2016-11-14T12:27:09-06:00 2015-12-31 990 2015-01-01 592951990 MEMORIAL HOSPITAL FLAGLER INC MEMO 3865862000 60 MEMORIAL MEDICAL PARKWAY PALM COAST FL 32164 LYNN C ADDISCOTT ASSISTANT SECRETARY 4079751492 2016-11-14 2015 2017-02-10 21:41:12Z FLORIDA HOSPITAL FLAGLER RON JIMENEZ 60 MEMORIAL MEDICAL PARKWAY PALM COAST FL 32164 894815527 0 X WWW.FLORIDAHOSPITAL.COM/FLAGLER X 1989 FL THE PROVISION OF MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF A 99 BED HOSPITAL. 18 9 1259 268 217462 147318 0 40960 167508911 183891770 2091869 -2610337 640007 281709 170240787 181604102 16250 91779 0 0 74091109 58010873 0 0 0 67609422 93182233 141716781 151284885 28524006 30319217 319009416 320581611 90519810 89369916 228489606 231211695 ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION AND ALL OF ITS SUBSIDIARY ORGANIZATIONS WERE ESTABLISHED BY THE SEVENTH-DAY ADVENTIST CHURCH TO BRING A MINISTRY OF HEALING AND HEALTH TO THE COMMUNITIES SERVED. OUR MISSION IS TO EXTEND THE HEALING MINISTRY OF CHRIST. 0 0 139984416 91779 183956017 PROVISION OF MEDICAL CARE TO BOTH INPATIENTS AND OUTPATIENTS. DURING THE CURRENT YEAR, THE HOSPITAL HAD 7,861 PATIENT ADMISSIONS WHICH RESULTED IN 34,623 PATIENT DAYS AND 148,559 OUTPATIENT VISITS. THE HOSPITAL IS AN 99-BED ACUTE CARE HOSPITAL LOCATED IN FLAGLER COUNTY, FLORIDA. 139984416 1 1 0 1 0 0 1 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 103 0 1 1259 1 1 1 0 0 0 0 0 0 0 0 0 X 18 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 FL X CORY DOMAYER 3865864200 60 MEMORIAL MEDICAL PARKWAY PALM COAST FL 32164 X DENNIS ALTER MD DIRECTOR 50.00 0.00 X 190 1006938 33132 STEVEN BROWN MD DIRECTOR (BEG 6/15) 0.20 15.00 X 190 110625 0 MICHAEL CHIUMENTO DIRECTOR 0.20 0.00 X 250 0 0 BOB DEVORE DIRECTOR (END 3/15) 0.20 0.00 X 0 0 0 DAVID FOWLER DIRECTOR (BEG 6/15) 0.20 0.00 X 250 0 0 ROBERT FULBRIGHT CHAIRMAN/DIR (BEG 12/15) 10.00 40.00 X 250 708804 131192 TED HAMILTON MD DIRECTOR 0.20 50.00 X 190 763873 53308 LARS HOUMANN CHAIRMAN/DIR (END 12/15) 0.20 50.00 X 0 1946070 269392 SANDRA JOHNSON DIRECTOR 0.20 50.00 X 0 982645 112798 ROGER LEVERTON DIRECTOR 0.20 0.00 X 250 0 0 KENNETH MATTISON DIRECTOR/CEO 50.00 0.00 X X 0 577134 83512 HOLSEY MOORMAN DIRECTOR 0.20 0.00 X 250 0 0 EDWARD NOSEWORTHY DIRECTOR 0.20 50.00 X 0 637640 93069 TONY PAPANDREA DIRECTOR 0.20 0.00 X 250 0 0 BARBARA REVELS DIRECTOR 0.20 0.00 X 250 0 0 SCOTT SOWERS DIRECTOR 0.20 0.00 X 250 0 0 RAVEN SWORD DIRECTOR 0.20 0.00 X 250 0 0 LEWIS SEIFERT DIRECTOR 0.20 50.00 X 0 808474 144733 DEBORA THOMAS DIRECTOR 10.00 40.00 X 250 496938 76278 DARYL TOL CHAIRMAN/DIRECTOR (END 12/15) 10.00 40.00 X 250 831645 125888 GLENN ZIMMET DO DIRECTOR 0.20 1.00 X 190 500 0 JERMAINE BUCKNOR CFO 50.00 0.00 X 250 289850 54969 JOANNE KING COO 50.00 0.00 X 250 199522 54620 ROBERT DAVIS CNO 50.00 0.00 X 250 211459 50043 RONALD THOMAS MD CMO 50.00 0.00 X 250 370786 46758 VENKATA THOTA MD PHYSICIAN 50.00 0.00 X 428130 0 33176 SATAR SHETH PHARMACIST 45.00 0.00 X 155477 0 15844 REMA COLE HOME HEALTH ADMINISTRATOR 50.00 0.00 X 149038 0 26293 MICHAEL DEBUSK DIRECTOR OF PHARMACY 50.00 0.00 X 137953 0 17878 GUY WARREN WAGNER PHARMACIST 50.00 0.00 X 134402 0 24904 DAVID OTTATI FORMER CEO 0.00 50.00 X 0 580844 116180 VALERIE ZIESMER FORMER CFO 0.00 50.00 X 0 301545 40666 1009510 10825292 1604633 19 1 1 0 SHERIDAN HEALTHCORP INC PO BOX 452197 SUNRISE FL 333232197 ANESTHESIA SERVICES 1393484 PT SOLUTIONS 120 CYPRESS EDGE DRIVE 101 PALM COAST FL 32164 PHYSICAL THERAPY SERVICES 1355444 MED PARTNERS HEALTHCARE STAFFING 02 KNIGHTS RUN 1025 TAMPA FL 33602 MEDICAL STAFFING SERVICES 675028 MORRISON MANAGEMENT PO BOX 102289 ATLANTA GA 303682289 CAFETERIA/CATERING SERVICES 472817 FLORIDA LINEN SERVICES 1407 SW 8TH STREET POMPANO BEACH FL 33069 LAUNDRY SERVICES 420150 14 31210 9750 40960 NET PATIENT REVENUE 622110 182073897 181856435 217462 MEDICAL OFFICE BUILDING 622110 1073437 1073437 CAFETERIA REVENUE 622110 505867 505867 238569 238569 183891770 4455937 4455937 706131872 13279 713211425 0 -7079553 13279 -7066274 -7066274 EHR REVENUE 622110 281709 281709 281709 181604102 183956017 217462 -2610337 X 91779 91779 3282914 3282914 41757060 41757060 1353656 1328192 25464 7912159 7912159 3705084 3635388 69696 183510 183510 53947 53947 1168322 1168322 39995276 36172157 3823119 277455 277455 3699607 2861578 838029 4630803 4085781 545022 3786323 3786323 534272 534272 40851 40851 2678194 2678194 7707300 7707300 2104966 2051081 53885 MEDICAL SUPPLIES 21433768 21433768 REPAIRS & MAINTENANCE 2937079 2937079 STATE TAX INDIGENT ASSE 1546145 1546145 UBI TAXES 45200 45200 359215 432 358783 151284885 139984416 11300469 0 4049 4042 201070927 202553069 21547240 22009849 0 0 2523927 2812668 2788268 3207598 148843259 73805618 76310288 75037641 50000 50000 14523608 14522088 191109 384656 319009416 320581611 9604002 9202793 179458 161356 80736350 80005767 90519810 89369916 X 228489606 231208240 0 3455 228489606 231211695 319009416 320581611 X 30319217 -1387252 -26209876 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5003 5003 0 PART II-B, LINE 1: AMERICAN HOSPITAL ASSOCIATION AND FLORIDA HOSPITAL ASSOCIATION DUES. X 1 0 0.00 0 0 7311502 7311502 57803348 19234906 38568442 76307177 50933067 25374110 7421232 3637645 3783587 75037641 CREDIT BALANCES IN A/R 886065 INTERCO. ALLOC. OF TE BOND PROCEEDS 67229543 DUE TO RELATED 4897657 PAYABLE TO THIRD PARTIES 6885037 OTHER LIABILITIES 107465 80005767 X PART II, LINE 9: THE FILING ORGANIZATION HAS RECORDED THE LAND CONSERVATION EASEMENT ON ITS FINANCIAL STATEMENTS AS A PROPERTY, PLANT, AND EQUIPMENT ASSET. THE CONSERVATION EASEMENT GENERATES NO REVENUE AND THE FILING ORGANIZATION DID NOT INCUR ANY EXPENSE RELATED TO THE MAINTENANCE AND MONITORING OF THE CONSERVATION EASEMENT. 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. 1 1 X 1 X 0 1 1 0 1 1 5305669 5305669 0.03510 14542764 11896727 2646037 0.01750 19848433 11896727 7951706 0.05260 323853 323853 0.00210 1461 1461 0.00000 325314 325314 0.00210 20173747 11896727 8277020 0.05470 80553 80553 0.00050 134463 134463 0.00090 215016 215016 0.00140 1 9712723 803965 61631275 55846432 5784843 X 1 1 1 1 FLORIDA HOSPITAL - FLAGLER 60 MEMORIAL MEDICAL PARKWAY PALM COAST FL 32164 WWW.FLORIDAHOSPITAL.COM/FLAGLER 4465 X X X MEMORIAL HOSPITAL FLAGLER INC 1 0 0 1 X X X X X X X X 13 1 0 0 1 X SEE STATEMENT X X 1 14 1 SEE STATEMENT 0 0 1 X 200.000000000000 X X X 1 1 X X X X 1 X SEE STATEMENT X SEE STATEMENT X SEE STATEMENT X X X X X 1 X 0 X X X X 1 X 0 0 MEMORIAL HOSPITAL FLAGLER, INC. PART V, SECTION B, LINE 5: MEMORIAL HOSPITAL FLAGLER, INC. D/B/A FLORIDA HOSPITAL FLAGLER, (FHF OR THE HOSPITAL) OPERATES A 99-BED ACUTE-CARE HOSPITAL IN FLAGLER COUNTY, FLORIDA. THE PRIMARY SERVICE AREA (PSA) FOR FHF IS ALL OF FLAGLER COUNTY, WHICH INCLUDES APPROXIMATELY 100,000 INDIVIDUALS. APPROXIMATELY 77% OF THE RESIDENTS IN FLAGLER COUNTY ARE WHITE, APPROXIMATELY 10% ARE AFRICAN-AMERICAN, AND APPROXIMATELY 9% ARE HISPANIC. APPROXIMATELY 16.5% OF THE POPULATION WITHIN THE PSA IS UNINSURED. IN CONDUCTING ITS 2013 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE HOSPITAL GATHERED PRIMARY AND SECONDARY DATA FROM A NUMBER OF SOURCES WITH AN INTENT TO MAKE SURE THAT INPUT WAS SOLICITED FROM THOSE REPRESENTING THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. COMMUNITY ORGANIZATIONS WERE IDENTIFIED IN ORDER TO GATHER STAKEHOLDER INPUT THROUGH INTERVIEWS AND SURVEYS. STAKEHOLDERS INCLUDED REPRESENTATIVES FROM THE FLAGLER COUNTY HEALTH DEPARTMENT, UNITED WAY, LOCAL CHURCHES, SCHOOLS AND GOVERNMENT. THE IDENTIFIED REPRESENTATIVES REFLECTED A COMPREHENSIVE VIEW OF ALL OF FLAGLER COUNTY'S RESIDENTS, INCLUSIVE OF ALL AGES, ETHNICITIES, AND ECONOMIC STATUS. AS A PART OF ITS EFFORTS TO ENSURE BROAD COMMUNITY-BASED INPUT INTO THE CHNA PROCESS, THE HOSPITAL ESTABLISHED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC). THE CHNAC WAS INTENDED TO REPRESENT THE NEEDS OF THE GENERAL COMMUNITY WITH A PARTICULAR FOCUS ON INCLUDING REPRESENTATIVES OF THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. EACH MEMBER OF THE CHNAC BROUGHT KNOWLEDGE AND EXPERIENCE IN WORKING WITH PEOPLE AND FAMILIES IN THE HOSPITAL'S COMMUNITY, AS WELL AS A UNIQUE PERSPECTIVE ON HEALTH CONCERNS IN THE COMMUNITY. UNDERSERVED POPULATIONS, INCLUDING THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS WERE ESPECIALLY REPRESENTED THROUGH PARTICIPATION FROM THE FLAGLER COUNTY HEALTH DEPARTMENT, A FREE HEALTH CLINIC, GRACE TABERNACLE CHURCH, THE FLAGLER COUNTY SCHOOL DISTRICT, AND THE UNITED WAY. MEMORIAL HOSPITAL FLAGLER, INC. PART V, SECTION B, LINE 7D: THE HOSPITAL HAS ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT MUST BE POSTED ON THE HOSPITAL'S WEBSITE BY THE END OF THE YEAR IN WHICH IT IS CONDUCTED. THE HOSPITAL WILL MAKE A COPY OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE UPON REQUEST. THE HOSPITAL WILL ALSO MAKE A PAPER COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE FOR PUBLIC INSPECTION AT THE HOSPITAL FACILITY. MEMORIAL HOSPITAL FLAGLER, INC. PART V, SECTION B, LINE 11: FLORIDA HOSPITAL FLAGLER IS LOCATED IN PALM COAST, FLORIDA. THE HOSPITAL IS LOCATED IN THE LESS POPULATED WESTERN PART OF THE CITY. BUNNELL, FL IS THE (FLAGLER) COUNTY SEAT AND IS INCLUDED IN THE HOSPITAL'S SERVICE AREA. IN GENERAL, THE 2,000 BUNNELL RESIDENTS HAVE LOWER INCOME AND EDUCATION LEVELS THAN MUCH OF PALM COAST. FLORIDA HOSPITAL FLAGLER'S 2013 COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED HIGH CHOLESTEROL, OBESITY/NUTRITION, SMOKING, AND CHRONIC DISEASE (HEART DISEASE, DIABETES AND CANCER) AS KEY HEALTH ISSUES. MANY OF THESE CONDITIONS ARE RELATED TO LIFESTYLE AND TO ACCESS TO HEALTH/COMMUNITY RESOURCES. IN 2015, THE HOSPITAL PROVIDED MULTIPLE COMMUNITY HEALTH EDUCATION PROGRAMS AND SEMINARS, AND TRIPLED ATTENDANCE IN MOST OF THEM OVER THE PAST YEAR. EFFORTS INCLUDED WORK WITH LOW INCOME POPULATIONS. SOME EFFORTS, SUCH AS CHANGE YOUR LIFE AND CREATION HEALTH, WERE ALIGNED WITH SIMILAR EFFORTS AT FOUR OTHER FLORIDA HOSPITAL FACILITIES IN ADJACENT VOLUSIA COUNTY. PRIORITY ISSUE: PROMPTING HEALTH & WELLNESS - HEART DISEASE, DIABETES AND WELLNESS/LIFESTYLE 2013 DESCRIPTION OF THE ISSUE: THE AGE-ADJUSTED DEATH RATE FOR CARDIAC DISEASE IN FLAGLER COUNTY IS 12.6 PER 100,000 COMPARED TO 7.8 PER 100,000 FOR THE REST OF FLORIDA. NEEDS ASSESSMENT FINDINGS ATTRIBUTE THE HIGHER RATE TO SEVERAL FACTORS: THE AGING POPULATION, LIFESTYLE FACTORS AND ACCESS/UNDERSTANDING OF THE COMMUNITY'S HEALTH AND COMMUNITY RESOURCES. THE COUNTY'S RATES OF DIABETES AND OBESITY ARE ALSO SLIGHTLY HIGHER THAN THE STATE AVERAGE.2015 UPDATE: IN 2015, NEARLY 1200 PEOPLE WERE ENROLLED IN THE CHANGE YOUR LIFE LIFESTYLE MEMBERSHIP PROGRAM. IN TOTAL, THE CHANGE YOUR LIFE WELLNESS PROGRAM REACHED 3,100 COMMUNITY MEMBERS AND HOSPITAL EMPLOYEES THROUGH EVENTS, PHYSICAL CHALLENGES, EDUCATION, ONLINE REPORTING AND PRIZES. THE PROGRAM CENTERED ON THE EIGHT CORE PRINCIPLES OF CREATION HEALTH (CHOICE, REST, ENVIRONMENT, ACTIVITY, TRUST IN GOD, INTERPERSONAL RELATIONSHIPS, OUTLOOK AND NUTRITION). OVER 94% OF PEOPLE WHO COMPLETED THE CREATION HEALTH PART OF THE PROGRAM REPORTED AN INCREASE IN KNOWLEDGE AND UNDERSTANDING OF THE IMPORTANCE OF THESE PRINCIPLES. THE CREATION HEALTH COMPLETION RATES AND POST-ASSESSMENT SCORES IN LOW-INCOMES AREAS WERE SLIGHTLY LOWER THAN THOSE OF THE REST OF THE COUNTY; THE HOSPITAL IS WORKING TO UNDERSTAND WHY. THE HOSPITAL ALSO REACHED 2000 PEOPLE AT WEEKLY BLOOD PRESSURE SCREENINGS; THE GOAL WAS 350. PEOPLE WHOSE SCREENINGS WERE ABNORMAL WERE REFERRED TO THEIR FAMILY DOCTORS OR OTHER AFFORDABLE SOURCES OF CARE. FLORIDA HOSPITAL FLAGLER ALSO PROVIDED FREE BLOOD SUGAR SCREENINGS AT MULTIPLE EVENTS, INCLUDING 75 TO RESIDENTS IN THE (LOW INCOME) BUNNELL COMMUNITY. RESIDENTS WITH HIGH SCORES WERE LINKED TO AFFORDABLE HEALTH SERVICES. IN ADDITION TO CREATION HEALTH, FLORIDA HOSPITAL FLAGLER HELD 19 EDUCATIONAL SEMINARS THAT ENGAGED OVER 1000 PEOPLE. IN ADDITION, THE HOSPITAL HOSTED OR PROVIDED MEETING SPACE TO COMMUNITY GROUPS FOR SUPPORT AND EDUCATION PROGRAMS THAT ADDRESS NOT ONLY HEALTH ISSUES, BUT SOCIAL CONDITIONS. PROGRAMS INCLUDED DIABETES EDUCATION, PROSTATE CANCER, BREAST CANCER, HEAD & NECK CANCER, CANCER CAREGIVERS, LUPUS, STROKE, STEP-PARENTS, DOMESTIC VIOLENCE, MULTIPLE MYELOMA SURVIVORS, PARKINSON'S DISEASE, GAMBLERS ANONYMOUS AND OVEREATERS ANONYMOUS. PRIORITY: ACCESS TO HEALTH CARE SERVICES2013 DESCRIPTION OF THE ISSUE: ACCESS TO HEALTH CARE EMERGED AS A PRIORITY FOR OUR COMMUNITY BENEFIT PLANS BECAUSE DATA SHOWED HIGH RATES OF RESIDENTS WITHOUT ACCESS TO HEALTH CARE (ESPECIALLY PRIMARY CARE) AND RESIDENTS WITHOUT INSURANCE. LIMITED ACCESS TO HEALTH CARE SERVICES CAN AGGRAVATE OTHER ISSUES IDENTIFIED THROUGH OUR RESEARCH INCLUDING CHRONIC DISEASE, MENTAL HEALTH ISSUES, AND MATERNAL AND CHILD HEALTH. IN 2013, THE COMMUNITY HAD A FREE CLINIC BUT LACKED A FEDERALLY QUALIFIED OR RURAL HEALTH CENTER. 2015 UPDATE: FLORIDA HOSPITAL FLAGLER WORKED WITH COMMUNITY PARTNERS TO BRING AZALEA HEALTH, A MULTI-LOCATION FQHC, TO PALM COAST. THE NEW CENTER OFFERS AFFORDABLE PRIMARY CARE SERVICES TO PALM COAST AND THE SURROUNDING AREA. THE FQHC SEES PATIENTS WITH MEDICAID AND MEDICARE, AND SEES UNINSURED PATIENTS ON A SLIDING FEE SCALE. IN ADDITION, THE HOSPITAL PROVIDED OVER 250 LAB VOUCHERS TO THE FLAGLER FREE CLINIC.PRIORITY: ACCESS TO HEALTH AND COMMUNITY RESOURCES 2013 DESCRIPTION OF THE ISSUE: AT THE TIME OF THE 2013 ASSESSMENT, THE COUNTY'S 2-1-1 COMMUNITY RESOURCE LINE WAS SORELY OUT-OF-DATE, AND LACKED LISTINGS FOR HEALTH AND WELLNESS RESOURCES. 2015 UPDATE: FLORIDA HOSPITAL FLAGLER WORKED WITH UNITED WAY AND OTHER COMMUNITY PARTNERS TO UPDATE THE LISTINGS OF HEALTH AND WELLNESS RESOURCES IN FLAGLER AND VOLUSIA COUNTY'S 2-1-1 SYSTEM. THE 2015 GOALS AND ACHIEVEMENTS WERE THREEFOLD: 1) INCREASE THE NUMBER OF HEALTH AND WELLNESS RESOURCES LISTED IN THE COUNTY'S 2-1-1 DATABASE FROM 0 (ACTUAL WAS 139); 2) INCREASE REFERRALS BY STAFF TO HEALTH AND WELLNESS RESOURCES FROM 0 (ACTUAL WAS 1,152); AND 3) INCREASE THE NUMBER OF WEB REFERRALS FOR HEALTH AND WELLNESS RESOURCES FROM 0 (ACTUAL WAS 2,360). PRIORITY: ADULT TOBACCO USE AND ABUSE PROGRAMS2013 DESCRIPTION OF THE ISSUE: THE RATE OF SMOKING IN FLAGLER COUNTY ADULTS (2010) FALLS IN THE THIRD QUARTILE IN THE STATE. 2015 UPDATE: 235 PEOPLE COMPLETED SMOKING CESSATION CLASSES OFFERED BY FLORIDA HOSPITAL FLAGLER (THE GOAL WAS 35). THE "TOOLS TO QUIT" SMOKING CESSATION PROGRAM WAS OFFERED ON CAMPUS AND IN UNDERSERVED AREAS. THE HOSPITAL IS ALSO A SUPPORTER OF THE TOBACCO FREE FLAGLER COUNTY PARTNERSHIP, A COMMUNITY COALITION WHOSE GOAL IS TO PREVENT YOUTH INITIATION AND REDUCE THE USE OF TOBACCO PRODUCTS.PRIORITIES CONSIDERED BUT NOT SELECTED COMMUNICABLE DISEASESFLORIDA HOSPITAL FLAGLER DID NOT SELECT COMMUNICABLE DISEASE AS A PRIORITY AT THIS TIME. WE DETERMINED THAT THERE ARE GROUPS ALREADY ADDRESSING THIS ISSUE: THE HEALTH DEPARTMENT, DIGGS MIRACLE CARE AND THE OUTREACH COMMUNITY CARE NETWORK. IN ADDITION, THE HOSPITAL DOES NOT HAVE THE CAPACITY TO EFFECTIVELY ADDRESS THIS ISSUE. INJURIESWE ALSO DETERMINED WE ARE NOT THE BEST COMMUNITY PARTNER TO ADDRESS INJURY, WHICH WAS IDENTIFIED AS A TOP PRIORITY THROUGH SECONDARY DATA. MULTIPLE COMMUNITY GROUPS ARE WORKING ON ISSUES LIKE UNINTENTIONAL INJURY, VIOLENCE AND DOMESTIC VIOLENCE IN OUR COMMUNITY. THESE GROUPS INCLUDE THE SCHOOL SYSTEMS, DOMESTIC ABUSE SHELTERS, AND GOVERNMENTAL GROUPS.MATERNAL AND CHILD HEALTH MATERNAL AND CHILD HEALTH ISSUES WERE NOT SELECTED AS A DIRECT EFFORT. WE BELIEVE OUR EFFORTS AROUND HEALTH AND WELLNESS AND INCREASING HEALTH CARE ACCESS SHOULD HAVE A POSITIVE IMPACT ON THESE ISSUES. THE HOSPITAL MATERNITY PROGRAM OFFERS NEW MOTHER AND PARENT SUPPORT AND EDUCATION. THE HEALTH DEPARTMENT OFFERS PRENATAL CARE FOR LOW-INCOME WOMEN, AND THE HEALTHY START COALITION OF VOLUSIA/FLAGLER OFFERS SUPPORT PROGRAMS, ESPECIALLY FOR HIGH-RISK MOTHERS. THE TEEN OUTREACH PROGRAM (TOP) IN THE COUNTY SCHOOL SYSTEM - A POSITIVE YOUTH DEVELOPMENT CURRICULUM THAT ENCOURAGES HEALTHY BEHAVIOR, LIFE SKILLS AND A SENSE OF PURPOSE - HAS A GOAL OF REDUCING TEEN PREGNANCIES. MEMORIAL HOSPITAL FLAGLER, INC. PART V, SECTION B, LINE 22D: IN DETERMINING THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE POLICY-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL USED THE FOLLOWING METHODOLOGY IN 2015:THE HOSPITAL UTILIZED THE LOOK-BACK METHOD FOR DETERMINING ITS AMOUNTS GENERALLY BILLED (AGB) PERCENTAGE. IN CALCULATING ITS AGB PERCENTAGE, THE HOSPITAL INCLUDED CLAIMS ALLOWED DURING ITS PRIOR 12-MONTH PERIOD BY MEDICARE FEE-FOR-SERVICE (INCLUDING MEDICARE ADVANTAGE) AND ALL COMMERCIAL PAYORS THAT HAD ANY ACTIVITY WITH THE HOSPITAL DURING THE TAXABLE YEAR. SCHEDULE H, PART V, SECTION B, LINE 7A: THE CHNA REPORT CAN BE FOUND AT URL:HTTPS://WWW.FLORIDAHOSPITAL.COM/SITES/DEFAULT/FILES/PDF/FLORIDA_HOSPITAL_FLAGLER_2013_CHNA.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_FHF_FH-EN.PDFTHE FINANCIAL ASSISTANCE POLICY APPLICATION CAN BE FOUND AT:HTTPS://WEBCDN.AHSS.ORG/INTERNET/POLICY/FH/EN/FAD_FHF_FH-EN.PDFTHE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://WEBCDN.AHSS.ORG/INTERNET/POLICY/FH/EN/FAD_FHF_FH-EN.PDF 46 1 - FLORIDA HOSPITAL FLAGLER TOWN CENTER SUR 120 CYPRESS EDGE DRIVE SUITE 102 PALM COAST FL 32164 SURGICAL SERVICES 2 - PALM COAST PARKWAY MRI 120 CYPRESS EDGE DRIVE PALM COAST FL 32164 IMAGING SERVICES 3 - PALM COAST PARKWAY LABORATORY 120 CYPRESS EDGE DRIVE PALM COAST FL 32164 LABORATORY SERVICES 4 - FLORIDA HOSPITAL MEMORIAL HOSPICE DBA HO 770 W GRANADA BLVD SUITE 304 ORMOND BEACH FL 32174 HOSPICE ADMINISTRATIVE OFFICE 5 - PALM COAST PARKWAY CT 120 CYPRESS EDGE DRIVE PALM COAST FL 32164 CT SERVICES 6 - FLORIDA HOSPITAL MEMORIAL HOME HEALTH 770 W GRANADA BLVD SUITE 319 ORMOND BEACH FL 32174 HOME CARE SERVICES 7 - HCP - ALTER GAY AND KEEN MD 21 HOSPITAL DRIVE SUITE 110 PALM COAST FL 32164 ORTHOPEDIC SERVICES 8 - PALM COAST PARKWAY PHYSICAL THERAPY 120 CYPRESS EDGE DRIVE PALM COAST FL 32164 PHYSICAL THERAPY 9 - PALM COAST PARKWAY ULTRASOUND 120 CYPRESS EDGE DRIVE PALM COAST FL 32164 ULTRASOUND SERVICES 10 - PALM COAST PARKWAY RADIOLOGY 120 CYPRESS EDGE DRIVE PALM COAST FL 32174 RADIOLOGY SERVICES 11 - FLORIDA HOSPITAL HOSPICE - MEMORIAL 301 MEMORIAL MEDICAL PARKWAY DAYTONA BEACH FL 32117 HOSPICE CARE SERVICES 12 - HCP - JOINER THOMAS A MD 61 MEMORIAL MEDICAL PARKWAY SUITE 2811 PALM COAST FL 32164 FAMILY PRACTICE SERVICES 13 - HCP - MCKINLEY JOSEPH MD 3 PINE CONE CIRCLE SUITE 105 PALM COAST FL 32137 GASTROENTEROLOGY SERVICES 14 - STUART F MEYER HOSPICE HOUSE 150 MEMORIAL PARKWAY PALM COAST FL 32164 HOSPICE CARE SERVICES 15 - HCP - KURIAN KIZHAKE MD 61 MEMORIAL MEDICAL PARKWAY SUITE 3808 PALM COAST FL 32164 CARDIOLOGY SERVICES 16 - PROMPT CARE 120 CYPRESS EDGE DRIVE SUITE 102 PALM COAST FL 32164 URGENT CARE & FAMILY PRACTICE 17 - HCP - BOWER STEVEN C MD 61 MEMORIAL MEDICAL PARKWAY SUITE 3807 PALM COAST FL 32164 SURGICAL SERVICES 18 - HCP - COMBS WALLACE MD 120 PINNACLES DRIVE SUITE 1 PALM COAST FL 32164 GASTROENTEROLOGY SERVICES 19 - HCP - BOLLA JOHN D MD 61 MEMORIAL MEDICAL PARKWAY SUITE 3803 PALM COAST FL 32164 FAMILY PRACTICE SERVICES 20 - PALM COAST PARKWAY WOMEN'S CENTER 120 CYPRESS EDGE DRIVE PALM COAST FL 32164 WOMEN'S HEALTH SERVICES 21 - FLORIDA HOSPITAL HOSPICE - FISH 190 N CHARLES RICHARD BEALL BLVD DEBARY FL 32713 HOSPICE ADMINISTRATIVE OFFICE 22 - HCP - DAVIS MICHAEL DO DBA PEDIATRICS 61 MEMORIAL MEDICAL PARKWAY SUITE 3811 PALM COAST FL 32164 PEDIATRIC SERVICES 23 - HCP - GARCIA-GUERRA JOSE MD 61 MEMORIAL MEDICAL PARKWAY SUITE 2808 PALM COAST FL 32164 NEUROLOGICAL SERVICES 24 - HCP - CEBALLOS JECEBU MD 61 MEMORIAL MEDICAL PARKWAY SUITE 2806 PALM COAST FL 32164 FAMILY PRACTICE SERVICES 25 - HCP - WARD JEFFERY J DO 61 MEMORIAL MEDICAL PARKWAY SUITE 3813 PALM COAST FL 32164 FAMILY PRACTICE SERVICES 26 - HCP - TURCHIN SERGEY MD 120 CYPRESS EDGE DRIVE SUITE 209 PALM COAST FL 32164 INTERNAL MEDICINE SERVICES 27 - HCP - SHAMS SAFWAN MD 61 MEMORIAL MEDICAL PARKWAY SUITE 1800- PALM COAST FL 32164 GASTROENTEROLOGY SERVICES 28 - HCP - KARRAFFA DAVID MD 120 CYPRESS EDGE DRIVE SUITE 206 PALM COAST FL 32164 NEPHROLOGY SERVICES 29 - HCP - AHMED TANAM MD 120 CYPRESS EDGE DRIVE SUITE 207 PALM COAST FL 32164 FAMILY PRACTICE SERVICES 30 - HCP - BLAIR-BRITT LORAY MD 61 MEMORIAL MEDICAL PARKWAY SUITE 3802 PALM COAST FL 32164 FAMILY PRACTICE SERVICES 31 - HCP - OGLESBY ALLAN C MD 61 MEMORIAL MEDICAL PARKWAY SUITE 3805 PALM COAST FL 32164 INTERNAL MEDICINE SERVICES 32 - HCP - MACLSAAC GREGORY MD 120 CYPRESS EDGE DRIVE SUITE 210 PALM COAST FL 32164 FAMILY PRACTICE SERVICES 33 - HCP - SCRENOCK JONATHAN MD 120 CYPRESS EDGE DRIVE SUITE 204 PALM COAST FL 32164 FAMILY PRACTICE SERVICES 34 - HCP - WALSH JOHN A MD 61 MEMORIAL MEDICAL PARKWAY SUITE 1800- PALM COAST FL 32164 SURGERY, CARDIOVASCULAR/THORACIC SERVICES 35 - HCP - HOSKOTE JAIDEEP MD 120 CYPRESS EDGE DRIVE SUITE 201 PALM COAST FL 32164 NEPHROLOGY SERVICES 36 - HCP - SIDDIQUI REHANA MD 61 MEMORIAL MEDICAL PARKWAY SUITE 3812 PALM COAST FL 32164 GENERAL PRACTICE SERVICES 37 - HCP - BURNS LAWRENCE W MD 61 MEMORIAL MEDICAL PARKWAY SUITE 3817 PALM COAST FL 32164 INTERNAL MEDICINE/PULMONOLOGY SERVICES 38 - HCP - OLIVIER CHAMION MD 120 CYPRESS EDGE DRIVE PALM COAST FL 32164 INFECTIOUS DISEASE SERVICES 39 - HCP - PALM COAST FAMILY PRACTICEPLANTAT 42A COROLINE STREET BUNNELL FL 32110 FAMILY PRACTICE SERVICES 40 - PALM COAST PARKWAY OCCUPATIONAL THERAPY 120 CYPRESS EDGE DRIVE PALM COAST FL 32164 OCCUPATIONAL THERAPY 41 - PALM COAST PARKWAY SPEECH THERAPY 120 CYPRESS EDGE DRIVE PALM COAST FL 32164 SPEECH THERAPY 42 - HCP - PETERSON DARREN L MD 61 MEMORIAL MEDICAL PARKWAY SUITE 2815 PALM COAST FL 32164 GENERAL SURGERY SERVICES 43 - HCP - CASHIO RICHARD MD 61 MEMORIAL MEDICAL PARKWAY SUITE 2802 PALM COAST FL 32164 SURGICAL, PLASTIC, & RECONSTRUCTIVE SERVICES 44 - HCP - TUCKER ANTHONY MD 120 CYPRESS EDGE DRIVE SUITE 202 PALM COAST FL 32164 ENT SERVICES 45 - FAMILY FOCUS MEDICAL CENTER 61 MEMORIAL MEDICAL PARKWAY SUITE 2802 PALM COAST FL 32164 FAMILY PRACTICE SERVICES 46 - FLORIDA HOSPITAL HOSPICE - ORLANDO 901 NORTH LAKE DESTINY ROAD SUITE 400 MAITLAND FL 32751 HOSPICE ADMINISTRATIVE OFFICE PART I, LINE 6A: THE FILING ORGANIZATION WAS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) DURING ITS CURRENT TAX YEAR. DURING THE CURRENT YEAR, AHSSHC SERVED AS A PARENT ORGANIZATION TO 23 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS THAT OPERATED 44 HOSPITALS IN TEN STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS "ADVENTIST HEALTH SYSTEM" (AHS).ALL HOSPITAL ORGANIZATIONS WITHIN AHS COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. AHS ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. AHS HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. ON AN ANNUAL BASIS, THE COMMUNITY BENEFITS OF ALL AHS ORGANIZATIONS ARE CONSOLIDATED AND REPORTED IN THE AHS ANNUAL REPORT DOCUMENT PREPARED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (EIN 59-2170012). ADDITIONALLY, THE FILING ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY ARE POSTED ON THE FILING ORGANIZATION'S WEBSITE. PART I, LINE 7: THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. PART II, COMMUNITY BUILDING ACTIVITIES: MEMORIAL HOSPITAL FLAGLER, INC. (THE HOSPITAL) IS INVOLVED WITH AND SUPPORTIVE OF VARIOUS OTHER COMMUNITY AGENCIES IN ITS SERVICE AREA THAT WORK COLLABORATIVELY TO HELP THOSE IN NEED AND TO IMPROVE THE HEALTH AND SAFETY OF THE RESIDENTS OF THE COMMUNITY. THE HOSPITAL PARTICIPATES WITH A NUMBER OF OTHER COMMUNITY ORGANIZATIONS TO ADDRESS THE HEALTHCARE NEEDS OF THE COMMUNITY. THE HOSPITAL PROVIDES SUPPLIES AND CASH DONATIONS TO A LOCAL COMMUNITY FREE CLINIC ORGANIZATION. THE HOSPITAL ALSO PARTICIPATES IN COMMUNITY EVENTS, SUCH AS THE RELY FOR LIFE, AMERICAN CANCER SOCIETY, AND HEARTWALK.THE COSTS OF COMMUNITY BUILDING ACTIVITIES REPORTED ON PART II OF SCHEDULE H ALSO REPRESENT THE COSTS ASSOCIATED WITH PROVIDING EDUCATION FOR THE FILING ORGANIZATION'S STAFF PHYSICIANS AND EMPLOYEES. THE FILING ORGANIZATION'S PROVISION OF THESE EDUCATIONAL PROGRAMS/ACTIVITIES TO STAFF PHYSICIANS AND EMPLOYEES PROVIDES AN OPPORTUNITY FOR HEALTH CARE PROFESSIONALS TO ENHANCE THEIR SKILLS AND EXPERTISE AND KEEP UP-TO-DATE WITH THE LATEST ADVANCEMENTS IN MEDICAL PROCEDURES AND TECHNOLOGY. IN ADDITION, TRAINING OPPORTUNITIES ARE OFTEN PROVIDED ON-SITE AT THE FILING ORGANIZATION'S HOSPITAL FACILITY, THEREBY ALLOWING FOR HEALTH CARE PROFESSIONALS TO BE MORE READILY AVAILABLE TO ASSIST IN MEETING IMMEDIATE PATIENT CARE NEEDS. EDUCATION AND TRAINING PROVIDED TO THE FACILITY'S WORKFORCE IS VITAL IN ASSISTING HEALTH CARE PROFESSIONALS DIRECTLY INVOLVED IN PATIENT CARE WITH KEEPING ABREAST OF THE LATEST DEVELOPMENTS IN THEIR RESPECTIVE AREAS OF EXPERTISE, LEARNING POSSIBLE NEW AND INNOVATE WAYS OF DELIVERING CARE TO PATIENTS, AND UNDERSTANDING THE NEWEST TECHNOLOGIES AVAILABLE FOR THE TREATMENT OF PATIENTS. 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. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGE 7. PLEASE NOTE THAT DOLLAR AMOUNTS ON THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE IN THOUSANDS. PART III, LINE 8: COSTING METHODOLOGY:MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. PART III, LINE 9B: THE HOSPITAL FILING ORGANIZATION'S COLLECTION PRACTICES ARE IN CONFORMITY WITH THE REQUIREMENTS SET FORTH IN THE 2012 PROPOSED REGULATIONS REGARDING THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(R)(4) - (R)(6). NO EXTRAORDINARY COLLECTION ACTIONS (ECA'S) ARE INITIATED BY THE HOSPITAL FILING ORGANIZATION IN THE 120-DAY PERIOD FOLLOWING THE DATE AFTER THE FIRST BILLING STATEMENT IS SENT TO THE INDIVIDUAL (OR, IF LATER, THE SPECIFIED DEADLINE GIVEN IN A WRITTEN NOTICE OF ACTIONS THAT MAY BE TAKEN, AS DESCRIBED BELOW). INDIVIDUALS ARE PROVIDED WITH AT LEAST ONE WRITTEN NOTICE (NOTICE OF ACTIONS THAT MAY BE TAKEN) THAT INFORMS THE INDIVIDUAL THAT THE HOSPITAL FILING ORGANIZATION MAY TAKE ACTIONS TO REPORT ADVERSE INFORMATION TO CREDIT REPORTING AGENCIES/BUREAUS IF THE INDIVIDUAL DOES NOT SUBMIT A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM) OR PAY THE AMOUNT DUE BY A SPECIFIED DEADLINE. THE SPECIFIED DEADLINE IS NOT EARLIER THAT 120 DAYS AFTER THE FIRST BILLING STATEMENT IS SENT TO THE INDIVIDUAL AND IS AT LEAST 30 DAYS AFTER THE NOTICE IS PROVIDED. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FAA FORM DURING THE 240-DAY PERIOD FOLLOWING THE DATE ON WHICH THE FIRST BILLING STATEMENT WAS SENT TO THE INDIVIDUAL, THE HOSPITAL FILING ORGANIZATION SUSPENDS ANY REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS AND PROVIDES A WRITTEN NOTICE TO THE INDIVIDUAL DESCRIBING WHAT ADDITIONAL INFORMATION OR DOCUMENTATION IS NEEDED TO COMPETE THE FAA FORM. THIS WRITTEN NOTICE INCLUDES A COPY OF THE HOSPITAL FILING ORGANIZATION'S PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) AND INFORMS THE INDIVIDUAL THAT THE HOSPITAL FILING ORGANIZATION MAY ENGAGE IN ADVERSE REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS IF THE FAA FORM IS NOT COMPLETED BY A SPECIFIED DEADLINE WHICH IS NO EARLIER THAN THE 240-DAY PERIOD FOLLOWING THE DATE ON WHICH THE FIRST BILLING STATEMENT WAS SENT TO THE INDIVIDUAL OR, IF LATER, 30 DAYS AFTER THE WRITTEN NOTICE IS PROVIDED. IF AN INDIVIDUAL SUBMITS A COMPETE FAA FORM WITHIN THE 240-DAY PERIOD AFTER THE FIRST BILLING STATEMENT IS SENT, THE HOSPITAL FILING ORGANIZATION WILL SUSPEND ANY ADVERSE REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS UNTIL A FINANCIAL ASSISTANCE POLICY ELIGIBILITY DETERMINATION CAN BE MADE. PART 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: MEMORIAL HOSPITAL FLAGLER (THE HOSPITAL) IS A 99-BED ACUTE CARE FACILITY THAT PROVIDES QUALITY HEALTH CARE SERVICES TO THE RESIDENTS OF PALM COAST AND SURROUNDING FLAGLER COUNTY IN THE STATE OF FLORIDA. IN 2002, THE HOSPITAL OPENED ITS NEW FACILITY, EQUIPPED WITH CARE CENTERS FOR HEART, CANCER AND WOMEN'S HEALTH. THE HOSPITAL IS THE SOLE PROVIDER OF EMERGENCY HOSPITAL SERVICES IN FLAGLER COUNTY. THE HOSPITAL IS LOCATED IN A RURAL COMMUNITY LOCATED BETWEEN TWO LARGER CITIES. THE HOSPITAL IS A CRUCIAL COMMUNITY AND REGIONAL ASSET. MEDICARE HAS DESIGNATED FLORIDA HOSPITAL FLAGLER AS A MEDICARE DEPENDENT HOSPITAL AS IT IS LOCATED IN A RURAL AREA. THE NEAREST OTHER HOSPITAL IS 15 MILES AWAY AND THIS FACILITY IS OWNED BY AN AFFILIATE. THE HOSPITAL CURRENTLY OFFERS MOST HOSPITAL SERVICES INCLUDING CANCER, HOME HEALTH AND HOSPICE PROGRAMS. THE HOSPITAL IS ALSO THE THIRD LARGEST EMPLOYER IN FLAGLER COUNTY.THE HOSPITAL'S PRIMARY MARKET HAS A POPULATION OF APPROXIMATELY 89,564, WITH AN ESTIMATED 21,996 OVER THE AGE OF 65. THE MEDIAN HOUSEHOLD INCOME, BASED ON POPULATION, IN THE PRIMARY MARKET IS APPROXIMATELY $45,825. UNINSURED IN THE HOSPITAL'S PRIMARY MARKET IS 17%.APPROXIMATELY 62.5% OF THE HOSPITAL'S PATIENTS DURING 2015 WERE MEDICARE PATIENTS, ABOUT 8.9% WERE MEDICAID PATIENTS, ABOUT 4.9% WERE SELF-PAY PATIENTS, AND THE REMAINING PERCENTAGE WERE PATIENTS COVERED UNDER COMMERCIAL INSURANCE. IN 2015, ABOUT 90.1% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO MEMORIAL HOSPITAL FLAGLER'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, THE HOSPITAL PROVIDED $120,267 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 $6,433,134 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. PART VI, LINE 6: THE FILING ORGANIZATION IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 44 HOSPITALS IN 10 STATES THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 16 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AS THE PARENT ORGANIZATION OF THE AHS SYSTEM, AHSSHC PROVIDES EXECUTIVE LEADERSHIP AND OTHER PROFESSIONAL SUPPORT SERVICES TO ITS SUBSIDIARY ORGANIZATIONS. PROFESSIONAL SUPPORT SERVICES INCLUDE AMONG OTHERS CORPORATE COMPLIANCE, LEGAL, HUMAN RESOURCES, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH AHS SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER 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. 1 PALM COAST SEVENTH DAY ADVENTIST CHURCH 5650 BELLE TERRE PARKWAY PALM COAST FL 32137 590806975 501(C)(3) 44000 GENERAL SUPPORT FLAGLER CARES INC 36 SEA VISTA DRIVE PALM COAST FL 32137 474145174 501(C)(3) 25000 GENERAL SUPPORT AMERICAN HEART ASSOCIATION 237 E MARKS ST ORLANDO FL 32803 135613797 501(C)(3) 8438 GENERAL SUPPORT AMERICAN CANCER SOCIETY 1737 N CLYDE MORRIS BLVD 140 DAYTONA BEACH FL 32137 131788491 501(C)(3) 7500 GENERAL SUPPORT CITY OF PALM COAST 305 PALM COAST PARKWAY EAST PALM COAST FL 32137 593614294 GOV'T 6500 GENERAL SUPPORT 5 0 PART I, LINE 2: GRANTS ARE GENERALLY MADE ONLY TO RELATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3), OR TO OTHER LOCAL CHARITABLE COMMUNITY ORGANIZATIONS, OR TO OTHER 501(C)(3) ORGANIZATIONS THAT ARE A PART OF THE GROUP EXEMPTION RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES. X X X X 1 1 0 1 0 0 0 0 0 0 0 DENNIS ALTER MD DIRECTOR 0 526676 0 437351 190 42911 0 14388 0 18744 190 1040070 0 0 ROBERT FULBRIGHT CHAIRMAN/DIR (BEG 12/15) 0 502587 0 128497 250 77720 0 89312 0 41880 250 839996 0 45916 TED HAMILTON MD DIRECTOR 0 423483 0 95683 190 244707 0 14388 0 38920 190 817181 0 0 LARS HOUMANN CHAIRMAN/DIR (END 12/15) 0 1021643 0 330238 0 594189 0 220082 0 49310 0 2215462 0 184069 SANDRA JOHNSON DIRECTOR 0 490343 0 141983 0 350319 0 68227 0 44571 0 1095443 0 35730 KENNETH MATTISON DIRECTOR/CEO 0 386494 0 96199 0 94441 0 51934 0 31578 0 660646 0 35213 EDWARD NOSEWORTHY DIRECTOR 0 355741 0 94049 0 187850 0 62375 0 30694 0 730709 0 39708 LEWIS SEIFERT DIRECTOR 0 542927 0 139865 0 125682 0 99475 0 45258 0 953207 0 76798 DEBORA THOMAS DIRECTOR 0 354709 0 89861 250 52368 0 34303 0 41975 250 573216 0 16533 DARYL TOL CHAIRMAN/DIRECTOR (END 12/15) 0 553084 0 158970 250 119591 0 84034 0 41854 250 957533 0 68547 JERMAINE BUCKNOR CFO 0 236887 0 31877 250 21086 0 14450 0 40519 250 344819 0 0 JOANNE KING COO 0 144035 0 20897 250 34590 0 10694 0 43926 250 254142 0 0 ROBERT DAVIS CNO 0 176655 0 19122 250 15682 0 10667 0 39376 250 261502 0 0 RONALD THOMAS MD CMO 0 303827 0 0 250 66959 0 14388 0 32370 250 417544 0 0 VENKATA THOTA MD PHYSICIAN 228607 0 191888 0 7635 0 14388 0 18788 0 461306 0 0 0 SATAR SHETH PHARMACIST 118153 0 14789 0 22535 0 7917 0 7927 0 171321 0 0 0 REMA COLE HOME HEALTH ADMINISTRATOR 130740 0 10084 0 8214 0 7437 0 18856 0 175331 0 0 0 MICHAEL DEBUSK DIRECTOR OF PHARMACY 127446 0 5000 0 5507 0 6367 0 11511 0 155831 0 0 0 GUY WARREN WAGNER PHARMACIST 112236 0 1488 0 20678 0 6831 0 18073 0 159306 0 0 0 DAVID OTTATI FORMER CEO 0 405112 0 87292 0 88440 0 64761 0 51419 0 697024 0 37856 VALERIE ZIESMER FORMER CFO 0 238189 0 34710 0 28646 0 25454 0 15212 0 342211 0 4181 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 ------------------------------------------------------- TED HAMILTON $ 64,802 $ 64,802 $127,649 $ 0 LARS HOUMANN $205,694 $200,461 $348,287 $ 0 SANDRA JOHNSON $ 71,840 $ 41,053 $268,423 $ 0 KENNETH MATTISON $ 55,546 $ 41,185 $ 6,802 $ 0 EDWARD NOSEWORTHY $ 47,988 $ 46,850 $121,715 $ 0 DAVID OTTATI $ 50,373 $ 44,912 $ 0 $ 0 LEWIS SEIFERT $ 85,088 $ 77,479 $ 0 $ 0 DARYL TOL $ 87,647 $ 72,079 $ 0 $ 0 DEBORA THOMAS $ 37,916 $ 16,540 $ 0 $ 0 RONALD THOMAS, MD $ 36,011 $ 36,011 $ 0 $ 0 VALERIE ZIESMER $ 29,067 $ 4,546 $ 0 $ 0 ROBERT FULBRIGHT $ 74,925 $ 45,943 $ 0 $ 0 JERMAINE BUCKNOR $ 10,945 $ 0 $ 0 $ 0 *INCLUDING INVESTMENT EARNINGS BILL TOL FAMILY OF BOARD MEMBER 89332 EMPLOYEE COMPENSATION 0 DENNIS ALTER MD PA DBA ALTER ORTH 100% OWNED BY BOARD MEMBER 208290 OFFICE SPACE LEASE 0 FORM 990, PART VI, SECTION A, LINE 2 DAVID FOWLER AND MICHAEL CHIUMENTO - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 MEMORIAL HOSPITAL - FLAGLER, INC. (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS MEMORIAL HEALTH SYSTEMS, INC. MEMORIAL HEALTH SYSTEMS, INC. (MHS) IS A FLORIDA, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE FILING ORGANIZATION IS MHS. THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION ARE APPOINTED BY THE SOLE MEMBER, MHS, WHO HAS THE RIGHT TO ELECT, APPOINT OR REMOVE ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B MHS, AS THE SOLE MEMBER OF THE FILING ORGANIZATION, HAS CERTAIN RESERVED POWERS AS SET FORTH IN THE BYLAWS OF THE FILING ORGANIZATION. THESE RESERVED POWERS INCLUDE THE FOLLOWING: A) TO APPROVE AND DISAPPROVE THE EXECUTIVE AND/OR ADMINISTRATIVE LEADERSHIP OF THE FILING ORGANIZATION, AND THEIR SALARIES; B) TO ADOPT, AMEND, RESTATE, AND REPEAL THE BYLAWS OF THE FILING ORGANIZATION; C) TO SET LIMITS AND TERMS FOR THE BORROWING OF FUNDS IN EXCESS OF AN ESTABLISHED AMOUNT; D) TO APPROVE OR DISAPPROVE MATERIAL CHANGES IN SERVICES OFFERED AND/OR PURCHASE OR SALE OF PERSONAL PROPERTY OR REAL PROPERTY EQUAL TO OR IN EXCESS OF AN ESTABLISHED AMOUNT; E) TO APPROVE OR DISAPPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION; F) TO DIRECT THE PLACEMENT OF FUNDS AND CAPITAL OF THE FILING ORGANIZATION; G) TO ESTABLISH GENERAL GUIDING POLICIES, TO IMPLEMENT QUALITY ASSESSMENT, IMPROVEMENT AND CASE MANAGEMENT; H) TO APPROVE THE APPOINTMENT OF AN AUDITING FIRM AND ELECTION OF THE FISCAL YEAR FOR THE FILING ORGANIZATION; AND I) TO ESTABLISH A PROCESS FOR ADDRESSING PATIENT GRIEVANCES. FORM 990, PART VI, SECTION B, LINE 11 THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND BY THE CFO PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND THE CFO DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTERESTS, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR ANY PRINCIPAL OFFICER OF THE FILING ORGANIZATION (I.E. INTERESTED PERSONS) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTERESTS POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES ARE NOT COMPENSATED BY THE FILING ORGANIZATION. SUCH INDIVIDUALS ARE COMPENSATED BY THE RELATED TOP-TIER PARENT ORGANIZATION OF THE FILING ORGANIZATION. PLEASE SEE THE DISCUSSION CONCERNING THE PROCESS FOLLOWED BY THE RELATED TOP-TIER PARENT ORGANIZATION IN DETERMINING EXECUTIVE COMPENSATION IN OUR RESPONSE TO SCHEDULE J, LINE 3. FORM 990, PART VI, SECTION C, LINE 19 THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). EACH YEAR, AHS PUBLISHES AN ANNUAL REPORT DOCUMENT THAT INCLUDES A FINANCIAL REPORT FOR THE RELEVANT YEAR AS WELL AS A COMMUNITY BENEFIT REPORT. THE FINANCIAL REPORT AND COMMUNITY BENEFIT REPORT ARE PRESENTED ON A CONSOLIDATED BASIS AND REPRESENT ALL OF THE ACTIVITIES, RESULTS OF OPERATIONS, AND FINANCIAL POSITION AT YEAR-END OF THE ENTIRE AHS SYSTEM. IN ADDITION, THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF AHS AND OF THE AHS "OBLIGATED GROUP" ARE FILED ANNUALLY WITH THE MUNICIPAL SECURITIES RULEMAKING BOARD (MSRB). THE "OBLIGATED GROUP" IS A GROUP OF AHSSHC SUBSIDIARIES THAT ARE JOINTLY AND SEVERALLY LIABLE UNDER A MASTER TRUST INDENTURE THAT SECURES DEBT PRIMARILY ISSUED ON A TAX-EXEMPT BASIS. UNAUDITED QUARTERLY FINANCIAL STATEMENTS PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) ARE ALSO FILED WITH MSRB FOR AHS ON A CONSOLIDATED BASIS AND FOR THE GROUPING OF AHS SUBSIDIARIES COMPRISING THE "OBLIGATED GROUP". THE FILING ORGANIZATION DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. PART VII, SECTION A FOR THOSE BOARD OF DIRECTOR MEMBERS 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 6,829,316. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,829,316. PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 1,226,803. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,226,803. PURCHASED MEDICAL SERVICES : PROGRAM SERVICE EXPENSES 19,234,191. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,234,191. ENVIRONMENTAL SERVICES : PROGRAM SERVICE EXPENSES 592,953. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 592,953. TRANSCRIPTION SERVICES : PROGRAM SERVICE EXPENSES 4,149. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,149. RECRUITING : PROGRAM SERVICE EXPENSES 146,623. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 146,623. FOOD SERVICE CONTRACTS : PROGRAM SERVICE EXPENSES 437,216. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 437,216. MISCELLANEOUS PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 7,700,906. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,700,906. AHS MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,907,663. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,907,663. BILLING & COLLECTION SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 817,246. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 817,246. EHR MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 98,210. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 98,210. FORM 990, PART XI, LINE 9: TRANSFER TO TAX-EXEMPT PARENT -1,472,274. DEBT ALLOCATION FROM PARENT -60,780. INTERNAL ALLOCATION OF SETTLEMENT -24,680,278. GIFTS 3,456. PART X, LINE 2 THE AMOUNTS SHOWN ON LINE 2 OF PART X OF THIS RETURN INCLUDE THE FILING ORGANIZATION'S INTEREST IN A CENTRAL INVESTMENT POOL MAINTAINED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, THE FILING ORGANIZATION'S TOP-TIER PARENT. THE INVESTMENTS IN THE CENTRAL INVESTMENT POOL ARE RECORDED AT MARKET VALUE. ADVENTIST BOLINGBROOK HOSPITAL 500 REMINGTON BLVD BOLINGBROOK IL 60440 651219504 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST MIDWEST HEALTH 1 ADVENTIST CARE CENTERS - COURTLAND INC 730 COURTLAND STREET ORLANDO FL 32804 205774723 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 1 ADVENTIST GLENOAKS HOSPITAL 701 WINTHROP AVENUE GLENDALE HEIGHTS IL 60139 363208390 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST MIDWEST HEALTH 1 ADVENTIST HLTH MID-AMERICA INC 9100 W 74TH STREET SHAWNEE MISSION KS 66204 521347407 SUPPORT OF AFFILIATED HOSPITAL KS 501(C)(3) LINE 11C, III-FI ADVENTIST HLTH SYSTEMSUNBELT INC 1 ADVENTIST HLTH PARTNERS INC 1000 REMINGTON BLVD STE 200 BOLINGBROOK IL 60440 364138353 OPERATE OUT-PATIENT PHYSICIAN CLINICS IL 501(C)(3) LINE 3 AHS MIDWEST MANAGEMENT INC 1 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 592170012 MANAGEMENT SERVICES FL 501(C)(3) LINE 11A, I N/A 0 ADVENTIST HLTH SYSTEM GEORGIA INC 1035 RED BUD ROAD CALHOUN GA 30701 581425000 OPERATION OF HOSPITAL & RELATED SERVICES GA 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 ADVENTIST HLTH SYSTEMSUNBELT INC 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 591479658 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 ADVENTIST HLTH SYSTEMTEXAS INC 11801 S FREEWAY BURLESON TX 36028 742578952 LEASING PERSONNEL TO AFFILIATED HOSPITAL TX 501(C)(3) LINE 11C, III-FI ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 ADVENTIST MIDWEST HEALTH 120 NORTH OAK STREET HINSDALE IL 60521 362276984 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 ADVENTIST UNIVERSITY OF HEALTH SCIENCES INC (630 YEAR END) 671 LAKE WINYAH DRIVE ORLANDO FL 32803 593069793 EDUCATION/OPERATION OF SCHOOL FL 501(C)(3) LINE 2 ADVENTIST HLTH SYSTEMSUNBELT INC 1 AHP SPECIALTY CARE NFP (1230-123115) 3040 SALT CREEK LANE ARLINGTON HEIGHTS IL 60005 811105774 OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES IL 501(C)(3) LINE 3 AHS MIDWEST MANAGEMENT INC 1 AHS MIDWEST MANAGEMENT INC 1000 REMINGTON BLVD STE 200 BOLINGBROOK IL 60440 363354567 OPERATION OF PHYSICIAN PRACTICE MGMT IL 501(C)(3) LINE 11A, I ADVENTIST MIDWEST HEALTH 1 AHSCENTRAL TEXAS INC 1301 WONDER WORLD DRIVE SAN MARCOS TX 78666 742621825 PROVIDE OFFICE SPACE - MEDICAL PROFESSIONALS TX 501(C)(3) LINE 11C, III-FI ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 APOPKA HLTH CARE PROPERTIES INC 305 E OAK STREET APOPKA FL 32703 510605694 LEASE TO RELATED ORGANIZATION GA 501(C)(3) LINE 11C, III-FI SUNBELT HLTH CARE CENTERS INC 1 BATTLE CREEK ADVENTIST HOSPITAL 1000 REMINGTON BLVD STE 200 BOLINGBROOK IL 60440 381359189 INACTIVE MI 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 BOLINGBROOK HOSPITAL FOUNDATION 1000 REMINGTON BLVD N ENTRANCE 2ND BOLINGBROOK IL 60440 900494445 FUND-RAISING FOR TAX-EXEMPT HOSPITAL IL 501(C)(3) LINE 7 MIDWEST HLTH FOUNDATION 0 BRADFORD HEIGHTS HLTH & REHAB CENTER INC 950 HIGHPOINT DRIVE HOPKINSVILLE KY 42240 205782342 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY KY 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 1 BURLESON NURSING & REHAB CENTER INC 301 HUGULEY BLVD BURLESON TX 76028 205782243 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY TX 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 1 CALDWELL HLTH CARE PROPERTIES INC 1333 WEST MAIN PRINCETON KY 42445 510605680 LEASE TO RELATED ORGANIZATION GA 501(C)(3) LINE 11C, III-FI SUNBELT HLTH CARE CENTERS INC 1 CENTRAL TEXAS HLTHCARE COLLABORATIVE 1301 WONDER WORLD DRIVE SAN MARCOS TX 78666 453739929 SUPPORT OPERATION OF HOSPITAL TX 501(C)(3) LINE 11A, I ADVENTIST HLTH SYSTEMSUNBELT INC 1 CHICKASAW HLTH CARE PROPERTIES INC 250 S CHICKASAW TRAIL ORLANDO FL 32825 510605681 LEASE TO RELATED ORGANIZATION GA 501(C)(3) LINE 11C, III-FI SUNBELT HLTH CARE CENTERS INC 1 CHIPPEWA VALLEY HOSPITAL & OAKVIEW CARE CENTER INC 1220 THIRD AVENUE WEST DURAND WI 54736 391365168 OPERATION OF HOSPITAL & RELATED SERVICES WI 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 COBB MEDICAL ASSOCIATES LLC (11-122315) 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 582617089 INACTIVE GA 501(C)(3) LINE 3 EMORY-ADVENTIST INC 1 COURTLAND HLTH CARE PROPERTIES INC 730 COURTLAND STREET ORLANDO FL 32804 510605682 LEASE TO RELATED ORGANIZATION GA 501(C)(3) LINE 11C, III-FI SUNBELT HLTH CARE CENTERS INC 1 CREEKWOOD PLACE NURSING & REHAB CENTER INC 107 BOYLES DRIVE RUSSELLVILLE KY 42276 205782260 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY KY 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 1 DAIRY ROAD HLTH CARE PROPERTIES INC 7350 DAIRY ROAD ZEPHYRHILLS FL 33540 510605684 LEASE TO RELATED ORGANIZATION GA 501(C)(3) LINE 11C, III-FI SUNBELT HLTH CARE CENTERS INC 1 EAST ORLANDO HLTH & REHAB CENTER INC 250 S CHICKASAW TRAIL ORLANDO FL 32825 205774748 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 1 EMORY-ADVENTIST INC 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 582171011 INACTIVE GA 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 FLETCHER HOSPITAL INC 100 HOSPITAL DRIVE HENDERSONVILLE NC 28792 560543246 OPERATION OF HOSPITAL & RELATED SVCS NC 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 FLNC INC 3355 E SEMORAN BLVD APOPKA FL 32703 205774761 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 1 FLORIDA HOSPITAL HEALTHCARE PARTNERS INC 770 WEST GRANADA BLVD 101 ORMOND BEACH FL 32174 462354804 OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 FLORIDA HOSPITAL MEDICAL GROUP INC 2600 WESTHALL LN MAITLAND FL 32751 593214635 OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 FLORIDA HOSPITAL PHYSICIAN GROUP INC 2700 HEALING WAY WESLEY CHAPEL FL 33545 462021581 OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 FLORIDA HOSPITAL WATERMAN INC 1000 WATERMAN WAY TAVARES FL 32778 593140669 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 FLORIDA HOSPITAL ZEPHYRHILLS INC 7050 GALL BLVD ZEPHYRHILLS FL 33541 592108057 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 FOUNDATION FOR SHAWNEE MISSION MEDICAL CENTER INC 9100 W 74TH STREET SHAWNEE MISSION KS 66204 480868859 FUND-RAISING FOR TAX-EXEMPT HOSPITAL KS 501(C)(3) LINE 11A, I SHAWNEE MISSION MEDICAL CENTER INC 1 FOUNTAIN INN NURSING & REHAB CENTER INC 485 NORTH KELLER ROAD 250 MAITLAND FL 32751 472180518 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 1 GLENOAKS HOSPITAL FOUNDATION 701 WINTHROP AVENUE GLENDALE HEIGHTS IL 60139 363926044 FUND-RAISING FOR TAX-EXEMPT HOSPITAL IL 501(C)(3) LINE 7 MIDWEST HLTH FOUNDATION 0 HELEN ELLIS MEMORIAL HOSPITAL AUXILIARY INC 1395 S PINELLAS AVE TARPON SPRINGS FL 34689 592106043 FUND-RAISING FOR TAX-EXEMPT HOSPITAL/FOUNDATION FL 501(C)(3) LINE 11C, III-FI 0 HELEN ELLIS MEMORIAL HOSPITAL FOUNDATION INC 1395 S PINELLAS AVE TARPON SPRINGS FL 34689 593690149 FUND-RAISING FOR TAX-EXEMPT HOSPITAL FL 501(C)(3) LINE 7 TARPON SPRINGS HOSPITAL FOUNDATION INC 0 HINSDALE HOSPITAL FOUNDATION 7 SALT CREEK LANE SUITE 203 HINSDALE IL 60521 521466387 FUND-RAISING FOR TAX-EXEMPT HOSPITAL IL 501(C)(3) LINE 7 MIDWEST HLTH FOUNDATION 0 HOSPICE OF THE COMFORTER INC 480 W CENTRAL PARKWAY ALTAMONTE SPRINGS FL 32714 592935928 OPERATION OF HOSPICE FL 501(C)(3) LINE 9 THE COMFORTER HEALTH CARE GROUP INC 1 HOSPICE OF THE COMFORTER FOUNDATION INC 480 W CENTRAL PARKWAY ALTAMONTE SPRINGS FL 32714 271858033 FUND RAISING FOR AFFILIATED TAX-EXEMPT HOSPICE FL 501(C)(3) LINE 7 THE COMFORTER HEALTH CARE GROUP INC 1 IN-MOTION REHAB INC 485 NORTH KELLER ROAD 250 MAITLAND FL 32751 208023411 THERAPY SERVICES TO TAX EXEMPT NURSING HOMES KS 501(C)(3) LINE 11B, II SUNBELT HLTH CARE CENTERS INC 1 JELLICO COMMUNITY HOSPITAL INC (11-43015) 188 HOSPITAL LANE JELLICO TN 37762 620924706 OPERATION OF HOSPITAL & RELATED SERVICES TN 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 LA GRANGE MEMORIAL HOSPITAL FOUNDATION 5101 S WILLOW SPRINGS RD LA GRANGE IL 60525 300247776 FUND-RAISING FOR TAX-EXEMPT HOSPITAL IL 501(C)(3) LINE 7 MIDWEST HLTH FOUNDATION 0 MEMORIAL HLTH SYSTEMS FOUNDATION INC 770 WEST GRANADA BLVD ORMOND BEACH FL 32174 311771522 FUND-RAISING FOR TAX-EXEMPT HOSPITAL FL 501(C)(3) LINE 7 0 MEMORIAL HLTH SYSTEMS INC 301 MEMORIAL MEDICAL PARKWAY DAYTONA BEACH FL 32117 590973502 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 MEMORIAL HOSPITAL - WEST VOLUSIA INC 701 WEST PLYMOUTH AVENUE DELAND FL 32720 593256803 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 MEMORIAL HLTH SYSTEMS INC 1 MEMORIAL HOSPITAL FLAGLER INC 60 MEMORIAL MEDICAL PARKWAY PALM COAST FL 32164 592951990 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 MEMORIAL HLTH SYSTEMS INC 1 MEMORIAL HOSPITAL INC 210 MARIE LANGDON DRIVE MANCHESTER KY 40962 610594620 OPERATION OF HOSPITAL & RELATED SERVICES KY 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 MERRIAM HLTH CARE PROPERTIES INC 9700 WEST 62ND STREET MERRIAM KS 66203 364595806 LEASE TO RELATED ORGANIZATION KS 501(C)(3) LINE 11C, III-FI SUNBELT HLTH CARE CENTERS INC 1 METROPLEX ADVENTIST HOSPITAL INC 2201 S CLEAR CREEK ROAD KILLEEN TX 76549 742225672 OPERATION OF HOSPITAL & RELATED SERVICES TX 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 METROPLEX CLINIC PHYSICIANS INC 2201 S CLEAR CREEK ROAD KILLEEN TX 76549 113762050 PHYSICIAN HLTHCARE SERVICES TO THE COMMUNITY TX 501(C)(3) LINE 3 METROPLEX ADVENTIST HOSPITAL INC 1 METROPLEX HOSPITAL INC (11-6815) 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 461256516 INACTIVE FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 MIDWEST HLTH FOUNDATION 120 NORTH OAK STREET HINSDALE IL 60521 352230515 SUPPORT OF SUBSIDIARY FOUNDATIONS IL 501(C)(3) LINE 11B, II N/A 0 MILLS HLTH & REHAB CENTER INC 500 BECK LANE MAYFIELD KY 42066 205782320 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY KY 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 1 MISSION STRATEGIES OF GEORGIA INC 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 900866024 PROVISION OF SUPPORT TO THE NURSING HOME DIVISION GA 501(C)(3) LINE 11B, II SUNBELT HLTH CARE CENTERS INC 1 MISSOURI ADVENTIST HLTH INC 9100 W 74TH STREET SHAWNEE MISSION KS 66204 431224729 SUPPORT HLTH CARE SERVICES MO 501(C)(3) LINE 11D, III-O ADVENTIST HLTH MID-AMERICA INC 1 NORTH REGIONAL EMS INC (11-41615) 188 HOSPITAL LANE JELLICO TN 37762 262653616 EMS SERVICES TN 501(C)(3) LINE 9 JELLICO COMMUNITY HOSPITAL INC 1 ORMOND BEACH MEMORIAL HOSPITAL AUXILIARY INC 301 MEMORIAL MEDICAL PARKWAY DAYTONA BEACH FL 32117 591721962 VOLUNTEER SUPPORT SERVICES FL 501(C)(3) LINE 11C, III-FI 0 OVERLAND PARK NURSING & REHAB CENTER INC 6501 WEST 75TH STREET OVERLAND PARK KS 66204 205774821 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY KS 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 1 PARAGON HLTH CARE PROPERTIES INC 950 HIGHPOINT DRIVE HOPKINSVILLE KY 42240 510605686 LEASE TO RELATED ORGANIZATION GA 501(C)(3) LINE 11C, III-FI SUNBELT HLTH CARE CENTERS INC 1 PASCO-PINELLAS HILLSBOROUGH COMMUNITY HLTH SYSTEM INC 2600 BRUCE B DOWNS BLVD WESLEY CHAPEL FL 33544 208488713 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 PORTERCARE ADVENTIST HLTH SYSTEM (630 YEAR END) 2525 S DOWNING STREET DENVER CO 80210 840438224 OPERATION OF HOSPITAL & RELATED SERVICES CO 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 PRINCETON HLTH & REHAB CENTER INC 1333 WEST MAIN PRINCETON KY 42445 205782272 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY KY 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 1 PRINCETON PROFESSIONAL SERVICES INC 601 E ROLLINS STREET ORLANDO FL 32803 591191045 PROVISION OF HLTHCARE SERVICES FL 501(C)(3) LINE 9 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 QUALITY CIRCLE FOR HLTHCARE INC 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 263789368 HLTHCARE QUALITY SERVICES FL 501(C)(3) LINE 11A, I ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 RESOURCE PERSONNEL INC 485 NORTH KELLER ROAD 250 MAITLAND FL 32751 208040875 PROVIDE ADMINISTRATIVE SUPPORT TO TAX EXEMPT NURSING HOMES FL 501(C)(3) LINE 11B, II SUNBELT HLTH CARE CENTERS INC 1 ROCKY MOUNTAIN ADVENTIST HLTHCARE FOUNDATION (630 YEAR END) 7995 E PRENTICE AVE 204 GREENWOOD VILLAGE CO 80111 840745018 FUND-RAISING FOR TAX-EXEMPT HOSPITAL CO 501(C)(3) LINE 7 0 ROLLINS BROOK COMMUNITY CARE CORP 2201 S CLEAR CREEK ROAD KILLEEN TX 76549 461656773 INACTIVE TX 501(C)(3) LINE 11A, I ADVENTIST HLTH SYSTEMSUNBELT INC 1 RUSSELLVILLE HLTH CARE PROPERTIES INC 683 EAST THIRD STREET RUSSELLVILLE KY 42276 510605691 LEASE TO RELATED ORGANIZATION GA 501(C)(3) LINE 11C, III-FI SUNBELT HLTH CARE CENTERS INC 1 SAN MARCOS HLTH CARE PROPERTIES INC 1900 MEDICAL PARKWAY SAN MARCOS TX 78666 510605693 LEASE TO RELATED ORGANIZATION GA 501(C)(3) LINE 11C, III-FI SUNBELT HLTH CARE CENTERS INC 1 SAN MARCOS NURSING & REHAB CENTER INC 1900 MEDICAL PARKWAY SAN MARCOS TX 78666 205782224 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY TX 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 1 SHAWNEE MISSION HLTH CARE INC 6501 WEST 75TH STREET OVERLAND PARK KS 66204 480952508 LEASE TO RELATED ORGANIZATION KS 501(C)(3) LINE 11C, III-FI SUNBELT HLTH CARE CENTERS INC 1 SHAWNEE MISSION MEDICAL CENTER INC 9100 W 74TH STREET SHAWNEE MISSION KS 66204 480637331 OPERATION OF HOSPITAL & RELATED SERVICES KS 501(C)(3) LINE 3 ADVENTIST HLTH MID-AMERICA INC 1 SOUTH CENTRAL INC 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 593689740 MANAGEMENT SUPPORT GA 501(C)(3) LINE 11C, III-FI N/A 0 SOUTH PASCO HLTH CARE PROPERTIES INC 38250 A AVENUE ZEPHYRHILLS FL 33542 510605679 LEASE TO RELATED ORGANIZATION GA 501(C)(3) LINE 11C, III-FI SUNBELT HLTH CARE CENTERS INC 1 SOUTHEAST VOLUSIA HEALTHCARE CORP (421-123115) 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 473793197 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 SOUTHWEST VOLUSIA HLTH SERVICES INC 1055 SAXON BLVD ORANGE CITY FL 32763 593281591 MEDICAL OFFICE BUILDING FOR HOSPITAL FL 501(C)(3) LINE 11A, I SOUTHWEST VOLUSIA HLTHCARE CORP 1 SOUTHWEST VOLUSIA HLTHCARE CORP 1055 SAXON BLVD ORANGE CITY FL 32763 593149293 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 SPECIALTY PHYSICIANS OF CENTRAL TEXAS INC 1301 WONDER WORLD DRIVE SAN MARCOS TX 78666 208814408 PHYSICIAN HLTHCARE SERVICES TO THE COMMUNITY TX 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 SPRING VIEW HLTH & REHAB CENTER INC 718 GOODWIN LANE LEITCHFIELD KY 42754 205782288 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY KY 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 1 SUNBELT HLTH & REHAB CENTER - APOPKA INC 305 EAST OAK STREET APOPKA FL 32703 205774856 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 1 SUNBELT HLTH CARE CENTERS INC 485 NORTH KELLER ROAD 250 MAITLAND FL 32751 581473135 MANAGEMENT SERVICES TN 501(C)(3) LINE 11B, II ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 SUNSYSTEM DEVELOPMENT CORP 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 592219301 FUND RAISING FOR AFFILIATED TAX-EXEMPT HOSPITALS FL 501(C)(3) LINE 7 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 TAKOMA REGIONAL HOSPITAL INC (630 YEAR END) 401 TAKOMA AVE GREENEVILLE TN 37743 510603966 OPERATION OF HOSPITAL & RELATED SERVICES TN 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 TAKOMA REGIONAL HOSPITAL FOUNDATION INC 401 TAKOMA AVE GREENEVILLE TN 37743 471334302 FUND RAISING FOR AFFILIATED TAX-EXEMPT HOSPITAL TN 501(C)(3) LINE 7 TAKOMA REGIONAL HOSPITAL INC 1 TARPON SPRINGS HOSPITAL 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