2023-11-10T12:45:32-06:00 2022-12-31 420714325 RSM US LLP 30 South Wacker Dr Suite 3300 Chicago IL 606063392 990 2022-01-01 461875883 Atlantic Coast ASC Holding Company Inc ATLA 9543024765 3109 Stirling Road 201 Ft Lauderdale FL 33312 Paul Sallwasser CEO 9543024765 2023-11-07 1 Paul Sallwasser XXX-XX-XXXX 0 Rebekuh Eley P01247672 3126343400 2023-11-07 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Paul Sallwasser 3109 Stirling Road 201 Ft Lauderdale FL 33312 0 0 X N/A X 2012 FL To serve the objectives and purposes of its parent, Florida Community Health Network Corp., in supporting its parent, Memorial Foundation, Inc, in its mission of supporting and benefiting the South Broward Hospital District and its residents through the structuring of relationships, ventures and other activities, in furtherance of the health care mission of the district, by enhancing the delivery of health care services and being responsive to the health needs of the residents of the district. The organization will be the sole member of or otherwise control separate single purpose subsidiary exempt entities who will be the participants or partners in qualifying exempt related activities. 2 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6320 5281 6320 5281 -6320 -5281 0 0 3695 7496 -3695 -7496 X To serve the objectives and purposes of its parent, Florida Community Health Network Corp., in supporting its parent, Memorial Foundation, Inc in its mission of supporting and benefiting the South Broward Hospital District and its residents through the structuring of relationships, ventures and other activities, in furtherance of the health care mission of the district, by enhancing the delivery of health care services and being responsive to the health needs of the residents of the district. The organization will be the sole member of or otherwise control separate single purpose subsidiary exempt entities who will be the participants or partners in qualifying exempt related activities. 0 0 0 0 0 To provide more efficient and reduced cost healthcare services to the community, in accordance with the policies of the South Broward Hospital District. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 2 2 0 0 0 0 1 1 1 0 0 0 0 0 1 1 1 0 0 0 0 0 X Paul Sallwasser 9543024765 3109 Stirling Road 201 Ft Lauderdale FL 33312 Steve Einhorn Chairman/Director 1.00 4.00 X X 0 0 0 Scott Wester Director 1.00 4.00 X 0 0 0 Paul Sallwasser CEO 1.00 39.00 X 0 504894 0 0 504894 0 0 0 1 0 0 0 0 0 0 1481 1481 3800 3800 5281 0 5281 0 0 0 3695 7496 3695 7496 X -3695 -7496 -3695 -7496 0 0 X -5281 1480 X X 0 1 X 1 0 X X X 1 Memorial Foundation Inc 592082218 7 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Paer IV, Section A, Line 1 Atlantic Coast ASC Holding Company, Inc. is wholly owned by Florida Community Health Network Corp, a tax-exempt organization under 501(c)(3). Florida Community Health Network Corp is wholly owned by Memorial Foundation, Inc., a tax-exempt organization under 501(c)(3). Atlantic Coast ASC Holding Company and Florida Community Health Network Corp are organized for the exclusive support of Memorial Foundation and its mission of supporting and benefiting the South Broward Hospital District. Part IV, Section B, line 1 The sole member of Atlantic Coast ASC Holding Company, Inc. is Florida Community Health Network Corp. The sole member of Florida Community Health Network Corp. is Memorial Foundation, the supported organization. Memorial Foundation indirectly controls Atlantic Coast ASC Holding Company. As provided in its articles of incorporation and its bylaws, and similarly that of its parent corporation: 1. The sole member (Florida Community Health Network Corp.) has exclusive authority to take action to ensure the corporation (Atlantic Coast ASC Holding Company, Inc.) serves its stated purpose, ensure the corporation protects and promotes the community benefits served by the member and corporation, ensure the assets and income are used to service the community objectives of the member and corporation, maintain the federal tax exempt status of the member and the corporation. 2. Written consent of the member is required for any amendment, repeal, modification or restatement of the articles or bylaws, and the other actions as stated in that section. 3. The initial board consisted of four directors elected by the member for a term of one year. Following the initial one year term, all directors shall be elected by the directors then in office for a term of one year. 4. If the member determines that any director is not independent or has a conflict of interest, the member or board may remove that director. 5. The board may not take any action which is in contravention of: the stated purpose as set in the articles and bylaws, protecting and promoting the community benefits served by the member, directly or indirectly, ensuring the assets and income are used to serve the community objectives of the foundation and the corporation, and maintaining the tax exempt status of the member and the corporation. 6. If the member believes, based on the reasonable advice of counsel, the board has taken any action that jeopardized the federal tax exempt status of the member of the company (Atlantic Coast ASC Holding Company, Inc.), it may take any necessary action on behalf of the corporation including voiding and reversing the action of the board. If the board fails to take action which the member believes, based on the reasonable advice of counsel, must be taken to maintain the federal tax exempt status of the member and the corporation, the member may take action on behalf of the corporation. The chairman of the foundation's audit committee attends, or at least is invited to attend, the audit committee meetings of Florida Community Health Network. In addition, the CEO of Florida Community Health Network attends the foundation's board meetings to provide an update of Florida Community Health Network's activities and operations and respond to questions of the foundation board. 0 X Part X, Line 2: The organization applies the provisions of FASB ASC Topic 740 for income taxes in accounting for uncertainty in income taxes. ASC 740 provides guidance on when tax positions are recognized in an entity's financial statements and how the values of these positions are determined. There is currently no impact on the organization's financial statements as a result of the application of ASC 740. The organization's income tax returns are subject to possible internal revenue examinations, generally for three years after they are filed. 0 0 0 0 0 0 0 0 0 Paul Sallwasser CEO 0 420466 0 84428 0 0 0 0 0 0 0 504894 0 0 Part I, Line 3 The organization's CEO is compensated by a related 501(c)(3) tax-exempt organization, Florida Community Health Network Corp (FCHN). Atlantic Coast ASC Holding Company is 100% wholly-owned by FCHN. The methods used by the related organization for determining the CEO's compensation include use of a compensation committee and approval by the board or compensation committee. Form 990, Part VI, Section A, line 6 The Organization is a wholly owned subsidiary of Florida Community Health Network Corp., a 501(c)(3) public charity supporting and benefiting the South Broward Hospital District. Form 990, Part VI, Section A, line 7a The initial board shall consist of five directors elected by the member, Florida Community Health Network Corp., who shall each serve for a term of one year. Following the initial one year term, all directors shall be elected by the directors then in office for a term of one year, subject to the reserve powers of the sole member, Florida Community Health Network Corp., in ensuring the organization serves its charitable purpose. Form 990, Part VI, Section A, line 7b The sole member, Florida Community Health Network, Corp., has authority to ensure the organization operates and serves its charitable purpose, and its assets and income are used to serve the community benefits of Memorial Foundation, Inc. and the South Broward Hospital District. Form 990, Part VI, Section A, line 8a The governing body did not hold any meetings nor undertake any written actions during the year. Form 990, Part VI, Section A, line 8b Neither the governing body nor any committees with authority to act on behalf of the governing body held any meetings nor undertook any written actions during the year. Form 990, Part VI, Section B, line 11b Management and the chairman of the board review and comment on the form 990 before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The organization's board shall regularly and consistently monitor and enforce compliance with its conflict of interest policy by reviewing annual statements and taking such other actions as are necessary for effective oversight. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and consolidated financial statements available to public upon request. The financial statements are available for the same period of disclosure as set forth by IRC Section 6104(d). Form 990, Part XI, line 9: Contribution of Capital from Florida Community Health Network 1,480. Form 990, Part XII, line 2c There has been no change from the prior year. Memorial Foundation Inc 3329 Johnson Street Hollywood FL 33021 592082218 Support Charitable Activities of South Broward Hospital District FL 501(c)(3) Line 7 N/A 0 Florida Community Health Network Corp 3109 Stirling Road Ste 201 Ft Lauderdale FL 33312 461405669 Support Charitable Activities of Memorial Foundation, Inc. FL 501(c)(3) Line 12a, I Memorial Foundation Inc 0 Atlantic Coast ASC GP1 Inc 3109 Stirling Road Ste 201 Ft Lauderdale FL 33312 461876304 Majority General Partner in Ambulatory Surgical Center FL 501(c)(3) Line 12a, I Atlantic Coast ASC Holding Company Inc 1 Joe DiMaggio Children's Hospital Foundation Inc 3329 Johnson Street Hollywood FL 33021 650492343 Support Charitable Activities of Joe DiMaggio Children's Hospital FL 501(c)(3) Line 7 Memorial Foundation Inc 0 Ambulatory Surgical Facility of South Florida LLLP 4470 Sheridan Street Hollywood FL 33021 592753716 Operating and/or managing Ambulatory Surgical Facility FL N/A N/A 0 0 SBE Holdings LLC 11011 Sheridan St Ste 106 Cooper City FL 33026 465454822 Member of South Broward Endoscopy, LLC FL N/A N/A 0 0 Cohen Medical Associates LLC 1300 Jog Rd Ste 205 Delray Beach FL 33446 043782956 Primary Care Medical Practice FL N/A N/A 0 0 Cypress Creek Outpatient Surgical Center Holding Company LLC 3109 Stirling Road Ste 201 Ft Lauderdale FL 33312 352596854 Holding Company FL N/A N/A 0 0 Amsurg FCHN ASC Ventures LLC 14 Burton Hills Blvd Nashville TN 37215 815071853 Holding Company FL N/A N/A 0 0 Hallandale Outpatient Surgery Center LTD C/O Lance J Lehman 306 E Hallandale Hallandale Beach FL 33009 200244303 Operate Ambulatory Surgery Center FL N/A N/A 0 0 MHS Staffing Resources LLC 1000 Sawgrass Corp Pkwy 100 Sunrise FL 33323 834468496 Temporary Staffing Services FL N/A N/A 0 0 Atlantic Coast Holdings Inc 3109 Stirling Road Ste 201 Ft Lauderdale FL 33312 463231265 Invest in Health Care ventures within or close to SBHD FL N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1