2024-01-23T15:20:54-06:00 2022-12-31 990 2022-01-01 593149293 SOUTHWEST VOLUSIA HEALTHCARE CORPORATION SOUT 3869175000 1055 SAXON BOULEVARD ORANGE CITY FL 32763 LYNN C ADDISCOTT ASSISTANT SECRETARY 4073572317 2024-01-22 LYNN ADDISCOTT 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ADVENTHEALTH FISH MEMORIAL LORENZO BROWN 1055 SAXON BOULEVARD ORANGE CITY FL 32763 243104000 0 X WWW.ADVENTHEALTH.COM/HOSPITAL/ X 1992 FL THE PROVISION OF MEDICAL CARE TO THE COMMUNITY SERVED THROUGH THE OPERATION OF A 253 BED HOSPITAL. 15 9 1525 50 108161 0 127012 181336 235786377 240588935 5556597 994212 0 0 241469986 241764483 104522 102262 0 0 69234004 76337763 0 0 0 156742002 159066053 226080528 235506078 15389458 6258405 312751673 271674096 109170066 75913889 203581607 195760207 X ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION AND ALL ITS SUBSIDIARY ORGANIZATIONS WERE ESTABLISHED BY THE SEVENTH-DAY ADVENTIST CHURCH TO BRING A MINISTRY OF HEALING AND HEALTH TO THE COMMUNITIES SERVED. OUR MISSION IS TO EXTEND THE HEALING MINISTRY OF CHRIST.THE HOSPITAL AND HEALTHCARE SYSTEM WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION IS KNOWN AS ADVENTHEALTH. ADVENTHEALTH SEEKS TO BE WIDELY RESPECTED AS A CONSUMER-FOCUSED ORGANIZATION THAT ENGAGES INDIVIDUALS IN THEIR HEALTH BY DELIVERING WHOLISTIC, BEST PRACTICE CARE ACROSS A CONNECTED, COMPREHENSIVE CONTINUUM OF SERVICES. WITH CHRIST AS OUR EXAMPLE, ADVENTHEALTH CARES FOR AND NURTURES PEOPLE: OUR EMPLOYEES, OUR COMMUNITIES, OUR HEALTHCARE PROFESSIONALS, AND THOSE WHO TRUST US FOR CARE AND HEALING. 0 0 221765595 102262 240480774 THE ORGANIZATION'S EXEMPT PURPOSE INCLUDES THE PROVISION OF MEDICAL CARE TO THE SURROUNDING COMMUNITY THROUGH THE OPERATION OF A 253-BED INPATIENT FACILITY & A RELATED OUTPATIENT FACILITY PROVIDING AMBULATORY SURGERY, DIAGNOSTIC RADIOLOGY, (INCLUDING MRI AND CT SCANNERS), LABORATORY SERVICES AND PHYSICAL THERAPY. THERE WERE 10,097 PATIENT ADMISSIONS, 49,395 PATIENT DAYS, 126,099 OUTPATIENT VISITS, AND 115,845 PHYSICIAN PRACTICE PATIENT VISITS DURING THE CURRENT YEAR. 221765595 1 1 0 1 0 0 0 0 0 0 1 0 0 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 X 0 0 1 1525 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X KYLE GLASS 3869434455 1055 SAXON BOULEVARD ORANGE CITY FL 32763 X OTTATI DAVID FORMER CEO CFN REG 0.00 50.00 X 0 3686151 220120 BANKS DAVID DIRECTOR/AH CHIEF STRATEGY 0.20 50.00 X 0 2647274 205822 CELANO PATRICIA FORMER REGIONAL CCO 0.00 50.00 X 0 1713469 157405 GREGORY PHD AUDREY DIR/CHAIR/CEO CFN REGION 6.00 44.00 X X 0 1335554 231534 THOMAS DEBORA DIRECTOR 0.20 50.00 X 0 817018 101436 DEININGER ROBERT FORMER CEO 0.00 50.00 X 0 736963 140188 BROWN LORENZO DIRECTOR/CEO-HOSPITAL/W.VOLUSIA MKT 40.00 10.00 X X 0 562472 125132 KNYCH MD STEPHEN CMO - REG & HOSPITAL FACIL 40.00 10.00 X 0 568140 85057 WEIS DAVID DIRECTOR (END 09/22) 0.20 50.00 X 0 523042 117147 CALLA MD SHRISH DIRECTOR 0.20 50.00 X 0 455111 48925 LUNDE ERIC DIRECTOR (BEG 09/22) 0.20 50.00 X 0 370922 109691 GLASS KYLE CFO - HOSPITAL/W.VOLUSIA MKT 35.00 15.00 X 0 356649 60853 CHILSON APRIL COO - HOSPITAL FACILITY (BEG 01/22) 50.00 0.00 X 0 298503 54677 JOHNSON MICHELE CNO - HOSPITAL FACILITY 50.00 0.00 X 0 264021 53270 OSTARLY ERIC FORMER CFO (END 04/22) 0.00 50.00 X 0 287630 23786 ADADZI WINIFRED AH FISH DIR PHARMACY 50.00 0.00 X 186955 0 37132 MCKAY LOREN AH FISH PHARMACIST 50.00 0.00 X 165823 0 38297 STERLING-SMITH DEBBIE-ANN AH FISH PHARMACIST 50.00 0.00 X 168932 0 23278 GHANSAH JACQULYN AH FISH REGISTERED NURSE 50.00 0.00 X 184751 0 3855 LUKE LUTIFIYAH AH FISH REGISTERED NURSE 50.00 0.00 X 167317 0 8136 JOHNSON DANIELLE COO - HOSPITAL FACILITY (END 01/22) 0.00 0.00 X 0 170774 1021 DESAI MD ROHAN DIRECTOR (END 12/22) 0.20 0.40 X 2853 0 0 GUPTA MD VISHAL DIRECTOR 0.20 0.20 X 1978 0 0 BOWMAN MD KURT DIRECTOR 0.20 0.20 X 1728 0 0 FOLEY DOUG DIRECTOR 0.20 0.10 X 253 0 0 NORTHEY PATRICIA DIRECTOR 0.20 0.10 X 253 0 0 PATTERSON PAT DIRECTOR 0.20 0.10 X 253 0 0 RITCHEYJEFF DIRECTOR 0.20 0.10 X 253 0 0 VALDERRAMA CARLOS DIRECTOR 0.20 0.10 X 253 0 0 WANAMAKER JOHN DIRECTOR 0.20 0.10 X 253 0 0 881855 14793693 1846762 152 1 1 0 AMN HEALTHCARE INC 12400 HIGH BLUFF DRIVE SAN DIEGO CA 92130 AGENCY FEES 10023111 CROTHALL HEALTHCARE INC 1500 LIBERTY RIDGE DRIVE 210 WAYNE PA 19087 CLEANING & BIO MED MAINTENANCE SERVICES 3982816 USAP-FL US ANESTHESIA PARTNERS 12222 MERIT DRIVE SUITE 600 DALLAS TX 75251 ANESTHESIOLOGY SERVICES 2854902 FIDE LLC 624 GRASSMERE PARK SUITE 16 NASHVILLE TN 37211 AGENCY FEES 2712793 AYA HEALTHCARE INC 5930 CORNERSTONE COURT W SUITE 300 SAN DIEGO CA 92121 AGENCY FEES 2139829 36 X 58831 122505 181336 NET PATIENT REVENUE 622110 235933086 235824925 108161 REIMB OF EXP- TE AFFILIATE 622110 3496513 3496513 CAFETERIA REVENUE 622110 737638 737638 GIFT SHOP REVENUE 622110 254758 254758 RENT FROM EXEMPT AFFILIATES 622110 114414 114414 52526 52526 240588935 2328128 2328128 5601 1339517 0 -1339517 5601 -1333916 -1333916 241764483 240480774 108161 994212 X 102262 102262 2229214 5800 2223414 54511443 54511443 2096797 2062632 34165 12207260 11869005 338255 5293049 5206804 86245 536444 536444 50949 50949 229293 229293 84001564 76605302 7396262 436279 436279 3487542 2312042 1175500 12391347 11654380 736967 6060437 6060437 102989 102989 103647 103647 1243613 1243613 11490657 11490657 361841 278417 83424 MEDICAL SUPPLIES 29665422 29665422 STATE TAX INDIGENT ASSE 4325416 4325416 REPAIRS & MAINTENANCE 4307599 4307599 UBI TAXES -769 -769 271783 64364 207419 235506078 221765595 13740483 0 3259 2788 96443418 57852977 29286282 27282054 3637439 3958822 7719506 8670948 307227430 142079125 168293265 165148305 135873 -45744 166996 148815 7065635 8655131 312751673 271674096 26291291 15653511 82878775 60260378 109170066 75913889 X 203506000 195684600 75607 75607 203581607 195760207 312751673 271674096 X 6258405 -12370728 -1709077 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7215 7215 0 PART II-B, LINE 1: AMERICAN HOSPITAL ASSOCIATION DUES AND FLORIDA HOSPITAL ASSOCIATION DUES. 20554680 20554680 171880646 69566009 102314637 101382032 65381219 36000813 13410072 7131897 6278175 165148305 DUE TO RELATED 7178019 PAYABLE TO THIRD PARTIES 2138447 CREDIT BALANCES IN A/R 1369943 OTHER DEFERRED REVENUE 820657 ACCRUED INTEREST PAYABLE 6808 INTERCO. ALLOC OF TE BOND PROCEEDS 45272199 OPERATING LEASE LIABILITY 3440296 OTHER LIABILITIES 34009 60260378 X PART X, LINE 2: THE FILING ORGANIZATION IS A SUBSIDIARY ORGANIZATION WITHIN ADVENTHEALTH. THE CONSOLIDATED FINANCIAL STATEMENTS OF ADVENTHEALTH CONTAIN THE FOLLOWING FIN 48 (ASC 740) FOOTNOTE: PLEASE NOTE THAT DOLLAR AMOUNTS ARE IN THOUSANDS. HEALTHCARE CORPORATION AND ITS AFFILIATED ORGANIZATIONS, OTHER THAN NORTH AMERICAN HEALTH SERVICES, INC. AND ITS SUBSIDIARY (NAHS), ARE EXEMPT FROM STATE AND FEDERAL INCOME TAXES. ACCORDINGLY, HEALTHCARE CORPORATION AND ITS TAX-EXEMPT AFFILIATES ARE NOT SUBJECT TO FEDERAL, STATE OR LOCAL INCOME TAXES EXCEPT FOR ANY NET UNRELATED BUSINESS TAXABLE INCOME. NAHS IS A WHOLLY OWNED, FOR-PROFIT SUBSIDIARY OF HEALTHCARE CORPORATION. NAHS AND ITS SUBSIDIARY ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. NAHS FILES A CONSOLIDATED FEDERAL INCOME TAX RETURN AND, WHERE APPROPRIATE, CONSOLIDATED STATE INCOME TAX RETURNS. ALL TAXABLE INCOME WAS FULLY OFFSET BY NET OPERATING LOSS CARRYFORWARDS FOR FEDERAL INCOME TAX PURPOSES; AS SUCH, THERE IS NO PROVISION FOR CURRENT FEDERAL OR STATE INCOME TAX FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021. NAHS ALSO HAS TEMPORARY DEDUCTIBLE DIFFERENCES OF APPROXIMATELY $18,200 AND $33,000 AT DECEMBER 31, 2022 AND 2021, RESPECTIVELY, PRIMARILY AS A RESULT OF NET OPERATING LOSS CARRYFORWARDS. AT DECEMBER 31, 2022, NAHS HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $10,000, EXPIRING IN 2023 THROUGH 2026. DEFERRED TAXES HAVE BEEN PROVIDED FOR THESE AMOUNTS, RESULTING IN A NET DEFERRED TAX ASSET OF APPROXIMATELY $4,500 AND $8,100 AT DECEMBER 31, 2022 AND 2021, RESPECTIVELY. NAHS REMEASURED ITS DEFERRED TAX ASSETS AND LIABILITIES BASED ON THE RATES AT WHICH THEY ARE EXPECTED TO REVERSE IN THE FUTURE, WHICH IS GENERALLY 21%. A FULL VALUATION ALLOWANCE HAS BEEN PROVIDED AT DECEMBER 31, 2022 AND 2021 TO OFFSET THE DEFERRED TAX ASSET SINCE HEALTHCARE CORPORATION HAS DETERMINED THAT IT IS MORE LIKELY THAN NOT THAT THE BENEFIT OF THE NET OPERATING LOSS CARRYFORWARDS WILL NOT BE REALIZED IN FUTURE YEARS. THE INCOME TAXES TOPIC OF THE ACCOUNTING STANDARDS CODIFICATION (ASC) (ASC 740) PRESCRIBES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAX POSITIONS RECOGNIZED IN FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN, OR EXPECTED TO BE TAKEN, IN A TAX RETURN. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2022 AND 2021. 1 1 X 1 X 1 X 1 1 1 0 1 0 9539043 9539043 0.04050 36212238 16415651 19796587 0.08410 45751281 16415651 29335630 0.12460 11108 11108 0.00000 44174 44174 0.00020 55282 55282 0.00020 45806563 16415651 29390912 0.12480 727 727 0.00000 727 727 0.00000 1 14768734 2235977 38585215 42119932 -3534717 X 1 1 1 ORANGE CITY SURGICAL LLC OUTPATIENT SURGICAL CENTER 0.25000 0.00000 0.75000 1 1 ADVENTHEALTH FISH MEMORIAL 1055 SAXON BLVD ORANGE CITY FL 32763 WWW.ADVENTHEALTH.COM/HOSPITAL/ADVENTHE 4408 X X X ADVENTHEALTH FISH MEMORIAL 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE PART V, PAGE 8 X X 1 20 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 ADVENTHEALTH FISH MEMORIAL PART V, SECTION B, LINE 5: SOUTHWEST VOLUSIA HEALTHCARE CORPORATION, D/B/A ADVENTHEALTH FISH MEMORIAL (AHFM OR THE HOSPITAL) OPERATES A HOSPITAL IN VOLUSIA COUNTY, FLORIDA WITH A TOTAL OF 253 LICENSED BEDS. FOR PURPOSES OF ITS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL DEFINED ITS COMMUNITY AS ITS PRIMARY SERVICE AREA FROM WHICH 70% OF ITS PATIENTS COME. AS A PART OF ITS EFFORTS TO ENSURE BROAD COMMUNITY-BASED INPUT INTO THE CHNA PROCESS, THE HOSPITAL PARTICIPATED IN THE VOLUSIA/FLAGLER COUNTIES CHNA COLLABORATIVE (THE COLLABORATIVE) TO HELP GUIDE THE HOSPITAL THROUGH THE ASSESSMENT PROCESS. THE COLLABORATIVE INCLUDED REPRESENTATION FROM THE HOSPITAL, PUBLIC HEALTH EXPERTS AND THE BROAD COMMUNITY WITH INTENTIONAL REPRESENTATION FROM LOW-INCOME, MINORITY AND OTHER UNDERSERVED POPULATIONS. THE COLLABORATIVE COLLECTED INPUT DIRECTLY FROM THE COMMUNITY AND COMMUNITY STAKEHOLDERS, INCLUDING INDIVIDUALS WORKING IN ORGANIZATIONS THAT ADDRESS THE NEEDS AND INTERESTS OF THE COMMUNITY. PRIMARY DATA WAS COLLECTED THROUGH A COMMUNITY SURVEY, STAKEHOLDER INTERVIEWS, AND FOCUS GROUPS. A TOTAL OF 50 STAKEHOLDERS PARTICIPATED IN THE COLLABORATIVE AND INCLUDED THE FOLLOWING ORGANIZATIONS WHICH SPECIFICALLY ADDRESS THE NEEDS OF THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY MEMBERS OF THE HOSPITAL'S COMMUNITY. SMA HEALTHCARE, PROVIDING BEHAVIORAL HEALTH SERVICES,ADDICTION EDUCATION FOUNDATION,AFRICAN AMERICAN ENTREPRENEURS ASSOCIATION, INC.,BLACK HOMESCHOOLERS OF CENTRAL FLORIDA,CARVER CENTER,CATALYST GLOBAL YOUTH INITIATIVES, INC.,CHISHOLM COMMUNITY CENTER IN DELAND,DEPARTMENT OF HEALTH IN VOLUSIA COUNTY,DEPARTMENT OF HEALTH IN FLAGLER COUNTY,EARLY LEARNING COALITION OF FLAGLER AND VOLUSIA,EASTERSEALS NORTHEAST CENTRAL FLORIDA,FAMILY LIFE CENTER,FLAGLER CARES/ONE VOICE FOR VOLUSIA,FLAGLER COUNTY FREE CLINIC,FLAGLER COUNTY SCHOOL BOARD,FLAGLER NAACP,FLAGLER OARS,FLAGLER SHELTERING TREE,FOOD BRINGS HOPE,HALIFAX URBAN MINISTRIES,HEALTHY START COALITION OF FLAGLER AND VOLUSIA COUNTIES,JESUS CLINIC,UNITED WAY OF VOLUSIA/FLAGLER COUNTIES,VOLUSIA COUNTY SCHOOLS, ANDVOLUSIA/FLAGLER COALITION FOR THE HOMELESS. ADVENTHEALTH FISH MEMORIAL 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. ADVENTHEALTH FISH MEMORIAL PART V, SECTION B, LINE 11: SEE LINE 11 FOOTNOTE BELOW. ADVENTHEALTH FISH MEMORIAL PART V, SECTION B, LINE 13H: EFFECTIVE MARCH 1, 2020, THE FILING ORGANIZATION'S HOSPITAL FACILITY (OR FACILITIES) AUGMENTED THEIR FINANCIAL ASSISTANCE POLICY WITH A COVID-19 FINANCIAL GRACE ADDENDUM. PURSUANT TO THE COVID-19 FINANCIAL GRACE ADDENDUM, UNINSURED PATIENTS TREATED FOR COVID-19 RELATED EVALUATIONS ARE TO RECEIVE FREE OR DISCOUNTED CARE DEPENDING ON THE PATIENT'S COOPERATION IN SUBMITTING NECESSARY FINANCIAL ASSISTANCE INFORMATION. INSURED PATIENTS TESTED FOR COVID-19 ARE NOT EXPECTED TO HAVE OUT-OF-POCKET EXPENSES BASED ON INSURANCE COMMUNITY RESPONSE TO WAIVE PATIENT FINANCIAL RESPONSIBILITY. IF A PAYER UNEXPECTEDLY FAILS TO WAIVE PATIENT RESPONSIBILITY FOR COVID-19 RELATED TESTING, THE FILING ORGANIZATION WILL NOT BALANCE BILL PATIENTS FOR ANY OUT-OF-POCKET EXPENSES RELATED TO COVID-19. IN ADDITION, PATIENTS WITH EXISTING PAYMENT PLANS ARE PROVIDED OPPORTUNITIES FOR REDUCING THEIR MONTHLY PAYMENTS. SCHEDULE H, PART V, SECTION B, LINE 7A: THE CHNA REPORT FOR ADVENTHEALTH FISH MEMORIAL CAN BE FOUND AT URL:HTTPS://WWW.ADVENTHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS SCHEDULE H, PART V, SECTION B, LINES 8-10A: CHNA IMPLEMENTATION STRATEGY:THE FILING ORGANIZATION ADOPTED A COMMUNITY HEALTH NEEDS ASSESSMENT REPORT BY 12/31/2022 AND WAS IN THE PROCESS OF DEVELOPING ITS COMMUNITY HEALTH NEEDS IMPLEMENTATION STRATEGY AT THAT TIME. THE FILING ORGANIZATION'S 2023-2025 COMMUNITY HEALTH NEEDS IMPLEMENTATION STRATEGY IS DOCUMENTED IN A WRITTEN REPORT CALLED THE "COMMUNITY HEALTH PLAN". THE COMMUNITY HEALTH PLAN (CHP) DESCRIBES HOW THE FILING ORGANIZATION PLANS TO MEET ITS IDENTIFIED PRIORITIZED HEALTH NEEDS OR IDENTIFIES THE HEALTH NEED AS ONE THE FILING ORGANIZATION DOES NOT INTEND TO SPECIFICALLY ADDRESS AND PROVIDES AN EXPLANATION AS TO WHY THE FILING ORGANIZATION DOES NOT INTEND TO ADDRESS THAT HEALTH NEED. THE FILING ORGANIZATION'S 2023-2025 CHP WAS ADOPTED BY MAY 15, 2023 AND IS POSTED ON THE HOSPITAL FACILITY'S WEBSITE.SCHEDULE H, PART V, SECTION B, LINE 10A:THE HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND AT:HTTPS://WWW.ADVENTHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS SCHEDULE H, PART V, SECTION B, LINE 11: SOUTHWEST VOLUSIA HEALTHCARE CORPORATION D/B/A ADVENTHEALTH FISH MEMORIAL WILL BE REFERRED TO IN THIS DOCUMENT AS ADVENTHEALTH FISH MEMORIAL OR "THE HOSPITAL".THE HOSPITAL IS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS THE 501(C)(3) PARENT ORGANIZATION OF A HOSPITAL AND HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. IN JANUARY 2019, EVERY WHOLLY OWNED ENTITY OF AHSSHC ADOPTED THE ADVENTHEALTH SYSTEM BRAND. OUR IDENTITY HAS BEEN UNIFIED TO REPRESENT THE FULL CONTINUUM OF CARE OUR SYSTEM OFFERS. ANY REFERENCES TO OUR PRIOR COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNAS) OR PRIOR COMMUNITY HEALTH PLANS (CHPS) WILL UTILIZE OUR NEW NAME FOR CONSISTENCY.ADVENTHEALTH FISH MEMORIAL IS INCLUDED IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH. CENTRAL FLORIDA DIVISION - NORTH REGION (THE DIVISION) INCLUDES ADVENTHEALTH DAYTONA BEACH, ADVENTHEALTH DELAND, ADVENTHEALTH FISH MEMORIAL, ADVENTHEALTH NEW SMYRNA BEACH, ADVENTHEALTH PALM COAST, AND ADVENTHEALTH WATERMAN. THE CENTRAL FLORIDA DIVISION INCLUDES 14 HOSPITALS.THIS IS THE THIRD-YEAR UPDATE FOR ADVENTHEALTH FISH MEMORIAL'S 2020-2022 COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY. THE HOSPITAL DEVELOPED THIS PLAN AND POSTED IT IN MAY 2020 AS PART OF ITS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS.FOR THE DEVELOPMENT OF BOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY, ADVENTHEALTH FISH MEMORIAL WORKED TO DEFINE AND ADDRESS THE NEEDS OF LOW-INCOME, MINORITY AND UNDERSERVED POPULATIONS IN ITS SERVICE AREA. THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT USED PRIMARY DATA INTERVIEWS AND SURVEYS; SECONDARY DATA FROM LOCAL, REGIONAL, AND NATIONAL HEALTH-RELATED SOURCES; AND HOSPITAL PREVALENCE DATA TO HELP THE HOSPITAL DETERMINE THE HEALTH NEEDS OF THE COMMUNITY IT SERVES.ONCE THE DATA WAS GATHERED, THE PRIMARY ISSUES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT WERE PRIORITIZED BY COMMUNITY AND HOSPITAL STAKEHOLDERS, WHO THEN SELECTED KEY ISSUES FOR THE HOSPITAL TO ADDRESS IN ITS 2020-2022 COMMUNITY HEALTH PLAN. THE THIRD-YEAR PROGRESS ON THE COMMUNITY HEALTH PLAN IS NOTED BELOW. THE NARRATIVE DESCRIBES THE PRIORITIZED ISSUES IDENTIFIED IN 2019 AND GIVES AN UPDATE ON THE STRATEGIES ADDRESSING THOSE ISSUES. THERE IS ALSO A DESCRIPTION OF THE IDENTIFIED ISSUES THAT THE HOSPITAL DID NOT ADDRESS. ADVENTHEALTH FISH MEMORIAL CHOSE FIVE PRIORITIES FOR ITS 2020-2022 COMMUNITY HEALTH PLAN: 1. ADULT & YOUTH BEHAVIORAL HEALTH 2. CARDIOVASCULAR DISEASES & DIABETES 3. BARRIERS TO ACCESSING HEALTH CARE SERVICES 4. HEALTHY EATING & PHYSICAL ACTIVITY 5. SOCIAL AND ECONOMIC ISSUES (SOCIAL DETERMINANTS OF HEALTH) PRIORITY 1: ADULT & YOUTH BEHAVIORAL HEALTH 2019 DESCRIPTION OF THE ISSUE:ALCOHOL USE - HEAVY/BINGE DRINKING HAS INCREASED SLIGHTLY FROM 2010 TO 2016. THE PERCENT IS HIGHEST FOR WHITE INDIVIDUALS. - VOLUSIA COUNTY ALCOHOL-SUSPECTED MOTOR VEHICLE CRASHES AND TRAFFIC CRASH INJURIES' RATES HAVE DECREASED SINCE 2014 BUT ARE SLIGHTLY HIGHER THAN FLORIDA. - ALCOHOL-SUSPECTED TRAFFIC CRASH DEATHS INCREASED BETWEEN 2015 AND 2016 IN VOLUSIA COUNTY AND THE VOLUSIA COUNTY RATE IS HIGHER THAN FLORIDA. - THE PERCENT OF STUDENT ALCOHOL USE HAS BEEN DECREASING SINCE 2008 BUT REMAINS SLIGHTLY HIGHER THAN FLORIDA. SMOKING AND SUBSTANCE MISUSE - VOLUSIA COUNTY'S RATE OF OPIOID-INVOLVED OVERDOSE HOSPITALIZATIONS INCREASED FROM 2015 TO 2017 AND IS HIGHER THAN FLORIDA'S. THE RATE OF DEATH FROM OPIOID OVERDOSES INCREASED IN THE LAST YEAR AND NOW EXCEEDS THE FLORIDA RATE. - THE PERCENT OF VOLUSIA COUNTY ADULTS WHO SMOKE IS HIGHER THAN FLORIDA. - THE PERCENT OF VOLUSIA COUNTY MIDDLE AND HIGH SCHOOL STUDENTS USING MARIJUANA DECREASED BETWEEN 2016 AND 2018 BUT REMAINS HIGHER THAN FLORIDA. - REPORTED CIGARETTE USE AMONG VOLUSIA COUNTY MIDDLE AND HIGH SCHOOL STUDENTS HAS DECLINED, BUT BOTH RATES REMAIN HIGHER THAN FLORIDA.MENTAL HEALTH- THE PERCENT OF VOLUSIA COUNTY ADULTS WHO HAD 14 OR MORE POOR MENTAL HEALTH DAYS IN THE LAST MONTH IS HIGHER THAN FLORIDA. - THE PERCENT OF VOLUSIA COUNTY ADULTS WITH A DEPRESSIVE DISORDER IS HIGHER THAN FLORIDA. - VOLUSIA COUNTY'S SUICIDE RATE IS INCREASING AND IS HIGHER THAN FLORIDA'S.- VOLUSIA COUNTY'S AGE 19-21 RATE OF HOSPITALIZATIONS FOR SELF-INFLICTED INJURIES HAS INCREASED BUT IS LOWER THAN FLORIDA'S.2022 UPDATE:THE ADVENTHEALTH FISH MEMORIAL COMMUNITY HEALTH PLAN HAS FIVE DESIRED GOAL STATEMENTS UNDER THE ADULT & YOUTH BEHAVIORAL HEALTH PRIORITY.1. ESTABLISH A MULTI-AGENCY REFERRAL AND COMMUNICATION MANAGEMENT SYSTEM IN VOLUSIA/FLAGLER COUNTY TO EFFECTIVELY CONNECT INDIVIDUALS IN NEED TO BEHAVIORAL HEALTH CARE SERVICES.2. PROVIDE SPECIAL PROGRAMS FOR AT-RISK STUDENTS IN THE DELTONA AREA. 3. PROVIDE ACCESS TO TOBACCO CESSATION SUPPORT. 4. PROVIDE ONE STOP CENTER FOR HEALTH AND HUMAN SERVICES IN DELTONA FOR BEHAVIORAL HEALTH. 5. ESTABLISH STRESS RESILIENCE WORKSHOP FOR YOUTH TO TEACH STRESS MANAGEMENT SKILLS THROUGH POSITIVE PSYCHOLOGICAL APPROACHES.GOAL 1: ESTABLISH A MULTI-AGENCY REFERRAL AND COMMUNICATION MANAGEMENT SYSTEM IN VOLUSIA/FLAGLER COUNTY TO EFFECTIVELY CONNECT INDIVIDUALS IN NEED TO BEHAVIORAL HEALTH CARE SERVICES.OBJECTIVE 1: THE FIRST OBJECTIVE IS A DIVISIONAL INITIATIVE AND APPEARS ON MULTIPLE COMMUNITY HEALTH PLANS OF HOSPITALS IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, THE SAME DIVISION AS THE REPORTING HOSPITAL. THE HOSPITALS PARTNERED ON THIS INITIATIVE BECAUSE OF A SHARED CHNA PRIORITY. THE OBJECTIVE IS TO SUPPORT THE DEVELOPMENT OF A PILOT PROJECT TO CONNECT HEALTH AND BEHAVIORAL HEALTH SYSTEMS THROUGH THE UTILIZATION OF A REFERRAL AND COMMUNICATION MANAGEMENT TECHNOLOGY SYSTEM TO BE LAUNCHED BY THE END OF YEAR TWO. THIS OBJECTIVE IS MANAGED AT A DIVISIONAL LEVEL AND OUTCOMES ARE REPORTED AT A DIVISIONAL LEVEL; HOWEVER, ALL FUNDING IS SPECIFIC TO THE REPORTING HOSPITAL. THE HOSPITAL'S SUPPORT PROVIDES FUNDING TO FLAGLER CARES, A LOCAL NOT-FOR-PROFIT, WHICH FOCUSES ON INCREASING CAPACITY AND COORDINATION FOR HEALTH AND HUMAN SERVICES PROGRAMS, FOR THE PLANNING AND IMPLEMENTATION OF A DIGITAL SOLUTION TO FACILITATE REFERRALS TO BEHAVIORAL HEALTH SERVICES, AND TO INCREASE ACCESS TO CARE AND IMPROVE HEALTH. THE DIVISION MET ITS SET METRIC THROUGH THE LAUNCH OF A PLAN TO SUPPORT THE LARGER OBJECTIVE. FLAGLER CARES LAUNCHED THE LINKING INDIVIDUALS TO NETWORK OF CARE (LINC) FLAGLER VOLUSIA REFERRAL MANAGEMENT SYSTEM IN AUGUST 2021 WITH AN INITIAL FOCUS ON BEHAVIORAL HEALTH SERVICES. DURING 2022, TWENTY-EIGHT ORGANIZATIONS PARTICIPATED IN THE NETWORK AND 999 REFERRALS WERE SENT THROUGH THE SYSTEM.** SEE CONTINUATION SCHEDULE H, PART V, SECTION B, LINE 11 CONTINUATION GOAL 2: PROVIDE SPECIAL PROGRAMS FOR AT-RISK STUDENTS IN THE DELTONA AREA. OBJECTIVE 1: THE FIRST OBJECTIVE IS TO SUPPORT A BEFORE-SCHOOL CLUB AT GALAXY MIDDLE SCHOOL, WHICH SERVES 30 AT-RISK MIDDLE SCHOOL YOUNG MEN ANNUALLY, WITH A FACULTY SPONSOR TO FOCUS ON PROVIDING YOUTH OPPORTUNITIES FOR SELF-DEVELOPMENT AND INSPIRE YOUTH TO GROW INTO HEALTHY WELL-BALANCED ADULTS. THIS OBJECTIVE IS MANAGED AT A DIVISIONAL LEVEL AND APPEARS ON SEVERAL COMMUNITY HEALTH PLANS IN THE DIVISION; HOWEVER, ALL FUNDING AND OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE HOSPITAL'S FINANCIAL SUPPORT PROVIDES ACCESS TO A FOCUSED YOUTH DEVELOPMENT PROGRAM FOR AT-RISK MIDDLE SCHOOL YOUTH. THE OBJECTIVE WAS MODIFIED BECAUSE COVID-19 AFFECTED THE ABILITY TO BEGIN A BEFORE-SCHOOL CLUB AT GALAXY MIDDLE SCHOOL. THE HOSPITAL PIVOTED TO MEET ITS MODIFIED OBJECTIVE WHICH IS TO SUPPORT AT-RISK YOUTH IN THE ORANGE CITY AREA. A TOTAL OF $13,750 IN FUNDING SUPPORT WAS PROVIDED TO BLACK HOMESCHOOLERS OF CENTRAL FLORIDA, THE EARLY LEARNING COALITION OF FLAGLER AND VOLUSIA, SISTERS BUILD GIRLS UNITY, AND THE VOLUSIA COUNTY HISPANIC ASSOCIATION ON INITIATIVES BENEFITING OVER 1,500 AT RISK YOUTH. INITIATIVES SUPPORTED PARENTS WHO HOMESCHOOL AND MENTORSHIP FOR YOUNG WOMEN WHILE ENHANCING SCHOOL READINESS THROUGH THE PURCHASE OF BACKPACKS, SCHOOL SUPPLIES AND BOOKS.GOAL 3: PROVIDE ACCESS TO TOBACCO CESSATION SUPPORT. OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE FREE TOOLS TO QUIT TOBACCO CESSATION PROGRAMS TO 50 INDIVIDUALS EACH YEAR. THE OBJECTIVE IS MANAGED BY THE DIVISION; HOWEVER, THE HOSPITAL PROVIDES IN-KIND RESOURCES AND ALL OUTCOMES REPORTED ARE SPECIFIC TO THE REPORTING HOSPITAL. THE NORTHEAST FLORIDA AREA HEALTH EDUCATION CENTER (NEFAHEC) TOBACCO CESSATION PROGRAMS PROVIDE FREE INTERVENTION THERAPIES TO QUIT SMOKING TOBACCO. THROUGH A PARTNERSHIP WITH NEFAHEC, A LOCAL CHAPTER OF THE NATIONAL AREA HEALTH EDUCATION CENTER (AHEC) ORGANIZATION, WE WILL INCREASE THE NUMBER OF INDIVIDUALS PARTICIPATING IN THE CLASSES BY PROVIDING CONNECTION POINTS TO NEFAHEC'S CLASSES THROUGH SOCIAL MEDIA POSTS AND INTERNAL RESOURCES. NEFAHEC IS A COMMUNITY FOCUSED ORGANIZATION THAT DEVELOPS AND IMPLEMENTS COMMUNITY-BASED HEALTH PROMOTION ACTIVITIES AND EDUCATION PROGRAMS, WHICH TARGETS THE UNDERSERVED. AS IT RELATES TO OUR RELATIONSHIP WITH NEFAHEC, WE ARE PARTNERING WITH NEFAHEC TO PROVIDE COMMUNITY MEMBERS THE TOOLS AND RESOURCES TO ASSIST WITH TOBACCO CESSATION. THE HOSPITAL DID NOT MEET ITS SET METRIC. THE HOSPITAL REFERRED THREE INDIVIDUALS FOR TOBACCO CESSATION SERVICES PROVIDED BY NEFAHEC IN 2022. THERE WERE TWO INDIVIDUALS ENROLLED IN SERVICES AND ONE INDIVIDUAL WHO ATTENDED SERVICES.GOAL 4: PROVIDE ONE STOP CENTER FOR HEALTH AND HUMAN SERVICES IN DELTONA FOR BEHAVIORAL HEALTH. OBJECTIVE 1: THE FIRST OBJECTIVE IS A FUNDING INITIATIVE. THIS OBJECTIVE IS TO PARTNER WITH THE HOUSE NEXT DOOR, INC., A 501(C)(3) ORGANIZATION, TO CREATE A ONE STOP CENTER FOR HEALTH AND HUMAN SERVICES IN DELTONA. THE HOUSE NEXT DOOR PROVIDES FAMILY CENTERED PROGRAMS, INCLUDING COUNSELING, IN-HOME FAMILY SUPPORT AND AFTER SCHOOL SUPPORT/MENTORING, FAMILY COUNSELING, A CHILDCARE FOOD PROGRAM, PARENTING PROGRAMS, AND THE LITTLE HOUSE NEXT DOOR. THE INITIATIVE WOULD PROVIDE ACCESS TO AT LEAST FIVE PROGRAMS TO WEST VOLUSIA COUNTY RESIDENTS AND IS FUNDED SOLELY THROUGH THE REPORTING HOSPITAL. THE OBJECTIVE DOES NOT APPEAR ON OTHER COMMUNITY HEALTH PLANS WITHIN THE CENTRAL FLORIDA DIVISION. DUE TO A CHANGE IN STRATEGY BY THE HOUSE NEXT DOOR, THE ORGANIZATION WILL NO LONGER DEVELOP A NEW ONE-STOP LOCATION IN THE DELTONA COMMUNITY. THE HOSPITAL DECIDED TO SHIFT FUNDING TO SUPPORT OTHER PROGRAMMING THE HOUSE NEXT DOOR PROVIDES. THE HOSPITAL MET ITS MODIFIED OBJECTIVE BY PROVIDING $5,000 TO THE ORGANIZATION IN 2022. FUNDING SUPPORTED UNDERSERVED FAMILIES RECEIVING MENTAL HEALTH THERAPY IN ADDITION TO OTHER PROGRAMS. THE HOSPITAL HAS A LONG-STANDING RELATIONSHIP WITH THE ORGANIZATION, INCLUDING BOARD PARTICIPATION. THE HOUSE NEXT DOOR CHANGED STRATEGY TO DEVELOP A NEW ONE-STOP LOCATION IN THE DELTONA COMMUNITY.GOAL 5: ESTABLISH STRESS RESILIENCE WORKSHOP FOR YOUTH TO TEACH STRESS MANAGEMENT SKILLS THROUGH POSITIVE PSYCHOLOGICAL APPROACHES. OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE AN 8-HOUR WORKSHOP DESIGNED FOR YOUTH TO DECREASE THEIR STRESS AND INCREASE THEIR RESILIENCY AND EMOTIONAL WELL-BEING AS MEASURED BY PRE- AND POST-TESTING THROUGH A PARTNERSHIP WITH VOLUSIA COUNTY SCHOOLS, FLORIDA UNITED METHODIST CHILDREN'S HOME, AND OTHER YOUTH-SERVING AGENCIES TO SPONSOR YOUTH WORKSHOPS. THE YOUTH STRESS WORKSHOP PROGRAM IS FUNDED AND DEPLOYED THROUGH ADVENTHEALTH FISH MEMORIAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE YOUTH STRESS WORKSHOP PROVIDES ACCESS TO 8-HOUR WORKSHOPS TO TEACH YOUTH STRESS REDUCTION AND RESILIENCY TECHNIQUES. THE HOSPITAL MODIFIED THE OBJECTIVE BECAUSE THE PARTNERING AGENCY FACILITATING THE YOUTH WORKSHOPS MOVED TO ANOTHER COMMUNITY. THE MODIFIED OBJECTIVE IS TO IDENTIFY AGENCIES ADDRESSING MENTAL HEALTH AND PROVIDE SUPPORT THROUGH FUNDING AND IN-KIND DONATIONS. THE HOSPITAL MET THE OBJECTIVE BY PROVIDING $1,500 TO SUPPORT LIFE-SPIRE COUNSELING SERVICES' BIPOC MENTAL HEALTH FAIR. THE PURPOSE OF THE HEALTH FAIR WAS TO RAISE AWARENESS AND CONNECT INDIVIDUALS WITH BIPOC MENTAL HEALTH PROVIDERS. THE 2022 BIPOC MENTAL HEALTH FAIR IN DELTONA HAD 78 ATTENDEES. LIFE-SPIRE PROMOTES STRENGTH-BASED PRACTICES THAT ENCOURAGE INDIVIDUALS AND FAMILIES TO USE THEIR STRENGTHS AND GIFTS TO RESOLVE THEIR PROBLEMS. THROUGH THE PROCESS OF EDUCATION AND EVIDENCE-BASED PRACTICES CLIENTS ARE MOTIVATED TO ACHIEVE THEIR GOALS THROUGH REALISTIC PROCESSES. PRIORITY 2: CARDIOVASCULAR DISEASES & DIABETES 2019 DESCRIPTION OF THE ISSUE:CARDIOVASCULAR DISEASES - THE YEARS OF POTENTIAL LIFE LOST (YPLL) RATE FOR VOLUSIA COUNTY INCREASED FROM 2014 TO 2017 AND IS HIGHER THAN FLORIDA. - THE VOLUSIA COUNTY DEATH RATE FOR HEART FAILURE IS HIGHER THAN FLORIDA. - VOLUSIA COUNTY'S HOSPITALIZATION RATE FOR CONGESTIVE HEART FAILURE IS HIGHER THAN FLORIDA'S AND THE RATE FOR BLACK INDIVIDUALS IS MUCH HIGHER. - THE VOLUSIA COUNTY HOSPITALIZATION RATE FOR CORONARY HEART DISEASE IS HIGHER THAN FLORIDA AND THE RATE FOR BLACK INDIVIDUALS IS HIGHER THAN THE RATE FOR ALL. - THE VOLUSIA COUNTY DEATH RATE FOR CORONARY HEART DISEASE IS HIGHER THAN FLORIDA. - THE VOLUSIA COUNTY HOSPITALIZATION RATE FOR STROKE IS HIGHER THAN FLORIDA AND THE RATE FOR BLACK INDIVIDUALS IS HIGHER THAN OTHER GROUPS.- THE VOLUSIA COUNTY DEATH RATE FOR STROKE IS HIGHER THAN FLORIDA AND THE RATE FOR BLACK INDIVIDUALS IS HIGHER THAN OTHER GROUPS. DIABETES - THE DEATH RATE FROM DIABETES INCREASED BETWEEN 2016 AND 2017 AND IS HIGHER IN VOLUSIA COUNTY THAN IN FLORIDA. THE RATE IS HIGHEST FOR BLACK INDIVIDUALS.- THE RATE OF PREVENTABLE HOSPITALIZATIONS FOR ADULTS UNDER 65 FROM DIABETES IS INCREASING AND HIGHER THAN FLORIDA.2022 UPDATE: THE ADVENTHEALTH FISH MEMORIAL COMMUNITY HEALTH PLAN HAS TWO DESIRED GOAL STATEMENTS UNDER THE CARDIOVASCULAR DISEASES & DIABETES PRIORITY. 1. REDUCE THE INCIDENCE OF DIABETES AMONG YOUTH2. PARTNER WITH THE ADVENTHEALTH FISH MEMORIAL FOUNDATION, COMMUNITY GARDENS, LOCAL GROWERS, AND FOOD PANTRIES TO DEVELOP A DISTRIBUTION NETWORK TO INCREASE THE AVAILABILITY OF FRESH PRODUCE PROVIDED THROUGH FOOD BANKS IN WEST VOLUSIA ** SEE CONTINUATION SCHEDULE H, PART V, SECTION B, LINE 11 CONTINUATION GOAL 1: REDUCE THE INCIDENCE OF DIABETES AMONG YOUTHOBJECTIVE 1: THE FIRST OBJECTIVE IS TO IMPLEMENT A DIABETES EDUCATION PROGRAM FOR 75% OF THIRD GRADERS IN IDENTIFIED ELEMENTARY SCHOOLS DURING THE 2020-2021 SCHOOL YEAR AND TO PROVIDE A NUTRITIONAL STUDENT EDUCATION PROGRAM IN ORANGE CITY/DELTONA. THIS OBJECTIVE IS MANAGED AT A DIVISIONAL LEVEL; HOWEVER, ALL FUNDING AND OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE SCHOOL-BASED DIABETES PROGRAM PROVIDES EDUCATIONAL PROGRAMMING TO THIRD GRADERS AT AN IDENTIFIED AT-RISK SCHOOL IN THE ORANGE CITY AREA. THIS OBJECTIVE WAS MODIFIED BECAUSE THE DIABETES EDUCATION PROGRAM WAS CANCELLED DUE TO COVID-19. THE HOSPITAL MET THE MODIFIED OBJECTIVE, WHICH IS TO IMPLEMENT THE MISSION FIT PROGRAM, A COMPREHENSIVE CHILDREN'S WELLNESS INITIATIVE THAT EMPOWERS STUDENTS TO BE AGENTS OF HEALTH, AS A VIABLE ALTERNATIVE. IN YEAR THREE, 110 SECOND GRADE STUDENTS AT MANATEE COVE ELEMENTARY PARTICIPATED IN THE PROGRAM. GOAL 2: PARTNER WITH THE ADVENTHEALTH FISH MEMORIAL FOUNDATION, COMMUNITY GARDENS, LOCAL GROWERS, AND FOOD PANTRIES TO DEVELOP A DISTRIBUTION NETWORK TO INCREASE THE AVAILABILITY OF FRESH PRODUCE PROVIDED THROUGH FOOD BANKS IN WEST VOLUSIA. OBJECTIVE 1: THE FIRST OBJECTIVE IS TO IDENTIFY WEST VOLUSIA COMMUNITY GARDENS, PARTNERS AND FOOD PANTRIES AND COLLABORATE TO DEVELOP A DISTRIBUTION PLAN BY THE END OF YEAR ONE. TO ACHIEVE THIS THE HOSPITAL HAS FORMED THE FRESH PRODUCE PARTNERSHIP, AN INITIATIVE WHICH IS FUNDED AND DEPLOYED THROUGH ADVENTHEALTH FISH MEMORIAL WITH ALL OUTCOMES SPECIFIC TO THE REPORTING HOSPITAL. THE FRESH PRODUCE PARTNERSHIP INITIATIVE'S AIM IS TO PARTNER WITH COMMUNITY ORGANIZATIONS INCLUDING EXISTING COMMUNITY GARDENS AND FOOD PANTRIES AND TO CREATE A COLLABORATIVE APPROACH TO ADDRESSING FOOD INSECURITY BY DISTRIBUTING FRESH PRODUCE TO AREA RESIDENTS. THE HOSPITAL DID NOT MEET ITS SET METRIC WITH ZERO PARTNERS IDENTIFIED AND COMMITTED. ADVENTHEALTH FISH MEMORIAL HAS RECOGNIZED THAT AN ALTERNATIVE STRATEGY WILL LEAD TO MORE SUCCESSFUL OUTCOMES TO ADDRESS THIS PRIORITY. THE HOSPITAL HAS WORKED TO IDENTIFY THE DIABETES UNDONE PROGRAM WHICH HAS BEEN SUCCESSFUL IN EAST VOLUSIA COUNTY; THIS PROGRAM WILL BE UTILIZED TO ADDRESS THIS PRIORITY IN PLACE OF THE ORIGINAL GOAL. THE DIVISION WILL MANAGE THE OBJECTIVE; HOWEVER, THE HOSPITAL WILL CONDUCT AND FUND THE OBJECTIVE. ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. AS THE PROGRAM AND THE OBJECTIVE CONTINUE TO BE DEVELOPED, THE HOSPITAL WILL IDENTIFY ADDITIONAL POTENTIAL OUTCOMES TO REPORT. TO SUPPORT THIS OBJECTIVE THE HOSPITAL WILL PROVIDE THE AMERICAN DIABETES SCREENING TOOL WHICH IS A PAPER SCREEN TO ALL PARTICIPANTS AND WILL ALSO WORK WITH DIABETES EDUCATORS. THE DIVISION HAS IDENTIFIED A LOCAL SEVENTH DAY ADVENTIST CHURCH, DEBARY-ORANGE CITY ADVENTIST CHURCH, LOCATED IN A VULNERABLE ZIP CODE, TO PARTNER WITH AS A SITE IN THE COMMUNITY TO HOST THE PROGRAM. THE HOSPITAL DID NOT MEET THE MODIFIED OBJECTIVE TO OFFER THE DIABETES UNDONE PROGRAM DUE TO LEADERSHIP CHANGES. THE HOSPITAL IDENTIFIED OTHER OPPORTUNITIES TO STILL ADDRESS THE PRIORITY AREA OF CARDIOVASCULAR DISEASE AND DIABETES. THE HOSPITAL PARTICIPATED IN THE ORANGE CITY 2022 BENEFITS FAIR. TEAM MEMBERS PROVIDED BLOOD PRESSURE CHECKS, DIABETES EDUCATION AND SCREENINGS TO OVER 80 PARTICIPANTS. THE HOSPITAL ALSO SUPPORTED THE 2022 ORANGE CITY MAYORS FITNESS CHALLENGE. THE HOSPITAL PROVIDED A DONATION OF $1,000 IN ADDITION TO PROVIDING IN-KIND SERVICES SUCH AS BIOMETRIC SCREENINGS. THE 80 PARTICIPANTS COLLECTIVELY LOST A TOTAL OF 376.4 POUNDS AND 83 INCHES.OBJECTIVE 2:THE SECOND OBJECTIVE IS TO INCREASE THE AVAILABILITY OF FRESH PRODUCE AT WEST VOLUSIA FOOD PANTRIES BY THE END OF YEAR TWO. THE INITIATIVE TO INCREASE ACCESS TO FRESH PRODUCE IS DEPLOYED THROUGH ADVENTHEALTH FISH MEMORIAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE INITIATIVE PLANNED FOR YEAR TWO WILL IMPROVE ACCESS TO THE FRESH PRODUCE AT LOCAL FOOD PANTRIES. THE HOSPITAL FELL SHORT OF ITS SET METRIC OF INCREASING THE VOLUME OF PRODUCE AVAILABLE THROUGH FOOD PANTRIES THROUGH THE IDENTIFICATION OF PARTNERS AND WILL IDENTIFY AN ALTERNATIVE STRATEGY TO INCREASE ACCESS TO FRESH PRODUCE IN THE AREA. THE DIVISION HAS IDENTIFIED AN ALTERNATIVE OBJECTIVE TO SUPPORT THIS GOAL. THE MODIFIED OBJECTIVE IS TO COLLABORATE WITH WEST VOLUSIA FOOD PANTRY (BACKPACK BUDDIES) TO PROVIDE HEALTHY KID PACKS TO SCHOOL CHILDREN. THE OBJECTIVE WILL BE MANAGED BY THE DIVISION; HOWEVER, IT WILL BE CONDUCTED BY THE HOSPITAL. ALL FUNDING AND OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE HOSPITAL MET THE OBJECTIVE IN YEAR TWO WHERE 4,959 SCHOOL CHILDREN WERE PROVIDED HEALTHY KID PACKS BY OUR TWO STORIES, A LOCAL NON-PROFIT ORGANIZATION. IN 2022, THE BACKPACK BUDDIES PROGRAM WITH OUR TWO STORIES SERVED 746 YOUTH (A TOTAL OF 31,332 MEALS) AT ORANGE CITY ELEMENTARY, MANATEE COVE ELEMENTARY, RIVER SPRINGS ELEMENTARY AND PRIDE ELEMENTARY. THE HOSPITAL PROVIDED $10,000 IN 2022 TO DISTRIBUTE FOOD TO STUDENTS IN WEST VOLUSIA. PRIORITY 3: BARRIERS TO ACCESSING HEALTH CARE SERVICES2019 DESCRIPTION OF THE ISSUE:- VOLUSIA COUNTY RATE OF HEALTH RESOURCES PER POPULATION IS LOWER THAN FLORIDA IN THE CATEGORIES OF PHYSICIANS, INTERNISTS, OB/GYN AND PEDIATRICIANS. - VOLUSIA COUNTY HAS A HIGHER PERCENTAGE OF BIRTHS COVERED BY MEDICAID THAN FLORIDA. RATES FOR BLACK AND HISPANIC INDIVIDUALS ARE HIGHER. - THE PERCENT OF VOLUSIA COUNTY ADULTS WITH A PERSONAL DOCTOR IS LOWER THAN FLORIDA. - VOLUSIA COUNTY HAS A LOWER RATIO OF PRIMARY CARE PHYSICIANS, DENTISTS, AND MENTAL HEALTH PROVIDERS TO POPULATION THAN FLORIDA. 2022 UPDATE: THE ADVENTHEALTH FISH MEMORIAL COMMUNITY HEALTH PLAN HAS ONE DESIRED GOAL STATEMENT UNDER THE BARRIERS TO ACCESSING HEALTH CARE SERVICES PRIORITY. 1. IMPROVE HEALTH AND SOCIAL OUTCOMES FOR COMMUNITY CARE PROGRAM PARTICIPANTS.GOAL 1: IMPROVE HEALTH AND SOCIAL OUTCOMES FOR VULNERABLE PATIENTS AND COMMUNITY CARE PROGRAM PARTICIPANTS.OBJECTIVE 1: THE FIRST OBJECTIVE IS TO INCREASE THE CAPACITY OF THE COMMUNITY CARE PROGRAM TO DESIGN AND FACILITATE A PARTNERSHIP WITH FAMILY HEALTH SOURCE (WEST VOLUSIA FEDERALLY QUALIFIED HEALTH CENTER) TO INCREASE ACCESS TO CARE. THE COMMUNITY CARE PROGRAM AT THE HOSPITAL PROVIDES EDUCATION, SUPPORT AND CARE COORDINATION THROUGH AN INTERDISCIPLINARY TEAM SERVING THE MOST VULNERABLE PATIENTS. THE TEAM PROVIDES HOME VISITS AT NO CHARGE, FOCUSING ON EDUCATING PATIENTS AND FAMILIES ON PREVENTATIVE CARE AND REDUCING BARRIERS RELATED TO THE SOCIAL DETERMINANTS OF HEALTH. THE FAMILY HEALTH SOURCE PARTNERSHIP INITIATIVE IS DEPLOYED THROUGH ADVENTHEALTH FISH MEMORIAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE FAMILY HEALTH SOURCE PARTNERSHIP AIMS TO CREATE A NEW CONNECTION FOR COMMUNITY CARE PATIENTS TO FAMILY HEALTH SOURCE MEDICAL CARE AND TO ESTABLISH A NEW PRIMARY CARE HOME. THE HOSPITAL DID NOT MEET THE OBJECTIVE. THE HOSPITAL HAS AN INFORMAL PARTNERSHIP WITH FAMILY HEALTH SOURCE AND, DUE TO LEADERSHIP CHANGES, A FORMALIZED PARTNERSHIP WAS NOT SOUGHT. THE COMMUNITY CARE PROGRAM ENROLLED 82 NEW PATIENTS IN 2022. ADDITIONALLY, THE HOSPITAL ADDRESSED THE PRIORITY AREA BY SUPPORTING THE NEIGHBORHOOD CENTER OF WEST VOLUSIA ROCK 'N HEARTS FOR THE HOMELESS IN WEST VOLUSIA BY DONATING $1,000 AND 66.5 HOURS OF CASE MANAGEMENT SERVICES. OBJECTIVE 2:THE SECOND OBJECTIVE IS TO IMPLEMENT A PILOT PROGRAM TO ESTABLISH REMOTE ACCESS TO FAMILY HEALTH SOURCE SERVICES FOR VULNERABLE HOSPITAL PATIENTS AND COMMUNITY CARE PROGRAM PARTICIPANTS. THE FAMILY HEALTH SOURCE PILOT PROJECT IS DEPLOYED THROUGH ADVENTHEALTH FISH MEMORIAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE FAMILY HEALTH SOURCE PILOT PROJECT AIMS TO CREATE A NEW CONNECTION THROUGH TELEHEALTH, FOR COMMUNITY CARE PATIENTS TO FAMILY HEALTH SOURCE MEDICAL CARE.DUE TO THE CHANGING NEEDS AND THE QUICK RESPONSE OF THE HEALTH CARE COMMUNITY BECAUSE OF COVID-19, THIS OBJECTIVE WAS ORGANICALLY MET IN 2020. ALTHOUGH THE HOSPITAL HAD SOUGHT TO CREATE THIS CONNECTION AND PROVIDE AN ADDITIONAL AVENUE FOR ACCESS, THIS HAPPENED AS HEALTH CARE PIVOTED TO TELEHEALTH MODELS THROUGHOUT THE COUNTRY AS A RESPONSE TO THE PANDEMIC. THIS PIVOT ALSO INCLUDED THE COMMUNITY CARE PROGRAM FOR WHICH THIS INITIATIVE WAS DEVELOPED. IN SUPPORT OF COMMUNITY CARE PATIENTS, THE HOSPITAL PROVIDED APPROXIMATELY 800 ITEMS INCLUDING NONPERISHABLE FOOD ITEMS, HYGIENE, AND CLEANING PRODUCTS DURING THE WEEK OF CARING 2022. SCHEDULE H, PART V, SECTION B, LINE 11 CONTINUATION PRIORITY 4: HEALTHY EATING & PHYSICAL ACTIVITY 2019 DESCRIPTION OF THE ISSUE:- OVER 70% OF VOLUSIA COUNTY MIDDLE AND HIGH SCHOOL STUDENTS LACK VIGOROUS PHYSICAL ACTIVITY AND THE PERCENT INCREASED FROM 2014 TO 2016. THE PERCENT IS BETTER THAN FLORIDA. - THE PERCENT OF VOLUSIA COUNTY ADULTS WHO ARE SEDENTARY INCREASED FROM 2007 TO 2016 AND IS NOW HIGHER THAN FLORIDA. - THE PERCENT OF VOLUSIA COUNTY MIDDLE AND HIGH SCHOOLERS WHO WERE OBESE INCREASED SIGNIFICANTLY FROM 2014 TO 2016. - THE PERCENT OF VOLUSIA COUNTY ADULTS WHO ARE OBESE INCREASED BETWEEN 2013 AND 2016 AND THE PERCENT IS NOW HIGHER THAN FLORIDA. - INJURY DEATHS ARE INCREASING AND HIGHER THAN FLORIDA. 2022 UPDATE: THE ADVENTHEALTH FISH MEMORIAL COMMUNITY HEALTH PLAN HAS ONE DESIRED GOAL STATEMENT UNDER THE HEALTHY EATING & PHYSICAL ACTIVITY PRIORITY.1. INCREASE PHYSICAL ACTIVITY AND HEALTHY EATING AMONG VULNERABLE RESIDENTS.GOAL 1: INCREASE PHYSICAL ACTIVITY AND HEALTHY EATING AMONG VULNERABLE RESIDENTS.OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE MENTORSHIP AND EDUCATION ABOUT HEALTHY EATING AND PHYSICAL ACTIVITY TO 75% OF BOYS & GIRLS CLUBS' MEMBERS AT TWO AREA CLUBS FOUR TIMES ANNUALLY. THIS OBJECTIVE, A DIVISIONAL INITIATIVE WHICH APPEARS ON MULTIPLE COMMUNITY HEALTH PLANS OF HOSPITALS IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, IS FUNDED AND DEPLOYED THROUGH ADVENTHEALTH FISH MEMORIAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE BOYS & GIRLS CLUBS' EDUCATION INITIATIVE IS FOCUSED ON PROVIDING AT LEAST FOUR EDUCATION SESSIONS A YEAR TO CLUB PARTICIPANTS TO INCREASE THEIR UNDERSTANDING OF HEALTHY EATING AND PHYSICAL ACTIVITY. THE HOSPITAL MET ITS SET METRIC OF PROVIDING FOUR EDUCATION SESSIONS REACHING CLUB PARTICIPANTS WITH FOUR SESSIONS PROVIDED IN YEAR THREE. THE SECOND METRIC FOR THE OBJECTIVE WAS MET OF REACHING 75% OF THE CLUB MEMBERS FOUR TIMES ANNUALLY. FOUR EDUCATIONAL PROGRAMS ON MENTAL ACTIVITY GAME, WATER CONSERVATION, RECYCLING, AND NUTRITION WERE PROVIDED TO CLUB MEMBERS AT THE HARRIS SAXON AND MID-FLORIDA JEEP/LAKE HELEN BOYS & GIRLS CLUB.OBJECTIVE 2: THE SECOND OBJECTIVE IS A DIVISIONAL INITIATIVE AND APPEARS ON MULTIPLE COMMUNITY HEALTH PLANS OF HOSPITALS IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, THE SAME DIVISION AS THE REPORTING HOSPITAL. THE DIVISION CHOSE THIS INITIATIVE BECAUSE OF A SHARED CHNA PRIORITY. THIS OBJECTIVE IS TO PROVIDE $4,000 IN FINANCIAL SUPPORT ANNUALLY TO THE BOYS & GIRLS CLUBS, AS PART OF A STRATEGIC PARTNERSHIP, TO PROVIDE DAILY FRESH FRUIT AND WHOLE GRAIN SNACKS TO CLUB MEMBERS. THE OBJECTIVE IS FUNDED THROUGH THE HOSPITAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL, HOWEVER THE INITIATIVE IS MANAGED BY THE DIVISION. THIS INITIATIVE PROVIDES FINANCIAL SUPPORT SO THAT YOUTH PARTICIPATING IN LOCAL BOYS & GIRLS CLUBS CAN HAVE ACCESS TO DAILY HEALTHY SNACKS. THE HOSPITAL MET ITS SET METRIC OF PROVIDING FUNDING SUPPORT WITH $4,000 DOLLARS PROVIDED. THE PROVIDED FUNDING WAS ABLE TO MAKE UP FOR A SHORTFALL IN THE USDA GRANT BOYS & GIRLS CLUBS OF VOLUSIA/FLAGLER USES TO PROVIDE HARRIS SAXON BOYS & GIRLS CLUB AND MID-FLORIDA JEEP/LAKE HELEN BOYS & GIRLS CLUB MEMBERS WITH DAILY FRESH FRUIT AND WHOLE GRAIN SNACKS. PRIORITY 5: SOCIAL AND ECONOMIC ISSUES (SOCIAL DETERMINANTS OF HEALTH) 2019 DESCRIPTION OF THE ISSUE:- VOLUSIA COUNTY'S MEDIAN HOUSEHOLD INCOME IS LOWER THAN FLORIDA'S. - VOLUSIA COUNTY'S PERCENT OF INDIVIDUALS AND INDIVIDUALS BELOW AGE 18 BELOW POVERTY ARE BOTH SLIGHTLY HIGHER THAN FLORIDA'S. - THE VOLUSIA COUNTY PERCENT OF ELEMENTARY AND MIDDLE SCHOOL STUDENTS ELIGIBLE FOR FREE/REDUCED PRICE LUNCHES IS HIGHER THAN FLORIDA. (A PROXY MEASURE FOR LOW INCOME) - THE VOLUSIA COUNTY HIGH SCHOOL GRADUATION RATE IS LOWER THAN FLORIDA.- THE VOLUSIA COUNTY PERCENT OF ADULTS LIMITED BY PHYSICAL, MENTAL, OR EMOTIONAL PROBLEMS IS HIGHER THAN FLORIDA. (DIFFERENCE IS STATISTICALLY SIGNIFICANT) - VOLUSIA COUNTY'S FOOD INSECURITY RATE IS HIGHER THAN FLORIDA'S. - VOLUSIA COUNTY'S PER CAPITA INCOME IS LOWER THAN FLORIDA'S. - OVER 30% OF VOLUSIA COUNTY HOUSEHOLDS SPEND MORE THAN 30% OF THEIR INCOME ON HOUSING AND WORKERS IN 8 OF THE TOP 20 INDUSTRIES IN VOLUSIA COUNTY ARE ESTIMATED TO BE HOUSING BURDENED BASED ON AVERAGE HOURLY WAGE. - THE VOLUSIA COUNTY NUMBER OF INDIVIDUALS COUNTED DURING THE POINT-IN-TIME COUNT WAS HIGHER IN 2019 THAN IN 2018. - THE VOLUSIA COUNTY NUMBER OF HOMELESS STUDENTS HAS BEEN INCREASING SINCE 2016. - VOLUSIA COUNTY'S PERCENT OF SINGLE PARENT HOUSEHOLDS IS HIGHER THAN FLORIDA'S. 2022 UPDATE: THE ADVENTHEALTH FISH MEMORIAL COMMUNITY HEALTH PLAN HAS ONE DESIRED GOAL STATEMENT UNDER THE SOCIAL AND ECONOMIC ISSUES (SOCIAL DETERMINANTS OF HEALTH) PRIORITY.1. INCREASE ACCESS TO INCOME AND HEALTH INSURANCE COVERAGE FOR VULNERABLE INDIVIDUALS.GOAL 1: INCREASE ACCESS TO INCOME AND HEALTH INSURANCE COVERAGE FOR VULNERABLE INDIVIDUALS.OBJECTIVE 1:THE FIRST OBJECTIVE IS A SHARED INITIATIVE BETWEEN ADVENTHEALTH FISH MEMORIAL, ADVENTHEALTH DAYTONA BEACH AND ADVENTHEALTH NEW SMYRNA BEACH. THESE HOSPITALS ARE PART OF THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, THE SAME DIVISION AS THE REPORTING HOSPITAL. THE HOSPITALS PARTNERED ON THIS INITIATIVE BECAUSE OF A SHARED CHNA PRIORITY. THIS OBJECTIVE IS TO ENHANCE THE SUPPORTS AVAILABLE TO VULNERABLE INDIVIDUALS TO APPLY FOR AND OBTAIN SUPPLEMENTAL SECURITY INCOME/SOCIAL SECURITY DISABILITY INSURANCE (SSI/SSDI) BENEFITS (INCLUDING INCOME AND MEDICAID/MEDICARE) THROUGH THE ESTABLISHMENT OF A COORDINATED NETWORK OF ADVOCATES. INCREASED CAPACITY IN THE COMMUNITY SETTING FOR SSI/SSDI OUTREACH, ACCESS, AND RECOVERY IS FUNDED THROUGH ALL HOSPITALS, HOWEVER REPORTED OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THIS INITIATIVE PROVIDES ACCESS TO A CERTIFIED SOAR (SSI/SSDI OUTREACH, ACCESS, AND RECOVERY) PROCESSOR WHO ASSISTS VULNERABLE PATIENTS OF THE COMMUNITY CARE PROGRAM TO APPLY FOR SSI/SSDI BENEFITS TO INCREASE THEIR INCOME AND OBTAIN MEDICAL COVERAGE. THE HOSPITAL MET ITS SET METRIC REFERRING 18 WEST VOLUSIA RESIDENTS TO SOAR IN 2022. THE SOAR PROCESSOR (SSI/SSDI OUTREACH, ACCESS, AND RECOVERY) THROUGH PARTNERSHIP WITH FLAGLER CARES SOAR ASSISTS ELIGIBLE PATIENTS TO APPLY FOR AND OBTAIN SSI/SSDI BENEFITS (TO INCLUDING INCOME AND MEDICAID/MEDICARE).COMMUNITY NEEDS NOT CHOSEN BY ADVENTHEALTH FISH MEMORIAL:THE PRIMARY AND SECONDARY DATA IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED MULTIPLE COMMUNITY ISSUES. THE HOSPITAL AND COMMUNITY STAKEHOLDERS USED THE FOLLOWING CRITERIA TO NARROW THE LARGER LIST TO THE PRIORITY AREAS NOTED ABOVE:1. HOW ACUTE IS THE NEED? (BASED ON DATA AND COMMUNITY CONCERN)2. WHAT IS THE TREND? IS THE NEED GETTING WORSE?3. DOES THE HOSPITAL PROVIDE SERVICES THAT RELATE TO THE PRIORITY? 4. IS SOMEONE ELSE - OR MULTIPLE GROUPS - IN THE COMMUNITY ALREADY WORKING ON THIS ISSUE? 5. IF THE HOSPITAL WERE TO ADDRESS THIS ISSUE, ARE THERE OPPORTUNITIES TO WORK WITH COMMUNITY PARTNERS? BASED ON THIS PRIORITIZATION PROCESS, THE HOSPITAL DID NOT CHOOSE THE FOLLOWING COMMUNITY ISSUES:1. THE YEARS OF POTENTIAL AGING-RELATED ISSUES THE DATA COLLECTED FOR INDIVIDUALS 65 AND OLDER DID NOT DEMONSTRATE SIGNIFICANT NEGATIVE TRENDS OR NEGATIVE COMPARISON TO STATE DATA. THE ONLY INDICATOR OF CONCERN NOTED WAS SUICIDE RATE FOR INDIVIDUALS OVER 65 WHICH WILL BE ADDRESSED THROUGH THE PRIORITIZATION OF ADULT BEHAVIORAL HEALTH. THERE ARE NUMEROUS INITIATIVES IN PLACE TO PROVIDE SERVICES TO THIS TARGET POPULATION. 2. CHILD & ADOLESCENT ISSUES THE MOST SIGNIFICANT CHILDHOOD ISSUES ARE ADDRESSED THROUGH OTHER PRIORITY ISSUES (BEHAVIORAL HEALTH, ACCESS TO SERVICES, HEALTHY EATING, AND PHYSICAL ACTIVITY). 3. COMMUNICABLE & INFECTIOUS DISEASES THE DATA COLLECTED DID NOT DEMONSTRATE SIGNIFICANT NEGATIVE TRENDS OR COMPARISON DATA. MANY ISSUES NOTED IN THE INDICATORS OF CONCERN WILL BE ADDRESSED THROUGH THE PRIORITIZATION OF ACCESS TO HEALTH CARE SERVICES. 4. CRIME, DOMESTIC VIOLENCE & CHILD ABUSE THE DATA COLLECTED DID NOT DEMONSTRATE SIGNIFICANT NEGATIVE TRENDS OR NEGATIVE COMPARISON TO STATE DATA. MANY ISSUES NOTED IN THE INDICATORS OF CONCERN WILL BE ADDRESS THROUGH THE PRIORITIZATION OF SOCIAL AND ECONOMIC ISSUES. 5. EARLY CHILDHOOD THERE ARE SIGNIFICANT EFFORTS ALREADY IN PLACE TO ADDRESS THIS TARGET POPULATION. 6. WOMEN'S HEALTH, PRENATAL CARE & BIRTH OUTCOMES THERE ARE SIGNIFICANT EFFORTS ALREADY IN PLACE TO ADDRESS THIS TARGET POPULATION. MANY OF THE INDICATORS OF CONCERN WILL BE ADDRESSED THROUGH THE PRIORITIZATION OF ACCESS TO HEALTH CARE SERVICES. SCHEDULE H, PART V, SECTION B, LINE 16A,B,C: THE FINANCIAL ASSISTANCE POLICY FOR THE HOSPITAL CAN BE FOUND AT URL:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCETHE FINANCIAL ASSISTANCE POLICY APPLICATION FOR THE HOSPITAL CAN BE FOUND AT:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCETHE PLAIN LANGUAGE SUMMARY FOR THE HOSPITAL IS AVAILABLE AT:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCE 12 1 - ORANGE CITY SURGICAL LLC 1053 MEDICAL CENTER DRIVE STE 201 ORANGE CITY FL 32763 AMBULATORY SURGERY CENTER 2 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 1565 SAXON BOULEVARD STE 201 DELTONA FL 32725 PHYSICIAN CLINIC 3 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 1565 SAXON BOULEVARD STE 102 DELTONA FL 32725 PHYSICIAN CLINIC 4 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 1061 MEDICAL CENTER DRIVE STE 300 ORANGE CITY FL 32763 PHYSICIAN CLINIC 5 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 999 S VOLUSIA AVENUE ORANGE CITY FL 32763 PHYSICIAN CLINIC 6 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 1061 MEDICAL CENTER DRIVE STE 305 ORANGE CITY FL 32763 PHYSICIAN CLINIC 7 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 1061 MEDICAL CENTER DRIVE STE 102 ORANGE CITY FL 32763 PHYSICIAN CLINIC 8 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 2885 WELLNESS AVENUE ORANGE CITY FL 32763 PHYSICIAN CLINIC 9 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 2521 JUNIOR STREET ORANGE CITY FL 32763 PHYSICIAN CLINIC 10 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 190 N CHARLES BEALL BOULEVARD DEBARY FL 32713 PHYSICIAN CLINIC 11 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 1061 MEDICAL CENTER DRIVE STE 205 ORANGE CITY FL 32763 PHYSICIAN CLINIC 12 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 1061 MEDICAL CENTER DRIVE STE 212 ORANGE CITY FL 32763 PHYSICIAN CLINIC PART I, LINE 3C: UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY, AN INDIVIDUAL IS ELIGIBLE FOR A 100% REDUCTION FROM APPLICABLE CHARGES IF THE INDIVIDUAL'S HOUSEHOLD INCOME IS AT OR BELOW 200% OF THE CURRENT FEDERAL POVERTY GUIDELINES. ALTERNATIVELY, A PATIENT MAY ALSO QUALIFY FOR A 100% REDUCTION FROM CHARGES WHEN THE UNPAID PORTION OF A PATIENT'S BILL EXCEEDS 25% OF THE INDIVIDUAL'S ANNUAL HOUSEHOLD INCOME AND WHERE THE TOTAL ANNUAL HOUSEHOLD INCOME IS LESS THAN 500% OF THE FEDERAL POVERTY GUIDELINES. MEDICARE RECIPIENTS MAY ALSO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY DEPENDING UPON THE INDIVIDUAL'S INCOME AND RESOURCES. RESOURCES ARE GENERALLY DEFINED AS ASSETS SUCH AS MONEY IN CHECKING OR SAVINGS ACCOUNTS, STOCKS, AND BONDS. PART I, LINE 6A: THE FILING ORGANIZATION WAS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) DURING ITS CURRENT TAX YEAR. DURING THE CURRENT YEAR, AHSSHC SERVED AS A PARENT ORGANIZATION TO 30 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS AND A NUMBER OF OTHER HEALTH CARE FACILITIES THAT OPERATED IN 10 STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS "ADVENTHEALTH".ALL HOSPITAL ORGANIZATIONS WITHIN ADVENTHEALTH COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. ADVENTHEALTH ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. ADVENTHEALTH HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. EACH ADVENTHEALTH HOSPITAL FACILITY REPORTS THEIR COMMUNITY BENEFITS TO THEIR BOARD OF DIRECTORS AND STRIVES TO COMMUNICATE THEIR COMMUNITY BENEFITS TO THEIR LOCAL COMMUNITIES. 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 A 24/7 EMERGENCY ROOM PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION CANNOT BE MADE BASED UPON INFORMATION SUPPLIED BY THE INDIVIDUAL. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGE 8-9. PLEASE NOTE THAT DOLLAR AMOUNTS ON THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE IN THOUSANDS. PART III, LINE 8: COSTING METHODOLOGY: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO.RATIONALE FOR INCLUDING A MEDICARE SHORTFALL AS COMMUNITY BENEFIT:AS A 501(C)(3) ORGANIZATION, THE FILING ORGANIZATION PROVIDES EMERGENCY AND NON-ELECTIVE CARE TO ALL REGARDLESS OF ABILITY TO PAY. ALL HOSPITAL SERVICES ARE PROVIDED IN A NON-DISCRIMINATORY MANNER TO PATIENTS WHO ARE COVERED BENEFICIARIES UNDER THE MEDICARE PROGRAM. AS A PUBLIC INSURANCE PROGRAM, MEDICARE PROVIDES A PRE-ESTABLISHED REIMBURSEMENT RATE/AMOUNT TO HEALTH CARE PROVIDERS FOR THE SERVICES THEY PROVIDE TO PATIENTS. IN SOME CASES, THE REIMBURSEMENT AMOUNT PROVIDED TO A HOSPITAL MAY EXCEED ITS COSTS OF PROVIDING A PARTICULAR SERVICE OR SERVICES TO A PATIENT. IN OTHER CASES, THE MEDICARE REIMBURSEMENT AMOUNT MAY RESULT IN THE HOSPITAL EXPERIENCING A SHORTFALL OF REIMBURSEMENT RECEIVED OVER COSTS INCURRED. IN THOSE CASES WHERE AN OVERALL SHORTFALL IS GENERATED FOR PROVIDING SERVICES TO ALL MEDICARE PATIENTS, THE SHORTFALL AMOUNT SHOULD BE CONSIDERED AS A BENEFIT TO THE COMMUNITY. TAX-EXEMPT HOSPITALS ARE REQUIRED TO ACCEPT ALL MEDICARE PATIENTS REGARDLESS OF THE PROFITABILITY, OR LACK THEREOF, WITH RESPECT TO THE SERVICES THEY PROVIDE TO MEDICARE PATIENTS. THE POPULATION OF INDIVIDUALS COVERED UNDER THE MEDICARE PROGRAM IS SUFFICIENTLY LARGE SO THAT THE PROVISION OF SERVICES TO THE POPULATION IS A BENEFIT TO THE COMMUNITY AND RELIEVES THE BURDENS OF GOVERNMENT. IN THOSE SITUATIONS WHERE THE PROVISION OF SERVICES TO THE TOTAL MEDICARE PATIENT POPULATION OF A TAX-EXEMPT HOSPITAL DURING ANY YEAR RESULTS IN A SHORTFALL OF REIMBURSEMENT RECEIVED OVER THE COST OF PROVIDING CARE, THE TAX-EXEMPT HOSPITAL HAS PROVIDED A BENEFIT TO A CLASS OF PERSONS BROAD ENOUGH TO BE CONSIDERED A BENEFIT TO THE COMMUNITY. DESPITE A FINANCIAL SHORTFALL, A TAX-EXEMPT HOSPITAL MUST AND WILL CONTINUE TO ACCEPT AND CARE FOR MEDICARE PATIENTS. TYPICALLY, TAX-EXEMPT HOSPITALS PROVIDE HEALTH CARE SERVICES BASED UPON AN ASSESSMENT OF THE HEALTH CARE NEEDS OF THEIR COMMUNITY AS OPPOSED TO THEIR TAXABLE COUNTERPARTS WHERE PROFITABILITY OFTEN DRIVES DECISIONS ABOUT PATIENT CARE SERVICES THAT ARE OFFERED. PATIENT CARE PROVIDED BY TAX-EXEMPT HOSPITALS THAT RESULTS IN MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS PROVIDING A BENEFIT TO THE COMMUNITY AND RELIEVING THE BURDENS OF GOVERNMENT. PART III, LINE 9B: THE HOSPITAL FILING ORGANIZATION'S COLLECTION PRACTICES ARE IN CONFORMITY WITH THE REQUIREMENTS SET FORTH IN THE 2014 FINAL REGULATIONS REGARDING THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(R)(4) - (R)(6). NO EXTRAORDINARY COLLECTION ACTIONS (ECA'S) ARE INITIATED BY THE HOSPITAL FILING ORGANIZATION IN THE 120-DAY PERIOD FOLLOWING THE DATE AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL (OR, IF LATER, THE SPECIFIED DEADLINE GIVEN IN A WRITTEN NOTICE OF ACTIONS THAT MAY BE TAKEN, AS DESCRIBED BELOW). INDIVIDUALS ARE PROVIDED WITH AT LEAST ONE WRITTEN NOTICE (NOTICE OF ACTIONS THAT MAY BE TAKEN) AND A COPY OF THE FILING ORGANIZATION'S PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY THAT INFORMS THE INDIVIDUAL THAT THE HOSPITAL FILING ORGANIZATION MAY TAKE ACTIONS TO REPORT ADVERSE INFORMATION TO CREDIT REPORTING AGENCIES/BUREAUS IF THE INDIVIDUAL DOES NOT SUBMIT A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM) OR PAY THE AMOUNT DUE BY A SPECIFIED DEADLINE. THE SPECIFIED DEADLINE IS NOT EARLIER 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 ALL MEDICARE PATIENTS ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ (3,534,717)- DIFFERENCE IN COSTING METHODOLOGY: (2,599,664)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (9,593,728) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITYBENEFIT REPORTING $(15,728,109)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 WILL CONDUCT COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) EVERY THREE YEARS. ITS 2022 CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2022, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S 2022 CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN FINAL REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY.SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY. PART VI, LINE 3: THE FINANCIAL ASSISTANCE POLICY (FAP), FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM), AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) OF THE FILING ORGANIZATION'S HOSPITAL FACILITY ARE TRANSPARENT AND AVAILABLE TO ALL INDIVIDUALS SERVED AT ANY POINT IN THE CARE CONTINUUM. THE FAP, FAA FORM, PLS, AND CONTACT INFORMATION FOR THE HOSPITAL FACILITY'S FINANCIAL COUNSELORS ARE PROMINENTLY AND CONSPICUOUSLY POSTED ON THE FILING ORGANIZATION'S HOSPITAL FACILITY'S WEBSITE. THE WEBSITE INDICATES THAT A COPY OF THE FAP, FAA FORM, AND PLS IS AVAILABLE AND HOW TO OBTAIN SUCH COPIES IN THE PRIMARY LANGUAGES OF ANY POPULATIONS WITH LIMITED PROFICIENCY IN ENGLISH THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY (REFERRED TO BELOW AS LEP DEFINED POPULATIONS). SIGNAGE IS DISPLAYED IN PUBLIC LOCATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, INCLUDING AT ALL POINTS OF ADMISSION AND REGISTRATION AND THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE HOSPITAL FACILITY'S WEBSITE ADDRESS WHERE THE FAP, FAA FORM, AND PLS CAN BE ACCESSED AND THE TELEPHONE NUMBER AND PHYSICAL LOCATION THAT INDIVIDUALS CAN CALL OR VISIT TO OBTAIN COPIES OF THE FAP, FAA FORM AND PLS OR TO OBTAIN MORE INFORMATION ABOUT THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS. PAPER COPIES OF THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. PAPER COPIES ARE MADE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGES OF ANY LEP DEFINED POPULATIONS. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A PAPER COPY OF THE HOSPITAL FACILITY'S PLS WILL BE OFFERED TO EVERY PATIENT AS A PART OF THE INTAKE OR DISCHARGE PROCESS. A CONSPICUOUS WRITTEN NOTICE IS INCLUDED ON ALL BILLING STATEMENTS SENT TO PATIENTS THAT NOTIFIES AND INFORMS RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, INCLUDING THE FOLLOWING: 1) THE TELEPHONE NUMBER OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND THE FAA FORM; AND 2) THE WEBSITE ADDRESS WHERE COPIES OF THE FAP, FAA FORM AND PLS MAY BE OBTAINED. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE. COPIES OF THE PLS ARE DISTRIBUTED TO MEMBERS OF THE COMMUNITY IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. PART VI, LINE 4: LOCATED IN VOLUSIA COUNTY, SOUTHWEST VOLUSIA HEALTHCARE CORPORATION, D/B/A ADVENTHEALTH FISH MEMORIAL (AHFM OR THE HOSPITAL), OPERATES A 253-BED HOSPITAL FACILITY IN ORANGE CITY, FLORIDA. THE HOSPITAL IS ONE OF 15 HOSPITALS THAT COMPRISE THE ADVENTHEALTH CENTRAL FLORIDA DIVISION. THE HOSPITAL DEFINES ITS COMMUNITY AS THE PRIMARY SERVICE AREA, THE AREA IN WHICH 75-80% OF ITS PATIENT POPULATION LIVES. THIS INCLUDES FOUR ZIP CODES ACROSS VOLUSIA COUNTY. FOR OVER 30 YEARS, ADVENTHEALTH FISH MEMORIAL HAS SERVED THE WEST VOLUSIA AREA AND SURROUNDING COMMUNITIES BY PROVIDING THE FOLLOWING COMPREHENSIVE HEALTHCARE SERVICES: CANCER CARE, DIABETES CARE, HEART AND VASCULAR CARE, HOME CARE, HOSPICE CARE, IMAGING SERVICES, LAB SERVICES, NUTRITIONAL AND DIETETIC SERVICES, ORTHOPEDIC CARE, SPORTS MEDICINE AND REHAB CARE, SURGICAL CARE, EMERGENCY AND URGENT CARE, WOMEN AND CHILDREN SERVICES AND WOUND CARE. DURING 2022, THE HOSPITAL'S PATIENT PERCENTAGE POPULATION WAS MADE UP OF THE BELOW PAYORS WITH THE REMAINING PERCENTAGE OF THE PATIENTS BEING COVERED UNDER COMMERCIAL INSURANCE. IN 2022, ABOUT 89.1% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. - MEDICARE PATIENTS 53.8% - MEDICAID PATIENTS 13.9% - SELF-PAY PATIENTS 5.4% THE DEMOGRAPHIC MAKEUP OF THE HOSPITAL'S COMMUNITY IS AS FOLLOWS: - POPULATION 143,548 - POPULATION OVER 65 18.4% - POVERTY (BELOW 100% FPL) 10.6% - HIGH SCHOOL GRADUATION RATE 89.7% - UNINSURED ADULTS 10.7% - FOOD INSECURITY RATE 14.1% - POP. WITH LOW FOOD ACCESS 63.4% PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO ADVENTHEALTH FISH MEMORIAL'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT AND COMMUNITY BUILDING INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, THE HOSPITAL PROVIDED $331,599 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF A COMMUNITY HOSPITAL. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE HOSPITAL EXPENDED $8,345,697 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. PART VI, LINE 6: THE FILING ORGANIZATION IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTHEALTH. AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 49 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 10 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AS THE PARENT ORGANIZATION OF ADVENTHEALTH, AHSSHC PROVIDES EXECUTIVE LEADERSHIP AND OTHER PROFESSIONAL SUPPORT SERVICES TO ITS SUBSIDIARY ORGANIZATIONS. PROFESSIONAL SUPPORT SERVICES INCLUDE AMONG OTHERS IT, CORPORATE COMPLIANCE, LEGAL, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. CERTAIN SUPPORT SERVICES, SUCH AS HUMAN RESOURCES, PAYROLL, A/P, AND SUPPLY CHAIN MANAGEMENT ARE PROVIDED PURSUANT TO A SHARED SERVICES MODEL BY AHSSHC TO ITS SUBSIDIARY ORGANIZATIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH ADVENTHEALTH SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. EACH ADVENTHEALTH SUBSIDIARY PAYS A MANAGEMENT FEE TO AHSSHC FOR THE INTERNAL SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY AN ADVENTHEALTH SUBSIDIARY ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY BY ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF ADVENTHEALTH AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEB-SITE OF ADVENTHEALTH AT WWW.ADVENTHEALTH.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF ADVENTHEALTH. SCHEDULE H, PART VI, LINE 7: THE FILING ORGANIZATION DOES NOT FILE AN ANNUAL COMMUNITY BENEFIT REPORT WITH ANY STATE AGENCIES. 1 ADVENTHEALTH FOUNDATION DBA ADVENTHEALTH FISH MEMORIAL FOUNDATION 1055 SAXON BLVD ORANGE CITY FL 32763 592219301 501 (C)(3) 0 58352 BOOK GENERAL ADMINISTRATIVE SUPPORT PROVISION OF GENERAL ADMINISTRATIVE SUPPORT FLAGLER CARES INC 2561 MOODY BLVD SUITE 211 FLAGLER BEACH FL 32136 474145174 501 (C)(3) 14680 0 GENERAL SUPPORT BOYS & GIRLS CLUB OF VOLUSIA FLAGLER COUNTIES INC 101 NORTH WOODLAND BLVD SUITE 40 DELAND FL 32720 593158162 501 (C)(3) 7300 0 GENERAL SUPPORT 3 0 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 X 1 1 0 1 0 0 0 0 0 0 0 OTTATI DAVID FORMER CEO CFN REG 0 990100 0 268500 0 2427551 0 166400 0 53720 0 3906271 0 104040 BANKS DAVID DIRECTOR/AH CHIEF STRATEGY 0 1285224 0 396123 0 965927 0 166400 0 39422 0 2853096 0 125316 CELANO PATRICIA FORMER REGIONAL CCO 0 586288 0 120334 0 1006847 0 109292 0 48113 0 1870874 0 52483 GREGORY PHD AUDREY DIR/CHAIR/CEO CFN REGION 0 890725 0 0 0 444829 0 187400 0 44134 0 1567088 0 0 THOMAS DEBORA DIRECTOR 0 478627 0 140091 0 198300 0 70810 0 30626 0 918454 0 48080 DEININGER ROBERT FORMER CEO 0 547187 0 123750 0 66026 0 92862 0 47326 0 877151 0 20120 BROWN LORENZO DIRECTOR/CEO-HOSPITAL/W.VOLUSIA MKT 0 417649 0 99712 0 45111 0 67245 0 57887 0 687604 0 27035 KNYCH MD STEPHEN CMO - REG & HOSPITAL FACIL 0 415774 0 81923 0 70443 0 55139 0 29918 0 653197 0 26653 WEIS DAVID DIRECTOR (END 09/22) 0 406063 0 87239 0 29740 0 71453 0 45694 0 640189 0 13066 CALLA MD SHRISH DIRECTOR 0 262418 0 171727 0 20966 0 16400 0 32525 0 504036 0 0 LUNDE ERIC DIRECTOR (BEG 09/22) 0 324955 0 32230 0 13737 0 66535 0 43156 0 480613 0 0 GLASS KYLE CFO - HOSPITAL/W.VOLUSIA MKT 0 288224 0 57115 0 11310 0 16400 0 44453 0 417502 0 0 CHILSON APRIL COO - HOSPITAL FACILITY (BEG 01/22) 0 253367 0 34780 0 10356 0 15279 0 39398 0 353180 0 0 JOHNSON MICHELE CNO - HOSPITAL FACILITY 0 212303 0 41965 0 9753 0 13908 0 39362 0 317291 0 0 OSTARLY ERIC FORMER CFO (END 04/22) 0 188770 0 62256 0 36604 0 8924 0 14862 0 311416 0 52385 ADADZI WINIFRED AH FISH DIR PHARMACY 165701 0 16834 0 4420 0 9545 0 27587 0 224087 0 0 0 MCKAY LOREN AH FISH PHARMACIST 153770 0 2810 0 9243 0 8433 0 29864 0 204120 0 0 0 STERLING-SMITH DEBBIE-ANN AH FISH PHARMACIST 150666 0 3230 0 15036 0 8394 0 14884 0 192210 0 0 0 GHANSAH JACQULYN AH FISH REGISTERED NURSE 181213 0 2352 0 1186 0 0 0 3855 0 188606 0 0 0 LUKE LUTIFIYAH AH FISH REGISTERED NURSE 127410 0 18174 0 21733 0 7683 0 453 0 175453 0 0 0 JOHNSON DANIELLE COO - HOSPITAL FACILITY (END 01/22) 0 42006 0 72740 0 56028 0 0 0 1021 0 171795 0 45231 PART I, LINE 1A THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTHEALTH. MEMBERS OF THE FILING ORGANIZATION'S EXECUTIVE MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF THE HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). THE FILING ORGANIZATION REIMBURSES AHSSHC FOR THE SALARY AND BENEFIT COST OF THOSE EXECUTIVES LISTED IN PART VII THAT ARE ON THE PAYROLL OF AHSSHC. AT THE DIRECTION OF AHSSHC, AND IN ACCORDANCE WITH THE RESERVED POWERS IN THE FILING ORGANIZATION'S GOVERNING DOCUMENTS, THE EXECUTIVE TEAM LISTED ON PART VII PROVIDES SERVICES TO THE FILING ORGANIZATION. FIRST-CLASS OR CHARTER TRAVEL: PURSUANT TO THE ADVENTHEALTH SYSTEM-WIDE GENERAL POLICY REGARDING BUSINESS TRAVEL, NO REIMBURSEMENT WILL BE PROVIDED FOR ANY ADDITIONAL COST INCURRED WITH RESPECT TO FIRST-CLASS OR CHARTER AIR TRAVEL BEYOND THE COST OF A REGULAR COACH AIRFARE. AS A MEANS OF PROVIDING ADDITIONAL BUSINESS TRAVEL REIMBURSEMENT FOR THOSE MEMBERS OF THE AHSSHC SENIOR EXECUTIVE MANAGEMENT TEAM THAT TRAVEL FREQUENTLY ON BEHALF OF ADVENTHEALTH, A SPECIAL ANNUAL TRAVEL ALLOWANCE IS PROVIDED FOR THOSE EXECUTIVES. AS ADVENTHEALTH OPERATES 49 HOSPITALS IN 9 STATES, THE SENIOR LEADERSHIP OF AHSSHC TRAVEL EXTENSIVELY AND OFTEN VISIT MULTIPLE HOSPITAL LOCATIONS IN DIFFERENT STATES AS A PART OF A SINGLE BUSINESS TRIP. THE SPECIAL TRAVEL ALLOWANCE CAN PROVIDE REIMBURSEMENTS TO THE EXECUTIVE FOR SUCH ITEMS AS THE PURCHASE OF AIR TRAVEL UPGRADE COUPONS, TO COVER THE COST DIFFERENTIAL BETWEEN COACH AND FIRST-CLASS TRAVEL, OR TO COVER THE COST OF A CHARTER FLIGHT. THE SPECIAL TRAVEL ALLOWANCE BENEFIT WAS ORIGINALLY AUTHORIZED BY AND CODIFIED INTO A POLICY BY THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE), AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS, WHO ALSO APPROVES THE ANNUAL CAP ON THE AMOUNT OF THE ALLOWANCE. THE SPECIAL TRAVEL ALLOWANCE HAS AN ANNUAL CAP OF $24,000 FOR MEMBERS OF THE LEADERSHIP EXECUTIVE TEAM (13 ADVENTHEALTH CABINET MEMBERS AND THE ADVENTHEALTH MULTI-STATE CFO) AND $15,000 FOR ADVENTHEALTH CORPORATE OFFICE SENIOR VICE PRESIDENTS, REGIONAL CEO'S, AND DIVISION CHIEF OFFICERS (GENERALLY 50 - 55 INDIVIDUAL EXECUTIVES). 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. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES ASSISTANCE TO EXECUTIVES WHO HAVE BEEN RELOCATED BY THE COMPANY DURING THE YEAR. RELOCATION ASSISTANCE PROVIDED TO EXECUTIVES MAY INCLUDE RELOCATION ALLOWANCES TO ASSIST WITH DUPLICATE HOUSING EXPENSES. RELOCATION ASSISTANCE IS ADMINISTERED PER AHSSHC POLICY BY AN EXTERNAL RELOCATION COMPANY. ALL TAXABLE REIMBURSEMENTS MADE TO EXECUTIVES IN CONNECTION WITH RELOCATION ASSISTANCE ARE TREATED AS WAGES TO THE EXECUTIVE AND ARE SUBJECT TO ALL PAYROLL WITHHOLDING AND REPORTING REQUIREMENTS. 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 DETERMINE IF CONTINUANCE OF THE CLUB MEMBERSHIP FURTHERS THE BUSINESS INTERESTS OF ADVENTHEALTH. IN THE CURRENT YEAR, THE CEO OF THE FILING ORGANIZATION 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 APPOINTED AND COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC HAS TAKEN STEPS TO ENSURE THAT PROCESSES ARE IN PLACE TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS STANDARD AS SET FORTH IN TREASURY REGULATION SECTION 53.4958-6 WITH RESPECT TO ITS ACTIVE EXECUTIVE-LEVEL POSITIONS. THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE) SERVES AS THE GOVERNING BODY FOR ALL EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE IS COMPOSED OF CERTAIN MEMBERS OF THE BOARD OF DIRECTORS (THE BOARD) OF AHSSHC. VOTING MEMBERS OF THE COMMITTEE INCLUDE ONLY INDIVIDUALS WHO SERVE ON THE BOARD AS INDEPENDENT REPRESENTATIVES, WHO HOLD NO EMPLOYMENT POSITIONS WITH AHSSHC AND WHO DO NOT HAVE RELATIONSHIPS WITH ANY OF THE INDIVIDUALS WHOSE COMPENSATION IS UNDER THEIR REVIEW THAT IMPACTS THEIR BEST INDEPENDENT JUDGMENT AS FIDUCIARIES OF AHSSHC. THE COMMITTEE'S ROLE IS TO REVIEW AND APPROVE ALL COMPONENTS OF THE EXECUTIVE COMPENSATION PLAN OF AHSSHC. AS AN INDEPENDENT GOVERNING BODY WITH RESPECT TO EXECUTIVE COMPENSATION, IT SHOULD BE NOTED THAT THE COMMITTEE WILL OFTEN CONFER IN EXECUTIVE SESSIONS ON MATTERS OF COMPENSATION POLICY AND POLICY CHANGES. IN SUCH EXECUTIVE SESSIONS, NO MEMBERS OF MANAGEMENT OF AHSSHC ARE PRESENT, OTHER THAN THE CHIEF PEOPLE OFFICER, WHO REMAINS AT THE REQUEST OF THE CHAIRMAN/COMMITTEE TO PROVIDE ASSISTANCE/INFORMATION AS NEEDED. THE COMMITTEE IS ADVISED BY AN INDEPENDENT THIRD-PARTY COMPENSATION ADVISOR. THIS ADVISOR PREPARES ALL THE BENCHMARK STUDIES FOR THE COMMITTEE. COMPENSATION LEVELS ARE BENCHMARKED WITH A NATIONAL PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS OF SIMILAR SIZE AND COMPLEXITY TO ADVENTHEALTH AND EACH OF ITS AFFILIATED ENTITIES. THE FOLLOWING PRINCIPLES GUIDE THE ESTABLISHMENT OF INDIVIDUAL EXECUTIVE COMPENSATION: - THE SALARY OF THE PRESIDENT/CEO OF ADVENTHEALTH WILL NOT EXCEED THE 50TH PERCENTILE OF COMPARABLE SALARIES PAID BY SIMILARLY SITUATED ORGANIZATIONS; AND - OTHER EXECUTIVE SALARIES SHALL BE ESTABLISHED USING MARKET MEDIANS. THE COMPENSATION PHILOSOPHY, POLICIES, AND PRACTICES OF AHSSHC ARE CONSISTENT WITH THE ORGANIZATION'S FAITH-BASED MISSION AND CONFORM TO APPLICABLE LAWS, REGULATIONS, AND BUSINESS PRACTICES. AS A FAITH-BASED ORGANIZATION SPONSORED BY THE SEVENTH-DAY ADVENTIST CHURCH (THE CHURCH), AHSSHC'S PHILOSOPHY AND PRINCIPLES WITH RESPECT TO ITS EXECUTIVE COMPENSATION PRACTICES REFLECT THE CONSERVATIVE APPROACH OF THE CHURCH'S MISSION OF SERVICE AND WERE DEVELOPED IN COUNSEL WITH THE CHURCH'S LEADERSHIP. PART I, LINE 4B AS DISCUSSED IN LINE 1A ABOVE, EXECUTIVES ON THE FILING ORGANIZATION'S MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF THE HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. IN RECOGNITION OF THE CONTRIBUTION THAT EACH EXECUTIVE MAKES TO THE SUCCESS OF ADVENTHEALTH, ADVENTHEALTH PROVIDES SUPPLEMENTAL EXECUTIVE RETIREMENT BENEFIT PLANS TO ELIGIBLE EXECUTIVES. AS THE SUPPLEMENTAL EXECUTIVE RETIREMENT BENEFIT PLANS WERE UPDATED IN 2020 AND CERTAIN INDIVIDUALS STILL PARTICIPATE AS GRAND-FATHERED PARTICIPANTS IN CERTAIN PLANS, THE NARRATIVE BELOW DISCUSSES ALL PLANS IN WHICH THERE WERE ANY PARTICIPANTS IN 2022. THE SERP III PLAN EFFECTIVELY REPLACES THE PRIOR SERP II PLAN, THE EXECUTIVE FLEX BENEFIT PROGRAM PLAN, AND THE SENIOR EXECUTIVE DEATH BENEFIT PLAN FOR QUALIFIED EXECUTIVES EXCEPT FOR CERTAIN GRANDFATHERED EXECUTIVE EMPLOYEES. SERP III PLAN: THE SERP III PLAN PROVIDES ELIGIBLE EXECUTIVES A PERCENTAGE OF THEIR BASE PAY, WHICH IS CREDITED TO A DEFERRED COMPENSATION ACCOUNT. THE PLAN ALSO PROVIDES FOR COMPENSATION DEFERRAL AND SELECTION OF LIFE INSURANCE COVERAGE AND LONG-TERM CARE INSURANCE. TO BE ELIGIBLE TO PARTICIPATE IN THE SERP III PLAN, EXECUTIVES MUST BE ON THE AHSSHC CORPORATE PAYROLL AND BE EITHER A CEO OF AN ADVENTHEALTH ENTITY, AN AHSSHC VICE PRESIDENT (VP) OR VP OF AN ADVENTHEALTH ENTITY WITH A BASE SALARY OF AT LEAST $305,000 IN 2022 (ADJUSTED ANNUALLY BY THE SAME PERCENTAGE AS IRC SECTION 401(A)(17) LIMIT INCREASES), OR OTHER LEADER SPECIFICALLY APPROVED BY THE ADVENTHEALTH PRESIDENT. ELIGIBLE EXECUTIVES DO NOT INCLUDE GRANDFATHERED EXECUTIVES, MEANING THOSE EXECUTIVES WHO WOULD SATISFY ALL THE ELIGIBILITY REQUIREMENTS OF THE SERP II PLAN PRIOR TO DEC 31, 2027, HAD THE PLAN NOT BEEN AMENDED AND RESTATED AS OF JAN. 1, 2020. CONTRIBUTION CREDITS WILL BE ESTABLISHED AND MAINTAINED BY CLASS YEAR ACCOUNTS FOR EACH PARTICIPANT USING TIERED CONTRIBUTION CREDIT PERCENTAGES OF ANNUAL BASE COMPENSATION. CONTRIBUTION CREDIT PERCENTAGES RANGE BETWEEN 15% AND 19% OF BASE COMPENSATION. CONTRIBUTION CREDITS WILL BE MADE EACH QUARTER IN 25% INCREMENTS WITH REDUCTIONS IN CONTRIBUTIONS IF THE EXECUTIVE IS ALSO A GRANDFATHERED FLEX PARTICIPANT (SEE BELOW). SERP III PROVIDES FOR A CLASS YEAR VESTING AND PAYMENT SCHEDULE (7 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S DEFERRED COMPENSATION ACCOUNT. UPON ATTAINMENT OF A NORMAL RETIREMENT AGE (AGE 62), OR UPON CERTAIN OTHER CIRCUMSTANCES AS DEFINED IN THE SERP III PLAN DOCUMENT, ALL DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT. FOR ANY EXECUTIVES WORKING BEYOND THE NORMAL RETIREMENT AGE, FUTURE EMPLOYER CONTRIBUTIONS WILL BE MADE QUARTERLY FROM SERP III DIRECTLY TO THE PARTICIPANT AS A TAXABLE CASH BONUS. SERP II PLAN: THE SERP II PLAN IS A DEFINED BENEFIT, NON-TAX-QUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN EXECUTIVES WHO HAVE PROVIDED LENGTHY SERVICE TO ADVENTHEALTH AND/OR TO OTHER SEVENTH-DAY ADVENTIST CHURCH HOSPITALS OR HEALTH CARE INSTITUTIONS. UNDER THE PROVISIONS OF THE SERP II PLAN, BENEFITS ARE PROVIDED TO QUALIFYING EXECUTIVE PARTICIPANTS ON A PRO-RATA SCHEDULE BEGINNING WITH 20 YEARS OF SERVICE AS AN EMPLOYEE OF ADVENTHEALTH AND/OR ANOTHER HOSPITAL OR HEALTH CARE INSTITUTION CONTROLLED BY THE SEVENTH-DAY ADVENTIST CHURCH AND WHO SATISFY CERTAIN OTHER QUALIFYING CRITERIA. ELIGIBLE EMPLOYEES ARE RESTRICTED TO THOSE EXECUTIVES WHO, AS OF JANUARY 1, 2020, SATISFIED, OR IF EMPLOYMENT CONTINUES, WILL SATISFY THE ELIGIBILITY REQUIREMENTS OF SERP II PRIOR TO DECEMBER 31, 2027. THIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP II) WAS DESIGNED TO PROVIDE ELIGIBLE EXECUTIVES WITH THE ECONOMIC EQUIVALENT OF AN ANNUAL INCOME BEGINNING AT NORMAL RETIREMENT AGE EQUAL TO 60% OF THE AVERAGE OF THE PARTICIPANT'S THREE, FIVE OR SEVEN HIGHEST YEARS OF BASE SALARY FROM ADVENTHEALTH ACTIVE EMPLOYMENT INCLUSIVE OF INCOME FROM ALL OTHER SEVENTH-DAY ADVENTIST CHURCH HEALTHCARE EMPLOYER-FINANCED RETIREMENT INCOME SOURCES AND INVESTMENT INCOME EARNED ON THOSE CONTRIBUTIONS THROUGH SOCIAL SECURITY NORMAL RETIREMENT AGE AS DEFINED IN THE PLAN. THE NUMBER OF YEARS INCLUDED IN HIGHEST AVERAGE COMPENSATION IS DETERMINED BY THE INDIVIDUAL'S YEAR OF ENTRY TO SERP II AND BY THE INDIVIDUAL'S YEAR OF ENTRY TO THE ADVENTHEALTH EXECUTIVE FLEX BENEFIT PROGRAM. FLEX PLAN: THE FLEX PLAN WAS ORIGINALLY DESIGNED TO PROVIDE ELIGIBLE EXECUTIVES AN OPPORTUNITY TO SELECT FROM AMONG A VARIETY OF SUPPLEMENTAL BENEFITS, INCLUDING A SPLIT DOLLAR LIFE INSURANCE POLICY AND LONG-TERM CARE INSURANCE, TO INDIVIDUALLY TAILOR A BENEFITS PROGRAM APPROPRIATE TO EACH EXECUTIVE'S NEEDS. IN 2020, THE FLEX PLAN WAS AMENDED TO EXCLUDE EMPLOYED EXECUTIVES WHO ARE HIRED OR PROMOTED AFTER A CERTAIN DATE FROM BEING ELIGIBLE TO PARTICIPATE IN THE FLEX PLAN EXCEPT FOR CERTAIN INSURANCE COVERAGE FEATURES OF THE PLAN. THE FLEX PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS IS DEDUCTED. THE BENEFITS ALLOWANCE CREDIT PERCENTAGE FOR ANY PLAN YEAR SHALL NOT BE GREATER THAN THE MAXIMUM DOLLAR AMOUNT OR THE PERCENTAGE OF COMPENSATION AS DETERMINED BY THE ADVENTHEALTH BENEFITS ADMINISTRATION COMMITTEE. FOR GRANDFATHERED ELIGIBLE EMPLOYEES, THE ANNUAL PRE-DETERMINED FLEX ALLOWANCE IS CONTRIBUTED AND ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED ARE, AT THE EMPLOYEE'S OPTION, CONTRIBUTED TO EITHER AN IRC 457(F) DEFERRED COMPENSATION ACCOUNT OR TO AN IRC 457(B) ELIGIBLE DEFERRED COMPENSATION PLAN. UPON ATTAINMENT OF AGE 65, ALL PREVIOUS 457(F) DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT AND ANY FUTURE EMPLOYER CONTRIBUTIONS ARE MADE QUARTERLY FROM THE PLAN DIRECTLY TO THE PARTICIPANT. THE PLAN PROVIDES FOR A CLASS YEAR VESTING SCHEDULE (2 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT. DISTRIBUTIONS COULD ALSO BE MADE FROM THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT UPON ATTAINMENT OF AGE 65 OR UPON AN INVOLUNTARY SEPARATION. THE ACCOUNT WILL BE FORFEITED BY THE EXECUTIVE UPON A VOLUNTARY SEPARATION. WITH RESPECT TO GRANDFATHERED PARTICIPANTS, THE FLEX PLAN DOCUMENTS DEFINE ELIGIBLE EMPLOYEES TO INCLUDE THE CHIEF EXECUTIVE OFFICERS OF ADVENTHEALTH ENTITIES AND VICE PRESIDENTS OF ALL ADVENTHEALTH ENTITIES WHOSE BASE SALARY WAS AT LEAST EQUAL TO THE INTERNAL REVENUE CODE SECTION 401(A)(17) COMPENSATION LIMIT EACH YEAR. FLEX PLAN FLEX PLAN SERP II SERP III AHS 457B CONTR. DISTR.* CONTR./DISTR. CONTR. DISTR.* OTTATI,DAVID $ 150,000 $ 140,915 $ 2,256,444 $ 0 $ 0 BANKS,DAVID $ 150,000 $ 125,363 $ 809,672 $ 0 $ 0 CELANO,PATRICIA $ 92,892 $ 60,594 $ 913,228 $ 0 $ 0 GREGORY,AUDREY $ 0 $ 0 $ 0 $ 171,000 $ 0 THOMAS,DEBORA $ 74,910 $ 48,092 $ 102,171 $ 0 $ 0 DEININGER,ROBERT $ 78,654 $ 25,469 $ 0 $ 18,308 $ 0 BROWN,LORENZO $ 50,845 $ 28,338 $ 0 $ 0 $ 0 KNYCH,STEPHEN $ 59,239 $ 26,658 $ 0 $ 0 $ 0 WEIS,DAVID $ 45,712 $ 13,071 $ 0 $ 15,441 $ 0 LUNDE,ERIC $ 0 $ 0 $ 0 $ 50,135 $ 0 OSTARLY,ERIC $ 3,847 $ 17,571 $ 0 $ 5,078 $ 20,685 JOHNSON,DANIELLE $ 0 $ 23,476 $ 1,010 $ 0 $ 21,767 * INCLUDING INVESTMENT EARNINGS PART V, LINE 1A: THE PARENT CORPORATION AND SOLE TOP-TIER MEMBER OF SOUTHWEST VOLUSIA HEALTHCARE CORPORATION (THE FILING ORGANIZATION) IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS A FLORIDA, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). AHSSHC HAS ESTABLISHED A SHARED SERVICE CENTER TO CENTRALIZE THE ACCOUNTS PAYABLE (A/P) FUNCTION FOR ALL AHSSHC SUBSIDIARY ORGANIZATIONS. THE FILING ORGANIZATION HAS ENTERED "0" IN PART V, LINE 1A BECAUSE THE FILING ORGANIZATION NO LONGER ISSUES FORM 1099 RETURNS, RATHER, ALL SUCH RETURNS ARE FILED BY AND UNDER THE NAME AND EIN OF AHSSHC AS THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. THE FACTS AND CIRCUMSTANCES SUPPORT A POSITION THAT AHSSHC, AS A PAYOR ON BEHALF OF ITS SUBSIDIARY ORGANIZATIONS IN A SHARED SERVICE ENVIRONMENT, WILL HAVE SUFFICIENT MANAGEMENT AND OVERSIGHT IN CONNECTION WITH THE SUBSIDIARY ORGANIZATIONS' PAYMENTS TO MEET THE STANDARD SET FORTH IN TREAS. REG. SECTION 1.6041-1(E). AHSSHC WILL NOT MERELY BE MAKING PAYMENTS AT THE DIRECTION OF ITS SUBSIDIARY ORGANIZATIONS. ACCORDINGLY, AHSSHC IS CONSIDERED THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. FORM 990, PART VI, SECTION A, LINE 6 SOUTHWEST VOLUSIA HEALTHCARE CORPORATION (SVHC) HAS ONE MEMBER. THE SOLE MEMBER OF SVHC IS ADVENTIST HEALTH SYSTEM SUNBELT, INC. ADVENTIST HEALTH SYSTEM SUNBELT, INC. (AHSS) IS A FLORIDA, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN SVHC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF SVHC IS AHSS. THE BOARD OF DIRECTORS OF SVHC ARE APPOINTED BY THE SOLE MEMBER, AHSS, WHO HAS THE RIGHT TO ELECT, APPOINT OR REMOVE ANY MEMBER OF THE BOARD OF DIRECTORS OF SVHC. FORM 990, PART VI, SECTION A, LINE 7B AHSS, AS THE SOLE MEMBER OF THE FILING ORGANIZATION, HAS CERTAIN RESERVED POWERS AS SET FORTH IN THE BYLAWS OF THE FILING ORGANIZATION. THESE RESERVED POWERS INCLUDE THE FOLLOWING: A) TO APPOINT AND REMOVE THE DIRECTORS AND ALL OFFICERS AND ADMINISTRATORS OF THE FILING ORGANIZATION, AND THEIR SALARIES; B) TO ADOPT, AMEND, RESTATE, AND REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS OF THE FILING ORGANIZATION AND THE MEDICAL STAFF BYLAWS; C) TO APPROVE OR DISAPPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION; D) TO APPROVE THE APPOINTMENT OF AN AUDITING FIRM AND ELECTION OF THE FISCAL YEAR FOR THE FILING ORGANIZATION; E) TO APPROVE OR DISAPPROVE MATERIAL CHANGES IN SERVICES OFFERED BY THE FILING ORGANIZATION; F) TO APPROVE OR DISAPPROVE CAPITAL EXPENDITURES IN EXCESS OF $1,000,000; G) TO APPROVE OR DISAPPROVE THE SALE, PURCHASE, DONATION, OR OTHER CONVEYANCE OF PERSONAL PROPERTY WITH A VALUE IN EXCESS OF $1,000,000 NOT OTHERWISE APPROVED IN THE CURRENT CAPITAL OR OPERATING BUDGETS; H) THE AUTHORITY TO REQUIRE THE FILING ORGANIZATION'S ADHERENCE TO POLICIES ADOPTED BY THE MEMBER OR AHSSHC; I) THE AUTHORITY TO SECURE NAMING RIGHTS AND TO DIRECT THE PLACEMENT OF FUNDS AND CAPITAL AND THE MAKING OF GIFTS, SPONSORSHIPS, DONATIONS, LOANS AND TRANSFERS OF FUNDS OR OTHER ASSETS BY THE FILING ORGANIZATION IN EXCESS OF $100,000; J) TO APPROVE OR DISAPPROVE THE SALE, DONATION, OR OTHER TRANSFER OF REAL PROPERTY WITH A VALUE IN EXCESS OF $1,000,000; K) TO APPROVE OR DISAPPROVE THE IMPLEMENTATION OF NON-TRADITIONAL, NON-HEALTHCARE RELATED ACTIVITIES; L) TO APPROVE OR DISAPPROVE THE SELECTION OF THE FILING ORGANIZATION'S GROUP PURCHASING ORGANIZATION(S); M) TO APPROVE OR DISAPPROVE ANY JOINT VENTURE OR PARTNERSHIP IN WHICH THE FILING ORGANIZATION WOULD BE A MEMBER OR PARTNER; N) TO APPROVE THE IT SYSTEMS USED BY THE FILING ORGANIZATION; AND O) THE AUTHORITY TO REQUIRE THE FILING ORGANIZATION'S ADHERENCE TO THE SYSTEM-WIDE NAMING NOMENCLATURE ADOPTED BY THE MEMBER OR AHSSHC; P) THE AUTHORITY TO SET LIMITS AND TERMS FOR ANY AND ALL TYPES OF FINANCIAL TRANSACTIONS EXCEEDING $100,000 FOR ANY SINGLE OR RELATED PROJECTS INCLUDING, WITHOUT LIMITATION, BORROWING OF FUNDS, ANY TYPE OF FINANCING, ANY BANKING ACTIVITIES, ACCOUNTS RECEIVABLE SECURITIZATION, SALE OF ACCOUNTS RECEIVABLE, LETTERS OF CREDIT, CREDIT LINES, TAX EXEMPT AND TAXABLE DEBT PROGRAMS AND STRUCTURES, ANY TRANSACTIONS PERMITTED BY THE FINANCIAL DOCUMENTS AND FINANCIAL STRUCTURE OF AHSSHC AND ANY OF ITS AFFILIATED ORGANIZATIONS, AND ANY OTHER FINANCING TRANSACTIONS NOT IDENTIFIED HEREIN, AND Q) TO APPROVE OR DISAPPROVE PERFORMANCE/QUALITY IMPROVEMENT AND CASE MANAGEMENT PROGRAMS. FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND BY THE CFO PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND THE CFO DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR ANY PRINCIPAL OFFICER OF THE FILING ORGANIZATION (I.E. INTERESTED PERSONS) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES ARE NOT COMPENSATED BY THE FILING ORGANIZATION. SUCH INDIVIDUALS ARE COMPENSATED BY THE RELATED TOP-TIER PARENT ORGANIZATION OF THE FILING ORGANIZATION. PLEASE SEE THE DISCUSSION CONCERNING THE PROCESS FOLLOWED BY THE RELATED TOP-TIER PARENT ORGANIZATION IN DETERMINING EXECUTIVE COMPENSATION IN OUR RESPONSE TO SCHEDULE J, LINE 3. FORM 990, PART VI, SECTION C, LINE 19 THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTHEALTH. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF ADVENTHEALTH AND OF THE ADVENTHEALTH "OBLIGATED GROUP" ARE FILED ANNUALLY WITH THE MUNICIPAL SECURITIES RULEMAKING BOARD (MSRB). THE "OBLIGATED GROUP" IS A GROUP OF AHSSHC SUBSIDIARIES THAT ARE JOINTLY AND SEVERALLY LIABLE UNDER A MASTER TRUST INDENTURE THAT SECURES DEBT PRIMARILY ISSUED ON A TAX-EXEMPT BASIS. UNAUDITED QUARTERLY FINANCIAL STATEMENTS PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) ARE ALSO FILED WITH MSRB FOR ADVENTHEALTH ON A CONSOLIDATED BASIS AND FOR THE GROUPING OF ADVENTHEALTH SUBSIDIARIES COMPRISING THE "OBLIGATED GROUP". THE FILING ORGANIZATION DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. PART VII, SECTION A: FOR THOSE BOARD OF DIRECTOR MEMBERS (NOT INCLUDING PHYSICIAN MEMBERS OF THE BOARD), OFFICER(S) AND KEY EMPLOYEES WHO DEVOTE LESS THAN FULL-TIME TO THE FILING ORGANIZATION (BASED UPON THE AVERAGE NUMBER OF HOURS PER WEEK SHOWN IN COLUMN (B) ON PAGE 7 OF THE RETURN) THE COMPENSATION AMOUNTS SHOWN IN COLUMNS (E) AND (F) ON PAGE 7 WERE PROVIDED IN CONJUNCTION WITH THAT PERSON'S RESPONSIBILITIES AND ROLES IN SERVING IN AN EXECUTIVE LEADERSHIP POSITION AS AN EMPLOYEE OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION. PHYSICIAN MEMBERS OF THE BOARD OF DIRECTORS RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS AS A RESULT OF PROVIDING VARIOUS MEDICAL SERVICES TO THOSE RELATED ENTITIES. PART VIII, LINES 7A, B AND C: THE 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 39,746,777. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,746,777. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,034,667. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,034,667. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 24,187,826. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,187,826. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 165,152. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 165,152. TRANSCRIPTION SERVICES: PROGRAM SERVICE EXPENSES 53,789. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,789. RECRUITING: PROGRAM SERVICE EXPENSES 824,814. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 824,814. FOOD SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 22. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 9,592,255. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,592,255. ADVENTHEALTH MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 4,144,995. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,144,995. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,179,723. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,179,723. ADVENTHEALTH SHARED SERVICE FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,071,544. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,071,544. FORM 990, PART XI, LINE 9: TRANSFER TO TOP-TIER TAX-EXEMPT PARENT -2,104,895. ALLOCATION FROM TAX-EXEMPT PARENT WITH RESPECT TO DEBT 395,820. ROUNDING -2. FORM 990, PART XII, LINE 3B: THE TAXPAYER IS PART OF A CONTROLLED GROUP OF ORGANIZATIONS THAT COMPRISE A CONSOLIDATED FINANCIAL STATEMENT AUDIT. THE CONTROLLED GROUP'S PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), A 501(C)(3) ORGANIZATION. THE SYSTEM OF HEALTHCARE ENTITIES OWNED AND CONTROLLED BY AHSSHC IS KNOWN AS ADVENTHEALTH. FOR THE YEAR ENDED DECEMBER 31, 2022, ADVENTHEALTH WILL FILE A CONSOLIDATED SINGLE AUDIT WHICH WILL INCLUDE ALL ENTITIES THAT ARE PART OF THE CONTROLLED GROUP. ACCORDINGLY, THE TAXPAYER HAS CHECKED YES TO THE QUESTIONS ON PART XII, LINE 3A AND 3B. PART X, LINE 2: THE AMOUNTS SHOWN ON LINE 2 OF PART X OF THIS RETURN INCLUDES THE FILING ORGANIZATION'S INTEREST IN A CENTRAL INVESTMENT POOL MAINTAINED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, THE FILING ORGANIZATION'S TOP-TIER PARENT. THE INVESTMENTS IN THE CENTRAL INVESTMENT POOL ARE RECORDED AT MARKET VALUE. 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