2014-11-10T18:34:13-06:00 2013-12-31 990 2013-01-01 590973502 MEMORIAL HEALTH SYSTEMS INC MEMO 3866766000 301 MEMORIAL MEDICAL PARKWAY DAYTONA BEACH FL 32117 LYNN C ADDISCOTT ASSISTANT SECRETARY 4079751492 2014-11-10 2013 2015-11-30 17:44:51Z FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER DARYL TOL 301 MEMORIAL MEDICAL PARKWAY DAYTONA BEACH FL 32117 255596080 0 X WWW.FLORIDAHOSPITALMEMORIAL.ORG X 1961 FL MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF TWO HOSPITALS WITH A TOTAL OF 396 BEDS. 20 8 2275 236 53730 30955 0 0 245872207 251309229 1996583 2454604 2315873 1832247 250184663 255596080 105713 164459 0 0 106892001 116271145 0 0 0 132937234 130339662 239934948 246775266 10249715 8820814 440515926 435916188 187836321 171813696 252679605 264102492 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 229255587 164459 253087746 OPERATION OF 2 ACUTE CARE HOSPITALS WITH 13,351 PATIENT ADMISSIONS, 66,049 PATIENT DAYS, AND 116,283 OUTPATIENT VISITS IN THE CURRENT YEAR. BOTH HOSPITALS ARE LOCATED IN ORMOND BEACH AND DAYTONA BEACH, FLORIDA. IN ADDITION, THE CORPORATION OPERATES AN INTEGRATED HEALTHCARE DELIVERY SYSTEM. 229255587 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 0 0 0 0 0 0 1 1 1 0 0 1 197 0 1 2275 1 1 1 0 0 0 0 0 0 0 0 0 X 20 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 FL X DEBORA THOMAS 3862313901 301 MEMORIAL MEDICAL PARKWAY DAYTONA BEACH FL 32117 X JOHN ADAMS DIRECTOR (BEG 1/13) 0.60 0.00 X 300 0 0 RICK BANKER DIRECTOR 0.60 0.00 X 300 0 0 LONNIE BROWN DIRECTOR 0.60 0.00 X 300 0 0 DAVID BURT DIRECTOR 0.60 0.00 X 300 0 0 PAUL CLARE DIRECTOR 0.60 0.00 X 300 0 0 SURESH DESAI MD DIRECTOR 5.30 0.00 X 36614 0 0 CHARLES D HOOD JR DIRECTOR 0.60 0.00 X 300 0 0 SANDRA K JOHNSON DIRECTOR 0.60 50.00 X 0 685560 91718 NANCY LOHMAN DIRECTOR 0.60 0.00 X 300 0 0 KENNETH MATTISON DIRECTOR (BEG 6/13) 0.60 50.00 X 300 524455 117526 WILLIAM MCMUNN DIRECTOR 0.60 0.00 X 300 0 0 ED NOSEWORTHY DIRECTOR 0.60 50.00 X 0 865264 82047 DAVID OTTATI DIRECTOR (END 6/13) 0.60 50.00 X 0 611984 105731 RON RASMUSSEN MD DIRECTOR (BEG 1/13) 60.60 0.00 X 503224 0 32360 EDDIE SCHATZ JR DIRECTOR 0.60 0.00 X 300 0 0 JULIE SCHNEIDER MD DIRECTOR 80.60 0.00 X 1149216 0 19043 MICHAEL SCHULTZ CHAIRMAN/DIRECTOR 0.60 50.00 X 300 1430716 157109 LEWIS SEIFERT DIRECTOR 0.60 50.00 X 300 709665 125841 DARYL TOL DIRECTOR/CEO 32.00 18.00 X X 0 644930 121246 ELIZABETH WEAGRAFF DIRECTOR 0.60 50.00 X 300 323717 63298 DEBORA THOMAS REGION CFO/DIRECTOR 32.00 18.00 X X 0 427009 65207 DARLINDA COPELAND COO 50.00 0.00 X 0 355168 72863 MICHELE GOEB-BURKETT CNO 50.00 0.00 X 0 247072 44220 RONALD JIMENEZ CMO 50.00 0.00 X 0 398624 62336 MICHAEL KELLEY MD PHYSICIAN 70.00 0.00 X 811322 0 32166 ROBERT MARTIN MD PHYSICIAN 87.00 0.00 X 743790 0 29794 CHRISTOPHER SUTTON KENT MD PHYSICIAN 87.00 0.00 X 737410 0 31910 KARIN BIGMAN MD PHYSICIAN 45.00 0.00 X 710873 0 853 ROBERT HEWES MD PHYSICIAN 52.00 0.00 X 682642 0 28314 NIGEL HINDS FORMER CFO 0.00 50.00 X 0 291340 59247 5378991 7515504 1342829 84 1 1 0 HURON CONSULTING GROUP 3005 MOMENTUM PLACE CHICAGO IL 60689 CONSULTING SERVICE 5953789 SHERIDAN HEALTHCORP INC PO BOX 452197 SUNRISE FL 33323 MEDICAL SERVICE 2754088 ADVENTIST HEALTH SYSTEMSUNBELT INC DBA 601 E ROLLINS STREET ORLANDO FL 32803 LAB AND MARKETING SERVICE 1280540 FLORIDA LINEN SERVICES 1407 SW 8TH STREET POMPANO BEACH FL 33069 LINEN SERVICE 574792 MED HOLDINGS LLC PO BOX 538449 ATLANTA GA 30353 COLLECTION SERVICES 567591 41 NET PATIENT REVENUE 900099 242562807 242562807 MANAGEMENT FEES 561000 5665157 5665157 MEDICAL OFFICE BUILDING 531120 1553860 1553860 CAFETERIA REVENUE 900099 1327148 1327148 HEALTH EDUCATION 900099 126732 126732 73525 19795 53730 251309229 1309596 1309596 1137567 7441 0 0 1137567 7441 1145008 1145008 EHR REVENUE 900099 1832247 1832247 1832247 255596080 253087746 53730 2454604 X 164459 164459 4179132 4179132 86606611 86606611 2555562 2508907 46655 16542015 16413282 128733 6387825 6256613 131212 586641 586641 18962559 14136603 4825956 1075089 1075089 4523603 3435715 1087888 8188243 6758365 1429878 5377153 5377153 449257 449257 190095 190095 6181017 6181017 15626769 15626769 3389955 3279479 110476 MEDICAL SUPPLIES 53082761 53082761 REPAIRS & MAINTENANCE 6118010 6118010 PURCHASED SERVICES 3881654 602987 3278667 STATE TAX INDIGENT ASSE 2706856 2706856 246775266 229255587 17519679 0 4987 5786 121912428 119133731 27653963 29678971 5413676 4923767 6780042 5790548 349370106 97892598 255131355 251477508 3502352 6546501 233505 76875 19883618 18282501 440515926 435916188 12370776 14791762 175465545 157021934 187836321 171813696 X 249231866 259548554 622004 644723 2825735 3909215 252679605 264102492 440515926 435916188 X 8820814 -11654 2613727 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10342 10342 0 PART II-B, LINE 1: AMERICAN HOSPITAL ASSOCIATION DUES AND FLORIDA HOSPITAL ASSOCIATION DUES X 0 1 0 0.00 0 19759070 19759070 241889719 45534407 196355312 79005546 51991877 27013669 8715771 366314 8349457 251477508 PAYABLE TO THIRD PARTIES 7054723 CREDIT BALANCES IN A/R 804409 OTHER LIABILITIES 2175980 INTERCO. ALLOC. OF TE BOND PROCEEDS 145515957 DUE TO RELATED 1470865 157021934 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 IN THE CURRENT YEAR 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 THE INCOME TAXES TOPIC OF THE ASC (ASC 740), 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, 2013. 1 1 X 1 X 1 X 1 1 1 0 1 1 11579778 11579778 0.04690 25012791 10358369 14654422 0.05940 36592569 10358369 26234200 0.10630 37281 37281 0.00020 613 613 0.00000 37894 37894 0.00020 36630463 10358369 26272094 0.10650 2777 2777 0.00000 10903 10903 0.00000 13680 13680 1 15065316 1776420 84254310 78549628 5704682 X 1 1 2 1 FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER 301 MEMORIAL MEDICAL PARKWAY DAYTONA BEACH FL 32117 WWW.FLORIDAHOSPITALMEMORIAL.ORG 4201 X X X 2 FLORIDA HOSPITAL OCEANSIDE 264 SOUTH ATLANTIC AVE ORMOND BEACH FL 32176 WWW.FLORIDAHOSPITALMEMORIAL.ORG 4201 X X X FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER 1 1 X X X X X X X X 13 1 0 1 X WWW.FLORIDAHOSPITALMEMORIAL.ORG X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X 1 0 1 X 0 0 FLORIDA HOSPITAL OCEANSIDE 2 1 X X X X X X X X 13 1 0 1 X WWW.FLORIDAHOSPITALMEMORIAL.ORG X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X 1 0 1 X 0 0 FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 3: MEMORIAL HEALTH SYSTEMS, INC. D/B/A FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER, (FHMMC OR THE HOSPITAL) OPERATES TWO HOSPITALS IN VOLUSIA COUNTY, FLORIDA WITH A TOTAL OF 396 BEDS. THE PRIMARY SERVICE AREA (PSA) FOR FHMMC HAS A TOTAL POPULATION OF APPROXIMATELY 300,000. ABOUT 17.4% OF THE POPULATION IS UNDER AGE 18 AND 25% OF THE POPULATION IS 65 YEARS OR OLDER. APPROXIMATELY 23.4% OF THE POPULATION WITHIN THE PSA IS UNINSURED. IN CONDUCTING ITS 2013 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE HOSPITAL CONTRACTED WITH A LOCAL NON-PROFIT ORGANIZATION TO ASSIST IN PRIMARY DATA COLLECTION, COMPILATION AND ANALYSIS AND FACILITATION OF THE REVIEW AND PRIORITIZATION PROCESS FOR IDENTIFIED COMMUNITY HEALTH NEEDS. THIS LOCAL NON-PROFIT ORGANIZATION ASSISTED THE HOSPITAL WITH PRIMARY DATA COLLECTION WHICH CONSISTED OF INTERVIEWS (BY PHONE OR ON-LINE) WITH IDENTIFIED STAKEHOLDERS. STAKEHOLDERS WERE CHOSEN TO ENSURE REPRESENTATION OF THE UNDERSERVED POPULATIONS IN VOLUSIA COUNTY. IN ADDITION, A LINK WAS ESTABLISHED ON THE HOSPITAL'S WEBSITE WHEREBY RESIDENTS OF THE HOSPITAL'S COMMUNITY COULD PARTICIPATE IN A COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY. 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. THE FOLLOWING COMMUNITY-BASED ORGANIZATIONS WERE PARTICIPANTS IN THE CHNAC:THE VOLUSIA COUNTY HEALTH DEPARTMENT;THE JESUS CLINIC A CLINIC PROVIDING FREE HEALTHCARE TO FAMILIES THAT DO NOT QUALIFY FOR MEDICAID AND ARE UNINSURED;JUNIOR LEAGUE OF DAYTONA BEACH A NOT-FOR-PROFIT THAT SUPPORTS COMMUNITY ORGANIZATIONS SUCH AS EASTER SEALS, ASSOCIATION OF RETARDED CITIZENS, HEALTHY START, PROJECT W.A.R.M. (WOMEN ASSISTING RECOVERING MOTHERS), BEST FOOT FORWARD (EVENT TO CLOTHE TITLE I SCHOOL CHILDREN) AND KIDS IN THE KITCHEN (WELLNESS PROGRAM); UNITED WAY OF VOLUSIA-FLAGLER COUNTIES; ANDSTEWART MARCHMAN ACT- RECOVERY FOR MENTAL ILLNESS AND ADDICTION. FLORIDA HOSPITAL OCEANSIDE PART V, SECTION B, LINE 3: MEMORIAL HEALTH SYSTEMS, INC. D/B/A FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER, (FHMMC OR THE HOSPITAL) OPERATES TWO HOSPITALS IN VOLUSIA COUNTY, FLORIDA WITH A TOTAL OF 396 BEDS. THE PRIMARY SERVICE AREA (PSA) FOR FHMMC HAS A TOTAL POPULATION OF APPROXIMATELY 300,000. ABOUT 17.4% OF THE POPULATION IS UNDER AGE 18 AND 25% OF THE POPULATION IS 65 YEARS OR OLDER. APPROXIMATELY 23.4% OF THE POPULATION WITHIN THE PSA IS UNINSURED. IN CONDUCTING ITS 2013 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE HOSPITAL CONTRACTED WITH A LOCAL NON-PROFIT ORGANIZATION TO ASSIST IN PRIMARY DATA COLLECTION, COMPILATION AND ANALYSIS AND FACILITATION OF THE REVIEW AND PRIORITIZATION PROCESS FOR IDENTIFIED COMMUNITY HEALTH NEEDS. THIS LOCAL NON-PROFIT ORGANIZATION ASSISTED THE HOSPITAL WITH PRIMARY DATA COLLECTION WHICH CONSISTED OF INTERVIEWS (BY PHONE OR ON-LINE) WITH IDENTIFIED STAKEHOLDERS. STAKEHOLDERS WERE CHOSEN TO ENSURE REPRESENTATION OF THE UNDERSERVED POPULATIONS IN VOLUSIA COUNTY. IN ADDITION, A LINK WAS ESTABLISHED ON THE HOSPITAL'S WEBSITE WHEREBY RESIDENTS OF THE HOSPITAL'S COMMUNITY COULD PARTICIPATE IN A COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY. 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. THE FOLLOWING COMMUNITY-BASED ORGANIZATIONS WERE PARTICIPANTS IN THE CHNAC:THE VOLUSIA COUNTY HEALTH DEPARTMENT;THE JESUS CLINIC A CLINIC PROVIDING FREE HEALTHCARE TO FAMILIES THAT DO NOT QUALIFY FOR MEDICAID AND ARE UNINSURED;JUNIOR LEAGUE OF DAYTONA BEACH A NOT-FOR-PROFIT THAT SUPPORTS COMMUNITY ORGANIZATIONS SUCH AS EASTER SEALS, ASSOCIATION OF RETARDED CITIZENS, HEALTHY START, PROJECT W.A.R.M. (WOMEN ASSISTING RECOVERING MOTHERS), BEST FOOT FORWARD (EVENT TO CLOTHE TITLE I SCHOOL CHILDREN) AND KIDS IN THE KITCHEN (WELLNESS PROGRAM); UNITED WAY OF VOLUSIA-FLAGLER COUNTIES; ANDSTEWART MARCHMAN ACT- RECOVERY FOR MENTAL ILLNESS AND ADDICTION. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 5D: THE HOSPITAL HAS ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT MUST BE POSTED ON THE HOSPITAL'S WEBSITE BY THE END OF THE YEAR IN WHICH IT IS CONDUCTED. THE HOSPITAL WILL MAKE A COPY OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE UPON REQUEST. THE HOSPITAL WILL ALSO MAKE A PAPER COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE FOR PUBLIC INSPECTION AT THE HOSPITAL FACILITY. FLORIDA HOSPITAL OCEANSIDE PART V, SECTION B, LINE 5D: THE HOSPITAL HAS ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT MUST BE POSTED ON THE HOSPITAL'S WEBSITE BY THE END OF THE YEAR IN WHICH IT IS CONDUCTED. THE HOSPITAL WILL MAKE A COPY OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE UPON REQUEST. THE HOSPITAL WILL ALSO MAKE A PAPER COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE FOR PUBLIC INSPECTION AT THE HOSPITAL FACILITY. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 6I: AS A PART OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT, THE FILING ORGANIZATION CONDUCTED AN EXTENSIVE AND THOROUGH ANALYSIS AND PRIORITIZATION OF ITS SIGNIFICANT IDENTIFIED HEALTH NEEDS. PLEASE SEE OUR DISCUSSION IN PART V, SECTION B, LINE 7.THE FILING ORGANIZATION ADOPTED ITS INITIAL COMMUNITY HEALTH NEEDS ASSESSMENT BY 12/31/13 AND WAS IN THE PROCESS OF DEVELOPING ITS COMMUNITY HEALTH NEEDS IMPLEMENTATION STRATEGY. THE FILING ORGANIZATION'S IMPLEMENTATION STRATEGY WILL BE DOCUMENTED IN A WRITTEN REPORT CALLED THE "COMMUNITY HEALTH PLAN". THE COMMUNITY HEALTH PLAN (CHP) WILL DESCRIBE HOW THE FILING ORGANIZATION PLANS TO MEET ITS IDENTIFIED PRIORITIZED HEALTH NEEDS OR WILL IDENTIFY THE HEALTH NEED AS ONE THE FILING ORGANIZATION DOES NOT INTEND TO SPECIFICALLY ADDRESS AND PROVIDE AN EXPLANATION AS TO WHY THE FILING ORGANIZATION DOES NOT INTEND TO ADDRESS THAT HEALTH NEED. IN ACCORDANCE WITH PROPOSED REGULATION SECTION 1.501(R)-3(E)(2), THE FILING ORGANIZATION'S CHP WILL BE ADOPTED NO LATER THAN MAY 15, 2014. FLORIDA HOSPITAL OCEANSIDE PART V, SECTION B, LINE 6I: AS A PART OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT, THE FILING ORGANIZATION CONDUCTED AN EXTENSIVE AND THOROUGH ANALYSIS AND PRIORITIZATION OF ITS SIGNIFICANT IDENTIFIED HEALTH NEEDS. PLEASE SEE OUR DISCUSSION IN PART V, SECTION B, LINE 7.THE FILING ORGANIZATION ADOPTED ITS INITIAL COMMUNITY HEALTH NEEDS ASSESSMENT BY 12/31/13 AND WAS IN THE PROCESS OF DEVELOPING ITS COMMUNITY HEALTH NEEDS IMPLEMENTATION STRATEGY. THE FILING ORGANIZATION'S IMPLEMENTATION STRATEGY WILL BE DOCUMENTED IN A WRITTEN REPORT CALLED THE "COMMUNITY HEALTH PLAN". THE COMMUNITY HEALTH PLAN (CHP) WILL DESCRIBE HOW THE FILING ORGANIZATION PLANS TO MEET ITS IDENTIFIED PRIORITIZED HEALTH NEEDS OR WILL IDENTIFY THE HEALTH NEED AS ONE THE FILING ORGANIZATION DOES NOT INTEND TO SPECIFICALLY ADDRESS AND PROVIDE AN EXPLANATION AS TO WHY THE FILING ORGANIZATION DOES NOT INTEND TO ADDRESS THAT HEALTH NEED. IN ACCORDANCE WITH PROPOSED REGULATION SECTION 1.501(R)-3(E)(2), THE FILING ORGANIZATION'S CHP WILL BE ADOPTED NO LATER THAN MAY 15, 2014. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 7: MEMORIAL HEALTH SYSTEMS, INC., D/B/A FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER, (FHMMC OR THE HOSPITAL) FORMED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) TO REVIEW PRIMARY AND SECONDARY DATA COLLECTED AND TO FORMULATE THE DETERMINATION OF HEALTH PRIORITIES USING A SYSTEMATIC APPROACH THAT RELIED HEAVILY ON A DECISION TREE PRIORITY SELECTION PROCESS. THE CHNAC USED A PRIORITY SELECTION REPORT TOOL TO ASSIST IN THE REVIEW OF DATA COLLECTED AND PRIORITIZATION OF THE TOP AREAS OF SIGNIFICANT COMMUNITY NEED FOR THE HOSPITAL'S COMMUNITY. BASED UPON THE PRIMARY AND SECONDARY DATA COLLECTED, THIRTEEN HEALTH ISSUES WERE INITIALLY IDENTIFIED FOR THE HOSPITAL'S COMMUNITY THAT REPRESENTED A CLUSTERING OF 41 HEALTH INDICATORS FOR WHICH VOLUSIA COUNTY RANKED IN THE 3RD OR 4TH QUARTILE COMPARED TO OTHER COUNTIES IN FLORIDA. THE INITIAL THIRTEEN IDENTIFIED HEALTH NEEDS WERE ANALYZED AND PRIORITIZED USING A DECISION-TREE FORMAT. THE DECISION TREE FORMAT ASSISTED THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE IN FOCUSING ON THOSE NEEDS THAT THE HOSPITAL WOULD HAVE THE ABILITY TO INFLUENCE THROUGH THE IMPLEMENTATION OR EXPANSION OF PROGRAMS, SERVICES, OR OTHER ACTIONS, AND THAT MAY BE THE FOCUS OF OTHER COMMUNITY RESOURCES/ORGANIZATIONS THAT MAY BE ALREADY ADDRESSING THE NEED IN SOME WAY. UPON FINAL HEALTH NEEDS PRIORITY SELECTION, THE CHNAC CHOSE THE FOLLOWING FIVE PRIORITIES: CARDIOVASCULAR DISEASE DIABETES PROMOTE HEALTH AND WELLNESS (OBESITY, HEALTH LITERACY) SUBSTANCE USE AND ABUSE (TOBACCO, DRUGS, ALCOHOL, PRESCRIPTION DRUGS) HEALTH ACCESS.FHMMC CHOSE NOT TO CONCENTRATE ITS EFFORT ON THE ISSUE OF MENTAL HEALTH DISORDERS DUE TO A LACK OF SUFFICIENT INTERNAL RESOURCES AT THIS TIME TO FULLY SUPPORT A PROGRAM. THE ISSUE OF THE CHRONIC DISEASE OF ASTHMA WAS ALSO DETERMINED TO BE OUTSIDE THE SCOPE OF EXISTING HOSPITAL PROGRAMS BUT POTENTIALLY COULD BE ADDRESSED AS PART OF A HEALTH AND WELLNESS INITIATIVE. FLORIDA HOSPITAL OCEANSIDE PART V, SECTION B, LINE 7: MEMORIAL HEALTH SYSTEMS, INC., D/B/A FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER, (FHMMC OR THE HOSPITAL) FORMED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) TO REVIEW PRIMARY AND SECONDARY DATA COLLECTED AND TO FORMULATE THE DETERMINATION OF HEALTH PRIORITIES USING A SYSTEMATIC APPROACH THAT RELIED HEAVILY ON A DECISION TREE PRIORITY SELECTION PROCESS. THE CHNAC USED A PRIORITY SELECTION REPORT TOOL TO ASSIST IN THE REVIEW OF DATA COLLECTED AND PRIORITIZATION OF THE TOP AREAS OF SIGNIFICANT COMMUNITY NEED FOR THE HOSPITAL'S COMMUNITY. BASED UPON THE PRIMARY AND SECONDARY DATA COLLECTED, THIRTEEN HEALTH ISSUES WERE INITIALLY IDENTIFIED FOR THE HOSPITAL'S COMMUNITY THAT REPRESENTED A CLUSTERING OF 41 HEALTH INDICATORS FOR WHICH VOLUSIA COUNTY RANKED IN THE 3RD OR 4TH QUARTILE COMPARED TO OTHER COUNTIES IN FLORIDA. THE INITIAL THIRTEEN IDENTIFIED HEALTH NEEDS WERE ANALYZED AND PRIORITIZED USING A DECISION-TREE FORMAT. THE DECISION TREE FORMAT ASSISTED THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE IN FOCUSING ON THOSE NEEDS THAT THE HOSPITAL WOULD HAVE THE ABILITY TO INFLUENCE THROUGH THE IMPLEMENTATION OR EXPANSION OF PROGRAMS, SERVICES, OR OTHER ACTIONS, AND THAT MAY BE THE FOCUS OF OTHER COMMUNITY RESOURCES/ORGANIZATIONS THAT MAY BE ALREADY ADDRESSING THE NEED IN SOME WAY. UPON FINAL HEALTH NEEDS PRIORITY SELECTION, THE CHNAC CHOSE THE FOLLOWING FIVE PRIORITIES: CARDIOVASCULAR DISEASE DIABETES PROMOTE HEALTH AND WELLNESS (OBESITY, HEALTH LITERACY) SUBSTANCE USE AND ABUSE (TOBACCO, DRUGS, ALCOHOL, PRESCRIPTION DRUGS) HEALTH ACCESS.FHMMC CHOSE NOT TO CONCENTRATE ITS EFFORT ON THE ISSUE OF MENTAL HEALTH DISORDERS DUE TO A LACK OF SUFFICIENT INTERNAL RESOURCES AT THIS TIME TO FULLY SUPPORT A PROGRAM. THE ISSUE OF THE CHRONIC DISEASE OF ASTHMA WAS ALSO DETERMINED TO BE OUTSIDE THE SCOPE OF EXISTING HOSPITAL PROGRAMS BUT POTENTIALLY COULD BE ADDRESSED AS PART OF A HEALTH AND WELLNESS INITIATIVE. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 14G: FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER HAS DEVELOPED A PATIENT-FRIENDLY SUMMARY VERSION OF ITS FINANCIAL ASSISTANCE POLICY (FAP). THE FILING ORGANIZATION'S FAP PROVIDES THAT ITS HOSPITAL FACILITY WILL POST THE PATIENT-FRIENDLY SUMMARY VERSION OF ITS FAP ON THE HOSPITAL'S WEBSITE. IN ADDITION, THE FAP OF THE HOSPITAL FACILITY STATES THAT SIGNAGE REGARDING THE AVAILABILITY OF THE HOSPITAL FACILITY'S FAP WILL BE VISIBLE AT POINTS OF ADMISSION AND REGISTRATION, INCLUDING THE EMERGENCY DEPARTMENT. FLORIDA HOSPITAL OCEANSIDE PART V, SECTION B, LINE 14G: FLORIDA HOSPITAL OCEANSIDE HAS DEVELOPED A PATIENT-FRIENDLY SUMMARY VERSION OF ITS FINANCIAL ASSISTANCE POLICY (FAP). THE FILING ORGANIZATION'S FAP PROVIDES THAT ITS HOSPITAL FACILITY WILL POST THE PATIENT-FRIENDLY SUMMARY VERSION OF ITS FAP ON THE HOSPITAL'S WEBSITE. IN ADDITION, THE FAP OF THE HOSPITAL FACILITY STATES THAT SIGNAGE REGARDING THE AVAILABILITY OF THE HOSPITAL FACILITY'S FAP WILL BE VISIBLE AT POINTS OF ADMISSION AND REGISTRATION, INCLUDING THE EMERGENCY DEPARTMENT. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 20D: IN DETERMINING THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE POLICY-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL USES THE FOLLOWING METHODOLOGY:THE HOSPITAL IDENTIFIES ALL COMMERCIAL PAYORS THAT HAD ANY ACTIVITY WITH THE HOSPITAL DURING THE TAXABLE YEAR. FOR THOSE IDENTIFIED COMMERCIAL PAYORS, AN AVERAGE OF THE NEGOTIATED COMMERCIAL INSURANCE RATES IS DETERMINED. THE AVERAGE OF ALL OF THE NEGOTIATED COMMERCIAL INSURANCE RATES FOR THOSE IDENTIFIED COMMERCIAL PAYORS DETERMINES THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. FLORIDA HOSPITAL OCEANSIDE PART V, SECTION B, LINE 20D: IN DETERMINING THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE POLICY-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL USES THE FOLLOWING METHODOLOGY:THE HOSPITAL IDENTIFIES ALL COMMERCIAL PAYORS THAT HAD ANY ACTIVITY WITH THE HOSPITAL DURING THE TAXABLE YEAR. FOR THOSE IDENTIFIED COMMERCIAL PAYORS, AN AVERAGE OF THE NEGOTIATED COMMERCIAL INSURANCE RATES IS DETERMINED. THE AVERAGE OF ALL OF THE NEGOTIATED COMMERCIAL INSURANCE RATES FOR THOSE IDENTIFIED COMMERCIAL PAYORS DETERMINES THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. 25 FLORIDA MEMORIAL HOSPITAL IMAGING CENTER 335 CLYDE MORRIS BLVD ORMOND BEACH FL 32174 DIAGNOSTIC IMAGING HEMATOLOGY ONCOLOGY ASSOCIATES 345 CLYDE MORRIS BLVD 490 ORMOND BEACH FL 32174 HEMATOLOGY/ONCOLOGY SERVICES PRACTICE OF DR MURRPHY MARTIN & KENT 305 MEMORIAL MEDICAL PKWY 206 DAYTONA BEACH FL 32117 NEURO SURGERY FLORIDA WOMEN'S HEALTH CENTER 335 CLYDE MORRIS BLVD 240 ORMOND BEACH FL 32174 WOMEN'S HEALTH SERVICES WOUND CARE 305 MEMORIAL MEDICAL PKWY 101 DAYTONA BEACH FL 32117 WOUND CARE SERVICES PRACTICE OF DR BIRKEDAL 305 MEMORIAL MEDICAL PKWY 205 DAYTONA BEACH FL 32117 GENERAL SURGERY PRACTICE OF DR LEVINE 305 MEMORIAL MEDICAL PKWY 207 DAYTONA BEACH FL 32117 GEN SURGERY / BARIATRICS FHMMC CANCER CARE CENTER 224 MEMORIAL MEDICAL PKWY DAYTONA BEACH FL 32117 ONCOLOGY SERVICES PRACTICE OF DR DAAS 305 MEMORIAL MEDICAL PKWY 203 DAYTONA BEACH FL 32117 GASTROENTEROLOGY FHMMC REHABILITATION SVCS OUTPATIENT CTR 501 STERTHAUS AVENUE ORMOND BEACH FL 32174 REHABILITATIVE SERVICES PRACTICE OF DR RASMUSSEN 305 MEMORIAL MEDICAL PKWY 209 DAYTONA BEACH FL 32117 GENERAL SURGERY PRACTICE OF DR COHEN 305 MEMORIAL MEDICAL PKWY 208 ORMOND BEACH FL 32174 FAMILY MEDICINE PRACTICE OF DR CASIMIRO 290 N CLYDE MORRIS BLVD A-2 ORMOND BEACH FL 32174 FAMILY MEDICINE FHMMC AT THE PAVILION-DR MANTINEO 5535 S WILLIAMSON BLVD700 PORT ORANGE FL 32128 FAMILY MEDICINE MEMORIAL FAMILY CARE DR GONSALVES 335 CLYDE MORRIS BLVD 240 ORMOND BEACH FL 32174 FAMILY MEDICINE FHMMC AT THE PAVILION-REHAB 5535 S WILLIAMSON BLVD700 PORT ORANGE FL 32128 HEALTHCARE REHABILITATION SERVICES FHMMC AT THE PAVILION-DR GAINES 5535 S WILLIAMSON BLVD700 PORT ORANGE FL 32128 FAMILY MEDICINE FHMMC AT THE PAVILION-DR MOSCA 5535 S WILLIAMSON BLVD700 PORT ORANGE FL 32128 FAMILY MEDICINE MEMORIAL MEDLAB 290 N CLYDE MORRIS BLVD ORMOND BEACH FL 32174 LAB SERVICES DR NIEWALD 305 MEMORIAL MEDICAL PKWY 208 DAYTONA BEACH FL 32117 FAMILY MEDICINE FHMMC AT THE PAVILION-LAB 5535 S WILLIAMSON BLVD700 PORT ORANGE FL 32128 LAB SERVICES FHMMC AT THE PAVILION-RADIOLOGY 5535 S WILLIAMSON BLVD700 PORT ORANGE FL 32128 RADIOLOGY SERVICES FHMMC CARDIAC REHAB 305 MEMORIAL MEDICAL PKWY 306 DAYTONA BEACH FL 32117 REHABILITATIVE SERVICES DAYTONA BEACH SHORES OUTPATIENT REHAB 3506 S ATLANTIC AVE DAYTONA BEACH SHORES FL 32118 REHAB AND LAB SERVICES NEW SMYRNA BEACH OUTPATIENT SERVICES 125 127 FLORIDA MEMORIAL PARKWAY NEW SMYRNA BEACH FL 32168 LAB, OUTPATIENT, IMAGING SERVICES PART I, LINE 6A: THE FILING ORGANIZATION IS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC SERVES AS A PARENT ORGANIZATION TO 24 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS THAT OPERATE 44 HOSPITALS IN TEN STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS "ADVENTIST HEALTH SYSTEM" (AHS).ALL HOSPITAL ORGANIZATIONS WITHIN AHS COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. AHS ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. AHS HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. ON AN ANNUAL BASIS, THE COMMUNITY BENEFITS OF ALL AHS ORGANIZATIONS ARE CONSOLIDATED AND REPORTED IN THE AHS ANNUAL REPORT DOCUMENT PREPARED BY AHSSHC (EIN 59-2170012). PART I, LINE 7: THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE, REPORTED ON LINE 2 OF SECTION A OF PART III IS RECORDED IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO REVENUE, NOT BAD DEBT EXPENSE. PART III, LINE 3: METHODOLOGY FOR DETERMINING THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT MAY REPRESENT PATIENTS WHO COULD HAVE QUALIFIED UNDER THE FILING ORGANIZATION'S CHARITY CARE POLICY:SELF-PAY PATIENTS ARE REQUIRED TO COMPLETE A PATIENT FINANCIAL ASSISTANCE APPLICATION SHORT FORM (PFAA). IF THE PFAA IS NOT COMPLETED AFTER REASONABLE ATTEMPTS TO OBTAIN IT ARE EXHAUSTED, PATIENT INFORMATION IS PROCESSED THROUGH A SCORER PRODUCT. THE SCORER PRODUCT UTILIZES PUBLICLY AVAILABLE DATA, SUCH AS CREDIT REPORTS, TO ASSESS AN INDIVIDUAL PATIENT'S FINANCIAL VIABILITY. PATIENTS WHO EARN A CERTAIN SCORE ON THE SCORER PRODUCT 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 SCORER PRODUCT 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 CHARITY CARE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR CHARITY CARE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A CHARITY CARE ELIGIBILITY DETERMINATION CAN NOT BE MADE. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED TO BE COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGES 6 AND 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: AT THE TIME OF PATIENT REGISTRATION, NON-ELECTIVE SELF-PAY PATIENTS ARE INFORMED OF THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND TOLD THAT THEY WILL BE REQUIRED TO SUBMIT NECESSARY FINANCIAL DATA IN ORDER TO POTENTIALLY RECEIVE ANY DISCOUNTS. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, PERCENTAGE DISCOUNTS ARE APPLIED TO A PATIENT'S ACCOUNT BASED UPON AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE.UNDER THE FILING ORGANIZATION'S POLICIES, PAYMENT PLANS FOR PARTIAL CHARITY ACCOUNTS WILL BE INDIVIDUALLY DEVELOPED WITH THE PATIENT. PARTIAL CHARITY ACCOUNTS RESULT WHEN A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION ALLOWS FOR A PERCENTAGE REDUCTION BUT LEAVES THE PATIENT WITH A SELF-PAY BALANCE. IF THE PATIENT COMPLIES WITH THE AGREED-UPON PAYMENT PLAN, THE FILING ORGANIZATION DOES NOT PURSUE ANY COLLECTION ACTION WITH RESPECT TO THE PATIENT. THE FILING ORGANIZATION DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR A 100% REDUCTION IN CHARGES UNDER ITS FINANCIAL ASSISTANCE POLICY. SUPPLEMENTAL SCHEDULE TO SCHEDULE H, PART III, SECTION B RECONCILIATION OF SCHEDULE H REPORTED MEDICARE SURPLUS/(SHORTFALL) TO UNREIMBURSED MEDICARE COSTS ASSOCIATED WITH THE PROVISION OF SERVICESTO ALL MEDICARE BENEFICIARIES:THE MEDICARE REVENUE AND ALLOWABLE COSTS OF CARE REPORTED IN SECTION B OF PART III OF SCHEDULE H ARE BASED UPON THE AMOUNTS REPORTED IN THE FILING ORGANIZATION'S MEDICARE COST REPORT IN ACCORDANCE WITH THE IRS INSTRUCTIONS FOR SCHEDULE H. ON AN ANNUAL BASIS, THE FILING ORGANIZATION ALSO DETERMINES ITS TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS. UNREIMBURSED COSTS ARE REPORTED AS A COMMUNITY BENEFIT TO THE ELDERLY AND ARE INCLUDED IN THE CONSOLIDATED ADVENTIST HEALTH SYSTEM (AHS OR THE COMPANY) COMMUNITY BENEFITS REPORT CONTAINED IN THE AHS ANNUAL REPORT DOCUMENT. THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO MEDICARE PATIENTS AS REPORTED IN THE AHS COMMUNITY BENEFIT REPORT ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ 5,704,682- DIFFERENCE IN COSTING METHODOLOGY: (8,729,746)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (7,770,921) -------------TOTAL SURPLUS/(SHORTFALL) COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITY BENEFIT REPORTING: $(10,795,985)AS INDICATED ABOVE, THE PRIMARY DIFFERENCES BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) REPORTED ON SCHEDULE H, PART III, SECTION B, LINE 7 AND THE FILING ORGANIZATION'S PORTION OF THE COMPANY'S ANNUAL COMMUNITY BENEFIT STATEMENT IS DUE TO A DIFFERENCE IN THE COSTING METHODOLOGY AND DIFFERENCES IN THE POPULATION OF MEDICARE PATIENTS WITHIN THE CALCULATION. THE COST METHODOLOGY UTILIZED IN CALCULATING ANY MEDICARE SURPLUS/(SHORTFALL) FOR PURPOSES OF THE ANNUAL COMMUNITY BENEFIT REPORTING IS BASED UPON THE COST-TO-CHARGE RATIO OUTLINED IN WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE SAME COST-TO-CHARGE RATIO IS USED TO DETERMINE THE COSTS ASSOCIATED WITH SERVICES PROVIDED TO CHARITY CARE PATIENTS AND MEDICAID PATIENTS AS REPORTED IN SCHEDULE H, PART I, LINE 7. IN ADDITION, THE MEDICARE COST REPORT EXCLUDES SERVICES PROVIDED TO MEDICARE PATIENTS FOR PHYSICIAN SERVICES, SERVICES PROVIDED TO PATIENTS ENROLLED IN MEDICARE HMOS, AND CERTAIN SERVICES PROVIDED BY OUTPATIENT DEPARTMENTS OF THE FILING ORGANIZATION THAT ARE REIMBURSED ON A FEE SCHEDULE. THE COMPANY'S OWN COMMUNITY BENEFIT STATEMENT CAPTURES THE UNREIMBURSED COST OF PROVIDING SERVICES TO ALL MEDICARE BENEFICIARIES THROUGHOUT THE ORGANIZATION. PART VI, LINE 2: AS REPORTED IN SCHEDULE H, PART V, SECTION B, LINES 1-8, THE HOSPITAL CONDUCTED ITS INITIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING THE CURRENT YEAR. ITS INITIAL CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2013, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S INITIAL CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN PROPOSED REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY.SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY. PART VI, LINE 3: THE FACILITY HAS A PROCESS IN PLACE WHEREBY PATIENTS ARE INFORMED ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. SIGNAGE IS POSTED IN THE EMERGENCY ROOM INDICATING THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR THOSE SELF-PAY PATIENTS MEETING ELIGIBILITY REQUIREMENTS. AFTER EMTALA MEDICAL SCREENING AND STABILIZATION REQUIREMENTS ARE MET, REGISTRATION PERSONNEL WILL SECURE FINANCIAL INFORMATION ON AS MANY SELF-PAY PATIENTS AS POSSIBLE AT THE TIME OF SERVICE. FOR THOSE WHO APPEAR TO QUALIFY FOR MEDICAID OR UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE FINANCIAL COUNSELORS WILL CONTINUE TO WORK WITH THOSE PATIENTS UNTIL FINAL ACCOUNT RESOLUTION IS ACHIEVED. ALL OTHER SELF-PAY PATIENTS ARE COVERED UNDER THIS PROCESS. AT ANY TIME DURING THE PROCESS THAT DATA IS PROVIDED SHOWING THAT A PATIENT QUALIFIES FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY THE DISCOUNTS EXTENDED UNDER THAT POLICY WILL BE APPLIED.AS PART OF THE BILLING PROCESS, THE HOSPITAL INCLUDES THE APPLICATION FOR FINANCIAL ASSISTANCE ALONG WITH THE INITIAL PATIENT BILL. THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATION IS ALSO AVAILABLE TO PATIENTS ON THE HOSPITAL'S WEB-SITE IN BOTH AN ENGLISH AND SPANISH VERSION. ADDITIONALLY, THE HOSPITAL'S FINANCIAL COUNSELORS ARE AVAILABLE TO WORK WITH EVERY PATIENT DURING THE FIRST 120 DAYS OF THE BILLING PROCESS TO ASSIST THE PATIENT WITH COMPLETING FINANCIAL ASSISTANCE APPLICATIONS AND INVESTIGATING OTHER POTENTIAL SOURCES OF THIRD-PARTY ASSISTANCE. THE DETERMINATION OF A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE IS MADE ON A CASE-BY-CASE BASIS. VARIOUS FACTORS ARE CONSIDERED IN THAT DETERMINATION. EACH INDIVIDUAL PATIENT WHO IS IDENTIFIED AS POTENTIALLY BEING ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE IS SEEN BY A FINANCIAL COUNSELOR AT THE HOSPITAL. THE FINANCIAL COUNSELOR WILL WORK WITH THE PATIENT TO MAKE SURE THAT OTHER SOURCES OF ASSISTANCE (PUBLIC OR OTHERWISE) HAVE BEEN SOUGHT TO THE FULLEST EXTENT POSSIBLE. WHEN OTHER FORMS OF ASSISTANCE ARE NOT AVAILABLE OR HAVE BEEN EXHAUSTED, THE HOSPITAL WILL GATHER CERTAIN FINANCIAL INFORMATION FROM THE PATIENT TO DETERMINE THE PATIENT'S ABILITY TO PAY BASED UPON LEVEL OF INCOME. PART VI, LINE 4: THE FILING ORGANIZATION OPERATES 2 HOSPITALS IN VOLUSIA COUNTY, FLORIDA; FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER (MEMORIAL), A 277-BED FACILITY AND FLORIDA HOSPITAL OCEANSIDE (OCEANSIDE), A 119-BED FACILITY. ADDITIONALLY, THE FILING ORGANIZATION SERVES ITS COMMUNITIES WITH PHYICIAN PRACTICES, IMAGING SERVICES, AND LABORATORY SERVICES THROUGHOUT EAST CENTRAL FLORIDA. MORE THAN 400 PHYSICIANS HOLD PRIVILEGES AT THE FILING ORGANIZATION'S FACILITIES AND COMBINED, THE FILING ORGANIZATION EMPLOYS MORE THAN 2,100 INDIVIDUALS. THERE IS AN AFFILIATE HOSPITAL AND TWO OTHER HOSPITALS WITHIN A RADIUS OF 20 MILES OR LESS FROM MEMORIAL AND OCEANSIDE. APPROXIMATELY 62% OF THE FILING ORGANIZATION'S PATIENTS DURING 2013 WERE MEDICARE PATIENTS, ABOUT 10% WERE MEDICAID PATIENTS, 6% WERE SELF-PAY, AND THE REMAINING PERCENTAGE WERE PATIENTS COVERED UNDER COMMERCIAL INSURANCE. FOR 2013, ABOUT 59% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT.MEMORIAL IS VOLUSIA COUNTY'S NEWEST AND MOST COMPREHENSIVE FACILITY. ITS NEW FACILITY FEATURES THE AREA'S ONLY ENDOVASCULAR/HYBRID OPERATING ROOM WHERE PATIENTS ARE DIAGNOSED AND TREATED IN ONE LOCATION FOR A VARIETY OF HEART AND ENDOVASCULAR CONDITIONS; THE AREA'S ONLY SIEMENS SOMOTOM 64-SLICE CT SCANNER FOR FASTER, PAINLESS DIAGNOSES OF HEART CONDITIONS AND STROKES USING 50 PERCENT LESS RADIATION; AND A NEWLY EXPANDED EMERGENCY DEPARTMENT FEATURING "NO WAIT" SERVICES. MEMORIAL SERVES A POPULATION OF APPROXIMATELY 297,000 PEOPLE IN THE HOSPITAL'S PRIMARY MARKET. DAYTONA BEACH IS THE REGIONAL COMMERCIAL AND CULTURAL HUB OF DELTONA-DAYTONA BEACH-ORMOND BEACH AREA. THE CITY IS AN INTEGRAL SEGMENT OF THE INTERSTATE HIGHWAY 4 CORRIDOR WITH SPECIALIZED INDUSTRIES IN AEROSPACE, AUTOMOTIVE, AND MANUFACTURING. THE WEIGHTED AVERAGE HOUSEHOLD INCOME, BASED ON POPULATION, IN THE PRIMARY MARKET IS APPROXIMATELY $41,000, WITH AN ESTIMATED 71,000 OVER THE AGE OF 65. HIGH SCHOOL GRADUATES ACCOUNT FOR APPROXIMATELY 87% OF VOLUSIA COUNTY WITH AN ESTIMATED 21% HAVING A BACHELOR'S DEGREE OR HIGHER. IT IS ESTIMATED THAT 13% OF THE INDIVIDUALS RESIDING IN VOLUSIA COUNTY LIVE BELOW THE POVERTY LEVEL AND THE UNEMPLOYMENT RATE IS ABOUT 7%.OCEANSIDE HAS A LONG HISTORY OF COMMUNITY SUPPORT AND SERVICES WHICH INCLUDES MEDICAL/SURGICAL CARE AND THE OPERATION OF PENINSULA REHABILITATION CENTER, VOLUSIA COUNTY'S ONLY INPATIENT REHABILITATION CENTER. IT ALSO OFFERS AN OUTPATIENT REHAB UNIT, IMAGING SERVICES, LABORATORY SERVICES, AND CARDIOPULMONARY SERVICES. PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO THE FILING ORGANIZATION'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE FILING ORGANIZATION IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST" AND EMBODIES THE FIING ORGANIZATION'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE FILING ORGANIZATION COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, THE FILING ORGANIZATION PROVIDED $471,604 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF 2 COMMUNITY HOSPITALS. THE FILING ORGANIZATION ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE FILING ORGANIZATION EXPENDED $13,397,271 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE FILING ORGANIZATION IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. PART VI, LINE 6: THE FILING ORGANIZATION IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SEC. 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 ORGANIZATION IS NOT FILED WITH ANY STATE AGENCIES. 1 MEMORIAL HEALTH SYSTEMS FOUNDATION INC 301 MEMORIAL MEDICAL PKWY DAYTONA BEACH FL 32117 311771522 501(C)(3) 85800 COST GENERAL ADMINISTRATIVE SUPPORT PROVISION OF GENERAL ADMINISTRATIVE SUPPORT AMERICAN CANCER SOCIETY INC 1737 N CLYDE MORRIS BLVD 140 DAYTONA BEACH FL 32117 131788491 501(C)(3) 5500 GENERAL SUPPORT AMERICAN HEART ASSOCIATION PO BOX 4002900 DES MOINES IA 50340 135613797 501(C)(3) 10000 GENERAL SUPPORT CHILDREN ADVOCACY CTR OF VOLUSIA & FLAGLER COUNTIES INC 1011 W INTERNATIONAL SPEEDWAY BLVD DAYTONA BEACH FL 32114 592065914 501(C)(3) 7800 GENERAL SUPPORT COUNCIL ON AGING OF VOLUSIA COUNTY INC PO BOX 671 DAYTONA BEACH FL 32115 591160221 501(C)(3) 7500 GENERAL SUPPORT DAYTONA STATE COLLEGE FOUNDATION INC 1200 W INTERNATIONAL SPEEDWAY BLVD DAYTONA BEACH FL 32114 591581805 501(C)(3) 18171 GENERAL SUPPORT EMBRY-RIDDLE AERONAUTICAL UNIVERSITY INC 600 S CLYDE MORRIS BLVD DAYTONA BEACH FL 32114 590936101 501(C)(3) 8500 GENERAL SUPPORT ORMOND BEACH CHAMBER OF COMMERCE INC 165 W GRANADA BLVD ORMOND BEACH FL 32174 590618671 501(C)(6) 15000 GENERAL SUPPORT ORMOND MEMORIAL ART MUSEUM & GARDENS 78 EAST GRANADA BLVD ORMOND BEACH FL 32176 596152272 501(C)(3) 6188 BOOK SUPPORT ANNUAL EVENT CATERING FOOD & SERVICES FOR EVENT 8 1 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 1 1 0 1 0 0 0 0 0 0 0 SANDRA K JOHNSON DIRECTOR 0 405653 0 117349 0 162558 0 49580 0 42138 0 777278 0 31179 KENNETH MATTISON DIRECTOR (BEG 6/13) 0 362840 0 64416 300 97199 0 49063 0 68463 300 641981 0 32128 ED NOSEWORTHY DIRECTOR 0 323611 0 24108 0 517545 0 53557 0 28490 0 947311 0 33704 DAVID OTTATI DIRECTOR (END 6/13) 0 358215 0 69667 0 184102 0 51706 0 54025 0 717715 0 27076 RON RASMUSSEN MD DIRECTOR (BEG 1/13) 438774 0 63447 0 1003 0 13850 0 18510 0 535584 0 0 0 JULIE SCHNEIDER MD DIRECTOR 491261 0 655270 0 2685 0 13850 0 5193 0 1168259 0 0 0 MICHAEL SCHULTZ CHAIRMAN/DIRECTOR 0 662144 0 193658 300 574914 0 114208 0 42901 300 1587825 0 107872 LEWIS SEIFERT DIRECTOR 0 485343 0 119810 300 104512 0 90647 0 35194 300 835506 0 67614 DARYL TOL DIRECTOR/CEO 0 466518 0 104552 0 73860 0 82397 0 38849 0 766176 0 60969 ELIZABETH WEAGRAFF DIRECTOR 0 230000 0 55728 300 37989 0 30793 0 32505 300 387015 0 13827 DEBORA THOMAS REGION CFO/DIRECTOR 0 313995 0 68909 0 44105 0 30382 0 34825 0 492216 0 8101 DARLINDA COPELAND COO 0 273595 0 47205 0 34368 0 26846 0 46017 0 428031 0 11399 MICHELE GOEB-BURKETT CNO 0 205698 0 35992 0 5382 0 13370 0 30850 0 291292 0 0 RONALD JIMENEZ CMO 0 306881 0 53188 0 38555 0 28509 0 33827 0 460960 0 12323 MICHAEL KELLEY MD PHYSICIAN 483532 0 297027 0 30763 0 13850 0 18316 0 843488 0 0 0 ROBERT MARTIN MD PHYSICIAN 740322 0 0 0 3468 0 13850 0 15944 0 773584 0 0 0 CHRISTOPHER SUTTON KENT MD PHYSICIAN 736719 0 0 0 691 0 13850 0 18060 0 769320 0 0 0 KARIN BIGMAN MD PHYSICIAN 395776 0 314474 0 623 0 547 0 306 0 711726 0 0 0 ROBERT HEWES MD PHYSICIAN 498695 0 177253 0 6694 0 13850 0 14464 0 710956 0 0 0 NIGEL HINDS FORMER CFO 0 229104 0 34623 0 27613 0 26646 0 32601 0 350587 0 17530 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 BUSINESS MEETING ($300 PER EXECUTIVE). OTHER DISCRETIONARY SPENDING ACCOUNTS MAY BE PROVIDED IN CONNECTION WITH OTHER AHS SPONSORED CONFERENCES BUT TYPICALLY DO NOT EXCEED $200 PER PARTICIPANT. WITH RESPECT TO THE AHS PRESIDENT'S COUNCIL MEETING, ELIGIBLE EXECUTIVES MAY INCLUDE AHSSHC VICE PRESIDENTS AND ABOVE AND ALL AHSSHC SUBSIDIARY ORGANIZATION CEOS AND REGIONAL CFOS. THE PAYMENT PROVIDED TO EACH EXECUTIVE WAS CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. PART I, LINE 3 THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) FOR THAT INDIVIDUAL'S ROLE IN SERVING AS THE CEO. COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC HAS TAKEN STEPS TO ENSURE THAT PROCESSES ARE IN PLACE TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS STANDARD AS SET FORTH IN TREASURY REGULATION 53.4958-6 WITH RESPECT TO ITS ACTIVE EXECUTIVE-LEVEL POSITIONS. THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE) SERVES AS THE GOVERNING BODY FOR ALL EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE IS COMPOSED OF CERTAIN MEMBERS OF THE BOARD OF DIRECTORS (THE BOARD) OF AHSSHC. VOTING MEMBERS OF THE COMMITTEE INCLUDE ONLY INDIVIDUALS WHO SERVE ON THE BOARD AS INDEPENDENT REPRESENTATIVES OF THE COMMUNITY, WHO HOLD NO EMPLOYMENT POSITIONS WITH AHSSHC AND WHO DO NOT HAVE RELATIONSHIPS WITH ANY OF THE INDIVIDUALS WHOSE COMPENSATION IS UNDER THEIR REVIEW THAT IMPACTS THEIR BEST INDEPENDENT JUDGMENT AS FIDUCIARIES OF AHSSHC. THE COMMITTEE'S ROLE IS TO REVIEW AND APPROVE ALL COMPONENTS OF THE EXECUTIVE COMPENSATION PLAN OF AHSSHC. AS AN INDEPENDENT GOVERNING BODY WITH RESPECT TO EXECUTIVE COMPENSATION, IT SHOULD BE NOTED THAT THE COMMITTEE WILL OFTEN CONFER IN EXECUTIVE SESSIONS ON MATTERS OF COMPENSATION POLICY AND POLICY CHANGES. IN SUCH EXECUTIVE SESSIONS, NO MEMBERS OF MANAGEMENT OF AHSSHC ARE PRESENT. THE COMMITTEE IS ADVISED BY AN INDEPENDENT THIRD PARTY COMPENSATION ADVISOR. THIS ADVISOR PREPARES ALL THE BENCHMARK STUDIES FOR THE COMMITTEE. COMPENSATION LEVELS ARE BENCHMARKED WITH A NATIONAL PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS OF SIMILAR SIZE AND COMPLEXITY TO AHS AND EACH OF ITS AFFILIATED ENTITIES. THE FOLLOWING PRINCIPLES GUIDE THE ESTABLISHMENT OF INDIVIDUAL EXECUTIVE COMPENSATION: - THE SALARY OF THE PRESIDENT/CEO OF AHS WILL NOT EXCEED THE 40TH PERCENTILE OF COMPARABLE SALARIES PAID BY SIMILARLY SITUATED ORGANIZATIONS; AND - OTHER EXECUTIVE SALARIES SHALL BE ESTABLISHED USING MARKET MEDIANS. THE COMPENSATION PHILOSOPHY, POLICIES, AND PRACTICES OF AHSSHC ARE CONSISTENT WITH THE ORGANIZATION'S FAITH-BASED MISSION AND CONFORM TO APPLICABLE LAWS, REGULATIONS, AND BUSINESS PRACTICES. AS A FAITH-BASED ORGANIZATION SPONSORED BY THE SEVENTH-DAY ADVENTIST CHURCH (THE CHURCH), AHSSHC'S PHILOSOPHY AND PRINCIPLES WITH RESPECT TO ITS EXECUTIVE COMPENSATION PRACTICES REFLECT THE CONSERVATIVE APPROACH OF THE CHURCH'S MISSION OF SERVICE AND WERE DEVELOPED IN COUNSEL WITH THE CHURCH'S LEADERSHIP. PART I, LINE 4B AS DISCUSSED IN LINE 1A ABOVE, EXECUTIVES ON THE FILING ORGANIZATION'S MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF A HEALTHCARE SYSTEM KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). IN RECOGNITION OF THE CONTRIBUTION THAT EACH EXECUTIVE MAKES TO THE SUCCESS OF AHS, AHS PROVIDES TO ELIGIBLE EXECUTIVES PARTICIPATION IN THE AHS EXECUTIVE FLEX BENEFIT PROGRAM (THE PLAN). THE PURPOSE OF THE PLAN IS TO OFFER ELIGIBLE EXECUTIVES AN OPPORTUNITY TO ELECT FROM AMONG A VARIETY OF SUPPLEMENTAL BENEFITS, INCLUDING DEFERRED COMPENSATION BENEFITS TAXABLE UNDER INTERNAL REVENUE CODE (IRC) SECTION 457(F), TO INDIVIDUALLY TAILOR A BENEFITS PROGRAM APPROPRIATE TO EACH EXECUTIVE'S NEEDS. THE PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH IS DEDUCTED THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS. THE PRE-DETERMINED BENEFITS ALLOWANCE CREDIT PERCENTAGE IS APPROVED BY THE 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 $218,000. 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 ------------------------------------------------------- MICHAEL H. SCHULTZ $117,859 $124,294 $397,783 $ 0 KENNETH MATTISON $ 52,713 $ 39,299 $ 0 $ 0 DEBORA H. THOMAS $ 34,033 $ 8,104 $ 0 $ 0 SANDRA K. JOHNSON $ 53,230 $ 34,629 $ 94,186 $ 0 DAVID A. OTTATI $ 37,856 $ 31,045 $ 0 $ 0 LEWIS A. SEIFERT $ 76,798 $ 68,452 $ 0 $ 0 DARLINDA G. COPELAND $ 30,497 $ 11,404 $ 0 $ 0 ELIZABETH WEAGRAFF $ 16,944 $ 13,834 $ 0 $ 0 ED NOSEWORTHY $ 39,708 $ 38,978 $460,764 $ 0 DARYL TOL $ 68,547 $ 62,664 $ 0 $ 0 RONALD JIMENEZ $ 32,160 $ 12,328 $ 0 $ 0 NIGEL HINDS $ 17,896 $ 20,143 $ 0 $ 0 *INCLUDING INVESTMENT EARNINGS GERI MANLEY FAMILY MEMBER OF KEY EMPLOYEE 28122 EMPLOYEE COMPENSATION 0 ADAMS CAMERON TITLE SERVICES INC OWNED BY FAMILY MEMBER OF BOARD MEMBER 114025 CONTRACTOR 0 FORM 990, PART VI, SECTION A, LINE 2 CHARLES D. HOOD, JR. AND LONNIE BROWN - BUSINESS RELATIONSHIP NANCY LOHMAN AND JULIE SCHNEIDER, MD - BUSINESS RELATIONSHIP CHARLES D. HOOD, JR. AND NANCY LOHMAN - BUSINESS RELATIONSHIP CHARLES D. HOOD, JR. AND JULIE SCHNEIDER, MD - BUSINESS RELATIONSHIP CHARLES D. HOOD, JR. AND SURESH DESAI, MD - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 MEMORIAL HEALTH SYSTEMS, INC. (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS ADVENTIST HEALTH SYSTEM/SUNBELT, INC. ADVENTIST HEALTH SYSTEM/SUNBELT, INC.(AHSSI) IS A FLORIDA, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE FILING ORGANIZATION IS AHSSI. THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION ARE APPOINTED BY THE SOLE MEMBER, AHSSI, WHO HAS THE RIGHT TO ELECT, APPOINT OR REMOVE ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B AHSSI, AS THE SOLE MEMBER OF THE FILING ORGANIZATION, HAS CERTAIN RESERVED POWERS AS SET FORTH IN THE BYLAWS OF THE FILING ORGANIZATION. THESE RESERVED POWERS INCLUDE THE FOLLOWING: A) TO APPROVE AND DISAPPROVE THE EXECUTIVE AND/OR ADMINISTRATIVE LEADERSHIP OF THE FILING ORGANIZATION, AND THEIR SALARIES; B) TO ADOPT, AMEND, RESTATE, AND REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS OF THE FILING ORGANIZATION; C) TO SET LIMITS AND TERMS FOR THE BORROWING OF FUNDS; D) TO APPROVE OR DISAPPROVE THE PURCHASE OR SALE OF PERSONAL PROPERTY OR REAL PROPERTY EQUAL TO OR IN EXCESS OF CERTAIN DOLLAR AMOUNT THRESHOLDS; E) TO APPROVE OR DISAPPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION; F) TO DIRECT THE PLACEMENT OF FUNDS AND CAPITAL OF THE FILING ORGANIZATION; G) TO ESTABLISH GENERAL GUIDING POLICIES, TO IMPLEMENT QUALITY ASSESSMENT, IMPROVEMENT AND UTILIZATION REVIEW PROGRAMS; 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 TRUSTEE 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 8,291,068. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,291,068. PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 3,728,002. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,728,002. ENVIRONMENTAL SERVICES : PROGRAM SERVICE EXPENSES 1,486,827. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,486,827. RECRUITING : PROGRAM SERVICE EXPENSES 282,081. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 282,081. MISCELLANEOUS PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 348,625. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 348,625. AHS MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,356,472. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,356,472. BILLING & COLLECTION SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,340,049. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,340,049. EHR MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,129,435. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,129,435. FORM 990, PART XI, LINE 9: ALLOCATIONS WITH RESPECT TO TAX-EXEMPT DEBT 534,457. TRANSFER TO TAX-EXEMPT PARENT CORPORATION -1,245,983. CHANGE IN INVESTMENT IN RELATED FOUNDATION - TEMPORARILY RESTRICTED 3,069,008. GIFTS - TEMPORARILY RESTRICTED 286,275. TRANSFER FROM AFFILIATED ORGANIZATION -5,170. PRIOR YEAR ADJUSTMENT -24,860. 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 HLTH SYSTEMSUNBELT INC 0 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 0 ADVENTIST GLENOAKS HOSPITAL 701 WINTHROP AVENUE GLENDALE HEIGHTS IL 60139 363208390 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 0 ADVENTIST HINSDALE HOSPITAL 120 NORTH OAK STREET HINSDALE IL 60521 362276984 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 0 ADVENTIST HLTH MID-AMERICA INC 9100 W 74TH STREET SHAWNEE MISSION KS 66204 521347407 HLTHCARE RELATED SERVICES KS 501(C)(3) LINE 11A, I ADVENTIST HLTH SYSTEMSUNBELT INC 0 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 0 ADVENTIST HLTH SYSTEM AFFILIATED BENEFIT TRUST 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 266422966 PROMOTION OF HLTHCARE FL 501(C)(3) LINE 11A, I ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 0 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 SYSTEMGEORGIA 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 0 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 0 ADVENTIST HLTH SYSTEMTEXAS INC 602 COURTLAND STREET ORLANDO FL 32804 742578952 LEASING PERSONNEL TO AFFILIATED HOSPITAL TX 501(C)(3) LINE 11C, III-FI ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 0 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 0 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 HLTH SYSTEMSUNBELT INC 0 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 0 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 0 BATTLE CREEK ADVENTIST HOSPITAL 1000 REMINGTON BLVD STE 200 BOLINGBROOK IL 60440 381359189 INACTIVE MI 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 0 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 0 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 0 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 0 CEDAR CRAG TERRACE INC (630 YEAR END) (11-72213) RT 5 BOX 900 MANCHESTER KY 40962 611120442 OPERATION OF HOME FOR THE ELDERLY-DISABLED KY 501(C)(3) LINE 7 MEMORIAL HOSPITAL INC 0 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 0 CENTRAL TEXAS MEDICAL CENTER FOUNDATION 1301 WONDER WORLD DRIVE SAN MARCOS TX 78666 742259907 FUND-RAISING FOR TAX-EXEMPT HOSPITAL TX 501(C)(3) LINE 7 ADVENTIST HLTH SYSTEMSUNBELT INC 0 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 0 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 0 COBB MEDICAL ASSOCIATES LLC 3949 SOUTH COBB DRIVE SE SMYRNA GA 30080 582617089 OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES GA 501(C)(3) LINE 3 EMORY-ADVENTIST INC 0 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 0 CREEKWOOD PLACE NURSING & REHAB CENTER INC 683 E THIRD STREET RUSSELLVILLE KY 42276 205782260 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY KY 501(C)(3) LINE 9 SUNBELT HLTH CARE CENTERS INC 0 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 0 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 0 EMORY-ADVENTIST INC 3949 SOUTH COBB DRIVE SMYRNA GA 30080 582171011 OPERATION OF HOSPITAL & RELATED SVCS GA 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 0 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 0 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 0 FLORIDA HOSPITAL HEALTHCARE PARTNERS INC (130-123113) 301 MEMORIAL MEDICAL PARKWAY 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501(C)(3) LINE 11B, II SUNBELT HLTH CARE CENTERS INC 0 JELLICO COMMUNITY HOSPITAL INC 188 HOSPITAL LANE JELLICO TN 37762 620924706 OPERATION OF HOSPITAL & RELATED SERVICES TN 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 0 JOHNSON COUNTY COMMUNITY CARE CORPORATION (11-5613) 11801 SOUTH FREEWAY BURLESON TX 76028 452793120 SUPPORT OPERATION OF HOSPITAL TX 501(C)(3) LINE 11A, I ADVENTIST HLTH SYSTEMSUNBELT INC 0 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 MEMORIAL HLTH SYSTEMS INC 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 0 MEMORIAL HOSPITAL - WEST VOLUSIA INC 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