2013-11-15T13:03:59-06:00 2012-12-31 990 2012-01-01 208488713 Pasco-Pinellas Hillsborough Community Health System Inc PASC 8139295490 2600 Bruce B Downs Blvd Wesley Chapel FL 33544 Lynn C Addiscott 8139295490 2013-11-15 2012 2016-02-25 16:41:14Z X Florida Hospital Wesley Chapel Brian Adams 2600 Bruce B Downs Blvd Wesley Chapel FL 33544 13297836 0 X www.fhwesleychapel.com X 2007 FL The provision of medical care to the community through the operation of a 83 bed hospital. 8 2 427 75 0 0 0 0 0 13033814 252102 264022 0 0 252102 13297836 5000 0 0 0 405398 9459563 0 0 0 604360 10999808 1014758 20459371 -762656 -7161535 82240814 173726902 52625480 151256893 29615334 22470009 Adventist Health System Sunbelt Healthcare Corporation and all of its subsidiary organizations were established by the Seventh-Day Adventist Church to bring a ministry of healing and health to the communities served. Our mission is to extend the healing ministry of Christ. 0 0 17957411 13033814 Pasco-Pinellas Hillsborough Community Health System, Inc. (PPHCHS) was formed to provide healthcare services in Pasco, Pinellas, and Hillsborough Counties of Florida. Florida Hospital Wesley Chapel opened its doors in October 2012. It operates a 83-bed acute care hospital. During the first few months in 2012 there were 724 admissions resulting in 2,475 patient days and 6,313 outpatient visits. 17957411 1 1 0 0 0 0 1 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 390 0 1 427 1 0 0 0 0 0 0 0 0 0 0 X 8 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Mike Lukens 8139295490 2600 Bruce B Downs Wesley Chapel FL 33544 X Robert Anderson PhD 2.00 0.00 X 0 0 0 Robert Rosequist MD 7.00 0.00 X 40302 0 0 Lewis Seifert 2.00 50.00 X 0 681597 118449 Michael Schultz 2.00 50.00 X 0 1305933 169103 Ken Lightfoot 2.00 0.00 X 0 0 0 Lars Houmann 1.00 50.00 X 0 1371852 242069 John Harding 2.00 50.00 X 0 1030205 119615 Jancie Hagensicker 2.00 50.00 X X 0 1007652 67105 Brian Adams 50.00 0.00 X 0 308853 51779 Mike Lukens 50.00 0.00 X 0 358320 54415 Mary Brady 50.00 0.00 X 0 182424 20201 Mary Nelson Sanidad 45.00 0.00 X 106689 0 18747 Holley Bush 45.00 0.00 X 100262 0 9691 Donald Welch 0.00 50.00 X 0 269791 61363 247253 6516627 932537 2 1 1 0 Robins & Morton Group 1900 Summit Tower Blvd 150 Orlando FL 32810 Construction & Management 20387174 Brasfield & Gorrie LLC 200 Colonial Ctr Parkway 200 Lake Mary FL 32751 Construction & Management 945073 Hunton Brady Architects 800 N Magnolia Ave 600 Orlando FL 32803 Architect Services 807344 Parsons Environment & Infrastructure 4701 Hedgemore Drive Charlotte NC 28209 Construction & Management 378632 Morrison Management Specialists Inc PO BOX 102289 Atlanta GA 30368 Food Service Management 349914 14 Net Patient Revenue 900099 12846198 12846198 Medical Office Building 531120 96153 96153 Cafeteria Revenue 900099 72539 72539 Gift Shop Revenue 900099 18917 18917 7 7 13033814 106004 106004 158018 0 158018 158018 158018 13297836 13033814 0 264022 994478 994478 6444069 6444069 100982 95775 5207 1412161 1368263 43898 507873 481685 26188 61902 61902 41300 41300 1873524 1764548 108976 801340 801340 410880 229216 181664 427730 359588 68142 663692 663692 120228 120228 2352645 2352645 1992294 1992294 102252 100136 2116 Medical Supplies 1708092 1708092 State Tax Indigent Asse 176469 176469 Repairs & maintenance 129323 129323 Purchased Services 94215 91616 2599 43922 43922 20459371 17957411 2501960 0 1252 13233784 16973367 98368 6670650 1032880 65211 150163571 1926074 68820271 148237497 23180 811256 82240814 173726902 6502804 9406658 46122676 141850235 52625480 151256893 X 29581878 22470009 33456 0 29615334 22470009 82240814 173726902 X -7161535 16210 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 1 0 0.00 0 0 9042351 9042351 88217508 551359 87666149 44008147 1374715 42633432 8895565 8895565 148237497 Due to affiliated 476459 Interco Alloc of TE Bond Proceeds 136273841 Payable to third parties -16058 Other liability 5108660 Credit balance in prepaid 7333 141850235 X Description of How Organization Reports Conservation Easements: Part II, Line 9: The filing organization has recorded the land conservation easement on its financial statements as a Property, Plant, and Equipment Asset. The conservation easement generates no revenue and the filing organization did not incur any expense in the current year related to the maintenance and monitoring of the conservation easement. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The filing organization is a subsidiary organization within Adventist Health System (AHS). The consolidated financial statements of AHS contain the following FIN 48 footnote - The Income Taxes Topic of the ASC (ASC 740) 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. 1 1 X 1 X 1 X 1 1 0 1 1 2614193 476894 2137299 0.10450 2614193 476894 2137299 0.10450 2614193 476894 2137299 0.10450 1 2483161 6416 1 1 1 1 Florida Hospital Wesley Chapel

2600 Bruce B Downs Blvd Wesley Chapel FL 33544

www.fhwesleychapel.com X X X Florida Hospital Wesley Chapel 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X 1 0 1 X 0 0 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 43 hospitals in ten states within the U.S. The system of organizations under the control and ownership of AHSSHC is known as "Adventist Health System" (AHS).All hospital organizations within AHS collect, calculate, and report the community benefits they provide to the communities they serve. AHS organizations exist solely to improve and enhance the local communities they serve. AHS has a system-wide community benefits accounting policy that provides guidelines for its health care provider organizations to capture and report the costs of services provided to the underprivileged and to the broader community. On an annual basis, the community benefits of all AHS organizations are consolidated and reported in the AHS Annual Report document prepared by AHSSHC (EIN 59-2170012). Part I, Line 7: The amounts of costs reported in the table in line 7 of Part I of Schedule H were determined by utilizing a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges, contained in the Schedule H instructions. Part III, Line 9b: At the time of patient registration, non-elective self-pay patients are informed of the minimum discount available under the filing organization's self-pay discount policy. Such patients are also informed of the filing organization's charity care policy and told that they will be required to submit necessary financial data in order to potentially receive any additional 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. However, if a patient does not make any payments for three consecutive months, the account may be referred for further collection activity. The filing organization does not pursue collection of amounts from patients determined to qualify for a 100% reduction in charges under its charity care policy. 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 5 & 6: The filing organization's single hospital facility opened on October 1, 2012. The first Medicare Cost Report for the hospital will be filed for the period beginning October 1, 2012 through December 31, 2013. The Form 990 instructions state that lines 5 and 6 of Section B of Part III should be completed with amounts as reported in the organization's Medicare Cost Report. Since the organization's initial Medicare Cost Report has not yet been completed, no amounts have been entered on lines 5 and 6 of Section B of Part III. Part III, Section B: On Section B of Part III of Schedule H, no amounts are shown for lines 5 and 6 for total revenues received from Medicare and for Medicare allowable costs relating to such revenue payments. This is due to the fact that the filing organization's initial Medicare Cost Report will be filed for the period beginning October 1, 2012 (the date the filing organization's hospital facility opened) through December 31, 2013. Accordingly, there are no current Medicare Cost Report amounts to enter on lines 5 and 6 of Section B of Part III on Schedule H.For purposes of its annual community benefit statement, the filing organization has determined its total unreimbursed costs associated with providing services to all Medicare patients. As noted in our response to Schedule H, Part I, line 6a, the filing organization is a wholly-owned subsidiary of Adventist Health System. Unreimbursed Medicare costs are reported as a community benefit to the elderly and are included in the consolidated Adventist Health System (AHS) Community Benefits Report contained in the AHS Annual Report document. The total unreimbursed costs of serving all Medicare patients per the filing organization's community benefits reporting for the period beginning on the opening of the hospital facility on October 1, 2012 to December 31, 2012 were $4,478,042. Florida Hospital Wesley Chapel Part V, Section B, Line 14g: Florida Hospital Wesley Chapel has developed a patient-friendly summary version of its financial assistance policy (FAP). The filing organization's FAP provides that its hospital facility will post the patient-friendly summary version of its FAP on the Hospital's website. In addition, the FAP of the Hospital facility states that signage regarding the availability of the Hospital facility's FAP will be visible at points of admission and registration, including the emergency department. Florida Hospital Wesley Chapel 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 whose volume of activity with the Hospital equals or exceeds $100,000 for 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. Part VI, Line 2: In accordance with IRC Section 501(r)(3), the filing organization has adopted and implemented a policy that sets forth the general requirements, processes and procedures with respect to conducting a community health needs assessment and associated implementation strategy. During 2012, the filing organization was in the process of planning for their initial Community Health Needs Assessment (CHNA) that is to be completed by 12/31/2013. In addition to the CHNA that is being conducted, a variety of practices and processes are and will be put in place to ensure that the filing organization is responsive to the health needs of its community. Such practices and processes include 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 filing organization has a process in place whereby patients are informed about the Hospital's Charity Care Policy and other forms of financial assistance, such as self-pay discounts. 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 Charity Care 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 Charity Care Policy the discounts extended under that policy will be applied.As part of the billing process, the Hospital includes the application for charity care assistance along with the initial patient bill. The Hospital's charity care 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 charity care applications and investigating other potential sources of third-party assistance. The determination of a patient's eligibility for charity care 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 charity care is seen by a financial counselor at the Hospital. The financial counselor will work with the patient to make sure that other sources of assistance (public or otherwise) have been sought to the fullest extent possible. When other forms of assistance are not available or have been exhausted, the Hospital will gather certain financial information from the patient to determine the patient's ability to pay based upon level of income. Part VI, Line 4: The filing organization owns and operates one hospital facility, Florida Hospital Wesley Chapel, which opened in October 2012. The hospital was originally planned as a partnership between Adventist Health System (AHS) and University Community Hospital (UCH) until Adventist Health System acquired the UCH system in September 2011. The 200,000 sq. ft. Wesley Chapel hospital opened with 83 inpatient beds (all private rooms) on a 52 acre campus as a full service, community hospital after 22 months of construction. The hospital opened with state-of-theart technology much of it first in the area including a patient education/entertainment system that is tied in with real time location services that tracks hourly rounding and hand sanitation, among other things. The hospital achieved Primary Stroke Certification within two months of opening.The new hospital facility also has a hybrid operating room that can be used for minimally invasive surgery, or as an imaging suite. Other high-tech features include an 18-room ER with digital technology that allows patients to be checked in at bedside rather than a triage area or waiting room, and patient rooms equipped with the GetWell Network, an in-room technology system that allows patients to research and watch videos regarding treatment and recovery. As hospital staff enter a room, it records who came in and how long they stayed so family members can monitor care.Florida Hospital Wesley Chapel (FHWC) serves a population of approximately 467,600 people in the Hospital's primary market. Florida Hospital Wesley Chapel primarily serves eastern Pasco and northeastern Hillsborough Counties (including Wesley Chapel, New Tampa (northeast Tampa), Land O'Lakes and portions of San Antonio, Lutz and Zephyrhills). The hospital is located in between two Adventist Health System facilities (Florida Hospital Tampa- 15 miles, Florida Hospital Zephyrhills- 16 miles) in a suburb just north of Tampa. The largest hospital system in the Tampa Bay Market is BayCare Health System. There are two BayCare hospitals near Florida Hospital Wesley Chapel (St. Joseph's Hospital (also has a children's hospital and a women's hospital) and St. Joseph's North ( a community hospital that opened two years before FHWC). The weighted average household income, based on population, in the primary market is approximately $60,000, with an estimated 99,000 over the age of 65. High school graduates account for approximately 85% of Pasco County with an estimated 19% having a bachelor's degree or higher. It is estimated that 12% of the individuals residing in Pasco County live below the poverty level and the unemployment rate is about 8%.Approximately 34% of the filing organization's patients during 2012 were Medicare patients, about 13% were Medicaid patients, 8.5% were self-pay, and the remaining percentage were patients covered under commercial insurance. For 2012, about 81% of the Hospital's in-patients were admitted through the Hospital's emergency department. Part VI, Line 5: The provision of community benefit is central to the filing organization's mission of service and compassion. Restoring and promoting the health and quality of life of those in the communities served by the filing organization is a function of "extending the healing ministry of Christ" and embodies the fiing organization's commitment to its values and principles. The filing organization commits substantial resources to provide a broad range of services to both the underprivileged as well as the broader community. In addition to the community benefit information provided in Parts I, II and III of this Schedule H, the Hospital captures and reports the benefits provided to its community through faith-based care. Examples of such benefits include the cost associated with chaplaincy care programs and mission peer reviews and mission conferences. During the current year, the filing organization provided $17,809 of benefit with respect to the faith-based and spiritual needs of the community in conjunction with its operation of a community hospital. The filing organization also provides benefits to its community's infrastructure by investing in capital improvements to ensure that facilities and technology provide the best possible care to the community. During the current year, the filing organization expended $77,424,933 in new capital improvements. As a faith-based mission-driven community hospital, the filing organization is continually involved in monitoring its community, identifying unmet health care needs and developing solutions and programs to address those needs. In accordance with its conservative approach to fiscal responsibility, surplus funds of the Hospital are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its community. Part VI, Line 6: The filing organization is a part of a faith-based healthcare system of organizations whose parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). The system is known as Adventist Health System (AHS). AHSSHC is an organization exempt from federal income tax under IRC Sec. 501(c)(3). AHSSHC and its subsidiary organizations operate 43 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 IV, line 7: The annual community benefit report contained in the annual report prepared by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) on behalf of the entire AHS System of healthcare organization is not filed with any state agencies. X X X X 1 1 0 1 0 0 0 0 0 0 0 Lewis Seifert 0 462337 0 126959 0 92301 0 86337 0 32112 0 800046 0 42022 Michael Schultz 0 642188 0 195183 0 468562 0 128507 0 40596 0 1475036 0 91255 Lars Houmann 0 869760 0 266769 0 235323 0 189569 0 52500 0 1613921 0 158447 John Harding 0 492989 0 150967 0 386249 0 100602 0 19013 0 1149820 0 68527 Jancie Hagensicker 0 336777 0 96874 0 574001 0 44100 0 23005 0 1074757 0 27496 Brian Adams 0 224088 0 66947 0 17818 0 30018 0 21761 0 360632 0 0 Mike Lukens 0 211298 0 37573 0 109449 0 26834 0 27581 0 412735 0 12291 Mary Brady 0 159900 0 0 0 22524 0 6690 0 13511 0 202625 0 0 Donald Welch 0 211298 0 35080 0 23413 0 24629 0 36734 0 331154 0 404 Part I, Line 1a As discussed in our response to Form 990, Section B, Part VI, Question 15a & b, 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 Strategy & 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). 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 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 Strategy & 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 $210,000. 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 ------------------------------------------------------- John Harding $ 87,003 $ 74,888 $275,725 $ 0 Lars Houmann $175,971 $161,469 $ 25,617 $ 0 Mike Lukens $ 13,236 $ 13,605 $ 0 $ 0 Michael Schultz $114,908 $ 97,967 $300,548 $ 0 Lewis Seifert $ 72,738 $ 42,384 $ 0 $ 0 Janice Hagensicker $ 47,501 $ 27,513 $489,559 $ 0 Donald Welch $ 11,030 $ 404 $ 0 $ 0 Brian Adams $ 16,419 $ 0 $ 0 $ 0 *Including Investment Earnings Supplemental Information Part III Part I, Question 3 As noted in our response to question 15 of Part VI of Form 990, 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 uses all of the following to establish compensation of the CEO: - Compensation committee; - Independent compensation consultant; - Compensation survey or study; and - Approval by the board or compensation committee. X 2 Dealer vehicles 2 0 2 0 0 1 Method for Determining Number of Contributors: Part I, Column (b): The number of contributions reported in column (b) of Schedule M, Part I represents the number of items received by the filing organization during the current year. Third Party Use: Part I, Line 32b: The filing organization's supporting foundation conducts fund-raising activities on behalf of the filing organization, generally including the soliciting, processing, and selling of non-cash contributions. Non Reporting of Revenue: Part I, Line 33: Pursuant to the filing organization's Net Assets Accounting Policy, gifts of donated property are recorded by the filing organization to the unrestricted net assets (equity) account. Accordingly, donated property is recorded directly to equity accounts and are not recorded in the income statement. Form 990, Part VI, Section A, line 6 Pasco-Pinellas Hillsborough Community Health System, Inc. (the filing organization) has two 50% members. The members of the filing organization are Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) and University Community Hospital, Inc.(UCH). Both members are Florida, not-for-profit corporations that are 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. On September 1, 2010, AHSSHC became the sole member of UCH. Form 990, Part VI, Section A, line 7a The two 50% members of the filing organization are AHSSHC and UCH. Each of the two members has the power to appoint 50% of the members of the board of directors of the filing organization. Form 990, Part VI, Section A, line 7b AHSSHC and UCH, as the equal members of the filing organization, have certain reserved powers as set forth in the Bylaws of the filing organization. These reserved powers include the following: a) to appoint and remove the Directors of the filing organization; b) to adopt, amend, restate, and repeal the Articles of Incorporation or Bylaws of the filing organization; c) to amend, restate, or repeal the Mission Statement of the filing organization; d) to approve or disapprove the sale, transfer, or disposal of all or substantially all of the assets of the filing organization; and e) to direct the use and application of net revenue of the filing organization. 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 top-tier parent of the filing organization is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is the parent organization of a healthcare system, known as Adventist Health System, that operates hospitals, nursing home facilities, and other healthcare provider organizations. AHSSHC is exempt from federal income tax under IRC Section 501(c)(3) pursuant to a group ruling issued to the General Conference of Seventh-day Adventists. The individuals who serve as the CEO, CFO or Vice President of the filing organization are compensated by AHSSHC. Compensation and benefits provided to these individuals is 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 Strategy and 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. 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 and officers 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Allocation from Tax-Exempt Parent with respect to debt 49,666. Transfer to expenses for operations -33,456. Part X, Line 2: The amounts shown on line 2 of Part X of this return include the filing organization's interest in a central investment pool maintained by Adventist Health System Sunbelt Healthcare Corporation, one of the filing organization's 50% parent organizations. The investments in the central investment pool are recorded at market value. Adventist Bolingbrook Hospital 500 Remington Blvd Bolingbrook IL 60440 651219504 Operation of Hospital & Related Services IL 501(c)(3) 170(b)(1)(A)(iii) 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) 509(a)(2) 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) 170(b)(1)(A)(iii) 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) 509(a)(3) Type 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) 170(b)(1)(A)(iii) 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) 509(a)(3) Type 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) 509(a)(3) Type I N/A 0 Adventist Hlth SystemGeorgia Inc 1035 Red Bud Road Calhoun GA 30701 581425000 Operation of Hospital & Related Services GA 501(c)(3) 170(b)(1)(A)(iii) 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) 170(b)(1)(A)(iii) 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) 509(a)(3) Type III Adventist Hlth System Sunbelt Hlthcare Corp 0 Adventist Hinsdale Hospital 120 North Oak Street Hinsdale IL 60521 362276984 Operation of Hospital & Related Services IL 501(c)(3) 170(b)(1)(A)(iii) Adventist Hlth SystemSunbelt Inc 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) 170(b)(1)(A)(ii) 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) 509(a)(3) Type 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) 509(a)(3) Type III-F 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) 509(a)(3) Type III-F Sunbelt Hlth Care Centers Inc 0 Battle Creek Adventist Hospital 1000 Remington Blvd Ste 200 Bolingbrook IL 60440 381359189 Inactive MI 501(c)(3) 170(b)(1)(A)(iii) 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) 170(b)(1)(A)(vi) 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) 509(a)(2) 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) 509(a)(2) 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) 509(a)(3) Type III-F Sunbelt Hlth Care Centers Inc 0 Central Texas Hlthcare Collaborative 1301 Wonder World Drive San Marcos TX 78666 453739929 Support Operation of Hospital TX 501(c)(3) 509(a)(3) Type I Adventist Hlth SystemSunbelt Inc 0 Cedar Crag Terrace Inc (630 Year End) Rt 5 Box 900 Manchester KY 40962 611120442 Operation of Home for the elderly-disabled KY 501(c)(3) 170(b)(1)(A)(vi) Memorial Hospital 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) 170(b)(1)(A)(vi) 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) 509(a)(3) Type III-F 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) 170(b)(1)(A)(iii) Adventist Hlth SystemSunbelt Inc 0 Cobb Medical Associates LLC 3949 South Cobb Drive SE Smyrna GA 300806342 582617089 Operation of Physician Practices & Medical Services GA 501(c)(3) 170(b)(1)(A)(iii) Emory-Adventist Inc 0 Courtland Hlth Care Properties Inc 730 Courtland Street Orlando FL 32804 510605682 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F 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) 509(a)(2) 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) 509(a)(3) Type III-F 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) 509(a)(2) 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) 170(b)(1)(A)(iii) Adventist Hlth SystemSunbelt Inc 0 Fletcher Hospital Inc 100 Hospital Drive Hendersonville NC 28792 560543246 Operation of Hospital & Related Svcs NC 501(c)(3) 170(b)(1)(A)(iii) 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) 509(a)(2) Sunbelt Hlth Care Centers Inc 0 Florida Hospital Waterman Inc 1000 Waterman Way Tavares FL 32778 593140669 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) 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) 170(b)(1)(A)(iii) 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) 170(b)(1)(A)(iii) 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) 509(a)(3) Type 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) 170(b)(1)(A)(vi) Midwest Hlth Foundation 0 Hays Memorial Hospital Association of Seventh-Day Adventists 1301 Wonder World Drive San Marcos TX 78667 741362785 Lease of Hospital Personnel TX 501(c)(3) 509(a)(3) Type II Adventist Hlth System Sunbelt Hlthcare Corp 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) 509(a)(3) Type I 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) 509(a)(3) Type I 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) 170(b)(1)(A)(vi) Midwest Hlth Foundation 0 Huguley Community Care Corp 11801 South Freeway Burleson TX 76028 452793120 Support Operation of Hospital TX 501(c)(3) 509(a)(3) Type I Adventist Hlth SystemSunbelt Inc 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) 509(a)(3) Type 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) 170(b)(1)(A)(iii) Adventist Hlth System Sunbelt Hlthcare Corp 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) 170(b)(1)(A)(vi) 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) 170(b)(1)(A)(vi) 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) 170(b)(1)(A)(iii) Adventist Hlth SystemSunbelt Inc 0 Memorial Hospital Flagler Inc 60 Memorial Medical Parkway Palm Coast FL 32164 592951990 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) Memorial Hlth Systems Inc 0 Memorial Hospital - West Volusia Inc 701 West Plymouth Avenue Deland FL 32720 593256803 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) 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) 170(b)(1)(A)(iii) 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) 509(a)(3) Type III-F 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) 170(b)(1)(A)(iii) 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) 170(b)(1)(A)(iii) Metroplex Adventist Hospital Inc 0 Metroplex Hospital Inc (1023-123112) 900 Hope Way Altamonte Springs FL 32714 461256516 Future Operation of Hospital & Related Svcs FL 501(c)(3) 170(b)(1)(A)(iii) 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) 509(a)(3) Type II N/A 0 Mills Hlth & Rehab Center Inc 500 Beck Lane Mayfield KY 42066 205782320 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) 509(a)(2) 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) 509(a)(3) Type II 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) 509(a)(3) Type 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) 509(a)(3) Type 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) 509(a)(2) 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) 509(a)(3) Type III-F 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) 509(a)(2) 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) 509(a)(3) Type III-F 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) 170(b)(1)(A)(iii) N/A 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) 170(b)(1)(A)(iii) Adventist Hlth System Sunbelt Hlthcare Corp 0 Portland Nursing & Rehab Center Inc 215 Highland Circle Drive Portland TN 37148 205774842 Operation of Home for the Aged/Hlthcare Delivery TN 501(c)(3) 509(a)(2) 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) 509(a)(2) 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) 509(a)(2) 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) 509(a)(3) Type III-F 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) 509(a)(3) Type 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) 170(b)(1)(A)(vi) PorterCare Adventist Hlth System 0 Rollins Bedford Corp 602 Courtland Street Ste 200 Orlando FL 32804 370908840 Inactive FL 501(c)(3) 509(a)(3) Type II Sunbelt Hlth Care Centers Inc 0 Rollins Brook Community Care Corp (1120-123112) 2201 S Clear Creek Road Killeen TX 76549 461656773 Inactive TX 501(c)(3) Metroplex Adventist Hospital Inc 0 Russellville Hlth Care Properties Inc 683 East Third Street Russellville KY 42276 510605691 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F 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) 509(a)(3) Type III-F 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) 509(a)(2) 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) 509(a)(3) Type III-F 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) 170(b)(1)(A)(iii) 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) 509(a)(3) Type III-O South Central Inc 0 South Central Nursing Homes Inc 602 Courtland Street Orlando FL 32804 611242373 Management Support KY 501(c)(3) 509(a)(3) Type 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) 509(a)(3) Type III-F N/A 0 South Pasco Hlth Care Properties Inc 38250 A Avenue Zephyrhills FL 33542 510605679 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F Sunbelt Hlth Care Centers Inc 0 Southwest Volusia Hlth Services Inc 1055 Saxon Blvd Orange City FL 327638468 593281591 Medical Office Building for Hospital FL 501(c)(3) 509(a)(3) Type I Southwest Volusia Hlthcare Corp 0 Southwest Volusia Hlthcare Corp 1055 Saxon Blvd Orange City FL 327638468 593149293 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) 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) 170(b)(1)(A)(iii) 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) 509(a)(2) 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) 509(a)(2) 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) 509(a)(3) Type 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) 170(b)(1)(A)(vi) 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) 170(b)(1)(A)(iii) 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) 509(a)(3) Type III-F 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) 509(a)(3) Type III-F Sunbelt Hlth Care Centers Inc 0 Texas Hlth Huguley Inc (11-43012) 900 Hope Way Altamonte Springs FL 32714 452694620 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) Adventist Hlth SystemSunbelt 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) 509(a)(3) Type III-F 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) 509(a)(2) Sunbelt Hlth Care Centers Inc 0 University Community Hospital Auxiliary Inc 3100 E Fletcher Ave Tampa FL 33613 237011345 Volunteer support services FL 501(c)(3) 509(a)(3) Type III-F University Community Hospital 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) 509(a)(3) Type 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) 509(a)(3) 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) 170(b)(1)(A)(iii) 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) 509(a)(3) Type III-F 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) 509(a)(2) 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) 509(a)(2) Sunbelt Hlth Care Centers Inc 0 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 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 Huguley Surgery Ctr LLP (11-4112) 15305 Dallas Pkwy Ste 1600 LB 28 Addison TX 75001 200910694 Outpatient Surgery TX N/A KCCCSMMC Cancer Center LLC 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 Shawnee Mission Open MRI LLC 9100 W 74th Street Box 2923 Shawnee Mission KS 66201 270011796 Imaging & Testing KS N/A Skyland MRI LLC (11-12012) 100 Hospital Drive Hendersonville NC 28792 043646559 Imaging & Testing KS N/A 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 Arapahoe Medical Building I Inc (7111-12512) 2525 S Downing Street Denver CO 80210 841574506 Real Estate Leasing CO N/A C 0 Arapahoe Medical Building II Inc (7111-12512) 2525 S Downing Street Denver CO 80210 841574507 Real Estate Leasing CO 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 N/A C 0 Florida Hospital Healthcare System Inc 602 Courtland Street Orlando FL 32804 593215680 PHO/TPA FL N/A C 0 Florida Hospital Wesley Chapel Inc (11-51512) 900 Hope Way Altamonte Springs FL 32714 203965753 Inactive 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 N/A C 0 Harvard Park East Inc (7111-12512) 2525 S Downing Street Denver CO 80210 841574365 Real Estate Leasing CO N/A C 0 Helen Ellis Memorial Hospital Real Estate Corp (11-101912) 1395 S Pinellas Ave Tarpon Springs FL 34689 593375731 Real Estate Rental FL N/A C 0 Huguley Alliance Foundation 11801 South Freeway Fort Worth TX 76115 752642209 Inactive TX N/A C 0 Huguley Medical Associates Inc (11-43012) 11801 South Freeway Burleson TX 76028 752547668 Physician Clinics 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 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 Porter Medical Plaza Inc (7111-12512) 2525 S Downing Street Denver CO 80210 841574369 Real Estate Leasing 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 C/O AON Insurance Managers PO Box Grand Cayman CJ Captive Insurance CJ N/A C 0 UCH Services Inc 3100 East Fletcher Ave Tampa FL 33613 593508454 Management Company FL N/A C 0 West Coast Medical Group Inc (11-101912) 1395 S Pinellas Ave Tarpon Springs FL 34689 593537305 Physician Clinics 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 Florida Hospital Zephyrhills Inc P 284946 Cost Adventist Health System Sunbelt Healthcare Corporation P 1008382 Cost Florida Hospital Zephyrhills Inc O 55780 Cost University Community Hospital Inc P 288954 Cost Adventist Health System Sunbelt Healthcare Corporation M 96551 % of facilities operating expense Adventist Health System Sunbelt Healthcare Corp dba AHS IS M 450167 % of facilities operating expense