MEMORIAL HOSPITAL FLAGLER INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HOSPITAL FLAGLER INC (EIN 59-2951990)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-10
- IRS object ID
- 201433149349303088
- Schema version
- 2013v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-10T18:34:13-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 592951990 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL FLAGLER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEMO | BusinessNameControlTxt |
| Phone | 3865862000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 60 MEMORIAL MEDICAL PARKWAY | AddressLine1 |
| City | PALM COAST | City |
| State | FL | State |
| ZIP Code | 32164 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LYNN C ADDISCOTT | PersonNm |
| Person Title | ASSISTANT SECRETARY | PersonTitleTxt |
| Phone | 4079751492 | PhoneNum |
| Signature | 2014-11-10 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FLORIDA HOSPITAL FLAGLER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KEN MATTISON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 60 MEMORIAL MEDICAL PARKWAY | AddressLine1 |
| City | PALM COAST | City |
| State | FL | State |
| ZIP Code | 32164 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $164,824,429 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FLORIDAHOSPITALFLAGLER.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1989 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | THE PROVISION OF MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF A 99 BED HOSPITAL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 1177 | TotalEmployeeCnt |
| Total Volunteers | 293 | TotalVolunteersCnt |
| Total Gross UBI | $133,747 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $70,140 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $161,284,913 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $159,923,271 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,940,062 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,286,435 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,938,158 | PYOtherRevenueAmt |
| CY Other Revenue | $1,441,516 | CYOtherRevenueAmt |
| PY Total Revenue | $166,163,133 | PYTotalRevenueAmt |
| CY Total Revenue | $164,651,222 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $15,450 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $13,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $68,470,280 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $71,900,313 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $71,218,765 | PYOtherExpensesAmt |
| CY Other Expenses | $69,053,628 | CYOtherExpensesAmt |
| PY Total Expenses | $139,704,495 | PYTotalExpensesAmt |
| CY Total Expenses | $140,966,941 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $26,458,638 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $23,684,281 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $275,372,166 | TotalAssetsBOYAmt |
| Total Assets EOY | $290,854,768 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $96,826,547 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $89,568,818 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $178,545,619 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $201,285,950 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION AND ALL OF ITS SUBSIDIARY ORGANIZATIONS WERE ESTABLISHED BY THE SEVENTH-DAY ADVENTIST CHURCH TO BRING A MINISTRY OF HEALING AND HEALTH TO THE COMMUNITIES SERVED. OUR MISSION IS TO EXTEND THE HEALING MINISTRY OF CHRIST. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $132,321,970 | ExpenseAmt |
| Grant | $13,000 | GrantAmt |
| Revenue | $161,231,040 | RevenueAmt |
| Desc | PROVISION OF MEDICAL CARE TO BOTH INPATIENTS AND OUTPATIENTS. DURING THE CURRENT YEAR, THE HOSPITAL HAD 6,879 PATIENT ADMISSIONS WHICH RESULTED IN 29,704 PATIENT DAYS AND 96,271 OUTPATIENT VISITS. THE HOSPITAL IS AN 99-BED ACUTE CARE HOSPITAL LOCATED IN FLAGLER COUNTY, FLORIDA. | Desc |
| Total Program Service Expenses | $132,321,970 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | Yes (1) | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 161 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1177 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | FL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERMAINE BUCKNOR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3865864210 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 60 MEMORIAL MEDICAL PARKWAY | AddressLine1 |
| City | PALM COAST | City |
| State | FL | State |
| ZIP Code | 32164 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| DENNIS ALTER MD | |||||||||
| DIRECTOR | 50.20 | 0.00 | Yes (X) | $609,014 | $0 | $25,214 | |||
| STEVEN BROWN MD | |||||||||
| DIRECTOR (END 12/13) | 4.50 | 0.00 | Yes (X) | $32,964 | $0 | $0 | |||
| MICHAEL CHIUMENTO | |||||||||
| DIRECTOR | 0.40 | 0.00 | Yes (X) | $214 | $0 | $0 | |||
| BOB DEVORE | |||||||||
| DIRECTOR | 0.20 | 0.00 | Yes (X) | $214 | $0 | $0 | |||
| TED HAMILTON MD | |||||||||
| DIRECTOR | 0.20 | 50.00 | Yes (X) | $214 | $640,219 | $41,743 | |||
| SANDRA JOHNSON | |||||||||
| DIRECTOR | 0.10 | 50.00 | Yes (X) | $0 | $685,560 | $91,718 | |||
| ROGER LEVERTON | |||||||||
| DIRECTOR | 0.40 | 0.00 | Yes (X) | $214 | $0 | $0 | |||
| KENNETH MATTISON | |||||||||
| DIRECTOR/CEO (BEG 6/13) | 25.00 | 25.00 | Yes (X) | $214 | $524,455 | $117,526 | Yes (X) | ||
| HOLSEY MOORMAN | |||||||||
| DIRECTOR | 0.20 | 0.00 | Yes (X) | $214 | $0 | $0 | |||
| EDWARD NOSEWORTHY | |||||||||
| DIRECTOR | 0.10 | 50.00 | Yes (X) | $0 | $865,264 | $82,047 | |||
| DAVID OTTATI | |||||||||
| CEO/FLAGLER/DIR (END 6/13) | 25.00 | 25.00 | Yes (X) | $214 | $611,984 | $105,731 | Yes (X) | ||
| BRUCE PAGE | |||||||||
| DIRECTOR | 0.40 | 0.00 | Yes (X) | $214 | $0 | $0 | |||
| TONY PAPANDREA | |||||||||
| DIRECTOR | 0.40 | 0.00 | Yes (X) | $214 | $0 | $0 | |||
| TERRANCE REGAN MD | |||||||||
| DIRECTOR | 4.00 | 0.00 | Yes (X) | $28,814 | $0 | $0 | |||
| BARBARA REVELS | |||||||||
| DIRECTOR | 0.40 | 0.00 | Yes (X) | $214 | $0 | $0 | |||
| MICHAEL SCHULTZ | |||||||||
| CHAIRMAN | 0.10 | 50.00 | Yes (X) | $0 | $1,430,716 | $157,109 | |||
| LEWIS SEIFERT | |||||||||
| DIRECTOR | 0.10 | 50.00 | Yes (X) | $0 | $709,665 | $125,841 | |||
| DARYL TOL | |||||||||
| CHAIRMAN/DIRECTOR | 6.00 | 44.00 | Yes (X) | $214 | $644,930 | $121,246 | |||
| DEBORA THOMAS | |||||||||
| DIRECTOR | 6.00 | 44.00 | Yes (X) | $214 | $427,009 | $65,207 | |||
| VALERIE ZIESMER | |||||||||
| CFO | 50.00 | 0.00 | $0 | $288,750 | $37,135 | Yes (X) | |||
| ELLEN LENKEVICH | |||||||||
| CNO | 50.00 | 0.00 | $1 | $205,225 | $37,833 | Yes (X) | |||
| JOSEPH MCKINLEY MD | |||||||||
| PHYSICIAN | 75.00 | 0.00 | $1,031,696 | $0 | $29,809 | Yes (X) | |||
| PADMAJA SAI MD | |||||||||
| PHYSICIAN | 65.00 | 0.00 | $803,802 | $0 | $20,159 | Yes (X) | |||
| KIZHAKE KURIAN MD | |||||||||
| PHYSICIAN | 70.00 | 0.00 | $762,810 | $0 | $21,639 | Yes (X) | |||
| ANTHONY TUCKER MD | |||||||||
| PHYSICIAN | 65.00 | 0.00 | $719,957 | $0 | $25,657 | Yes (X) | |||
| PHILIP NDUM MD | |||||||||
| PHYSICIAN | 70.00 | 0.00 | $572,120 | $0 | $19,791 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,563,746 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $7,033,777 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,125,405 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 65 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SHERIDAN HEALTHCORP INC | |||||
| PO BOX 452197 | SUNRISE | FL | 33323 | ANESTHESIA/PHYSICIAN SERVICES | $1,175,024 |
| ADVENTIST HEALTH SYSTEMSUNBELT INC DB | |||||
| 601 E ROLLINS STREET | ORLANDO | FL | 32803 | LAB & MARKETING SERVICES | $953,157 |
| MEDICAID ELIGIBILITY & DENIAL SOLUTIONS | |||||
| PO BOX 538449 | ATLANTA | GA | 30353 | COLLECTION SERVICES | $485,495 |
| ADVANTAGE MEDICAL STAFFING OF CENTRAL FL | |||||
| PO BOX 101004 | ATLANTA | GA | 30392 | MEDICAL STAFFING SERVICES | $434,282 |
| C & A INDUSTRIES INC | |||||
| PO BOX 3037 | OMAHA | NE | 68103 | MEDICAL STAFFING SERVICES | $313,931 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 81 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT REVENUE | 900099 | $158,228,111 | $158,228,111 | |
| MEDICAL OFFICE BUILDING | 531120 | $1,094,569 | $1,094,569 | |
| CAFETERIA REVENUE | 900099 | $414,485 | $414,485 | |
| LAB REVENUE | 621500 | $133,747 | $133,747 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $52,359 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $52,359 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $159,923,271 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,735,674 | TotalRevenueColumnAmt |
| Exclusion | $1,735,674 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,565,334 | SecuritiesAmt |
| Other | $158,634 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $173,207 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,565,334 | SecuritiesAmt |
| Other | -$14,573 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,550,761 | TotalRevenueColumnAmt |
| Exclusion | $1,550,761 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | EHR REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $1,441,516 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,441,516 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,441,516 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $164,651,222 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $161,231,040 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $133,747 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,286,435 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,000 | TotalAmt |
| Program Services | $13,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,947,366 | TotalAmt |
| Management And General | $1,947,366 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,296,941 | TotalAmt |
| Program Services | $55,296,941 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,482,180 | TotalAmt |
| Program Services | $1,456,749 | ProgramServicesAmt |
| Management And General | $25,431 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,599,289 | TotalAmt |
| Program Services | $9,469,043 | ProgramServicesAmt |
| Management And General | $130,246 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,574,537 | TotalAmt |
| Program Services | $3,513,205 | ProgramServicesAmt |
| Management And General | $61,332 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,801 | TotalAmt |
| Management And General | $132,801 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,128 | TotalAmt |
| Management And General | $51,128 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,911,083 | TotalAmt |
| Program Services | $12,668,609 | ProgramServicesAmt |
| Management And General | $3,242,474 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $808,406 | TotalAmt |
| Management And General | $808,406 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,882,627 | TotalAmt |
| Program Services | $2,156,773 | ProgramServicesAmt |
| Management And General | $725,854 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,282,474 | TotalAmt |
| Program Services | $3,588,263 | ProgramServicesAmt |
| Management And General | $694,211 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,890,098 | TotalAmt |
| Program Services | $3,884,577 | ProgramServicesAmt |
| Management And General | $5,521 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $547,777 | TotalAmt |
| Management And General | $547,777 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,491 | TotalAmt |
| Management And General | $45,491 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,129,348 | TotalAmt |
| Program Services | $3,129,348 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,037,321 | TotalAmt |
| Program Services | $8,037,321 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,010,622 | TotalAmt |
| Program Services | $1,945,354 | ProgramServicesAmt |
| Management And General | $65,268 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $22,670,372 | $22,670,372 | |
| REPAIRS & MAINTENANCE | $3,038,360 | $3,038,360 | |
| STATE TAX INDIGENT ASSE | $1,425,250 | $1,425,250 | |
| UNRELATED BUSINESS INCO | $9,000 | $9,000 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $181,470 | TotalAmt |
| Program Services | $28,805 | ProgramServicesAmt |
| Management And General | $152,665 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140,966,941 | TotalAmt |
| Program Services | $132,321,970 | ProgramServicesAmt |
| Management And General | $8,644,971 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,502 | BOYAmt |
| EOY | $4,449 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $153,304,725 | BOYAmt |
| EOY | $170,412,443 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,518,254 | BOYAmt |
| EOY | $17,736,161 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,899,731 | BOYAmt |
| EOY | $2,813,100 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,741,434 | BOYAmt |
| EOY | $2,470,193 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $137,177,788 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $57,533,693 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,438,960 | BOYAmt |
| EOY | $79,644,095 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,611,981 | BOYAmt |
| EOY | $14,568,648 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,852,579 | BOYAmt |
| EOY | $3,205,679 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $275,372,166 | BOYAmt |
| EOY | $290,854,768 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,608,331 | BOYAmt |
| EOY | $8,416,317 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $111,385 | BOYAmt |
| EOY | $139,542 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $89,106,831 | BOYAmt |
| EOY | $81,012,959 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,826,547 | BOYAmt |
| EOY | $89,568,818 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $178,545,619 | BOYAmt |
| EOY | $201,256,930 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $29,020 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $178,545,619 | BOYAmt |
| EOY | $201,285,950 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $275,372,166 | BOYAmt |
| EOY | $290,854,768 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $23,684,281 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$5,859 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$938,091 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $4,610 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,610 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | AMERICAN HOSPITAL ASSOCIATION AND FLORIDA HOSPITAL ASSOCIATION DUES. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Protection Natural Habitat | Yes (X) | ProtectionNaturalHabitatInd |
| States Easements Held | 1 | StatesEasementsHeldCnt |
| Written Policy Monitoring | 0 | WrittenPolicyMonitoringInd |
| Staff Hours Spent Enforcement | 0.00 | StaffHoursSpentEnforcementCnt |
| Expenses Incurred Enforcement | $0 | ExpensesIncurredEnforcementAmt |
| Section170h Rqr Stsfd | 0 | Section170hRqrStsfdInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,311,502 | OtherCostOrOtherBasisAmt |
| Book Value | $7,311,502 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $56,729,689 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,980,226 | DepreciationAmt |
| Book Value | $41,749,463 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $66,927,783 | OtherCostOrOtherBasisAmt |
| Depreciation | $39,607,178 | DepreciationAmt |
| Book Value | $27,320,605 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,208,814 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,946,289 | DepreciationAmt |
| Book Value | $3,262,525 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $79,644,095 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| OTHER CURRENT LIABILITIES | $120,670 |
| CREDIT BALANCES IN A/R | $760,911 |
| INTERCO. ALLOC. OF TE BOND PROCEEDS | $73,148,971 |
| DUE TO THIRD PARTIES | $5,443,064 |
| DUE TO RELATED | $1,539,343 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $81,012,959 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART II, LINE 9: | THE FILING ORGANIZATION HAS RECORDED THE LAND CONSERVATION EASEMENT ON ITS FINANCIAL STATEMENTS AS A PROPERTY, PLANT, AND EQUIPMENT ASSET. THE CONSERVATION EASEMENT GENERATES NO REVENUE AND THE FILING ORGANIZATION DID NOT INCUR ANY EXPENSE RELATED TO THE MAINTENANCE AND MONITORING OF THE CONSERVATION EASEMENT. |
| PART X, LINE 2: | THE HOSPITAL IS PART OF A CONSOLIDATED AUDITED FINANCIAL STATEMENT. THE CONSOLIDATED AUDITED FINANCIAL STATEMENT INCLUDES THE FOLLOWING FIN 48 FOOTNOTE - THE DIVISION FOLLOWS 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. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,480,524 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,480,524 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03890 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,162,728 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,506,015 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,656,713 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02590 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,643,252 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,506,015 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,137,237 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06480 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $220,888 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $220,888 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $220,888 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $220,888 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,864,140 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,506,015 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,358,125 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06640 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,026 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,026 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,530 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $17,530 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $32,556 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $32,556 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $11,227,931 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $765,590 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $54,496,438 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $53,640,712 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $855,726 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FLORIDA HOSPITAL - FLAGLER | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 60 MEMORIAL MEDICAL PARKWAY | AddressLine1 |
| City | PALM COAST | City |
| State | FL | State |
| ZIP Code | 32164 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.FLORIDAHOSPITALFLAGLER.COM | WebsiteAddressTxt |
| State License | 4465 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL FLAGLER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.FLORIDAHOSPITALFLAGLER.COM | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Other Needs Addressed | Yes (X) | OtherNeedsAddressedInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| State Regulation | Yes (X) | StateRegulationInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MEMORIAL HOSPITAL FLAGLER, INC. | PART V, SECTION B, LINE 3: MEMORIAL HOSPITAL FLAGLER, INC. D/B/A FLORIDA HOSPITAL FLAGLER, (FHF OR THE HOSPITAL) OPERATES A 99-BED ACUTE-CARE HOSPITAL IN FLAGLER COUNTY, FLORIDA. THE PRIMARY SERVICE AREA (PSA) FOR FHF IS ALL OF FLAGLER COUNTY, WHICH INCLUDES APPROXIMATELY 100,000 INDIVIDUALS. APPROXIMATELY 77% OF THE RESIDENTS IN FLAGLER COUNTY ARE WHITE, APPROXIMATELY 10% ARE AFRICAN-AMERICAN, AND APPROXIMATELY 9% ARE HISPANIC. APPROXIMATELY 16.5% OF THE POPULATION WITHIN THE PSA IS UNINSURED. IN CONDUCTING ITS 2013 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE HOSPITAL GATHERED PRIMARY AND SECONDARY DATA FROM A NUMBER OF SOURCES WITH AN INTENT TO MAKE SURE THAT INPUT WAS SOLICITED FROM THOSE REPRESENTING THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. COMMUNITY ORGANIZATIONS WERE IDENTIFIED IN ORDER TO GATHER STAKEHOLDER INPUT THROUGH INTERVIEWS AND SURVEYS. STAKEHOLDERS INCLUDED REPRESENTATIVES FROM THE FLAGLER COUNTY HEALTH DEPARTMENT, UNITED WAY, LOCAL CHURCHES, SCHOOLS AND GOVERNMENT. THE IDENTIFIED REPRESENTATIVES REFLECTED A COMPREHENSIVE VIEW OF ALL OF FLAGLER COUNTY'S RESIDENTS, INCLUSIVE OF ALL AGES, ETHNICITIES, AND ECONOMIC STATUS. AS A PART OF ITS EFFORTS TO ENSURE BROAD COMMUNITY-BASED INPUT INTO THE CHNA PROCESS, THE HOSPITAL ESTABLISHED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC). THE CHNAC WAS INTENDED TO REPRESENT THE NEEDS OF THE GENERAL COMMUNITY WITH A PARTICULAR FOCUS ON INCLUDING REPRESENTATIVES OF THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. EACH MEMBER OF THE CHNAC BROUGHT KNOWLEDGE AND EXPERIENCE IN WORKING WITH PEOPLE AND FAMILIES IN THE HOSPITAL'S COMMUNITY, AS WELL AS A UNIQUE PERSPECTIVE ON HEALTH CONCERNS IN THE COMMUNITY. UNDERSERVED POPULATIONS, INCLUDING THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS WERE ESPECIALLY REPRESENTED THROUGH PARTICIPATION FROM THE FLAGLER COUNTY HEALTH DEPARTMENT, A FREE HEALTH CLINIC, GRACE TABERNACLE CHURCH, THE FLAGLER COUNTY SCHOOL DISTRICT, AND THE UNITED WAY. |
| MEMORIAL HOSPITAL FLAGLER, INC. | PART V, SECTION B, LINE 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. |
| MEMORIAL HOSPITAL FLAGLER, INC. | 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. |
| MEMORIAL HOSPITAL FLAGLER, INC. | PART V, SECTION B, LINE 7: MEMORIAL HOSPITAL FLAGLER, INC., D/B/A FLORIDA HOSPITAL FLAGLER, (FHF 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, SEVEN KEY HEALTH ISSUES WERE INITIALLY IDENTIFIED FOR THE HOSPITAL'S COMMUNITY FOR WHICH FLAGLER COUNTY RANKED IN THE 3RD OR 4TH QUARTILE COMPARED TO OTHER COUNTIES IN FLORIDA. THESE SEVEN KEY ISSUES WERE: 1) CHRONIC DISEASE (CANCER, HEART DISEASE, CHRONIC LOWER RESPIRATORY, ASTHMA, STROKE, AND DIABETES); 2) RISK FACTORS/HEALTH AND WELLNESS (TOBACCO USE, OBESITY, AND PHYSICAL ACTIVITY); 3) COMMUNICABLE DISEASE (HIV/AIDS, SEXUALLY TRANSMITTED DISEASES); 4) INJURY (UNINTENTIONAL INJURY, VIOLENCE, DOMESTIC VIOLENCE); 5) BEHAVIORAL HEALTH (ALCOHOL ABUSE, MENTAL HEALTH, SUICIDE); 6) MATERNAL AND CHILD HEALTH (INFANT MORTALITY, LOW BIRTH WEIGHT, PRENATAL CARE, TEEN BIRTHS, RISK FACTORS ASSOCIATED WITH POOR BIRTH OUTCOMES, CHILDHOOD IMMUNIZATIONS); AND 7) ACCESS TO HEALTH CARE SERVICES (HEALTH INSURANCE COVERAGE, HEALTH CARE PROVIDERS AND FACILITIES). THESE SEVEN KEY ISSUES 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 TWO PRIORITIES: HEALTH AND WELLNESS (OBESITY, SMOKING RATES AND CHRONIC DISEASES); AND ACCESS TO HEALTH CARE SERVICES. FHF DID NOT SELECT THE FOLLOWING ISSUES IN CONNECTION WITH ITS 2013 CHNA AS FOLLOWS:COMMUNICABLE DISEASES WERE NOT SELECTED AS A PRIORITY AS THE HOSPITAL DETERMINED IT WAS NOT AN ISSUE THAT THE HOSPITAL WOULD BE ABLE TO EFFECTIVELY ADDRESS. IN ADDITION, THERE ARE CURRENT COMMUNITY GROUPS ALREADY ADDRESSING THE ISSUE.INJURY WAS NOT SELECTED AS A PRIORITY FOR THE 2013 CHNA AS THERE ARE ALREADY COMMUNITY GROUPS WORKING ON COMBATING ISSUES OF UNINTENTIONAL INJURY, VIOLENCE AND DOMESTIC VIOLENCE SUCH AS THE SCHOOL SYSTEMS, DOMESTIC ABUSE SHELTERS, AND OTHER GOVERNMENT AGENCIES.THE ISSUE OF MATERNAL AND CHILD HEALTH WAS NOT SELECTED AS A TOP PRIORITY AS THE HOSPITAL DOES NOT HAVE AN OB PROGRAM. |
| MEMORIAL HOSPITAL FLAGLER, INC. | PART V, SECTION B, LINE 14G: THE FILING ORGANIZATION 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. |
| MEMORIAL HOSPITAL FLAGLER, INC. | 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 50 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (50 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt | Address Line2USAddress/AddressLine2 |
|---|---|---|---|---|---|
| FLORIDA HOSPITAL MEMORIAL HOSPICE | |||||
| 770 W GRANADA BLVD 304 | ORMOND BEACH | FL | 32174 | HOSPICE ADMINISTRATIVE OFFICE | |
| HCP - SAI PADMAJA MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | ONCOLOGY SERVICES | 2812 |
| FLORIDA HOSPITAL MEMORIAL HOME HEALTH | |||||
| 770 W GRANADA BLVD 319 | ORMOND BEACH | FL | 32174 | HOME CARE SERVICES | |
| HCP - NDUM PHILIP MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | ONCOLOGY SERVICES | 2818 |
| FLORIDA HOSPITAL FLAGLER TOWN CENTER SUR | |||||
| 21 HOSPITAL DRIVE SUITE 120 | PALM COAST | FL | 32164 | SURGICAL SERVICES | |
| FLORIDA HOSPITAL HOSPICE - ORLANDO | |||||
| 901 NORTH LAKE DESTINY ROAD SUITE | MAITLAND | FL | 32751 | HOSPICE ADMINISTRATIVE OFFICE | 400 |
| PALM COAST PARKWAY PHYSICAL THERAPY | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | PHYSICAL THERAPY | |
| FLORIDA HOSPITAL HOSPICE - MEMORIAL | |||||
| 301 MEMORIAL MEDICAL PARKWAY | DAYTONA BEACH | FL | 32117 | HOSPICE CARE SERVICES | |
| HCP - MCKINLEY JOSEPH MD | |||||
| 3 PINE CONE CIRCLE SUITE 105 | PALM COAST | FL | 32137 | GASTROENTEROLOGY SERVICES | |
| STUART F MEYER HOSPICE HOUSE | |||||
| 150 MEMORIAL PARKWAY | PALM COAST | FL | 32164 | HOSPICE CARE SERVICES | |
| HCP - TUCKER ANTHONY MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 202 | PALM COAST | FL | 32164 | ENT SERVICES | |
| HCP - KURIAN KIZHAKE MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | CARDIOLOGY SERVICES | 3808 |
| HCP - BOWER STEVEN C MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | SURGICAL SERVICES | 3807 |
| HCP - ALTER DENNIS MD | |||||
| 21 HOSPITAL DRIVE SUITE 110 | PALM COAST | FL | 32164 | ORTHOPEDIC SERVICES | |
| HCP - CAHSIO RICHARD MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | SURGICAL, PLASTIC, & RECONSTRUCTIVE SERVICES | 2802 |
| HCP - COMBS WALLACE MD | |||||
| 120 PINNACLES DRIVE SUITE 1 | PALM COAST | FL | 32164 | GASTROENTEROLOGY SERVICES | |
| PALM COAST PARKWAY MRI | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | IMAGING SERVICES | |
| HCP - GAY DAVID M MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY 2801 | PALM COAST | FL | 32164 | ORTHOPEDIC SERVICES | |
| HCP - BOLLA JOHN D MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | FAMILY PRACTICE SERVICES | 3803 |
| HCP - PALM COAST FAMILY PRACTICE | |||||
| 42A CAROLINE STREET | BUNNELL | FL | 32110 | FAMILY PRACTICE SERVICES | |
| PALM COAST PARKWAY CT | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | CT SERVICES | |
| HCP - GARCIA-GUERRA JOSE MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | NEUROLOGICAL SERVICES | 2808 |
| HCP - KEEN JEFFREY MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | ORTHOPEDIC SERVICES | 2801 |
| PROMPT CARE | |||||
| 120 CYPRESS EDGE DRIVE SUITE 102 | PALM COAST | FL | 32164 | URGENT CARE & FAMILY PRACTICE | |
| HCP - DAVIS MICHAEL DO DBA PEDIATRICS | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | PEDIATRIC SERVICES | 3811 |
| HCP - SHAMS SAFWAN MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | GASTROENTEROLOGY SERVICES | 1800- |
| HCP - PETERSON DARREN L MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | GENERAL SURGERY SERVICES | 2815 |
| HCP - WARD JEFFERY J DO | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | FAMILY PRACTICE SERVICES | 3813 |
| HCP - WALSH JOHN A MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | SURGERY, CARDIOVASCULAR/THORACIC SERVICES | 1800- |
| HCP - CEBALLOS JECEBU MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | FAMILY PRACTICE SERVICES | 2806 |
| HCP - TURCHIN SERGEY MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 209 | PALM COAST | FL | 32164 | INTERNAL MEDICINE SERVICES | |
| HCP - AHMED TANAM MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 207 | PALM COAST | FL | 32164 | FAMILY PRACTICE SERVICES | |
| PALM COAST PARKWAY SPEECH THERAPY | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | SPEECH THERAPY | |
| HCP - OLIVIER CHAMION MD | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | INFECTIOUS DISEASE SERVICES | |
| HCP - BURNS LAWRENCE W MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | INTERNAL MEDICINE/PULMONOLOGY SERVICES | 3817 |
| HCP - JOINER THOMAS A MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY 2811 | PALM COAST | FL | 32164 | CARDIOLOGY SERVICES | |
| HCP - OGLESBY ALLAN C MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | INTERNAL MEDICINE SERVICES | 3805 |
| HCP - KARRAFFA DAVID MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 206 | PALM COAST | FL | 32164 | HEALTHCARE -NEPHROLOGY SERVICES | |
| PALM COAST PARKWAY ULTRASOUND | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | ULTRASOUND SERVICES | |
| HCP - TRAUTSCHOLD JULIE MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 210 | PALM COAST | FL | 32137 | FAMILY PRACTICE SERVICES | |
| PALM COAST PARKWAY OCCUPATIONAL THERAPY | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | OCCUPATIONAL THERAPY | |
| FAMILY FOCUS MEDICAL CENTER | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | FAMILY PRACTICE SERVICES | 2802 |
| HCP - SIDDIQUI REHANA MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | PALM COAST | FL | 32164 | GENERAL PRACTICE SERVICES | 3812 |
| PALM COAST PARKWAY WOMEN'S CENTER | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | WOMEN'S HEALTH SERVICES | |
| PALM COAST PARKWAY RADIOLOGY | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32174 | RADIOLOGY SERVICES | |
| HCP - SCHINCO MIREN A MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY 2815 | PALM COAST | FL | 32164 | GENERAL SURGERY SERVICES | |
| HCP - THEILADE CHRISTIANE MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 203 | PALM COAST | FL | 32137 | CARDIOLOGY SERVICES | |
| HCP - HSOKOTE JAIDEEP MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 201 | PALM COAST | FL | 32164 | NEPHROLOGY SERVICES | |
| HCP - ADAMS RICHARD DO | |||||
| 28 OFFICE PARK DRIVE | PALM COAST | FL | 32164 | FAMILY PRACTICE SERVICES | |
| PALM COAST PARKWAY LABORATORY | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | LABORATORY SERVICES | |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A: | THE FILING ORGANIZATION IS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). 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 (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 II, COMMUNITY BUILDING ACTIVITIES: | MEMORIAL HOSPITAL FLAGLER, INC. (THE HOSPITAL) IS INVOLVED WITH AND SUPPORTIVE OF VARIOUS OTHER COMMUNITY AGENCIES IN ITS SERVICE AREA THAT WORK COLLABORATIVELY TO HELP THOSE IN NEED AND TO IMPROVE THE HEALTH AND SAFETY OF THE RESIDENTS OF THE COMMUNITY. THE HOSPITAL PARTICIPATES WITH A NUMBER OF OTHER COMMUNITY ORGANIZATIONS TO ADDRESS THE HEALTHCARE NEEDS OF THE COMMUNITY. THE HOSPITAL PROVIDES SUPPLIES AND CASH DONATIONS TO A LOCAL COMMUNITY FREE CLINIC ORGANIZATION. THE HOSPITAL ALSO PARTICIPATES IN COMMUNITY EVENTS, SUCH AS THE RELY FOR LIFE, AMERICAN CANCER SOCIETY, AND HEARTWALK. |
| 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: | COLLECTION POLICIES: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/SURPLUS 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/SURPLUS FROM 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: $ 855,726- DIFFERENCE IN COSTING METHODOLOGY: 4,100,268- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (9,761,357) -------------TOTAL MEDICARE SHORTFALL FROM SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITY BENEFIT REPORTING: $(4,805,363)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: | MEMORIAL HOSPITAL FLAGLER (THE HOSPITAL) IS A 99-BED ACUTE CARE FACILITY THAT PROVIDES QUALITY HEALTH CARE SERVICES TO THE RESIDENTS OF PALM COAST AND SURROUNDING FLAGLER COUNTY IN THE STATE OF FLORIDA. IN 2002, THE HOSPITAL OPENED ITS NEW FACILITY, EQUIPPED WITH CARE CENTERS FOR HEART, CANCER AND WOMEN'S HEALTH. THE HOSPITAL IS THE SOLE PROVIDER OF EMERGENCY HOSPITAL SERVICES IN FLAGLER COUNTY. THE HOSPITAL IS LOCATED IN A RURAL COMMUNITY LOCATED BETWEEN TWO LARGER CITIES. THE HOSPITAL IS A CRUCIAL COMMUNITY AND REGIONAL ASSET. MEDICARE HAS DESIGNATED FLORIDA HOSPITAL FLAGLER AS A MEDICARE DEPENDENT HOSPITAL AS IT IS LOCATED IN A RURAL AREA. THE NEAREST OTHER HOSPITAL IS 15 MILES AWAY AND THIS FACILITY IS OWNED BY AN AFFILIATE. THE HOSPITAL CURRENTLY OFFERS MOST HOSPITAL SERVICES INCLUDING CANCER, HOME HEALTH AND HOSPICE PROGRAMS. THE HOSPITAL IS ALSO THE THIRD LARGEST EMPLOYER IN FLAGLER COUNTY.THE HOSPITAL'S PRIMARY MARKET HAS A POPULATION OF APPROXIMATELY 98,000, WITH AN ESTIMATED 24,500 OVER THE AGE OF 65. THE WEIGHTED AVERAGE HOUSEHOLD INCOME, BASED ON POPULATION, IN THE PRIMARY MARKET IS APPROXIMATELY $46,330. HIGH SCHOOL GRADUATES ACCOUNT FOR APPROXIMATELY 89% OF FLAGLER COUNTY, WITH AN ESTIMATED 21% HAVING A BACHELOR'S DEGREE OR HIGHER. IT IS ESTIMATED THAT 11% OF THE INDIVDUALS RESIDING IN FLAGLER COUNTY LIVE BELOW THE POVERTY LEVEL AND THE UNEMPLOYMENT RATE IS ABOUT 7%.APPROXIMATELY 66% OF THE HOSPITAL'S PATIENTS ARE COVERED BY MEDICARE OR MEDICAID. MEDICARE PATIENTS COMPRISE ABOUT 56% OF THE HOSPITAL'S PATIENTS. APPROXIMATELY 9% OF THE HOSPITAL'S PATIENTS ARE COVERED BY THE MEDICAID PROGRAM, WITH 5% REPRESENTING SELF-PAY AND THE REMAINING ARE COMMERCIAL PAYORS. APPROXIMATELY 89% OF THE HOSPITAL'S IN-PATIENTS ARE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. |
| PART VI, LINE 5: | THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO MEMORIAL HOSPITAL FLAGLER'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST" AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, THE HOSPITAL PROVIDED $252,541 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF A COMMUNITY HOSPITAL. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE HOSPITAL EXPENDED $4,869,717 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. |
| PART VI, LINE 6: | THE HOSPITAL IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 44 HOSPITALS IN 10 STATES THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 16 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AS THE PARENT ORGANIZATION OF THE AHS SYSTEM, AHSSHC PROVIDES EXECUTIVE LEADERSHIP AND OTHER PROFESSIONAL SUPPORT SERVICES TO ITS SUBSIDIARY ORGANIZATIONS. PROFESSIONAL SUPPORT SERVICES INCLUDE AMONG OTHERS CORPORATE COMPLIANCE, LEGAL, HUMAN RESOURCES, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH AHS SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. EACH AHS SUBSIDIARY PAYS A MANAGEMENT FEE TO AHSSHC FOR THE INTERNAL SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY A AHS SUBSIDIARY ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY BY ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF AHS AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEB-SITE OF AHS AT WWW.ADVENTISTHEALTHSYSTEM.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF AHS AND TO ACCESS AHS'S ANNUAL REPORT THAT CONTAINS FINANCIAL DATA AS WELL AS COMMUNITY BENEFIT REPORTING FOR THE ENTIRE SYSTEM. |
| PART VI, LINE 7: | THE ANNUAL COMMUNITY BENEFIT REPORT CONTAINED IN THE ANNUAL REPORT PREPARED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) ON BEHALF OF THE ENTIRE AHS SYSTEM OF HEALTHCARE ORGANIZATIONS IS NOT FILED WITH ANY STATE AGENCIES. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FLAGLER AUDITORIUM GOVERNING BOARD INC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 755 | AddressLine1 |
| City | BUNNELL | City |
| State | FL | State |
| ZIP Code | 32110 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 593079371 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $13,000 | CashGrantAmt |
| Purpose Of Grant | GENERAL SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | GRANTS ARE GENERALLY MADE ONLY TO RELATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3), OR TO OTHER LOCAL CHARITABLE COMMUNITY ORGANIZATIONS, OR TO OTHER 501(C)(3) ORGANIZATIONS THAT ARE A PART OF THE GROUP EXEMPTION RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Discretionary Spending Acct | Yes (X) | DiscretionarySpendingAcctInd |
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (17 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DENNIS ALTER MD | ||||||||||||||
| DIRECTOR | $416,861 | $0 | $190,918 | $0 | $1,235 | $0 | $13,850 | $0 | $11,364 | $0 | $634,228 | $0 | $0 | $0 |
| TED HAMILTON MD | ||||||||||||||
| DIRECTOR | $0 | $368,335 | $0 | $89,088 | $214 | $182,796 | $0 | $13,850 | $0 | $27,893 | $214 | $681,962 | $0 | $0 |
| SANDRA JOHNSON | ||||||||||||||
| DIRECTOR | $0 | $405,653 | $0 | $117,349 | $0 | $162,558 | $0 | $49,580 | $0 | $42,138 | $0 | $777,278 | $0 | $31,179 |
| KENNETH MATTISON | ||||||||||||||
| DIRECTOR/CEO (BEG 6/13) | $0 | $362,840 | $0 | $64,416 | $214 | $97,199 | $0 | $49,063 | $0 | $68,463 | $214 | $641,981 | $0 | $32,128 |
| EDWARD NOSEWORTHY | ||||||||||||||
| DIRECTOR | $0 | $323,611 | $0 | $24,108 | $0 | $517,545 | $0 | $53,557 | $0 | $28,490 | $0 | $947,311 | $0 | $33,704 |
| DAVID OTTATI | ||||||||||||||
| CEO/FLAGLER/DIR (END 6/13) | $0 | $358,215 | $0 | $69,667 | $214 | $184,102 | $0 | $51,706 | $0 | $54,025 | $214 | $717,715 | $0 | $27,076 |
| MICHAEL SCHULTZ | ||||||||||||||
| CHAIRMAN | $0 | $662,144 | $0 | $193,658 | $0 | $574,914 | $0 | $114,208 | $0 | $42,901 | $0 | $1,587,825 | $0 | $107,872 |
| LEWIS SEIFERT | ||||||||||||||
| DIRECTOR | $0 | $485,343 | $0 | $119,810 | $0 | $104,512 | $0 | $90,647 | $0 | $35,194 | $0 | $835,506 | $0 | $67,614 |
| DARYL TOL | ||||||||||||||
| CHAIRMAN/DIRECTOR | $0 | $466,518 | $0 | $104,552 | $214 | $73,860 | $0 | $82,397 | $0 | $38,849 | $214 | $766,176 | $0 | $60,969 |
| DEBORA THOMAS | ||||||||||||||
| DIRECTOR | $0 | $313,995 | $0 | $68,909 | $214 | $44,105 | $0 | $30,382 | $0 | $34,825 | $214 | $492,216 | $0 | $8,101 |
| VALERIE ZIESMER | ||||||||||||||
| CFO | $0 | $224,993 | $0 | $37,384 | $0 | $26,373 | $0 | $18,030 | $0 | $19,105 | $0 | $325,885 | $0 | $4,628 |
| ELLEN LENKEVICH | ||||||||||||||
| CNO | $0 | $170,479 | $0 | $27,898 | $1 | $6,848 | $0 | $27,064 | $0 | $10,769 | $1 | $243,058 | $0 | $0 |
| JOSEPH MCKINLEY MD | ||||||||||||||
| PHYSICIAN | $365,761 | $0 | $664,434 | $0 | $1,501 | $0 | $13,850 | $0 | $15,959 | $0 | $1,061,505 | $0 | $0 | $0 |
| PADMAJA SAI MD | ||||||||||||||
| PHYSICIAN | $253,366 | $0 | $549,685 | $0 | $751 | $0 | $11,725 | $0 | $8,434 | $0 | $823,961 | $0 | $0 | $0 |
| KIZHAKE KURIAN MD | ||||||||||||||
| PHYSICIAN | $596,364 | $0 | $166,145 | $0 | $301 | $0 | $13,850 | $0 | $7,789 | $0 | $784,449 | $0 | $0 | $0 |
| ANTHONY TUCKER MD | ||||||||||||||
| PHYSICIAN | $637,895 | $0 | $81,791 | $0 | $271 | $0 | $8,750 | $0 | $16,907 | $0 | $745,614 | $0 | $0 | $0 |
| PHILIP NDUM MD | ||||||||||||||
| PHYSICIAN | $250,314 | $0 | $321,444 | $0 | $362 | $0 | $11,750 | $0 | $8,041 | $0 | $591,911 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). MEMBERS OF THE FILING ORGANIZATION'S EXECUTIVE MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF AHS. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). THE FILING ORGANIZATION REIMBURSES AHSSHC FOR THE SALARY AND BENEFIT COST OF THOSE EXECUTIVES ON THE PAYROLL OF AHSSHC THAT PROVIDE SERVICES AND ARE ON THE MANAGEMENT TEAM OF THE FILING ORGANIZATION. TRAVEL FOR COMPANIONS: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING AHSSHC EXECUTIVE TO HAVE HIS OR HER SPOUSE ACCOMPANY THE EXECUTIVE ON CERTAIN BUSINESS TRIPS EACH YEAR. TYPICALLY, REIMBURSEMENT IS ONLY PROVIDED TO VICE PRESIDENTS AND ABOVE AND IS USUALLY LIMITED TO ONE BUSINESS TRIP PER YEAR BEYOND THE ANNUAL AHS PRESIDENT'S COUNCIL BUSINESS MEETING AND OTHER MEETINGS WHERE THE SPOUSE IS SPECIFICALLY INVITED. THE AHSSHC CORPORATE EXECUTIVE SPOUSAL TRAVEL POLICY WAS ORIGINALLY APPROVED AND REVIEWED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. ALL SPOUSAL TRAVEL COSTS REIMBURSED TO THE EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: AHS HAS A SYSTEM-WIDE POLICY ADDRESSING GROSS-UP PAYMENTS PROVIDED IN CONNECTION WITH EMPLOYER-PROVIDED BENEFITS/OTHER TAXABLE ITEMS. UNDER THE POLICY, CERTAIN TAXABLE BUSINESS-RELATED REIMBURSEMENTS (I.E. TAXABLE BUSINESS-RELATED MOVING EXPENSES, TAXABLE ITEMS PROVIDED IN CONNECTION WITH EMPLOYMENT) PROVIDED TO ANY EMPLOYEE MAY BE GROSSED-UP AT A 25% RATE UPON APPROVAL OF THE FILING ORGANIZATION'S CEO AND CFO. ADDITIONALLY, EMPLOYEES AT THE DIRECTOR LEVEL AND ABOVE ARE ELIGIBLE FOR GROSS-UP PAYMENTS ON GIFTS RECEIVED FOR BOARD OF DIRECTOR SERVICES. DISCRETIONARY SPENDING ACCOUNT: A NOMINAL DISCRETIONARY SPENDING AMOUNT WAS PROVIDED IN THE CURRENT YEAR TO ALL ELIGIBLE EXECUTIVES WHO ATTEND THE ANNUAL AHS PRESIDENT'S COUNCIL BUSINESS MEETING ($500 PER EXECUTIVE) OR THE ANNUAL AHS CFO CONFERENCE BUSINESS MEETING ($300 PER EXECUTIVE). OTHER DISCRETIONARY SPENDING ACCOUNTS MAY BE PROVIDED IN CONNECTION WITH OTHER AHS SPONSORED CONFERENCES BUT TYPICALLY DO NOT EXCEED $200 PER PARTICIPANT. WITH RESPECT TO THE AHS PRESIDENT'S COUNCIL MEETING, ELIGIBLE EXECUTIVES MAY INCLUDE AHSSHC VICE PRESIDENTS AND ABOVE AND ALL AHSSHC SUBSIDIARY ORGANIZATION CEOS AND REGIONAL CFOS. THE PAYMENT PROVIDED TO EACH EXECUTIVE WAS CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES ASSISTANCE TO EXECUTIVES WHO HAVE BEEN RELOCATED BY THE COMPANY DURING THE YEAR. RELOCATION ASSISTANCE PROVIDED TO EXECUTIVES MAY INCLUDE RELOCATION ALLOWANCES TO ASSIST WITH DUPLICATE HOUSING EXPENSES. RELOCATION ASSISTANCE IS ADMINISTERED PER AHSSHC POLICY BY AN EXTERNAL RELOCATION COMPANY. ANY TAXABLE REIMBURSEMENTS MADE TO EXECUTIVES IN CONNECTION WITH RELOCATION ASSISTANCE ARE TREATED AS WAGES TO THE EXECUTIVE AND ARE SUBJECT TO ALL PAYROLL WITHHOLDING AND REPORTING REQUIREMENTS. |
| PART I, LINE 3 | THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) FOR THAT INDIVIDUAL'S ROLE IN SERVING AS THE CEO. COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC HAS TAKEN STEPS TO ENSURE THAT PROCESSES ARE IN PLACE TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS STANDARD AS SET FORTH IN TREASURY REGULATION 53.4958-6 WITH RESPECT TO ITS ACTIVE EXECUTIVE-LEVEL POSITIONS. THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE) SERVES AS THE GOVERNING BODY FOR ALL EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE IS COMPOSED OF CERTAIN MEMBERS OF THE BOARD OF DIRECTORS (THE BOARD) OF AHSSHC. VOTING MEMBERS OF THE COMMITTEE INCLUDE ONLY INDIVIDUALS WHO SERVE ON THE BOARD AS INDEPENDENT REPRESENTATIVES OF THE COMMUNITY, WHO HOLD NO EMPLOYMENT POSITIONS WITH AHSSHC AND WHO DO NOT HAVE RELATIONSHIPS WITH ANY OF THE INDIVIDUALS WHOSE COMPENSATION IS UNDER THEIR REVIEW THAT IMPACTS THEIR BEST INDEPENDENT JUDGMENT AS FIDUCIARIES OF AHSSHC. THE COMMITTEE'S ROLE IS TO REVIEW AND APPROVE ALL COMPONENTS OF THE EXECUTIVE COMPENSATION PLAN OF AHSSHC. AS AN INDEPENDENT GOVERNING BODY WITH RESPECT TO EXECUTIVE COMPENSATION, IT SHOULD BE NOTED THAT THE COMMITTEE WILL OFTEN CONFER IN EXECUTIVE SESSIONS ON MATTERS OF COMPENSATION POLICY AND POLICY CHANGES. IN SUCH EXECUTIVE SESSIONS, NO MEMBERS OF MANAGEMENT OF AHSSHC ARE PRESENT. THE COMMITTEE IS ADVISED BY AN INDEPENDENT THIRD PARTY COMPENSATION ADVISOR. THIS ADVISOR PREPARES ALL THE BENCHMARK STUDIES FOR THE COMMITTEE. COMPENSATION LEVELS ARE BENCHMARKED WITH A NATIONAL PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS OF SIMILAR SIZE AND COMPLEXITY TO AHS AND EACH OF ITS AFFILIATED ENTITIES. THE FOLLOWING PRINCIPLES GUIDE THE ESTABLISHMENT OF INDIVIDUAL EXECUTIVE COMPENSATION: - THE SALARY OF THE PRESIDENT/CEO OF AHS WILL NOT EXCEED THE 40TH PERCENTILE OF COMPARABLE SALARIES PAID BY SIMILARLY SITUATED ORGANIZATIONS; AND - OTHER EXECUTIVE SALARIES SHALL BE ESTABLISHED USING MARKET MEDIANS. THE COMPENSATION PHILOSOPHY, POLICIES, AND PRACTICES OF AHSSHC ARE CONSISTENT WITH THE ORGANIZATION'S FAITH-BASED MISSION AND CONFORM TO APPLICABLE LAWS, REGULATIONS, AND BUSINESS PRACTICES. AS A FAITH-BASED ORGANIZATION SPONSORED BY THE SEVENTH-DAY ADVENTIST CHURCH (THE CHURCH), AHSSHC'S PHILOSOPHY AND PRINCIPLES WITH RESPECT TO ITS EXECUTIVE COMPENSATION PRACTICES REFLECT THE CONSERVATIVE APPROACH OF THE CHURCH'S MISSION OF SERVICE AND WERE DEVELOPED IN COUNSEL WITH THE CHURCH'S LEADERSHIP. |
| PART I, LINE 4B | AS DISCUSSED IN LINE 1A ABOVE, EXECUTIVES ON THE FILING ORGANIZATION'S MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF A HEALTHCARE SYSTEM KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). IN RECOGNITION OF THE CONTRIBUTION THAT EACH EXECUTIVE MAKES TO THE SUCCESS OF AHS, AHS PROVIDES TO ELIGIBLE EXECUTIVES PARTICIPATION IN THE AHS EXECUTIVE FLEX BENEFIT PROGRAM (THE PLAN). THE PURPOSE OF THE PLAN IS TO OFFER ELIGIBLE EXECUTIVES AN OPPORTUNITY TO ELECT FROM AMONG A VARIETY OF SUPPLEMENTAL BENEFITS, INCLUDING DEFERRED COMPENSATION BENEFITS TAXABLE UNDER INTERNAL REVENUE CODE (IRC) SECTION 457(F), TO INDIVIDUALLY TAILOR A BENEFITS PROGRAM APPROPRIATE TO EACH EXECUTIVE'S NEEDS. THE PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH IS DEDUCTED THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS. THE PRE-DETERMINED BENEFITS ALLOWANCE CREDIT PERCENTAGE IS APPROVED BY THE AHS BOARD COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF AHSSHC. ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED FROM THE ANNUAL PRE-DETERMINED BENEFITS ALLOWANCE ARE CONTRIBUTED, AT THE EMPLOYEE'S OPTION, TO EITHER AN IRC 457(F) DEFERRED COMPENSATION ACCOUNT OR TO AN IRC 457(B) ELIGIBLE DEFERRED COMPENSATION PLAN. UPON ATTAINMENT OF AGE 65, ALL PREVIOUS 457(F) DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT AND ANY FUTURE EMPLOYER CONTRIBUTIONS ARE MADE QUARTERLY FROM THE PLAN DIRECTLY TO THE PARTICIPANT. THE PLAN DOCUMENTS DEFINE AN EMPLOYEE WHO IS ELIGIBLE TO PARTICIPATE IN THE PLAN TO GENERALLY INCLUDE THE CHIEF EXECUTIVE OFFICERS OF AHS ENTITIES AND VICE PRESIDENTS OF ALL AHS ENTITIES WHOSE BASE SALARY IS AT LEAST $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 ------------------------------------------------------- TED HAMILTON $ 54,079 $ 54,079 $ 97,035 $ 0 SANDRA JOHNSON $ 53,230 $ 34,629 $ 94,186 $ 0 KENNETH MATTISON $ 52,713 $ 39,299 $ 0 $ 0 EDWARD NOSEWORTHY $ 39,708 $ 38,978 $460,764 $ 0 DAVID OTTATI $ 37,856 $ 31,045 $ 0 $ 0 MICHAEL SCHULTZ $117,859 $124,294 $397,783 $ 0 LEWIS SEIFERT $ 76,798 $ 68,452 $ 0 $ 0 DARYL TOL $ 68,547 $ 62,664 $ 0 $ 0 DEBORA THOMAS $ 34,033 $ 8,104 $ 0 $ 0 VALERIE ZIESMER $ 21,681 $ 4,841 $ 0 $ 0 *INCLUDING INVESTMENT EARNINGS |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BILL TOL | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | EMPLOYEE OF BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $57,445 | TransactionAmt |
| Transaction | EMPLOYEE COMPENSATION | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | BRUCE PAGE AND BARBARA REVELS - BUSINESS RELATIONSHIP BRUCE PAGE AND BOB DEVORE - BUSINESS RELATIONSHIP BRUCE PAGE AND MICHAEL CHIUMENTO - BUSINESS RELATIONSHIP BRUCE PAGE AND TONY PAPANDREA - BUSINESS RELATIONSHIP BARBARA REVELS AND KENNETH MATTISON - BUSINESS RELATIONSHIP |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMORIAL HOSPITAL - FLAGLER, INC. (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS MEMORIAL HEALTH SYSTEMS, INC. MEMORIAL HEALTH SYSTEMS, INC. (MHS) IS A FLORIDA, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN THE FILING ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER OF THE FILING ORGANIZATION IS MHS. THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION ARE APPOINTED BY THE SOLE MEMBER, MHS, WHO HAS THE RIGHT TO ELECT, APPOINT OR REMOVE ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | MHS, AS THE SOLE MEMBER OF THE FILING ORGANIZATION, HAS CERTAIN RESERVED POWERS AS SET FORTH IN THE BYLAWS OF THE FILING ORGANIZATION. THESE RESERVED POWERS INCLUDE THE FOLLOWING: A) TO APPROVE AND DISAPPROVE THE EXECUTIVE AND/OR ADMINISTRATIVE LEADERSHIP OF THE FILING ORGANIZATION, AND THEIR SALARIES; B) TO ADOPT, AMEND, RESTATE, AND REPEAL THE BYLAWS OF THE FILING ORGANIZATION; C) TO SET LIMITS AND TERMS FOR THE BORROWING OF FUNDS IN EXCESS OF AN ESTABLISHED AMOUNT; D) TO APPROVE OR DISAPPROVE MATERIAL CHANGES IN SERVICES OFFERED AND/OR PURCHASE OR SALE OF PERSONAL PROPERTY OR REAL PROPERTY EQUAL TO OR IN EXCESS OF AN ESTABLISHED AMOUNT; E) TO APPROVE OR DISAPPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION; F) TO DIRECT THE PLACEMENT OF FUNDS AND CAPITAL OF THE FILING ORGANIZATION; G) TO ESTABLISH GENERAL GUIDING POLICIES, TO IMPLEMENT QUALITY ASSESSMENT, IMPROVEMENT AND CASE MANAGEMENT; H) TO APPROVE THE APPOINTMENT OF AN AUDITING FIRM AND ELECTION OF THE FISCAL YEAR FOR THE FILING ORGANIZATION; AND I) TO ESTABLISH A PROCESS FOR ADDRESSING PATIENT GRIEVANCES. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND BY THE CFO PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND THE CFO DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTERESTS, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR ANY PRINCIPAL OFFICER OF THE FILING ORGANIZATION (I.E. INTERESTED PERSONS) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTERESTS POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE FILING ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES ARE NOT COMPENSATED BY THE FILING ORGANIZATION. SUCH INDIVIDUALS ARE COMPENSATED BY THE RELATED TOP-TIER PARENT ORGANIZATION OF THE FILING ORGANIZATION. PLEASE SEE THE DISCUSSION CONCERNING THE PROCESS FOLLOWED BY THE RELATED TOP-TIER PARENT ORGANIZATION IN DETERMINING EXECUTIVE COMPENSATION IN OUR RESPONSE TO SCHEDULE J, LINE 3. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). EACH YEAR, AHS PUBLISHES AN ANNUAL REPORT DOCUMENT THAT INCLUDES A FINANCIAL REPORT FOR THE RELEVANT YEAR AS WELL AS A COMMUNITY BENEFIT REPORT. THE FINANCIAL REPORT AND COMMUNITY BENEFIT REPORT ARE PRESENTED ON A CONSOLIDATED BASIS AND REPRESENT ALL OF THE ACTIVITIES, RESULTS OF OPERATIONS, AND FINANCIAL POSITION AT YEAR-END OF THE ENTIRE AHS SYSTEM. IN ADDITION, THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF AHS AND OF THE AHS "OBLIGATED GROUP" ARE FILED ANNUALLY WITH THE MUNICIPAL SECURITIES RULEMAKING BOARD (MSRB). THE "OBLIGATED GROUP" IS A GROUP OF AHSSHC SUBSIDIARIES THAT ARE JOINTLY AND SEVERALLY LIABLE UNDER A MASTER TRUST INDENTURE THAT SECURES DEBT PRIMARILY ISSUED ON A TAX-EXEMPT BASIS. UNAUDITED QUARTERLY FINANCIAL STATEMENTS PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) ARE ALSO FILED WITH MSRB FOR AHS ON A CONSOLIDATED BASIS AND FOR THE GROUPING OF AHS SUBSIDIARIES COMPRISING THE "OBLIGATED GROUP". THE FILING ORGANIZATION DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. |
| PART VII, SECTION A | FOR THOSE BOARD OF DIRECTOR MEMBERS WHO DEVOTE LESS THAN FULL-TIME TO THE FILING ORGANIZATION (BASED UPON THE AVERAGE NUMBER OF HOURS PER WEEK SHOWN IN COLUMN (B) ON PAGE 7 OF THE RETURN) THE COMPENSATION AMOUNTS SHOWN IN COLUMNS (E) AND (F) ON PAGE 7 WERE PROVIDED IN CONJUNCTION WITH THAT PERSON'S RESPONSIBILITIES AND ROLES IN SERVING IN AN EXECUTIVE LEADERSHIP POSITION WITHIN ADVENTIST HEALTH SYSTEM. |
| FORM 990, PART IX, LINE 11G | PAYMENTS TO HEALTHCARE PROFESSIONAL : PROGRAM SERVICE EXPENSES 5,970,228. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,970,228. PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 1,814,920. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,814,920. PURCHASED MEDICAL SERVICES : PROGRAM SERVICE EXPENSES 81,322. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 81,322. ENVIRONMENTAL SERVICES : PROGRAM SERVICE EXPENSES 459,676. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 459,676. RECRUITING : PROGRAM SERVICE EXPENSES 34,019. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 34,019. FOOD SERVICE CONTRACTS : PROGRAM SERVICE EXPENSES 311,155. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 311,155. MISCELLANEOUS PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 3,997,289. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,997,289. AHS MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,440,374. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,440,374. BILLING & COLLECTION SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 933,414. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 933,414. EHR MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 868,686. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 868,686. |
| FORM 990, PART XI, LINE 9: | ALLOCATIONS FROM TAX-EXEMPT PARENT WITH RESPECT TO DEBT 266,068. TRANSFER TO TAX-EXEMPT PARENT -1,319,028. TRANSFER FROM RESTRICTED 85,849. OTHER RESTRICTED 29,020. |
| PART X, LINE 2 | THE AMOUNTS SHOWN ON LINE 2 OF PART X OF THIS RETURN INCLUDE THE FILING ORGANIZATION'S INTEREST IN A CENTRAL INVESTMENT POOL MAINTAINED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, THE FILING ORGANIZATION'S TOP-TIER PARENT. THE INVESTMENTS IN THE CENTRAL INVESTMENT POOL ARE RECORDED AT MARKET VALUE. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (105 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ADVENTIST BOLINGBROOK HOSPITAL | |||||||||||
| 500 REMINGTON BLVD | BOLINGBROOK | IL | 60440 | 651219504 | OPERATION OF HOSPITAL & RELATED SERVICES | IL | 501(C)(3) | LINE 3 | ADVENTIST 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 | 0 | N/A | |
| 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 | DAYTONA BEACH | FL | 32117 | 462354804 | OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | 0 | |
| FLORIDA HOSPITAL MEDICAL GROUP INC | |||||||||||
| 900 WINDERLEY PLACE | MAITLAND | FL | 32751 | 593214635 | OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | 0 | |
| FLORIDA HOSPITAL PHYSICIAN GROUP INC (21-123113) | |||||||||||
| 14055 RIVEREDGE DRIVE STE 250 | TAMPA | FL | 33637 | 462021581 | OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | 0 | |
| FLORIDA HOSPITAL WATERMAN INC | |||||||||||
| 1000 WATERMAN WAY | TAVARES | FL | 32778 | 593140669 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | 0 | |
| FLORIDA HOSPITAL ZEPHYRHILLS INC | |||||||||||
| 7050 GALL BLVD | ZEPHYRHILLS | FL | 33541 | 592108057 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | 0 | |
| FOUNDATION FOR SHAWNEE MISSION MEDICAL CENTER INC | |||||||||||
| 9100 W 74TH STREET | SHAWNEE MISSION | KS | 66204 | 480868859 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | KS | 501(C)(3) | LINE 11A, I | SHAWNEE MISSION MEDICAL CENTER INC | 0 | |
| GLENOAKS HOSPITAL FOUNDATION | |||||||||||
| 701 WINTHROP AVENUE | GLENDALE HEIGHTS | IL | 60139 | 363926044 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | IL | 501(C)(3) | LINE 7 | MIDWEST HLTH FOUNDATION | 0 | |
| HELEN ELLIS MEMORIAL HOSPITAL AUXILIARY INC | |||||||||||
| 1395 S PINELLAS AVE | TARPON SPRINGS | FL | 34689 | 592106043 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL/FOUNDATION | FL | 501(C)(3) | LINE 11C, III-FI | TARPON SPRINGS HOSPITAL FOUNDATION INC | 0 | |
| HELEN ELLIS MEMORIAL HOSPITAL FOUNDATION INC | |||||||||||
| 1395 S PINELLAS AVE | TARPON SPRINGS | FL | 34689 | 593690149 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | FL | 501(C)(3) | LINE 11C, III-FI | TARPON SPRINGS HOSPITAL FOUNDATION INC | 0 | |
| HINSDALE HOSPITAL FOUNDATION | |||||||||||
| 7 SALT CREEK LANE SUITE 203 | HINSDALE | IL | 60521 | 521466387 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | IL | 501(C)(3) | LINE 7 | MIDWEST HLTH FOUNDATION | 0 | |
| IN-MOTION REHAB INC | |||||||||||
| 602 COURTLAND STREET STE 200 | ORLANDO | FL | 32804 | 208023411 | THERAPY SERVICES TO TAX EXEMPT NURSING HOMES | KS | 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 | |||||||||||
| 701 WEST PLYMOUTH AVENUE | DELAND | FL | 32720 | 593256803 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | MEMORIAL HLTH SYSTEMS INC | 0 | |
| MEMORIAL HOSPITAL FLAGLER INC | |||||||||||
| 60 MEMORIAL MEDICAL PARKWAY | PALM COAST | FL | 32164 | 592951990 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | MEMORIAL HLTH SYSTEMS INC | 0 | |
| MEMORIAL HOSPITAL INC | |||||||||||
| 210 MARIE LANGDON DRIVE | MANCHESTER | KY | 40962 | 610594620 | OPERATION OF HOSPITAL & RELATED SERVICES | KY | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | 0 | |
| MERRIAM HLTH CARE PROPERTIES INC | |||||||||||
| 9700 WEST 62ND STREET | MERRIAM | KS | 66203 | 364595806 | LEASE TO RELATED ORGANIZATION | KS | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | 0 | |
| METROPLEX ADVENTIST HOSPITAL INC | |||||||||||
| 2201 S CLEAR CREEK ROAD | KILLEEN | TX | 76549 | 742225672 | OPERATION OF HOSPITAL & RELATED SERVICES | TX | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | 0 | |
| METROPLEX CLINIC PHYSICIANS INC | |||||||||||
| 2201 S CLEAR CREEK ROAD | KILLEEN | TX | 76549 | 113762050 | PHYSICIAN HLTHCARE SERVICES TO THE COMMUNITY | TX | 501(C)(3) | LINE 3 | METROPLEX ADVENTIST HOSPITAL INC | 0 | |
| METROPLEX HOSPITAL INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 461256516 | FUTURE OPERATION OF HOSPITAL & RELATED SVCS | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | 0 | |
| MIDWEST HLTH FOUNDATION | |||||||||||
| 120 NORTH OAK STREET | HINSDALE | IL | 60521 | 352230515 | SUPPORT OF SUBSIDIARY FOUNDATIONS | IL | 501(C)(3) | LINE 11B, II | 0 | N/A | |
| MILLS HLTH & REHAB CENTER INC | |||||||||||
| 500 BECK LANE | MAYFIELD | KY | 42066 | 205782320 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | KY | 501(C)(3) | LINE 9 | SUNBELT HLTH CARE CENTERS INC | 0 | |
| MISSION STRATEGIES OF GEORGIA INC | |||||||||||
| 3949 S COBB DRIVE | SMYRNA | GA | 30080 | 900866024 | PROVISION OF SUPPORT TO THE NURSING HOME DIVISION | GA | 501(C)(3) | LINE 11B, II | SUNBELT HLTH CARE CENTERS INC | 0 | |
| MISSION STRATEGIES INC | |||||||||||
| 602 COURTLAND STREET STE 200 | ORLANDO | FL | 32804 | 205982365 | PROVISION OF SUPPORT TO THE NURSING HOME DIVISION | KS | 501(C)(3) | LINE 11B, II | SUNBELT HLTH CARE CENTERS INC | 0 | |
| MISSOURI ADVENTIST HLTH INC | |||||||||||
| 9100 W 74TH STREET | SHAWNEE MISSION | KS | 66204 | 431224729 | SUPPORT HLTH CARE SERVICES | MO | 501(C)(3) | LINE 11D, III-O | ADVENTIST HLTH MID-AMERICA INC | 0 | |
| NORTH REGIONAL EMS INC | |||||||||||
| 188 HOSPITAL LANE | JELLICO | TN | 37762 | 262653616 | EMS SERVICES | TN | 501(C)(3) | LINE 9 | JELLICO COMMUNITY HOSPITAL INC | 0 | |
| ORMOND BEACH MEMORIAL HOSPITAL AUXILIARY INC | |||||||||||
| 301 MEMORIAL MEDICAL PARKWAY | DAYTONA BEACH | FL | 32117 | 591721962 | VOLUNTEER SUPPORT SERVICES | FL | 501(C)(3) | LINE 11C, III-FI | MEMORIAL HLTH SYSTEMS INC | 0 | |
| OVERLAND PARK NURSING & REHAB CENTER INC | |||||||||||
| 6501 WEST 75TH STREET | OVERLAND PARK | KS | 66204 | 205774821 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | KS | 501(C)(3) | LINE 9 | SUNBELT HLTH CARE CENTERS INC | 0 | |
| PARAGON HLTH CARE PROPERTIES INC | |||||||||||
| 950 HIGHPOINT DRIVE | HOPKINSVILLE | KY | 42240 | 510605686 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | 0 | |
| PASCO-PINELLAS HILLSBOROUGH COMMUNITY HLTH SYSTEM INC | |||||||||||
| 2400 BEDFORD ROAD | ORLANDO | FL | 32803 | 208488713 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | 0 | |
| PORTERCARE ADVENTIST HLTH SYSTEM (630 YEAR END) | |||||||||||
| 2525 S DOWNING STREET | DENVER | CO | 80210 | 840438224 | OPERATION OF HOSPITAL & RELATED SERVICES | CO | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | 0 | |
| PORTLAND NURSING & REHAB CENTER INC (11-6513) | |||||||||||
| 215 HIGHLAND CIRCLE DRIVE | PORTLAND | TN | 37148 | 205774842 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | TN | 501(C)(3) | LINE 9 | SUNBELT HLTH CARE CENTERS INC | 0 | |
| PRINCETON HLTH & REHAB CENTER INC | |||||||||||
| 1333 WEST MAIN | PRINCETON | KY | 42445 | 205782272 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | KY | 501(C)(3) | LINE 9 | SUNBELT HLTH CARE CENTERS INC | 0 | |
| PRINCETON PROFESSIONAL SERVICES INC | |||||||||||
| 601 E ROLLINS STREET | ORLANDO | FL | 32803 | 591191045 | PROVISION OF HLTHCARE SERVICES | FL | 501(C)(3) | LINE 9 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | 0 | |
| QUALITY CIRCLE FOR HLTHCARE INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 263789368 | HLTHCARE QUALITY SERVICES | FL | 501(C)(3) | LINE 11A, I | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | 0 | |
| RESOURCE PERSONNEL INC | |||||||||||
| 602 COURTLAND STREET STE 200 | ORLANDO | FL | 32804 | 208040875 | PROVIDE ADMINISTRATIVE SUPPORT TO TAX EXEMPT NURSING HOMES | FL | 501(C)(3) | LINE 11B, II | SUNBELT HLTH CARE CENTERS INC | 0 | |
| ROCKY MOUNTAIN ADVENTIST HLTHCARE FOUNDATION (630 YEAR END) | |||||||||||
| 2525 SOUTH DOWNING STREET | DENVER | CO | 80210 | 840745018 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | CO | 501(C)(3) | LINE 7 | PORTERCARE ADVENTIST HLTH SYSTEM | 0 | |
| ROLLINS BROOK COMMUNITY CARE CORP | |||||||||||
| 2201 S CLEAR CREEK ROAD | KILLEEN | TX | 76549 | 461656773 | INACTIVE | TX | 501(C)(3) | LINE 11A, I | ADVENTIST HLTH SYSTEMSUNBELT INC | 0 | |
| RUSSELLVILLE HLTH CARE PROPERTIES INC | |||||||||||
| 683 EAST THIRD STREET | RUSSELLVILLE | KY | 42276 | 510605691 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | 0 | |
| SAN MARCOS HLTH CARE PROPERTIES INC | |||||||||||
| 1900 MEDICAL PARKWAY | SAN MARCOS | TX | 78666 | 510605693 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | 0 | |
| SAN MARCOS NURSING & REHAB CENTER INC | |||||||||||
| 1900 MEDICAL PARKWAY | SAN MARCOS | TX | 78666 | 205782224 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | TX | 501(C)(3) | LINE 9 | SUNBELT HLTH CARE CENTERS INC | 0 | |
| SHAWNEE MISSION HLTH CARE INC | |||||||||||
| 6501 WEST 75TH STREET | OVERLAND PARK | KS | 66204 | 480952508 | LEASE TO RELATED ORGANIZATION | KS | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | 0 | |
| SHAWNEE MISSION MEDICAL CENTER INC | |||||||||||
| 9100 W 74TH STREET | SHAWNEE MISSION | KS | 66204 | 480637331 | OPERATION OF HOSPITAL & RELATED SERVICES | KS | 501(C)(3) | LINE 3 | ADVENTIST HLTH MID-AMERICA INC | 0 | |
| SOUTH CENTRAL NURSING HOMES PROPERTIES INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 593686109 | MANAGEMENT SUPPORT | GA | 501(C)(3) | LINE 11D, III-O | SOUTH CENTRAL INC | 0 | |
| SOUTH CENTRAL NURSING HOMES INC | |||||||||||
| 602 COURTLAND STREET | ORLANDO | FL | 32804 | 611242373 | MANAGEMENT SUPPORT | KY | 501(C)(3) | LINE 11D, III-O | SOUTH CENTRAL INC | 0 | |
| SOUTH CENTRAL PROPERTIES III INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 593692860 | REAL ESTATE | GA | 501(C)(2) | SOUTH CENTRAL NURSING HOMES PROPERTIES INC | 0 | ||
| SOUTH CENTRAL PROPERTIES IV INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 593692862 | REAL ESTATE | GA | 501(C)(2) | SOUTH CENTRAL NURSING HOMES PROPERTIES INC | 0 | ||
| SOUTH CENTRAL PROPERTIES VI INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 593692857 | REAL ESTATE | GA | 501(C)(2) | SOUTH CENTRAL NURSING HOMES PROPERTIES INC | 0 | ||
| SOUTH CENTRAL PROPERTIES INC | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 593651692 | REAL ESTATE | GA | 501(C)(2) | SOUTH CENTRAL NURSING HOMES PROPERTIES INC | 0 | ||
| SOUTH CENTRAL INC | |||||||||||
| 602 COURTLAND STREET | ORLANDO | FL | 32804 | 593689740 | MANAGEMENT SUPPORT | GA | 501(C)(3) | LINE 11C, III-FI | 0 | N/A | |
| SOUTH PASCO HLTH CARE PROPERTIES INC | |||||||||||
| 38250 A AVENUE | ZEPHYRHILLS | FL | 33542 | 510605679 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | 0 | |
| SOUTHWEST VOLUSIA HLTH SERVICES INC | |||||||||||
| 1055 SAXON BLVD | ORANGE CITY | FL | 32763 | 593281591 | MEDICAL OFFICE BUILDING FOR HOSPITAL | FL | 501(C)(3) | LINE 11A, I | SOUTHWEST VOLUSIA HLTHCARE CORP | 0 | |
| SOUTHWEST VOLUSIA HLTHCARE CORP | |||||||||||
| 1055 SAXON BLVD | ORANGE CITY | FL | 32763 | 593149293 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | 0 | |
| SPECIALTY PHYSICIANS OF CENTRAL TEXAS INC | |||||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 208814408 | PHYSICIAN HLTHCARE SERVICES TO THE COMMUNITY | TX | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEMSUNBELT INC | 0 | |
| SPRING VIEW HLTH & REHAB CENTER INC | |||||||||||
| 718 GOODWIN LANE | LEITCHFIELD | KY | 42754 | 205782288 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | KY | 501(C)(3) | LINE 9 | SUNBELT HLTH CARE CENTERS INC | 0 | |
| SUNBELT HLTH & REHAB CENTER - APOPKA INC | |||||||||||
| 305 EAST OAK STREET | APOPKA | FL | 32703 | 205774856 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | FL | 501(C)(3) | LINE 9 | SUNBELT HLTH CARE CENTERS INC | 0 | |
| SUNBELT HLTH CARE CENTERS INC | |||||||||||
| 602 COURTLAND STREET STE 200 | ORLANDO | FL | 32804 | 581473135 | MANAGEMENT SERVICES | TN | 501(C)(3) | LINE 11B, II | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | 0 | |
| SUNSYSTEM DEVELOPMENT CORP | |||||||||||
| 900 HOPE WAY | ALTAMONTE SPRINGS | FL | 32714 | 592219301 | FUND RAISING FOR AFFILIATED TAX-EXEMPT HOSPITALS | FL | 501(C)(3) | LINE 7 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | 0 | |
| TARPON SPRINGS HOSPITAL FOUNDATION INC | |||||||||||
| 1395 S PINELLAS AVE | TARPON SPRINGS | FL | 34689 | 590898901 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | UNIVERSITY COMMUNITY HOSPITAL INC | 0 | |
| TARRANT COUNTY HLTH CARE PROPERTIES INC | |||||||||||
| 301 HUGULEY BLVD | BURLESON | TX | 76028 | 510605677 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | 0 | |
| TAYLOR CREEK HLTH CARE PROPERTIES INC | |||||||||||
| 718 GOODWIN LANE | LEITCHFIELD | KY | 42754 | 510605678 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | 0 | |
| THE VOLUNTEER AUXILIARY OF FLORIDA HOSPITAL - FLAGLER INC | |||||||||||
| 60 MEMORIAL MEDICAL PARKWAY | PALM COAST | FL | 32164 | 592486582 | VOLUNTEER SUPPORT SERVICES | FL | 501(C)(3) | LINE 11C, III-FI | MEMORIAL HOSPITAL FLAGLER INC | 0 | |
| TRINITY NURSING & REHAB CENTER INC | |||||||||||
| 9700 WEST 62ND STREET | MERRIAM | KS | 66203 | 205774890 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | KS | 501(C)(3) | LINE 9 | SUNBELT HLTH CARE CENTERS INC | 0 | |
| UNIVERSITY COMMUNITY HOSPITAL FOUNDATION INC | |||||||||||
| 3100 E FLETCHER AVE | TAMPA | FL | 33613 | 592554889 | FUND-RAISING FOR TAX-EXEMPT HOSPITAL | FL | 501(C)(3) | LINE 11A, I | UNIVERSITY COMMUNITY HOSPITAL INC | 0 | |
| UNIVERSITY COMMUNITY HOSPITAL SPECIALTY CARE INC | |||||||||||
| 3100 E FLETCHER AVE | TAMPA | FL | 33613 | 593231322 | INACTIVE | FL | 501(C)(3) | LINE 11A, I | UNIVERSITY COMMUNITY HOSPITAL INC | 0 | |
| UNIVERSITY COMMUNITY HOSPITAL INC | |||||||||||
| 3100 E FLETCHER AVE | TAMPA | FL | 33613 | 591113901 | OPERATION OF HOSPITAL & RELATED SERVICES | FL | 501(C)(3) | LINE 3 | ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP | 0 | |
| WEST KENTUCKY HLTH CARE PROPERTIES INC | |||||||||||
| 500 BECK LANE | MAYFIELD | KY | 42066 | 510605676 | LEASE TO RELATED ORGANIZATION | GA | 501(C)(3) | LINE 11C, III-FI | SUNBELT HLTH CARE CENTERS INC | 0 | |
| ZEPHYR HAVEN HLTH & REHAB CENTER INC | |||||||||||
| 38250 A AVENUE | ZEPHYRHILLS | FL | 33542 | 205774930 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | FL | 501(C)(3) | LINE 9 | SUNBELT HLTH CARE CENTERS INC | 0 | |
| ZEPHYRHILLS HLTH & REHAB CENTER INC | |||||||||||
| 7350 DAIRY ROAD | ZEPHYRHILLS | FL | 33540 | 205774967 | OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY | FL | 501(C)(3) | LINE 9 | SUNBELT HLTH CARE CENTERS INC | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (9 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| APPALACHIAN THERAPY SERVICES LLC | |||||||
| 100 HOSPITAL DRIVE | HENDERSONVILLE | NC | 28792 | 202463851 | THERAPY STAFFING | NC | N/A |
| CLEAR CREEK MOB LTD | |||||||
| 2201 S CLEAR CREEK RD | KILLEEN | TX | 76549 | 742609195 | REAL ESTATE | TX | N/A |
| ENDOSCOPY CENTER AT PORTER LLC | |||||||
| 1001 SOUTH PARK DRIVE | LITTLETON | CO | 80120 | 205855038 | MEDICAL SERVICES | CO | N/A |
| FLORIDA HOSPITAL DMERT LLC | |||||||
| 2450 MAITLAND CENTER PKWY STE 200 | MAITLAND | FL | 32751 | 202392253 | MEDICAL EQUIPMENT | FL | N/A |
| FLORIDA HOSPITAL HOME INFUSION | |||||||
| 2450 MAITLAND CENTER PKWY STE 200 | MAITLAND | FL | 32751 | 593142824 | HOME INFUSION SERVICES | FL | N/A |
| KCCCSMMC CANCER CENTER LLC (11-4813) | |||||||
| 9100 W 74TH STREET | SHAWNEE MISSION | KS | 66204 | 270909763 | EQUIPMENT RENTAL | KS | N/A |
| PAHSUSP SURGERY CENTERS LLC | |||||||
| 15305 DALLAS PKWY STE 1600 LB 28 | ADDISON | TX | 75010 | 263057950 | MEDICAL SERVICES | CO | N/A |
| SAN MARCOS MRI LP | |||||||
| 1330 WONDER WORLD DR STE 202 | SAN MARCOS | TX | 78666 | 770597972 | IMAGING & TESTING | TX | N/A |
| SHAWNEE MISSION OPEN MRI LLC | |||||||
| 9100 W 74TH STREET BOX 2923 | SHAWNEE MISSION | KS | 66201 | 270011796 | IMAGING & TESTING | KS | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (22 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Address Line1ForeignAddress/AddressLine1 | Province Or StateForeignAddress/ProvinceOrState | CountryForeignAddress/Country | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ALTAMONTE MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC | |||||||||||||||||
| 601 EAST ROLLINS STREET | ORLANDO | FL | 32803 | 592855792 | CONDO ASSOCIATION | FL | N/A | C | 0 | ||||||||
| APOPKA MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC | |||||||||||||||||
| 601 EAST ROLLINS STREET | ORLANDO | FL | 32803 | 593000857 | CONDO ASSOCIATION | FL | N/A | C | 0 | ||||||||
| CC MOB INC | |||||||||||||||||
| 2201 S CLEAR CREEK ROAD | KILLEEN | TX | 76549 | 742616875 | REAL ESTATE RENTAL | TX | N/A | C | 0 | ||||||||
| CENTRAL TEXAS MEDICAL ASSOCIATES | |||||||||||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 742729873 | PHYSICIAN CLINICS | TX | N/A | C | 0 | ||||||||
| CENTRAL TEXAS PROVIDER'S NETWORK | |||||||||||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 742827652 | PHYSICIAN HOSPITAL ORG. | TX | N/A | C | 0 | ||||||||
| FLORIDA HOSPITAL FLAGLER MEDICAL OFFICES ASSOCIATION INC | |||||||||||||||||
| 60 MEMORIAL MEDICAL PARKWAY | PALM COAST | FL | 32164 | 262158309 | CONDO ASSOCIATION | FL | C | Yes (1) | MEMORIAL HOSPITAL-FLAGLER INC | $8,213 | $47,947 | 0.91250 | |||||
| FLORIDA HOSPITAL HEALTHCARE SYSTEM INC | |||||||||||||||||
| 602 COURTLAND STREET | ORLANDO | FL | 32804 | 593215680 | PHO/TPA | FL | N/A | C | 0 | ||||||||
| FLORIDA MEDICAL PLAZA CONDO ASSOCIATION INC | |||||||||||||||||
| 601 EAST ROLLINS STREET | ORLANDO | FL | 32803 | 592855791 | CONDO ASSOCIATION | FL | N/A | C | 0 | ||||||||
| FLORIDA MEMORIAL HEALTH NETWORK INC | |||||||||||||||||
| 770 W GRANADA BLVD STE 317 | ORMOND BEACH | FL | 32174 | 593403558 | PHYSICIAN HOSPITAL ORG. | FL | C | 0 | MHS MHF MHWV OR SWVHC | $6,072,636 | $842,798 | 0.25000 | |||||
| HUGULEY ALLIANCE FOUNDATION | |||||||||||||||||
| 11801 SOUTH FREEWAY | FORT WORTH | TX | 76115 | 752642209 | INACTIVE | TX | N/A | C | 0 | ||||||||
| KISSIMMEE MULTISPECIALTY CLINIC CONDOMINIUM ASSOCIATION INC | |||||||||||||||||
| 201 HILDA STREET SUITE 30 | KISSIMMEE | FL | 34741 | 593539564 | CONDO ASSOCIATION | FL | N/A | C | 0 | ||||||||
| MIDWEST MANAGEMENT SERVICES INC | |||||||||||||||||
| 9100 WEST 74TH STREET | SHAWNEE MISSION | KS | 66204 | 480901551 | REAL ESTATE RENTAL | KS | N/A | C | 0 | ||||||||
| METROPLEX ADVENTIST HOSPITAL CRNA (11-111113) | |||||||||||||||||
| 2201 S CLEAR CREEK ROAD | KILLEEN | TX | 76549 | 260760794 | SUPPORT HOSPITAL - PROVIDE ALLIED HEALTH PROFESSIONALS | TX | N/A | C | 0 | ||||||||
| NORTH AMERICAN HEALTH SERVICES INC & SUBS | |||||||||||||||||
| 111 N ORLANDO AVENUE | WINTER PARK | FL | 32789 | 621041820 | LESSOR/HOLDING CO. | TN | N/A | C | 0 | ||||||||
| ORMOND PROFESSIONAL CONDO ASSOCIATION (430 YEAR END) | |||||||||||||||||
| 770 W GRANADA BLVD STE 101 | ORMOND BEACH | FL | 32174 | 592694434 | CONDO ASSOCIATION | FL | N/A | C | 0 | ||||||||
| PARK RIDGE PROPERTY OWNER'S ASSOCIATION INC | |||||||||||||||||
| 1 PARK PLACE NAPLES ROAD | FLETCHER | NC | 28732 | 030380531 | CONDO ASSOCIATION | NC | N/A | C | 0 | ||||||||
| PORTER AFFILIATED HLTH SERVICES INC DBA DIVERSIFIED AFFILIATED HLTH SVCS | |||||||||||||||||
| 2525 S DOWNING STREET | DENVER | CO | 80210 | 840956175 | HEALTHCARE SERVICES | CO | N/A | C | 0 | ||||||||
| SAN MARCOS REGIONAL MRI INC | |||||||||||||||||
| 1301 WONDER WORLD DRIVE | SAN MARCOS | TX | 78666 | 770597968 | HOLDING COMPANY | TX | N/A | C | 0 | ||||||||
| THE GARDEN RETIREMENT COMMUNITY INC | |||||||||||||||||
| 602 COURTLAND STREET STE 200 | ORLANDO | FL | 32804 | 593414055 | REAL ESTATE RENTAL | FL | N/A | C | 0 | ||||||||
| UNIVERSITY COMMUNITY HEALTH INSURANCE COMPANY SPC LTD (11-32813) | |||||||||||||||||
| CAPTIVE INSURANCE | N/A | C | 0 | C/O AON INSURANCE MANAGERS PO BOX | GRAND CAYMAN | CJ | CJ | ||||||||||
| UCH SERVICES INC (11-61213) | |||||||||||||||||
| 3100 EAST FLETCHER AVE | TAMPA | FL | 33613 | 593508454 | MANAGEMENT COMPANY | FL | N/A | C | 0 | ||||||||
| WINTER PARK MEDICAL OFFICE BUILDING I CONDO ASSOC INC | |||||||||||||||||
| 200 LAKEMONT AVE | WINTER PARK | FL | 32792 | 452228478 | PHYSICIAN CLINICS | FL | N/A | C | 0 | ||||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (12 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| MEMORIAL HEALTH SYSTEMS INC | ||
| P | $2,158,561 | COST |
| MEMORIAL HEALTH SYSTEMS INC | ||
| M | $3,712,307 | COST |
| MEMORIAL HEALTH SYSTEMS INC | ||
| K | $258,072 | COST |
| FLORIDA HOSPITAL MEDICAL GROUP INC | ||
| P | $604,297 | COST |
| ADVENTIST HEALTH SYSTEMSUNBELT INC DBA FLORIDA HOSPITAL | ||
| M | $953,157 | COST |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION | ||
| M | $1,387,673 | % OF FACILITY'S OPERATING EXP. |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION DBA AHS IS | ||
| M | $3,741,296 | % OF FACILITY'S OPERATING EXP. |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION | ||
| P | $5,791,243 | COST |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION | ||
| B | $1,319,028 | ACTUAL AMOUNT GIVEN |
| SUNSYSTEM DEVELOPMENT CORP DBA FLORIDA HOSPITAL FLAGLER FOUNDATION | ||
| Q | $75,118 | COST |
| FLORIDA MEMORIAL HEALTH NETWORK INC | ||
| M | $448,795 | COST |
| ADVENTIST HEALTH SYSTEMSUNBELT INC | ||
| M | $868,686 | % OF FACILITY'S EHR REVENUE |