2024-08-14T16:18:46-05:00 2023-09-30 440160260 FORVIS MAZARS LLP 120 E PALMETTO PARK ROAD SUITE 403 BOCA RATON FL 33432 990 2022-10-01 592477479 CAPE CANAVERAL HOSPITAL INC CAPE 3214345150 3300 FISKE BLVD ROCKLEDGE FL 329554306 ARTHUR CRAIG SPRINGER II SYS VP CAO 3214345150 2024-08-13 1 1 APRIL ARNOLD P01559426 8164894235 2024-08-13 2022 2024-08-08 14:25:15Z TAYLOR K SMITH 3300 FISKE BLVD ROCKLEDGE FL 329554306 197725415 0 X HTTPS://HF.ORG/ X 1984 FL OUR TEAM IMPROVING THE WELLNESS AND HEALTH OF YOU AND YOUR FAMILY THROUGH EXCELLENT AND COMPASSIONATE HEALTH CARE. 11 9 0 198 6211 0 1845723 690623 189083433 196236201 15981 362086 58177 436505 191003314 197725415 120222 137910 0 0 87869643 86034633 0 0 0 85900696 104428878 173890561 190601421 17112753 7123994 488118537 487459807 375373640 375333623 112744897 112126184 X OUR TEAM IMPROVING THE WELLNESS AND HEALTH OF YOU AND YOUR FAMILY THROUGH EXCELLENT AND COMPASSIONATE HEALTH CARE. 0 0 159226937 137910 196229990 HEALTH FIRST'S CAPE CANAVERAL HOSPITAL (CCH) IS A FULL SERVICE, NOT-FOR-PROFIT HOSPITAL FEATURING A CERTIFIED BABY-FRIENDLY MOTHER/BABY UNIT, FULLY EQUIPPED SURGICAL SERVICES, A STATE-OF-THE-ART CANCER PROGRAM AND FULL-SERVICE LABORATORY. CCH FEATURES 150 BEDS AND HAS OVER 200 HIGHLY SKILLED ATTENDING PHYSICIANS.THE WOMEN'S DIAGNOSTIC CENTER FEATURES STATE-OF-THE-ART, PERSONALIZED SERVICES INCLUDING DIGITAL MAMMOGRAPHY, ULTRASOUND, STEREOTACTIC BREAST BIOPSY, AND MRI BREAST IMAGING AND IS ACCREDITED BY THE AMERICAN COLLEGE OF RADIOLOGY AND THE U.S. FOOD AND DRUG ADMINISTRATION. AS PART OF THE WOMEN'S SERVICE LINE, THERE WERE APPROXIMATELY 814 BIRTHS DURING THE FISCAL YEAR.THE FACILITY ALSO OPERATES A SEVEN-SUITE OPERATING ROOM, TWO-SUITE CATH LAB, TWO-SUITE GASTROINTESTINAL (GI)/ENDOSCOPY AREA THAT ARE AVAILABLE FOR BOTH INPATIENT AND OUTPATIENT PROCEDURES. CCH ALSO BOASTS VITALWATCH EICU, WHICH COMBINES TELEMEDICINE, SOFTWARE AND 24/7 ELECTRONIC MONITORING TECHNOLOGY.ADDITIONALLY, CCH INCLUDES A 24-BED EMERGENCY DEPARTMENT AND AN ADJOINING SIX-STORY MEDICAL PLAZA THAT INCLUDES PHYSICIAN'S OFFICES, A CONFERENCE CENTER, PRE-OPERATIVE TESTING, OUTPATIENT REGISTRATION FOR LABORATORY TESTING AND SAME-DAY SURGERY, AS WELL AS A HEALTH RESOURCE CENTER FOR THE COMMUNITY.CCH RECEIVED A 5-STAR RATING BY THE CENTERS FOR MEDICARE & MEDICAID SERVICES IN 2023 AND IS ACCREDITED BY THE JOINT COMMISSION AS A PRIMARY STROKE CENTER. AS PART OF THE U.S. NEWS & WORLD REPORT TOP HOSPITALIST LIST, CCH EARNED A HIGH PERFORMANCE RATING FOR HEART ATTACK CARE.CCH PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, GENDER, NATIONAL ORIGIN, DISABILITY, AGE, OR ABILITY TO PAY, ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE HOSPITAL.IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND FURTHER, THAT OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION.IN KEEPING WITH THE HOSPITAL'S COMMITMENT, TO SERVE ALL MEMBERS OF ITS COMMUNITY:(1) FREE CARE AND/OR SUBSIDIZED CARE IS PROVIDED WHERE THE NEED AND/ORINABILITY TO PAY EXISTS AS DETERMINED BY HEALTH FIRST'S FINANCIAL ASSISTANCE POLICY.(2) CARE IS PROVIDED AT BELOW COST TO PERSONS COVERED BY GOVERNMENTALPROGRAMS SUCH AS MEDICARE AND MEDICAID.(3) FREE WELLNESS AND HEALTH ACTIVITIES AND PROGRAMS ARE PROVIDED TO THE COMMUNITY. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR ELDERLY, HANDICAPPED, ANDMENTALLY UNDERSERVED ALONG WITH A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES.AS A NOT-FOR-PROFIT HOSPITAL, CCH IS SUPPORTED IN PART BY CONTRIBUTIONS TO THE HEALTH FIRST FOUNDATION. 159226937 1 1 0 0 0 0 0 0 0 0 1 0 1 0 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 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X KIMBERLY MYERS 3214345150 3300 FISKE BLVD ROCKLEDGE FL 329554306 X STEVEN P JOHNSON PRESIDENT/CEO HFI (END 02/2023) 2.00 38.00 X X 0 2183427 25072 BRETT A ESROCK EXEC VP CFO/COO/ASST TREAS (BEG 01/2023) 5.00 35.00 X X 0 735252 26499 SHERRI CAPLAN DO MEDICAL STAFF PRES (END 12/2022) 1.00 39.00 X 0 546895 16872 TAYLOR K SMITH CHAIR/ INTERIM CEO HFI (BEG 02/2023) 2.00 38.00 X X 0 61634 0 JAMES C SHAW VICE CHAIR 1.00 5.00 X X 0 25837 0 JOSEPH GURRI MD TRUSTEE 1.00 5.00 X 0 20735 0 DANA S KILBORNE TREASURER 1.00 5.00 X X 0 18000 0 LARRY S BISHOP MD TRUSTEE (BEG 10/2021) 1.00 4.00 X 0 13559 0 ROBERT K HENRY TRUSTEE 1.00 5.00 X 0 12368 0 ALAN L PRESTWOOD TRUSTEE 1.00 8.00 X 0 7891 0 SCOTT T MIKUEN SECRETARY 1.00 5.00 X X 0 0 0 KIM K PATRICK TRUSTEE 1.00 8.00 X 0 0 0 HANY GUIRGIS MD MEDICAL STAFF PRES CCH (BEG 1/2023) 1.00 0.00 X 0 0 0 MICHAEL A SCIALDONE EVP/CFO HFI (END 01/2023) 2.00 38.00 X 0 896876 21100 NICHOLAS W ROMANELLO ESQ ASSISTANT SECRETARY 2.00 38.00 X 0 736683 29300 JEFFREY C STALNAKER MD SR VP CCO/ INTERIM CEO HOSP (BEG 01/2023) 2.00 38.00 X 0 730001 24632 ANITA A DHOPLE PHYSICIAN ADVISOR 40.00 0.00 X 0 316460 22873 DANIEL R BOWEN HOSPITAL ADMINISTRATOR 40.00 0.00 X 0 273997 8908 CLAY D SMITH RN 40.00 0.00 X 0 208828 26386 EDWARDS B ROBERTS II VP OF NURSING COMM HOSPITAL 40.00 0.00 X 0 189189 24978 MICHELLE S ROGERS SYS DIR HOME CARE PRIVATE 40.00 0.00 X 0 191067 24876 JAMES S MITCHELL III FORMER EXEC VP/COO HFI (EN 0.00 0.00 X 0 325397 5007 MARTIN W ISENMAN MD FORMER TRUSTEE (END 9/2021 0.00 0.00 X 0 19132 0 JOHN F BREITFELLER FORMER V CHAIR (END 9/2020 0.00 0.00 X 0 14356 0 DALE A DETTMER ESQ FORMER TRUSTEE (END 9/2019 0.00 0.00 X 0 13968 0 PAMELA A GATTO FORMER TRUSTEE (END 9/2021 0.00 0.00 X 0 11172 0 VICTOR M VARGAS FORMER MED AFFAIRS COMM. HOSP (END 07/22) 0.00 40.00 X 0 404322 18853 0 7957046 275356 0 1 1 0 0 210966 479657 690623 PATIENT SERVICES 621110 151339263 151339263 MEDICARE/MEDICAID 621110 44834745 44834745 RELATED COMPANY RENT 531120 55982 55982 REFERENCE LAB 621500 6211 6211 196236201 362086 362086 CAFETERIA 722514 392315 392315 GIFT SHOP 459420 44190 44190 436505 197725415 196229990 6211 798591 X 137910 137910 65025982 53080709 11945273 1314089 1072691 241398 14448742 11794508 2654234 5245820 4282163 963657 277439 277439 71404 71404 20839085 17808425 3030660 223527 182465 41062 2493712 2035617 458095 4668050 4642586 25464 2915080 2379580 535500 982069 801663 180406 7584 6191 1393 15700243 12816108 2884135 11504860 9782584 1722276 4595260 4595260 MEDICAL SUPPLIES 23117910 23117910 BAD DEBT 5650613 5650613 FLORIDA INDIGENT TAX 1872907 1872907 9509135 7762307 1746828 190601421 159226937 31374484 0 392549739 387851144 22239534 27004214 3611095 4248559 965335 829292 214480820 181680020 34027266 32800800 29952377 29657881 4773191 5067917 488118537 487459807 15248505 15273524 427955 471195 327423552 325138716 32273628 34450188 375373640 375333623 X 112081012 112126184 663885 0 112744897 112126184 488118537 487459807 X 7123994 -7742707 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 71173 71173 116195594 98529018 17666576 1385124 1280319 104805 94040568 81870683 12169885 2788361 2788361 32800800 DEMAND NOTE -HEALTH FIRST INC. 21960694 C DEMAND NOTE -HEALTH FIRST FOUNDATION 507909 C INVESTMENT IN JOINT VENTURE -COASTAL HEALTH 3895864 C INVESTMENT IN CAPE HEALTH PROPERTIES 3293414 C 29657881 INTER-COMPANY PAYABLE 16789868 GOVERNMENT RELATED PAYABLE 2163872 OTHER CURRENT LIABILITIES 7540430 OTHER NONCURRENT LIABILITIES 7646896 OPERATING LEASE LIABILITIES 309122 34450188 X PART X, LINE 2: FASB ASC 740 FOOTNOTE: THE HOSPITAL IS GENERALLY EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(A), AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3), OF THE INTERNAL REVENUE CODE AND SECTION 220.13 OF THE FLORIDA STATUTES, RESPECTIVELY. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS. ASC TOPIC 740, INCOME TAXES, PRESCRIBES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAX POSITIONS RECOGNIZED IN FINANCIAL STATEMENTS. ASC TOPIC 740 PROVIDES GUIDANCE FOR RECOGNITION THRESHOLD AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. 1 1 X 1 X 0 1 1 0 1 1 11205616 822 11204794 0.06060 14807866 7806554 7001312 0.03790 1857287 1857287 0.01000 27870769 7807376 20063393 0.10850 477074 477074 0.00260 722292 722292 0.00390 102408 102408 0.00060 126941 126941 0.00070 1428715 1428715 0.00780 29299484 7807376 21492108 0.11630 1 1281648 501684 37028191 49122366 -12094175 X 1 1 1 1 CAPE CANAVERAL HOSPITAL 701 W COCOA BEACH CSWY COCOA BEACH FL 32931 SEE SUPPLEMENTAL INFO FOR WEBSITE FL STATE LIC. NO.: 3948 X X X ACUTE CARE HOSPITAL CAPE CANAVERAL HOSPTIAL INC 1 0 0 1 X X X X X X X X X 21 1 1 0 1 X SEE SUPPLEMENTAL INFO FOR WEBSITE X 1 21 1 SEE SUPPLEMENTAL INFO FOR WEBSITE 0 1 X 200.000000000000 X X X X 1 1 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 CAPE CANAVERAL HOSPTIAL, INC. PART V, SECTION B, LINE 5: THE RESULTS OF THE PRC 2022 COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY WERE ANALYZED AND THIRTEEN "AREAS OF OPPORTUNITY" WERE IDENTIFIED. A PRESENTATION OF THE DATA WAS MADE TO THE SPACE COAST HEALTH FOUNDATION BOARD OF DIRECTORS, COMMUNITY PARTNERS AND EQUITY FORUM ATTENDEES DURING THREE MEETINGS HELD IN APRIL AND MAY 2022. UPON REVIEW OF THE FINDINGS IN EACH CATEGORY, THE FOLLOWING HEALTH ISSUES WERE PRIORITIZED. THE RESULTS WERE DETERMINED BY AVERAGING MULTIPLE CRITERIA RATINGS (SCOPE/SEVERITY AND ABILITY TO IMPACT) AS LISTED BELOW. A SCALE OF 1 (LOW PRIORITY) TO 10 (HIGH PRIORITY) WAS USED AS THE RANKING CRITERIA. A PANEL OF 130 LEADERS IN THE COMMUNITY, FROM BOTH PUBLIC AND PRIVATE ORGANIZATIONS, WERE CONSULTED IN THE PROCESS OF IDENTIFYING SIGNIFICANT NEEDS OF THE COMMUNITY. CAPE CANAVERAL HOSPTIAL, INC. PART V, SECTION B, LINE 6A: HOLMES REGIONAL MEDICAL CENTER, PALM BAY HOSPITAL, & VIERA HOSPITAL CAPE CANAVERAL HOSPTIAL, INC. PART V, SECTION B, LINE 11: BASED ON THE SIGNIFICANT NEEDS IDENTIFIED IN THE MOST RECENTLY CONDUCTED CHNA, HEALTH FIRST WILL ADDRESS THE FOLLOWING ACTIONS IN FY23 TO ADDRESS IDENTIFIED HEALTH DISPARITIES:WELLNESS GRANT PROGRAM: IN ALIGNMENT WITH OUR IMPLEMENTATION STRATEGIES, HEALTH FIRST CONTINUED OUR WELLNESS GRANT PROGRAM, AWARDING OVER $360,000 TO 12 LOCAL NON-PROFITS THAT DIRECTLY ADDRESS THE IDENTIFIED PRIORITY AREAS OF NUTRITION, PHYSICAL ACTIVITY, WEIGHT, AND ACCESSS TO HEALTHCARE. COMMUNITY PARTNERS WERE SELECTED BASED ON THEIR DEMONSTRATED ABILITY TO MAKE A MEASURABLE IMPACT, AND PROGRAM OUTCOMES ARE REPORTED TO HEALTH FIRST QUARTERLY.1. NUTRITION, PHYSICAL ACTIVITY AND WEIGHT - RECOGNIZING THAT A HEALTHY DIET AND REGULAR PHYSICAL ACTIVITY ARE CRUCIAL FOR REDUCING THE RISK OF CHRONIC DISEASES, HEALTH FIRST'S WELLNESS GRANT PROGRAM SUPPORTED INITIATIVES THAT REACHED 14,436 INDIVIDUALS IN FY23. THESE PROGRAMS FOCUSED ON INCREASING FRUIT AND VEGETABLE CONSUMPTION, PROMOTING PHYSICAL ACTIVITY, AND ADDRESSING OVERWEIGHT AND OBESITY, PARTICULARLY AMONG CHILDREN AND FAMILIES. PARTNERS IN THIS EFFORT INCLUDED BREVARD PUBLIC SCHOOLS, BOYS & GIRLS CLUBS OF CENTRAL FLORIDA, SOUTH BREVARD SHARING CENTER, PROMISE IN BREVARD, AND THE JUNIOR LEAGUE OF THE SPACE COAST. 2. ACCESS TO HEALTHCARE - TO TACKLE THE ISSUE OF MORE THAN 54% OF BREVARD COUNTY ADULTS EXPERIENCING DIFFICULTIES OR DELAYS IN RECEIVING NEEDED HEALTHCARE, HEALTH FIRST'S WELLNESS GRANT PROGRAM SUPPORTED INITIATIVES THAT REACHED 14,815 INDIVIDUALS IN FY23. THESE PROGRAMS FOCUSED ON IMPROVING ACCESS TO HEALTHCARE THROUGH OUTREACH SERVICES, CARE COORDINATION, AND NAVIGATION ASSISTANCE. PARTNERS IN THIS EFFORT INCLUDED WHO WE PLAY FOR, FLORIDA DEPARTMENT OF HEALTH-BREVARD COUNTY, FAMILY PROMISE OF BREVARD, AND WAYS FOR LIFE.SIGNIFICANT HEALTH NEEDS NOT ADDRESSED:HEALTH FIRST ACKNOWLEDGES THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS AND DETERMINED THAT WE COULD EFFECTIVELY FOCUS ON THOSE HEALTH NEEDS WHICH ARE THE MOST PRESSING, UNDER-ADDRESSED, AND WITHIN OUR ABILITY TO INFLUENCE. WE WILL NOT TAKE FOCUSED ACTION ON THE FOLLOWING HEALTH NEEDS DURING THE 2023-2025 CHNA PERIOD:1. DIABETES - HEALTH FIRST MEDICAL GROUP OFFERS A DIABETES EDUCATION PROGRAM AND MEDICAL NUTRITION THERAPY. RISK FACTORS ASSOCIATED WITH PHYSICAL ACTIVITY AND NUTRITION.2. ORAL HEALTH - HEALTH FIRST-SPONSORED ADULT DENTAL CLINIC IN PARTNERSHIP WITH FLORIDA DEPARTMENT OF HEALTH-BREVARD COUNTY.3. SUBSTANCE ABUSE - SERVICES PROVIDED BY CIRCLES OF CARE.4. TOBACCO USE - SERVICES PROVIDED BY TOBACCO FREE FLORIDA'S AREA HEALTH EDUCATION CENTERS.5. RESPIRATORY DISEASES - RISK FACTOR ASSOCIATED WITH OVERWEIGHT/OBESITY.6. CANCER - HEALTH FIRST CANCER INSTITUTE-PROVIDED TREATMENT.7. POTENTIALLY DISABLING CONDITIONS - MOST CONDITIONS ARE ASSOCIATED WITH OVERWEIGHT/OBESITY.8. MENTAL HEALTH - SERVICES PROVIDED BY CIRCLES OF CARE.9. SOCIAL DETERMINANTS OF HEALTH - SERVICES PROVIDED BY SEVERAL COMMUNITY ORGANIZATIONS INCLUDING HEALTH FIRST PARTNER, FAMILY PROMISE OF BREVARD.10. HEART DISEASE/STROKE - CARDIOVASCULAR RISK FACTORS ASSOCIATED WITH PHYSICAL INACTIVITY AND OVERWEIGHT/OBESITY.11. INJURY/VIOLENCE - SERVICES PROVIDED BY SEVERAL COMMUNITY ORGANIZATIONS INCLUDING SERENE HARBOR AND THE WOMEN'S CENTER. CAPE CANAVERAL HOSPTIAL, INC. PART V, SECTION B, LINE 13B: THE ORGANIZATION DOES NOT OFFER DISCOUNTED CARE BASED ON FPG PERCENTAGES. ONLY SELF-PAY DISCOUNT IS PROVIDED TO PATIENTS REGARDLESS OF INCOME LEVEL, WHICH IS DETERMINED BY THE LOOK BACK METHOD AND IS REFERRED TO AS AVERAGE GENERALLY BILLED (AGB). PATIENTS WITH HOUSEHOLD INCOMES AT OR BELOW 200% OR WHOSE HOSPITAL-RELATED EXPENSES EXCEED 25% OF THE HOUSEHOLD INCOME WILL BE ENTITLED TO 100% WRITE-OFF CHARGES. PART V, SECTION B, LINE 7A: HTTPS://HF.ORG/ABOUT-US/GIVING-BACK/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-IMPLEMENTATION-STRATEGIES PART V, SECTION B, LINE 10A: HTTPS://HF.ORG/ABOUT-US/GIVING-BACK/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-IMPLEMENTATION-STRATEGIES PART V, SECTION B, LINE 16A-C: FINANCIAL ASSISTANCE POLICY WEBSITE: HTTPS://HF.ORG/HEALTHCARE-HOME/PATIENTS-VISITORS/PRICE-ESTIMATES-AND-FINANCIAL-ASSISTANCE#-----------FINANCIAL-ASSISTANCE-POLICIES---------- 2 1 - HEALTH FIRST AGING INSTITUTE 3661 S BABCOCK STREET SUITE B MELBOURNE FL 32901 ELDER CARE 2 - HEALTH FIRST HOME CARE 3566 N HARBOUR CITY BLVD MELBOURNE FL 32935 IN-HOME CARE PART I, LINE 3C: THE ORGANIZATION DOES NOT OFFER DISCOUNTED CARE BASED ON FPG PERCENTAGES. ONLY SELF-PAY DISCOUNT IS PROVIDED TO PATIENTS REGARDLESS OF INCOME LEVEL, WHICH IS DETERMINED BY THE LOOK BACK METHOD AND IS REFERRED TO AS AVERAGE GENERALLY BILLED (AGB). PATIENTS WITH HOUSEHOLD INCOMES AT OR BELOW 200% OR WHOSE HOSPITAL-RELATED EXPENSES EXCEED 25% OF THE HOUSEHOLD INCOME WILL BE ENTITLED TO 100% WRITE-OFF CHARGES. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS PREPARED BY HEALTH FIRST SHARED SERVICES, INC., THE PARENT COMPANY TO THE ORGANIZATION. THE COMMUNITY BENEFITS OF THIS ORGANIZATION ARE INCLUDED WITHIN THAT REPORT. PART I, LINE 7: THE ORGANIZATION CALCULATED THE COST AMOUNTS NOTED IN PART I, LINE 7 BY UTILIZING THE COST TO CHARGE RATIO ON THE MEDICARE COST REPORT WHICH ADDRESSES ALL PATIENT SEGMENTS REPORTED ON, INCLUDING, BUT NOT LIMITED TO INPATIENT, OUTPATIENT, MEDICAID, UNINSURED, AND MEDICARE. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 5,650,613. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ARE PRIMARILY SUBSIDIZED BY HEALTH FIRST SHARED SERVICES, INC. (PARENT) AND THEREFORE ARE NOT REPORTED AT EACH INDIVIDUAL HOSPITAL. THE NEEDS IDENTIFIED ARE, IN PART, BASED ON THE COMMUNITY NEEDS ASSESSMENT. HEALTH FIRST SHARED SERVICES, INC. (HFSS) UTILIZED HOURS OF PAID PHYSICIANS AND NURSES TO SUPPORT THE COMMUNITY WHILE ON PAYROLL. IN ADDITION, AN AMOUNT IN EXCESS OF $500K WAS CONTRIBUTED TO VARIOUS LOCAL ORGANIZATIONS PRIMARILY SUPPORTING THE VARIOUS COMMUNITY PUBLIC HEALTH NEEDS. HFSS ALSO SUPPORTED THE ECONOMIC DEVELOPMENT NEEDS, PROVIDED OTHER COMMUNITY SUPPORT, PARTICIPATED IN ENVIRONMENTAL IMPROVEMENTS, COALITION BUILDING PROJECTS, SUPPORTED A COMMUNITY HEALTH IMPROVEMENT ADVOCACY, AND SUPPORTED THE LOCAL WORKFORCE DEVELOPMENT PROGRAM. HFSS AND ITS EMPLOYEES ALSO ACTIVELY SUPPORT THE LOCAL UNITED WAY IN EXCESS OF $96K. PART III, LINE 2: THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATON STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH IN GAAP. BAD DEBT AT COST IS CALCULATED BY MULTIPLYING ACTUAL BAD DEBT WRITE-OFFS BY THE FILING ORGANIZATION'S COST-TO-CHARGE RATIO ON THE MEDICARE COST REPORT. THE ORGANIZATION USED A COST TO CHARGE RATIO TO DETERMINE THE COST AMOUNT OF THE BAD DEBT EXPENSE. PATIENT CARE COST TO CHARGES, AS PROVIDED IN THE IRS INSTRUCTIONS WAS USED TO VALIDATE THE COST TO CHARGE RATIO WHICH APPROXIMATES INTERNAL COST CALCULATION. PART III, LINE 3: BASED ON THE GUIDANCE PROVIDED FOR HEALTH CARE ENTITIES REVENUE RECOGNITION, HEALTH FIRST PERFORMS AN ANNUAL ANALYSIS ON ALL FOUR OF OUR HOSPITALS. THE ANALYSIS PULLS A PATIENT LEVEL DETAIL OF A POPULATION OF CHARITY WRITE-OFF'S FOR SELF PAY AND NON SELF PAY ACCOUNTS DURING THE FISCAL YEAR. THE CLAIMS ARE REVIEWED BY A THIRD PARTY VENDOR SPECIALIZING IN CAPTURING INCOME AND POVERTY LEVEL SCORES AND PROVIDES RESULTS TO BE COMPARED WITH THE DOCUMENTED CHARITY ACCOUNTS MEETING THE APPROPRIATE POVERTY GUIDELINE REQUIREMENTS PER OUR POLICIES.THIS ANALYSIS ALSO REVIEWS THE INCOME LEVEL OF THOSE ACCOUNTS THAT ARE IN OUR BAD DEBT WRITE-OFF POPULATION OF CLAIMS, FOR EXAMPLE THOSE PATIENT ACCOUNTS THAT MAY NOT INITIALLY PRESENT WITH APPROPRIATE INCOME INFORMATION, AND THEREFORE WRITTEN OFF TO BAD DEBT RATHER THAN CHARITY AT THAT TIME.FROM THERE, FOR THOSE ACCOUNTS IN THE BAD DEBT LIST THAT HAVE A INCOME LEVEL SCORE THAT FALLS WITHIN THE CHARITY SCORES, A PERCENTAGE OF THOSE TOTAL CLAIMS IS DERIVED. THIS PERCENTAGE IS THEN APPLIED TO THE BAD DEBT WRITE-OFFS, TO ESTIMATE THE AMOUNTS IN LINE 3. PART III, LINE 4: THE ORGANIZATION DOES NOT ISSUE A STANDALONE FINANCIAL STATEMENT; HOWEVER, IT IS INCLUDED AS A PART OF THE HEALTH FIRST, INC. CONSOLIDATED FINANCIAL STATEMENTS. THE FOOTNOTE FROM THE HEALTH FIRST, INC. CONSOLIDATED FINANCIAL STATEMENTS CAN BE FOUND ON PAGES 10-14 OF THE SEPTEMBER 30, 2023 AUDITED STATEMENTS WITHIN THE REVENUE FOOTNOTE. PART III, LINE 8: THE ORGANIZATION DERIVED ITS COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT BY USING COST REPORT WORKSHEETS. MEDICARE COSTS ARE DETERMINED THROUGH THE MEDICARE COST FINDING PROCESS WHICH ALLOCATES GENERAL SERVICE CENTER COSTS TO REVENUE DEPARTMENTS. ROUTINE AND ICU COSTS ARE DETERMINED BASED ON AN AVERAGE COST PER DAY MULTIPLIED BY THE NUMBER OF MEDICARE ALLOWABLE DAYS. MEDICARE ANCILLARY COSTS ARE DETERMINED BY THE RATIO OF DEPARTMENT COSTS TO DEPARTMENT CHARGES THEN THE RESULTING % IS APPLIED TO MEDICARE ALLOWABLE CHARGES. THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE REASONS MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT ARE: ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND THE AMOUNT SPENT TO COVER MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. PART III, LINE 9B: WITHIN THE POLICY'S REASONABLE COLLECTION EFFORTS, PATIENTS ARE EVALUATED FINANCIALLY TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR CHARITY CARE. THE EVALUATION IS BASED UPON THE CURRENT YEAR'S DEPARTMENT OF HEALTH AND HUMAN SERVICES FEDERAL POVERTY GUIDELINE AND THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PATIENTS OR GUARANTORS DESIRING TO APPLY FOR FINANCIAL ASSISTANCE MAY BE REQUIRED TO COMPLETE A HEALTH FIRST FINANCIAL ASSISTANCE APPLICATION THAT CAN BE OBTAINED FROM THE HEALTH FIRST PATIENT BUSINESS SERVICES, THE HOSPITAL EMERGENCY DEPARTMENT, HOSPITAL REGISTRATION, OR HTTPS://HF.ORG/HEALTHCARE-HOME/PATIENTS-VISITORS/PRICE-ESTIMATES-AND-FINANCIAL-ASSISTANCE. PART V, SECTION A: CAPE CANAVERAL HOSPITAL, INC. WEBSITE: HTTPS://HF.ORG/HEALTHCARE-HOME/LOCATION-DIRECTORY/CAPE-CANAVERAL-HOSPITAL#-ABOUT-THIS-LOCATION- PART VI, LINE 2: THE HEALTH CARE NEEDS OF THE COMMUNITIES ARE ASSESSED THROUGH COLLABORATION WITH LOCAL COMMUNITY PARTNERS INCLUDING BREVARD HEALTH ALLIANCE, A FEDERALLY QUALIFIED HEALTH CENTER, IN ADDITION TO LEADERSHIP PARTICIPATION ON SEVERAL LOCAL NOT-FOR-PROFIT ORGANIZATION'S BOARDS. PART VI, LINE 3: IT IS THE POLICY OF HEALTH FIRST TO GRANT FINANCIAL ASSISTANCE TO ELIGIBLE INDIVIDUALS WHO ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM, OR OTHERWISE UNABLE TO PAY FOR HEALTH CARE SERVICES DUE TO THEIR LIMITED FINANCIAL RESOURCES. IT IS ALSO HEALTH FIRST POLICY TO PROVIDE, WITHOUT DISCRIMINATION, CARE FOR EMERGENCY MEDICAL CONDITIONS (AS DEFINED BY FEDERAL LAW KNOWN AS "EMTALA") TO INDIVIDUALS REGARDLESS OF THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER THIS POLICY.INFORMATION ABOUT HEALTH FIRST'S FINANCIAL ASSISTANCE PROGRAM SHALL BE MADE AVAILABLE TO PATIENTS AND GUARANTORS BY VARIOUS MEANS, INCLUDING THE PUBLICATION OF NOTICES IN PATIENT BILLS AND BY POSTING NOTICES IN THEEMERGENCY AND ADMITTING DEPARTMENTS, AND AT OTHER PUBLIC PLACES THE HEALTH FIRST FACILITY MAY ELECT. WRITTEN SUMMARY INFORMATION DESCRIBING THE POLICY ALONG WITH FINANCIAL ASSISTANCE CONTACT INFORMATION WILL BE MADEAVAILABLE TO EACH PATIENT IN ALL EMERGENCY AND ADMITTING DEPARTMENTS. THE POLICY WILL ALSO BE POSTED ON THE HEALTH FIRST WEBSITE. SUCH INFORMATION SHALL BE PROVIDED IN THE PRIMARY LANGUAGE SPOKEN BY THE GENERAL POPULATIONS SERVED BY THE HEALTH FIRST FACILITY.ANY HEALTH FIRST ASSOCIATE OR MEMBER OF THE MEDICAL STAFF MAY REFER PATIENTS FOR FINANCIAL ASSISTANCE. A PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT MAY ALSO MAKE A REQUEST FOR FINANCIALASSISTANCE ON BEHALF OF THE PATIENT. PART VI, LINE 4: BREVARD COUNTY IS THE 15TH-LARGEST COUNTY IN FLORIDA BY AREA, COVERING 1,015 SQUARE MILES. IT STRETCHES MORE THAN 70 MILES ALONG THE ATLANTIC COAST. BEST KNOWN AS THE LOCATION OF THE KENNEDY SPACE CENTER, THE SPACE COAST IS ALSO HOME TO PORT CANAVERAL, ONE OF THE WORLD'S BUSIEST PASSENGER CRUISE PORTS. THE COUNTY IS UNOFFICIALLY DIVIDED INTO THREE SECTIONS: NORTH COUNTY, COMPRISING OF TITUSVILLE, MIMS, AND PORT ST. JOHN; CENTRAL BREVARD, WHICH INCLUDES VIERA, COCOA, ROCKLEDGE, MERRITT ISLAND, AND COCOA BEACH; AND SOUTH COUNTY, INCLUDING MELBOURNE, PALM BAY, GRANT-VALKARIA AND THE SOUTH BEACHES, WHICH STRETCH TO THE SOUTH BREVARD-INDIAN RIVER COUNTY LINE.ACCORDING TO U.S. CENSUS DATA, THE POPULATION OF BREVARD COUNTY WAS 606,612 IN APRIL 2020. BASED ON THE U.S. CENSUS BUREAU'S QUICK FACTS, POPULATION ESTIMATES, JULY 1, 2023:- BREVARD COUNTY'S POPULATION WAS ESTIMATED TO BE 643,979- RACE AND HISPANIC ORIGIN: 82.5 PERCENT WHITE, 11.1 PERCENT BLACK OR AFRICAN AMERICAN, 12.1 PERCENT HISPANIC OR LATINO, AND 6.5 PERCENT OTHER OR TWO OR MORE RACES. - AGE: 19.8 PERCENT ARE UNDER THE AGE OF 20; AGES 20 TO 64 MAKE UP 55.5 PERCENT; AND 24.7 PERCENT ARE 65 YEARS OF AGE OR OLDER- THE AVERAGE HOUSEHOLD SIZE IS 2.43 PERSONS- 93.4 PERCENT OF BREVARD COUNTY RESIDENTS ARE HIGH SCHOOL GRADUATES OR HIGHER- 10 PERCENT OF RESIDENTS LIVE IN POVERTY, COMPARED WITH 11.5 PERCENT NATIONWIDE.ACCORDING TO THE U.S. CENSUS BUREAU'S 2022 AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES, BREVARD COUNTY'S MEDIAN AGE IS 47 YEARS; 48.9 PERCENT ARE MARRIED COUPLES LIVING TOGETHER; 23 PERCENT OF HOUSEHOLDS IN BREVARD COUNTY HAVE CHILDREN UNDER THE AGE OF 18 LIVING WITH THEM. THE UNEMPLOYMENT RATE FOR THE CIVILIAN LABOR FORCE IS 4.9 PERCENT AND 24,845 PERSONS RECEIVED FOOD STAMP/SNAP BENEFITS IN THE PAST 12 MONTHS.THERE ARE SEVEN ACUTE-CARE HOSPITALS SERVING PATIENTS IN BREVARD COUNTY: PARRISH MEDICAL CENTER, LOCATED IN THE NORTH PART OF THE COUNTY; HEALTH FIRST'S CAPE CANAVERAL HOSPITAL, HEALTH FIRST'S VIERA HOSPITAL AND ROCKLEDGE REGIONAL MEDICAL CENTER IN CENTRAL BREVARD COUNTY; AND HEALTH FIRST'S HOLMES REGIONAL MEDICAL CENTER, HEALTH FIRST'S PALM BAY HOSPITAL AND MELBOURNE REGIONAL MEDICAL CENTER IN SOUTH BREVARD.DATA REFERENCES: US CENSUS QUICK FACTS:HTTPS://WWW.CENSUS.GOV/QUICKFACTS/FACT/TABLE/BREVARDCOUNTYFLORIDA,US/PST045218US CENSUS BUREAU AMERICAN COMMUNITY SURVEY DATA: HTTPS://WWW.CENSUS.GOV/PROGRAMS-SURVEYS/ACS/DATA.HTML PART VI, LINE 5: THE GOVERNING BODY OF CAPE CANAVERAL HOSPITAL, INC. IS COMPRISED OF PERSONS WHO PRIMARILY RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES NOR CONTRACTORS NOR FAMILY MEMBERSOF THE ORGANIZATION NOR ITS KEY EMPLOYEES.THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS.THE ORGANIZATION DOES APPLY RESOURCES THROUGHOUT THE YEAR TO SUPPORT IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION AND TRAINING. THE ORGANIZATION SPENT MORE THAN $722K TO SUPPORT LOCAL STUDENTS VIA TRAINING, EDUCATION, AND SCHOLARSHIPS.THE EMERGENCY DEPARTMENT AT CAPE CANAVERAL HOSPITAL, INC. HAD MORE THAN 35,882 VISITS DURING THE YEAR REGARDLESS OF ABILITY TO PAY. IN ADDITION, THE ORGANIZATION PARTICIPATES IN SEVERAL GOVERNMENT SPONSORED HEALTH CARE PROGRAMS, INCLUDING, BUT NOT LIMITED TO, MEDICARE, MEDICAID, AND TRICARE.CAPE CANAVERAL HOSPITAL, INC. REINVEST THEIR NET OPERATING INCOME TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE. PART VI, LINE 6: THE ROOTS OF HEALTH FIRST RUN DEEP IN BREVARD, DATING BACK TO 1931 WHEN BREVARD HOSPITAL FIRST OPENED IN MELBOURNE WITH 27 BEDS. NOW KNOWN AS HOLMES REGIONAL MEDICAL CENTER (HRMC), THE HOSPITAL IS BREVARD'S LARGEST, WITH 550 BEDS. CAPE CANAVERAL HOSPITAL (CCH) OPENED IN 1962 WITH 44 BEDS, AND HAS SINCE GROWN TO 150 BEDS. PALM BAY HOSPITAL (PBH) OPENED IN 1992 AS A SATELLITE OF HRMC WITH 60 BEDS AND HAS SINCE GROWN TO 120 BEDS. VIERA HOSPITAL (VH) OPENED IN APRIL OF 2011 WITH 84 BEDS.HEALTH FIRST WAS FORMED WHEN CCH, HRMC, AND PBH JOINED TOGETHER IN AUGUST 1995 TO CREATE A TRULY INTEGRATED NOT-FOR-PROFIT HEALTHCARE DELIVERY SYSTEM AND FULFILL A COMMON MISSION OF IMPROVING THE HEALTH OF OUR COMMUNITY. THE FIRST NEW SERVICES ADDED IN THE HEALTH FIRST FAMILY WERE HEALTH FIRST PHYSICIANS, OPENING IN LATE 1995, AND HEALTH FIRST HEALTH PLANS, OPENING IN JANUARY 1996. SINCE THEN, WE'VE ALSO ADDED, HOLMES REGIONAL TRAUMA CENTER, VIERA HOSPITAL IN APRIL OF 2011, VITALWATCH - ELECTRONIC INTENSIVE CARE UNIT AND MANY OTHER SERVICES TO OUR FAMILY.OTHER SERVICES INCLUDE STATE-OF-THE-ART ROBOTICS-ASSISTED SURGERY FOR CARDIOTHORACIC, GENERAL SURGERY, UROLOGY AND GYNECOLOGICAL PROCEDURES; OUTPATIENT CENTERS; THE COUNTY'S ONLY TRAUMA CENTER; HOME CARE; SPECIALIZED PROGRAMS FOR CANCER, DIABETES, HEART, STROKE, AND REHABILITATIVE SERVICES; STATE-OF-THE-ART WOMEN'S DIAGNOSTIC CENTER FOR PERSONALIZED SERVICES; CENTRAL BREVARD'S LARGEST MEDICAL GROUP; A FITNESS CENTER; ELECTRONIC MEDICAL RECORDS (EMS)AND MEDICARE ADVANTAGE, COMMERCIAL POS AND HMO HEALTH PLANS.WORKING TOGETHER IN A SEAMLESS SYSTEM, HEALTH FIRST IS DEVOTED TO INTEGRATING QUALITY HEALTHCARE SERVICES WITH STATE-OF-THE-ART TECHNOLOGY. HFSS ALSO WORKS TOGETHER WITH OTHER ORGANIZATIONS AND PHYSICIANS IN OUR COMMUNITY.OUR ASSOCIATES ARE ALSO ACTIVELY BUILDING A HEALTHIER COMMUNITY THROUGH VOLUNTEERING FOR ORGANIZATIONS DEDICATED TO PREVENTING AND TREATING HEALTH CONCERNS SUCH AS CANCER, DIABETES, AND HEART DISEASE. WE'RE ALSO PROUD OF OUR ASSOCIATE CHARITABLE GIVING PROGRAM, SUPPORTING A VARIETY OF SERVICES AND A PATIENT AND FAMILY CARE FUND. PART VI, LINE 7: NOT APPLICABLE. NEITHER THE FILING ORGANIZATION NOR ANY RELATED ORGANIZATION FILES A COMMUNITY BENEFIT REPORT WITH ANY STATE OTHER THAN THE EXTENT TO WHICH THE COMMUNITY BENEFIT INFORMATION IS INCLUDED IN OTHER REPORTING REQUIREMENTS, SUCH AS INFORMATION PROVIDED TO THE FLORIDA HOSPITAL ASSOCIATION. 1 WAYS FOR LIFE 1401 GUAVA AVENUE MELBOURNE FL 32935 843366048 501(C)(3) 18400 0 GENERAL SUPPORT - WELLNESS GRANT FY23 SCHOOL BOARD OF BREVARD COUNTY 2700 JUDGE FRAN JAMIESON WAY VIERA FL 32940 596000522 PUBLIC SCHOOL GOV'T 16750 0 GENERAL SUPPORT - THRIVE FOR FIVE STREETSIDE SHOWERS INC PO BOX 2623 MCKINNEY TX 75070 822043901 501(C)(3) 14500 0 GENERAL SUPPORT - WELLNESS GRANT FY23 MOBILE SHOWER BREVARD PUBLIC SCHOOLS FOUNDATION 2700 JUDGE FRAN JAMIESON WAY VIERA FL 32940 592895155 501(C)(3) 13250 0 GENERAL SUPPORT - WELLNESS GRANT FY23 FIND YOUR JAM PROMISE INC 4105 NORFOLK PARKWAY WEST MELBOURNE FL 32904 900520600 501(C)(3) 11540 0 GENERAL SUPPORT - WELLNESS GRANT FY23 NUTRITION & FOOD SKILLS FAMILY PROMISE OF BREVARD INC 3505 MURRELL RD ROCKLEDGE FL 32955 331170962 501(C)(3) 10000 0 GENERAL SUPPORT - WELLNESS GRANT FY23 HEALTH NAVIGATION EXPANSION THE CHILDREN'S HUNGER PROJECT INC 1855 WEST KING ST COCOA FL 32922 364686823 501(C)(3) 10000 0 GENERAL SUPPORT - HUNGER PROJECT BOYS & GIRLS CLUBS OF CENTRAL FLORIDA 101 E COLONIAL DR ORLANDO FL 32801 590951887 501(C)(3) 6250 0 GENERAL SUPPORT - WELLNESS GRANT FY23 HEALTH & LIFE SKILLS PROGRAMMING RUNNING ZONE FOUNDATION INC 3696 N WICKHAM RD MELBOURNE FL 32935 263316016 501(C)(3) 5813 0 GENERAL SUPPORT - SPONSORSHIP FOR RACES 9 0 PART I, LINE 2: THE CAPE CANAVERAL HOSPITAL BOARD MONITORS USAGE BY EACH ENTITY TO ASSURE FUNDS ARE RAISED AND USED APPROPRIATELY. 1 1 0 0 0 0 0 0 0 STEVEN P JOHNSON PRESIDENT/CEO HFI (END 02/2023) 0 2162221 0 0 0 21206 0 8200 0 16872 0 2208499 0 0 MICHAEL A SCIALDONE EVP/CFO HFI (END 01/2023) 0 723726 0 0 0 173150 0 0 0 21100 0 917976 0 0 NICHOLAS W ROMANELLO ESQ ASSISTANT SECRETARY 0 588875 0 0 0 147808 0 8200 0 21100 0 765983 0 0 BRETT A ESROCK EXEC VP CFO/COO/ASST TREAS (BEG 01/2 0 725700 0 0 0 9552 0 8200 0 18299 0 761751 0 0 JEFFREY C STALNAKER MD SR VP CCO/ INTERIM CEO HOSP (BEG 01/ 0 714250 0 0 0 15751 0 6639 0 17993 0 754633 0 0 SHERRI CAPLAN DO MEDICAL STAFF PRES (END 12/2022) 0 544273 0 0 0 2622 0 0 0 16872 0 563767 0 0 VICTOR M VARGAS FORMER MED AFFAIRS COMM. HOSP (END 0 0 401660 0 0 0 2662 0 8200 0 10653 0 423175 0 0 ANITA A DHOPLE PHYSICIAN ADVISOR 0 313838 0 0 0 2622 0 5195 0 17678 0 339333 0 0 JAMES S MITCHELL III FORMER EXEC VP/COO HFI (EN 0 37156 0 0 0 288241 0 0 0 5007 0 330404 0 0 DANIEL R BOWEN HOSPITAL ADMINISTRATOR 0 272287 0 0 0 1710 0 6005 0 2903 0 282905 0 0 CLAY D SMITH RN 0 207860 0 0 0 968 0 6481 0 19905 0 235214 0 0 MICHELLE S ROGERS SYS DIR HOME CARE PRIVATE 0 185543 0 0 0 5524 0 6146 0 18730 0 215943 0 0 EDWARDS B ROBERTS II VP OF NURSING COMM HOSPITAL 0 188253 0 0 0 936 0 6217 0 18759 0 214165 0 0 MARTIN W ISENMAN MD FORMER TRUSTEE (END 9/2021 0 0 0 0 0 19132 0 0 0 0 0 19132 0 0 JOHN F BREITFELLER FORMER V CHAIR (END 9/2020 0 0 0 0 0 14356 0 0 0 0 0 14356 0 0 DALE A DETTMER ESQ FORMER TRUSTEE (END 9/2019 0 0 0 0 0 13968 0 0 0 0 0 13968 0 0 PAMELA A GATTO FORMER TRUSTEE (END 9/2021 0 0 0 0 0 11172 0 0 0 0 0 11172 0 0 PART I, LINE 3 COMPENSATION IS PAID BY HEALTH FIRST SHARED SERVICES, INC. EIN: 59-3336894 AND REIMBURSED BY CAPE CANAVERAL HOSPITAL, INC. SALARY AND BENEFITS EXPENSE DISCLOSED IN PART IX ARE ALLOCATED TO THIS ENTITY. THE FILING ORGANIZATION RELIED ON HEALTH FIRST SHARED SERVICES, INC. FOR ESTABLISHING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE SCHEDULE O NARRATIVE FOR PART VI, LINE 15A FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED. PART I, LINE 4A: THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS AND ARE INCLUDED IN TAXABLE COMPENSATION REPORTED ON 2022 FORM W-2: JAMES S. MITCHELL III $288,241 PART I, LINE 4B: THE FOLLOWING INDIVIDUALS PARTICIPATE IN CAP-EX (A SPLIT DOLLAR LIFE INSURANCE AGREEMENT IN PLACE OF A TRADITIONAL SERP) AND HAVE ESTABLISHED A PREMIUM DEPOSIT ACCOUNT. THE ACCOUNT IS CONNECTED TO THE INSURANCE POLICY AND WILL BE USED TO PAY FUTRE PREMIUMS ON THE POLICY. THE INDIVIDUALS ARE TAXED ON ANY EARNINGS GENERATED BY THIS ACCOUNT. DURING THE TAX YEAR, THE FOLLOWING INDIVIDUALS RECEIVED TAX WITHDRAWAL AMOUNTS TO COVER THEIR TAX LIABILITY. SEE HEALTH FIRST SHARED SERVICES, INC. (EIN: 59-3336894) FORM 990, AND RELATED SCHEDULES FOR FURTHER DETAILS ON THE PROGRAM. STEVEN P. JOHNSON $2,136 JAMES S. MITCHELL III $4,264 BRETT A. ESROCK $1,566 JEFFREY C. STALNAKER $0 MICHAEL A. SCIALDONE $0 FORM 990, PART IV, LINE 24A, BONDS ISSUED AFTER DECEMBER 31, 2002: THE FILING ORGANIZATION IS PART OF AN OBLIGATED GROUP THAT HAD MORE THAN $100,000 IN BONDS ISSUED AFTER DECEMBER 31, 2002 THAT WERE OUTSTANDING ON THE LAST DAY OF ITS TAX YEAR. THE FILING ORGANIZATION'S SHARE OF THESE OBLIGATIONS IS REPORTED ON PART X, LINE 20 OF HEALTH FIRST SHARED SERVICES, INC. THE PARENT OF THE OBLIGATED GROUP IS FILING SCHEDULE K ON BEHALF OF ITSELF AND ALL MEMBERS OF THE OBLIGATED GROUP. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF CAPE CANAVERAL HOSPITAL, INC. IS HEALTH FIRST SHARED SERVICES, INC. (HFSS), A FLORIDA NOT-FOR-PROFIT CORPORATION THAT SERVES AS THE CORPORATE PARENT OF THE HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A HEALTH FIRST SHARED SERVICES, INC. (HFSS), A SECTION 501(C)(3) EXEMPT ORGANIZATION AND THE PARENT OF THE EXEMPT HEALTHCARE SYSTEM, IS THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION WITH THE POWER TO ELECT OR APPOINT ANY MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B PER THE BYLAWS AND THE LAWS OF THE STATE OF FLORIDA, THE ADMINISTRATIVE POWER OF THE CORPORATION SHALL BE VESTED IN THE BOARD OF TRUSTEES WHICH SHALL HAVE CHARGE, CONTROL AND MANAGEMENT OF PROPERTY, AFFAIRS AND FUNDS OF THE CORPORATION. THE BOARD OF TRUSTEES SHALL NOT TAKE ANY ACTION WITH RESPECT TO THE FOLLOWING WITHOUT APPROVAL OF THE MEMBER: - CHANGE IN THE MISSION, PURPOSE OR SCOPE OF THE CORPORATION AND ITS OPERATION; - INCURRENCE OF DEBT OR GUARANTEE THE DEBT OF ANOTHER; - APPROVAL OF THE SALE, LEASE, PURCHASE, CONVEYANCE OR OTHER DISPOSITION OF ANY REAL OR OF ANY PERSONAL PROPERTY OF THE CORPORATION HAVING A FAIR MARKET VALUE IN EXCESS OF $250,000; - APPROVAL OF THE SALE, LEASE, PURCHASE, CONVEYANCE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; - APPROVAL OF ANNUAL OPERATING AND CAPITAL EXPENDITURE BUDGETS OF THE CORPORATION AND ANY MATERIAL DEVIATIONS FROM SUCH BUDGETS; -APPROVAL OF THE ENGAGEMENT OF ANY AUDITORS, LEGAL COUNSEL; OR CONSULTANT; - APPROVAL OF SIGNIFICANT CHANGES OF HUMAN RESOURCE AND EMPLOYEE BENEFIT, ACCOUNTING, FINANCIAL AND OTHER POLICIES AND PROCEDURES; - APPROVAL OF STRATEGIC LONG-RANGE PLANS, MAJOR FUND RAISING PROGRAMS AND FINANCIAL COMMITMENTS NOT BUDGETED OR APPROVED BY THE MEMBER; - CREATION, ACQUISITION, SALE, PURCHASE, DISSOLUTION OR OTHER DISPOSITION OF ANY AFFILIATED OR CONTROLLED ENTITY OR JOINT VENTURE OR ANY INTEREST IN SUCH ENTITY; - RELOCATION, IMPLEMENTATION OR DISCONTINUATION OF A MAJOR PROGRAM SERVICE; - THE APPROVAL OF MANAGED CARE AGREEMENTS; - THE REPEAL, AMENDMENT, OR RESTATEMENT OF ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION; AND - CAPITAL EXPENDITURES AND CAPITAL LEASES EXCEEDING $500,000 ANNUALLY OR $1,000,000 IN TOTAL ANNUALLY OR $1,000,000 IN TOTAL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY HEALTH FIRST'S TAX DEPARTMENT AND THEN REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. AFTER REVIEW AND APPROVAL BY THE SYSTEM VICE PRESIDENT CHIEF ACCOUNTING OFFICER, THE FORM 990 IS SENT TO EACH MEMBER OF THE BOARD OF TRUSTEES ELECTRONICALLY FOR THEIR REVIEW AND APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C A COPY OF THE CONFLICT OF INTEREST POLICY IS PROVIDED TO ALL ASSOCIATES, INCLUDING MANAGEMENT, IN WHICH THEY REVIEW AND ELECTRONICALLY ATTEST THAT THEY HAVE AGREED TO THE TERMS NOTED IN THE POLICY ON AN ANNUAL BASIS. IN ADDITION, SENIOR LEADERSHIP AND BOARD OF TRUSTEES MEMBERS ON AN ANNUAL BASIS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE PREPARED AND MONITORED BY THE CHIEF COMPLIANCE OFFICER. THE QUESTIONNAIRE REQUIRES AN ATTESTATION STATING THAT THE INDIVIDUAL IS FREE OF CONFLICTS SHOULD THEY NOT REPORT ANYTHING OF CONCERN. THESE FORMS ARE TRACKED AND KEPT ON FILE. SHOULD A CONFLICT ARISE, THE CHIEF COMPLIANCE OFFICER INVESTIGATES THE ISSUE AND DETERMINES A COURSE OF ACTION TO ENSURE ENFORCEMENT OF THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION PROCESS IS DETERMINED BY HEALTH FIRST SHARED SERVICES, INC. (HFSS). HFSS' PROCESS IS AS FOLLOWS: THE SALARIES OF THE CHIEF EXECUTIVE OFFICER AND OTHER HFSS EXECUTIVES ARE REVIEWED AND RECOMMENDED ANNUALLY TO THE BOARD OF TRUSTEES AND APPROVED IN EXECUTIVE SESSION BY THE FULL BOARD OF HFSS. HFSS CONTRACTS ANNUALLY, WITH A HIGHLY RESPECTED NATIONAL CONSULTING FIRM, TO PROVIDE THESE RECOMMENDATIONS TO ENSURE THAT OUR EXECUTIVES ARE COMPENSATED FAIRLY AND COMPETITIVELY WHEN COMPARED WITH SIMILAR ROLES IN OTHER HEALTHCARE ORGANIZATIONS NATIONALLY. THE COMPENSATION COMMITTEE IS INDEPENDENT FOR INTERNAL REVENUE CODE SECTION 4958 FOR THE INDIVIDUALS WHOSE SALARY IS REVIEWED. MINUTES ARE KEPT FOR ALL BOARD OF TRUSTEES AND COMPENSATION COMMITTEE MEETINGS. THE PROCESS IS DOCUMENTED CONTEMPORANEOUSLY IN THE BOARD AND COMMITTEE MEETINGS. FORM 990, PART VI, SECTION C, LINE 19 QUARTERLY AND ANNUALLY CONSOLIDATED FINANCIAL STATEMENTS AND CONSOLIDATED STATISTICAL INFORMATION IS FILED ELECTRONICALLY ON WWW.DACBOND.COM AND IS AVAILABLE TO THE PUBLIC. IN ADDITION, ANY REQUESTS MADE TO THE CHIEF FINANCIAL OFFICER FOR THE ABOVE REFERENCED ITEMS ARE PROVIDED UPON REQUEST IN A TIMELY MANNER. A COPY OF THE CONFLICTS OF INTEREST POLICY ARE AVAILABLE UPON REQUEST TO THE CHIEF COMPLIANCE OFFICER. DOCUMENTS ARE AVAILABLE FOR THE SAME PERIOD OF DISCLOSURE AS PROVIDED IN SECTION 6104(D). PART VII, SECTION A: BRETT A. ESROCK: FORMER SR. VP CEO HOSPITAL SERVICES/ EXEC VP CFO/COO/TREASURER (BEG 1/2023) JEFFREY C. STALNAKER: SR. VP CCO/INTERIM CEO HOSPITAL DIVISION (BEG 1/2023) VICTOR M. VARGAS FORMER MEDICAL AFFAIRS COMMUNITY HOSPITALS (END 07/2022) JAMES S. MITCHELL III: FORMER EXEC VP/COO HFI (END 09/2020) FORM 990, PART IX, LINE 11G HFMG HOSPITALISTS SUPPORT EXPENSE: PROGRAM SERVICE EXPENSES 6,676,625. MANAGEMENT AND GENERAL EXPENSES 686,549. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,363,174. RECRUITMENT: PROGRAM SERVICE EXPENSES 83,908. MANAGEMENT AND GENERAL EXPENSES 18,883. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 102,791. RELOCATION EXPENSES: PROGRAM SERVICE EXPENSES 14,561. MANAGEMENT AND GENERAL EXPENSES 3,276. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,837. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 9,329,920. MANAGEMENT AND GENERAL EXPENSES 1,938,616. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,268,536. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 1,703,411. MANAGEMENT AND GENERAL EXPENSES 383,336. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,086,747. FORM 990, PART XI, LINE 9: TRANSFER OF NET ASSETS TO A RELATED TAX-EXEMPT -7,125,792. TRANSFER OF NET ASSET TO FOUNDATION -616,915. FORM 990, PART XII, LINE 2C, AUDITED FINANCIAL STATEMENT: THE AUDIT COMMITTEE OF HEALTH FIRST REVIEWS AND APPROVES THE ANNUAL AUDIT AND COMPLIANCE AUDIT PLANS THEN MAKES ITS REPORT TO THE HEALTH FIRST BOARD OF TRUSTEES. THE AUDIT COMMITTEE IS RESPONSIBLE FOR THE SELECTION OF THE INDEPENDENT AUDITORS. THERE WAS NO CHANGE FROM PRIOR YEAR. CAPE CANAVERAL HOSPITAL, INC. WAS A SUBJECT TO A SINGLE AUDIT DURING THE YEAR BECAUSE OF FUNDS RECEIVED AS PART OF FEDERAL PROGRAMS RELATED TO COVID-19. THE SINGLE AUDIT WAS CONDUCTED ON A CONSOLIDATED BASIS AND INCLUDED ALL THE ORGANIZATIONS WITHIN HEALTH FIRST THAT RECEIVED FUNDS FROM THE PROGRAMS. HEALTH FIRST FOUNDATION INC 3300 FISKE BLVD ROCKLEDGE FL 32955 843851693 FUNDRAISING FL 501(C)(3) LINE 7 HEALTH FIRST SHARED SERVICES INC 1 HEALTH FIRST SHARED SERVICES INC 3300 FISKE BLVD ROCKLEDGE FL 32955 593336894 SHARED SERVICES FL 501(C)(3) LINE 10 HEALTH FIRST INC 0 HEALTH FIRST INC 3300 FISKE BLVD ROCKLEDGE FL 32955 593528774 SUPPORT ORG FL 501(C)(3) LINE 12B, II N/A 0 HOLMES REGIONAL MEDICAL CENTER INC 3300 FISKE BLVD ROCKLEDGE FL 32955 590624371 HOSPITAL FL 501(C)(3) LINE 3 HEALTH FIRST SHARED SERVICES INC 1 HOSPICE OF HEALTH FIRST INC 3300 FISKE BLVD ROCKLEDGE FL 32955 591911574 HEALTHCARE FL 501(C)(3) LINE 10 HEALTH FIRST SHARED SERVICES INC 1 VIERA HOSPITAL INC 3300 FISKE BLVD ROCKLEDGE FL 32955 264019868 HOSPITAL FL 501(C)(3) LINE 3 HEALTH FIRST SHARED SERVICES INC 1 HEALTH FIRST ADMINISTRATIVE PLANS INC 3300 FISKE BLVD ROCKLEDGE FL 32955 821851221 HEALTHCARE FL 501(C)(4) HEALTH FIRST SHARED SERVICES INC 1 HEALTH FIRST COMMERCIAL PLANS INC 3300 FISKE BLVD ROCKLEDGE FL 32955 821866443 HEALTHCARE FL 501(C)(4) HEALTH FIRST SHARED SERVICES INC 1 HEALTH FIRST HEALTH PLANS INC 3300 FISKE BLVD ROCKLEDGE FL 32955 472736029 HEALTHCARE FL 501(C)(4) HEALTH FIRST SHARED SERVICES INC 1 DOCTORS GI PARTNERSHIP LTD 3300 FISKE BLVD ROCKLEDGE FL 32955 593758988 HEALTHCARE FL N/A RELATED 0 0 CAPE HEALTH PROPERTIES INC 3300 FISKE BLVD ROCKLEDGE FL 32955 593086711 REAL ESTATE FL CAPE CANAVERAL HOSPITAL INC C 851579 3003649 1.00000 1 DOCTOR'S SURGICAL PARTNERSHIP LLC 3300 FISKE BLVD ROCKLEDGE FL 32955 593348252 HEALTH CARE FL N/A C 1 HEALTH FIRST HOLDING CORP 3300 FISKE BLVD ROCKLEDGE FL 32955 593509709 HOLDING CORP. FL N/A C 1 HEALTH FIRST INSURANCE INC 3300 FISKE BLVD ROCKLEDGE FL 32955 453131932 HEALTH CARE FL N/A C 1 HEALTH FIRST MEDICAL MANAGEMENT INC 3300 FISKE BLVD ROCKLEDGE FL 32955 593348252 HEALTH CARE FL N/A C 1 HEALTH FIRST PHYSICIAN SPECIALTIES 3300 FISKE BLVD ROCKLEDGE FL 32955 263094596 HEALTH CARE FL N/A C 1 HEALTH FIRST PHYSICIANS INC 3300 FISKE BLVD ROCKLEDGE FL 32955 593346397 HEALTH CARE FL N/A C 1 HOLMES REGIONAL ENTERPRISES INC 3300 FISKE BLVD ROCKLEDGE FL 32955 592109953 REAL ESTATE FL N/A C 1 PHYSICIANS GI PARTNERSHIP INC 3300 FISKE BLVD ROCKLEDGE FL 32955 593756961 HEALTH CARE FL N/A C 1 SPACE COAST INDEMNITY PO BOX 1051 GRAND CAYMAN CJ KY1-1102 981612801 SELF-INSURANCE CJ N/A C 1 1 0 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 HOLMES REGIONAL ENTERPRISES INC A 4101 SEE PART VII HOSPICE OF HEALTH FIRST INC A 41062 SEE PART VII HEALTH FIRST FOUNDATION INC C 210966 SEE PART VII HOLMES REGIONAL MEDICAL CENTER INC K 176515 SEE PART VII VIERA HOSPITAL INC Q 60804 SEE PART VII HOLMES REGIONAL MEDICAL CENTER INC Q 192645 SEE PART VII HEALTH FIRST FOUNDATION INC R 616916 SEE PART VII FORM 990, SCHEDULE R, PART V: ALL TRANSACTIONS REPORTED IN THIS SECTION ARE BASED UPON CORPORATE BOOKS AND RECORDS WHICH ARE KEPT ACCORDING TO GENERALLY ACCEPTED ACCOUNTING PRINCIPLES.