SOUTHWEST VOLUSIA HEALTHCARE CORPORATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: SOUTHWEST VOLUSIA HEALTHCARE CORPORATION (EIN 59-3149293)
Tax period: 2011-01-01 to 2011-12-31
Filed: 2012-11-13
IRS object ID: 201233189349302633
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
Form 990
Schedule A
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-11-13T12:46:54-06:00	Timestamp
Tax Period End Date	2011-12-31	TaxPeriodEndDate
Return Type	990	ReturnType
Tax Period Begin Date	2011-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	593149293	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	SOUTHWEST VOLUSIA HEALTHCARE CORPORATION	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	SOUT	NameControl
Phone	3869175000	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1055 SAXON BOULEVARD	AddressLine1
City	ORANGE CITY	City
State	FL	State
ZIP Code	327638468	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	LYNN C ADDISCOTT	Name
Title	ASSISTANT SECRETARY	Title
Phone	4079751464	Phone
Date Signed	2012-11-13	DateSigned

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

Field	Value	IRS element (for citing)
Business Name Line1	FLORIDA HOSPITAL FISH MEMORIAL	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	ED NOSEWORTHY	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	1055 SAXON BOULEVARD	AddressLine1
City	ORANGE CITY	City
State	FL	State
ZIP Code	327638468	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	133213537	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.FHFISHMEMORIAL.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1992	YearFormation
State Legal Domicile	FL	StateLegalDomicile
Activity Or Mission Description	THE PROVISION OF MEDICAL CARE TO THE COMMUNITY SERVED THROUGH THE OPERATION OF A 139 BED HOSPITAL.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	12	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	6	NbrIndependentVotingMembers
Total Nbr Employees	1210	TotalNbrEmployees
Total Nbr Volunteers	192	TotalNbrVolunteers
Total Gross UBI	9009	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	0	ContributionsGrantsPriorYear
Contributions Grants Current Year	0	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	142452138	ProgramServiceRevenuePriorYear
Program Service Revenue CY	131865469	ProgramServiceRevenueCY
Investment Income Prior Year	2061978	InvestmentIncomePriorYear
Investment Income Current Year	1308908	InvestmentIncomeCurrentYear
Other Revenue Prior Year	-37625	OtherRevenuePriorYear
Other Revenue Current Year	30430	OtherRevenueCurrentYear
Total Revenue Prior Year	144476491	TotalRevenuePriorYear
Total Revenue Current Year	133204807	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	152705	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	158283	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	58271619	SalariesEtcPriorYear
Salaries Etc Current Year	58065778	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	73367183	OtherExpensePriorYear
Other Expenses Current Year	65081355	OtherExpensesCurrentYear
Total Expenses Prior Year	131791507	TotalExpensesPriorYear
Total Expenses Current Year	123305416	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	12684984	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	9899391	RevenuesLessExpensesCY
Total Assets BOY	148144238	TotalAssetsBOY
Total Assets EOY	155285874	TotalAssetsEOY
Total Liabilities BOY	83383457	TotalLiabilitiesBOY
Total Liabilities EOY	81211523	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	64760781	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	74074351	NetAssetsOrFundBalancesEOY
Mission Description	ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION AND ALL OF ITS SUBSIDIARY ORGANIZATIONS WERE ESTABLISHED BY THE SEVENTH-DAY ADVENTIST CHURCH TO BRING A MINISTRY OF HEALING AND HEALTH TO THE COMMUNITIES SERVED. OUR MISSION IS TO EXTEND THE HEALING MINISTRY OF CHRIST.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	113307125	Expense
Grants	158283	Grants
Revenue	131886890	Revenue
Description	THE ORGANIZATION'S EXEMPT PURPOSE INCLUDES THE PROVISION OF MEDICAL CARE TO THE SURROUNDING COMMUNITY THROUGH THE OPERATION OF A 139-BED INPATIENT FACILITY & A RELATED OUTPATIENT FACILITY PROVIDING AMBULATORY SURGERY, DIAGNOSTIC RADIOLOGY, (INCLUDING MRI AND CT SCANNERS), LABORATORY SERVICES AND PHYSICAL THERAPY. THERE WERE 8,394 PATIENT ADMISSIONS RESULTING IN 36,867 PATIENT DAYS DURING THE CURRENT YEAR.	Description
Total Program Service Expense	113307125	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transaction Related Entity	1	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	141	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	1210	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	12	NbrVotingGoverningBodyMembers
Number Independent Voting Members	6	NumberIndependentVotingMembers
Family Or Business Relationship	1	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	1	InvestmentInJointVenture
Written Policy Or Procedure	1	WrittenPolicyOrProcedure
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	ERIC OSTARLY	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	3869175017	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1055 SAXON BOULEVARD	AddressLine1
City	ORANGE CITY	City
State	FL	State
ZIP Code	327638468	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (26 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee	FormerFormer
BRADLEY KENNETH W
DIRECTOR	0.30	X	0	644349	77022
GRAY CHARLES
DIRECTOR (ENDED 6/11)	0.30	X	0	0	0
HAYNES TIM
DIRECTOR	0.30	X	0	0	0
HIPPALGAONKAR MD RAJENDRA
DIRECTOR	4.50	X	33867	0	0
LAVOIE MD STEPHANNE
DIRECTOR (BEGAN 8/11)	0.60	X	2100	0	0
MATTISON KENNETH R
DIRECTOR	0.30	X	0	562021	82597
MORRISON RICHARD E
DIRECTOR (ENDED 12/11)	0.30	X	0	468048	64372
NORTHEY PATRICIA
DIRECTOR	0.30	X	0	0	0
PATTERSON PAT
DIRECTOR	0.30	X	0	0	0
SMITH MD PAUL T
DIRECTOR (BEGAN 8/11)	1.30	X	9377	0	0
STEINBAUM MD JEREMY
DIRECTOR	0.60	X	1900	0	0
TOL DARYL L
CHAIRMAN	0.30	X	0	553006	112458
WOODRUFF GEORGE
DIRECTOR	0.30	X	100	0	0
JOHNSON JOEL D
SECRETARY/CEO (ENDED 7/11)	50.00	X	0	666244	101996	X
NOSEWORTHY G EDWARD
SECRETARY/CEO (BEGAN 7/11)	50.00	X	0	449008	71379	X
LUKENS MICHAEL B
CFO	50.00		0	251814	41424	X
SHULL JENNIFER M
CNO	50.00		0	205112	30815		X
JOHNSON DANIELLE C
COO (BEGAN 6/11)	50.00		0	220543	33752		X
PARIKHMD NITIN J
HOSPITAL BASED PHYSICIAN	50.00		430912	0	25652			X
MASRIMD MOHAMAD
HOSPITAL BASED PHYSICIAN	50.00		378551	0	25172			X
HAYNEMD WALTER
HOSPITAL BASED PHYSICIAN	50.00		321306	0	23116			X
KALLAMD SHRISH
HOSPITAL BASED PHYSICIAN	50.00		279188	0	28615			X
SHOUKASMD JAMES
HOSPITAL BASED PHYSICIAN	50.00		274600	0	18808			X
FOWLER SUSAN
FORMER AVP-CNO	0.00		0	136141	12310				X
LOWE EVELYN M
FORMER COO	0.00		0	210717	65079				X
BERGHERM BRUCE
FORMER COO	0.00		0	511904	70852				X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1731901	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	4878907	TotalReportableCompFrmRltdOrgs
Total Other Compensation	885419	TotalOtherCompensation
Number Individuals GT100 K	36	NumberIndividualsGT100K
Formers Listed	1	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
CENTRAL FLORIDA MEDICAL IMAGING
1053 MEDICAL CENTER DR 151	ORANGE CITY	FL	32763	RADIOLOGY SERVICE	1315097
DIVERSIFIED CLINICAL SERVICES
PO BOX 636981	CINCINNATI	OH	45263	WOUND CARE STAFFING	1155230
MEDS (MONTI ELIGIBILITY & DENIAL SOL
100 TREEMONTE DRIVE	ORANGE CITY	FL	32763	COLLECTION SERVICES	878316
JLR ANESTHESIAJLR MEDICAL GROUP
PO BOX 948075	MAITLAND	FL	32794	ANESTHESIA SERVICE	741777
ELITE MEDICAL STAFFING
PO BOX 60839	CHARLOTTE	NC	28260	NURSING AGENCY	584809

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	22	NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE	900099	131085745	131085745
CAFETERIA REVENUE	900099	512105	512105
HOUSEKEEPING	900099	74637	74637
GIFT SHOP REVENUE	900099	72217	72217
TRANSCRIPTION REVENUE	900099	28420	28420

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	92345	TotalRevenueColumn
Related Or Exempt Function Income	83336	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	9009	UnrelatedBusinessRevenue

Field	Value	IRS element (for citing)
Total Program Service Revenue	131865469	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	823675	TotalRevenueColumn
Exclusion	$823,675	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	485329	Securities
Other	8634	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	0	Securities
Other	8730	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	485329	Securities
Other	-96	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	485233	TotalRevenueColumn
Exclusion	$485,233	ExclusionAmount

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	EQUITY EARNINGS FROM R	Description
Business Code	900099	BusinessCode
Total Revenue Column	30430	TotalRevenueColumn
Related Or Exempt Function Income	30430	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	30430	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	133204807	TotalRevenueColumn
Related Or Exempt Function Income	131886890	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	9009	UnrelatedBusinessRevenue
Exclusion	$1,308,908	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	158283	Total
Program Services	158283	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	2119431	Total
Management And General	2119431	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	42899531	Total
Program Services	42899531	ProgramServices

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	1374131	Total
Program Services	1347136	ProgramServices
Management And General	26995	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	8300370	Total
Program Services	8300370	ProgramServices

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	3372315	Total
Program Services	3305894	ProgramServices
Management And General	66421	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	64474	Total
Management And General	64474	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	50160	Total
Management And General	50160	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	15183020	Total
Program Services	10447271	ProgramServices
Management And General	4735749	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	769651	Total
Management And General	769651	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	3918528	Total
Program Services	3114253	ProgramServices
Management And General	804275	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	4849270	Total
Program Services	3946369	ProgramServices
Management And General	902901	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	3503948	Total
Program Services	3503948	ProgramServices

Travel Travel

Field	Value	IRS element (for citing)
Total	130086	Total
Management And General	130086	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	62713	Total
Management And General	62713	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	3235616	Total
Program Services	3235616	ProgramServices

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	6323358	Total
Program Services	6323358	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	1173583	Total
Program Services	1148307	ProgramServices
Management And General	25276	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
MEDICAL SUPPLIES	20778370	20778370
REPAIRS & MAINTENANCE	3191420	3191420
STATE TAX INDIGENT ASSE	1569667	1569667
FED INC TAX UBI	2000		2000

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	275491	Total
Program Services	37332	ProgramServices
Management And General	238159	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	123305416	Total
Program Services	113307125	ProgramServices
Management And General	9998291	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	2436	BOY
EOY	2634	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	67658617	BOY
EOY	69713799	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	14987159	BOY
EOY	15160331	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	2075215	BOY
EOY	2139237	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	4498556	BOY
EOY	3652163	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	147575068	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	87399368	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	54912320	BOY
EOY	60175700	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	470654	BOY
EOY	501084	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	134613	BOY
EOY	56417	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	3404668	BOY
EOY	3884509	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	148144238	BOY
EOY	155285874	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	6047754	BOY
EOY	7226269	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	21857	BOY
EOY	7610	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	77313846	BOY
EOY	73977644	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	83383457	BOY
EOY	81211523	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	64745946	BOY
EOY	74059516	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	14835	BOY
EOY	14835	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	64760781	BOY
EOY	74074351	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	148144238	BOY
EOY	155285874	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	9899391	ReconcilationRevenueExpenses
Reconcilation Other Changes	-585821	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	0	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	0	GrantsOtherOrganizations
Direct Contact Legislators	0	DirectContactLegislators
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	1	OtherActivities
Other Activities	$7,777	OtherActivitiesAmount
Total Lobbying Expenditures IIB	7777	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	EXPLANATION OF LOBBYING ACTIVITIES:	Identifier
Return Reference	PART II-B, LINE 1:	ReturnReference
Explanation	AMERICAN HOSPITAL ASSOCIATION DUES AND FLORIDA HOSPITAL ASSOCIATION DUES	Explanation

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	9118495	OtherCostOrOtherBasis
Book Value	9118495	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	64903728	OtherCostOrOtherBasis
Depreciation	36059234	Depreciation
Book Value	28844494	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	57437103	OtherCostOrOtherBasis
Depreciation	48619219	Depreciation
Book Value	8817884	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	16115742	OtherCostOrOtherBasis
Depreciation	2720915	Depreciation
Book Value	13394827	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	60175700	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescription	AmountAmount
DUE TO AFFILIATED	$2,121,553
PAYABLE TO THIRD PARTIES	-$1,591,624
CREDIT BALANCES IN A/R	$349,407
OTHER CURRENT LIABILITIES	$6,487
INTERCO. ALLOC. OF TE BOND PROCEEDS	$72,741,748
CAPITAL LEASE	$350,073

Field	Value	IRS element (for citing)
Total Of Amounts	73977644	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:	Identifier
Return Reference	PART X:	ReturnReference
Explanation	THE HOSPITAL IS PART OF A CONSOLIDATED AUDITED FINANCIAL STATEMENT. THE CONSOLIDATED AUDITED FINANCIAL STATEMENT INCLUDES THE FOLLOWING FIN 48 FOOTNOTE - THE DIVISION FOLLOWS THE INCOME TAXES TOPIC OF THE ASC (ASC 740), WHICH PRESCRIBES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAX POSITIONS RECOGNIZED IN FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN.	Explanation

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent400	X	Pcent400
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	0	ExpensesExceededBudget
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	7807565	TotalCommunityBenefitExpense
Net Community Benefit Expense	7807565	NetCommunityBenefitExpense
Percent Of Total Expense	0.06330	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	17856500	TotalCommunityBenefitExpense
Direct Offsetting Revenue	12557569	DirectOffsettingRevenue
Net Community Benefit Expense	5298931	NetCommunityBenefitExpense
Percent Of Total Expense	0.04300	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	25664065	TotalCommunityBenefitExpense
Direct Offsetting Revenue	12557569	DirectOffsettingRevenue
Net Community Benefit Expense	13106496	NetCommunityBenefitExpense
Percent Of Total Expense	0.10630	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	148452	TotalCommunityBenefitExpense
Net Community Benefit Expense	148452	NetCommunityBenefitExpense
Percent Of Total Expense	0.00120	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	103532	TotalCommunityBenefitExpense
Net Community Benefit Expense	103532	NetCommunityBenefitExpense
Percent Of Total Expense	0.00080	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	21762	TotalCommunityBenefitExpense
Net Community Benefit Expense	21762	NetCommunityBenefitExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	273746	TotalCommunityBenefitExpense
Net Community Benefit Expense	273746	NetCommunityBenefitExpense
Percent Of Total Expense	0.00220	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	25937811	TotalCommunityBenefitExpense
Direct Offsetting Revenue	12557569	DirectOffsettingRevenue
Net Community Benefit Expense	13380242	NetCommunityBenefitExpense
Percent Of Total Expense	0.10850	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$7,487,943	BadDebtExpenseAmount
Amount Attributable To	1455725	AmountAttributableTo
Amount Reimbursed By Medicare	36907931	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	37391267	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-483336	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

Field	Value	IRS element (for citing)
Business Name Line1	1 ORANGE CITY SURGICAL LLC	BusinessNameLine1

Field	Value	IRS element (for citing)
Description Ent Primary Activity	OUTPATIENT SURGICAL CENTER	DescriptionEntPrimaryActivity
Organization Profit Or Ownership	0.29000	OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership	0.19000	OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership	0.18000	PhysicansProfitOrOwnership

Field	Value	IRS element (for citing)
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	FLORIDA HOSPITAL FISH MEMORIAL	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	1055 SAXON BLVD	AddressLine1
City	ORANGE CITY	City
State	FL	State
ZIP Code	32763	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	SOUTHWEST VOLUSIA HEALTHCARE CORPORATION	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
Eligibility Criteria Explained	1	EligibilityCriteriaExplained
Uses FPG Free	1	UsesFPGFree
FPG Free Percent	200.000000000000	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	400.000000000000	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Uninsured Discount	X	UninsuredDiscount
Medicaid Medicare	X	MedicaidMedicare
State Regulation	X	StateRegulation
Explains Application Method	1	ExplainsApplicationMethod
Includes Publicity Measures	1	IncludesPublicityMeasures
Available On Request	X	AvailableOnRequest
Other Publicity	X	OtherPublicity
Actions On Nonpayment	1	ActionsOnNonpayment
Collection Activities	0	CollectionActivities
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	0	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	16	NumberOfOtherFacilities

Other Facilities OtherFacilities (16 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
FLORIDA HOSPITAL FISH IMAGING
1053 MEDICAL CENTER DR 151	ORANGE CITY	FL	32763	DIAGNOSTIC IMAGING SERVICES
ORANGE CITY SURGICAL LLC
1053 MEDICAL CENTER DR 201	ORANGE CITY	FL	32763	AMBULATORY SURGERY CENTER
FLORIDA HOSPITAL VOLUSIA HOME CARE SERV
1061 MEDICAL CENTER DR 202	ORANGE CITY	FL	32763	HOME CARE SERVICES
SOUTHWEST VOLUSIA MEDICAL ASSOCSHRISH K
1565 SAXON BLVD 202	DELTONA	FL	32725	PHYSICIAN OFFICE - FAMILY PRACTICE
SOUTHWEST VOLUSIA MEDICAL ASSOC-CANCER C
1061 MEDICAL CENTER DR SUITE 305	ORANGE CITY	FL	32763	PHYSICIAN OFFICE - CANCER
SOUTHWEST VOLUSIA MEDICAL ASSOCJOSE ROS
1035 TOWN CENTER DR	ORANGE CITY	FL	32763	PHYSICIAN OFFICE - FAMILY PRACTICE
SOUTHWEST VOLUSIA MEDICAL ASSOCWALTER H
1061 MEDICAL CENTER DR 310	ORANGE CITY	FL	32763	PHYSICIAN OFFICE - GENERAL SURGERY
SOUTHWEST VOLUSIA MEDICAL ASSOCGEORGE B
2582 SOUTH VOLUSIA AVE	ORANGE CITY	FL	32763	PHYSICIAN OFFICE - OBSTETRICS & GYNECOLOGY
SOUTHWEST VOLUSIA MEDICAL ASSOCNITIN PA
1053 MEDICAL CENTER DR 251	ORANGE CITY	FL	32763	PHYSICIAN OFFICE - GASTROENTEROLOGY
SOUTHWEST VOLUSIA MEDICAL ASSOCJAMES SH
934 WILLISTON PARK POINT 1028	LAKE MARY	FL	32746	PHYSICIAN OFFICE - PLASTIC & RECONST SURGERY
SOUTHWEST VOLUSIA MEDICAL ASSOCSUNITA T
1061 MEDICAL CENTER DR 205	ORANGE CITY	FL	32763	PHYSICIAN OFFICE - PSYCHIATRY
SOUTHWEST VOLUSIA MEDICAL ASSOCDORNA BR
1027 TOWN CENTER DRIVE	ORANGE CITY	FL	32763	PHYSICIAN OFFICE - INTERNAL MEDICINE
SOUTHWEST VOLUSIA MEDICAL ASSOCSTEVEN G
275 S HIGHWAY 17-92 SUITE 108	DEBARY	FL	32713	PHYSICIAN OFFICE - FAMILY PRACTICE
SOUTHWEST VOLUSIA MEDICAL ASSOCCHARLENE
1081 TOWN CENTER DR SUITE 200	ORANGE CITY	FL	32763	PHYSICIAN OFFICE - ENDOCRINOLOGIST
SOUTHWEST VOLUSIA MEDICAL ASSOCWILLIAM
2783 ELKCAM BLVD	DELTONA	FL	32738	PHYSICIAN OFFICE - FAMILY PRACTICE W/OUT OB
SOUTHWEST VOLUSIA MEDICAL ASSOCMALIKA G
605 COURTLAND BLVD SUITE 104/105	DELTONA	FL	32738	PHYSICIAN OFFICE - INTERNAL MEDICINE

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

ExplanationExplanation	Return ReferenceReturnReference	IdentifierIdentifier
PART I, LINE 6A: THE FILING ORGANIZATION IS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC SERVES AS A PARENT ORGANIZATION TO 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 PREPARED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION.
PART I, LINE 7: THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS.
PART III, LINE 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.
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.		SOUTHWEST VOLUSIA HEALTHCARE CORPORATION
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.		SOUTHWEST VOLUSIA HEALTHCARE CORPORATION
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: FLORIDA HOSPITAL FISH MEMORIAL HAS A PROCESS IN PLACE WHEREBY PATIENTS ARE INFORMED ABOUT THE HOSPITAL'S CHARITY CARE POLICY AND OTHER FORMS OF FINANCIAL ASSISTANCE, SUCH AS SELF-PAY DISCOUNTS. SIGNAGE IS POSTED IN THE EMERGENCY ROOM INDICATING THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR THOSE SELF-PAY PATIENTS MEETING ELIGIBILITY REQUIREMENTS. AFTER EMTALA MEDICAL SCREENING AND STABILIZATION REQUIREMENTS ARE MET, REGISTRATION PERSONNEL WILL SECURE FINANCIAL INFORMATION ON AS MANY SELF-PAY PATIENTS AS POSSIBLE AT THE TIME OF SERVICE. FOR THOSE WHO APPEAR TO QUALIFY FOR MEDICAID OR UNDER THE HOSPITAL'S CHARITY CARE POLICY, THE FINANCIAL COUNSELORS WILL CONTINUE TO WORK WITH THOSE PATIENTS UNTIL FINAL ACCOUNT RESOLUTION IS ACHIEVED. ALL OTHER SELF-PAY PATIENTS ARE COVERED UNDER THIS PROCESS. AT ANY TIME DURING THE PROCESS THAT DATA IS PROVIDED SHOWING THAT A PATIENT QUALIFIES FOR ASSISTANCE UNDER THE CHARITY CARE POLICY THE DISCOUNTS EXTENDED UNDER THAT POLICY WILL BE APPLIED.AS PART OF THE BILLING PROCESS, THE HOSPITAL INCLUDES THE APPLICATION FOR CHARITY CARE ASSISTANCE ALONG WITH THE INITIAL PATIENT BILL. THE HOSPITAL'S CHARITY CARE APPLICATION IS ALSO AVAILABLE TO PATIENTS ON THE HOSPITAL'S WEB-SITE IN BOTH AN ENGLISH AND SPANISH VERSION. ADDITIONALLY, THE HOSPITAL'S FINANCIAL COUNSELORS ARE AVAILABLE TO WORK WITH EVERY PATIENT DURING THE FIRST 120 DAYS OF THE BILLING PROCESS TO ASSIST THE PATIENT WITH COMPLETING CHARITY CARE APPLICATIONS AND INVESTIGATING OTHER POTENTIAL SOURCES OF THIRD-PARTY ASSISTANCE. THE DETERMINATION OF A PATIENT'S ELIGIBILITY FOR CHARITY CARE IS MADE ON A CASE-BY-CASE BASIS. VARIOUS FACTORS ARE CONSIDERED IN THAT DETERMINATION. EACH INDIVIDUAL PATIENT WHO IS IDENTIFIED AS POTENTIALLY BEING ELIGIBLE TO RECEIVE CHARITY CARE IS SEEN BY A FINANCIAL COUNSELOR AT THE HOSPITAL. THE FINANCIAL COUNSELOR WILL WORK WITH THE PATIENT TO MAKE SURE THAT OTHER SOURCES OF ASSISTANCE (PUBLIC OR OTHERWISE) HAVE BEEN SOUGHT TO THE FULLEST EXTENT POSSIBLE. WHEN OTHER FORMS OF ASSISTANCE ARE NOT AVAILABLE OR HAVE BEEN EXHAUSTED, THE HOSPITAL WILL GATHER CERTAIN FINANCIAL INFORMATION FROM THE PATIENT TO DETERMINE THE PATIENT'S ABILITY TO PAY BASED UPON LEVEL OF INCOME.
PART VI, LINE 4: THE FILING ORGANIZATION IS LOCATED IN ORANGE CITY, FLORIDA. IT CURRENTLY OPERATES A HOSPITAL FACILITY AND IS LICENSED FOR 139 BEDS. ITS AVERAGE OCCUPANCY RATE FOR ITS PATIENT ROOMS IS THE HIGHEST IN THE REGION WHICH DEMONSTRATES THE CRITICAL NEED FOR THESE SERVICES. THE HOSPITAL'S SERVICES INCLUDE: EMERGENCY CARE, INTENSIVE CARE, DIAGNOSTIC IMAGING/RADIOLOGY, LABORATORY, SLEEP DISORDERS, CANCER INSTITUTE & RADIATION ONCOLOGY CENTER, REHABILITATION, PAIN MANAGEMENT, SURGERY, ENDOSCOPY, CARDIOLOGY, HOME CARE, EDUCATION, AND PASTORAL CARE.ORANGE CITY, FLORIDA IS LOCATED IN VOLUSIA COUNTY. THE HOSPITAL'S PRIMARY MARKET HAS A POPULATION OF APPROXIMATELY 127,000, WITH AN ESTIMATED 22,000 OVER THE AGE OF 65. THE WEIGHTED AVERAGE HOUSEHOLD INCOME, BASED ON POPULATION, IN THE PRIMARY MARKET IS APPROXIMATELY $46,000. HIGH SCHOOL GRADUATES ACCOUNT FOR APPROXIMATELY 87% OF VOLUSIA COUNTY, WITH AN ESTIMATED 21% HAVING A BACHELOR'S DEGREE OR HIGHER. IT IS ESTIMATED THAT 13% OF THE INDIVIDUALS RESIDING IN VOLUSIA COUNTY LIVE BELOW THE POVERTY LEVEL AND THE UNEMPLOYMENT RATE IS ABOUT 7%. APPROXIMATELY 53.4% OF THE HOSPITAL'S PATIENTS DURING 2011 WERE MEDICARE PATIENTS, ABOUT 13.6% WERE MEDICAID PATIENTS, ABOUT 6.8% WERE SELF-PAY PATIENTS, AND THE REMAINING PERCENTAGE WERE PATIENTS COVERED UNDER COMMERCIAL INSURANCE. IN 2011, ABOUT 87% 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 FLORIDA HOSPITAL FISH MEMORIAL'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST" AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, HOSPITAL PROVIDED $311,206 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF A COMMUNITY HOSPITAL. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE HOSPITAL EXPENDED $12,217,897 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY.
PART VI, LINE 6: THE 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 42 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 HOSPITALS 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

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	SUNSYSTEM DEVELOPMENT CORP DBA FLORIDA HOSPITAL FISH MEMORIAL FOUNDATION	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	900 HOPE WAY	AddressLine1
City	ALTAMONTE SPRINGS	City
State	FL	State
ZIP Code	32714	ZIPCode

Field	Value	IRS element (for citing)
EIN Of Recipient	592219301	EINOfRecipient
IRC Section	501 (C)(3)	IRCSection
Amount Of Non Cash Assistance	158283	AmountOfNonCashAssistance
Method Of Valuation	COST	MethodOfValuation
Description Of Non Cash Assistance	GENERAL ADMINISTRATIVE SUPPORT	DescriptionOfNonCashAssistance
Purpose Of Grant	PROVISION OF GENERAL ADMINISTRATIVE SUPPORT	PurposeOfGrant

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	1	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	0	TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Explanation	GRANTS 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

Field	Value	IRS element (for citing)
Travel For Companions	X	TravelForCompanions
Idemnification Gross Up Payments	X	IdemnificationGrossUpPayments
Discretionary Spending Account	X	DiscretionarySpendingAccount
Housing Allowance Or Residence	X	HousingAllowanceOrResidence
Club Dues Or Fees	X	ClubDuesOrFees
Written Policy Re T And E Expenses	1	WrittenPolicyReTAndEExpenses
Substantiation Required	1	SubstantiationRequired
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	1	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (17 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
BRADLEY KENNETH W
0	290320	0	71229	0	282800	0	48485	0	28537	0	721371	0	34353
MATTISON KENNETH R
0	345358	0	80590	0	136073	0	45471	0	37126	0	644618	0	31327
MORRISON RICHARD E
0	288824	0	48212	0	131012	0	28159	0	36213	0	532420	0	8254
TOL DARYL L
0	437174	0	60862	0	54970	0	74312	0	38146	0	665464	0	29897
JOHNSON JOEL D
0	311655	0	73338	0	281251	0	46790	0	55206	0	768240	0	31130
NOSEWORTHY G EDWARD
0	298730	0	68639	0	81639	0	47047	0	24332	0	520387	0	27821
LUKENS MICHAEL B
0	209549	0	38303	0	3962	0	25874	0	15550	0	293238	0	0
SHULL JENNIFER M
0	167789	0	23840	0	13483	0	10138	0	20677	0	235927	0	0
JOHNSON DANIELLE C
0	195765	0	15998	0	8780	0	5658	0	28094	0	254295	0	0
PARIKHMD NITIN J
426087	0	0	0	4825	0	13343	0	12309	0	456564	0	0	0
MASRIMD MOHAMAD
332498	0	42000	0	4053	0	13343	0	11829	0	403723	0	0	0
HAYNEMD WALTER
316398	0	0	0	4908	0	8443	0	14673	0	344422	0	0	0
KALLAMD SHRISH
164264	0	110316	0	4608	0	13343	0	15272	0	307803	0	0	0
SHOUKASMD JAMES
271273	0	0	0	3327	0	8443	0	10365	0	293408	0	0	0
FOWLER SUSAN
0	121648	0	14366	0	127	0	6699	0	5611	0	148451	0	0
LOWE EVELYN M
0	174000	0	23271	0	13446	0	10834	0	54245	0	275796	0	0
BERGHERM BRUCE
0	267193	0	30676	0	214035	0	39335	0	31517	0	582756	0	20327

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
PART I, LINE 1A	AS DISCUSSED IN OUR RESPONSE TO FORM 990, SECTION B, PART VI, QUESTION 15A & B, THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). MEMBERS OF THE FILING ORGANIZATION'S EXECUTIVE MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF AHS. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). THE FILING ORGANIZATION REIMBURSES AHSSHC FOR THE SALARY AND BENEFIT COST OF THOSE EXECUTIVES ON THE PAYROLL OF AHSSHC THAT PROVIDE SERVICES AND ARE ON THE MANAGEMENT TEAM OF THE FILING ORGANIZATION. TRAVEL FOR COMPANIONS: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING AHSSHC EXECUTIVE TO HAVE HIS OR HER SPOUSE ACCOMPANY THE EXECUTIVE ON 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. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES BUSINESS DEVELOPMENT EXPENDITURES. UNDER THIS POLICY, CERTAIN AHS ELIGIBLE EXECUTIVES MAY BE REIMBURSED FOR MEMBER DUES AND USAGE CHARGES FOR A COUNTRY CLUB OR OTHER SOCIAL CLUB UPON AUTHORIZATION. CLUB MEMBERSHIPS MUST BE RECOMMENDED BY THE CEO OF THE AHS HOSPITAL ORGANIZATION AND APPROVED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS OF THE ORGANIZATION. IN ADDITION, THE PROPOSED MEMBERSHIP MUST BE APPROVED ANNUALLY BY THE AHSSHC BOARD STRATEGY & COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF AHSSHC. ELIGIBLE EXECUTIVES ARE LIMITED TO CERTAIN SENIOR LEVEL EXECUTIVES (HOSPITAL ORGANIZATION CEOS, THE CEO OF THE NURSING HOME DIVISION OF AHS, SENIOR VICE PRESIDENTS AT THREE LARGE HOSPITAL ORGANIZATIONS, REGIONAL CEOS AND CFOS AND THE PRESIDENT AND SENIOR VICE PRESIDENTS OF AHSSHC). IN THE CURRENT YEAR, FOR THIS FILING ORGANIZATION, ONE EXECUTIVE WAS ELIGIBLE TO RECEIVE REIMBURSEMENT FOR CLUB FEES. EACH AHS EXECUTIVE WHO IS APPROVED FOR A CLUB MEMBERSHIP MUST SUBMIT AN ANNUAL REPORT TO THE AHSSHC BOARD STRATEGY & COMPENSATION COMMITTEE THAT DESCRIBES HOW THE MEMBERSHIP BENEFITED THEIR ORGANIZATION DURING THE PRECEDING YEAR.
PART I, LINE 4B	AS DISCUSSED IN LINE 1A ABOVE, EXECUTIVES ON THE FILING ORGANIZATION'S MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF A HEALTHCARE SYSTEM KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). IN RECOGNITION OF THE CONTRIBUTION THAT EACH EXECUTIVE MAKES TO THE SUCCESS OF AHS, AHS PROVIDES TO ELIGIBLE EXECUTIVES PARTICIPATION IN THE AHS EXECUTIVE FLEX BENEFIT PROGRAM (THE PLAN). THE PURPOSE OF THE PLAN IS TO OFFER ELIGIBLE EXECUTIVES AN OPPORTUNITY TO ELECT FROM AMONG A VARIETY OF SUPPLEMENTAL BENEFITS, INCLUDING DEFERRED COMPENSATION BENEFITS TAXABLE UNDER INTERNAL REVENUE CODE (IRC) SECTION 457(F), TO INDIVIDUALLY TAILOR A BENEFITS PROGRAM APPROPRIATE TO EACH EXECUTIVE'S NEEDS. THE PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH IS DEDUCTED THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS. THE PRE-DETERMINED BENEFITS ALLOWANCE CREDIT PERCENTAGE IS APPROVED BY THE AHS BOARD STRATEGY & COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF AHSSHC. ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED FROM THE ANNUAL PRE-DETERMINED BENEFITS ALLOWANCE ARE CONTRIBUTED, AT THE EMPLOYEE'S OPTION, TO EITHER AN IRC 457(F) DEFERRED COMPENSATION ACCOUNT OR TO AN IRC 457(B) ELIGIBLE DEFERRED COMPENSATION PLAN. UPON ATTAINMENT OF AGE 65, ALL PREVIOUS 457(F) DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT AND ANY FUTURE EMPLOYER CONTRIBUTIONS ARE MADE QUARTERLY FROM THE PLAN DIRECTLY TO THE PARTICIPANT. THE PLAN DOCUMENTS DEFINE AN EMPLOYEE WHO IS ELIGIBLE TO PARTICIPATE IN THE PLAN TO GENERALLY INCLUDE THE CHIEF EXECUTIVE OFFICERS OF AHS ENTITIES AND VICE PRESIDENTS OF ALL AHS ENTITIES WHOSE BASE SALARY IS AT LEAST $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. ------------------------------------------------------- BRADLEY, KENNETH W. $ 35,142 $ 34,468 $ 222,952 $ 0 MATTISON, KENNETH R. $ 48,628 $ 39,481 $ 31,566 $ 0 MORRISON, RICHARD E. $ 31,316 $ 9,779 $ 61,165 $ 0 TOL, DARYL L. $ 60,969 $ 31,393 $ 0 $ 0 JOHNSON, JOEL D. $ 33,447 $ 34,347 $ 112,625 $ 0 NOSEWORTHY, G. EDWARD $ 33,704 $ 36,176 $ 0 $ 0 LUKENS, MICHAEL B. $ 12,531 $ 4 $ 0 $ 0 JOHNSON, DANIELLE C. $ 6,670 $ 0 $ 0 $ 0 BERGHERM, BRUCE $ 25,992 $ 20,393 $ 0 $ 0
PART I, LINE 6	THE FILING ORGANIZATION'S PHYSICIAN COMPENSATION FORMULA IS DESIGNED TO RESULT IN TOTAL COMPENSATION THAT WOULD BE REASONABLE FOR EACH PHYSICIAN. THE FILING ORGANIZATION UTILIZES NATIONAL SURVEY PRODUCTIVITY, COST, AND COMPENSATION DATA IN FORMULATING ALL ASPECTS OF THE COMPENSATION PLAN. PHYSICIAN COMPENSATION ARRANGEMENTS INCLUDE A CEILING OR REASONABLE MAXIMUM ON THE AMOUNT A PHYSICIAN MAY EARN. THE FILING ORGANIZATION'S EMPLOYED PHYSICIANS ENTER INTO A WRITTEN AGREEMENT THAT REQUIRES THE PHYSICIANS TO PROVIDE MEDICAL CARE TO INDIVIDUALS WHO ARE REFERRED BY THE FILING ORGANIZATION. PURSUANT TO THE AGREEMENT, AN INDIVIDUAL MAY NOT BE REJECTED AS A PATIENT BY A PHYSICIAN DUE TO RACE, SEX, AGE, COLOR, CREED, NATIONAL ORIGIN OR INABILITY TO PAY. THE FILING ORGANIZATION'S COMPENSATION ARRANGEMENT DOES NOT USE A METHOD OF COMPENSATION THAT IS BASED UPON A PERCENTAGE OF THE ORGANIZATION'S NET INCOME. RATHER, UNDER THE COMPENSATION ARRANGEMENT, PHYSICIAN BASE SALARY IS SET BASED ON FAIR MARKET VALUE BENCHMARKS, AND ANY ADDITIONAL COMPENSATION IS BASED ON A PERCENTAGE OF THE PRACTICE/LOCATION NET REVENUE.
PART III	PART I, QUESTION 3: AS NOTED IN OUR RESPONSE TO QUESTION 15 OF PART VI OF FORM 990, THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) FOR THAT INDIVIDUAL'S ROLE IN SERVING AS THE CEO. COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC USES ALL OF THE FOLLOWING TO ESTABLISH COMPENSATION OF THE CEO: - COMPENSATION COMMITTEE; - INDEPENDENT COMPENSATION CONSULTANT; - COMPENSATION SURVEY OR STUDY; AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.	SUPPLEMENTAL INFORMATION

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 2	PATRICIA NORTHEY AND JEREMY STEINBAUM, MD - BUSINESS RELATIONSHIP PATRICIA NORTHEY AND RAJENDRA HIPPALGAONKAR, MD - BUSINESS RELATIONSHIP CHARLES GRAY AND JEREMY STEINBAUM, MD - FAMILY RELATIONSHIP
FORM 990, PART VI, SECTION A, LINE 6	SOUTHWEST VOLUSIA HEALTHCARE CORPORATION (SVHC) HAS ONE MEMBER. THE SOLE MEMBER OF SVHC IS ADVENTIST HEALTH SYSTEM SUNBELT, INC. ADVENTIST HEALTH SYSTEM SUNBELT, INC. (AHSS) 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 SVHC.
FORM 990, PART VI, SECTION A, LINE 7A	THE SOLE MEMBER OF SVHC IS AHSS. THE BOARD OF DIRECTORS OF SVHC ARE APPOINTED BY THE SOLE MEMBER, AHSS, WHO HAS THE RIGHT TO ELECT, APPOINT OR REMOVE ANY MEMBER OF THE BOARD OF DIRECTORS OF SVHC.
FORM 990, PART VI, SECTION A, LINE 7B	AHSS, 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 APPOINT AND REMOVE THE DIRECTORS AND ALL OFFICERS AND ADMINISTRATORS 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 THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION; E) TO DIRECT THE PLACEMENT OF FUNDS AND CAPITAL OF THE FILING ORGANIZATION; F) TO APPROVE OR DISAPPROVE CERTAIN PURCHASES OR SALES OF PERSONAL PROPERTY OR REAL PROPERTY EQUAL TO OR IN EXCESS OF ESTABLISHED DOLLAR THRESHOLDS; 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 11	THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND BY THE CFO PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND THE CFO DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES.
FORM 990, PART VI, SECTION B, LINE 12C	THE CONFLICT OF INTEREST POLICY OF SVHC 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 SVHC OR ANY PRINCIPAL OFFICER OF SVHC (I.E. INTERESTED PERSONS) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH SVHC AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS OF SVHC 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 SVHC'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 SVHC'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 SVHC IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. SVHC'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT SVHC OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES.
FORM 990, PART VI, SECTION B, LINE 15	THE TOP-TIER PARENT OF THE FILING ORGANIZATION IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS THE PARENT ORGANIZATION OF A HEALTHCARE SYSTEM, KNOWN AS ADVENTIST HEALTH SYSTEM, THAT OPERATES HOSPITALS, NURSING HOME FACILITIES, AND OTHER HEALTHCARE PROVIDER ORGANIZATIONS. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3) PURSUANT TO A GROUP RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. THE INDIVIDUALS WHO SERVE AS THE CEO, CFO OR VICE PRESIDENT OF THE FILING ORGANIZATION ARE COMPENSATED BY AHSSHC. COMPENSATION AND BENEFITS PROVIDED TO THESE INDIVIDUALS IS DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC HAS TAKEN STEPS TO ENSURE THAT PROCESSES ARE IN PLACE TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS STANDARD AS SET FORTH IN TREASURY REGULATION 53.4958-6 WITH RESPECT TO ITS ACTIVE EXECUTIVE-LEVEL POSITIONS. THE AHSSHC BOARD STRATEGY AND COMPENSATION COMMITTEE (THE COMMITTEE) SERVES AS THE GOVERNING BODY FOR ALL EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE IS COMPOSED OF CERTAIN MEMBERS OF THE BOARD OF DIRECTORS (THE BOARD) OF AHSSHC. VOTING MEMBERS OF THE COMMITTEE INCLUDE ONLY INDIVIDUALS WHO SERVE ON THE BOARD AS INDEPENDENT REPRESENTATIVES OF THE COMMUNITY, WHO HOLD NO EMPLOYMENT POSITIONS WITH AHSSHC AND WHO DO NOT HAVE RELATIONSHIPS WITH ANY OF THE INDIVIDUALS WHOSE COMPENSATION IS UNDER THEIR REVIEW THAT IMPACTS THEIR BEST INDEPENDENT JUDGMENT AS FIDUCIARIES OF AHSSHC. THE COMMITTEE'S ROLE IS TO REVIEW AND APPROVE ALL COMPONENTS OF THE EXECUTIVE COMPENSATION PLAN OF AHSSHC. AS AN INDEPENDENT GOVERNING BODY WITH RESPECT TO EXECUTIVE COMPENSATION, IT SHOULD BE NOTED THAT THE COMMITTEE WILL OFTEN CONFER IN EXECUTIVE SESSIONS ON MATTERS OF COMPENSATION POLICY AND POLICY CHANGES. IN SUCH EXECUTIVE SESSIONS, NO MEMBERS OF MANAGEMENT OF AHSSHC ARE PRESENT. THE COMMITTEE IS ADVISED BY AN INDEPENDENT THIRD PARTY COMPENSATION ADVISOR. THIS ADVISOR PREPARES ALL THE BENCHMARK STUDIES FOR THE COMMITTEE. COMPENSATION LEVELS ARE BENCHMARKED WITH A NATIONAL PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS OF SIMILAR SIZE AND COMPLEXITY TO AHS AND EACH OF ITS AFFILIATED ENTITIES. THE FOLLOWING PRINCIPLES GUIDE THE ESTABLISHMENT OF INDIVIDUAL EXECUTIVE COMPENSATION: - THE SALARY OF THE PRESIDENT/CEO OF AHS WILL NOT EXCEED THE 40TH PERCENTILE OF COMPARABLE SALARIES PAID BY SIMILARLY SITUATED ORGANIZATIONS; AND - OTHER EXECUTIVE SALARIES SHALL BE ESTABLISHED USING MARKET MEDIANS. THE COMPENSATION PHILOSOPHY, POLICIES, AND PRACTICES OF AHSSHC ARE CONSISTENT WITH THE ORGANIZATION'S FAITH-BASED MISSION AND CONFORM TO APPLICABLE LAWS, REGULATIONS, AND BUSINESS PRACTICES. AS A FAITH-BASED ORGANIZATION SPONSORED BY THE SEVENTH-DAY ADVENTIST CHURCH (THE CHURCH), AHSSHC'S PHILOSOPHY AND PRINCIPLES WITH RESPECT TO ITS EXECUTIVE COMPENSATION PRACTICES REFLECT THE CONSERVATIVE APPROACH OF THE CHURCH'S MISSION OF SERVICE AND WERE DEVELOPED IN COUNSEL WITH THE CHURCH'S LEADERSHIP.
FORM 990, PART VI, SECTION C, LINE 19	AS DISCUSSED IN OUR RESPONSE TO QUESTION 15A & B IN SECTION B OF THIS PART VI, THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). EACH YEAR, AHS PUBLISHES AN ANNUAL REPORT DOCUMENT THAT INCLUDES A FINANCIAL REPORT FOR THE RELEVANT YEAR AS WELL AS A COMMUNITY BENEFIT REPORT. THE FINANCIAL REPORT AND COMMUNITY BENEFIT REPORT ARE PRESENTED ON A CONSOLIDATED BASIS AND REPRESENT ALL OF THE ACTIVITIES, RESULTS OF OPERATIONS, AND FINANCIAL POSITION AT YEAR-END OF THE ENTIRE AHS SYSTEM. IN ADDITION, THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF AHS AND OF THE AHS "OBLIGATED GROUP" ARE FILED ANNUALLY WITH THE MUNICIPAL SECURITIES RULEMAKING BOARD (MSRB). THE "OBLIGATED GROUP" IS A GROUP OF AHSSHC SUBSIDIARIES THAT ARE JOINTLY AND SEVERALLY LIABLE UNDER A MASTER TRUST INDENTURE THAT SECURES DEBT PRIMARILY ISSUED ON A TAX-EXEMPT BASIS. UNAUDITED QUARTERLY FINANCIAL STATEMENTS PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) ARE ALSO FILED WITH MSRB FOR AHS ON A CONSOLIDATED BASIS AND FOR THE GROUPING OF AHS SUBSIDIARIES COMPRISING THE "OBLIGATED GROUP". THE FILING ORGANIZATION DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC.
PART VII, SECTION A	FOR THOSE BOARD OF DIRECTOR MEMBERS (NOT INCLUDING PHYSICIAN MEMBERS OF THE BOARD) 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 A	THE 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 (LOSSES) ON DSRF FUNDS 11,794. TRANSFER TO/FROM TAX-EXEMPT PARENT -751,125. DEBT ALLOCATION FROM PARENT 153,509. ROUNDING 1. TOTAL TO FORM 990, PART XI, LINE 5: -585,821.	CHANGES IN NET ASSETS OR FUND BALANCES:
PART X, LINE 2	THE AMOUNTS SHOWN ON LINE 2 OF PART X OF THIS RETURN INCLUDES THE FILING ORGANIZATION'S INTEREST IN A CENTRAL INVESTMENT POOL MAINTAINED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, THE FILING ORGANIZATION'S TOP-TIER PARENT. THE INVESTMENTS IN THE CENTRAL INVESTMENT POOL ARE RECORDED AT MARKET VALUE.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (107 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg	Direct Controlling Entity NADirectControllingEntityNA
ADVENTIST BOLINGBROOK HOSPITAL
500 REMINGTON BLVD	BOLINGBROOK	IL	60440	651219504	OPERATION OF HOSPITAL & RELATED SERVICES	IL	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
ADVENTIST CARE CENTERS - COURTLAND INC
730 COURTLAND STREET	ORLANDO	FL	32804	205774723	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	FL	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
ADVENTIST GLENOAKS HOSPITAL
701 WINTHROP AVENUE	GLENDALE HEIGHTS	IL	60139	363208390	OPERATION OF HOSPITAL & RELATED SERVICES	IL	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
ADVENTIST HLTH MID-AMERICA INC
9100 W 74TH STREET	SHAWNEE MISSION	KS	66204	521347407	HLTHCARE RELATED SERVICES	KS	501(C)(3)	509(A)(3) TYPE I	ADVENTIST HLTH SYSTEMSUNBELT INC	0
ADVENTIST HLTH PARTNERS INC
1000 REMINGTON BLVD STE 200	BOLINGBROOK	IL	60440	364138353	OPERATE OUT-PATIENT PHYSICIAN CLINICS	IL	501(C)(3)	170(B)(1)(A)(III)	AHS MIDWEST MANAGEMENT INC	0
ADVENTIST HLTH SYSTEM AFFILIATED BENEFIT TRUST
111 N ORLANDO AVENUE	WINTER PARK	FL	32789	266422966	PROMOTION OF HLTHCARE	FL	501(C)(3)	509(A)(3) TYPE I	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP
111 N ORLANDO AVENUE	WINTER PARK	FL	32789	592170012	MANAGEMENT SERVICES	FL	501(C)(3)	509(A)(3) TYPE I		0	N/A
ADVENTIST HLTH SYSTEMGEORGIA INC
1035 RED BUD ROAD	CALHOUN	GA	30701	581425000	OPERATION OF HOSPITAL & RELATED SERVICES	GA	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
ADVENTIST HLTH SYSTEMSUNBELT INC
111 N ORLANDO AVENUE	WINTER PARK	FL	32789	591479658	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
ADVENTIST HLTH SYSTEMTEXAS INC
602 COURTLAND STREET	ORLANDO	FL	32804	742578952	INACTIVE	TX	501(C)(3)	509(A)(2)	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
ADVENTIST HINSDALE HOSPITAL
120 NORTH OAK STREET	HINSDALE	IL	60521	362276984	OPERATION OF HOSPITAL & RELATED SERVICES	IL	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
AHS MIDWEST MANAGEMENT INC
1000 REMINGTON BLVD STE 200	BOLINGBROOK	IL	60440	363354567	OPERATION OF PHYSICIAN PRACTICE MGMT	IL	501(C)(3)	509(A)(3) TYPE I	ADVENTIST HLTH SYSTEMSUNBELT INC	0
AHSCENTRAL TEXAS INC
1301 WONDER WORLD DRIVE	SAN MARCOS	TX	78666	742621825	PROVIDE OFFICE SPACE - MEDICAL PROFESSIONALS	TX	501(C)(3)	509(A)(3) TYPE III-F	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
APOPKA HLTH CARE PROPERTIES INC
305 E OAK STREET	APOPKA	FL	32703	510605694	LEASE TO RELATED ORGANIZATION	GA	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
BATTLE CREEK ADVENTIST HOSPITAL
1000 REMINGTON BLVD STE 200	BOLINGBROOK	IL	60440	381359189	INACTIVE	MI	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
BERT FISH MEDICAL CENTER INC (10110-63011)
401 PALMETTO STREET	NEW SMYRNA BEACH	FL	32168	362276984	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
BOLINGBROOK HOSPITAL FOUNDATION
1000 REMINGTON BLVD N ENTRANCE 2ND	BOLINGBROOK	IL	60440	900494445	FUND-RAISING FOR TAX-EXEMPT HOSPITAL	IL	501(C)(3)	170(B)(1)(A)(VI)	MIDWEST HLTH FOUNDATION	0
BRADFORD HEIGHTS HLTH & REHAB CENTER INC
950 HIGHPOINT DRIVE	HOPKINSVILLE	KY	42240	205782342	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	KY	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
BURLESON NURSING & REHAB CENTER INC
301 HUGULEY BLVD	BURLESON	TX	76028	205782243	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	TX	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
CALDWELL HLTH CARE PROPERTIES INC
1333 WEST MAIN	PRINCETON	KY	42445	510605680	LEASE TO RELATED ORGANIZATION	GA	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
CENTRAL TEXAS HLTHCARE COLLABORATIVE (112-123111)
1301 WONDER WORLD DRIVE	SAN MARCOS	TX	78666	453739929	SUPPORT OPERATION OF HOSPITAL	TX	501(C)(3)	509(A)(3) TYPE I	ADVENTIST HLTH SYSTEMSUNBELT INC	0
CEDAR CRAG TERRACE INC (630 YEAR END)
RT 5 BOX 900	MANCHESTER	KY	40962	611120442	OPERATION OF HOME FOR THE ELDERLY-DISABLED	KY	501(C)(3)	170(B)(1)(A)(VI)	MEMORIAL HOSPITAL INC	0
CENTRAL TEXAS MEDICAL CENTER FOUNDATION
1301 WONDER WORLD DRIVE	SAN MARCOS	TX	78666	742259907	FUND-RAISING FOR TAX-EXEMPT HOSPITAL	TX	501(C)(3)	170(B)(1)(A)(VI)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
CHICKASAW HLTH CARE PROPERTIES INC
250 S CHICKASAW TRAIL	ORLANDO	FL	32825	510605681	LEASE TO RELATED ORGANIZATION	GA	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
CHIPPEWA VALLEY HOSPITAL & OAKVIEW CARE CENTER INC
1220 THIRD AVENUE WEST	DURAND	WI	54736	391365168	OPERATION OF HOSPITAL & RELATED SERVICES	WI	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
COBB MEDICAL ASSOCIATES LLC
3949 SOUTH COBB DRIVE SE	SMYRNA	GA	300806342	582617089	OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES	GA	501(C)(3)	170(B)(1)(A)(III)	EMORY-ADVENTIST INC	0
COURTLAND HLTH CARE PROPERTIES INC
730 COURTLAND STREET	ORLANDO	FL	32804	510605682	LEASE TO RELATED ORGANIZATION	GA	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
CREEKWOOD PLACE NURSING & REHAB CENTER INC
683 E THIRD STREET	RUSSELLVILLE	KY	42276	205782260	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	KY	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
DAIRY ROAD HLTH CARE PROPERTIES INC
7350 DAIRY ROAD	ZEPHYRHILLS	FL	33540	510605684	LEASE TO RELATED ORGANIZATION	GA	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
EAST ORLANDO HLTH & REHAB CENTER INC
250 S CHICKASAW TRAIL	ORLANDO	FL	32825	205774748	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	FL	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
EMORY-ADVENTIST INC
3949 SOUTH COBB DRIVE	SMYRNA	GA	30080	582171011	OPERATION OF HOSPITAL & RELATED SVCS	GA	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
FLETCHER HOSPITAL INC
100 HOSPITAL DRIVE	HENDERSONVILLE	NC	28792	560543246	OPERATION OF HOSPITAL & RELATED SVCS	NC	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
FLNC INC
3355 E SEMORAN BLVD	APOPKA	FL	32703	205774761	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	FL	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
FLORIDA HOSPITAL COLLEGE OF HLTH SCIENCES INC (630 YEAR END)
671 LAKE WINYAH DRIVE	ORLANDO	FL	32803	593069793	EDUCATION/OPERATION OF SCHOOL	FL	501(C)(3)	170(B)(1)(A)(II)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
FLORIDA HOSPITAL DELAND AUXILIARY INC (11-82411)
701 WEST PLYMOUTH AVENUE	DELAND	FL	32720	593425543	VOLUNTEER SUPPORT SERVICES	FL	501(C)(3)	509(A)(3) TYPE III-F	MEMORIAL HOSPITAL WEST VOLUSIA INC	0
FLORIDA HOSPITAL WATERMAN INC
1000 WATERMAN WAY	TAVARES	FL	32778	593140669	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
FLORIDA HOSPITAL ZEPHYRHILLS INC
7050 GALL BLVD	ZEPHYRHILLS	FL	33541	592108057	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
FLORIDA HOSPITAL MEDICAL GROUP INC
900 WINDERLEY PLACE	MAITLAND	FL	32751	593214635	OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES	FL	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
FOUNDATION FOR SHAWNEE MISSION MEDICAL CENTER INC
9100 W 74TH STREET	SHAWNEE MISSION	KS	66204	480868859	FUND-RAISING FOR TAX-EXEMPT HOSPITAL	KS	501(C)(3)	509(A)(3) TYPE I	SHAWNEE MISSION MEDICAL CENTER INC	0
GLENOAKS HOSPITAL FOUNDATION
701 WINTHROP AVENUE	GLENDALE HEIGHTS	IL	60139	363926044	FUND-RAISING FOR TAX-EXEMPT HOSPITAL	IL	501(C)(3)	170(B)(1)(A)(VI)	MIDWEST HLTH FOUNDATION	0
HAYS MEMORIAL HOSPITAL ASSOCIATION OF SEVENTH-DAY ADVENTISTS
1301 WONDER WORLD DRIVE	SAN MARCOS	TX	78667	741362785	LEASE OF HOSPITAL PERSONNEL	TX	501(C)(3)	509(A)(3) TYPE II	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
HELEN ELLIS MEMORIAL HOSPITAL AUXILIARY INC
1395 S PINELLAS AVE	TARPON SPRINGS	FL	34689	592106043	FUND-RAISING FOR TAX-EXEMPT HOSPITAL/FOUNDATION	FL	501(C)(3)	509(A)(3) TYPE I	TARPON SPRINGS HOSPITAL FOUNDATION INC	0
HELEN ELLIS MEMORIAL HOSPITAL FOUNDATION INC
1395 S PINELLAS AVE	TARPON SPRINGS	FL	34689	593690149	FUND-RAISING FOR TAX-EXEMPT HOSPITAL	FL	501(C)(3)	509(A)(3) TYPE I	TARPON SPRINGS HOSPITAL FOUNDATION INC	0
HINSDALE HOSPITAL FOUNDATION
7 SALT CREEK LANE SUITE 203	HINSDALE	IL	60521	521466387	FUND-RAISING FOR TAX-EXEMPT HOSPITAL	IL	501(C)(3)	170(B)(1)(A)(VI)	MIDWEST HLTH FOUNDATION	0
HUGULEY COMMUNITY CARE CORP
11801 SOUTH FREEWAY	BURLESON	TX	76028	452793120	SUPPORT OPERATION OF HOSPITAL	TX	501(C)(3)	509(A)(3) TYPE I	ADVENTIST HLTH SYSTEMSUNBELT INC	0
IN-MOTION REHAB INC
602 COURTLAND STREET STE 200	ORLANDO	FL	32804	208023411	THERAPY SERVICES TO TAX EXEMPT NURSING HOMES	KS	501(C)(3)	509(A)(3) TYPE II	SUNBELT HLTH CARE CENTERS INC	0
JELLICO COMMUNITY HOSPITAL INC
188 HOSPITAL LANE	JELLICO	TN	37762	620924706	OPERATION OF HOSPITAL & RELATED SERVICES	TN	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
LA GRANGE MEMORIAL HOSPITAL FOUNDATION
5101 S WILLOW SPRINGS RD	LA GRANGE	IL	60525	300247776	FUND-RAISING FOR TAX-EXEMPT HOSPITAL	IL	501(C)(3)	170(B)(1)(A)(VI)	MIDWEST HLTH FOUNDATION	0
MEMORIAL HLTH SYSTEMS FOUNDATION INC
770 WEST GRANADA BLVD	ORMOND BEACH	FL	32174	311771522	FUND-RAISING FOR TAX-EXEMPT HOSPITAL	FL	501(C)(3)	170(B)(1)(A)(VI)	MEMORIAL HLTH SYSTEMS INC	0
MEMORIAL HLTH SYSTEMS INC
301 MEMORIAL MEDICAL PARKWAY	DAYTONA BEACH	FL	32117	590973502	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
MEMORIAL HOSPITAL FLAGLER INC
60 MEMORIAL MEDICAL PARKWAY	PALM COAST	FL	32164	592951990	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	170(B)(1)(A)(III)	MEMORIAL HLTH SYSTEMS INC	0
MEMORIAL HOSPITAL - WEST VOLUSIA INC
701 WEST PLYMOUTH AVENUE	DELAND	FL	32720	593256803	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	170(B)(1)(A)(III)	MEMORIAL HLTH SYSTEMS INC	0
MEMORIAL HOSPITAL INC
210 MARIE LANGDON DRIVE	MANCHESTER	KY	40962	610594620	OPERATION OF HOSPITAL & RELATED SERVICES	KY	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
MERRIAM HLTH CARE PROPERTIES INC
9700 WEST 62ND STREET	MERRIAM	KS	66203	364595806	LEASE TO RELATED ORGANIZATION	KS	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
METROPLEX ADVENTIST HOSPITAL INC
2201 S CLEAR CREEK ROAD	KILLEEN	TX	76549	742225672	OPERATION OF HOSPITAL & RELATED SERVICES	TX	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
METROPLEX CLINIC PHYSICIANS INC
2201 S CLEAR CREEK ROAD	KILLEEN	TX	76549	113762050	PHYSICIAN HLTHCARE SERVICES TO THE COMMUNITY	TX	501(C)(3)	170(B)(1)(A)(III)	METROPLEX ADVENTIST HOSPITAL INC	0
MIDWEST HLTH FOUNDATION
120 NORTH OAK STREET	HINSDALE	IL	60521	352230515	SUPPORT OF SUBSIDIARY FOUNDATIONS	IL	501(C)(3)	509(A)(3) TYPE II		0	N/A
MILLS HLTH & REHAB CENTER INC
500 BECK LANE	MAYFIELD	KY	42066	205782320	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	KY	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
MISSION STRATEGIES INC
602 COURTLAND STREET STE 200	ORLANDO	FL	32804	205982365	PROVISION OF SUPPORT TO THE NURSING HOME DIVISION	KS	501(C)(3)	509(A)(3) TYPE II	SUNBELT HLTH CARE CENTERS INC	0
MISSION STRATEGIES OF GEORGIA INC (1114-123111)
3949 S COBB DRIVE	SMYRNA	GA	30080	900866024	PROVISION OF SUPPORT TO THE NURSING HOME DIVISION	GA	501(C)(3)	509(A)(3) TYPE II	SUNBELT HLTH CARE CENTERS INC	0
MISSOURI ADVENTIST HLTH INC
9100 W 74TH STREET	SHAWNEE MISSION	KS	66204	431224729	SUPPORT HLTH CARE SERVICES	MO	501(C)(3)	509(A)(3) TYPE III-O	ADVENTIST HLTH MID-AMERICA INC	0
NORTH REGIONAL EMS INC
188 HOSPITAL LANE	JELLICO	TN	37762	262653616	EMS SERVICES	TN	501(C)(3)	509(A)(2)	JELLICO COMMUNITY HOSPITAL INC	0
ORMOND BEACH MEMORIAL HOSPITAL AUXILIARY INC
301 MEMORIAL MEDICAL PARKWAY	DAYTONA BEACH	FL	32117	591721962	VOLUNTEER SUPPORT SERVICES	FL	501(C)(3)	509(A)(3) TYPE III-F	MEMORIAL HLTH SYSTEMS INC	0
OVERLAND PARK NURSING & REHAB CENTER INC
6501 WEST 75TH STREET	OVERLAND PARK	KS	66204	205774821	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	KS	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
PARAGON HLTH CARE PROPERTIES INC
950 HIGHPOINT DRIVE	HOPKINSVILLE	KY	42240	510605686	LEASE TO RELATED ORGANIZATION	GA	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
PASCO-PINELLAS HILLSBOROUGH COMMUNITY HLTH SYSTEM INC
2400 BEDFORD ROAD	ORLANDO	FL	32803	208488713	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	170(B)(1)(A)(III)		0	N/A
PORTERCARE ADVENTIST HLTH SYSTEM (630 YEAR END)
2525 S DOWNING STREET	DENVER	CO	80210	840438224	OPERATION OF HOSPITAL & RELATED SERVICES	CO	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
PORTLAND NURSING & REHAB CENTER INC
215 HIGHLAND CIRCLE DRIVE	PORTLAND	TN	37148	205774842	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	TN	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
PRINCETON HLTH & REHAB CENTER INC
1333 WEST MAIN	PRINCETON	KY	42445	205782272	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	KY	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
PRINCETON PROFESSIONAL SERVICES INC
601 E ROLLINS STREET	ORLANDO	FL	32803	591191045	PROVISION OF HLTHCARE SERVICES	FL	501(C)(3)	509(A)(2)	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
QUALITY CIRCLE FOR HLTHCARE INC
111 N ORLANDO AVENUE	WINTER PARK	FL	32789	263789368	HLTHCARE QUALITY SERVICES	FL	501(C)(3)	509(A)(3) TYPE III-F	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
RESOURCE PERSONNEL INC
602 COURTLAND STREET STE 200	ORLANDO	FL	32804	208040875	PROVIDE ADMINISTRATIVE SUPPORT TO TAX EXEMPT NURSING HOMES	FL	501(C)(3)	509(A)(3) TYPE II	SUNBELT HLTH CARE CENTERS INC	0
ROCKY MOUNTAIN ADVENTIST HLTHCARE FOUNDATION (630 YEAR END)
2525 SOUTH DOWNING STREET	DENVER	CO	80210	840745018	FUND-RAISING FOR TAX-EXEMPT HOSPITAL	CO	501(C)(3)	170(B)(1)(A)(VI)	PORTERCARE ADVENTIST HLTH SYSTEM	0
ROLLINS BEDFORD CORP
602 COURTLAND STREET STE 200	ORLANDO	FL	32804	370908840	INACTIVE	FL	501(C)(3)	509(A)(3) TYPE II	SUNBELT HLTH CARE CENTERS INC	0
RUSSELLVILLE HLTH CARE PROPERTIES INC
683 EAST THIRD STREET	RUSSELLVILLE	KY	42276	510605691	LEASE TO RELATED ORGANIZATION	GA	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
SAN MARCOS HLTH CARE PROPERTIES INC
1900 MEDICAL PARKWAY	SAN MARCOS	TX	78666	510605693	LEASE TO RELATED ORGANIZATION	GA	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
SAN MARCOS NURSING & REHAB CENTER INC
1900 MEDICAL PARKWAY	SAN MARCOS	TX	78666	205782224	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	TX	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
SHAWNEE MISSION HLTH CARE INC
6501 WEST 75TH STREET	OVERLAND PARK	KS	66204	480952508	LEASE TO RELATED ORGANIZATION	KS	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
SHAWNEE MISSION MEDICAL CENTER INC
9100 W 74TH STREET	SHAWNEE MISSION	KS	66204	480637331	OPERATION OF HOSPITAL & RELATED SERVICES	KS	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH MID-AMERICA INC	0
SOUTH CENTRAL NURSING HOMES PROPERTIES INC
111 NORTH ORLANDO AVE	WINTER PARK	FL	32789	593686109	MANAGEMENT SUPPORT	GA	501(C)(3)	509(A)(3) TYPE III-O	SOUTH CENTRAL INC	0
SOUTH CENTRAL NURSING HOMES INC
602 COURTLAND STREET	ORLANDO	FL	32804	611242373	MANAGEMENT SUPPORT	KY	501(C)(3)	509(A)(3) TYPE III-O	SOUTH CENTRAL INC	0
SOUTH CENTRAL PROPERTIES III INC
111 NORTH ORLANDO AVE	WINTER PARK	FL	32789	593692860	REAL ESTATE	GA	501(C)(2)		SOUTH CENTRAL NURSING HOMES PROPERTIES INC	0
SOUTH CENTRAL PROPERTIES IV INC
111 NORTH ORLANDO AVE	WINTER PARK	FL	32789	593692862	REAL ESTATE	GA	501(C)(2)		SOUTH CENTRAL NURSING HOMES PROPERTIES INC	0
SOUTH CENTRAL PROPERTIES VI INC
111 NORTH ORLANDO AVE	WINTER PARK	FL	32789	593692857	REAL ESTATE	GA	501(C)(2)		SOUTH CENTRAL NURSING HOMES PROPERTIES INC	0
SOUTH CENTRAL PROPERTIES INC
111 NORTH ORLANDO AVE	WINTER PARK	FL	32789	593651692	REAL ESTATE	GA	501(C)(2)		SOUTH CENTRAL NURSING HOMES PROPERTIES INC	0
SOUTH CENTRAL INC
602 COURTLAND STREET	ORLANDO	FL	32804	593689740	MANAGEMENT SUPPORT	GA	501(C)(3)	509(A)(3) TYPE III-F		0	N/A
SOUTH PASCO HLTH CARE PROPERTIES INC
38250 A AVENUE	ZEPHYRHILLS	FL	33542	510605679	LEASE TO RELATED ORGANIZATION	GA	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
SOUTHWEST VOLUSIA HLTH SERVICES INC
1055 SAXON BLVD	ORANGE CITY	FL	327638468	593281591	MEDICAL OFFICE BUILDING FOR HOSPITAL	FL	501(C)(3)	509(A)(3) TYPE I	SOUTHWEST VOLUSIA HLTHCARE CORP	1
SOUTHWEST VOLUSIA HLTHCARE CORP
1055 SAXON BLVD	ORANGE CITY	FL	327638468	593149293	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
SPECIALTY PHYSICIANS OF CENTRAL TEXAS INC
1301 WONDER WORLD DRIVE	SAN MARCOS	TX	78666	208814408	PHYSICIAN HLTHCARE SERVICES TO THE COMMUNITY	TX	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
SPRING VIEW HLTH & REHAB CENTER INC
718 GOODWIN LANE	LEITCHFIELD	KY	42754	205782288	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	KY	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
SUNBELT HLTH & REHAB CENTER - APOPKA INC
305 EAST OAK STREET	APOPKA	FL	32703	205774856	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	FL	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
SUNBELT HLTH CARE CENTERS INC
602 COURTLAND STREET STE 200	ORLANDO	FL	32804	581473135	MANAGEMENT SERVICES	TN	501(C)(3)	509(A)(3) TYPE II	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
SUNSYSTEM DEVELOPMENT CORP
111 N ORLANDO AVENUE	WINTER PARK	FL	32789	592219301	FUND RAISING FOR AFFILIATED TAX-EXEMPT HOSPITALS	FL	501(C)(3)	170(B)(1)(A)(VI)	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
TARPON SPRINGS HOSPITAL FOUNDATION INC
1395 S PINELLAS AVE	TARPON SPRINGS	FL	34689	590898901	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	170(B)(1)(A)(III)	UNIVERSITY COMMUNITY HOSPITAL INC	0
TARRANT COUNTY HLTH CARE PROPERTIES INC
301 HUGULEY BLVD	BURLESON	TX	76028	510605677	LEASE TO RELATED ORGANIZATION	GA	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
TAYLOR CREEK HLTH CARE PROPERTIES INC
718 GOODWIN LANE	LEITCHFIELD	KY	42754	510605678	LEASE TO RELATED ORGANIZATION	GA	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
TEXAS HLTH HUGULEY INC (76-123111)
900 HOPE WAY	ALTAMONTE SPRINGS	FL	32714	452694620	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEMSUNBELT INC	0
THE VOLUNTEER AUXILIARY OF FLORIDA HOSPITAL - FLAGLER INC
60 MEMORIAL MEDICAL PARKWAY	PALM COAST	FL	32164	592486582	VOLUNTEER SUPPORT SERVICES	FL	501(C)(3)	509(A)(3) TYPE III-F	MEMORIAL HOSPITAL FLAGLER INC	0
TRINITY NURSING & REHAB CENTER INC
9700 WEST 62ND STREET	MERRIAM	KS	66203	205774890	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	KS	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
UNIVERSITY COMMUNITY HOSPITAL AUXILIARY INC
3100 E FLETCHER AVE	TAMPA	FL	33613	237011345	VOLUNTEER SUPPORT SERVICES	FL	501(C)(3)	509(A)(3) TYPE III-F	UNIVERSITY COMMUNITY HOSPITAL INC	0
UNIVERSITY COMMUNITY HOSPITAL FOUNDATION INC
3100 E FLETCHER AVE	TAMPA	FL	33613	592554889	FUND-RAISING FOR TAX-EXEMPT HOSPITAL	FL	501(C)(3)	509(A)(3) TYPE I	UNIVERSITY COMMUNITY HOSPITAL INC	0
UNIVERSITY COMMUNITY HOSPITAL SPECIALTY CARE INC
3100 E FLETCHER AVE	TAMPA	FL	33613	593231322	INACTIVE	FL	501(C)(3)	509(A)(3)	UNIVERSITY COMMUNITY HOSPITAL INC	0
UNIVERSITY COMMUNITY HOSPITAL INC
3100 E FLETCHER AVE	TAMPA	FL	33613	591113901	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	170(B)(1)(A)(III)	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	0
WEST KENTUCKY HLTH CARE PROPERTIES INC
500 BECK LANE	MAYFIELD	KY	42066	510605676	LEASE TO RELATED ORGANIZATION	GA	501(C)(3)	509(A)(3) TYPE III-F	SUNBELT HLTH CARE CENTERS INC	0
ZEPHYR HAVEN HLTH & REHAB CENTER INC
38250 A AVENUE	ZEPHYRHILLS	FL	33542	205774930	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	FL	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0
ZEPHYRHILLS HLTH & REHAB CENTER INC
7350 DAIRY ROAD	ZEPHYRHILLS	FL	33540	205774967	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	FL	501(C)(3)	509(A)(2)	SUNBELT HLTH CARE CENTERS INC	0

Form990 Schedule R Part III Form990ScheduleRPartIII (10 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Direct Controlling Entity NADirectControllingEntityNA
APPALACHIAN THERAPY SERVICES LLC
100 HOSPITAL DRIVE	HENDERSONVILLE	NC	28792	202463851	THERAPY STAFFING	NC	N/A
CENTRAL TEXAS MEDICAL CENTER BOND LLC (11-111411)
1301 WONDER WORLD DRIVE	SAN MARCOS	TX	78666	204314236	INVESTMENT	TX	N/A
CLEAR CREEK MOB LTD
2201 S CLEAR CREEK RD	KILLEEN	TX	76549	742609195	REAL ESTATE	TX	N/A
FLORIDA HOSPITAL DMERT LLC
2450 MAITLAND CENTER PKWY STE 200	MAITLAND	FL	32751	202392253	MEDICAL EQUIPMENT	FL	N/A
FLORIDA HOSPITAL HOME INFUSION
2450 MAITLAND CENTER PKWY STE 200	MAITLAND	FL	32751	593142824	HOME INFUSION SERVICES	FL	N/A
KCCCSMMC CANCER CENTER LLC
9100 W 74TH STREET	SHAWNEE MISSION	KS	66204	270909763	EQUIPMENT RENTAL	KS	N/A
SAN MARCOS MRI LP
1330 WONDER WORLD DRIVE STE 202	SAN MARCOS	TX	78666	770597972	IMAGING & TESTING	TX	N/A
SHAWNEE MISSION OPEN MRI LLC
9100 W 74TH STREET BOX 2923	SHAWNEE MISSION	KS	66201	270011796	IMAGING & TESTING	KS	N/A
SHAWNEE MISSION SURGERY CENTER LLC
PO BOX 2923	SHAWNEE MISSION	KS	66201	481243914	SURGICAL SERVICES	KS	N/A
SKYLAND MRI LLC
100 HOSPITAL DRIVE	HENDERSONVILLE	NC	28792	043646559	IMAGING & TESTING	NC	N/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (32 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Direct Controlling Entity NADirectControllingEntityNA	Type Of EntityTypeOfEntity	Address Line1AddressForeign/AddressLine1	Province Or StateAddressForeign/ProvinceOrState	CountryAddressForeign/Country	Legal Domicile Foreign CountryLegalDomicileForeignCountry
ADVENTIST HLTH SYS SUNBELT HLTHCARE CORP EMPL BENEFIT TRUST
111 N ORLANDO AVENUE	WINTER PARK	FL	32789	581318939	ADMINISTRATION OF SELF-INSURED BENEFIT PLANS	FL	N/A	T
AHS SERVICES INC
11801 SOUTH FREEWAY	FORT WORTH	TX	76028	752049583	MEDICAL EQUIPMENT	TX	N/A	C
ALTAMONTE MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC
601 EAST ROLLINS STREET	ORLANDO	FL	32803	592855792	CONDO ASSOCIATION	FL	N/A	C
APOPKA MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC
601 EAST ROLLINS STREET	ORLANDO	FL	32803	593000857	CONDO ASSOCIATION	FL	N/A	C
ARAPAHOE MEDICAL BUILDING I INC (630 YEAR END)
2525 S DOWNING STREET	DENVER	CO	80210	841574506	REAL ESTATE LEASING	CO	N/A	C
ARAPAHOE MEDICAL BUILDING II INC (630 YEAR END)
2525 S DOWNING STREET	DENVER	CO	80210	841574507	REAL ESTATE LEASING	CO	N/A	C
CC MOB INC
2201 S CLEAR CREEK ROAD	KILLEEN	TX	76549	742616875	REAL ESTATE RENTAL	TX	N/A	C
CENTRAL TEXAS MEDICAL ASSOCIATES
1301 WONDER WORLD DRIVE	SAN MARCOS	TX	78666	742729873	PHYSICIAN CLINICS	TX	N/A	C
CENTRAL TEXAS PROVIDER'S NETWORK
1301 WONDER WORLD DRIVE	SAN MARCOS	TX	78666	742827652	PHYSICIAN HOSPITAL ORG.	TX	N/A	C
FLORIDA HOSPITAL FLAGLER MEDICAL OFFICES ASSOCIATION INC
60 MEMORIAL MEDICAL PARKWAY	PALM COAST	FL	32164	262158309	CONDO ASSOCIATION	FL	N/A	C
FLORIDA HOSPITAL HEALTHCARE SYSTEM INC
602 COURTLAND STREET	ORLANDO	FL	32804	593215680	PHO/TPA	FL	N/A	C
FLORIDA MEDICAL PLAZA CONDO ASSOCIATION INC
601 EAST ROLLINS STREET	ORLANDO	FL	32803	592855791	CONDO ASSOCIATION	FL	N/A	C
FLORIDA MEMORIAL HEALTH NETWORK INC
770 W GRANADA BLVD STE 317	ORMOND BEACH	FL	32174	593403558	PHYSICIAN HOSPITAL ORG.	FL	N/A	C
HARVARD PARK EAST INC (630 YEAR END)
2525 S DOWNING STREET	DENVER	CO	80210	841574365	REAL ESTATE LEASING	CO	N/A	C
HELEN ELLIS MEMORIAL HOSPITAL REAL ESTATE CORP
1395 S PINELLAS AVE	TARPON SPRINGS	FL	34689	593375731	REAL ESTATE RENTAL	FL	N/A	C
HUGULEY ALLIANCE FOUNDATION
11801 SOUTH FREEWAY	FORT WORTH	TX	76115	752642209	INACTIVE	TX	N/A	C
HUGULEY MEDICAL ASSOCIATES INC
11801 SOUTH FREEWAY	BURLESON	TX	76028	752547668	PHYSICIAN CLINICS	TX	N/A	C
KISSIMMEE MULTISPECIALTY CLINIC CONDOMINIUM ASSOCIATION INC
201 HILDA STREET SUITE 30	KISSIMMEE	FL	34741	593539564	CONDO ASSOCIATION	FL	N/A	C
MIDWEST MANAGEMENT SERVICES INC
9100 WEST 74TH STREET	SHAWNEE MISSION	KS	66204	480901551	REAL ESTATE RENTAL	KS	N/A	C
METROPLEX ADVENTIST HOSPITAL CRNA
2201 S CLEAR CREEK ROAD	KILLEEN	TX	76549	260760794	SUPPORT HOSPITAL - PROVIDE ALLIED HEALTH PROFESSIONALS	TX	N/A	C
NORTH AMERICAN HEALTH SERVICES INC & SUBS
111 N ORLANDO AVENUE	WINTER PARK	FL	32789	621041820	LESSOR/HOLDING CO.	TN	N/A	C
ORMOND PROFESSIONAL CONDO ASSOCIATION (430 YEAR END)
770 W GRANADA BLVD STE 101	ORMOND BEACH	FL	32174	592694434	CONDO ASSOCIATION	FL	N/A	C
PARK RIDGE PROPERTY OWNER'S ASSOCIATION INC
1 PARK PLACE NAPLES ROAD	FLETCHER	NC	28732	030380531	CONDO ASSOCIATION	NC	N/A	C
PORTER AFFILIATED HLTH SERVICES INC DBA DIVERSIFIED AFFILIATED HLTH SVCS
2525 S DOWNING STREET	DENVER	CO	80210	840956175	HEALTHCARE SERVICES	CO	N/A	C
PORTER MEDICAL PLAZA INC (630 YEAR END)
2525 S DOWNING STREET	DENVER	CO	80210	841574369	REAL ESTATE LEASING	CO	N/A	C
SAN MARCOS REGIONAL MRI INC
1301 WONDER WORLD DRIVE	SAN MARCOS	TX	78666	770597968	HOLDING COMPANY	TX	N/A	C
SOUTHEAST VOLUSIA MEDICAL SERVICES INC (10110-63011)
401 PALMETTO STREET	NEW SMYRNA BEACH	FL	32168	593287185	INACTIVE	FL	N/A	C
THE GARDEN RETIREMENT COMMUNITY INC
602 COURTLAND STREET STE 200	ORLANDO	FL	32804	593414055	REAL ESTATE RENTAL	FL	N/A	C
UNIVERSITY COMMUNITY HEALTH INSURANCE COMPANY SPC LTD
					CAPTIVE INSURANCE		N/A	C	C/O AON INSURANCE MANAGERS PO BOX	GRAND CAYMAN	CJ	CJ
UCH SERVICES INC
3100 EAST FLETCHER AVE	TAMPA	FL	33613	593508454	MANAGEMENT COMPANY	FL	N/A	C
WEST COAST MEDICAL GROUP INC
1395 S PINELLAS AVE	TARPON SPRINGS	FL	34689	593537305	PHYSICIAN CLINICS	FL	N/A	C
WINTER PARK MEDICAL OFFICE BUILDING I CONDO ASSOC INC (330-123111)
200 LAKEMONT AVE	WINTER PARK	FL	32792	452228478	PHYSICIAN CLINICS	FL	N/A	C

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	0	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	1	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	0	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	0	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	1	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	0	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	1	PerformOfServicesByOtherOrgs
Sharing Of Facilities	0	SharingOfFacilities
Sharing Of Paid Employees	0	SharingOfPaidEmployees
Reimbursement Paid To Other Org	1	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	1	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	0	OtherTransferToOtherOrg
Other Transfer From Other Org	0	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (12 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION
L	1209756	% OF FACILITY'S OPER. EXP.
ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION DBA AHS IS
L	4360616	% OF FACILITY'S OPER. EXP.
ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION
O	4546826	COST
ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION
B	751125	AMOUNT GIVEN
MEMORIAL HEALTH SYSTEMS INC
L	740615	COST PLUS APPROPRIATE MARGIN
MEMORIAL HOSPITAL - WEST VOLUSIA INC
O	284458	COST
ADVENTIST HEALTH SYSTEMSUNBELT INC DBA FLORIDA HOSPITAL
O	403512	COST
SOUTHWEST VOLUSIA HEALTH SERVICES INC
J	714511	COST PLUS APPROPRIATE MARGIN
SUNSYSTEM DEVELOPMENT CORPORATION DBA FLORIDA HOSPITAL FISH MEMORIAL FOUND
B	158283	AMOUNT GIVEN
ADVENTIST HEALTH SYSTEMSUNBELT INC DBA FLORIDA HOSPITAL
P	67604	COST
MEMORIAL HOSPITAL - WEST VOLUSIA INC
P	65165	COST
FLORIDA MEMORIAL HEALTH NETWORK INC
L	5872383	COST PLUS APPROPRIATE MARGIN