2023-11-14T15:46:00-06:00 2022-12-31 990 2022-01-01 352230515 MIDWEST HEALTH FOUNDATION MIDW 6303127504 120 N OAK STREET HINSDALE IL 60521 MEGHAN MORENO VICE PRESIDENT 2242734113 2023-11-10 MEGHAN MORENO 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z THOR THORDARSON 120 N OAK STREET HINSDALE IL 60521 1226879 0 X WWW.ADVENTHEALTH.COM/ADVENTHEALTH-FOUNDATION X 2004 IL SUPPORT OF THREE AFFILIATED TAX-EXEMPT HOSPITAL ORGANIZATIONS AND ONE AFFILIATED TAX-EXEMPT FOUNDATION ORGANIZATION. 14 6 0 180 0 0 221205 505165 336189 460886 109534 183748 -7920 8471 659008 1158270 518147 662817 0 0 0 0 0 0 0 150067 286692 668214 949509 -9206 208761 2934981 3145815 20329 21536 2914652 3124279 CONDUCT FUND-RAISING AND OTHER PHILANTHROPIC ACTIVITIES IN SUPPORT OF AND FOR THE BENEFIT OF THREE AFFILIATED TAX-EXEMPT HOSPITAL ORGANIZATIONS AND ONE AFFILIATED TAX-EXEMPT FOUNDATION ORGANIZATION. 0 0 662817 662817 460886 MIDWEST HEALTH FOUNDATION CARRIES ON FUND-RAISING ACTIVITIES FOR THE BENEFIT OF THREE 501(C)(3) HOSPITAL ORGANIZATIONS, ADVENTIST BOLINGBROOK HOSPITAL, ADVENTIST GLENOAKS HOSPITAL AND ADVENTIST MIDWEST HEALTH, AND PROVIDES SUPPORT AND DIRECTION TO HINSDALE HOSPITAL FOUNDATION, ALSO A 501(C)(3) ORGANIZATION. 662817 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 X 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 14 6 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 IL X REBECCA MATHIS 7082452211 5101 S WILLOW SPRINGS RD SUITE LA GRANGE IL 60525 X THORDARSON THOR DIRECTOR/PRESIDENT 0.50 50.00 X X 0 1297253 147708 MURPHY MARY DIRECTOR (BEGAN 5/2022) 0.50 50.00 X 0 1363227 66691 BUCHANAN HERBERT DIRECTOR 0.50 50.00 X 0 795983 32818 MAYCOCK ADAM DIRECTOR 0.50 50.00 X 0 598002 98625 CHEN YUESHA SHASHA DIRECTOR (END 4/2022) 0.50 50.00 X 0 607538 73691 MATHIS REBECCA DIRECTOR/TREASURER (BEGAN 5/2022) 0.50 50.00 X 0 407099 112217 RADIVOJEVIC VLADIMIR DIRECTOR (BEGAN 7/2022) 0.50 50.00 X 0 356458 72651 MORENO MEGHAN DIR/VP FDTN DEVELOPMENT 25.00 25.00 X X 0 320739 33520 GUIDOTTI JOHN DIRECTOR 0.50 50.00 X 0 190633 35232 MORGAN DIANE EXECUTIVE DIRECTOR 25.00 25.00 X 0 135401 27493 HULTEN JILL DIR/VP FDTN OPERATIONS (END 4/2022) 0.50 5.00 X 24576 8192 7633 BUDAK DONNA DIRECTOR (END 4/2022) 0.50 0.00 X 0 0 0 DOEPKE MIKE DIRECTOR/CHAIRMAN 0.50 0.00 X 0 0 0 FIASCONE KAREN DIRECTOR 0.50 0.30 X 0 0 0 FURLAN MELANIE DIRECTOR (END 4/2022) 0.50 0.00 X 0 0 0 HOU LINDA DIRECTOR 0.50 0.00 X 0 0 0 PHILLIPS MD RICHARD DIRECTOR/SECRETARY 0.50 0.00 X 0 0 0 POLLITT JAY DIRECTOR/VICE CHAIR 0.50 0.30 X 0 0 0 WARING RANDY DIRECTOR 0.50 0.30 X 0 0 0 24576 6080525 708279 0 0 1 1 0 261809 235827 7529 235827 505165 SATISFACTION OF PROGRA 900099 460886 460886 460886 183748 183748 77080 261809 68609 8471 8471 1158270 460886 0 192219 659217 659217 3600 3600 8700 8700 38000 38000 47856 47856 18258 18258 74308 74308 5000 5000 1672 1672 BAD DEBT EXPENSE 38720 38720 PURCHASED SERVICES 27900 27900 MISCELLANEOUS EXPENSE 26278 26278 949509 662817 286692 0 X 132887 105101 2109206 2645172 619120 353636 39951 23475 7500 7500 26317 10931 2934981 3145815 20000 0 329 21536 20329 21536 X 157924 27796 2756728 3096483 2914652 3124279 2934981 3145815 X 208761 866 X 0 1 X 1 0 X 97970 592986 1146871 867559 902167 3607553 97970 592986 1146871 867559 902167 3607553 772444 2835109 119676 233856 109314 248498 711344 34152 19240 26400 77080 156872 4475769 0.63340 0.67200 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 85685 85685 85685 85685 85685 85685 85685 85685 0.00000 1.00000 0.00000 0 0 0 OTHER LIABILITIES 21536 21536 X 1757694 529949 530361 1060310 697384 460886 460886 1158270 1548067 529949 68609 598558 949509 0 949509 PART V, LINE 4: THE PERMANENT ENDOWMENT WAS TRANSFERRED FROM LA GRANGE MEMORIAL HOSPITAL FOUNDATION AS THE RESULT OF A LEGAL MERGER. THE FILING ORGANIZATION WAS THE SOLE MEMBER OF LA GRANGE MEMORIAL HOSPITAL FOUNDATION PRIOR TO THE MERGER. EFFECTIVE 6/21/19, LA GRANGE MEMORIAL HOSPITAL FOUNDATION WAS LEGALLY MERGED INTO THE FILING ORGANIZATION PURSUANT TO THE LAWS OF THE STATE OF ILLINOIS. THE PERMANENT ENDOWMENT REPRESENTS A SCHOLARSHIP FUND ESTABLISHED TO SUPPORT NURSING SCHOLARSHIPS. PART X, LINE 2: THE AUDITED FINANCIAL STATMENTS OF THE FILING ORGANIZATION CONTAIN THE FOLLOWING FIN 48 (ASC NO. 740) STATEMENT: MIDWEST AND HINSDALE HAVE BEEN DETERMINED TO BE EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR EITHER FEDERAL OR STATE INCOME TAXES. MIDWEST AND HINSDALE HAVE EVALUATED THE TAX POSITIONS TAKEN FOR ALL OPEN TAX YEARS. CURRENTLY, THE 2019, 2020 AND 2021 TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE; HOWEVER, MIDWEST AND HINSDALE ARE NOT CURRENTLY UNDER AUDIT NOR HAS MIDWEST OR HINSDALE BEEN CONTACTED BY THIS JURISDICTION. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSE 68,609. RESTRICTED CONTRIBUTIONS 397,002. NET INVESTMENT INCOME WITH DONOR RESTRICTIONS 64,750. PART XI, LINE 4B - OTHER ADJUSTMENTS: TRANSFER OF NET ASSETS FROM RESTRICTED FUND BALANCE 460,886. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSE RECLASSED TO REVENUE 68,609. GOLF EVENT MIDWEST 177805 138475 39330 0 0 15023 0 0 9530 GOLF EVENT LAGRANGE 161084 123334 37750 0 0 35512 0 0 8544 338889 261809 77080 50535 18074 68609 8471 1 ADVENTIST BOLINGBROOK HOSPITAL 500 REMINGTON BLVD BOLINGBROOK IL 60440 651219504 501(C)(3) 66540 0 GENERAL SUPPORT ADVENTIST GLENOAKS HOSPITAL 701 WINTHROP AVE GLENDALE HEIGHTS IL 60139 363208390 501(C)(3) 137893 0 GENERAL SUPPORT ADVENTIST MIDWEST HEALTH 5101 WILLOW SPRINGS RD LA GRANGE IL 60525 362276984 501(C)(3) 452284 0 GENERAL SUPPORT 3 0 PART I, LINE 2: GRANTS ARE GENERALLY MADE ONLY TO THE SUPPORTED HOSPITAL ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3) AND OTHER ORGANIZATIONS EXEMPT UNDER 501(C)(3). 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. 1 1 0 0 0 0 0 0 0 THORDARSON THOR DIRECTOR/PRESIDENT 0 744389 0 0 0 552864 0 118312 0 29396 0 1444961 0 0 MURPHY MARY DIRECTOR (BEGAN 5/2022) 0 389493 0 0 0 973734 0 55043 0 11648 0 1429918 0 0 BUCHANAN HERBERT DIRECTOR 0 476166 0 0 0 319817 0 17255 0 15563 0 828801 0 0 MAYCOCK ADAM DIRECTOR 0 382427 0 0 0 215575 0 59011 0 39614 0 696627 0 0 CHEN YUESHA SHASHA DIRECTOR (END 4/2022) 0 375459 0 0 0 232079 0 48577 0 25114 0 681229 0 0 MATHIS REBECCA DIRECTOR/TREASURER (BEGAN 5/2022) 0 370485 0 0 0 36614 0 71093 0 41124 0 519316 0 0 RADIVOJEVIC VLADIMIR DIRECTOR (BEGAN 7/2022) 0 291307 0 0 0 65151 0 33188 0 39463 0 429109 0 0 MORENO MEGHAN DIR/VP FDTN DEVELOPMENT 0 261846 0 0 0 58893 0 10803 0 22717 0 354259 0 0 GUIDOTTI JOHN DIRECTOR 0 178269 0 0 0 12364 0 7822 0 27410 0 225865 0 0 MORGAN DIANE EXECUTIVE DIRECTOR 0 131431 0 0 0 3970 0 9798 0 17695 0 162894 0 0 PART I, LINE 3 THE FILING ORGANIZATION'S SUPPORTED HOSPITAL ORGANIZATIONS WERE COVERED AFFILIATES OF THE JOINT OPERATING COMPANY, ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO. D/B/A AMITA HEALTH (AMITA OR JOC) FOR THE PERIOD FROM JANUARY 1 TO MARCH 31 OF 2022. AS A RESULT OF A DISAFFILIATION AGREEMENT BETWEEN ALEXIAN BROTHERS HEALTH SYSTEM AND ADVENTIST MIDWEST HEALTH, THE FILING ORGANIZATION'S SUPPORTED HOSPITAL ORGANIZATIONS CEASED TO BE COVERED AFFILIATES OF THE JOC EFFECTIVE APRIL 1, 2022. THE 2022 COMPENSATION OF THE DIRECTOR/PRESIDENT WAS DETERMINED BY AMITA. UPON THE DISAFFILIATION ON APRIL 1, 2022, THE COMPENSATION OF THE DIRECTOR/PRESIDENT LISTED IN PART VII WAS REVIEWED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, THE FILING ORGANIZATION'S SUPPORTED HOSPITAL ORGANIZATIONS' TOP-TIER 501(C)(3) PARENT ORGANIZATION, FOR REASONABLENESS AND APPROPRIATENESS AND LEFT UNCHANGED FOR 2022. THE INDIVIDUAL WHO SERVES AS VICE PRESIDENT OF FOUNDATION DEVELOPMENT OF THE FILING ORGANIZATION IS COMPENSATED BY ADVENTIST MIDWEST HEALTH (AMH) FOR THIS INDIVIDUAL'S ROLE IN SERVING AS A MEMBER OF THE EXECUTIVE TEAM OF THE FILING ORGANIZATION'S SUPPORTED HOSPITAL ORGANIZATIONS. COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AMH THAT ARE DESIGNED TO ENSURE THAT ALL EMPLOYEES SERVING IN MANAGEMENT ROLES ARE PROVIDED WITH COMPENSATION REFLECTIVE OF FAIR MARKET VALUE GIVEN THEIR ROLES AND RESPONSIBLITIES. AMH USES THE FOLLOWING TO ESTABLISH COMPENSATION OF THE VICE PRESIDENT OF FOUNDATION DEVELOPMENT: - COMPENSATION SURVEY OR STUDY. AMITA UTILIZED VARIOUS COMPARABILITY DATA IN ESTABLISHING THE 2022 COMPENSATION FOR THOSE EXECUTIVES LISTED IN PART VII THAT PERFORMED SERVICES FOR AMITA DURING THE FIRST QUARTER OF 2022 AND FOR THE FILING ORGANIZATION AND FOR ITS RELATED 501(C)(3) HOSPITAL AND PHYSICIAN PRACTICE ENTITIES FOR CALENDAR YEAR 2022. COMPARABILITY DATA UTILIZED BY AMITA INCLUDED COMPENSATION SURVEYS AND STUDIES AND THE FORMS 990 OF OTHER UNRELATED COMPARABLE ORGANIZATIONS. AMITA ALSO HAD A COMPENSATION COMMITTEE THAT APPROVED ALL RELEVANT EXECUTIVE COMPENSATION, INCLUDING THE COMPENSATION OF THE FILING ORGANIZATION'S PRESIDENT FOR 2022. PART I, LINES 4A-B DURING THE YEAR ENDING DECEMBER 31, 2022, YUESHA CHEN RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $86,539 FROM ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, THE 501(C)(3) PARENT ORGANIZATION OF THE SUPPORTED HOSPITAL ORGANIZATIONS. PURSUANT TO THE AHSSHC CORPORATE EXECUTIVE POLICY GOVERNING EXECUTIVE SEVERANCE, SEVERANCE AGREEMENTS FOR EXECUTIVES OPERATING AT THE VICE PRESIDENT LEVEL AND ABOVE ARE ENTERED INTO UPON ELIGIBILITY TO FACILITATE THE TRANSITION TO SUBSEQUENT EMPLOYMENT FOLLOWING AN INVOLUNTARY SEPARATION FROM EMPLOYMENT WITH ADVENTHEALTH. CERTAIN MEMBERS OF THE BOARD OF DIRECTORS 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.* THORDARSON, THOR $ 0 $ 0 $ 0 $ 98,072 $ 0 MURPHY, MARY $ 36,648 $ 0 $ 761,856 $ 0 $ 0 BUCHANAN, HERBERT $ 0 $ 0 $ 0 $ 50,754 $ 50,754 MAYCOCK, ADAM $ 0 $ 0 $ 0 $ 41,539 $ 0 CHEN, YUESHA $ 0 $ 0 $ 0 $ 31,154 $ 0 MATHIS, REBECCA $ 0 $ 0 $ 0 $ 54,693 $ 0 RADIVOJEVIC, VLADIMIR $ 0 $ 0 $ 0 $ 19,327 $ 0 * INCLUDING INVESTMENT EARNINGS FORM 990, PART VII, SECTION A, LINE 5: JILL HULTEN, DIRECTOR AND VP FOUNDATION OPERATIONS, WAS COMPENSATED BY ALEXIAN BROTHERS HEALTH SYSTEM, A SECTION 501(C)(3) ORGANIZATION NOT RELATED TO THE FILING ORGANIZATION, FOR THE PERIOD FROM JANUARY 1 - MARCH 31, 2022 FOR SERVICES PROVIDED TO THE FILING ORGANIZATION. FOR THE PERIOD FROM JANUARY 1 - MARCH 31, 2022, THE FILING ORGANIZATION'S THREE SUPPORTED HOSPITAL ORGANIZATIONS (ADVENTIST MIDWEST HEALTH, ADVENTIST BOLINGBROOK HOSPITAL, AND ADVENTIST GLENOAKS HOSPITAL), AND ALEXIAN BROTHERS HEALTH SYSTEM WERE COVERED AFFILIATES OF THE JOINT OPERATING COMPANY KNOWN AS AMITA HEALTH. COMPENSATION FOR THIS INDIVIDUAL RELATED TO SERVICES PROVIDED TO THE FILING ORGANIZATION AND ANY RELATED ORGANIZATIONS IS DISCLOSED IN PART VII OF THIS FORM 990. X IN-KIND ADMINISTRATIVE EXPENSES 1 235827 COST 0 1 0 SCHEDULE M, PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS REPORTED IN COLUMN (B) OF SCHEDULE M, PART I, REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED BY THE FILING ORGANIZATION. PART V, LINE 1A: ONE OF THE SUPPORTED HOSPITAL ORGANIZATIONS OF MIDWEST HEALTH FOUNDATION (THE FILING ORGANIZATION) IS ADVENTIST MIDWEST HEALTH (AMH). AMH IS AN ILLINOIS, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THE PARENT CORPORATION AND SOLE TOP-TIER MEMBER OF AMH 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 4 THE ARTICLES OF INCORPORATION OF THE FILING ORGANIZATION WERE AMENDED ON DECEMBER 29, 2022. ARTICLE 4 OF THE UPDATED BYLAWS ADDS ADVENTIST BOLINGBROOK HOSPITAL AND HINSDALE HOSPITAL FOUNDATION AS ORGANIZATIONS THAT THE FILING ORGANIZATION SUPPORTS. ALL THE ORGANIZATIONS THAT THE FILING ORGANIZATION SUPPORTS ARE AFFILIATED 501(C)(3) ORGANIZATIONS THAT OPERATE HOSPITALS OR PHYSICIAN PRACTICE SITES OR ENGAGE IN FUND-RAISING ACTIVITIES FOR THOSE HEALTHCARE PROVIDER ENTITIES. ALL THE AFFILIATED AND RELATED ORGANIZATIONS ARE OWNED AND/OR OPERATED BY THE HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. ARTICLE 7 OF THE AMENDED BYLAWS PROVIDES THAT THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION MAY AMEND THE FILING ORGANIZATION'S ARTICLES OF INCORPORATION, EXCEPT THAT ANY CHANGES TO THE PURPOSES CLAUSE OR ARTICLE 7 CANNOT BE MADE WITHOUT THE APPROVAL OF ADVENTIST MIDWEST HEALTH. ADVENTIST MIDWEST HEALTH IS ONE OF THE SUPPORTED ORGANIZATIONS OF THE FILING ORGANIZATION AND OPERATES TWO ACUTE-CARE HOSPITALS. PREVIOUSLY, THIS APPROVAL RIGHT WAS HELD BY ADVENTIST HEALTH SYSTEM/SUNBELT, INC., THE 501(C)(3) PARENT ORGANIZATION OF ADVENTIST MIDWEST HEALTH. THE BYLAWS OF THE FILING ORGANIZATION WERE AMENDED ON APRIL 1, 2022. SEVEN MEMBERS OF THE BOARD OF DIRECTORS SERVE AS EX OFFICIO DIRECTORS BY VIRTUE OF POSITIONS THEY HOLD. IN THE PREVIOUS BYLAWS, SIX OF THE SEVEN EX OFFICIO MEMBERS WERE POSITIONS HELD IN CONNECTION WITH AMITA HEALTH. PRIOR TO APRIL 1, 2022, THE SUPPORTED HOSPITALS AND PHYSICIAN PRACTICE ENTITIES WERE COVERED AFFILIATES OF AN AFFILIATION COMPRISING A REGIONAL HEALTH CARE DELIVERY NETWORK OPERATED AND MANAGED BY ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO., A JOINT OPERATING COMPANY BETWEEN ALEXIAN BROTHERS HEALTH SYSTEM AND ADVENTIST MIDWEST HEALTH (THE JOINT OPERATING COMPANY). THE JOINT OPERATING COMPANY WAS KNOWN AS AMITA HEALTH. EFFECTIVE APRIL 1, 2022, ALEXIAN BROTHERS HEALTH SYSTEM AND ADVENTIST MIDWEST HEALTH EXECUTED A DISAFFILIATION AGREEMENT (THE DISAFFILIATION) WHEREBY IT WAS AGREED THAT THE JOINT OPERATING COMPANY, ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO., WOULD WIND UP ITS AFFAIRS AND DISSOLVE AND THAT THE PARTIES TO THE ORIGINAL AFFILIATION AGREEMENT WOULD NO LONGER BE UNDER THE MANAGEMENT CONTROL OF THE JOINT OPERATING COMPANY. THE APRIL 1, 2022 BYLAWS OF THE FILING ORGANIZATION PROVIDE THAT SIX OF THE SEVEN EX OFFICIO BOARD MEMBERS WILL BE THOSE SERVING IN SENIOR EXECUTIVE LEADERSHIP POSITIONS WITHIN THE SUPPORTED ORGANIZATIONS. TWO MEMBERS OF THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS THAT SERVE BY VIRTUE OF POSITION WERE ALSO UPDATED TO DELETE TWO EXECUTIVE POSITIONS ASSOCIATED WITH AMITA HEALTH AND WERE REPLACED WITH THE VICE PRESIDENT OF THE FILING ORGANIZATION AND THE EXECUTIVE VP/REGIONAL CHIEF FINANCIAL OFFER OF THE ADVENTHEALTH MIDWEST REGION. FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE VICE PRESIDENT OF FOUNDATION DEVELOPMENT OF THE FILING ORGANIZATION PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE VICE PRESIDENT OF FOUNDATION DEVELOPMENT 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 PRESIDENT IS NOT COMPENSATED BY THE FILING ORGANIZATION. FOR 2022, THE COMPENSATION PACKAGE FOR THIS INDIVIDUAL WAS INITIALLY DETERMINED BY THE JOINT OPERATING COMPANY, ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO., DBA AMITA HEALTH (AMITA HEALTH OR JOC). THE FILING ORGANIZATION'S SUPPORTED HOSPITAL ORGANIZATIONS CEASED TO BE COVERED AFFILIATES OF THE JOC EFFECTIVE APRIL 1, 2022, DUE TO THE DISAFFILIATION AGREEMENT BETWEEN ALEXIAN BROTHERS HEALTH SYSTEM AND ADVENTIST MIDWEST HEALTH. PLEASE SEE THE DISCUSSION CONCERNING THE PROCESS FOLLOWED BY AMITA HEALTH IN DETERMINING 2022 EXECUTIVE COMPENSATION IN OUR RESPONSE TO SCHEDULE J, LINE 3. FORM 990, PART VI, SECTION C, LINE 19 THE FILING ORGANIZATION DOES NOT GENERALLY MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS 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 FOR THE SUPPORTED HOSPITAL ORGANIZATIONS. FORM 990, PART X, LINE 2: THE AMOUNTS SHOWN ON LINE 2 OF PART X OF THIS RETURN INCLUDE THE FILING ORGANIZATION'S INTEREST IN A CENTRAL INVESTMENT POOL MAINTAINED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, THE TOP-TIER PARENT OF THE FILING ORGANIZATION'S SUPPORTED HOSPITALS. THE INVESTMENTS IN THE CENTRAL INVESTMENT POOL ARE RECORDED AT MARKET VALUE. FORM 990, PART XI, LINE 9: TEMPORARILY RESTRICTED CONTRIBUTIONS 397,002. TEMPORARILY RESTRICTED INVESTMENT INCOME 64,750. TRANSFER OF NET ASSETS RELEASED FROM RESTRICTIONS -460,886. 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