2023-10-31T09:59:20-05:00 2022-12-31 990 2022-01-01 822567308 Florida Hospital Dade City Inc FLOR 3525211100 13100 Fort King Road Dade City FL 33525 Lynn C Addiscott Assistant Secretary 4073572317 2023-10-19 Lynn Addiscott 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z AdventHealth Dade City Mike Murrill 13100 Fort King Road Dade City FL 33525 84608947 0 1071 X www.adventhealth.com/hospital/ X 2017 FL Provision of medical care to the community through the operation of a 120 bed acute-care hospital. 18 12 0 25 0 0 311166 13859 75096007 84374064 339247 135852 0 0 75746420 84523775 22600 27000 0 0 969949 1216219 0 0 0 74038916 80244914 75031465 81488133 714955 3035642 47946588 49935386 26703019 26346630 21243569 23588756 X Adventist Health System Sunbelt Healthcare Corporation and all 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.The hospital and healthcare system whose parent is Adventist Health System Sunbelt Healthcare Corporation is known as AdventHealth. AdventHealth seeks to be widely respected as a consumer-focused organization that engages individuals in their health by delivering wholistic, best practice care across a connected, comprehensive continuum of services. With Christ as our example, AdventHealth cares for and nurtures people: our employees, our communities, our healthcare professionals, and those who trust us for care and healing. 0 0 76364368 27000 84374064 Operation of acute care hospital totaling 120 beds. During the current year there were 4,811 admissions resulting in 28,386 patient days and 27,017 outpatient visits. 76364368 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 18 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X Ryan Willis 8137796201 13100 Fort King Road Dade City FL 33525 X Bruce Bergherm Dir/Chair/SEO West FL Reg (end 6/22) 0.50 50.00 X 0 1410394 49535 Jennifer Wandersleben Dir/Chair/CEO Heartland Reg (beg 6/22) 1.36 48.64 X X 0 949270 170444 Denyse Bales-Chubb Director (end 7/22) 0.50 50.00 X 0 850496 165316 Amanda Maggard Director/Sec/CEO 25.00 25.00 X X 0 571667 126972 Rainer Chan MD Director 0.50 50.00 X 0 449774 109845 Rosalie Oliver Director 2.95 47.05 X 0 445009 93000 Royce Brown Director (beg 10/22) 0.50 50.00 X 0 262188 88355 Ken Bradley Director 0.50 50.00 X 0 193548 34267 Dale Maggard Director 0.50 0.50 X 0 0 0 John Scott Director 0.50 0.50 X 0 0 0 Rebecca Gaddis Director 0.50 0.50 X 0 0 0 Stephen Herr Director 0.50 0.50 X 0 0 0 Scott Cameron Director 0.50 0.50 X 0 0 0 Marcus McCants Director (end 8/22) 0.50 0.50 X 0 0 0 Elaine Jones Director 0.50 0.50 X 0 0 0 Randall Belcher Director 0.50 0.50 X 0 0 0 Edwin Aguayo Director 0.50 0.50 X 0 0 0 Leroy Hauff Director 0.50 0.50 X 0 0 0 Raymond Pichette Director 0.50 0.50 X 0 0 0 Melanie Barriffe Director (beg 6/22) 0.50 0.50 X 0 0 0 Reggie Roberts Director (beg 6/22) 0.50 0.50 X 0 0 0 Ryan Willis CFO & COO (COO end 2/22) 25.00 25.00 X 0 350195 42951 Rodrigo Torres MD CMO 25.00 25.00 X 0 449353 90911 Gwen Alonso CNO 25.00 25.00 X 0 332427 42927 Shane Bedward COO (beg 2/22) 25.00 25.00 X 0 247575 53286 Michael Schultz Former Officer 0.00 0.00 X 0 566508 10300 Jason Newmyer Former VP/Admin 0.00 50.00 X 0 298304 93930 Robin McGuinness Regional CNO - Former Key 1.36 48.64 X 0 633401 89768 0 8010109 1261807 0 1 1 0 AMN Healthcare Inc 12400 High Bluff Drive San Diego CA 92130 Staffing Services 2064070 KR Management LLC 200 Clearwater-Largo Rd Largo FL 33525 Staffing Services 1018280 Tampa Bay Anesthesiology Assoc LLC 3414 Loggerhead Way Wesley Chapel FL 33544 Anesthesiology Services 1001256 AYA Healthcare Inc 5930 Cornerstone Crt W 300 San Diego CA 92121 Staffing Services 816999 GQR 1038B Princeton Drive Marina del Rey CA 90292 Staffing Services 764088 24 X 13859 13859 Net patient revenue 622110 84025929 84025929 Cafeteria revenue 622110 258009 258009 Rent from tax-exempt affiliate 622110 84816 84816 5310 5310 84374064 162824 162824 58200 85172 0 -85172 58200 -26972 -26972 84523775 84374064 0 135852 X 27000 27000 1216219 1216219 -195076 -195076 21835 21835 14579 14579 54678358 52020991 2657367 309170 309170 1594159 989443 604716 4301207 4054976 246231 1627371 1627371 11357 11357 142295 142295 265076 265076 3351107 3351107 693203 674864 18339 Medical supplies 10509196 10509196 Repairs & maintenance 1942687 1942687 State tax indigent asse 876970 876970 101420 24687 76733 81488133 76364368 5123765 0 X 450 649 5946665 3120161 9750140 13116943 2412348 2498712 2529076 2665346 37498931 13680159 23191612 23818772 290394 90417 3825903 4624386 47946588 49935386 5729741 4971763 20973278 21374867 26703019 26346630 X 21243569 23588756 21243569 23588756 47946588 49935386 X 3035642 -786581 96126 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3206 3206 0 Part II-B, Line 1: American Hospital Association and Florida Hospital Association dues. 930000 930000 17009096 4569508 12439588 19117906 8985105 10132801 441929 125546 316383 23818772 Other receivables 290166 Receivable from third parties 168425 Right Of Use Asset-Oper Lease 4165795 4624386 Due to related 5416108 Other liabilities 70477 Credit balances in A/R 472798 Payable to third parties 747773 Other deferred Revenue 519966 Accrued Interest Payable 7417 Interco Alloc of TE Bond Proceeds 9618693 Operating Lease Liability 4521635 21374867 X Part X, Line 2: The filing organization is a subsidiary organization within AdventHealth. The consolidated financial statements of AdventHealth contain the following FIN 48 (ASC 740) footnote: Please note that dollar amounts are in thousands. Healthcare Corporation and its affiliated organizations, other than North American Health Services, Inc. and its subsidiary (NAHS), are exempt from state and federal income taxes. Accordingly, Healthcare Corporation and its tax-exempt affiliates are not subject to federal, state or local income taxes except for any net unrelated business taxable income. NAHS is a wholly owned, for-profit subsidiary of Healthcare Corporation. NAHS and its subsidiary are subject to federal and state income taxes. NAHS files a consolidated federal income tax return and, where appropriate, consolidated state income tax returns. All taxable income was fully offset by net operating loss carryforwards for federal income tax purposes; as such, there is no provision for current federal or state income tax for the years ended December 31, 2022 and 2021. NAHS also has temporary deductible differences of approximately $18,200 and $33,000 at December 31, 2022 and 2021, respectively, primarily as a result of net operating loss carryforwards. At December 31, 2022, NAHS had net operating loss carryforwards of approximately $10,000, expiring in 2023 through 2026. Deferred taxes have been provided for these amounts, resulting in a net deferred tax asset of approximately $4,500 and $8,100 at December 31, 2022 and 2021, respectively. NAHS remeasured its deferred tax assets and liabilities based on the rates at which they are expected to reverse in the future, which is generally 21%. A full valuation allowance has been provided at December 31, 2022 and 2021 to offset the deferred tax asset since Healthcare Corporation has determined that it is more likely than not that the benefit of the net operating loss carryforwards will not be realized in future years. The Income Taxes Topic of the Accounting Standards Codification (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. There were no material uncertain tax positions as of December 31, 2022 and 2021. 1 1 X 1 X 1 X 1 1 0 1 0 3293944 3293944 0.04040 14308489 5232691 9075798 0.11140 17602433 5232691 12369742 0.15180 17602433 5232691 12369742 0.15180 1 5168426 1005396 10336757 14335794 -3999037 X 1 1 1 1 Florida Hospital Dade City Inc 13100 Fort King Road Dade City FL 33525 adventhealth.com/hospitals/dade-city 3935 X X X Florida Hospital Dade City Inc 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X See Part V, page 8 X X 1 20 1 See Part V, page 8 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X See Part V, page 8 X See Part V, page 8 X See Part V, page 8 X X X X X X 1 X 0 X X X X 1 X 0 0 Florida Hospital Dade City, Inc. Part V, Section B, Line 5: Florida Hospital Dade City Inc., d/b/a AdventHealth Dade City (FHDC or the Hospital) is a 120-bed acute care hospital located in Pasco County in Florida. FHDC primarily serves five zip codes across Pasco County and a small part of Hernando County. In conducting its 2022 Community Health Needs Assessment (CHNA), the Hospital solicited input directly from the community and from individuals who represent the broad interests of the community, including medically underserved, low-income and minority community members. The Hospital partnered with local community organizations and stakeholders, including those in public health, to form the All4HealthFL Collaborative. The All4HealthFL Collaborative is a regional effort of local hospital systems and public health departments that work to improve community health. The Collaborative collected input directly from the community and from community stakeholders through a community survey and focus groups. The Collaborative met several times in 2021 and 2022 and reviewed primary and secondary data and helped to define the top health priority needs in the community. FHDC also formed a Community Health Needs Assessment Committee (CHNAC) that included representatives from organizations that serve low-income, low-access individuals and communities. The purpose of the CHNAC was to select the needs the Hospital would address from the findings in the community health needs assessment. Key CHNAC members that represented low-income and underserved populations were from the following organizations- Sunrise of Pasco County Domestic and Sexual Violence Center, East Pasco Adventist Church, First Church of the Nazarene, Pasco County Schools, Premier Community Healthcare, UF/IFAS Cooperative Extension Pasco County, NAMI Pasco, Pioneer Medical Group, United Way Pasco, Florida Department of Health Pasco, Pasco Homeless Coalition, Metropolitan Ministries, and Glorious Church of God in Christ Lacoochee. Florida Hospital Dade City, Inc. Part V, Section B, Line 7d: The Hospital has adopted a policy that addresses the public posting requirements of the Community Health Needs Assessment. Under this policy, the Community Health Needs Assessment Reports must be posted on the Hospital's website at least until the date the Hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the Hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports. Florida Hospital Dade City, Inc. Part V, Section B, Line 11: Florida Hospital Dade City, Inc,. d/b/a AdventHealth Dade City, will be referred to in this document as AdventHealth Dade City or "the Hospital". The Hospital is a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is the 501(c)(3) parent organization of a hospital and healthcare system known as AdventHealth. In January 2019, every wholly-owned entity of AHSSHC adopted the AdventHealth system brand. Our identity has been unified to represent the full continuum of care our system offers. Any references to our prior Community Health Needs Assessments (CHNAs) or prior Community Health Plans (CHPs) will utilize our new name for consistency. AdventHealth Dade City is part of the West Florida Division (the Division) of AdventHealth. The Division includes 13 hospital facilities. This is the third-year update for AdventHealth Dade City's 2020-2022 Community Health Plan/Implementation Strategy. The Hospital developed this plan and posted it in May 2020 as part of its 2019 Community Health Needs Assessment process. For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AdventHealth Dade City worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2019 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the community health needs assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2020-2022 Community Health Plan. The third-year progress on the Community Health Plan is noted below. The narrative describes the prioritized issues identified in 2019 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital did not address. AdventHealth Dade City chose five priorities for its 2020-2022 Community Health Plan: 1. Dental Health2. Heart Disease 3. Low Food Access (Social Determinant of Health) 4. Mental Health/Suicide/Depression 5. Obesity/Overweight Priority 1: Dental Health2019 Description of the Issue:Many oral diseases can be prevented with routine care and regular dental checkups. The health of the teeth, the mouth, and the surrounding craniofacial (skull and face) structures is central to a person's overall health and well-being. Lack of access to dental care for all ages remains a public health challenge. In the AdventHealth Dade City Primary Service Area (PSA) the access to dentists' rate is 33 per 100,000 population (in 2015), as compared to the state rate of 56. The AdventHealth Dade City Community Health Plan has two desired goal statements under the Dental Health priority. 1. Implement strategies to support community efforts to improve access to primary care and dental care providers2. Improve access to health education, early intervention programs and resources related to oral health preventative dental careGoal 1: Implement strategies to support community efforts to improve access to primary care and dental care providersObjective 1: The first objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. Their objective is to create a volunteer network of local dentists to volunteer at local community mobile dental clinics to provide free dental services to underinsured/uninsured adults residing in the Hospital's PSA by mobilizing three volunteer dentists from a baseline of zero by the end of year three. This objective is conducted through AdventHealth Dade City and outcomes reported are specific to the reporting Hospital. This initiative provides volunteer dentists to Premier Community HealthCare Group, Inc., a non-profit organization and Federally Qualified Health Center (FQHC) serving Pasco and Hernando Counties, by providing quality, affordable and accessible healthcare services for all. 2022 Update:The Hospital did not meet its set metric of recruiting three dentists by December 31st, 2022. Dental Lifeline Network is a non-profit that is primarily funded by the American Dental Association and helps connect uninsured patients to dentists who will provide care at no or low cost in their own offices. Many dentists reported preferring this approach over a mobile dental clinic, which prevented the Hospital from achieving this objective. The Hospital held a Dental Health Equity Summit to call for volunteer dentists and budgeted money to incentivize dentists to join the network without any success.Objective 2: The second objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to increase access to dental care among underinsured/uninsured adults residing in the Hospital's PSA by providing on-going donations of dental medical supplies to at least one local community mobile dental clinic from a baseline of zero by the end of year three. This objective is funded through AdventHealth Dade City and outcomes reported are specific to the reporting Hospital. AdventHealth Dade City has connected with Premier Community Healthcare, a 501(c)(3) nonprofit organization and the only Federally Qualified Health Center (FQHC) serving Pasco and Hernando Counties. By providing ongoing donations to Premier Community Healthcare, we increase the capacity for this community-based organization to provide additional services to the uninsured and underinsured residents and improve oral health outcomes for the community. 2022 Update:The Hospital met its set metric of supporting one mobile dental clinic by the end of year three. The Hospital made a $250 donation to Premier Community Healthcare in 2022 to purchase dental and medical supplies to support their mobile dental clinic.Goal 2: Improve access to health education, early intervention programs and resources related to oral health preventative dental careObjective 1: The first objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to partner with MORE HEALTH, Inc. to offer oral health training workshops to staff from local community agencies to increase access to oral health education for parents and youth residing in the Hospital's PSA and sponsor the costs to train 45 community health providers from a baseline of zero by the end of year three. MORE HEALTH, Inc is a 501(c)(3) nonprofit organization, which develops effective health and safety lessons, trains high-quality instructors, and delivers lessons to students in Pre-K to 12th grade. This objective is managed through the Division, however all funding and outcomes reported are specific to the reporting Hospital. This initiative will enable more lay educators who are trained on K-5 dental education to be able to teach in community spaces versus just in the school setting. 2022 Update:The Hospital met its set metric with 45 summer camp coaches from Pasco County Parks and Recreation trained in 2022. Objective 2: The second objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is a part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to partner with Premier Community Healthcare to create a taskforce on dental care access in Pasco County and co-host with AdventHealth Zephyrhills at least two community summits from a baseline of zero summits to bring awareness, health education and develop action steps to address the problem of dental care access for underinsured/uninsured adults residing in the Hospital's PSA by the end of year three. This objective is managed by the Division, however the Hospital funds the objective. All outcomes reported represent both Hospitals. This initiative provides strategies to address the unmet dental health needs of underinsured and uninsured community members and create collaborative relationships between our team and local organizations. See Continuation 2 Florida Hospital Dade City, Inc. Part V, Section B, Line 13h: Effective March 1, 2020, the filing organization's hospital facility (or facilities) augmented their Financial Assistance Policy with a COVID-19 Financial Grace Addendum. Pursuant to the COVID-19 Financial Grace Addendum, uninsured patients treated for COVID-19 related evaluations are to receive free or discounted care depending on the patient's cooperation in submitting necessary financial assistance information. Insured patients tested for COVID-19 are not expected to have out-of-pocket expenses based on insurance community response to waive patient financial responsibility. If a payer unexpectedly fails to waive patient responsibility for COVID-19 related testing, the filing organization will not balance bill patients for any out-of-pocket expenses related to COVID-19. In addition, patients with existing payment plans are provided opportunities for reducing their monthly payments. Schedule H, Part V, Section B, Line 11: Continuation 2 2022 Update:The Hospitals did not meet their set metric of two summits convened by December 31st, 2022. On November 12th, 2021, AdventHealth Zephyrhills and AdventHealth Dade City partnered with Premier Community Healthcare to host the first Dental Health Equity Summit. The event had 36 attendees and all attendees received Amazon gift cards for attending. There was not enough interest to hold a second Dental Health Equity Summit.Priority 2: Heart Disease 2019 Description of the Issue:Heart disease is the leading cause of death in the U.S., responsible for one in four deaths annually. The major risk factors for heart disease are high blood pressure, high cholesterol, being overweight/obese and having an unhealthy diet. One in four deaths in the U.S. are due to heart disease. By managing blood pressure and cholesterol, eating a healthy diet, and incorporating physical activity daily, the risk of developing heart disease could be greatly reduced. In the AdventHealth Dade City PSA, the rate of death due to heart disease per 100,000 population is 156, which is higher than the state rate of 150. The AdventHealth Dade City Community Health Plan has two desired goal statements under the Heart Disease priority. 1. Improve access to health education, early intervention programs and resources related to prevention of heart disease2. Enhance community to clinical linkages between community organizations and stakeholders to promote coordinated patient care strategies to control high blood pressure and high cholesterolGoal 1: Improve access to health education, early intervention programs and resources related to prevention of heart diseaseObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to increase the number of Hospital sponsored American Heart Association (AHA) community CPR out-of-hospital bystander classes for adults and youth from a baseline of zero to three by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. This initiative provides training to lay community members to be able to save the lives of individuals experiencing a cardiac event by administering the two-step Hands-Only CPR. 2022 Update:The Hospital met and exceeded this metric by completing five Hands-Only CPR classes by December 31st, 2022. The Hospital collaborated with community organizations, churches, and Pasco County Schools to complete these trainings.Objective 2: The second objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. This objective is managed by the Division, however the Hospital funds the objective and all outcomes reported are specific to the reporting Hospital. The objective is to provide patient referrals at discharge to enroll in free Gulfcoast North Area Health Education Center (GNAHEC) tobacco cessation programs and receive free intervention therapies to quit smoking tobacco. Through a partnership with GNAHEC, a local chapter of the national Area Health Education Center (AHEC) organization, we will create an internal referral system to link adults residing in the Hospital's PSA to the programs, providing resources for 50 patients from a baseline of zero by end of year three. GNAHEC is a community focused organization that develops and implements community-based health promotion activities and education programs, which targets the underserved. As it relates to our relationship with GNAHEC, we are partnering with GNAHEC to provide community members the tools and resources to assist with tobacco cessation. 2022 Update:The Hospital did not meet its set metric of referring 50 patients by December 31, 2022. Staff trainings were completed to encourage an increase in referrals. However, the Hospital was only able to complete 13 referrals. Overall referrals have been historically low due to low interest.Objective 3:The third objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. This objective is managed by the Hospital and all funding and outcomes reported are specific to the reporting Hospital.The objective is to increase access to AHEC free tobacco cessation classes for adults residing in the Hospital's PSA by five classes from a baseline of zero by the end of year three. As it relates to our relationship with GNAHEC, we are partnering with GNAHEC to provide community members the tools and resources to assist with tobacco cessation. 2022 Update:The Hospital did not meet this metric of increasing access to five tobacco cessation classes by the end of year three. In person classes were initially suspended due to the COVID-19 pandemic and were not restarted until 2022. When in person classes started again, several classes were canceled due to low attendance resulting in the Hospital only providing 2 classes. See Continuation 3 Schedule H, Part V, Section B, Line 11: Continuation 3 Goal 2: Enhance community to clinical linkages between community organizations and stakeholders to promote coordinated patient care strategies to control high blood pressure and high cholesterolObjective 1: The first objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. This objective is managed by the Hospital and all funding and outcomes reported are specific to the reporting Hospital. The objective is to increase the number of underinsured/uninsured community members receiving linkages to follow up clinical care at Pioneer Medical Group by providing free biometric screenings and health education at a minimum of three Pioneer Medical Group free mobile clinic events for 75 patients from a baseline of zero patients by the end of year three. This initiative provides community members with access to free biometric health screenings and primary care follow up to identify, treat and manage potentially unknown chronic conditions, including heart disease. 2022 Update:The Hospital did not meet its set metric of 75 community members linked by December 31st, 2022. The COVID-19 pandemic made in-person screenings difficult to complete. The Hospital was able to support one free mobile clinic event with Pioneer Medical Group providing screenings for 50 community members. Priority 3: Low Food Access (Social Determinant of Health)2019 Description of the Issue:Low food access is defined as living more than half a mile from the nearest supermarket, supercenter, or large grocery store. The ability to easily access and afford food greatly influences diet and overall health. People who have low food access face greater barriers to access affordable and healthy food, which can negatively affect health and wellness. In the AdventHealth Dade City PSA, 26% of the population has low food access.The AdventHealth Dade City Community Health Plan has two desired goal statements under the Low Food Access (Social Determinant of Health) priority. 1. Increase access to nutrition education by supporting community organizations and other community stakeholders offering health education and resources2. Implement strategies that support existing community initiatives aimed to address the problem of low food access in the Hospital's PSAGoal 1: Increase access to nutrition education by supporting community organizations and other community stakeholders offering health education and resourcesObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to provide the Food is Health program to low-income families in the PSA by offering two class series from a baseline of zero by the end of year three. The program is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. The Food is Health program is an AdventHealth West Florida Division program which increases access to health education and healthy foods to improve the overall health of the communities the Hospital serves. Through collaboration with community partners, the program connects with low-income/low access communities and provides free health education, health screenings and produce vouchers which are used to purchase fresh fruits and vegetables. 2022 Update:The Hospital did not meet its set metric of two education class series by December 31st, 2022. Due to the COVID-19 pandemic, the Hospital had to develop and provide virtual classes, which were not completed until the second year of the plan. The Hospital was able to provide one AdventHealth Food is Health class series virtually in 2021. The Hospital did not complete any classes in 2022.Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to increase access to culturally appropriate nutritious food options among Food is Health program participants through the distribution of 80 produce vouchers from a baseline of zero produce vouchers by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. 2022 Update:The Hospital did not meet its set metric of distributing 80 produce vouchers by December 31st, 2022. Due to the COVID-19 pandemic, the Hospital had to develop and provide virtual classes, which were not completed until the second year of the plan. Participation in classes has been historically low due to low interest in Dade City. The Hospital was able to distribute 40 produce vouchers in 2021. The Hospital did not distribute any vouchers in 2022. Objective 3:The third objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to increase new partnerships with local community organizations in the Food is Health program to five partners from a baseline of zero partners by the end of year three. This objective is managed at the Divisional level; however, the Hospital funds the objective. All outcomes reported represent both AdventHealth Dade City and AdventHealth Zephyrhills. See Continuation 4 Schedule H, Part V, Section B, Line 11: Continuation 4 2022 Update:The Hospital exceeded its set metric of establishing five new community partners by attaining six new community partners. The Hospital partnered with the First Nazarene Church of Dade City and Dube's Mobile Market to expand our Food is Health program throughout the Pasco County region. The Hospital identified the East Pasco Seventh-Day Adventist Church as a future community-based site. We have also partnered with the Pasco County Department of Parks and Recreation and the Lacoochee Boys & Girls Club. In year three, the Hospital did not establish any new community partners, because the metric was met in year two. Year three was spent further developing the new connections made in year two. Objective 4:The fourth objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to increase participation in the Food is Health program among low-income families in the Hospital's PSA to 20 participants from a baseline of zero by the end of year three. The objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. 2022 Update:The Hospital did not meet its set metric of 20 participants by December 31, 2022. There was a delay in starting classes for this three-year cycle due to the COVID-19 pandemic. This coupled with a history of low attendance at classes due to low interest made it difficult to achieve this objective. The Hospital was able to serve 10 unique participants for this three-year plan.Objective 5:The fifth objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is through the Food is Health program to increase access to health screenings among adults living in food deserts or low-income/low-access communities to 30 screenings from a baseline of zero screenings by the end of year three. The objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. 2022 Update:The Hospital did not meet this metric of 30 health screenings by December 31, 2022. Unfortunately, health screenings were unavailable throughout the three-year plan to reduce the risk of spreading COVID-19. Furthermore, community health nursing staff members were redeployed to hospital facilities to assist with treating patients diagnosed with COVID-19. Attempts were made to recruit nurses from other departments but staffing issues have been prevalent throughout the pandemic making this metric unattainable. Goal 2: Implement strategies that support existing community initiatives aimed to address the problem of low food access in the Hospital's PSAObjective 1: The first objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to partner with the University of Florida/Institute of Food and Agricultural Sciences (UF/IFAS) Extension Pasco County to implement the "Healthy Corner Stores in Pasco County" initiative aimed at increasing the number of corner stores providing access to fresh produce to low-income/low-access communities in the Hospital's PSA by six from a baseline of zero by the end of year three. This objective is managed at the Divisional level; however, it is funded through AdventHealth Dade City and outcomes reported are specific to the reporting Hospital. This initiative provides fresh fruits and vegetables to community members living in food deserts by bringing the produce to a location that is convenient for them and profitable for store owners. 2022 Update: Due to the COVID-19 pandemic, the Community Health Needs Assessment Committee changed this objective to make a one-time donation to an emergency food pantry to help re-stock stores that were depleted of food. Based on this new objective, the Hospital met its goal of supporting one emergency food pantry. A cash donation was made to Farmworker's Self-Help to support the food pantry that they operate. This donation will help them purchase food to provide to the homeless, low-income, and food insecure residents of Dade City. In year three, the Hospital did not conduct any activities because the objective metric was met in year two.Objective 2: The second objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to increase Hospital staff/team volunteer participation efforts with organizations addressing food security from a baseline of zero hours volunteered to 200 hours by the end of year three. This objective is funded and managed through AdventHealth Dade City. All funding and outcomes reported are specific to the reporting Hospital. The Hospital provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations which are addressing this priority area. 2022 Update:The Hospital did not meet its set metric of providing 200 paid staff hours for food insecurity by December 31st, 2022. The COVID-19 pandemic limited the number of opportunities to volunteer during this three-year cycle for an organization due to health and safety and inability to volunteer virtually. An online portal was created for team members to find volunteer opportunities and track their hours. However, staff did not sign up for and complete any paid volunteer hours for this priority area.Priority 4: Mental Health/Suicide/Depression2019 Description of the Issue:The burden of mental illness in the United States is among the highest of all diseases, and mental disorders are among the most common causes of disability for adults, children, and adolescents. When mental health disorders are untreated, those affected are at high risk for many unhealthy and unsafe behaviors, including alcohol or drug abuse, violent or self-destructive behavior and suicide. Mental health disorders are the 11th leading cause of death in the United States for all age groups and the second leading cause of death among people age 25 to 34. In the AdventHealth Dade City PSA, the rate of death due to self-harm (suicide) is 19 per 100,000 population. Also, about 22% of the Medicare-fee-for-service PSA population are depressed, which is higher than the state average of 19%.The AdventHealth Dade City Community Health Plan has two desired goal statements under the Mental Health/Suicide/Depression priority. 1. Reduce the stigma associated with mental illness in youth and adults by providing access to health education to help communities better understand and respond to signs of mental illness and substance use disorders2. Increase community-level partnerships to enhance existing efforts currently addressing factors that impact suicide/depression in youth and adultsSee Continuation 5 Schedule H, Part V, Section B, Line 11: Continuation 5 Goal 1: Reduce the stigma associated with mental illness in youth and adults by providing access to health education to help communities better understand and respond to signs of mental illness and substance use disordersObjective 1: The first objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to increase the Hospital's support of local advocacy groups that provide resources, interventions, and support to adults and youth who are affected by mental illness in the Hospital's PSA by supporting two advocacy groups from a baseline of zero advocacy groups by the end of year three. This objective is managed at the Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. This initiative provides resources, interventions, and support to adults and youth who are affected by mental illness in the Hospital's PSA. 2022 Update:The Hospital met its set metric of supporting two advocacy groups by December 31st, 2022. We connected with three advocacy groups, Overeaters Anonymous, Serenity Al-Anon, and Noon Solutions Al-Anon, that operate out of the East Pasco Seventh Day Adventist Church. The Hospital provides monthly financial support to these groups to provide them with space to meet. In year three, the Hospital continued to financially support these groups monthly for a total of $1,080.Objective 2: The second objective is to increase the number of Mental Health First Aid USA certification training classes provided for free to community members residing in the Hospital's PSA by three certification classes from a baseline of zero by the end of year three. The deployment of the Mental Health First Aid classes is a shared initiative between AdventHealth Dade City, AdventHealth Carrollwood, AdventHealth Connerton, AdventHealth Zephyrhills, AdventHealth North Pinellas, AdventHealth Tampa, AdventHealth Ocala, AdventHealth Wauchula, AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wesley Chapel. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The initiative is managed at the Divisional level and funded through the Hospital and all reported outcomes are specific to the reporting Hospital. The initiative provides the Mental Health First Aid USA class to the community for free. The class is a course that teaches you how to help someone who may be experiencing mental health or substance use challenges. The training helps you identify, understand, and respond to signs of addictions and mental illnesses.2022 Update:The Hospital met its goal of providing three Mental Health First Aid classes by December 31, 2022. The Hospital was able to provide three classes for Sunrise Pasco, two in-person and one virtual. There were 30 participants in total.Goal 2: Increase community-level partnerships to enhance existing efforts currently addressing factors that impact suicide/depression in youth and adultsObjective 1: The first objective is a shared initiative between AdventHealth Dade City, AdventHealth Wesley Chapel, AdventHealth Tampa, AdventHealth Carrollwood, AdventHealth Zephyrhills, AdventHealth Ocala and AdventHealth North Pinellas. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The initiative is managed at the Divisional level and funded through the Hospital, and all reported outcomes are specific to the reporting Hospital. For this initiative, the Hospital decided to partner with the National Alliance on Mental Illness (NAMI) Pasco, the local affiliate of the National Alliance on Mental Illness. The objective is to increase the number of Pasco County NAMI Ending the Silence presentations provided for free to middle and high school-aged youth residing in the Hospital's PSA by three classes from a baseline of zero by the end of year three. Ending the Silence is a presentation that helps destigmatize mental illness by providing community members with education to recognize signs and symptoms of an individual dealing with a mental health condition, along with the action steps to help the individual suffering from a mental health crisis. 2022 Update:The Hospital met its set metric of holding three Ending the Silence presentations by December 31, 2022. The Hospital partnered with the Lewis Abrams Boys and Girls Club and sponsored three mental health/ wellness classes providing catered lunches for each class in 2022.Objective 2: The second objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to increase the amount of paid staff time for Hospital staff/team members to volunteer with community organizations addressing mental health from a baseline of zero hours volunteered to 200 hours by the end of year three. This objective is funded and managed through AdventHealth Dade City and all funding and outcomes reported are specific to the reporting Hospital. The Hospital provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations which are addressing this priority area. 2022 Update:The Hospital did not meet its set metric of providing 200 paid staff hours to volunteer with community organizations addressing mental health by December 31st, 2022. The COVID-19 pandemic limited the number of opportunities to volunteer during this three-year cycle for an organization due to health and safety and inability to volunteer virtually. An online portal was created for team members to find volunteer opportunities and track their hours. There was a total of 2 paid staff hours and a donation was made of $3,000 to Sunrise Pasco to help support their efforts to provide shelter and resources for those experiencing domestic and sexual violence. See Continuation 6 Schedule H, Part V, Section B, Line 11: Continuation 6 Priority 5: Obesity/Overweight2019 Description of the Issue:Obesity occurs when an individual's weight is higher than what is considered healthy. Obesity can be caused by behavioral and genetic factors. Other factors that contribute to obesity is the built environment, for example where you live and if you have access to healthy food and the ability to exercise outside. Obesity can cause serious health complications including high blood pressure, high cholesterol, heart disease, osteoarthritis, and some cancers. From 2015 - 2016, obesity affected about 93 million adults and 13 million children in the U.S. In the AdventHealth Dade City PSA, 32% of adults are obese (BMI greater than 30), while 39% of adults in the PSA are considered overweight (BMI between 25 and 30). The AdventHealth Dade City Community Health Plan has two desired goal statements under the Obesity/Overweight priority. 1. Improve access to health education, support programs and resources related to the obesity2. Implement strategies that support existing community initiatives aimed to address the problem of obesity in the Hospital's Primary Service Area (PSA)Goal 1: Improve access to health education, support programs and resources related to the obesityObjective 1: The first objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to partner with Premier Health Care to increase access to obesity programs among underserved youth and families residing in the Hospital's PSA by co-sponsoring with AdventHealth Zephyrhills the costs to implement one KidShape program, a family-based intervention for overweight children, community site from a baseline of zero sites by the end of year three. Although a shared initiative, the funding and outcomes reported are specific to the reporting Hospital. This initiative provides children with an opportunity to exercise in a fun and engaging environment, lose weight and develop healthy habits that will improve health outcomes in youth and adulthood. 2022 Update:The Hospital met its set metric of one community site for the KidShape program with one site established. Additionally, the Hospital enrolled 26 children into the KidShape program. The Hospital worked with Premier Health Care to transform the KidShape program into a virtual format and executed this program over the course of 2021. The Hospital continued to support this program and hold Kidshape classes at the AdventHealth Zephyrhills Wellness Center in year three.Objective 2: The second objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to partner with MORE HEALTH, Inc. to offer nutrition and healthy lifestyles train-the-trainer workshops to members/staff from local community churches to increase access to nutrition education for underserved families residing in the Hospital's PSA by sponsoring costs to train 25 members/church staff members from a baseline of zero by the end of year three. Although a shared initiative, the funding and outcomes reported are specific to the reporting Hospital. This initiative helps community members become local leaders in nutrition and exercise for their churches to help their congregations develop healthier lifestyles and eating habits.2022 Update:The Hospital met its metric to train 25 members by December 31, 2022. MORE Health completed a nutrition workshop to train camp counselors of the Pasco County Parks and Recreation summer camps for a total of 50 camp counselors in 2022.Goal 2: Implement strategies that support existing community initiatives aimed to address the problem of obesity in the Hospital's Primary Service Area (PSA)Objective 1: The first objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to sponsor the cost of registration fees for the Healthy Heart program, a 12-week exercise training program at AdventHealth Zephyrhills Wellness Center (includes healthy eating classes, educational seminars, and personal fitness assessments), by providing seven scholarship vouchers for underinsured/uninsured participants residing in the Hospital's PSA from a baseline of zero by end of year three. Although a shared initiative, the funding and outcomes reported are specific to the reporting Hospital. This initiative provides low-income community members with access to an exercise program that will help lower their risk of heart disease and improve overall health outcomes. 2022 Update:The Hospital did not meet its set metric of seven scholarship vouchers provided for the Healthy Heart program by December 31, 2022. The Healthy Heart program was conducted by the program manager of the AdventHealth Zephyrhills Wellness Center. The Wellness Center went through some staffing changes throughout the COVID-19 pandemic which required some elimination of programs offered, including the Healthy Heart Program. This program was replaced with a single nutrition workshop that was completed in 2022.Objective 2: The second objective is a shared initiative with AdventHealth Zephyrhills. AdventHealth Zephyrhills is part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to increase the amount of paid staff time for Hospital staff/team members to volunteer with community organizations addressing obesity from a baseline of zero hours to 200 hours by the end of year three. Although a shared initiative, the funding and outcomes reported are specific to the reporting Hospital. The Hospital provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations which are addressing this priority area. 2022 Update:The Hospital did not meet its set metric of providing 200 paid staff hours to volunteer with community organizations addressing obesity by December 31st, 2022. The COVID 19 pandemic limited the number of opportunities to volunteer during this three-year cycle for an organization due to health and safety and inability to volunteer virtually. An online portal was created for team members to find volunteer opportunities and track their hours. However, staff did not sign up for and complete any paid volunteer hours for this priority area. See Continuation 7 Schedule H, Part V, Section B, Line 11: Continuation 7 Community Needs Not Chosen by AdventHealth Dade City:The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. The Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else - or multiple groups - in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? After review and discussion, the Community Health Needs Assessment Committee (CHNAC) agreed that the below issues would not be addressed due to the following: (1) The CHNAC felt that the issue/concern should not be addressed as an individual problem but can be indirectly impacted positively by first addressing multiple issues selected above by the Hospital CHNAC. (2) The CHNAC did not perceive the ability to have a measurable impact on the issue with the current resources available to the community and the Hospital.Based on the prioritization process discussed above, the Hospital did not choose the following community issues:1. Asthma - Asthma is a chronic condition when the airways in the lungs are always inflamed. The inflammation causes coughing, wheezing, chest tightness, and shortness of breath. In the AdventHealth Dade City PSA, 16% of adults aged 18 and above have asthma. 2. Poverty/Livable Wage (Social Determinant of Health) - One of the greatest public health challenges is addressing poverty. Poverty increases the likelihood of an individual developing poor health. In reverse, poor health can also trap an individual in poverty. For example, those living in poverty may face competing priorities between paying for basic needs such as housing and food or paying for medical care. In the AdventHealth Dade City PSA, 18% of the community is below 100% of the federal poverty level ($25,750 for a family of four in 2019). 3. Transportation (Social Determinant of Health) - A poor transportation system prevents those who do not own a car or have reliable transportation from accessing health care. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. In the AdventHealth Dade City PSA, less than 1% of the population uses public transportation as their primary means to commute to work. While the CHNAC agreed that this is an important barrier, the Hospital felt better equipped to address the issue of access through focusing on increasing access to healthy food, dental care, and preventative screenings. 4. Cervix, Colon and Rectum Cancer - Cancer is the second leading cause of death in the U.S. with more than 100 types. Many are preventable and research advances in detection and treatment have greatly improved survival rates. In the AdventHealth Dade City PSA, the rate of death due to cancer is 171 per 100,000 population. Schedule H, Part V, Section B, Line 16a,b,c: The Financial Assistance Policy can be found at URL:https://www.adventhealth.com/legal/financial-assistance The Financial Assistance Policy application can be found at:https://www.adventhealth.com/legal/financial-assistance The plain language summary is available at:https://www.adventhealth.com/legal/financial-assistance Schedule H, Part V, Section B, Line 7a: The CHNA report can be found at URL:https://www.adventhealth.com/community-health-needs-assessments Schedule H, Part V, Section B, Line 10a: The Hospital's most recently adopted implementation strategy can be found at URL:https://www.adventhealth.com/community-health-needs-assessments Schedule H, Part V, Section B, Line 8 - 10a CHNA Implementation Strategy The filing organization adopted a Community Health Needs Assessment Report by 12/31/2022 and was in the process of developing its Community Health Needs Implementation Strategy at that time. The filing organization's 2023-2025 Community Health Needs Implementation Strategy is documented in a written report called the "Community Health Plan". The Community Health Plan (CHP) describes how the filing organization plans to meet its identified prioritized health needs or identifies the health need as one the filing organization does not intend to specifically address and provides an explanation as to why the filing organization does not intend to address that health need. The filing organization's 2023-2025 CHP was adopted by May 15, 2023 and is posted on the hospital facility's website. Part I, Line 3c: Under the Hospital facility's Financial Assistance Policy, an individual is eligible for a 100% reduction from applicable charges if the individual's household income is at or below 200% of the current Federal Poverty Guidelines. Alternatively, a patient may also qualify for a 100% reduction from charges when the unpaid portion of a patient's bill exceeds 25% of the individual's annual household income and where the total annual household income is less than 500% of the Federal Poverty Guidelines. Medicare recipients may also be eligible for financial assistance under the Hospital's Financial Assistance Policy depending upon the individual's income and resources. Resources are generally defined as assets such as money in checking or savings accounts, stocks, and bonds. Part I, Line 6a: The filing organization was a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) during its current tax year. During the current year, AHSSHC served as a parent organization to 30 tax-exempt 501(c)(3) hospital organizations and a number of other health care facilities that operated in 10 states within the U.S. The system of organizations under the control and ownership of AHSSHC is known as "AdventHealth".All hospital organizations within AdventHealth collect, calculate, and report the community benefits they provide to the communities they serve. AdventHealth organizations exist solely to improve and enhance the local communities they serve. AdventHealth 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. Each AdventHealth hospital facility reports their community benefits to their Board of Directors and strives to communicate their community benefits to their local communities. Part I, Line 7: The amounts of costs reported in the table in line 7 of Part I of Schedule H were determined by utilizing a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges, contained in the Schedule H instructions. Part III, Line 2: The amount of bad debt expense reported on line 2 of Section A of Part III is recorded in accordance with Healthcare Financial Management Association Statement No. 15. Discounts and payments on patient accounts are recorded as adjustments to revenue, not bad debt expense. Part III, Line 3: Methodology for Determining the Estimated Amount of Bad Debt Expense that May Represent Patients who could Have Qualified under the Filing Organization's Financial Assistance Policy:Self-pay patients may apply for financial assistance by completing a Financial Assistance Application Form (FAA Form). If an individual does not submit a complete FAA Form within 240 days after the first post-discharge billing statement is sent to the individual, an individual may be considered for presumptive eligibility based upon a scoring tool that is designed to classify patients into groups of varying economic means. The scoring tool uses algorithms that incorporate data from credit bureaus, demographic databases, and hospital specific data to infer and classify patients into respective economic means categories. Individuals who earn a certain score on the scoring tool are considered to qualify as eligible for the most generous financial assistance under the filing organization's Financial Assistance Policy. As determined by the filing organization, a nominal amount of such a patient's bill is written off as bad debt expense, while the remaining portion of the patient's bill is considered non-state charity. The amount written off as bad debt expense for those patients who potentially qualify as non-state charity using the scoring tool 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 Financial Assistance Policy, every effort is made to obtain a patient's necessary financial information to determine eligibility for financial assistance. However, not all patients will cooperate with such efforts and a financial assistance eligibility determination cannot be made based upon information supplied by the individual. 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 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. Part III, Line 4: 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 attached consolidated audited financial statements that addresses accounts receivable, the allowance for uncollectible accounts, and the provision for bad debts can be found on pages 8-9. Please note that dollar amounts on the attached consolidated audited financial statements are in thousands. Part III, Line 8: Costing Methodology:Medicare allowable costs were calculated using a cost-to-charge ratio.Rationale for Including a Medicare Shortfall as Community Benefit:As a 501(c)(3) organization, the filing organization provides emergency and non-elective care to all regardless of ability to pay. All hospital services are provided in a non-discriminatory manner to patients who are covered beneficiaries under the Medicare program. As a public insurance program, Medicare provides a pre-established reimbursement rate/amount to health care providers for the services they provide to patients. In some cases, the reimbursement amount provided to a hospital may exceed its costs of providing a particular service or services to a patient. In other cases, the Medicare reimbursement amount may result in the hospital experiencing a shortfall of reimbursement received over costs incurred. In those cases where an overall shortfall is generated for providing services to all Medicare patients, the shortfall amount should be considered as a benefit to the community. Tax-exempt hospitals are required to accept all Medicare patients regardless of the profitability, or lack thereof, with respect to the services they provide to Medicare patients. The population of individuals covered under the Medicare program is sufficiently large so that the provision of services to the population is a benefit to the community and relieves the burdens of government. In those situations where the provision of services to the total Medicare patient population of a tax-exempt hospital during any year results in a shortfall of reimbursement received over the cost of providing care, the tax-exempt hospital has provided a benefit to a class of persons broad enough to be considered a benefit to the community. Despite a financial shortfall, a tax-exempt hospital must and will continue to accept and care for Medicare patients. Typically, tax-exempt hospitals provide health care services based upon an assessment of the health care needs of their community as opposed to their taxable counterparts where profitability often drives decisions about patient care services that are offered. Patient care provided by tax-exempt hospitals that results in Medicare shortfalls should be considered as providing a benefit to the community and relieving the burdens of government. Part III, Line 9b: The hospital filing organization's collection practices are in conformity with the requirements set forth in the 2014 Final Regulations regarding the requirements of Internal Revenue Code Section 501(r)(4) - (r)(6). No extraordinary collection actions (ECA's) are initiated by the hospital filing organization in the 120-day period following the date after the first post-discharge billing statement is sent to the individual (or, if later, the specified deadline given in a written notice of actions that may be taken, as described below). Individuals are provided with at least one written notice (notice of actions that may be taken) and a copy of the filing organization's Plain Language Summary of the Financial Assistance Policy that informs the individual that the hospital filing organization may take actions to report adverse information to credit reporting agencies/bureaus if the individual does not submit a Financial Assistance Application Form (FAA Form) or pay the amount due by a specified deadline. The specified deadline is not earlier that 120 days after the first post-discharge billing statement is sent to the individual and is at least 30 days after the notice is provided. A reasonable attempt is also made to orally notify an individual about the filing organization's Financial Assistance Policy and how the individual may obtain assistance with the Financial Assistance application process. If an individual submits an incomplete FAA Form during the 240-day period following the date on which the first post-discharge billing statement was sent to the individual, the hospital filing organization suspends any reporting to consumer credit reporting agencies/bureaus (or ceases any other ECA's) and provides a written notice to the individual describing what additional information or documentation is needed to complete the FAA Form. This written notice contains contact information including the telephone number and physical location of the hospital facility's office or department that can provide information about the Financial Assistance Policy, as well as contact information of the hospital facility's office or department that can provide assistance with the financial assistance application process or, alternatively, a nonprofit organization or governmental agency that can provide assistance with the financial assistance application process if the hospital facility is unable to do so. If an individual submits a complete FAA Form within a reasonable time-period as set forth in the notice described above, the hospital filing organization will suspend any adverse reporting to consumer credit reporting agencies/bureaus until a financial assistance policy eligibility determination can be made. Part VI, Line 2: The Hospital will conduct community health needs assessments (CHNA) every three years. Its 2022 CHNA was adopted by its governing board by December 31, 2022, the end of the Hospital's taxable year in which it conducted the CHNA. The Hospital's 2022 CHNA complied with the guidance set forth by the IRS in Final Regulation Section 1.501(r)-3. In addition to the CHNA discussed above, 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: The Financial Assistance Policy (FAP), Financial Assistance Application Form (FAA Form), and the Plain Language Summary of the Financial Assistance Policy (PLS) of the filing organization's hospital facility are transparent and available to all individuals served at any point in the care continuum. The FAP, FAA Form, PLS, and contact information for the hospital facility's financial counselors are prominently and conspicuously posted on the filing organization's hospital facility's website. The website indicates that a copy of the FAP, FAA Form, and PLS is available and how to obtain such copies in the primary languages of any populations with limited proficiency in English that constitute the lesser of 1,000 individuals or 5% of the members of the community served by the hospital facility (referred to below as LEP defined populations). Signage is displayed in public locations of the filing organization's hospital facility, including at all points of admission and registration and the Emergency Department. The signage contains the hospital facility's website address where the FAP, FAA Form, and PLS can be accessed and the telephone number and physical location that individuals can call or visit to obtain copies of the FAP, FAA Form and PLS or to obtain more information about the hospital facility's FAP, FAA Form and PLS. Paper copies of the hospital facility's FAP, FAA Form and PLS are available upon request and without charge, both in public locations in the hospital facility and by mail. Paper copies are made available in English and in the primary languages of any LEP defined populations. The filing organization's hospital facility's financial counselors seek to provide personal financial counseling to all individuals admitted to the hospital facility who are classified as self-pay during the course of their hospital stay or at time of discharge to explain the FAP and FAA Form and to provide information concerning other sources of assistance that may be available, such as Medicaid. A paper copy of the hospital facility's PLS will be offered to every patient as a part of the intake or discharge process. A conspicuous written notice is included on all billing statements sent to patients that notifies and informs recipients about the availability of financial assistance under the filing organization's financial assistance policy, including the following: 1) the telephone number of the hospital facility's office or department that can provide information about the FAP and the FAA Form; and 2) the website address where copies of the FAP, FAA Form and PLS may be obtained. Reasonable attempts are made to inform individuals about the hospital facility's FAP in all oral communications regarding the amount due for the individual's care. Copies of the PLS are distributed to members of the community in a manner reasonably calculated to reach those members of the community who are most likely to require financial assistance. Part VI, Line 4: Florida Hospital Dade City, Inc. d/b/a AdventHealth Dade City (AHDC) is a 120-bed, full-service acute-care facility that provides healthcare services to residents in central and eastern Pasco County. AHDC is the only hospital in Dade City and is located just 39 miles northeast of Tampa. As part of its patient-first focus, AHDC continues to expand its services so that patients and their families can receive unparalleled and compassionate treatment in their own community. During 2022, the Hospital's patient percentage population was made up of the below payors with the remaining percentage of the patients being covered under commercial insurance. In 2022, about 75.8% of the Hospital's in-patients were admitted through the Hospital's Emergency Department. - Medicare Patients 51.9% - Medicaid Patients 16.7% - Self-Pay Patients 5.8% The demographic makeup of the Hospital's community is as follows: - Population 92,104 - Population Over 65 31.8% - Poverty (Below 100% FPL) 16.2% - High School Graduation Rate 85.7% - Uninsured Adults 12.6% - Food Insecurity Rate 17.6% - Pop. with Low Food Access 55.7% Part VI, Line 5: The provision of community benefit is central to the filing organization'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 and community building 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, the Hospital provided $102,489 of benefit with respect to the faith-based and spiritual needs of the community in conjunction with its operation of a community hospital.The Hospital also provides benefits to its community's infrastructure by investing in capital improvements to ensure that facilities and technology provide the best possible care to the community. During the current year, the Hospital expended $3,978,267 in new capital improvements. As a faith-based mission-driven community hospital, the Hospital is continually involved in monitoring its community, identifying unmet health care needs and developing solutions and programs to address those needs. In accordance with its conservative approach to fiscal responsibility, surplus funds of the Hospital are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its community. Part VI, Line 6: The filing organization is a part of a faith-based healthcare system of organizations whose parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). The system is known as AdventHealth. AHSSHC is an organization exempt from federal income tax under IRC Section 501(c)(3). AHSSHC and its subsidiary organizations operate 49 hospitals throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC and its subsidiaries also operate 10 nursing home facilities and other ancillary health care provider facilities, such as ambulatory surgery centers and diagnostic imaging centers. As the parent organization of AdventHealth, AHSSHC provides executive leadership and other professional support services to its subsidiary organizations. Professional support services include among others IT, corporate compliance, legal, reimbursement, risk management, and tax as well as treasury functions. Certain support services, such as human resources, payroll, A/P, and supply chain management are provided pursuant to a shared services model by AHSSHC to its subsidiary organizations. The provision of these executive and support services on a centralized basis by AHSSHC provides an appropriate balance between providing each AdventHealth subsidiary hospital organization with mission-driven consistent leadership and support while allowing the hospital organization to focus its resources on meeting the specific health care needs of the community it serves. The reader of this Form 990 should keep in mind that this reporting entity may differ in certain areas from that of a stand-alone hospital organization due to its inclusion in a larger system of healthcare organizations. As a part of a system of hospital and other health care organizations, the filing organization benefits from reduced costs due to system efficiencies, such as large group purchasing discounts, and the availability of internal resources such as internal legal counsel. Each AdventHealth subsidiary pays a management fee to AHSSHC for the internal services provided by AHSSHC. As a result, management fee expense reported by an AdventHealth 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 AdventHealth as a whole. The reader is directed to visit the web-site of AdventHealth at www.adventhealth.com to learn more about the mission and operations of AdventHealth. Part VI, Line 7 The filing organization does not file an annual community benefit report with any state agencies. 1 The Greater Dade City Chamber of Commerce 14112 8th Street Dade City FL 33525 590549446 501(c)(6) 20000 0 General Support Community Aging & Retirement Services Inc 12417 Clock Tower Parkway Hudson FL 34667 237348090 501(c)(3) 7000 0 General Support 1 1 Part I, Line 2: Grants are generally made only to related organizations that are exempt from federal income tax under IRC Section 501(c)(3), or to other local charitable community organizations, or to other 501(c)(3) organizations that are a part of the group exemption ruling issued to the General Conference of Seventh-Day Adventists. Accordingly, the filing organization has not established specific procedures for monitoring the use of grant funds in the United States as the filing organization does not have a grant making program that would necessitate such procedures. X X X X X 1 1 0 1 0 0 0 0 0 0 0 Bruce Bergherm Dir/Chair/SEO West FL Reg (end 6/22) 0 673281 0 174998 0 562115 0 16400 0 33135 0 1459929 0 0 Jennifer Wandersleben Dir/Chair/CEO Heartland Reg (beg 6/2 0 649654 0 180378 0 119238 0 114611 0 55833 0 1119714 0 59424 Denyse Bales-Chubb Director (end 7/22) 0 582520 0 114023 0 153953 0 118558 0 46758 0 1015812 0 65968 Robin McGuinness Regional CNO - Former Key 0 406695 0 94539 0 132167 0 56683 0 33085 0 723169 0 59918 Amanda Maggard Director/Sec/CEO 0 419708 0 95122 0 56837 0 80628 0 46344 0 698639 0 32766 Michael Schultz Former Officer 0 156759 0 397536 0 12213 0 10300 0 0 0 576808 0 0 Rainer Chan MD Director 0 320453 0 56984 0 72337 0 64239 0 45606 0 559619 0 14881 Rodrigo Torres MD CMO 0 352463 0 64709 0 32181 0 48445 0 42466 0 540264 0 0 Rosalie Oliver Director 0 355552 0 59207 0 30250 0 51763 0 41237 0 538009 0 14890 Ryan Willis CFO & COO (COO end 2/22) 0 290356 0 51982 0 7857 0 16400 0 26551 0 393146 0 0 Jason Newmyer Former VP/Admin 0 243695 0 40705 0 13904 0 52467 0 41463 0 392234 0 0 Gwen Alonso CNO 0 270820 0 50116 0 11491 0 16400 0 26527 0 375354 0 0 Royce Brown Director (beg 10/22) 0 210760 0 38601 0 12827 0 46577 0 41778 0 350543 0 0 Shane Bedward COO (beg 2/22) 0 216358 0 18923 0 12294 0 11267 0 42019 0 300861 0 0 Ken Bradley Director 0 158577 0 21765 0 13206 0 9165 0 25102 0 227815 0 0 Part I, Line 1a The filing organization is a part of the system of healthcare organizations known as AdventHealth. 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 the healthcare system known as AdventHealth. 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 listed in Part VII that are on the payroll of AHSSHC. At the direction of AHSSHC, and in accordance with the reserved powers in the filing organization's governing documents, the executive team listed on Part VII provides services to the filing organization. First-class or charter travel: Pursuant to the AdventHealth system-wide general policy regarding business travel, no reimbursement will be provided for any additional cost incurred with respect to first-class or charter air travel beyond the cost of a regular coach airfare. As a means of providing additional business travel reimbursement for those members of the AHSSHC senior executive management team that travel frequently on behalf of AdventHealth, a special annual travel allowance is provided for those executives. As AdventHealth operates 49 hospitals in 9 states, the senior leadership of AHSSHC travel extensively and often visit multiple hospital locations in different states as a part of a single business trip. The special travel allowance can provide reimbursements to the executive for such items as the purchase of air travel upgrade coupons, to cover the cost differential between coach and first-class travel, or to cover the cost of a charter flight. The special travel allowance benefit was originally authorized by and codified into a policy by the AHSSHC Board Compensation Committee (the Committee), an independent body of the AHSSHC Board of Directors, who also approves the annual cap on the amount of the allowance. The special travel allowance has an annual cap of $24,000 for members of the Leadership Executive Team (13 AdventHealth Cabinet members and the AdventHealth Multi-State CFO) and $15,000 for AdventHealth Corporate Office Senior Vice Presidents, Regional CEO's, and Division Chief Officers (generally 50 - 55 individual executives). Two individuals listed in Part VII (J. Wandersleben and R. McGuinness) received the special travel allowance in 2022. These two individuals are considered common law employees of and are on the payroll of AHSSHC. While the special travel allowance benefit is an AHSSHC compensation policy and practice, the cost of providing this benefit is allocated to and either wholly or partially reimbursed by the filing organization. Accordingly, the filing organization has checked the box in Schedule J, Part I, line 1a for first-class or charter travel since it has wholly or partially paid for the cost of providing this benefit. Those executives who receive the special travel allowance are responsible for tracking the expenses reimbursable under the special travel allowance and must submit such expenses on their accountable plan expense report. A report on charter travel is provided to the AHSSHC Board Compensation Committee at each meeting. Any taxable reimbursements made to executives under the special travel allowance arrangement are treated as taxable compensation to the executive. 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 certain business trips each year. Typically, reimbursement is only provided to certain executive leaders and is usually limited to one business trip per year beyond the annual AdventHealth President's Council business meeting and other meetings where the spouse is specifically invited. The AHSSHC Corporate Executive Spousal Travel Policy was originally approved and reviewed by the AHSSHC Board 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: AdventHealth 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 by 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: Occasional discretionary spending amounts are periodically provided to eligible executives who attend annual business meetings such as the AdventHealth President's Council, CFO Conference or the CMO/CNO business meeting. Payments provided to each executive are considered taxable compensation to the executive. Housing allowance or residence for personal use: AHSSHC has a Corporate Executive Policy that addresses assistance to executives who have been relocated by the company during the year. Relocation assistance provided to executives may include relocation allowances to assist with duplicate housing expenses. Relocation assistance is administered per AHSSHC policy by an external relocation company. All taxable reimbursements made to executives in connection with relocation assistance are treated as wages to the executive and are subject to all payroll withholding and reporting requirements. Part I, Line 3 The individual who serves as the CEO of the filing organization is appointed and compensated by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). 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 has taken steps to ensure that processes are in place to satisfy the rebuttable presumption of reasonableness standard as set forth in Treasury Regulation Section 53.4958-6 with respect to its active executive-level positions. The AHSSHC Board 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, 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, other than the Chief People Officer, who remains at the request of the Chairman/committee to provide assistance/information as needed. 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 AdventHealth and each of its affiliated entities. The following principles guide the establishment of individual executive compensation: - The salary of the President/CEO of AdventHealth will not exceed the 50th 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. 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 the healthcare system known as AdventHealth. In recognition of the contribution that each executive makes to the success of AdventHealth, AdventHealth provides supplemental executive retirement benefit plans to eligible executives. As the supplemental executive retirement benefit plans were updated in 2020 and certain individuals still participate as grand-fathered participants in certain plans, the narrative below discusses all plans in which there were any participants in 2022. The SERP III plan effectively replaces the prior SERP II plan, the Executive Flex Benefit Program Plan, and the Senior Executive Death Benefit Plan for qualified executives except for certain grandfathered executive employees. SERP III Plan: The SERP III plan provides eligible executives a percentage of their base pay, which is credited to a deferred compensation account. The plan also provides for compensation deferral and selection of life insurance coverage and long-term care insurance. To be eligible to participate in the SERP III plan, executives must be on the AHSSHC corporate payroll and be either a CEO of an AdventHealth entity, an AHSSHC Vice President (VP) or VP of an AdventHealth entity with a base salary of at least $305,000 in 2022 (adjusted annually by the same percentage as IRC Section 401(a)(17) limit increases), or other leader specifically approved by the AdventHealth President. Eligible executives do not include grandfathered executives, meaning those executives who would satisfy all the eligibility requirements of the SERP II plan prior to Dec 31, 2027, had the plan not been amended and restated as of Jan. 1, 2020. Contribution credits will be established and maintained by class year accounts for each participant using tiered contribution credit percentages of annual base compensation. Contribution credit percentages range between 15% and 19% of base compensation. Contribution credits will be made each quarter in 25% increments with reductions in contributions if the executive is also a grandfathered FLEX participant (see below). SERP III provides for a class year vesting and payment schedule (7 years for each class year) with respect to amounts accumulated in the executive's deferred compensation account. Upon attainment of a normal retirement age (age 62), or upon certain other circumstances as defined in the SERP III plan document, all deferred amounts are paid immediately to the participant. For any executives working beyond the normal retirement age, future employer contributions will be made quarterly from SERP III directly to the participant as a taxable cash bonus. SERP II Plan: The SERP II plan is a defined benefit, non-tax-qualified deferred compensation plan for certain executives who have provided lengthy service to AdventHealth and/or to other Seventh-day Adventist Church hospitals or health care institutions. Under the provisions of the SERP II plan, benefits are provided to qualifying executive participants on a pro-rata schedule beginning with 20 years of service as an employee of AdventHealth and/or another hospital or health care institution controlled by the Seventh-day Adventist Church and who satisfy certain other qualifying criteria. Eligible employees are restricted to those executives who, as of January 1, 2020, satisfied, or if employment continues, will satisfy the eligibility requirements of SERP II prior to December 31, 2027. This supplemental executive retirement plan (SERP II) 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, five or seven highest years of base salary from AdventHealth 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. The number of years included in highest average compensation is determined by the individual's year of entry to SERP II and by the individual's year of entry to the AdventHealth Executive FLEX Benefit Program. FLEX Plan: The Flex Plan was originally designed to provide eligible executives an opportunity to select from among a variety of supplemental benefits, including a split dollar life insurance policy and long-term care insurance, to individually tailor a benefits program appropriate to each executive's needs. In 2020, the Flex Plan was amended to exclude employed executives who are hired or promoted after a certain date from being eligible to participate in the Flex Plan except for certain insurance coverage features of the plan. The Flex Plan provides eligible participants a pre-determined benefits allowance credit that is equal to a percentage of the executive's base pay from which the cost of mandatory and elective employee benefits is deducted. The benefits allowance credit percentage for any plan year shall not be greater than the maximum dollar amount or the percentage of compensation as determined by the AdventHealth Benefits Administration Committee. For grandfathered eligible employees, the annual pre-determined Flex allowance is contributed and any funds that remain after the cost of mandatory and elective benefits are subtracted are, at the employee's option, contributed to either an IRC 457(f) deferred compensation account or to an IRC 457(b) eligible deferred compensation plan. Upon attainment of age 65, all previous 457(f) deferred amounts are paid immediately to the participant and any future employer contributions are made quarterly from the Plan directly to the participant. The Plan 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 will be forfeited by the executive upon a voluntary separation. With respect to grandfathered participants, the Flex Plan documents define eligible employees to include the Chief Executive Officers of AdventHealth entities and Vice Presidents of all AdventHealth entities whose base salary was at least equal to the Internal Revenue Code Section 401(a)(17) compensation limit each year. FLEX Plan FLEX Plan SERP II SERP III SERP III Contr. Distr.* Contr/Distr Contr. Distr.* Bruce Bergherm $103,125 $ 82,625 $ 386,102 $ 0 $ 0 Jennifer Wandersleben $108,827 $60,800 $ 0 $ 9,884 $ 0 Denyse Bales-Chubb $95,900 $ 87,080 $ 0 $ 6,258 $ 0 Robin McGuinness $56,975 $ 57,069 $ 0 $ 4,953 $ 19,805 Amanda Maggard $51,359 $ 36,773 $ 0 $ 12,870 $ 0 Rainer Chan MD $23,919 $ 21,787 $ 0 $ 23,920 $ 0 Rodrigo Torres $31,569 $ 0 $ 0 $ 20,977 $ 0 Rosalie Oliver $35,363 $ 16,239 $ 0 $ 0 $ 0 Jason Newmyer $ 0 $ 0 $ 36,758 $ 0 $ 0 Royce Brown $ 0 $ 0 $ 0 $ 33,005 $ 0 * Including Investment Earnings Part V, Line 1a: The parent corporation and sole top-tier member of the filing organization is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). AHSSHC has established a shared service center to centralize the Accounts Payable (A/P) function for all AHSSHC subsidiary organizations. The filing organization has entered "0" in Part V, Line 1a because the filing organization no longer issues Form 1099 returns, rather, all such returns are filed by and under the name and EIN of AHSSHC as the payor subject to the information reporting requirements of Section 6041. The facts and circumstances support a position that AHSSHC, as a payor on behalf of its subsidiary organizations in a shared service environment, will have sufficient management and oversight in connection with the subsidiary organizations' payments to meet the standard set forth in Treas. Reg. Section 1.6041-1(e). AHSSHC will not merely be making payments at the direction of its subsidiary organizations. Accordingly, AHSSHC is considered the payor subject to the information reporting requirements of Section 6041. Form 990, Part VI, Section A, line 6 Florida Hospital Dade City, Inc. has one member. The sole member of Florida Hospital Dade City, Inc. 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 Florida Hospital Dade City, Inc. Form 990, Part VI, Section A, line 7a The sole member of Florida Hospital Dade City, Inc. is AHSSHC. The Board of Directors of Florida Hospital Dade City, Inc. are appointed by the sole member, AHSSHC, who has the right to elect, appoint or remove any member of the Board of Directors of Florida Hospital Dade City, Inc. 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 approve or disapprove the executive and/or administrative leadership of the Hospital and their salaries; b) to adopt, amend, restate, and repeal the Articles of Incorporation or Bylaws of the filing organization and the medical staff Bylaws; c) to set limits and terms for the borrowing of funds; d) to approve or disapprove the annual operating and capital budgets of the filing organization; e) to direct the placement of funds and capital of the filing organization; f) to approve or disapprove certain purchases or sales of personal property or real property equal to or in excess of established dollar thresholds; g) to establish general guiding policies, to implement quality assessment, improvement and utilization review programs; and h) to approve the appointment of an auditing firm and election of the fiscal year for the filing organization. Form 990, Part VI, Section B, line 11b 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 Chair, CEO and the CFO did not include the review of any supporting workpapers that were used in preparation of the current year Form 990, but did include a review of the entire Form 990 and all supporting schedules. Form 990, Part VI, Section B, line 12c The Conflict of Interest Policy of 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 conflicts of interest, 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 Interest 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 15 The filing organization's CEO, other officers and key employees are not compensated by the filing organization. Such individuals are compensated by the related top-tier parent organization of the filing organization. Please see the discussion concerning the process followed by the related top-tier parent organization in determining executive compensation in our response to Schedule J, Line 3. Form 990, Part VI, Section C, line 19 The filing organization is a part of the system of healthcare organizations known as AdventHealth. The audited consolidated financial statements of AdventHealth and of the AdventHealth "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 AdventHealth on a consolidated basis and for the grouping of AdventHealth subsidiaries comprising the "Obligated Group". The filing organization does not generally make its governing documents or conflict of interest policy available to the public. Part VII, Section A For those Board of Director members (not including physician members of the board), officer(s) and key employees who devote less than full-time to the filing organization (based upon the average number of hours per week shown in column (B) on page 7 of the return) the compensation amounts shown in columns (E) and (F) on page 7 were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position as an employee of Adventist Health System Sunbelt Healthcare Corporation. Physician members of the Board of Directors received compensation from related organizations as a result of providing various medical services to those related entities. Part VIII, Lines 7a, b and c: The amounts shown in Part VIII, Lines 7b(i) and 7c(i) of the Form 990 represent an allocated share of capital gain/(loss) from a system wide, corporate administered, investment program. Form 990, Part IX, line 11g Payment to Healthcare Professionals: Program service expenses 8,779,937. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,779,937. Professional fees: Program service expenses 581,103. Management and general expenses 0. Fundraising expenses 0. Total expenses 581,103. Purchased medical services: Program service expenses 2,176,692. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,176,692. Environmental services: Program service expenses 858,322. Management and general expenses 0. Fundraising expenses 0. Total expenses 858,322. Transcription: Program service expenses 8,476. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,476. Recruiting: Program service expenses 101,964. Management and general expenses 0. Fundraising expenses 0. Total expenses 101,964. Leased Personnel: Program service expenses 37,552,576. Management and general expenses 0. Fundraising expenses 0. Total expenses 37,552,576. Miscellaneous purchased services: Program service expenses 1,961,921. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,961,921. AdventHealth Management fees: Program service expenses 0. Management and general expenses 1,423,419. Fundraising expenses 0. Total expenses 1,423,419. Billing & collection services: Program service expenses 0. Management and general expenses 521,706. Fundraising expenses 0. Total expenses 521,706. AdventHealth Shared Services fees: Program service expenses 0. Management and general expenses 712,242. Fundraising expenses 0. Total expenses 712,242. Part X, Line 2 The amount shown on line 2 of Part X of this return includes the filing organization's interest in a central investment pool maintained by Adventist Health System Sunbelt Healthcare Corporation, the filing organization's top-tier parent. The investments in the central investment pool are recorded at market value. Form 990, Part XI, line 9: Transfer from Related Tax-Exempt Foundation 459,709. Transfer to Related Tax-Exempt Top-Tier Parent -401,519. Transfer from Related Tax-Exempt Organizations -46,159. Tax-Exempt Bond Allocation 84,095. Part XII, Line 3b OMB Circular A-133 Audit Although the taxpayer is not required to undergo an audit as set forth in the Single Audit Act and OMB Circular A-133, the taxpayer is part of a controlled group of organizations that comprise a consolidated financial statement audit. The controlled group's parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), a 501(c)(3) organization. The system of healthcare entities owned and controlled by AHSSHC is known as AdventHealth. For the year ended December 31, 2022, AdventHealth will file a consolidated Single Audit which will include all entities that are part of the controlled group. Accordingly, the taxpayer has checked yes to the questions on Part XII, line 3a and 3b. AdventHealth Ashville Inc (5922 - 123122) 900 Hope Way Altamonte Springs FL 32714 921144574 Future Operation of Hospital & Related Services NC 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth Family Medicine Rural Health Clinics Inc 187 PR 4060 Lampasas TX 76550 271858033 Operation of Rural Health Clinics & Medical Services FL 501(c)(3) Line 3 Metroplex Adventist Hospital Inc 1 AdventHealth Foundation fka SunSystem Development Corp 900 Hope Way Altamonte Springs FL 32714 592219301 Fund-Raising for Affiliated Tax-Exempt Hospitals FL 501(c)(3) Line 7 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth Home Care East Florida LLC 770 West Granada Blvd 319 Ormond Beach FL 32174 833768458 Inactive FL 501(c)(3) Line 10 Memorial Hlth Systems Inc 1 AdventHealth Hospice Care East Florida Inc 770 West Granada Blvd 304 Ormond Beach FL 32174 833748461 Inactive FL 501(c)(3) Line 10 Memorial Hlth Systems Inc 1 AdventHealth Kansas City Foundation 7315 E Frontage Road Merriam KS 66204 480868859 Fund-raising for Tax-exempt hospitals KS 501(c)(3) Line 7 Shawnee Mission Medical Center Inc 1 AdventHealth North Polk Inc 3100 E Fletcher Ave Tampa FL 33613 593231322 Inactive FL 501(c)(3) Line 12a, I University Community Hospital Inc 1 AdventHealth Palm Coast Parkway Inc fka AH East Florida Inc 900 Hope Way Altamonte Springs FL 32714 882288563 Future Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth Polk North Inc 40100 US Highway 27 N Davenport FL 33837 841793121 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth Polk South Inc 410 South 11th Street Lake Wales FL 33853 834672945 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth Ransom Memorial Inc 1301 S Main Street Ottawa KS 66067 830976641 Operation of Hospital & Related Services KS 501(c)(3) Line 3 Adventist Hlth Mid-America Inc 1 AdventHealth Riverview Inc 14055 Riveredge Drive Ste 150 Tampa FL 33637 870901094 Future Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth Senior Care Inc 900 Hope Way Altamonte Springs FL 32714 841817046 Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth South Overland Park Inc 7820 W 165th Street Overland Park KS 66223 364595806 Operation of Hospital & Related Services KS 501(c)(3) Line 3 Adventist Hlth Mid-America Inc 1 AdventHealth University Inc 671 Winyah Drive Orlando FL 32803 593069793 Education/Operation of School FL 501(c)(3) Line 2 Adventist Hlth SystemSunbelt Inc 1 AdventHealth West Florida Ambulatory Services Inc 14055 Riveredge Drive Ste 250 Tampa FL 33637 471881744 Support of Imaging Center & Home Health Subsidiaries FL 501(c)(3) Line 12b, II Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth West Florida Imaging Inc 14055 Riveredge Drive Ste 250 Tampa FL 33637 843225135 Imaging & Testing FL 501(c)(3) Line 3 AdventHealth West Florida Ambulatory Services Inc 1 Adventist Bolingbrook Hospital 500 Remington Blvd Bolingbrook IL 60440 651219504 Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 Adventist Care Centers - Courtland Inc 730 Courtland Street Orlando FL 32804 205774723 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Adventist GlenOaks Hospital 701 Winthrop Avenue Glendale Heights IL 60139 363208390 Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 Adventist Health Mid-America Inc 9100 W 74th Street Shawnee Mission KS 66204 521347407 Support of Affiliated Hospital KS 501(c)(3) Line 12c, III-FI Adventist Hlth SystemSunbelt Inc 1 Adventist Health Partners Inc 5101 S Willow Springs Rd Suite B101 La Grange IL 60525 364138353 Operation of Physician Practices & Medical Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 Adventist Health System Georgia Inc 1035 Red Bud Road NE Calhoun GA 30701 581425000 Operation of Hospital & Related Services GA 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Adventist Hlth System Sunbelt Hlthcare Corp 900 Hope Way Altamonte Springs FL 32714 592170012 Management Services FL 501(c)(3) Line 12a, I N/A 0 Adventist Hlth SystemSunbelt Inc 900 Hope Way Altamonte Springs FL 32714 591479658 Operation of Hospitals & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Adventist Hlth SystemTexas Inc 11801 S Freeway Burleson TX 76028 742578952 Leasing Personnel to Affiliated Hospital TX 501(c)(3) Line 12c, III-FI Adventist Hlth System Sunbelt Hlthcare Corp 1 Adventist Midwest Health 120 North Oak Street Hinsdale IL 60521 362276984 Operation of Hospitals & Related Services IL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 AHP Specialty Care NFP 5101 S Willow Springs Rd Suite B101 La Grange IL 60525 811105774 Operation of Physician Practices & Medical Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 AHS Midwest Management Inc 500 Remington Blvd Bolingbrook IL 60440 363354567 Operation of Physician Practice Management IL 501(c)(3) Line 12a, I Adventist Hlth System Sunbelt Hlthcare Corp 1 Apopka Health Care Properties Inc 305 E Oak Street Apopka FL 32703 510605694 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Bert Fish Medical Center Auxiliary Inc 401 Palmetto Street New Smyrna Beach FL 32168 591054892 Volunteer support services FL 501(c)(3) Line 10 Southeast Volusia Healthcare Corp 0 Bradford Heights Health & Rehab Center Inc (11-122222) 485 North Keller Road 250 Maitland FL 32751 205782342 Inactive - Wind-Down KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Burleson Nursing & Rehab Center Inc 301 Huguley Blvd Burleson TX 76028 205782243 Operation of Home for the Aged/Hlthcare Delivery TX 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Chickasaw Health Care Properties Inc 250 S Chickasaw Trail Orlando FL 32825 510605681 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Chippewa Valley Hospital & Oakview Care Center Inc 1220 Third Avenue West Durand WI 54736 391365168 Operation of Hospital & Related Services WI 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Coalition For Physician Well-Being Inc 900 Hope Way Altamonte Springs FL 32714 463477012 Provide support for Physician well-being FL 501(c)(3) Line 10 Adventist Hlth System Sunbelt Hlthcare Corp 1 Courtland Health Care Properties Inc 730 Courtland Street Orlando FL 32804 510605682 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Creekwood Place Nursing & Rehab Center Inc (11-12622) 485 North Keller Road 250 Maitland FL 32751 205782260 Inactive - Wind-Down KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Dairy Road Health Care Properties Inc 7350 Dairy Road Zephyrhills FL 33540 510605684 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 East Orlando Health & Rehab Center Inc 250 S Chickasaw Trail Orlando FL 32825 205774748 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Fletcher Hospital Inc 100 Hospital Drive Hendersonville NC 28792 560543246 Operation of Hospital & Related Services NC 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 FLNC Inc 3355 E Semoran Blvd Apopka FL 32703 205774761 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Florida Hospital Dade City Inc 13100 Fort King Road Dade City FL 33525 822567308 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Florida Hospital Healthcare Partners Inc 770 West Granada Blvd 101 Ormond Beach FL 32174 462354804 Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Florida Hospital Medical Group Inc 2600 Westhall Lane 4th Floor Maitland FL 32751 593214635 Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Florida Hospital Ocala Inc 1500 SW 1st Avenue Ocala FL 34471 824372339 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Florida Hospital Physician Group Inc 12470 Telecom Dr 100 Tampa FL 33637 462021581 Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Florida Hospital Waterman Inc 1000 Waterman Way Tavares FL 32778 593140669 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Florida Hospital Zephyrhills Inc 7050 Gall Blvd Zephyrhills FL 33541 592108057 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Florida Radiology Imaging at Lake Mary LLC 2600 Westhall Lane 4th Floor Maitland FL 32751 550789387 Imaging & Testing FL 501(c)(3) Line 3 Florida Hospital Medical Group Inc 1 Fountain Inn Nursing & Rehab Center Inc 4501 Waterman Way Tavares FL 32778 472180518 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Helen Ellis Memorial Hospital Auxiliary Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 592106043 Fund-raising for Tax-exempt hospital/foundation FL 501(c)(3) Line 12c, III-FI N/A 0 Helen Ellis Memorial Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 593690149 Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 7 N/A 0 Hinsdale Hospital Foundation 120 North Oak Street Hinsdale IL 60521 521466387 Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation 0 Hospice of the Comforter Inc 480 W Central Parkway Altamonte Springs FL 32714 592935928 Operation of Hospice FL 501(c)(3) Line 10 The Comforter Health Care Group Inc 1 In-Motion Rehab Inc (11-122722) 485 North Keller Road 250 Maitland FL 32751 208023411 Inactive KS 501(c)(3) Line 12b, II Sunbelt Hlth Care Centers Inc 1 Lake County Health Care Properties Inc (11-122822) 485 North Keller Road 250 Maitland FL 32751 813923985 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Memorial Health Systems Foundation Inc 305 Memorial Medical Pkwy 212 Daytona Beach FL 32117 311771522 Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 7 N/A 0 Memorial Health Systems Inc 301 Memorial Medical Parkway Daytona Beach FL 32117 590973502 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Memorial Hospital - West Volusia Inc 701 West Plymouth Avenue Deland FL 32720 593256803 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Memorial Hlth Systems Inc 1 Memorial Hospital Flagler Inc 60 Memorial Medical Parkway Palm Coast FL 32164 592951990 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Memorial Hlth Systems Inc 1 Memorial Hospital Inc 210 Marie Langdon Drive Manchester KY 40962 610594620 Operation of Hospital & Related Services KY 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Metroplex Adventist Hospital Inc 2201 S Clear Creek Road Killeen TX 76549 742225672 Operation of Hospital & Related Services TX 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Metroplex Clinic Physicians Inc 2201 S Clear Creek Road Killeen TX 76549 113762050 Physician Healthcare services to the community TX 501(c)(3) Line 3 Metroplex Adventist Hospital Inc 1 Midwest Health Foundation 120 North Oak Street Hinsdale IL 60521 352230515 Fund-Raising for Supported Exempt Hospitals IL 501(c)(3) Line 7 N/A 0 Mills Health & Rehab Center Inc(11-12622) 485 North Keller Road 250 Maitland FL 32751 205782320 Inactive - Wind-Down KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Mission Strategies of Georgia Inc 485 North Keller Road 250 Maitland FL 32751 900866024 Provision of support to the nursing home division GA 501(c)(3) Line 12b, II Sunbelt Hlth Care Centers Inc 1 Missouri Adventist Health Inc 9100 W 74th Street Shawnee Mission KS 66204 431224729 Support Health Care Services MO 501(c)(3) Line 12d, III-O Adventist Hlth Mid-America Inc 1 Osceola Health Care Properties Inc 485 North Keller Road 250 Maitland FL 32751 813165729 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Overland Park Nursing & Rehab Center Inc 6501 West 75th Street Overland Park KS 66204 205774821 Operation of Home for the Aged/Hlthcare Delivery KS 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Pasco-Pinellas Hillsborough Community Hlth System Inc 2600 Bruce B Downs Blvd Wesley Chapel FL 33544 208488713 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Portercare Adventist Health System (630 YE) 9100 E Mineral Circle Centennial CO 80112 840438224 Operation of Hospitals & Related Services CO 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Princeton Health & Rehab Center Inc (11-12622) 485 North Keller Road 250 Maitland FL 32751 205782272 Inactive - Wind-Down KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Princeton Homecare Services LLC (81 - 123122) 602 Courtland Street 310 Orlando FL 32804 814196648 Home Health Care Servcies FL 501(c)(3) Line 10 Princeton Prof Services Inc 1 Princeton Professional Services Inc 601 E Rollins Street Orlando FL 32803 591191045 Provision of Healthcare Services FL 501(c)(3) Line 10 Adventist Hlth System Sunbelt Hlthcare Corp 1 Quality Circle for Healthcare Inc 900 Hope Way Altamonte Springs FL 32714 263789368 Healthcare Quality Services FL 501(c)(3) Line 12a, I Adventist Hlth System Sunbelt Hlthcare Corp 1 Redmond Park Hospital LLC 501 Redmond Road NW Rome GA 30165 581123037 Operation of Hospital & Related Services GA 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Resource Personnel Inc 485 North Keller Road 250 Maitland FL 32751 208040875 Provide administrative support to tax exempt nursing homes FL 501(c)(3) Line 12b, II Sunbelt Hlth Care Centers Inc 1 Rocky Mountain Adventist Hlthcare Foundation (630 YE) 960 E Harvard Avenue Ste 230 Denver CO 80210 840745018 Fund-raising for Tax-exempt hospital CO 501(c)(3) Line 7 N/A 0 Rollins Brook Community Care Corp 2201 S Clear Creek Road Killeen TX 76549 461656773 Support Operation of Hospital TX 501(c)(3) Line 12a, I Adventist Hlth SystemSunbelt Inc 1 San Marcos Nursing & Rehab Center Inc 1900 Medical Parkway San Marcos TX 78666 205782224 Operation of Home for the Aged/Hlthcare Delivery TX 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Shawnee Mission Hlth Care Properties Inc 485 North Keller Road 250 Maitland FL 32751 813914908 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Shawnee Mission Health Care Inc 6501 West 75th Street Overland Park KS 66204 480952508 Lease to Related Organization KS 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Shawnee Mission Medical Center Inc 9100 W 74th Street Shawnee Mission KS 66204 480637331 Operation of Hospital & Related Services KS 501(c)(3) Line 3 Adventist Hlth Mid-America Inc 1 South Pasco Health Care Properties Inc 38250 A Avenue Zephyrhills FL 33542 510605679 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Southeast Volusia Healthcare Corp 401 Palmetto Street New Smyrna Beach FL 32168 473793197 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Southwest Volusia Health Services Inc 1055 Saxon Blvd Orange City FL 32763 593281591 Medical Office Building for Hospital FL 501(c)(3) Line 12a, I Southwest Volusia Hlthcare Corp 1 Southwest Volusia Healthcare Corp 1055 Saxon Blvd Orange City FL 32763 593149293 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Spring View Health & Rehab Center Inc (11-122222) 485 North Keller Road 250 Maitland FL 32751 205782288 Inactive - Wind-Down KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Sunbelt Health & Rehab Center - Apopka Inc 305 East Oak Street Apopka FL 32703 205774856 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Sunbelt Health Care Centers Inc 485 North Keller Road 250 Maitland FL 32751 581473135 Management Services TN 501(c)(3) Line 12b, II Adventist Hlth System Sunbelt Hlthcare Corp 1 Tarpon Springs Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 590898901 Operation of Hospital & Related Services FL 501(c)(3) Line 3 University Community Hospital Inc 1 Tarrant County Health Care Properties Inc 301 Huguley Blvd Burleson TX 76028 510605677 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 The Comforter Health Care Group Inc 605 Montgomery Road Altamonte Springs FL 32714 271857940 Support Services to Related Hospice FL 501(c)(3) Line 12c, III-FI Adventist Hlth System Sunbelt Hlthcare Corp 1 Tri-County Nursing and Rehab Center Inc 1290 Celebration Blvd Kissimmee FL 34747 472219363 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 University Community Hospital Foundation Inc 3100 E Fletcher Ave Tampa FL 33613 592554889 Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 7 N/A 0 University Community Hospital Inc 3100 E Fletcher Ave Tampa FL 33613 591113901 Operation of Hospitals & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 West Florida Health Home Care Inc 13601 Bruce B Downs Blvd Ste 110 Tampa FL 33613 593686109 Home Health Services GA 501(c)(3) Line 10 AdventHealth West Florida Ambulatory Svcs Inc 1 Zephyr Haven Health & Rehab Center Inc 38250 A Avenue Zephyrhills FL 33542 205774930 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Zephyrhills Health & Rehab Center Inc 7350 Dairy Road Zephyrhills FL 33540 205774967 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Fletcher Hospital Surgical Ventures LLC 9131 Anson Way Ste 304 Raleigh NC 27615 861482646 Indirect Interest in Surgery Center NC N/A 0 0 Florida Hospital DMERT LLC 500 Winderley Place Ste 324 Maitland FL 32751 202392253 Medical Equipment FL N/A 0 1 Florida Hospital Home Infusion LLP 500 Winderley Place Ste 226 Maitland FL 32751 593142824 Home Infusion Services FL N/A 0 1 Functional Neurosurgical Ambulatory Surgery Ctr LLC 11 W Dry Creek Circle 120 Littleton CO 80120 464426708 Surgery Center CO N/A 0 0 M&O Orlando MOB I LLC 1919 N Orange Ave Ste E Orlando FL 32804 844259138 Operation of Medical Office Building DE N/A 0 0 OnPoint OBGYN LLC (21-123122) 7780 S Broadway 280 Littleton CO 80122 873522453 Healthcare Services CO N/A 0 0 PAHS OnPoint Imaging LLC 9205 S Broadway Highlands Ranch CO 80129 833275105 Imaging Center CO N/A 0 0 PAHS OnPoint Urgent Care LLC 9100 E Mineral Circle Centennial CO 80112 832465331 Urgent Care Center CO N/A 0 0 Princeton Homecare Services LLC (11-8122) 602 Courtland Street 310 Orlando FL 32804 814196648 Operation of Home Health Agency FL N/A 0 0 Surgery Center of Rome LP 501 Redmond Road NW Rome GA 30165 200390305 Surgery Center GA N/A 0 0 The Bariatric Center of Kansas City LLC 9100 W 74th Street Merriam KS 66204 823025378 Surgery Center KS N/A 0 0 Urgent Care Centers of Brevard County LLC 2600 Westhall Lane Maitland FL 32751 844261523 Urgent Care Centers FL N/A 0 1 AdventHealth Orlando Network Inc (11 - 41922) 900 Hope Way Altamonte Springs FL 32714 862639185 Inactive FL N/A C 1 AdventHealth Professional Staffing Inc (11 - 12822) 900 Hope Way Altamonte Springs FL 32714 880742779 INACTIVE FL N/A C 1 AdventHealth Tampa Network Inc (11 - 41922) 900 Hope Way Altamonte Springs FL 32714 862666178 Inactive FL N/A C 1 AdventHealth Team Members Inc (11 - 12822) 900 Hope Way Altamonte Springs FL 32714 880763664 INACTIVE FL N/A C 1 AdventHealth Value Based Bundle Management LLC (61-123122) 101 Southhall Lane Ste 150 Maitland FL 32751 873487910 Medical Contracting and Billing FL N/A C 1 Altamonte Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 592855792 Condo Association FL N/A C 1 Apopka Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 593000857 Condo Association FL N/A C 1 Battle Creek Adventist Hospital 900 Hope Way Altamonte Springs FL 32714 381359189 Inactive MI N/A C 1 Florida Hospital Flagler Medical Offices Association Inc 60 Memorial Medical Parkway Palm Coast FL 32164 262158309 Condo Association FL N/A C 1 Florida Hosp Hlth Village Property Owner's Assoc Inc 550 E Rollins Street 7th Floor Orlando FL 32803 821748255 Condo Association FL N/A C 1 Florida Hospital Healthcare System Inc 101 Southhall Lane Ste 150 Maitland FL 32751 593215680 PHSO / CIN FL N/A C 1 Florida Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 592855791 Condo Association FL N/A C 1 Kissimmee Multispecialty Clinic Condominium Association Inc 201 Hilda Street Suite 30 Kissimmee FL 34741 593539564 Condo Association FL N/A C 1 Midwest Management Services Inc 9100 West 74th Street Shawnee Mission KS 66204 480901551 Inactive KS N/A C 1 North American Health Services Inc & Sub 900 Hope Way Altamonte Springs FL 32714 621041820 Holding Co. TN N/A C 1 Ormond Prof Associates Condo Assoc Inc (430 year end) 770 W Granada Blvd Ste 101 Ormond Beach FL 32174 592694434 Condo Association FL N/A C 1 Park Ridge Property Owner's Association Inc 1 Park Place Naples Road Fletcher NC 28732 030380531 Condo Association NC N/A C 1 Park Ridge Condominium #1 Unit Owners Association Inc 1 Park Place Naples Road Fletcher NC 28732 010584623 Condo Association NC N/A C 1 Surgicare of Rome Inc 501 Redmond Rd Rome GA 30165 200376307 Holding Company GA N/A C 1 Redmond Park Health Services Inc 501 Redmond Rd Rome GA 30165 621330078 Holding Company GA N/A C 1 The Garden Retirement Community Inc 485 North Keller Road Ste 250 Maitland FL 32751 593414055 Real Estate Rental FL N/A C 1 Winter Park Medical Office Building I Condo Assoc Inc 601 East Rollins Street Orlando FL 32803 452228478 Condo Association FL N/A C 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 Florida Hospital Physician Group Inc P 1099984 Cost University Community Hospital Inc P 3594921 Cost Florida Hospital Zephyrhills Inc P 3420934 Cost Adventist Health SystemSunbelt Inc dba AdventHealth Orlando P 213970 Cost Adventist Health System Sunbelt Healthcare Corporation M 665501 % of facility's operating expense Adventist Health System Sunbelt Healthcare Corporation - Shared Services M 712242 % of facility's operating expense Adventist Health System Sunbelt Healthcare Corporation dba AHIT M 2823571 % of facility's operating expense Adventist Health System Sunbelt Healthcare Corporation P 2541153 Cost Adventist Health System Sunbelt Healthcare Corporation B 401519 Actual Amount Given AdventHealth Foundation Inc dba AH Zephyrhills Foundation C 459709 Actual Amount Received Pasco-Pinellas Hillsborough Community Health System Inc P 122089 Cost Pasco-Pinellas Hillsborough Community Health System Inc M 98550 Allocated Cost