2016-11-14T22:02:50-06:00 2015-12-31 990 2015-01-01 593140669 Florida Hospital Waterman Inc FLOR 3522533300 1000 Waterman Way Tavares FL 32778 Lynn C Addiscott Officer/Asst. Secretary 4079751492 2016-11-14 2015 2017-02-10 21:41:12Z David Ottati 1000 Waterman Way Tavares FL 32778 991819842 0 1071 X www.floridahospital.com/waterman X 1992 FL Operate 269-bed acute care hospital 15 8 2103 218 316913 0 769393 182256 228948170 235373640 1994046 -2707926 774237 72737 232485846 232920707 330309 258693 0 0 96286246 103791758 0 0 0 104424143 115283817 201040698 219334268 31445148 13586439 412828364 422348917 126930288 125854761 285898076 296494156 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. 0 0 205920056 258693 235129464 All program services revenues and expenses relate to the operation of a 269-bed acute care hospital in Tavares, Florida. There were 14,859 admissions, 68,750 patient days and 117,881 outpatient visits. 205920056 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 1 1 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 0 0 2103 1 1 1 0 0 0 0 0 0 0 0 0 X 15 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X Frances Crunk 3522533300 1000 Waterman Way Tavares FL 32778 X Bow Pam Director 0.15 0.00 X 0 0 0 Bryce MD Miguel Director/Vice Chief of Staff (Beg 2/15) 4.23 0.00 X 40435 0 0 Carpenter Ken Director (Beg 6/15) 0.27 0.00 X 0 0 0 Comfort Lynda Director 0.49 0.00 X 0 0 0 Gaylord Frank Director 0.15 0.00 X 0 0 0 Goodman Todd A Director (Beg 12/15) 0.00 50.00 X 0 534628 85582 Hepner Thomas C Director 0.35 0.10 X 0 6500 0 Howard Barbara Director 0.31 0.00 X 0 0 0 Marzek MD Peter Director/Secretary/Treasurer 1.71 0.00 X 46488 0 0 Paradis J Brian Director/Chairman (End 12/15) 0.35 50.00 X 0 1279047 205220 Putigna DO Floriano Director/Chief of Staff 0.35 0.00 X 0 0 0 Radnothy DO Jon Director/Past Chief of Staff 1.08 0.00 X 28517 0 0 Tol Daryl L Director/Chairman (Beg 12/15) 0.00 50.00 X 0 831645 125888 Weiss CPA David L Director 0.53 0.00 X 0 0 0 Werner Thomas L Director 0.15 4.00 X 0 49089 0 Ottati David A President/Director 50.00 0.00 X X 0 580845 116180 Crunk Frances CFO/Asst. Secretary 50.00 0.00 X 0 368547 69504 Biri Abel B COO 50.00 0.00 X 0 235755 51633 Edmundson MD Ross B CMO 50.00 0.00 X 0 415328 63889 Pearce Richard E Director Critical Care Svs 40.00 0.00 X 195686 0 23208 Davis Adrienne Chief Medical Physicist 40.00 0.00 X 195282 0 17449 Golab Richard John Director Diagnostic Service 40.00 0.00 X 181605 0 11987 Barnes James R Director Pharmacy 40.00 0.00 X 179765 0 20241 Rathbun Mark B AVP Revenue Cycle 40.00 0.00 X 176762 0 24453 Mattison Kenneth R Former President/Director (End 2013) 0.00 50.00 X 0 577134 83512 Mehindru MD Vinay K Former CMO (End 2014) 0.00 0.00 X 0 198054 6636 Fish Carrie L Former COO (End 2013) 0.00 0.00 X 0 150583 0 1044540 5227155 905382 67 1 1 0 Waterman Anesthesiology Group Inc 291 Southhall Lane Maitland FL 32751 Physician Fees 872153 Florida Hospital Laundry 645 Campus Loop Apopka FL 32703 Services 797165 Sunbelt Staffing LLC PO Box 1024640 Atlanta GA 303684640 Staffing 560618 Philips Healthcare 1450 N Rock Spr Rd Apopka FL 327120000 Service Contracts 554060 Morrison Management Specialist PO BOX 102289 Atlanta GA 303682289 Management Fees - Catering 549556 54 100000 82256 182256 Net patient revenue 622110 231098910 231098910 Cafeteria revenue 622110 1915390 1915390 Medical office building 622110 853151 853151 Daycare revenue 622110 447949 447949 Medical records revenue 622110 356338 356338 701902 384989 316913 235373640 4740701 4740701 751258349 192159 758790332 108803 -7531983 83356 -7448627 -7448627 EHR Revenue 622110 72737 72737 72737 232920707 235129464 316913 -2707926 X 248317 248317 10376 10376 2017120 2017120 75492671 75492671 2142044 2102853 39191 18205915 18168499 37416 5934008 5825546 108462 184803 184803 53947 53947 1242985 1242985 27202189 22043868 5158321 1146294 1146294 6728382 5182907 1545475 8533863 7508019 1025844 3415818 3415818 260840 260840 335177 335177 3713151 3713151 11835480 11835480 1568555 1522295 46260 Medical Supplies 39904753 39904753 Repairs & maintenance 6483851 6483851 State Tax Indigent Asse 2456596 2456596 217133 5056 212077 219334268 205920056 13414212 0 8850 8848 223041853 235445433 31010411 32032377 3790401 3371624 5564141 6104296 263358899 138447810 129493238 124911089 19271157 19556813 332961 157219 315352 761218 412828364 422348917 14258592 12228884 211350 161909 112460346 113463968 126930288 125854761 X 266601253 276916319 19296823 19577837 285898076 296494156 412828364 422348917 X 13586439 -1477362 -1512997 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 9527 0 1 9206 18733 0 Part II-B, Line 1: Line (g): During the year salary expense was incurred for paid staff to attend public meetings and email legistlative officals all relating to the North Lake County Hospital Taxing District in which the hosptial is located. Salary expense of $9,527 was incurred for meetings and emails. Item (i): Dues were paid both to the American Hospital Association and the Florida Hospital Association who use a portion of the dues to conduct lobbying activities. 8622127 8622127 145945241 61737883 84207358 100149679 73401646 26748033 8641852 3308281 5333571 124911089 Payable to third parties 7996781 Credit balances in A/R 1884955 Interco. Alloc. of TE Bond Proceeds 92978701 Due to related 7772573 Leases payable 32500 Other liabilities 2798458 113463968 X Part X, Line 2: The Hospital is part of a consolidated audited financial statement. The consolidated audited financial statement includes the following FIN 48 footnote - The Division follows ASC 740, Income Taxes, which prescribes the accounting for uncertainty in income tax positions recognized in financial statements. ASC 740 prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken, or expected to be taken, in a tax return. There were no material uncertain tax positions as of December 31, 2015. 0 Central America and the Caribbean 0 0 Grantmaking 10376 0 0 0 0 0 0 10376 0 10376 Central America and the Caribbean General Support 10376 Check Book 0 0 0 0 0 0 Part I, Line 2: Foreign grants are generally non-cash donations of medical equipment and supplies to assist foreign health care providers in fulfilling their mission of providing health care services to the populations they serve. The foreign health care providers are often hospitals and/or clinics operated and/or sponsored by or affiliated with the Seventh-Day Adventist Church. The foreign hospitals/clinics may be located in remote and/or underserved villages and townships of developing countries. Grants are typically made to other U.S. charitable organizations or foreign entities recognized as charitable by the foreign country in which they are located. As a result of the nature of the grants as non-cash medical equipment and supplies and the fact that most grants are made indirectly through other U.S. or foreign charitable organizations, the filing organization has not established specific procedures for monitoring the use of grant funds outside the United States. 1 1 1 X 0 1 1 0 1 1 11025958 11025958 0.05030 32211977 22602009 9609968 0.04380 43237935 22602009 20635926 0.09410 376100 376100 0.00170 21796 21796 0.00010 397896 397896 0.00180 43635831 22602009 21033822 0.09590 25158 25158 0.00010 25158 25158 0.00010 1 15240924 1193429 89216491 82702760 6513731 X 1 1 1 1 Florida Hospital Waterman Inc 1000 Waterman Way Tavares FL 32778 www.floridahospital.com/waterman 4409 X X X Florida Hospital Waterman Inc 1 0 0 1 X X X X X X X X 13 1 0 0 1 X See statement X X 1 14 1 See statement 0 0 1 X 200.000000000000 X X X 1 1 X X X X 1 X https://webcdn.ahss.org/internet/policy/fh/en/FAD_fhw_fh-en.pdf X https://webcdn.ahss.org/internet/policy/fh/en/FAD_fhw_fh-en.pdf X https://webcdn.ahss.org/internet/policy/fh/en/FAD_fhw_fh-en.pdf X X X X X 1 X 0 X X X X 1 X 0 0 Florida Hospital Waterman, Inc. Part V, Section B, Line 5: Florida Hospital Waterman, Inc. (the Hospital) took into account input from persons who represent the community in multiple ways during the process of conducting their initial Community Health Needs Assessment (CHNA) in 2013. One of the base sources of data in conducting the CHNA was the 2011 WellFlorida Council, "Lake County Mobilizing For Action Through Planning and Partnerships (MAPP)" Community Health Needs Assessment. Through the MAPP process four focus groups were conducted during August, September and October of 2011. Participates in the focus groups were recruited by advertisements in local shopping centers, heath department, churches, community centers, libraries and word of mouth. The Hospital augmented this data by administering a survey to a diverse group of community members, business professionals, physicians and hospital employees. The survey included the questions presented to the MAPP focus groups and two additional questions. The individuals that participated in the survey representing underserved and minority populations included a representative from the health department, a local law enforcement officer, three representatives from community churches, three representatives from the local community college and its related foundation, a representative from the local school board and the director of Lake Emergency Management Services. Florida Hospital Waterman, Inc. Part V, Section B, Line 7d: The Hospital has adopted a policy that addresses the public posting requirements of the Community Health Needs Assessment. Under this policy, the Community Health Needs Assessment Report must be posted on the Hospital's website by the end of the year in which it is conducted. The Hospital will make a copy of its Community Health Needs Assessment Report available upon request. The Hospital will also make a paper copy of the Community Health Needs Assessment Report available for public inspection at the Hospital facility. Florida Hospital Waterman, Inc. Part V, Section B, Line 11: Florida Hospital Waterman is located in Tavares, Florida, in east central Lake County. 2013 Community Health Needs Assessment data showed that the largest age group in Florida Hospital Waterman's primary service area is ages 65 and older (34.7%). Because its demographic characteristics cross zip code boundaries, the totality of Lake County is also examined. The hospital formed a Community Health Needs Assessment Committee that included representation from the hospital, the board community and public health, as well as low-income, minority and other underserved populations. The Committee reviewed multiple primary and secondary data sources including the 2011 Lake County "Mobilizing Through Action for Planning and Partnership (MAPP)" Community Health Needs Assessment conducted by the Lake County Health Department, and chose its priority areas based on that data. Priority: Access to Care 2013 Description of the Issue: Focusing on all ethnicities and all age groups, this issue was selected because data shows that access to care is limited by affordability for the uninsured and underinsured. Florida did not expand Medicaid, leaving many vulnerable citizens without access to health care. In addition, Lake County lacks enough Medicare and Medicaid providers. Total physicians per 100,000 residents are 55.7% lower in Lake County than the State average, and individuals having a personal doctor are 8.8% lower than the Healthy People 2020 goal. 2015 Update: Florida Hospital Waterman worked to help uninsured community residents and patients find regular sources of health care, and access care at the most appropriate level. The hospital operates a free Family Health Clinic on its campus; the Clinic treats patients whose incomes are less than 130% of poverty. The Clinic provided scheduling assistance and no-cost medical care to 2,400 patients, and transitioned 37% of the ER's low-income patients (with non-acute or chronic health issues) to the Primary Health Clinic for post-discharge follow-up. In addition, patients (from the hospital and/or the Family Health Clinic) who did not have a regular primary care provider were referred to the nearby Leesburg Community Health Center (FQHC). The Community Health Center sees uninsured patients on a sliding fee scale basis; it also accepts Medicaid, Medicare and insurance. The hospital also developed a transitional care program to reduce preventable readmissions for heart attacks, congestive heart failure, and pneumonia. These readmissions dropped by 9% in 2015. Because of the Lake County's physician shortage and its designation is both a HRSA-designated Medically Underserved Area (MUA) and Health Provider Shortage Area (HPSA), the hospital continued to recruit additional primary care providers to the county. Priority: Breast Cancer 2013 Description of the Issue: Focusing on female adults ages 40+ (per ACS guidelines), this condition was selected because data shows breast cancer screenings are lower in Lake County than the Healthy People 2020 goal, and cancer is in the top five causes of death in Lake County. 2015 Update: Florida Hospital Waterman provided 40 free mammograms, and promoted low-cost ($39) screening mammograms to 40% of the service area. In 2015, 4,436 community members enlisted in the Pink Army. The Pink Army initiative enlists cancer survivors, employees and other community members to educate community members on the importance of mammograms and other screenings, increase screening compliance rates, and raise funds for mammograms for low-income women. Funds were also raised through the Pink Out 5K walk and run. The hospital holds regular support groups for Breast Cancer and Gyn Cancer, and co-sponsors "Look Good Feel Better" with the American Cancer Society. It also hosts the "I Have Cancer, Now What?" educational program. There is no charge for these programs. Priority Area: Colon Cancer 2013 Description of the Issue: Focusing on all ethnicities ages 40+, this condition was selected because data shows colorectal screenings in Lake County are lower than the Healthy People 2020 goal, and cancer is in the top five causes of death in Lake County. 2015 Update: With a focus on prevention and early detection, Florida Hospital Waterman set out to increase education on the importance of colon cancer screenings. In 2015, the hospital used paid and earned media to reach 40% of the residents in the hospital's service area with messaging on the importance of screening and early detection of colon cancer. Believing that colon cancer screenings rates were particularly low in Lake County, the hospital had intended to distribute 250 fecal occult blood tests (FOBT) in the community. Further research showed that the current screening compliance rates in the hospital's service area were actually higher than the state average. The hospital is reevaluating this initiative for 2016. Florida Hospital Waterman educated 112 providers on cancer patient navigator services (the goal was 75). Because Lake County is a HRSA-designated Health Provider Shortage Area (HPSA) and Medically Underserved Area (MUA), the hospital recruited a GI physician and mid-level practitioner to the Tavares area. The hospital provides the "I Have Cancer, Now What?" educational program, and hosts a regular Cancer support group. (Non-colon cancer support groups include Cancer Caregivers and Oral, Head and Neck Cancer.) There is no charge for these programs. Priority: Obesity 2013 Description of the Issue: Focusing on all ethnicities and all age groups, this condition was selected because data shows the proportion of obese adults in Lake County is higher than the Healthy People 2020 goal, and there is strong community concern about the impact of obesity on both children and adults. 2015 Update: Florida Hospital Waterman provided 560 BMI (body mass index) screenings to the community in 2015 (the goal was 500). 100% of people whose BMI was greater than 40% were referred to a physician or healthy eating program (the goal was 92%). People without physicians were referred to the Leesburg Community Health Center (FQHC) that sees uninsured patients on a sliding fee scale basis. The hospital also offered a "Biggest Loser" weight-loss challenge for employees and the community. 171 people completed the Biggest Loser; all lost weight and reported an increased understanding of healthy eating skills. A new childhood obesity effort was launched in the summer; the CREATION Health Bible School reached 100 children with health education relating to nutrition and fitness. The CREATION Health wellness and lifestyle message (based on the tenets of choice, rest, environment, activity, trust, interpersonal relationships, outlook and nutrition) was deployed through media outlets to 20% of the service area. The hospital also offered multiple CREATION Health classes and other program at the hospital and in community settings. Two Fit for Life classes, in cooperation with CREATION Health programming, had 31 "completers." Program success was measured by post class surveys on healthy eating skills. Priority: Heart Disease 2013 Description of the Issue: Focusing on all ethnicities ages 18+, this condition was selected because data shows that heart disease is in the top five causes of death in Lake County and among the top 10 causes of death among Black residents. 2015 Update: Florida Hospital Waterman provided 557 cardiac health assessments and screenings (blood pressure and cholesterol). 100% of those with high cholesterol or blood pressure were referred to physicians, the hospital's Family Health Clinic and/or the nearby Leesburg Community Health Center (FQHC) for follow-up care. 158 other people completed on-line education and health assessment. Because this online assessment number was down from 2014, the hospital is modifying this project to one of Early Heart Attack Education; it will align with the standards for the national Chest Pain Center accreditation (by the Society of Chest Pain Centers). The hospital also sponsored blood pressure kiosks at Publix Supermarkets; over 13,000 people were screened and received a follow-up message. The hospital provided the ongoing Mended Hearts support group as well as multiple "Tools to Quit" (smoking) and "Stop Smoking Now" programs for employees and the community. There are no charges for these programs. **see continuation of footnote Florida Hospital Waterman, Inc. 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 2015: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 The hospital facility's CHNA report was made widely available through the following website:https://www.floridahospital.com/sites/default/files/floridahospitalwaterman2013communityhealthneedsassessment.pdf Part V, Section B, Line 10 The hospital facility's most recently adopted implementation strategy was posted on the following website:https://www.floridahospital.com/sites/default/files/waterman_2014-16_community_health_plan.docx Part V, Section B, Line 11 Continuation of Footnote Description of CHNA Significant Needs Continued Priority: Diabetes 2013 Description of the Issue: Focusing on African-American adults ages 40+, this condition was selected because data shows that diabetes is in the top 10 causes of death among Black residents, and the majority of deaths in Lake County are attributable to chronic disease. 2015 Update: Florida Hospital Waterman offered 12 diabetes education courses for 96 adults who were newly diagnosed with diabetes. Scholarships were provided to people without health insurance. The hospital also provided 40 glucose screenings and diabetes education for African American and Hispanic adults in the hospital community. Of those people found to have elevated glucose levels, 95% were referred to private physicians, the hospital's free Family Health Clinic, and/or the Community Health Center FQHC in nearly Leesburg. These same community members were also referred to the hospital's diabetes education program that offered scholarships to low-income people with diabetes. Issues Considered but Not Chosen The six health priorities listed above were the main health issues identified in the Florida Hospital Waterman 2013 Needs Assessment. The hospital chose to address all six. 6 1 - Center for Medical Imaging 1922 Salk Ave B Tavares FL 32778 Diagnostics Center (CMI) 2 - Cancer Institute 4000 Waterman Way Tavares FL 32778 Cancer Center 3 - Florida Hospital Home Infusion 2450 Maitland Ctr Pkwy Suite 200 Maitland FL 32751 Infusion Services 4 - Home Care Services 3260 Waterman Way Tavares FL 32778 Home Care Services 5 - Wound Care Center 3290 Waterman Way Tavares FL 32778 Wound and HBO Services 6 - Community Primary Health Clinic 2300 Kurt St Eustis FL 32726 Non-emergent Health Care Services Part I, Line 6a: The filing organization was a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) during its current tax year. During the current year, AHSSHC served as a parent organization to 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 II, Community Building Activities: The Hospital is committed to improving the health of its community and works with other organizations to reduce the need for healthcare services. The costs of community building activities reported on Part II of Schedule H primarily represent the costs associated with paid staff time and sponsorships related to community events. 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 7. Please note that dollar amounts on the attached consolidated audited financial statements are in thousands. Part III, Line 8: Costing Methodology: Medicare allowable costs were calculated using a cost-to-charge ratio. Part III, Line 9b: Collection Policies:The hospital filing organization's collection practices are in conformity with the requirements set forth in the 2012 Proposed 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 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) that informs the individual that the hospital filing organization may take actions to report adverse information to credit reporting agencies/bureaus if the individual does not submit a Financial Assistance Application Form (FAA Form) or pay the amount due by a specified deadline. The specified deadline is not earlier that 120 days after the first 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 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 deadline which is no earlier than the 240-day period following the date on which the first billing statement was sent to the individual or, if later, 30 days after the written notice is provided. If an individual submits a compete FAA Form within the 240-day period after the first 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. Part III, Section B Reconciliation of Schedule H Reported Medicare Surplus/(Shortfall) to Unreimbursed Medicare Costs Associated with the Provision of ServicesTo All Medicare Beneficiaries:The Medicare revenue and allowable costs of care reported in Section B of Part III of Schedule H are based upon the amounts reported in the filing organization's Medicare cost report in accordance with the IRS instructions for Schedule H. On an annual basis, the filing organization also determines its total unreimbursed costs associated with providing services to all Medicare patients. Unreimbursed costs are reported as a community benefit to the elderly and are included in the consolidated Adventist Health System (AHS or the Company) Community Benefits Report contained in the AHS Annual Report document. The primary reconciling items between the Medicare surplus/(shortfall) shown on line 7 of Section B of Part III of Schedule H and the filing organization's unreimbursed costs of services provided to Medicare patients as reported in the AHS Community Benefit Report are as follows:- Medicare surplus/(shortfall) shown on line 7 of Section B of Schedule H: $ 6,513,731- Difference in costing methodology: (7,341,693)- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (8,470,418) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's community benefit reporting: $ (9,298,380)As indicated above, the primary differences between the Medicare surplus/(shortfall) reported on Schedule H, Part III, Section B, line 7 and the filing organization's portion of the Company's annual community benefit statement is due to a difference in the costing methodology and differences in the population of Medicare patients within the calculation. The cost methodology utilized in calculating any Medicare surplus/(shortfall) for purposes of the annual community benefit reporting is based upon the cost-to-charge ratio outlined in Worksheet 2 of the Schedule H instructions. The same cost-to-charge ratio is used to determine the costs associated with services provided to charity care patients and Medicaid patients as reported in Schedule H, Part I, line 7. In addition, the Medicare cost report excludes services provided to Medicare patients for physician services, services provided to patients enrolled in Medicare HMOs, and certain services provided by outpatient departments of the filing organization that are reimbursed on a fee schedule. The Company's own community benefit statement captures the unreimbursed cost of providing services to all Medicare beneficiaries throughout the organization. Part VI, Line 2: As reported in Schedule H, Part V, Section B, Lines 1-8, the Hospital conducted its initial community health needs assessment (CHNA) during the current year. Its initial CHNA was adopted by its governing board by December 31, 2013, the end of the Hospital's taxable year in which it conducted the CHNA. The Hospital's initial CHNA complied with the guidance set forth by the IRS in Proposed Regulation Section 1.501(r)-3. In addition to the CHNA discussed above, a variety of practices and processes are in place to ensure that the filing organization is responsive to the health needs of its community.Such practices and processes involve the following:1. A hospital operating/community board composed of individuals broadly representative of the community, community leaders, and those with specialized medical training and expertise;2. Post-discharge patient follow-up related to the on-going care and treatment of patients who suffer from chronic diseases; 3. Sponsorship and participation in community health and wellness activities that reach a broad spectrum of the filing organization's community; and 4. Collaboration with other local community groups to address the health care needs of the filing organization's community. Part VI, Line 3: The Financial Assistance Policy (FAP) 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 copy of the hospital facility's PLS and FAA Form is distributed to every individual before discharge from the hospital facility. Additionally, a copy of the PLS is included with at least three billing statements that are sent to the individual during the 120-day period after the first billing statement is sent. Individuals are informed about the hospital facility's FAP in all oral communications regarding the amount due for the individual's care. Part VI, Line 4: Florida Hospital Waterman is Lake County's leading provider of acute services with more than 12,000 annual admissions and 64,000 emergency department visits. It is Lake County's only A-rated hospital for safety by the Leapfrog group, and the only hospital in the region to have an accredited Chest Pain Center by the Society of Cardiovascular Patient Care and Joint Commission Accredited Joint Replacement Center. In addition to inpatient, surgical and emergency services, Florida Hospital Waterman is a leading provider of home care services, imaging services including a free-standing outpatient diagnostic center, and full-service rehabilitation care. Part of the Florida Hospital network, The Florida Hospital Waterman Cancer Institute, Center for Women and Children and Florida Hospital Heart Institute provide patients with access to some of the state's leading specialists, clinical trials and advanced care. The hospital is located in scenic Lake County in central Florida, and primarily serves the Golden Triangle communities of Eustis, Mount Dora and Tavares. The hospital's primary service area includes portions of Leesburg and stretches into north west Orange County. It includes the following zip codes: 32726, 32736, 32757, 32776, 32778, 32784, 34748, 34788. Tavares, Florida is located in Lake County. Florida Hospital Waterman's primary service area has a population of approximately 148,618, with an estimated 41,790 over the age of 65. The per capita income in the Lake County is approximately $24,186. High school graduates account for approximately 86% of the primary service area. It is estimated that 15% of the individuals residing in primary service area live below 100% of the Federal Poverty Level and the unemployment rate is about 6.3. Uninsured in Lake County is approximately 25%.Approximately 57.8% of the Hospital's patients during 2015 were Medicare patients, about 14.2% were Medicaid patients, about 6.3% were self-pay patients, and the remaining percentage were patients covered under commercial insurance. In 2015, about 87% of the hospital's in-patients were admitted through the hospital's Emergency Department. Part VI, Line 5: The provision of community benefit is central to the filing organization's mission of service and compassion. Restoring and promoting the health and quality of life of those in the communities served by the filing organization is a function of "extending the healing ministry of Christ and embodies the fiing organization's commitment to its values and principles. The filing organization commits substantial resources to provide a broad range of services to both the underprivileged as well as the broader community. In addition to the community benefit 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 filing organization provided $451,770 of benefit with respect to the faith-based and spiritual needs of the community in conjunction with its operation of a community hospital. The filing organization also provides benefits to its community's infrastructure by investing in capital improvements to ensure that facilities and technology provide the best possible care to the community. During the current year, the filing organization expended $7,253,331 in new capital improvements. As a faith-based mission-driven community hospital, the filing organization is continually involved in monitoring its community, identifying unmet health care needs and developing solutions and programs to address those needs. In accordance with its conservative approach to fiscal responsibility, surplus funds of the Hospital are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its community. Part VI, Line 6: The filing organization is a part of a faith-based healthcare system of organizations whose parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). The system is known as Adventist Health System (AHS). AHSSHC is an organization exempt from federal income tax under IRC Section 501(c)(3). AHSSHC and its subsidiary organizations operate 44 hospitals in 10 states throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC and its subsidiaries also operate 16 nursing home facilities and other ancillary health care provider facilities, such as ambulatory surgery centers and diagnostic imaging centers. As the parent organization of the AHS system, AHSSHC provides executive leadership and other professional support services to its subsidiary organizations. Professional support services include among others corporate compliance, legal, human resources, reimbursement, risk management, and tax as well as treasury functions. The provision of these executive and support services on a centralized basis by AHSSHC provides an appropriate balance between providing each AHS subsidiary hospital organization with mission-driven consistent leadership and support while allowing the hospital organization to focus its resources on meeting the specific health care needs of the community it serves. The reader of this Form 990 should keep in mind that this reporting entity may differ in certain areas from that of a stand-alone hospital organization due to its inclusion in a larger system of healthcare organizations. As a part of a system of hospital and other healthcare 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. 0 Florida Hospital Waterman Foundation 1500 Waterman Way Tavares FL 32778 592330166 501(c)(3) 164960 18357 Book Provision of general administrative support General Support Gateway Christian School 18440 US Highway 441 Mt Dora FL 32757 590806975 501(c)(3) 15000 General Support Lake-Sumter Community College 9501 US Hwy 441 Leesburg FL 34788 581990323 501(c)(3) 50000 General Support 3 0 Part I, Line 2: Grants are generally made only to related organizations that are exempt from federal income tax under IRC Section 501(c)(3), or to other local charitable community organizations, or to other 501(c)(3) organizations that are a part of the group exemption ruling issued to the General Conference of Seventh-Day Adventists. Accordingly, the filing organization has not established specific procedures for monitoring the use of grant funds in the United States as the filing organization does not have a grant making program that would necessitate such procedures. X X X X 1 1 0 1 0 0 0 0 0 0 0 Goodman Todd A Director (Beg 12/15) 0 395080 0 80863 0 58685 0 44227 0 41355 0 620210 0 21427 Paradis J Brian Director/Chairman (End 12/15) 0 712000 0 211181 0 355866 0 150022 0 55198 0 1484267 0 119345 Tol Daryl L Director/Chairman (Beg 12/15) 0 553084 0 158970 0 119591 0 84034 0 41854 0 957533 0 68547 Ottati David A President/Director 0 405112 0 87292 0 88441 0 64761 0 51419 0 697025 0 37856 Crunk Frances CFO/Asst. Secretary 0 268838 0 45497 0 54212 0 40645 0 28859 0 438051 0 22441 Biri Abel B COO 0 201087 0 25521 0 9147 0 12521 0 39112 0 287388 0 0 Edmundson MD Ross B CMO 0 315808 0 39193 0 60327 0 34314 0 29575 0 479217 0 12413 Pearce Richard E Director Critical Care Svs 148373 0 31755 0 15558 0 9721 0 13487 0 218894 0 0 0 Davis Adrienne Chief Medical Physicist 188501 0 2623 0 4158 0 15586 0 1863 0 212731 0 0 0 Golab Richard John Director Diagnostic Service 148908 0 17992 0 14705 0 0 0 11987 0 193592 0 0 0 Barnes James R Director Pharmacy 156666 0 13201 0 9898 0 8960 0 11281 0 200006 0 0 0 Rathbun Mark B AVP Revenue Cycle 148520 0 19975 0 8267 0 8966 0 15487 0 201215 0 0 0 Mattison Kenneth R Former President/Director (End 2013) 0 386494 0 96199 0 94441 0 51934 0 31578 0 660646 0 35213 Mehindru MD Vinay K Former CMO (End 2014) 0 0 0 47974 0 150080 0 0 0 6636 0 204690 0 67547 Fish Carrie L Former COO (End 2013) 0 0 0 0 0 150583 0 0 0 0 0 150583 0 99799 Part I, Line 1a The filing organization is a part of the system of healthcare organizations known as Adventist Health System (AHS). Members of the filing organization's executive management team that hold the position of Vice-President or above are compensated by and on the payroll of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), the parent organization of AHS. AHSSHC is exempt from federal income tax under IRC Section 501(c)(3). The filing organization reimburses AHSSHC for the salary and benefit cost of those executives on the payroll of AHSSHC that provide services and are on the management team of the filing organization. Travel for companions: AHSSHC has a Corporate Executive Policy that provides a benefit to allow for a traveling AHSSHC executive to have his or her spouse accompany the executive on certain business trips each year. Typically, reimbursement is only provided to Vice Presidents and above and is usually limited to one business trip per year beyond the annual AHS President's Council business meeting and other meetings where the spouse is specifically invited. The AHSSHC Corporate Executive Spousal Travel Policy was originally approved and reviewed by the AHSSHC Board Compensation Committee, an independent body of the AHSSHC Board of Directors. All spousal travel costs reimbursed to the executive are considered taxable compensation to the executive. Tax Indemnification and gross-up payments: AHS has a system-wide policy addressing gross-up payments provided in connection with employer-provided benefits/other taxable items. Under the policy, certain taxable business-related reimbursements (i.e. taxable business-related moving expenses, taxable items provided in connection with employment) provided to any employee may be grossed-up at a 25% rate upon approval of the filing organization's CEO and CFO. Additionally, employees at the Director level and above are eligible for gross-up payments on gifts received for board of director services. Discretionary spending account: A nominal discretionary spending amount was provided in the current year to all eligible executives who attend the annual AHS President's Council business meeting ($500 per executive) or the annual AHS CFO Conference or CMO/CNO business meeting ($300 per executive). Other discretionary spending accounts may be provided in connection with other AHS sponsored conferences but typically do not exceed $200 per participant. With respect to the AHS President's Council meeting, eligible executives may include AHSSHC Vice Presidents and above and all AHSSHC subsidiary organization CEOs and Regional CFOs. The payment provided to each executive was considered taxable compensation to the executive. Housing allowance or residence for personal use: AHSSHC has a Corporate Executive Policy that addresses assistance to executives who have been relocated by the company during the year. Relocation assistance provided to executives may include relocation allowances to assist with duplicate housing expenses. Relocation assistance is administered per AHSSHC policy by an external relocation company. Any taxable reimbursements made to executives in connection with relocation assistance are treated as wages to the executive and are subject to all payroll withholding and reporting requirements. 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 ------------------------------------------------------- Goodman, Todd A. $ 47,839 $ 24,300 $ 0 $ 0 Paradis, J. Brian $135,635 $ 119,417 $151,808 $ 0 Tol, Daryl L. $ 87,647 $ 72,079 $ 0 $ 0 Ottati, David A. $ 50,373 $ 44,912 $ 0 $ 0 Crunk, Frances $ 26,257 $ 26,605 $ 0 $ 0 Edmundson, MD, Ross B. $ 37,927 $ 13,759 $ 0 $ 0 Mehindru, MD, Vinay K. $ 0 $ 79,771 $ 0 $ 70,344 Mattison, Kenneth R.$ 55,546 $ 41,185 $ 6,802 $ 0 Fish, Carrie L. $ 0 $ 150,583 $ 0 $ 150,583 * Including Investment Earnings X 203 Cost X Supplies 7 0 Cost 0 1 0 Form 990, Part VI, Section A, line 2 David L. Weiss, CPA and Thomas C. Hepner - Business Relationship Form 990, Part VI, Section A, line 6 Florida Hospital Waterman, Inc. (the filing organization) has one member. The sole member of the filing organization is Adventist Health System Sunbelt Healthcare Corporation. Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). There are no other classes of membership in the filing organization. Form 990, Part VI, Section A, line 7a The sole member of the filing organization is AHSSHC. The Board of Directors of the filing organization are appointed by the sole member, AHSSHC, who has the right to elect, appoint or remove any member of the Board of Directors of the filing organization. Form 990, Part VI, Section A, line 7b AHSSHC, as the sole member of the filing organization, has certain reserved powers as set forth in the Bylaws of the filing organization. These reserved powers include the following: a) to approve and disapprove the executive and/or administrative leadership of the filing organization, and their salaries; b) to 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; and h) to approve the appointment of an auditing firm and election of the fiscal year for the filing organization. Form 990, Part VI, Section B, line 11 The filing organization's current year Form 990 was reviewed by the Board Chairman, Board Finance Committee Chair, CEO and by the CFO prior to its filing with the IRS. The review conducted by the Board Chairman, Board Finance Committee Chair, CEO and the CFO did not include the review of any supporting workpapers that were used in preparation of the current year Form 990, but did include a review of the entire Form 990 and all supporting schedules. Form 990, Part VI, Section B, line 12c The Conflict of Interest Policy of the filing organization applies to members of its Board of Directors and its principal officers (to be known as Interested Persons). In connection with any actual or possible conflict of interests, any member of the Board of Directors of the filing organization or any principal officer of the filing organization (i.e. Interested Persons) must disclose the existence of any financial interest with the filing organization and must be given the opportunity to disclose all material facts concerning the financial interest/arrangement to the Board of Directors of the filing organization or to any members of a committee with board delegated powers that is considering the proposed transaction or arrangement. Subsequent to any disclosure of any financial interest/arrangement and all material facts, and after any discussion with the relevant Board member or principal officer, the remaining members of the Board of Directors or committee with board delegated powers shall discuss, analyze, and vote upon the potential financial interest/arrangement to determine if a conflict of interest exists. According to the filing organization's Conflict of Interest Policy, an Interested Person may make a presentation to the Board of Directors (or committee with board delegated powers), but after such presentation, shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that results in a conflict of interest. Each Interested Person, as defined under the filing organization's Conflict of Interest Policy, shall annually sign a statement which affirms that such person has received a copy of the Conflict of Interests policy, has read and understands the policy, has agreed to comply with the policy, and understands that the filing organization is a charitable organization that must primarily engage in activities which accomplish one or more of its exempt purposes. The filing organization's Conflict of Interest Policy also requires that periodic reviews shall be conducted to ensure that the filing organization operates in a manner consistent with its charitable purposes. Form 990, Part VI, Section B, line 15 The filing organization's CEO, other officers and key employees are not compensated by the filing organization. Such individuals are compensated by the related top-tier parent organization of the filing organization. Please see the discussion concerning the process followed by the related top-tier parent organization in determining executive compensation in our response to Schedule J, Line 3. Form 990, Part VI, Section C, line 19 The filing organization is a part of the system of healthcare organizations known as Adventist Health System (AHS). 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. Part VII, Section A For those Board of Director members (not including physician members of the board), officer(s) and key employees who devote less than full-time to the filing organization (based upon the average number of hours per week shown in column (B) on page 7 of the return) the compensation amounts shown in columns (E) and (F) on page 7 were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position within Adventist Health System. Physician members of the Board of Directors received compensation from related organizations as a result of providing various medical services to those related entities. During the year ending December 31, 2014, Peter Marzek, MD's reported compensation includes call coverage for services provided to the Hospital. Form 990, Part IX, line 11g Payments to Healthcare Professional: Program service expenses 8,659,967. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,659,967. Professional Fees : Program service expenses 1,979,767. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,979,767. Purchased Medical Services : Program service expenses 1,353,673. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,353,673. Environmental Services : Program service expenses 1,902,150. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,902,150. Transcription Services : Program service expenses 192,267. Management and general expenses 0. Fundraising expenses 0. Total expenses 192,267. Recruiting : Program service expenses 4,961,451. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,961,451. Food Service Contracts : Program service expenses 592,720. Management and general expenses 0. Fundraising expenses 0. Total expenses 592,720. Miscellaneous Purchased Services : Program service expenses 2,401,873. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,401,873. AHS Management Fees : Program service expenses 0. Management and general expenses 4,929,253. Fundraising expenses 0. Total expenses 4,929,253. Billing & Collection Services : Program service expenses 0. Management and general expenses 228,595. Fundraising expenses 0. Total expenses 228,595. EHR Management Fees : Program service expenses 0. Management and general expenses 473. Fundraising expenses 0. Total expenses 473. Form 990, Part XI, line 9: Transfers to parent -1,709,958. Allocations from tax-exempt parent -84,053. Change in interest in Foundation 281,014. Part V, Line 1a-1b The parent corporation and sole member of Florida Hospital Waterman, Inc. (the Hospital) is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). AHSSHC has established a shared service center to centralize the Accounts Payable (A/P), Payroll, HR, and Materials Management functions for all AHSSHC subsidiary organizations. The facts and circumstances support a position that AHSSHC, as a payor on behalf of its subsidiary organizations in a shared service environment, will have sufficient management and oversight in connection with the subsidiary organizations' payments to meet the standard set forth in Treas. Reg. Section 1.6041-1(e). AHSSHC will not merely be making payments at the direction of its subsidiary organizations. Accordingly, AHSSHC is considered the payor subject to the information reporting requirements of Section 6041. The Hospital has entered "0" in Part V, Line 1a because in 2015 the Hospital's Account Payable function was transferred to the AHSSHC shared service center. As a result of this transition, the Hospital no longer issues Form 1099 returns, rather, all such returns are filed by and under the name and EIN of AHSSHC as the payor subject to the information reporting requirements of Section 6041. Part X, Line 2 The amounts shown on line 2 of Part X of this return include the filing organization's interest in a central investment pool maintained by Adventist Health System Sunbelt Healthcare Corporation, the filing organization's top-tier parent. The investments in the central investment pool are recorded at market value. Adventist Bolingbrook Hospital 500 Remington Blvd Bolingbrook IL 60440 651219504 Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 Adventist Care Centers - Courtland Inc 730 Courtland Street Orlando FL 32804 205774723 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc 1 Adventist GlenOaks Hospital 701 Winthrop Avenue Glendale Heights IL 60139 363208390 Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 Adventist Hlth Mid-America Inc 9100 W 74th Street Shawnee Mission KS 66204 521347407 Support of Affiliated Hospital KS 501(c)(3) Line 11c, III-FI Adventist Hlth SystemSunbelt Inc 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 1 Adventist Hlth System Sunbelt Hlthcare Corp 900 Hope Way Altamonte Springs FL 32714 592170012 Management Services FL 501(c)(3) Line 11a, I N/A 0 Adventist Hlth System Georgia Inc 1035 Red Bud Road Calhoun GA 30701 581425000 Operation of Hospital & Related Services GA 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Adventist Hlth SystemSunbelt Inc 900 Hope Way Altamonte Springs FL 32714 591479658 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Adventist Hlth SystemTexas Inc 11801 S Freeway Burleson TX 36028 742578952 Leasing Personnel to Affiliated Hospital TX 501(c)(3) Line 11c, III-FI Adventist Hlth System Sunbelt Hlthcare Corp 1 Adventist Midwest Health 120 North Oak Street Hinsdale IL 60521 362276984 Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Adventist University of Health Sciences Inc (630 Year End) 671 Lake Winyah Drive Orlando FL 32803 593069793 Education/Operation of School FL 501(c)(3) Line 2 Adventist Hlth SystemSunbelt Inc 1 AHP Specialty Care NFP (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 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 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 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 1 Battle Creek Adventist Hospital 1000 Remington Blvd Ste 200 Bolingbrook IL 60440 381359189 Inactive MI 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Bolingbrook Hospital Foundation 1000 Remington Blvd N Entrance 2nd Bolingbrook IL 60440 900494445 Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation 0 Bradford Heights Hlth & Rehab Center Inc 950 Highpoint Drive Hopkinsville KY 42240 205782342 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc 1 Burleson Nursing & Rehab Center Inc 301 Huguley Blvd Burleson TX 76028 205782243 Operation of Home for the Aged/Hlthcare Delivery TX 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc 1 Caldwell Hlth Care Properties Inc 1333 West Main Princeton KY 42445 510605680 Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc 1 Central Texas Hlthcare Collaborative 1301 Wonder World Drive San Marcos TX 78666 453739929 Support Operation of Hospital TX 501(c)(3) Line 11a, I Adventist Hlth SystemSunbelt Inc 1 Chickasaw Hlth Care Properties Inc 250 S Chickasaw Trail Orlando FL 32825 510605681 Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc 1 Chippewa Valley Hospital & Oakview Care Center Inc 1220 Third Avenue West Durand WI 54736 391365168 Operation of Hospital & Related Services WI 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Cobb Medical Associates LLC (11-122315) 900 Hope Way Altamonte Springs FL 32714 582617089 Inactive GA 501(c)(3) Line 3 Emory-Adventist Inc 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 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 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 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 1 Emory-Adventist Inc 900 Hope Way Altamonte Springs FL 32714 582171011 Inactive GA 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Fletcher Hospital Inc 100 Hospital Drive Hendersonville NC 28792 560543246 Operation of Hospital & Related Svcs NC 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 FLNC Inc 3355 E Semoran Blvd Apopka FL 32703 205774761 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc 1 FLORIDA HOSPITAL HEALTHCARE PARTNERS INC 770 West Granada Blvd 101 Ormond Beach FL 32174 462354804 Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Florida Hospital Medical Group Inc 2600 Westhall Ln Maitland FL 32751 593214635 Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Florida Hospital Physician Group Inc 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 1 Florida Hospital Waterman Inc 1000 Waterman Way Tavares FL 32778 593140669 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Florida Hospital Zephyrhills Inc 7050 Gall Blvd Zephyrhills FL 33541 592108057 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Foundation for Shawnee Mission Medical Center Inc 9100 W 74th Street Shawnee Mission KS 66204 480868859 Fund-raising for Tax-exempt hospital KS 501(c)(3) Line 11a, I Shawnee Mission Medical Center Inc 1 Fountain Inn Nursing & Rehab Center Inc 485 North Keller Road 250 Maitland FL 32751 472180518 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc 1 GlenOaks Hospital Foundation 701 Winthrop Avenue Glendale Heights IL 60139 363926044 Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation 0 Helen Ellis Memorial Hospital Auxiliary Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 592106043 Fund-raising for Tax-exempt hospital/foundation FL 501(c)(3) Line 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 1 Hospice of the Comforter Foundation Inc 480 W Central Parkway Altamonte Springs FL 32714 271858033 Fund Raising for Affiliated Tax-Exempt Hospice FL 501(c)(3) Line 7 The Comforter Health Care Group Inc 1 In-Motion Rehab Inc 485 North Keller Road 250 Maitland FL 32751 208023411 Therapy services to tax exempt nursing homes KS 501(c)(3) Line 11b, II Sunbelt Hlth Care Centers Inc 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 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 1 Memorial Hospital - West Volusia Inc 701 West Plymouth Avenue Deland FL 32720 593256803 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Memorial Hlth Systems Inc 1 Memorial Hospital Flagler Inc 60 Memorial Medical Parkway Palm Coast FL 32164 592951990 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Memorial Hlth Systems Inc 1 Memorial Hospital Inc 210 Marie Langdon Drive Manchester KY 40962 610594620 Operation of Hospital & Related Services KY 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Merriam Hlth Care Properties Inc 9700 West 62nd Street Merriam KS 66203 364595806 Lease to Related Organization KS 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc 1 Metroplex Adventist Hospital Inc 2201 S Clear Creek Road Killeen TX 76549 742225672 Operation of Hospital & Related Services TX 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Metroplex Clinic Physicians Inc 2201 S Clear Creek Road Killeen TX 76549 113762050 Physician Hlthcare services to the community TX 501(c)(3) Line 3 Metroplex Adventist Hospital Inc 1 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 1 Midwest Hlth Foundation 120 North Oak Street Hinsdale IL 60521 352230515 Support of subsidiary Foundations IL 501(c)(3) Line 11b, II N/A 0 Mills Hlth & Rehab Center Inc 500 Beck Lane Mayfield KY 42066 205782320 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc 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 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 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 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 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 1 Pasco-Pinellas Hillsborough Community Hlth System Inc 2600 Bruce B Downs Blvd Wesley Chapel FL 33544 208488713 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Portercare Adventist Hlth System (630 Year End) 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 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 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 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 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 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 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 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 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 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 1 Shawnee Mission Medical Center Inc 9100 W 74th Street Shawnee Mission KS 66204 480637331 Operation of Hospital & Related Services KS 501(c)(3) Line 3 Adventist Hlth Mid-America Inc 1 South Central Inc 900 Hope Way Altamonte Springs FL 32714 593689740 Management Support GA 501(c)(3) Line 11c, III-FI N/A 0 South Pasco Hlth Care Properties Inc 38250 A Avenue Zephyrhills FL 33542 510605679 Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc 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 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 1 Southwest Volusia Hlthcare Corp 1055 Saxon Blvd Orange City FL 32763 593149293 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Specialty Physicians of Central Texas Inc 1301 Wonder World Drive San Marcos TX 78666 208814408 Physician Hlthcare services to the community TX 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Spring View Hlth & Rehab Center Inc 718 Goodwin Lane Leitchfield KY 42754 205782288 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc 1 Sunbelt Hlth & Rehab Center - Apopka Inc 305 East Oak Street Apopka FL 32703 205774856 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc 1 Sunbelt Hlth Care Centers Inc 485 North Keller Road 250 Maitland FL 32751 581473135 Management Services TN 501(c)(3) Line 11b, II Adventist Hlth System Sunbelt Hlthcare Corp 1 SunSystem Development Corp 900 Hope Way Altamonte Springs FL 32714 592219301 Fund Raising for Affiliated Tax-Exempt Hospitals FL 501(c)(3) Line 7 Adventist Hlth System Sunbelt Hlthcare Corp 1 Takoma Regional Hospital Inc (630 Year End) 401 Takoma Ave Greeneville TN 37743 510603966 Operation of Hospital & Related Services TN 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 TAKOMA REGIONAL HOSPITAL Foundation INC 401 Takoma Ave Greeneville TN 37743 471334302 Fund Raising for Affiliated Tax-Exempt Hospital TN 501(c)(3) Line 7 Takoma Regional Hospital Inc 1 Tarpon Springs Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 590898901 Operation of Hospital & Related Services FL 501(c)(3) Line 3 University Community Hospital Inc 1 Tarrant County Hlth Care Properties Inc 301 Huguley Blvd Burleson TX 76028 510605677 Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc 1 Taylor Creek Hlth Care Properties Inc 718 Goodwin Lane Leitchfield KY 42754 510605678 Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc 1 The Comforter Health Care Group Inc 605 Montgomery Road Altamonte Springs FL 32714 271857940 Lease to Related Organization FL 501(c)(3) Line 11c, III-FI Adventist Hlth System Sunbelt Hlthcare Corp 1 The Volunteer Auxiliary of Florida Hospital - Flagler Inc 60 Memorial Medical Parkway Palm Coast FL 32164 592486582 Volunteer support services FL 501(c)(3) Line 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 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 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 1 University Community Hospital Inc 3100 E Fletcher Ave Tampa FL 33613 591113901 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 West Kentucky Hlth Care Properties Inc 500 Beck Lane Mayfield KY 42066 510605676 Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc 1 Zephyr Haven Hlth & Rehab Center Inc 38250 A Avenue Zephyrhills FL 33542 205774930 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc 1 Zephyrhills Hlth & Rehab Center Inc 7350 Dairy Road Zephyrhills FL 33540 205774967 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc 1 Clear Creek MOB Ltd 2201 S Clear Creek Rd Killeen TX 76549 742609195 Real Estate TX N/A Endoscopy Center at Porter LLC 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 Princeton Prof ServsFH Waterman Related 24957 160385 0 1 0.04900 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 Altamonte Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 592855792 Condo Association FL N/A C 0 Apopka Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 593000857 Condo Association FL N/A C 0 CC MOB Inc 2201 S Clear Creek Road Killeen TX 76549 742616875 Real Estate Rental TX N/A C 0 Central Texas Medical Associates 1301 Wonder World Drive San Marcos TX 78666 742729873 Inactive TX N/A C 0 Central Texas Provider's Network 1301 Wonder World Drive San Marcos TX 78666 742827652 Physician Hospital Org. TX N/A C 0 Florida Hospital Flagler Medical Offices Association Inc 60 Memorial Medical Parkway Palm Coast FL 32164 262158309 Condo Association FL N/A C 0 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 0 Florida Hospital Healthcare System Inc 602 Courtland Street Orlando FL 32804 593215680 PHSO FL N/A C 0 Florida Medical Plaza Condo Association Inc 601 East Rollins Street Orlando FL 32803 592855791 Condo Association FL N/A C 0 Florida Memorial Health Network Inc 770 W Granada Blvd Ste 317 Ormond Beach FL 32174 593403558 Physician Hospital Org. FL N/A C 0 Kissimmee Multispecialty Clinic Condominium Association Inc 201 Hilda Street Suite 30 Kissimmee FL 34741 593539564 Condo Association FL N/A C 0 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 0 Midwest Management Services Inc 9100 West 74th Street Shawnee Mission KS 66204 480901551 Inactive KS N/A C 0 North American Health Services Inc & Sub 900 Hope Way Altamonte Springs FL 32714 621041820 Lessor/Holding Co. TN N/A C 0 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 0 Park Ridge Property Owner's Association Inc 1 Park Place Naples Road Fletcher NC 28732 030380531 Condo Association NC N/A C 0 PORTER AFF HLTH SVCS INC DBA DIVERSIFIED AFF HLTH SVCS 2525 S Downing Street Denver CO 80210 840956175 Healthcare Services CO N/A C 0 San Marcos Regional MRI Inc 1301 Wonder World Drive San Marcos TX 78666 770597968 Holding Company TX N/A C 0 The Garden Retirement Community Inc 485 North Keller Road Ste 250 Maitland FL 32751 593414055 Real Estate Rental FL N/A C 0 Winter Park Medical Office Building I Condo Assoc Inc 601 East Rollins Street Orlando FL 32803 452228478 Condo Association FL N/A C 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 Adventist Health System Sunbelt Healthcare Corporation B 1709958 Amount Given Adventist Health System Sunbelt Healthcare Corporation C 100000 Amount Received Adventist Health System Sunbelt Healthcare Corporation M 2195408 % of Facility's Oper. Exp. Adventist Health System Sunbelt Healthcare Corp - Shared Svcs M 1901220 % of Facility's Oper. Exp. Adventist Health System Sunbelt Healthcare Corp dba AHSIS M 7772417 % of Facility's Oper. Exp. Adventist Health System Sunbelt Healthcare Corporation P 7300776 Cost Adventist Health SystemSunbelt Inc dba Florida Hospital M 1035895 Cost Plus Appropriate Margin Adventist Health SystemSunbelt Inc dba Florida Hospital P 186382 Cost Adventist Health SystemSunbelt Inc dba Florida Hospital Centra Care M 50892 Cost Plus Appropriate Margin Florida Hospital Medical Group Inc A 411750 FMV Rent Florida Hospital Medical Group Inc M 128925 Cost Plus Appropriate Margin Florida Hospital Medical Group Inc R 4184911 Cost