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FLORIDA HOSPITAL WATERMAN INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
FLORIDA HOSPITAL WATERMAN INC (EIN 59-3140669)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-14
IRS object ID
201213199349302366
Schema version
2011v1.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-14T11:35:33-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN593140669EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FLORIDA HOSPITAL WATERMAN INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFLORNameControl
Phone3522533300Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 WATERMAN WAYAddressLine1
CityTAVARESCity
StateFLState
ZIP Code32778ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLYNN C ADDISCOTTName
TitleOFFICER/ASST SECRETARYTitle
Phone4079751492Phone
Date Signed2012-11-14DateSigned
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKENNETH MATTISONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11000 WATERMAN WAYAddressLine1
CityTAVARESCity
StateFLState
ZIP Code32778ZIPCode
FieldValueIRS element (for citing)
Gross Receipts204727419GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number1071GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.FHWAT.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1992YearFormation
State Legal DomicileFLStateLegalDomicile
Activity Or Mission DescriptionOPERATE 204-BED ACUTE CARE HOSPITALActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees1879TotalNbrEmployees
Total Nbr Volunteers248TotalNbrVolunteers
Total Gross UBI908669TotalGrossUBI
Net Unrelated Business Txbl Income-367261NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1000000ContributionsGrantsPriorYear
Contributions Grants Current Year54811ContributionsGrantsCurrentYear
Program Service Revenue Prior Year199744781ProgramServiceRevenuePriorYear
Program Service Revenue CY202004181ProgramServiceRevenueCY
Investment Income Prior Year4832437InvestmentIncomePriorYear
Investment Income Current Year2637950InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year205577218TotalRevenuePriorYear
Total Revenue Current Year204696942TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year764245GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY706073GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year80766377SalariesEtcPriorYear
Salaries Etc Current Year85293616SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year105102201OtherExpensePriorYear
Other Expenses Current Year98293564OtherExpensesCurrentYear
Total Expenses Prior Year186632823TotalExpensesPriorYear
Total Expenses Current Year184293253TotalExpensesCurrentYear
Revenues Less Expenses Prior Year18944395RevenuesLessExpensesPriorYear
Revenues Less Expenses CY20403689RevenuesLessExpensesCY
Total Assets BOY336657606TotalAssetsBOY
Total Assets EOY360071745TotalAssetsEOY
Total Liabilities BOY140117848TotalLiabilitiesBOY
Total Liabilities EOY142052183TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY196539758NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY218019562NetAssetsOrFundBalancesEOY
Mission DescriptionADVENTIST 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 Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense171991980Expense
Grants706073Grants
Revenue201095512Revenue
DescriptionALL PROGRAM SERVICES REVENUES AND EXPENSES RELATE TO THE OPERATION OF AN ACUTE CARE HOSPITAL IN TAVARES, FLORIDA. THERE WERE 13,638 ADMISSIONS RESULTING IN 53,544 PATIENT DAYS.Description
Total Program Service Expense171991980TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096232NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1879NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1FRANCES CRUNKBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3522533300TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11000 WATERMAN WAYAddressLine1
CityTAVARESCity
StateFLState
ZIP Code32778ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (26 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
SCHULTZ MICHAEL H
CHAIRMAN0.60X01295015154608
COMFORT LYNDA
DIRECTOR0.60X000
FERNANDEZ DAVID F
DIRECTOR/MEDICATION MGMT CHAIRMAN3.80X2848500
GAYLORD FRANK
DIRECTOR (BEGAN 12/11)0.40X000
HAUCK MD LORAN D
DIRECTOR (ENDED 5/11)0.50X0750390121916
HEPNER THOMAS C
DIRECTOR0.60X000
HOFMEISTER TOM
DIRECTOR0.60X000
HOWARD BARBARA
DIRECTOR0.50X000
KOTULLA MARLENE A
DIRECTOR0.60X000
PURDON ROBERT L
DIRECTOR/CHIEF OF STAFF6.90X5209800
RADNOTHY DO JON
DIRECTOR/VICE CHIEF OF STAFF4.40X3328700
WEISS CPA DAVE
DIRECTOR (BEGAN 6/11)0.60X000
WERNER THOMAS L
DIRECTOR0.60X0612911249
WHITE-FINDLEY MD SHARON
DIRECTOR/IMMEDIATE PAST CHIEF OF STAFF1.70X1265400
WHITWORTH ROBERT S
DIRECTOR (ENDED 12/11)0.50X000
MATTISON KENNETH R
PRESIDENT/DIRECTOR50.00X056202182597X
CRUNK FRANCES
CFO50.00031240159374X
FISH CARRIE L
COO50.00033737263370X
EDELSTEIN MD PETER S
CMO (ENDED 4/11)50.00025253330696X
DOLAN PATRICIA R
CNO50.005024234751632X
LAMTUAN
PHARMACIST42.80176378012499X
SZALMARCEL
CHIEF MEDICAL PHYSICS40.00165569034182X
BARNESJAMES R
DIRECTOR PHARMACY40.00151587028384X
DAHLINPATRICIA
PHARMACIST35.10148648021323X
PEARCERICHARD E
DIRECTOR CARDIOVASCULAR40.00147342021589X
SHULL JENNIFER M
FORMER CNO0.00020511230815X
FieldValueIRS element (for citing)
Total Reportable Comp From Org916098TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3963320TotalReportableCompFrmRltdOrgs
Total Other Compensation724234TotalOtherCompensation
Number Individuals GT100 K48NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
LAKE COUNTY ANESTHESIA ASSOCIATES
PO BOX 3130OCALAFL34478PHYSICIAN FEES1774701
GE HEALTHCARE
PO BOX 402076ATLANTAGA30384SERVICE CONTRACTS1068383
JOHNSON-LAUX CONSTRUCTION
4502 35TH ST SUITE 500ORLANDOFL32811CONSTRUCTION SERVICES669220
MORRISON MANAGEMENT SPECIALISTS INC
PO BOX 102289ATLANTAGA30368MANAGEMENT FEES583064
MEDICAL STAFFING NETWORK HEALTHCARE LLC
PO BOX 202996DALLASTX75320AGENCY STAFFING575989
FieldValueIRS element (for citing)
Number Of Contractors GT100 K52NumberOfContractorsGT100K
All Other Contributions54811AllOtherContributions
Total Contributions54811TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT REVENUE900099198479115198479115
CAFETERIA REVENUE90009913351981335198
MEDICAL OFFICE BUILDIN531120638651638651
DAYCARE REVENUE624410367478367478
LAB REVENUE621500306284306284

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column877455TotalRevenueColumn
Related Or Exempt Function Income275070RelatedOrExemptFunctionIncome
Unrelated Business Revenue602385UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Program Service Revenue202004181TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1532265TotalRevenueColumn
Exclusion$1,532,265ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1057162Securities
Other79000Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities
Other30477Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1057162Securities
Other48523Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1105685TotalRevenueColumn
Exclusion$1,105,685ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column204696942TotalRevenueColumn
Related Or Exempt Function Income201095512RelatedOrExemptFunctionIncome
Unrelated Business Revenue908669UnrelatedBusinessRevenue
Exclusion$2,637,950ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total706073Total
Program Services706073ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2120917Total
Management And General2120917ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total62861662Total
Program Services62777576ProgramServices
Management And General84086ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2139537Total
Program Services2139537ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total12946149Total
Program Services12398713ProgramServices
Management And General547436ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total5225351Total
Program Services5225351ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total217757Total
Management And General217757ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total50160Total
Management And General50160ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total21947055Total
Program Services17393579ProgramServices
Management And General4553476ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1229951Total
Management And General1229951ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total6077116Total
Program Services4691187ProgramServices
Management And General1385929ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total7228340Total
Program Services5909719ProgramServices
Management And General1318621ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total3647023Total
Program Services3647023ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total326529Total
Management And General326529ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total136454Total
Management And General136454ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total5517302Total
Program Services5517302ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total11157400Total
Program Services11157400ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total1332990Total
Program Services1309226ProgramServices
Management And General23764ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES3175189231751892
REPAIRS & MAINTENANCE52364105236410
STATE TAX INDIGENT ASSE21309922130992
PURCHASED SERVICES166657166657

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total139536Total
Management And General139536ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total184293253Total
Program Services171991980ProgramServices
Management And General12301273ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY6458BOY
EOY5477EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY153458450BOY
EOY172200064EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY20476786BOY
EOY26880995EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY3484731BOY
EOY3674163EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY6079621BOY
EOY5065579EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis238655515LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec104460028LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY134031037BOY
EOY134195487EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY17258867BOY
EOY16414786EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY380380BOY
EOY723187EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1481276BOY
EOY912007EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY336657606BOY
EOY360071745EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY10639612BOY
EOY10300784EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY251576BOY
EOY237314EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY129226660BOY
EOY131514085EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY140117848BOY
EOY142052183EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY179355947BOY
EOY201502699EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY14023017BOY
EOY12959002EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3160794BOY
EOY3557861EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY196539758BOY
EOY218019562EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY336657606BOY
EOY360071745EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses20403689ReconcilationRevenueExpenses
Reconcilation Other Changes1076115ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers1Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$3,912DirectContactLegislatorsAmount
Rallies Demonstrations1RalliesDemonstrations
Rallies Demonstrations$6,936RalliesDemonstrationsAmount
Other Activities1OtherActivities
Other Activities$11,040OtherActivitiesAmount
Total Lobbying Expenditures IIB21888TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationITEM (A): HOSPITAL VOLUNTEERS ATTENDED PUBLIC MEETING AND EMAILED THEIR LEGISLATIVE OFFICIALS OPPOSING THE ELIMINATION OF FUNDS PROPOSED BY A MEMBER OF THE NORTH LAKE COUNTY HOSPITAL TAXING DISTRICT. LINE (G) AND (H): DURING THE YEAR SALARY EXPENSE WAS INCURRED FOR PAID STAFF TO ATTEND PUBLIC MEETING, EMAIL LEGISTLATIVE OFFICALS AND GIVE SPEECHES ALL RELATING TO THE NORTH LAKE COUNTY HOSPITAL TAXING DISTRICT IN WHICH THE HOSPTIAL IS LOCATED. SALARY EXPENSE OF $3,912 WAS INCURRED FOR MEETINGS AND EMAILS AND AN ADDITIONAL $6,936 FOR PAID STAFF TO GIVE PUBLIC SPEECHES. ITEM (I): DUES WERE PAID BOTH TO THE AMERICAN HOSPITAL ASSOCIATION AND THE FLORIDA HOSPITAL ASSOCIATION WHO USE A PORTION OF THE DUES TO CONDUCT LOBBYING ACTIVITIES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis8622127OtherCostOrOtherBasis
Book Value8622127BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis133356249OtherCostOrOtherBasis
Depreciation40871323Depreciation
Book Value92484926BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis88657508OtherCostOrOtherBasis
Depreciation61323574Depreciation
Book Value27333934BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8019631OtherCostOrOtherBasis
Depreciation2265131Depreciation
Book Value5754500BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings134195487TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
LEASES PAYABLE$1,570,284
DUE TO AFFILIATED$2,868,114
PAYABLE TO THIRD PARTIES$4,052,428
CREDIT BALANCES IN A/R$1,122,615
OTHER CURRENT LIABILITIES$2,386,131
INTERCO. ALLOC. OF TE BOND PROCEEDS$119,514,513
FieldValueIRS element (for citing)
Total Of Amounts131514085TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE 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.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense6779157TotalCommunityBenefitExpense
Net Community Benefit Expense6779157NetCommunityBenefitExpense
Percent Of Total Expense0.03680PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense24769396TotalCommunityBenefitExpense
Direct Offsetting Revenue23045887DirectOffsettingRevenue
Net Community Benefit Expense1723509NetCommunityBenefitExpense
Percent Of Total Expense0.00940PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense31548553TotalCommunityBenefitExpense
Direct Offsetting Revenue23045887DirectOffsettingRevenue
Net Community Benefit Expense8502666NetCommunityBenefitExpense
Percent Of Total Expense0.04620PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense330810TotalCommunityBenefitExpense
Net Community Benefit Expense330810NetCommunityBenefitExpense
Percent Of Total Expense0.00180PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense427547TotalCommunityBenefitExpense
Net Community Benefit Expense427547NetCommunityBenefitExpense
Percent Of Total Expense0.00230PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense758357TotalCommunityBenefitExpense
Net Community Benefit Expense758357NetCommunityBenefitExpense
Percent Of Total Expense0.00410PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense32306910TotalCommunityBenefitExpense
Direct Offsetting Revenue23045887DirectOffsettingRevenue
Net Community Benefit Expense9261023NetCommunityBenefitExpense
Percent Of Total Expense0.05030PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Total Community Building Expense66164TotalCommunityBuildingExpense
Net Community Building Expense66164NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense66164TotalCommunityBuildingExpense
Net Community Building Expense66164NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$10,232,026BadDebtExpenseAmount
Amount Attributable To2467665AmountAttributableTo
Amount Reimbursed By Medicare80278932AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare83285110CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-3006178MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1FLORIDA HOSPITAL WATERMAN INCBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11000 WATERMAN WAYAddressLine1
CityTAVARESCity
StateFLState
ZIP Code32778ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1FLORIDA HOSPITAL WATERMAN INCBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent400.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities6NumberOfOtherFacilities

Other Facilities OtherFacilities (6 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
CANCER INSTITUTE
4000 WATERMAN WAYTAVARESFL32778CANCER CENTER
FLORIDA HOSPITAL HOME INFUSION
2450 MAITLAND CTR PKWY SUITE 200MAITLANDFL32751INFUSION SERVICES
HOME CARE SERVICES
3260 WATERMAN WAYTAVARESFL32778HOME CARE SERVICES
CENTER FOR MEDICAL IMAGING
1922 SALK AVE BTAVARESFL32778DIAGNOSTICS CENTER (CMI)
WOUND CARE CENTER
3290 WATERMAN WAYTAVARESFL32778WOUND AND HBO SERVICES
COMMUNITY PRIMARY HEALTH CLINIC
2300 KURT STEUSTISFL32726NON-EMERGENT HEALTH CARE SERVICES

Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)

ExplanationExplanationReturn ReferenceReturnReferenceIdentifierIdentifier
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 22 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS THAT OPERATE 42 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.
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: THE HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH OF ITS COMMUNITY AND WORKS WITH OTHER ORGANIZATIONS TO REDUCE THE NEED FOR HEALTHCARE SERVICES. THE COSTS OF COMMUNITY BUILDING ACTIVITIES REPORTED ON PART II OF SCHEDULE H PRIMARILY REPRESENT THE COSTS ASSOCIATED WITH PAID STAFF TIME AND SPONSORSHIPS RELATED TO COMMUNITY EVENTS.
PART III, LINE 4: BAD DEBT EXPENSE: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. 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. 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 CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS IS AS FOLLOWS: PLEASE NOTE THAT DOLLAR AMOUNTS ARE IN THOUSANDS.THE DIVISION'S PATIENT ACCEPTANCE POLICY IS BASED ON ITS MISSION TO IMPROVE AND ENHANCE LOCAL COMMUNITIES THAT IT SERVES IN HARMONY WITH CHRIST'S HEALING MINISTRY AND ITS CHARITABLE PURPOSES. ACCORDINGLY, THE DIVISION ACCEPTS PATIENTS IN IMMEDIATE NEED OF CARE, REGARDLESS OF THEIR ABILITY TO PAY. THE DIVISION SERVES CERTAIN PATIENTS WHOSE MEDICAL CARE COSTS ARE NOT PAID AT ESTABLISHED RATES. THESE PATIENTS INCLUDE THOSE SPONSORED UNDER GOVERNMENT PROGRAMS SUCH AS MEDICARE AND MEDICAID, THOSE SPONSORED UNDER PRIVATE CONTRACTUAL AGREEMENTS, CHARITY PATIENTS AND OTHER UNINSURED PATIENTS WHO HAVE LIMITED ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BASED ON THE ESTABLISHED POLICIES OF THE DIVISION, WHICH REQUIRE THAT THE PATIENT PROVIDE CERTAIN INFORMATION TO QUALIFY FOR CHARITY. PATIENTS THAT QUALIFY FOR CHARITY ARE PROVIDED SERVICES FOR WHICH NO PAYMENT IS DUE FOR ALL OR A PORTION OF THE PATIENT'S BILL FROM EITHER THE PATIENT OR OTHER THIRD PARTIES. FOR FINANCIAL REPORTING PURPOSES, CHARITY CARE IS EXCLUDED FROM PATIENT SERVICE REVENUE.FOR ALL OTHER PATIENTS, PATIENT SERVICE REVENUE IS REPORTED AT ESTIMATED NET REALIZABLE AMOUNTS FOR SERVICES RENDERED. THE DIVISION RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, REVENUE IS RECOGNIZED ON THE BASIS OF DISCOUNTED RATES IN ACCORDANCE WITH THE DIVISION'S POLICY.PATIENT SERVICE REVENUE IS REDUCED BY THE PROVISION FOR BAD DEBTS AND ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THESE AMOUNTS ARE BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS FOR EACH MAJOR PAYOR SOURCE, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS. MANAGEMENT REGULARLY REVIEWS COLLECTIONS DATA BY MAJOR PAYOR SOURCES IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE DIVISION'S SELF-PAY PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE DIVISION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD SERVICES ARE PROVIDED RELATED TO SELF-PAY PATIENTS. THE DIVISION'S ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FOR SELF-PAY PATIENTS WAS 97% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2011. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE DIVISION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE DIVISION'S POLICIES.PATIENT SERVICE REVENUE IS NOT RECOGNIZED FOR THOSE PATIENTS THAT QUALIFY FOR CHARITY UNDER THE DIVISION'S POLICIES. FOR ALL OTHER PATIENTS, PATIENT SERVICE REVENUE, NET OF CONTRACTUAL ALLOWANCES AND SELF-PAY DISCOUNTS AND BEFORE THE PROVISION FOR BAD DEBTS, RECOGNIZED FROM MAJOR PAYOR SOURCES FOR THE YEAR ENDED DECEMBER 31, 2011, IS AS FOLLOWS:THIRD-PARTY PAYORS, NET OF CONTRACTUAL ALLOWANCES $3,724,724SELF-PAY PATIENTS, NET OF DISCOUNTS $94,729 --------- $3,819,453THE DIVISION CHANGED ITS UNINSURED DISCOUNT POLICY, EFFECTIVE JANUARY 1, 2011, AS REQUIRED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACT). THE ACT HAS RESULTED IN AN INCREASE IN SELF-PAY DISCOUNTS, WHICH ARE A REDUCTION OF PATIENT SERVICE REVENUE, AND A CORRESPONDING DECREASE IN SELF-PAY WRITE-OFFS THAT ARE INCLUDED IN THE PROVISION FOR BAD DEBTS. OVERALL, THE TOTAL OF SELF-PAY DISCOUNTS AND WRITE-OFFS HAS NOT CHANGED SIGNIFICANTLY FOR THE YEAR ENDED DECEMBER 31, 2011. THE DIVISION HAS NOT EXPERIENCED SIGNIFICANT CHANGES IN WRITE-OFF TRENDS AND HAS NOT CHANGED ITS CHARITY CARE POLICY FOR THE YEAR ENDED DECEMBER 31, 2011.THE DIVISION HAS DETERMINED, BASED ON AN ASSESSMENT AT THE REPORTING-ENTITY LEVEL, THAT PATIENT SERVICE REVENUE IS PRIMARILY RECORDED PRIOR TO ASSESSING THE PATIENT'S ABILITY TO PAY AND AS SUCH, THE ENTIRE PROVISION FOR BAD DEBTS IS RECORDED AS A DEDUCTION FROM PATIENT SERVICE REVENUE IN THE ACCOMPANYING COMBINED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS.*** SEE CONTINUATION OF FOOTNOTE
PART III, LINE 8: COSTING METHODOLOGY:MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO.RATIONALE FOR INCLUDING A MEDICARE SHORTFALL AS COMMUNITY BENEFIT:AS A 501(C)(3) ORGANIZATION, THE FILING ORGANIZATION PROVIDES EMERGENCY AND NON-ELECTIVE CARE TO ALL REGARDLESS OF ABILITY TO PAY. ALL HOSPITAL SERVICES ARE PROVIDED IN A NON-DISCRIMINATORY MANNER TO PATIENTS WHO ARE COVERED BENEFICIARIES UNDER THE MEDICARE PROGRAM. AS A PUBLIC INSURANCE PROGRAM, MEDICARE PROVIDES A PRE-ESTABLISHED REIMBURSEMENT RATE/AMOUNT TO HEALTH CARE PROVIDERS FOR THE SERVICES THEY PROVIDE TO PATIENTS. IN SOME CASES, THE REIMBURSEMENT AMOUNT PROVIDED TO A HOSPITAL MAY EXCEED ITS COSTS OF PROVIDING A PARTICULAR SERVICE OR SERVICES TO A PATIENT. IN OTHER CASES, THE MEDICARE REIMBURSEMENT AMOUNT MAY RESULT IN THE HOSPITAL EXPERIENCING A SHORTFALL OF REIMBURSEMENT RECEIVED OVER COSTS INCURRED. IN THOSE CASES WHERE AN OVERALL SHORTFALL IS GENERATED FOR PROVIDING SERVICES TO ALL MEDICARE PATIENTS, THE SHORTFALL AMOUNT SHOULD BE CONSIDERED AS A BENEFIT TO THE COMMUNITY. TAX-EXEMPT HOSPITALS ARE REQUIRED TO ACCEPT ALL MEDICARE PATIENTS REGARDLESS OF THE PROFITABILITY, OR LACK THEREOF, WITH RESPECT TO THE SERVICES THEY PROVIDE TO MEDICARE PATIENTS. THE POPULATION OF INDIVIDUALS COVERED UNDER THE MEDICARE PROGRAM IS SUFFICIENTLY LARGE SO THAT THE PROVISION OF SERVICES TO THE POPULATION IS A BENEFIT TO THE COMMUNITY AND RELIEVES THE BURDENS OF GOVERNMENT. IN THOSE SITUATIONS WHERE THE PROVISION OF SERVICES TO THE TOTAL MEDICARE PATIENT POPULATION OF A TAX-EXEMPT HOSPITAL DURING ANY YEAR RESULTS IN A SHORTFALL OF REIMBURSEMENT RECEIVED OVER THE COST OF PROVIDING CARE, THE TAX-EXEMPT HOSPITAL HAS PROVIDED A BENEFIT TO A CLASS OF PERSONS BROAD ENOUGH TO BE CONSIDERED A BENEFIT TO THE COMMUNITY. DESPITE A FINANCIAL SHORTFALL, A TAX-EXEMPT HOSPITAL MUST AND WILL CONTINUE TO ACCEPT AND CARE FOR MEDICARE PATIENTS. TYPICALLY, TAX-EXEMPT HOSPITALS PROVIDE HEALTH CARE SERVICES BASED UPON AN ASSESSMENT OF THE HEALTH CARE NEEDS OF THEIR COMMUNITY AS OPPOSED TO THEIR TAXABLE COUNTERPARTS WHERE PROFITABILITY OFTEN DRIVES DECISIONS ABOUT PATIENT CARE SERVICES THAT ARE OFFERED. PATIENT CARE PROVIDED BY TAX-EXEMPT HOSPITALS THAT RESULTS IN MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS PROVIDING A BENEFIT TO THE COMMUNITY AND RELIEVING THE BURDENS OF GOVERNMENT.
PART III, LINE 9B: AT THE TIME OF PATIENT REGISTRATION, NON-ELECTIVE SELF-PAY PATIENTS ARE INFORMED OF THE MINIMUM DISCOUNT AVAILABLE UNDER THE FILING ORGANIZATION'S SELF-PAY DISCOUNT POLICY. SUCH PATIENTS ARE ALSO INFORMED OF THE FILING ORGANIZATION'S CHARITY CARE POLICY AND TOLD THAT THEY WILL BE REQUIRED TO SUBMIT NECESSARY FINANCIAL DATA IN ORDER TO POTENTIALLY RECEIVE ANY ADDITIONAL DISCOUNTS. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, PERCENTAGE DISCOUNTS ARE APPLIED TO A PATIENT'S ACCOUNT BASED UPON AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE.UNDER THE FILING ORGANIZATION'S POLICIES, PAYMENT PLANS FOR PARTIAL CHARITY ACCOUNTS WILL BE INDIVIDUALLY DEVELOPED WITH THE PATIENT. PARTIAL CHARITY ACCOUNTS RESULT WHEN A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION ALLOWS FOR A PERCENTAGE REDUCTION BUT LEAVES THE PATIENT WITH A SELF-PAY BALANCE. IF THE PATIENT COMPLIES WITH THE AGREED-UPON PAYMENT PLAN, THE FILING ORGANIZATION DOES NOT PURSUE ANY COLLECTION ACTION WITH RESPECT TO THE PATIENT. HOWEVER, IF A PATIENT DOES NOT MAKE ANY PAYMENTS FOR THREE CONSECUTIVE MONTHS, THE ACCOUNT MAY BE REFERRED FOR FURTHER COLLECTION ACTIVITY. THE FILING ORGANIZATION DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR A 100% REDUCTION IN CHARGES UNDER ITS CHARITY CARE POLICY.
RECONCILIATION OF SCHEDULE H REPORTED MEDICARE SURPLUS/(SHORTFALL) TO UNREIMBURSED MEDICARE COSTS ASSOCIATED WITH THE PROVISION OF SERVICESTO ALL MEDICARE BENEFICIARIES:THE MEDICARE REVENUE AND ALLOWABLE COSTS OF CARE REPORTED IN SECTION B OF PART III OF SCHEDULE H ARE BASED UPON THE AMOUNTS REPORTED IN THE FILING ORGANIZATION'S MEDICARE COST REPORT IN ACCORDANCE WITH THE IRS INSTRUCTIONS FOR SCHEDULE H. ON AN ANNUAL BASIS, THE FILING ORGANIZATION ALSO DETERMINES ITS TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS. UNREIMBURSED COSTS ARE REPORTED AS A COMMUNITY BENEFIT TO THE ELDERLY AND ARE INCLUDED IN THE CONSOLIDATED ADVENTIST HEALTH SYSTEM (AHS OR THE COMPANY) COMMUNITY BENEFITS REPORT CONTAINED IN THE AHS ANNUAL REPORT DOCUMENT. THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO MEDICARE PATIENTS AS REPORTED IN THE AHS COMMUNITY BENEFIT REPORT ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ (3,006,178)- DIFFERENCE IN COSTING METHODOLOGY: (2,623,005)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (2,109,707) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITY BENEFIT REPORTING: $ (7,738,890)AS INDICATED ABOVE, THE PRIMARY DIFFERENCES BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) REPORTED ON SCHEDULE H, PART III, SECTION B, LINE 7 AND THE FILING ORGANIZATION'S PORTION OF THE COMPANY'S ANNUAL COMMUNITY BENEFIT STATEMENT IS DUE TO A DIFFERENCE IN THE COSTING METHODOLOGY AND DIFFERENCES IN THE POPULATION OF MEDICARE PATIENTS WITHIN THE CALCULATION. THE COST METHODOLOGY UTILIZED IN CALCULATING ANY MEDICARE SURPLUS/(SHORTFALL) FOR PURPOSES OF THE ANNUAL COMMUNITY BENEFIT REPORTING IS BASED UPON THE COST-TO-CHARGE RATIO OUTLINED IN WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE SAME COST-TO-CHARGE RATIO IS USED TO DETERMINE THE COSTS ASSOCIATED WITH SERVICES PROVIDED TO CHARITY CARE PATIENTS AND MEDICAID PATIENTS AS REPORTED IN SCHEDULE H, PART I, LINE 7. IN ADDITION, THE MEDICARE COST REPORT EXCLUDES SERVICES PROVIDED TO MEDICARE PATIENTS FOR PHYSICIAN SERVICES, SERVICES PROVIDED TO PATIENTS ENROLLED IN MEDICARE HMOS, AND CERTAIN SERVICES PROVIDED BY OUTPATIENT DEPARTMENTS OF THE FILING ORGANIZATION THAT ARE REIMBURSED ON A FEE SCHEDULE. THE COMPANY'S OWN COMMUNITY BENEFIT STATEMENT CAPTURES THE UNREIMBURSED COST OF PROVIDING SERVICES TO ALL MEDICARE BENEFICIARIES THROUGHOUT THE ORGANIZATION.PART III, SECTION B
REVENUE FROM THE MEDICARE AND MEDICAID PROGRAMS REPRESENTS APPROXIMATELY 36% OF THE DIVISION'S PATIENT SERVICE REVENUE FOR THE YEAR ENDED DECEMBER 31, 2011. LAWS AND REGULATIONS GOVERNING THE MEDICARE AND MEDICAID PROGRAMS ARE EXTREMELY COMPLEX AND SUBJECT TO INTERPRETATION. AS A RESULT, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM. OTHER THAN THE ACCOUNTS RECEIVABLE RELATED TO THE MEDICARE AND MEDICAID PROGRAMS, THERE ARE NO SIGNIFICANT CONCENTRATIONS OF ACCOUNTS RECEIVABLE DUE FROM AN INDIVIDUAL PAYOR AT DECEMBER 31, 2011.THE DIVISION IS SUBJECT TO RETROACTIVE REVENUE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEWS AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE CONSIDERED IN THE RECOGNITION OF REVENUE ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED, AND SUCH AMOUNTS ARE ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS AND INVESTIGATIONS. ADJUSTMENTS TO REVENUE RELATED TO PRIOR PERIODS INCREASED PATIENT SERVICE REVENUE BY APPROXIMATELY $30,500 FOR THE YEAR ENDED DECEMBER 31, 2011.PART III, LINE 4 CONTINUATION OF FOOTNOTE
PART V, SECTION B, LINE 13G: 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.FLORIDA HOSPITAL WATERMAN, INC.
PART V, SECTION B, LINE 19D: 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.FLORIDA HOSPITAL WATERMAN, INC.
PART VI, LINE 2: THE FILING ORGANIZATION DOES NOT CURRENTLY CONDUCT ANY FORMAL ANNUAL HEALTH CARE NEEDS ASSESSMENT. HOWEVER, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY. SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY.
PART VI, LINE 3: THE 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'S BILLING STATEMENTS REQUESTS THAT PATIENTS NOTIFY THE HOSPITAL IF THEY NEED CHARITY CARE. THE HOSPITAL'S CHARITY CARE POLICY 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 180 DAYS OF THE BILLING PROCESS TO ASSIST THE PATIENT WITH COMPLETING CHARITY CARE APPLICATIONS AND INVESTIGATING OTHER POTENTIAL SOURCES OF THIRD-PARTY ASSISTANCE. THE DETERMINATION OF A PATIENT'S ELIGIBILITY FOR CHARITY CARE IS MADE ON A CASE-BY-CASE BASIS. VARIOUS FACTORS ARE CONSIDERED IN THAT DETERMINATION. EACH INDIVIDUAL PATIENT WHO IS IDENTIFIED AS POTENTIALLY BEING ELIGIBLE TO RECEIVE CHARITY CARE IS SEEN BY A FINANCIAL COUNSELOR AT THE HOSPITAL. THE FINANCIAL COUNSELOR WILL WORK WITH THE PATIENT TO MAKE SURE THAT OTHER SOURCES OF ASSISTANCE (PUBLIC OR OTHERWISE) HAVE BEEN SOUGHT TO THE FULLEST EXTENT POSSIBLE. WHEN OTHER FORMS OF ASSISTANCE ARE NOT AVAILABLE OR HAVE BEEN EXHAUSTED, THE HOSPITAL WILL GATHER CERTAIN FINANCIAL INFORMATION FROM THE PATIENT TO DETERMINE THE PATIENT'S ABILITY TO PAY BASED UPON LEVEL OF INCOME.
PART VI, LINE 4: THE FILING ORGANIZATION (THE HOSPITAL) IS A FULLY CERTIFIED 204-BED ACUTE CARE HOSPITAL LOCATED IN TAVARES, FLORIDA. FROM AMBULATORY SURGERY TO UROLOGY, THE HOSPITAL OFFERS AN ARRAY OF SERVICES AND SPECIALITIES COMIBINED WITH THE LATEST IN MEDICAL TECHNOLOGY. THE HOSPITAL WAS ONE OF THE TOP 100 COMPANIES FOR WORKING FAMILIES AND RECEIVED THE 2011 CUTTING EDGE AWARD FROM THE PRIMARY ORLANDO, FL NEWSPAPER. THE HOSPITAL'S EXTENSIVE HOME CARE SERVICES ARE DESIGNED TO ACCOMMODATE THE NEEDS OF IN-HOME PATIENTS THROUGH NURSING CARE, HOME MEDICAL EQUIPMENT AND NON-EMERGENCY TRANSPORTAION, SUCH AS TO DOCTORS APPOINTMENTS. THE HOSPITAL'S UNIQUELY DESIGNED "CLOVER LEAF" PATIENT CARE UNITS CONSIST OF THREE 10-BED ZONES WITH 30 BEDS PER NURSE STATION AND 60 BEDS PER FLOOR. THE EMERGENCY DEPARTMENT IS SIZED FOR 60,000 VISITS PER YEAR. THE HOSPITAL HAS THE ONLY COMPREHENSIVE CANCER PROGRAM AND THE ONLY FELLOWSHIP TRAINED SURGICAL ONCOLOGIST IN LAKE COUNTY. FLORIDA HOSPITAL CANCER INSTITUTE WATERMAN IS AFFILIATED WITH FLORIDA HOSPITAL CANCER INSTITUTE (FHCI). THE FHCI AND ITS AFFILIATES TREAT OVER 3,800 NEWLY DIAGNOSED CANCER PATIENTS EACH YEAR - MORE THAN ANY OTHER PROGRAM IN FLORIDA. THERE IS 1 COMPETING HOSPITAL LOCATED APPROXIMATELY 15 MILES FROM THE HOSPITAL'S PRIMARY HOSPITAL FACILITY. TAVARES, FLORIDA IS LOCATED IN LAKE COUNTY AND IS LOCATED ALONG HIGHWAY 441. THE HOSPITAL'S PRIMARY MARKET HAS A POPULATION OF APPROXIMATELY 159,000, WITH AN ESTIMATED 55,000 OVER THE AGE OF 65. THE WEIGHTED AVERAGE HOUSEHOLD INCOME, BASED ON POPULATION, IN THE PRIMARY MARKET IS APPROXIMATELY $40,000. HIGH SCHOOL GRADUATES ACCOUNT FOR APPROXIMATELY 85% OF LAKE COUNTY, WITH AN ESTIMATED 20% HAVING A BACHELOR'S DEGREE OR HIGHER. IT IS ESTIMATED THAT 10% OF THE INDIVIDUALS RESIDING IN LAKE COUNTY LIVE BELOW THE POVERTY LEVEL AND THE UNEMPLOYMENT RATE IS ABOUT 8%. APPROXIMATELY 57.8% OF THE HOSPITAL'S PATIENTS DURING 2011 WERE MEDICARE PATIENTS, ABOUT 12.9% WERE MEDICAID PATIENTS, ABOUT 7.7% WERE SELF-PAY PATIENTS, AND THE REMAINING PERCENTAGE WERE PATIENTS COVERED UNDER COMMERCIAL INSURANCE. IN 2011, ABOUT 83% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT
PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO THE FILING ORGANIZATION'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE FILING ORGANIZATION IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST" AND EMBODIES THE FIING ORGANIZATION'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE FILING ORGANIZATION COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, THE FILING ORGANIZATION PROVIDED $529,748 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF A COMMUNITY HOSPITAL. THE FILING ORGANIZATION ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE FILING ORGANIZATION EXPENDED $6,759,428 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE FILING ORGANIZATION IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY.
PART VI, LINE 6: THE FILING ORGANIZATION IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC 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 ORGANIZATION IS NOT FILED WITH ANY STATE AGENCIES.PART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
LIFESTREAM BEHAVIORAL CENTER
PO BOX 491000LEESBURGFL34749591561501501(C)(3)253035MEDICAL CARE
FLORIDA HOSPITAL WATERMAN FOUNDATION
1500 WATERMAN WAYTAVARESFL32778592330166501(C)(3)278773GENERAL SUPPORT
FLORIDA DEPARTMENT OF HEALTH LAKE COUNTY HEALTH DEPARTMENT
PO BOX 1305TAVARESFL32778593502843GOV'T75000MEDICAL CARE
AMERICAN CANCER SOCIETY
3261 US HIGHWAY 441/27 B2FRUITLAND PARKFL34731590657320501(C)(3)10200GENERAL SUPPORT
ADVENTIST HEALTH SYSTEMSUNBELT INC DBA FLORIDA HOSPITAL CENTRA CARE
901 N LAKE DESTINY DR 400MAITLANDFL32751593209688501(C)(3)89065GENERAL SUPPORT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants5TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierSCHEDULE I, PART I, LINE 2Identifier
ExplanationGRANTS ARE GENERALLY MADE ONLY TO RELATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER 501(C)(3) 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

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Discretionary Spending AccountXDiscretionarySpendingAccount
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
SCHULTZ MICHAEL H
062640801575810511026012121503339301449623082488
HAUCK MD LORAN D
0517595012044201123530846100373060872306061896
MATTISON KENNETH R
034535808059001360730454710371260644618031327
CRUNK FRANCES
02302510430460391040338180255560371775013530
FISH CARRIE L
02562640360830450250401700232000400742026988
EDELSTEIN MD PETER S
01705870335990483470173300133660283229024194
DOLAN PATRICIA R
0175001005067346092950423375029397900
LAMTUAN
1607180110000466004690120300188877000
SZALMARCEL
1563920100008177090540251280199751000
BARNESJAMES R
1386430900003944079190204650179971000
DAHLINPATRICIA
1461620100001486076790136440169971000
PEARCERICHARD E
1332920800006050070200145690168931000
SHULL JENNIFER M
0167789023840013483010138020677023592700

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 1AAS DISCUSSED IN OUR RESPONSE TO FORM 990, SECTION B, PART VI, QUESTION 15A & B, THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). MEMBERS OF THE FILING ORGANIZATION'S EXECUTIVE MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF AHS. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). THE FILING ORGANIZATION REIMBURSES AHSSHC FOR THE SALARY AND BENEFIT COST OF THOSE EXECUTIVES ON THE PAYROLL OF AHSSHC THAT PROVIDE SERVICES AND ARE ON THE MANAGEMENT TEAM OF THE FILING ORGANIZATION. TRAVEL FOR COMPANIONS: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING AHSSHC EXECUTIVE TO HAVE HIS OR HER SPOUSE ACCOMPANY THE EXECUTIVE ON TWO BUSINESS TRIPS EACH YEAR. TYPICALLY, REIMBURSEMENT IS ONLY PROVIDED TO VICE PRESIDENTS AND ABOVE AND IS LIMITED TO ONE BUSINESS TRIP PER YEAR AND THE ANNUAL AHS PRESIDENT'S COUNCIL BUSINESS MEETING. 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). ELIGIBLE EXECUTIVES INCLUDE ALL AHSSHC VICE PRESIDENTS AND ABOVE AND ALL AHSSHC SUBSIDIARY ORGANIZATION CEOS AND REGIONAL CFOS. THE PAYMENT PROVIDED TO EACH EXECUTIVE WAS CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES ASSISTANCE TO EXECUTIVES WHO HAVE BEEN RELOCATED BY THE COMPANY DURING THE YEAR. RELOCATION ASSISTANCE PROVIDED TO EXECUTIVES MAY INCLUDE RELOCATION ALLOWANCES TO ASSIST WITH DUPLICATE HOUSING EXPENSES. RELOCATION ASSISTANCE IS ADMINISTERED PER AHSSHC POLICY BY AN EXTERNAL RELOCATION COMPANY. ANY TAXABLE REIMBURSEMENTS MADE TO EXECUTIVES IN CONNECTION WITH RELOCATION ASSISTANCE ARE TREATED AS WAGES TO THE EXECUTIVE AND ARE SUBJECT TO ALL PAYROLL WITHHOLDING AND REPORTING REQUIREMENTS.
PART I, LINES 4A-BDURING THE YEAR ENDING DECEMBER 31, 2011, PETER S. EDELSTEIN, MD RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $72,895. PURSUANT TO THE AHSSHC CORPORATE EXECUTIVE POLICY GOVERNING EXECUTIVE SEVERANCE, SEVERANCE AGREEMENTS FOR EXECUTIVES OPERATING AT THE VICE PRESIDENT LEVEL AND ABOVE ARE ENTERED INTO UPON ELIGIBILITY TO FACILITATE THE TRANSITION TO SUBSEQUENT EMPLOYMENT FOLLOWING AN INVOLUNTARY SEPARATION FROM EMPLOYMENT WITH AHS. 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 $204,000. 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 HOSPITAL 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 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. FLEX PLAN/ FLEX PLAN/ SERP 457(B) CY 457(F) CY 457(F) CY CONTRIB./ DISTRIBUTIONS EMPLOYER DISTRIBUTIONS PAYMENT CONTRIB. ------------------------------------------------------- SCHULTZ, MICHAEL H. $107,872 $ 102,555 $342,979 $ 0 HAUCK, MD, LORAN D. $ 87,767 $ 72,207 $ 0 $ 0 MATTISON, KENNETH R $ 48,628 $ 39,481 $ 31,566 $ 0 CRUNK, FRANCES $ 20,475 $ 18,184 $ 0 $ 0 FISH, CARRIE L. $ 26,827 $ 27,079 $ 0 $ 0 EDELSTEIN, MD, PETER S. $ 6,214 $ 30,446 $ 0 $ 0
PART IIIPART 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 M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions3107NumberOfContributions
Noncash Contribs Rptd F9900NoncashContribsRptdF990
Method Of Determining RevenuesCOSTMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts1ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (14 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 1THE BYLAWS WERE AMENDED TO PROVIDE THAT ONE OF THE RESPONSIBILITIES OF THE BOARD OF DIRECTORS IS TO ESTABLISH A PROCESS FOR ADDRESSING PATIENT GRIEVANCES, INCLUDING RESOLVING THE GRIEVANCE THEMSELVES OR BY ESTABLISHING A GRIEVANCE COMMITTEE OR SIMILAR BODY AND DELEGATING THE TASK TO SUCH A COMMITTEE.
FORM 990, PART VI, SECTION A, LINE 2PETER S. EDELSTEIN, MD AND TOM I. HOFMEISTER - BUSINESS RELATIONSHIP
FORM 990, PART VI, SECTION A, LINE 4THE BYLAWS WERE AMENDED TO PROVIDE THAT ONE OF THE RESPONSIBILITIES OF THE BOARD OF DIRECTORS IS TO ESTABLISH A PROCESS FOR ADDRESSING PATIENT GRIEVANCES, INCLUDING RESOLVING THE GRIEVANCE UNLESS DELEGATED BY THE BOARD TO A GRIEVANCE COMMITTEE OR SIMILAR BODY.
FORM 990, PART VI, SECTION A, LINE 6FLORIDA HOSPITAL WATERMAN, INC. (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION. ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) 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 7ATHE SOLE MEMBER OF THE FILING ORGANIZATION IS AHSSHC. THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION ARE APPOINTED BY THE SOLE MEMBER, AHSSHC, 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 7BAHSSHC, AS THE SOLE MEMBER OF THE FILING ORGANIZATION, HAS CERTAIN RESERVED POWERS AS SET FORTH IN THE BYLAWS OF THE FILING ORGANIZATION. THESE RESERVED POWERS INCLUDE THE FOLLOWING: A) TO APPROVE AND DISAPPROVE THE EXECUTIVE AND/OR ADMINISTRATIVE LEADERSHIP OF THE FILING ORGANIZATION, AND THEIR SALARIES; B) TO ADOPT, AMEND, RESTATE, AND REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS OF THE FILING ORGANIZATION, AND THE MEDICAL STAFF BYLAWS; C) TO SET LIMITS AND TERMS FOR THE BORROWING OF FUNDS; D) TO APPROVE OR DISAPPROVE MAJOR BUILDING PROGRAMS AND/OR PURCHASE OR SALE OF PERSONAL PROPERTY OR REAL PROPERTY EQUAL TO OR IN EXCESS OF ONE MILLION DOLLARS; E) TO APPROVE OR DISAPPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION; F) TO DIRECT THE PLACEMENT OF FUNDS AND CAPITAL OF THE FILING ORGANIZATION; G) TO ESTABLISH GENERAL GUIDING POLICIES, TO IMPLEMENT QUALITY ASSESSMENT, IMPROVEMENT AND UTILIZATION REVIEW PROGRAMS; AND H) TO APPROVE THE APPOINTMENT OF AN AUDITING FIRM AND ELECTION OF THE FISCAL YEAR FOR THE FILING ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CTHE 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 15THE 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 19AS 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. THE FILING ORGANIZATION DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC.
PART VII, SECTION AFOR THOSE BOARD OF DIRECTOR MEMBERS (NOT INCLUDING PHYSICIAN MEMBERS OF THE BOARD), OFFICER(S) AND KEY EMPLOYEES 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. PHYSICIAN MEMBERS OF THE BOARD OF DIRECTORS RECEIVED COMPENSATION FROM THE FILING ORGANIZATION AS A RESULT OF PROVIDING VARIOUS MEDICAL SERVICES.COLUMNS (E) & (F)
PART VII, SECTION ATHE MEMBERS OF THE BOARD OF DIRECTORS AND OFFICER(S) WHO RECEIVED COMPENSATION FROM A RELATED ORGANIZATION AS SHOWN IN COLUMN (E) AND (F) OF SECTION A EACH DEVOTE APPROXIMATELY 50 HOURS PER WEEK IN CONJUNCTION WITH SERVING IN THEIR RESPECTIVE EXECUTIVE LEADERSHIP POSITION WITHIN ADVENTIST HEALTH SYSTEM.COLUMN (B)
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 19,698. TRANSFERS TO PARENT -1,532,991. ALLOCATIONS FROM TAX-EXEMPT PARENT WITH RESPECT TO DEBT TRANSFERS TO PARENT 256,357. CHANGE IN INTEREST IN FOUNDATION -841,947. GIFTS 3,175,000. ROUNDING -2. TOTAL TO FORM 990, PART XI, LINE 5: 1,076,115.CHANGES IN NET ASSETS OR FUND BALANCES:
PART X, LINE 2THE 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.SAVINGS AND TEMPORARY CASH INVESTMENTS

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (107 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
ADVENTIST BOLINGBROOK HOSPITAL
500 REMINGTON BLVDBOLINGBROOKIL60440651219504OPERATION OF HOSPITAL & RELATED SERVICESIL501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEMSUNBELT INC0
ADVENTIST CARE CENTERS - COURTLAND INC
730 COURTLAND STREETORLANDOFL32804205774723OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYFL501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
ADVENTIST GLENOAKS HOSPITAL
701 WINTHROP AVENUEGLENDALE HEIGHTSIL60139363208390OPERATION OF HOSPITAL & RELATED SERVICESIL501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEMSUNBELT INC0
ADVENTIST HLTH MID-AMERICA INC
9100 W 74TH STREETSHAWNEE MISSIONKS66204521347407HLTHCARE RELATED SERVICESKS501(C)(3)509(A)(3) TYPE IADVENTIST HLTH SYSTEMSUNBELT INC0
ADVENTIST HLTH PARTNERS INC
1000 REMINGTON BLVD STE 200BOLINGBROOKIL60440364138353OPERATE OUT-PATIENT PHYSICIAN CLINICSIL501(C)(3)170(B)(1)(A)(III)AHS MIDWEST MANAGEMENT INC0
ADVENTIST HLTH SYSTEM AFFILIATED BENEFIT TRUST
111 N ORLANDO AVENUEWINTER PARKFL32789266422966PROMOTION OF HLTHCAREFL501(C)(3)509(A)(3) TYPE IADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP
111 N ORLANDO AVENUEWINTER PARKFL32789592170012MANAGEMENT SERVICESFL501(C)(3)509(A)(3) TYPE I0N/A
ADVENTIST HLTH SYSTEMGEORGIA INC
1035 RED BUD ROADCALHOUNGA30701581425000OPERATION OF HOSPITAL & RELATED SERVICESGA501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
ADVENTIST HLTH SYSTEMSUNBELT INC
111 N ORLANDO AVENUEWINTER PARKFL32789591479658OPERATION OF HOSPITAL & RELATED SERVICESFL501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
ADVENTIST HLTH SYSTEMTEXAS INC
602 COURTLAND STREETORLANDOFL32804742578952INACTIVETX501(C)(3)509(A)(2)ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
ADVENTIST HINSDALE HOSPITAL
120 NORTH OAK STREETHINSDALEIL60521362276984OPERATION OF HOSPITAL & RELATED SERVICESIL501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEMSUNBELT INC0
AHS MIDWEST MANAGEMENT INC
1000 REMINGTON BLVD STE 200BOLINGBROOKIL60440363354567OPERATION OF PHYSICIAN PRACTICE MGMTIL501(C)(3)509(A)(3) TYPE IADVENTIST HLTH SYSTEMSUNBELT INC0
AHSCENTRAL TEXAS INC
1301 WONDER WORLD DRIVESAN MARCOSTX78666742621825PROVIDE OFFICE SPACE - MEDICAL PROFESSIONALSTX501(C)(3)509(A)(3) TYPE III-FADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
APOPKA HLTH CARE PROPERTIES INC
305 E OAK STREETAPOPKAFL32703510605694LEASE TO RELATED ORGANIZATIONGA501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
BATTLE CREEK ADVENTIST HOSPITAL
1000 REMINGTON BLVD STE 200BOLINGBROOKIL60440381359189INACTIVEMI501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEMSUNBELT INC0
BERT FISH MEDICAL CENTER INC (10110-63011)
401 PALMETTO STREETNEW SMYRNA BEACHFL32168362276984OPERATION OF HOSPITAL & RELATED SERVICESFL501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
BOLINGBROOK HOSPITAL FOUNDATION
1000 REMINGTON BLVD N ENTRANCE 2NDBOLINGBROOKIL60440900494445FUND-RAISING FOR TAX-EXEMPT HOSPITALIL501(C)(3)170(B)(1)(A)(VI)MIDWEST HLTH FOUNDATION0
BRADFORD HEIGHTS HLTH & REHAB CENTER INC
950 HIGHPOINT DRIVEHOPKINSVILLEKY42240205782342OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYKY501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
BURLESON NURSING & REHAB CENTER INC
301 HUGULEY BLVDBURLESONTX76028205782243OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYTX501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
CALDWELL HLTH CARE PROPERTIES INC
1333 WEST MAINPRINCETONKY42445510605680LEASE TO RELATED ORGANIZATIONGA501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
CENTRAL TEXAS HLTHCARE COLLABORATIVE (112-123111)
1301 WONDER WORLD DRIVESAN MARCOSTX78666453739929SUPPORT OPERATION OF HOSPITALTX501(C)(3)509(A)(3) TYPE IADVENTIST HLTH SYSTEMSUNBELT INC0
CEDAR CRAG TERRACE INC (630 YEAR END)
RT 5 BOX 900MANCHESTERKY40962611120442OPERATION OF HOME FOR THE ELDERLY-DISABLEDKY501(C)(3)170(B)(1)(A)(VI)MEMORIAL HOSPITAL INC0
CENTRAL TEXAS MEDICAL CENTER FOUNDATION
1301 WONDER WORLD DRIVESAN MARCOSTX78666742259907FUND-RAISING FOR TAX-EXEMPT HOSPITALTX501(C)(3)170(B)(1)(A)(VI)ADVENTIST HLTH SYSTEMSUNBELT INC0
CHICKASAW HLTH CARE PROPERTIES INC
250 S CHICKASAW TRAILORLANDOFL32825510605681LEASE TO RELATED ORGANIZATIONGA501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
CHIPPEWA VALLEY HOSPITAL & OAKVIEW CARE CENTER INC
1220 THIRD AVENUE WESTDURANDWI54736391365168OPERATION OF HOSPITAL & RELATED SERVICESWI501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEMSUNBELT INC0
COBB MEDICAL ASSOCIATES LLC
3949 SOUTH COBB DRIVE SESMYRNAGA300806342582617089OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICESGA501(C)(3)170(B)(1)(A)(III)EMORY-ADVENTIST INC0
COURTLAND HLTH CARE PROPERTIES INC
730 COURTLAND STREETORLANDOFL32804510605682LEASE TO RELATED ORGANIZATIONGA501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
CREEKWOOD PLACE NURSING & REHAB CENTER INC
683 E THIRD STREETRUSSELLVILLEKY42276205782260OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYKY501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
DAIRY ROAD HLTH CARE PROPERTIES INC
7350 DAIRY ROADZEPHYRHILLSFL33540510605684LEASE TO RELATED ORGANIZATIONGA501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
EAST ORLANDO HLTH & REHAB CENTER INC
250 S CHICKASAW TRAILORLANDOFL32825205774748OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYFL501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
EMORY-ADVENTIST INC
3949 SOUTH COBB DRIVESMYRNAGA30080582171011OPERATION OF HOSPITAL & RELATED SVCSGA501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEMSUNBELT INC0
FLETCHER HOSPITAL INC
100 HOSPITAL DRIVEHENDERSONVILLENC28792560543246OPERATION OF HOSPITAL & RELATED SVCSNC501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
FLNC INC
3355 E SEMORAN BLVDAPOPKAFL32703205774761OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYFL501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
FLORIDA HOSPITAL COLLEGE OF HLTH SCIENCES INC (630 YEAR END)
671 LAKE WINYAH DRIVEORLANDOFL32803593069793EDUCATION/OPERATION OF SCHOOLFL501(C)(3)170(B)(1)(A)(II)ADVENTIST HLTH SYSTEMSUNBELT INC0
FLORIDA HOSPITAL DELAND AUXILIARY INC (11-82411)
701 WEST PLYMOUTH AVENUEDELANDFL32720593425543VOLUNTEER SUPPORT SERVICESFL501(C)(3)509(A)(3) TYPE III-FMEMORIAL HOSPITAL WEST VOLUSIA INC0
FLORIDA HOSPITAL WATERMAN INC
1000 WATERMAN WAYTAVARESFL32778593140669OPERATION OF HOSPITAL & RELATED SERVICESFL501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
FLORIDA HOSPITAL ZEPHYRHILLS INC
7050 GALL BLVDZEPHYRHILLSFL33541592108057OPERATION OF HOSPITAL & RELATED SERVICESFL501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEMSUNBELT INC0
FLORIDA HOSPITAL MEDICAL GROUP INC
900 WINDERLEY PLACEMAITLANDFL32751593214635OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICESFL501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEMSUNBELT INC0
FOUNDATION FOR SHAWNEE MISSION MEDICAL CENTER INC
9100 W 74TH STREETSHAWNEE MISSIONKS66204480868859FUND-RAISING FOR TAX-EXEMPT HOSPITALKS501(C)(3)509(A)(3) TYPE ISHAWNEE MISSION MEDICAL CENTER INC0
GLENOAKS HOSPITAL FOUNDATION
701 WINTHROP AVENUEGLENDALE HEIGHTSIL60139363926044FUND-RAISING FOR TAX-EXEMPT HOSPITALIL501(C)(3)170(B)(1)(A)(VI)MIDWEST HLTH FOUNDATION0
HAYS MEMORIAL HOSPITAL ASSOCIATION OF SEVENTH-DAY ADVENTISTS
1301 WONDER WORLD DRIVESAN MARCOSTX78667741362785LEASE OF HOSPITAL PERSONNELTX501(C)(3)509(A)(3) TYPE IIADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
HELEN ELLIS MEMORIAL HOSPITAL AUXILIARY INC
1395 S PINELLAS AVETARPON SPRINGSFL34689592106043FUND-RAISING FOR TAX-EXEMPT HOSPITAL/FOUNDATIONFL501(C)(3)509(A)(3) TYPE ITARPON SPRINGS HOSPITAL FOUNDATION INC0
HELEN ELLIS MEMORIAL HOSPITAL FOUNDATION INC
1395 S PINELLAS AVETARPON SPRINGSFL34689593690149FUND-RAISING FOR TAX-EXEMPT HOSPITALFL501(C)(3)509(A)(3) TYPE ITARPON SPRINGS HOSPITAL FOUNDATION INC0
HINSDALE HOSPITAL FOUNDATION
7 SALT CREEK LANE SUITE 203HINSDALEIL60521521466387FUND-RAISING FOR TAX-EXEMPT HOSPITALIL501(C)(3)170(B)(1)(A)(VI)MIDWEST HLTH FOUNDATION0
HUGULEY COMMUNITY CARE CORP
11801 SOUTH FREEWAYBURLESONTX76028452793120SUPPORT OPERATION OF HOSPITALTX501(C)(3)509(A)(3) TYPE IADVENTIST HLTH SYSTEMSUNBELT INC0
IN-MOTION REHAB INC
602 COURTLAND STREET STE 200ORLANDOFL32804208023411THERAPY SERVICES TO TAX EXEMPT NURSING HOMESKS501(C)(3)509(A)(3) TYPE IISUNBELT HLTH CARE CENTERS INC0
JELLICO COMMUNITY HOSPITAL INC
188 HOSPITAL LANEJELLICOTN37762620924706OPERATION OF HOSPITAL & RELATED SERVICESTN501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
LA GRANGE MEMORIAL HOSPITAL FOUNDATION
5101 S WILLOW SPRINGS RDLA GRANGEIL60525300247776FUND-RAISING FOR TAX-EXEMPT HOSPITALIL501(C)(3)170(B)(1)(A)(VI)MIDWEST HLTH FOUNDATION0
MEMORIAL HLTH SYSTEMS FOUNDATION INC
770 WEST GRANADA BLVDORMOND BEACHFL32174311771522FUND-RAISING FOR TAX-EXEMPT HOSPITALFL501(C)(3)170(B)(1)(A)(VI)MEMORIAL HLTH SYSTEMS INC0
MEMORIAL HLTH SYSTEMS INC
301 MEMORIAL MEDICAL PARKWAYDAYTONA BEACHFL32117590973502OPERATION OF HOSPITAL & RELATED SERVICESFL501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEMSUNBELT INC0
MEMORIAL HOSPITAL FLAGLER INC
60 MEMORIAL MEDICAL PARKWAYPALM COASTFL32164592951990OPERATION OF HOSPITAL & RELATED SERVICESFL501(C)(3)170(B)(1)(A)(III)MEMORIAL HLTH SYSTEMS INC0
MEMORIAL HOSPITAL - WEST VOLUSIA INC
701 WEST PLYMOUTH AVENUEDELANDFL32720593256803OPERATION OF HOSPITAL & RELATED SERVICESFL501(C)(3)170(B)(1)(A)(III)MEMORIAL HLTH SYSTEMS INC0
MEMORIAL HOSPITAL INC
210 MARIE LANGDON DRIVEMANCHESTERKY40962610594620OPERATION OF HOSPITAL & RELATED SERVICESKY501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
MERRIAM HLTH CARE PROPERTIES INC
9700 WEST 62ND STREETMERRIAMKS66203364595806LEASE TO RELATED ORGANIZATIONKS501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
METROPLEX ADVENTIST HOSPITAL INC
2201 S CLEAR CREEK ROADKILLEENTX76549742225672OPERATION OF HOSPITAL & RELATED SERVICESTX501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
METROPLEX CLINIC PHYSICIANS INC
2201 S CLEAR CREEK ROADKILLEENTX76549113762050PHYSICIAN HLTHCARE SERVICES TO THE COMMUNITYTX501(C)(3)170(B)(1)(A)(III)METROPLEX ADVENTIST HOSPITAL INC0
MIDWEST HLTH FOUNDATION
120 NORTH OAK STREETHINSDALEIL60521352230515SUPPORT OF SUBSIDIARY FOUNDATIONSIL501(C)(3)509(A)(3) TYPE II0N/A
MILLS HLTH & REHAB CENTER INC
500 BECK LANEMAYFIELDKY42066205782320OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYKY501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
MISSION STRATEGIES INC
602 COURTLAND STREET STE 200ORLANDOFL32804205982365PROVISION OF SUPPORT TO THE NURSING HOME DIVISIONKS501(C)(3)509(A)(3) TYPE IISUNBELT HLTH CARE CENTERS INC0
MISSION STRATEGIES OF GEORGIA INC (1114-123111)
3949 S COBB DRIVESMYRNAGA30080900866024PROVISION OF SUPPORT TO THE NURSING HOME DIVISIONGA501(C)(3)509(A)(3) TYPE IISUNBELT HLTH CARE CENTERS INC0
MISSOURI ADVENTIST HLTH INC
9100 W 74TH STREETSHAWNEE MISSIONKS66204431224729SUPPORT HLTH CARE SERVICESMO501(C)(3)509(A)(3) TYPE III-OADVENTIST HLTH MID-AMERICA INC0
NORTH REGIONAL EMS INC
188 HOSPITAL LANEJELLICOTN37762262653616EMS SERVICESTN501(C)(3)509(A)(2)JELLICO COMMUNITY HOSPITAL INC0
ORMOND BEACH MEMORIAL HOSPITAL AUXILIARY INC
301 MEMORIAL MEDICAL PARKWAYDAYTONA BEACHFL32117591721962VOLUNTEER SUPPORT SERVICESFL501(C)(3)509(A)(3) TYPE III-FMEMORIAL HLTH SYSTEMS INC0
OVERLAND PARK NURSING & REHAB CENTER INC
6501 WEST 75TH STREETOVERLAND PARKKS66204205774821OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYKS501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
PARAGON HLTH CARE PROPERTIES INC
950 HIGHPOINT DRIVEHOPKINSVILLEKY42240510605686LEASE TO RELATED ORGANIZATIONGA501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
PASCO-PINELLAS HILLSBOROUGH COMMUNITY HLTH SYSTEM INC
2400 BEDFORD ROADORLANDOFL32803208488713OPERATION OF HOSPITAL & RELATED SERVICESFL501(C)(3)170(B)(1)(A)(III)0N/A
PORTERCARE ADVENTIST HLTH SYSTEM (630 YEAR END)
2525 S DOWNING STREETDENVERCO80210840438224OPERATION OF HOSPITAL & RELATED SERVICESCO501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
PORTLAND NURSING & REHAB CENTER INC
215 HIGHLAND CIRCLE DRIVEPORTLANDTN37148205774842OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYTN501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
PRINCETON HLTH & REHAB CENTER INC
1333 WEST MAINPRINCETONKY42445205782272OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYKY501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
PRINCETON PROFESSIONAL SERVICES INC
601 E ROLLINS STREETORLANDOFL32803591191045PROVISION OF HLTHCARE SERVICESFL501(C)(3)509(A)(2)ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
QUALITY CIRCLE FOR HLTHCARE INC
111 N ORLANDO AVENUEWINTER PARKFL32789263789368HLTHCARE QUALITY SERVICESFL501(C)(3)509(A)(3) TYPE III-FADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
RESOURCE PERSONNEL INC
602 COURTLAND STREET STE 200ORLANDOFL32804208040875PROVIDE ADMINISTRATIVE SUPPORT TO TAX EXEMPT NURSING HOMESFL501(C)(3)509(A)(3) TYPE IISUNBELT HLTH CARE CENTERS INC0
ROCKY MOUNTAIN ADVENTIST HLTHCARE FOUNDATION (630 YEAR END)
2525 SOUTH DOWNING STREETDENVERCO80210840745018FUND-RAISING FOR TAX-EXEMPT HOSPITALCO501(C)(3)170(B)(1)(A)(VI)PORTERCARE ADVENTIST HLTH SYSTEM0
ROLLINS BEDFORD CORP
602 COURTLAND STREET STE 200ORLANDOFL32804370908840INACTIVEFL501(C)(3)509(A)(3) TYPE IISUNBELT HLTH CARE CENTERS INC0
RUSSELLVILLE HLTH CARE PROPERTIES INC
683 EAST THIRD STREETRUSSELLVILLEKY42276510605691LEASE TO RELATED ORGANIZATIONGA501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
SAN MARCOS HLTH CARE PROPERTIES INC
1900 MEDICAL PARKWAYSAN MARCOSTX78666510605693LEASE TO RELATED ORGANIZATIONGA501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
SAN MARCOS NURSING & REHAB CENTER INC
1900 MEDICAL PARKWAYSAN MARCOSTX78666205782224OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYTX501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
SHAWNEE MISSION HLTH CARE INC
6501 WEST 75TH STREETOVERLAND PARKKS66204480952508LEASE TO RELATED ORGANIZATIONKS501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
SHAWNEE MISSION MEDICAL CENTER INC
9100 W 74TH STREETSHAWNEE MISSIONKS66204480637331OPERATION OF HOSPITAL & RELATED SERVICESKS501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH MID-AMERICA INC0
SOUTH CENTRAL NURSING HOMES PROPERTIES INC
111 NORTH ORLANDO AVEWINTER PARKFL32789593686109MANAGEMENT SUPPORTGA501(C)(3)509(A)(3) TYPE III-OSOUTH CENTRAL INC0
SOUTH CENTRAL NURSING HOMES INC
602 COURTLAND STREETORLANDOFL32804611242373MANAGEMENT SUPPORTKY501(C)(3)509(A)(3) TYPE III-OSOUTH CENTRAL INC0
SOUTH CENTRAL PROPERTIES III INC
111 NORTH ORLANDO AVEWINTER PARKFL32789593692860REAL ESTATEGA501(C)(2)SOUTH CENTRAL NURSING HOMES PROPERTIES INC0
SOUTH CENTRAL PROPERTIES IV INC
111 NORTH ORLANDO AVEWINTER PARKFL32789593692862REAL ESTATEGA501(C)(2)SOUTH CENTRAL NURSING HOMES PROPERTIES INC0
SOUTH CENTRAL PROPERTIES VI INC
111 NORTH ORLANDO AVEWINTER PARKFL32789593692857REAL ESTATEGA501(C)(2)SOUTH CENTRAL NURSING HOMES PROPERTIES INC0
SOUTH CENTRAL PROPERTIES INC
111 NORTH ORLANDO AVEWINTER PARKFL32789593651692REAL ESTATEGA501(C)(2)SOUTH CENTRAL NURSING HOMES PROPERTIES INC0
SOUTH CENTRAL INC
602 COURTLAND STREETORLANDOFL32804593689740MANAGEMENT SUPPORTGA501(C)(3)509(A)(3) TYPE III-F0N/A
SOUTH PASCO HLTH CARE PROPERTIES INC
38250 A AVENUEZEPHYRHILLSFL33542510605679LEASE TO RELATED ORGANIZATIONGA501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
SOUTHWEST VOLUSIA HLTH SERVICES INC
1055 SAXON BLVDORANGE CITYFL327638468593281591MEDICAL OFFICE BUILDING FOR HOSPITALFL501(C)(3)509(A)(3) TYPE ISOUTHWEST VOLUSIA HLTHCARE CORP0
SOUTHWEST VOLUSIA HLTHCARE CORP
1055 SAXON BLVDORANGE CITYFL327638468593149293OPERATION OF HOSPITAL & RELATED SERVICESFL501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEMSUNBELT INC0
SPECIALTY PHYSICIANS OF CENTRAL TEXAS INC
1301 WONDER WORLD DRIVESAN MARCOSTX78666208814408PHYSICIAN HLTHCARE SERVICES TO THE COMMUNITYTX501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEMSUNBELT INC0
SPRING VIEW HLTH & REHAB CENTER INC
718 GOODWIN LANELEITCHFIELDKY42754205782288OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYKY501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
SUNBELT HLTH & REHAB CENTER - APOPKA INC
305 EAST OAK STREETAPOPKAFL32703205774856OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYFL501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
SUNBELT HLTH CARE CENTERS INC
602 COURTLAND STREET STE 200ORLANDOFL32804581473135MANAGEMENT SERVICESTN501(C)(3)509(A)(3) TYPE IIADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
SUNSYSTEM DEVELOPMENT CORP
111 N ORLANDO AVENUEWINTER PARKFL32789592219301FUND RAISING FOR AFFILIATED TAX-EXEMPT HOSPITALSFL501(C)(3)170(B)(1)(A)(VI)ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
TARPON SPRINGS HOSPITAL FOUNDATION INC
1395 S PINELLAS AVETARPON SPRINGSFL34689590898901OPERATION OF HOSPITAL & RELATED SERVICESFL501(C)(3)170(B)(1)(A)(III)UNIVERSITY COMMUNITY HOSPITAL INC0
TARRANT COUNTY HLTH CARE PROPERTIES INC
301 HUGULEY BLVDBURLESONTX76028510605677LEASE TO RELATED ORGANIZATIONGA501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
TAYLOR CREEK HLTH CARE PROPERTIES INC
718 GOODWIN LANELEITCHFIELDKY42754510605678LEASE TO RELATED ORGANIZATIONGA501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
TEXAS HLTH HUGULEY INC (76-123111)
900 HOPE WAYALTAMONTE SPRINGSFL32714452694620OPERATION OF HOSPITAL & RELATED SERVICESFL501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEMSUNBELT INC0
THE VOLUNTEER AUXILIARY OF FLORIDA HOSPITAL - FLAGLER INC
60 MEMORIAL MEDICAL PARKWAYPALM COASTFL32164592486582VOLUNTEER SUPPORT SERVICESFL501(C)(3)509(A)(3) TYPE III-FMEMORIAL HOSPITAL FLAGLER INC0
TRINITY NURSING & REHAB CENTER INC
9700 WEST 62ND STREETMERRIAMKS66203205774890OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYKS501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
UNIVERSITY COMMUNITY HOSPITAL AUXILIARY INC
3100 E FLETCHER AVETAMPAFL33613237011345VOLUNTEER SUPPORT SERVICESFL501(C)(3)509(A)(3) TYPE III-FUNIVERSITY COMMUNITY HOSPITAL INC0
UNIVERSITY COMMUNITY HOSPITAL FOUNDATION INC
3100 E FLETCHER AVETAMPAFL33613592554889FUND-RAISING FOR TAX-EXEMPT HOSPITALFL501(C)(3)509(A)(3) TYPE IUNIVERSITY COMMUNITY HOSPITAL INC0
UNIVERSITY COMMUNITY HOSPITAL SPECIALTY CARE INC
3100 E FLETCHER AVETAMPAFL33613593231322INACTIVEFL501(C)(3)509(A)(3)UNIVERSITY COMMUNITY HOSPITAL INC0
UNIVERSITY COMMUNITY HOSPITAL INC
3100 E FLETCHER AVETAMPAFL33613591113901OPERATION OF HOSPITAL & RELATED SERVICESFL501(C)(3)170(B)(1)(A)(III)ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP0
WEST KENTUCKY HLTH CARE PROPERTIES INC
500 BECK LANEMAYFIELDKY42066510605676LEASE TO RELATED ORGANIZATIONGA501(C)(3)509(A)(3) TYPE III-FSUNBELT HLTH CARE CENTERS INC0
ZEPHYR HAVEN HLTH & REHAB CENTER INC
38250 A AVENUEZEPHYRHILLSFL33542205774930OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYFL501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0
ZEPHYRHILLS HLTH & REHAB CENTER INC
7350 DAIRY ROADZEPHYRHILLSFL33540205774967OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERYFL501(C)(3)509(A)(2)SUNBELT HLTH CARE CENTERS INC0

Form990 Schedule R Part III Form990ScheduleRPartIII (10 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNABusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
APPALACHIAN THERAPY SERVICES LLC
100 HOSPITAL DRIVEHENDERSONVILLENC28792202463851THERAPY STAFFINGNCN/A
CENTRAL TEXAS MEDICAL CENTER BOND LLC (11-111411)
1301 WONDER WORLD DRIVESAN MARCOSTX78666204314236INVESTMENTTXN/A
CLEAR CREEK MOB LTD
2201 S CLEAR CREEK RDKILLEENTX76549742609195REAL ESTATETXN/A
FLORIDA HOSPITAL DMERT LLC
2450 MAITLAND CENTER PKWY STE 200MAITLANDFL32751202392253MEDICAL EQUIPMENTFLN/A
FLORIDA HOSPITAL HOME INFUSION
2450 MAITLAND CENTER PKWY STE 200MAITLANDFL32751593142824HOME INFUSION SERVICESFLPRINCETON PROF SERVSFH WATERMANRELATED18254132407010.04900
KCCCSMMC CANCER CENTER LLC
9100 W 74TH STREETSHAWNEE MISSIONKS66204270909763EQUIPMENT RENTALKSN/A
SAN MARCOS MRI LP
1330 WONDER WORLD DRIVE STE 202SAN MARCOSTX78666770597972IMAGING & TESTINGTXN/A
SHAWNEE MISSION OPEN MRI LLC
9100 W 74TH STREET BOX 2923SHAWNEE MISSIONKS66201270011796IMAGING & TESTINGKSN/A
SHAWNEE MISSION SURGERY CENTER LLC
PO BOX 2923SHAWNEE MISSIONKS66201481243914SURGICAL SERVICESKSN/A
SKYLAND MRI LLC
100 HOSPITAL DRIVEHENDERSONVILLENC28792043646559IMAGING & TESTINGNCN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (32 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityAddress Line1AddressForeign/AddressLine1Province Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryLegal Domicile Foreign CountryLegalDomicileForeignCountry
ADVENTIST HLTH SYS SUNBELT HLTHCARE CORP EMPL BENEFIT TRUST
111 N ORLANDO AVENUEWINTER PARKFL32789581318939ADMINISTRATION OF SELF-INSURED BENEFIT PLANSFLN/AT
AHS SERVICES INC
11801 SOUTH FREEWAYFORT WORTHTX76028752049583MEDICAL EQUIPMENTTXN/AC
ALTAMONTE MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC
601 EAST ROLLINS STREETORLANDOFL32803592855792CONDO ASSOCIATIONFLN/AC
APOPKA MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC
601 EAST ROLLINS STREETORLANDOFL32803593000857CONDO ASSOCIATIONFLN/AC
ARAPAHOE MEDICAL BUILDING I INC (630 YEAR END)
2525 S DOWNING STREETDENVERCO80210841574506REAL ESTATE LEASINGCON/AC
ARAPAHOE MEDICAL BUILDING II INC (630 YEAR END)
2525 S DOWNING STREETDENVERCO80210841574507REAL ESTATE LEASINGCON/AC
CC MOB INC
2201 S CLEAR CREEK ROADKILLEENTX76549742616875REAL ESTATE RENTALTXN/AC
CENTRAL TEXAS MEDICAL ASSOCIATES
1301 WONDER WORLD DRIVESAN MARCOSTX78666742729873PHYSICIAN CLINICSTXN/AC
CENTRAL TEXAS PROVIDER'S NETWORK
1301 WONDER WORLD DRIVESAN MARCOSTX78666742827652PHYSICIAN HOSPITAL ORG.TXN/AC
FLORIDA HOSPITAL FLAGLER MEDICAL OFFICES ASSOCIATION INC
60 MEMORIAL MEDICAL PARKWAYPALM COASTFL32164262158309CONDO ASSOCIATIONFLN/AC
FLORIDA HOSPITAL HEALTHCARE SYSTEM INC
602 COURTLAND STREETORLANDOFL32804593215680PHO/TPAFLN/AC
FLORIDA MEDICAL PLAZA CONDO ASSOCIATION INC
601 EAST ROLLINS STREETORLANDOFL32803592855791CONDO ASSOCIATIONFLN/AC
FLORIDA MEMORIAL HEALTH NETWORK INC
770 W GRANADA BLVD STE 317ORMOND BEACHFL32174593403558PHYSICIAN HOSPITAL ORG.FLN/AC
HARVARD PARK EAST INC (630 YEAR END)
2525 S DOWNING STREETDENVERCO80210841574365REAL ESTATE LEASINGCON/AC
HELEN ELLIS MEMORIAL HOSPITAL REAL ESTATE CORP
1395 S PINELLAS AVETARPON SPRINGSFL34689593375731REAL ESTATE RENTALFLN/AC
HUGULEY ALLIANCE FOUNDATION
11801 SOUTH FREEWAYFORT WORTHTX76115752642209INACTIVETXN/AC
HUGULEY MEDICAL ASSOCIATES INC
11801 SOUTH FREEWAYBURLESONTX76028752547668PHYSICIAN CLINICSTXN/AC
KISSIMMEE MULTISPECIALTY CLINIC CONDOMINIUM ASSOCIATION INC
201 HILDA STREET SUITE 30KISSIMMEEFL34741593539564CONDO ASSOCIATIONFLN/AC
MIDWEST MANAGEMENT SERVICES INC
9100 WEST 74TH STREETSHAWNEE MISSIONKS66204480901551REAL ESTATE RENTALKSN/AC
METROPLEX ADVENTIST HOSPITAL CRNA
2201 S CLEAR CREEK ROADKILLEENTX76549260760794SUPPORT HOSPITAL - PROVIDE ALLIED HEALTH PROFESSIONALSTXN/AC
NORTH AMERICAN HEALTH SERVICES INC & SUBS
111 N ORLANDO AVENUEWINTER PARKFL32789621041820LESSOR/HOLDING CO.TNN/AC
ORMOND PROFESSIONAL CONDO ASSOCIATION (430 YEAR END)
770 W GRANADA BLVD STE 101ORMOND BEACHFL32174592694434CONDO ASSOCIATIONFLN/AC
PARK RIDGE PROPERTY OWNER'S ASSOCIATION INC
1 PARK PLACE NAPLES ROADFLETCHERNC28732030380531CONDO ASSOCIATIONNCN/AC
PORTER AFFILIATED HLTH SERVICES INC DBA DIVERSIFIED AFFILIATED HLTH SVCS
2525 S DOWNING STREETDENVERCO80210840956175HEALTHCARE SERVICESCON/AC
PORTER MEDICAL PLAZA INC (630 YEAR END)
2525 S DOWNING STREETDENVERCO80210841574369REAL ESTATE LEASINGCON/AC
SAN MARCOS REGIONAL MRI INC
1301 WONDER WORLD DRIVESAN MARCOSTX78666770597968HOLDING COMPANYTXN/AC
SOUTHEAST VOLUSIA MEDICAL SERVICES INC (10110-63011)
401 PALMETTO STREETNEW SMYRNA BEACHFL32168593287185INACTIVEFLN/AC
THE GARDEN RETIREMENT COMMUNITY INC
602 COURTLAND STREET STE 200ORLANDOFL32804593414055REAL ESTATE RENTALFLN/AC
UNIVERSITY COMMUNITY HEALTH INSURANCE COMPANY SPC LTD
CAPTIVE INSURANCEN/ACC/O AON INSURANCE MANAGERS PO BOXGRAND CAYMANCJCJ
UCH SERVICES INC
3100 EAST FLETCHER AVETAMPAFL33613593508454MANAGEMENT COMPANYFLN/AC
WEST COAST MEDICAL GROUP INC
1395 S PINELLAS AVETARPON SPRINGSFL34689593537305PHYSICIAN CLINICSFLN/AC
WINTER PARK MEDICAL OFFICE BUILDING I CONDO ASSOC INC (330-123111)
200 LAKEMONT AVEWINTER PARKFL32792452228478PHYSICIAN CLINICSFLN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (11 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORP
L1766325% OF FACILITY'S OPER. EXP.
ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORP DBA AHS IS
L6423330% OF FACILITY'S OPER. EXP.
ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORP
O6245336COST
ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORP
B1532991AMOUNT GIVEN
FLORIDA PHYSICIANS MEDICAL GROUP INC
L2825535COST PLUS APPROPRIATE MARGIN
FLORIDA PHYSICIANS MEDICAL GROUP INC
I241917COST PLUS APPROPRIATE MARGIN
ADVENTIST HEALTH SYSTEMSUNBELT INC
O110000COST
ADVENTIST HEALTH SYSTEMSUNBELT INC
L407356COST PLUS APPROPRIATE MARGIN
ADVENTIST HEALTH SYSTEMSUNBELT INC
B89065AMOUNT GIVEN
ADVENTIST HEALTH SYSTEMSUNBELT INC
P78693COST
ADVENTIST HEALTH SYSTEMSUNBELT INC
J443042COST PLUS APPROPRIATE MARGIN