TAKOMA REGIONAL HOSPITAL INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- TAKOMA REGIONAL HOSPITAL INC (EIN 51-0603966)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-15
- IRS object ID
- 201711359349302116
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule F
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-15T08:56:58-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 510603966 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TAKOMA REGIONAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TAKO | BusinessNameControlTxt |
| Phone | 4236362350 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 TAKOMA AVENUE | AddressLine1Txt |
| City | GREENEVILLE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 377434647 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TODD DOUGAN | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 4232308512 | PhoneNum |
| Signature | 2017-05-15 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TODD DOUGAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1905 AMERICAN WAY | AddressLine1Txt |
| City | KINGSPORT | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37660 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $64,265,160 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.TAKOMA.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2006 | FormationYr |
| Legal Domicile State | TN | LegalDomicileStateCd |
| Activity Or Mission | THE PROVISION OF MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF A 100 BED HOSPITAL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 687 | TotalEmployeeCnt |
| Total Volunteers | 52 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $79,727 | PYContributionsGrantsAmt |
| CY Contributions Grants | $40,585 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $58,635,418 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $64,214,606 | CYProgramServiceRevenueAmt |
| PY Investment Income | $27,970 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,769 | CYInvestmentIncomeAmt |
| PY Other Revenue | $381,384 | PYOtherRevenueAmt |
| CY Other Revenue | $7,200 | CYOtherRevenueAmt |
| PY Total Revenue | $59,124,499 | PYTotalRevenueAmt |
| CY Total Revenue | $64,265,160 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $78,601 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $51,340 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $35,603,931 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $37,605,933 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $24,377,844 | PYOtherExpensesAmt |
| CY Other Expenses | $27,283,230 | CYOtherExpensesAmt |
| PY Total Expenses | $60,060,376 | PYTotalExpensesAmt |
| CY Total Expenses | $64,940,503 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$935,877 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$675,343 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $26,906,980 | TotalAssetsBOYAmt |
| Total Assets EOY | $27,694,714 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,515,998 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,887,097 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,390,982 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $15,807,617 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION AND ALL OF 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $60,719,283 | ExpenseAmt |
| Grant | $51,340 | GrantAmt |
| Revenue | $64,214,606 | RevenueAmt |
| Desc | TAKOMA REGIONAL HOSPITAL, INC. OPERATES A 100 BED ACUTE CARE HOSPITAL IN GREENEVILLE, TN. IN THE CURRENT YEAR, THERE WERE 2,321 ADMISSIONS, 10,090 PATIENT DAYS, AND 82,067 OUTPATIENT VISITS. | Desc |
| Total Program Service Expenses | $60,719,283 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | Yes (1) | ForeignActivitiesInd |
| More Than5000 K To Org | Yes (1) | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 88 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 687 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | TN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TODD DOUGAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4232308512 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1905 AMERICAN WAY | AddressLine1Txt |
| City | KINGSPORT | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37660 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| BUNCH JAMES A JIMM | |||||||||
| DIRECTOR/CHAIRMAN | 0.40 | 50.00 | Yes (X) | $0 | $758,395 | $99,437 | |||
| BALLARD JOEY | |||||||||
| DIRECTOR | 0.40 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| BULAWA MD ERICK | |||||||||
| DIRECTOR | 50.00 | 0.00 | Yes (X) | $240,365 | $0 | $21,790 | |||
| FOLK SHARON | |||||||||
| DIRECTOR | 0.40 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| GILES AL | |||||||||
| DIRECTOR | 0.40 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| MCKINNEY MD JR | |||||||||
| DIRECTOR | 50.40 | 0.00 | Yes (X) | $144,725 | $0 | $0 | |||
| OVERHOLT MD CANDI | |||||||||
| DIRECTOR | 50.40 | 0.00 | Yes (X) | $217,559 | $0 | $15,148 | |||
| SMITH DON | |||||||||
| DIRECTOR | 0.40 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| SVENDSEN MD CLAES | |||||||||
| DIRECTOR | 50.40 | 0.00 | Yes (X) | $243,951 | $0 | $20,241 | |||
| WILLIAMS MARK | |||||||||
| DIRECTOR | 0.40 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| WRIGHT ED | |||||||||
| DIRECTOR | 0.40 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| KILEY DENNIS | |||||||||
| CEO/DIRECTOR (BEG 8/15) | 50.40 | 0.00 | Yes (X) | $0 | $392,482 | $36,174 | Yes (X) | ||
| WOLCOTT DANIEL | |||||||||
| CEO/DIRECTOR (END 7/15) | 50.40 | 0.00 | Yes (X) | $0 | $286,604 | $46,580 | Yes (X) | ||
| MILLER STEVEN | |||||||||
| CFO | 50.00 | 0.00 | $0 | $318,372 | $64,068 | Yes (X) | |||
| LEWIS MD DANIEL | |||||||||
| CMO | 50.00 | 0.00 | $267,400 | $0 | $28,651 | Yes (X) | |||
| ALBRIGHT TAMMY | |||||||||
| CNO | 50.00 | 0.00 | $0 | $189,311 | $48,081 | Yes (X) | |||
| CHRISTENSEN TODD | |||||||||
| PHYSICIAN | 50.00 | 0.00 | $523,600 | $0 | $36,727 | Yes (X) | |||
| GOODWIN JAMI | |||||||||
| PHYSICIAN | 50.00 | 0.00 | $382,475 | $0 | $27,784 | Yes (X) | |||
| UHL MD GREGORY | |||||||||
| PHYSICIAN | 50.00 | 0.00 | $348,350 | $0 | $22,235 | Yes (X) | |||
| BRIDGES MD WILLIAM ROBERT | |||||||||
| PHYSICIAN | 50.00 | 0.00 | $324,795 | $0 | $45,283 | Yes (X) | |||
| BULAWA BETH | |||||||||
| PHYSICIAN | 50.00 | 0.00 | $309,312 | $0 | $63,896 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,002,532 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,945,164 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $576,095 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 42 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ARUP LABORATORIES | |||||
| PO BOX 27964 | SALT LAKE CITY | UT | 84127 | LAB SERVICES | $535,842 |
| BARTON ASSOCIATES | |||||
| PO BOX 417844 | BOSTON | MA | 022417844 | PHYSICIAN SERVICES | $301,754 |
| GE HEALTHCARE | |||||
| PO BOX 96483 | CHICAGO | IL | 60693 | SERVICE MAINTENANCE AGREEMENT | $228,710 |
| EQUISCRIPT | |||||
| 1360 TRUXTUN AVE | NORTH CHARLESTON | SC | 29405 | MAIL ORDER PHARMACY | $201,755 |
| MEDICAL LAUNDRY | |||||
| 1905 AMERICAN WAY | KINGSPORT | TN | 37660 | LAUNDRY SERVICE | $151,430 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $40,585 | RelatedOrganizationsAmt |
| Total Contributions | $40,585 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 900099 | $64,015,463 | $64,015,463 |
| CAFETERIA REVENUE | 900099 | $96,654 | $96,654 |
| GIFT SHOP REVENUE | 900099 | $37,883 | $37,883 |
| MEDICAL OFFICE BUILDING | 531120 | $2,340 | $2,340 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $62,266 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $62,266 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $64,214,606 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,769 | TotalRevenueColumnAmt |
| Exclusion | $2,769 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $7,200 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $7,200 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,200 | TotalRevenueColumnAmt |
| Exclusion | $7,200 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $64,265,160 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $64,214,606 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $9,969 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,340 | TotalAmt |
| Program Services | $51,340 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,581,502 | TotalAmt |
| Program Services | $1,677,723 | ProgramServicesAmt |
| Management And General | $903,779 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,875,266 | TotalAmt |
| Program Services | $25,875,266 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $738,751 | TotalAmt |
| Program Services | $738,751 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,490,573 | TotalAmt |
| Program Services | $6,462,383 | ProgramServicesAmt |
| Management And General | $28,190 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,919,841 | TotalAmt |
| Program Services | $1,919,841 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,982 | TotalAmt |
| Management And General | $101,982 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,441,457 | TotalAmt |
| Program Services | $6,686,074 | ProgramServicesAmt |
| Management And General | $1,755,383 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $242,144 | TotalAmt |
| Management And General | $242,144 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,835,475 | TotalAmt |
| Program Services | $1,337,815 | ProgramServicesAmt |
| Management And General | $497,660 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,407,674 | TotalAmt |
| Program Services | $2,125,407 | ProgramServicesAmt |
| Management And General | $282,267 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,263,442 | TotalAmt |
| Program Services | $2,263,442 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $198,741 | TotalAmt |
| Management And General | $198,741 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,549 | TotalAmt |
| Program Services | $72,549 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,512,761 | TotalAmt |
| Program Services | $1,512,761 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $763,596 | TotalAmt |
| Program Services | $761,096 | ProgramServicesAmt |
| Management And General | $2,500 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $6,057,787 | $6,057,787 | |
| STATE TAX INDIGENT ASSE | $1,877,498 | $1,877,498 | |
| REPAIRS & MAINTENANCE | $1,299,550 | $1,299,550 | |
| PURCHASED SERVICES | $91,725 | $91,725 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $116,849 | TotalAmt |
| Management And General | $116,849 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,940,503 | TotalAmt |
| Program Services | $60,719,283 | ProgramServicesAmt |
| Management And General | $4,221,220 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,245 | BOYAmt |
| EOY | $3,556 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,273,559 | BOYAmt |
| EOY | $3,195,993 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105 | BOYAmt |
| EOY | $105 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,230,077 | BOYAmt |
| EOY | $7,777,519 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,189,238 | BOYAmt |
| EOY | $1,337,129 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $164,341 | BOYAmt |
| EOY | $77,378 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $47,564,015 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $33,457,234 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,639,623 | BOYAmt |
| EOY | $14,106,781 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,406,792 | BOYAmt |
| EOY | $1,196,253 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,906,980 | BOYAmt |
| EOY | $27,694,714 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,074,533 | BOYAmt |
| EOY | $4,616,099 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,441,465 | BOYAmt |
| EOY | $7,270,998 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,515,998 | BOYAmt |
| EOY | $11,887,097 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,178,052 | BOYAmt |
| EOY | $15,506,804 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $212,930 | BOYAmt |
| EOY | $300,813 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,390,982 | BOYAmt |
| EOY | $15,807,617 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,906,980 | BOYAmt |
| EOY | $27,694,714 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$675,343 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $91,978 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,215 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,215 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | REPRESENTS THE AMOUNT OF TOTAL DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, HOSPITAL ALLIANCE OF TENNESSEE, AND TENNESSEE HOSPITAL ASSOCIATION THAT IS COMPRISED OF LOBBYING EXPENDITURES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,604,550 | OtherCostOrOtherBasisAmt |
| Book Value | $2,604,550 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,615,438 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,580,743 | DepreciationAmt |
| Book Value | $7,034,695 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,381,725 | OtherCostOrOtherBasisAmt |
| Depreciation | $22,791,224 | DepreciationAmt |
| Book Value | $3,590,501 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,962,302 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,085,267 | DepreciationAmt |
| Book Value | $877,035 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,106,781 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| CREDIT BALANCES IN A/R | $1,110,972 |
| LEASES PAYABLE | $644,247 |
| DUE TO AFFILIATED | $2,322,160 |
| PAYABLE TO THIRD PARTIES | $1,221,302 |
| OTHER NONCURRENT LIABILITIES | $1,972,317 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $7,270,998 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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, 2015 AND 2014. NAHS ALSO HAS TEMPORARY DEDUCTIBLE DIFFERENCES OF APPROXIMATELY $62,700 AND $63,600 AT DECEMBER 31, 2015 AND 2014, RESPECTIVELY, PRIMARILY AS A RESULT OF NET OPERATING LOSS CARRYFORWARDS. AT DECEMBER 31, 2015, NAHS HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $62,500, EXPIRING BEGINNING IN 2022 THROUGH 2026. DEFERRED TAXES HAVE BEEN PROVIDED FOR THESE AMOUNTS, RESULTING IN A NET DEFERRED TAX ASSET OF APPROXIMATELY $23,800 AND $24,200 AT DECEMBER 31, 2015 AND 2014, RESPECTIVELY. A FULL VALUATION ALLOWANCE HAS BEEN PROVIDED AT DECEMBER 31, 2015 AND 2014 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, 2015 AND 2014. | ExplanationTxt |
Schedule F IRS990ScheduleF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Account Activities Outside US AccountActivitiesOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | SOUTH AMERICA | RegionTxt |
| Offices | 0 | OfficesCnt |
| Employee | 0 | EmployeeCnt |
| Type Of Activities Conducted | GRANT MAKING | TypeOfActivitiesConductedTxt |
| Region Total Expenditures | $54,366 | RegionTotalExpendituresAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Offices | 0 | SubtotalOfficesCnt |
| Subtotal Employees | 0 | SubtotalEmployeesCnt |
| Continutation Total Office | 0 | ContinutationTotalOfficeCnt |
| Continutation Total Employee | 0 | ContinutationTotalEmployeeCnt |
| Total Office | 0 | TotalOfficeCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Subtotal Spent | $54,366 | SubtotalSpentAmt |
| Continuation Spent | $0 | ContinuationSpentAmt |
| Total Spent | $54,366 | TotalSpentAmt |
Grants To Org Outside US GrantsToOrgOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | SOUTH AMERICA | RegionTxt |
| Purpose Of Grant | MEDICAL SERVICES | PurposeOfGrantTxt |
| Cash Grant | $54,366 | CashGrantAmt |
| Manner Of Cash Disbursement | CHECK | MannerOfCashDisbursementTxt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
| Transfer To Foreign Corp | 0 | TransferToForeignCorpInd |
| Interest In Foreign Trust | 0 | InterestInForeignTrustInd |
| Foreign Corp Ownership | 0 | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | 0 | PassiveForeignInvestmestCoInd |
| Foreign Partnership | 0 | ForeignPartnershipInd |
| Boycott Countries | 0 | BoycottCountriesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE CURRENT YEAR GRANT REPORTED ON THIS SCHEDULE F WAS MADE TO AN EXEMPT ORGANIZATION FOR THE PURPOSE OF SUPPORTING A MISSION RELATED TRIP WHOSE PURPOSE WAS TO PROVIDE HEALTH CARE IN A FOREIGN LOCATION. AS THE FILING ORGANIZATION DOES NOT GENERALLY MAKE GRANTS TO FOREIGN ORGANIZATIONS AND/OR INDIVIDUALS, A FORMAL GRANT MONITORING PROGRAM HAS NOT BEEN DEVELOPED BY THE FILING ORGANIZATION. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,677,703 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,677,703 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04120 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,715,079 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,898,322 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,816,757 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05880 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,392,782 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,898,322 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,494,460 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10000 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $196,824 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $196,824 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $196,824 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $196,824 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,589,606 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,898,322 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,691,284 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10300 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,859,221 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $296,812 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,592,643 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,286,541 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,306,102 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TAKOMA REGIONAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 TAKOMA AVENUE | AddressLine1Txt |
| City | GREENEVILLE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37743 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.TAKOMA.ORG | WebsiteAddressTxt |
| State License | 86 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TAKOMA REGIONAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE STATEMENT | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE STATEMENT | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.TAKOMA.ORG/PATIENTS-VISITORS/AFTER-MY-STAY/FINANCIAL-ASSISTANCE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.TAKOMA.ORG/PATIENTS-VISITORS/AFTER-MY-STAY/FINANCIAL-ASSISTANCE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.TAKOMA.ORG/PATIENTS-VISITORS/AFTER-MY-STAY/FINANCIAL-ASSISTANCE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| TAKOMA REGIONAL HOSPITAL | PART V, SECTION B, LINE 5: IN CONJUNCTION WITH CONDUCTING THEIR 2015 COMMUNITY HEALTH NEEDS ASSESSMENT, TAKOMA REGIONAL HOSPITAL, INC. (TRH OR THE HOSPITAL) CREATED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) TO PROVIDE INPUT AND GUIDE THE HEALTH NEEDS ASSESSMENT PROCESS. ORGANIZATIONS AND INDIVIDUALS SERVING ON THE CHNAC INCLUDED REPRESENTATIVES FROM COUNTY AND CITY GOVERNMENT, THE GREENE COUNTY PUBLIC HEALTH DEPARTMENT, AND GREENE COUNTY PUBLIC SCHOOL HEALTH COORDINATORS. THE SPECIFIC ORGANIZATIONS AND INDIVIDUALS PARTICIPATING IN THE CHNAC AND REPRESENTING THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE INCLUDED REPRESENTATIVES FROM FRONTIER HEALTH, A PROVIDER OF BEHAVIORAL HEALTH SERVICES, THE FOOD BANK OF GREENEVILLE AND THE TABERNACLE SOUP KITCHEN, RURAL RESOURCES, AN ORGANIZATION SERVING AS A RESOURCE AND EDUCATOR WITH RESPECT TO SUSTAINABLE AGRICULTURAL PRACTICES, AND WESLEY HEIGHTS, A LOWER-INCOME UNDERSERVED NEIGHBORHOOD LOCATED WITHIN THE HOSPITAL'S COMMUNITY. THE LISTING BELOW REFLECTS ALL OF THE ORGANIZATIONS/COMMUNITY AREAS REPRESENTED ON THE HOSPITAL'S CHNAC: TRH REPRESENTATIVES; GREENE COUNTY MAYOR'S OFFICE; RURAL RESOURCES; GREENE COUNTY HEALTH DEPARTMENT; CITY OF GREENEVILLE MAYOR'S OFFICE; THE HOPE CENTER; LAUGHLIN MEMORIAL HOSPITAL REPRESENTATIVES; FRONTIER HEALTH; WESLEY HEIGHTS; FOOD BANK OF GREENEVILLE; TABERNACLE SOUP KITCHEN; GREENE COUNTY PUBLIC SCHOOLS; AND GREENEVILLE CITY SCHOOLS.PRIMARY AND SECONDARY DATA WERE COLLECTED FOR THE PURPOSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. IN ADDITION TO THE INPUT RECEIVED FROM INDIVIDUALS/ORGANIZATIONS SERVING ON THE CHNAC, PRIMARY DATA WAS COLLECTED. PRIMARY DATA CONSISTED OF FOCUS GROUPS, GROUP INTERVIEWS, AN ON-LINE COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY AND A HARD COPY QUESTIONNAIRE. THE INTERVIEWS INCLUDED A CROSS SECTION OF INDIVIDUALS WHO WERE ASSOCIATED WITH ORGANIZATIONS THAT SERVED THE MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY AND CHRONICALLY DISEASED POPULATIONS. THE QUESTIONNAIRE WAS COMPLETED BY 652 RESPONDENTS. APPROXIMATELY 12% OF THE RESPONDENTS HAD HOUSEHOLD INCOMES BELOW $25,000. |
| TAKOMA REGIONAL HOSPITAL | PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY TAKOMA REGIONAL HOSPITAL, INC. (THE HOSPITAL) WAS BASED UPON THE HOSPITAL'S INVOLVEMENT AND ENRICHMENT OF THOSE WHO LIVE WITHIN GREENE COUNTY, TENNESSEE. THE PRIMARY SERVICE AREA IS SHARED BY LAUGHLIN MEMORIAL HOSPITAL AND THUS THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN COOPERATION WITH BOTH LOCAL HOSPITALS. |
| TAKOMA REGIONAL HOSPITAL | PART V, SECTION B, LINE 7D: TAKOMA REGIONAL HOSPITAL, INC. (THE HOSPITAL) ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT WAS REQUIRED TO BE POSTED ON THE HOSPITAL'S WEBSITE BY THE END OF THE YEAR IN WHICH IT WAS CONDUCTED. THE HOSPITAL MAKES A COPY OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE UPON REQUEST. THE HOSPITAL ALSO MAKES A PAPER COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE FOR PUBLIC INSPECTION AT THE HOSPITAL FACILITY. |
| TAKOMA REGIONAL HOSPITAL | PART V, SECTION B, LINE 11: KEY FINDINGS NOTED DURING THE CHNA WERE THE LOW RANKINGS OF THE COUNTIES WE SERVE IN SEVERAL CATEGORIES RELATED TO HEALTH AND WELLNESS, INCLUDING PREVALENCE OF CHRONIC DISEASE MANAGEMENT, TOBACCO USE, DIET AND EXERCISE, AS WELL AS A NEED FOR EXPANDED AND ENHANCED MENTAL SERVICES. THEY ALSO EMPHASIZED THE VULNERABILITY OF OUR UNDERINSURED AND UNINSURED POPULATIONS, AND THAT IF OUR COMMUNITIES ARE TO THRIVE, WE MUST FOCUS ON ENCOURAGING HEALTHY CHILDREN AND FAMILIES.TO HELP MEET THESE NEEDS, TAKOMA REGIONAL HOSPITAL WILL CONTINUE TO STRENGTHEN OUR PARTNERSHIPS AND CONTINUUM OF CARE OPPORTUNITIES WITH AREA HEALTH DEPARTMENTS, FEDERALLY QUALIFIED HEALTH CENTERS AND FRONTIER HEALTH, THE REGION'S LEADING PROVIDER OF BEHAVIORAL HEALTH SERVICES. |
| TAKOMA REGIONAL HOSPITAL | PART V, SECTION B, LINE 22D: IN DETERMINING THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE POLICY-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL USED THE FOLLOWING METHODOLOGY IN ITS CURRENT TAX YEAR:THE HOSPITAL UTILIZED THE LOOK-BACK METHOD FOR DETERMINING ITS AMOUNTS GENERALLY BILLED (AGB) PERCENTAGE. IN CALCULATING ITS AGB PERCENTAGE, THE HOSPITAL INCLUDED CLAIMS ALLOWED DURING ITS PRIOR 12-MONTH PERIOD BY MEDICARE FEE-FOR-SERVICE (INCLUDING MEDICARE ADVANTAGE) AND ALL COMMERCIAL PAYORS THAT HAD ANY ACTIVITY WITH THE HOSPITAL DURING THE TAXABLE YEAR. |
| PART V, SECTION B, LINE 7A | URL FOR HOSPITAL'S CHNA:HTTP://WEBCDN.AHSS.ORG/INTERNET/HEALTH_ASSESSMENT/HEALTH_ASSESSMENT_TAKOMA.PDF |
| PART V, SECTION B, LINE 10A | URL FOR THE HOSPITAL FACILITY'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY:WWW.TAKOMA.ORG/PORTALS/38/DOCS/TAKOMA%20MEMORIAL%20HOSPITAL%202016%20COMMUNITY%20HEALTH%20PLAN.PDF |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - TAKOMA MEDICAL ASSOCIATES | ||||
| 438 E VANN ROAD | GREENEVILLE | TN | 37743 | PHYSICIAN SERVICES |
| 2 - WOMENS CENTER OF GREENEVILLE | ||||
| 1021 COOLIDGE STREET SUITE 2 | GREENEVILLE | TN | 37743 | OUTPATIENT CLINIC |
| 3 - GREENEVILLE URGENT CARE & OCCUPATIONAL | ||||
| 1021 COOLIDGE STREET SUITE 4 | GREENEVILLE | TN | 37743 | OUTPATIENT CLINIC |
| 4 - TAKOMA OUT PATIENT REHABILITATION | ||||
| 108W SUMMERS STREET | GREENEVILLE | TN | 37743 | REHABILITATION SERVICES |
| 5 - KIDSFIRST PEDIATRICS | ||||
| 5000 MONARCH POINTE | GREENEVILLE | TN | 37745 | OUTPATIENT CLINIC |
| 6 - TAKOMA CENTER FOR SLEEP DISORDERS | ||||
| 1024 COOLIDGE STREET | GREENEVILLE | TN | 37743 | OUTPATIENT CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 23 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. ON AN ANNUAL BASIS, THE COMMUNITY BENEFITS OF ALL AHS ORGANIZATIONS ARE CONSOLIDATED AND REPORTED IN THE AHS ANNUAL REPORT DOCUMENT PREPARED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (EIN 59-2170012). ADDITIONALLY, THE FILING ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY ARE POSTED ON THE FILING ORGANIZATION'S WEBSITE. |
| PART I, LINE 7: | THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. |
| PART 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 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 NON-STATE CHARITY PATIENTS. AN AMOUNT UP TO $1,000 OF SUCH A PATIENT'S BILL IS WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED TO BE 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 TO BE COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. |
| PART III, LINE 4: | FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGE 9. PLEASE NOTE THAT DOLLAR AMOUNTS ON THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE IN THOUSANDS. |
| PART III, LINE 8: | COSTING METHODOLOGY:MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. |
| PART III, LINE 9B: | THE HOSPITAL FILING ORGANIZATION'S COLLECTION PRACTICES ARE IN CONFORMITY WITH THE REQUIREMENTS SET FORTH IN THE 2012 PROPOSED REGULATIONS, AND EFFECTIVE 1/1/16, ARE IN CONFORMITY WITH THE 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) ALONG WITH THE PLAIN LANGUAGE SUMMARY 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. IN ADDITION, A REASONABLE ATTEMPT IS MADE TO ORALLY NOTIFY THE INDIVIDUAL ABOUT THE HOSPITAL'S FAP. THE SPECIFIED DEADLINE IS NOT EARLIER THAT 120 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL AND IS AT LEAST 30 DAYS AFTER THE NOTICE IS PROVIDED. 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 AND PROVIDES A WRITTEN NOTICE TO THE INDIVIDUAL DESCRIBING WHAT ADDITIONAL INFORMATION OR DOCUMENTATION IS NEEDED TO COMPETE THE FAA FORM. THIS WRITTEN NOTICE INCLUDES A COPY OF THE HOSPITAL FILING ORGANIZATION'S PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) AND INFORMS THE INDIVIDUAL THAT THE HOSPITAL FILING ORGANIZATION MAY ENGAGE IN ADVERSE REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS IF THE FAA FORM IS NOT COMPLETED BY A SPECIFIED REASONABLE DEADLINE. IF AN INDIVIDUAL SUBMITS A COMPETE FAA FORM WITHIN THE 240-DAY PERIOD AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT, 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. THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO MEDICARE PATIENTS ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ 1,306,102- DIFFERENCE IN COSTING METHODOLOGY: (845,726)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (3,969,943) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS: $(3,509,567)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 TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS 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 THE TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS 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. |
| PART VI, LINE 2: | AS REPORTED IN SCHEDULE H, PART V, SECTION B, TAKOMA REGIONAL HOSPITAL, INC. (THE HOSPITAL) CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA'S) IN 2012 AND 2015. THE HOSPITAL'S 2012 AND 2015 CHNA'S COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN PROPOSED REGULATION SECTION 1.501(R)-(1)-(3). IN ADDITION TO THE CHNA'S DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY. SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY. |
| PART VI, LINE 3: | THE FINANCIAL ASSISTANCE POLICY (FAP) OF THE FILING ORGANIZATION'S HOSPITAL FACILITY IS TRANSPARENT AND AVAILABLE TO ALL INDIVIDUALS SERVED AT ANY POINT IN THE CARE CONTINUUM. THE FAP, THE FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM), THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS), AND CONTACT INFORMATION FOR THE HOSPITAL FACILITY'S FINANCIAL COUNSELORS ARE PROMINENTLY AND CONSPICUOUSLY POSTED ON THE FILING ORGANIZATION'S HOSPITAL FACILITY'S WEBSITE. SIGNAGE IS DISPLAYED IN THE FILING ORGANIZATION'S HOSPITAL FACILITY AT ALL POINTS OF ADMISSION AND REGISTRATION, INCLUDING THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE HOSPITAL FACILITY'S WEBSITE ADDRESS WHERE THE FAP AND THE FAA FORM CAN BE ACCESSED AND THE TELEPHONE NUMBER AND PHYSICAL LOCATION THAT INDIVIDUALS CAN CALL OR VISIT WITH ANY QUESTIONS ABOUT THE FAP OR THE APPLICATION PROCESS. PAPER COPIES OF THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A PAPER COPY OF THE HOSPITAL FACILITY'S PLS IS OFFERED TO EVERY INDIVIDUAL AS PART OF THE INTAKE OR DISCHARGE PROCESS. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE. |
| PART VI, LINE 4: | TAKOMA REGIONAL HOSPITAL (THE HOSPITAL) IS A 100-BED ACUTE CARE FACILITY THAT HAS PROVIDED QUALITY HEALTH CARE SERVICES TO THE RESIDENTS OF NORTHEASTERN TENNESSEE FOR OVER 81 YEARS. IN 1974, TAKOMA ADVENTIST HOSPITAL BECAME A MEMBER OF THE SOUTHERN ADVENTIST HEALTH AND HOSPITAL SYSTEM. MAY OF 2007 BROUGHT ADDITIONAL CHANGE TO TAKOMA WHEN WELLMONT HEALTH SYSTEM BOUGHT A 60% SHARE OF THE HOSPITAL AND TAKOMA ADVENTIST HOSPITAL BECAME TAKOMA REGIONAL HOSPITAL. IN JUNE OF 2014, THE JOINT VENTURE ENDED AND ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI) BECAME THE SOLE MEMBER OF THE FILING ORGANIZATION. AHSSI IS A WHOLLY-OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, THE PARENT ORGANIZATION OF A HEALTHCARE SYSTEM KNOWN AS "ADVENTIST HEALTH SYSTEM". THE HOSPITAL IS LOCATED IN GREENE COUNTY, TENNESSEE IN THE FOOTHILLS OF THE GREAT SMOKEY MOUNTAINS IN HISTORIC GREENEVILLE, TENNESSEE. GREENE COUNTY, TENNESSEE HAS A POPULATION OF APPROXIMATELY 69,000, WITH AN ESTIMATED 13,000 OVER THE AGE OF 65.THE HOSPITAL IS A CRUCIAL COMMUNITY AND REGIONAL ASSET. TAKOMA REGIONAL HOSPITAL IS ONE OF TWO HOSPITALS IN GREENEVILLE, TN. THE NEAREST PROVIDER DOES NOT OFFER MANY OF THE SERVICES OFFERED AT THE HOSPITAL, SUCH AS GERIATRIC PSYCHIATRIC INPATIENT SERVICES, OUTPATIENT BEHAVIORAL SERVICES, AND A CENTER FOR INPATIENT REHABILITATION. THE HOSPITAL IS ALSO ONE OF THE LARGEST EMPLOYERS IN THE CITY OF GREENEVILLE, TN.GREENE COUNTY, TENNESSEE COVERS JUST OVER 622 SQUARE MILES. THE MEDIAN HOUSEHOLD INCOME, IN GREENE COUNTY IS APPROXIMATELY $37,000. ABOUT 20% OF GREENE COUNTY'S RESIDENTS HAVE INCOMES BELOW THE FEDERAL POVERTY LEVEL. HIGH SCHOOL GRADUATES 25+ YEARS OF AGE ACCOUNT FOR APPROXIMATELY 77% OF GREENE COUNTY, WITH AN ESTIMATED 14% HAVING A BACHELOR'S DEGREE OR HIGHER. GREENE COUNTY'S CURRENT UNEMPLOYMENT RATE IS ABOUT 8.3%. APPROXIMATELY 48.9% OF THE HOSPITAL'S PATIENTS DURING FISCAL YEAR ENDING JUNE 30, 2016 WERE MEDICARE PATIENTS, ABOUT 17.9% WERE MEDICAID PATIENTS, ABOUT 5.7% WERE SELF-PAY PATIENTS, AND THE REMAINING PERCENTAGE WERE PATIENTS COVERED UNDER COMMERCIAL INSURANCE. APPROXIMATELY 69.4% OF THE HOSPITAL'S IN-PATIENTS ARE ADMITTED THROUGH THE EMERGENCY DEPARTMENT. |
| PART VI, LINE 5: | THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO TAKOMA REGIONAL HOSPITAL'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT AND COMMUNITY BUILDING INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, THE HOSPITAL PROVIDED $80,983 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF A COMMUNITY HOSPITAL. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE HOSPITAL EXPENDED $1,130,051 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. |
| PART VI, LINE 6: | TAKOMA REGIONAL HOSPITAL 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 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 RESPONSIBILITY, LEGAL, HUMAN RESOURCES, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH AHS SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. EACH AHS SUBSIDIARY PAYS A MANAGEMENT FEE TO AHSSHC FOR THE INTERNAL SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY A AHS SUBSIDIARY ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY BY ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF AHS AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEB-SITE OF AHS AT WWW.ADVENTISTHEALTHSYSTEM.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF AHS AND TO ACCESS AHS'S ANNUAL REPORT THAT CONTAINS FINANCIAL DATA AS WELL AS COMMUNITY BENEFIT REPORTING FOR THE ENTIRE SYSTEM. |
| PART VI, LINE 7: | THE ANNUAL COMMUNITY BENEFIT REPORT CONTAINED IN THE ANNUAL REPORT PREPARED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) ON BEHALF OF THE ENTIRE AHS SYSTEM OF HEALTHCARE ORGANIZATIONS IS NOT FILED WITH ANY STATE AGENCIES. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| GREENE COUNTY PARTNERSHIP INC | |||||||
| 115 ACADEMY ST | GREENEVILLE | TN | 37743 | 621552105 | 501(C)(4) | $12,973 | GENERAL SUPPORT |
| GREENE COUNTY LOCAL EDUCATIONAL ADVANCEMENT FOUNDATION | |||||||
| PO BOX 22 | AFTON | TN | 37616 | 454418460 | 501(C)(3) | $6,250 | GENERAL SUPPORT |
| GREENEVILLE CITY SCHOOLS FOUNDATION | |||||||
| PO BOX 1420 | GREENEVILLE | TN | 37744 | 621672018 | 501(C)(3) | $7,250 | GENERAL SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | GRANTS ARE GENERALLY MADE TO AFFILIATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER 501(C)(3) OR TO LOCAL 501(C)(3) COMMUNITY ORGANIZATIONS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Discretionary Spending Acct | Yes (X) | DiscretionarySpendingAcctInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BUNCH JAMES A JIMM | ||||||||||||||
| DIRECTOR/CHAIRMAN | $0 | $437,816 | $0 | $124,048 | $0 | $196,531 | $0 | $54,994 | $0 | $44,443 | $0 | $857,832 | $0 | $43,863 |
| BULAWA MD ERICK | ||||||||||||||
| DIRECTOR | $198,259 | $0 | $36,639 | $0 | $5,467 | $0 | $12,829 | $0 | $8,961 | $0 | $262,155 | $0 | $0 | $0 |
| OVERHOLT MD CANDI | ||||||||||||||
| DIRECTOR | $169,308 | $0 | $34,450 | $0 | $13,801 | $0 | $8,150 | $0 | $6,998 | $0 | $232,707 | $0 | $0 | $0 |
| SVENDSEN MD CLAES | ||||||||||||||
| DIRECTOR | $202,010 | $0 | $35,500 | $0 | $6,441 | $0 | $9,500 | $0 | $10,741 | $0 | $264,192 | $0 | $0 | $0 |
| KILEY DENNIS | ||||||||||||||
| CEO/DIRECTOR (BEG 8/15) | $0 | $190,410 | $0 | $79,324 | $0 | $122,748 | $0 | $14,388 | $0 | $21,786 | $0 | $428,656 | $0 | $0 |
| WOLCOTT DANIEL | ||||||||||||||
| CEO/DIRECTOR (END 7/15) | $0 | $160,064 | $0 | $56,268 | $0 | $70,272 | $0 | $22,360 | $0 | $24,220 | $0 | $333,184 | $0 | $12,234 |
| MILLER STEVEN | ||||||||||||||
| CFO | $0 | $190,000 | $0 | $31,234 | $0 | $97,138 | $0 | $12,560 | $0 | $51,508 | $0 | $382,440 | $0 | $0 |
| LEWIS MD DANIEL | ||||||||||||||
| CMO | $226,995 | $0 | $21,512 | $0 | $18,893 | $0 | $11,904 | $0 | $16,747 | $0 | $296,051 | $0 | $0 | $0 |
| ALBRIGHT TAMMY | ||||||||||||||
| CNO | $0 | $148,035 | $0 | $25,791 | $0 | $15,485 | $0 | $9,301 | $0 | $38,780 | $0 | $237,392 | $0 | $0 |
| CHRISTENSEN TODD | ||||||||||||||
| PHYSICIAN | $509,606 | $0 | $0 | $0 | $13,994 | $0 | $20,384 | $0 | $16,343 | $0 | $560,327 | $0 | $0 | $0 |
| GOODWIN JAMI | ||||||||||||||
| PHYSICIAN | $326,922 | $0 | $10,000 | $0 | $45,553 | $0 | $17,498 | $0 | $10,286 | $0 | $410,259 | $0 | $0 | $0 |
| UHL MD GREGORY | ||||||||||||||
| PHYSICIAN | $310,099 | $0 | $30,026 | $0 | $8,225 | $0 | $13,605 | $0 | $8,630 | $0 | $370,585 | $0 | $0 | $0 |
| BRIDGES MD WILLIAM ROBERT | ||||||||||||||
| PHYSICIAN | $310,003 | $0 | $4,536 | $0 | $10,256 | $0 | $29,900 | $0 | $15,383 | $0 | $370,078 | $0 | $0 | $0 |
| BULAWA BETH | ||||||||||||||
| PHYSICIAN | $299,998 | $0 | $0 | $0 | $9,314 | $0 | $42,940 | $0 | $20,956 | $0 | $373,208 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 SUNBLET 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 TWO BUSINESS TRIPS EACH YEAR. TYPICALLY, REIMBURSEMENT IS ONLY PROVIDED TO VICE PRESIDENTS AND ABOVE AND IS USUALLY LIMITED TO ONE BUSINESS TRIP PER YEAR BEYOND THE ANNUAL AHS PRESIDENT'S COUNCIL BUSINESS MEETING AND OTHER MEETINGS WHERE THE SPOUSE IS SPECIFICALLY INVITED. THE AHSSHC CORPORATE EXECUTIVE SPOUSAL TRAVEL POLICY WAS ORIGINALLY APPROVED AND REVIEWED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. ALL SPOUSAL TRAVEL COSTS REIMBURSED TO THE EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: AHS HAS A SYSTEM-WIDE POLICY ADDRESSING GROSS-UP PAYMENTS PROVIDED IN CONNECTION WITH EMPLOYER-PROVIDED BENEFITS/OTHER TAXABLE ITEMS. UNDER THE POLICY, CERTAIN TAXABLE BUSINESS-RELATED REIMBURSEMENTS (I.E. TAXABLE BUSINESS-RELATED MOVING EXPENSES, TAXABLE ITEMS PROVIDED IN CONNECTION WITH EMPLOYMENT) PROVIDED TO ANY EMPLOYEE MAY BE GROSSED-UP AT A 25% RATE UPON APPROVAL OF THE FILING ORGANIZATION'S CEO AND CFO. ADDITIONALLY, EMPLOYEES AT THE DIRECTOR LEVEL AND ABOVE ARE ELIGIBLE FOR GROSS-UP PAYMENTS ON GIFTS RECEIVED FOR BOARD OF DIRECTOR SERVICES. DISCRETIONARY SPENDING ACCOUNT: A NOMINAL DISCRETIONARY SPENDING AMOUNT WAS PROVIDED IN THE CURRENT YEAR TO ALL ELIGIBLE EXECUTIVES WHO ATTEND THE ANNUAL AHS PRESIDENT'S COUNCIL BUSINESS MEETING ($500 PER EXECUTIVE) OR THE ANNUAL AHS CFO CONFERENCE, OR CMO/CNO BUSINESS MEETING ($300 PER EXECUTIVE). OTHER DISCRETIONARY SPENDING ACCOUNTS MAY BE PROVIDED IN CONNECTION WITH OTHER AHS SPONSORED CONFERENCES BUT TYPICALLY DO NOT EXCEED $200 PER PARTICIPANT. WITH RESPECT TO THE AHS PRESIDENT'S COUNCIL MEETING, ELIGIBLE EXECUTIVES MAY INCLUDE AHSSHC VICE PRESIDENTS AND ABOVE AND ALL AHSSHC SUBSIDIARY ORGANIZATION CEOS AND REGIONAL CFOS. THE PAYMENT PROVIDED TO EACH EXECUTIVE WAS CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. |
| PART I, LINE 3 | THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) FOR THAT INDIVIDUAL'S ROLE IN SERVING AS THE CEO. COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC HAS TAKEN STEPS TO ENSURE THAT PROCESSES ARE IN PLACE TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS STANDARD AS SET FORTH IN TREASURY REGULATION 53.4958-6 WITH RESPECT TO ITS ACTIVE EXECUTIVE-LEVEL POSITIONS. THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE) SERVES AS THE GOVERNING BODY FOR ALL EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE IS COMPOSED OF CERTAIN MEMBERS OF THE BOARD OF DIRECTORS (THE BOARD) OF AHSSHC. VOTING MEMBERS OF THE COMMITTEE INCLUDE ONLY INDIVIDUALS WHO SERVE ON THE BOARD AS INDEPENDENT REPRESENTATIVES OF THE COMMUNITY, WHO HOLD NO EMPLOYMENT POSITIONS WITH AHSSHC AND WHO DO NOT HAVE RELATIONSHIPS WITH ANY OF THE INDIVIDUALS WHOSE COMPENSATION IS UNDER THEIR REVIEW THAT IMPACTS THEIR BEST INDEPENDENT JUDGMENT AS FIDUCIARIES OF AHSSHC. THE COMMITTEE'S ROLE IS TO REVIEW AND APPROVE ALL COMPONENTS OF THE EXECUTIVE COMPENSATION PLAN OF AHSSHC. AS AN INDEPENDENT GOVERNING BODY WITH RESPECT TO EXECUTIVE COMPENSATION, IT SHOULD BE NOTED THAT THE COMMITTEE WILL OFTEN CONFER IN EXECUTIVE SESSIONS ON MATTERS OF COMPENSATION POLICY AND POLICY CHANGES. IN SUCH EXECUTIVE SESSIONS, NO MEMBERS OF MANAGEMENT OF AHSSHC ARE PRESENT. THE COMMITTEE IS ADVISED BY AN INDEPENDENT THIRD PARTY COMPENSATION ADVISOR. THIS ADVISOR PREPARES ALL THE BENCHMARK STUDIES FOR THE COMMITTEE. COMPENSATION LEVELS ARE BENCHMARKED WITH A NATIONAL PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS OF SIMILAR SIZE AND COMPLEXITY TO AHS AND EACH OF ITS AFFILIATED ENTITIES. THE FOLLOWING PRINCIPLES GUIDE THE ESTABLISHMENT OF INDIVIDUAL EXECUTIVE COMPENSATION: - THE SALARY OF THE PRESIDENT/CEO OF AHS WILL NOT EXCEED THE 40TH PERCENTILE OF COMPARABLE SALARIES PAID BY SIMILARLY SITUATED ORGANIZATIONS; AND - OTHER EXECUTIVE SALARIES SHALL BE ESTABLISHED USING MARKET MEDIANS. THE COMPENSATION PHILOSOPHY, POLICIES, AND PRACTICES OF AHSSHC ARE CONSISTENT WITH THE ORGANIZATION'S FAITH-BASED MISSION AND CONFORM TO APPLICABLE LAWS, REGULATIONS, AND BUSINESS PRACTICES. AS A FAITH-BASED ORGANIZATION SPONSORED BY THE SEVENTH-DAY ADVENTIST CHURCH (THE CHURCH), AHSSHC'S PHILOSOPHY AND PRINCIPLES WITH RESPECT TO ITS EXECUTIVE COMPENSATION PRACTICES REFLECT THE CONSERVATIVE APPROACH OF THE CHURCH'S MISSION OF SERVICE AND WERE DEVELOPED IN COUNSEL WITH THE CHURCH'S LEADERSHIP. |
| PART I, LINE 4B | AS DISCUSSED IN LINE 1A ABOVE, EXECUTIVES ON THE FILING ORGANIZATION'S MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF A HEALTHCARE SYSTEM KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). IN RECOGNITION OF THE CONTRIBUTION THAT EACH EXECUTIVE MAKES TO THE SUCCESS OF AHS, AHS PROVIDES TO ELIGIBLE EXECUTIVES PARTICIPATION IN THE AHS EXECUTIVE FLEX BENEFIT PROGRAM (THE PLAN). THE PURPOSE OF THE PLAN IS TO OFFER ELIGIBLE EXECUTIVES AN OPPORTUNITY TO ELECT FROM AMONG A VARIETY OF SUPPLEMENTAL BENEFITS, INCLUDING DEFERRED COMPENSATION BENEFITS TAXABLE UNDER INTERNAL REVENUE CODE (IRC) SECTION 457(F), TO INDIVIDUALLY TAILOR A BENEFITS PROGRAM APPROPRIATE TO EACH EXECUTIVE'S NEEDS. THE PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH IS DEDUCTED THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS. THE PRE-DETERMINED BENEFITS ALLOWANCE CREDIT PERCENTAGE IS APPROVED BY THE 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 $230,000. 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 ------------------------------------------------------- JAMES BUNCH $ 58,606 $ 51,019 $ 93,616 $ 0 DENNIS KILEY $ 5,416 $ 5,416 $ 0 $ 0 DANIEL WOLCOTT $ 8,135 $ 14,304 $ 0 $ 0 *INCLUDING INVESTMENT EARNINGS |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| ELIZABETH A WILLIAMS | |||
| FAMILY OF BOARD MEMBER | $22,005 | EMPLOYEE COMPENSATION | 0 |
| BETH BULAWA | |||
| FAMILY OF BOARD MEMBER | $309,312 | EMPLOYEE COMPENSATION | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | MARK WILLIAMS AND SHARON FOLK - BUSINESS RELATIONSHIP |
| FORM 990, PART VI, SECTION A, LINE 6 | TAKOMA REGIONAL HOSPITAL, INC. (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS ADVENTIST HEALTH SYSTEM/SUNBELT, INC. ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI) 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 AHSSI. THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION ARE APPOINTED BY THE SOLE MEMBER, AHSSI, 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 | AHSSI, AS THE SOLE MEMBER OF THE FILING ORGANIZATION, HAS CERTAIN RESERVED POWERS AS SET FORTH IN THE BYLAWS OF THE FILING ORGANIZATION. THESE RESERVED POWERS INCLUDE THE FOLLOWING: A) TO APPROVE AND DISAPPROVE THE EXECUTIVE AND/OR ADMINISTRATIVE LEADERSHIP OF THE FILING ORGANIZATION, AND THEIR SALARIES; B) TO ADOPT, AMEND, RESTATE, AND REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS OF THE FILING ORGANIZATION, AND THE MEDICAL STAFF BYLAWS; 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; G) TO ESTABLISH GENERAL GUIDING POLICIES, TO IMPLEMENT QUALITY ASSESSMENT, IMPROVEMENT AND UTILIZATION REVIEW PROGRAMS. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE CFO, CORPORATE CONTROLLER, AND MANAGER OF ACCOUNTING PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE CFO, CORPORATE CONTROLLER, AND MANAGER OF ACCOUNTING 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). EACH YEAR, AHS PUBLISHES AN ANNUAL REPORT DOCUMENT THAT INCLUDES A FINANCIAL REPORT FOR THE RELEVANT YEAR AS WELL AS A COMMUNITY BENEFIT REPORT. THE FINANCIAL REPORT AND COMMUNITY BENEFIT REPORT ARE PRESENTED ON A CONSOLIDATED BASIS AND REPRESENT ALL OF THE ACTIVITIES, RESULTS OF OPERATIONS, AND FINANCIAL POSITION AT YEAR-END OF THE ENTIRE AHS SYSTEM. IN ADDITION, 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. |
| FORM 990, PART IX, LINE 11G | PAYMENTS TO HEALTHCARE PROFESSIONALS: PROGRAM SERVICE EXPENSES 1,485,170. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,485,170. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 3,469,077. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,469,077. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 1,557,273. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,557,273. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 39,408. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,408. RECRUITING : PROGRAM SERVICE EXPENSES 67,736. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 67,736. MISC PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 67,410. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 67,410. AHS MGMT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 716,271. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 716,271. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,039,112. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,039,112. |
| FORM 990, PART XI, LINE 9: | GIFTS 100,000. TRANSFER TO UNRESTRICTED FOR CREATION HEALTH GRANT -11,268. OTHER MISCELLANEOUS ADJUSTMENTS 3,246. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (102 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ADVENTIST BOLINGBROOK HOSPITAL | |||||||||||
| 500 REMINGTON BLVD | BOLINGBROOK | IL | 60440 | 651219504 | OPERATION OF HOSPITAL & RELATED SERVICES | IL | 501(C)(3) | LINE 3 | ADVENTIST MIDWEST HEALTH | Yes (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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (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 | Yes (1) | |
| ADVENTIST HLTH MID-AMERICA INC | |||||||||||
| 9100 W 74TH STREET | SHAWNEE MISSION | KS | 66204 | 521347407 | SUPPORT OF AFFILIATED HOSPITAL | KS | 501(C)(3) | LINE 11C, III-FI | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| ADVENTIST HLTH PARTNERS INC | |||||||||||
| 1000 REMINGTON BLVD STE 200 | BOLINGBROOK | IL | 60440 | 364138353 | OPERATE OUT-PATIENT PHYSICIAN CLINICS | IL | 501(C)(3) | LINE 3 | AHS MIDWEST MANAGEMENT INC | Yes (1) | |
| ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 592170012 | MANAGEMENT SERVICES | FL | 501(C)(3) | LINE 11A, I | 0 | N/A | |
| 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 | Yes (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 | Yes (1) | |
| ADVENTIST HLTH SYSTEMTEXAS INC | |||||||||||
| 11801 S FREEWAY | BURLESON | TX | 36028 | 742578952 | LEASING PERSONNEL TO AFFILIATED HOSPITAL | TX | 501(C)(3) | LINE 11C, III-FI | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (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 | Yes (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 | Yes (1) | |
| AHP SPECIALTY CARE NFP (1230-123115) | |||||||||||
| 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 | Yes (1) | |
| AHS MIDWEST MANAGEMENT INC | |||||||||||
| 1000 REMINGTON BLVD STE 200 | BOLINGBROOK | IL | 60440 | 363354567 | OPERATION OF PHYSICIAN PRACTICE MGMT | IL | 501(C)(3) | LINE 11A, I | ADVENTIST MIDWEST HEALTH | Yes (1) | |
| AHSCENTRAL TEXAS INC | |||||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 742621825 | PROVIDE OFFICE SPACE - MEDICAL PROFESSIONALS | TX | 501(C)(3) | LINE 11C, III-FI | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| APOPKA HLTH CARE PROPERTIES INC | |||||||||||
| 305 E OAK STREET | APOPKA | FL | 32703 | 510605694 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (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 | Yes (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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| CALDWELL HLTH CARE PROPERTIES INC | |||||||||||
| 1333 WEST MAIN | PRINCETON | KY | 42445 | 510605680 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| CENTRAL TEXAS HLTHCARE COLLABORATIVE | |||||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 453739929 | SUPPORT OPERATION OF HOSPITAL | TX | 501(C)(3) | LINE 11A, I | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| CHICKASAW HLTH CARE PROPERTIES INC | |||||||||||
| 250 S CHICKASAW TRAIL | ORLANDO | FL | 32825 | 510605681 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (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 | Yes (1) | |
| COBB MEDICAL ASSOCIATES LLC (11-122315) | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 582617089 | INACTIVE | GA | 501(C)(3) | LINE 3 | EMORY-ADVENTIST INC | Yes (1) | |
| COURTLAND HLTH CARE PROPERTIES INC | |||||||||||
| 730 COURTLAND STREET | ORLANDO | FL | 32804 | 510605682 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| DAIRY ROAD HLTH CARE PROPERTIES INC | |||||||||||
| 7350 DAIRY ROAD | ZEPHYRHILLS | FL | 33540 | 510605684 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| EMORY-ADVENTIST INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 582171011 | INACTIVE | GA | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (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 | Yes (1) | |
| FLNC INC | |||||||||||
| 3355 E SEMORAN BLVD | APOPKA | FL | 32703 | 205774761 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | FL | 501(C)(3) | LINE 9 | SUNBELT HLTH CARE CENTERS INC | Yes (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 | Yes (1) | |
| FLORIDA HOSPITAL MEDICAL GROUP INC | |||||||||||
| 2600 WESTHALL LN | MAITLAND | FL | 32751 | 593214635 | OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| FLORIDA HOSPITAL PHYSICIAN GROUP INC | |||||||||||
| 2700 HEALING WAY | WESLEY CHAPEL | FL | 33545 | 462021581 | OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (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 | Yes (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 | Yes (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 11A, I | SHAWNEE MISSION MEDICAL CENTER INC | Yes (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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (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 11C, 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 9 | THE COMFORTER HEALTH CARE GROUP INC | Yes (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 | Yes (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 11B, II | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| JELLICO COMMUNITY HOSPITAL INC (11-43015) | |||||||||||
| 188 HOSPITAL LANE | JELLICO | TN | 37762 | 620924706 | OPERATION OF HOSPITAL & RELATED SERVICES | TN | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (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 | |
| 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 | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
| MERRIAM HLTH CARE PROPERTIES INC | |||||||||||
| 9700 WEST 62ND STREET | MERRIAM | KS | 66203 | 364595806 | LEASE TO RELATED ORGANIZATION | KS | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (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 | Yes (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 | Yes (1) | |
| METROPLEX HOSPITAL INC (11-6815) | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 461256516 | INACTIVE | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| MIDWEST HLTH FOUNDATION | |||||||||||
| 120 NORTH OAK STREET | HINSDALE | IL | 60521 | 352230515 | SUPPORT OF SUBSIDIARY FOUNDATIONS | IL | 501(C)(3) | LINE 11B, II | 0 | N/A | |
| 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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| MISSION STRATEGIES OF GEORGIA INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 900866024 | PROVISION OF SUPPORT TO THE NURSING HOME DIVISION | GA | 501(C)(3) | LINE 11B, II | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| MISSOURI ADVENTIST HLTH INC | |||||||||||
| 9100 W 74TH STREET | SHAWNEE MISSION | KS | 66204 | 431224729 | SUPPORT HLTH CARE SERVICES | MO | 501(C)(3) | LINE 11D, III-O | ADVENTIST HLTH MID-AMERICA INC | Yes (1) | |
| NORTH REGIONAL EMS INC (11-41615) | |||||||||||
| 188 HOSPITAL LANE | JELLICO | TN | 37762 | 262653616 | EMS SERVICES | TN | 501(C)(3) | LINE 9 | JELLICO COMMUNITY HOSPITAL INC | Yes (1) | |
| ORMOND BEACH MEMORIAL HOSPITAL AUXILIARY INC | |||||||||||
| 301 MEMORIAL MEDICAL PARKWAY | DAYTONA BEACH | FL | 32117 | 591721962 | VOLUNTEER SUPPORT SERVICES | FL | 501(C)(3) | LINE 11C, III-FI | 0 | ||
| 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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| PARAGON HLTH CARE PROPERTIES INC | |||||||||||
| 950 HIGHPOINT DRIVE | HOPKINSVILLE | KY | 42240 | 510605686 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (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 | Yes (1) | |
| PORTERCARE ADVENTIST HLTH SYSTEM (630 YEAR END) | |||||||||||
| 2525 S DOWNING STREET | DENVER | CO | 80210 | 840438224 | OPERATION OF HOSPITAL & RELATED SERVICES | CO | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| PRINCETON PROFESSIONAL SERVICES INC | |||||||||||
| 601 E ROLLINS STREET | ORLANDO | FL | 32803 | 591191045 | PROVISION OF HLTHCARE SERVICES | FL | 501(C)(3) | LINE 9 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| QUALITY CIRCLE FOR HLTHCARE INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 263789368 | HLTHCARE QUALITY SERVICES | FL | 501(C)(3) | LINE 11A, I | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (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 11B, II | SUNBELT HLTH CARE CENTERS INC | Yes (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 | INACTIVE | TX | 501(C)(3) | LINE 11A, I | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (1) | |
| RUSSELLVILLE HLTH CARE PROPERTIES INC | |||||||||||
| 683 EAST THIRD STREET | RUSSELLVILLE | KY | 42276 | 510605691 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| SAN MARCOS HLTH CARE PROPERTIES INC | |||||||||||
| 1900 MEDICAL PARKWAY | SAN MARCOS | TX | 78666 | 510605693 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| SHAWNEE MISSION HLTH CARE INC | |||||||||||
| 6501 WEST 75TH STREET | OVERLAND PARK | KS | 66204 | 480952508 | LEASE TO RELATED ORGANIZATION | KS | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (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 | Yes (1) | |
| SOUTH CENTRAL INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 593689740 | MANAGEMENT SUPPORT | GA | 501(C)(3) | LINE 11C, III-FI | 0 | N/A | |
| SOUTH PASCO HLTH CARE PROPERTIES INC | |||||||||||
| 38250 A AVENUE | ZEPHYRHILLS | FL | 33542 | 510605679 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| SOUTHEAST VOLUSIA HEALTHCARE CORP (421-123115) | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 473793197 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (1) | |
| SOUTHWEST VOLUSIA HLTH SERVICES INC | |||||||||||
| 1055 SAXON BLVD | ORANGE CITY | FL | 32763 | 593281591 | MEDICAL OFFICE BUILDING FOR HOSPITAL | FL | 501(C)(3) | LINE 11A, I | SOUTHWEST VOLUSIA HLTHCARE CORP | Yes (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 | Yes (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 | Yes (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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| SUNBELT HLTH CARE CENTERS INC | |||||||||||
| 485 NORTH KELLER ROAD 250 | MAITLAND | FL | 32751 | 581473135 | MANAGEMENT SERVICES | TN | 501(C)(3) | LINE 11B, II | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (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 | Yes (1) | |
| TAKOMA REGIONAL HOSPITAL INC (630 YEAR END) | |||||||||||
| 401 TAKOMA AVE | GREENEVILLE | TN | 37743 | 510603966 | OPERATION OF HOSPITAL & RELATED SERVICES | TN | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | Yes (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 | Yes (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 | Yes (1) | |
| TARRANT COUNTY HLTH CARE PROPERTIES INC | |||||||||||
| 301 HUGULEY BLVD | BURLESON | TX | 76028 | 510605677 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| TAYLOR CREEK HLTH CARE PROPERTIES INC | |||||||||||
| 718 GOODWIN LANE | LEITCHFIELD | KY | 42754 | 510605678 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
| THE COMFORTER HEALTH CARE GROUP INC | |||||||||||
| 605 MONTGOMERY ROAD | ALTAMONTE SPRINGS | FL | 32714 | 271857940 | LEASE TO RELATED ORGANIZATION | FL | 501(C)(3) | LINE 11C, III-FI | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | Yes (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 11C, 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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (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 11A, I | 0 | ||
| UNIVERSITY COMMUNITY HOSPITAL SPECIALTY CARE INC | |||||||||||
| 3100 E FLETCHER AVE | TAMPA | FL | 33613 | 593231322 | INACTIVE | FL | 501(C)(3) | LINE 11A, I | UNIVERSITY COMMUNITY HOSPITAL INC | Yes (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 | Yes (1) | |
| WEST KENTUCKY HLTH CARE PROPERTIES INC | |||||||||||
| 500 BECK LANE | MAYFIELD | KY | 42066 | 510605676 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | Yes (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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (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 9 | SUNBELT HLTH CARE CENTERS INC | Yes (1) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| CLEAR CREEK MOB LTD | |||||||
| 2201 S CLEAR CREEK RD | KILLEEN | TX | 76549 | 742609195 | REAL ESTATE | TX | N/A |
| ENDOSCOPY CENTER AT PORTER LLC | |||||||
| 1001 SOUTH PARK DRIVE | LITTLETON | CO | 80120 | 205855038 | MEDICAL SERVICES | CO | N/A |
| FLORIDA HOSPITAL DMERT LLC | |||||||
| 2450 MAITLAND CENTER PKWY STE 200 | MAITLAND | FL | 32751 | 202392253 | MEDICAL EQUIPMENT | FL | N/A |
| FLORIDA HOSPITAL HOME INFUSION LLP | |||||||
| 2450 MAITLAND CENTER PKWY STE 200 | 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 | |||||||
| 188 INVERNESS DR WEST 500 | ENGLEWOOD | CO | 80112 | 474211060 | MEDICAL SERVICES | CO | N/A |
| PAHSUSP SURGERY CENTERS LLC | |||||||
| 15305 DALLAS PKWY STE 1600 LB 28 | ADDISON | TX | 75010 | 263057950 | MEDICAL SERVICES | CO | N/A |
| SAN MARCOS MRI LP | |||||||
| 1330 WONDER WORLD DR STE 202 | SAN MARCOS | TX | 78666 | 770597972 | IMAGING & TESTING | TX | N/A |
| SHAWNEE MISSION OPEN MRI LLC | |||||||
| 9100 W 74TH STREET BOX 2923 | SHAWNEE MISSION | KS | 66201 | 270011796 | IMAGING & TESTING | KS | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (20 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| ALTAMONTE MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC | |||||||||
| 601 EAST ROLLINS STREET | ORLANDO | FL | 32803 | 592855792 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| APOPKA MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC | |||||||||
| 601 EAST ROLLINS STREET | ORLANDO | FL | 32803 | 593000857 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| CC MOB INC | |||||||||
| 2201 S CLEAR CREEK ROAD | KILLEEN | TX | 76549 | 742616875 | REAL ESTATE RENTAL | TX | N/A | C | Yes (1) |
| CENTRAL TEXAS MEDICAL ASSOCIATES | |||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 742729873 | INACTIVE | TX | N/A | C | Yes (1) |
| CENTRAL TEXAS PROVIDER'S NETWORK | |||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 742827652 | PHYSICIAN HOSPITAL ORG. | TX | N/A | C | Yes (1) |
| FLORIDA HOSPITAL FLAGLER MEDICAL OFFICES ASSOCIATION INC | |||||||||
| 60 MEMORIAL MEDICAL PARKWAY | PALM COAST | FL | 32164 | 262158309 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| FLORIDA HOSP HLTH VILLAGE PROPERTY OWNER'S ASSOC INC EIN APPLIED FOR | |||||||||
| 550 E ROLLINS STREET 7TH FLOOR | ORLANDO | FL | 32803 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) | |
| FLORIDA HOSPITAL HEALTHCARE SYSTEM INC | |||||||||
| 602 COURTLAND STREET | ORLANDO | FL | 32804 | 593215680 | PHSO | FL | N/A | C | Yes (1) |
| FLORIDA MEDICAL PLAZA CONDO ASSOCIATION INC | |||||||||
| 601 EAST ROLLINS STREET | ORLANDO | FL | 32803 | 592855791 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| FLORIDA MEMORIAL HEALTH NETWORK INC | |||||||||
| 770 W GRANADA BLVD STE 317 | ORMOND BEACH | FL | 32174 | 593403558 | PHYSICIAN HOSPITAL ORG. | FL | N/A | C | Yes (1) |
| KISSIMMEE MULTISPECIALTY CLINIC CONDOMINIUM ASSOCIATION INC | |||||||||
| 201 HILDA STREET SUITE 30 | KISSIMMEE | FL | 34741 | 593539564 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| LAKE COUNTY HEALTH CARE PROPERTIES INC (END 123115) | |||||||||
| 485 NORTH KELLER ROAD STE 250 | MAITLAND | FL | 32751 | 472179868 | REAL ESTATE RENTAL | FL | N/A | C | Yes (1) |
| MIDWEST MANAGEMENT SERVICES INC | |||||||||
| 9100 WEST 74TH STREET | SHAWNEE MISSION | KS | 66204 | 480901551 | INACTIVE | KS | N/A | C | Yes (1) |
| NORTH AMERICAN HEALTH SERVICES INC & SUB | |||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 621041820 | LESSOR/HOLDING CO. | TN | N/A | C | Yes (1) |
| ORMOND PROF ASSOCIATES CONDO ASSOC'N INC (430 YR END) | |||||||||
| 770 W GRANADA BLVD STE 101 | ORMOND BEACH | FL | 32174 | 592694434 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| PARK RIDGE PROPERTY OWNER'S ASSOCIATION INC | |||||||||
| 1 PARK PLACE NAPLES ROAD | FLETCHER | NC | 28732 | 030380531 | CONDO ASSOCIATION | NC | N/A | C | Yes (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 | Yes (1) |
| SAN MARCOS REGIONAL MRI INC | |||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 770597968 | HOLDING COMPANY | TX | N/A | C | Yes (1) |
| THE GARDEN RETIREMENT COMMUNITY INC | |||||||||
| 485 NORTH KELLER ROAD STE 250 | MAITLAND | FL | 32751 | 593414055 | REAL ESTATE RENTAL | FL | N/A | C | Yes (1) |
| WINTER PARK MEDICAL OFFICE BUILDING I CONDO ASSOC INC | |||||||||
| 601 EAST ROLLINS STREET | ORLANDO | FL | 32803 | 452228478 | CONDO ASSOCIATION | FL | N/A | C | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION | ||
| M | $602,624 | % OF FACILITY'S OPER. EXP. |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION DBA AHS IS | ||
| M | $2,021,904 | % OF FACILITY'S OPER. EXP. |
| TAKOMA REGIONAL HOSPITAL FOUNDATION INC | ||
| B | $54,366 | ACTUAL AMOUNT GIVEN |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION | ||
| C | $100,000 | ACTUAL AMOUNT RECEIVED |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION | ||
| P | $2,590,720 | COST |