orange Blossom Trail Kissimmee FL 34744 Physician Clinics 105 - FHHMC Therapy Center Lake Placid 1210 US Highway 27 North Lake Placid FL 33852 Outpatient Physical Therapy 106 - FH Sports Med & Rehab - Lake Nona 9975 Tavistock Lakes Blvd Suite 140 Orlando FL 32827 Therapy Center 107 - CTMC Home Health 2007 Medical Parkway San Marcos TX 78666 Home Health services 108 - FHHMC Urology Specialist 4215 Sun N Lake Blvd Sebring FL 33872 Outpatient Phys Clinic 109 - Florida Hospital Rehabilitation and Sports 1603 S Hiawassee Road Suite 105 Orlando FL 32835 Therapy Center 110 - FHHMC Psychiatric Services 4023 Sun N Lake Blvd Sebring FL 33872 Outpatient Phys Clinic 111 - Florida Hospital Rehab University of Centr UCF Health Service/Building 124-Rm 114 40 Orlando FL 32816 Therapy Center 112 - FHHMC Family Medicine Associates 5909 US Highway 27 N Suite 102 Sebring FL 33870 Outpatient Phys Clinic 113 - FHHMC Sleep Lab 4301 Sun N Lake Blvd Sebring FL 33872 Sleep Lab 114 - Florida Hospital Urology Surgery Center 1812 N Mills Avenue Orlando FL 32803 Outpatient Surgery Center 115 - Florida Hospital Kissimmee Clinical Pharma 201 Hilda Street Suite 36 Kissimmee FL 34741 Outpatient Services 116 - FHHMC Complete Family Care 935 Mall Ring Road Sebring FL 33870 Outpatient Phys Clinic 117 - Eden Spa 2501 N Orange Avenue Suite 186 Orlando FL 32804 Therapy 118 - Darden Onsite 1000 Darden Center Drive Orlando FL 32837 Employer Onsite Clinic 119 - FH Wauchula Cardiology Associates 463 Carlton Street Wauchula FL 33873 Outpatient Phys Clinic 120 - FH Wauchula The Therapy Center 1330 Highway 17 S Wauchula FL 33873 Outpatient Physical Therapy 121 - FHHMC SeaScape Internal Medicine Sebring 2950 Alt US 27 S Suite B Sebring FL 33870 Outpatient Phys Clinic 122 - FHHMC ENT Specialist 4325 Sun N Lake Blvd Suite 102 Sebring FL 33872 Outpatient Phys Clinic 123 - Center for Pediatric & Adolescent Medicine 15502 Stoneybrook West Parkway Suite 2-11 Winter Garden FL 34787 Pediatric Center / Outpatient Services 124 - Florida Hospital Sleep Disorder Center - A 203 N Park Avenue Suite 106 Apopka FL 32703 Sleep Center 125 - Florida Hospital Laboratory - Lucerne Terr 1723 Lucerne Terrace Orlando FL 32806 Lab Services 126 - FHHMC Family Care of Lake Placid 201 US Highway S Lake Placid FL 33852 Outpatient Phys Clinic 127 - FHHMC Highlands Surgical Associates Lake P 1352 US 27 North Lake Placid FL 33852 Outpatient Phys Clinic 128 - FH Lab - Lake Nona 9975 Tavistock Lakes Blvd Suite 260 Orlando FL 32827 Lab Services 129 - Siemens Onsite 4400 N Alafaya Trail MC Q1-240 Orlando FL 32826 Employer Onsite Clinic 130 - Florida Hospital Laboratory - Palm Springs 631 Palm Springs Drive Suite 113 Altamonte Springs FL 32701 Lab Services 131 - FHHMC Internal Medicine Specialist 6801 US Highway 27 N Suite B-2 Sebring FL 33870 Outpatient Phys Clinic 132 - JP Morgan Chase Onsite 550 International Parkway Floor 1 Lake Mary FL 32746 Employer Onsite Clinic 133 - Deland 2293 S Woodland Blvd Deland FL 32720 Urgent Care Clinic 134 - Wyndham Onsite 6277 Sea Harbor Drive Orlando FL 32821 Employer Onsite Clinic 135 - Florida Hospital Laboratory - Tavares 1769 David Walker Drive Tavares FL 32778 Lab Services 136 - Florida Hospital Sports Medicine & Rehabil 3131 Daniels Road Winter Garden FL 34787 Outpatient Rehab 137 - FHHMC Family Care of Sebring 844 Poinsettia Avenue Sebring FL 33870 Outpatient Phys Clinic 138 - Florida Hospital Laboratory - Altamonte 661 E Altamonte Drive Suite 131 Altamonte Springs FL 32701 Lab Services 139 - Florida Hospital Women's CenterLactation 2520 N Orange Avenue Suite 103 Orlando FL 32804 Lactation Center, Birthing Classes 140 - FH Wauchula Sleep Lab 457 W Carlton Street Wauchula FL 33873 Sleep Lab 141 - Florida Hospital Hearing Center East Orla 7975 Lake Underhill Road Suite 300 Orlando FL 32822 Hearing Center 142 - OCG Onsite 450 E South Street Orlando FL 32802 Employer Onsite Clinic 143 - FHHMC Outpatient Laboratory 6801 US Highway 27 N Suite C-1 Sebring FL 33870 Outpatient Laboratory 144 - FHHMC Diabetes Center 4023 Sun N Lake Blvd Sebring FL 33872 Diabetes Center 145 - Waterman Onsite 1000 Waterman Way Tavares FL 32778 Employer Onsite Clinic 146 - Florida Hospital Sports Medicine & Rehabil 626 N Alafaya Trail Orlando FL 32828 Outpatient Rehab 147 - FHWRHC Frostproof Family Health 200 Scenic Hwy Frostproof FL 33843 Outpatient Clinic 148 - FHHMC Womens Health 114 N Parrott Avenue Okeechobee FL 34972 Outpatient Clinic 149 - FH Wauchula Women's Wellness 526 W Carlton Street Wauchula FL 33873 Outpatient Phys Clinic 150 - FHCC - WESLEY CHAPEL 5504 Gateway Blvd Wesley Chapel FL 33544 Urgent Care Clinic 151 - Florida Hospital Orlando Genetic Counselin 2501 N Orange Avenue Suite 249B Orlando FL 32804 Outpatient Services 152 - Florida Hospital East Infusion Center 7975 Lake Underhill Road Suite 130 Orlando FL 32822 Infusion Center 153 - Florida Hospital Altamonte Infusion Center 894 E Altamonte Drive Suite 3000 Altamonte Springs FL 32701 Infusion Center 154 - Florida Hospital Kissimmee Infusion Center 1300 West Oak Street Suite A Kissimmee FL 34741 Infusion Center 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 organization's most recently conducted community health needs assessments and associated implementation strategies are posted on the filing organization's websites. Part I, Line 7: The amounts of costs reported in the table in line 7 of Part I of Schedule H were determined by utilizing a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges, contained in the Schedule H instructions. Part II, Community Building Activities: The costs of community building activities reported on Part II of Schedule H primarily represent the costs associated with commercially sponsored research conducted by two of the organization's hospitals. These two hospitals participate in clinical drug and device research that is performed on patients who have a condition or disease for which the eventual commercial use of a drug or device is intended. This research is related to patient care and serves to expand scientific knowledge with respect to potential treatments and cures for various diseases and conditions.The costs of community building activities reported on Part II of Schedule H also include the costs associated with providing education for the filing organization's staff physicians and employees. The filing organization's provision of these educational programs/activities to staff physicians and employees provides an opportunity for health care professionals to enhance their skills and expertise and keep up-to-date with the latest advancements in medical procedures and technology. In addition, training opportunities are often provided on-site at the filing organization's hospital facilities, thereby allowing for health care professionals to be more readily available to assist in meeting immediate patient care needs. Education and training provided to each facility's workforce is vital in assisting health care professionals directly involved in patient care with keeping abreast of the latest developments in their respective areas of expertise, learning possible new and innovate ways of delivering care to patients, and understanding the newest technologies available for the treatment of patients.The remainder of the costs incurred stem from the hospitals' involvement in and support of various other community agencies in its service area that work collaboratively to help those in need and to improve the health and safety of the residents of the community. The organization's hospitals participate with a number of other community organizations to address the healthcare needs of the community. Both cash and in-kind donations are made annually to various local charitable organizations. 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: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 8. 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: Collection Policies: 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: $ (118,727,025)- Difference in costing methodology: 10,208,057- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (130,944,270) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's communitybenefit reporting $(239,463,238)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: As reported in Schedule H, Part V, Section B, the filing organization's hospital facilities conducted their community health needs assessments (CHNAs) during 2013 and 2016. The 2016 CHNAs were adopted by all hospital governing boards by December 31, 2016, the end of the filing organization's taxable year in which the CHNAs were conducted. All of the filing organization's hospital facilities' 2016 CHNAs complied with the guidance set forth by the IRS in Final Regulation Section 1.501(r)-3. In addition to the CHNAs discussed above, a variety of practices and processes are in place to ensure that the filing organization is responsive to the health needs of all of its communities. Such practices and processes involve the following:1. Hospitals' operating/community boards 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 hospital communities; and 4. Collaboration with other local community groups to address the health care needs of the filing organization's hospital communities. Part VI, Line 3: The Financial Assistance Policy (FAP), Financial Assistance Application Form (FAA Form), and the Plain Language Summary of the Financial Assistance Policy (PLS) of the filing organization's hospital facilities are transparent and available to all individuals served at any point in the care continuum. The FAP, FAA Form, PLS, and contact information for the hospital facilities' financial counselors are prominently and conspicuously posted on the filing organization's hospital facilities' websites. Each hospital facility's 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 relevant hospital facility (referred to below as LEP defined populations). Signage is displayed in public locations of the filing organization's hospital facilities, including at all points of admission and registration and the Emergency Department. The signage contains each 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 hospital facility's FAP, FAA Form and PLS are available upon request and without charge, both in public locations in the hospital facility and by mail. Paper copies are made available in English and in the primary languages of any LEP defined populations. The filing organization's hospital facilities' financial counselors seek to provide personal financial counseling to all individuals admitted to the hospital facilities 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 hospital facility's PLS will be offered to every patient as a part of the intake or discharge process. A conspicuous written notice is included on all billing statements sent to patients that notifies and informs recipients about the availability of financial assistance under the filing organization's financial assistance policy, including the following: 1) the telephone number of the hospital facilities' office or department that can provide information about the FAP and the FAA Form; and 2) the website address where copies of the FAP, FAA Form and PLS may be obtained. Reasonable attempts are made to inform individuals about the hospital facilities' FAP in all oral communications regarding the amount due for the individual's care. Copies of the PLS are distributed to members of each hospital facility's 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: In 2016, the filing organization operated 4 separately licensed hospitals that together encompassed 11 separate campus locations. The hospitals are located in Florida and Texas. A description of each of the hospital campuses is described below.Adventist Health System/Sunbelt, Inc. dba Central Texas Medical Center:Central Texas Medical Center (CTMC) is a 178-bed acute-care hospital providing a wide range of healthcare services in San Marcos, Texas and the neighboring communities within Hays and Caldwell counties, Texas. Special services offered at CTMC include a 24/7, Level 4 emergency and trauma center, state-of-the-art medical imaging and laboratory services, a new women's center featuring a Level 2 Neonatal Intensive Care Unit, newly renovated and expanded surgery suites--including two equipped with robotic capabilities--a Rehabilitation Institute, a center for advanced wound healing and hyperbaric medicine, and two cardiac catheterization labs. As a health resource for their community, CTMC's Creation Health Institute also annually hosts the oldest and largest health screening and fair event in Hays County, as well as a number of ongoing classes and workshops ranging in topics from diabetes prevention and management to heart disease, stroke, arthritis, self-help, nutrition and more. CTMC received accreditation as a certified chest pain center from the Society of Chest Pain Centers in 2011. The accreditation enhances CTMC's ability to receive and treat patients suffering from chest pain and/or a possible heart attack. The result is a focus on reduced time from symptom onset to diagnosis and treatment, getting patients treated more quickly during the critical window of time when the integrity of the heart muscle can be preserved, and monitoring of patients whose diagnosis is uncertain to ensure they are not sent home too quickly or admitted unnecessarily. CTMC remains the only hospital in the region that provides an inpatient Hospice unit. From 2010 through 2015, CTMC was named The Best Hospital in Hays County. In Fall 2015 and Spring 2016, CTMC was the first hospital between Austin and San Antonio to be awarded two consecutive "A" ratings by the Leapfrog Group recognizing outstanding achievement in hospital safety. In 2014, CTMC received awards and recognitions from the American Heart Association, American Stroke Association, The Joint Commission, Premier, Inc. and Healogics, Inc. related to the quality of care given to its patients. San Marcos, Texas is located in Hays County, Texas and is in close proximity to Austin and San Antonio. CTMC's primary service area has a population of approximately 111,700, with an estimated 13% over the age of 65. The per capita income in Hays County is approximately $27,080. It is estimated that 13% of the individuals residing in the primary service area live below 100% of the Federal Poverty Level. Approximately 43% of CTMC's patients during 2016 were Medicare patients, about 10% were Medicaid patients, about 14% were self-pay patients and the remaining percentage were patients covered under commercial insurance. In 2016, about 69% of CTMC's in-patients were admitted through the Emergency Department.Adventist Health System/Sunbelt, Inc. dba Florida Hospital Heartland Medical Center:Florida Hospital Heartland Medical Center (FHHMC) is comprised of three separate hospital campuses with a total of 222 beds. Two of the hospital campuses are located in Highlands County, Florida and operate under a single hospital license and the third separately licensed campus is located in Hardee County, Florida. Highlands and Hardee counties are in the south central areas of Florida and are adjacent to each other. *Florida Hospital Heartland Medical Center, Highlands County - The main 147-bed hospital facility is located in north Sebring. The facility provides a wide range of healthcare services including Certified Stroke and Chest Pain Centers, the county's busiest emergency department, ACR-accredited imaging services, surgical services, Blessed Beginnings obstetrics, outpatient psychiatric and Tele ICU. Since 2012, the Heart & Vascular Center has added a third cath lab, expanded the emergency care department and renovated the lab services area. Sebring, Florida is located in Highlands County. Florida Hospital Heartland Medical Center's primary service area has a population of approximately 104,797, with an estimated 34% age 65 or over the age of 65. The per capita income in Highlands County is approximately $20,455. It is estimated that approximately 20% of the individuals residing in the primary service area live in poverty. *Florida Hospital Heartland Medical Center Lake Placid, Highlands County - This satellite facility houses 33 medical and surgical beds, the county's only 17-bed inpatient mental health unit and a wide range of services that are highly sophisticated for a small community hospital. This campus also specializes in inpatient geriatric psychiatric services within Highlands and Hardee counties. The need for behavioral health services is extreme in both counties since there is no other program closer than sixty miles. Since 2012, this campus has added a Tele-ICU program and its imaging services are ACR-accredited. Lake Placid, Florida is located in Highlands County. Florida Hospital Heartland Medical Center Lake Placid's primary service area has a population of approximately 66,574, with an estimated 34% age 65 or over the age of 65. The per capita income in Highlands County is approximately $20,455. It is estimated that approximately 20% of the individuals residing in the primary service area live in poverty. *Florida Hospital Wauchula, Hardee County - This campus is licensed for 25 beds and specializes in emergency and outpatient care, while offering excellent medical inpatient services. The inpatient unit is mixed with both acutely ill patients and patients who need short-term rehabilitation (transitional care). This campus offers the only emergency care in Hardee County. In 2000, Florida Hospital Wauchula became the first Critical Access Hospital in the state of Florida. Since 2012, this campus has added the county's only mammography program, updated the lab services area and its imaging services are ACR-accredited. Wauchula, Florida is located in Hardee County. Florida Hospital Wauchula's primary service area has a population of approximately 27,159, with an estimated 14% age 65 or over the age of 65. The per capita income in Hardee County is approximately $15,366. It is estimated that 30% of the individuals residing in the primary service area live below 100% of the Federal Poverty Level and the unemployment rate is about 9.4%. Uninsured in Hardee County is approximately 39%. Approximately 67% of FHHMC's patients during 2016 were Medicare patients, about 12% were Medicaid patients, about 5% were self-pay patients and the remaining percentage were patients covered under commercial insurance. In 2016, about 74% of FHHMC's in-patients were admitted through the Emergency Department.Adventist Health System/Sunbelt, Inc. dba Florida Hospital (FH):FH is a 2,760-bed medical complex in Central Florida with seven separate hospital campuses (the Hospitals) that operate under a single hospital license. FH serves the residents of Central Florida (primarily serving the residents of Orange, Osceola, Seminole and Lake County) but also draws patients from other parts of the Southeastern United States, the Caribbean and South America. The 7-campus health system is the largest healthcare provider in Central Florida with more than 2 million patient visits per year and is the nation's largest Medicare provider. Florida Hospital is the second largest employer in the area. The main campus of the FH system is located in Orlando, Florida (Orange County) near the downtown area. The other 6 campuses are located in surrounding communities in the counties of Orange, Osceola, and Seminole. In addition to operating the 7 hospitals, FH also operates 28 full-service urgent care clinics in convenient community settings. For all seven campuses of FH, approximately 43% of the Hospitals' patients during 2016 were Medicare patients, about 16% were Medicaid patients, about 7% were self-pay patients and the remaining percentage were patients covered under commercial insurance. In 2016, about 70% of the Hospitals' in-patients were admitted through the Hospitals' Emergency Departments. *** see continuation of footnote 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 organization'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 and community building information provided in Parts I, II and III of this Schedule H, the filing organization captures and reports the benefits provided to its community through faith-based care. Examples of such benefits include the cost associated with chaplaincy care programs and mission peer reviews and mission conferences. During the current year, the filing organization provided $7,709,349 of benefit with respect to the faith-based and spiritual needs of the communities it serves in conjunction with its operation of community hospitals. The filing organization also provides benefits to its communities' infrastructure by investing in capital improvements to ensure that facilities and technology provide the best possible care. During the current year, the filing organization expended $316,445,646 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 Hospitals are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its communities. Part VI, Line 6: The filing organization is a part of a faith-based healthcare system of organizations whose parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). The system is known as Adventist Health System (AHS). AHSSHC is an organization exempt from federal income tax under IRC Section 501(c)(3). AHSSHC and its subsidiary organizations operate 44 hospitals in 10 states throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC and its subsidiaries also operate 16 nursing home facilities and other ancillary health care provider facilities, such as ambulatory surgery centers and diagnostic imaging centers. As the parent organization of the AHS system, AHSSHC provides executive leadership and other professional support services to its subsidiary organizations. Professional support services include among others corporate compliance, legal, human resources, reimbursement, risk management, and tax as well as treasury functions. The provision of these executive and support services on a centralized basis by AHSSHC provides an appropriate balance between providing each AHS subsidiary hospital organization with mission-driven consistent leadership and support while allowing the hospital organization to focus its resources on meeting the specific health care needs of the 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 an annual community benefit report with any state agencies. Part VI, Line 4 Continuation of Footnote Description of Community Information - ContinuedA brief description of each of the 7 hospital campuses is described below:*Florida Hospital Orlando (Orange County) - At the core of the FH system, FH Orlando is a 1,398-bed acute-care tertiary hospital. FH Orlando is home to nationally recognized Centers of Excellence for cancer, cardiology, children's health, diabetes, neuroscience, orthopedics, transplant and global robotics. Florida Hospital Orlando houses one of the largest Emergency Departments and cardiac catheterization labs in the country and is one of the busiest hospitals in the nation, providing service excellence to more than 56,000 inpatients and 195,000 outpatients each year. The recent opening of a 15-story patient tower features 200 more beds and 500 new jobs. The campus also includes a state-of-the-art Cardiac Diagnostic Center featuring 15 Cath and electro physiology (EPS) Labs. The cardiology team currently treats 32,000+ individuals for chest pain and performs over 2,300 open heart surgeries each year making them first in the state for the number of surgeries performed. Additionally, FH Orlando houses the Translational Research Institute, a 54,000 square-foot facility devoted to the study of obesity and metabolic origins of cardiovascular disease with the aim of developing new treatments to battle diabetes and obesity. FH Orlando also serves as a teaching hospital for family medicine, allopathic and osteopathic tracts, emergency medicine, neuromusculoskeletal medicine, general surgery, podiatric medicine and surgery, and internal medicine. As one of the premier health systems in the nation, FH Orlando sets the standard for innovation, quality and comprehensive care. The new Florida Hospital for Women is a 12-story hospital located on the Orlando campus. The first floor houses the Center for Women's Wellness, which includes a high-risk breast cancer clinic, mammography services, lactation center, cardiac screenings and health classes. Ten of the 12 floors are complete, which include 72 mother-baby rooms and high-risk OB rooms, 14 labor and delivery suites, 13 operating rooms, 82 NICU and 104 oncology beds which include GYN oncology, medical oncology and an ICU capable BMT unit.Also located on the Florida Hospital Orlando Campus is the Walt Disney Pavilion at Florida Hospital for Children. The Walt Disney Pavilion is not a stand-alone facility but rather a 7-story, 202-bed tower located on Florida Hospital Orlando's campus. It is a full-service facility served by more than 100 pediatric specialists and a highly trained pediatric team of more than 700 employees. The Walt Disney Pavilion at Florida Hospital for Children delivers a complete range of pediatric health services for younger patients including advanced surgery, oncology, neurosurgery, cardiology and transplant services; full-service pediatrics; and an innovative health and obesity platform.Florida Hospital Orlando is located in Orange County. Orange County, Florida is part of the Orlando-Kissimmee-Sanford Metropolitan Statistical Area (MSA). Orange County's median income was below the state of Florida level in 2015 for the first year since 2000. The County has also seen an 50% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place a 42% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 72% of Orange County residents spent 30% or more of their income on rent and 47% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Orange County has fluctuated significantly since 2008. Four percent of Orange County's student population is homeless.*Florida Hospital Altamonte (Seminole County) - FH Altamonte is a 362-bed facility, which has recently doubled in size with a new patient tower to better serve a busy community. FH Altamonte was the first "satellite" hospital, built in 1973 on what was then pastureland, miles from the nearest business district. Located north of Orlando in fast-growing Seminole County, Florida Hospital Altamonte is the largest satellite campus within the Florida Hospital health care system. FH Altamonte is home to the Center for Spine Health, the Baby Place, Heartburn and Acid Reflux Center, and the Breast Imaging Center of Excellence. FH Altamonte also operates the Martin Andersen Cancer Center (along with the region's only Cancer Resource Library), a recognized cardiac institute with a spectrum of diagnostic services and treatments. Other services include women's health, orthopedics, urology, inpatient rehabilitation, sleep services, digestive health, sports medicine and rehabilitation, as well as a robust surgery program and imaging services. Since 2000, Seminole County has had a median household income that is well above that of the state of Florida. However, the County has also seen a 74% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place a 59% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 42% of Seminole County residents spent 35% or more of their income on rent and 41% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Seminole County has fluctuated significantly since 2008. Three percent of Seminole County's student population is homeless.*Florida Hospital Apopka (Orange County) - In 1975, FH Apopka became the second satellite hospital. For nearly four decades, Florida Hospital Apopka has set the standard in hometown health care by providing high-tech, quality care with a personalized touch. They are situated just 12 miles northwest of Orlando, with a small, yet advanced, 50-bed campus that houses a certified Chest Pain Center. In addition to cardiology, FH Apopka offers services in critical care, advanced diagnostic imaging, comprehensive aging assessments, diabetes care, gastroenterology, sleep disorders, and rehabilitation and sports medicine. Florida Hospital Apopka is located in Orange County. Orange County, Florida is part of the Orlando-Kissimmee-Sanford Metropolitan Statistical Area (MSA). Orange County's median income was below the state of Florida level in 2015 for the first year since 2000. The County has also seen an 50% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place a 42% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 72% of Orange County residents spent 30% or more of their income on rent and 47% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Orange County has fluctuated significantly since 2008. Four percent of Orange County's student population is homeless.***see continuation of footnote Part VI, Line 4 Continuation of Footnote Description of Community Information - Continued *Florida Hospital Celebration Health (Osceola County) - FH Celebration Health is a cornerstone of Disney's planned community in Celebration, Florida. Today, this 203-bed acute care hospital delivers a state-of-the-art healing environment to residents of Osceola, Orange, Polk and Lake Counties, as well as to visitors from across the United States and the world. From its creation FH Celebration Health has been about promoting health and wellness as well as healing. Inside the resort-style hospital there is a wellness center, complete with workout area, pool, and rehabilitation facility. FH Celebration Health also houses the Global Robotics Institute, which provides patients with access to some of the most experienced robotic surgeons in the world. The Nicholson Center for Surgical Advancement also is a location where surgeons from around the world travel to learn the latest robotic surgery techniques. In 2011, a 234,000 square-foot patient tower added 62 beds and housed the Interactive Patient Care Unit, which was the first of its kind in the nation. In 2013, a four-story medical office building was added in which the Women's Institute is situated. In 2014, a new 5th floor inpatient 32 bed state-of-the art medical/surgical unit was added. FH Celebration offers services in cancer, digestive health, neuroscience, weight-loss services and surgery, orthopedic health, spine health, thoracic surgery, women's and men's health, robotic-assisted surgeries and imaging diagnostics. Osceola County has consistently had a median household income below the state of Florida average. The County has also seen an 80% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place a 71% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 75% of Osceola County residents spent 30% or more of their income on rent and 50% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Osceola County has fluctuated significantly since 2008. Five percent of Osceola County's student population is homeless.*Florida Hospital East Orlando (Orange County) - FH East Orlando is an innovative local leader that fills a vital need in a fast-growing area. A recent 200,000 square-foot expansion project upgraded the Hospital to 265 beds, with a spacious patient tower and 80 new private rooms designed to enhance the holistic care experience. In 2014, a new expanded ED provided 60 new treatment rooms. Florida Hospital East Orlando includes a teaching hospital with residencies in family medicine, podiatry and emergency medicine. The campus is also home to an outpatient surgery center, a hospital-based Center for Medical Simulation and Education, a Cancer Institute featuring state-of-the-art technology for radiation oncology and a dedicated infusion center, as well as a 12-bed Children's Emergency Center. Alongside having the largest emergency room in Central Florida, other services include cardiovascular, pulmonary and digestive health, orthopedics and rehabilitation, ear/nose/throat, andrology, and urology. Florida Hospital East Orlando's primary service area includes approximately 10 zip codes located in east Orange County. Orange County, Florida is part of the Orlando-Kissimmee-Sanford Metropolitan Statistical Area (MSA). Orange County's median income was below the state of Florida level in 2015 for the first year since 2000. The County has also seen an 50% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place a 42% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 72% of Orange County residents spent 30% or more of their income on rent and 47% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Orange County has fluctuated significantly since 2008. Four percent of Orange County's student population is homeless.*Florida Hospital Kissimmee (Osceola County) - FH Kissimmee is a 162-bed community-focused hospital, conveniently located near Walt Disney World. The team located at FH Kissimmee is dedicated to bringing mission-focused, faith-based care to residents and visitors of Osceola and Orange Counties. This facility has recently expanded to include a new medical office building, patient tower, new main entrance, expanded Emergency Department and a parking garage. The new three-story patient tower includes private patient rooms and a host of modern amenities and technologies. Services offered include cardiovascular services, orthopedics and rehabilitation, neuroscience, cancer, diabetes, gastroenterology, emergency services, urology, and imaging resources. Osceola County has consistently had a median household income below the state of Florida average. The County has also seen an 80% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place a 71% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 75% of Osceola County residents spent 30% or more of their income on rent and 50% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Osceola County has fluctuated significantly since 2008. Five percent of Osceola County's student population is homeless.*Winter Park Memorial Hospital (WPMH) (Orange County) - WPMH is a 320-bed facility that is a model of community health and wellness. The facility boasts spacious patient care areas and a full spectrum of specialties and services, including the Dr. P. Phillips Baby Place (with Level II NICU), Florida Hospital Orthopedic Institute, and state-of-the-art surgery, recovery and rehabilitation at the Florida Hospital Cancer Institute. WPMH has the Central Florida Region's only senior-friendly emergency room. Services offered at WPMH include cancer, cardiovascular, digestive health, women's health, neuroscience, ophthalmology, orthopedics and rehabilitation, urology, and sports medicine. WPMH's primary service area includes most of northwestern Orange County. Orange County, Florida is part of the Orlando-Kissimmee-Sanford Metropolitan Statistical Area (MSA). Orange County's median income was below the state of Florida level in 2015 for the first year since 2000. The County has also seen an 50% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place a 42% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 72% of Orange County residents spent 30% or more of their income on rent and 47% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Orange County has fluctuated significantly since 2008. Four percent of Orange County's student population is homeless. 1 Adventist Care Centers - Courtland Inc 730 Courtland Street Orlando FL 32804 205774723 501(c)(3) 1377700 General Support American Diabetes Association Inc 1701 N Beauregard Street Alexandria VA 22311 131623888 501(c)(3) 60000 General Support American Cancer Society 507 N New York Avenue Suite 100 Winter Park FL 32789 131788491 501(c)(3) 6000 General Support American Cancer Society Florida Division Inc 3709 W Jetton Avenue Tampa FL 33873 131788491 501(c)(3) 6000 General Support American Heart Association 10900-B Stonelake Blvd Austin TX 78759 135613797 501(c)(3) 10000 General Support American Heart AssociationGreater South Affiliate-Ar 9900 Ninth St North St Petersburg FL 33716 590637852 501(c)(3) 116000 General Support AopoAssoc Of Organ Procurement Organiza 8500 Leesburg Pike Suite 300 Vienna FL 221822409 581652896 501(c)(3) 6500 General Support Asian American Chamber Of Commerce 3201 E Colonial Drive Unit A20 Orlando FL 32803 593217297 501(c)(6) 7500 General Support Aspire Health Partners Inc 5151 Adanson Street Orlando FL 32804 592301233 501(c)(3) 1198150 General Support Association Of Physician Assistants In Cardiovascular Surgery 500 Cummings Ctr Suite 4550 Beverly MA 01915 592147565 501(c)(6) 10000 General Support Avon Park SDA Church 1410 W Avon Blvd Avon Park FL 33825 593057686 501(c)(3) 50000 Other Boggy Creek Gang IncCamp Boggy Creek 30500 Brantley Branch Road Eustis FL 32736 593012889 501(c)(3) 10500 General Support Boy Scouts Of America Inc Central Florida Council 1951 S Orange Blossom Trail 102 Apopka FL 32703 590624376 501(c)(3) 11000 General Support Boys Girls Club Of Central Florida PO Box 2987 Orlando FL 32802 590951887 501(c)(3) 15000 General Support Building Us Inc Dba Friend Talking Faith PO Box 3310 Winter Park FL 32790 455420165 501(c)(3) 25000 General Support Celebration Foundation Inc 610 Sycamore Street Celebration FL 34747 593370753 501(c)(3) 11000 General Support Center For Multicultural Wellness And Prevention Inc 641 N Rio Grande Avenue Orlando FL 32805 593368679 501(c)(3) 12500 General Support Central Florida Chamber For Persons With Disabilities LLC 3201 E Colonial Drive Unit A20 Orlando FL 328035174 264201627 Other 10000 General Support Central Florida Commission On Homelessness 255 S Orange Avenue Suite 108 Orlando FL 32801 460994106 501(c)(3) 50000 General Support Central Florida Partnership Inc PO Box 1234 Orlando FL 32804 331202266 501(c)(6) 205000 General Support Central Florida Young Men's Christian Association 433 N Mills Avenue Orlando FL 32803 590624430 501(c)(3) 12500 General Support Central Texas Healthcare Collaborative 1301 Wonder World Drive San Marcos TX 78666 453739929 501(c)(3) 322662 Other Central Texas Medical Center Foundation 1301 Wonder World Drive San Marcos TX 78666 742259907 501(c)(3) 89289 Book Other General Support Christian Service Center For Central Florida Inc 808 W Central Blvd Orlando FL 32805 591353031 501(c)(3) 7000 General Support City Of Kissimmee 101 N Church Street Kissimmee FL 34741 596000348 Gov't 8500 General Support City Of Winter Garden 300 W Plant Street Winter Garden FL 34787 596000452 Gov't 200000 General Support Creation Development Foundation dba Creation Kids Village 599 Celebration Place Celebration FL 34747 300724172 501(c)(3) 30000 General Support Downtown College Park Partnership Inc PO Box 547744 Orlando FL 32854 237250533 501(c)(3) 15000 General Support Downtown Orlando Foundation Inc 189 S Orange Ave Orlando FL 32801 593586659 501(c)(3) 25000 General Support Dr Phillips Center For The Performing Arts 155 E Anderson Street Orlando FL 32801 200695917 Other 100000 General Support East Orlando Health & Rehab Center Inc 250 South Chickasaw Trail Orlando FL 32825 205774748 501(c)(3) 1954850 General Support Edible Education Experience Inc PO Box 540676 Orlando FL 32854 465655482 501(c)(3) 100000 General Support Florida Abolitionist Inc PO Box 536832 Orlando FL 32853 593178045 501(c)(3) 10000 General Support Florida Chamber Of Commerce 136 S Bronough Street Tallahassee FL 32301 590248200 Other 100000 General Support Forest Lake Academy 500 Education Loop Apopka FL 327036176 590816443 501(c)(3) 8500 General Support Forest Lake Education Center 500 Education Loop Apopka FL 32703 593143238 501(c)(3) 7500 General Support Forest Lake SDA Church 515 Harley Lester Lane Apopka FL 32703 592885433 501(c)(3) 15000 General Support Foundation For Orange County Public Schools Inc 445 W Amelia Street Suite 901 Orlando FL 328011153 592788435 501(c)(3) 30742 General Support Foundation For Seminole State College Of Florida Inc 1055 Aaa Drive Suite 209 Heathrow FL 32746 237033822 501(c)(3) 256000 General Support Friends Of The Mennello Museum Of American Art Inc 900 E Princeton Street Orlando FL 32803 593618760 501(c)(3) 10000 General Support Gr8 To Don8 Inc 7624 San Remo Place Orlando FL 32835 271946207 501(c)(3) 10000 General Support Grace Medical Home Inc 51 Pennsylvania Street Orlando FL 328062938 281817966 501(c)(3) 110000 General Support Greater San Marcos Partnership 1340 Wonder World Drive 108 San Marcos TX 78666 800624502 501(c)(6) 20000 General Support Guidewell Innovation LLC 6555 Sanger Road Orlando FL 32827 473453318 Other 15000 General Support Habitat For Humanity For Greater Orlando 4116 Silver Star Road Orlando FL 32808 592789167 501(c)(3) 12500 General Support Health Care Center For The Homeless Inc 232 N Orange Blossom Trail Orlando FL 32805 593185020 501(c)(3) 100000 General Support Healthy Start Coalition Of Osceola County Inc PO Box 701995 St Cloud FL 34770 593212535 501(c)(3) 15000 General Support Heartland Triathlon Of Highlands County Inc 1200 Highlands Drive Lake Placid FL 33852 452232127 501(c)(3) 15000 General Support Hispanic Business Initiative Fund Of Florida Inc 3201 E Colonial Drive Unit A20 Orlando FL 32803 593341405 501(c)(3) 61000 General Support Hispanic Chamber Of Commerce Metro Orlando Inc 3201 E Colonial Drive Orlando FL 32803 593103840 501(c)(6) 25000 General Support Holocaust Memorial Resource & Education 851 N Maitland Avenue Orlando FL 32751 592219851 501(c)(3) 6000 General Support JDRF International 370 Center Pointe Cir Suite 1154 Altamonte Springs FL 32701 231907729 501(c)(3) 19000 General Support Junior Achievement Of Central Florida Inc PO Box 917197 Orlando FL 32891 590972112 501(c)(3) 26000 General Support Kids Beating Cancer Inc 615 E Princeton Street Suite 400 Orlando FL 32803 593136203 501(c)(3) 14500 General Support Lakeside Behavioral Healthcare Inc 1800 Mercy Drive Suite 302 Orlando FL 32808 592301233 501(c)(3) 239440 General Support Lifework Leadership 1220 E Concord Street Orlando FL 328035453 371592618 501(c)(3) 10000 General Support Lift Orlando 215 E Central Blvd Orlando FL 32801 463607865 501(c)(3) 5100000 General Support Make A Wish Foundation Of Central And 1020 N Orlando Avenue Suite 100 Maitland FL 32751 593235806 501(c)(3) 11000 General Support Mental Health Association Of Central Florida Inc 1525 E Robinson Street Orlando FL 32801 590816432 501(c)(3) 132504 General Support Metro Orlando Economic Development Comm 301 E Pine Street Suite 900 Orlando FL 32801 591767933 Other 57349 General Support Mothers Milk Bank Of Florida 8669 Commodity Circle Suite 490 Orlando FL 32819 273939245 501(c)(3) 50000 General Support New Beginnings Of Central Florida PO Box 121129 Clermont FL 34712 260353679 501(c)(3) 8500 General Support Oakwood University 7000 Adventist Blvd NW Huntsville AL 35896 630366652 501(c)(3) 21000 General Support Orange County Healthy Start Coalition 1040 Woodcock Road Orlando FL 32803 593125675 501(c)(3) 68650 General Support Orange County School Readiness Coalition PO Box 540387 Orlando FL 32854 311759186 501(c)(3) 12500 General Support Orlando Science Center Inc 777 E Princeton Street Orlando FL 32803 590896343 501(c)(3) 17500 General Support Osceola County Council On Aging Inc 700 Generation Point Kissimmee FL 34744 591595398 501(c)(3) 99000 General Support Osceola Mental Health Inc dba Park Place 206 Park Place Blvd Kissimmee FL 34741 591677912 501(c)(3) 104167 General Support Ronald McDonald House Charities Of Central Florida Inc 1030 N Orange Avenue Winter Park FL 327894709 593211250 501(c)(3) 20000 8400 Estimated Other General Support Runway To Hope Inc 189 S Orange Avenue Orlando FL 328013261 273272616 501(c)(3) 6250 General Support Samaritan Touch Care Center Inc 3015 Herring Avenue Sebring FL 33870 020773338 501(c)(3) 197920 General Support San Marcos Adventist Jr Academy 1523 Old Ranch Road 12 San Marcos TX 78667 264136229 501(c)(3) 10000 General Support San Marcos CISD 501 South LBJ Drive San Marcos TX 78667 746002246 Other 23471 General Support San Marcos Sights & Sounds Of Christmas Inc 630 E Hopkins San Marcos TX 78666 742759206 501(c)(3) 12000 General Support School Board Of Orange County 901 N Lakemont Avenue Winter Park FL 32792 596000771 Gov't 24500 General Support Shepherds Hope Inc 4851 S Apopka Vineland Road Orlando FL 328193128 593420727 501(c)(3) 110000 General Support Southwestern Adventist University 100 W Hillcrest Street Keene TX 76059 750891465 501(c)(3) 50000 Construction Strengthen Orlando Inc 400 S Orange Avenue Orlando FL 32801 271964941 501(c)(3) 250500 General Support Sun 'N Lake Elementary School 426 School Street Sebring FL 33870 596000654 Gov't 10000 General Support Sunbelt Health & Rehab Center - Apopka Inc 305 East Oak Street Apopka FL 32703 205774856 501(c)(3) 599300 General Support Sunsystem Development Corporation 900 Hope Way Altamonte Springs FL 32714 592219301 501(c)(3) 5021090 Book Other General Support Texas State University 601 University Drive San Marcos TX 72893 746002248 Gov't 13143 General Support The Leukemia & Lymphoma Society 341 N Maitland Avenue Suite 100 Maitland FL 32751 135644916 501(c)(3) 10000 General Support The School Board Of Highlands County 426 School Street Sebring FL 33870 566000654 Gov't 10000 Other United Global Outreach Inc 2301 N Orange Avenue Orlando FL 32804 030511875 501(c)(3) 164250 General Support United Way - The Heart Of Florida 1940 Traylor Blvd Orlando FL 32804 590808854 501(c)(3) 15000 General Support Universal Orlando Foundation 1000 Universal Studios Plaza Orlando FL 32819 593510383 501(c)(3) 15000 General Support University Of Central Florida PO Box 163250 Orlando FL 32816 592924021 Gov't 1500998 General Support University Of Central Florida Foundation Inc 12424 Research Parkway Suite 140 Orlando FL 32826 596211832 501(c)(3) 25000 General Support University Of Miami Dba Florida Bioethic PO Box 16960 D23-3 Miami FL 33101 590624458 501(c)(3) 5500 General Support Valencia College Foundation Inc PO Box 3028 Orlando FL 32802 237442785 501(c)(3) 10000 General Support Winter Park Health Foundation Inc 220 Edinburgh Drive Winter Park FL 32792 590669460 501(c)(3) 135000 General Support Winter Park Improvement Foundation Inc PO Box 280 Winter Park FL 32790 593035266 501(c)(3) 7500 General Support African American Chamber of Commerce 3201 E Colonial Drive Orlando FL 32803 590683252 501(c)(6) 20000 General Support FLNC Inc 3355 E Semoran Blvd Apopka FL 32703 205774761 501(c)(3) 3315500 General Support Hope Now International Inc PO Box 181173 Casselberry FL 327181173 274498303 501(c)(3) 7500 General Support 83 12 Part I, Line 2: Grants are generally made only to related organizations that are exempt from federal income tax under IRC Section 501(c)(3), or to other local charitable community organizations, or to other 501(c)(3) organizations that are a part of the group exemption ruling issued to the General Conference of Seventh-Day Adventists. Accordingly, the filing organization has not established specific procedures for monitoring the use of grant funds in the United States as the filing organization does not have a grant making program that would necessitate such procedures. X X X X X 1 1 1 1 0 0 0 1 0 0 0 Haffner PhD Randall L Director 0 1013441 0 257210 0 436890 0 216000 0 49682 0 1973223 0 0 Houmann Lars D Director 0 1016342 0 360215 90 538362 0 216729 0 56990 90 2188638 0 190258 Jernigan PhD Donald L Director/CEO (End 12/16) 0 1384853 0 428796 0 426774 0 14388 0 94308 0 2349119 0 0 Shaw Terry D Director/CFO (CEO Beg 12/16) 0 1033253 0 356613 0 446287 0 220978 0 56607 0 2113738 0 190258 Bradley Kenneth W SEO/SW Mkt & Admin FH Celebration He 0 369013 0 93327 1003 133982 0 64565 0 31624 1003 692511 0 41888 Dodds Sheryl D SEO/Chief Clinical Officer FH System 0 387004 0 87578 0 74545 0 61633 0 24652 0 635412 0 34218 Goodman Todd A SEO/CFO FH & AHS Central FL Region 0 468741 0 90752 0 58399 0 61435 0 46424 0 725751 0 23809 Harcombe Douglas W SEO/NE Mkt & Admin FH Altamonte 0 351249 0 72805 90 32086 0 50181 0 42116 90 548437 0 19503 Hilliard Douglas W Sr VP/Sr Finance Officer FH Orlando 0 400247 0 89284 0 65899 0 63142 0 42660 0 661232 0 38661 Moorhead MD John David SEO/Chief Medical Officer FH System 0 530010 0 120504 0 139452 0 14388 0 53848 0 858202 0 0 Owen Terry R SEO/Ambulatory & System Serv FH Syst 0 445909 0 121712 0 173388 0 65724 0 35785 0 842518 0 45499 Reed MD Monica P SEO/Care Innovation FH System 0 498047 0 136686 1450 334094 0 87476 0 47219 1450 1103522 0 72638 Stevens Eric A SEO/Cent Mkt & Admin FH Orl/FH Women 0 456642 0 89851 90 243883 0 59174 0 79622 90 929172 0 24486 Tol Daryl L Pres/CEO FH & AHS Central FL Region 0 683740 0 177428 90 390877 0 115153 0 46585 90 1413783 0 75218 Zbarschuk Amy L Sr VP/Sr Finance Officer, FH System 0 345000 0 66664 0 54213 0 48624 0 42258 0 556759 0 26419 Davis Jr MD Robert Duane Physician/Dir - FH Cardio Institute 1125563 0 157143 0 20814 0 14388 0 6394 0 1324302 0 0 0 Jones MD Phillip E Physician 706090 0 312623 0 65063 0 14388 0 23587 0 1121751 0 0 0 Lee MD Kathy Physician 401577 0 570656 0 44043 0 14388 0 15091 0 1045755 0 0 0 Silvestry MD Scott Phys/Dir - FH Thoracic Transplant 914976 0 0 0 9241 0 14388 0 22856 0 961461 0 0 0 Shimshak MD Thomas M Physician 688153 0 66990 0 139263 0 14388 0 25839 0 934633 0 0 0 Banks David P Former key employee 0 557297 0 179282 0 1022859 0 101470 0 47676 0 1908584 0 86312 Fulbright Robert D Former key employee 0 553740 0 139180 0 97438 0 100585 0 49118 0 940061 0 62736 Hagensicker Janice K Former key employee 0 394666 0 103402 0 250042 0 52974 0 37041 0 838125 0 25725 Hurst Jeffery D Former key employee 0 262663 0 85702 1272 315737 0 31763 0 23503 1272 719368 0 258486 Paradis J Brian Former key employee 0 696134 0 227311 0 735712 0 139781 0 49480 0 1848418 0 362484 Soler Eddie Former key employee 0 620123 0 198315 0 350984 0 127131 0 34408 0 1330961 0 101329 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 or board member are considered taxable compensation. 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 to the executives and board members 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 or board member was considered taxable compensation. 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. Additionally, the filing organization has a policy that addresses select hard to fill clinical/professional positions. According to this policy, one highest compensated employee received a relocation allowance that included assistance for duplicate housing expenses. The relocation assistance was administered by the filing organization. Any taxable reimbursements made to executives or applicable employees in connection with relocation assistance are treated as wages to the executive or employee 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, two 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, Lines 4a-b During the year ending December 31, 2016, J. Brian Paradis received severance payments in the amount of $49,104. Pursuant to the AHSSHC Corporate Executive Policy governing executive severance, severance agreements for executives operating at the Vice President level and above are entered into upon eligibility to facilitate the transition to subsequent employment following an involuntary separation from employment with AHS. 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 ------------------------------------------------------- Haffner, PhD, Randall L. $ 201,612 $ 0 $409,583 $ 0 Houmann, Lars D. $ 202,341 $ 192,775 $297,528 $ 0 Jernigan, Ph.D., Donald L. $ 305,020 $ 287,020 $ 0 $ 0 Shaw, Terry D. $ 206,591 $ 196,625 $211,140 $ 0 Werner, Thomas L. $ 0 $ 0 $ 0 $ 46,230 Bradley, Kenneth W.$ 50,178 $ 41,913 $ 72,658 $ 0 Dodds, Sheryl D. $ 65,245 $ 34,238 $ 0 $ 0 Goodman, Todd A. $ 65,048 $ 23,133 $ 0 $ 0 Harcombe, Douglas W. $ 35,793 $ 19,003 $ 0 $ 0 Hilliard, Douglas W. $ 48,754 $ 35,038 $ 0 $ 0 Moorhead, MD, John David $ 95,677 $ 95,677 $ 0 $ 0 Owen, Terry R. $ 69,337 $ 44,519 $ 89,139 $ 0 Reed, MD, Monica P.$ 73,089 $ 72,680 $235,999 $ 0 Stevens, Eric A. $ 62,787 $ 23,549 $ 0 $ 0 Tol, Daryl L. $ 118,765 $ 73,604 $ 0 $ 0 Zbarschuk, Amy L. $ 34,237 $ 26,386 $ 0 $ 0 Banks, David P. $ 87,082 $ 86,362 $915,470 $ 0 Fulbright, Robert D. $ 86,197 $ 62,771 $ 0 $ 0 Hagensicker, Janice K. $ 56,586 $ 25,740 $170,808 $ 0 Hurst, Jeffery D. $ 35,375 $ 19,925 $ 0 $ 254,372 Paradis, J. Brian $ 125,394 $ 363,440 $179,484 $ 0 Soler, Eddie $ 112,743 $ 95,938 $233,757 $ 0 * Including Investment Earnings Part I, Line 6 The filing organization's physician compensation formula is designed to result in total compensation that would be reasonable for each physician. The filing organization utilizes national survey productivity, cost, and compensation data in formulating all aspects of the compensation plan. Physician compensation contractual agreements include a ceiling or reasonable maximum on the amount a physician may earn. The filing organization's employed physicians enter into a written agreement that requires the physicians to provide medical care to individuals who are referred by the filing organization. The filing organization's compensation arrangement does not use a method of compensation that is based upon a percentage of the organization's net income. Under the compensation arrangement, physician base salary, including any additional compensation based on a percentage of the practice/location net revenue, is documented as being within a range of Fair Market Value. A Highlands County Health Facilities Authority 521313569 431022KK7 2007-08-08 366445000 2007A B C D, Expand/refurbish facilities, purchase equipment 0 0 0 B Kansas Development Finance Authority 481066589 48542ABX8 2009-07-08 325394417 2009C, Ref 96/05&97/05 iss 1/13/05, 03A 1/16/03, 08B 12/19/08, exp facility 0 0 0 C Kansas Development Finance Authority 481066589 48542ACY5 2009-10-01 102271154 2009D, Refund Highlands 07C, 8/8/07 & expand/refurbish facilities/purc equip 1 0 0 D Highlands County Health Facilities Authority 521313569 431022SP8 2009-11-16 190752502 09E & 08B Conv, Ref Orange 91/01 10/11/01, 92/03 5/15/03, 08B 12/19/08 0 0 0 A 262025000 372572414 5560382 367012032 2007 0 0 1 1 B 74430000 325394417 12004967 313389450 2009 1 0 1 1 C 16795000 71105000 102271154 21844721 80426433 2009 1 0 1 1 D 30300000 190752502 190752502 2008 1 0 1 1 A 0 1 1 1 1 1 0.01420 0.01420 0 0 1 B 0 1 1 1 1 1 0.00540 0.00540 0 0 1 C 0 0 1 1 1 1 0 0 1 D 0 1 1 1 1 1 0.00670 0.00670 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 0 0 0 0 1 C 0 0 1 0 0 0 0 0 1 D 0 0 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 Part II, Line 3, Total Proceeds of Issue Highlands County Health Facilities Authority 2007A B C D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part II, Line 3, Total Proceeds of Issue Orange County Health Facilities Authority 2010B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part II, Line 3, Total Proceeds of Issue Kansas Development Finance Authority 2010C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part II, Line 3, Total Proceeds of Issue Colorado Health Facilities Authority 2010D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part II, Line 3, Total Proceeds of Issue Highlands County Health Facilities Authority 2013A-C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part II, Line 3, Total Proceeds of Issue Highlands County Health Facilities Authority 2014A&D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part II, Line 3, Total Proceeds of Issue Highlands County Health Facilities Authority 2014B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part II, Line 3, Total Proceeds of Issue Highlands County Health Facilities Authority 2014C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part II, Line 3, Total Proceeds of Issue Highlands County Health Facilities Authority 2014E: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part III, Line 8c Highlands County Health Facilities Authority 2012A, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds. Part III, Line 8c Highlands County Health Facilities Authority 2012B, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds. Part III, Line 8c Kansas Development Finance Authority 2012A: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015. Part III, Line 8c Highlands County Health Facilities Authority 2012B-F: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015. A Highlands County Health Facilities Authority 521313569 431022SG8 2009-11-16 178936632 2005I Conv, Refund Highlands 05I 12/22/05 & expand/refurbish facilities 0 0 0 B Highlands County Health Facilities Authority 521313569 2010-12-17 57000000 2010A, Expand/refurbish facilities, purchase equipment 0 0 0 C Orange County Health Facilities Authority 521378595 2010-12-22 25000000 2010B, Expand/refurbish facilities, purchase equipment 0 0 0 D Kansas Development Finance Authority 481066589 2010-12-22 25000000 2010C, Expand/refurbish facilities, purchase equipment 0 0 0 A 143625000 178936632 1696632 177240000 2005 1 0 1 1 B 57000000 57000000 2010 0 0 1 1 C 5000000 25008422 25008422 2010 0 0 1 1 D 5000000 25007891 25007891 2010 0 0 1 1 A 0 1 1 1 1 1 0.00900 0.00900 0 0 1 B 0 0 1 1 1 1 0 0 1 C 0 0 1 1 1 1 0 0 1 D 0 0 1 1 1 1 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 D 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 A Colorado Health Facilities Authority 840752932 2010-12-22 25000000 2010D, Expand/refurbish facilities, purchase equipment 0 0 0 B Highlands County Health Facilities Authority 521313569 2010-12-30 225000000 2010E, Expand/refurbish facilities, purchase equipment 0 0 0 C Highlands County Health Facilities Authority 521313569 2011-11-16 80000000 2011A, Expand/refurbish facilities 0 0 0 D Highlands County Health Facilities Authority 521313569 2012-03-21 294985000 2012A, AR Program - Refund 2009 A-F AR Program 0 0 0 A 5000000 25008355 25008355 2010 0 0 1 1 B 45000000 225000000 225000000 2010 0 0 1 1 C 900000 80000000 80000000 2011 0 0 1 1 D 400000 294985000 294985000 2004 1 0 1 1 A 0 0 1 1 1 1 0 0 1 B 0 0 1 1 1 1 0 0 1 C 0 0 1 1 1 1 0 0 1 D 0 0 1 1 1 1 0 1 0.00140 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 D 0 1 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 A Highlands County Health Facilities Authority 521313569 2012-07-25 115015000 2012B, AR Program - Expand/refurbish facilities, purchase equipment 0 0 0 B Kansas Development Finance Authority 481066589 48542ADG3 2012-08-29 310952245 2012A - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C 0 0 0 C Highlands County Health Facilities Authority 521313569 431022TL6 2012-08-29 348320000 2012B-F - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C 0 0 0 D Highlands County Health Facilities Authority 521313569 2012-08-29 125000000 2012G&H - Refund Highlands 2005I Conversion Bonds 0 0 0 A 115015000 115015000 2012 0 0 1 1 B 310952245 310952245 2008 1 0 1 1 C 93635000 348320000 348320000 2008 1 0 1 1 D 125000000 125000000 2005 1 0 1 1 A 0 0 1 1 1 1 0 1 0.00140 0 1 B 0 1 1 1 1 1 0.00500 0.00500 0 1 0.00370 0 1 C 0 1 1 1 1 1 0.00500 0.00500 0 1 0.00370 0 1 D 0 1 1 1 1 1 0.00900 0.00900 0 0 1 A 0 1 1 0 1 0 0 0 1 B 0 1 1 0 1 0 0 0 1 C 0 1 1 0 1 0 0 0 1 D 0 1 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 A Highlands County Health Facilities Authority 521313569 431022TR3 2012-11-08 232125000 2012I - Refunded Volusia 1994-A; Highlands 2004A, 2005E, 2005F, 2005G 0 0 0 B Highlands County Health Facilities Authority 521313569 2013-09-18 485000000 2013A B C, Expand/refurbish facilities, purchase equipment 0 0 0 C Highlands County Health Facilities Authority 521313569 2014-07-02 110000000 2014A&D, Refund 2013C, expand/refurbish facilities, purchase equipment 0 0 0 D Orange County Health Facilities Authority 521378595 2014-07-02 50000000 2014B, Expand/refurbish facilities, purchase equipment 0 0 0 A 5535000 232125000 232125000 2005 1 0 1 1 B 66925000 485340528 485340528 2013 0 0 1 1 C 11403335 110068380 50068380 60000000 2015 1 0 1 1 D 8333335 50068380 50068380 2015 0 0 1 1 A 0 1 1 1 1 1 0.00200 0.00200 0 0 1 B 0 0 1 1 1 1 0 0 1 C 0 0 1 1 1 1 0 0 1 D 0 0 1 1 1 1 0 0 1 A 0 1 1 0 1 0 0 0 1 B 0 1 1 0 1 0 0 0 1 C 0 1 1 0 1 0 0 0 1 D 0 1 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 A Kansas Development Finance Authority 481066589 2014-07-02 30000000 2014C, Expand/refurbish facilities, purchase equipment 0 0 0 B Colorado Health Facilities Authority 840752932 19648AT39 2014-07-23 82501800 2014E, Expand/refurbish facilities, purchase equipment 0 0 0 C Colorado Health Facilities Authority 840752932 19648FAB0 2016-07-21 235724616 2016 A&B, Adv ref portion 2009D, Exp/refurbish facilities, purchase equip 0 0 0 D Colorado Health Facilities Authority 840752932 1964745K2 2016-08-17 216517920 2016C, Refund 2006C, Expand/refurbish facilities, purchase equipment 0 0 0 A 5000000 30041050 30041050 2015 0 0 1 1 B 82616012 82616012 2015 0 0 1 1 C 235724616 169561866 66162750 2016 0 1 1 1 D 216517920 63248816 153269104 2016 1 0 1 1 A 0 0 1 1 1 1 0 0 1 B 0 0 1 1 1 1 0 0 1 C 0 0 1 1 1 1 0 0 1 D 0 1 1 1 1 1 0.00250 0.00070 0.00320 0 0 1 A 0 1 1 0 1 0 0 0 1 B 0 1 1 0 1 0 0 0 1 C 0 1 1 0 0 0 0 0 1 D 0 1 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 Karen Tilstra Family of key employee 139531 Consulting 0 Dan Tilstra Family of key employee 26180 Professional Services 0 Clifton Scott Family of board member 127219 Employee Compensation 0 Kirsten Cutler Family of board member 52554 Employee Compensation 0 Shelby Houmann Family of board member 53901 Employee Compensation 0 Jacqueline Soler-Lemon Family of key employee 42086 Employee Compensation 0 Jeanette Vasquez Family of key employee 38158 Employee Compensation 0 Sean Lemon Family of key employee 113634 Employee Compensation 0 Form 990, Part VI, Section A, line 2 Lars Houmann and Terry Owen - Family Relationship Form 990, Part VI, Section A, line 6 Adventist Health System/Sunbelt, 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. The Board of Directors of the filing organization are appointed by the sole member, AHSSHC, who has the right to elect, appoint or remove any member of the Board of Directors of the filing organization. Form 990, Part VI, Section A, line 7b 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: a) to approve and disapprove the executive and/or administrative leadership of the filing organization, and their salaries; b) to approve and disapprove the operating Bylaws of the filing organization; c) to set limits and terms for the borrowing of funds; d) to approve or disapprove major building programs and/or purchase or sale of personal property or real property equal to or in excess of One Million dollars; e) to approve or disapprove the annual operating and capital budgets of the filing organization; f) to direct the placement of funds and capital of the filing organization; and g) to establish general guiding policies. Form 990, Part VI, Section B, line 11b The filing organization's current year Form 990 was reviewed by the Chief Financial Executive prior to its filing with the IRS. The review conducted by the Chief Financial Executive did not include the review of any supporting workpapers that were used in preparation of the current year Form 990, but did include a review of the entire Form 990 and all supporting schedules. Form 990, Part VI, Section B, line 12c The Conflict of Interest Policy of the filing organization applies to members of its Board of Directors and its principal officers (to be known as Interested Persons). In connection with any actual or possible conflict of interests, any member of the Board of Directors of the filing organization or any principal officer of the filing organization (i.e. Interested Persons) must disclose the existence of any financial interest with the filing organization and must be given the opportunity to disclose all material facts concerning the financial interest/arrangement to the Board of Directors of the filing organization or to any members of a committee with board delegated powers that is considering the proposed transaction or arrangement. Subsequent to any disclosure of any financial interest/arrangement and all material facts, and after any discussion with the relevant Board member or principal officer, the remaining members of the Board of Directors or committee with board delegated powers shall discuss, analyze, and vote upon the potential financial interest/arrangement to determine if a conflict of interest exists. According to the filing organization's Conflict of Interest Policy, an Interested Person may make a presentation to the Board of Directors (or committee with board delegated powers), but after such presentation, shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that results in a conflict of interest. Each Interested Person, as defined under the filing organization's Conflict of Interest Policy, shall annually sign a statement which affirms that such person has received a copy of the Conflict of Interests policy, has read and understands the policy, has agreed to comply with the policy, and understands that the filing organization is a charitable organization that must primarily engage in activities which accomplish one or more of its exempt purposes. The filing organization's Conflict of Interest Policy also requires that periodic reviews shall be conducted to ensure that the filing organization operates in a manner consistent with its charitable purposes. Form 990, Part VI, Section B, line 15 The filing organization's CEO, other officers and key employees are not compensated by the filing organization. Such individuals are compensated by the related top-tier parent organization of the filing organization. Please see the discussion concerning the process followed by the related top-tier parent organization in determining executive compensation in our response to Schedule J, Line 3. Form 990, Part VI, Section C, line 19 The filing organization is a part of the system of healthcare organizations known as Adventist Health System (AHS). The audited consolidated financial statements of AHS and of the AHS "Obligated Group" are filed annually with the Municipal Securities Rulemaking Board (MSRB). The "Obligated Group" is a group of AHSSHC subsidiaries that are jointly and severally liable under a Master Trust Indenture that secures debt primarily issued on a tax-exempt basis. Unaudited quarterly financial statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) are also filed with MSRB for AHS on a consolidated basis and for the grouping of AHS subsidiaries comprising the "Obligated Group". The filing organization does not generally make its governing documents or conflict of interest policy available to the public. Part VII, Section A For those Board of Director members who devote less than full-time to the filing organization (based upon the average number of hours per week shown in column (B) on page 7 of the return) the compensation amounts shown in columns (E) and (F) on page 7 for Don Jernigan, Randall Haffner, Lars Houmann, and Terry Shaw, were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position within Adventist Health System (AHS). Don Jernigan, Randall Haffner, Lars Houmann, and Terry Shaw devote approximately 50 hours per week in conjunction with serving in their respective executive leadership position within AHS. Part VIII, Lines 7b and 7c The amounts shown in Part VIII Lines 7b and 7c of the Form 990 represent an allocated share of capital gain/(loss) from a system wide, corporate administered, investment program. Form 990, Part IX, line 11g Payments to Healthcare Professionals: Program service expenses 219,217,543. Management and general expenses 0. Fundraising expenses 0. Total expenses 219,217,543. Professional Fees: Program service expenses 95,365,597. Management and general expenses 6,107. Fundraising expenses 0. Total expenses 95,371,704. Purchased Medical Services: Program service expenses 4,438,706. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,438,706. Environmental Services: Program service expenses 831,863. Management and general expenses 0. Fundraising expenses 0. Total expenses 831,863. Transcription Services: Program service expenses 303,615. Management and general expenses 0. Fundraising expenses 0. Total expenses 303,615. Recruiting: Program service expenses 603,757. Management and general expenses 0. Fundraising expenses 0. Total expenses 603,757. Food Service Contracts: Program service expenses 37. Management and general expenses 0. Fundraising expenses 0. Total expenses 37. Miscellaneous Purchased Services: Program service expenses 5,345,509. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,345,509. AHS Management Fees: Program service expenses 0. Management and general expenses 40,878,215. Fundraising expenses 0. Total expenses 40,878,215. Billing & Collection Services: Program service expenses 0. Management and general expenses 7,405,305. Fundraising expenses 0. Total expenses 7,405,305. AHS Shared Services Fee: Program service expenses 0. Management and general expenses 1,454,955. Fundraising expenses 0. Total expenses 1,454,955. Part X, Line 2 The amounts shown on line 2 of Part X of this return include the filing organization's interest in a central investment pool maintained by Adventist Health System Sunbelt Healthcare Corporation, the filing organization's top-tier parent. The investments in the central investment pool are recorded at market value. Form 990, Part XI, line 9: Transfer to tax-exempt affiliates -22,095,303. Transfer to tax-exempt parent -32,932,227. Donated Property 4,319,842. SWAP loss amortization 3,846,171. Allocations from Tax-exempt Parent with respect to Debt 4,317,864. Transfer for expenses -394,912. Gifts 12,554,992. Other -208,445. Rounding -1. Adventist Bolingbrook Hospital 500 Remington Blvd Bolingbrook IL 60440 651219504 Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 Adventist Care Centers - Courtland Inc 730 Courtland Street Orlando FL 32804 205774723 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Adventist GlenOaks Hospital 701 Winthrop Avenue Glendale Heights IL 60139 363208390 Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 Adventist Hlth Mid-America Inc 9100 W 74th Street Shawnee Mission KS 66204 521347407 Support of Affiliated Hospital KS 501(c)(3) Line 12c, III-FI Adventist Hlth SystemSunbelt Inc 1 Adventist Hlth Partners Inc 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 Adventist Hlth SystemSunbelt Inc Related 58058 528744 0 0 0.60000 Altamonte Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 592855792 Condo Association FL Adventist Hlth SystemSunbelt Inc C 124982 209018 0.59000 1 Apopka Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 593000857 Condo Association FL Adventist Hlth SystemSunbelt Inc C 28992 28131 0.92000 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 Adventist Hlth SystemSunbelt Inc C 1.00000 1 Central Texas Providers Network 1301 Wonder World Drive San Marcos TX 78666 742827652 Physician Hospital Org. TX Adventist Hlth SystemSunbelt Inc C 132663 91858 1.00000 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 Adventist Hlth SystemSunbelt Inc C 1.00000 1 Florida Hospital Healthcare System Inc 101 Southhall Lane Ste 150 Maitland FL 32751 593215680 PHSO FL Adventist Hlth SystemSunbelt Inc C 4946862 23365847 1.00000 1 Florida Medical Plaza Condo Association Inc 601 East Rollins Street Orlando FL 32803 592855791 Condo Association FL Adventist Hlth SystemSunbelt Inc C 462435 1541601 0.79880 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 Adventist Hlth SystemSunbelt Inc C 56654 0.54400 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 Adventist Hlth SystemSunbelt Inc C 1935 13970 1.00000 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 Adventist Hlth SystemSunbelt Inc C 137836 71464 0.51580 1 1 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 Adventist Care Centers Courtland Inc B 1377700 Actual Amount Given Adventist Health System Sunbelt Healthcare Corporation B 32932227 Actual Amount Given Adventist Health System Sunbelt Healthcare Corporation C 9598834 Actual Amount Received Adventist Health System Sunbelt Healthcare Corporation M 58408581 % of Facility's Operating Exp Adventist Health System Sunbelt Healthcare Corporation P 342253025 Cost Adventist Health System Sunbelt Healthcare Corporation Q 5505985 Cost Adventist Health System Sunbelt Healthcare Corporation S 3349679 Actual Amount Received Adventist Health Partners Inc L 114485 Cost Plus Appropriate % Adventist Health System Georgia Inc M 65134 % of Facility's Operating Exp Adventist Health Partners Inc S 10006212 Actual Amount Received Adventist University of Health Sciences A 3234060 FMV Rental Rate Adventist University of Health Sciences Q 15849447 Cost Adventist University of Health Sciences R 5704719 Actual Amount Given AHSCentral Texas Inc K 129424 FMV Rental Rate Central Texas Healthcare Collaborative B 322662 Actual Amount Given Central Texas Medical Center Foundation B 89289 Actual Amount Given Central Texas Medical Center Foundation C 277526 Actual Amount Received Central Texas Providers Network Q 62326 Cost East Orlando Health & Rehab Center Inc B 1954850 Actual Amount Given FLNC Inc B 3315500 Actual Amount Given Fletcher Hospital Inc L 93671 Cost Florida Hospital Healthcare System Inc A 239623 FMV Rental Rate Florida Hospital Healthcare System Inc B 19897498 Actual Amount Given Florida Hospital Healthcare System Inc Q 6031188 Cost Florida Hospital Medical Group Inc A 8952369 FMV Rental Rate Florida Hospital Medical Group Inc B 6906332 Actual Amount Given Florida Hospital Medical Group Inc K 292119 FMV Rental Rate Florida Hospital Medical Group Inc L 80237 Cost Plus Appropriate % Florida Hospital Medical Group Inc M 104531659 Cost Plus Appropriate % Florida Hospital Medical Group Inc P 7396102 Cost Florida Hospital Medical Group Inc Q 12351164 Cost Florida Hospital Waterman Inc L 1019823 Cost Florida Hospital Waterman Inc Q 207421 Cost Hospice of the Comforter B 3930000 Actual Amount Given Hospice of the Comforter K 212993 FMV Rental Rate Hospice of the Comforter Q 1127491 Cost Memorial Health Systems Inc A 25779 FMV Rental Rate Memorial Health Systems Inc L 569150 Cost Memorial Health Systems Inc P 540038 Cost Memorial Health Systems Inc Q 602407 Cost Memorial Health Systems Inc S 3816835 Actual Amount Received Memorial Hospital Inc L 51000 Cost Memorial Hospital - Flagler Inc L 184259 Cost Memorial Hospital - Flagler Inc Q 108959 Cost Memorial Hospital - West Volusia Inc L 107945 Cost Memorial Hospital - West Volusia Inc Q 152799 Cost Metroplex Hospital P 115305 Cost Pasco-Pinellas Hillsborough Community Health System Inc L 490297 Cost Princeton Professional Services Inc (PPS) Home Care A 249428 FMV Rental Rate Princeton Professional Services Inc (PPS) Home Care M 114841 Cost Plus Appropriate % San Marcos MRI LP A 17807 FMV Rental Rate Shawnee Mission Medical Center Inc L 458332 Cost Shawnee Mission Medical Center Inc Q 4090885 Cost South Central Inc C 76220 Actual Amount Received Southwest Volusia Healthcare Corporation L 225219 Cost Southwest Volusia Healthcare Corporation Q 137578 Cost Specialty Physicians of Central Texas Inc B 5126243 Actual Amount Given Sunbelt Health & Rehab Center Apopka Inc B 599300 Actual Amount Given Sunsystem Development Corporation B 5021090 Actual Amount Given Sunsystem Development Corporation C 13657117 Actual Amount Received Sunsystem Development Corporation Q 3707491 Cost University Community Hospital Inc K 140021 FMV Rental Rate University Community Hospital Inc L 490485 Cost University Community Hospital Inc P 143354 Cost University Community Hospital Inc Q 498641 Cost