TARPON SPRINGS HOSPITAL FOUNDATION INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- TARPON SPRINGS HOSPITAL FOUNDATION INC (EIN 59-0898901)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-11
- IRS object ID
- 201633169349302233
- Schema version
- 2015v2.1
- 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 H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-11T11:11:30-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 590898901 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tarpon Springs Hospital Foundation Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TARP | BusinessNameControlTxt |
| Phone | 7279425006 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1395 South Pinellas Avenue | AddressLine1Txt |
| City | Tarpon Springs | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 346893790 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Tricia Williams | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7279425006 | PhoneNum |
| Signature | 2016-10-27 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Florida Hospital North Pinellas | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Tricia Williams | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1395 South Pinellas Avenue | AddressLine1Txt |
| City | Tarpon Springs | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 346893790 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $118,866,080 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.floridahospital.com/north-pinellas | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1970 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | The provision of medical care to the community through the operation of one general acute care hospital with a total of 168 beds. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 751 | TotalEmployeeCnt |
| Total Volunteers | 223 | TotalVolunteersCnt |
| Total Gross UBI | $19,260 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$16,329 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $44,327 | PYContributionsGrantsAmt |
| CY Contributions Grants | $85,085 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $89,781,757 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $97,516,917 | CYProgramServiceRevenueAmt |
| PY Investment Income | $133,966 | PYInvestmentIncomeAmt |
| CY Investment Income | -$76,549 | CYInvestmentIncomeAmt |
| PY Other Revenue | $846,884 | PYOtherRevenueAmt |
| CY Other Revenue | $531,419 | CYOtherRevenueAmt |
| PY Total Revenue | $90,806,934 | PYTotalRevenueAmt |
| CY Total Revenue | $98,056,872 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $489,750 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $38,779,399 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $39,599,379 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $50,039,900 | PYOtherExpensesAmt |
| CY Other Expenses | $53,512,784 | CYOtherExpensesAmt |
| PY Total Expenses | $88,819,299 | PYTotalExpensesAmt |
| CY Total Expenses | $93,601,913 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,987,635 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,454,959 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $48,195,550 | TotalAssetsBOYAmt |
| Total Assets EOY | $51,388,258 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $31,095,390 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $26,226,782 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,100,160 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $25,161,476 | 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 | $86,465,702 | ExpenseAmt |
| Grant | $489,750 | GrantAmt |
| Revenue | $98,029,076 | RevenueAmt |
| Desc | Operation of acute care hospital totaling 168 beds with 5,248 patient admissions resulting in 25,987 patient days in the current year, and 34,207 outpatient visits. | Desc |
| Total Program Service Expenses | $86,465,702 | 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 | Yes (1) | 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 | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | 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 | Yes (1) | 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 | 0 | 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 | 144 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 751 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Steven Miller CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7279425107 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1395 S Pinellas Ave | AddressLine1Txt |
| City | Tarpon Springs | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 34689 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 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 |
|---|---|---|---|---|---|---|---|---|---|
| Brian Adams | |||||||||
| Director | 0.50 | 50.00 | Yes (X) | $0 | $552,452 | $115,015 | |||
| Paul Arnold MD | |||||||||
| Director/CMO | 1.50 | 0.00 | Yes (X) | $8,061 | $0 | $0 | |||
| Bruce Bergherm | |||||||||
| Director/CEO | 50.00 | 0.00 | Yes (X) | $0 | $435,195 | $71,764 | Yes (X) | ||
| Jack Butcher | |||||||||
| Secretary | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Thomas Carson MD | |||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Joe Johnson | |||||||||
| Director | 0.50 | 50.00 | Yes (X) | $0 | $436,556 | $69,359 | |||
| N Michael Kouskoutis | |||||||||
| Vice Chairman | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Mark Schiefer | |||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Michael Schultz | |||||||||
| Chairman | 0.50 | 50.00 | Yes (X) | $0 | $1,600,510 | $176,827 | |||
| Roger Sellew | |||||||||
| Treasurer | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Michael Mewhirter | |||||||||
| CFO (end 3/15) | 50.00 | 0.00 | $0 | $110,247 | $12,282 | Yes (X) | |||
| Steve Miller | |||||||||
| CFO (beg 7/15) | 25.00 | 25.00 | $0 | $318,371 | $64,068 | Yes (X) | |||
| Karen Owensby | |||||||||
| CNO/COO | 50.00 | 0.00 | $0 | $264,247 | $26,751 | Yes (X) | |||
| Louis Astra MD | |||||||||
| Physician | 40.60 | 0.00 | $579,168 | $0 | $40,689 | Yes (X) | |||
| Rajesh Kotak MD | |||||||||
| Physician | 40.00 | 0.00 | $261,710 | $0 | $33,122 | Yes (X) | |||
| Jose Torres MD | |||||||||
| Physician | 40.00 | 0.00 | $254,017 | $0 | $9,087 | Yes (X) | |||
| Angelo Cappiello MD | |||||||||
| Physician | 40.30 | 0.00 | $250,986 | $0 | $41,587 | Yes (X) | |||
| Glenn Lura MD | |||||||||
| Physician | 40.00 | 0.00 | $191,285 | $0 | $26,813 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,545,227 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,717,578 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $687,364 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 26 | 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 |
|---|---|---|---|---|---|
| Morrison Management Specialists Inc | |||||
| PO Box 102289 | Atlanta | GA | 30368 | Food Service Mgmt & Operations | $1,791,312 |
| PT Solutions | |||||
| PO Box 242278 | Montgomery | AL | 36124 | Therapy Services | $1,642,001 |
| Crothall Healthcare Inc | |||||
| 1500 Liberty Ridge Dr 210 | Wayne | PA | 19087 | Environmental Services | $1,172,767 |
| Wound Healing Institute | |||||
| 6919 N Dale Mabry Hwy 250 | Tampa | FL | 33614 | Woundcare Mgmt Services | $1,024,868 |
| Polin Rutledge & Fischer | |||||
| 34637 US Hwy 19 | Palm Harbor | FL | 34684 | Physician Services | $922,435 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 25 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $85,085 | RelatedOrganizationsAmt |
| Total Contributions | $85,085 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Net patient revenue | 622110 | $97,236,968 | $97,217,708 | $19,260 |
| Medical Office Building | 622110 | $121,792 | $121,792 | |
| Satisfaction of Program Restricti | 622110 | $62,328 | $62,328 | |
| Medical Staff Fees | 622110 | $39,050 | $39,050 | |
| Cafeteria revenue | 622110 | $17,036 | $17,036 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,743 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $39,743 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $97,516,917 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $130,010 | TotalRevenueColumnAmt |
| Exclusion | $130,010 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $20,602,649 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $20,809,208 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$206,559 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$206,559 | TotalRevenueColumnAmt |
| Exclusion | -$206,559 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | EHR Revenue | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $531,419 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $531,419 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $531,419 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $98,056,872 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $98,029,076 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $19,260 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$76,549 | 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 | $474,750 | TotalAmt |
| Program Services | $474,750 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,000 | TotalAmt |
| Program Services | $15,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,119,767 | TotalAmt |
| Management And General | $1,119,767 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,921,670 | TotalAmt |
| Program Services | $28,879,014 | ProgramServicesAmt |
| Management And General | $42,656 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $760,329 | TotalAmt |
| Program Services | $734,599 | ProgramServicesAmt |
| Management And General | $25,730 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,567,674 | TotalAmt |
| Program Services | $6,483,415 | ProgramServicesAmt |
| Management And General | $84,259 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,229,939 | TotalAmt |
| Program Services | $2,154,476 | ProgramServicesAmt |
| Management And General | $75,463 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,424 | TotalAmt |
| Management And General | $132,424 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,049 | TotalAmt |
| Management And General | $29,049 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,088 | TotalAmt |
| Management And General | $34,088 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,466,140 | TotalAmt |
| Program Services | $17,987,365 | ProgramServicesAmt |
| Management And General | $2,478,775 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,361,565 | TotalAmt |
| Management And General | $1,361,565 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,790,807 | TotalAmt |
| Program Services | $2,263,561 | ProgramServicesAmt |
| Management And General | $527,246 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,632,769 | TotalAmt |
| Program Services | $3,152,169 | ProgramServicesAmt |
| Management And General | $480,600 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,484,440 | TotalAmt |
| Program Services | $2,484,440 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $208,328 | TotalAmt |
| Management And General | $208,328 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $121,720 | TotalAmt |
| Management And General | $121,720 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $271,459 | TotalAmt |
| Program Services | $271,459 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,335,506 | TotalAmt |
| Program Services | $2,335,506 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,040,593 | TotalAmt |
| Program Services | $1,005,844 | ProgramServicesAmt |
| Management And General | $34,749 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $14,949,080 | $14,949,080 | |
| Repairs & maintenance | $2,256,772 | $2,256,772 | |
| State Tax Indigent Asse | $998,350 | $998,350 | |
| Other expense | $399,694 | $19,902 | $379,792 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,601,913 | TotalAmt |
| Program Services | $86,465,702 | ProgramServicesAmt |
| Management And General | $7,136,211 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,525 | BOYAmt |
| EOY | $3,293 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,833,750 | BOYAmt |
| EOY | $7,976,790 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,074,261 | BOYAmt |
| EOY | $13,801,869 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,694,978 | BOYAmt |
| EOY | $2,799,000 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,001,463 | BOYAmt |
| EOY | $2,348,827 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $32,181,155 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $11,119,346 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,334,820 | BOYAmt |
| EOY | $21,061,809 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,085,241 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,783,314 | BOYAmt |
| EOY | $1,782,791 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,469,439 | BOYAmt |
| EOY | $528,638 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,195,550 | BOYAmt |
| EOY | $51,388,258 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,296,155 | BOYAmt |
| EOY | $8,127,227 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,799,235 | BOYAmt |
| EOY | $18,099,555 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,095,390 | BOYAmt |
| EOY | $26,226,782 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,014,919 | BOYAmt |
| EOY | $24,002,842 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,085,241 | BOYAmt |
| EOY | $1,158,634 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,100,160 | BOYAmt |
| EOY | $25,161,476 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,195,550 | BOYAmt |
| EOY | $51,388,258 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $4,454,959 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$40,343 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $3,646,700 | 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 | $3,569 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,569 | 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 | AMERICAN HOSPITAL ASSOCIATION and FLORIDA HOSPITAL ASSOCIATION DUES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,085,241 | BeginningYearBalanceAmt |
| Contributions | $136,176 | ContributionsAmt |
| Investment Earnings Or Losses | -$33,164 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $29,619 | OtherExpendituresAmt |
| End Year Balance | $1,158,634 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,334,036 | BeginningYearBalanceAmt |
| Contributions | $837,160 | ContributionsAmt |
| Investment Earnings Or Losses | $27,847 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,113,802 | OtherExpendituresAmt |
| End Year Balance | $1,085,241 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,238,985 | BeginningYearBalanceAmt |
| Contributions | $358,577 | ContributionsAmt |
| Investment Earnings Or Losses | $81,980 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $345,505 | OtherExpendituresAmt |
| End Year Balance | $1,334,036 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,658,478 | BeginningYearBalanceAmt |
| Contributions | $194,442 | ContributionsAmt |
| Other Expenditures | $613,935 | OtherExpendituresAmt |
| End Year Balance | $1,238,985 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,138,368 | BeginningYearBalanceAmt |
| Contributions | $76,262 | ContributionsAmt |
| Other Expenditures | $556,152 | OtherExpendituresAmt |
| End Year Balance | $1,658,478 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,283,896 | OtherCostOrOtherBasisAmt |
| Book Value | $8,283,896 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,900,310 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,601,259 | DepreciationAmt |
| Book Value | $5,299,051 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,483,312 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,420,787 | DepreciationAmt |
| Book Value | $6,062,525 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,513,637 | OtherCostOrOtherBasisAmt |
| Depreciation | $97,300 | DepreciationAmt |
| Book Value | $1,416,337 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $21,061,809 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| Payable to third parties | $2,219,978 |
| Other liabilities | $7,243,076 |
| Due to related | $1,707,374 |
| Leases payable | $6,126,977 |
| Credit balances in A/R | $802,150 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $18,099,555 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | Helen Ellis Memorial Hospital Foundation, Inc. (HEMHF), a related organization formed and maintained exclusively to further the exempt purpose of Florida Hospital North Pinellas(the Hospital) held assets in temporary endowment funds during the current tax year. HEMHF's endowment consists of individual donor restricted endowment funds where the assets have been designated for endowment established to support various purposes benefiting the Hospital and its patients. |
| 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. |
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 | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| 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 | $3,697,173 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,697,173 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03950 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,532,104 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,871,608 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,660,496 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07120 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,229,277 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,871,608 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,357,669 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11070 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $107,298 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $107,298 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $44,318 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $44,318 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $151,616 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $151,616 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,380,893 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,871,608 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,509,285 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11230 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $7,046,538 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $281,029 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $26,548,984 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $27,543,929 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$994,945 | 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 | Florida Hospital North Pinellas | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1395 South Pinellas Avenue | AddressLine1Txt |
| City | Tarpon Springs | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 34689 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | fhnorthpinellas.com STATE LIC# 4333 | WebsiteAddressTxt |
| 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 | Florida Hospital North Pinellas | 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 | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | 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 | 14 | 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 | See Statement | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Statement | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Statement | 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 |
|---|---|
| Florida Hospital North Pinellas | Part V, Section B, Line 5: Tarpon Springs Hospital Foundation, Inc. d/b/a Florida Hospital North Pinellas (FHNP or the Hospital), is a 168-bed hospital located in Pinellas County in Florida. FHNP primarily serves the residents in the northern part of Pinellas County and western Pasco County. CHNA data indicated that the population in the Hospital's service area is primarily Caucasian (approximately 83% of the population) and over 52% of the community's permanent residents are over the age of 65. To provide broad community input with respect to the conduct of its 2013 Community Health Needs Assessment, the Hospital formed a Community Health Needs Assessment Committee (CHNAC). The CHNAC included representatives from the Hospital, representatives from the Pinellas and Pasco County Health Departments, and community participants that represented low-income, minority, and underserved populations. The members of the CHNAC participated in data collection through interviews and survey questions. The following is a listing of the community/governmental organizations that were represented on the Hospital's CHNAC:Pinellas County School Board;Shephard Center in Tarpon Springs a community service agency that provides programs and services to the local homeless and other underserved community members;Pasco County Health Department;Community volunteer/activist; andPinellas County Health Department. |
| Florida Hospital North Pinellas | 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 North Pinellas | Part V, Section B, Line 11: Priority: Heart Disease2013 Description of the Issue: Pinellas and Pasco Counties have twice the state and national levels for adults with high total blood cholesterol levels (240 mg or greater), and are 10% above state and national levels for adults with hypertension. These higher-than-average rates of heart disease lead to a higher incidence of cardiac-related ER visits, cardiac complications, and cardiac-related deaths. 2015 Update: In 2014, Florida Hospital North Pinellas established a Congestive Heart Failure (CHF) clinic for both insured and uninsured adults. Interventions included bedside visits/education by a nurse to all CHF patients, help with transitioning home, and use of the Stanford Chronic Disease Self-Management Program (CDMSP). The CDMSP is a train-the-trainer education program recognized by the CDC as effective in teaching self-management skills and reducing preventable hospitalizations and ED visits related to CHF. In 2015, the Hospital held four CDMSP classes (six weeks each) and hosted 26 CHF support group sessions. The Hospital saw a 7.95% decrease in CHF admissions from the prior year. The CHF Clinic incorporates the eight principles of CREATION Health: choice, rest, environment, activity, trust, interpersonal relationships, outlook and nutrition. Priority: Cancer Screening2013 Description of the Issue: Pinellas and Pasco Counties have much lower rates (than the state averages) of compliance with current cancer screening guidelines. Screening tests can help find cancer at an early stage, before symptoms appear. By the time symptoms appear, the cancer may have grown and spread. This can make the cancer harder to treat or cure. By increasing compliance with cancer screenings, we hope to reduce the stage at which cancer is detected, improve long-term survival, improve quality of life, and reduce the cost/burden of care for cancer in our community. The rate of skin cancer is higher in the North Pinellas community because it is a beach community. 2015 Update: The Operation Sunshine program screened 1,675 people for melanoma and other skin cancers; 610 were referred for further testing (the expected referral numbers was 445). Florida Hospital North Pinellas also provided PSA screenings for prostate cancer for 300 men (the goal was 100); 75 were referred for further testing. Priority: Flu Shot Education2013 Description of the Issue: While there have been increases in the number of individuals who get the flu vaccine in Pinellas and Pasco County, the area still falls below state and national averages. There are also a higher number of hospitalizations and deaths related to influenza in our area. Senior Citizens and Blacks are nearly two times as likely in our area to die from complications of the flu.2015 Update: Florida Hospital North Pinellas used community lectures and its Health Happening magazine to educate community residents on the importance of flu shots. The Health Happenings magazine reached 50,000 people of all incomes, ages and ethnicities. The Hospital also provided 830 flu shots. Priority: Lack of Physical Exercise/Provision of Community Health Education 2013 Description of the Issue: In both Pinellas and Pasco Counties, the lack of moderate-to-vigorous exercise 150 and 75 minutes per week is significantly less than that of the nation and far below the HP 2020 goal. The lack of physical exercise has been shown to have a high degree of correlation with the increase in other diseases such as diabetes, heart disease and some cancers. By elevating the issue of physical activity and increasing the number of active individuals in our area, we believe we can positively impact other disease categories.2015 Update: Florida Hospital North Pinellas sponsored multiple exercise and walking events in 2015. Examples include the Beach to Bayou 5K Race, American Heart Association 5K Run, the Tarpon Springs Triathlon, and the American Cancer Society's Relay for Life. The Hospital also reached several hundred people at Healthy Happenings screenings and lectures. 100% of participants reported an increased understanding of healthy living principles. Priorities Considered but Not Selected Lack of health insuranceThe Community Health Needs Assessment Committee did not choose to address the lack of health insurance. The Committee believed that the Hospital was not equipped to address enrollment in the new federal health care exchanges. However, the University of South Florida received a large federal grant for Marketplace Navigators in the Pasco/Pinellas area. The Hospital enrolls eligible patients in Medicaid and has a strong partnership with the local Federal Qualified Health Center that sees uninsured patients on a sliding fee basis. In addition, the Florida Hospital North Pinellas area has large numbers of people 65+ who are enrolled in Medicare.Mental Health Florida Hospital North Pinellas does not offer mental health services. The Pinellas County Health and Human Services department links patients with the various not-for-profits, Veterans Administration and other mental health facilities in the county. The County also has a 2-1-1 crisis line. |
| Florida Hospital North Pinellas | 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. |
| Schedule H, Part V, Section B, Line 7a: | The CHNA report can be found at URL:https://www.floridahospital.com/sites/default/files/florida_hospital_north_pinellas_2013_chna_final_report.pdf |
| Schedule H, Part V, Section B, Line 10a: | The hospital's most recently adopted implementation strategy can be found at:https://www.floridahospital.com/community-health-needs-assessments |
| Schedule H, Part V, Section B, Line 16a,b,c: | The Financial Assistance Policy can be found at URL:https://webcdn.ahss.org/internet/policy/fh/en/FAD_fhnp_fh-en.pdfThe Financial Assistance Policy application can be found at:https://webcdn.ahss.org/internet/policy/fh/en/FAD_fhnp_fh-en.pdfThe plain language summary is available at:https://webcdn.ahss.org/internet/policy/fh/en/FAD_fhnp_fh-en.pdf |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 2 - Helen Ellis Center for Wound Care | ||||
| 1501 S Pinellas Ave Suite J | Tarpon Springs | FL | 34689 | Wound Care Institute |
| 3 - Sonesta Sleep Center of Helen Ellis | ||||
| 2317 Belleair Road | Clearwater | FL | 33764 | Sleep Disorders Center |
| 4 - FL Hosp N Pinellas Wound Healing Instit | ||||
| 5140 Deer Park Dr 105 | New Port Richey | FL | 34653 | Wound Care Institute |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a: | The filing organization is a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) during its current tax year. AHSSHC serves as a parent organization to 23 tax-exempt 501(c)(3) hospital organizations that operate 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 7. Please note that dollar amounts on the attached consolidated audited financial statements are in thousands. |
| Part III, Line 8: | Costing Methodology:Medicare allowable costs were calculated using a cost-to-charge ratio.Rationale for Including a Medicare Shortfall as Community Benefit:As a 501(c)(3) organization, the filing organization provides emergency and non-elective care to all regardless of ability to pay. All hospital services are provided in a non-discriminatory manner to patients who are covered beneficiaries under the Medicare program. As a public insurance program, Medicare provides a pre-established reimbursement rate/amount to health care providers for the services they provide to patients. In some cases, the reimbursement amount provided to a hospital may exceed its costs of providing a particular service or services to a patient. In other cases, the Medicare reimbursement amount may result in the hospital experiencing a shortfall of reimbursement received over costs incurred. In those cases where an overall shortfall is generated for providing services to all Medicare patients, the shortfall amount should be considered as a benefit to the community. Tax-exempt hospitals are required to accept all Medicare patients regardless of the profitability, or lack thereof, with respect to the services they provide to Medicare patients. The population of individuals covered under the Medicare program is sufficiently large so that the provision of services to the population is a benefit to the community and relieves the burdens of government. In those situations where the provision of services to the total Medicare patient population of a tax-exempt hospital during any year results in a shortfall of reimbursement received over the cost of providing care, the tax-exempt hospital has provided a benefit to a class of persons broad enough to be considered a benefit to the community. Despite a financial shortfall, a tax-exempt hospital must and will continue to accept and care for Medicare patients. Typically, tax-exempt hospitals provide health care services based upon an assessment of the health care needs of their community as opposed to their taxable counterparts where profitability often drives decisions about patient care services that are offered. Patient care provided by tax-exempt hospitals that results in Medicare shortfalls should be considered as providing a benefit to the community and relieving the burdens of government. |
| Part III, Line 9b: | The hospital filing organization's collection practices are in conformity with the requirements set forth in the 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. |
| Supplemental Schedule to Schedule H, Part III, Section B | Reconciliation of Schedule H Reported Medicare Surplus/(Shortfall) to Unreimbursed Medicare Costs Associated with the Provision of ServicesTo All Medicare Beneficiaries:The Medicare revenue and allowable costs of care reported in Section B of Part III of Schedule H are based upon the amounts reported in the filing organization's Medicare cost report in accordance with the IRS instructions for Schedule H. On an annual basis, the filing organization also determines its total unreimbursed costs associated with providing services to all Medicare patients. Unreimbursed costs are 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: $ (994,945)- Difference in costing methodology: (1,719,019)- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (5,670,542) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's community benefit reporting: $ (8,384,506)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 2013. 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. A conspicuous written notice is included on all billing statements sent to patients that notifies and informs recipients about the availability of financial assistance under the filing organization's financial assistance policy, including the following: 1) the telephone number of the hospital facility's office or department that can provide information about the FAP and the FAA Form; and 2) the website address where copies of the FAP, FAA Form and PLS may be obtained. Reasonable attempts are made to inform individuals about the hospital facility's FAP in all oral communications regarding the amount due for the individual's care. |
| Part VI, Line 4: | Florida Hospital North Pinellas (FHNP), a 168-bed facility, situated on the west coast of central Florida along the Anclote River where the river meets the Gulf of Mexico, serves the residents of North Pinellas and surrounding communities with vital healthcare services. A Medical Staff of 300 physicians, including primary care and specialists, have privileges at FHNP. These doctors bring a tremendous resource of medical expertise to our hospital and the communities we serve.In its ongoing pursuit of providing quality healthcare services, the dedication of FHNP's staff was recognized as a result of the triennial accreditation survey conducted in late 2010 by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Florida Hospital North Pinellas achieved full accreditation and was commended for its overall commitment to maintaining high standards of patient care practice.Florida Hospital North Pinellas is a crucial community asset. In addition to operating a hospital facility, FHNP also operates 1 wound healing institute, and 1 sleep center.Florida Hospital North Pinellas is located in the City of Tarpon Springs, Florida. The Hospital's service area has a population of approximately 185,845, with 25% of the permanent residents over the age of 65. Pinellas County is the most densely populated county in Florida, with the smallest land area of 280 square miles. The per capita income, based on population, in Pinellas County is approximately $29,261. High school graduates account for approximately 89% of Pinellas County, with an estimated 27% having a bachelor's degree or higher. It is estimated that 14.05% of the individuals residing in Pinellas County live below the poverty level and the unemployment rate is about 5.6%. Uninsured in Pinellas County is 25.44%.Approximately 57% of the Hospital's patients during the current tax year were Medicare patients, about 13% were Medicaid patients, and self pay was about 7% and the remaining percentage were patients covered under commercial insurance and other payor classes. Approximately 76% of the Hospital's in-patients are admitted through the Emergency Department. |
| Part VI, Line 5: | The provision of community benefit and community building is central to Florida Hospital North Pinellas' (FHNP) 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". As a member of the AHS system, FHNP will continue to commit substantial resources to provide a broad range of services to its community. During the current year, Hospital provided $31,962 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 $5,062,496 in new capital improvements. |
| Part VI, Line 6: | Florida Hospital North Pinellas 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 hospital facilities 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 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 (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Florida Conference Assoc of Seventh Day Adventists | |||||||
| 351 S SR 434 | Altamonte Springs | FL | 32714 | 596137501 | 501(c)(3) | $374,500 | Seventh Day Adventist Funding for School construction. |
| University Community Hospital Foundation Inc | |||||||
| 3100 East Fletcher Ave | Tampa | FL | 33613 | 592554889 | 501(c)(3) | $25,000 | General Support |
| SunSystem Development Corporation dba Florida Hosp Foundation | |||||||
| 2710 N Orange Ave 200 | Orlando | FL | 32804 | 592219301 | 501(c)(3) | $23,000 | General Support |
| City of Tarpon Springs | |||||||
| 324 E Pine Street | Tarpon Springs | FL | 34688 | 596000437 | Gov't | $14,750 | Donation to Tarpon Springs Police Department |
| Helen Ellis Memorial Hospital Foundation Inc | |||||||
| PO Box 549 | Tarpon Springs | FL | 34688 | 593690149 | 501(c)(3) | $11,500 | Care Program, and General Support |
| New Port Richey Adventist Christian Academy | |||||||
| 4416 Thys Road | New Port Richey | FL | 34653 | 620643036 | 501(c)(3) | $10,000 | General Support |
| Tarpon Springs Shepherd Center Inc | |||||||
| 304 S Pinellas Ave | Tarpon Springs | FL | 34689 | 593070882 | 501(c)(3) | $6,000 | General Support |
| CAP Inc dba Citizens Alliance for Progress Inc | |||||||
| 401 E Martin Luther King Jr | Tarpon Springs | FL | 34689 | 592299047 | 501(c)(3) | $5,000 | General Support |
| International Curry Festival Inc | |||||||
| 2595 Tampa Road Suite N | Palm Harbor | FL | 34684 | 261536804 | 501(c)(3) | $5,000 | General Support |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 9 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Financial assistance to family of deceased police officer | GrantTypeTxt |
| Recipient | 1 | RecipientCnt |
| Cash Grant | $15,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | 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. | 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 |
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| 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 (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Brian Adams | ||||||||||||||
| Director | $0 | $440,035 | $0 | $86,059 | $0 | $26,358 | $0 | $73,553 | $0 | $41,462 | $0 | $667,467 | $0 | $13,575 |
| Bruce Bergherm | ||||||||||||||
| Director/CEO | $0 | $304,188 | $0 | $68,611 | $0 | $62,396 | $0 | $29,606 | $0 | $42,158 | $0 | $506,959 | $0 | $28,557 |
| Joe Johnson | ||||||||||||||
| Director | $0 | $303,377 | $0 | $74,125 | $0 | $59,054 | $0 | $27,454 | $0 | $41,905 | $0 | $505,915 | $0 | $26,709 |
| Michael Schultz | ||||||||||||||
| Chairman | $0 | $727,404 | $0 | $223,251 | $0 | $649,855 | $0 | $128,002 | $0 | $48,825 | $0 | $1,777,337 | $0 | $100,359 |
| Steve Miller | ||||||||||||||
| CFO (beg 7/15) | $0 | $189,999 | $0 | $31,234 | $0 | $97,138 | $0 | $12,560 | $0 | $51,508 | $0 | $382,439 | $0 | $0 |
| Karen Owensby | ||||||||||||||
| CNO/COO | $0 | $205,439 | $0 | $36,407 | $0 | $22,401 | $0 | $13,189 | $0 | $13,562 | $0 | $290,998 | $0 | $0 |
| Louis Astra MD | ||||||||||||||
| Physician | $576,000 | $0 | $0 | $0 | $3,168 | $0 | $14,388 | $0 | $26,301 | $0 | $619,857 | $0 | $0 | $0 |
| Rajesh Kotak MD | ||||||||||||||
| Physician | $247,491 | $0 | $0 | $0 | $14,219 | $0 | $9,546 | $0 | $23,576 | $0 | $294,832 | $0 | $0 | $0 |
| Jose Torres MD | ||||||||||||||
| Physician | $216,669 | $0 | $200 | $0 | $37,148 | $0 | $8,717 | $0 | $370 | $0 | $263,104 | $0 | $0 | $0 |
| Angelo Cappiello MD | ||||||||||||||
| Physician | $242,978 | $0 | $0 | $0 | $8,008 | $0 | $14,476 | $0 | $27,111 | $0 | $292,573 | $0 | $0 | $0 |
| Glenn Lura MD | ||||||||||||||
| Physician | $180,937 | $0 | $0 | $0 | $10,348 | $0 | $10,473 | $0 | $16,340 | $0 | $218,098 | $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 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 AHS 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 ------------------------------------------------------- Brian Adams $ 59,165 $ 13,584 $ 0 $ 0 Bruce Bergherm $ 25,219 $ 28,574 $ 0 $ 0 Joe Johnson $ 25,066 $ 27,404 $ 0 $ 0 Michael Schultz $131,615 $111,340 $406,876 $ 0 *Including Investment Earnings |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Roger Sellew and Thomas Carson, MD - Business Relationship |
| Form 990, Part VI, Section A, line 6 | Tarpon Springs Hospital Foundation, Inc., d/b/a Florida Hospital North Pinellas (the filing organization) has one member. The sole member of the filing organization is University Community Hospital, Inc. (UCH). UCH is a Florida non-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) is the sole member of UCH. AHSSHC is the parent organization of a healthcare system that operates hospitals, nursing home facilities and other healthcare provider organizations. AHSSHC is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). |
| Form 990, Part VI, Section A, line 7a | The Board of Directors of the filing organization is to consist of not less than 12 members. One half of the Board of Directors is composed of qualified individuals who are residents of the City of Tarpon Springs, Florida or any other community located in the filing organization's primary service area. These community appointees are nominated to serve on the Board of Directors by the Helen Ellis Memorial Hospital Foundation, Inc. (HEMH Foundation). The HEMH Foundation is a separate supporting organization to the filing organization that is exempt from federal income tax under IRC Section 501(c)(3). These community appointees must be approved by UCH as the member. The remaining one half of the Board of Directors are appointed to the Board by UCH as the member. |
| Form 990, Part VI, Section A, line 7b | UCH, 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) Approval of the selection of and removal of, and the compensation level of, senior management of the filing organization; b) Approval of the filing organization's Articles of Incorporation; c) Approval of any material changes in services at the health care facilities; d) Approval of major building programs and purchases or sales of property in excess of $500,000 and sales/purchases of less than $500,000 when the filing organization's net revenues are not available for such purpose; e) Approval of the terms and conditions of borrowing; f) Appointment of one-half of the Board of Directors and approval of the community appointees to the Board of Directors; g) Approval of all operating and capital budgets and strategic plans of the filing organization; and h) To direct the placement of funds and capital of the filing organization. |
| Form 990, Part VI, Section B, line 11 | The filing organization's current tax year Form 990 was reviewed by the CEO and CFO of the filing organization prior to its filing with the IRS. The review conducted by these individuals did not include the review of any supporting workpapers that were used in preparation of the current year Form 990, but did include a review of the entire Form 990 and all supporting schedules. |
| Form 990, Part VI, Section B, line 12c | The Conflict of Interest Policy of the filing organization applies to members of its Board of Trustees/Directors, its officers, executive employees, physician employees, and officers of the medical staff (to be known as Interested Persons). In connection with any actual or possible conflict of interests, any member of the Board of Trustees/Directors of the filing organization or any other Interested Person of the filing organization 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 Trustees/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 Interested Person, the remaining members of the Board of Trustees/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 Trustees/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 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. |
| Form 990, Part IX, line 11g | Payments to Healthcare Professional: Program service expenses 6,630,783. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,630,783. Professional Fees : Program service expenses 3,330,468. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,330,468. Purchased Medical Services : Program service expenses 608,582. Management and general expenses 0. Fundraising expenses 0. Total expenses 608,582. Environmental Services : Program service expenses 20,254. Management and general expenses 0. Fundraising expenses 0. Total expenses 20,254. Recruiting : Program service expenses 48,227. Management and general expenses 0. Fundraising expenses 0. Total expenses 48,227. Miscellaneous Purchased Services : Program service expenses 7,349,051. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,349,051. AHS Management Fees : Program service expenses 0. Management and general expenses 1,111,941. Fundraising expenses 0. Total expenses 1,111,941. Billing & Collection Services : Program service expenses 0. Management and general expenses 1,059,065. Fundraising expenses 0. Total expenses 1,059,065. EHR Management Fees : Program service expenses 0. Management and general expenses 307,769. Fundraising expenses 0. Total expenses 307,769. |
| Form 990, Part XI, line 9: | Transfer to tax-exempt parent -240,295. Pension Liability Adjustment 3,960,000. Internal Allocated Settlement Amount -146,402. Gifts 124,121. Released from Restricted -50,728. Rounding 4. |
| 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. |
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 | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (12 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Adventist Health System Sunbelt Healthcare Corp | ||
| M | $972,601 | % of facility's operating exp. |
| Adventist Health System Sunbelt Healthcare Corp dba AHS IS | ||
| M | $3,613,639 | % of facility's operating exp. |
| Adventist Health System Sunbelt Healthcare Corp | ||
| P | $3,367,755 | Cost |
| Adventist Health System Sunbelt Healthcare Corp | ||
| M | $307,769 | % of facility's EHR revenue |
| University Community Hospital Inc | ||
| P | $5,375,359 | Cost |
| Helen Ellis Memorial Hospital Foundation | ||
| C | $85,085 | Actual Amount Received |
| Helen Ellis Memorial Hospital Foundation | ||
| Q | $127,818 | Cost |
| Florida Hospital Physician Group Inc | ||
| P | $1,524,640 | Cost |
| Adventist Health System Sunbelt Healthcare Corp | ||
| B | $240,295 | Actual Amount Given |
| Adventist Health System Sunbelt Healthcare Corp | ||
| C | $70,000 | Actual Amount Received |
| Adventist Health SystemSunbelt Inc | ||
| P | $146,402 | Internally Allocated Settlement |
| Adventist Health System Sunbelt Healthcare Corp | ||
| S | $2,400,000 | Actual Amount Received |