MEMORIAL HOSPITAL FLAGLER INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HOSPITAL FLAGLER INC (EIN 59-2951990)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-05
- IRS object ID
- 201313099349302101
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2013-11-05T17:40:13-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 592951990 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL FLAGLER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MEMO | NameControl |
| Phone | 3865862000 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LYNN C ADDISCOTT | Name |
| Title | ASSISTANT SECRETARY | Title |
| Phone | 4079751492 | Phone |
| Date Signed | 2013-11-04 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FLORIDA HOSPITAL FLAGLER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | KEN MATTISON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 166163133 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.FLORIDAHOSPITALFLAGLER.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1989 | YearFormation |
| State Legal Domicile | FL | StateLegalDomicile |
| Activity Or Mission Description | THE PROVISION OF MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF A 99 BED HOSPITAL. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1112 | TotalNbrEmployees |
| Total Nbr Volunteers | 313 | TotalNbrVolunteers |
| Total Gross UBI | 161733 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 81915 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 500 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 153686740 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 161284913 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2282790 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2940062 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1938158 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 155970030 | TotalRevenuePriorYear |
| Total Revenue Current Year | 166163133 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 130599 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 15450 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 61878805 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 68470280 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 68738811 | OtherExpensePriorYear |
| Other Expenses Current Year | 71218765 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 130748215 | TotalExpensesPriorYear |
| Total Expenses Current Year | 139704495 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 25221815 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 26458638 | RevenuesLessExpensesCY |
| Total Assets BOY | 251755520 | TotalAssetsBOY |
| Total Assets EOY | 275372166 | TotalAssetsEOY |
| Total Liabilities BOY | 98435492 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 96826547 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 153320028 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 178545619 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 131746316 | Expense |
| Grants | 15450 | Grants |
| Revenue | 163061338 | Revenue |
| Description | PROVISION OF MEDICAL CARE TO BOTH INPATIENTS AND OUTPATIENTS. DURING THE CURRENT YEAR, THE HOSPITAL HAD 6,752 PATIENT ADMISSIONS WHICH RESULTED IN 26,701 PATIENT DAYS AND 102,261 OUTPATIENT VISITS. THE HOSPITAL IS AN 99-BED ACUTE CARE HOSPITAL LOCATED IN FLAGLER COUNTY, FLORIDA. | Description |
| Total Program Service Expense | 131746316 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 1 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 141 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1112 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | FL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VALERIE ZIESMER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3865864210 | TelephoneNumber |
Address US AddressUS
| 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 | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (26 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| MICHAEL SCHULTZ | |||||||||
| CHAIRMAN | 0.20 | 50.00 | X | 0 | 1305933 | 169103 | |||
| LEWIS SEIFERT | |||||||||
| DIRECTOR | 0.20 | 50.00 | X | 0 | 681597 | 118449 | |||
| EDWARD NOSEWORTHY | |||||||||
| DIRECTOR | 0.20 | 50.00 | X | 0 | 446272 | 75791 | |||
| SANDRA JOHNSON | |||||||||
| DIRECTOR | 0.20 | 50.00 | X | 0 | 590485 | 99955 | |||
| MARK LAROSE | |||||||||
| DIRECTOR (END 2/12) | 0.20 | 50.00 | X | 0 | 575006 | 96916 | |||
| DAVID OTTATI | |||||||||
| CEO/FLAGLER/DIRECTOR | 50.00 | 0.00 | X | 0 | 432475 | 78624 | X | ||
| BRUCE PAGE | |||||||||
| DIRECTOR | 0.40 | 0.00 | X | 428 | 0 | 0 | |||
| MICHAEL CHIUMENTO | |||||||||
| DIRECTOR | 0.40 | 0.00 | X | 428 | 0 | 0 | |||
| DENNIS ALTER MD | |||||||||
| DIRECTOR | 4.00 | 0.00 | X | 24912 | 0 | 0 | |||
| STEVEN BROWN MD | |||||||||
| DIRECTOR (BEG 1/12) | 5.00 | 0.00 | X | 40828 | 0 | 0 | |||
| BOB DEVORE | |||||||||
| DIRECTOR | 0.20 | 0.00 | X | 428 | 0 | 0 | |||
| TED HAMILTON MD | |||||||||
| DIRECTOR | 0.20 | 50.00 | X | 0 | 713749 | 35634 | |||
| ROGER LEVERTON | |||||||||
| DIRECTOR (BEG 1/12) | 0.40 | 0.00 | X | 428 | 0 | 0 | |||
| TONY PAPANDREA | |||||||||
| DIRECTOR | 0.40 | 0.00 | X | 428 | 0 | 0 | |||
| BARBARA REVELS | |||||||||
| DIRECTOR | 0.40 | 0.00 | X | 428 | 0 | 0 | |||
| DARYL TOL | |||||||||
| CHAIRMAN/DIRECTOR | 1.00 | 50.00 | X | 0 | 564953 | 116809 | |||
| HOLSEY MOORMAN | |||||||||
| DIRECTOR | 0.20 | 0.00 | X | 428 | 0 | 0 | |||
| TERRANCE REGAN MD | |||||||||
| DIRECTOR | 5.00 | 0.00 | X | 28678 | 0 | 0 | |||
| DEBORA THOMAS | |||||||||
| DIRECTOR | 1.00 | 50.00 | X | 0 | 401061 | 57811 | |||
| VALERIE ZIESMER | |||||||||
| CFO | 50.00 | 0.00 | 0 | 288458 | 24990 | X | |||
| ELLEN LENKEVICH | |||||||||
| CNO | 50.00 | 0.00 | 0 | 183150 | 34699 | X | |||
| PADMAJA SAI MD | |||||||||
| PHYSICIAN | 65.00 | 0.00 | 1260881 | 0 | 34334 | X | |||
| PHILIP NDUM MD | |||||||||
| PHYSICIAN | 70.00 | 0.00 | 1030225 | 0 | 31236 | X | |||
| JOSEPH MCKINLEY MD | |||||||||
| PHYSICIAN | 75.00 | 0.00 | 924913 | 0 | 33100 | X | |||
| KIZHAKE KURIAN MD | |||||||||
| PHYSICIAN | 70.00 | 0.00 | 875587 | 0 | 21137 | X | |||
| KAREN THEILADE MD | |||||||||
| PHYSICIAN | 60.00 | 0.00 | 527251 | 0 | 17379 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 4716271 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 6183139 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1045967 | TotalOtherCompensation |
| Number Individuals GT100 K | 52 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| SHERIDAN HEALTHCORP INC | |||||
| PO BOX 452197 | SUNRISE | FL | 33323 | ANESTHESIA/PHYSICIAN SERVICES | 1528727 |
| ADVANTAGE MEDICAL STAFFING OF CENTRAL FL | |||||
| PO BOX 101004 | ATLANTA | GA | 30392 | MEDICAL STAFFING SERVICES | 383574 |
| MONTI ELIGIBILITY & DENIAL | |||||
| 100 TREEMONTE AVE | ORANGE CITY | FL | 32763 | DEBT RECOVERY SERVICES | 312280 |
| BE SMITH INTERIM SERVICES INC | |||||
| 9777 RIDGE DRIVE | LENEXA | KS | 66219 | STAFFING SERVICES | 237848 |
| AVANTE AT ORMOND BEACH INC | |||||
| 170 NORTH KINGS ROAD | ORMOND BEACH | FL | 32174 | HOSPICE SERVICES | 173775 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 84 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| NET PATIENT REVENUE | 900099 | 159790922 | 159790922 | |
| MEDICAL OFFICE BUILDING | 531120 | 918294 | 918294 | |
| CAFETERIA REVENUE | 900099 | 390181 | 390181 | |
| LAB REVENUE | 621500 | 161733 | 161733 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 23783 | TotalRevenueColumn |
| Related Or Exempt Function Income | 23783 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 161284913 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1158537 | TotalRevenueColumn |
| Exclusion | $1,158,537 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1749200 | Securities |
| Other | 32325 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1749200 | Securities |
| Other | 32325 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1781525 | TotalRevenueColumn |
| Exclusion | $1,781,525 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | EHR REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 1938158 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1938158 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1938158 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 166163133 | TotalRevenueColumn |
| Related Or Exempt Function Income | 163061338 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 161733 | UnrelatedBusinessRevenue |
| Exclusion | $2,940,062 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15450 | Total |
| Program Services | 15450 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1095988 | Total |
| Management And General | 1095988 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53259552 | Total |
| Program Services | 53259552 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1500208 | Total |
| Program Services | 1477705 | ProgramServices |
| Management And General | 22503 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9124229 | Total |
| Program Services | 9123606 | ProgramServices |
| Management And General | 623 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3490303 | Total |
| Program Services | 3437948 | ProgramServices |
| Management And General | 52355 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 250697 | Total |
| Management And General | 250697 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56764 | Total |
| Management And General | 56764 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14652530 | Total |
| Program Services | 11052764 | ProgramServices |
| Management And General | 3599766 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 695761 | Total |
| Management And General | 695761 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2902188 | Total |
| Program Services | 2193400 | ProgramServices |
| Management And General | 708788 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3925593 | Total |
| Program Services | 3392296 | ProgramServices |
| Management And General | 533297 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3684948 | Total |
| Program Services | 3684948 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 511150 | Total |
| Management And General | 511150 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62840 | Total |
| Management And General | 62840 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3435855 | Total |
| Program Services | 3435855 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7204285 | Total |
| Program Services | 7204285 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2468751 | Total |
| Program Services | 2415875 | ProgramServices |
| Management And General | 52876 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices |
|---|---|---|---|
| UNRELATED BUSINESS INCO | 109000 | 109000 | |
| MEDICAL SUPPLIES | 26811985 | 26811985 | |
| REPAIRS & MAINTENANCE | 2739098 | 2739098 | |
| STATE TAX INDIGENT ASSE | 1460760 | 1460760 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 246560 | Total |
| Program Services | 40789 | ProgramServices |
| Management And General | 205771 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 139704495 | Total |
| Program Services | 131746316 | ProgramServices |
| Management And General | 7958179 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4200 | BOY |
| EOY | 4502 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 136593864 | BOY |
| EOY | 153304725 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15712714 | BOY |
| EOY | 15518254 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2935522 | BOY |
| EOY | 2899731 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3491845 | BOY |
| EOY | 3741434 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 136141275 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 52702315 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77815578 | BOY |
| EOY | 83438960 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14667981 | BOY |
| EOY | 14611981 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 533816 | BOY |
| EOY | 1852579 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 251755520 | BOY |
| EOY | 275372166 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7779601 | BOY |
| EOY | 7608331 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 138309 | BOY |
| EOY | 111385 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 90517582 | BOY |
| EOY | 89106831 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 98435492 | BOY |
| EOY | 96826547 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 153320028 | BOY |
| EOY | 178545619 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 153320028 | BOY |
| EOY | 178545619 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 251755520 | BOY |
| EOY | 275372166 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 26458638 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | -5837 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -1227210 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $4,575 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 4575 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | AMERICAN HOSPITAL ASSOCIATION AND FLORIDA HOSPITAL ASSOCIATION DUES. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Protection Of Natural Habitat | X | ProtectionOfNaturalHabitat |
| Nmbr States In Which Easements Held | 1 | NmbrStatesInWhichEasementsHeld |
| Written Policy Monitoring | 0 | WrittenPolicyMonitoring |
| Staff Hours Spent On Enforcement | 0.00 | StaffHoursSpentOnEnforcement |
| Expenses Incurred For Enforcement | 0 | ExpensesIncurredForEnforcement |
| Sect170h Requirements Satisfied | 0 | Sect170hRequirementsSatisfied |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7311502 | OtherCostOrOtherBasis |
| Book Value | 7311502 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 56017227 | OtherCostOrOtherBasis |
| Depreciation | 12796933 | Depreciation |
| Book Value | 43220294 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 66251762 | OtherCostOrOtherBasis |
| Depreciation | 37294762 | Depreciation |
| Book Value | 28957000 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6560784 | OtherCostOrOtherBasis |
| Depreciation | 2610620 | Depreciation |
| Book Value | 3950164 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 83438960 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (6 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| OTHER CURRENT LIABILITIES | $110,870 |
| PAYABLE TO THIRD PARTIES | $3,086,302 |
| DUE TO AFFILIATED | $2,002,045 |
| CREDIT BALANCES IN A/R | $530,762 |
| INTERCO. ALLOC. OF TE BOND PROCEEDS | $83,372,398 |
| LEASES PAYABLE | $4,454 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 89106831 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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 RELATED TO THE MAINTENANCE AND MONITORING OF THE CONSERVATION EASEMENT. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | 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. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5533597 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 5533597 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03960 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13358648 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7860527 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5498121 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03940 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18892245 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7860527 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11031718 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07900 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 260918 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 260918 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 260918 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 260918 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 19153163 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7860527 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11292636 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08090 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 16870 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 16870 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 40202 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 40202 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 57072 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 57072 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $8,346,998 | BadDebtExpenseAmount |
| Amount Attributable To | 913418 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 57912281 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 48154427 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 9757854 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FLORIDA HOSPITAL - FLAGLER | BusinessNameLine1 |
Address Address
| 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 | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL FLAGLER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 47 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (47 entries)
| Address Line1Address/AddressLine1 | Address Line2Address/AddressLine2 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|---|
| HCP - SAI PADMAJA MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 2812 | PALM COAST | FL | 32164 | ONCOLOGY SERVICES |
| FLORIDA HOSPITAL FLAGLER TOWN CENTER SUR | |||||
| 120 CYPRESS EDGE DRIVE SUITE 102 | PALM COAST | FL | 32164 | SURGICAL SERVICES | |
| HCP - NDUM PHILIP MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 2818 | PALM COAST | FL | 32164 | ONCOLOGY SERVICES |
| FLORIDA HOSPITAL MEMORIAL HOME HEALTH | |||||
| 770 W GRANADA BLVD 319 | ORMOND BEACH | FL | 32174 | HOME CARE SERVICES | |
| FLORIDA HOSPITAL MEMORIAL HOSPICE | |||||
| 770 W GRANADA BLVD 304 | ORMOND BEACH | FL | 32174 | HOSPICE ADMINISTRATIVE OFFICE | |
| PALM COAST PARKWAY RADIOLOGY | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32174 | RADIOLOGY SERVICES | |
| FLORIDA HOSPITAL HOSPICE - ORLANDO | |||||
| 901 NORTH LAKE DESTINY ROAD SUITE | 400 | MAITLAND | FL | 32751 | HOSPICE ADMINISTRATIVE OFFICE |
| HCP - MCKINLEY JOSEPH MD | |||||
| 3 PINE CONE CIRCLE SUITE 105 | PALM COAST | FL | 32137 | GASTROENTEROLOGY SERVICES | |
| FLORIDA HOSPITAL HOSPICE - MEMORIAL | |||||
| 301 MEMORIAL MEDICAL PARKWAY | DAYTONA BEACH | FL | 32117 | HOSPICE CARE SERVICES | |
| STUART F MEYER HOSPICE HOUSE | |||||
| 150 MEMORIAL PARKWAY | PALM COAST | FL | 32164 | HOSPICE CARE SERVICES | |
| HCP - KURIAN KIZHAKE MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 3808 | PALM COAST | FL | 32164 | CARDIOLOGY SERVICES |
| HCP - BOWER STEVEN C MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 3807 | PALM COAST | FL | 32164 | SURGICAL SERVICES |
| HCP - CAHSIO RICHARD MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 2802 | PALM COAST | FL | 32164 | SURGICAL, PLASTIC, & RECONSTRUCTIVE SERVICES |
| HCP - COMBS WALLACE MD | |||||
| 120 PINNACLES DRIVE SUITE 1 | PALM COAST | FL | 32164 | GASTROENTEROLOGY SERVICES | |
| 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 | |
| PALM COAST PARKWAY MRI | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | IMAGING SERVICES | |
| HCP - THEILADE CHRISTIANE MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 203 | PALM COAST | FL | 32137 | CARDIOLOGY SERVICES | |
| HCP - BOLLA JOHN D MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 3803 | PALM COAST | FL | 32164 | FAMILY PRACTICE SERVICES |
| HCP - GARCIA-GUERRA JOSE MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 2808 | PALM COAST | FL | 32164 | NEUROLOGICAL SERVICES |
| HCP - DAVIS MICHAEL DO DBA PEDIATRICS | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 3811 | PALM COAST | FL | 32164 | PEDIATRIC SERVICES |
| HCP - GAY DAVID M MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY 2801 | PALM COAST | FL | 32164 | ORTHOPEDIC SERVICES | |
| HCP - TRAUTSCHOLD JULIE MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 210 | PALM COAST | FL | 32137 | FAMILY PRACTICE SERVICES | |
| HCP - PETERSON DARREN L MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 2815 | PALM COAST | FL | 32164 | GENERAL SURGERY SERVICES |
| HCP - TUCKER ANTHONY MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 202 | PALM COAST | FL | 32164 | ENT SERVICES | |
| HCP - SHAMS SAFWAN MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 1800- | PALM COAST | FL | 32164 | GASTROENTEROLOGY SERVICES |
| HCP - WARD JEFFERY J DO | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 3813 | PALM COAST | FL | 32164 | FAMILY PRACTICE SERVICES |
| HCP - CEBALLOS JECEBU MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 2806 | PALM COAST | FL | 32164 | FAMILY PRACTICE SERVICES |
| HCP - BURNS LAWRENCE W MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 3817 | PALM COAST | FL | 32164 | INTERNAL MEDICINE/PULMONOLOGY SERVICES |
| PROMPT CARE | |||||
| 120 CYPRESS EDGE DRIVE SUITE 102 | PALM COAST | FL | 32164 | URGENT CARE & FAMILY PRACTICE | |
| HCP - ADAMS RICHARD DO | |||||
| 28 OFFICE PARK DRIVE | PALM COAST | FL | 32164 | FAMILY PRACTICE SERVICES | |
| HCP - WALSH JOHN A MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 1800- | PALM COAST | FL | 32164 | SURGERY, CARDIOVASCULAR/THORATIC SERVICES |
| HCP - TURCHIN SERGEY MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 209 | PALM COAST | FL | 32164 | INTERNAL MEDICINE SERVICES | |
| HCP - KEEN JEFFREY MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 2801 | PALM COAST | FL | 32164 | ORTHOPEDIC SERVICES |
| HCP - OGLESBY ALLAN C MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 3805 | PALM COAST | FL | 32164 | INTERNAL MEDICINE SERVICES |
| PALM COAST PARKWAY PHYSICAL THERAPY | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | PHYSICAL THERAPY | |
| HCP - AHMED TANAM MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 207 | PALM COAST | FL | 32164 | FAMILY PRACTICE SERVICES | |
| PALM COAST PARKWAY ULTRASOUND | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | ULTRASOUND SERVICES | |
| FAMILY FOCUS MEDICAL CENTER | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 2802 | PALM COAST | FL | 32164 | FAMILY PRACTICE SERVICES |
| HCP - SIDDIQUI REHANA MD | |||||
| 61 MEMORIAL MEDICAL PARKWAY SUITE | 3812 | PALM COAST | FL | 32164 | GENERAL PRACTICE SERVICES |
| PALM COAST PARKWAY SPEECH THERAPY | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | SPEECH THERAPY | |
| PALM COAST PARKWAY OCCUPATIONAL THERAPY | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | OCCUPATIONAL THERAPY | |
| HCP - KARRAFFA DAVID MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 206 | PALM COAST | FL | 32164 | HEALTHCARE -NEPHROLOGY SERVICES | |
| PALM COAST PARKWAY WOMEN'S CENTER | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | WOMEN'S HEALTH SERVICES | |
| HCP - HSOKOTE JAIDEEP MD | |||||
| 120 CYPRESS EDGE DRIVE SUITE 201 | PALM COAST | FL | 32164 | NEPHROLOGY SERVICES | |
| HCP - OLIVIER CHAMION MD | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | INFECTIOUS DISEASE SERVICES | |
| PALM COAST PARKWAY LABORATORY | |||||
| 120 CYPRESS EDGE DRIVE | PALM COAST | FL | 32164 | LABORATORY SERVICES | |
Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)
| ExplanationExplanation | Return ReferenceReturnReference | IdentifierIdentifier |
|---|---|---|
| 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 (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: 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 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 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. | ||
| 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: $ 9,757,854- DIFFERENCE IN COSTING METHODOLOGY: 356,534- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (10,487,545) -------------TOTAL MEDICARE SHORTFALL FROM SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITY BENEFIT REPORTING: $ (373,157)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. | SUPPLEMENTAL SCHEDULE TO SCHEDULE H, PART III, SECTION B | |
| 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 2: | |
| 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 3: | |
| 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 4: | |
| 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 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. | MEMORIAL HOSPITAL FLAGLER, INC. | |
| 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 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 ORGANIZATIONS COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATIONS 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: 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 90,000, WITH AN ESTIMATED 22,000 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 63% OF THE HOSPITAL'S PATIENTS ARE COVERED BY MEDICARE OR MEDICAID. MEDICARE PATIENTS COMPRISE ABOUT 54% 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 88% 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 $252,221 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 $13,293,686 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 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. | ||
| 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. | PART VI, LINE 7: |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| PALM COAST SEVENTH DAY ADVENTIST CHURCH | |||||||
| 5650 BELLE TERRE PKWY | PALM COAST | FL | 32137 | 590806975 | 501(C)(3) | 7000 | CREATION HEALTH CLASSES AND PATHWAYS SPONSORSHIP |
| FLAGLER AUDITORIUM GOVERNING BOARD INC | |||||||
| PO BOX 755 | BUNNELL | FL | 32110 | 593079371 | 501(C)(3) | 8450 | GENERAL SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: GRANTS ARE GENERALLY MADE ONLY TO RELATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3), OR TO OTHER LOCAL CHARITABLE COMMUNITY ORGANIZATIONS, OR TO OTHER 501(C)(3) ORGANIZATIONS THAT ARE A PART OF THE GROUP EXEMPTION RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Discretionary Spending Account | X | DiscretionarySpendingAccount |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (16 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL SCHULTZ | ||||||||||||||
| CHAIRMAN | 0 | 642188 | 0 | 195183 | 0 | 468562 | 0 | 128507 | 0 | 40596 | 0 | 1475036 | 0 | 91255 |
| LEWIS SEIFERT | ||||||||||||||
| DIRECTOR | 0 | 462337 | 0 | 126959 | 0 | 92301 | 0 | 86337 | 0 | 32112 | 0 | 800046 | 0 | 42022 |
| EDWARD NOSEWORTHY | ||||||||||||||
| DIRECTOR | 0 | 313162 | 0 | 62353 | 0 | 70757 | 0 | 52350 | 0 | 23441 | 0 | 522063 | 0 | 27967 |
| SANDRA JOHNSON | ||||||||||||||
| DIRECTOR | 0 | 390514 | 0 | 120945 | 0 | 79026 | 0 | 47701 | 0 | 52254 | 0 | 690440 | 0 | 29763 |
| MARK LAROSE | ||||||||||||||
| DIRECTOR (END 2/12) | 0 | 423408 | 0 | 65966 | 0 | 85632 | 0 | 82864 | 0 | 14052 | 0 | 671922 | 0 | 53478 |
| DAVID OTTATI | ||||||||||||||
| CEO/FLAGLER/DIRECTOR | 0 | 323487 | 0 | 69726 | 0 | 39262 | 0 | 44434 | 0 | 34190 | 0 | 511099 | 0 | 14825 |
| TED HAMILTON MD | ||||||||||||||
| DIRECTOR | 0 | 357355 | 0 | 94902 | 0 | 261492 | 0 | 13599 | 0 | 22035 | 0 | 749383 | 0 | 97107 |
| DARYL TOL | ||||||||||||||
| CHAIRMAN/DIRECTOR | 0 | 447934 | 0 | 70129 | 0 | 46890 | 0 | 79237 | 0 | 37572 | 0 | 681762 | 0 | 34812 |
| DEBORA THOMAS | ||||||||||||||
| DIRECTOR | 0 | 293181 | 0 | 49914 | 0 | 57966 | 0 | 23449 | 0 | 34362 | 0 | 458872 | 0 | 9460 |
| VALERIE ZIESMER | ||||||||||||||
| CFO | 0 | 218689 | 0 | 49268 | 0 | 20501 | 0 | 17762 | 0 | 7228 | 0 | 313448 | 0 | 0 |
| ELLEN LENKEVICH | ||||||||||||||
| CNO | 0 | 159196 | 0 | 15610 | 0 | 8344 | 0 | 9488 | 0 | 25211 | 0 | 217849 | 0 | 0 |
| PADMAJA SAI MD | ||||||||||||||
| PHYSICIAN | 441053 | 0 | 819508 | 0 | 320 | 0 | 13599 | 0 | 20735 | 0 | 1295215 | 0 | 0 | 0 |
| PHILIP NDUM MD | ||||||||||||||
| PHYSICIAN | 293469 | 0 | 693635 | 0 | 43121 | 0 | 12199 | 0 | 19037 | 0 | 1061461 | 0 | 0 | 0 |
| JOSEPH MCKINLEY MD | ||||||||||||||
| PHYSICIAN | 368011 | 0 | 547575 | 0 | 9327 | 0 | 13599 | 0 | 19501 | 0 | 958013 | 0 | 0 | 0 |
| KIZHAKE KURIAN MD | ||||||||||||||
| PHYSICIAN | 596397 | 0 | 240256 | 0 | 38934 | 0 | 13599 | 0 | 7538 | 0 | 896724 | 0 | 0 | 0 |
| KAREN THEILADE MD | ||||||||||||||
| PHYSICIAN | 496798 | 0 | 0 | 0 | 30453 | 0 | 8599 | 0 | 8780 | 0 | 544630 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 1A | AS DISCUSSED IN OUR RESPONSE TO 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. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES BUSINESS DEVELOPMENT EXPENDITURES. UNDER THIS POLICY, CERTAIN AHS ELIGIBLE EXECUTIVES MAY BE REIMBURSED FOR MEMBER DUES AND USAGE CHARGES FOR A COUNTRY CLUB OR OTHER SOCIAL CLUB UPON AUTHORIZATION. CLUB MEMBERSHIPS MUST BE RECOMMENDED BY THE CEO OF THE AHS HOSPITAL ORGANIZATION AND APPROVED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS OF THE ORGANIZATION. IN ADDITION, THE PROPOSED MEMBERSHIP MUST BE APPROVED ANNUALLY BY THE AHSSHC BOARD STRATEGY & COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF AHSSHC. ELIGIBLE EXECUTIVES ARE LIMITED TO CERTAIN SENIOR LEVEL EXECUTIVES (HOSPITAL ORGANIZATION CEOS, THE CEO OF THE NURSING HOME DIVISION OF AHS, SENIOR VICE PRESIDENTS AT THREE LARGE HOSPITAL ORGANIZATIONS, REGIONAL CEOS AND CFOS AND THE PRESIDENT AND SENIOR VICE PRESIDENTS OF AHSSHC). IN THE CURRENT YEAR, FOR THIS FILING ORGANIZATION, ONE EXECUTIVE WAS ELIGIBLE TO RECEIVE REIMBURSEMENT FOR CLUB FEES. EACH AHS EXECUTIVE WHO IS APPROVED FOR A CLUB MEMBERSHIP MUST SUBMIT AN ANNUAL REPORT TO THE AHSSHC BOARD STRATEGY & COMPENSATION COMMITTEE THAT DESCRIBES HOW THE MEMBERSHIP BENEFITED THEIR ORGANIZATION DURING THE PRECEDING YEAR. | |
| 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 ------------------------------------------------------- MICHAEL SCHULTZ $114,908 $ 97,967 $300,548 $ 0 LEWIS SEIFERT $ 72,738 $ 42,384 $ 0 $ 0 SANDRA JOHNSON $ 51,102 $ 32,385 $ 0 $ 0 MARK LAROSE $ 69,265 $ 53,519 $ 0 $ 0 DAVID OTTATI $ 30,836 $ 14,836 $ 0 $ 0 TED HAMILTON $ 52,651 $158,308 $ 35,498 $ 0 DEBORA THOMAS $ 26,850 $ 9,465 $ 0 $ 0 DARYL TOL $ 65,638 $ 35,595 $ 0 $ 0 EDWARD NOSEWORTHY $ 38,752 $ 31,019 $ 0 $ 0 VALERIE ZIESMER $ 21,163 $ 0 $ 0 $ 0 *INCLUDING INVESTMENT EARNINGS | |
| PART I, LINE 6 | THE FILING ORGANIZATION'S PHYSICIAN COMPENSATION FORMULA IS DESIGNED TO RESULT IN TOTAL COMPENSATION THAT WOULD BE REASONABLE FOR EACH PHYSICIAN. THE FILING ORGANIZATION UTILIZES NATIONAL SURVEY PRODUCTIVITY, COST, AND COMPENSATION DATA IN FORMULATING ALL ASPECTS OF THE COMPENSATION PLAN. PHYSICIAN COMPENSATION CONTRACTUAL AGREEMENTS INCLUDE A CEILING OR REASONABLE MAXIMUM ON THE AMOUNT A PHYSICIAN MAY EARN. THE FILING ORGANIZATION'S EMPLOYED PHYSICIANS ENTER INTO A WRITTEN AGREEMENT THAT REQUIRES THE PHYSICIANS TO PROVIDE MEDICAL CARE TO INDIVIDUALS WHO ARE REFERRED BY THE FILING ORGANIZATION. THE FILING ORGANIZATION'S COMPENSATION ARRANGEMENT DOES NOT USE A METHOD OF COMPENSATION THAT IS BASED UPON A PERCENTAGE OF THE ORGANIZATION'S NET INCOME. RATHER, UNDER THE COMPENSATION ARRANGEMENT, PHYSICIAN BASE SALARY IS SET BASED ON FAIR MARKET VALUE BENCHMARKS, AND ANY ADDITIONAL COMPENSATION IS BASED ON A PERCENTAGE OF THE PRACTICE/LOCATION NET REVENUE. | |
| 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. | SUPPLEMENTAL INFORMATION |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | BILL TOL | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | EMPLOYEE OF BOARD MEMBER | Relationship |
| Amount Of Transaction | 64246 | AmountOfTransaction |
| Description Of Transaction | EMPLOYEE COMPENSATION | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 MICHAEL CHIUMENTO AND BOB DEVORE - BUSINESS RELATIONSHIP BARBARA REVELS AND BOB DEVORE - 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 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 | AS DISCUSSED IN OUR RESPONSE TO QUESTION 15A & B IN SECTION B OF THIS PART VI, 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 5,385,538. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,385,538. PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 1,797,174. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,797,174. PURCHASED MEDICAL SERVICES : PROGRAM SERVICE EXPENSES 75,278. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 75,278. ENVIRONMENTAL SERVICES : PROGRAM SERVICE EXPENSES 389,495. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 389,495. RECRUITING : PROGRAM SERVICE EXPENSES 147,786. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 147,786. FOOD SERVICE CONTRACTS : PROGRAM SERVICE EXPENSES 270,583. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 270,583. MISCELLANEOUS PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 2,986,910. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,986,910. AHS MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,415,906. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,415,906. BILLING & COLLECTION SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 960,696. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 960,696. EHR MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,223,164. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,223,164. | OTHER FEES |
| FORM 990, PART XI, LINE 9: | ALLOCATIONS FROM TAX-EXEMPT PARENT WITH RESPECT TO DEBT 52,662. TRANSFER TO TAX-EXEMPT PARENT -1,279,872. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| 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
Form990 Schedule R Part II Form990ScheduleRPartII (107 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | N/A | |
| 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 | 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) | 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) | 0 | N/A | |
| 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 | 0 | N/A | |
| 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 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| 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 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (30 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Address Line1AddressForeign/AddressLine1 | Province Or StateAddressForeign/ProvinceOrState | CountryAddressForeign/Country | Legal Domicile Foreign CountryLegalDomicileForeignCountry |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | C | 1 | MEMORIAL HOSPITAL-FLAGLER INC | 7855 | 38005 | 0.87280 | |||||
| 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 | |||||||||||||||||
| CAPTIVE INSURANCE | N/A | C | 0 | C/O AON INSURANCE MANAGERS PO BOX | GRAND CAYMAN | CJ | CJ | ||||||||||
| 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 | ||||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (13 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| MEMORIAL HEALTH SYSTEMS INC | ||
| P | 901345 | COST |
| MEMORIAL HEALTH SYSTEMS INC | ||
| M | 3871480 | COST |
| MEMORIAL HEALTH SYSTEMS INC | ||
| Q | 75255 | COST |
| MEMORIAL HEALTH SYSTEMS INC | ||
| K | 251755 | COST |
| FLORIDA HOSPITAL MEDICAL GROUP INC | ||
| P | 567697 | COST |
| ADVENTIST HEALTH SYSTEMSUNBELT INC DBA FLORIDA HOSPITAL | ||
| M | 344127 | COST |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION | ||
| M | 1356450 | % OF FACILITY'S OPERATING EXP. |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION DBA AHS IS | ||
| M | 3555244 | % OF FACILITY'S OPERATING EXP. |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION | ||
| P | 5984420 | COST |
| ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION | ||
| B | 1279872 | ACTUAL AMOUNT GIVEN |
| SUNSYSTEM DEVELOPMENT CORP DBA FLORIDA HOSPITAL FLAGLER FOUNDATION | ||
| Q | 85328 | COST |
| FLORIDA MEMORIAL HEALTH NETWORK INC | ||
| Q | 821073 | COST |
| ADVENTIST HEALTH SYSTEMSUNBELT INC | ||
| M | 1278683 | % OF FACILITY'S EHR REVENUE |