2011-11-14T10:50:54-06:00 2010-12-31 990 2010-01-01 593149293 SOUTHWEST VOLUSIA HEALTHCARE CORPORATION SOUT 3869175000 1055 SAXON BOULEVARD ORANGE CITY FL 327638468 LYNN C ADDISCOTT 4079751464 2011-11-11 2010 2016-02-24 21:20:13Z FLORIDA HOSPITAL FISH MEMORIAL ED NOSEWORTHY 1055 SAXON BOULEVARD ORANGE CITY FL 327638468 144477856 0 X WWW.FHFISHMEMORIAL.ORG X 1992 FL THE PROVISION OF MEDICAL CARE TO THE COMMUNITY SERVED THROUGH THE OPERATION OF A 139 BED HOSPITAL. 13 4 1224 186 2810 0 73197 0 138233630 142452138 2028514 2061978 -132702 -37625 140202639 144476491 144452 152705 0 0 56644185 58271619 0 0 0 72551361 73367183 129339998 131791507 10862641 12684984 136867735 148144238 84117107 83383457 52750628 64760781 ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION AND ALL OF ITS SUBSIDIARY ORGANIZATIONS WERE ESTABLISHED BY THE SEVENTH-DAY ADVENTIST CHURCH TO BRING A MINISTRY OF HEALING AND HEALTH TO THE COMMUNITIES SERVED. OUR MISSION IS TO EXTEND THE HEALING MINISTRY OF CHRIST. 0 0 124627598 152705 142449328 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 9,122 PATIENT ADMISSIONS RESULTING IN 38,683 PATIENT DAYS DURING THE CURRENT YEAR. 124627598 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 107 0 1 1224 1 1 1 0 0 0 0 0 0 0 0 0 X 13 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X MIKE LUKENS 3869175017 1055 SAXON BOULEVARD ORANGE CITY FL 327638468 X AMILINENI MD RAM 4.00 X 26694 0 0 BRADLEY KENNETH W 0.30 X 0 389556 69048 GRAY CHARLES 0.30 X 0 0 0 HAYNES TIM 0.30 X 0 0 0 HIPPALGAONKAR RAJENDRA 11.00 X 80750 0 0 MATTISON KENNNETH R 0.30 X 0 471337 81749 MORRISON RICHARD E 0.30 X 0 397585 54628 NORTHEY PATRICIA 0.30 X 1773 0 0 PATTERSON PAT 0.30 X 0 0 0 SCHULTZ MICHAEL H 0.30 X 0 1753215 138723 STEINBAUM MD JEREMY 7.50 X 56100 0 0 TOL DARYL L 0.30 X 0 424562 80284 WOODRUFF GEORGE 2.00 X 4876 0 0 JOHNSON JOEL D 50.00 X X 0 622580 84230 LUKENS MICHAEL B 50.00 X 823 236328 43390 BERGHERM BRUCE LEFT IN 2010 50.00 X 0 269860 49324 SHULL JENNIFER M 50.00 X 16943 184165 29727 BESONG GEORGE T MD 50.00 X 432959 0 17688 PARIKH NITIN J MD 50.00 X 431442 0 17747 HAYNE WALTER MD 50.00 X 322826 0 12847 SHOUKAS MD JAMES 50.00 X 272500 0 11925 KALLA MD SHRISH 50.00 X 254914 0 17597 LOWE EVELYN M 0.00 X 0 190486 17801 FOWLER SUE 0.00 X 0 121986 9567 1902600 5061660 736275 32 1 1 0 CENTRAL FLORIDA MEDICAL IMAGING 1053 MEDICAL CENTER DR 151 ORANGE CITY FL 32763 RADIOLOGY SERVICE 1626082 DIVERSIFIED CLINICAL SERVICES PO BOX 636981 CINCINNATI OH 45263 WOUND CARE STAFFING 987478 ELITE MEDICAL STAFFING PO BOX 60839 CHARLOTTE NC 28260 NURSING AGENCY 908255 JLR ANESTHESIAJLR MEDICAL GROUP PO BOX 948075 MAITLAND FL 32794 ANESTHESIA SERVICE 890615 MAXIM HEALTHCARE SERVICES 12558 COLLECTION CENTER DR CHICAGO IL 60693 NURSING AGENCY 838172 19 NET PATIENT REVENUE 900099 141717850 141717850 CAFETERIA REVENUE 900099 524513 524513 GIFT SHOP REVENUE 900099 75886 75886 HOUSEKEEPING 900099 68753 68753 FITNESS CENTER REVENUE 900099 17745 17745 47391 44581 2810 142452138 611502 611502 1451221 620 1365 1451221 -745 1450476 1450476 EQUITY EARNINGS FROM R 900099 -37625 -37625 -37625 144476491 142411703 2810 2061978 152705 152705 1707563 1707563 43187719 43187719 1564069 1529649 34420 8413394 8413394 3398874 3323891 74983 29694 29694 83600 83600 15337639 12629524 2708115 687125 687125 24673074 23926282 746792 4772990 4089924 683066 3695513 3695513 139166 139166 40555 40555 3525697 3525697 6427292 6427292 922131 899053 23078 BAD DEBT EXPENSE 7816292 7816292 REPAIRS & MAINTENANCE 3421418 3421418 STATE TAX INDIGENT ASSE 1514961 1514961 PURCHASED SERVICES 119913 119913 160123 74284 85839 131791507 124627598 7163909 0 2436 2436 53210826 67658617 16445578 14987159 1458293 2075215 3729550 4498556 136069532 81157212 57975640 54912320 508279 470654 314990 134613 3222143 3404668 136867735 148144238 5839962 6047754 39045 21857 78238100 77313846 84117107 83383457 X 52726793 64745946 23835 14835 52750628 64760781 136867735 148144238 X 12684984 -674831 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6735 6735 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: AMERICAN HOSPITAL ASSOCIATION DUES FLORIDA HOSPITAL ASSOCIATION DUES 9118495 9118495 64440637 33409805 31030832 54936366 45296721 9639645 7574034 2450686 5123348 54912320 DUE TO AFFILIATED 267609 PAYABLE TO THIRD PARTIES 1372188 CREDIT BALANCES IN A/R 630694 OTHER CURRENT LIABILITIES 50750 INTERCO. ALLOC. OF TE BOND PROCEEDS 74401449 CAPITAL LEASE 591156 77313846 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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. 1 1 X 1 X 1 X 1 1 0 1 1 8807029 8807029 0.07100 18092200 10876960 7215240 0.05820 26899229 10876960 16022269 0.12920 164066 164066 0.00130 84076 84076 0.00070 17948 17948 0.00010 266090 266090 0.00210 27165319 10876960 16288359 0.13130 2431 2431 0.00000 2431 2431 1 2007224 476405 37603681 39495926 -1892245 X 1 1 1 ORANGE CITY SURGICAL LLC OUTPATIENT SURGICAL CENTER 0.29000 0.15000 0.22000 1 1 FLORIDA HOSPITAL FISH MEMORIAL

1055 SAXON BLVD ORANGE CITY FL 32763

X X X NA FOR 2010 1 13 FLORIDA HOSPITAL FISH IMAGING

1053 MEDICAL CENTER DR 151 ORANGE CITY FL 32763

DIAGNOSTIC IMAGING SERVICES ORANGE CITY SURGICAL LLC DBA BLUE SPRIN

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 ASSOCBESONG

2582 SOUTH VOLUSIA AVE ORANGE CITY FL 32763

PHYSICIAN OFFICE - OBSTETRICS & GYNECOLOGY SOUTHWEST VOLUSIA MEDICAL ASSOCKALLA &

1565 SAXON BLVD 202 DELTONA FL 32725

PHYSICIAN OFFICE - FAMILY PRACTICE SOUTHWEST VOLUSIA MEDICAL ASSOCROSALES

1035 TOWN CENTER DR ORANGE CITY FL 32763

PHYSICIAN OFFICE - FAMILY PRACTICE SOUTHWEST VOLUSIA MEDICAL ASSOCPARIKH

1053 MEDICAL CENTER DR 251 ORANGE CITY FL 32763

PHYSICIAN OFFICE - GASTROENTEROLOGY SOUTHWEST VOLUSIA MEDICAL ASSOCHAYNE

1061 MEDICAL CENTER DR 305 ORANGE CITY FL 32763

PHYSICIAN OFFICE - GENERAL SURGERY SOUTHWEST VOLUSIA MEDICAL ASSOC-CANCER C

1061 MEDICAL CENTER DR SUITE 305 ORANGE CITY FL 32763

PHYSICIAN OFFICE - CANCER SOUTHWEST VOLUSIA MEDICAL ASSOCTIKKU

1061 MEDICAL CENTER DR 205 ORANGE CITY FL 32763

PHYSICIAN OFFICE - PSYCHIATRY SOUTHWEST VOLUSIA MEDICAL ASSOCSHOUKAS

934 WILLISTON PARK POINT 1028 LAKE MARY FL 32746

PHYSICIAN OFFICE - PLASTIC & RECONST SURGERY SOUTHWEST VOLUSIA MEDICAL ASSOCBROOME-W

1027 TOWN CENTER DRIVE ORANGE CITY FL 32763

PHYSICIAN OFFICE - INTERNAL MEDICINE SOUTHWEST VOLUSIA MEDICAL ASSOCGALLAS

275 S HIGHWAY 17-92 SUITE 108 DEBARY FL 32713

PHYSICIAN OFFICE - FAMILY PRACTICE PART I, LINE 6A: THE FILING ORGANIZATION IS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC SERVES AS THE PARENT ORGANIZATION TO 21 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS THAT OPERATE 43 HOSPITALS IN TEN STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS "ADVENTIST HEALTH SYSTEM" (AHS).ALL HOSPITAL ORGANIZATIONS WITHIN AHS COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. AHS ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. AHS HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. ON AN ANNUAL BASIS, THE COMMUNITY BENEFITS OF ALL AHS ORGANIZATIONS ARE CONSOLIDATED AND REPORTED IN THE AHS ANNUAL REPORT DOCUMENT PREPARED BY 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 I, L7 COL(F): BAD DEBT EXPENSE OF $7,816,292 WAS INCLUDED ON FORM 990, PART IX, LINE 25, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSES IN COLUMN (F) OF LINE 7. PART III, LINE 4: COSTING METHODOLOGY:THE AMOUNTS OF BAD DEBT EXPENSE, AT COST, REPORTED ON LINE 2 AND 3 OF SECTION A OF PART III WERE DETERMINED UTILIZING A RATIO OF PATIENT CARE COST TO CHARGES AS SHOWN ON WORKSHEET A CONTAINED IN THE INSTRUCTIONS FOR SCHEDULE H, PART III, LINE 3. 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: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.PATIENT SERVICE REVENUE IS REPORTED AT ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED. 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 $16,200,000 FOR THE YEAR ENDED DECEMBER 31, 2010.REVENUE FROM THE MEDICARE AND MEDICAID PROGRAMS REPRESENTS APPROXIMATELY 36% OF THE DIVISION'S PATIENT SERVICE REVENUE FOR THE YEAR ENDED DECEMBER 31, 2010. 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. THE DIVISION GRANTS CREDIT WITHOUT COLLATERAL TO ITS PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY PAYOR ARRANGEMENTS. TO THE EXTENT THE DIVISION REALIZES ADDITIONAL LOSSES RESULTING FROM HIGHER CREDIT RISK FOR PATIENTS WHO ARE NOT IDENTIFIED AS MEETING OR DO NOT MEET THE CHARITY DEFINITION DESCRIBED BELOW, SUCH ADDITIONAL LOSSES ARE INCLUDED IN THE PROVISION FOR BAD DEBTS. 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, 2010.THE PROVISION FOR BAD DEBTS IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON THE PAYOR COMPOSITION AND AGING OF ACCOUNTS RECEIVABLE AS WELL AS RETROSPECTIVE REVIEWS OF SUBSEQUENT CASH COLLECTIONS. THE RESULTS OF THESE REVIEWS ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE DIVISION'S POLICIES. 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. PERCENTAGE DISCOUNTS ARE APPLIED TO A PATIENT'S ACCOUNT (FROM A 100% DISCOUNT TO A 30% DISCOUNT) BASED UPON THE PATIENT'S HOUSEHOLD INCOME AS A PERCENTAGE OF THE FEDERAL POVERTY GUIDELINES.UNDER THE FILING ORGANIZATION'S POLICIES, PAYMENT PLANS FOR PARTIAL CHARITY ACCOUNTS WILL BE INDIVIDUALLY DEVELOPED WITH THE PATIENT. PARTIAL CHARITY ACCOUNTS RESULT WHEN A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION ALLOWS FOR A PERCENTAGE REDUCTION BUT LEAVES THE PATIENT WITH A SELF-PAY BALANCE. IF THE PATIENT COMPLIES WITH THE AGREED-UPON PAYMENT PLAN, THE FILING ORGANIZATION DOES NOT PURSUE ANY COLLECTION ACTION WITH RESPECT TO THE PATIENT. HOWEVER, IF A PATIENT DOES NOT MAKE ANY PAYMENTS FOR THREE CONSECUTIVE MONTHS, THE ACCOUNT MAY BE REFERRED FOR FURTHER COLLECTION ACTIVITY. THE FILING ORGANIZATION DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR A 100% REDUCTION IN CHARGES UNDER ITS CHARITY CARE POLICY. PART VI, LINE 7:THE ANNUAL COMMUNITY BENEFIT REPORT CONTAINED IN THE ANNUAL REPORT PREPARED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) ON BEHALF OF THE ENTIRE AHS SYSTEM OF HEALTHCARE ORGANIZATION IS NOT FILED WITH ANY STATE AGENCIES. 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 129,000, WITH AN ESTIMATED 22,000 OVER THE AGE OF 65. THE WEIGHTED AVERAGE HOUSEHOLD INCOME, BASED ON POPULATION, IN THE PRIMARY MARKET IS APPROXIMATELY $59,000. 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 12%. APPROXIMATELY 52.0% OF THE HOSPITAL'S PATIENTS DURING 2010 WERE MEDICARE PATIENTS, ABOUT 13.8% WERE MEDICAID PATIENTS, ABOUT 6.5% WERE SELF-PAY PATIENTS, AND THE REMAINING PERCENTAGE WERE PATIENTS COVERED UNDER COMMERCIAL INSURANCE. IN 2010, ABOUT 86% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. PART VI, LINE 6: 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 $140,712 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 $3,950,504 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 7: FLORIDA HOSPITAL FISH MEMORIAL IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 43 HOSPITALS IN 10 STATES THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 16 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AS THE PARENT ORGANIZATION OF THE AHS SYSTEM, AHSSHC PROVIDES EXECUTIVE LEADERSHIP AND OTHER PROFESSIONAL SUPPORT SERVICES TO ITS SUBSIDIARY ORGANIZATIONS. PROFESSIONAL SUPPORT SERVICES INCLUDE AMONG OTHERS CORPORATE COMPLIANCE, LEGAL, HUMAN RESOURCES, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH AHS SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. EACH AHS SUBSIDIARY PAYS A MANAGEMENT FEE TO AHSSHC FOR THE INTERNAL SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY A AHS SUBSIDIARY ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY BY ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF AHS AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEB-SITE OF AHS AT WWW.ADVENTISTHEALTHSYSTEM.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF AHS AND TO ACCESS AHS'S ANNUAL REPORT THAT CONTAINS FINANCIAL DATA AS WELL AS COMMUNITY BENEFIT REPORTING FOR THE ENTIRE SYSTEM. 1 SUNSYSTEM DEVELOPMENT CORP DBA FLORIDA HOSPITAL FISH MEMORIAL FOUNDATION 111 N ORLANDO AVE WINTER PARK FL 32789 592219301 501 (C)(3) 152705 COST GENERAL ADMINISTRATIVE SUPPORT PROVISION OF GENERAL ADMINISTRATIVE SUPPORT 1 0 OTHER INFORMATION: PART IV: 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. X X X X 1 1 0 1 0 0 0 1 0 0 0 BRADLEY KENNETH W 0 284917 0 67719 0 36920 0 47931 0 21117 0 458604 0 0 MATTISON KENNNETH R 0 342937 0 82750 0 45650 0 45421 0 36328 0 553086 0 0 MORRISON RICHARD E 0 241059 0 50000 0 106526 0 21609 0 33019 0 452213 0 0 SCHULTZ MICHAEL H 0 540455 0 151199 0 1061561 0 104598 0 34125 0 1891938 0 0 TOL DARYL L 0 327551 0 68993 0 28018 0 48155 0 32129 0 504846 0 0 JOHNSON JOEL D 0 302424 0 71750 0 248406 0 44876 0 39354 0 706810 0 0 LUKENS MICHAEL B 0 197440 0 34692 823 4196 0 25065 0 18325 823 279718 0 0 BERGHERM BRUCE LEFT IN 2010 0 215023 0 30870 0 23967 0 27224 0 22100 0 319184 0 0 SHULL JENNIFER M 0 163848 0 7887 16943 12430 0 9231 0 20496 16943 213892 0 0 BESONG GEORGE T MD 238065 0 194894 0 0 0 13343 0 4345 0 450647 0 0 0 PARIKH NITIN J MD 431042 0 400 0 0 0 13343 0 4404 0 449189 0 0 0 HAYNE WALTER MD 322426 0 400 0 0 0 8443 0 4404 0 335673 0 0 0 SHOUKAS MD JAMES 272100 0 400 0 0 0 8443 0 3482 0 284425 0 0 0 KALLA MD SHRISH 167440 0 87474 0 0 0 13343 0 4254 0 272511 0 0 0 LOWE EVELYN M 0 150869 0 21047 0 18570 0 0 0 17801 0 208287 0 0 FOWLER SUE 0 119083 0 2668 0 235 0 5825 0 3742 0 131553 0 0 PART I, LINE 1A AS DISCUSSED IN OUR RESPONSE TO SECTION B, PART VI, QUESTION 15A & B, THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). MEMBERS OF THE FILING ORGANIZATION'S EXECUTIVE MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF AHS. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). THE FILING ORGANIZATION REIMBURSES AHSSHC FOR THE SALARY AND BENEFIT COST OF THOSE EXECUTIVES ON THE PAYROLL OF AHSSHC THAT PROVIDE SERVICES AND ARE ON THE MANAGEMENT TEAM OF THE FILING ORGANIZATION. FOR ADMINISTRATIVE EASE, EXECUTIVE EMPLOYEES ON THE PAYROLL OF AHSSHC WHO PROVIDE SERVICES AT AHS SUBSIDIARY ORGANIZATIONS RECEIVE REIMBURSEMENTS OF TRAVEL AND OTHER BUSINESS-RELATED EXPENSES FROM THE SUBSIDIARY 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. 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 PRE-DETERMINED BENEFITS ANNUAL AMOUNT 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. 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 $196,000. 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. 457(F) EMPLOYER SERP CONTRIBUTIONS CONTR./PYMT KENNETH BRADLEY $ 34,588 $ 0 KENNETH MATTISON $ 48,578 $ 0 RICHARD MORRISON $ 24,766 $ 52,390 MICHAEL SCHULTZ $ 91,255 $995,981 DARYL TOL $ 34,812 $ 0 JOEL JOHNSON $ 31,533 $231,742 MICHAEL LUKENS $ 12,291 $ 0 BRUCE BERGHERM $ 13,881 $ 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. SINCE IMPLEMENTING THE PRODUCTIVITY-BASED INCENTIVE COMPENSATION MODEL, THE FINANCIAL LOSSES FROM THE OPERATIONS OF ORGANIZATION'S PHYSICIAN PRACTICES HAVE SIGNIFICANTLY DECREASED, AND ESTABLISHED PHYSICIAN PRACTICES HAVE GENERALLY BECOME PROFITABLE. 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. SUPPLEMENTAL INFORMATION PART III PART I, QUESTION 3: AS NOTED IN OUR RESPONSE TO QUESTION 15 OF PART VI OF FORM 990, THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) FOR THAT INDIVIDUAL'S ROLE IN SERVING AS THE CEO. COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC USES ALL OF THE FOLLOWING TO ESTABLISH COMPENSATION OF THE CEO: - COMPENSATION COMMITTEE; - INDEPENDENT COMPENSATION CONSULTANT; - COMPENSATION SURVEY OR STUDY; AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. 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. COLUMNS (E) & (F) PART VII, SECTION A FOR THOSE BOARD OF DIRECTOR MEMBERS WHO DEVOTE LESS THAN FULL-TIME TO THE FILING ORGANIZATION (BASED UPON THE AVERAGE NUMBER OF HOURS PER WEEK SHOWN IN COLUMN (B) ON PAGE 7 OF THE RETURN) THE COMPENSATION AMOUNTS SHOWN IN COLUMNS (E) AND (F) ON PAGE 7 WERE PROVIDED IN CONJUNCTION WITH THAT PERSON'S RESPONSIBILITIES AND ROLES IN SERVING IN AN EXECUTIVE LEADERSHIP POSITION WITHIN ADVENTIST HEALTH SYSTEM. COLUMN (B) PART VII, SECTION A THE MEMBERS OF THE BOARD OF DIRECTORS 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS (LOSSES) ON DSRF FUNDS -10,900. TRANSFER FOR EXPENSES FOR OPERATIONS -24,266. ALLOCATIONS FROM TAX-EXEMPT PARENT WITH RESPECT TO DEBT 88,837. GIFTS 39,709. TRANSFER TO/FROM TAX EXEMPT PARENT -768,211. TOTAL TO FORM 990, PART XI, LINE 5: -674,831. 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. 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 HEALTH SYSTEMSUNBELT INC 0 ADVENTIST CARE CENTERS - COURTLAND INC 730 COURTLAND STREET ORLANDO FL 32804 205774723 OPERATION OF HOME FOR THE AGED/HEALTHCARE DELIVERY FL 501(C)(3) 509(A)(2) SUNBELT HEALTH 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 HEALTH SYSTEMSUNBELT INC 0 ADVENTIST HEALTH MID-AMERICA INC 9100 W 74TH STREET SHAWNEE MISSION KS 66204 521347407 HEALTHCARE RELATED SERVICES KS 501(C)(3) 509(A)(3) TYPE I ADVENTIST HEALTH SYSTEMSUNBELT INC 0 ADVENTIST HEALTH 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 HEALTH SYSTEM AFFILIATED BENEFIT TRUST 111 N ORLANDO AVENUE WINTER PARK FL 32789 266422966 PROMOTION OF HEALTHCARE FL 501(C)(3) 509(A)(3) TYPE I ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 0 ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 111 N ORLANDO AVENUE WINTER PARK FL 32789 592170012 MANAGEMENT SERVICES FL 501(C)(3) 509(A)(3) TYPE I N/A 0 ADVENTIST HEALTH 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 HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 0 ADVENTIST HEALTH 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 HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 0 ADVENTIST HEALTH SYSTEMTEXAS INC 602 COURTLAND STREET ORLANDO FL 32804 742578952 INACTIVE TX 501(C)(3) 509(A)(2) ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 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 HEALTH SYSTEMSUNBELT INC 0 AHS MIDWEST MANAGEMENT INC 1000 REMINGTON BLVD STE 200 BOLINGBROOK IL 60440 363354567 OPERATION OF OCCUPATIONAL HLTH CLINIC & PHYSICIAN PRACTICE MGMT IL 501(C)(3) 509(A)(3) TYPE I ADVENTIST HEALTH 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 HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 0 APOPKA HEALTH 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 HEALTH CARE CENTERS INC 0 BATTLE CREEK ADVENTIST HOSPITAL 1000 REMINGTON BLVD STE 200 BOLINGBROOK IL 60440 381359189 OPERATION OF HOSPITAL & RELATED SERVICES MI 501(C)(3) 170(B)(1)(A)(III) ADVENTIST HEALTH 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 HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 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 HEALTH FOUNDATION 0 BRADFORD HEIGHTS HEALTH & REHAB CENTER INC 950 HIGHPOINT DRIVE HOPKINSVILLE KY 42240 205782342 OPERATION OF HOME FOR THE AGED/HEALTHCARE DELIVERY KY 501(C)(3) 509(A)(2) SUNBELT HEALTH CARE CENTERS INC 0 BURLESON NURSING & REHAB CENTER INC 301 HUGULEY BLVD BURLESON TX 76028 205782243 OPERATION OF HOME FOR THE AGED/HEALTHCARE DELIVERY TX 501(C)(3) 509(A)(2) SUNBELT HEALTH CARE CENTERS INC 0 CALDWELL HEALTH 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 HEALTH CARE CENTERS 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 HEALTH SYSTEMSUNBELT INC 0 CHICKASAW HEALTH 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 HEALTH 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 HEALTH 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 HEALTH 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 HEALTH CARE CENTERS INC 0 CREEKWOOD PLACE NURSING & REHAB CENTER INC 683 E THIRD STREET RUSSELLVILLE KY 42276 205782260 OPERATION OF HOME FOR THE AGED/HEALTHCARE DELIVERY KY 501(C)(3) 509(A)(2) SUNBELT HEALTH CARE CENTERS INC 0 DAIRY ROAD HEALTH 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 HEALTH CARE CENTERS INC 0 EAST ORLANDO HEALTH & REHAB CENTER INC 250 S CHICKASAW TRAIL ORLANDO FL 32825 205774748 OPERATION OF HOME FOR THE AGED/HEALTHCARE DELIVERY FL 501(C)(3) 509(A)(2) SUNBELT HEALTH 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 HEALTH 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 HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 0 FLNC INC 3355 E SEMORAN BLVD APOPKA FL 32703 205774761 OPERATION OF HOME FOR THE AGED/HEALTHCARE DELIVERY FL 501(C)(3) 509(A)(2) SUNBELT HEALTH CARE CENTERS INC 0 FLORIDA HOSPITAL COLLEGE OF HEALTH SCIENCES INC (630 YEAR END) 671 LAKE WINYAH DRIVE ORLANDO FL 32803 593069793 EDUCATION/OPERATION OF SCHOOL FL 501(C)(3) 170(B)(1)(A)(II) ADVENTIST HEALTH SYSTEMSUNBELT INC 0 FLORIDA HOSPITAL DELAND AUXILIARY INC 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 HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 0 FLORIDA HOSPITAL WESLEY CHAPEL INC 2528 BRUCE B DOWNS BLVD CR 581 S WESLEY CHAPEL FL 33543 203965753 INACTIVE FL 501(C)(3) 509(A)(3) TYPE III-F ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 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 HEALTH SYSTEMSUNBELT INC 0 FLORIDA PHYSICIANS 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 HEALTH 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 HEALTH 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 HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 0 HELEN ELLIS MEMORIAL HOSPITAL AUXILIARY INC (51-123110) 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 (101-123110) 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 HEALTH FOUNDATION 0 IN-MOTION REHAB INC 602 COURTLAND STREET STE 200 ORLANDO FL 32804 208023411 THERAPY SERVICES TO TAX EXEMPT NURSING HOMES KS 501(C)(3) 509(A)(3) TYPE II SUNBELT HEALTH 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 HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 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 HEALTH FOUNDATION 0 MEMORIAL HEALTH 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 HEALTH SYSTEMS INC 0 MEMORIAL HEALTH 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 HEALTH 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 HEALTH 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 HEALTH 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 HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 0 MERRIAM HEALTH 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 HEALTH 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 HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION 0 METROPLEX CLINIC PHYSICIANS INC 2201 S CLEAR CREEK ROAD KILLEEN TX 76549 113762050 PHYSICIAN HEALTHCARE SERVICES TO THE COMMUNITY TX 501(C)(3) 170(B)(1)(A)(III) METROPLEX ADVENTIST HOSPITAL INC 0 MIDWEST HEALTH FOUNDATION 120 NORTH OAK STREET HINSDALE IL 60521 352230515 SUPPORT OF SUBSIDIARY FOUNDATIONS IL 501(C)(3) 509(A)(3) TYPE II N/A 0 MILLS HEALTH & REHAB CENTER INC 500 BECK LANE MAYFIELD KY 42066 205782320 OPERATION OF HOME FOR THE AGED/HEALTHCARE DELIVERY KY 501(C)(3) 509(A)(2) SUNBELT HEALTH 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 HEALTH CARE CENTERS INC 0 MISSOURI ADVENTIST HEALTH INC 9100 W 74TH STREET SHAWNEE MISSION KS 66204 431224729 SUPPORT HEALTH CARE SERVICES MO 501(C)(3) 509(A)(3) TYPE III-O ADVENTIST HEALTH 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 HEALTH SYSTEMS INC 0 OVERLAND PARK NURSING & REHAB CENTER INC 6501 WEST 75TH STREET OVERLAND PARK KS 66204 205774821 OPERATION OF HOME FOR THE AGED/HEALTHCARE DELIVERY KS 501(C)(3) 509(A)(2) SUNBELT HEALTH CARE CENTERS INC 0 PARAGON HEALTH CARE PROPERTIES INC 950 HIGHPOINT DRIVE HOPKINSVILLE KY 42240 510605686 LEASE TO RELATED ORGANIZATION GA 501(C)(3) 509(A)(3) TYPE 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