2014-08-13T08:19:03-05:00 2013-09-30 420714325 MCGLADREY LLP 1 SWACKER DRIVE STE 800 CHICAGO IL 60606 990 2012-10-01 592477479 Cape Canaveral Hospital Inc CAPE 3214345150 3300 Fiske Blvd Rockledge FL 329554305 Joseph G Felkner 3214345150 2014-07-28 1 Wayne Harder P00294296 3126343400 2012 2015-11-30 17:44:51Z Steven P Johnson 3300 Fiske Blvd Rockledge FL 329554305 107651408 0 X WWW.HEALTH-FIRST.ORG X 1984 FL Our team positively changing the health and well-being of you and your family through excellent and compassionate health care.Cape Canaveral Hospital is a full-service, not-for-profit hospital with services including a 21-bed level II emergency department, a certified baby-friendly mother/baby unit, fully equipped surgical services, a state-of-the-art cancer program and a full-service laboratory. 19 17 0 623 69921 -85649 170500 51188 108176841 106736870 48338 -38646 1036848 822743 109432527 107572155 4887276 23229 0 0 55301918 54688236 0 0 0 45544694 43170798 105733888 97882263 3698639 9689892 155087950 159736167 82864809 82704118 72223141 77032049 X Our team positively changing the health and well-being of you and your family through excellent and compassionate health care. 0 0 82941579 23229 106666949 Cape Canaveral Hospital, Inc. (CCH ) features 150 beds and has 279 highly skilled medical staff members. The women's diagnostic center features state-of-the-art, personalized services including digital mammography, ultrasound, stereotactic breast biopsy, and MRI breast imaging and is accredited by theAmerican College of Radiology and the US Food and Drug Administration. The facility also operates a 7 suite operating room and 2 suite cath lab available for both inpatient and outpatient procedures.Additionally, Cape Canaveral Hospital includes a 21-bed Level II emergency department and an adjoining six-story medical plaza that includes physician's offices, a conference center, pre-operative testing, outpatient registration for laboratory testing and same-day surgery, as well as a health resource center for the community. Cape Canaveral Hospital provides quality medical healthcare regardless of race, creed, gender, national origin, handicap, age or ability to pay, although reimbursement for services rendered is critical to the operation and stability of Cape Canaveral Hospital, Inc.It is recognized that not all individuals possess the ability to purchase essential medical services and further, that our mission is to serve the community with respect to providing healthcare services and health care education such as "Healthy Happenings" seminars and support groups for the public.In keeping with this hospital's commitment to serve all members of its community,1) Free care and/or subsidized care is provided where the need and/or inability to pay exists.2) Care is provided at below cost to persons covered by governmental programs.3) Free healthcare activities and programs are provided to the community. These activities include: wellness programs, community education programs, special programs for elderly, handicapped, and mentally underserved along with a variety of broad community support activities.See our Health First Community Benefit video @www.health-first.org/cr2013 82941579 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X 19 17 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Joseph G Felkner 3214345150 3300 Fiske Blvd Rockledge FL 32955 James C Shaw 1.00 3.00 X X 0 9110 27650 Catherine A Ford 1.00 3.00 X X 0 10640 16050 Eugene S Cavallucci Esq 1.00 3.00 X X 0 6313 19850 Kevin B Steele 1.00 4.00 X X 0 0 22800 Robert R Wright 13.00 28.00 X X 0 521533 26132 Nicholas E Pellegrino 1.00 3.00 X 0 1487 15300 A Thomas Hollingsworth PhD 1.00 3.00 X 0 10552 15150 Brian J Bussen 1.00 3.00 X 0 9110 14300 James Dwight 1.00 3.00 X 0 0 0 Cathy Eddy 1.00 3.00 X 0 0 0 Pamela A Gatto 1.00 3.00 X 0 4804 9150 Donald F Hagen MD 1.00 3.00 X 0 0 10000 Martin W Isenman MD 1.00 3.00 X 0 0 0 Richard McNeight 1.00 3.00 X 0 0 0 Frances Pickett 1.00 3.00 X 0 0 0 William C Potter Esq 1.00 3.00 X 0 1000 20550 Kevin S Pruett 1.00 3.00 X 0 800 15200 Bryan R Roub 1.00 3.00 X 0 0 10000 Steven P Johnson 1.00 44.00 X X 0 1320804 13203 Robert Bashore MD 1.00 0.00 X 0 0 0 Todd F Bibens 40.00 0.00 X 0 154098 12161 Rodney R Moore 40.00 0.00 X 0 357509 7603 Wesley C Ott 40.00 0.00 X 0 172781 20716 Ronald C McGrier Jr 40.00 0.00 X 0 148091 8994 Tracy L Lott Longobardi 40.00 0.00 X 0 139149 18761 Tony Hernandez III Esq 1.00 1.00 X 0 18830 4950 Judith A George 1.00 2.00 X 0 76519 1150 James E Carter MD 1.00 1.00 X 0 66643 54800 George W Lewis 1.00 1.00 X 0 68713 6750 Alphonse Pecoraro Jr MD 1.00 0.00 X 0 356566 17851 0 3455052 389071 0 1 1 0 Health First Inc 3300 Fiske Blvd Rockledge FL 32955 Management Support 84683896 Holmes Regional Medical Center Inc 3300 Fiske Blvd Rockledge FL 32955 Hospital Services 865859 Cape Health Properties Inc 3300 Fiske Blvd Rockledge FL 32955 Real Estate Services 149628 3 51188 51188 Patient Services 621110 74774689 74774689 Medicare/Medicaid 621110 31805805 31805805 Reference Lab 621500 69921 69921 Medical Monitoring 900099 65815 65815 Related Company Rent 531120 20640 20640 106736870 40607 40607 324 0 324 324 324 79253 -79253 -79253 -79253 Cafeteria 722210 641672 641672 180747 180747 822419 107572155 106666949 69921 784097 23229 23229 702758 702758 40794355 37328908 3465447 874235 836011 38224 8977697 7262627 1715070 3339191 2984702 354489 883848 883848 107136 107136 854 854 6095638 4437551 1658087 140011 7684 132327 1120124 881200 238924 1846149 14746 1831403 2116202 1976229 139973 322175 304394 17781 20023 7471 12552 3597500 3542664 54836 7594472 5640227 1954245 797018 797018 Medical Supplies 12618012 12606471 11541 Maintenance & Repair 2426115 2269611 156504 Florida Indigent Tax 1223284 1223284 0 Licenses & Taxes 75412 30605 44807 2186825 1563965 622860 97882263 82941579 14940684 0 59193698 65450734 9507647 10967934 218125 1386958 2320511 2990048 328325 310621 165959942 116422011 53745266 49537931 27985910 28155765 576875 617517 1211593 318659 155087950 159736167 6276356 4910470 37306293 15072940 39282160 62720708 82864809 82704118 X 71089984 75819600 1133157 1212449 72223141 77032049 155087950 159736167 X 9689892 -4880984 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 71173 71173 87458817 46926627 40532190 865174 723267 141907 77440431 68772117 8668314 124347 124347 49537931 Demand Note - Health First Inc. 20762347 C Demand Note - Health First Foundation 719672 C Other Temporarily Restricted Net Assets 1212449 C Investment In Joint Ventures - Coastal Health 2167884 C Investment In Joint Affiliates - Cape Health Properties 3293413 C 28155765 Other Current Liabilities 7903677 Intercompany Payable 6764342 Other Noncurrent Liabilities 1952624 Tax-exempt bonds held by Health First, Inc. 46100065 62720708 X Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: FIN 48 footnote: The Company is exempt from Federal and State income taxes under section 501(a), as an organization described in section 501(c)(3), of the Internal Revenue Code and Section 220.13 of the Florida Statutes, respectively. Accordingly, no provision for income taxes is made in the accompanying Financial Statements. ASC Topic 740, Income Taxes, prescribes the accounting for uncertainty in income tax positions recognized in financial statements. ASC Topic 740 provides guidance for recognition threshold and measurement attributes for the Financial Statement recognition and measurement of a tax position taken or expected to be taken in a tax return. 1 1 X 1 X 0 1 1 1 0 1 1 4963990 1382423 3581567 0.03660 9374259 4723857 4650402 0.04750 1223284 1223284 0.01250 15561533 6106280 9455253 0.09660 5434 5434 0.00010 429266 429266 0.00440 517475 27860 489615 0.00500 0.00000 23229 23229 0.00020 975404 27860 947544 0.00970 16536937 6134140 10402797 0.10630 1 1829239 876737 27081948 31819331 -4737383 X 1 1 1 1 Cape Canaveral Hospital

701 W Cocoa Beach Cswy Cocoa Beach FL 32931

X X X Acute Care Hospital Cape Canaveral Hospital 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X 0 0 1 1 200.000000000000 0 0 1 1 X X X 1 0 X X 1 X 0 0 2 Health First Aging Institute

701 W Cocoa Beach Cswy Cocoa Beach FL 32931

Elder Care Health First Home Care

701 W Cocoa Beach Cswy Cocoa Beach FL 32931

In-Home Care Part I, Line 3c: Health First does make provision for providing discounted care to low income individuals through processes and formularies which include consideration of individuals incomes in comparison to FPG. Discounts range from expected token payments (such as $100) to a 60% discount of billed charges. Part I, Line 6a: The Community Benefit Report is prepared by Health First, Inc. the parent company to the organization. The community benefits of this organization are included within that report. Part I, Line 7: The organization calculated the cost amounts noted in part I, line 7 by utilizing its current cost accounting system. The cost accounting system addresses all patient segments reported on, including, but not limited to inpatient, outpatient, Medicaid, uninsured, and Medicare. Part II: Community building activities are primarily subsidized by Health First, Inc. (parent) and therefore are not reported at each individual hospital. The needs identified are, in part, based on the community needs assessment. Health First, Inc. utilized hours of paid physicians and nurses to support the community while on payroll. In addition, an amount in excess of $1.5M was contributed to various local organizations primarily supporting the various community public health needs. Health First, Inc. also supported the economic development needs, provided other community support, participated in environmental improvements, coalition building projects, supported a community health improvement advocacy, and supported the local workforce development program. Health First, Inc. and its employees also actively support the local United Way in excess of $195k. Part III, Line 4: Bad Debt at cost is calculated by multiplying actual bad debt write-offs by the filing organization's cost-to-charge ratio.The organization used a cost to charge ratio to determine the cost amount of the bad debt expense. Worksheet 2, ratio of patient care cost to charges, as provided in the IRS instructions was used to validate the cost to charge ratio which approximates internal cost calculation.The organization provides uninsured accounts with a discount for prompt payment. The discount is not collected, nor pursued, and therefore not included in net patient revenue. The remaining balance is pursued, and if not collected, reported as a bad debt expense.The organization does not issue a standalone financial statement; however, it is included as a part of the Health First, Inc. consolidated financial statements. The footnote from the Health First, Inc. consolidated financial statements is as follows: The provision for bad debts and allowance for uncollectible accounts are based upon management's assessment of historical and expected net collections and historical write-off experience by payor and aging category, considering the business and economic conditions, trends in health care coverage, and other collection indicators. Accounts written off as uncollectible are deducted from the allowance and subsequent recoveries are added.The method the organization used to determine the amount that could be attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy if sufficient information had been available to make a determination of their eligibility is based on a collection scoring system. The scoring system attributed a recover score to each patient. it was then determined that patients below a certain score would typically qualify for charity care if they were to provide sufficient information. Part III, Line 8: The organization derived its costing methodology used to determine the Medicare allowable costs reported in the organization's Medicare cost report by using cost report worksheets. Medicare costs are determined through the Medicare cost finding process which allocates general service center costs to revenue departments. Routine and ICU costs are determined based on an average cost per day multiplied by the number of Medicare allowable days. Medicare ancillary costs are determined by the ratio of department costs to department charges then the resulting % is applied to Medicare allowable charges. The methodology described in the instructions to Schedule H, Part III, Section B, Line 6 does not take into account all costs incurred by the hospital and does not represent the total community benefit conferred in this area. The reasons Medicare shortfall should be treated as community benefit are: absent the Medicare program, it is likely many of the individuals would qualify for financial assistance or other needs-based government programs; by accepting payment below cost to treat these individuals, the burdens of government are relieved with respect to these individuals; there is a significant possibility that continued reduction in reimbursement may actually create difficulties in access for these individuals; and the amount spent to cover Medicare shortfall is money not available to cover financial assistance and other community benefit needs. Part III, Line 9b: The organization applies the following procedures in its collection practices for those who may qualify for financial assistance:1. Patients or guarantors desiring to apply for financial assistance will be required to complete a Health First financial assistance application. the application process may begin at pre-admission or at any time thereafter. For financial assistance approval on elective procedures, please refer to policy addendum below.2. Income guidelines for qualification for financial assistance will be based on the federal poverty guideline as furnished annually by the department of HRS.3. AHCA guidelines and documentation requirements will be used in establishing qualification for financial assistance. This documentation may include, but not be limited to, the following:a. Completed and signed financial assistance applicationb. Proof of household incomec. Credit bureau report and/or asset check4. Patients who are eligible for Medicaid will not be required to complete a financial assistance application.5. The financial assistance application and supporting documentation will be reviewed for propriety when determining eligibility for financial assistance.6. A notification letter will be sent to the guarantor or patient to communicate eligibility for financial assistance or denial.7. Patients who do not provide information necessary to completely and accurately assess their financial situation and/or who do not cooperate with efforts to secure other third party coverage will not be eligible for financial assistance.8. Patients who are uninsured and do not qualify for full or partial financial assistance will be eligible for Health First's prompt pay discount for self pay patients (PBS 5.12).9. All approved financial assistance applications will be valid for a period of 90 days. Approved tumor clinic applications are valid for a period of one year. Part III, Section A, Line 1:The filing organization reports bad debt in accordance with Generally Accepted Accounting Principles (GAAP). Healthcare Financial Management Association Statement 15 is followed to the extent that it aligns with the guidelines set forth by GAAP. Cape Canaveral Hospital Part V, Section B, Line 3: The Health Council of East Central Florida held phone interviews with the following persons who represent the community:Lisa Gurri, Brevard Health AllianceJennifer Floyd, Healthy Start Coalition of Brevard County, Inc.Christine Michaels, Melbourne/Palm Bay Chamber of CommerceHoward Tipton, Brevard County Manager's OfficeAra Deumedjian, MD, Brevard Medical SocietyDr. Kristi Van Sickle, FitDr. Jenny Gessler, Women's CenterLisa Rice, Brevard WorkforceKristin Bakke, Lead BrevardCindy Kane, Corporate Relations, Harris Corp.Shawna Kelsch, Reduce Obesity in Central Florida KidsKay Heimmer, Prevent! of BrevardIan Golden, Brevard County Housing & Human ServicesMaria Stahl, Brevard Co. Health DepartmentDr. Lana Saal, Brevard Public SchoolsJohnette Gindling, Space Coast Health FoundationPaul Ringenberger, Space Coast Volunteers in MedicineDr. John McPherson, Fire Rescue Medical DirectorDr. Rochelle Jones, The Coalition of the Hungry & Homeless of Brevard County, Inc.Teresa Miles, Children's Home SocietyRob Rains, United Way of Brevard Cape Canaveral Hospital Part V, Section B, Line 4: Holmes Regional Medical Center, Palm Bay Hospital, Viera Hospital Cape Canaveral Hospital Part V, Section B, Line 7: Cancer - Due to existing cancer programs at Health First including Health First Holmes Regional Medical Center, Health First Cape Canaveral Hospital, Hospice of Health First, and Health First Cancer Care Medical Group. Coronary Heart disease - Due to risk factors of high blood pressure, high cholesterol and diabetes are same as those associated with cerebrovascular disease and cardiovascular disease and will be addressed in those implementation strategies.Binge drinking, youth substance abuse & youth cigarette smoking - These are being addressed through efforts of several community partners including Circles of Care, Brevard Tobacco Initiative, and Prevent! of Brevard. Cape Canaveral Hospital Part V, Section B, Line 11: Health First does make provision for providing discounted care to low income individuals through processes and formularies which include consideration of individuals incomes in comparison to FPG. Discounts range from expected token payments (such as $100) to a 60% discount of billed charges. Cape Canaveral Hospital Part V, Section B, Line 14g: Signage is posted in the emergency room, waiting rooms, & admissions, that the financial assistance policy is available upon request. Cape Canaveral Hospital Part V, Section B, Line 20d: Individuals that do not have insurance are eligible for a 60% prompt pay discount. This discount is approximately the average negotiated commercial insurance rate for those services at the hospital facility. Part VI, Line 2: Health First, Inc. (parent), on behalf of its member hospital organizations, partners with the Health Council of East Central Florida in assessing the health care needs of our community. The most recent community needs assessment report is available at http://www.cflhealthymeasures.org Part VI, Line 3: It is the policy of Health First to grant financial assistance to eligible individuals who are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay for health care services due to their limited financial resources. It is also the Health First policy to provide, without discrimination, care for emergency medical conditions (as defined by federal law known as "EMTALA") to individuals regardless of their eligibility for financial assistance under this policy.Information about Health First's financial assistance program shall bemade available to patients and guarantors by various means, including thepublication of notices in patient bills and by posting notices in theemergency and admitting departments, and at other public places the HealthFirst facility may elect. Written summary information describing thepolicy along with financial assistance contact information will be madeavailable to each patient in all emergency and admitting departments. Thepolicy will also be posted on the Health First website. Such informationshall be provided in the primary language spoken by the general populations served by the Health First facility.Any Health First associate or member of the medical staff may referpatients for financial assistance. a patient or a family member, closefriend or associate of the patient may also make a request for financialassistance on behalf of the patient. Part VI, Line 4: Brevard County, also known as the Space Coast, stretches over 70 miles along the Atlantic coast. Best known as the location of the Kennedy Space Center, the "Space Coast" is also home to Port Canaveral, the world's busiest passenger cruise port. The county is unofficially divided into three sections, North County, comprising Titusville, Mims, and Port St. John; Central Brevard, which includes Viera, Cocoa, Rockledge, Merritt Island, and Cocoa Beach; and South County, which includes Melbourne, Palm Bay, Grant, Valkaria and the South Beaches which stretch to the line between Brevard and Indian River Counties. According to July 2013 US census data, the population of Brevard County was 543,376 in 2010 and has grown to an estimated population of 550,823 in 2013. The county is over 84% white, 11% African American, and 5% other races. Hispanics/Latinos comprise 9%.The average household size is 2.43 persons. The population distribution is as follows: 19% under the age of 18, 59% from ages 18 to 64, and 22% who are 65 years of age or older. The median age is 45 years. In 2012, 12.5% of the residents live in poverty compared with 15.6% statewide. There were 17.36% receiving SNAP benefits in 2012. According to the U.S. Bureau of Labor Statistics, the unemployment rate was 6.9% in November 2013. Statistics reveal that 90% of Brevard County residents have a high school diploma, compared with 86% statewide.The economy in Brevard County has taken a hit in recent years as has theeconomy in Florida. In 2010, the brooking institution reported thatBrevard County ranked in the bottom fifth of the nation's top metro areasbased on unemployment, gross metropolitan product, housing prices andforeclosed properties. There are seven acute care hospitals serving patients in Brevard County:Parrish Medical Center located in North County; Cape Canaveral Hospital,Viera Hospital and Wuesthoff Rockledge in Central County; and HolmesRegional Medical Center, Wuesthoff Melbourne and Palm Bay Hospital inSouth County. Part VI, Line 5: The governing body of Cape Canaveral Hospital, Inc. is comprised of persons who primarily reside in the organization's primary service area and are neither employees nor contractors nor family membersof the organization nor its key employees.The organization extends medical staff privileges to all qualifiedphysicians in its community for some or all of its departments.The organization does apply resources throughout the year to supportimprovements in patient care, medical education and training. The organization spent more than $420k to support local students via training, education, and scholarship.The emergency department at Cape Canaveral Hospital, Inc. had more than27,000 visits during the year regardless of ability to pay. In additionthe organization participates in several government sponsored health careprograms, including, but not limited to, Medicare, Medicaid, Champus, andTricare.Cape Canaveral Hospital, Inc. reinvest their net operating income tosustain its mission and prepare for the future. Part VI, Line 6: The roots of Health First run deep in Brevard, dating back to 1931 when Brevard Hospital first opened in Melbourne with 27 beds. Now known as Holmes Regional Medical Center (HRMC), the hospital is Brevard's largest, with 514 beds. Cape Canaveral Hospital (CCH) opened in 1962 with 44 beds, and has since grown to 150 beds. Palm Bay Hospital (PBH) opened in 1992 as a satellite of HRMC with 60 beds and has since grown to 152 beds. Viera Hospital (VH) opened in April of 2011 with 84 beds.Health First was formed when CCH, HRMC, and PBH joined together in August1995 to create a truly integrated not-for-profit healthcare deliverysystem and fulfill a common mission of improving the health of ourcommunity. The first new services added in the Health First Family wereHealth First Physicians, opening in late 1995, and Health First HealthPlans, opening in January 1996. Since then, we've also added, HolmesRegional Trauma Center, Viera Hospital in April of 2011, Vitalwatch - electronic intensive care unit and many other services to our family.Other services include outpatient centers; the county's only traumacenter; home care; specialized programs for cancer, diabetes, heart,stroke, and rehabilitative services; Central Brevard's largest medicalgroup; three fitness centers; and Medicare advantage, commercial POS, andcommercial HMO health plans.Working together in a seamless system, Health First is devoted tointegrating quality healthcare services with state-of-the-art technology.Health First also works together with other organizations and physiciansin our community.Our associates are also actively building a healthier community throughvolunteering for organizations dedicated to preventing and treating healthconcerns such as cancer, diabetes, and heart disease. We're also proud ofour associate's charitable giving plan, EAGLES (Every Associate's GiftLeaves Everlasting Spirit), that promotes tissue and organ donorawareness, provides dental services for Brevard Health Alliance patients,and supports the Bright Star center for grieving children & families.Part VI, Line 7: Not applicable. Neither the filing organization nor any related organization files a community benefit report with any state other than the extent to which community benefit information is included in other reporting requirements such as information provided to the Florida Hospital Association. 1 Health First Foundation Inc 3300 Fiske Blvd Rockledge FL 32955 593528774 501(c)(3) 20229 General Support Health Council of East Central Florida 2461 W State Road 426 Suite 2041 Oviedo FL 32765 592227752 501(c)(3) 3000 General Support 2 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The Cape Canaveral Hospital Board monitors usage by each entity to assure funds are raised and used appropriately. 1 1 0 0 0 0 0 0 0 Robert R Wright 0 389982 0 0 0 131551 0 7600 0 18532 0 547665 0 13995 Steven P Johnson 0 1081750 0 0 0 239054 0 0 0 13203 0 1334007 0 21758 Todd F Bibens 0 153294 0 0 0 804 0 4932 0 7229 0 166259 0 0 Rodney R Moore 0 112034 0 0 0 245475 0 2335 0 5268 0 365112 0 0 Wesley C Ott 0 167524 0 0 0 5257 0 3853 0 16863 0 193497 0 0 Ronald C McGrier Jr 0 147836 0 0 0 255 0 2294 0 6700 0 157085 0 0 Tracy L Lott Longobardi 0 138447 0 0 0 702 0 4363 0 14398 0 157910 0 0 Tony Hernandez III Esq 0 8193 0 0 0 10637 0 4950 0 0 0 23780 0 5625 Judith A George 0 9762 0 0 0 66757 0 1150 0 0 0 77669 0 51025 James E Carter MD 0 9803 0 0 0 56840 0 4800 0 0 0 71443 0 51825 George W Lewis 0 8675 0 0 0 60038 0 6750 0 0 0 75463 0 49425 Alphonse Pecoraro Jr MD 0 354856 0 0 0 1710 0 0 0 17851 0 374417 0 0 Part I, Lines 4a-b The following individuals received severance payments for their service to Health First, Inc.: Rodney Moore, $244,344 Health First, Inc has a non-qualified SERP for certain executives. The SERP was terminated during the 2012 tax year, and all amounts deferred were paid out. The payouts are included in column B(iii), and there is no representation per column C as the payout was made in the same year. Amounts reported as deferred in prior years have now been paid out with the closure of the plan and are included with column B(iii) and represented per column F due to prior deferral. Below are the 2012 deferred amounts: Robert Wright, $2,613 Steven Johnson, 183,012 Supplemental Information Part III Compensation is paid by Health First, Inc. EIN: 59-3336894 and reimbursed by Cape Canaveral Hospital, Inc. Salary and benefit expenses disclosed in part IX is allocated to this entity. Amounts reported in column F represent deferred compensation previously reported on prior years' Form 990. The filing organization relied on Health First for establishing the top management official's compensation. See core 990, part VI, section B, number 15 for further information regarding the process utilized. James E. Carter received payments of $50,000 from Health First, Inc. reported in Box 3 of 1099-MISC. This compensation is not reported on Schedule J, Part II. Form 990, Part VI, Section A, line 6 The sole member of Cape Canaveral Hospital, Inc. is Health First, Inc., a Florida not-for-profit corporation that serves as the corporate parent of the health system. Form 990, Part VI, Section A, line 7a Health First, Inc. (HFI), a section 501(c)(3) exempt organization and the parent of the exempt healthcare system, is the sole corporate member of the filing organization. Form 990, Part VI, Section A, line 7b Per the bylaws and the laws of the state of Florida, the administrative power of the corporation shall be vested in the Board of Directors which shall have charge, control and management of property, affairs and funds of the corporation. The Board of Directors shall not take any action with respect to the following without approval of the member: -Change in the mission, purpose or scope of the corporation and its operation; -Incurrence of long-term debt or guarantee the debt of another; -Approval of the sale, lease, purchase, conveyance or other disposition of any real or personal property having a total capitalized cost in excess of $1,000,000; -Approval of the sale, lease, purchase, conveyance or other disposition of all or substantially all of the assets of the organization; -Approval of annual operating and capital expenditure budgets and any material deviations therefrom; -Appointment or engagement of auditors, legal counsel or consultants; -Creation, acquisition, sale, purchase, dissolution or other disposition of any affiliated or controlled entity or joint venture or any interest in such entity; -Relocation, implementation or discontinuation of a major program service. -The repeal, amendment, or restatement of articles of incorporation and bylaws of the corporation; and -Capital expenditures and capital leases exceeding $1,000,000 in total Form 990, Part VI, Section B, line 11 After review and approval by the Chief Financial Officer the Form 990 is sent to each member of the Board of Directors electronically for their review and approval. Form 990, Part VI, Section B, line 12c A copy of the conflict of interest policy is provided to all BOD members, officers, management, and associates in which they review and sign that they have agreed to the terms noted in the policy on an annual basis. In addition, all management, officers, and BOD members on an annual basis are required to fill out a conflict of interest questionnaire prepared and monitored by the Chief Compliance Officer. The questionnaire requires an attestation in regards to stating the individual is free of conflicts should they not report anything of concern. These forms are tracked and kept on file. Should a conflict arise, the Chief Compliance Officer investigates the issue and determines a course of action to ensure enforcement of the policy. Form 990, Part VI, Section B, line 15 The compensation process is determined by the parent company. The parent company's process is as follows: the salaries of our CEO and other health executives are reviewed and recommended annually to the Board of Directors and approved in executive session by the full Board of Health First. Health First contracts annually with a highly respected national consulting firm to provide these recommendations to ensure that our executives are compensated fairly and competitively when compared with similar roles in other healthcare organizations nationally. The Compensation Committee is independent for Internal Revenue Code section 4958 for the individuals whose salary is reviewed. Minutes are kept for all Board of Directors and Compensation Committee meetings. The process is documented contemporaneously in the Board and Committee meetings. Form 990, Part VI, Section C, line 19 Form 990, Part VI, Section C, Line 19: Quarterly and Annually Consolidated Financials and Consolidated Statistical Information is filed electronically on www.dacbond.com and is available to the public. In addition, any requests made to the Chief Financial Officer for the above referenced items are provided upon request in a timely manner. A copy of the conflicts of interest policy is available upon request to the Compliance Officer. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfer of net assets to a related tax-exempt -4,960,276. Change in temporarily restricted net assets 79,292. FORM 990, PART XII, QUESTION 2C, AUDITED FINANCIAL STATEMENT: The Audit Committee of Health First reviews and approves the annual audit and compliance audit plans then makes its report to the Health First Board of Directors. The Audit Committee is responsible for the selection of the independent auditors. There was no change from prior year. FORM 990, PART IV, QUESTION 24A, BONDS ISSUED AFTER DECEMBER 31, 2002: The filing organization is part of an obligated group that had more than $100,000 in bonds issued after December 31, 2002 that were outstanding on the last day of its tax year. The filing organization's share of these obligations is reported on part X, line 20 of Health First, Inc. The parent of the obligated group, is filing schedule K on behalf of itself and all members of the obligated group. FORM 990, PART V, QUESTION 2A, NUMBER OF EMPLOYEES: Employees at Cape Canaveral Hospital, Inc. are included in the Form 941 filed by Health First, Inc. EIN: 59-3336894. Health First Inc 3300 Fiske Blvd Rockledge FL 32955 593336894 Support Org FL 501(c)(3) Line 11c, III-FI N/A 0 Holmes Regional Medical Center Inc 3300 Fiske Blvd Rockledge FL 32955 590624371 Hospital FL 501(c)(3) Line 3 Health First Inc 1 Hospice of Health First Inc 3300 Fiske Blvd Rockledge FL 32955 591911574 Healthcare FL 501(c)(3) Line 9 Health First Inc 1 Health First Foundation Inc 3300 Fiske Blvd Rockledge FL 32955 593528774 Fundraising FL 501(c)(3) Line 7 Health First Inc 1 Viera Hospital Inc 3300 Fiske Blvd Rockledge FL 32955 264019868 Hospital FL 501(c)(3) Line 3 Health First Inc 1 Cape Health Properties Inc 3300 Fiske Blvd Rockledge FL 32955 593086711 Real Estate FL Cape Canaveral Hospital Inc C 1.00000 0 Health First Medical Management Inc 3300 Fiske Blvd Rockledge FL 32955 593348252 Health Care FL Health First Holding Corp Inc C 0 Health First Physicians Inc 3300 Fiske Blvd Rockledge FL 32955 593346397 Health Care FL Health First Holding Corp Inc C 0 Holmes Regional Enterprises Inc 3300 Fiske Blvd Rockledge FL 32955 592109953 Real Estate FL Health First Holding Corp Inc C 0 Health First Health Plans Inc 3300 Fiske Blvd Rockledge FL 32955 593315064 Health Care FL Health First Holding Corp Inc C 0 Health First Insurance Inc 3300 Fiske Blvd Rockledge FL 32955 453131932 Health Care FL Health First Holding Corp Inc C 0 Health First Holding Company & Subs 3300 Fiske Blvd Rockledge FL 32955 593509709 Holding Corp. FL Health First Inc C 0 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 0 Health First Foundation Inc C 51188 Holmes Regional Medical Center Inc K 68061 Cape Health Properties Inc K 132583 Health First Health Plans Inc L 19134152 Viera Hospital Inc L 64798 Holmes Regional Medical Center Inc M 797798 Health First Physicians Inc P 80783 Form 990, Schedule R, Part V, Schedule R Disclosures: All transactions reported in this section are based upon corporate books and records which are kept according to Generally Accepted Accounting Standards.