JELLICO COMMUNITY HOSPITAL INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- JELLICO COMMUNITY HOSPITAL INC (EIN 62-0924706)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-14
- IRS object ID
- 201143189349300244
- Schema version
- 2010v3.4
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-14T10:50:54-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 620924706 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jellico Community Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | JELL | NameControl |
| Phone | 4237847252 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 188 Hospital Lane | AddressLine1 |
| City | Jellico | City |
| State | TN | State |
| ZIP Code | 37762 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Lynn C Addiscott | Name |
| Title | Assistant Secretary | Title |
| Phone | 4079751492 | Phone |
| Date Signed | 2011-11-14 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Erik Wangsness | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 188 Hospital Lane | AddressLine1 |
| City | Jellico | City |
| State | TN | State |
| ZIP Code | 37762 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 25197908 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 1071 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.jellicohospital.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1974 | YearFormation |
| State Legal Domicile | TN | StateLegalDomicile |
| Activity Or Mission Description | The provision of medical care to the community through the operation of a 54 bed hospital. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 356 | TotalNbrEmployees |
| Total Nbr Volunteers | 5 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1000000 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1130923 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 24598559 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 23931064 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 185012 | InvestmentIncomePriorYear |
| Investment Income Current Year | 131121 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1103 | OtherRevenuePriorYear |
| Other Revenue Current Year | 522 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 25784674 | TotalRevenuePriorYear |
| Total Revenue Current Year | 25193630 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 115580 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 123244 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 12777373 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12559739 | 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 | 14520596 | OtherExpensePriorYear |
| Other Expenses Current Year | 14179473 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 27413549 | TotalExpensesPriorYear |
| Total Expenses Current Year | 26862456 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1628875 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1668826 | RevenuesLessExpensesCY |
| Total Assets BOY | 14469013 | TotalAssetsBOY |
| Total Assets EOY | 12697282 | TotalAssetsEOY |
| Total Liabilities BOY | 9116064 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8523787 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 5352949 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 4173495 | 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 | 24903722 | Expense |
| Grants | 123244 | Grants |
| Revenue | 23931064 | Revenue |
| Description | JELLICO COMMUNITY HOSPITAL, INC. (THE HOSPITAL) OPERATES A 54-BED ACUTE CARE HOSPITAL IN JELLICO, TN. IN THE CURRENT YEAR, THERE WERE 1,830 ADMISSIONS AND 5,640 PATIENT DAYS. | Description |
| Total Program Service Expense | 24903722 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| 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 | 0 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | 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 | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 93 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 356 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| 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 | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | 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 | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | TN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | William Villegas | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4237841206 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 188 Hospital Lane | AddressLine1 |
| City | Jellico | City |
| State | TN | State |
| ZIP Code | 37762 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (20 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 |
|---|---|---|---|---|---|---|---|---|---|
| Jimm Bunch | |||||||||
| Chairman | 1.00 | X | 0 | 1135535 | 89866 | ||||
| David Butler | |||||||||
| President | 50.00 | X | 0 | 275572 | 48610 | X | |||
| Lonnie Anderson | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| Thomas E Barclay | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| Herbert Carithers | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| Kevin Doe | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| David Escalante MD | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| Allen McClary | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| Cindi Norton PhD | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| Charles H Wilkens MD | |||||||||
| Director | 1.00 | X | 3667 | 0 | 0 | ||||
| Geogy Thomas MD | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| Edward Wright | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| Steve Morgan | |||||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||||
| Joanne Watts | |||||||||
| Director (beg 12/10) | 1.00 | X | 0 | 0 | 0 | ||||
| William Villegas | |||||||||
| CFO | 50.00 | 0 | 138750 | 26596 | X | ||||
| Pam Hodge | |||||||||
| VP - CNO & Risk Mgr | 50.00 | 0 | 128057 | 16352 | X | ||||
| Raul Vila MD | |||||||||
| Physician | 45.00 | 226561 | 0 | 21715 | X | ||||
| Darrell C Mack | |||||||||
| Pharmacist/Dir of Pharmacy | 40.00 | 151599 | 0 | 23469 | X | ||||
| Patricia Branson | |||||||||
| Pharmacist | 40.00 | 136845 | 0 | 14890 | X | ||||
| James M Smith | |||||||||
| CRNA-former High Emp | 40.00 | 200645 | 0 | 0 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 719317 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1549857 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 225146 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | 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 |
|---|---|---|---|---|---|
| EMCARE Physician Services | |||||
| 7032 Collection Center | Chicago | IL | 60693 | ER Physician Services | 352888 |
| South East Biomed Co | |||||
| PO BOX 700 | Hindman | KY | 41822 | Equipment Maintenance | 262393 |
| Nursefinders of Knoxville | |||||
| 127A Perimeter Park Road | Knoxville | TN | 37922 | Nursing Staffing Agency | 257183 |
| Duffsie Anesthesia | |||||
| 1567 Leighton Dr | Soddy Daisy | TN | 37379 | CRNA | 200830 |
| James M Smith | |||||
| 185 Valley View Lane | Jellico | TN | 37762 | CRNA | 200645 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| Government Grants | 1130923 | GovernmentGrants |
| Total Contributions | 1130923 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Net patient revenue | 900099 | 22997840 | 22997840 |
| Mgmt Fee fr Affiliate | 561000 | 807645 | 807645 |
| Cafeteria & Gift Shop | 900099 | 47459 | 47459 |
| Medical Records | 900099 | 13989 | 13989 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 64131 | TotalRevenueColumn |
| Related Or Exempt Function Income | 64131 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 23931064 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 34322 | TotalRevenueColumn |
| Exclusion | $34,322 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 4800 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 4278 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 522 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 522 | TotalRevenueColumn |
| Exclusion | $522 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 96799 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 96799 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 96799 | TotalRevenueColumn |
| Exclusion | $96,799 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25193630 | TotalRevenueColumn |
| Related Or Exempt Function Income | 23931064 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $131,643 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 123244 | Total |
| Program Services | 123244 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 489528 | Total |
| Management And General | 489528 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9196253 | Total |
| Program Services | 9133027 | ProgramServices |
| Management And General | 63226 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 217149 | Total |
| Program Services | 206748 | ProgramServices |
| Management And General | 10401 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1924799 | Total |
| Program Services | 1904456 | ProgramServices |
| Management And General | 20343 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 732010 | Total |
| Program Services | 696949 | ProgramServices |
| Management And General | 35061 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 81382 | Total |
| Management And General | 81382 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25080 | Total |
| Management And General | 25080 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4293551 | Total |
| Program Services | 3958389 | ProgramServices |
| Management And General | 335162 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 199590 | Total |
| Management And General | 199590 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3144351 | Total |
| Program Services | 2980962 | ProgramServices |
| Management And General | 163389 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1029800 | Total |
| Program Services | 865419 | ProgramServices |
| Management And General | 164381 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 793098 | Total |
| Program Services | 793098 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 158329 | Total |
| Management And General | 158329 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9115 | Total |
| Management And General | 9115 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 306850 | Total |
| Program Services | 306850 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 989213 | Total |
| Program Services | 989213 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 147488 | Total |
| Management And General | 147488 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad Debt expense | 1842895 | 1842895 | |
| Repairs & maintenance | 1099100 | 1099100 | |
| Purchased services | 40739 | 40739 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18892 | Total |
| Program Services | 3372 | ProgramServices |
| Management And General | 15520 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26862456 | Total |
| Program Services | 24903722 | ProgramServices |
| Management And General | 1958734 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11337 | BOY |
| EOY | 17981 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5805303 | BOY |
| EOY | 4580796 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3016611 | BOY |
| EOY | 2993288 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 357693 | BOY |
| EOY | 349346 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 795123 | BOY |
| EOY | 875665 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 13874955 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 10396053 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4105551 | BOY |
| EOY | 3478902 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 377395 | BOY |
| EOY | 401304 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14469013 | BOY |
| EOY | 12697282 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1547486 | BOY |
| EOY | 1217228 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68222 | BOY |
| EOY | 57898 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7500356 | BOY |
| EOY | 7248661 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9116064 | BOY |
| EOY | 8523787 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5352949 | BOY |
| EOY | 4093627 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 79868 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5352949 | BOY |
| EOY | 4173495 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14469013 | BOY |
| EOY | 12697282 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1668826 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 489372 | 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 B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $8,072 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 8072 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Other Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1i: | ReturnReference |
| Explanation | DUES PAID TO AMERICAN HOSPITAL ASSOCIATION, HOSPITAL ALLIANCE OF TENNESSEE, AND TENNESSEE HOSPITAL ASSOCIATION. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19297 | OtherCostOrOtherBasis |
| Book Value | 19297 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1551746 | OtherCostOrOtherBasis |
| Depreciation | 425806 | Depreciation |
| Book Value | 1125940 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12144339 | OtherCostOrOtherBasis |
| Depreciation | 9970247 | Depreciation |
| Book Value | 2174092 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 159573 | OtherCostOrOtherBasis |
| Book Value | 159573 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3478902 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Other current liabilities | $27,848 |
| Due to affiliated | $66,629 |
| Payable to third parties | $160,981 |
| Credit balances in A/R | $79,913 |
| Interco Alloc of TE Bond Proceeds | $6,913,290 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 7248661 | 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 filing organization is a subsidiary organization within Adventist Health System (AHS). The consolidated financial statements of AHS contain the following FIN 48 footnote - The Income Taxes Topic of the ASC (ASC 740) prescribes the accounting for uncertainty in income tax positions recognized in financial statements. ASC 740 prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. | 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 | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1204710 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1204710 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04820 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7514704 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5102205 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2412499 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09640 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8719414 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5102205 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3617209 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.14460 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 636747 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 507722 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 129025 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00520 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 636747 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 507722 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 129025 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00520 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9356161 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5609927 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3746234 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.14980 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 39430 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 39430 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 39430 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 39430 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $681,686 | BadDebtExpenseAmount |
| Amount Attributable To | 122225 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 7456675 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6662611 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 794064 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jellico Community Hospital Inc | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 188 Hospital Lane | AddressLine1 |
| City | Jellico | City |
| State | TN | State |
| ZIP Code | 37762 | 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 | NA FOR 2010 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Sunbelt Homecare | ||||
| 149 Health Care Lane | Jellico | TN | 37762 | Home Health Services |
| Care Plus Work Health Solutions | ||||
| 990 Hwy 25 West | Williamsburg | KY | 40769 | Rehabilitation Clinic |
| Care Plus Diagnostic Center | ||||
| 990 Hwy 25 West | Williamsburg | KY | 40769 | Diagnostic Center |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | Return ReferenceReturnReference |
|---|---|
| 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 $1,842,895 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 II: Jellico Community Hospital, Inc. (the Hospital) is involved with and supportive of various other community agencies in its service area that work collaboratively to help those in need and to improve the health and safety of the residents of the community. The Hospital participates with a number of other community organizations to address the healthcare needs of the community, such as the Campbell County Health Council. The Hospital is supportive of other health and wellness programs currently conducted in its community, such as the Dayspring Family Health Center and the Live Well wellness program conducted by a local physician group. The Hospital also provides financial support and assistance to other community groups, such as Caring Hearts of Jellico which assists needy families and helps such families to remain in their homes by assisting with the payment of utility bills, etc. | |
| 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 System 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 System 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 $29,500,000 and $23,900,000 for the years ended December 31, 2010 and 2009, respectively.Revenue from the Medicare and Medicaid programs represents approximately 35% of the System's patient service revenue for the years ended December 31, 2010 and 2009. 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 System 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 System 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 and 2009.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 System's policies. | |
| Part III, Line 8: Costing Methodology:Medicare allowable costs were calculated using a cost-to-charge ratio. | |
| 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. | |
| Reconciliation of Schedule H Reported Medicare Surplus/(Shortfall) to Unreimbursed Medicare Costs Associated with the Provision of ServicesTo All Medicare Beneficiaries:The Medicare revenue and allowable costs of care reported in Section B of Part III of Schedule H are based upon the amounts reported in the filing organization's Medicare cost report in accordance with the IRS instructions for Schedule H. On an annual basis, the filing organization also determines its total unreimbursed costs associated with providing services to all Medicare patients. Unreimbursed costs are reported as a community benefit to the elderly and are included in the consolidated Adventist Health System (AHS or the Company) Community Benefits Report contained in the AHS Annual Report document. The primary reconciling items between the Medicare surplus/(shortfall) shown on line 7 of Section B of Part III of Schedule H and the filing organization's unreimbursed costs of services provided to Medicare patients as reported in the AHS Community Benefit Report are as follows:- Medicare surplus/(shortfall) shown on line 7 of Section B of Schedule H: $ 794,064- Difference in costing methodology: 1,023,571- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (1,551,620) -------------Total Medicare surplus from serving all Medicare patients per the filing organization's community benefit reporting: $ 266,015As indicated above, the primary differences between the Medicare surplus/(shortfall) reported on Schedule H, Part III, Section B, line 7 and the filing organization's portion of the Company's annual community benefit statement is due to a difference in the costing methodology and differences in the population of Medicare patients within the calculation. The cost methodology utilized in calculating any Medicare surplus/(shortfall) for purposes of the annual community benefit reporting is based upon the cost-to-charge ratio outlined in Worksheet 2 of the Schedule H instructions. The same cost-to-charge ratio is used to determine the costs associated with services provided to charity care patients and Medicaid patients as reported in Schedule H, Part I, line 7. In addition, the Medicare cost report excludes services provided to Medicare patients for physician services, services provided to patients enrolled in Medicare HMOs, and certain services provided by outpatient departments of the filing organization that are reimbursed on a fee schedule. The Company's own community benefit statement captures the unreimbursed cost of providing services to all Medicare beneficiaries throughout the organization. | Supplemental Schedule to Schedule H, Part III, Section B |
| 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: Jellico Community Hospital 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: Jellico Community Hospital (the Hospital) is a 54-bed acute care facility and Sole Community Provider that has provided quality health care services to the residents of northeastern Tennessee and southeastern Kentucky for over 35 years. The Hospital is located in the tiny, historic town of Jellico, Tennessee (population of under 3,000) and primarily serves patients from the counties of Campbell County in Tennessee and Whitley County in Kentucky. The Hospital is a crucial community and regional asset. It is the only provider of obstetrics, specialized surgeries and advanced technology in its service area. The Hospital is part of Adventist Health System and has benefited from the investment in over $6.78 million in new technology during the years from 2005 through 2008. Medicare has designated the Hospital as a Sole Community Provider for Campbell County, TN. The nearest other hospital is 36 miles away. This nearest provider does not offer many of the services offered at the Hospital, such as women's and children's health, including obstetrics, labor & delivery, C-sections, gyn surgeries, and prenatal classes. The Hospital is also the largest employer in the city of Jellico, TN.The city of Jellico, TN cover 4.36 square miles. It sits on the TN/KY state border. The Hospital's primary market has a population of approximately 30,000, with an estimated 4,550 over the age of 65. The weighted average household income, based on population, in the primary market is approximately $34,500. High school graduates account for approximately 68% of Campbell County, with an estimated 9% having a bachelor's degree or higher. It is estimated that 23% of the individuals residing in Campbell County live below the poverty level and the unemployment rate is about 12%. Over 75% of the Hospital's patients are covered by Medicare or Medicaid. Medicare patients comprise about 44% of the Hospital's patients. Approximately 31% of the Hospital's patients are covered by the Medicaid program, with 8% representing self-pay and the remaining 17% commercial payors. Approximately 72% of the Hospital's in-patients are admitted through the Hospital's emergency department. | |
| Part VI, Line 6: The provision of community benefit is central to Jellico Community Hospital'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 $ 139,192 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 $ 330,834 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: Jellico Community Hospital is a part of a faith-based healthcare system of organizations whose parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). The system is known as Adventist Health System (AHS). AHSSHC is an organization exempt from federal income tax under IRC Section 501(c)(3). AHSSHC and its subsidiary organizations operate 43 hospitals in 10 states throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC and its subsidiaries also operate 16 nursing home facilities and other ancillary health care provider facilities, such as ambulatory surgery centers and diagnostic imaging centers. As the parent organization of the AHS system, AHSSHC provides executive leadership and other professional support services to its subsidiary organizations. Professional support services include among others corporate compliance, legal, human resources, reimbursement, risk management, and tax as well as treasury functions. The provision of these executive and support services on a centralized basis by AHSSHC provides an appropriate balance between providing each AHS subsidiary hospital organization with mission-driven consistent leadership and support while allowing the hospital organization to focus its resources on meeting the specific health care needs of the community it serves. The reader of this Form 990 should keep in mind that this reporting entity may differ in certain areas from that of a stand-alone hospital organization due to its inclusion in a larger system of healthcare organizations. As a part of a system of 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. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance |
|---|---|---|---|---|---|---|---|---|---|---|
| Jellico SDA Church | ||||||||||
| 324 Adventist Lane | Jellico | TN | 37762 | 621193991 | 501(c)(3) | 12200 | general support | |||
| Jellico SDA School | ||||||||||
| 170 Adventist Lane | Jellico | TN | 37762 | 264447703 | 501(c)(3) | 14125 | general support | |||
| SunSystem DevelopCorp dba Jellico Found | ||||||||||
| 111 N Orlando Ave | Winter Park | FL | 32789 | 592219301 | 501(c)(3) | provision of general administrative support | 83814 | cost | general administrative support | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: Grants are generally made only to related organizations that are exempt from Federal Income Tax under 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 |
| 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jimm Bunch | |||||||||||||
| 0 | 388523 | 0 | 111522 | 0 | 635490 | 0 | 49518 | 0 | 40348 | 0 | 1225401 | 0 | 0 |
| David Butler | |||||||||||||
| 0 | 213847 | 0 | 41738 | 0 | 19987 | 0 | 23508 | 0 | 25102 | 0 | 324182 | 0 | 0 |
| William Villegas | |||||||||||||
| 0 | 111185 | 0 | 17340 | 0 | 10225 | 0 | 4070 | 0 | 22526 | 0 | 165346 | 0 | 0 |
| Raul Vila MD | |||||||||||||
| 132926 | 0 | 10000 | 0 | 83635 | 0 | 7423 | 0 | 14292 | 0 | 248276 | 0 | 0 | 0 |
| Darrell C Mack | |||||||||||||
| 106501 | 0 | 0 | 0 | 45098 | 0 | 7653 | 0 | 15816 | 0 | 175068 | 0 | 0 | 0 |
| Patricia Branson | |||||||||||||
| 93861 | 0 | 0 | 0 | 42984 | 0 | 6669 | 0 | 8221 | 0 | 151735 | 0 | 0 | 0 |
| James M Smith | |||||||||||||
| 0 | 0 | 0 | 0 | 200645 | 0 | 0 | 0 | 0 | 0 | 200645 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 1a | As discussed in our response to Section B, Part VI, Question 15a & b, the filing organization is a part of the system of healthcare organizations known as Adventist Health System (AHS). Members of the filing organization's executive management team that hold the position of Vice-President or above are compensated by and on the payroll of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), the parent organization of AHS. AHSSHC is exempt from federal income tax under IRC Section 501(c)(3). The filing organization reimburses AHSSHC for the salary and benefit cost of those executives on the payroll of AHSSHC that provide services and are on the management team of the filing organization. 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. | |
| 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 James A. Bunch $52,675 $598,998 David A. Butler $15,065 $ 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. | |
| Part III | Part I, Question 3: As noted in our response to question 15 of Part VI of Form 990, the individual who serves as the CEO of the filing organization is compensated by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) for that individual's role in serving as the CEO. Compensation and benefits provided to this individual are determined pursuant to policies, procedures, and processes of AHSSHC that are designed to ensure compliance with the intermediate sanctions laws as set forth in IRC Section 4958. AHSSHC uses all of the following to establish compensation of the CEO: - Compensation committee; - Independent compensation consultant; - Compensation survey or study; and - Approval by the board or compensation committee. | Supplemental Information |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (5 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Wilkens Medical Group | |||
| >35% owned by family board members | 227600 | Professional service agreement, rent, and support services. | 0 |
| Deborah Barclay | |||
| Family member of board member | 40499 | Employee Compensation | 0 |
| Tim Carithers | |||
| Family member of board member | 12727 | Independent Contractor | 0 |
| Roger Butler | |||
| Family member of board member | 9990 | Employee Compensation | 0 |
| Appalachia Health Service | |||
| >35% owned by family board members | 45184 | Professional Service Agreement | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 2 | Kevin Doe and Allen McClary - Business Relationship Lonnie Anderson and Charles H. Wilkens, MD - Business Relationship Allen McClary and Steve Morgan - Business Relationship Allen McClary and Charles H. Wilkens, MD - Business Relationship Allen McClary and David Butler - Business Relationship Allen McClary and David Escalante, MD - Business Relationship Allen McClary and Geogy Thomas - Business Relationship Allen McClary and Herbert Carithers - Business Relationship Allen McClary and Thomas Barclay - Business Relationship Allen McClary and William Villegas - Business Relationship Steve Morgan and Charles H. Wilkens, MD - Business Relationship | |
| Form 990, Part VI, Section A, line 6 | Jellico Community Hospital, Inc. (the filing organization) has one member. The sole member of the filing organization is Adventist Health System Sunbelt Healthcare Corporation. Adventist Health System Sunbelt Healthcare Corporation. (AHSSHC) is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). There are no other classes of membership in the filing organization. | |
| Form 990, Part VI, Section A, line 7a | The sole member of the filing organization is AHSSHC. The Board of Directors of the filing organization are appointed by the sole member, AHSSHC, who has the right to elect, appoint or remove any member of the Board of Directors of the filing organization. | |
| Form 990, Part VI, Section A, line 7b | AHSSHC, 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 executives and all officers and administrators of the filing organization; b) to adopt, amend, restate, and repeal the Articles of Incorporation or Bylaws of the filing organization and 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 and, f) to establish general guiding policies and approve or disapprove major building programs and purchases or sales above a established amount. | |
| 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. | |
| The Conflict of Interest Policy of the filing organization applies to members of its Board of Directors and its principal officers (to be known as Interested Persons). In connection with any actual or possible conflict of interests, any member of the Board of Directors of the filing organization or any principal officer of the filing organization (i.e. Interested Persons) must disclose the existence of any financial interest with the filing organization and must be given the opportunity to disclose all material facts concerning the financial interest/arrangement to the Board of Directors of the filing organization or to any members of a committee with board delegated powers that is considering the proposed transaction or arrangement. Subsequent to any disclosure of any financial interest/arrangement and all material facts, and after any discussion with the relevant Board member or principal officer, the remaining members of the Board of Directors or committee with board delegated powers shall discuss, analyze, and vote upon the potential financial interest/arrangement to determine if a conflict of interest exists. According to the filing organization's Conflict of Interest Policy, an Interested Person may make a presentation to the Board of Directors (or committee with board delegated powers), but after such presentation, shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that results in a conflict of interest. Each Interested Person, as defined under the filing organization's Conflict of Interest Policy, shall annually sign a statement which affirms that such person has received a copy of the Conflict of Interests policy, has read and understands the policy, has agreed to comply with the policy, and understands that the filing organization is a charitable organization that must primarily engage in activities which accomplish one or more of its exempt purposes. The filing organization's Conflict of Interest Policy also requires that periodic reviews shall be conducted to ensure that the filing organization operates in a manner consistent with its charitable purposes. | Form 990, Part VI, Section B, line 12c | |
| 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 B, line 15 | |
| 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. | Form 990, Part VI, Section C, line 19 | |
| For the Board of Director member who devoted 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. | Part VII, Section A | |
| The member of the Board of Directors who received compensation from a related organization as shown in column (E) and (F) of Section A devotes approximately 50 hours per week in conjunction with serving in his respective executive leadership position within Adventist Health System. | Part VII, Section A, Column (B) | |
| Changes in Net Assets or Fund Balances: | Net unrealized losses on investments: -960. Allocations from tax-exempt parent with respect to debt 13,901. Gifts 482,500. Transfer to tax-exempt affiliate hospital -6,072. Rounding 3. Total to Form 990, Part XI, Line 5: 489,372. | Form 990, Part XI, line 5: |
| The amounts shown on line 2 of Part X of this return include the filing organization's interest in a central investment pool maintained by Adventist Health System Sunbelt Healthcare Corporation, the filing organization's top-tier parent. The investments in the central investment pool are recorded at market value. | Part X, Line 2 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (102 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 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 | 0 | N/A | |
| 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 | 0 | N/A | |
| 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 | 1 | |
| 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 III-F | Sunbelt Health Care Centers Inc | 0 | |
| Portercare Adventist Health 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 Health System Sunbelt Healthcare Corporation | 0 | |
| Portland Nursing & Rehab Center Inc | |||||||||||
| 215 Highland Circle Drive | Portland | TN | 37148 | 205774842 | Operation of Home for the Aged/Healthcare Delivery | TN | 501(c)(3) | 509(a)(2) | Sunbelt Health Care Centers Inc | 0 | |
| Princeton Health & Rehab Center Inc | |||||||||||
| 1333 West Main | Princeton | KY | 42445 | 205782272 | Operation of Home for the Aged/Healthcare Delivery | KY | 501(c)(3) | 509(a)(2) | Sunbelt Health Care Centers Inc | 0 | |
| Princeton Professional Services Inc | |||||||||||
| 601 E Rollins Street | Orlando | FL | 32803 | 591191045 | Provision of Healthcare Services | FL | 501(c)(3) | 509(a)(2) | Adventist Health System Sunbelt Healthcare Corporation | 0 | |
| Quality Circle for Healthcare Inc | |||||||||||
| 111 N Orlando Avenue | Winter Park | FL | 32789 | 263789368 | Healthcare Quality Services | FL | 501(c)(3) | 509(a)(3) Type III-F | Adventist Health System Sunbelt Healthcare Corporation | 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 Health Care Centers Inc | 0 | |
| Rocky Mountain Adventist Healthcare 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 Health System | 0 | |
| Rollins Bedford Corporation | |||||||||||
| 602 Courtland Street Ste 200 | Orlando | FL | 32804 | 370908840 | Inactive | FL | 501(c)(3) | 509(a)(3) Type II | Sunbelt Health Care Centers Inc | 0 | |
| Russellville Health 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 Health Care Centers Inc | 0 | |
| San Marcos Health 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 Health Care Centers Inc | 0 | |
| San Marcos Nursing & Rehab Center Inc | |||||||||||
| 1900 Medical Parkway | San Marcos | TX | 78666 | 205782224 | Operation of Home for the Aged/Healthcare Delivery | TX | 501(c)(3) | 509(a)(2) | Sunbelt Health Care Centers Inc | 0 | |
| Shawnee Mission Health 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 Health 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 Health 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 Health 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 Health Care Centers Inc | 0 | |
| Southwest Volusia Health 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 Healthcare Corporation | 0 | |
| Southwest Volusia Healthcare Corporation | |||||||||||
| 1055 Saxon Blvd | Orange City | FL | 327638468 | 593149293 | Operation of Hospital & Related Services | FL | 501(c)(3) | 170(b)(1)(A)(iii) | Adventist Health SystemSunbelt Inc | 0 | |
| Specialty Physicians of Central Texas Inc | |||||||||||
| 1301 Wonder World Drive | San Marcos | TX | 78666 | 208814408 | Physician healthcare services to the community | TX | 501(c)(3) | 170(b)(1)(A)(iii) | Adventist Health SystemSunbelt Inc | 0 | |
| Spring View Health & Rehab Center Inc | |||||||||||
| 718 Goodwin Lane | Leitchfield | KY | 42754 | 205782288 | Operation of Home for the Aged/Healthcare Delivery | KY | 501(c)(3) | 509(a)(2) | Sunbelt Health Care Centers Inc | 0 | |
| Sunbelt Health & Rehab Center - Apopka Inc | |||||||||||
| 305 East Oak Street | Apopka | FL | 32703 | 205774856 | Operation of Home for the Aged/Healthcare Delivery | FL | 501(c)(3) | 509(a)(2) | Sunbelt Health Care Centers Inc | 0 | |
| Sunbelt Health Care Centers Inc | |||||||||||
| 602 Courtland Street Ste 200 | Orlando | FL | 32804 | 581473135 | Management Services | TN | 501(c)(3) | 509(a)(3) Type II | Adventist Health System Sunbelt Healthcare Corporation | 0 | |
| SunSystem Development Corporation | |||||||||||
| 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 Health System Sunbelt Healthcare Corporation | 0 | |
| Tarpon Springs Hosp Foundation Inc (101-123110) | |||||||||||
| 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 Health 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 Health Care Centers Inc | 0 | |
| Taylor Creek Health 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 Health Care Centers 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/Healthcare Delivery | KS | 501(c)(3) | 509(a)(2) | Sunbelt Health Care Centers Inc | 0 | |
| University Community Hospital Auxiliary Inc(101-123110) | |||||||||||
| 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(101-123110) | |||||||||||
| 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(101-123110) | |||||||||||
| 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(101-123110) | |||||||||||
| 3100 E Fletcher Ave | Tampa | FL | 33613 | 591113901 | Operation of Hospital & Related Services | FL | 501(c)(3) | 170(b)(1)(A)(iii) | Adventist Health System Sunbelt Healthcare Corporation | 0 | |
| West Kentucky Health 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 Health Care Centers Inc | 0 | |
| Zephyr Haven Health & Rehab Center Inc | |||||||||||
| 38250 A Avenue | Zephyrhills | FL | 33542 | 205774930 | Operation of Home for the Aged/Healthcare Delivery | FL | 501(c)(3) | 509(a)(2) | Sunbelt Health Care Centers Inc | 0 | |
| Zephyrhills Health & Rehab Center Inc | |||||||||||
| 7350 Dairy Road | Zephyrhills | FL | 33540 | 205774967 | Operation of Home for the Aged/Healthcare Delivery | FL | 501(c)(3) | 509(a)(2) | Sunbelt Health 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 |
| 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 Prairie Star Surgery Center LLC | |||||||
| 23401 Prairie Star Parkway | Lenexa | KS | 66227 | 364634843 | Surgical Center | 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 Health Sys Sunbelt Healthcare Corp Employee 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 Office 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 (101-123110) | ||||||||||||
| 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 through the provision of 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 | ||||
| Reflections Commercial Condominium Association Inc | ||||||||||||
| 875 Sterthaus Ave | Ormond Beach | FL | 32174 | 593519055 | Condo Association | FL | 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 (10110-93011) | ||||||||||||
| 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 (101-123110) | ||||||||||||
| 3100 East Fletcher Ave | Tampa | FL | 33613 | 593508454 | Management Company | FL | N/A | C | ||||
| West Coast Medical Group Inc (101-123110) | ||||||||||||
| 1395 S Pinellas Ave | Tarpon Springs | FL | 34689 | 593537305 | 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 | 1 | 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 | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | 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 (7 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Fletcher Hospital Inc | ||
| L | 718475 | Cost |
| Memorial Hospital Inc | ||
| L | 68970 | Cost |
| Sunsystem Development Corp dba Jellico Foundation | ||
| B | 83814 | Actual Cash Given |
| Sunsystem Development Corp dba Jellico Foundation | ||
| C | 507293 | Actual Cash Received |
| Adventist Health System Sunbelt Healthcare Corporation | ||
| L | 236046 | % of facility's operating expense |
| Adventist Health System Sunbelt Healthcare Corporation | ||
| O | 1311625 | Cost |
| North Regional EMS Inc | ||
| K | 807645 | Cost |