2024-11-14T09:14:02-06:00 2023-12-31 990 2023-01-01 452694620 TEXAS HEALTH HUGULEY INC TEXA 8172939110 11801 S FREEWAY BURLESON TX 76028 LYNN C ADDISCOTT ASSISTANT SECRETARY 8172939110 2024-11-12 1 2023 2024-10-15 13:58:12Z PENNY JOHNSON 11801 S FREEWAY BURLESON TX 76028 294563482 0 X WWW.TEXASHEALTHHUGULEY.ORG X 2011 FL THE PROVISION OF MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF A 327 BED HOSPITAL. 11 6 0 71 1141856 225669 1682859 299819 262747831 292270668 2287794 1470200 12142 20236 266730626 294060923 97555 85500 0 0 2142890 2076618 0 0 0 237324467 257974662 239564912 260136780 27165714 33924143 322242277 354962612 34677060 42632380 287565217 312330232 OUR MISSION IS TO EXTEND THE HEALING MINISTRY OF CHRIST BY IDENTIFYING AND MEETING THE HEALTH NEEDS OF OUR COMMUNITY, PROVIDING QUALITY, CUSTOMER ORIENTED AND COST EFFECTIVE SERVICES, AND ENSURING ACCESS TO THOSE SERVICES. 0 0 240472697 85500 291128812 OPERATION OF AN ACUTE CARE HOSPITAL TOTALING 327 BEDS WITH 12,053 PATIENT ADMISSIONS, 53,796 PATIENT DAYS, AND 133,731 OUTPATIENT VISITS IN THE CURRENT YEAR. 240472697 1 1 0 1 0 0 0 0 0 1 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 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 6 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X JESSE SUTTON 8175512704 11801 S FREEWAY BURLESON TX 76028 X KING JAMES KIRK DIRECTOR/VICE CHAIRMAN 0.20 50.00 X 0 1271947 369248 JOHNSON PENNY CEO 25.00 16.00 X 696775 445936 146620 PAPST AMY DIRECTOR (BEG 01/23) 0.20 50.00 X 0 600343 139698 CRAFT BRIAN DIRECTOR 0.20 50.00 X 0 560964 128379 JACKSON DAVID DIRECTOR 0.20 50.00 X 0 515108 165877 FORD MD RONNY CMO 35.00 15.00 X 339226 145383 114242 LLOYD MD DAVID DIRECTOR (END 01/23) 0.20 50.00 X 0 475340 110030 SUTTON JESSE CFO 25.00 15.00 X 295084 177050 71680 PAI AJITH DIRECTOR 0.20 50.00 X 0 421491 121521 ROSE KENNETH FORMER COO 0.00 50.00 X 0 414119 100504 LEMON SEAN COO 37.50 12.50 X 247029 82344 45496 ELLIS TAMMY CNO 30.00 10.00 X 228215 76071 29324 BACON KENNETH DIRECTOR/CHAIRMAN (END 10/23) 0.20 0.00 X 0 0 0 BANKS DAVID DIRECTOR/CHAIRPERSON (BEG 11/23) 0.20 0.00 X 0 0 0 BOND JUSTIN DIRECTOR 0.20 0.00 X 0 0 0 CRAIG CARLOS DIRECTOR 0.20 0.00 X 0 0 0 OWEN DALLAS DIRECTOR 0.20 0.00 X 0 0 0 PAGE JOHN DIRECTOR 0.20 0.00 X 0 0 0 RANDOLPH KARSTEN DIRECTOR 0.20 0.00 X 0 0 0 1806329 5186096 1542619 5 1 1 1 THE BECK GROUP 1601 ELM STREET DALLAS TX 75201 GENERAL CONTRACTOR 18733470 SOUND PHYSICIANS OF TEXAS 1498 PACIFIC AVENUE SUITE 400 TACOMA WA 98402 HOSPITALIST STAFFING 4358712 PEDIATRIX MEDICAL GROUP OF FLORIDA INC 1301 CONCORD TERRACE SUNRISE FL 33323 PEDIATRIC SERVICES 2302593 NORTHSTAR ANESTHESIA PA 6225 STATE HIGHWAY 161 SUITE 200 IRVING TX 75038 ANESTHESIA SERVICES 1464990 TEXAS PATHOLOGY CONSULTANTS PA PO BOX 879 BURLESON TX 76028 LABORATORY DIRECTOR SERVICES 1167082 73 X 275390 24429 299819 NET PATIENT REVENUE 622110 286407800 286407800 MEDICAL OFFICE BUILDING 622110 1564538 1564538 CAFETERIA REVENUE 622110 1485083 1477033 8050 FITNESS CENTER REVENUE 622110 885868 885868 MANAGEMENT FEE REVENUE 622110 806052 37428 768624 1121327 756145 365182 292270668 1811555 1811555 20236 0 20236 20236 20236 161204 497935 4624 -497935 156580 -341355 -341355 294060923 291128812 1141856 1490436 X 85500 85500 2076618 2076618 -59918 -59918 326849 326849 173564 173564 169521133 157415848 12105285 748009 748009 4125942 2846584 1279358 13999213 12799740 1199473 6092060 6092060 296724 19648 277076 815581 815581 271307 271307 11348007 11348007 622667 308312 314355 MEDICAL SUPPLIES 38312975 38312975 STATE TAX INDIGENT ASSE 5691988 5691988 REPAIRS & MAINTENANCE 5178627 5178627 UBI TAXES 182399 182399 327535 102101 225434 260136780 240472697 19664083 0 X 5900 5600 53431080 34231879 36204132 39482142 6672449 5601831 16381701 22139970 304148756 100219601 166151150 203929155 16403324 17334243 383626 767861 26608915 31469931 322242277 354962612 11376852 9157250 6528226 3242488 16771982 30232642 34677060 42632380 X 285048984 309862273 2516233 2467959 287565217 312330232 322242277 354962612 X 33924143 2871260 -12030388 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7819 7819 0 PART II-B, LINE 1: AMERICAN HOSPITAL ASSOCIATION AND TEXAS HOSPITAL ASSOCIATION DUES. 1413027 102887 102887 1413027 1413027 207433 207433 1413027 1413027 100428 100428 1413027 1413027 60834 60834 1413027 1413027 167596 167596 1413027 0.00000 1.00000 0.00000 0 0 6742536 6742536 117829841 39585922 78243919 92715519 56225779 36489740 86860860 4407900 82452960 203929155 DUE FROM RELATED 18000000 OTHER RECEIVABLES 9392684 RECEIVABLE FROM THIRD PARTIES 405858 RIGHT OF USE ASSET-OPERATING LEASE 1971476 OTHER ASSETS 1699913 31469931 DUE TO RELATED 19738834 PAYABLE TO THIRD PARTIES 4301152 CREDIT BALANCES IN A/R 1132797 ACCRUED INTEREST PAYABLE 6925 LEASES PAYABLE 163553 OPERATING LEASE LIABILITY 2159120 OTHER LIABILITIES 2730261 30232642 X PART V, LINE 4: THE FILING ORGANIZATION'S ENDOWMENT CONSISTS OF TWO DONOR-RESTRICTED ENDOWMENT FUNDS ESTABLISHED TO SUPPORT A VARIETY OF PURPOSES INCLUDING THE ACQUISITION AND MAINTENANCE OF THE HOSPITAL'S EQUIPMENT, AND ASSISTANCE TO THE HELPING HAND FUND WHICH PROVIDES ASSISTANCE TO ORGANIZATIONS AND NEEDY INDIVIDUALS WITHIN THE COMMUNITY. AN ENDOWNMENT FUND TOTALING $1,313,027 HAS A DONOR-IMPOSED RESTRICTION ON THE INVESTMENT RETURN TO BE USED EXCLUSIVELY FOR CAPITAL IMPROVEMENTS AND MAINTENANCE OF THE HOSPITAL. THE REMAINING FUND HAS NO DONOR-IMPOSED RESTRICTION ON ITS INVESTMENT RETURN. PART V, LINE 1C, COLUMNS (B)-(E) - EXPLANATION FOR CHANGE IN NET INVESTMENT EARNINGS, GAINS, AND LOSSES: INVESTMENT EARNINGS FOR THE PRIOR YEAR, TWO YEARS BACK, THREE YEARS BACK, AND FOUR YEARS BACK WERE UPDATED IN 2023 TO REFLECT THE AMOUNTS DISCLOSED ON THE FILING ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. PART V, LINE 1E, COLUMNS (B)-(E) - EXPLANATION FOR CHANGE IN OTHER EXPENDITURES FOR FACILITIES AND PROGRAMS: OTHER EXPENDITURES FOR FACILITIES AND PROGRAMS FOR THE PRIOR YEAR, TWO YEARS BACK, THREE YEARS BACK, AND FOUR YEARS BACK WERE UPDATED IN 2023 TO REFLECT THE AMOUNTS DISCLOSED ON THE FILING ORGANIZATION'S AUDITED FINANCIAL STATEMENTS. PART X, LINE 2: THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR THE TWELVE-MONTH PERIOD ENDED 12/31/2023 INCLUDE THE FILING ORGANIZATION AND ITS MEMBER TAX-EXEMPT HOSPITAL, TEXAS HEALTH HUGULEY (THH OR THE COMPANY). THESE CONSOLIDATED AUDITED FINANCIAL STATEMENTS CONTAIN THE FOLLOWING FIN 48 FOOTNOTE: THE COMPANY IS EXEMPT FROM STATE AND FEDERAL INCOME TAXES. ACCORDINGLY, THE COMPANY AND ITS TAX-EXEMPT AFFILIATES ARE NOT SUBJECT TO FEDERAL, STATE, OR LOCAL INCOME TAXES, EXCEPT FOR ANY NET UNRELATED BUSINESS TAXABLE INCOME. FOR THE YEARS ENDED DECEMBER 31, 2023 AND 2022, UNRELATED BUSINESS INCOME ACTIVITIES CONDUCTED BY THE COMPANY AND ITS TAX-EXEMPT AFFILIATES DID NOT GENERATE A MATERIAL AMOUNT OF COMBINED FEDERAL, STATE, OR LOCAL INCOME TAX. THE COMPANY FOLLOWS THE INCOME TAXES TOPIC OF THE ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES (ASC 740), WHICH 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, 2023 AND 2022. 1 1 X 1 X 1 X 1 1 1 0 1 1 19518319 19518319 0.07500 32489312 32799442 0 0.00000 52007631 32799442 19518319 0.07500 278354 7246 271108 0.00100 241826 241826 0.00090 520180 7246 512934 0.00190 52527811 32806688 20031253 0.07690 13790 13790 0.00010 13790 13790 0.00010 1 25285338 3408089 36450215 37758293 -1308078 X 1 1 1 TEXAS HEALTH HUGULEY SURGERY CENTER LLC AMBULATORY SURGERY CENTER 0.46050 0.00000 0.17500 1 1 TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH 11801 S FREEWAY BURLESON TX 76028 WWW.TEXASHEALTHHUGULEY.ORG 100157 X X X TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH 1 0 0 1 X X X X X X X X X 22 1 1 0 1 X SEE PART V, PAGE 8 X X 1 23 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 400.000000000000 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 TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH PART V, SECTION B, LINE 5: TEXAS HEALTH HUGULEY, INC. (THH OR THE HOSPITAL) OPERATES A 327-BED ACUTE-CARE HOSPITAL FACILITY IN BURLESON, TEXAS IN THE FORT WORTH, TEXAS AREA. THE MEMBERSHIP OF THH IS HELD BY TEXAS HEALTH RESOURCES (51%) AND ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (49%), BOTH ORGANIZATIONS ARE EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(C)(3).THE DEVELOPMENT OF TEXAS HEALTH'S CHNA WAS A COLLECTIVE APPROACH THAT INCLUDED TEXAS HEALTH EMPLOYEES, COMMUNITY-SERVING ORGANIZATIONS, AND COMMUNITY MEMBERS FROM WITHIN AREAS OF FOCUS THAT GAVE US INPUT AND KNOWLEDGE OF ISSUES AND SOLUTIONS AND THOSE WHO SHARE OUR COMMITMENT TO IMPROVING HEALTH AND QUALITY OF LIFE. THE 2022 CHNA PLANNING EFFORT PUSHED TEXAS HEALTH BEYOND OUR TRADITIONAL PRIMARY SERVICE AREA TO DIRECTLY IMPACT PRIORITIZED HEALTH NEEDS IN AREAS OF THE COMMUNITY WITH THE GREATEST HEALTH NEEDS. THIS WAS AN INTEGRAL STEP TO ENSURING OUR ABILITY TO UNDERSTAND THE NEEDS OF THE COMMUNITY AND DEVELOP PROGRAMS AND SERVICES THAT WILL POSITIVELY IMPACT THE HEALTH AND WELL-BEING OF THOSE WE SERVE.FOR THE 2022 CHNA PROCESS, TEXAS HEALTH BUILT ON KEY FINDINGS AND ACHIEVEMENTS FROM THE 2019 CHNA PROCESS WHICH INCLUDED OVER 463 ZIP CODES WITHIN THE TEXAS HEALTH PRIMARY AND SECONDARY SERVICE AREAS. TEXAS HEALTH, WITH THE SUPPORT OF FIVE TEXAS HEALTH COMMUNITY IMPACT LEADERSHIP COUNCILS, UTILIZED PRIMARY AND SECONDARY DATA TO NARROW THE GEOGRAPHY DOWN TO 56 PRIORITIZED ZIP CODES. THESE COMMUNITIES WERE EXPERIENCING DISPROPORTIONATE HEALTH OUTCOMES IN THE AREAS OF CHRONIC DISEASE, BEHAVIORAL HEALTH AND AWARENESS, AND HEALTH LITERACY AND NAVIGATION.THE COMMUNITIES' HEALTH NEEDS WERE ASSESSED THROUGH KEY INFORMANT INTERVIEWS, COMMUNITY FOCUS GROUPS, AND LISTENING SESSIONS THAT INCLUDED ONLINE SURVEYS AND VIRTUAL DISCUSSIONS. KEY INFORMANT INTERVIEWS (KIIS) WERE CONDUCTED WITH LEADERS AND STAFF FROM ORGANIZATIONS THAT PROVIDE SERVICES DIRECTLY TO THE COMMUNITY AND OFFICIALS THAT REPRESENT GOVERNMENTAL AND NON-GOVERNMENTAL ENTITIES. INTERVIEWEES INVITED TO PARTICIPATE WERE RECOGNIZED AS HAVING EXPERTISE IN PUBLIC HEALTH, SPECIAL KNOWLEDGE OF COMMUNITY HEALTH NEEDS, REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, AND/OR BEING ABLE TO SPEAK TO THE NEEDS OF MEDICALLY UNDERSERVED OR VULNERABLE POPULATIONS. SPANNING ACROSS ALL REGIONS, THE 41 KIIS TOOK PLACEFROM OCTOBER 2021 THROUGH MARCH 2022 AND FOCUSED ON THE INTERVIEWEE'S BACKGROUND AND ORGANIZATION, THE BIGGEST PERCEIVED HEALTH NEEDS AND BARRIERS OF CONCERN IN THE COMMUNITY, AND THE IMPACT OF HEALTH ISSUES ON THE POPULATIONS THEY SERVE. ORGANIZATIONS PARTICIPATING IN THE KIIS THAT HAD SPECIFIC FAMILIARITY WITH THE NEEDS OF THE PRIMARY SERVICE AREA OF THE HOSPITAL INCLUDED, CLEBURNE FIRE DEPARTMENT, JOHNSON COUNTY FAMILY CRISIS CENTER, NORTH TEXAS BEHAVIORAL HEALTH AUTHORITY, ALZHEIMER'S ASSOCIATION, MANSFIELD MISSION CENTER, SAFEHAVEN OF TARRANT COUNTY, AND THE TEXAS DEPARTMENT OF STATE HEALTH SERVICES. TEXAS HEALTH AND CONDUENT HCI CONDUCTED FOCUS GROUPS TO GAIN DEEPER INSIGHT INTO PERCEPTIONS, ATTITUDES, EXPERIENCES, OR BELIEFS HELD BY COMMUNITY MEMBERS ABOUT THEIR HEALTH. A TOTAL OF 19 VIRTUAL AND IN-PERSON FOCUS GROUPS WERE CONDUCTED FROM NOVEMBER 2021 THROUGH MAY 2022 ACROSS ALL REGIONS. AN ARRAY OF RESIDENTS AND EMPLOYEES FROM THE TARRANT/PARKER AND THE SOUTHERN REGIONS PROVIDED INSIGHTS WHEN FACILITATORS ASKED A SERIES OF NINE QUESTIONS TO PROMPT DISCUSSION ON TOP COMMUNITY HEALTH ISSUES, BARRIERS/CHALLENGES TO HEALTH, AND THE IMPACT OF COVID-19. THE RELATIVE IMPORTANCE OF HEALTH AND/OR SOCIAL NEED WAS DETERMINED, IN PART, BY THE FREQUENCY OF THE TOPIC OR ISSUE DISCUSSED ACROSS ALL THREE FOCUS GROUPS.TEXAS HEALTH AND CONDUENT HCI CONDUCTED AN ONLINE SURVEY WITH KEY COMMUNITY STAKEHOLDERS TO CAPTURE QUANTITATIVE DATA IN RELATION TO TEXAS HEALTH 2019 CHNA AND IMPLEMENTATION PLAN. CONDUENT HCI HOSTED A FOLLOW-UP VIRTUAL DISCUSSION WITH THE STAKEHOLDERS TO CAPTURE QUALITATIVE INSIGHTS AND FEEDBACK. THE MAIN GOAL OF THE LISTENING SESSION WAS TO DETERMINE OPPORTUNITIES TO STRENGTHEN COLLABORATIONS WITHIN THE COMMUNITIES SERVED BY TEXAS HEALTH RESOURCES HEALTH SYSTEM. INVITED COMMUNITY LEADERS WERE FROM THE FOLLOWING SECTORS: EDUCATION, NON-PROFIT, PHILANTHROPY, FOR-PROFIT, AND HEALTHCARE. TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH PART V, SECTION B, LINE 6A: THE PRIMARY SERVICE AREA OF THE HOSPITAL WAS INCLUDED IN TWO REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNAS) IN COOPERATION WITH TEXAS HEALTH RESOURCES AND CONDUENT HEALTH COMMUNITIES INSTITUTE (HCI). THE HOSPITAL FACILITIES INCLUDED IN EACH OF THE REGIONAL CHNAS ARE AS FOLLOWS:SOUTHERN REGION - TEXAS HEALTH CLEBURNE (THC), TEXAS HEALTH STEPHENVILLE (THS), TEXAS HEALTH KAUFMAN (THK), AND TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTHTARRANT/PARKER REGION - TEXAS HEALTH ALLIANCE (THAL), TEXAS HEALTH ARLINGTON MEMORIAL (THAM), TEXAS HEALTH FORT WORTH (THFW), TEXAS HEALTH SPECIALTY HOSPITAL (THSH), TEXAS HEALTH SOUTHWEST FORT WORTH (THSW), TEXAS HEALTH HEB (THHEB), TEXAS HEALTH AZLE (THAZ), AMH CATH LABS (AMHH), TEXAS HEALTH SOUTHLAKE (THSL), USMD AT ARLINGTON (USMD-ARL), USMD AT FORT WORTH (USMD-FW), AND TEXAS HEALTH HOSPITAL MANSFIELD (THHM). TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH 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. TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH PART V, SECTION B, LINE 11: SEE LINE 11 FOOTNOTE BELOW. PART V, SECTION B, LINES 7A: THE CHNA REPORT CAN BE FOUND AT URL:WWW.TEXASHEALTHHUGULEY.ORG/HOSPITAL-AND-EMERGENCY-ROOMS/TEXAS-HEALTH-HUGULEY-HOSPITAL-FORT-WORTH-SOUTH/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS SCH H, PART V, SECTION B, LINE 10A: THE HOSPITALS' MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND AT URL:WWW.TEXASHEALTHHUGULEY.ORG/HOSPITAL-AND-EMERGENCY-ROOMS/TEXAS-HEALTH-HUGULEY-HOSPITAL-FORT-WORTH-SOUTH/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS SCH H, PART V, SECTION B, LINE 11: TEXAS HEALTH HUGULEY INC., D/B/A TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH, WILL BE REFERRED TO IN THIS DOCUMENT AS TEXAS HEALTH HUGULEY OR "THE HOSPITAL".THE HOSPITAL WAS ORGANIZED IN 2012 AS A JOINT VENTURE HOSPITAL BETWEEN TEXAS HEALTH RESOURCES (THR) AND ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), DBA ADVENTHEALTH. THR OWNS 51% OF THE MEMBERSHIP OF THE HOSPITAL WITH ADVENTHEALTH OWNING THE REMAINING 49%. ADVENTHEALTH MANAGES THE DAILY OPERATION OF THE HOSPITAL. AHSSHC IS THE 501(C)(3) PARENT ORGANIZATION OF A HOSPITAL AND HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. THIS IS THE FIRST-YEAR UPDATE FOR THE HOSPITAL'S 2023-2025 COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY. THE HOSPITAL DEVELOPED THIS PLAN AND POSTED IT IN MAY 2023 AS PART OF ITS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. FOR THE DEVELOPMENT OF BOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY, TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH WORKED TO DEFINE AND ADDRESS THE NEEDS OF LOW-INCOME, MINORITY AND UNDERSERVED POPULATIONS IN ITS SERVICE AREA. THE COMMUNITY HEALTH NEEDS ASSESSMENT USED PRIMARY DATA; 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 HEALTH ISSUES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT WERE PRIORITIZED BY COMMUNITY AND HOSPITAL STAKEHOLDERS, WHO THEN SELECTED KEY PRIORITIES FOR THE HOSPITAL TO ADDRESS IN ITS COMMUNITY HEALTH PLAN. THE FIRST-YEAR PROGRESS ON THE COMMUNITY HEALTH PLAN IS NOTED BELOW. THE NARRATIVE DESCRIBES THE PRIORITIES IDENTIFIED IN 2022 AND GIVES AN UPDATE ON THE STRATEGIES ADDRESSING THOSE PRIORITIZED NEEDS. THERE IS ALSO A DESCRIPTION OF THE IDENTIFIED NEEDS THAT THE HOSPITAL DID NOT PRIORITIZE TO ADDRESS. THE HOSPITAL'S CHOSEN PRIORITIES ARE LISTED BELOW:1. MENTAL HEALTH2. FOOD INSECURITY3. HIGH BLOOD PRESSURE4. HEALTHCARE ACCESS AND QUALITY PRIORITY 1: MENTAL HEALTH 2022 DESCRIPTION OF THE PRIORITY: MENTAL ILLNESSES ARE CONDITIONS THAT AFFECT A PERSON'S THINKING, FEELING, MOOD OR BEHAVIOR, SUCH AS DEPRESSION, ANXIETY, BIPOLAR DISORDER, OR SCHIZOPHRENIA. SUCH CONDITIONS MAY BE OCCASIONAL OR LONG-LASTING (CHRONIC) AND AFFECT SOMEONE'S ABILITY TO RELATE TO OTHERS AND FUNCTION EACH DAY. IN TEXAS HEALTH HUGULEY'S AND TEXAS HEALTH HOSPITAL MANSFIELD'S PSA, 21.6% OF ADULTS HAVE DEPRESSION WHICH IS HIGHER THAN BOTH THE STATE (18.4%) AND NATIONAL (19.6%) RATES. ADDITIONALLY, 14.6% OF ADULTS IN THE COMMUNITY INDICATED THEY HAD POOR MENTAL HEALTH. POOR MENTAL HEALTH IS DEFINED AS 14 OR MORE DAYS DURING THE PAST 30 DAYS DURING WHICH MENTAL HEALTH WAS NOT GOOD. 2023 UPDATE: GOAL 1.1: IMPROVE AWARENESS AND SUPPORT AROUND MENTAL ILLNESS AND GRIEF THROUGH EDUCATION. OBJECTIVE 1.1.1: BY DECEMBER 31, 2025, OFFER TRAINING TO PASTORS AND LAY CHAPLAINS IN 20 FAITH ORGANIZATIONS IN THE BASICS OF GRIEF RECOVERY AND MENTAL HEALTH SUPPORT FOR PARISHIONERS AND COMMUNITY MEMBERS. TRAINING TO PASTORS AND LAY CHAPLAINS WAS OFFERED TO THREE FAITH ORGANIZATIONS IN 2023. OBJECTIVE 1.1.2: BY DECEMBER 31, 2025, EDUCATE AND IMPLEMENT THE SPIRITUAL WHOLENESS SCREENING PROGRAM WITH 5 SAFETY-NET ORGANIZATIONS, 10 FAITH ORGANIZATIONS, AND 2 INDEPENDENT SCHOOL DISTRICTS. THE PILOT FOR THE SPIRITUAL WHOLENESS SCREENING PROGRAM IS UP AND RUNNING WITH HARVEST HOUSE. HARVEST HOUSE EXISTS TO FEED, CLOTHE, AND RESTORE BY PROVIDING BASIC NECESSITIES, SPIRITUAL ENCOURAGEMENT, EDUCATION, AND CARE TO INDIVIDUALS AND FAMILIES IN OUR COMMUNITY BY FOLLOWING BIBLICAL PRINCIPLES. THEIR GOAL IS TO HELP FAMILIES BREAK THE CYCLE OF HOPELESSNESS BY PROVIDING RESOURCES THAT ASSIST IN RESTORING THEIR DIGNITY AND INDEPENDENCE. OBJECTIVE 1.1.3: BY DECEMBER 31, 2025, OFFER MENTAL HEALTH FIRST AID TRAINING FOR 5 SAFETY-NET ORGANIZATIONS, 10 FAITH ORGANIZATIONS, AND 2 INDEPENDENT SCHOOL DISTRICTS. ONE TRAINING TOOK PLACE IN DECEMBER 2023 WITH HARVEST HOUSE AND AREA CHURCH MEMBERS. PRIORITY 2: FOOD INSECURITY 2022 DESCRIPTION OF THE PRIORITY: FOOD INSECURITY IS A LACK OF CONSISTENT ACCESS TO AFFORDABLE AND NUTRITIOUS FOOD FOR EVERY PERSON IN A HOUSEHOLD TO LIVE AN ACTIVE, HEALTHY LIFE. PEOPLE WHO ARE FOOD INSECURE MAY BE AT AN INCREASED RISK OF NEGATIVE HEALTH OUTCOMES. AS OF 2020, 13.9% OF RESIDENTS IN THE COMMUNITY HAVE EXPERIENCED FOOD INSECURITY WHICH IS HIGHER THAN THE STATE (13%) AND NATIONAL (11.5%) RATES. 2023 UPDATE: GOAL 2.1: INCREASE ACCESS AND QUANTITY OF AVAILABLE FOOD WITH AN EMPHASIS ON MAKING HEALTHY FOOD AVAILABLE. OBJECTIVE 2.1.1: BY DECEMBER 31, 2025, FACILITATE THE CREATION OF A ONE-FOURTH ACRE COMMUNITY GARDEN. THE COMMUNITY GARDEN PROJECT IS UP AND RUNNING. INSTEAD OF CREATING A ONE-FOURTH ACRE SITE, WE PIVOTED TO CREATE 10 RAISED BED STYLE GARDENS. BETWEEN SEPTEMBER AND NOVEMBER OF 2023, 75LBS OF PRODUCE WAS HARVESTED. OBJECTIVE 2.1.2: BY DECEMBER 31, 2025, INCREASE ANNUAL FOOD PANTRY DISTRIBUTION AT GRACE TEMPLE CHURCH IN FORT WORTH TO 2,640 BAGS. NO PROGRESS HAS BEEN MADE ON THIS INITIATIVE. PRIORITY 3: HIGH BLOOD PRESSURE 2022 DESCRIPTION OF THE PRIORITY: HIGH BLOOD PRESSURE, OR HYPERTENSION, IS WHEN THE FORCE OF THE BLOOD PUSHING AGAINST THE WALLS OF YOUR BLOOD VESSELS IS CONSISTENTLY TOO HIGH. THE HIGHER YOUR BLOOD PRESSURE LEVELS, THE MORE RISK YOU HAVE FOR OTHER HEALTH PROBLEMS, SUCH AS HEART DISEASE, HEART ATTACK, AND STROKE. IN 2019 31.6% OF ADULTS HAD HIGH BLOOD PRESSURE WHICH IS SLIGHTLY LOWER THAN THE 2017 RATE OF 33% OF ADULTS. GOAL 3.1: IMPROVE AWARENESS ABOUT HIGH BLOOD PRESSURE THROUGH COMMUNITY EDUCATION. OBJECTIVE 3.1.1: BY DECEMBER 31, 2025, FACILITATE DIETARY APPROACHES TO STOP HYPERTENSION (DASH) DIET WORKSHOPS FOR 180 COMMUNITY MEMBERS. THE HOSPITAL PROVIDED DIABETES AND NUTRITION EDUCATION TO 72 COMMUNITY MEMBERS TO INCLUDE COOKING DEMONSTRATION, FREE HEALTHY LUNCH, EXERCISE COACHING, AND BLOOD PRESSURE SCREENING. *** SEE CONTINUATION OF PART V, SECTION B, LINE 11 SCH H, PART V, SECTION B, LINE 11 CONTINUATION PRIORITY 4: HEALTHCARE ACCESS AND QUALITY 2022 DESCRIPTION OF THE PRIORITY: MANY PEOPLE FACE BARRIERS THAT PREVENT OR LIMIT ACCESS TO NEEDED HEALTH CARE SERVICES, WHICH MAY INCREASE THE RISK OF POOR HEALTH OUTCOMES AND HEALTH DISPARITIES. INADEQUATE HEALTH INSURANCE COVERAGE IS ONE OF THE LARGEST BARRIERS TO HEALTH CARE ACCESS, AND THE UNEQUAL DISTRIBUTION OF COVERAGE CONTRIBUTES TO DISPARITIES IN HEALTH. THE PSA HAS A HIGHER PERCENTAGE OF RESIDENTS WITHOUT HEALTH INSURANCE (15%) COMPARED TO THE UNITED STATES (8.7%). LACK OF TRANSPORTATION IS ANOTHER BARRIER IMPACTING ACCESS AND CAN LEAD TO MISSED OR DELAYED HEALTH CARE APPOINTMENTS AND OVERALL POORER HEALTH OUTCOMES. ACCESS TO A PRIMARY CARE PROVIDER OR HAVING AN ESTABLISHED MEDICAL HOME IS ONE WAY TO IMPROVE HEALTH OUTCOMES BECAUSE PEOPLE CAN SEE THE SAME PROVIDER WHO IS FAMILIAR WITH THEIR MEDICAL HISTORY AND CAN MONITOR THEIR PERSONAL HEALTH OVER YEARS. 2023 UPDATE: GOAL 4.1: PROVIDE ACCESS TO BASIC HEALTHCARE SERVICES. OBJECTIVE 4.1.1: BY DECEMBER 31, 2025, THE TEXAS HEALTH MOBILE HEALTH BUS WILL CONTINUE PROVIDING PRIMARY HEALTHCARE SERVICES TO INDIVIDUALS LIVING IN UNDER-SERVED COMMUNITIES AT 8 LOCATIONS (11 UNIQUE CLINIC DAYS) EACH MONTH IN OUR PRIMARY SERVICE AREA. THE MOBILE HEALTH BUS SERVED ALL 8 LOCATIONS IN 2023 AND INCURRED 653 PATIENT ENCOUNTERS. OBJECTIVE 4.1.2: BY DECEMBER 31, 2025, THE CARE CLINIC (HOSPITAL-RUN PRIMARY CARE CLINIC) WILL CONTINUE PROVIDING 1,200 PRIMARY HEALTHCARE SERVICES TO UNINSURED INDIVIDUALS DISCHARGED FROM TEXAS HEALTH HUGULEY WITHOUT A MEDICAL HOME. THE CARE CLINIC OPERATES TWO DAYS PER WEEK AND INCURRED 1,012 PATIENT ENCOUNTERS. PRIORITIES NOT ADDRESSED BY THE HOSPITAL:THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED MULTIPLE HEALTH NEEDS THROUGH THE COLLECTION OF PRIMARY AND SECONDARY DATA. AFTER REVIEWING THE DATA, THE HOSPITAL AND COMMUNITY STAKEHOLDERS CONDUCTED A PRIORITIZATION PROCESS. LISTED BELOW ARE THE PRIORITIES NOT ADDRESSED AND THE REASON WHY THEY WERE NOT SELECTED TO BE ADDRESSED. 1. HOUSING: THE HOSPITALS DID NOT PERCEIVE THE ABILITY TO HAVE A MEASURABLE IMPACT ON THIS ISSUE WITHIN THE THREE YEARS ALLOTTED FOR THE COMMUNITY HEALTH PLAN WITH THE CURRENT RESOURCES AVAILABLE TO THE HOSPITAL AT THIS TIME. 2. EMPLOYMENT: THE HOSPITALS DID NOT PERCEIVE THE ABILITY TO HAVE A MEASURABLE IMPACT ON THIS ISSUE WITHIN THE THREE YEARS ALLOTTED FOR THE COMMUNITY HEALTH PLAN WITH THE CURRENT RESOURCES AVAILABLE TO THE HOSPITAL AT THIS TIME. PART V, SECTION B, LINE 16A, 16B, AND 16C: 16A. FAP WEBSITE:WWW.TEXASHEALTHHUGULEY.ORG/HOSPITAL-AND-EMERGENCY-ROOMS/TEXAS-HEALTH-HUGULEY-HOSPITAL-FORT-WORTH-SOUTH/BILLING-AND-FINANCIAL-SERVICES 16B. FAP APPLICATION WEBSITE:WWW.TEXASHEALTHHUGULEY.ORG/HOSPITAL-AND-EMERGENCY-ROOMS/TEXAS-HEALTH-HUGULEY-HOSPITAL-FORT-WORTH-SOUTH/BILLING-AND-FINANCIAL-SERVICES 16C. PLAIN LANGUAGE SUMMARY OF FAP WEBSITE:WWW.TEXASHEALTHHUGULEY.ORG/HOSPITAL-AND-EMERGENCY-ROOMS/TEXAS-HEALTH-HUGULEY-HOSPITAL-FORT-WORTH-SOUTH/BILLING-AND-FINANCIAL-SERVICES 4 1 - TEXAS HEALTH HUGULEY IMAGING CENTER 12001 S FREEWAY SUITE 100 BURLESON TX 76028 OUTPATIENT IMAGING 2 - OUTPATIENT REHABILITATION 215 OLD HIGHWAY 1187 BURLESON TX 76028 OUTPATIENT REHAB THERAPY 3 - CENTER FOR WOUND CARE & HYPERBARIC MED 12001 S FREEWAY SUITE 301 BURLESON TX 76028 OUTPATIENT WOUND CARE 4 - OUTPATIENT MRI 215 OLD HIGHWAY 1187 BURLESON TX 76028 OUTPATIENT MRI 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 PARTIALLY 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 33 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS AND A NUMBER OF OTHER HEALTH CARE FACILITIES THAT OPERATED IN 12 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. ADDITIONALLY, THE FILING ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY CAN BE ACCESSED ON THE FILING ORGANIZATION'S WEBSITE. 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 ONE OR MORE 24/7 EMERGENCY ROOM(S) 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 THROUGH 10. 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 THAN 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. SUPPLEMENTAL SCHEDULE TO SCHEDULE H, PART III, SECTION B, LINE 8 RECONCILIATION OF SCHEDULE H REPORTED MEDICARE SURPLUS/(SHORTFALL) TO UNREIMBURSED MEDICARE COSTS ASSOCIATED WITH THE PROVISION OF SERVICESTO ALL MEDICARE BENEFICIARIES:THE MEDICARE REVENUE AND ALLOWABLE COSTS OF CARE REPORTED IN SECTION B OF PART III OF SCHEDULE H ARE BASED UPON THE AMOUNTS REPORTED IN THE FILING ORGANIZATION'S MEDICARE COST REPORT IN ACCORDANCE WITH THE IRS INSTRUCTIONS FOR SCHEDULE H. ON AN ANNUAL BASIS, THE FILING ORGANIZATION ALSO DETERMINES ITS TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS. UNREIMBURSED COSTS ARE CONSIDERED A COMMUNITY BENEFIT TO THE ELDERLY AND ARE COMBINED INTO AN ANNUAL COMMUNITY BENEFIT STATEMENT PREPARED BY ADVENTHEALTH.THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO MEDICARE PATIENTS AS REPORTED IN THE AHS COMMUNITY BENEFIT REPORT ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ (1,308,078)- DIFFERENCE IN COSTING METHODOLOGY: (1,601,247)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (21,069,530) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITY BENEFIT REPORTING: $(23,978,855) AS INDICATED ABOVE, THE PRIMARY DIFFERENCES BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) REPORTED ON SCHEDULE H, PART III, SECTION B, LINE 7 AND THE FILING ORGANIZATION'S PORTION OF THE COMPANY'S ANNUAL COMMUNITY BENEFIT STATEMENT IS DUE TO A DIFFERENCE IN THE COSTING METHODOLOGY AND DIFFERENCES IN THE POPULATION OF MEDICARE PATIENTS WITHIN THE CALCULATION. THE COST METHODOLOGY UTILIZED IN CALCULATING ANY MEDICARE SURPLUS/(SHORTFALL) FOR PURPOSES OF THE ANNUAL COMMUNITY BENEFIT REPORTING IS BASED UPON THE COST-TO-CHARGE RATIO OUTLINED IN WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE SAME COST-TO-CHARGE RATIO IS USED TO DETERMINE THE COSTS ASSOCIATED WITH SERVICES PROVIDED TO CHARITY CARE PATIENTS AND MEDICAID PATIENTS AS REPORTED IN SCHEDULE H, PART I, LINE 7. IN ADDITION, THE MEDICARE COST REPORT EXCLUDES SERVICES PROVIDED TO MEDICARE PATIENTS FOR PHYSICIAN SERVICES, SERVICES PROVIDED TO PATIENTS ENROLLED IN MEDICARE HMOS, AND CERTAIN SERVICES PROVIDED BY OUTPATIENT DEPARTMENTS OF THE FILING ORGANIZATION THAT ARE REIMBURSED ON A FEE SCHEDULE. THE COMPANY'S OWN COMMUNITY BENEFIT STATEMENT CAPTURES THE UNREIMBURSED COST OF PROVIDING SERVICES TO ALL MEDICARE BENEFICIARIES THROUGHOUT THE ORGANIZATION. PART VI, LINE 2: THE HOSPITAL CONDUCTS 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: THE FILING ORGANIZATION CURRENTLY OPERATES TEXAS HEALTH HUGULEY (THH) A 327-BED ACUTE-CARE HOSPITAL IN BURLESON, TEXAS. BURLESON, TEXAS IS LOCATED IN JOHNSON COUNTY. THH SERVES THE SOUTH FORT WORTH AREA. THE HOSPITAL INCLUDES A MEDICAL INTENSIVE CARE UNIT, A CARDIOVASCULAR CRITICAL CARE UNIT, A PROGRESSIVE CARE UNIT, OPEN HEART SURGERY CENTER AND BEHAVIORAL HEALTH. THH ALSO HAS AN ACCREDITED BONE AND JOINT PROGRAM, DIABETES CENTER, AN ACCREDITED CHEST PAIN CENTER, AND AN AWARD WINNING EMERGENCY DEPARTMENT AVAILABLE 24 HOURS A DAY, SEVEN DAYS A WEEK. MORE THAN 350 PRIMARY CARE AND SPECIALTY PHYSICIANS PROVIDE A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES. PART OF THH'S PRIMARY SERVICE AREA INCLUDES A NUMBER OF SMALLER COMMUNITIES WITH LIMITED ACCESS TO HEALTHCARE SERVICES. TO MEET THE NEEDS OF THESE RESIDENTS, THH HAS A SUBSIDIARY THAT OPERATES MULTIPLE PRIMARY CARE CLINICS THROUGHOUT ITS PRIMARY SERVICE AREA. IN ADDITION, THE MOBILE HEALTH SERVICES BUS PROVIDES HEALTH SCREENINGS AND WELLNESS EDUCATION SERVICES THROUGHOUT TARRANT AND JOHNSON COUNTIES. DURING 2023, 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 2023, ABOUT 81.3% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. - MEDICARE PATIENTS 49.0% - MEDICAID PATIENTS 11.0% - SELF-PAY PATIENTS 9.4% THE DEMOGRAPHIC MAKEUP OF THE HOSPITAL'S COMMUNITY IS AS FOLLOWS: - POPULATION (APPROXIMATELY) 579,705 - POPULATION OVER 65 (APPROXIMATELY) 11.8% - POVERTY (BELOW 100% FPL) 9.3% - HIGH SCHOOL GRADUATION RATE 88.3% - UNINSURED ADULTS 15.3% - FOOD INSECURITY RATE 13.9% - POP. WITH LOW FOOD ACCESS 64.6% PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO TEXAS HEALTH HUGULEY'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE FILING ORGANIZATION IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE FIING ORGANIZATION'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE FILING ORGANIZATION 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 FILING ORGANIZATION PROVIDED $616,065 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY. THE FILING ORGANIZATION 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 FILING ORGANIZATION EXPENDED $50,800,158 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE FILING ORGANIZATION 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: AS EXPLAINED IN OUR RESPONSE TO FORM 990, PART VI, SECTION A, LINE 6, TEXAS HEALTH HUGULEY, INC. (THH OR THE HOSPITAL) HAS TWO MEMBERS. THE MEMBERS ARE TEXAS HEALTH RESOURCES AND ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI). AHSSI IS A WHOLLY-OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION. THH IS ABLE TO DRAW UPON THE EXPERTISE AND LEADERSHIP OF BOTH ITS HEALTH SYSTEM MEMBERS IN ITS EFFORT TO CREATE EXCELLENT PATIENT EXPERIENCES AND OFFER A BROAD SPECTRUM OF HEALTH SERVICES NEEDED IN ITS COMMUNITY.DURING ITS CURRENT TAX YEAR, THH WAS MANAGED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 50 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 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. THE FILING ORGANIZATION PAYS A MANAGEMENT FEE TO AHSSHC FOR THE SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY THE FILING 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 WEBSITE OF ADVENTHEALTH AT WWW.ADVENTHEALTH.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF THE FILING ORGANIZATION. PART VI, LINE 7, REPORTS FILED WITH STATES TX 1 BURLESON AREA CHAMBER OF COMMERCE 124 S MAIN STREET SUITE 226 BURLESON TX 76028 751228140 501(C)(6) 18900 0 GENERAL SUPPORT BURLESON INDEPENDENT SCHOOL DISTRICT 1160 SW WILSHIRE BOULEVARD BURLESON TX 76028 756000295 GOV'T 12000 0 GENERAL SUPPORT BURLESON HIGHER EDUCATION OPPORTUNITY FUND PO BOX 3097 BURLESON TX 76097 262998116 501(C)(3) 9000 0 GENERAL SUPPORT CITY OF BURLESON 141 RENFRO STREET BURLESON TX 76028 756000475 GOV'T 10000 0 GENERAL SUPPORT MEALS ON WHEELS CENTRAL TEXAS INC 106 E KILPATRICK STREET CLEBURNE TX 76031 751555153 501(C)(3) 5300 0 GENERAL SUPPORT SOUTHWESTERN ADVENTIST UNIVERSITY 100 W HILLCREST STREET KEENE TX 76059 750891465 501(C)(3) 28000 0 GENERAL SUPPORT 5 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 KING JAMES KIRK DIRECTOR/VICE CHAIRMAN 0 744380 0 379709 0 147858 0 316307 0 52941 0 1641195 0 182417 JOHNSON PENNY CEO 361994 231676 115147 73694 219634 140566 68905 44099 20498 13118 786178 503153 56582 36212 PAPST AMY DIRECTOR (BEG 01/23) 0 453036 0 87844 0 59463 0 85407 0 54291 0 740041 0 14234 CRAFT BRIAN DIRECTOR 0 375500 0 133572 0 51892 0 77594 0 50785 0 689343 0 59425 JACKSON DAVID DIRECTOR 0 348305 0 117613 0 49190 0 125200 0 40677 0 680985 0 53142 FORD MD RONNY CMO 270571 115959 53702 23015 14953 6409 54389 23309 25581 10963 419196 179655 0 0 LLOYD MD DAVID DIRECTOR (END 01/23) 0 324633 0 92833 0 57874 0 57231 0 52799 0 585370 0 36753 SUTTON JESSE CFO 209486 125692 50822 30493 34776 20865 31288 18773 13512 8107 339884 203930 21762 13057 PAI AJITH DIRECTOR 0 291160 0 86666 0 43665 0 70990 0 50531 0 543012 0 35776 ROSE KENNETH FORMER COO 0 316359 0 77162 0 20598 0 65293 0 35211 0 514623 0 0 LEMON SEAN COO 196625 65542 37388 12463 13016 4339 12837 4279 21285 7095 281151 93718 0 0 ELLIS TAMMY CNO 180799 60266 36772 12257 10644 3548 10636 3545 11357 3786 250208 83402 0 0 PART I, LINE 1A AS DISCLOSED IN OUR RESPONSE TO FORM 990, PART VI, SECTION A, LINE 3, INDIVIDUALS WHO SERVE AS OFFICERS OF THE FILING ORGANIZATION IN THE ROLES OF CEO, CFO, COO, CMO, AND CNO 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 50 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 (15 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 45-55 INDIVIDUAL EXECUTIVES). A REGIONAL CEO FOR ADVENTHEALTH IS A MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION. THE REGIONAL CEO IS CONSIDERED A COMMON LAW EMPLOYEE OF AND IS 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. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES BUSINESS DEVELOPMENT EXPENDITURES. UNDER THIS POLICY, TO ENCOURAGE EXECUTIVES TO ESTABLISH AND CULTIVATE STRONG WORKING RELATIONSHIPS WITH THE MEDICAL COMMUNITY AND OTHER LEADERS IN THE COMMUNITY AND INDUSTRY, CERTAIN ADVENTHEALTH EXECUTIVES MAY BE REIMBURSED FOR MEMBER DUES AND USAGE CHARGES FOR A COUNTRY CLUB OR OTHER SOCIAL CLUB UPON AUTHORIZATION. CLUB MEMBERSHIPS MUST BE APPROVED BY THE ADVENTHEALTH PRESIDENT/CEO INITIALLY AS WELL AS ON AN ANNUAL BASIS. EACH ADVENTHEALTH EXECUTIVE WHO IS APPROVED FOR A CLUB MEMBERSHIP MUST SUBMIT AN ANNUAL REPORT DESCRIBING HOW THEY USED THE MEMBERSHIP TO BENEFIT THEIR ORGANIZATION DURING THE PRECEDING YEAR SO THAT THE ADVENTHEALTH PRESIDENT/CEO CAN MAKE A DETERMINATION IF CONTINUANCE OF THE CLUB MEMBERSHIP FURTHERS THE BUSINESS INTERESTS OF ADVENTHEALTH. IN THE CURRENT YEAR, FOR THIS FILING ORGANIZATION, ONE EXECUTIVE LISTED IN PART VII RECEIVED REIMBURSEMENT FOR CLUB FEES. WHILE THE CLUB DUES MEMBERSHIP IS AN AHSSHC COMPENSATION POLICY AND PRACTICE, THE COST OF PROVIDING THIS BENEFIT IS ALLOCATED TO AND REIMBURSED IN WHOLE OR IN PART BY THE FILING ORGANIZATION. ACCORDINGLY, THE FILING ORGANIZATION HAS CHECKED THE BOX IN SCHEDULE J, PART I, LINE 1A FOR HEALTH OR SOCIAL CLUB DUES SINCE IT HAS WHOLLY OR PARTIALLY PAID FOR THE COST OF PROVIDING THIS BENEFIT. PART I, LINE 3 THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), AN UNRELATED ENTITY AS DISCLOSED IN OUR RESPONSE TO FORM 990, PART VI, SECTION A, LINE 3, FOR THAT INDIVIDUAL'S ROLE IN SERVING AS THE CEO PURSUANT TO THE MANAGEMENT SERVICES AGREEMENT BETWEEN THE FILING ORGANIZATION AND 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 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 NONQUALIFIED RETIREMENT PLAN - TEXAS HEALTH RESOURCES: CERTAIN OF THE BOARD MEMBERS ARE COMPENSATED BY TEXAS HEALTH RESOURCES (THR), A RELATED ENTITY TO THE FILING ORGANIZATION, AND ARE COVERED BY A NONQUALIFIED RETIREMENT PLAN. PARTICIPATION IN THE PLAN IS MADE AVAILABLE TO A SELECT GROUP OF MANAGEMENT AND HIGHLY COMPENSATED EMPLOYEES WHO ARE PROVIDING SERVICES IN KEY POSITIONS OF MANAGEMENT AND/OR RESPONSIBILITY AND WHO ARE DETERMINED BY THE THR BOARD OF TRUSTEES. FOR THE ACTIVE RESTORATION ACCOUNT (ACCOUNT BALANCES AFTER 12/31/2009), SERP BENEFITS VEST WHILE THE PARTICIPANT IS EMPLOYED IF THE PARTICIPANT: * REACHES AGE 65, * BECOMES DISABLED OR DIES, * REACHES THE FOLLOWING YEARS OF SERVICE: 2 YEARS - 25%; 3 YEARS -50%; 4 YEARS - 75%; AND 5 OR MORE - 100%. PARTICIPANTS MUST BE EMPLOYED ON DECEMBER 1 TO QUALIFY FOR THE CURRENT YEAR'S SERP BENEFIT UNLESS SEPARATION IS DUE TO DEATH, DISABILITY, RETIREMENT (AGE 65) OR EARLY RETIREMENT (SEPARATION FROM SERVICE AT OR AFTER AGE 55 WITH 75 YEARS OF COMBINED AGE AND CONTINUOUS SERVICE WITH THE SYSTEM). SERP BENEFITS ARE CALCULATED EACH DECEMBER 1. VESTED BALANCES ARE TAXED TO THE EMPLOYEE AND THE NET BALANCES BEGIN ACCRUING EARNINGS. VESTED BALANCES ARE PAID IN A CASH LUMP SUM WITHIN A 90-DAY PERIOD COMMENCING ON THE EARLIER OF DEATH, DISABILITY, OR SEPARATION FROM SERVICE. THE DEFERRED PORTION IS INCLUDED IN SCHEDULE J, PART II, COLUMN C. IN FROZEN RESTORATION ACCOUNTS (ACCOUNT BALANCES PRIOR TO 1/1/2010), THE PARTICIPANT OR BENEFICIARY SHALL BE TAXED ON HIS OR HER VESTED SERP BENEFITS UPON THE EARLIEST OF: * CONTINUED EMPLOYMENT IN THR UNTIL AGE 68 * TERMINATION OF EMPLOYMENT FOR DISABILITY OR DEATH * INVOLUNTARY TERMINATION OF EMPLOYMENT WITHOUT REASONABLE CAUSE; OR * SATISFYING A 24 MONTH NON-COMPETE PERIOD FOLLOWING HIS/HER TERMINATION OF EMPLOYMENT. PAYMENT FOLLOWS THE BEFORE MENTIONED EVENTS, EXCEPT IN THE CASE OF INVOLUNTARY SEPARATIONS FOR WHICH THE PARTICIPANT MUST WAIT 24 MONTHS TO RECEIVE THE PREVIOUSLY TAXED BENEFIT. THE LONG TERM INCENTIVE PLAN COVERS 2, 3 OR 4 YEARS. PAYOUTS ARE MADE OVER 2, 3, OR 4 YEARS AFTER KEY PERFORMANCE GOALS ARE MET. BENEFITS VEST IF THEY ARE EMPLOYED AT THE END OF THE YEAR THE PAYOUT IS MADE. PAYMENTS CAN ALSO BE MADE IF SEPARATION IS DUE TO DEATH, DISABILITY, RETIREMENT (AGE 65) OR EARLY RETIREMENT (SEPARATION FROM SERVICE AT OR AFTER AGE 55 WITH 75 YEARS OF COMBINED AGE AND SERVICE WITH THE SYSTEM.) IN THE CASE OF RETIREMENT AND EARLY RETIREMENT, CEO APPROVAL MUST BE OBTAINED AND A NON-COMPETE MUST BE SATISFIED PRIOR TO THE END OF YEAR PAYOUT. A RETENTION AGREEMENT MAY BE OFFERED TO AN EXECUTIVE IN A KEY POSITION OR BASED ON SUCCESSION PLANNING NEEDS OF THE SYSTEM. THE LENGTH OF THE RETENTION PERIOD WILL BE DEPENDENT UPON THE NEEDS OF THE ORGANIZATION TO RETAIN THE KEY EXECUTIVE. PAYMENTS ARE MADE WITHIN 2.50 MONTHS FOLLOWING THE END OF THE RETENTION PERIOD. PAYOUTS TO THE FOLLOWING EMPLOYEES WERE MADE DURING THE YEAR FOR ALL THE PLANS LISTED ABOVE. THE AMOUNTS BELOW ARE INCLUDED IN THE AMOUNT REPORTED ON SCH J, PART II, COLUMN B(III) AND COLUMN (F). KING, JAMES K. 182,417 PAPST, AMY 23,117 CRAFT, BRIAN 59,425 JACKSON, DAVID 53,142 LLOYD, DAVID 36,753 PAI, AJITH 35,776 NONQUALIFIED RETIREMENT PLAN - ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION PENNY JOHNSON, JESSE SUTTON, RONNY FORD, MD, SEAN LEMON, AND TAMMY ELLIS RECEIVED COMPENSATION FROM ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE TOP-TIER PARENT OF THE THE 49% OWNER OF THE FILING ORGANIZATION AND 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 2023. 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 $330,000 IN 2023 (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. PART I, LINE 4B CONT'D: 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 CONTR. DISTR.* CONTR./DISTR. CONTR. JOHNSON,PENNY $ 98,467 $ 85,565 $ 245,198 $ 0 SUTTON,JESSE $ 35,878 $ 35,371 $ 0 $ 0 FORD MD,RONNY $ 0 $ 0 $ 0 $ 59,971 ROSE,KENNETH $ 0 $ 0 $ 0 $ 47,599 * INCLUDING INVESTMENT EARNINGS FORM 990, PART VII, SECTION A, LINE 5: PENNY JOHNSON, CEO, JESSE SUTTON, CFO, SEAN LEMON, COO, RONNY FORD, MD, CMO, AND TAMMY ELLIS, CNO, WERE COMPENSATED BY AHSSHC IN 2023 FOR SERVICES PROVIDED TO THE FILING ORGANIZATION. PLEASE SEE OUR RESPONSE TO FORM 990, PART VI, SECTION A, LINE 3 FOR A DISCUSSION CONCERNING THE FILING ORGANIZATIONS AFFILIATION WITH AHSSHC. COMPENSATION FOR PENNY JOHNSON, JESSE SUTTON, SEAN LEMON, RONNY FORD, MD, AND TAMMY ELLIS IS DISCLOSED IN SCHEDULE J, PART II. COMPENSATION FOR PENNY JOHNSON, JESSE SUTTON, AND TAMMY ELLIS REFLECTS COMPENSATION FOR SERVICES PROVIDED TO THE FILING ORGANIZATION AND RELATED ENTITIES. THESE EXECUTIVES ALSO PROVIDE SERVICES TO AHHSSHC AFFILIATES, WHICH ARE UNRELATED, AND ARE NOT REFLECTED IN THIS RETURN. PART V, LINE 1A: EFFECTIVE JANUARY 1, 2012, TEXAS HEALTH HUGULEY, INC. (THE FILING ORGANIZATION) ENTERED INTO A MANAGEMENT SERVICES AGREEMENT WITH ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). A 501(C)(3) SUBSIDIARY HOSPITAL ORGANIZATION OF AHSSHC, ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI), OWNS A 49% MEMBER INTEREST IN THE FILING ORGANIZATION. 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 1A THE MEMBERS OF THE BOARD OF DIRECTORS LISTED ON PART VII OF THIS FORM 990 INCLUDE THE FILING ORGANIZATION'S GOVERNING BOARD AND THE MEMBERS OF THE FILING ORGANIZATION'S HOSPITAL BOARD. THE HOSPITAL BOARD IS PRIMARILY RESPONSIBLE FOR MATTERS OF THE HOSPITAL INVOLVING THE OVERSIGHT OF MEDICAL STAFF (INCLUDING THE REVIEW AND APPROVAL OF MEDICAL STAFF BYLAWS, AND APPROVAL OF APPOINTMENTS TO AND DISMISSALS FROM THE MEDICAL STAFF), CARE OF PATIENTS, IMPROVEMENTS TO LAND, BUILDINGS AND EQUIPMENT, QUALITY ASSESSMENT AND IMPROVEMENT PROGRAMS IMPLEMENTED AT THE HOSPITAL AND RISK MANAGEMENT FUNCTIONS. FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE JANUARY 1, 2012, TEXAS HEALTH HUGULEY, INC. (THE FILING ORGANIZATION) ENTERED INTO A MANAGEMENT SERVICES AGREEMENT WITH ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). DURING THE CURRENT YEAR, AHSSHC SERVED AS A PARENT ORGANIZATION TO 33 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS AND A NUMBER OF OTHER HEALTH CARE FACILITIES THAT OPERATED IN 12 STATES WITHIN THE U.S. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). A 501(C)(3) SUBSIDIARY HOSPITAL ORGANIZATION OF AHSSHC, ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI), OWNS A 49% MEMBER INTEREST IN THE FILING ORGANIZATION. UNDER THE MANAGEMENT SERVICES AGREEMENT (THE AGREEMENT), AHSSHC MUST FOLLOW THE POLICIES OF THE FILING ORGANIZATION'S BOARD OF DIRECTORS. MANAGERIAL SERVICES PROVIDED BY AHSSHC INCLUDED OVERSIGHT AND DAY TO DAY MANAGEMENT OF THE FILING ORGANIZATION'S HOSPITAL, INCLUDING THE FOLLOWING FUNCTIONS: PERSONNEL ADMINISTRATION, INCLUDING RECRUITMENT, HIRING, TRAINING, PROMOTING, DIRECTING AND TERMINATING PERSONNEL; PROCUREMENT, INCLUDING THE ACQUISITION OF FOOD AND BEVERAGE ITEMS, SUPPLIES, DEVICES, FURNITURE, AND MEDICAL EQUIPMENT; HEALTH INFORMATION MANAGEMENT; MAINTENANCE AND SECURITY; CONTRACTING FOR SERVICES AND CONSULTING SERVICES; FINANCIAL ACCOUNTING SYSTEMS; DEVELOPMENT OF OPERATIONAL AND CAPITAL BUDGETS; BILLING AND COLLECTION OF RECEIVABLES AND REMITTANCES OF PAYABLES; PATIENT SAFETY AND QUALITY SYSTEMS; MARKETING; REGULATORY COMPLIANCE; ADMINISTRATION - POLICIES AND PROCEDURES, INCLUDING APPOINTMENT OF THE CFO, COO, AND CNO. THE INDIVIDUALS WHO SERVE AS OFFICERS OF THE FILING ORGANIZATION IN THE ROLES OF CEO, CFO, COO, CMO, AND CNO ARE LISTED IN PART VII, SECTION A. THESE INDIVIDUALS WERE COMPENSATED BY AND ON THE PAYROLL OF AHSSHC FOR SERVICES RENDERED TO THE FILING ORGANIZATION. THEIR COMPENSATION HAS BEEN REPORTED ON PART VII AND SCHEDULE J IN ACCORDANCE WITH THE INSTRUCTIONS FOR PART VII, SECTION A, LINE 5. FORM 990, PART VI, SECTION A, LINE 6 THE ARTICLES OF INCORPORATION OF THE FILING ORGANIZATION PROVIDE THAT 51% OF THE MEMBERSHIP IN THE FILING ORGANIZATION SHALL BE HELD BY TEXAS HEALTH RESOURCES, THE SOLE CLASS A MEMBER, AND 49% OF THE MEMBERSHIP IN THE FILING ORGANIZATION SHALL BE HELD BY ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI), THE SOLE CLASS B MEMBER. BOTH AHSSI AND THR ARE EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN THH. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE BOARD OF DIRECTORS (GOVERNING BOARD) OF THE FILING ORGANIZATION ARE APPOINTED BY THR (MAJORITY MEMBER) AND AHSSI (MINORITY MEMBER). THE MAJORITY MEMBER IS ENTITLED TO ELECT THREE DIRECTORS TO THE BOARD OF THE FILING ORGANIZATION AND THE MINORITY MEMBER IS ENTITLED TO ELECT TWO DIRECTORS TO THE BOARD. IN ADDITION, THE MEMBERSHIP SHALL APPOINT FOR THE HOSPITAL A COMMUNITY HOSPITAL BOARD TO OVERSEE THE OPERATIONS OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN GOVERNANCE POWERS ARE RESERVED TO THE MEMBERS OF THE FILING ORGANIZATION. THE GOVERNING DOCUMENTS OF THE FILING ORGANIZATION DESCRIBE THOSE MATTERS REQUIRING ONLY AN AFFIRMITIVE VOTE OF THE CLASS A MEMBER (THR), THOSE MATTERS REQUIRING ONLY AN AFFIRMATIVE VOTE OF THE CLASS B MEMBER (AHSSI) AND THOSE MATTERS REQUIRING A SUPERMAJORITY VOTE OF THE MEMBERS. A SUPERMAJORITY VOTE REQUIRES AN AFFIRMATIVE VOTE OF NOT LESS THAN 52% OF THE OUTSTANDING MEMBERSHIP INTERESTS. THE RESERVED POWERS REQUIRING AN AFFIRMATIVE VOTE OF ONLY THE CLASS A MEMBER, THR, INCLUDE THE FOLLOWING: 1) TO APPROVE OR AMEND MANAGED CARE CONTRACTS TO WHICH THE FILING ORGANIZATION IS A PARTICIPATING PROVIDER; 2) TO APPROVE THE STRATEGIC PLANS OF THE FILING ORGANIZATION; 3) TO APPROVE THE ANNUAL OPERATING PLANS AND OPERATING AND CAPITAL BUDGET OF THE FILING ORGANIZATION; AND 4) TO APPROVE THE SELECTION, REMOVAL AND/OR MODIFICATION OF THE AUTHORITY AND RESPONSIBILITIES OF LAWYERS, ACCOUNTANTS AND OTHER ADVISORS AND CONSULTANTS TO THE FILING ORGANIZATION THAT ARE NOT OTHERWISE IDENTIFIED IN THE APPROVED ANNUAL OPERATING BUDGET. THE RESERVED POWERS REQUIRING AN AFFIRMATIVE VOTE OF ONLY THE CLASS B MEMBER, AHSSI, INCLUDE THE FOLLOWING: 1) TO APPROVE CHANGES TO THE MISSION, VISION, OR VALUES OF THE HOSPITAL; 2) TO APPROVE CHANGES TO RELIGIOUS AFFILIATION OF HOSPITAL; AND 3) TO APPROVE CHANGES TO OPERATIONAL POLICIES, PLANS, PROCEDURES THAT ARE SPECIFICALLY RELATED TO THE HOSPITAL'S RELIGIOUS AFFILIATION WITH THE SEVENTH-DAY ADVENTIST CHURCH. BOTH THR, THE MAJORITY MEMBER, AND AHSSI, THE MINORITY MEMBER HAVE THE RESERVED POWER TO TERMINATE THE APPOINTMENT OF THE INDIVIDUAL HOLDING THE OFFICE OF PRESIDENT/CEO. THE FOLLOWING MATTERS REQUIRE A SUPERMAJORITY VOTE OF THE MEMBERSHIP: 1) TO AMEND THE ARTICLES OF INCORPORATION OR BYLAWS; 2) TO CHANGE THE NAME OF THE HOSPITAL; 3) TO ADD NEW CORPORATE MEMBERS OF THE FILING ORGANIZATION; 4) TO APPOINT AND REMOVE THE HOSPITAL BOARD; 5) TO APPROVE DISTRIBUTIONS OF CASH AND OTHER PROPERTY; 6) TO APPROVE THE BORROWING OF MONEY OR OTHERWISE COMMITTING THE CREDIT OF THE FILING ORGANIZATION FOR CORPORATE ACTIVITIES, AND THE VOLUNTARY PREPAYMENT OR EXTENSION OF DEBT IN EXCESS OF $200,000; 7) TO ADOPT AND THEREAFTER AMEND QUALITY AND/OR RISK MANAGEMENT PLANS; 8) TO APPROVE THE TRANSFER OF CORPORATE PROPERTY HAVING A VALUE IN EXCESS OF $500,000; 9) TO APPROVE ANY SALE, LEASE, TRANSFER, MERGER OR CONSOLIDATION OF THE FILING ORGANIZATION WITH A THIRD PARTY; 10) TO DISSOLVE THE FILING ORGANIZATION; 11) TO APPROVE THE FORMATION OF ANY SUBSIDIARY OF THE FILING ORGANIZATION OR APPROVE THE FILING ORGANIZATION ENTERING INTO ANY AFFILIATION OR JOINT VENTURE AGREEMENT; AND 12) TO APPROVE ANY SINGLE CAPITAL BUDGET ITEM OF $1,000,000 (OR MORE). FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE CEO, CFO, AND BOARD CHAIRMAN PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THESE INDIVIDUALS 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 INTERESTS POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION, ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT GENERALLY MADE AVAILABLE TO THE PUBLIC AS A WHOLE. PART VII, SECTION A, COLUMN (B) FOR THOSE BOARD OF DIRECTOR MEMBERS 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 WITHIN THR. PHYSICIAN MEMBERS OF THE BOARD OF DIRECTORS RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS AS A RESULT OF PROVIDING VARIOUS MEDICAL SERVICES TO THOSE RELATED ENTITIES. ADDITIONALLY, COMPENSATION FOR PENNY JOHNSON, JESSE SUTTON, AND TAMMY ELLIS DOES NOT REFLECT SERVICES PROVIDED TO AFFFILIATES OF AHSSHC, WHICH ARE NOT RELATED TO THE TAXPAYER. PART VIII, LINES 7A, B AND C: THE AMOUNT SHOWN IN PART VIII, LINE 7C(I) OF THE FORM 990 REPRESENTS AN ALLOCATED SHARE OF CAPITAL GAIN/(LOSS) FROM A SYSTEM WIDE, CORPORATE ADMINISTERED, INVESTMENT PROGRAM. FORM 990, PART IX, LINE 11G PAYMENTS TO HEALTHCARE PROFESSIONALS: PROGRAM SERVICE EXPENSES 15,945,804. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,945,804. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,832,789. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,832,789. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 3,956,204. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,956,204. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 1,363,543. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,363,543. RECRUITING: PROGRAM SERVICE EXPENSES 715,752. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 715,752. FOOD SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 539. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 539. LEASE PERSONNEL COSTS: PROGRAM SERVICE EXPENSES 131,519,050. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 131,519,050. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,082,167. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,082,167. ADVENTHEALTH MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 4,991,996. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,991,996. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,732,285. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,732,285. ADVENTHEALTH SHARED SERVICE FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,826,034. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,826,034. LEASE PERSONNEL COSTS MGMT: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,554,970. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,554,970. 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 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 TO RELATED AND AFFILIATED ENTITIES -11,982,114. RESTRICTED GIFTS -30,090. OTHER -18,184. HUGULEY MEDICAL ASSOCIATES 11801 SOUTH FREEWAY BURLESON TX 76028 752547668 PHYS. 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