2023-07-19T07:30:24-05:00 2022-12-31 440160260 FORVIS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2022-01-01 582460001 SMHA HEALTHCARE INC SMHA 3219723585 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 NEIL LURIA CHIEF WIND-DOWN OFFICER 3219723585 2023-06-07 1 NEIL LURIA 999009999 1 AMY BIBBY P00445891 8282542254 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z NEIL LURIA 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 20637 0 X N/A X 1997 GA THE ORGANIZATION SUPPORTS THE EXCLUDED ASSETS AND LIABILITIES ASSOCIATED WITH THE ASSET PURCHASE TRANSACTION AND THE WIND DOWN OF SUCH ACTIVITIES. 7 7 0 0 0 0 0 0 576222 250 0 0 1389401 20387 1965623 20637 0 0 0 0 0 0 0 0 0 2131054 2835280 2131054 2835280 -165431 -2814643 23371773 20395823 3305697 12408964 20066076 7986859 THE ORGANIZATION SUPPORTS THE EXCLUDED ASSETS AND LIABILITIES ASSOCIATED WITH THE ASSET PURCHASE TRANSACTION AND THE WIND DOWN OF SUCH ACTIVITIES. 0 0 1591629 250 TO PROVIDE ADMINISTRATIVE SUPPORT BY ENGAGING IN SUCH OTHER ACTIVITIES THAT BENEFIT, PERFORM THE FUNCTIONS OF, OR CARRY OUT THE PURPOSES OF SMHA HEALTH, INC.JANUARY 31, 2018 THE ORGANIZATION CLOSED ON THE ASSET PURCHASE AGREEMENT WITH HOSPITAL CORPORATION OF AMERICA (HCA). DISCLOSURES AND ACTIVITIES REPORTED REPRESENT THIS TRANSACTION.THE ORGANIZATION SUPPORTS THE EXCLUDED ASSETS AND LIABILITIES ASSOCIATED WITH THE ASSET PURCHASE TRANSACTION AND THE WIND DOWN OF SUCH ACTIVITIES. 1591629 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 GA X X KIRA ABRAMOVS 3219723585 425 W NEW ENGLAND AVE SUITE 300 WINTER PARK FL 32789 X REX TEMPLETON CHAIRMAN 0.25 0.25 X X 0 0 0 ISRAEL SMALL DIRECTOR 0.25 0.25 X 0 0 0 CHARLES MCMILLIAN DIRECTOR 0.25 0.25 X 0 0 0 CURTIS LEWIS III DIRECTOR 0.25 0.25 X 0 0 0 SUSAN WILLETTS DIRECTOR 0.25 0.25 X 0 0 0 FRANK ROSSITER MD DIRECTOR 0.25 0.25 X 0 0 0 ARTHUR DANA DIRECTOR 0.25 0.25 X 0 0 0 0 0 0 0 0 0 0 0 PATIENTS RECEIPTS 621400 250 250 250 MISCELLANEOUS INCOME 900099 20387 20387 20387 20637 250 0 20387 360000 360000 1122935 1122935 103158 103158 62584 62584 10857 10857 1055563 1055563 13975 13975 60098 60098 NET PATIENT RECEIPTS / 29990 29990 PRE-CLOSE INVOICES 16120 16120 2835280 1591629 1243651 0 15818796 14167399 3674545 2971257 3878432 3257167 23371773 20395823 711300 351642 2594397 12057322 3305697 12408964 X 20066076 7986859 20066076 7986859 23371773 20395823 X -2814643 -9264574 X 0 0 0 X X 1 SMHA HEALTHCARE CENTER 311126469 3 1 0 1591629 1 0 1591629 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 ASSETS FOR DISPOSITION 3017409 FUNDS HELD AT STERLING SEACREST 239758 3257167 PATIENT/INSURANCE REFUND LIABILITY 2057322 ESTIMATED PHYSICIAN SETTLEMENT 10000000 12057322 FORM 990, PART VI, SECTION B, LINE 11B THE TAX RETURN IS PREPARED BY AN UNRELATED, INDEPENDENT ACCOUNTING FIRM AND THEN SUBMITTED TO MANAGEMENT FOR REVIEW BEFORE BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO UPDATE AND SUBMIT A NEW CONFLICT OF INTEREST STATEMENT ANNUALLY. THE CHAIRMAN OF THE BOARD SHALL BECOME FAMILIAR WITH THE STATEMENTS OF THE BOARD MEMBERS IN ORDER TO GUIDE THEIR CONDUCT SHOULD A CONFLICT ARISE AT SUCH TIMES AS ANY MATTER COMES BEFORE THE BOARD THAT MAY POTENTIALLY RESULT IN A CONFLICT OF INTEREST. THE AFFECTED BOARD MEMBER SHALL MAKE KNOWN THE POTENTIAL CONFLICT, WHETHER OR NOT DISCLOSED IN A WRITTEN STATEMENT. THE AFFECTED BOARD MEMBER MAY MAKE A PRESENTATION TO THE BOARD, BUT AFTER SUCH PRESENTATION, HE OR SHE MUST LEAVE THE MEETING DURING THE DISCUSSION OF AND THE VOTE ON THE TRANSACTION OR ARRANGEMENT CONSIDERED TO BE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 990 IS MADE AVAILABLE UPON REQUESTION. IN ADDITION, THE FORM 990 IS AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS OF THE ORGANIZATION ARE HELD AS PUBLIC RECORDS OF THE STATE OF GEORGIA SECRETARY OF STATE OFFICE. AS SUCH, THESE DOCUMENTS ARE OPEN TO THE PUBLIC. THE CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC AS THIS IS NOT A REQUIREMENT. FORM 990, PART XI, LINE 9: RECON OF INS REFUND LIABILITY TO ACTUAL 476,918. NET EQUITY TRANSFERS TO AFFILIATES -10,034,999. RECON OF COST REPORT RECOVERIES TO ACTUAL 293,507. SMHA CARDIOVASCULAR LLC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 473916622 PROVISION OF MEDICAL SERVICES (DISSOLVED 8/21) GA 0 0 MEMORIAL HEALTH INC SMHA PHYSICIANS LLC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 INACTIVE (DISSOLVED 8/21) GA 0 0 MEMORIAL HEALTH INC SMHA HEALTHCARE CENTER INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 311126469 HEALTH CARE PROVIDER GA 501(C)(3) LINE 3 SMHA HEALTHCARE INC 1 GODLEY STATION MEDICAL PROPERTIES LLC 4600 WATERS AVE SUITE 100 SAVANNAH GA 31404 HEALTH CARE GA N/A 0 0 ENCOMPASS HEALTH REHABILITATION HOSPITAL OF SAVANNAH 9001 LIBERTY PARKWAY BIRMINGHAM AL 35242 HEALTH CARE AL N/A 0 0 SMHA HEALTHCARE PARTNERS INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 581707311 MANAGED CARE (DISSOLVED 8/21) FL SMHA HEALTH SERVICES GROUP INC C 1.00000 1 SMHA ANESTHETISTS GROUP INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 431985441 MEDICAL SERVICES (DISSOLVED 8/21) FL SMHA HEALTH SERVICES GROUP INC C 1.00000 1 SMHA VENTURES INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 582162071 PHYSICIANS PRACTICE FL SMHA HEALTH SERVICES GROUP INC C 1.00000 1 SMHA HEALTH SERVICES GROUP INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 581611969 MEDICAL SERVICES/ CONSOLIDATING ENTITY FL SMHA HEALTH INC C 1.00000 1 SMHA PROPERTIES INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 582537941 REAL ESTATE HOLDING (DISSOLVED 8/21) FL SMHA HEALTH SERVICES GROUP INC C 1.00000 1 SMHA CORPORATE SERVICES INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 900963434 CORPORATE SERVICES (DISSOLVED 8/21) FL SMHA HEALTH SERVICES GROUP INC C 1.00000 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0