2024-02-15T17:24:18-06:00 2022-12-31 990 2022-01-01 591479658 Adventist Health SystemSunbelt Inc ADVE 4073572317 900 Hope Way Altamonte Springs FL 32714 Lynn C Addiscott Asst. Secretary 4073572317 2024-02-15 Lynn Addiscott 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Terry Shaw 900 Hope Way Altamonte Springs FL 32714 6716859729 0 1071 X www.adventhealth.com X 1973 FL Operation of 11 acute-care hospitals & related healthcare services. 22 15 36897 1539 27850887 4019418 71730639 104069888 5645631821 6021551256 175291624 128778123 14652267 -1693372 5907306351 6252705895 22086643 25705251 0 0 2133046330 2473662371 0 0 0 2993275611 3309863414 5148408584 5809231036 758897767 443474859 11276131812 11012939296 5196868532 4982376731 6079263280 6030562565 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 5328982795 25705251 5988701337 Operation of 11 acute care hospitals with 159,286 patient admissions, 900,829 patient days and 1,817,829 outpatient visits in the current year. In addition to hospital operations, the corporation provides medical care through a number of other activities such as urgent care centers, physician clinics, home health services, hospice services, sleep centers, wound centers, therapy and rehab. 5328982795 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 1 1 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 X 0 0 1 36897 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 22 15 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X Paul Rathbun 4073572419 900 Hope Way Altamonte Springs FL 32714 X Aguilera Ronald Director (End 5/22) 1.00 2.00 X 0 6088 0 Bernard Roger A Director (End 9/22) 1.00 2.00 X 0 5708 0 Bigalke John T Director 1.00 2.00 X 0 37511 0 Brooks Stephen Director (Beg 9/22) 1.00 1.50 X 0 5238 0 Cherry MD Robert A Director 1.00 2.00 X 0 29511 0 Craig Carlos J Dir./Vice Chair/Secretary 1.00 2.00 X 0 5417 0 Davidson James R Director (End 9/22) 1.00 1.50 X 0 5363 0 Denslow Kenneth Dir./Vice Chair 2.00 2.00 X 0 5692 0 Devore Susan D Director 1.00 2.00 X 0 34013 0 Freedman David Director (Beg 9/22) 1.00 1.50 X 0 5363 0 Gabriel Garth Director (Beg 9/22) 1.00 1.00 X 0 5088 0 Grys DMin MD John Director (Beg 5/22) 1.00 1.00 X 0 5013 0 Johnson Tidjani Michelle Director 1.00 2.00 X 0 26013 0 Machado Allan Director 1.00 1.50 X 0 5088 0 Morel Jr D Min Hubert J Director (Beg 9/22) 1.00 1.00 X 0 5238 0 Morgan William H Director 1.00 2.00 X 0 0 0 Page John M Director (End 9/22) 1.00 1.50 X 0 5213 0 Ramirez Elden Director (End 9/22) 1.00 2.00 X 0 5363 0 Rustad Gary Director (Beg 9/22) 1.00 1.50 X 0 6913 0 Sauder PhD Vinita Director 1.00 1.00 X 0 5213 0 Scott Glynn CW Director (Beg 9/22) 1.00 2.00 X 0 5363 0 Shaw EdD Kenneth Director 1.00 1.50 X 0 5613 0 Shaw Terry D Dir/President/AdventHealth CEO 1.00 50.00 X X 0 4723276 955707 Smith DMin PhD Ron C Director/Chairperson 2.00 2.00 X 0 5542 0 Thurber Gary F Director/Vice Chair 2.00 2.00 X 0 6063 0 Thurber John Mic Director (End 9/22) 1.00 2.00 X 0 5088 0 Tikker Blair Director 1.00 2.00 X 0 34013 0 VandeVere David Director (End 9/22) 1.00 1.00 X 0 5888 0 Werner Thomas L Director 1.00 2.00 X 0 5585 0 Haffner PhD Randall CEO Central FL Division 1.00 50.00 X 0 2420244 190032 Rathbun Paul C AdventHealth CFO 1.00 50.00 X 0 2536010 211956 Adams Brian CEO Central FL Div. South Region 50.00 0.00 X 0 1153386 182815 Cook Timothy CEO AH Altamonte & Seminole Market 50.00 0.00 X 0 697902 124531 Deininger Robert CEO AH Orlando 50.00 0.00 X 0 736963 140188 Finkler MD Neil Chief Clinical Officer AH Central FL Div. 50.00 0.00 X 0 1225302 43176 Goodman Todd CFO, AH Central FL Division 1.00 50.00 X 0 1822857 204341 Harcombe Douglas CEO AH Celebration & South Market 50.00 0.00 X 0 692609 132260 Hilliard Douglas Sr Finance Officer AH Orlando 50.00 0.00 X 0 1006458 138480 Moorhead Sheryl Chief People Off. AH Central FL Div. 50.00 0.00 X 0 748807 35912 Thompson Michael CEO IHS Central FL Div-South Region 40.00 10.00 X 0 1223927 146845 Vargas Karilynn CEO AH Winter Garden & West Market 50.00 0.00 X 0 576289 95411 Villanueva Jeffrey CEO AH East Orlando & East Market 50.00 0.00 X 0 1314892 119592 Zbaraschuk Amy Sr Fin Off. Central FL Div-South Region 40.00 10.00 X 0 680236 122000 Accola MD Kevin Phy/Exec Med Dir/Cardio Surgery & Structural Heart 50.00 0.00 X 1626444 0 35524 Bogar MD Linda Physician - Heart Transplant 75.00 0.00 X 1434928 0 44830 Palmer MD George Phy/AH Celebration Cardio Surgery 50.00 0.00 X 1416890 0 44716 Silvestry MD Scott Phy/Dir AH Thoracic Transplant 85.00 0.00 X 2909076 0 47861 Zeeshan MD Ahmad Physician - Heart Transplant 75.00 0.00 X 1458296 0 35593 Tol Daryl Former SEVP/CEO Central FL Div 0.00 0.00 X 0 792032 104 Bradley Kenneth W Former Key Emp/AH Dir Emerging Leader 0.00 50.00 X 0 193548 34267 Moorhead MD David Former EVP/Chief Clinical Officer 0.00 50.00 X 0 1734675 34340 Owen Terry R Former SVP Partnering Strategy CFD 0.00 0.00 X 0 305559 16138 Wandersleben Jennifer Former CEO AH CFD So Acute Care S 0.00 50.00 X 0 949270 170444 8845634 25816443 3307063 5089 1 1 0 AYA Healthcare Inc PO Box 123519 Dept 3519 Dallas TX 75312 Healthcare Staffing 102772195 AMN Healthcare Inc 8840 Cypress Waters Blvd Ste 300 Dallas TX 75019 Healthcare Staffing 98647901 Maxim Healthcare Services Inc 12558 Collections Center Dr Chicago IL 60693 Healthcare Staffing 62626668 Brasfield & Gorrie LLC 2999 Circle 75 Parkway Ste 100 Atlanta GA 30339 Construction Services 57508699 Cross Country Staffing Inc PO Box 404674 Atlanta GA 30384 Healthcare Staffing 27287329 588 X 13486038 12567034 78016816 104069888 Patient Revenue 622110 5932837048 5911465769 21371279 Rent from Exempt Affiliates 622110 23270145 23270145 Cafeteria/Vending Revenue 622110 17106689 16913019 193670 Research - Disease Related 622110 14255842 14255842 Laundry 622110 9727211 9650346 76865 24354321 18224956 6129365 6021551256 115433160 115433160 337604 337604 8637460 17260 5599932 7024 3037528 10236 3047764 70943 2976821 471891841 65575629 392971249 -65575629 78920592 13344963 13344963 Investment in Subs 622110 -592701 -592701 Equity earnings (losses) from rel 622110 -4486039 -4486039 -5078740 6252705895 5988701337 27842122 132092548 X 22744296 22744296 2960955 2960955 15975455 15975455 1854795319 1836385698 18409621 71701005 70441756 1259249 391320370 375710019 15610351 139870222 137418446 2451776 2048671 2048671 1139554 1139554 11225841 11225841 1058277854 836133278 222144576 41728674 41728674 105808193 81435454 24372739 295146713 277803390 17343323 124040429 124040429 7758420 1184955 6573465 6599226 6599226 47034922 47027047 7875 257469631 257469631 41212956 37635365 3577591 Medical Supplies 883948770 883948770 Assessments 230246000 230246000 Repairs/Maintenance 98537408 98537408 Unrelated Business Inco 313962 313962 97326190 7859898 89466292 5809231036 5328982795 480248241 0 X 92638 94153 3689627590 3635731209 794375439 904155025 142220964 143584990 62449459 67823674 6182143912 2890536665 3216229323 3291607247 15921797 15329096 22403806 19316664 3332810796 2935297238 11276131812 11012939296 428388507 425717506 4344524039 3920808527 423955986 635850698 5196868532 4982376731 X 6078902256 6030281108 361024 281457 6079263280 6030562565 11276131812 11012939296 X 443474859 -605651040 113475466 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 99450 99450 0 Part II-B, Line 1: The corporation paid dues to the American Hospital Association and the Florida Hospital Association who use a portion of the dues to conduct lobbying activities. 16447156 151931 986523 1258116 16327494 21347312 1213093 73573 22486832 20731829 50000 1197926 632443 21347312 20471913 50000 1196289 526694 21191508 19274406 100000 1099218 1711 20471913 0.86310 0.13690 0.00000 0 1 1 345612674 345612674 2421285045 862871716 1558413329 3139346787 1962932204 1176414583 275899406 64732745 211166661 3291607247 Due From Related/Affiliated Entities 57701363 Long-term Investments 484029881 Other Current Receivables 34050140 Other Non-Current Assets 378171708 Receivable - Interco Alloc of Tax-Exempt Bond Proceeds 1755720217 Receivable from Third Party 225623929 2935297238 Due to Related/Affiliated Entities 171148465 Notes and Loans Payable 152770404 Other Current Liabilities 57366129 Other Non-Current Liabilities 164361388 Payable to Third Party 90204312 635850698 X Part V, Line 4: All endowment funds are held by related 501(c)(3) exempt foundations. These endowment funds have been established for a variety of purposes in support of related tax-exempt hospitals. All of the foundation's permanently restricted endowment funds are required to be retained permanently either by explicit donor stipulation or by the Florida Uniform Prudent Management of Institutional Funds Act. Part V, line 1a, column (a) Current year - Explanation for change in opening balance: The current year beginning balance of the endowment funds on Line 1(a) in column (a) has been adjusted to exclude restricted funds that were held by a related tax-exempt organization for the benefit of a second related tax-exempt entity. Those funds have been properly disclosed on the second related tax-exempt entity's Form 990. Therefore, the beginning balance of the current year does not equal the ending balance of the prior year in column (b). Part V, line 1a, column (c) Two years back - Explanation for change in opening balance: During 2021 it was determined that endowments in the amount of $459,679, received prior to 2020, should be excluded as these funds do not represent endowments held for the benefit of the filing organization. As a result, the filing organization restated the beginning endowment fund balance in its 2020 tax year. Part V, line 1a, column (e) Four years back - Explanation for change in opening balance: During 2018, it was determined that an Endowment in the amount of $1,325,716 received prior to 2018 should be reclassified from permanent endowment to a temporarily restricted asset. 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 Central America and the Caribbean Grantmaking 1671047 Central America and the Caribbean Meetings 42653 Central America and the Caribbean Program Services Supplies, books, shipping costs 45936 East Asia and the Pacific Grantmaking 31637 East Asia and the Pacific Meetings 7657 East Asia and the Pacific Program Services Travel expenses (Hotels, luggage, insurance, materials) 1064 Europe (including Iceland and Greenland) Grantmaking 1250 Europe (including Iceland and Greenland) Meetings 16210 Europe (including Iceland and Greenland) Program Services Transportation expenses 1744 Middle East and North Africa Meetings 858 North America ( includes Canada & Mexico, but not the U.S.) Grantmaking 40665 North America (includes Canada & Mexico, but not the U.S.) Meetings 180466 North America (includes Canada & Mexico, but not the U.S.) Program Services Monthly stipends; Supplies, travel expenses, surgery, shipping cost 46876 Russia and Neighboring States Grantmaking 212112 South America Grantmaking 485665 South America Meetings 81146 South America Program Services Surgeries, supplies, travel expenses, stipends 71158 South Asia Grantmaking 102146 South Asia Meetings 958 Sub-Saharan Africa Grantmaking 414454 Sub-Saharan Africa Meetings 511 Sub-Saharan Africa Program Services Transportation expense 26 0 0 0 0 0 0 1817454 1638785 3456239 South Asia General Support 50000 Cash Payment 0 Book Russia and Neighboring States General Support 180000 Electronic Funds 0 Book Central America and the Caribbean Medical Supplies or Equipment 0 359203 Medical Equipment FMV Russia and Neighboring States Medical Supplies or Equipment 0 16342 Medical Equipment FMV Sub-Saharan Africa Medical Supplies or Equipment 0 24419 Medical Equipment FMV Central America and the Caribbean Medical Supplies or Equipment 0 10460 Medical Equipment FMV Russia and Neighboring States Medical Supplies or Equipment 0 10770 Medical Equipment FMV Central America and the Caribbean Medical Supplies or Equipment 0 43205 Medical Equipment FMV Central America and the Caribbean Medical Supplies or Equipment 0 284222 Medical Equipment FMV South America Medical Supplies or Equipment 0 210540 Medical Equipment FMV South America Medical Supplies or Equipment 0 62033 Medical Equipment FMV South America Medical Supplies or Equipment 0 31670 Medical Equipment FMV South America Medical Supplies or Equipment 0 40350 Medical Equipment FMV South America General Support/Medical Supplies or Equipment 100000 Electronic Funds 9750 Medical Equipment Book/FMV South America Medical Supplies or Equipment 0 25000 Medical Equipment FMV Central America and the Caribbean Medical Supplies or Equipment 0 11240 Medical Equipment FMV Sub-Saharan Africa Medical Supplies or Equipment 0 8965 Medical Equipment FMV Central America and the Caribbean Medical Supplies or Equipment 0 682859 Medical Equipment FMV Central America and the Caribbean Medical Supplies or Equipment 0 81334 Medical Equipment FMV Central America and the Caribbean Medical Supplies or Equipment 0 31974 Medical Equipment FMV North America (which includes Canada and Mexico, but not the U.S.) Medical Supplies or Equipment 0 33143 Medical Equipment FMV Sub-Saharan Africa Medical Supplies or Equipment 0 330790 Medical Equipment FMV East Asia and the Pacific Medical Supplies or Equipment 0 30000 Medical Equipment FMV Sub-Saharan Africa Medical Supplies or Equipment 0 50000 Medical Equipment FMV Central America and the Caribbean Medical Supplies or Equipment 0 11684 Medical Equipment FMV Central America and the Caribbean Medical Supplies or Equipment 0 133610 Medical Equipment FMV South Asia General Support 50000 Cash Payment 0 Book 27 0 Scholarship (Dental School Tuition) Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 2 7724 Cash Payment Book Stipend - Sharing Smiles (Cleft Palate) North America - Canada and Mexico, but not the United States 1 7522 Cash Payment Book Scholarship (Oral Surgery Tuition) South America - Argentina, Bolivia, Brazil, Chile, Columbia, Ecuador, 3 6066 Cash Payment Book Expense Reimbursement (ACP Program) South Asia - Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Paki 1 2146 Cash Payment Book 1 0 0 0 0 0 Part I, Line 2: Foreign grants are generally non-cash donations of medical equipment and supplies to assist foreign health care providers in fulfilling their mission of providing health care services to the populations they serve. The foreign health care providers are often hospitals and/or clinics operated and/or sponsored by or affiliated with the Seventh-Day Adventist Church. The foreign hospitals/clinics may be located in remote and/or underserved villages and townships of developing countries. Grants are typically made to other U.S. charitable organizations or foreign entities recognized as charitable by the foreign country in which they are located. As a result of the nature of the grants as non-cash medical equipment and supplies and the fact that most grants are made indirectly through other U.S. or foreign charitable organizations, the filing organization has not established specific procedures for monitoring the use of grant funds outside the United States. Part III Accounting Method: 1 1 X 1 X 1 X 1 1 0 1 0 156466629 156466629 0.02690 852937463 443238250 409699213 0.07050 1009404092 443238250 566165842 0.09740 42892850 0 42892850 0.00740 45325531 10443767 34881764 0.00600 0 0 6653608 5118160 1535448 0.00030 22679474 22679474 0.00390 117551463 15561927 101989536 0.01760 1126955555 458800177 668155378 0.11500 40525016 13006213 27518803 0.00470 0 0 40295 40295 0.00000 40565311 13006213 27559098 0.00470 1 244559375 4024045 766487884 993516324 -227028440 X 1 1 1 M&O Orlando MOB I LLC Manage & lease medical office building 0.78530 0.00000 0.14190 3 1 AdventHealth Orlando & Campuses 601 E Rollins Street Orlando FL 32803 www.adventhealth.com/hospital/adventhe 4369 X X X X X X Therapy Center, EPS Cath Lab, 4 Off-site EDs, Cancer Center A 2 AdventHealth Sebring & Lake Placid 4200 Sun N Lake Blvd Sebring FL 33825 www.adventhealth.com/hospital/adventhe 4171 X X X A 3 AdventHealth Wauchula 735 S 5th Avenue Wauchula FL 33873 www.adventhealth.com/hospital/adventhe 4239 X X X X Skilled Nursing A Facility Reporting Group - A 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 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: AdventHealth Orlando & Campuses, - Facility 2: AdventHealth Sebring & Lake Placid, - Facility 3: AdventHealth Wauchula Facility Reporting Group - A Part V, Section B, line 5: See Line 5 footnote below. Facility Reporting Group - A Part V, Section B, line 7d: See Line 7d footnote below. Facility Reporting Group - A Part V, Section B, line 11: See Line 11 footnote below. Facility Reporting Group - A Part V, Section B, line 13h: See Line 13h footnote below. Part V, Section B, Line 5: Facility Reporting Group - AAdventHealth Orlando & CampusesIn 2022, Adventist Health System/Sunbelt, Inc. owned and operated eight hospital campuses under a single hospital license in the greater Orlando, Florida area. The eight separate campuses operate under the following dba names: AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando, AdventHealth Winter Garden, and AdventHealth Winter Park (the Hospitals). These eight hospitals comprise the AdventHealth Central Florida Division South (CFD-South). The CFD-South conducted its 2022 Community Health Needs Assessment (CHNA) as a collaborative process with the Central Florida Collaborative (CFC), which included hospital systems, behavior health providers and federally qualified health centers (FQHCs) in Orange, Seminole, Lake and Osceola Counties (these four counties would be considered the Greater Orlando area), as well as the Florida Department of Health in Orange, Seminole, Lake, and Osceola Counties. The primary and secondary data collected by the CFC was utilized by the CFD-South Hospitals to prioritize the top health care needs that would be addressed in the 2022-2024 CHNA. To ensure that input was received from organizations representing low-income, minority, and other underserved populations, the CFC created a team of Equity Champions composed of ten individuals or organizations that represented multiracial or other minority communities. The Equity Champions included organizations and individuals from the Black/African American community and Hispanic/Latino/Spanish language speakers community, the LGBTQ+ community, and from members of the community of people living with disabilities (including HIV/AIDS), people experiencing homelessness, immigrants/migrant workers, faith-based communities, inmates, and members of the veteran community. Primary data gathering included Equity Champions Diversity Group Outreach, Stakeholder one-to-one interviews, and focus group discussions. The CFC conducted a broad-based community survey among residents of Orange, Seminole, Lake, and Osceola Counties. The surveys were conducted from December 29, 2021, to February 22, 2022 and were conducted online and in paper and offered in five languages, with approximately 4,000 community members. The survey instrument included topic areas that emerged from secondary data analysis, literature reviews of existing documents, initial qualitative research, and other early-stage research activities.One-to-one interviews were conducted with key community stakeholders, policymakers, and local residents. Interviews were conducted between October 29, 2021, and January 31, 2022. Most of the 105 interviews lasted approximately 20-30 minutes, although a few continued for over an hour. In addition to interviews and the survey, 30 focus group discussions were held from October of 2021 through February of 2022. In total there were approximately 250 participants and included the following community organizations: PCAN, Health and Hunger Task Force, Creating a Resilient Community Network, Black Nurses Rock, True Health FQHC, the Center for Independent Living, the Mayors Council for mental and behavioral health, the Seminole County Opioid Council, the Healthy Seminole Collaborative, and the Children's Cabinet.**see continuation of footnote Part V, Section B, Line 5 Continuation of Footnote: Facility Reporting Group - AAdventHealth Sebring & Lake Placid:Adventist Health System/Sunbelt, Inc. owns and operates a 171-bed hospital located in Highlands County, Florida. The hospital does business under the name of AdventHealth Sebring (AH Sebring). The primary service area of AH Sebring includes six zip codes across Highlands, Hardee and a small piece of Polk Counties. Adventist Health System/Sunbelt, Inc. owns and operates a 33-bed hospital located in Highlands County, Florida. The hospital does business under the name of AdventHealth Lake Placid (AH Lake Placid). The primary service area of AH Lake Placid includes five zip codes across Highlands and Hardee Counties. In conducting its 2022 Community Health Needs Assessment (CHNA), AH Sebring & Lake Placid solicited input directly from the community and from individuals who represent the broad interests of the community, including medically underserved, low-income and minority community members. AH Sebring & Lake Placid conducted their 2022 CHNAs from July to November of 2022. AH Sebring & Lake Placid partnered with the Florida Department of Health in Highlands County and in Hardee County to complete the community health needs assessment. AH Sebring & Lake Placid, in collaboration with the Departments of Health in Highlands and Hardee Counties, collected input directly from the community and from community stakeholders through a community survey and focus groups. Community surveys were made available to anyone in the community and were provided in three languages and were accessible through weblinks and QR codes. Five focus groups were held with community stakeholders specifically representing Black/African Americans, Hispanic/Latinos, Older Adults, and Parents of Pediatric Children. AH Sebring & Lake Placid also formed a Community Health Needs Assessment Committee (CHNAC) that included representatives from organizations that serve low-income, low-access individuals and communities. The purpose of the CHNAC was to select the needs the Hospitals would address from the findings in the community health needs assessment. Key CHNAC members that represented low-income and underserved populations were from the following organizations: Central Florida Area Health Education Center, Central Florida Health Care, Champion for Children Foundation, Drug Free Hardee, the Department of Health in Hardee County, the Department of Health in Highlands County, Hardee Help Center, Healthy Families Highlands County, Healthy Start Coalition of Hardee, Highlands, and Polk County, Heartland Core Wellness, Heartland Regional Transportation Planning Organization, Heartland Rural Health Network, the Highlands County Board of County Commissioners, Highlands County Veteran Services Office, Nu-Hope Elder Care Services, Peace River Center, Redlands Christian Migrant Association, Samaritan's Touch Care Center, South Florida State College, the Ruth E. Handley Children's Advocacy Center, Tri-County Human Services, and the United Way of Central Florida. AdventHealth Wauchula:Adventist Health System/Sunbelt, Inc. owns and operates a 25-bed critical access hospital located in Hardee County, Florida. The hospital does business under the name of AdventHealth Wauchula (AH Wauchula). The primary service area of AH Wauchula includes three zip codes across mainly Hardee County and a small part of Polk County. In conducting its 2022 Community Health Needs Assessment (CHNA), AH Wauchula solicited input directly from the community and from individuals who represent the broad interests of the community, including medically underserved, low-income and minority community members. AH Wauchula conducted its 2022 CHNA from July to November of 2022. AH Wauchula partnered with the Florida Department of Health in Highlands County and in Hardee County to complete the community health needs assessment. AH Wauchula, in collaboration with the Departments of Health in Highlands and Hardee Counties, collected input directly from the community and from community stakeholders through a community survey and focus groups. Community surveys were made available to anyone in the community and were provided in three languages and were accessible through weblinks and QR codes. Five focus groups were held with community stakeholders specifically representing Black/African Americans, Hispanic/Latinos, Older Adults, and Parents of Pediatric Children. AH Wauchula also formed a Community Health Needs Assessment Committee (CHNAC) that included representatives from organizations that serve low-income, low-access individuals and communities. The purpose of the CHNAC was to select the needs the Hospital would address from the findings in the community health needs assessment. Key CHNAC members that represented low-income and underserved populations were from the following organizations: Central Florida Area Health Education Center, Central Florida Health Care, Champion for Children Foundation, Drug Free Hardee, the Department of Health in Hardee County, the Department of Health in Highlands County, Hardee Help Center, Healthy Families Highlands County, Healthy Start Coalition of Hardee, Highlands, and Polk County, Heartland Core Wellness, Heartland Regional Transportation Planning Organization, Heartland Rural Health Network, the Highlands County Board of County Commissioners, Highlands County Veteran Services Office, Nu-Hope Elder Care Services, Peace River Center, Redlands Christian Migrant Association, Samaritan's Touch Care Center, South Florida State College, the Ruth E. Handley Children's Advocacy Center, Tri-County Human Services, and the United Way of Central Florida. Part V, Section B, Line 7a: Each hospital facility's CHNA report was made widely available through the following websites: Facility 1 -- AdventHealth Hospital Orlando & Campuseshttps://www.adventhealth.com/community-health-needs-assessments Facility 2 -- AdventHealth Sebring & Lake Placidhttps://www.adventhealth.com/community-health-needs-assessments Facility 3 -- AdventHealth Wauchulahttps://www.adventhealth.com/community-health-needs-assessments Part V, Section B, Line 7d: Facility Reporting Group - AThe Hospital facilities have 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 Hospitals' websites at least until the date the hospital facilities have made widely available on its websites its two subsequent Community Health Needs Assessment Reports. The Hospitals 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 facilities have made available for public inspection its two subsequent Community Health Needs Assessment Reports. Part V, Section B, Lines 8-10a: The filing organization's hospital facilities adopted a Community Health Needs Assessment Report by 12/31/2022 and were in the process of developing their Community Health Needs Implementation Strategy at that time. The filing organization's hospital facilities 2023-2025 Community Health Needs Implementation Strategies are documented in written reports called the "Community Health Plan". The Community Health Plan (CHP) describes how the filing organization's hospital facilities plan to meet their identified prioritized health needs or identifies the health need as one the filing organization's hospital facilities do not intend to specifically address and provides an explanation as to why the filing organization's hospital facilities do not intend to address that health need. The filing organization's hospital facilities 2023-2025 CHPs were adopted by May 15, 2023 and are posted on each hospital facility's website. Part V, Section B, Line 10a:Each hospital facility's most recently adopted implementation strategy was made widely available through the following websites: Facility 1 -- AdventHealth Hospital Orlando & Campuseshttps://www.adventhealth.com/community-health-needs-assessments Facility 2 -- AdventHealth Sebring & Lake Placidhttps://www.adventhealth.com/community-health-needs-assessments Facility 3 -- AdventHealth Wauchulahttps://www.adventhealth.com/community-health-needs-assessments Part V, Section B, Line 11: Group A-Facility 1 -- AdventHealth OrlandoDescription of CHNA Significant NeedsAdventist Health System/Sunbelt, Inc. d/b/a AdventHealth Orlando will be referred to in this document as AdventHealth Orlando 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 Orlando is part of the Central Florida Division of AdventHealth. In 2020, the Central Florida Division North-Region (CFD-N), which includes AdventHealth Daytona Beach, AdventHealth DeLand, AdventHealth Fish Memorial, AdventHealth New Smyrna, AdventHealth Palm Coast and AdventHealth Waterman was combined with the Central Florida Division South-Region, (CFD-S) which includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando, AdventHealth Winter Garden and AdventHealth Winter Park to unify as one under the Central Florida Division (the Division). This is the third-year update for AdventHealth Orlando'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 Orlando 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 Orlando chose four priorities for its 2020-2022 Community Health Plan: 1. Food Security2. Care Coordination3. Mental & Behavioral Health4. Community Development: Affordable Housing & HomelessnessPriority 1: Food Security 2019 Description of the Issue:Over one-third of community survey respondents indicated they lack access to high quality, affordable, healthy food. Having access to proper nutrition is necessary for a healthy life. Proper nutrition can also reduce the risk of, or complications from, certain diseases, such as diabetes. The Central Florida Division of AdventHealth is currently working to address food security with multiple partners, including Second Harvest Food Bank. AdventHealth intends to expand this work through current and future initiatives.2022 Update: The AdventHealth Orlando Community Health Plan has two desired goal statements under the Food Security priority.1. Increase access to healthy and affordable food for community members in need2. Work with community and government officials to address the root causes of food insecurity in our communitiesGoal 1: Increase access to healthy and affordable food for community members in needObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective, to sustain or build partnerships with at least six community organizations that focus on addressing food security is supported by multiple strategies: by providing in-kind contributions, financial support of at least $455,000 and annual board service over the next three years throughout the tri-county region. The tri-county region is defined as Orange, Osceola, and Seminole counties. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.The first strategy, to support the objective through in-kind contributions, was met by sustaining one partnership with a community organization in the Division. This sustained partnership was with Second Harvest Food Bank of Central Florida, a private, nonprofit organization that collects, stores, and distributes donated food to more than 550 feeding partners in six Central Florida counties. The Division continued its support to Second Harvest Food Bank through the Second Helpings program. This program enables each AdventHealth Central Florida Division hospital campus, including the reporting Hospital, to make in-kind donations of excess food to Second Harvest Food Bank to be distributed through local food pantries. In 2022, the reporting Hospital contributed 17,773 pounds of food or 14,811 meals toward this program.The second strategy, to support the objective through financial support, was met by sustaining 18 partnerships with community organizations in the Division. In 2022, the reporting Hospital contributed $259,519 in financial support toward the three-year goal of $455,000. Four of these partnerships were sustained on a tri-county level, this includes Orange County, Osceola County and Seminole County. The reporting Hospital sustained four of these partnerships. Some of these partnerships included financially supporting grassroot efforts at four nonprofit organizations to provide food to those in need through their food pantries or community gardens. Financial support was also provided for Seniors First, an organization that leads the local Meals on Wheels program, which provides home meal deliveries to seniors. The outcomes reported for this strategy, which supports the objective, are specific to Orange County.The third strategy to support the objective, providing annual representation on boards of organizations focusing on food security which support the tri-county region (Orange, Osceola, and Seminole counties), was met by serving on three boards. In 2022, the Central Florida Division of AdventHealth team members continued to serve on the boards of the Second Harvest Food Bank of Central Florida, the American Diabetes Association, and the American Heart Association, all of which impact the Central Florida Division's primary service area. Both the American Diabetes Association and the American Heart Association are nonprofit organizations that provide education on nutrition and food-related conditions.The reporting Hospital continued to provide representation to serve on two boards within their primary service area. The first is on the board of UP (United Against Poverty) Orlando, a local nonprofit that serves those in poverty by providing crisis case management, transformative education, food and household subsidies, job training and placement, personal empowerment training and referrals to other collaborative social service providers. The reporting Hospital also provides representation on the board of Heart of Florida United Way, a local nonprofit that provides education, health, and financial stability for every person in Central Florida.Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to identify new partners and best practices to increase the effectiveness of efforts to bring healthy food to community members in need. These partnerships will be utilized to drive strategies across the tri-county area. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth OrlandoDescription of CHNA Significant Needs Continued In 2022, the Division sustained their partnership with two local nonprofit organizations, HEBNI Nutrition Consultants, Inc., and Infinite Zion Farms. HEBNI Nutrition Consultants, Inc. was formed to educate high-risk, culturally diverse populations about nutrition strategies to prevent diet-related diseases. This partnership, over the past three-years, continued to increase the amount of healthy food available to community members in need. HEBNI Nutrition Consultants' services include nutrition education and a mobile market. The reporting Hospital provided $44,504 towards the mobile market which offers produce at a reduced cost in low-income, high-risk communities and food deserts. In 2022, 454 new, unique participants were referred to the Fresh Stop Veggie Rx & Diabetes Prevention Program and 1,086 food boxes were given to enrolled participants for food distribution. Through the reporting Hospital's funding, Infinite Zion Farms was able to build its first pilot greenhouse to provide additional fresh produce in Orange County, the county of the reporting Hospital. Infinite Zion Farms is a local nonprofit that is working to establish affordable sources of organic produce and education to the community at large. In 2022, the reporting Hospital provided funding to Infinite Zion Farms of $4,684 towards the installation of greenhouses to increase the fresh produce in Orange County, the county of the reporting Hospital.Goal 2: Work with community and government officials to address the root causes of food insecurity in our communitiesObjective 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; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This shared objective, to identify leadership from the tri-county area to participate in local coalitions focused on advocacy and reform to ensure equitable access to healthy food, is managed at a Divisional level, however all outcomes reported are specific to Orange County. This initiative provides an opportunity to form and participate in multisector collaboratives within Orange County, which are working on a shared goal to identify and strategize on best practices to address the root causes of food insecurity. In 2022, the Division continued to provide representation on behalf of the Hospital by participating in the Orange County Department of Health's Community Health Improvement Planning Committee. This committee is comprised of organizations throughout Orange County that plan and implement community improvement programs. By providing representation at a Divisional level, the Central Florida Division of AdventHealth can identify cross-county and various organizational partnerships that will benefit all the communities they serve, regardless of geography.Priority 2: Care Coordination 2019 Description of the Issue:AdventHealth Orlando identified care coordination as a need, specifically in the areas of prenatal care/early intervention/early childhood, access to care and chronic disease management. Orange County had an increase in infant deaths, low birthweight babies and preterm births. There was also a decrease in the percentage of mothers who had prenatal care in the first trimester. In Orange County, 31.6 percent of community survey respondents indicated that they lacked access to a primary care provider. An additional 35.5 percent indicated they lacked access to a specialist. Limited access to high quality primary care physicians and specialists was identified as a community issue by primary research participants. Orange County also had an increase in individuals who were obese, middle school and high school students who are reporting a body mass index at or above the 95th percentile, adults with diabetes, diabetes hospitalizations for children ages 12 to 18, adults with hypertension and adults who have been told they had a stroke. 2022 Update: The AdventHealth Orlando Community Health Plan has two desired goal statements under the Care Coordination priority.1. Increase the availability of appropriate and affordable care2. Decrease barriers community members encounter while seeking careGoal 1: Increase the availability of appropriate and affordable careObjective 1:The first objective is a Divisional initiative and appears on multiple community health plans 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 provide support to existing care facilities through multiple strategies, including financial contributions, in-kind labs, and residency rotations and to seek innovative ways to increase capacity through the provision of in-kind labs/imaging, volunteer services, etc. The first strategy is to provide support to existing care facilities through financial contributions. The strategy to support this objective is managed at a Divisional level. The reporting Hospital's funding included, but was not limited to, contributions for operational support for two local Federally Qualified Health Centers (FQHCs). A $46,847 contribution was made to the Health Care Center for the Homeless, which provides primary medical care, oral health services, behavioral health, and substance use services for underinsured and uninsured individuals. An additional $46,847 was contributed to True Health, which delivers medical and mental health services to underserved populations.The reporting Hospital also contributed $79,639 to Shepherd's Hope which will support medical homes to increase the availability of affordable care. Shepherd's Hope is a faith-based organization of volunteers who provide access to healthcare for uninsured patients. The second strategy is to provide in-kind labs to existing care facilities. The Division provided in-kind labs to the Health Care Center for the Homeless and Grace Medical Home. In the future, the Division will develop a process to track and quantify in-kind labs and imaging provided to local nonprofit organizations. The third strategy is to support a residency rotation to existing care facilities. The Division had a residency rotation program established with a local nonprofit. However, in 2021, for a multitude of reasons, including COVID-19, the program was discontinued. The Division continues to identify ways to support our community and the community-based organizations that may support residency rotations. The fourth strategy is to seek innovative ways to increase capacity through in-kind labs, imaging, and volunteer services. After reassessing the Division's capacity, it was determined that the initiative could not be met. However, we are working to identify new ways to support the needs originally identified in our CHNAs, as resources and public health recommendations develop. Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans of AdventHealth Hospitals in Orange County, Osceola County and Seminole County including AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. These Hospitals are part of the Central Florida Division of AdventHealth and are in the same Division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority.This shared objective, to expand on existing care navigation services to ensure uninsured and underinsured patients have an accessible entry point to the level of care they need, is managed at a Divisional level. This initiative provides an opportunity to support organizations with a shared goal to increase accessible entry points. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth OrlandoDescription of CHNA Significant Needs Continued This shared objective, to expand on existing care navigation services to ensure uninsured and underinsured patients have an accessible entry point to the level of care they need, is managed at a Divisional level. This initiative provides an opportunity to support organizations with a shared goal to increase accessible entry points. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.In 2022, the reporting Hospital contributed funding of $56,216 to the American Cancer Society's Road to Recovery Program. This program provides rides to and from cancer treatment for any cancer patient with a transportation barrier, regardless of insurance or economic status. In total, the Road to Recovery program provided 1,111 rides for cancer patients.In 2022, the reporting Hospital also contributed $27,784 towards the three-year funding partnership with AdventHealth University's Hope Clinic. The Hope Clinic provides free care to individuals with socio-economic barriers, to increase access to care regardless of financial circumstance. This partnership provides cardiac rehabilitation (wellness maintenance) services to uninsured and underinsured individuals to improve health outcomes and reduce readmissions. In 2022, the Hope Clinic enrolled 34 patients into the program.Goal 2: Decrease barriers community members encounter while seeking careObjective 1:The first objective is a Divisional initiative and appears on multiple community health plans in Orange County, Osceola County and Seminole County including AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. These Hospitals are part of the Central Florida Division of AdventHealth and are in the same Division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.This shared objective, to provide case management services for at least 81 patients over three years while identifying additional partners and methods to decrease barriers community members encounter while seeking care, is managed at a Divisional level. In 2022, the Division continued to support the Holistic Health program led by Center for Change, a local nonprofit, which aims to provide health education and social services to individuals and families who lack access to economic, social and health resources. The reporting Hospital contributed $40,357 toward the Holistic Health program which focuses its efforts in high-need communities identified in the CHNA. The Division met this objective by providing case management services to 83 unique individuals over three years. Additionally, in 2022, 189 referrals to services were provided, 162 individuals have improved their biometrics, and 200 individuals have improved health behaviors through the program.Priority 3: Mental & Behavioral Health2019 Description of the Issue:Mental health, behavioral health and substance use were all identified as top community needs by stakeholders, key informants, and focus groups. Only one in ten community survey respondents from Orange County believe there is sufficient substance abuse services. Poor mental health can exacerbate physical health conditions, decreasing quality of life and making it more difficult to maintain stable housing. The Central Florida Division of AdventHealth is heavily invested in addressing mental health and substance abuse and has partnered with community organizations such as the local Federally Qualified Health Centers (FQHCs), Seminole County Sheriff's Office, Aspire Health Partners, and the National Alliance on Mental Illness.2022 Update:The AdventHealth Orlando Community Health Plan has two desired goal statements under the Mental & Behavioral Health priority.1. Increase access to mental and behavioral health services2. Support existing resources and identify new partners and programs that proactively strengthen the communityGoal 1: Increase access to mental and behavioral health servicesObjective 1:The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase provider capacity through financial and in-kind support to at least three partners serving the tri-county community. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.This initiative provides an opportunity for the reporting Hospital to support at least three partners that have a shared goal of increasing provider capacity in the space of mental and behavioral health. In 2022, the Division sustained partnerships with three partners to implement programs that serve the tri-county community: Aspire Health Partners' Psychosocial Rehabilitation Program, True Health's Mental Health Expansion Program and Central Florida Community Arts' Community Music Therapy Program. The reporting Hospital met its set metric of providing financial support to at least three partners by funding these organizations for a total of $164,792. With the funding, they were able to provide programs that serve the underinsured and uninsured individuals in the reporting Hospital's service area.Aspire Health Partners is an organization committed to providing individuals and families of Central Florida with compassionate, comprehensive, and cost-effective behavioral health care services that lead to successful living and healthy, responsible lifestyles. Not only does Aspire Health Partners receive financial funding for the Psychosocial Rehabilitation Program, but the Division also leases five crisis stabilization unit (CSU) beds to connect individuals who have acute needs to mental health services.The Division also supports the Central Florida Community Arts which exists to serve and build community through the arts. Through the Music Therapy Program, the organization hired a music therapist to support individual and group music therapy across the tri-county area. The Division also established a new partnership to increase provider capacity with True Health, a local Federally Qualified Health Center (FQHC), to support their Mental Health Expansion Program which provided funding for a full-time psychiatrist.Other initiatives to address this objective include providing in-kind support through board service. In 2022, the reporting Hospital served on the following boards which focus on addressing the mental health needs of Central Floridians: Mental Health Association of Central Florida and IMPOWER. The Mental Health Association of Central Florida is an organization that provides mental health services, support, and information to the members of Orlando and surrounding Central Florida community. IMPOWER is a nonprofit organization based in Central Florida that focuses on changing lives by protecting, counseling, teaching and inspiring individuals and families to reach their full potential.Objective 2:The second objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is to develop and support pathways to mental and behavioral healthcare for those in need by expanding care navigation models to include mental and behavioral health focused initiatives over the next three years. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.In 2022, the reporting Hospital provided $2,342 to Bliss Cares to provide mental health services to their target clients. Bliss Cares is a nonprofit organization that has a mission to save lives by treating and preventing the spread of HIV, Hepatitis, and sexually transmitted diseases (STDs).Goal 2: Support existing resources and identify new partners and programs that proactively strengthen the community **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth OrlandoDescription of CHNA Significant Needs Continued Objective 1:The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is supported by multiple strategies: provide the Mission: FIT POSSIBLE program to at least two schools annually in the AdventHealth Orlando primary service area that were identified as hot spots and collaborate with partners to strengthen community resiliency by proactively educating and identifying resources to deliver resiliency-focused trainings and resources to the community. This objective is managed at a Divisional level; however, all outcomes are specific to AdventHealth Hospitals in Orange County.The first strategy was to provide the Mission: FIT POSSIBLE program to at least two schools that were identified as hot spots in the AdventHealth Orlando primary service area each year. The outcomes reported for this strategy, which support the objective, are specific to Orange County. In 2022, this objective was exceeded by the Division, with 28 schools in the reporting Hospital's primary service area receiving the program. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy.The second strategy is to collaborate with partners to strengthen community resiliency by proactively educating and identifying resources to deliver resiliency-focused trainings and resources to the community. Outcomes reported for this strategy, which support the objective, are specific to reporting AdventHealth Hospitals. This objective was met through an initiative, Circle of Security, led by the Early Learning Coalition of Orange County (ELCOC). The reporting Hospital contributed $11,711 toward ELCOC's Circle of Security program. ELCOC is dedicated to the success of early childhood development in the community through early education. The Circle of Security program builds teachers' responsiveness to young children's emotional needs to better support their positive mental health. The ELCOC seeks to provide the Circle of Security attachment training to early childhood teachers in Orange County's most under-resourced communities. The reporting Hospital was able to meet this objective in Orange County, the county of the reporting Hospital.In 2022, the reporting Hospital also contributed funding of $59,729 toward the No Limit Health and Education's program, No Limit Unit. No Limit Health and Education is a local nonprofit whose mission is to promote mental health (social, emotional, and psychological) wellness and awareness through advocacy, programs, services, and outreach. Through this partnership, No Limit Unit provides services to adults and youth for both individual empowerment and systemic change in the areas of mental and physical wellness. Barbershop Talk Tours, Thriving Moms Club and Flow Detox reach men, women and children through mental health education, support groups and reduction of stigma.Priority 4: Community Development: Affordable Housing & Homelessness2019 Description of the Issue:There were over 1,500 individuals experiencing homelessness in Orange County in 2018. When individuals are experiencing homelessness, it is more difficult to access health care and manage chronic physical and mental conditions. The AdventHealth Central Florida Division is heavily invested in addressing homelessness and is involved with partners such as: Christian Service Center, Coalition for the Homeless of Central Florida, Dave's House, Family Promise of Greater Orlando, Homeless Services Network of Central Florida, and others.2022 Update:The AdventHealth Orlando Community Health Plan has one desired goal statement under the Community Development: Affordable Housing & Homelessness priority.1. Support efforts to increase access to care and provide services to our homeless populationGoal 1: Support efforts to increase access to care and provide services to our homeless populationObjective 1:The first objective is a shared initiative between AdventHealth Orlando, AdventHealth Celebration and AdventHealth Kissimmee. 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. The objective is to provide annual financial and in-kind support, including board service and employee volunteers, to support community partners and increase the capacity to care for our homeless population. This objective is managed at the Divisional level; outcomes reported for this objective are for the Division and not specific to the reporting Hospital.The first strategy is to provide financial support to local organizations that are working to address the affordable housing needs and immediate needs of individuals experiencing homelessness. The reporting Hospital met this metric by providing financial support of $58,556 to five organizations in the Hospital's primary service area. Samaritan Resource Center received $44,504 to increase access to mental health resources and job skills training which aims to increase positive outcomes and decrease recidivism in the cycle of homelessness. The Coalition for the Homeless, a low-barrier shelter focusing on stabilization, rehousing and diversion, received $2,342. Dave's House received $4,684 to further provide supportive housing for individuals with serious mental illness. Habitat for Humanity received $2,342 to support a special project that served individuals dealing with homelessness. United Against Poverty received $4,684 to serve those in poverty by providing crisis care, case management, transformative education, food and household subsidies, employment training and placement, personal empowerment training and active referrals to other collaborative social service providers.The second strategy is to provide in-kind support to local organizations that are working to address the affordable housing needs and immediate needs of individuals experiencing homelessness. The reporting Hospital met this metric with in-kind services, including service on two boards. Boards served on include the Christian Service Center and The Sharing Center. Both organizations work to address the immediate and/or long-term needs of those experiencing homelessness.Community Needs Not Chosen by AdventHealth OrlandoThe 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:Community Resources Group: Although there are a multitude of resources available in the community, many community members may not know of these services or how to access them. To optimize utilization of available resources, the local CHNAC discussed potential solutions, which included creating community resource groups to inform community members of available resources, but it will not be included in the Community Health Plan. Although the Hospital did not choose to prioritize this issue and address it through the Community Health Plans, the Community Asset Inventory created for the CHNA report includes a list of available resources in the tri-county area. This Community Asset Inventory will be updated, shared with community organizations, and made publicly available. Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth CelebrationDescription of CHNA Significant Needs Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth Celebration will be referred to in this document as AdventHealth Celebration 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 Celebration is part of the Central Florida Division of AdventHealth. Central Florida Division South Region (the Division) includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando, AdventHealth Winter Garden and AdventHealth Winter Park. The Central Florida Division includes 14 hospitals. This is the third-year update for AdventHealth Celebration'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 Celebration 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 Celebration chose four priorities for its 2020-2022 Community Health Plan: 1. Food Security2. Care Coordination3. Mental & Behavioral Health4. Community Development: Affordable Housing & HomelessnessPriority 1: Food Security 2019 Description of the Issue:More than 40 percent of community survey respondents from Osceola County indicated that they do not have access to healthy, affordable food. Food security was also identified as a need related to chronic conditions. Having access to proper nutrition is necessary for a healthy life. Proper nutrition can also reduce the risk of, or complications from, certain diseases, such as diabetes. The Central Florida Division of AdventHealth (the Division) is currently working to address food security with multiple partners, including Second Harvest Food Bank. The Division intends to expand this work through current and future initiatives.2022 Update: The AdventHealth Celebration Community Health Plan has two desired goal statements under the Food Security priority.1. Increase access to healthy and affordable food for community members in need2. Work with community and government officials to address the root causes of food insecurity in our communitiesGoal 1: Increase access to healthy and affordable food for community members in needObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to sustain or build partnerships with at least six community organizations that focus on addressing food security, and is supported by multiple strategies including the provision of in-kind contributions, financial support of at least $455,000, and annual volunteer board service over the next three years throughout the tri-county region. The tri-county region is defined as Orange, Osceola, and Seminole counties. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.The first strategy, to support the objective through in-kind contributions, was met by sustaining one partnership with a community organization in the Division. This sustained partnership was with Second Harvest Food Bank of Central Florida, a private, nonprofit organization that collects, stores, and distributes donated food to more than 550 feeding partners in six Central Florida counties. The Division continued its support to Second Harvest through the Second Helpings program. This program enables each hospital campus, including the reporting Hospital, to make in-kind donations of excess food to Second Harvest to be distributed through local food pantries. In 2022, the reporting Hospital was unable to contribute towards this program due to staffing changes impacted by the COVID-19 pandemic. The second strategy, to support the objective through financial support, was met by sustaining 18 partnerships with community organizations in the Division. In 2022, the reporting Hospital contributed $34,271 in financial support towards the three-year goal of $455,000. Four of these partnerships were sustained by the Division on a tri-county level, this includes Orange County, Osceola County and Seminole County. The reporting Hospital sustained one of these partnerships. Financial support was provided to Celebration Foundation, an organization that leads the local Learning without Hunger program, which provides food to children living in Osceola County on the weekends. The outcomes reported for this strategy, which supports the objective, are specific to Osceola County.The third strategy to support the objective, providing annual representation on boards of organizations focusing on food security which support the tri-county region (Orange, Osceola, and Seminole counties), was met by serving on three boards. This strategy also focuses on advocacy and food system reform to ensure equitable access to healthy food across the community. In 2022, the Central Florida Division of AdventHealth team members continued to serve on the boards of the Second Harvest Food Bank of Central Florida, the American Diabetes Association, and the American Heart Association, all of which impact the Central Florida Division's primary service area. Both the American Diabetes Association and the American Heart Association are nonprofit organizations that provide education on nutrition and food-related conditions.The reporting Hospital continued to provide representation by serving on one board, the Celebration Foundation, within their primary service area. The Celebration Foundation is a local organization whose mission is to build better community through the arts, culture, and education.Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to identify new partners and best practices to increase the effectiveness of efforts to bring healthy food to community members in need. These partnerships will be utilized to drive strategies across the tri-county area. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth CelebrationDescription of CHNA Significant Needs Continued In 2022, the Division met this objective by sustaining their partnership with one local nonprofit, HEBNI Nutrition Consultants, Inc., which was formed to educate high-risk, culturally diverse populations about nutrition strategies to prevent diet-related diseases. This partnership, over the past three-years, continued to increase the amount of healthy food available to community members in need. HEBNI Nutrition Consultants' services include nutrition education and a mobile market. The reporting Hospital provided $12,195 toward the mobile market which offers produce at a reduced cost in low-income, high-risk communities and food deserts. In 2022, 454 new, unique participants were referred to the Fresh Stop Veggie Rx & Diabetes Prevention Program and 1,086 food boxes were given to enrolled participants for food distribution. In 2022, the reporting Hospital also sustained its partnership with the School District of Osceola County (SDOC)'s SMART Bus. The SMART Bus provides food, education, access to Wi-Fi and family support to meet the needs of the 2,500 homeless students enrolled in the SDOC. The new partnership is reported for the Division, not Hospital specific and appears on the community health plans of all Hospitals in Osceola County where the initiative is conducted. This includes the plans of AdventHealth Celebration and AdventHealth Kissimmee.Goal 2: Work with community and government officials to address the root causes of food insecurity in our communitiesObjective 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; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority.This shared objective, to identify leadership from the tri-county area to participate in local coalitions focused on advocacy and reform to ensure equitable access to healthy food, is managed at a Divisional level, however all outcomes reported are specific to Osceola County. This initiative provides an opportunity to form and participate in multisector collaboratives within Osceola County, which are working on a shared goal to identify and strategize on best practices to address the root causes of food insecurity.In 2022, the Division continued to provide representation on behalf of the Hospital by participating in the Osceola County Health Leadership Council. This council is comprised of organizations throughout Osceola County that plan and implement community improvement programs. By providing representation at a Divisional level, the Central Florida Division of AdventHealth can identify cross-county and various organizational partnerships that will benefit all the communities they serve, regardless of geography.Priority 2: Care Coordination 2019 Description of the Issue:AdventHealth Celebration identified care coordination as a need, specifically preventative care/health screenings, access to care, and pediatric and women's health (including prenatal). Osceola County primary data respondents were less likely to indicate that they accessed preventative care services, such as a PSA test, lab work and Pap tests. In 2016, 23.6 percent of Osceola County adults could not see a doctor due to cost. Primary data respondents from Osceola County also identified transportation and care coordination as barriers to care in relation to chronic conditions when seeking care. A little more than 10 percent of Osceola County community survey respondents indicated that they have difficulty accessing prenatal care.2022 Update: The AdventHealth Celebration Community Health Plan has two desired goal statements under the Care Coordination priority.1. Increase the availability of appropriate and affordable care2. Decrease barriers community members encounter while seeking careGoal 1: Increase the availability of appropriate and affordable careObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans 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 provide support to existing care facilities through multiple strategies, including financial contributions, in-kind labs, and residency rotations and to seek innovative ways to increase capacity through the provision of in-kind labs/imaging, volunteer services, etc. The first strategy is to provide support to existing care facilities through financial contributions. The strategy to support this objective is managed at a Divisional level. The reporting Hospital's funding included, but was not limited to, contributions for operational support for a local Federally Qualified Health Center (FQHC). A $12,837 contribution was made to the Health Care Center for the Homeless, which provides primary medical care, oral health services, behavioral health, and substance use services for underinsured and uninsured individuals. The reporting Hospital also provided $3,851 in financial contributions to Osceola Council on Aging to support clinical operations and $3,209 to Osceola Community Health Services, a local FQHC focused on meeting an individual's physical and mental health care needs through prevention, wellness, acute and chronic care, for operational support to increase the availability of affordable care.The second strategy is to provide in-kind labs to existing care facilities. The Division provided in-kind labs to the Health Care Center for the Homeless and Osceola Council on Aging. In the future, the Division will develop a process to track and quantify in-kind labs and imaging provided to local nonprofit organizations.The third strategy is to support a residency rotation to existing care facilities. The Division had a residency rotation program established with a local nonprofit. However, in 2021, for a multitude of reasons, including COVID-19, the program was discontinued. The Division continues to identify ways to support our community and the community-based organizations that may support residency rotations. The fourth strategy is to seek innovative ways to increase capacity through in-kind labs, imaging, and volunteer services. After reassessing the Division's capacity, it was determined that the initiative could not be met. However, we are working to identify new ways to support the needs originally identified in our CHNAs, as resources and public health recommendations develop. Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in Orange County, Osceola County and Seminole County: AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. These Hospitals are part of the Central Florida Division of AdventHealth and are in the same Division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority.This shared objective, to expand on existing care navigation services to ensure uninsured and underinsured patients have an accessible entry point to the level of care they need, is managed at a Divisional level. This initiative provides an opportunity to support organizations with a shared goal to increase accessible entry points. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.In 2022, the reporting Hospital contributed $15,404 to the American Cancer Society's Road to Recovery Program. This program provides rides to and from cancer treatment for any cancer patient with a transportation barrier, regardless of insurance or economic status. In total, the Road to Recovery program provided 1,111 rides for cancer patients. In 2022, the reporting Hospital also contributed $7,476 towards the three-year funding partnership with AdventHealth University's Hope Clinic. This partnership provides cardiac rehabilitation (wellness maintenance) services to uninsured and underinsured individuals to improve health outcomes and reduce readmissions. The Hope Clinic provides free care to individuals with socio-economic barriers, to increase access to care regardless of financial circumstance. In 2022, the Hope Clinic enrolled 34 patients into the program. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth CelebrationDescription of CHNA Significant Needs Continued Goal 2: Decrease barriers community members encounter while seeking careObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans of AdventHealth hospitals in Orange County, Osceola County and Seminole County: AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. These Hospitals are part of the Central Florida Division of AdventHealth and are in the same Division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.This shared objective, to provide case management services for at least 81 patients over three years while identifying additional partners and methods to decrease barriers community members encounter while seeking care, is managed at a Divisional level. In 2022, the Division continued to support the Holistic Health program led by Center for Change, a local nonprofit, which aims to provide health education and social services to individuals and families who lack access to economic, social and health resources. The reporting Hospital contributed $11,058 toward the Holistic Health program which focused its efforts in high-need communities identified in the CHNA. The Division met this objective by providing case management services to 83 unique individuals over three years. Additionally, in 2022, 189 referrals to services were provided, 162 individuals have improved their biometrics and 200 individuals have improved health behaviors through the program. Priority 3: Mental & Behavioral Health 2019 Description of the Issue:Less than 10 percent of community survey respondents from Osceola County believe there are enough mental health providers and nearly 60 percent of Osceola County community survey respondents indicated they feel depressed or hopeless. When discussing with primary research participants, it was stated that the high level of stress people were experiencing could make it difficult to cope with mental illness. This may be caused by lack of community support and available support services to manage mental health. The Central Florida Division of AdventHealth has several care options for mental health services. These include the Outlook Clinic and connections to FQHCs. The Central Florida Division of AdventHealth is funding several mental and behavioral health services in the community, including an eye movement desensitization and reprocessing (EMDR) psychotherapy treatment at a local FQHC and a music therapy program.2022 Update: The AdventHealth Celebration Community Health Plan has two desired goal statements under the Mental & Behavioral Health priority.1. Increase access to mental and behavioral health services2. Support existing resources and identify new partners and programs that proactively strengthen the communityGoal 1: Increase access to mental and behavioral health servicesObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase provider capacity through financial and in-kind support to at least three partners serving the tri-county community. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.This initiative provides an opportunity for the reporting Hospital to support at least three partners that have a shared goal of increasing provider capacity in the space of mental and behavioral health. In 2022, the Division sustained partnerships with two partners to implement programs that serve the tri-county community: True Health's Mental Health Expansion Program and Central Florida Community Arts' Community Music Therapy Program. In 2022, the reporting Hospital did not meet its set metric of providing financial support to at least three partners. However, with the funding provided, True Health and Central Florida Community Arts were able to provide programs that serve the underinsured and uninsured individuals in the reporting Hospital's service area. The Division supports the Central Florida Center for the Arts which exists to serve and build community through the arts. Through the Music Therapy Program, the organization hired a music therapist to support individual and group music therapy across the tri-county area. The Division also established a new partnership with True Health, a local Federally Qualified Health Center (FQHC), to increase provider capacity and support their Mental Health Expansion Program which provided funding for a full-time psychiatrist. Other initiatives to address this objective include providing in-kind support through board service. In 2022, a Hospital representative served on the board of Freedom Ride, a local nonprofit dedicated to enriching the lives and experiences of children and adults with disabilities in the Central Florida area through therapeutic horseback riding and related activities.Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is to develop and support pathways to mental and behavioral healthcare for those in need by expanding care navigation models to include mental and behavioral health focused initiatives over the next three years. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. In 2022, the reporting Hospital met this objective and provided $32,092 to Park Place Behavioral Health Care for operational support. Park Place Behavioral Health Care is an organization that provides therapeutic, psychiatric and substance use disorder services in Central Florida. Goal 2: Support existing resources and identify new partners and programs that proactively strengthen the communityObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is supported by multiple strategies: provide the Mission: FIT POSSIBLE program to at least two schools annually in the AdventHealth Celebration's primary service area that were identified as hot spots and collaborate with partners to strengthen community resiliency by proactively educating and identifying resources to deliver resiliency-focused trainings and resources to the community. This objective is managed at a Divisional level; however, all outcomes are specific to Hospitals in Osceola County. The first strategy was to provide the Mission: FIT POSSIBLE program to at least two schools that were identified as hot spots in AdventHealth Celebration's primary service area each year. This objective was exceeded by the Division, with nine schools in the reporting Hospital's primary service area receiving the program. The outcomes reported for this strategy, which support the objective, are specific to Osceola County. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth CelebrationDescription of CHNA Significant Needs Continued The second strategy is to collaborate with partners to strengthen community resiliency by proactivity educating and identifying resources to deliver resiliency-focused trainings and resources to the community. Outcomes reported for this strategy, which support the objective, are specific to reporting Hospitals in Osceola County. This includes AdventHealth Celebration and AdventHealth Kissimmee. The strategy was not conducted due to leadership changes.Priority 4: Community Development: Affordable Housing & Homelessness 2019 Description of the Issue:Osceola County has the highest percentage of renter households who were cost burdened (24.4 percent) and severely cost burdened (25.1 percent). Osceola County also had 21.1 percent of homeowner residents who are severely cost burdened. Affordable housing has a significant impact on other health outcomes and wellbeing. It enables families to have the opportunity to meet their respective health, education, and employment needs. The Central Florida Division of AdventHealth is heavily invested in addressing homelessness and is involved with partners such as: Coalition for the Homeless of Central Florida, Family Promise of Greater Orlando, Homeless Services Network of Central Florida, and others.2022 Update: The AdventHealth Celebration Community Health Plan has two desired goal statements under the Community Development: Affordable Housing & Homelessness priority.1. Support efforts to increase access to care and provide services to our homeless population2. Participate in advocacy efforts to provide affordable housing for community membersGoal 1: Support efforts to increase access to care and provide services to our homeless populationObjective 1: The first objective is a shared initiative between AdventHealth Orlando, AdventHealth Celebration and AdventHealth Kissimmee. 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. The objective is to provide annual financial and in-kind support, including board service and employee volunteers, to support community partners and increase the capacity to care for our homeless population. This objective is managed at the Divisional level; however, all outcomes are specific to Hospitals in Osceola County.The first strategy is to provide financial support to local organizations that are working to address the affordable housing needs and immediate needs of individuals experiencing homelessness. In 2022, the reporting Hospital met this metric by providing financial support to two organizations in the reporting Hospital's primary service area. Clarita's House received funding to support their emergency housing service for families in crisis and Habitat for Humanity received funding to support a special project that served individuals dealing with homelessness. The second strategy is to provide in-kind support to local organizations that are working to address the affordable housing needs and immediate needs of individuals experiencing homelessness. In 2022, the reporting Hospital partnered with the local Habitat for Humanity and team members volunteered, assisting with building homes for the surrounding community. Goal 2: Participate in advocacy efforts to provide affordable housing for community membersObjective 1: The first objective is a shared initiative between AdventHealth Celebration and AdventHealth Kissimmee. 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. The objective is to provide annual financial and in-kind support, including board service and employee volunteers, to support community partners and increase the capacity to care for our homeless population. This objective is managed at the Divisional level, but all outcomes are specific to the reporting Hospitals in Osceola County.The first strategy is to provide financial support to community partners to enhance their capacity to provide care. The reporting Hospital met this metric by providing financial support to Hope Partnership, a nonprofit organization that aims to provide a holistic continuum of care to end homelessness and poverty in Central Florida.The second strategy, to provide in-kind support to community partners to enhance their capacity to provide care, could not be met due to staffing shortages within the Hospital.Community Needs Not Chosen by AdventHealth CelebrationThe 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. Poverty: The local Community Health Needs Assessment Committee (CHNAC) understands that poverty has a significant impact on health and wellbeing. The CHNAC agreed that the scale of this need is too broad, and it would not be a realistic issue to be addressed with the resources available at this time. 2. Education: The local CHNAC discussed education, health education and literacy. It was determined that education was better addressed by existing organizations and resources in the community. Certain aspects of education such as health literacy will be addressed under care coordination initiatives. Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth Altamonte SpringsDescription of CHNA Significant Needs Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth Altamonte Springs will be referred to in this document as AdventHealth Altamonte Springs 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 Altamonte Springs is part of the Central Florida Division of AdventHealth. Central Florida Division South Region (the Division) includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando, AdventHealth Winter Garden and AdventHealth Winter Park. The Central Florida Division includes 14 hospitals. This is the third-year update for AdventHealth Altamonte Springs' 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 Altamonte Springs 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 Altamonte Springs chose four priorities for its 2020-2022 Community Health Plan: 1. Food Security2. Care Coordination3. Mental & Behavioral Health4. Community Development: Youth Development & Mentorship Priority 1: Food Security 2019 Description of the Issue:More than 25% of community survey respondents from Seminole County indicated that they do not have access to healthy, affordable food. Food security was also defined as a need related to chronic conditions. Having access to proper nutrition is necessary for a healthy life. Proper nutrition can also reduce the risk of, or complications from, certain diseases, such as diabetes. The Central Florida Division of AdventHealth is currently working to address food security with multiple partners, including Second Harvest Food Bank. The Central Florida Division of AdventHealth intends to expand this work through current and future initiatives.2022 Update: The AdventHealth Altamonte Springs Community Health Plan has two desired goal statements under the Food Security priority.1. Increase access to healthy and affordable food for community members in need2. Work with community and government officials to address the root causes of food insecurity in our communitiesGoal 1: Increase access to healthy and affordable food for community members in needObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to sustain or build partnerships with at least six community organizations that focus on addressing food security, and is supported by multiple strategies including the provision of in-kind contributions, financial support of at least $455,000, and annual volunteer board service over the next three years throughout the tri-county region. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.The first strategy, to support the objective through in-kind contributions, was met by sustaining one partnership with a community organization in the Division. This sustained partnership was with Second Harvest Food Bank of Central Florida, a private, nonprofit organization that collects, stores, and distributes donated food to more than 550 feeding partners in six Central Florida counties. The Division continued its support to Second Harvest through the Second Helpings program. This program enables each hospital campus, including the reporting Hospital, to make in-kind donations of excess food to Second Harvest to be distributed through local food pantries. In 2022, the reporting Hospital was unable to contribute towards this program due to staffing changes impacted by the COVID-19 pandemic. The second strategy, to support the objective through financial support, was met by sustaining 18 partnerships with community organizations in the Division. In 2022, the reporting Hospital contributed $53,011 in financial support toward the three-year goal of $455,000. Four of these partnerships were sustained on a tri-county level, this includes Orange County, Osceola County, and Seminole County. The reporting Hospital sustained three of these partnerships. For the reporting Hospital, one of these partnerships included financially supporting a grassroot effort at one local church, Mars Hill, to provide food to those in need through their church food pantry. Financial support was also provided to Meals on Wheels of Seminole County, which provides home meal deliveries to seniors and Harvest Time International which supports a family food voucher program. The outcomes reported for this strategy, which support the objective, are specific to Seminole County.The third strategy to support the objective, providing annual representation on boards of organizations focusing on food security which support the tri-county region (Orange, Osceola, and Seminole counties), was met by serving on three boards. Knowing that food security is a large-scale community issue, the Central Florida Division of AdventHealth will continue its efforts to serve on boards, coalitions and taskforces which work with local and state officials to address the root causes of food insecurity. This strategy also focuses on advocacy and food system reform to ensure equitable access to healthy food across the community. In 2022, the Central Florida Division of AdventHealth team members continued to serve on boards of the Second Harvest Food Bank of Central Florida, the American Diabetes Association, and the American Heart Association, all of which impact the Central Florida Division's primary service area. Both the American Diabetes Association and the American Heart Association are nonprofit organizations that provide education on nutrition and food-related conditions.The reporting Hospital continued to provide representation by serving on the board of Meals on Wheels of Seminole County, within their primary service area. Meals on Wheels of Seminole County is a local nonprofit that provides meals and assistance for vulnerable seniors living in Seminole County.Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to identify new partners and best practices to increase the effectiveness of efforts to bring healthy food to community members in need. These partnerships will be utilized to drive strategies across the tri-county area. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth Altamonte SpringsDescription of CHNA Significant Needs Continued In 2022, the Division sustained their partnership with one local nonprofit, HEBNI Nutrition Consultants, Inc., which was formed to educate high-risk, culturally diverse populations about nutrition strategies to prevent diet-related diseases. This partnership, over the past three years, continued to increase the amount of healthy food available to community members in need. HEBNI Nutrition Consultant's services include nutrition education and a mobile market. The reporting Hospital provided $10,901 toward the mobile market which offers produce at a reduced cost in low-income, high-risk communities and food deserts. In 2022, 454 new, unique participants were referred to the Fresh Stop Veggie Rx & Diabetes Prevention Program and 1,086 food boxes were given to enrolled participants for food distribution. Goal 2: Work with community and government officials to address the root causes of food insecurity in our communitiesObjective 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; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This shared objective, to identify leadership from the tri-county area to participate in local coalitions focused on advocacy and reform to ensure equitable access to healthy food, is managed at a Divisional level, however all outcomes reported are specific to the reporting Hospital. This initiative provides an opportunity to form and participate in multisector collaboratives within Seminole County, which are working on a shared goal to identify and strategize on best practices to address the root causes of food insecurity.In 2022, the Division continued to provide representation on behalf of the Hospital by participating in the Seminole County Department of Health's Healthy Seminole committee. This committee is comprised of organizations throughout Seminole County that plan and implement community improvement programs. By providing representation at a Divisional level, the Central Florida Division of AdventHealth can identify cross-county and various organizational partnerships that will benefit all the communities they serve, regardless of geography.Priority 2: Care Coordination 2019 Description of the Issue:AdventHealth Altamonte Springs identified care coordination as a need, specifically affordable specialty care, efficient and holistic care coordination, childhood obesity, and efficient and affordable transportation. In Seminole County, 35.4% of community survey participants indicated that they lacked access to a healthcare provider specialist. Limited access to high quality healthcare specialists was identified as a community issue. Care coordination was identified by the local Community Health Needs Assessment Committee and primary data participants as a needed service. Seminole County has seen an increase in both middle school and high school students reporting a BMI at or above the 95th percentile. More than seven percent of Seminole County community survey respondents indicated that a family member had childhood obesity. Transportation was identified as a barrier related to economic conditions and public transportation was identified as a need. Transportation was also identified as a need related to mental health services, chronic conditions, and overall access to health care. 2022 Update: The AdventHealth Altamonte Springs Community Health Plan has two desired goal statements under the Care Coordination priority.1. Increase the availability of appropriate and affordable care2. Decrease barriers community members encounter while seeking careGoal 1: Increase the availability of appropriate and affordable careObjective 1:The first objective is a Divisional initiative and appears on multiple community health plans 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 provide support to existing care facilities through multiple strategies, including financial contributions, in-kind labs, and residency rotations and to seek innovative ways to increase capacity through the provision of in-kind labs/imaging, volunteer services, etc. The first strategy is to provide support to existing care facilities through financial contributions. The strategy to support this objective is managed at a Divisional level. The reporting Hospital's funding included, but was not limited to, contributions for operational support to two local Federally Qualified Health Centers (FQHCs). An $11,475 contribution was made to the Health Care Center for the Homeless, which provides primary medical care, oral health services, behavioral health, and substance use services for underinsured and uninsured individuals. An additional $11,475 was provided to True Health, which delivers medical and mental health services to underserved populations. The reporting Hospital contributed $19,507 to Shepherd's Hope which supported medical homes to increase the availability of affordable care. Shepherd's Hope is a faith-based organization of volunteers who provide access to healthcare for uninsured patients. The reporting Hospital also contributed to IDignity Seminole County which assists individuals in obtaining birth certificates, Social Security cards and other documentation needed to obtain a FL ID or license. The second strategy is to provide in-kind labs to existing care facilities. The Division provided in-kind labs to the Health Care Center for the Homeless and Grace Medical Home. In the future, the Division will develop a process to track and quantify in-kind labs and imaging provided to local nonprofit organizations.The third strategy is to support a residency rotation to existing care facilities. The Division had a residency rotation program established with a local nonprofit. However, in 2021, for a multitude of reasons, including COVID-19, the program was discontinued. The Division continues to identify ways to support our community and the community-based organizations that may support residency rotations. The fourth strategy is to seek innovative ways to increase capacity through in-kind labs, imaging, and volunteer services. After reassessing the Division's capacity, it was determined that the initiative could not be met. However, we are working to identify new ways to support the needs originally identified in our CHNAs, as resources and public health recommendations develop. Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in AdventHealth Hospitals in Orange County, Osceola County and Seminole County: AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority.This shared objective, to expand on existing care navigation services to ensure uninsured and underinsured patients have an accessible entry point to the level of care they need, is managed at a Divisional level. This initiative provides an opportunity to support organizations with a shared goal to increase accessible entry points. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.In 2022, the reporting Hospital contributed funding of $13,770 to the American Cancer Society's Road to Recovery Program. This program provides rides to and from cancer treatment for any cancer patient with a transportation barrier, regardless of insurance or economic status. In total, the Road to Recovery program provided 1,111 rides for cancer patients. In 2022, the reporting Hospital contributed $6,683 toward the three-year funding partnership with AdventHealth University's Hope Clinic. This partnership provided cardiac rehabilitation (wellness maintenance) services to uninsured and underinsured individuals to improve health outcomes and reduce readmissions. The Hope Clinic provides free care to individuals with socio-economic barriers, to increase access to care regardless of financial circumstance. In 2022, the Hope Clinic enrolled 34 patients into the program. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth Altamonte SpringsDescription of CHNA Significant Needs Continued The reporting Hospital achieved this objective and continues to identify organizations to expand existing external care navigation services to ensure uninsured and underinsured patients have an accessible entry point to the level of care they need.Goal 2: Decrease barriers community members encounter while seeking careObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in AdventHealth Hospitals in Orange County, Osceola County and Seminole County: AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.This shared objective, to provide case management services for at least 81 patients over three years while identifying additional partners and methods to decrease barriers community members encounter while seeking care, is managed at a Divisional level. In 2022, the Division continued to support the Holistic Health program led by Center for Change, a local nonprofit, which aims to provide health education and social services to individuals and families who lack access to economic, social and health resources. The reporting Hospital contributed $5,495 toward the Holistic Health program which focuses its efforts in high-need communities identified in the CHNA. The Division met this objective by providing case management services to 83 unique individuals over three years. Additionally, in 2022, 189 referrals to services were provided, 162 individuals have improved their biometrics and 200 individuals have improved health behaviors through the program. Priority 3: Mental & Behavioral Health 2019 Description of the Issue:Mental and behavioral health, specifically the need for more providers and services, was identified as a top community need. Only 11% of community survey respondents in Seminole County believe there are enough mental health providers. Nearly 60% of community survey respondents indicate that they feel depressed or hopeless. Poor mental health can exacerbate physical health conditions, decreasing quality of life and making it more difficult to maintain stable housing. 2022 Update: The AdventHealth Altamonte Springs Community Health Plan has two desired goal statements under the Mental & Behavioral Health priority.1. Increase access to mental and behavioral health services2. Support existing resources and identify new partners and programs that proactively strengthen the communityGoal 1: Increase access to mental and behavioral health servicesObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase provider capacity through financial and in-kind support to at least three partners serving the tri-county community. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. This initiative provides an opportunity for the Division to support at least three partners that have a shared goal of increasing provider capacity in the space of mental and behavioral health. In 2022, the Division sustained partnerships with three partners to implement programs that serve the tri-county community: Aspire Health Partners' Psychosocial Rehabilitation Program, True Health's Mental Health Expansion Program and Central Florida Community Arts' Community Music Therapy Program. The reporting Hospital met its set metric of providing financial support to at least three partners by funding these organizations for a total of $351,767. With the funding, they were able to provide programs that serve the underinsured and uninsured individuals in the reporting Hospital's primary service area. Aspire Health Partners is an organization committed to providing individuals and families of Central Florida with compassionate, comprehensive, and cost-effective behavioral health care services that lead to successful living and healthy, responsible lifestyles. Not only does Aspire Health Partners receive financial funding for the Psychosocial Rehabilitation Program, but the Division also leases five crisis stabilization unit (CSU) beds to connect individuals who have acute needs to mental health services. The Division also supports the Central Florida Community Arts which exists to serve and build community through the arts. Through the Music Therapy Program, the organization hired a music therapist to support individual and group music therapy across the tri-county area. The Division also established a new partnership to increase provider capacity with True Health, a local Federally Qualified Health Center (FQHC), to support their Mental Health Expansion Program which provided funding for a full-time psychiatrist. Other initiatives to address this objective include providing in-kind support through board service. The reporting Hospital provided representation to serve on the board of True Health within their primary service area. True Health is a local federally qualified health center that serves low-income, uninsured, underinsured, and underserved populations in Central Florida. Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is to develop and support pathways to mental and behavioral healthcare for those in need by expanding care navigation models to include mental and behavioral health focused initiatives over the next three years. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.In 2022, the reporting Hospital provided financial support to National Alliance on Mental Illness (NAMI) Greater Orlando to provide operational support to increase the existing capacity to expand health services for individuals impacted by mental health. NAMI Greater Orlando is dedicated to improving lives of millions of Americans affected by mental illness.Goal 2: Support existing resources and identify new partners and programs that proactively strengthen the communityObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is supported by multiple strategies: provide the Mission: FIT POSSIBLE program to at least two schools annually in the AdventHealth Altamonte Springs' primary service area that were identified as hot spots and collaborate with partners to strengthen community resiliency by proactively educating and identifying resources to deliver resiliency-focused trainings and resources to the community. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth Altamonte SpringsDescription of CHNA Significant Needs Continued The first strategy was to provide the Mission: FIT POSSIBLE program to at least two schools that were identified as hot spots in the AdventHealth Altamonte Springs' primary service area each year. The outcomes reported for this strategy, which supports the objective, are specific to Seminole County. The Division met this objective by providing the program to one school in the reporting Hospital's primary service area. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy.The second strategy is to collaborate with partners to strengthen community resiliency by proactively educating and identifying resources to deliver resiliency-focused trainings and resources to the community. Outcomes reported for this strategy, which support the objective, are specific to the reporting Hospital. In 2022, the reporting Hospital contributed funding of $14,630 toward the No Limit Counseling and Education's program, No Limit Unit. No Limit Counseling and Education is a local nonprofit whose mission is to promote mental health (social, emotional, and psychological) wellness and awareness through advocacy, programs, services, and outreach. Through this partnership, No Limit Unit provides services to adults and youth for both individual empowerment and systemic change in the areas of mental and physical wellness. Barbershop Talk Tours, Thriving Moms Club and Flow Detox reach men, women and children through mental health education, support groups and reduction of stigma. Priority 4: Community Development: Youth Development & Mentorship 2019 Description of the Issue:Youth development and mentorship, specifically relating to youth education and enrichment, was identified by the local Community Health Needs Assessment Committee as a need. Seminole County has seen an increase in student absenteeism and high school gang activity. Positive influences combined with a strong education as a youth increases the chances for success in adulthood. 2022 Update: The AdventHealth Altamonte Springs Community Health Plan has one desired goal statement under the Community Development: Youth Development and Mentorship priority.1. Increase impact of efforts to provide positive experiences and healthy environments for youthGoal 1: Increase impact of efforts to provide positive experiences and healthy environments for youthObjective 1: The first objective is a shared initiative between AdventHealth Altamonte Springs and AdventHealth Apopka. These Hospitals are part of the Central Florida Division of AdventHealth. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is to provide annual financial and in-kind support, including board service and employee volunteers, for continuation of annual school engagement events and growing new partnerships to serve youth in the community. This objective is managed at the Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. The first strategy is to provide financial support to local organizations that are working to positively impact youth in the community. In 2022, the reporting Hospital provided financial support to Boys Town Central Florida. Boys Town Central Florida is focused on changing the way America cares for children and families by providing an array of life-changing youth care and health care services for each child and family. The second strategy is to provide in-kind support, including board-service and employee volunteers, to local organizations that are working to positively impact youth and host annual school engagement events. In 2022, the reporting Hospital served on the board of Kids House of Seminole, Inc., a local nonprofit whose mission is to prevent child abuse and to aid child abuse victims and families by providing coordinated services in a safe, child-friendly environment. The third strategy is to establish new partnerships to serve youth in the community. The Division met this metric by establishing a partnership with No Limit Health and Education, Inc. which is a local nonprofit that hosts several programs. One of these programs, the Flow Detox program, teaches young adults in historically underserved neighborhoods how to process anger and hostile emotions as well as to positively express themselves. The Division continued to partner with No Limit Health and Education and, in 2022, 126 youth completed Flow Detox, increasing their understanding of personal triggers and how to process anger and hostile emotions. Community Needs Not Chosen by AdventHealth Altamonte SpringsThe 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. Affordable Housing: The local Community Health Needs Assessment Committee (CHNAC) did not perceive the ability to improve upon the resources that already exist in Seminole County that address affordable housing. The Hospital decided it would be better to target their efforts in areas where the Hospital would have greater impact. Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth East OrlandoDescription of CHNA Significant Needs Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth East Orlando will be referred to in this document as AdventHealth East Orlando 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 East Orlando is part of the Central Florida Division of AdventHealth. Central Florida Division South Region (the Division) includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando, AdventHealth Winter Garden and AdventHealth Winter Park. The Central Florida Division includes 14 hospitals. This is the third-year update for AdventHealth East Orlando'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 East Orlando 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 East Orlando chose four priorities for its 2020-2022 Community Health Plan: 1. Food Security2. Care Coordination3. Mental & Behavioral Health4. Community Development: Job Skills Training & EmployabilityPriority 1: Food Security 2019 Description of the Issue:Over one-third of community survey respondents indicated they lack access to high quality, affordable, healthy food. Having access to proper nutrition is necessary for a healthy life. Proper nutrition can also reduce the risk of, or complications from, certain diseases, such as diabetes. The Central Florida Division of AdventHealth (the Division) is currently working to address food security with multiple partners, including Second Harvest Food Bank. The Central Florida Division of AdventHealth intends to expand this work through current and future initiatives.2022 Update: The AdventHealth East Orlando Community Health Plan has two desired goal statements under the Food Security priority.1. Increase access to healthy and affordable food for community members in need2. Work with community and government officials to address the root causes of food insecurity in our communitiesGoal 1: Increase access to healthy and affordable food for community members in needObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective, to sustain or build partnerships with at least six community organizations that focus on addressing food security, is supported by multiple strategies: by providing in-kind contributions, financial support of at least $455,000, and annual board service over the next three years throughout the tri-county region. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.The first strategy, to support the objective through in-kind contributions, was met by sustaining one partnership with a community organization in the Division. This sustained partnership was with Second Harvest Food Bank of Central Florida, a private, nonprofit organization that collects, stores, and distributes donated food to more than 550 feeding partners in six Central Florida counties. The Division continued its support to Second Harvest through the Second Helpings program. This program enables each hospital campus, including the reporting Hospital, to make in-kind donations of excess food to Second Harvest to be distributed through local food pantries. In 2022, the reporting Hospital was unable to contribute towards this program due to staffing changes impacted by the COVID-19 pandemic. The second strategy, to support the objective through financial support, was met by sustaining 18 partnerships with community organizations in the Division. In 2022, the reporting Hospital contributed $49,309 in financial support towards the three-year goal of $455,000. Four of these partnerships were sustained on a tri-county level, this includes Orange County, Osceola County and Seminole County. The reporting Hospital sustained four of these partnerships. Some of these partnerships included financially supporting grassroots efforts at four nonprofit organizations to provide food to those in need through their food pantries or community gardens. Financial support was also provided for Seniors First, an organization that leads the local Meals on Wheels program, which provides home meal deliveries to seniors. The outcomes reported for this strategy, which support the objective, are specific to Orange County.The third strategy to support the objective, providing annual representation on boards of organizations focusing on food security which support the tri-county region (Orange, Osceola, and Seminole counties), was met by serving on three boards. In 2022, the Central Florida Division of AdventHealth team members continued to serve on the boards of the Second Harvest Food Bank of Central Florida, the American Diabetes Association, and the American Heart Association, all of which impact the Central Florida Division's primary service area. Both the American Diabetes Association and the American Heart Association are nonprofit organizations that provide education on nutrition and food-related conditions.Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to identify new partners and best practices to increase the effectiveness of efforts to bring healthy food to community members in need. These partnerships will be utilized to drive strategies across the tri-county area. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.In 2022, the Division sustained their partnership with two local nonprofit organizations, HEBNI Nutrition Consultants, Inc., and Infinite Zion Farms. HEBNI Nutrition Consultants, Inc. was formed to educate high-risk, culturally diverse populations about nutrition strategies to prevent diet-related diseases. This partnership, over the past three-years, continued to increase the amount of healthy food available to community members in need. HEBNI Nutrition Consultants' services include nutrition education and a mobile market. The reporting Hospital provided $8,455 toward the mobile market which offers produce at a reduced cost in low-income, high-risk communities and food deserts. In 2022, 454 new, unique participants were referred to the Fresh Stop Veggie Rx & Diabetes Prevention Program and 1,086 food boxes were given to enrolled participants for food distribution. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth East OrlandoDescription of CHNA Significant Needs Continued In 2022, the reporting Hospital also provided funding to Infinite Zion Farms towards the installation of tower gardens to increase the fresh produce in Orange County, the county of the reporting Hospital. Infinite Zion Farms is a local nonprofit that is working to establish affordable sources of organic produce and education to the community at large.Goal 2: Work with community and government officials to address the root causes of food insecurity in our communitiesObjective 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; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This shared objective, to identify leadership from the tri-county area to participate in local coalitions focused on advocacy and reform to ensure equitable access to healthy food, is managed at a Divisional level, however all outcomes reported are specific to Orange County. This initiative provides an opportunity to form and participate in multisector collaboratives within Orange County which are working on a shared goal to identify and strategize on best practices to address the root causes of food insecurity. In 2022, the Division continued to provide representation on behalf of the Hospital by participating in the Orange County Department of Health's Community Health Improvement Planning Committee. This committee is comprised of organizations throughout Orange County that plan and implement community improvement programs. By providing representation at a Divisional level, the Central Florida Division of AdventHealth can identify cross-county and various organizational partnerships that will benefit all the communities they serve, regardless of geography.Priority 2: Care Coordination 2019 Description of the Issue:AdventHealth East Orlando identified care coordination as a need, specifically in the areas of prenatal care/early intervention/early childhood access to care and chronic disease management. Orange County had an increase in infant deaths, low birthweight babies and preterm births. There was also a decrease in the percentage of mothers who had prenatal care in the first trimester. In Orange County, 31.6 percent of community survey respondents indicated that they lacked access to a primary care provider. An additional 35.5 percent indicated they lacked access to a specialist. Limited access to high quality primary care physicians and specialists was identified as a community issue by primary research participants. Orange County also had an increase in individuals who were obese, middle school and high school students who are reporting a body mass index at or above the 95th percentile, adults with diabetes, diabetes hospitalizations for children ages 12 to 18, adults with hypertension and adults who have been told they had a stroke. 2022 Update: The AdventHealth East Orlando Community Health Plan has two desired goal statements under the Care Coordination priority.1. Increase the availability of appropriate and affordable care2. Decrease barriers community members encounter while seeking careGoal 1: Increase the availability of appropriate and affordable careObjective 1:The first objective is a Divisional initiative and appears on multiple community health plans 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 provide support to existing care facilities through multiple strategies, including financial contributions, in-kind labs, and residency rotations and to seek innovative ways to increase capacity through the in-kind provision of labs/imaging, volunteer services, etc. The first strategy is to provide support to existing care facilities through financial contributions. The strategy to support this objective is managed at a Divisional level. The reporting Hospital's funding included, but was not limited to, contributions for operational support for two local Federally Qualified Health Centers (FQHCs). An $8,901 contribution was made to the Health Care Center for the Homeless, which provides primary medical care, oral health services, behavioral health, and substance use services for underinsured and uninsured individuals. An additional $8,901 was provided to True Health, which delivers medical and mental health services to underserved populations.The reporting Hospital also provided $15,131 to Shepherd's Hope which will support medical homes to increase the availability of affordable care. Shepherd's Hope is a faith-based organization of volunteers who provide access to healthcare for uninsured patients. The second strategy is to provide in-kind labs to existing care facilities. The Division provided in-kind labs to the Health Care Center for the Homeless and Grace Medical Home. In the future, the Division will develop a process to track and quantify in-kind labs and imaging provided to local nonprofit organizations.The third strategy is to support a residency rotation to existing care facilities. The Division had a residency rotation program established with a local nonprofit. However, in 2021, for a multitude of reasons, including COVID-19, the program was discontinued. The Division continues to identify ways to support our community and the community-based organizations that may support residency rotations. The fourth strategy is to seek innovative ways to increase capacity through in-kind labs, imaging, and volunteer services. After reassessing the Division's capacity, it was determined that the initiative could not be met. However, we are working to identify new ways to support the needs originally identified in our CHNAs, as resources and public health recommendations develop. Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans of the Central Florida AdventHealth hospital facilities in Orange County, Osceola County and Seminole County: AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. These Hospitals are part of the Central Florida Division of AdventHealth and are in the same Division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority.The shared objective, to expand on existing care navigation services to ensure uninsured and underinsured patients have an accessible entry point to the level of care they need, is managed at a Divisional level. This initiative provides an opportunity to support organizations with a shared goal to increase accessible entry points. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.In 2022, the reporting Hospital contributed funding of $10,681 to the American Cancer Society's Road to Recovery Program. This program provides rides to and from cancer treatment for any cancer patient with a transportation barrier, regardless of insurance or economic status. In total, the Road to Recovery program provided 1,111 rides for cancer patients. In 2022 the reporting Hospital also contributed $5,184 in year three towards the three-year funding partnership with AdventHealth University's Hope Clinic. This partnership provides cardiac rehabilitation (wellness maintenance) services to uninsured and underinsured individuals to improve health outcomes and reduce readmissions. The Hope Clinic provides free care to individuals with socio-economic barriers, to increase access to care regardless of financial circumstance. In 2022, the Hope Clinic enrolled 34 patients into the program.Goal 2: Decrease barriers community members encounter while seeking care **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth East OrlandoDescription of CHNA Significant Needs Continued Objective 1: The first objective is a Divisional initiative and appears on multiple community health plans of the Central Florida AdventHealth hospital facilities in Orange County, Osceola County and Seminole County: AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. These Hospitals are part of the Central Florida Division of AdventHealth and are in the same Division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.The shared objective, to provide case management services for at least 81 patients over three years while identifying additional partners and methods to decrease barriers community members encounter while seeking care, is managed at a Divisional level. In 2022, the Division continued to support the Holistic Health program led by Center for Change, a local nonprofit, which aims to provide health education and social services to individuals and families who lack access to economic, social and health resources. The reporting Hospital contributed $7,667 toward the program which focuses its efforts in high-need communities identified in the CHNA. The Division met this objective by providing case management services to 83 unique individuals over three years. Additionally, in 2022, 189 referrals to services were provided, 162 individuals have improved their biometrics and 200 individuals have improved health behaviors through the program. Priority 3: Mental & Behavioral Health 2019 Description of the Issue:Mental health, behavioral health and substance use were all identified as top community needs by stakeholders, key informants, and focus groups. Only one in ten community survey respondents from Orange County believe there are sufficient substance abuse services. Poor mental health can exacerbate physical health conditions, decreasing quality of life and making it more difficult to maintain stable housing. The Central Florida Division of AdventHealth is heavily invested in addressing mental health and substance abuse and has partnered with community organizations such as the local Federally Qualified Health Centers (FQHCs), Seminole County Sheriff's Office, Aspire Health Partners, and the National Alliance on Mental Illness.2022 Update: The AdventHealth East Orlando Community Health Plan has two desired goal statements under the Mental & Behavioral Health priority.1. Increase access to mental and behavioral health services2. Support existing resources and identify new partners and programs that proactively strengthen the communityGoal 1: Increase access to mental and behavioral health servicesObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase provider capacity through financial and in-kind support to at least three partners serving the tri-county community. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.This initiative provides an opportunity for the reporting Hospital to support at least three partners that have a shared goal of increasing provider capacity in the space of mental and behavioral health. In 2022, the Division sustained partnerships with three partners to implement programs that serve the tri-county community: Aspire Health Partners' Psychosocial Rehabilitation Program, True Health's Mental Health Expansion Program and Central Florida Center for the Arts' Community Music Therapy Program. The reporting Hospital met its set metric of providing financial support to at least three partners by funding these organizations for a total of $31,310. With the funding, they were able to provide programs that serve the underinsured and uninsured individuals in the reporting Hospital's service area. Aspire Health Partners is an organization committed to providing individuals and families of Central Florida with compassionate, comprehensive, and cost-effective behavioral health care services that lead to successful living and healthy, responsible lifestyles. Not only does Aspire Health Partners receive financial funding for the Psychosocial Rehabilitation Program, but the Division also leases five crisis stabilization unit (CSU) beds to connect individuals who have acute needs to mental health services. The Division also supports the Central Florida Center for the Arts which exists to serve and build community through the arts. Through the Music Therapy Program, the organization hired a music therapist to support individual and group music therapy across the tri-county area. The Division also established a new partnership to increase provider capacity with True Health, a local Federally Qualified Health Center (FQHC), to support their Mental Health Expansion Program which provided funding for a full-time psychiatrist. Other initiatives to address this objective include providing in-kind support through board service. In 2022, the reporting Hospital served on the board of Harbor House which focuses on providing critical life-saving services to survivors, implementing and advancing best practices, and educating and engaging the community in a united front.Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority and budget. This objective is to develop and support pathways to mental and behavioral healthcare for those in need by expanding care navigation models to include mental and behavioral health focused initiatives over the next three years. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. In 2022, the reporting Hospital provided funding to Bliss Cares to provide mental health services to their target clients. Bliss Cares is a nonprofit organization that has a mission to save lives by treating and preventing the spread of HIV, Hepatitis, and sexually transmitted diseases (STDs). The reporting Hospital also contributed $2,670 to support the Mental Health Association's East Orlando Choices Clinic to help individuals dealing with mental health illness in the reporting Hospital's primary service area.Goal 2: Support existing resources and identify new partners and programs that proactively strengthen the communityObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is supported by multiple strategies: provide the Mission: FIT POSSIBLE program to at least two schools annually in the AdventHealth East Orlando primary service area that were identified as hot spots and collaborate with partners to strengthen community resiliency by proactively educating and identifying resources to deliver resiliency-focused trainings and resources to the community. This objective is managed at a Divisional level; however, all outcomes are specific to Hospitals in Orange County. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth East OrlandoDescription of CHNA Significant Needs Continued The first strategy was to provide the Mission: FIT POSSIBLE program to at least two schools that were identified as hot spots in the AdventHealth East Orlando primary service area each year. The outcomes reported for this strategy, which support the objective, are specific to Orange County. This objective was exceeded by the Division, with 28 schools in the reporting Hospital's primary service area receiving the program. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy.The second strategy is to collaborate with partners to strengthen community resiliency by proactively educating and identifying resources to deliver resiliency-focused trainings and resources to the community. Outcomes reported for this strategy, which support the objective, are specific to the reporting Hospital. This objective was met through an initiative, Circle of Security, led by the Early Learning Coalition of Orange County (ELCOC). The reporting Hospital contributed $2,225 toward ELCOC's Circle of Security program. ELCOC is dedicated to the success of early childhood development in the community through early education. The Circle of Security program builds teachers' responsiveness to young children's emotional needs to better support their positive mental health. The ELCOC seeks to provide the Circle of Security attachment training to early childhood teachers in Orange County's most under-resourced communities. The reporting Hospital was able to meet this objective in Orange County, the county of the reporting Hospital. In 2022, the reporting Hospital also contributed funding of $11,348 towards the No Limit Health and Education's program, No Limit Unit. No Limit Health and Education is a local nonprofit whose mission is to promote mental health (social, emotional, and psychological) wellness and awareness through advocacy, programs, services, and outreach. Through this partnership, No Limit Unit provides services to adults and youth for both individual empowerment and systemic change in the areas of mental and physical wellness. Barbershop Talk Tours, Thriving Moms Club and Flow Detox reach men, women and children through mental health education, support groups and reduction of stigma. Priority 4: Community Development: Job Skills Training & Employability2019 Description of the Issue:Job skills and training were identified as a top community need in the AdventHealth East Orlando breakout session. By attaining financial stability and alleviating the concerns associated with economic instability, individuals can more easily address health concerns. As an anchor organization in our community, the AdventHealth Central Florida Division can implement job training and education programs for communities in need.2022 Update: The AdventHealth East Orlando Community Health Plan has one desired goal statement under the Community Development: Job Skills Training and Employability priority.1. Advocate and work within the community to remove barriers to employmentGoal 1: Advocate and work within the community to remove barriers to employmentObjective 1: The first objective is to collaborate with the community to enhance existing efforts to provide training, support, and social services to those currently unemployed and underemployed. The objective is managed by the Division, but all outcomes are specific to the reporting Hospital. The reporting Hospital met this metric by contributing $8,455 to Samaritan Resource Center, a local nonprofit that provides job skills training and support to persons living in homelessness in East Orlando.Community Needs Not Chosen by AdventHealth East OrlandoThe 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. Adverse Childhood Events (ACEs): AdventHealth East Orlando will incorporate the issue of ACEs into their mental and behavioral health initiatives. The objective of working to identify and implement proactive mental health education and programs which focus on resiliency will include ACEs.2. Housing: By prioritizing job skills training and employability, the Hospital hopes to provide lasting solutions for community members to increase their ability to secure housing and decrease homelessness. Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth Winter ParkDescription of CHNA Significant Needs Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth Winter Park will be referred to in this document as AdventHealth Winter Park 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 Winter Park is part of the Central Florida Division of AdventHealth. Central Florida Division South Region (the Division) includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando, AdventHealth Winter Garden and AdventHealth Winter Park. The Central Florida Division includes 14 hospitals. This is the third-year update for AdventHealth Winter Park'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 Winter Park 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 Winter Park chose four priorities for its 2020-2022 Community Health Plan: 1. Food Security2. Care Coordination3. Mental & Behavioral Health4. Community Development: Senior VulnerabilityPriority 1: Food Security 2019 Description of the Issue:Over one-third of community survey respondents indicated they lack access to high quality, affordable, healthy food. Having access to proper nutrition is necessary for a healthy life. Proper nutrition can also reduce the risk of, or complications from, certain diseases, such as diabetes. The Central Florida Division of AdventHealth is currently working to address food security with multiple partners, including Second Harvest Food Bank. The Central Florida Division of AdventHealth intends to expand this work through current and future initiatives.2022 Update: The AdventHealth Winter Park Community Health Plan has two desired goal statements under the Food Security priority.1. Increase access to healthy and affordable food for community members in need2. Work with community and government officials to address the root causes of food insecurity in our communitiesGoal 1: Increase access to healthy and affordable food for community members in needObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective to sustain or build partnerships with at least six community organizations that focus on addressing food security is supported by multiple strategies: by providing in-kind contributions, financial support of at least $455,000 and annual board service over the next three years throughout the tri-county region. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.The first strategy, to support the objective through in-kind contributions, was met by sustaining one partnership with a community organization in the Division. This sustained partnership was with Second Harvest Food Bank of Central Florida, a private, nonprofit organization that collects, stores, and distributes donated food to more than 550 feeding partners in six Central Florida counties. The Division continued its support to Second Harvest through the Second Helpings program. This program enables each hospital campus, including the reporting Hospital, to make in-kind donations of excess food to Second Harvest to be distributed through local food pantries. In 2022, the reporting Hospital was unable to contribute towards this program due to staffing changes impacted by the COVID-19 pandemic. The second strategy, to support the objective through financial support, was met by sustaining 18 partnerships with community organizations in the Division. In 2022, the reporting Hospital contributed $41,331 in financial support in year three toward the three-year goal of $455,000. Four of these partnerships were sustained on a tri-county level, this includes Orange County, Osceola County and Seminole County. The reporting Hospital sustained four of these partnerships. Some of these partnerships included financially supporting grassroots efforts at four nonprofit organizations to provide food to those in need through their food pantries or community gardens. Financial support was also provided for Seniors First, an organization that leads the local Meals on Wheels program, which provides home meal deliveries to seniors. The outcomes reported for this strategy, which support the objective, are specific to Orange County.The third strategy to support the objective, providing annual representation on boards of organizations focusing on food security which support the tri-county region (Orange, Osceola, and Seminole counties), was met by serving on three boards. In 2022, the Central Florida Division of AdventHealth team members continued to serve on the board of the Second Harvest Food Bank of Central Florida, the American Diabetes Association, and the American Heart Association, all of which impact the Central Florida Division's primary service area. Both the American Diabetes Association and the American Heart Association are nonprofit organizations that provide education on nutrition and food-related conditions.Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is to identify new partners and best practices to increase effectiveness of efforts to bring healthy food to community members in need. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.In 2022, the Division sustained their partnership with two local nonprofit organizations, HEBNI Nutrition Consultants, Inc., and Infinite Zion Farms. HEBNI Nutrition Consultants, Inc. was formed to educate high-risk, culturally diverse populations about nutrition strategies to prevent diet-related diseases. This partnership, over the past three-years, continued to increase the amount of healthy food available to community members in need. HEBNI Nutrition Consultants' services include nutrition education and a mobile market. The reporting Hospital provided $7,080 toward the mobile market which offers produce at a reduced cost in low-income, high-risk communities and food deserts. In 2022, 454 new, unique participants were referred to the Fresh Stop Veggie Rx & Diabetes Prevention Program and 1,086 food boxes were given to enrolled participants for food distribution. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth Winter ParkDescription of CHNA Significant Needs Continued Through the reporting Hospital's funding, Infinite Zion Farms was able to build its first pilot greenhouse to provide additional fresh produce in Orange County, the county of the reporting Hospital. Infinite Zion Farms is a local nonprofit that is working to establish affordable sources of organic produce and education to the community at large. In 2022, the reporting Hospital provided additional funding to Infinite Zion Farms toward the installation of greenhouses to increase the fresh produce in Orange County, the county of the reporting Hospital.Goal 2: Work with community and government officials to address the root causes of food insecurity in our communitiesObjective 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; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This shared objective, to identify leadership from the tri-county area to participate in local coalitions focused on advocacy and reform to ensure equitable access to healthy food, is managed at a Divisional level, however all outcomes reported are specific to Orange County. This initiative provides an opportunity to form and participate in multisector collaboratives within Orange County, which are working on a shared goal to identify and strategize on best practices to address the root causes of food insecurity.In 2022, the Division continued to provide representation on behalf of the Hospital by participating in the Orange County Department of Health's Community Health Improvement Planning Committee. This committee is comprised of organizations throughout Orange County that plan and implement community improvement programs. By providing representation at a Divisional level, the Central Florida Division of AdventHealth can identify cross-county and various organizational partnerships that will benefit all the communities they serve, regardless of geography.Priority 2: Care Coordination 2019 Description of the Issue:AdventHealth Winter Park identified care coordination as a need, specifically in the areas of prenatal care/early intervention/early childhood, access to care, and chronic disease management. Orange County had an increase in infant deaths, low birthweight babies and preterm births. There was also a decrease in the percentage of mothers who had prenatal care in the first trimester. In Orange County, 31.6 percent of community survey respondents indicated that they lacked access to a primary care provider. An additional 35.5 percent indicated they lacked access to a healthcare specialist. Limited access to high quality primary care physicians and specialists was identified as a community issue by primary research participants. Orange County also had an increase in individuals who were obese, middle school and high school students who are reporting a body mass index at or above the 95th percentile, adults with diabetes, diabetes hospitalizations for children ages 12 to 18, adults with hypertension and adults who have been told they had a stroke. 2022 Update: The AdventHealth Winter Park Community Health Plan has two desired goal statements under the Care Coordination priority.1. Increase the availability of appropriate and affordable care2. Decrease barriers community members encounter while seeking careGoal 1: Increase the availability of appropriate and affordable careObjective 1:The first objective is a Divisional initiative and appears on multiple community health plans 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 provide support to existing care facilities through multiple strategies, including financial contributions, in-kind labs, and residency rotations, and to seek innovative ways to increase capacity through the provision of in-kind labs/imaging, volunteer services, etc. The first strategy is to provide support to existing care facilities through financial contributions. The strategy to support this objective is managed at a Divisional level. The reporting Hospital's funding included, but was not limited to, contributions for operational support for two local Federally Qualified Health Centers (FQHCs). A $7,461 contribution was made to the Health Care Center for the Homeless, which provides primary medical care, oral health services, behavioral health, and substance use services for underinsured and uninsured individuals. An additional $9,326 was provided to True Health, which delivers medical and mental health services to underserved populations.The reporting Hospital also provided $12,683 to Shepherd's Hope which will support medical homes to increase the availability of affordable care. Shepherd's Hope is a faith-based organization of volunteers who provide access to healthcare for uninsured patients. The second strategy is to provide in-kind labs to existing care facilities. The Division provided in-kind labs to the Health Care Center for the Homeless and Grace Medical Home. In the future, the Division will develop a process to track and quantify in-kind labs and imaging provided to local nonprofit organizations.The third strategy is to support a residency rotation to existing care facilities. The Division had a residency rotation program established with a local nonprofit. However, in 2021, for a multitude of reasons, including COVID-19, the program was discontinued. The Division continues to identify ways to support our community and the community-based organizations that may support residency rotations. The fourth strategy is to seek innovative ways to increase capacity through in-kind labs, imaging, and volunteer services. After reassessing the Division's capacity, it was determined that the initiative could not be met. However, we are working to identify new ways to support the needs originally identified in our CHNAs, as resources and public health recommendations develop. Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans of AdventHealth hospitals in Orange County, Osceola County and Seminole County including AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. These Hospitals are part of the Central Florida Division of AdventHealth and are in the same Division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority.This shared objective, to expand on existing care navigation services to ensure uninsured and underinsured patients have an accessible entry point to the level of care they need, is managed at a Divisional level. This initiative provides an opportunity to support organizations with a shared goal to increase accessible entry points. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.In 2022, the reporting Hospital contributed funding of $8,953 to the American Cancer Society's Road to Recovery program. This program provides rides to and from cancer treatment for any cancer patient with a transportation barrier, regardless of insurance or economic status. In total, the Road to Recovery program provided 1,111 rides for cancer patients. The reporting Hospital achieved this objective and continues to identify organizations to expand existing external care navigation services to ensure uninsured and underinsured patients have an accessible entry point to the level of care they need.Goal 2: Decrease barriers community members encounter while seeking careObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in AdventHealth hospitals in Orange County, Osceola County and Seminole County including AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. These Hospitals are part of the Central Florida Division of AdventHealth and are in the same Division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth Winter ParkDescription of CHNA Significant Needs Continued The shared objective, to provide case management services for at least 81 patients over three years while identifying additional partners and methods to decrease barriers community members encounter while seeking care, is managed at a Divisional level. In 2022, the Division continued to support the Holistic Health program led by Center for Change, a local nonprofit, which aims to provide health education and social services to individuals and families who lack access to economic, social and health resources. The reporting Hospital contributed $6,427 toward the Holistic Health program which focuses its efforts in high-need communities identified in the CHNA. The Division met this objective by providing case management services to 83 unique individuals over three years. Additionally, in 2022, 189 referrals to services were provided, 162 individuals have improved their biometrics and 200 individuals have improved health behaviors through the program. In 2022, the reporting Hospital also contributed $4,345 toward the three-year funding partnership with AdventHealth University's Hope Clinic. The Hope Clinic provides free care to individuals with socio-economic barriers, to increase access to care regardless of financial circumstance. This partnership provided cardiac rehabilitation (wellness maintenance) services to uninsured and underinsured individuals to improve health outcomes and reduce readmissions. In 2022, the Hope Clinic enrolled 34 patients into the program.Priority 3: Mental & Behavioral Health 2019 Description of the Issue:Mental health, behavioral health and substance use were all identified as top community needs by stakeholders, key informants, and focus groups. Only one in ten community survey respondents from Orange County believe there is sufficient substance abuse services. Poor mental health can exacerbate physical health conditions, decreasing quality of life and making it more difficult to maintain stable housing. The Central Florida Division of AdventHealth is heavily invested in addressing mental health and substance abuse and has partnered with community organizations such as the local Federally Qualified Health Centers (FQHCs), Seminole County Sheriff's Office, Aspire Health Partners, and the National Alliance on Mental Illness.2022 Update: The AdventHealth Winter Park Community Health Plan has two desired goal statements under the Mental & Behavioral Health priority.1. Increase access to mental and behavioral health services2. Support existing resources and identify new partners and programs that proactively strengthen the communityGoal 1: Increase access to mental and behavioral health servicesObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans of AdventHealth hospitals in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase provider capacity through financial and in-kind support to at least three partners serving the tri-county community. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.This initiative provides an opportunity for the reporting Hospital to support at least three partners that have a shared goal of increasing provider capacity in the space of mental and behavioral health. In 2022, the Division sustained partnerships with three partners to implement programs that serve the tri-county community: Aspire Health Partners' Psychosocial Rehabilitation Program, True Health's Mental Health Expansion Program and Central Florida Community Arts' Community Music Therapy Program. The reporting Hospital met its set metric of providing financial support to at least three partners by funding these organizations for a total of $26,245. With the funding, they were able to provide programs that serve the underinsured and uninsured individuals in the reporting Hospital's service area. Aspire Health Partners is an organization committed to providing individuals and families of Central Florida with compassionate, comprehensive, and cost-effective behavioral health care services that lead to successful living and healthy, responsible lifestyles. Not only does Aspire Health Partners receive financial funding for the Psychosocial Rehabilitation Program, but the Division also leases five crisis stabilization unit (CSU) beds to connect individuals who have acute needs to mental health services. The Division also supports the Central Florida Community Arts which exists to serve and build community through the arts. Through the Music Therapy Program, the organization hired a music therapist to support individual and group music therapy across the tri-county area. The Division also established a new partnership to increase provider capacity with True Health, a local Federally Qualified Health Center (FQHC), to support their Mental Health Expansion Program which provided funding for a full-time psychiatrist. Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans of AdventHealth hospitals in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to develop and support pathways to mental and behavioral healthcare for those in need by expanding care navigation models to include mental and behavioral health focused initiatives over the next three years. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. In 2022, the reporting Hospital provided funding to New Hope for Kids for their grief counseling program. New Hope for Kids is a nonprofit organization that helps children and their families during some of life's most difficult challenges. Goal 2: Support existing resources and identify new partners and programs that proactively strengthen the communityObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is supported by multiple strategies: provide the Mission: FIT POSSIBLE program to at least two schools annually in the AdventHealth Winter Park primary service area that were identified as hot spots and collaborate with partners to strengthen community resiliency by proactively educating and identifying resources to deliver resiliency-focused trainings and resources to the community. This objective is managed at a Divisional level; however, all outcomes are specific to Hospitals in Orange County. The first strategy was to provide the Mission: FIT POSSIBLE program to at least two schools that were identified as hot spots in the AdventHealth Winter Park primary service area each year. The outcomes reported for this strategy, which support the objective, are specific to Orange County. In 2022, this objective was exceeded by the Division, with 28 schools in the reporting Hospital's primary service area receiving the program. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth Winter ParkDescription of CHNA Significant Needs Continued The second strategy is to collaborate with partners to strengthen community resiliency by proactively educating and identifying resources to deliver resiliency-focused trainings and resources to the community. Outcomes reported for this strategy, which support the objective, are specific to the reporting Hospital. This objective was met through an initiative, Circle of Security, led by the Early Learning Coalition of Orange County (ELCOC). The reporting Hospital contributed $1,865 toward ELCOC's Circle of Security program. ELCOC is dedicated to the success of early childhood development in the community through early education. The Circle of Security program builds teachers' responsiveness to young children's emotional needs to better support their positive mental health. The ELCOC seeks to provide the Circle of Security attachment training to early childhood teachers in Orange County's most under-resourced communities. The reporting Hospital was able to meet this objective in Orange County, the county of the reporting Hospital. In 2022, the reporting Hospital also contributed funding of $9,512 towards the No Limit Health and Education's program, No Limit Unit. No Limit Health and Education is a local nonprofit whose mission is to promote mental health (social, emotional, and psychological) wellness and awareness through advocacy, programs, services, and outreach. Through this partnership, No Limit Unit provides services to adults and youth for both individual empowerment and systemic change in the areas of mental and physical wellness. Barbershop Talk Tours, Thriving Moms Club and Flow Detox reach men, women and children through mental health education, support groups and reduction of stigma. Priority 4: Community Development: Senior Vulnerability 2019 Description of the Issue:Seniors were identified as a unique population for AdventHealth Winter Park. Senior safety was identified as a community issue related to unintentional injuries by Orange County primary data participants. The senior population is especially vulnerable to negative effects of isolation including poor health outcomes and higher rates of depression. 2022 Update: The AdventHealth Winter Park Community Health Plan has one desired goal statement under the Community Development: Senior Vulnerability priority.1. Address unique mental, physical and spiritual needs of high senior populationGoal 1: Address unique mental, physical and spiritual needs of high senior populationObjective 1: The first objective is the reporting Hospital's initiative and appears only on the community health plan of AdventHealth Winter Park. The objective is to provide care navigation and social services for the senior population. The objective is managed by the Division, but all outcomes are specific to the reporting Hospital. The reporting Hospital met this objective by providing funding to Seniors First, an organization that leads the local Meals on Wheels program, which provides home meal deliveries to seniors. A representative from the reporting Hospital also serves as a board member to Seniors First.Objective 2: The second objective is the reporting Hospital's initiative and appears only on the community health plan of AdventHealth Winter Park. The objective is to provide services to educate and support caregivers in the community to increase quality of life for both the caregiver and receiver of care. The objective is managed by the Division, but all outcomes are specific to the reporting Hospital.The Division met this objective by funding a position, Senior Care Navigator, at the reporting Hospital's Emergency Department (ED) to help address the unique needs of seniors. In 2022, the Division continued to work on identifying a funding source to continue educating and supporting caregivers in the community. Community Needs Not Chosen by AdventHealth Winter ParkThe 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 issue:1. Built Environment (Affordable Housing): The local Community Health Needs Assessment Committee (CHNAC) did not perceive the ability to improve upon the resources that already exist in Orange County that address this issue. The Hospital decided it would be better to target their efforts in areas where it would have greater impact. Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth KissimmeeDescription of CHNA Significant Needs Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth Kissimmee will be referred to in this document as AdventHealth Kissimmee 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 Kissimmee is part of the Central Florida Division of AdventHealth. Central Florida Division South Region (the Division) includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando, AdventHealth Winter Garden and AdventHealth Winter Park. The Central Florida Division includes 14 hospitals. This is the third-year update for AdventHealth Kissimmee'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 Kissimmee 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 Kissimmee chose four priorities for its 2020-2022 Community Health Plan: 1. Food Security2. Care Coordination3. Mental & Behavioral Health4. Community Development: Affordable Housing & HomelessnessPriority 1: Food Security 2019 Description of the Issue:More than 40 percent of community survey respondents from Osceola County indicated that they do not have access to healthy, affordable food. Food security was also identified as a need related to chronic conditions. Having access to proper nutrition is necessary for a healthy life. Proper nutrition can also reduce the risk of, or complications from, certain diseases, such as diabetes. The Central Florida Division of AdventHealth (the Division) is currently working to address food security with multiple partners, including Second Harvest Food Bank. The Division intends to expand this work through current and future initiatives.2022 Update: The AdventHealth Kissimmee Community Health Plan has two desired goal statements under the Food Security priority.1. Increase access to healthy and affordable food for community members in need2. Work with community and government officials to address the root causes of food insecurity in our communitiesGoal 1: Increase access to healthy and affordable food for community members in needObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to sustain or build partnerships with at least six community organizations that focus on addressing food security and is supported by multiple strategies including the provision of in-kind contributions, financial support of at least $455,000, and annual volunteer board service over the next three years throughout the tri-county region. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.The first strategy, to support the objective through in-kind contributions, was met by sustaining one partnership with a community organization in the Division. This sustained partnership was with Second Harvest Food Bank of Central Florida, a private, nonprofit organization that collects, stores, and distributes donated food to more than 550 feeding partners in six Central Florida counties. The Division continued its support to Second Harvest through the Second Helpings program. This program enables each Hospital campus, including the reporting Hospital, to make in-kind donations of excess food to Second Harvest to be distributed through local food pantries. In 2022, the reporting Hospital was unable to contribute towards this program due to staffing changes impacted by the COVID-19 pandemic.The second strategy, to support the objective through financial support, was met by sustaining 18 partnerships with community organizations in the Division. In 2022, the reporting Hospital contributed $15,858 in financial support toward the three-year goal of $455,000. Four of these partnerships were sustained by the Division on a tri-county level, including Orange County, Osceola County and Seminole County. The reporting Hospital sustained one of these partnerships. Financial support was provided to Osceola Council on Aging, an organization that leads the local Meals on Wheels program, which provides home meal deliveries to seniors.The third strategy to support the objective, providing annual representation on boards of organizations focusing on food security which support the tri-county region (Orange, Osceola, and Seminole counties), was met by serving on three boards. In 2022, the Central Florida Division of AdventHealth team members continued to serve on the boards of the Second Harvest Food Bank of Central Florida, the American Diabetes Association, and the American Heart Association, all of which impact the Central Florida Division's primary service area. Both the American Diabetes Association and the American Heart Association are nonprofit organizations that provide education on nutrition and food-related conditions.The reporting Hospital continued to provide representation by serving on the board of the Osceola Council on Aging, within their primary service area. Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to identify new partners and best practices to increase the effectiveness of efforts to bring healthy food to community members in need. These partnerships will be utilized to drive strategies across the tri-county area. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.In 2022, the Division met this objective by sustaining their partnership with one local nonprofit, HEBNI Nutrition Consultants, Inc., which was formed to educate high-risk, culturally diverse populations about nutrition strategies to prevent diet-related diseases. This partnership, over the past three-years, continued to increase the amount of healthy food available to community members in need. HEBNI Nutrition Consultants' services include nutrition education and a mobile market. The reporting Hospital provided $7,087 toward the mobile market which offers produce at a reduced cost in low-income, high-risk communities and food deserts. In 2022, 454 new, unique participants were referred to the Fresh Stop Veggie Rx & Diabetes Prevention Program and 1,086 food boxes were given to enrolled participants for food distribution. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth KissimmeeDescription of CHNA Significant Needs ContinuedIn 2022, the reporting Hospital also sustained its partnership with the School District of Osceola County (SDOC)'s SMART Bus. The SMART Bus provides food, education, access to Wi-Fi and family support to meet the needs of the 2,500 homeless students enrolled in the SDOC. The new partnership is reported for the Division, not Hospital specific and appears on the community health plans of all Hospitals in Osceola County where the initiative is conducted. This includes the plans of AdventHealth Celebration and AdventHealth Kissimmee.Goal 2: Work with community and government officials to address the root causes of food insecurity in our communitiesObjective 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; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority.The shared objective, to identify leadership from the tri-county area to participate in local coalitions focused on advocacy and reform to ensure equitable access to healthy food, is managed at a Divisional level, however all outcomes reported are specific to Osceola County. This initiative provides an opportunity to form and participate in multisector collaboratives within Osceola County, which are working on a shared goal to identify and strategize on best practices to address the root causes of food insecurity.In 2022, the Division continued to provide representation on behalf of the Hospital by participating in the Osceola Health Leadership Council. This council is comprised of organizations throughout Osceola County that plan and implement community improvement programs. By providing representation at a Divisional level, the Central Florida Division of AdventHealth is able to identify cross-county and various organizational partnerships that will benefit all the communities they serve, regardless of geography.Priority 2: Care Coordination 2019 Description of the Issue:AdventHealth Kissimmee identified care coordination as a need, specifically preventative care/health screenings, access to care, and pediatric and women's health (including prenatal). Osceola County primary data respondents were less likely to indicate that they accessed preventative care services, such as a PSA test, lab work and Pap tests. In 2016, 23.6 percent of Osceola County adults could not see a doctor due to cost. Primary data respondents from Osceola County also identified transportation and care coordination as barriers to care in relation to chronic conditions when seeking care. A little more than 10 percent of Osceola County community survey respondents indicated that they have difficulty accessing prenatal care.2022 Update: The AdventHealth Kissimmee Community Health Plan has two desired goal statements under the Care Coordination priority.1. Increase the availability of appropriate and affordable care2. Decrease barriers community members encounter while seeking careGoal 1: Increase the availability of appropriate and affordable careObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans 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 provide support to existing care facilities through multiple strategies, including financial contributions, in-kind labs, and residency rotations and to seek innovative ways to increase capacity through the provision of in-kind labs/imaging, volunteer services, etc. The first strategy is to provide support to existing care facilities through financial contributions. The strategy to support this objective is managed at a Divisional level. The reporting Hospital's funding included, but was not limited to, contributions for operational support for a local Federally Qualified Health Center (FQHC). A $5,940 contribution was made to the Health Care Center for the Homeless, which provides primary medical care, oral health services, behavioral health, and substance use services for underinsured and uninsured individuals. The reporting Hospital also provided $1,782 in financial contributions to Osceola Council on Aging to support clinical operations and $1,485 to Osceola Community Health Services, a local FQHC focused on meeting an individual's physical and mental health care needs through prevention, wellness, acute and chronic care.The second strategy is to provide in-kind labs to existing care facilities. The Division provided in-kind labs to the Health Care Center for the Homeless. In the future, the Division will develop a process to track and quantify in-kind labs and imaging provided to local nonprofit organizations.The third strategy is to support a residency rotation to existing care facilities. The Division had a residency rotation program established with a local nonprofit. However, in 2021, for a multitude of reasons, including COVID-19, the program was discontinued. The Division continues to identify ways to support our community and the community-based organizations that may support residency rotations. The fourth strategy is to seek innovative ways to increase capacity through in-kind labs, imaging, and volunteer services. After reassessing the Division's capacity, it was determined that the initiative could not be met. However, we are working to identify new ways to support the needs originally identified in our CHNAs, as resources and public health recommendations develop. Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in Orange County, Osceola County and Seminole County to include AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. These Hospitals are part of the Central Florida Division of AdventHealth and are in the same Division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority.This shared objective, to expand on existing care navigation services to ensure uninsured and underinsured patients have an accessible entry point to the level of care they need, is managed at a Divisional level. This initiative provides an opportunity to support organizations with a shared goal to increase accessible entry points. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.In 2022, the reporting Hospital contributed $7,128 to the American Cancer Society's Road to Recovery Program. This program provides rides to and from cancer treatment for any cancer patient with a transportation barrier, regardless of insurance or economic status. In total, the Road to Recovery program provided 1,111 rides for cancer patients. In 2022, the reporting Hospital also contributed $3,459 toward the three-year funding partnership with AdventHealth University's Hope Clinic. This partnership provides cardiac rehabilitation (wellness maintenance) services to uninsured and underinsured individuals to improve health outcomes and reduce readmissions. The Hope Clinic provides free care to individuals with socio-economic barriers, allowing increased access to care regardless of financial circumstance. In 2022, the Hope Clinic enrolled 34 patients into the program.Goal 2: Decrease barriers community members encounter while seeking careObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in Orange County, Osceola County and Seminole County to include AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. These Hospitals are part of the Central Florida Division of AdventHealth and are in the same Division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.This shared objective, to provide case management services for at least 81 patients over three years while identifying additional partners and methods to decrease barriers community members encounter while seeking care, is managed at a Divisional level. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth KissimmeeDescription of CHNA Significant Needs ContinuedIn 2022, the Division continued to support the Holistic Health program led by Center for Change, a local nonprofit, which aims to provide health education and social services to individuals and families who lack access to economic, social and health resources. The reporting Hospital contributed $5,117 toward the Holistic Health program which focuses its efforts in high-need communities identified in the CHNA. The Division met this objective by providing case management services to 83 unique individuals over three years. Additionally, in 2022, 189 referrals to services were provided, 162 individuals have improved their biometrics and 200 individuals have improved health behaviors through the program. Priority 3: Mental & Behavioral Health 2019 Description of the Issue:Less than 10 percent of community survey respondents from Osceola County believe there are a sufficient number of mental health providers and nearly 60 percent of Osceola County community survey respondents indicated they feel depressed or hopeless. When discussing with primary research participants, it was stated that the high level of stress people are experiencing could make it difficult to cope with mental illness. This may be caused by lack of community support and available support services to manage mental health. The Central Florida Division of AdventHealth has several care options for mental health services. These include the Outlook Clinic and connections to FQHCs. The Central Florida Division of AdventHealth is funding several mental and behavioral health services in the community, including an eye movement desensitization and reprocessing (EMDR) psychotherapy treatment at a local FQHC and a music therapy program. 2022 Update: The AdventHealth Kissimmee Community Health Plan has two desired goal statements under the Mental & Behavioral Health priority.1. Increase access to mental and behavioral health services2. Support existing resources and identify new partners and programs that proactively strengthen the communityGoal 1: Increase access to mental and behavioral health servicesObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase provider capacity through financial and in-kind support to at least three partners serving the tri-county community. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.This initiative provides an opportunity for the reporting Hospital to support at least three partners that have a shared goal of increasing provider capacity in the space of mental and behavioral health. In 2022, the Division sustained partnerships with two partners to implement programs that serve the tri-county community: True Health's Mental Health Expansion Program and Central Florida Community Arts' Community Music Therapy Program. In 2022, the reporting Hospital did not meet its set metric of providing financial support to at least three partners. However, with $12,374 in contributions made, they were able to provide programs that serve the underinsured and uninsured individuals in the reporting Hospital's service area. The Division supports the Central Florida Community Arts which exists to serve and build community through the arts. Through the Music Therapy Program, the organization hired a music therapist to support individual and group music therapy across the tri-county area. The Division also established a new partnership with True Health, a local Federally Qualified Health Center (FQHC), to increase provider capacity and support their Mental Health Expansion Program which provided funding for a full-time psychiatrist. Other initiatives to address this objective include providing in-kind support through board service. Due to the aftermath of the COVID-19 pandemic, the initiative was delayed. As a result of the continued pandemic, AdventHealth has pivoted where necessary to address the immediate needs of our community. Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to develop and support pathways to mental and behavioral healthcare for those in need by expanding care navigation models to include mental and behavioral health focused initiatives over the next three years. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. In 2022, the reporting Hospital provided $14,850 to Park Place Behavioral Health Care for operational support. Park Place Behavioral Health Care is an organization that provides therapeutic, psychiatric and substance use disorder services in Central Florida. Goal 2: Support existing resources and identify new partners and programs that proactively strengthen the communityObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is supported by multiple strategies: provide the Mission: FIT POSSIBLE program to at least two schools annually in AdventHealth Kissimmee's primary service area that were identified as hot spots and collaborate with partners to strengthen community resiliency by proactively educating and identifying resources to deliver resiliency-focused trainings and resources to the community. This objective is managed at a Divisional level; however, all outcomes are specific to Hospitals in Osceola County.The first strategy was to provide the Mission: FIT POSSIBLE program to at least two schools that were identified as hot spots in the AdventHealth Kissimmee primary service area each year. This objective was exceeded by the Division, with nine schools in the reporting Hospital's primary service area receiving the program. Outcomes reported for this strategy, which support the objective, are specific to Osceola County. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy.The second strategy is to collaborate with partners to strengthen community resiliency by proactivity educating and identifying resources to deliver resiliency-focused training and resources to the community. Outcomes reported for this strategy, which support the objective, are specific to reporting Hospitals in Osceola County. This includes AdventHealth Celebration and AdventHealth Kissimmee. The strategy was not conducted due to leadership changes within the organization.Priority 4: Community Development: Affordable Housing & Homelessness 2019 Description of the Issue:Osceola County has the highest percentage of renter households who were cost burdened (24.4 percent) and severely cost burdened (25.1 percent). Osceola County also had 21.1 percent of homeowner residents who are severely cost burdened. Affordable housing has a large impact on other health outcomes and wellbeing. It enables families to have the opportunity to meet their respective health, education, and employment needs. The Central Florida Division of AdventHealth is heavily invested in addressing homelessness and is involved with partners such as: Coalition for the Homeless of Central Florida, Family Promise of Greater Orlando, Homeless Services Network of Central Florida, and others. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth KissimmeeDescription of CHNA Significant Needs Continued 2022 Update: The AdventHealth Kissimmee Community Health Plan has two desired goal statements under the Community Development: Affordable Housing & Homelessness priority.1. Support efforts to increase access to care and provide services to our homeless population2. Participate in advocacy efforts to provide affordable housing for community membersGoal 1: Support efforts to increase access to care and provide services to our homeless populationObjective 1: The first objective is a shared initiative between AdventHealth Orlando, AdventHealth Celebration and AdventHealth Kissimmee. 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. The objective is to provide annual financial and in-kind support, including board service and employee volunteers, to support community partners and increase the capacity for care for our homeless population. This objective is managed at the Divisional level; however, all outcomes are specific to Hospitals in Osceola County.The first strategy is to provide financial support to local organizations that are working to address the affordable housing needs and immediate needs of individuals experiencing homelessness. In 2022, the reporting Hospital met this metric by providing financial support to two organizations in the reporting Hospital's primary service area. Clarita's House received funding to support their emergency housing service for families in crisis and Habitat for Humanity received funding to support a special project that served individuals dealing with homelessness. The second strategy is to provide in-kind support to local organizations that are working to address the affordable housing needs and immediate needs of individuals experiencing homelessness. In 2022, the reporting Hospital partnered with the local Habitat for Humanity and team members volunteered with building homes for the surrounding community. Goal 2: Participate in advocacy efforts to provide affordable housing for community membersObjective 1: The first objective is a shared initiative between AdventHealth Celebration and AdventHealth Kissimmee. 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. The objective is to provide annual financial and in-kind support, including board service and employee volunteers, to support community partners and increase the capacity for care for our homeless population. This objective is managed at the Divisional level, but all outcomes are specific to the reporting Hospitals in Osceola County.The first strategy is to provide financial support to community partners to enhance their capacity to provide care. The reporting Hospital met this metric by providing financial support to Hope Partnership, a nonprofit organization that aims to provide a holistic continuum of care to end homelessness and poverty in Central Florida.The second strategy, to provide in-kind support to community partners to enhance their capacity to provide care, could not be met due to staffing shortages within the Hospital.Community Needs Not Chosen by AdventHealth KissimmeeThe 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. Poverty: The local Community Health Needs Assessment Committee (CHNAC) understands that poverty has a large impact on health and wellbeing. The CHNAC agreed that the scale of this need is too broad and would not be a realistic issue to be addressed with the resources available at this time. 2. Education: The local CHNAC discussed education, health education and literacy. It was determined that education was better addressed by existing organizations and resources in the community. Certain aspects of education such as health literacy will be addressed under care coordination initiatives. Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth ApopkaDescription of CHNA Significant Needs Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth Apopka will be referred to in this document as AdventHealth Apopka 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 Apopka is part of the Central Florida Division of AdventHealth. Central Florida Division South Region (the Division) includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando, AdventHealth Winter Garden and AdventHealth Winter Park. The Central Florida Division includes 14 hospitals. This is the third-year update for AdventHealth Apopka'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 Apopka 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 from 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 Apopka chose four priorities for its 2020-2022 Community Health Plan: 1. Food Security2. Care Coordination3. Mental & Behavioral Health4. Community Development: Youth Development & Mentorship Priority 1: Food Security 2019 Description of the Issue:Over one-third of community survey respondents indicated they lack access to high quality, affordable, healthy food. Having access to proper nutrition is necessary for a healthy life. Proper nutrition can also reduce the risk of, or complications from, certain diseases, such as diabetes. The Central Florida Division of AdventHealth is currently working to address food security with multiple partners, including Second Harvest Food Bank. The Central Florida Division of AdventHealth intends to expand this work through current and future initiatives.2022 Update: The AdventHealth Apopka Community Health Plan has two desired goal statements under the Food Security priority.1. Increase access to healthy and affordable food for community members in need2. Work with community and government officials to address the root causes of food insecurity in our communitiesGoal 1: Increase access to healthy and affordable food for community members in needObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to sustain or build partnerships with at least six community organizations that focus on addressing food security and is supported by multiple strategies including the provision of in-kind contributions, financial support of at least $455,000, and annual volunteer board service over the next three years throughout the tri-county region. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.The first strategy, to support the objective through in-kind contributions, was met by sustaining one partnership with a community organization in the Division. This sustained partnership was with Second Harvest Food Bank of Central Florida, a private, nonprofit organization that collects, stores, and distributes donated food to more than 550 feeding partners in six Central Florida counties. The Division continued its support to Second Harvest through the Second Helpings program. This program enables each hospital campus, including the reporting Hospital, to make in-kind donations of excess food to Second Harvest to be distributed through local food pantries. In 2022, the reporting Hospital was unable to contribute towards this program due to staffing changes impacted by the COVID-19 pandemic. The second strategy, to support the objective through financial support, was met by sustaining 18 partnerships with community organizations in the Division. In 2022, the reporting Hospital contributed $25,994 in financial support toward the three-year goal of $455,000. Four of these partnerships were sustained on a tri-county level, this includes Orange County, Osceola County, and Seminole County. The reporting Hospital sustained one of these partnerships. Some of these partnerships included financially supporting grassroots efforts at four nonprofit organizations to provide food to those in need through their food pantries or community gardens. Financial support was also provided for Seniors First, an organization that leads the local Meals on Wheels program, which provides home meal deliveries to seniors. The outcomes reported for this strategy, which support the objective, are specific to Orange County.The third strategy to support the objective, providing annual representation on boards of organizations focusing on food security which support the tri-county region (Orange, Osceola, and Seminole counties), was met by serving on three boards. Knowing that food security is a large-scale community issue, the Central Florida Division of AdventHealth will continue its efforts to serve on boards, coalitions and taskforces which work with local and state officials to address the root causes of food insecurity. This strategy also focuses on advocacy and food system reform to ensure equitable access to healthy food across the community. In 2022, the Central Florida Division of AdventHealth team members continued to serve on boards of the Second Harvest Food Bank of Central Florida, the American Diabetes Association, and the American Heart Association, all of which impact the Central Florida Division's primary service area. Both the American Diabetes Association and the American Heart Association are nonprofit organizations that provide education on nutrition and food-related conditions.Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is to identify new partners and best practices to increase effectiveness of efforts to bring healthy food to community members in need. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth ApopkaDescription of CHNA Significant Needs Continued In 2022, the Division sustained their partnership with two local nonprofit organizations, HEBNI Nutrition Consultants, Inc., and Infinite Zion Farms. HEBNI Nutrition Consultants, Inc. was formed to educate high-risk, culturally diverse populations about nutrition strategies to prevent diet-related diseases. This partnership, over the past three-years, continued to increase the amount of healthy food available to community members in need. HEBNI Nutrition Consultants' services include nutrition education and a mobile market. The reporting Hospital provided $6,060 toward the mobile market which offers produce at a reduced cost in low-income, high-risk communities and food deserts. In 2022, 454 new, unique participants were referred to the Fresh Stop Veggie Rx & Diabetes Prevention Program and 1,086 food boxes were given to enrolled participants for food distribution. Through the reporting Hospital's funding, Infinite Zion Farms was able to build its first pilot greenhouse, to provide additional fresh produce in Orange County, the county of the reporting Hospital. Infinite Zion Farms is a local nonprofit that is working to establish affordable sources of organic produce and provide education to the community at large. In 2022, the reporting Hospital contributed funding to Infinite Zion Farms toward the installation of greenhouses to increase the fresh produce in Orange County, the county of the reporting Hospital.Goal 2: Work with community and government officials to address the root causes of food insecurity in our communitiesObjective 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; this includes AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This shared objective, to identify leadership from the tri-county area to participate in local coalitions focused on advocacy and reform to ensure equitable access to healthy food, is managed at a Divisional level, however all outcomes reported are specific to Orange County. This initiative provides an opportunity to form and participate in multisector collaboratives within Orange County, which are working on a shared goal to identify and strategize on best practices to address the root causes of food insecurity.In 2022, the Division continued to provide representation on behalf of the Hospital by participating in the Orange County Department of Health's Community Health Improvement Planning Committee. This committee is comprised of organizations throughout Orange County that plan and implement community improvement programs. By providing representation at a Divisional level, the Central Florida Division of AdventHealth can identify cross-county and various organizational partnerships that will benefit all the communities they serve, regardless of geography.Priority 2: Care Coordination 2019 Description of the Issue:AdventHealth Apopka identified care coordination as a need, specifically in the areas of prenatal care/early intervention/early childhood access to care and chronic disease management. Orange County had an increase in infant deaths, low birthweight babies and preterm births. There was also a decrease in the percentage of mothers who had prenatal care in the first trimester. In Orange County, 31.6 percent of community survey respondents indicated that they lacked access to a primary care provider. An additional 35.5 percent indicated they lacked access to a healthcare provider specialist. Limited access to high quality primary care physicians and specialists was identified as a community issue by primary research participants. Orange County also had an increase in individuals who were obese, middle school and high school students who are reporting a body mass index at or above the 95th percentile, adults with diabetes, diabetes hospitalizations for children ages 12 to 18, adults with hypertension and adults who have been told they had a stroke. 2022 Update: The AdventHealth Apopka Community Health Plan has two desired goal statements under the Care Coordination priority.1. Increase the availability of appropriate and affordable care2. Decrease barriers community members encounter while seeking careGoal 1: Increase the availability of appropriate and affordable careObjective 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 provide support to existing care facilities through multiple strategies, including financial contributions, in-kind labs, and residency rotations and to seek innovative ways to increase capacity through the provision of in-kind labs/imaging, volunteer services, etc. The first strategy is to provide support to existing care facilities through financial contributions. The strategy to support this objective is managed at a Divisional level. The reporting Hospital's funding included, but was not limited to, contributions for operational support for two local Federally Qualified Health Centers (FQHCs). A $6,379 contribution was made to the Health Care Center for the Homeless, which provides primary medical care, oral health services, behavioral health, and substance use services for underinsured and uninsured individuals. An additional $6,379 was provided to True Health, which delivers medical and mental health services to underserved populations.The reporting Hospital also provided $10,844 to Shepherd's Hope which will support medical homes to increase the availability of affordable care. Shepherd's Hope is a faith-based organization of volunteers who provide access to healthcare for uninsured patients. The second strategy is to provide in-kind labs to existing care facilities. The Division provided in-kind labs to the Health Care Center for the Homeless and Grace Medical Home. In the future, the Division will develop a process to track and quantify in-kind labs and imaging provided to local nonprofit organizations.The third strategy is to support a residency rotation to existing care facilities. The Division had a residency rotation program established with a local nonprofit. However, in 2021, for a multitude of reasons, including COVID-19, the program was discontinued. The Division continues to identify ways to support our community and the community-based organizations that may support residency rotations. The fourth strategy is to seek innovative ways to increase capacity through in-kind labs, imaging, and volunteer services. After reassessing the Division's capacity, it was determined that the initiative could not be met. However, we are working to identify new ways to support the needs originally identified in our CHNAs, as resources and public health recommendations develop. Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans of AdventHealth hospitals in Orange County, Osceola County and Seminole County: AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. These Hospitals are part of the Central Florida Division of AdventHealth and are in the same Division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority.The shared objective, to expand on existing care navigation services to ensure uninsured and underinsured patients have an accessible entry point to the level of care they need, is managed at a Divisional level. This initiative provides an opportunity to support organizations with a shared goal to increase accessible entry points. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated.In 2022, the reporting Hospital contributed funding of $7,654 to the American Cancer Society's Road to Recovery Program. This program provides rides to and from cancer treatment for any cancer patient with a transportation barrier, regardless of insurance or economic status. In total, the Road to Recovery program provided 1,111 rides for cancer patients. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth ApopkaDescription of CHNA Significant Needs ContinuedIn 2022, the reporting Hospital contributed $3,715 toward the three-year funding partnership with AdventHealth University's Hope Clinic. This partnership provides cardiac rehabilitation (wellness maintenance) services to uninsured and underinsured individuals to improve health outcomes and reduce readmissions. The Hope Clinic provides free care to individuals with socio-economic barriers, allowing increased access to care regardless of financial circumstance. In 2022, the Hope Clinic enrolled 34 patients into the program.The reporting Hospital achieved this objective and continues to identify organizations to expand on existing external care navigation services to ensure uninsured and underinsured patients have an accessible entry point to the level of care they need.Goal 2: Decrease barriers community members encounter while seeking careObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans of AdventHealth hospitals in Orange County, Osceola County and Seminole County to include AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. These Hospitals are part of the Central Florida Division of AdventHealth and are in the same Division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. The shared objective, to provide case management services for at least 81 patients over three years while identifying additional partners and methods to decrease barriers community members encounter while seeking care, is managed at a Divisional level.In 2022, the Division continued to support the Holistic Health program led by Center for Change, a local nonprofit, which aims to provide health education and social services to individuals and families who lack access to economic, social and health resources. The reporting Hospital contributed $5,495 toward the Holistic Health program which focuses its efforts in high-need communities identified in the CHNA. The Division met this objective by providing case management services to 83 unique individuals over three years. Additionally, in 2022, 189 referrals to services were provided, 162 individuals have improved their biometrics and 200 individuals have improved health behaviors through the program. Priority 3: Mental & Behavioral Health 2019 Description of the Issue:Mental health, behavioral health and substance use were all identified as top community needs by stakeholders, key informants, and focus groups. Only one in ten community survey respondents from Orange County believe there is sufficient substance abuse services. Poor mental health can exacerbate physical health conditions, decreasing quality of life and making it more difficult to maintain stable housing. The Central Florida Division of AdventHealth is heavily invested in addressing mental health and substance abuse and has partnered with community organizations such as local Federally Qualified Health Centers (FQHCs), the Seminole County Sheriff's Office, Aspire Health Partners, and the National Alliance on Mental Illness.2022 Update: The AdventHealth Apopka Community Health Plan has two desired goal statements under the Mental & Behavioral Health priority.1. Increase access to mental and behavioral health services2. Support existing resources and identify new partners and programs that proactively strengthen the communityGoal 1: Increase access to mental and behavioral health servicesObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase provider capacity through financial and in-kind support to at least three partners serving the tri-county community. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. This initiative provides an opportunity for the reporting Hospital to support at least three partners that have a shared goal of increasing provider capacity in the space of mental and behavioral health. In 2022, the Division sustained partnerships with three partners to implement programs that serve the tri-county community: Aspire Health Partners' Psychosocial Rehabilitation Program, True Health's Mental Health Expansion Program and Central Florida Center for the Arts' Community Music Therapy Program. The reporting Hospital met its set metric of providing financial support to at least three partners by funding these organizations for a total of $22,439. With the funding, they were able to provide programs that serve the underinsured and uninsured individuals in the reporting Hospital's service area. Aspire Health Partners is an organization committed to providing individuals and families of Central Florida with compassionate, comprehensive, and cost-effective behavioral health care services that lead to successful living and healthy, responsible lifestyles. Not only does Aspire Health Partners receive financial funding for the Psychosocial Rehabilitation Program, but the Division also leases five crisis stabilization unit (CSU) beds to connect individuals who have acute needs to mental health services. The Division also supports the Central Florida Center for the Arts which exists to serve and build community through the arts. Through the Music Therapy Program, the organization hired a music therapist to support individual and group music therapy across the tri-county area. The Division also established a new partnership to increase provider capacity with True Health, a local Federally Qualified Health Center (FQHC), to support their Mental Health Expansion Program which provided funding for a full-time psychiatrist. Other initiatives to address this objective include providing in-kind support through board service. In 2022, the reporting Hospital served on the board of Dave's House which focuses on providing permanent supportive housing for individuals with serious mental illness (SMI) and co-occurring disabilities.Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to develop and support pathways to mental and behavioral healthcare for those in need by expanding care navigation models to include mental and behavioral health focused initiatives over the next three years. This shared objective is managed at a Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. In 2022, the reporting Hospital contributed funding to National Alliance on Mental Illness (NAMI) Greater Orlando to provide operational support to increase the existing capacity to expand health services for individuals impacted by mental health. NAMI Greater Orlando is dedicated to improving lives of millions of Americans affected by mental illness.Goal 2: Support existing resources and identify new partners and programs that proactively strengthen the community **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 1 -- AdventHealth ApopkaDescription of CHNA Significant Needs ContinuedObjective 1: The first objective is a Divisional initiative and appears on multiple community health plans in the Central Florida Division of AdventHealth, the same division as the reporting Hospital. This includes the plans of AdventHealth Altamonte Springs, AdventHealth Apopka, AdventHealth Celebration, AdventHealth East Orlando, AdventHealth Kissimmee, AdventHealth Orlando and AdventHealth Winter Park. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is supported by multiple strategies: provide the Mission: FIT POSSIBLE program to at least two schools annually in the AdventHealth Apopka primary service area that were identified as hot spots and collaborate with partners to strengthen community resiliency by proactively educating and identifying resources to deliver resiliency-focused training and resources to the community. This objective is managed at a Divisional level; however, all outcomes are specific to Hospitals in Orange County. The first strategy was to provide the Mission: FIT POSSIBLE program to at least two schools that were identified as hot spots in the AdventHealth Apopka primary service area each year. Outcomes reported for this strategy, which support the objective, are specific to Orange County. In 2022, this objective was exceeded by the Division, with 28 schools in the reporting Hospital's primary service area receiving the program. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy. The second strategy is to collaborate with partners to strengthen community resiliency by proactively educating and identifying resources to deliver resiliency-focused trainings and resources to the community. Outcomes reported for this strategy, which support the objective, are specific to the reporting Hospital. This objective was met through an initiative, Circle of Security, led by the Early Learning Coalition of Orange County (ELCOC). The reporting Hospital contributed $1,594 toward ELCOC's Circle of Security program. ELCOC is dedicated to the success of early childhood development in the community through early education. The Circle of Security program builds teachers' responsiveness to young children's emotional needs to better support their positive mental health. The ELCOC seeks to provide the Circle of Security attachment training to early childhood teachers in Orange County's most under-resourced communities. The reporting Hospital was able to meet this objective in Orange County, the county of the reporting Hospital.In 2022, the reporting Hospital also contributed funding of $8,133 toward the No Limit Counseling and Education's program, No Limit Unit. No Limit Counseling and Education is a local nonprofit whose mission is to promote mental health (social, emotional, and psychological) wellness and awareness through advocacy, programs, services, and outreach. Through this partnership, No Limit Unit provides services to adults and youth for both individual empowerment and systemic change in the areas of mental and physical wellness. Barbershop Talk Tours, Thriving Moms Club and Flow Detox reach men, women and children through mental health education, support groups and reduction of stigma. Priority 4: Community Development: Youth Development & Mentorship 2019 Description of the Issue:Youth development and mentorship, specifically relating to youth education and enrichment, was identified by the local Community Health Needs Assessment Committee as a need. Orange County has seen an increase in student absenteeism. Positive influences combined with a strong education as a youth increases the chances for success in adulthood. 2022 Update: The AdventHealth Apopka Community Health Plan has one desired goal statement under the Community Development: Youth Development and Mentorship priority.1. Increase impact of efforts to provide positive experiences and healthy environments for youthGoal 1: Increase impact of efforts to provide positive experiences and healthy environments for youthObjective 1: The first objective is a shared initiative between AdventHealth Altamonte Springs and AdventHealth Apopka. These Hospitals are part of the Central Florida Division of AdventHealth. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is to provide annual financial and in-kind support, including board service and employee volunteers, for continuation of annual school engagement events and growing new partnerships to serve youth in the community. This objective is managed at the Divisional level and outcomes are reported at a Divisional level unless otherwise indicated. The first strategy is to provide financial support to local organizations that are working to positively impact youth in the community. In 2022, the reporting Hospital provided financial support to Boys and Girls Central Florida, which is a nonprofit that works to inspire and enable all young people, especially those from disadvantaged circumstances, to realize their full potential as productive, responsible, and caring citizens.The second strategy is to provide in-kind support, including board-service and employee volunteers, to local organizations that are working to positively impact youth and host annual school engagement events. In 2022, AdventHealth's Volunteer Services department established a partnership with the Boys and Girls Club of Central Florida to provide a mentorship program between AdventHealth team members and participating youth. The third strategy is to establish new partnerships to serve youth in the community. The Division met this metric by establishing a partnership with No Limit Health and Education, Inc. which is a local nonprofit that hosts several programs. One of these programs, the Flow Detox program, teaches young adults in historically underserved neighborhoods how to process anger and hostile emotions as well as to positively express themselves. The Division continued to partner with No Limit Health and Education and, in 2022, 126 youth completed Flow Detox, increasing their understanding of personal triggers and how to process anger and hostile emotions. Community Needs Not Chosen by AdventHealth ApopkaThe 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. Homelessness: The local Community Health Needs Assessment Committee (CHNAC) did not perceive the ability to improve upon the resources that already exist in Orange County that address this issue. The Hospital decided it would be better to target their efforts in areas where the Hospital would have greater impact. Part V, Section B, Line 11 Footnote: Group A-Facility 2 -- AdventHealth Sebring & Lake PlacidDescription of CHNA Significant NeedsAdventist Health System/Sunbelt, Inc. d/b/a AdventHealth Sebring and AdventHealth Lake Placid will be referred to in this document as AdventHealth Sebring 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 Sebring is part of the West Florida Division (the Division) of AdventHealth. The Division includes 13 hospital facilities. This is the third-year update for AdventHealth Sebring'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 Sebring 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 Sebring chose four priorities for its 2020-2022 Community Health Plan: 1. Mental Health (Behavioral Health)2. Transportation 3. Cardiovascular Disease 4. Education (Social Determinant of Health) Priority 1: Mental Health (Behavioral Health)2019 Description of the Issue:The burden of mental illness in the United States is among the highest of all diseases, and mental disorders are among the most common causes of disability for adults, children, and adolescents. When mental health disorders are untreated, those affected are at high risk for many unhealthy and unsafe behaviors, including alcohol or drug abuse, violent or self-destructive behavior and suicide. Mental health disorders are the 11th leading cause of death in the United States for all age groups and the second leading cause of death among people age 25 to 34. In the AdventHealth Sebring primary service areas (PSA), the rate of death due to self-harm (suicide) is 19 (per 100,000 population), which is higher than the state rate of 14 (per 100,000 population). Furthermore, 25% of the adults in the PSA population selfreport that they receive insufficient social and emotional support all or most of the time, which is higher than the state rate (21%). This indicator is relevant because social and emotional support is critical for navigating the challenges of daily life as well as for good mental health. Additionally, 17% of the Medicare-fee-for-service PSA population are depressed.2022 Update: The AdventHealth Sebring Community Health Plan has two desired goal statements under the Mental Health (Behavioral Health) priority. 1. To increase education and awareness related to mental health by engaging public schools, community members, organizations and stakeholders2. To increase community-level partnerships to enhance existing efforts currently addressing factors that impact mental health in youth and adultsGoal 1: To increase education and awareness related to mental health by engaging public schools, community members, organizations and stakeholders Objective 1: The first objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to partner with the Champion for Children Advocacy Center to raise awareness of the impact of mental health in youth and adults residing in the Hospital's PSA by creating and implementing two local social media campaigns from a baseline of zero local social media campaigns by the end of 2022. The objective is funded and managed through all Hospitals and outcomes reported represent all Hospitals involved. This social media campaign initiative brings awareness to both youth and adult community members regarding mental illnesses and helps to encourage conversations around the topic of mental health to destigmatize mental illnesses and encourage those suffering to seek help. Champion for Children's Advocacy Center split into two organizations after the creation of the 2020-2022 Community Health Plans: the Ruth E. Handley Children's Advocacy Center and the Champion for Children Foundation. The Hospitals are partnering with both organizations for this initiative. The Ruth E. Handley Children's Advocacy Center's mission is to minimize the trauma of child abuse victims and provide prevention support to families needing assistance to keep them intact. The Champion for Children Foundation offers prevention services and assistance programs to protect children, educate parents, strengthen families, assist caregivers, reduce trauma, and provide resources. These partnerships, as well as insight from members of the Hospitals' Community Health Needs Assessment Committee (CHNAC), have helped us to determine the most important topics to address for the Hospitals' social media campaigns moving forward, which will be depression and anxiety. The Hospitals did not meet the set metric. Although the Hospital did not meet the metric as written, AdventHealth did sponsor an enterprise-wide social media campaign across all markets to raise awareness about mental health. Objective 2: The second objective is to increase the number of Mental Health First Aid USA certification training classes provided for free to community members residing in the Hospital's PSA to three certification classes from a baseline of zero by the end of 2022. The deployment of the Mental Health First Aid classes is a shared initiative between AdventHealth Sebring, AdventHealth Carrollwood, AdventHealth Connerton, AdventHealth Dade City, AdventHealth North Pinellas, AdventHealth Ocala, AdventHealth Tampa, AdventHealth Zephyrhills, AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Wesley Chapel. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The initiative is managed at the Divisional level and funded through the Hospital, and all reported outcomes are specific to the reporting Hospital.This initiative provides Mental Health First Aid USA certification classes to the community for free. The class is a course that teaches individuals how to help someone who may be experiencing mental health or substance use challenges. The training helps one to identify, understand and respond to signs of addictions and mental illnesses. Mental Health First Aid USA is a national program developed to teach the skills to respond to the signs of mental illness and substance use.The Hospitals exceeded the set metric of providing three free Mental Health First Aid USA certification training classes to community members by offering four classes. A total of 44 participants were trained through this initiative.Goal 2: To increase community-level partnerships to enhance existing efforts currently addressing factors that impact mental health in youth and adults **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 2 -- AdventHealth Sebring & Lake PlacidDescription of CHNA Significant Needs ContinuedObjective 1: The first objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to provide vouchers to cover the costs of household supplies for homeless adults residing in the Hospital's PSA who receive housing services at Peace River Center (PRC) from a baseline of zero vouchers to three by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved unless otherwise indicated. This initiative provides vouchers in the form of monetary funds to help cover some of the costs associated with purchasing household and personal supplies for community members that are supported by the residential housing programs offered at Peace River Center, a community partner. This monetary assistance will help lead to improved health outcomes by providing these essential supplies.Peace River Center is a 501(c)(3) not-for-profit organization that strives to impact the lives of its clients and the community they serve by engaging, restoring, and empowering individuals to reach their fullest potential by offering a broad range of mental health, victim and substance use disorder services throughout Polk, Highlands, and Hardee counties, including housing and domestic violence shelters. The Hospitals met the set metric. In 2022, the Hospitals donated $2,760 collectively to the Peace River Center which equated to covering the cost of household supplies for 69 people at $40 per person. Objective 2: The second objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase awareness of Hospital sponsored community benefit programs and resources available to uninsured/underinsured adults and youth residing in the Hospital's PSA through a partnership with Peace River Center (PRC) by providing three informative in-service presentations to Crisis Response Outreach Counselors at PRC from a baseline of zero presentations by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. This initiative provides information about the Hospital sponsored Community Benefit programs that are free to community members and targeted to reach those uninsured/underinsured, underserved, low-income and minority members of the community. These programs include, but are not limited to, the Hospitals' Food is Health program that gives participants 10 dollars' worth of free produce for participating in an education class about nutrition and healthy living. These informative in-service presentations are presented to the Crisis Response Outreach Counselors at the Peace River Center who connect directly with those community members in need of mental health and crisis response counseling. They may also benefit from the Hospitals' free community programs. By sharing these programs with counselors, they can then share this information with their clients. The Hospitals did not meet the set metric. Year two was spent getting the Hospitals' programs back up and running in the community after setbacks due to COVID-19. In 2022, the Hospitals' focus was on the implementation of these programs across the Division. Leaders from PRC were informed of these programs through meetings, emails, and phone calls. Formal in-service presentations were not conducted, as the other methods used to deliver this information were deemed to be sufficient. Objective 3: The third objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the amount of paid staff time for Hospital staff/team members to volunteer with community organizations addressing mental health from a baseline of zero hours to 300 hours by the end of 2022. The objective is funded and managed through all Hospitals, however reported outcomes are specific to the reporting Hospital. This initiative provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations addressing this priority area. The Hospitals did not meet the set metric. Due to restrictions in place during the COVID-19 pandemic, such as requiring staff members to stay within the Hospital during their normal working hours, and the subsequent shortage of internal staff members across the healthcare industry, the Hospitals did not have the capacity to meet the 300 hours of volunteer time. Despite the pandemic restrictions, team members found ways to give back, for example, by volunteering to write letters of encouragement to individuals struggling with a mental health challenge. As the pandemic subsided, the West Florida Division (of which the Hospitals are a part of) created a volunteer portal to market volunteer opportunities to team members, track volunteer hours by team members, and notify community partners when team members sign up for events across the Division. Priority 2: Transportation 2019 Description of the Issue:A poor transportation system prevents those who do not own a car or have reliable transportation from accessing healthcare. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. In the AdventHealth Sebring primary service area (PSA), 3% (1,026 persons) of the population are currently using public transportation as their primary means of transportation to work. Furthermore, 27% of the population (28,585 persons) age 18 years and older do not have a regular healthcare provider, which is higher than the state average of 25%.2022 Update: The AdventHealth Sebring Community Health Plan has two desired goal statements under the Transportation priority. 1. To increase community partnerships with local transportation systems, leaders, and businesses to develop new strategies for improving access to transportation2. To increase access to culturally appropriate nutritious food options in food desert or low income/low access areas by implementing the Food is Health programGoal 1: To increase community partnerships with local transportation systems, leaders, and businesses to develop new strategies for improving access to transportation Objective 1: The first objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to decrease transportation challenges (barriers) among vulnerable adults residing in the Hospital's PSA by creating and implementing two new collaborative strategies from a baseline of zero strategies by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. The initiative created a partnership between the Hospitals and community organizations who also share a goal of reducing transportation challenges within the community. This collaboration fostered an exchange of ideas, resources, and programs. The Hospitals also evaluated what additional resources were available, or may become available, to community members with transportation challenges.The Hospitals did not meet its set metric. Due to restrictions in place during the COVID-19 pandemic, we could not host the in-person community summits we had originally planned during years one or two. In 2022, we hosted one virtual community summit with the Heartland Regional Transportation Planning Organization (HRTPO) who delivered an informative presentation about the various transportation programs available to the community. During the virtual summit, HRTPO was able to share, hear from, and collaborate with other community organizations and leaders to help spread the word and enroll participants in need. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 2 -- AdventHealth Sebring & Lake PlacidDescription of CHNA Significant Needs ContinuedThe Heartland Regional Transportation Planning Organization coordinates transportation plans for the Heartland Region including the six counties of DeSoto, Glades, Hardee, Hendry, Highlands and Okeechobee and the urbanized area of Highlands County, including the cities of Sebring and Avon Park. The Heartland Regional Transportation Planning Organization's mission is to provide support to the citizens and counties of the Heartland region and to seek ways to improve the quality of life of the citizens of the Heartland.Objective 2: The second objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to establish a new transportation taskforce in Hardee/Highlands Counties to co-host at least two community summits (with AdventHealth Wauchula and AdventHealth Lake Placid) from a baseline of zero summits to increase awareness of the impact of transportation accessibility on community health, wellness and employment sustainability for community members residing in the Hospital's PSA by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. This initiative brings together multiple organizations from the community who share a common goal in seeking to improve transportation access and a platform for getting the transportation programs available out to the communities we serve. The Hospitals met the set metric. The Heartland Regional Transportation Planning Organization already had a transportation taskforce in place that consisted of local community leaders and representatives for the underserved community. In lieu of creating a separate taskforce, we decided it was a better use of resources to have an AdventHealth team member join the one that was already established and led by the leader in transportation programming for the Hospitals' PSA. Through this partnership, AdventHealth co-hosted one virtual community summit in 2022. Goal 2: Increase access to culturally appropriate nutritious food options in food desert or low income/low access areas Objective 1: The first objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food is Health program will support a series of three nutrition education class series among low-income families in the PSA from a baseline of one by the end of 2022. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Food is Health program is an AdventHealth West Florida Division program which increases access to health education and healthy foods to improve the overall health of the communities the Hospital serves. Through collaboration with community partners, the program connects with low-income/low access communities and provides free health education, health screenings and produce vouchers which are used to purchase fresh fruits and vegetables.The Hospital did not meet its set metric. During the three-year plan, Food is Health classes were scheduled in partnership with the University of Florida/Institute of Food & Agricultural Sciences (UF/IFAS) Extension, but the classes did not meet the minimum number of required attendees (10) and were therefore cancelled. In 2022 attempts were made to enroll participants into classes through marketing efforts such as flyers distributed throughout the community, email blasts, promotion through partner organizations, and other online marketing efforts. However, attempts to reach the minimum number of participants needed to hold a class were unsuccessful. Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food is Health program will distribute 120 produce vouchers (valued at $10 each) to program participants from a baseline of 40 by the end of 2022. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospital did not meet its set metric. During the three-year plan, classes were scheduled but unfortunately did not meet the minimum registration number, therefore, the classes were cancelled. Additionally, in 2022, a new produce vendor, Burgin Farms, was onboarded to replace the previous vendor. Burgin Farms was able to service the PSA in Wauchula for a class series but shortly thereafter closed for the rest of the season and was not able to support classes in the Sebring PSA. In the future, Burgin Farms will expand their services into this region and will be the primary produce vendor for Sebring classes moving forward. Objective 3: The third objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food Is Health program will build and maintain partnerships with local community organizations serving low-income/low access communities by engaging six community partners from a baseline of three by the end of 2022. This objective is managed at a Divisional level, and outcomes reported represent the Hospitals in Hardee and Highlands counties; AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. The Hospital met its set metric. By the end of 2022, partnerships were built and maintained with UF/IFAS Extension, Central Florida Area Health Education Center, Senior Connection Center, Feeding Tampa Bay, Burgin Farms, and the local Department of Health. During 2022, Burgin Farms was onboarded as a new produce vendor for the Wauchula market with the intention to expand to the Sebring and Lake Placid markets in the future. Additionally, the local Department of Health offered the use of their space for future classes. With the addition of new partners and resources, the Hospitals will continue to schedule new class series and identify ways to attract community members to sign up. Objective 4: The fourth objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states that the Food is Health program will increase the number of participants among low-income families in the PSA to 30 from a baseline of 11 by the end of 2022. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospital did not meet its set metric. During the three-year plan, classes were scheduled but unfortunately did not meet the minimum registration number, therefore, the classes were cancelled. However, attempts were made to recruit participants through flyers, email blasts, and other online marketing efforts. Objective 5:The fifth objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food is Health program will increase the number of health screenings among adults living in food deserts or low-income/low access communities to 45 from a baseline of 13 by the end of 2022. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospital did not meet its set metric. Due to issues such as COVID-19 requiring staff members to stay within the Hospital during their normal working hours, and then a shortage of internal staff members in the subsequent years as seen across the healthcare industry, there was no time available for nurses to volunteer to provide health screenings for these classes. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 2 -- AdventHealth Sebring & Lake PlacidDescription of CHNA Significant Needs ContinuedPriority 3: Cardiovascular Disease2019 Description of the Issue:Coronary heart disease is a leading cause of death in the U.S. and is also related to high blood pressure, high cholesterol, and heart attacks. In the AdventHealth Sebring primary service area (PSA), 9% of adults age 18 and older have coronary heart disease or angina (heart related chest pain). Additionally, the rate of death due to heart disease per 100,000 population is 156 (370 average annual deaths from 2012-2016), which is higher than the state rate of 150 and 22% of the PSA population smoke cigarettes (higher than the state rate of 19%). Tobacco use is also linked to cardiovascular disease.2022 Update: The AdventHealth Sebring Community Health Plan has two desired goal statements under the Cardiovascular Disease priority. 1. Improve access to health education, early intervention programs and resources related to cardiovascular disease2. Decrease tobacco use in adults and youth community membersGoal 1: Improve access to health education, early intervention programs and resources related to cardiovascular disease Objective 1: The first objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the number of Hospital sponsored American Heart Association (AHA) community CPR (Cardiopulmonary Resuscitation) out-of-hospital bystander classes for adults and youth from a baseline of zero to two by the end of 2022. This initiative provides training to lay community members to be able to save the lives of individuals experiencing a cardiac event by administering the two-step, Hands-Only CPR. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. The Hospital met its set metric. In 2022, we delivered a class to a senior community and one to United Way employees. In total, we trained 48 participants in hands-only CPR. Objective 2: The second objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to partner with the Florida Department of Health (FDOH) in Highlands County to provide patient referrals at discharge to enroll in free Diabetes Self-Management Education and Support (DSMES) classes by creating an internal referral system to refer 100 underinsured/uninsured adults residing in the Hospital's PSA from a baseline of zero by the end of 2022. The objective is funded and managed through all Hospitals, however reported outcomes are specific to the reporting Hospital. This initiative provides an internal referral system for the Hospital to directly enroll patients in need in the FDOH's DSMES classes. The Florida Department of Health works to protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. The DSMES referral program connects diabetic and pre-diabetic individuals to health education that provides them with knowledge and tools to self-manage their chronic condition, improve health behaviors, and change health outcomes. The Hospital did not meet the set metric. The internal plan for referring participants to the DSMES classes involved a tremendous amount of collaborative efforts with the AdventHealth Care 360 team to create an "at discharge" referral system to connect patients to the DSMES classes. In year two, the referral system was piloted to connect patients (at discharge) with a history of tobacco use to free tobacco cessation classes offered by the Central Florida Area Health Education Center (AHEC). After the pilot, many issues still needed to be resolved before the expansion of this service for the FDOH's DSMES classes. Unfortunately, they were not resolved before the end of 2022. Objective 3:The third objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the amount of paid time for Hospital staff/team members to volunteer with community organizations addressing heart disease and stroke from a baseline of zero hours to 200 hours by the end of 2022. The objective is funded through all Hospitals and managed by the Division, however reported outcomes are specific to the reporting Hospital. This initiative provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations which are addressing this priority area. The Hospital did not meet the set metric. Due to issues such as COVID-19 requiring staff members to stay within the Hospital during their normal working hours, and then a shortage of internal staff members in the subsequent years as seen across the healthcare industry, the Hospital did not have the capacity to meet the 200 hours of volunteer time in this three-year plan. Goal 2: Decrease tobacco use in adults and youth community members Objective 1: The first objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the knowledge of free tobacco cessation programs and tobacco prevention/treatment resources for patients at discharge by partnering with Central Florida Area Health Education Center (AHEC) to provide continuing education classes to 50 team members (treating patients with tobacco use) from a baseline of zero by the end of 2022. The objective is funded through all Hospitals but managed by the Division. Funding and outcomes reported represent all Hospitals involved. This initiative provides educational classes that lead to an increase in knowledge for those AdventHealth team members who treat patients with tobacco use, or work with these patients at discharge, about tobacco cessation resources available, which could potentially improve patients' health through support for eliminating tobacco use. This is conducted through a partnership with Central Florida AHEC, the local affiliate of the national organization of AHEC, that is a community focused organization that develops and implements community-based health promotion activities and education programs, which target the underserved. AHEC also provides community members tools and resources to assist with tobacco cessation, including tobacco replacement when medically necessary and available, and accredited classes for continuing education units (CEUs) and continuing medical education (CMEs) for Hospital team members.The Hospitals did not meet the set metric. The Division created a memorandum of understanding (MOU) between the Hospitals and AHEC. The MOU states AHEC will offer tobacco cessation programming in partnership with the Hospitals, which includes flyer and promotion templates, program materials, and client communications on the Hospitals' behalf. This also includes the understanding that Central Florida AHEC will provide accredited tobacco cessation education to Hospital providers and staff, thereby resulting in earned CEUs and CMEs for these team members. Due to issues such as COVID-19, staff members were focused on treating patients and filling in where needed due to staffing shortages. Because their time was needed for focus in these important areas, we were not able to create a program to offer team members CEUs and CMEs for addressing tobacco cessation by the end of the three-year plan. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 2 -- AdventHealth Sebring & Lake PlacidDescription of CHNA Significant Needs ContinuedObjective 2: The second objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to provide patient referrals at discharge to enroll in free AHEC tobacco cessation programs and receive free intervention therapies to quit smoking tobacco through a partnership with AHEC and create an internal referral system to link adults residing in the Hospital's PSA, providing resources for 18 patients from a baseline of zero by the end of 2022. The objective is funded through AdventHealth Sebring but managed by the Division. Reported referrals are specific to the reporting Hospital.This initiative provides an internal patient referral system at discharge to enroll in free AHEC tobacco cessation programs and receive free intervention therapies to quit tobacco. This initiative is conducted through a partnership with AHEC and the Hospital's internal Care 360 team. The Hospital's internal Care 360 team works with patients at discharge and serves to identify patients needing tobacco cessation. Once identified, the Care 360 team can use this internal referral system to directly enroll patients into AHEC's tobacco cessation program. The Hospital did not meet its set metric. The Division created a memorandum of understanding (MOU) between the Hospitals and AHEC. The MOU states AHEC will offer tobacco cessation programming in partnership with the Hospitals, which includes flyer and promotion templates, program materials and client communications on the Hospitals' behalf. The Division and the Hospitals' Care360 team created and piloted an internal referral system in year two. In 2022, no additional patients were referred through this system, leaving the total amount referred at 10 for the reporting Hospital (AdventHealth Sebring). Unfortunately, issues with the referral system needed to be resolved before referring additional patients.Objective 3: The third objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase access to tobacco cessation classes in adults residing in the Hospital's PSA by five classes from a baseline of zero by the end of 2022. The objective is funded through all Hospitals but managed by the Division. Funding and outcomes reported represent all Hospitals involved. This initiative increases access to tobacco cessation classes that improve health through a partnership with Central Florida Area Health Education Centers (AHEC). The Hospitals exceeded the set metric. By the end of 2022, 37 tobacco cessation classes were offered at the Hospitals in partnership with Central Florida Area Health Education Center. Priority 4: Education (Social Determinant of Health)2019 Description of the Issue:In the AdventHealth Sebring primary service area, 17% (14,018 persons) of the population aged 25 and older do not have a high school diploma (or equivalency) or higher and is higher than the state average of 12%. Educational attainment is a social determinant of health and is linked to health outcomes. Additionally, improving health literacy may be a useful strategy for reducing disparities in health related to education.2022 Update: The AdventHealth Sebring Community Health Plan has two desired goal statements under the Education (Social Determinant of Health) priority. 1. To increase partnerships with local school-based programs to better understand the problem of educational attainment as a social determinant of health2. To support community efforts to address the problem of educational attainment as a social determinant of healthGoal 1: To increase partnerships with local school-based programs to better understand the problem of educational attainment as a social determinant of health Objective 1: The first objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to partner with local community school and/or college programs to develop, implement and evaluate a community-based professional development program (interviewing skills, resume writing, basic computer skills, mentoring) for underserved adults residing in the Hospital's PSA by providing three community workshops from a baseline of zero by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. This initiative provides underserved adults with educational and hands-on training skills, such as resume writing and computer skills, needed to enter the workforce. The Hospitals did not meet the set metric. We established a partnership with CareerSource Heartland, South Florida State College, and the Panthers Youth Program. CareerSource Heartland is the primary deliverer of these workshops and programs. We decided it was a better use of resources to support their efforts by referring individuals to their programs and classes. Additionally, we provided South Florida State College with a monetary donation of $3,840 in total among the three hospitals ($1,280 donated was from AdventHealth Sebring) to help pay for adults in need of General Education Development (GED) classes or other technical skills trainings in lieu of providing these classes ourselves. CareerSource Heartland is a not-for-profit corporation that operates as a demand-driven and business focused public-private partnership. Through oversight provided by the local elected officials from DeSoto, Hardee, Highlands and Okeechobee counties, their Board of Directors offer workforce development related growth opportunities to business customers and job seekers throughout their four-county service delivery area.South Florida State College is a public college in Florida with campuses in Highlands, Desoto and Hardee counties and is part of the Florida College System. The South Florida State College Adult Education Program provides General Education Development (GED) preparation and testing. The Panthers Youth Partners program is affiliated with CareerSource Heartland and South Florida State College and serves to provide youth with services that will develop and strengthen employability skills, talents, and interests. Objective 2: The second objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to establish a new partnership with local community organizations to identify education access barriers facing underserved adults residing in the Hospital's PSA from a baseline of zero organizations to two by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. This initiative creates a partnership with local community organizations working in adult education to help discover challenges to educational attainment and means to help resolve them. The Hospitals exceeded the set metric. We established a partnership with three new community partners - CareerSource Heartland, South Florida State College, and the Panthers Youth Program. The metric was met in year two. Through the formation of these three new partnerships, we were able to discuss barriers to educational access for those underserved members of the community. The barriers identified include inaccessible or unreliable means of transportation, lack of child-care, work-hour inflexibility, financial constraints, and home-life challenges. In 2022, we provided donated funds in the amount of $3,840 in total from all three hospitals ($1,280 donated was from AdventHealth Sebring) to South Florida State College to help alleviate some of the financial constraints mentioned for those low-income individuals seeking to attain their high school diploma through the General Educational Development (GED) program. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 2 -- AdventHealth Sebring & Lake PlacidDescription of CHNA Significant Needs ContinuedGoal 2: To support community efforts that address the problem of educational attainment as a social determinant of health Objective 1: The first objective is a shared initiative between AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is to provide education vouchers to cover the costs of General Educational Development (GED) materials (textbooks, registration fees and tests) for adults residing in the Hospital's PSA from a baseline of zero vouchers to three vouchers by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. This initiative provides education vouchers in the form of monetary funds to help cover some of the cost associated with the GED test. The Hospitals met the set metric. A monetary donation in the amount of $3,840 collectively ($1,280 was donated from AdventHealth Sebring) was delivered to South Florida State College in 2022 to support those low-income, underserved individuals seeking to attain their high school diploma through the GED program. Objective 2: The second objective is a shared initiative between AdventHealth Sebring, AdventHealth Wauchula and AdventHealth Lake Placid. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the amount of paid staff time for Hospital staff/team members to volunteer with community organizations addressing education (as a social determinant of health) from a baseline of zero hours to 150 hours by the end of 2022. The objective is funded and managed through all Hospitals; however, outcomes are specific to the reporting Hospital. This initiative provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations which are addressing this priority area. The Hospital did not meet the set metric. Due to issues such as COVID-19 requiring staff members to stay within the Hospital during their normal working hours, and then a shortage of internal staff members in the subsequent years as seen across the healthcare industry, the Hospitals did not have the capacity to meet the 150 hours of volunteer time in this three-year plan. Community Needs Not Chosen by AdventHealth Sebring: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. Poor Dental Health: Many oral diseases can be prevented with routine care and regular dental checkups. The health of the teeth, the mouth and the surrounding craniofacial (skull and face) structures is central to a person's overall health and well-being. Lack of access to dental care for all ages remains a public health challenge. In the AdventHealth Sebring Primary Service Area (PSA), the access to dentists' rate per 100,000 population is 36.5 (in 2015), as compared to the state rate of 56. The Community Health Needs Assessment Committee (CHNAC) did not perceive the ability to have a measurable impact on the issue within the three years allotted for the Community Health Plan with the current resources available to the community and the Hospital at this time.2. Tobacco Use: In the AdventHealth Sebring PSA, an estimated 16,314 of adults age 18 or older selfreport currently smoking cigarettes some days or every day. This indicator is relevant because tobacco use is linked to leading causes of death such as cancer and cardiovascular disease. In the Hospital PSA, 22% of adults are currently smoking cigarettes, which is higher than the state percentage of 19%. The CHNAC felt the issue should not be addressed as an individual problem. Therefore, interventions to address tobacco use will be wrapped into the priority area of heart disease.3. Obesity/Overweight/Obese: In the AdventHealth Sebring PSA, approximately 33% of adults aged 20 and older selfreport that they have a Body Mass Index (BMI) greater than 30 (obese) in the report area. The state percentage is 27%. Excess weight may indicate an unhealthy lifestyle and puts individuals at risk for further health issues.The CHNAC felt the issue should not be addressed as an individual problem. Therefore, interventions to address Obesity/Overweight/Obese will be wrapped into the education priority area. The Community Health Needs Assessment Committee (CHNAC) will approach this area of need more comprehensively, as other barriers contribute to negative health outcomes in this area of priority. Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 2 -- AdventHealth Sebring & Lake PlacidDescription of CHNA Significant NeedsAdventist Health System/Sunbelt, Inc. d/b/a AdventHealth Sebring and AdventHealth Lake Placid will be referred to in this document as AdventHealth Lake Placid 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 Lake Placid is part of the West Florida Division (the Division) of AdventHealth. The Division includes 13 hospital facilities.This is the third-year update for AdventHealth Lake Placid'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 Lake Placid 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 Lake Placid chose four priorities for its 2020-2022 Community Health Plan:1. Mental Health (Behavioral Health)2. Transportation 3. Cardiovascular Disease4. Education (Social Determinant of Health)Priority 1: Mental Health (Behavioral Health)2019 Description of the Issue:The burden of mental illness in the United States is among the highest of all diseases and mental disorders are among the most common causes of disability for adults, children, and adolescents. When mental health disorders are untreated, those affected are at high risk for many unhealthy and unsafe behaviors, including alcohol or drug abuse, violent or self-destructive behavior and suicide. Mental health disorders are the 11th leading cause of death in the United States for all age groups and the second leading cause of death among people ages 25 to 34. In the AdventHealth Lake Placid primary service areas (PSA), the rate of death due to self harm (suicide) is 20.5 (per 100,000 population), which is higher than the state rate of 14 (per 100,000 population). Furthermore, 25% (16,345 persons) of the adults in the PSA population selfreport that they receive insufficient social and emotional support all or most of the time, which is higher than the state rate (21%). This indicator is relevant because social and emotional support is critical for navigating the challenges of daily life as well as for good mental health. Furthermore, 17% of the Medicare-fee-for-service PSA population are depressed.2022 Update: The AdventHealth Lake Placid Community Health Plan has two desired goal statements under the Mental Health (Behavioral Health) priority. 1. To increase education and awareness related to mental health by engaging public schools, community members, organizations and stakeholders2. To increase community-level partnerships to enhance existing efforts currently addressing factors that impact mental health in youth and adultsGoal 1: To increase education and awareness related to mental health by engaging public schools, community members, organizations and stakeholders Objective 1: The first objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to partner with the Champion for Children Advocacy Center to raise awareness of the impact of mental health in youth and adults residing in the Hospital's PSA by creating and implementing two local social media campaigns from a baseline of zero local social media campaigns by the end of year three. The objective is funded and managed through the Hospitals and outcomes reported represent all Hospitals involved. This social media campaign initiative brings awareness to both youth and adult community members regarding mental illnesses and helps to encourage conversations around the topic of mental health to destigmatize mental illnesses and encourage those suffering to seek help. Champion for Children's Advocacy Center split into two organizations after the creation of our 2020-2022 Community Health Plans. The two new organizations are the Ruth E. Handley Children's Advocacy Center and the Champion for Children Foundation. We are partnering with both organizations for this initiative. The Ruth E. Handley Children's Advocacy Center's mission is to minimize trauma of child abuse victims and provide prevention support to families needing assistance to keep them intact. The Champion for Children Foundation offers prevention services and assistance programs to protect children, educate parents, strengthen families, assist caregivers, reduce trauma, and provide resources. These partnerships, as well as insight from members of our Community Health Needs Assessment Committee (CHNAC), have helped us to determine the most important topics to address for our social media campaigns moving forward, which will be depression and anxiety. The Hospitals did not meet the set metric. Although the Hospital did not meet the metric as written, AdventHealth did sponsor an enterprise-wide social media campaign across all markets to raise awareness about mental health. Objective 2: The second objective is to increase the number of Mental Health First Aid USA certification training classes provided for free to community members residing in the Hospital's PSA to three certification classes from a baseline of zero by the end of year three. The deployment of the Mental Health First Aid classes is a shared initiative between AdventHealth Lake Placid, AdventHealth Carrollwood, AdventHealth Connerton, AdventHealth Dade City, AdventHealth North Pinellas, AdventHealth Ocala, AdventHealth Sebring, AdventHealth Tampa, AdventHealth Zephyrhills, AdventHealth Wauchula and AdventHealth Wesley Chapel. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The initiative is managed at the Divisional level and funded through the Hospital and all reported outcomes are specific to the reporting Hospital.This initiative provides Mental Health First Aid USA certification classes to the community for free. The class is a course that teaches individuals how to help someone who may be experiencing mental health or substance use challenges. The training helps one to identify, understand and respond to signs of addictions and mental illnesses. Mental Health First Aid USA is a national program developed to teach the skills to respond to the signs of mental illness and substance use.The Hospitals exceeded the set metric of providing three free Mental Health First Aid USA certification training classes to community members by offering four classes. A total of 44 participants were trained through this initiative. Goal 2: To increase community-level partnerships to enhance existing efforts currently addressing factors that impact mental health in youth and adults **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 2 -- AdventHealth Sebring & Lake PlacidDescription of CHNA Significant Needs ContinuedObjective 1: The first objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to provide vouchers to cover the costs of household supplies for homeless adults residing in the Hospital's PSA who receive housing services at Peace River Center (PRC) from a baseline of zero vouchers to three by the end of year three. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved unless otherwise indicated.This initiative provides vouchers in the form of monetary funds to help cover some of the costs associated with purchasing household and personal supplies for community members that are supported by the residential housing programs offered at Peace River Center, who is our community partner. This will thereby lead to improved health outcomes by providing these essential supplies.Peace River Center is a 501(c)(3) not-for-profit organization that strives to impact the lives of its clients and the community they serve by engaging, restoring, and empowering individuals to reach their fullest potential by offering a broad range of mental health, victim and substance use disorder services throughout Polk, Highlands, and Hardee counties, including housing and domestic violence shelters. The Hospitals met the set metric. In year three the Hospitals donated $2,760 collectively to Peace River Center which equated to covering the cost of household supplies for 69 people at $40 per person. Objective 2: The second objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase awareness of Hospital sponsored community benefit programs and resources available to uninsured/underinsured adults and youth residing in the Hospital's PSA through a partnership with Peace River Center (PRC), by providing three informative in-service presentations to Crisis Response Outreach Counselors at PRC from a baseline of zero presentations by the end of year three. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. This initiative provides information about our Hospital sponsored Community Benefit programs that are free to community members and targeted to reach those uninsured/underinsured, underserved, low-income and minority members of the community. These programs include, but are not limited to, our Food is Health program that gives participants 10 dollars' worth of free produce for participating in an education class about nutrition and healthy living. These informative in-service presentations are presented to the Crisis Response Outreach Counselors at Peace River Center who connect directly with those community members in need of mental health and crisis response counseling. They may also benefit from our free community programs. By sharing our programs with these counselors, they can then share this information with their clients. The Hospitals did not meet the set metric. Year two was spent getting our programs back up and running in the community after setbacks due to COVID-19. In year three our focus was on the implementation of these programs across the Division. While leaders from PRC were informed of these programs through meetings, emails, and phone calls, formal in-service presentations were not conducted, as we deemed the other methods sufficient to deliver this information. Objective 3: The third objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the amount of paid staff time for Hospital staff/team members to volunteer with community organizations addressing mental health from a baseline of zero hours to 300 hours by the end of year three. The objective is funded and managed through all Hospitals, however reported outcomes are specific to the reporting Hospital. This initiative provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations addressing this priority area. The Hospitals did not meet the set metric. Due to issues such as COVID-19 requiring staff members to stay within the Hospital during their normal working hours, and then a shortage of internal staff members in the subsequent years as seen across the healthcare industry, the Hospital did not have the capacity to meet the 300 hours of volunteer time in this three-year plan. Despite pandemic restrictions, team members were able to volunteer by writing letters of encouragement to individuals struggling with a mental health challenge. As the pandemic has subsided, the West Florida Division (of which the Hospital is a part of) created a volunteer portal to market volunteer opportunities to team members, track volunteer hours, and notify community partners when team members sign up for an event across the Division. Priority 2: Transportation 2019 Description of the Issue:A poor transportation system prevents those who do not own a car or have reliable transportation from accessing healthcare. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. In the AdventHealth Lake Placid primary service area (PSA), 3.62% (1,022 persons) of the population are currently using public transportation as their primary means of transportation to work. Additionally, approximately 30% of the population (22,810 persons) age 18 years and older do not have a regular healthcare provider, which is higher than the state average of 25%.2022 Update: The AdventHealth Lake Placid Community Health Plan has two desired goal statements under the Transportation priority. 1. To increase community partnerships with local transportation systems, leaders, and businesses to develop new strategies for improving access to transportation2. To increase access to culturally appropriate nutritious food options in food desert or low income/low access areas by implementing the Food is Health programGoal 1: To increase community partnerships with local transportation systems, leaders, and businesses to develop new strategies for improving access to transportation Objective 1: The first objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to decrease transportation challenges (barriers) among vulnerable adults residing in the Hospital's PSA by creating and implementing two new collaborative strategies from a baseline of zero strategies by the end of year three. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. The initiative created a partnership between our Hospitals and community organizations who also share a goal to reduce transportation challenges within the community. Through this collaboration, we exchanged ideas, resources, and programs. We also evaluated what additional resources are available, or may become available, to community members with transportation challenges. The Hospitals did not meet the set metric. Due to the restraints of COVID-19, we could not host in-person community summits in year one or two, as we originally aimed to do for this objective. Therefore, in year three, we hosted one virtual community summit where the Heartland Regional Transportation Planning Organization (HRTPO) was able to deliver an informative presentation about the various transportation programs available in our community. During this virtual summit, HRTPO was able to share, hear from, and collaborate with other community organizations and leaders to help spread the word and enroll participants in need. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 2 -- AdventHealth Sebring & Lake PlacidDescription of CHNA Significant Needs ContinuedThe Heartland Regional Transportation Planning Organization coordinates transportation plans for the Heartland Region including the six counties of DeSoto, Glades, Hardee, Hendry, Highlands and Okeechobee and the urbanized area of Highlands County, including the cities of Sebring and Avon Park. The Heartland Regional Transportation Planning Organization's mission is to provide support to the citizens and counties of the Heartland region and to seek ways to improve the quality of life of the citizens of the Heartland.Objective 2: The second objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to establish a new transportation taskforce in Hardee/Highlands County to co-host at least two community summits (with AdventHealth Wauchula and AdventHealth Sebring) from a baseline of zero summits to increase awareness of the impact of transportation accessibility on community health, wellness and employment sustainability for community members residing in the Hospital's PSA by the end of year three. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. This initiative brings together multiple organizations from the community who share a common goal in seeking to improve transportation access and a platform for getting the transportation programs available out to the communities we serve. The Hospitals met the set metric. The Heartland Regional Transportation Planning Organization already had a transportation taskforce in place that consisted of local community leaders and representatives for the underserved community. In lieu of creating a separate taskforce, we decided it was a better use of resources to have an AdventHealth team member join the one that was already established and led by the leader in transportation programming for our Hospital's PSA. Through this partnership, AdventHealth co-hosted one virtual community summit in year three. Goal 2: Increase access to culturally appropriate nutritious food options in food desert or low income/low access areas Objective 1: The first objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food is Health program will support a series of three nutrition education class series among low-income families in the PSA from a baseline of zero by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Food is Health program is an AdventHealth West Florida Division program which increases access to health education and healthy foods to improve the overall health of the communities the Hospital serves. Through collaboration with community partners, the program connects with low-income/low access communities and provides free health education, health screenings and produce vouchers which are used to purchase fresh fruits and vegetables.The Hospital did not meet its set metric. During the three-year plan, Food is Health classes were scheduled in partnership with the University of Florida/Institute of Food & Agricultural Sciences (UF/IFAS) Extension, but the classes did not meet the minimum number of required attendees (10) and were therefore cancelled. In year three attempts were made to enroll participants into classes through marketing efforts such as flyers distributed throughout the community, email blasts, promotion through partner organizations, and other online marketing efforts. However, attempts to reach the minimum number of participants needed to hold a class were unsuccessful. Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food is Health program will distribute 120 produce vouchers (valued at $10 each) to program participants from a baseline of zero by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospital did not meet its set metric. During the three-year plan, classes were scheduled but unfortunately did not meet the minimum registration number, therefore, the classes were cancelled. Additionally, in year three, a new produce vendor, Burgin Farms, was onboarded, to replace the previous vendor. Burgin Farms was able to service the PSA in Wauchula for a class series but shortly thereafter closed for the rest of the season and was not able to support classes in our Lake Placid PSA.Objective 3: The third objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food Is Health program will build and maintain partnerships with local community organizations serving low-income/low access communities by engaging four community partners from a baseline of zero by the end of year three. This objective is managed at a Divisional level and outcomes reported represent the Hospitals in Hardee and Highlands counties; AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. The Hospital exceeded its set metric. By the end of year three, partnerships were built and maintained with UF/IFAS Extension, Central Florida Area Health Education Center, Senior Connection Center, Feeding Tampa Bay, Burgin Farms, and the local Department of Health. During year three, Burgin Farms was onboarded as a new produce vendor for our Wauchula market with the intention to expand to our Sebring and Lake Placid markets in the future. Additionally, the local Department of Health offered the use of their space for future classes. With the addition of new partners and resources, the Hospitals will continue to schedule new class series and identify ways to attract community members to sign up.Objective 4: The fourth objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food is Health program will increase the number of participants among low-income families in the PSA to 30 from a baseline of zero by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospital did not meet its set metric. During the three-year plan, classes were scheduled but unfortunately did not meet the minimum registration number, therefore, the classes were cancelled. However, attempts were made to recruit participants through flyers, email blasts, and other online marketing efforts. Objective 5:The fifth objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food is Health program will increase the number of health screenings among adults living in food deserts or low-income/low-access communities to 45 from a baseline of zero by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospital did not meet its set metric. Due to issues such as COVID-19 requiring staff members to stay within the hospital during their normal working hours, and then a shortage of internal staff members in the subsequent years as seen across the healthcare industry, nurses were unavailable to volunteer time to provide health screenings for these classes. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 2 -- AdventHealth Sebring & Lake PlacidDescription of CHNA Significant Needs ContinuedPriority 3: Cardiovascular Disease2019 Description of the Issue:Coronary heart disease is a leading cause of death in the U.S. and is also related to high blood pressure, high cholesterol, and heart attacks. In the AdventHealth Lake Placid primary service area (PSA), 9% (7,820 persons) of adults age 18 and older have coronary heart disease or angina (heart related chest pain). Additionally, the rate of death due to heart disease per 100,000 population is 151 (289 average annual deaths from 2012-2016), which is higher than the state rate of 150 and 22% (13,180 persons) of the PSA population smoke cigarettes (higher than the state rate of 19%). Tobacco use is also linked to cardiovascular disease.2022 Update: The AdventHealth Lake Placid Community Health Plan has two desired goal statements under the Cardiovascular Disease priority. 1. Improve access to health education, early intervention programs and resources related to cardiovascular disease2. Decrease tobacco use in adults and youth community membersGoal 1: Improve access to health education, early intervention programs and resources related to cardiovascular disease Objective 1: The first objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the number of Hospital sponsored American Heart Association (AHA) community CPR (Cardiopulmonary Resuscitation) out-of-hospital bystander classes for adults and youth from a baseline of zero to two by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. This initiative provides training to lay community members to be able to save the lives of individuals experiencing a cardiac event by administering the two-step, Hands-Only CPR. The Hospital did not meet its set metric of providing two classes sponsored by the end of year three. Due to low interest, we were not able to hold the two classes needed to meet this metric in the Lake Placid PSA. Objective 2: The second objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to partner with the Florida Department of Health (FDOH) in Highlands County to provide patient referrals at discharge to enroll in free Diabetes Self-Management Education and Support (DSMES) classes by creating an internal referral system to refer 100 underinsured/uninsured adults residing in the Hospital's PSA from a baseline of zero by the end of year three. The objective is funded and managed through all Hospitals, however reported outcomes are specific to the reporting Hospital. This initiative provides an internal referral system for the Hospital to directly enroll patients in need in the FDOH's DSMES classes. The Florida Department of Health works to protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. The DSMES referral program connects diabetic and pre-diabetic individuals to health education that provides them with knowledge and tools to self-manage their chronic condition, improve health behaviors, and change health outcomes. The Hospital did not meet the set metric. The internal plan for referring participants to the DSMES classes involved a tremendous amount of collaborative efforts with our AdventHealth Care 360 team to create an "at discharge" referral system to connect patients to the DSMES programs and initiatives. In year two, the referral system was piloted to connect patients (at discharge) with a history of tobacco use to free tobacco cessation classes offered by the Central Florida Area Health Education Center (AHEC). After the pilot, many issues still needed to be resolved before the expansion of this service for the FDOH's DSMES classes. Unfortunately, they were not resolved before the end of year three. Objective 3:The third objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the amount of paid time for Hospital staff/team members to volunteer with community organizations addressing heart disease and stroke from a baseline of zero hours to 100 hours by the end of year three. The objective is funded through all Hospitals and managed by the Division, however reported outcomes are specific to the reporting Hospital. This initiative provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations which are addressing this priority area. The Hospital did not meet the set metric. Due to issues such as COVID-19 requiring staff members to stay within the Hospital during their normal working hours, and then a shortage of internal staff members in the subsequent years as seen across the healthcare industry, the Hospital did not have the capacity to meet the 100 hours of volunteer time in this three-year plan. Goal 2: Decrease tobacco use in adults and youth community members Objective 1: The first objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the knowledge of free tobacco cessation programs and tobacco prevention/treatment resources for patients at discharge by partnering with Central Florida Area Health Education Center (AHEC) to provide continuing education classes to 50 team members (treating patients with tobacco use) from a baseline of zero by the end of year three. The objective is funded through all Hospitals but managed by the Division. Funding and outcomes reported represent all Hospitals involved. This initiative provides educational classes that lead to an increase in knowledge for those AdventHealth team members who treat patients with tobacco use, or work with these patients at discharge, about tobacco cessation resources available, which could potentially improve patients' health through support for eliminating tobacco use. This is conducted through a partnership with Central Florida AHEC, the local affiliate of the national organization of AHEC, that is a community focused organization that develops and implements community-based health promotion activities and education programs, which target the underserved. AHEC also provides community members tools and resources to assist with tobacco cessation, including tobacco replacement when medically necessary and available, and accredited classes for continuing education units (CEUs) and continuing medical education (CMEs) for Hospital team members. The Hospitals did not meet the set metric. The Division created a memorandum of understanding (MOU) between the Hospitals and AHEC. The MOU states AHEC will offer tobacco cessation programming in partnership with the Hospitals, which includes flyer and promotion templates, program materials and client communications on the Hospital's behalf. This also includes the understanding that Central Florida AHEC will provide accredited tobacco cessation education to Hospital providers and staff, thereby resulting in earned CEUs and CMEs for these team members. Due to issues such as COVID-19, staff members were focused on treating patients and filling in where needed due to staffing shortages. Because their time was needed for focus in these important areas, we were not able to create a program to offer team members CEUs and CMEs for addressing tobacco cessation by the end of the three-year plan. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 2 -- AdventHealth Sebring & Lake PlacidDescription of CHNA Significant Needs ContinuedObjective 2: The second objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to provide patient referrals at discharge to enroll in free AHEC tobacco cessation programs and receive free intervention therapies to quit smoking tobacco through a partnership with AHEC, create an internal referral system to link adults residing in the Hospital's PSA and provide resources for 18 patients from a baseline of zero by end of year three. The objective is funded through all Hospitals but managed by the Division. Reported referrals are specific to the reporting Hospital. This initiative provides an internal patient referral system at discharge to enroll in free AHEC tobacco cessation programs and receive free intervention therapies to quit tobacco. This initiative is conducted through a partnership with AHEC and the Hospital's internal Care 360 team. The Hospital's internal Care 360 team works with patients at discharge and serves to identify patients needing tobacco cessation. Once identified, the Care 360 team can use this internal referral system to directly enroll patients into AHEC's tobacco cessation program. The Hospital did not meet its set metric. The Division created a memorandum of understanding (MOU) between the Hospitals and AHEC. The MOU states AHEC will offer tobacco cessation programming in partnership with the Hospitals, which includes flyer and promotion templates, program materials and client communications on the Hospitals' behalf. The Division and the Hospitals' Care360 team created and piloted an internal referral system in year two at AdventHealth Sebring and other Hospitals within the Division. Unfortunately, issues with the referral system needed to be resolved before referring additional patients and expanding it to AdventHealth Lake Placid, which did not occur by the end of year three.Objective 3: The third objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase access to tobacco cessation classes for adults residing in the Hospital's PSA by five classes from a baseline of zero by the end of year three. The objective is funded through all Hospitals but managed by the Division. Funding and outcomes reported represent all Hospitals involved. This initiative increases access to tobacco cessation classes that improve health through a partnership with Central Florida Area Health Education Centers (AHEC).The Hospitals exceeded the set metric. By the end of year three, 37 tobacco cessation classes were offered at the Hospitals in partnership with Central Florida Area Health Education Center. Priority 4: Education (Social Determinant of Health)2019 Description of the Issue:In the AdventHealth Lake Placid primary service area, 17% (10,986 persons) of the population aged 25 and older do not have a high school diploma (or equivalency) or higher and this percentage is higher than the state average of 12%. Educational attainment is a social determinant of health and is linked to health outcomes. Additionally, improving health literacy may be a useful strategy for reducing disparities in health related to education.2022 Update: The AdventHealth Lake Placid Community Health Plan has two desired goal statements under the Education (Social Determinant of Health) priority. 1. To increase partnerships with local school-based programs to better understand the problem of educational attainment as a social determinant of health2. To support community efforts that address the problem of educational attainment as a social determinant of healthGoal 1: To increase partnerships with local school-based programs to better understand the problem of educational attainment as a social determinant of health Objective 1: The first objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to partner with local community school and/or college programs to develop, implement and evaluate a community-based professional development program (interviewing skills, resume writing, basic computer skills, mentoring) for underserved adults residing in the Hospital's PSA by providing three community workshops from a baseline of zero by the end of year three. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. This initiative provides underserved adults with educational and hands-on training skills, such as resume writing and computer skills, needed to enter the workforce. The Hospitals did not meet the set metric. We established a partnership with CareerSource Heartland, South Florida State College, and the Panthers Youth Program. CareerSource Heartland is the primary deliverer of these workshops and programs. We decided it was a better use of resources to support their efforts by referring individuals to their programs and classes. Additionally, we provided South Florida State College with a monetary donation of $3,840 in total between the three Hospitals ($1,280 donated was from AdventHealth Lake Placid) to help pay for adults in need of General Education Development (GED) classes or other technical skills trainings in lieu of providing these classes ourselves. CareerSource Heartland is a not-for-profit corporation that operates as a demand-driven and business focused public-private partnership. Through oversight provided by the local elected officials from DeSoto, Hardee, Highlands and Okeechobee counties, their Board of Directors offer workforce development related growth opportunities to business customers and job seekers throughout their four-county service delivery area. South Florida State College is a public college in Florida with campuses in Highlands, Desoto and Hardee counties and is part of the Florida College System. The South Florida State College Adult Education Program provides General Education Development (GED) preparation and testing. The Panthers Youth Partners program is affiliated with CareerSource Heartland and South Florida State College and serves to provide youth with services that will develop and strengthen employability skills, talents, and interests. Objective 2: The second objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to establish a new partnership with local community organizations to identify education access barriers in underserved adults residing in the Hospital's PSA from a baseline of zero organizations to two by the end of year three. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved.This initiative creates a partnership with local community organizations working in adult education to help discover challenges to educational attainment and means to help resolve them. The Hospitals exceeded the set metric. We established a partnership with three new community partners - CareerSource Heartland, South Florida State College, and the Panthers Youth Program. The metric was met in year two.Through the formation of these three new partnerships, we were able to discuss barriers to educational access for those underserved members of our community. The barriers identified include inaccessible or unreliable means of transportation, lack of child-care, work-hour inflexibility, financial constraints, and home-life challenges. In year three we donated funds in the amount of $3,840 total from all three hospitals (of which $1,280 donated was from AdventHealth Lake Placid) to South Florida State College to help alleviate some of the financial constraints mentioned for those low-income individuals seeking to attain their high school diploma through the General Educational Development (GED) program. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 2 -- AdventHealth Sebring & Lake PlacidDescription of CHNA Significant Needs ContinuedGoal 2: To support community efforts that address the problem of educational attainment as a social determinant of health Objective 1: The first objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wauchula. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to provide education vouchers to cover the costs of General Educational Development (GED) materials (textbooks, registration fees and tests) for adults residing in the Hospital's PSA from a baseline of zero vouchers to three vouchers by the end of year three. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. This initiative provides education vouchers in the form of monetary funds to help cover some of the cost associated with the GED test. The Hospitals met the set metric. A monetary donation in the amount of $3,840 collectively ($1,280 was donated from AdventHealth Lake Placid) was delivered to South Florida State College in year three to support those low-income, underserved individuals seeking to attain their high school diploma through the GED program. Objective 2: The second objective is a shared initiative between AdventHealth Lake Placid, AdventHealth Wauchula and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the amount of paid staff time for Hospital staff/team members to volunteer with community organizations addressing education (as a social determinant of health) from a baseline of zero hours to 150 hours by the end of year three. The objective is funded and managed through all Hospitals; however, outcomes are specific to the reporting Hospital. This initiative provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations which are addressing this priority area. The Hospital did not meet the set metric. Due to issues such as COVID-19 requiring staff members to stay within the Hospital during their normal working hours, and then a shortage of internal staff members in the subsequent years as seen across the healthcare industry, the Hospitals did not have the capacity to meet the 150 hours of volunteer time in this three-year plan. Community Needs Not Chosen by AdventHealth Lake Placid: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. Poor Dental Health: Many oral diseases can be prevented with routine care and regular dental checkups. The health of the teeth, the mouth, and the surrounding craniofacial (skull and face) structures is central to a person's overall health and well-being. Lack of access to dental care for all ages remains a public health challenge. In the AdventHealth Lake Placid Primary Service Area (PSA), the access to dentists' rate per 100,000 population is 36 (in 2015), as compared to the state rate of 56. The Community Health Needs Assessment Committee (CHNAC) did not perceive the ability to have a measurable impact on the issue within the three years allotted for the Community Health Plan with the current resources available to the community and the Hospital at this time.2. Tobacco Use: In the AdventHealth Lake Placid PSA, an estimated 13,180 of adults aged 18 or older selfreport currently smoking cigarettes some days or every day. This indicator is relevant because tobacco use is linked to leading causes of death such as cancer and cardiovascular disease. In the Hospital PSA, 22.5% of adults are currently smoking cigarettes, which is higher than the state percentage of 19%.The CHNAC felt the issue should not be addressed as an individual problem. Therefore, interventions to address tobacco use will be wrapped into the priority area of heart disease.3. Obesity/Overweight/Obese: In the AdventHealth Lake Placid PSA, approximately 33% of adults aged 20 and older (21,741 persons) selfreport that they have a Body Mass Index (BMI) greater than 30.0 (obese) in the reporting area. The state percentage is 27%. Excess weight may indicate an unhealthy lifestyle and puts individuals at risk for further health issues.The CHNAC felt the issue should not be addressed as an individual problem. Therefore, interventions to address Obesity/Overweight/Obese will be wrapped into the education priority area. The Community Health Needs Assessment Committee (CHNAC) will approach this area of need more comprehensively, as other barriers contribute to negative health outcomes in this area of priority. Part V, Section B, Line 11 Footnote: Group A-Facility 3 -- AdventHealth WauchulaDescription of CHNA Significant Needs Adventist Health System/Sunbelt, Inc., dba AdventHealth Wauchula, will be referred to in this document as AdventHealth Wauchula 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 Wauchula is part of the West Florida Division (the Division) of AdventHealth. The Division includes 13 hospital facilities. This is the third-year update for AdventHealth Wauchula'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 Wauchula 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 Wauchula chose four priorities for its 2020-2022 Community Health Plan: 1. Mental Health (Behavioral Health)2. Access to Health Care 3. Cardiovascular Disease 4. Education (Social Determinant of Health) Priority 1: Mental Health (Behavioral Health)2019 Description of the Issue:The burden of mental illness in the United States is among the highest of all diseases, and mental disorders are among the most common causes of disability for adults, children, and adolescents. When mental health disorders are untreated, those affected are at high risk for many unhealthy and unsafe behaviors, including alcohol or drug abuse, violent or self-destructive behavior and suicide. Mental health disorders are the 11th leading cause of death in the United States for all age groups and the second leading cause of death among people aged 25 to 34. In the AdventHealth Wauchula primary service areas (PSA), the rate of death due to self- harm (suicide) is 19 (per 100,000 population), which is higher than the state rate of 14 (per 100,000 population). Furthermore, 25% (16,345 persons) of the adults in the PSA population selfreport that they receive insufficient social and emotional support all or most of the time, which is higher than the state rate (21%). This indicator is relevant because social and emotional support is critical for navigating the challenges of daily life as well as for good mental health. Additionally, 17% (15,062 persons) of the Medicare-fee-for-service PSA population is depressed.2022 Update: The AdventHealth Wauchula Community Health Plan has two desired goal statements under the Mental Health (Behavioral Health) priority. 1. To increase education and awareness related to mental health by engaging public schools, community members, organizations and stakeholders2. To increase community-level partnerships to enhance existing efforts currently addressing factors that impact mental health in youth and adultsGoal 1: To increase education and awareness related to mental health by engaging public schools, community members, organizations and stakeholders Objective 1: The first objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to partner with the Champion for Children Advocacy Center to raise awareness of the impact of mental health in youth and adults residing in the Hospital's PSA by creating and implementing two local social media campaigns from a baseline of zero local social media campaigns by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. The social media campaign initiative brings awareness to both youth and adult community members regarding mental illnesses and helps to encourage conversations around the topic of mental health to destigmatize mental illnesses and encourage those suffering to seek help. Champion for Children's Advocacy Center split into two organizations after the creation of the 2020-2022 Community Health Plans: the Ruth E. Handley Children's Advocacy Center and the Champion for Children Foundation. The Hospitals are partnering with both organizations for this initiative. The Ruth E. Handley Children's Advocacy Center's mission is to minimize trauma of child abuse victims and provide prevention support to families needing assistance to keep them intact. The Champion for Children Foundation offers prevention services and assistance programs to protect children, educate parents, strengthen families, assist caregivers, reduce trauma, and provide resources. These partnerships, as well as insight from members of the Hospital's Community Health Needs Assessment Committee (CHNAC), have helped us to determine the most important topics to address for the Hospital's social media campaigns moving forward, which will be depression and anxiety. The Hospitals did not meet the set metric. Although the Hospital did not meet the metric as written, AdventHealth did sponsor an enterprise-wide social media campaign across all markets to raise awareness about mental health. Objective 2: The second objective is to increase the number of Mental Health First Aid USA certification training classes provided for free to community members residing in the Hospital's PSA to three certification classes from a baseline of zero by the end of 2022. The deployment of the Mental Health First Aid classes is a shared initiative between AdventHealth Wauchula, AdventHealth Carrollwood, AdventHealth Connerton, AdventHealth Dade City, AdventHealth North Pinellas, AdventHealth Ocala, AdventHealth Sebring, AdventHealth Tampa, AdventHealth Zephyrhills, AdventHealth Lake Placid and AdventHealth Wesley Chapel. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The initiative is managed at the Divisional level and funded through the Hospital and all reported outcomes are specific to the reporting Hospital.This initiative provides Mental Health First Aid USA certification classes to the community for free. The class is a course that teaches individuals how to help someone who may be experiencing mental health or substance use challenges. The training helps one to identify, understand and respond to signs of addictions and mental illnesses. Mental Health First Aid USA is a national program developed to teach the skills to respond to the signs of mental illness and substance use.The Hospitals exceeded the set metric of providing three free Mental Health First Aid USA certification training classes to community members by offering four classes. A total of 44 participants were trained through this initiative.Goal 2: To increase community-level partnerships to enhance existing efforts currently addressing factors that impact mental health in youth and adults **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 3 -- AdventHealth WauchulaDescription of CHNA Significant Needs ContinuedObjective 1: The first objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to provide vouchers to cover the costs of household supplies for homeless adults residing in the Hospital's PSA who receive housing services at Peace River Center (PRC) from a baseline of zero vouchers to three by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved unless otherwise indicated.This initiative provides vouchers in the form of monetary funds to help cover some of the costs associated with purchasing household and personal supplies for community members that are supported by the residential housing programs offered at the Peace River Center, a community partner. This monetary assistance will help lead to improved health outcomes by providing these essential supplies. Peace River Center is a 501(c)(3) not-for-profit organization that strives to impact the lives of its clients and the community they serve by engaging, restoring and empowering individuals to reach their fullest potential by offering a broad range of mental health, victim services and substance use disorder services throughout Polk, Highlands and Hardee counties, including housing and domestic violence shelters. The Hospitals met the set metric. In 2022, the Hospitals donated $2,760 collectively to the Peace River Center which equated to covering the cost of household supplies for 69 people at $40 per person. Objective 2: The second objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase awareness of Hospital sponsored community benefit programs and resources available to uninsured/underinsured adults and youth residing in the Hospital's PSA through a partnership with Peace River Center (PRC), by providing three informative in-service presentations to Crisis Response Outreach Counselors at PRC from a baseline of zero presentations by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. This initiative provides information about the Hospital sponsored Community Benefit programs that are free to community members and targeted to reach those uninsured/underinsured, underserved, low-income and minority members of the community. These programs include, but are not limited to, the Hospital's Food is Health program that gives participants 10 dollars' worth of free produce for participating in an education class about nutrition and healthy living. These informative in-service presentations are presented to the Crisis Response Outreach Counselors at the Peace River Center who connect directly with those community members in need of mental health and crisis response counseling. They may also benefit from the Hospital's free community programs. By sharing these programs with counselors, they can then share this information with their clients. The Hospitals did not meet the set metric. Year two was spent getting the Hospital's programs back up and running in the community after setbacks due to COVID-19. In 2022, the Hospital's focus was on the implementation of these programs across the Division. Leaders from PRC were informed of these programs through meetings, emails, and phone calls. Formal in-service presentations were not conducted, as other methods used to deliver this information were deemed to be sufficient. Objective 3: The third objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the amount of paid staff time for Hospital staff/team members to volunteer with community organizations addressing mental health from a baseline of zero hours to 200 hours by the end of 2022. The objective is funded and managed through all Hospitals, however reported outcomes are specific to the reporting Hospital. This initiative provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations addressing this priority area. The Hospitals did not meet the set metric. Due to restrictions in place during the COVID-19 pandemic, such as requiring staff members to stay within the Hospital during their normal working hours, and the subsequent shortage of internal staff members across the healthcare industry, the Hospital did not have the capacity to meet the 200 hours of volunteer time. Despite the pandemic restrictions, team members found ways to give back, for example, by volunteering to write letters of encouragement to individuals struggling with a mental health challenge. As the pandemic subsided, the West Florida Division (of which the Hospital is a part of) created a volunteer portal to market volunteer opportunities to team members, track volunteer hours by team members, and notify community partners when team members sign up for events across the Division. Priority 2: Access to Health Care 2019 Description of the Issue:Access to health care is the equitable use of health services to achieve the highest level of health. Barriers to accessing healthcare services include cost of care, insurance coverage, availability of services and culturally competent care. Failure to overcome these barriers leads to delayed care, health complications and financial burdens. Accessing healthcare services is vital to prevent and treat diseases thereby reducing the likelihood of disability and premature death.In the AdventHealth Wauchula PSA, 24% of adults and 8% of children are uninsured or without medical insurance (both percentages are higher than the state averages). Additionally, 27% of adults do not have a regular doctor which is higher than the state average of 24.8%. 2022 Update: The AdventHealth Wauchula Community Health Plan has two desired goal statements under the Access to Health Care priority. 1. To implement strategies to reduce transportation barriers leading to improved access to primary care providers2. To provide resources that support the expansion of services that are available to community members and increase access. To increase partnerships with local community organizations with resources to offer community members assistance with gaining health insurance coverageGoal 1: To implement strategies to reduce transportation barriers leading to improved access to primary care providers Objective 1: The first objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to increase access to primary care by decreasing transportation challenges (barriers) among vulnerable adults residing in the Hospital's Primary Service Area (PSA) by developing, implementing, and evaluating three new collaborative strategies with community partners from a baseline of zero strategies by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. The initiative created a partnership between the Hospital and community organizations who also share a goal of reducing transportation challenges within the community. This collaboration fostered an exchange of ideas, resources, and programs. The Hospital also evaluated what additional resources were available, or may become available, to community members with transportation challenges. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 3 -- AdventHealth WauchulaDescription of CHNA Significant Needs ContinuedThe Hospitals did not meet the set metric. Due to the restrictions in place during the COVID-19 pandemic, the Hospitals were not able to host the in-person community summits that were originally planned for years one or two. In 2022, the Hospitals hosted one virtual community summit with the Heartland Regional Transportation Planning Organization (HRTPO) who delivered an informative presentation about the various transportation programs available to the community. During the virtual summit, HRTPO was able to share, hear from, and collaborate with other community organizations and leaders to help spread the word and enroll participants in need. The Heartland Regional Transportation Planning Organization coordinates transportation plans for the Heartland Region including the six counties of DeSoto, Glades, Hardee, Hendry, Highlands and Okeechobee and the urbanized area of Highlands County, including the cities of Sebring and Avon Park. The Heartland Regional Transportation Planning Organization's mission is to provide support to the citizens and counties of the Heartland region and to seek ways to improve the quality of life of the citizens of the Heartland.Objective 2: The second objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared primary service area. The objective is to establish a new transportation taskforce in Hardee and Highlands Counties to co-host at least two community summits (with AdventHealth Sebring and AdventHealth Lake Placid) from a baseline of zero summits to increase awareness of the impact of transportation accessibility on community health and wellness and employment sustainability for community members residing in the Hospital's PSA by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. This initiative brings together multiple organizations from the community who share a common goal in seeking to improve transportation access and a platform for getting the transportation programs available out to the communities we serve. The Hospitals met the set metric. The Heartland Regional Transportation Planning Organization already had a transportation taskforce in place that consisted of local community leaders and representatives for the underserved community. In lieu of creating a separate taskforce, we decided it was a better use of resources to have an AdventHealth team member join the one that was already established and led by the leader in transportation programming for the Hospital's PSA. Through this partnership, AdventHealth co-hosted one virtual community summit in 2022. Goal 2: To provide resources that support the expansion of services that are available to community members and increase access. To increase partnerships with local community organizations with resources to offer community members assistance with gaining health insurance coverageObjective 1: The first objective is to partner with the Florida Department of Health in Hardee and Highlands Counties to develop and implement the "Health Insurance 101" community workshop series (enrollment, how to use insurance, KidCare education, terms, and definitions, etc.) for adults residing in the Hospital's PSA by providing three free community workshop series from a baseline of zero workshop series by the end of 2022. The initiative is funded and managed through AdventHealth Wauchula and all outcomes are specific to the reporting Hospital. The initiative provides health education to uninsured and underinsured residents to help them understand how to enroll in affordable health insurance, utilize health insurance and seek out primary care services. This is done in partnership with the Healthcare Planning Council of Southwest Florida. This organization employs health insurance navigators to educate the public on the health insurance marketplace and other government assisted health insurance programs. Their mission is to improve the health and wellness of the community by promoting healthy lifestyles, reducing health disparities, increasing access to quality health related services, detecting, and eliminating gaps in services, expanding knowledge through education, and facilitating community partnerships. The Hospital did not meet its set metric of providing three free "Health Insurance 101" workshops for the community by the end of 2022.The Hospital provided one free virtual workshop in 2021, but attendance was low. We had hoped to offer this class in-person, but due to restrictions implemented during the COVID-19 pandemic, the class was only available through a virtual platform. In 2022, the Hospital's partner lost the grant funding that enabled them to provide this workshop, therefore no additional classes could be offered.Objective 2: The second objective is to increase access to primary care services among underinsured/uninsured community members by providing donated medical supplies to two local community clinics from a baseline of one by the end of 2022. The initiative is funded and managed through AdventHealth Wauchula and all outcomes are specific to the reporting Hospital. The initiative provides two identified clinics within the Hospital's PSA who serve low-income, uninsured, or underinsured populations, with donated medical supplies. The Hospital met its set metric by providing monetary donations to the Samaritan's Touch Care Center and Central Florida Health Care of Hardee County to be used toward the cost of medical supplies. Samaritan's Touch is a faith-based, charitable healthcare center in Highlands County offering free primary and specialized medical, dental and vision care to uninsured financially struggling families who have no medical insurance of any kind and whose income is at or below 200% of the Federal Poverty Guidelines. Central Florida Health Care of Hardee County is the local Federally Qualified Health Center (FQHC).Priority 3: Cardiovascular Disease2019 Description of the Issue:Coronary heart disease is a leading cause of death in the U.S. and is also related to high blood pressure, high cholesterol, and heart attacks. In the AdventHealth Wauchula primary service area (PSA), 9% (7,614 persons) of adults aged 18 and older have coronary heart disease or angina (heart related chest pain). Additionally, the rate of death due to heart disease per 100,000 population is 155 (268 average annual deaths from 2012 - 2016), which is higher than the state rate of 150 and 22% (13,201 persons) of the PSA population smoke cigarettes (higher than the state rate of 19%). Tobacco use is also linked to cardiovascular disease.2022 Update: The AdventHealth Wauchula Community Health Plan has two desired goal statements under the Cardiovascular Disease priority. 1. Improve access to health education, early intervention programs and resources related to cardiovascular disease2. Decrease tobacco use in adults and youth community membersGoal 1: Improve access to health education, early intervention programs and resources related to cardiovascular disease Objective 1: The first objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the number of Hospital sponsored American Heart Association (AHA) community CPR (Cardiopulmonary Resuscitation) out-of-hospital bystander classes for adults and youth from a baseline of zero to two by the end of 2022. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. This initiative provides training to lay community members to be able to save the lives of individuals experiencing a cardiac event by administering the two-step, Hands-Only CPR. The Hospital did not meet its set metric of providing two classes sponsored by the end of 2022. Due to low interest, we were not able to host the two classes needed to meet this metric in the Wauchula community. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 3 -- AdventHealth WauchulaDescription of CHNA Significant Needs ContinuedObjective 2: The second objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to partner with the Florida Department of Health (FDOH) in Highlands County to provide patient referrals at discharge to enroll in free Diabetes Self-Management Education and Support (DSMES) classes by creating an internal referral system to refer 75 underinsured or uninsured adults residing in the Hospital's PSA from a baseline of zero by the end of 2022. The objective is funded and managed through all Hospitals, however reported outcomes are specific to the reporting Hospital. The Hospital did not meet the set metric. The internal plan for referring participants to the DSMES classes involved a tremendous amount of collaborative effort with our AdventHealth Care 360 team to create an "at discharge" referral system to connect patients to our Community Benefit programs and initiatives. In year two, the referral system was piloted to connect patients (at discharge) with a history of tobacco use to free tobacco cessation classes offered by the Central Florida Area Health Education Center (AHEC). After the pilot, many issues still needed to be resolved before the expansion of this service for the FDOH's DSMES classes. Unfortunately, they were not resolved before the end of 2022. Objective 3:The third objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food is Health program will support a series of five nutrition education class series among low-income families in the PSA from a baseline of two by the end of 2022. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Food is Health program is an AdventHealth West Florida Division program which increases access to health education and healthy foods to improve the overall health of the communities the Hospital serves. Through collaboration with community partners, the program connects with low-income/low access communities and provides free health education, health screenings, and produce vouchers which are used to purchase fresh fruits and vegetables.The Hospital did not meet its set metric of providing five class series. In previous years we struggled with finding a health education partner to teach the classes, a produce vendor to provide the produce, and enough interest in the class to meet the minimum required number of participants to hold a class. By the end of 2022 we had an established partnership with UF/IFAS Extension to teach the nutrition education classes and we also onboarded Burgin Farms as our new produce vendor. Though interest remained low, we were still able to hold one class in 2022 before our produce vendor closed for the rest of the season. Objective 4:The fourth objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food is Health program will distribute 200 produce vouchers (valued at $10 each) to program participants from a baseline of 72 by the end of 2022. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospital did not meet its set metric of providing 200 produce vouchers due to not having an educational partner or a produce vendor in the first two years. However, we were able to schedule one class in 2022, before our produce vendor closed for the season, and provided 90 vouchers. Objective 5: The fifth objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food Is Health program will build and maintain partnerships with local community organizations serving low-income/low access communities by engaging seven community partners from a baseline of four by the end of 2022. This objective is managed at a Divisional level, and outcomes reported represent the Hospitals in Hardee and Highlands counties; AdventHealth Sebring, AdventHealth Lake Placid and AdventHealth Wauchula. The Hospital met its set metric. By the end of 2022, partnerships were built and maintained with the University of Florida/Institute of Food & Agricultural Sciences (UF/IFAS) Extension, the Central Florida Area Health Education Center, the Senior Connection Center, Feeding Tampa Bay, the Burgin Farms, the Hardee Help Center, and the local Department of Health. Objective 6: The sixth objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food is Health program will increase the number of participants among low-income families in the PSA to 50 from a baseline of 15 by the end of 2022. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospital did not meet its set metric of increasing participants to 50 for the Food is Health program. In previous years we struggled with finding a health education partner to teach the classes, a produce vendor to provide the produce, and enough interest in the class to meet the minimum required number of participants to hold a class. By the end of 2022 we had an established partnership with UF/IFAS Extension to teach the nutrition education classes and we also onboarded Burgin Farms as our new produce vendor. Though interest remained low, we were still able to hold one class in 2022 before our produce vendor closed for the rest of the season.Objective 7:The seventh objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The objective states the Food is Health program will increase the number of health screenings among adults living in food deserts or low-income/low access communities to 75 from a baseline of 23 by the end of 2022. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospitals did not meet the set metric. Due to restrictions in place during the COVID-19 pandemic, such as requiring staff members to stay within the Hospital during their normal working hours, and the subsequent shortage of internal staff members across the healthcare industry, the Hospital did not have the capacity to allow nurses to volunteer time to provide health screenings.Goal 2: Decrease tobacco use in adults and youth community members Objective 1: The first objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the knowledge of free tobacco cessation programs and tobacco prevention/treatment resources for patients at discharge by partnering with the Central Florida Area Health Education Center (AHEC) to provide continuing education classes to 50 team members (treating patients with tobacco use) from a baseline of zero by the end of 2022. The objective is funded through all Hospitals but managed by the Division. Funding and outcomes reported represent all Hospitals involved. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 3 -- AdventHealth WauchulaDescription of CHNA Significant Needs ContinuedThis initiative provides educational classes that lead to an increase in knowledge for those AdventHealth team members who treat patients with tobacco use, or work with these patients at discharge, about tobacco cessation resources available, which could potentially improve patients' health through support for eliminating tobacco use. This is conducted through a partnership with Central Florida AHEC, the local affiliate of the national organization of AHEC, that is a community focused organization that develops and implements community-based health promotion activities and education programs which target the underserved. AHEC also provides community members tools and resources to assist with tobacco cessation, including tobacco replacement when medically necessary and available, and accredited classes for continuing education units (CEUs) and continuing medical education (CMEs) for Hospital team members. The Hospital did not meet the set metric. The Division created a memorandum of understanding (MOU) between the Hospitals and AHEC. The MOU states AHEC will offer tobacco cessation programming in partnership with the Hospitals, which includes flyers, promotion templates, program materials, and client communications on the Hospital's behalf. As part of the MOU, Central Florida AHEC will provide accredited tobacco cessation education to Hospital providers and staff, thereby resulting in earned CEUs and CMEs for these team members. However, due to restrictions in place as a result of the COVID-19 pandemic and healthcare staffing shortages, staff members were focused on treating patients and filling in where needed. As a result, we were not able to create a program to offer team members CEUs and CMEs for addressing tobacco cessation by the end of 2022.Objective 2: The second objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to provide patient referrals at discharge to enroll in free AHEC tobacco cessation programs and receive free intervention therapies to quit smoking tobacco through a partnership with AHEC and create an internal referral system to link adults residing in the Hospital's PSA, providing resources for 18 patients from a baseline of zero by end of 2022. The objective is funded through AdventHealth Sebring but managed by the Division. Reported referrals are specific to the reporting Hospital.This initiative provides an internal patient referral system at discharge to enroll in free AHEC tobacco cessation programs and receive free intervention therapies to quit tobacco. This initiative is conducted through a partnership with AHEC and the Hospital's internal Care 360 team. The Hospital's internal Care 360 team works with patients at discharge and serves to identify patients needing tobacco cessation. Once identified, the Care 360 team can use this internal referral system to directly enroll patients into AHEC's tobacco cessation program. The Hospital did not meet its set metric. The Division and the Hospital's Care360 team created and piloted an internal referral system in 2021 at AdventHealth Sebring and other Hospitals within the Division. Unfortunately, issues with the referral system needed to be resolved before referring additional patients, therefore the system was not expanded into AdventHealth Wauchula by the end of 2022.Objective 3: The third objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase access to tobacco cessation classes for adults residing in the Hospital's PSA by five classes from a baseline of zero by the end of 2022. The objective is funded through all Hospitals but managed by the Division. Funding and outcomes reported represent all Hospitals involved. This initiative increases access to tobacco cessation classes that improve health through a partnership with Central Florida Area Health Education Centers (AHEC). The Hospitals exceeded the set metric. By the end of 2022, 37 tobacco cessation classes were offered at the Hospitals in partnership with Central Florida Area Health Education Center. Priority 4: Education (Social Determinant of Health)2019 Description of the Issue:In the AdventHealth Wauchula primary service area, 20% (12,547 persons) of the population aged 25 and older do not have a high school diploma (or equivalency) or higher and this percentage is higher than the state average of 12%. Educational attainment is a social determinant of health and is linked to health outcomes. Additionally, improving health literacy may be a useful strategy for reducing disparities in health related to education.2022 Update: The AdventHealth Wauchula Community Health Plan has two desired goal statements under the Education (Social Determinant of Health) priority. 1. To increase partnerships with local school-based programs to better understand the problem of educational attainment as a social determinant of health2. To support community efforts that address the problem of educational attainment as a social determinant of healthGoal 1: To increase partnerships with local school-based programs to better understand the problem of educational attainment as a social determinant of health Objective 1: The first objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to partner with local community school and/or college programs to create a community-based professional development program (interviewing skills, resume writing, basic computer skills, mentoring) for underserved adults residing in the Hospital's PSA by providing three community workshops from a baseline of zero by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. This initiative provides underserved adults with educational and hands-on training skills, such as resume writing and computer skills, needed to enter the workforce. The Hospital did not meet the set metric. We established a partnership with CareerSource Heartland, South Florida State College, and the Panthers Youth Program. CareerSource Heartland is the primary deliverer of these workshops and programs. We decided it was a better use of resources to support their efforts by referring individuals to their programs and classes. Additionally, we provided South Florida State College with a monetary donation of $3,840 in total between the three hospitals ($1,280 was donated from AdventHealth Wauchula) to help pay for adults in need of General Education Development (GED) classes or other technical skills trainings in lieu of providing these classes ourselves. CareerSource Heartland is a not-for-profit corporation that operates as a demand-driven and business focused public-private partnership. Through oversight provided by the local elected officials from DeSoto, Hardee, Highlands and Okeechobee counties, their Board of Directors offer workforce development related growth opportunities to business customers and job seekers throughout their four-county service delivery area. South Florida State College is a public college in Florida with campuses in Highlands, Desoto and Hardee counties and is part of the Florida College System. The South Florida State College Adult Education Program provides General Education Development (GED) preparation and testing. The Panthers Youth Partners program is affiliated with CareerSource Heartland and South Florida State College and serves to provide youth with services that will develop and strengthen employability skills, talents, and interests. **see continuation of footnote Part V, Section B, Line 11 Continuation of Footnote: Group A-Facility 3 -- AdventHealth WauchulaDescription of CHNA Significant Needs ContinuedObjective 2: The second objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to establish a new partnership with local community organizations to identify education access barriers faced by underserved adults residing in the Hospital's PSA from a baseline of zero organizations to three by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved.This initiative creates a partnership with local community organizations working in adult education to help discover challenges to educational attainment and means to help resolve them. The Hospitals exceeded the set metric. We established a partnership with three new community partners - CareerSource Heartland, South Florida State College, and the Panthers Youth Program. The metric was met in year two. Through the formation of these three new partnerships, we were able to discuss barriers to educational access for those underserved members of our community. The barriers identified include inaccessible or unreliable means of transportation, lack of child-care, work-hour inflexibility, financial constraints, and home-life challenges. In 2022 we provided donated funds in the amount of $3,840 in total from all three hospitals ($1,280 donated was from AdventHealth Wauchula) to South Florida State College to help alleviate some of the financial constraints mentioned for those low-income individuals seeking to attain their high school diploma through the General Educational Development (GED) program. Goal 2: To support community efforts that address the problem of educational attainment as a social determinant of health Objective 1: The first objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to provide education vouchers to cover the costs of General Educational Development (GED) materials (textbooks, registration fees and tests) for adults residing in the Hospital's PSA from a baseline of zero vouchers to three vouchers by the end of 2022. The objective is funded and managed through all Hospitals. Funding and outcomes reported represent all Hospitals involved. This initiative provides education vouchers in the form of monetary funds to help cover some of the cost associated with the GED test. The Hospitals met the set metric. A monetary donation in the amount of $3,840 collectively ($1,280 was donated from AdventHealth Wauchula) was delivered to South Florida State College in 2022 to support those low-income, underserved individuals seeking to attain their high school diploma through the GED program. Objective 2: The second objective is a shared initiative between AdventHealth Wauchula, AdventHealth Lake Placid and AdventHealth Sebring. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the amount of paid staff time for Hospital staff/team members to volunteer with community organizations addressing education (as a social determinant of health) from a baseline of zero hours to 150 hours by the end of 2022. The objective is funded and managed through all Hospitals; however, outcomes are specific to the reporting Hospital. This initiative provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations which are addressing this priority area. The Hospital did not meet the set metric. Due to issues such as COVID-19 requiring staff members to stay within the Hospital during their normal working hours, and then a shortage of internal staff members in the subsequent years as seen across the healthcare industry, the Hospitals did not have the capacity to meet the 150 hours of volunteer time in this three-year plan. Community Needs Not Chosen by AdventHealth Wauchula: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. Poor Dental Health: Many oral diseases can be prevented with routine care and regular dental checkups. The health of the teeth, the mouth and the surrounding craniofacial (skull and face) structures is central to a person's overall health and well-being. Lack of access to dental care for all ages remains a public health challenge. In the AdventHealth Wauchula Primary Service Area (PSA), the access to qualified dentists at a rate per 100,000 population is 36 (in 2015), as compared to the state rate of 56. The Community Health Needs Assessment Committee (CHNAC) did not perceive the ability to have a measurable impact on the issue within the three years allotted for the Community Health Plan with the current resources available to the community and the Hospital at this time.2. Tobacco Use: In the AdventHealth Wauchula PSA, an estimated 13,201 of adults aged 18 or older selfreport currently smoking cigarettes some days or every day. This indicator is relevant because tobacco use is linked to leading causes of death such as cancer and cardiovascular disease. In the Hospital PSA, 22% of adults are currently smoking cigarettes, which is higher than the state percentage of 19%. The CHNAC felt the issue should not be addressed as an individual problem. Therefore, interventions to address tobacco use will be wrapped into the priority area of heart disease.3. Obesity/Overweight/Obese: In the AdventHealth Wauchula PSA, approximately 33% of adults aged 20 and older (21,963 persons) selfreport that they have a Body Mass Index (BMI) greater than 30.0 (obese) in the report area. The state percentage is 27%. Excess weight may indicate an unhealthy lifestyle and puts individuals at risk for further health issues. The CHNAC felt the issue should not be addressed as an individual problem. Therefore, interventions to address Obesity/Overweight/Obese will be wrapped into the education priority area. The Community Health Needs Assessment Committee (CHNAC) will approach this area of need more comprehensively, as other barriers contribute to negative health outcomes in this area of priority. Part V, Section B, Line 13h: Facility Reporting Group - AEffective 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. Part V, Section B, Line 16a-16c: Each hospital facility's FAP, FAP application form and plain language summary of the FAP was made widely available through the following websites: Facility 1 -- AdventHealth Orlando & Campuseshttps://www.adventhealth.com/legal/financial-assistance Facility 2 -- AdventHealth Sebring & Lake Placidhttps://www.adventhealth.com/legal/financial-assistance Facility 3 -- AdventHealth Wauchulahttps://www.adventhealth.com/legal/financial-assistance 62 1 - Health First AdventHealth Centra Care 1223 Gateway Drive Suite 1E Melbourne FL 32901 Urgent Care Clinic 2 - AdventHealth Centra Care Lake Buena Vist 12500 South Apopka Vineland Road Orlando FL 32836 Urgent Care Clinic 3 - AdventHealth Centra Care South Orange 2609 South Orange Avenue Orlando FL 32806 Urgent Care Clinic & Employer Onsite Clinic 4 - AdventHealth Centra Care Waterford Lakes 250 North Alafaya Trail Suite 135 Orlando FL 32825 Urgent Care Clinic 5 - AdventHealth Centra Care Winter Garden 3005 Daniels Road Winter Garden FL 34787 Urgent Care Clinic 6 - AdventHealth Centra Care Lake Nona 9637 Lake Nona Village Place Orlando FL 32827 Urgent Care Clinic 7 - AdventHealth Centra Care Winter Haven 7375 Cypress Gardens Boulevard Winter Haven FL 33884 Urgent Care Clinic 8 - AdventHealth Centra Care St Cloud 4660 13th Street St Cloud FL 34769 Urgent Care Clinic 9 - AdventHealth Centra Care University 11550 University Boulevard Orlando FL 32817 Urgent Care Clinic 10 - AdventHealth Centra Care Mt Dora 19015 US Highway 441 Mount Dora FL 32757 Urgent Care Clinic 11 - AdventHealth Centra Care Hunter's Creek 3293 Greenwald Way North Kissimmee FL 34741 Urgent Care Clinic 12 - AdventHealth Centra Care Clermont 15701 State Road 50 Suite 101 Clermont FL 34711 Urgent Care Clinic 13 - AdventHealth Centra Care Winter Park 3099 Aloma Avenue Winter Park FL 32792 Urgent Care Clinic 14 - AdventHealth Centra Care Altamonte Sprin 440 West State Road 436 Altamonte Springs FL 32714 Urgent Care Clinic 15 - AdventHealth Centra Care Orange Lake 8201 West Irlo Bronson Highway Kissimmee FL 34747 Urgent Care Clinic 16 - AdventHealth Centra Care Poinciana 3759 Pleasant Hill Road Kissimmee FL 34746 Urgent Care Clinic 17 - AdventHealth Centra Care Sanford 4451 West 1st Street Sanford FL 32771 Urgent Care Clinic 18 - AdventHealth Centra Care Oviedo 8010 Red Bug Lake Road Oviedo FL 32765 Urgent Care Clinic 19 - AdventHealth Centra Care Wesley Chapel 1127 Bruce B Downs Boulevard Wesley Chapel FL 33544 Urgent Care Clinic 20 - AdventHealth Centra Care Lee Road 2540 Lee Road Winter Park FL 32789 Urgent Care Clinic 21 - AdventHealth Centra Care Kissimmee 4320 West Vine Street Kissimmee FL 34746 Urgent Care Clinic 22 - AdventHealth Centra Care Port Orange 1208 Dunlawton Avenue Port Orange FL 32127 Urgent Care Clinic 23 - AdventHealth Centra Care Dr Phillips 8014 Conroy-Windermere Road Suite 104 Orlando FL 32835 Urgent Care Clinic 24 - AdventHealth Centra Care Apopka 1520 West Orange Blossom Trail Apopka FL 32712 Urgent Care Clinic 25 - AdventHealth Centra Care Lake Mary 2948 West Lake Mary Boulevard Lake Mary FL 32746 Urgent Care Clinic 26 - AdventHealth Centra Care Brandon 10222 Bloomingdale Avenue Riverview FL 33578 Urgent Care Clinic 27 - AdventHealth Centra Care South Tampa 301 North Dale Mabry Highway Tampa FL 33609 Urgent Care Clinic 28 - AdventHealth Centra Care Temple Terrace 5802 East Fowler Avenue Temple Terrace FL 33617 Urgent Care Clinic 29 - AdventHealth Centra Care Azalea Park 509 South Semoran Boulevard Orlando FL 32807 Urgent Care Clinic 30 - AdventHealth Centra Care Orange City 1360 Saxon Boulevard Orange City FL 32763 Urgent Care Clinic 31 - AdventHealth Centra Care DeLand 2293 South Woodland Boulevard Deland FL 32720 Urgent Care Clinic 32 - AdventHealth Centra Care Sand Lake Road 2301 Sand Lake Road Orlando FL 32809 Urgent Care Clinic 33 - AdventHealth Centra Care Colonial Town 630 N Bumby Avenue Orlando FL 32803 Urgent Care Clinic 34 - AdventHealth Centra Care Daytona 1014 West International Speedway Bouleva Daytona Beach FL 32114 Urgent Care Clinic 35 - AdventHealth Centra Care Ormond Beach 1245 West Granada Boulevard Ormond Beach FL 32174 Urgent Care Clinic 36 - AdventHealth Centra Care Palm Coast 1270 Palm Coast Parkway NW Palm Coast FL 32137 Urgent Care Clinic 37 - AdventHealth Centra Care Lakeland 3637 N Road 98 Lakeland FL 33809 Urgent Care Clinic 38 - AdventHealth Centra Care Longwood 855 North US Highway 17-92 Longwood FL 32750 Urgent Care Clinic 39 - AdventHealth Centra Care Carrollwood 4001 West Linebaugh Avenue Tampa FL 33624 Urgent Care Clinic 40 - AdventHealth Centra Care Leesburg 1103 North 14th Street Leesburg FL 34748 Urgent Care Clinic 41 - AdventHealth Centra Care Citrus Park 6930 Gunn Highway Tampa FL 33625 Urgent Care Clinic 42 - AdventHealth Centra Care Kids Lake Mary 105 South Country Club Road Lake Mary FL 32746 Urgent Care Clinic 43 - AdventHealth Centra Care Kids Winter Par 2325 West Fairbanks Avenue Winter Park FL 32789 Urgent Care Clinic 44 - AdventHealth Centra Care Trinity 11826 State Road 54 Odessa FL 33556 Urgent Care Clinic 45 - AdventHealth Centra Care Conway 5810 South Semoran Boulevard Orlando FL 32822 Urgent Care Clinic 46 - AdventHealth Medical Group Orthopedics a 4409 Sun N Lake Boulevard Sebring FL 33872 Outpatient Phys Clinic 47 - AdventHealth Medical Group Cardiology at 4639 Sun N Lake Boulevard Sebring FL 33872 Outpatient Phys Clinic 48 - AdventHealth Medical Group OB GYNPrompt 524 Carlton Street Wauchula FL 33873 Outpatient Phys Clinic 49 - AdventHealth Primary Care Partin Settlem 2488 E Irlo Bronson Memorial Hwy Suite 2 Kissimmee FL 34744 Primary Care 50 - AdventHealth Primary Care Winter Garden 3131 Daniels Road Suite 106 Winter Garden FL 32825 Primary Care 51 - AdventHealth Centra Care Ocala 3708 SW College Road Ocala FL 34474 Urgent Care Clinic 52 - AdventHealth Medical Group Prompt Care a 2950 Alt US Hwy 27 S Suite B Sebring FL 33870 Prompt Care 53 - Darden Onsite 1000 Darden Center Drive Orlando FL 32837 Employer Onsite Clinic 54 - AdventHealth Medical Group Cardiology & 463 Carlton Street Wauchula FL 33873 Outpatient Phys Clinic 55 - Bethune Cookman Onsite 633 State Street Daytona Beach FL 32114 Employer Onsite Clinic 56 - SIEMENS Onsite 4400 North Alafaya Trail MC Q1-240 Orlando FL 32826 Employer Onsite Clinic 57 - AdventHealth Hope and Healing Center 212 Eslinger Way Sanford FL 32773 Residential Level 2 Substance Abuse Center & Intensive Outpatient Program 58 - OCG Onsite 450 East South Street Orlando FL 32802 Employer Onsite Clinic 59 - AdventHealth Waterman Employee Clinic 1000 Waterman Way Tavares FL 32778 Employer Onsite Clinic 60 - AdventHealth Primary Care Waterford 885 N Alafaya Trail Unit G04 Orlando FL 32828 Primary Care 61 - AdventHealth Medical Group Breast Surger 4145 Sun N Lake Boulevard Suite B Sebring FL 33872 Outpatient Phys Clinic 62 - AdventHealth Trina Hidalgo Heart Care Ce 101 South Westmoreland Drive Orlando FL 32805 Community Clinic Part I, Line 3c: Under each 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 assessments and associated implementation strategies can be accessed on the filing organization's websites. 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 II, Community Building Activities: The costs of community building activities reported on Part II of Schedule H primarily represent the costs associated with commercially sponsored research conducted by one of the organization's hospitals. This one hospital participates in clinical drug and device research that is performed on patients who have a condition or disease for which the eventual commercial use of a drug or device is intended. This research is related to patient care and serves to expand scientific knowledge with respect to potential treatments and cures for various diseases and conditions. The remainder of the costs incurred stem from the hospitals' involvement in and support of various other community agencies in its service area that work collaboratively to help those in need and to improve the health and safety of the residents of the community. The organization's hospitals participate with a number of other community organizations to address the healthcare needs of all its communities. Both cash and in-kind donations are made annually to various local charitable organizations. 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 Departments should be considered community benefit as charitable hospitals exist to provide such care in pursuit of their purpose of meeting the need for emergency medical care services available to all in the community. Part III, Line 4: Financial Statement Footnote Related to Accounts Receivable and Allowance for Uncollectible Accounts:The financial information of the filing organization is included in a consolidated audited financial statement for the current year. The applicable footnote from the attached consolidated audited financial statements that addresses accounts receivable, the allowance for uncollectible accounts, and the provision for bad debts can be found on pages 8 and 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. 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: $(227,028,440) - Difference in costing methodology: 39,591,732 - Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (380,611,304) ------------- Total Unreimbursed costs of serving all Medicare patients per the filing organization's communitybenefit reporting $(568,048,011) 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 III, Line 9b: Collection Policies: 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. Part VI, Line 2: As reported in Schedule H, Part V, Section B, the filing organization's hospital facilities conduct their community health needs assessments (CHNAs) every three years. Their 2022 CHNAs were adopted by all hospital governing boards by December 31, 2022, the end of the filing organization's taxable year in which the CHNAs were conducted. All of the filing organization's hospital facilities' CHNAs complied with the guidance set forth by the IRS in Final Regulation Section 1.501(r)-3. In addition to the CHNAs discussed above, a variety of practices and processes are in place to ensure that the filing organization is responsive to the health needs of all of its communities. Such practices and processes involve the following:1. Hospitals' operating/community boards 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 hospital communities; and 4. Collaboration with other local community groups to address the health care needs of the filing organization's hospital communities. 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 facilities 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 facilities' financial counselors are prominently and conspicuously posted on the filing organization's hospital facilities' websites. Each hospital facility's 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 relevant hospital facility (referred to below as LEP defined populations). Signage is displayed in public locations of the filing organization's hospital facilities, including at all points of admission and registration and the Emergency Department. The signage contains each 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 each 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 facilities' financial counselors seek to provide personal financial counseling to all individuals admitted to the hospital facilities 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 each 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 facilities' 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 facilities' FAP in all oral communications regarding the amount due for the individual's care. Copies of the PLS are distributed to members of each hospital facility's 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: See Part VI, Line 4 footnote below. Part VI, Line 5: The provision of community benefit is central to the filing organization's mission of service and compassion. Restoring and promoting the health and quality of life of those in the communities served by the filing organization is a function of "extending the healing ministry of Christ and embodies the filing organization's commitment to its values and principles. The filing organization commits substantial resources to provide a broad range of services to both the underprivileged as well as the broader community. In addition to the community benefit and community building information provided in Parts I, II and III of this Schedule H, the filing organization captures and reports the benefits provided to its community through faith-based care. Examples of such benefits include the cost associated with chaplaincy care programs and mission peer reviews and mission conferences. During the current year, the filing organization provided $9,737,911 of benefit with respect to the faith-based and spiritual needs of the communities it serves in conjunction with its operation of community hospitals. The filing organization also provides benefits to its communities' infrastructure by investing in capital improvements to ensure that facilities and technology provide the best possible care. During the current year, the filing organization expended $317,707,701 in new capital improvements. As faith-based mission-driven community hospitals, the filing organization is continually involved in monitoring its communities, 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 Hospitals are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its communities. Part VI, Line 6: The filing organization is a part of a faith-based healthcare system of organizations whose parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). The system is known as AdventHealth. AHSSHC is an organization exempt from federal income tax under IRC Section 501(c)(3). AHSSHC and its subsidiary organizations operate 49 hospitals throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC and its subsidiaries also operate 10 nursing home facilities and other ancillary health care provider facilities, such as ambulatory surgery centers and diagnostic imaging centers.As the parent organization of AdventHealth, AHSSHC provides executive leadership and other professional support services to its subsidiary organizations. Professional support services include among others IT, corporate compliance, legal, reimbursement, risk management, and tax as well as treasury functions. Certain support services, such as human resources, payroll, A/P, and supply chain management are provided pursuant to a shared services model by AHSSHC to its subsidiary organizations. The provision of these executive and support services on a centralized basis by AHSSHC provides an appropriate balance between providing each AdventHealth subsidiary hospital organization with mission-driven consistent leadership and support while allowing the hospital organization to focus its resources on meeting the specific health care needs of the community it serves. The reader of this Form 990 should keep in mind that this reporting entity may differ in certain areas from that of a stand-alone hospital organization due to its inclusion in a larger system of healthcare organizations. As a part of a system of hospital and other health care organizations, the filing organization benefits from reduced costs due to system efficiencies, such as large group purchasing discounts, and the availability of internal resources such as internal legal counsel. Each AdventHealth subsidiary pays a management fee to AHSSHC for the internal services provided by AHSSHC. As a result, management fee expense reported by an AdventHealth subsidiary organization may appear greater in relation to management fee expense that may be reported by a single stand-alone hospital. The single stand-alone hospital would likely report costs associated with management and other professional services on various expense line items in its statement of revenue and expense as opposed to reporting such costs in one overall management fee expense. As the reporting of the Form 990 is done on an entity by entity basis, there is no single Form 990 that captures the programs and operations of AdventHealth as a whole. The reader is directed to visit the web-site of AdventHealth at www.adventhealth.com to learn more about the mission and operations of AdventHealth. Part VI, Line 4: In 2022, the filing organization operated 3 separately licensed hospitals that together encompassed 11 separate campus locations and 8 off-site emergency departments. The hospitals are located in Florida. A description of each hospital and the communities they serve is described below.Facility Reporting Group - AAdventist Health System/Sunbelt, Inc.:AdventHealth's Central Florida Division South Region consists of a 3,260-bed medical complex in Central Florida with eight separate hospital campuses and eight off-site emergency departments (the Hospitals) that operate under a single hospital license. The Hospitals serve the residents of Central Florida (primarily serving the residents of Orange, Osceola, Seminole and Lake County) but also draw patients from other parts of the Southeastern United States, the Caribbean and South America. The 8-campus health system is the largest healthcare provider in Central Florida with more than 2 million patient visits per year and is the nation's largest Medicare provider. It is the second largest employer in the area.The main campus of AdventHealth's Central Florida Division South Region is located in Orlando, Florida (Orange County) near the downtown area. The other 7 campuses are located in surrounding communities in the counties of Orange, Osceola, and Seminole. In addition to operating the 8 hospitals, it also operates 61 full-service urgent care clinics in convenient community settings.During 2022, the patient percentage population for the eight campuses was made up of the below payors with the remaining percentage of the patients being covered under commercial insurance. In 2022, about 72.9% of the Hospital's in-patients were admitted through the Hospital's Emergency Department. - Medicare Patients 42.9% - Medicaid Patients 14.4% - Self-Pay Patients 5.3%The demographic makeup of the communities served and a brief description of each of the hospital campuses is described below: Lake Orange Osceola Seminole - Population 383,956 1,429,908 388,656 470,856 (2020 Data) - Population Over 65 26.5% 11.6% 13.0% 15.2% (2019 Data) - Poverty (Below 100% FPL) 12.0% 14.9% 14.8% 10.6% (2015-2019 Data) - High School Graduation Rate 89.5% 88.5% 86.7% 94.3% (2015-2019 Data) - Uninsured Adults 10.6% 13.3% 13.2% 9.5% (2016-2020 Data) - Food Insecurity Rate 13.9% 14.2% 14.6% 11.9% (2021 Data)*AdventHealth Orlando (Orange County) - At the core of AdventHealth's Central Florida Division South Region, AdventHealth Orlando (AHO) is a 1,400-bed acute-care tertiary hospital. AHO is home to nationally recognized Centers of Excellence for cancer, cardiology, children's health, diabetes, neuroscience, orthopedics, transplant and global robotics. AdventHealth Orlando houses one of the largest Emergency Departments and cardiac catheterization labs in the country and is one of the busiest hospitals in the nation. The campus also includes a state-of-the-art Cardiac Diagnostic Center, featuring 15 Cath and electro physiology (EPS) Labs, and an inpatient Hospice unit.Additionally, AHO houses the Translational Research Institute, a 54,000 square-foot facility devoted to the study of obesity and metabolic origins of cardiovascular disease with the aim of developing new treatments to battle diabetes and obesity. AHO also serves as a teaching hospital for family medicine, allopathic and osteopathic tracts, emergency medicine, neuromusculoskeletal medicine, general surgery, podiatric medicine and surgery, and internal medicine. As one of the premier health systems in the nation, AHO sets the standard for innovation, quality, and comprehensive care.AdventHealth for Women at Orlando is a 12-story hospital located on the Orlando campus. The first floor houses the Breastfeeding Center, parent education classroom as well as obstetrical triage and registration. 10 of the 12 floors are complete, which include 72 mother-baby rooms and high-risk OB rooms, 14 labor and delivery suites, 13 operating rooms, 82 NICU beds, 104 oncology beds which include GYN oncology, medical oncology, 32-bed ICU capable BMT unit, and a 36-bed thoracic pulmonary Unit.Also located on the AHO Campus is the Walt Disney Pavilion at AdventHealth for Children. The Walt Disney Pavilion is not a stand-alone facility but rather a 7-story, 198-bed tower located on AHO's campus. It is a full-service facility served by more than 140 pediatric specialists and a highly trained pediatric team of more than 800 employees. The Walt Disney Pavilion at AdventHealth for Children delivers a complete range of pediatric health services for younger patients including advanced surgery, oncology, neurosurgery, cardiology and transplant services; full-service pediatrics; and an innovative health and obesity platform.*AdventHealth Altamonte (Seminole County) - AdventHealth Altamonte is a 393-bed facility, which has recently doubled in size with a new patient tower to better serve a busy community. AdventHealth Altamonte was the first "satellite" hospital, built in 1973 on what was then pastureland, miles from the nearest business district. Located north of Orlando in fast-growing Seminole County, AdventHealth Altamonte is the second largest satellite campus within AdventHealth's Central Florida Division South Region. In addition to maternity, pediatric, NICU, emergency, medical and surgical services, the hospital operates the Martin Andersen Cancer Center (along with the region's only Cancer Resource Library), a heart catheterization lab, and a comprehensive outpatient program which includes surgery, diagnostics, and medical treatment programs. In 2014, the Mother Baby Unit was expanded to provide a 15-bed CDU, 10 new LDR rooms, 6 triage rooms, and a new C-section operating room and recovery unit. In 2018, a 10-bed Level II Neonatal Intensive Care Unit (NICU) was added. *** see continuation of footnote Part VI, Line 4 Continuation of Footnote: Facility Reporting Group - ADescription of Community Information - Continued*AdventHealth Apopka (Orange County) - In 1975, AdventHealth Apopka became the second satellite hospital. For over four decades, AdventHealth Apopka has set the standard in hometown health care by providing high-tech, quality care with a personalized touch. In December, 2017, construction was completed on a $203 million replacement facility located approximately three miles from the existing facility. The new, 320,000 square foot facility was built on a 71-acre site. Five of the seven floors have been built out with the remaining two floors to be shelled in for future expansion. The 120-bed facility includes intensive care, emergency medicine, endoscopy, outpatient, diagnostic, respiratory, and rehabilitation services.*AdventHealth Celebration (Osceola County) - AdventHealth Celebration is a cornerstone of Disney's planned community in Celebration, Florida. Today, this 357-bed acute care hospital delivers a state-of-the-art healing environment to residents of Osceola, Orange, Polk and Lake Counties, as well as to visitors from across the United States and the world. From its creation, AdventHealth Celebration has been about promoting health and wellness as well as healing. Inside the resort-style hospital there is a wellness center, complete with workout area, pool, and rehabilitation facility. AdventHealth Celebration also houses the Global Robotics Institute, which provides patients with access to some of the most experienced robotic surgeons in the world. The Nicholson Center for Surgical Advancement also is a location where surgeons from around the world travel to learn the latest robotic surgery techniques. The Institute for Interactive Patient Care is a 234,000 square-foot patient tower with 62 beds and was the first of its kind in the nation where physicians can study everything from new patient safety technology to the impact of changing communication with patients about their care. In 2013, a four-story medical office building was added in which the Women's Institute is situated. In 2014, a new 5th floor inpatient 32 bed state-of-the art medical/surgical unit was added. In 2018, two inpatient surgical cardiovascular OR's were added. In 2020, a five-story, 166,000 square foot tower was added which, in addition to 80 new acute care beds, includes a state-of-the art unit featuring six Cath labs and two cardiac operating rooms. The expansion allowed for the launch of comprehensive stroke care, which includes 24/7 emergency neurosurgery and interventional neurosurgery. AdventHealth Celebration offers services in cancer, digestive health, neuroscience, weight-loss services and surgery, orthopedic health, spine health, thoracic surgery, women's and men's health, robotic-assisted surgeries, and imaging diagnostics. *AdventHealth East Orlando (Orange County) - AdventHealth East Orlando is an innovative local leader that fills a vital need in a fast-growing area. A recent 200,000 square-foot expansion project upgraded the Hospital to 295 beds, with a spacious patient tower and 80 new private rooms designed to enhance the holistic care experience. In 2014, an expanded ED provided 60 new treatment rooms. AdventHealth East Orlando includes a teaching hospital with residencies in family medicine, podiatry, and emergency medicine. The campus is also home to an outpatient surgery center, a hospital-based Center for Medical Simulation and Education, a Cancer Institute featuring state-of-the-art technology for radiation oncology and a dedicated infusion center, as well as a 12-bed Children's Emergency Center. Alongside having the largest emergency room in Central Florida, other services include cardiovascular, pulmonary, and digestive health, orthopedics and rehabilitation, ear/nose/throat, andrology, and urology. The Hospital also meets the diverse needs of its growing community at its brand-new, freestanding emergency room, AdventHealth Waterford Lakes ER, which offers hospital-based ER services by board-certified emergency physicians, critical care nurses, and stroke and chest pain experts. *AdventHealth Kissimmee (Osceola County) - AdventHealth Kissimmee is a 242-bed community-focused hospital, conveniently located near Walt Disney World. The team located at AdventHealth Kissimmee is dedicated to bringing mission-focused, faith-based care to residents and visitors of Osceola and Orange Counties. This facility has recently expanded to include a new medical office building, patient tower, new main entrance, expanded Emergency Department and a parking garage. The three-story patient tower includes private patient rooms and a host of modern amenities and technologies. Services offered include cardiovascular services, orthopedics and rehabilitation, neuroscience, cancer, diabetes, gastroenterology, emergency services, urology, and imaging resources. *AdventHealth Winter Garden (Orange County) AdventHealth Winter Garden officially opened the inpatient pavilion May, 2022, to serve the residents of Winter Garden and West Orange County. The $229.5 million, five-story tower currently has 80 beds and compliments the existing 24-bed emergency department and medical office building. The hospital was designed to provide patients with a feeling of home and includes details such as single-occupancy rooms and private bathrooms, large windows that allow more natural light, an outdoor courtyard for patients and family to get sunshine and fresh air, and an indoor dining area with an array of food options so patients can access comfort food prepared in a healthier way. The tower also includes some high-tech features including a centralized patient monitoring system, a full service lab, seven surgery rooms and a dedicated imaging level. In addition to emergency services, the tower provides several new services, such as advanced gynecology, cardiology, gastroenterology, general surgery, neurology, spine health and urology. *AdventHealth Winter Park (Orange County) - AdventHealth Winter Park is a 373-bed facility that is a model of community health and wellness. The facility boasts spacious patient care areas and a full spectrum of specialties and services, including the Dr. P. Phillips Baby Place (with Level II NICU), AdventHealth Orthopedic Institute, and state-of-the-art surgery, recovery and rehabilitation at the AdventHealth Cancer Institute. In 2019, the new 5-story Nicholson Pavilion opened, adding 80 all-private rooms to the AdventHealth Winter Park campus. AdventHealth Winter Park has the Central Florida Region's only senior-friendly emergency room. Services offered at AdventHealth Winter Park include cancer, cardiovascular, digestive health, women's health, neuroscience, ophthalmology, orthopedics and rehabilitation, urology, and sports medicine The Hospital also provides timely, convenient and quality emergency care at its state-of-the-art freestanding emergency room, AdventHealth Oviedo ER, which is staffed with physicians trained to provide medical treatments for adults and children. *** see continuation of footnote Part VI, Line 4 Continuation of Footnote: Facility Reporting Group - ADescription of Community Information - ContinuedAdventist Health System/Sunbelt, Inc. dba AdventHealth Sebring:AdventHealth Sebring is comprised of three separate hospital campuses with a total of 229 beds. Two of the hospital campuses are located in Highlands County, Florida and operate under a single hospital license and the third separately licensed campus is located in Hardee County, Florida. Highlands and Hardee counties are in the south central areas of Florida and are adjacent to each other.During 2022, the patient percentage population for all three campuses of AdventHealth Sebring was made up of the below payors with the remaining percentage of the patients being covered under commercial insurance. In 2022, about 72.7% of the Hospital's in-patients were admitted through the Hospital's Emergency Department. - Medicare Patients 62.7% - Medicaid Patients 13.3% - Self-Pay Patients 4.1%*AdventHealth Sebring (Highlands County) - The main 171-bed hospital facility, located in north Sebring, was opened in 1998 to serve the Florida Heartland region which includes Highlands County and five surrounding inland, non-metropolitan counties. AdventHealth Sebring has key service lines, including a heart & vascular center, Cancer Institute, Breast Care Center, Blessed Beginnings Birthing Center, and Emergency Services. The Hospital has also established a retail pharmacy and Orthopedic unit. AdventHealth Sebring is on the cutting edge of technology in Highlands County, being the only Orthopedic program to use the MAKOplasty Robot and only Surgical Services Program to use the da Vinci Robot. The Hospital has received recognition for its patient safety, orthopedics, heart care, and as a breast imaging center of excellence. The Hospital has been recognized and received an "A" from the Leapfrog Group in patient safety.The demographic makeup of AdventHealth Sebring's community is as follows: - Population 108,442 - Population Over 65 32.3% - Poverty (Below 100% FPL) 16.9% - High School Graduation Rate 82.4% - Uninsured Adults 12.3% - Food Insecurity Rate 17.6% - Pop. with Low Food Access 44.5%*AdventHealth Lake Placid (Highlands County) - This satellite facility houses 33 medical and surgical beds, the county's only 17-bed inpatient mental health unit and a wide range of services that are highly sophisticated for a small community hospital. This campus also specializes in inpatient geriatric psychiatric services within Highlands and Hardee counties. The need for behavioral health services is extreme in both counties since there is no other program closer than sixty miles. AdventHealth Lake Placid has received national recognition in patient safety, ultrasound and computed tomography (CT), and Emergency Department (ED) areas. To better meet the needs of Highlands County, the Hospital offers a Wellness Center, along with educational classes, for the community. Key service lines include ER, ICU and the Medical Surgical Unit. AdventHealth Lake Placid is on the leading edge of technology in Highlands County as the only Hospital to utilize virtual and room sterilization technology.The demographic makeup of AdventHealth Lake Placid's community is as follows: - Population 64,751 - Population Over 65 27.2% - Poverty (Below 100% FPL) 20.2% - High School Graduation Rate 80.7% - Uninsured Adults 12.3% - Food Insecurity Rate 18.0% - Pop. with Low Food Access 43.4%*AdventHealth Wauchula (Hardee County) - Built at a new location in 2017, this campus is licensed for 25 beds and specializes in emergency and outpatient care, while offering excellent medical inpatient services. The Hospital contains the only ER in Hardee County. AdventHealth Wauchula offers many inpatient and outpatient services, including physical & occupational therapy, a transitional care unit, medical surgical swing unit, and the only mammography unit in Hardee County, the Linda Adler Mammography Center. In 2019, AdventHealth Wauchula opened a Wellness Center to better meet the health needs of Hardee County. The Hospital has been recognized as a Top Rural Hospital by The Leapfrog Group and best hospital for patient safety. The demographic makeup of AdventHealth Wauchula's community is as follows: - Population 113,160 - Population Over 65 31.6% - Poverty (Below 100% FPL) 17.5% - High School Graduation Rate 83.0% - Uninsured Adults 12.4% - Food Insecurity Rate 17.6% - Pop. with Low Food Access 45.3% Part VI, Line 7: The filing organization does not file an annual community benefit report with any state agencies. 1 AdventHealth Foundation Inc 900 Hope Way Altamonte Springs FL 32714 592219301 501(c)(3) 882316 212600 Book Other General Support Adventist Care Centers - Courtland Inc 730 Courtland St Orlando FL 32804 205774723 501(c)(3) 1240913 0 General Support American Diabetes Association Inc 1101 N Lake Destiny Rd Maitland FL 327517105 131623888 501(c)(3) 60000 0 General Support American Cancer Society Inc 1100 Pennsylvania Ave Kansas City MO 641050000 131788491 501(c)(3) 120000 0 General Support American Heart Association Inc 10460 Roosevelt Blvd N 306 St Petersburg FL 337160000 135613797 501(c)(3) 200000 0 General Support Aspire Health Partners Inc 5151 Adanson St Orlando FL 328040000 592301233 501(c)(3) 874458 0 General Support Bike Walk Central Florida Inc 100 E Pine St Ste 110 Orlando FL 328010000 461958502 501(c)(3) 6000 0 General Support Boy Scouts of America Inc Central Florida Council 1951 S Orange Blossom Tr Ste 102 Apopka FL 327037747 590624376 501(c)(3) 82000 0 General Support Boys & Girls Club of Central Florida 101 E Colonial Dr Orlando FL 328010000 590951887 501(c)(3) 15000 0 General Support Catholic Charities of Central Florida Inc 1819 N Semoran Blvd Orlando FL 328070000 591214353 501(c)(3) 10000 0 General Support Celebration Foundation Inc 610 Sycamore St Celebration FL 347470000 593370753 501(c)(3) 40000 0 General Support Center For Independent Living In Central Florida Inc 720 N Denning Dr Winter Park FL 327890000 591828770 501(c)(3) 16300 0 General Support Central Florida Family Health Center Inc Dba True Health 4930 E Lake Mary Blvd Sanford FL 327716012 591741286 501(c)(3) 100000 0 General Support Central Florida Pediatric Society Inc 1890 State Road 436 215 Winter Park FL 328040000 237422278 501(c)(3) 10000 0 General Support Coalition For The Homeless of Central Florida Inc 18 North Terry Avenue Orlando FL 328010000 592814255 501(c)(3) 10500 0 General Support Community Health Centers Inc 110 S Woodland St Winter Garden FL 347473546 591480970 501(c)(3) 106000 0 General Support Daves House Inc 9152 Point Cypress Dr Orlando FL 328360000 270533943 501(c)(3) 10000 0 General Support East Orlando Health & Rehab Center Inc 250 South Chickasaw Trail Orlando FL 32825 205774748 501(c)(3) 3336243 0 General Support Edible Education Experience Inc 26 E King St Orlando FL 328040000 465655482 501(c)(3) 25000 0 General Support Family Promise Of Greater Orlando Inc 1000 Clay Street Winter Park FL 327890000 593679904 501(c)(3) 20500 0 General Support Find Feed & Restore Inc 830 W Montrose Street Clermont FL 347110000 863070194 501(c)(3) 15000 0 General Support FLNC Inc 3355 E Semoran Blvd Apopka FL 32703 205774761 501(c)(3) 11057850 0 General Support Forest City Spanish Seventh Day Adventist Church 7601 Forest City Rd Orlando FL 328100000 593291153 501(c)(3) 22000 0 General Support Forest Lake Academy 500 Education Loop Apopka FL 327030000 590816443 501(c)(3) 15000 0 General Support Foundation For Orange County Public Schools 445 W Amelia St Ste 901 Orlando FL 328010000 592788435 501(c)(3) 66064 0 General Support Grace Medical Home Inc 1417 E Concord St Orlando FL 328030000 261817966 501(c)(3) 168000 0 General Support Harbor House of Central Florida Inc Po Box 680748 Orlando FL 328680000 591712936 501(c)(3) 10000 0 General Support Harvest Time International Inc 225 Harvest Time Dr Sanford FL 327710000 541698630 501(c)(3) 10000 0 General Support Health Care Center For The Homeless Inc 232 N Orange Blossom Trail Orlando FL 328051612 593185020 501(c)(3) 100000 0 General Support Healthy Start Coalition of Osceola County Inc 1014 Pennsylvania Ave St Cloud FL 347690000 593212535 501(c)(3) 15000 0 General Support Healthy Start Coalition of Seminole County Inc 820 W Lake Mary Blvd Ste 108 Sanford FL 327730000 464038747 501(c)(3) 6000 0 General Support Heart of Florida United Way Inc 1940 Traylor Blvd Orlando FL 328040000 590808854 501(c)(3) 65000 0 General Support Help Now of Osceola Inc 108 Church Street Kissimmee FL 347410000 592283508 501(c)(3) 12985 0 General Support Hispanic Business Initiative Fund Inc 3201 E Colonial Dr Ste A20 Orlando FL 328030000 593341405 501(c)(3) 13000 0 General Support Hispanic Heritage Scholarship Fund of Metro Orlando Inc 518 S Magnolia Ave Suite 100 Orlando FL 328010000 010807279 501(c)(3) 15000 0 General Support Hope Community Center Inc 1016 N Park Ave Apopka FL 327122720 562551312 501(c)(3) 21000 0 General Support Hope Helps Inc 812 Eyrie Dr Oviedo FL 327650000 208490916 501(c)(3) 15000 0 General Support Hope Now International Inc 423 Sandringham Court Ste 200 Winter Springs FL 327080000 274498303 501(c)(3) 10000 0 General Support Hope Partnership Inc dba Community Hope Center 2420 Old Vineland Road Kissimmee FL 347460000 800855060 501(c)(3) 15000 0 General Support Idignity Inc 424 E Central Blvd Ste 199 Orlando FL 328010000 010921490 501(c)(3) 10000 0 General Support Iglesia Cristiana Pentecostal de Orlando Inc 5850 Clarcona Ocoee Rd Orlando FL 328100000 593218454 501(c)(3) 20000 0 General Support Impower Inc 2290 N Ronald Reagan Blvd Longwood FL 327500000 650439778 501(c)(3) 80000 0 General Support Interfaith Council of Central Florida Po Box 3310 Winter Park FL 327900000 455420165 501(c)(3) 25000 0 General Support Jdrf International Incorporated 1850 Lee Rd Ste 132 Winter Park FL 327890000 231907729 501(c)(3) 30000 0 General Support Kids Beating Cancer 1720 Lee Rd Winter Park FL 327890000 593136203 501(c)(3) 15000 0 General Support Kids House of Seminole Inc 5467 N Ronald Reagan Blvd Sanford FL 327730000 593415005 501(c)(3) 47500 0 General Support Life Concepts Inc dba Quest Inc 1509 E Colonial Dr Ste 300 Orlando FL 328030000 592013160 501(c)(3) 20000 0 General Support Lifework Leadership Orlando Inc 1220 E Concord St Orlando FL 328035453 821245782 501(c)(3) 10000 0 General Support Lift Orlando 2043 Jacobs Pl Orlando FL 328050000 463607865 501(c)(3) 115000 0 General Support Mars Hill Seventh Day Adventist Church Po Box 1654 Sanford FL 327721654 264337526 501(c)(3) 25000 0 General Support Matthews Hope Ministries Inc 611 Business Park Blvd 101 Winter Garden FL 347870000 272245867 501(c)(3) 15000 0 General Support Meals on Wheels Etc Inc 2801 S Financial Ct Sanford FL 327730000 592977907 501(c)(3) 15000 0 General Support Mental Health Association of Central Florida Inc 1525 E Robinson St Orlando FL 328010000 590816432 501(c)(3) 199800 0 General Support Nami Greater Orlando Inc 300 Crown Oak Centre Dr Longwood FL 327500000 592600149 501(c)(3) 15000 0 General Support New Hope Missionary Baptist Church of Apopka Inc 927 South Central Ave Apopka FL 327030000 322335714 501(c)(3) 15000 0 General Support Nuevo Sendero Inc 1802 N Alafaya Trail Suite 156 Orlando FL 328260000 260298579 501(c)(3) 16000 0 General Support Orange County School Readiness Coalition Inc dba Early Learning Coalition o 7700 Southland Blvd Ste 100 Orlando FL 328090000 311759186 501(c)(3) 10000 0 General Support Orlando Economic Partnership Inc 200 South Orange Avenue No 200 Orlando FL 328010000 591767933 501(c)(3) 250000 0 General Support Osceola County Council on Aging Inc 700 Generation Point Kissimmee FL 347440000 591595398 501(c)(3) 30000 0 General Support Osceola Mental Health Inc dba Park Place Behavioral Health Care 206 Park Place Blvd Kissimmee FL 347410000 591677912 501(c)(3) 250000 0 General Support Poverty Solutions Group Inc 1000 Lincoln Ter Winter Garden FL 347872928 845151564 501(c)(3) 6700 0 General Support Primary Care Medical Services of Poinciana Inc 1877 Fortune Road Kissimmee FL 347440000 753147007 501(c)(3) 25000 0 General Support Ronald Mcdonald House Charities of Central Florida Inc 1030 N Orange Ave Suite 105 Orlando FL 328010000 593211250 501(c)(3) 112000 0 General Support Runway To Hope Inc 189 S Orange Ave Orlando FL 328013261 273272616 501(c)(3) 15000 0 General Support SOS Support Our Scholars Inc Po Box 1985 Winter Park FL 327900000 260711355 501(c)(3) 7500 0 General Support School District of Osceola County 817 Bill Beck Blvd Kissimmee FL 347444495 596000779 Gov't 25000 0 General Support Seminole State College of Florida 100 Weldon Blvd Sanford FL 327730000 591210158 Gov't 250000 0 General Support Seniors First Inc 5395 Lb Mcleod Rd Orlando FL 328112952 592759603 501(c)(3) 15000 0 General Support Shepherd'S Hope Inc 455 9Th St Winter Garden FL 347870000 593420727 501(c)(3) 170000 0 General Support South Florida State College 600 College Drive Avon Park FL 33825 591218159 Gov't 18785 0 General Support Sunbelt Health & Rehab Center - Apopka Inc 305 East Oak St Apopka FL 32703 205774856 501(c)(3) 1074829 0 General Support Teen Challenge of Florida Inc 3706 S Sanford Ave Sanford FL 327730000 592479228 501(c)(3) 10000 0 General Support The Christian Sharing Center Inc 600 N Hwy 17-92 Ste 130 Longwood FL 327500000 592744535 501(c)(3) 100000 0 General Support The Finley Project Inc 941 W Morse Blvd Ste 100 Winter Park FL 327890000 471325653 501(c)(3) 7500 0 General Support The Florida Endowmnet Foudnation For Vocational Rehabiliatation Inc ba Th 1709 Hermitage Blvd Ste 100 Tallahassee FL 323080000 593052307 501(c)(3) 7500 0 General Support The Foundation For Osceola Education Inc 2310 New Beginnings Rd Ste 118 Kissimmee FL 347440000 592960396 501(c)(3) 7000 0 General Support The Foundation For Seminole County Public Schools Inc 400 E Lake Mary Blvd Sanford FL 327730000 592775956 501(c)(3) 13500 0 General Support The School Board Of Highlands CountySebring High School 426 School Street Sebring FL 33870 596000654 Gov't 10000 0 General Support Tri-County Nursing Rehabilitation Center Inc 11290 Celebration Blvd Kissimmee FL 34747 472219363 501(c)(3) 210168 0 General Support United Abolitionist Inc Po Box 536832 Orlando FL 328530000 593178045 501(c)(3) 10000 0 General Support United Against Poverty Inc 1400 27Th St Vero Beach FL 329600000 113697936 501(c)(3) 10000 0 General Support United Cerebral Palsy of Central Florida 4780 Data Ct Orlando FL 328170000 590799925 501(c)(3) 7000 0 General Support United Global Outreach 2301 N Orange Ave Orlando FL 328045510 030511875 501(c)(3) 50000 0 General Support Universal Orlando Foundation Inc 1000 Universal Studios Plz Orlando FL 328197601 593510383 501(c)(3) 15000 0 General Support Us Dream Academy Inc 5950 Symphony Woods Dr Ste 504 Columbia MD 210440000 593514841 501(c)(3) 10000 0 General Support Valencia College Foundation Inc 1768 Park Center Drive Orlando FL 328350000 237442785 501(c)(3) 255000 0 General Support West Orange Chamber of Commerce 12184 W Colonial Drive Winter Garden FL 34787 590576757 501(c)(6) 8785 0 General Support Winter Park Library Association Inc 1052 W Morse Blvd Winter Park FL 327890000 590794396 501(c)(3) 50000 0 General Support 87 1 Part I, Line 2: Grants are generally made only to related organizations that are exempt from federal income tax under IRC Section 501(c)(3), or to other local charitable community organizations, or to other 501(c)(3) organizations that are a part of the group exemption ruling issued to the General Conference of Seventh-Day Adventists. Accordingly, the filing organization has not established specific procedures for monitoring the use of grant funds in the United States as the filing organization does not have a grant making program that would necessitate such procedures. X X X X X X 1 1 1 1 0 0 0 0 0 0 0 Shaw Terry D Dir/President/AdventHealth CEO 0 2220503 0 879735 0 1623038 0 895900 0 59807 0 5678983 0 130500 Silvestry MD Scott Phy/Dir AH Thoracic Transplant 1741716 0 1144480 0 22880 0 16400 0 31461 0 2956937 0 0 0 Rathbun Paul C AdventHealth CFO 0 1218839 0 421406 0 895765 0 166400 0 45556 0 2747966 0 150000 Haffner PhD Randall CEO Central FL Division 0 1552405 0 562179 0 305660 0 145900 0 44132 0 2610276 0 150000 Goodman Todd CFO, AH Central FL Division 0 860712 0 218316 0 743829 0 145900 0 58441 0 2027198 0 117093 Moorhead MD David Former EVP/Chief Clinical Officer 0 943380 0 295926 0 495369 0 16400 0 17940 0 1769015 0 0 Accola MD Kevin Phy/Exec Med Dir/Cardio Surgery & St 1409335 0 200000 0 17109 0 16400 0 19124 0 1661968 0 0 0 Zeeshan MD Ahmad Physician - Heart Transplant 770956 0 678152 0 9188 0 16400 0 19193 0 1493889 0 0 0 Bogar MD Linda Physician - Heart Transplant 742977 0 678152 0 13799 0 16400 0 28430 0 1479758 0 0 0 Palmer MD George Phy/AH Celebration Cardio Surgery 1297564 0 100000 0 19326 0 16400 0 28316 0 1461606 0 0 0 Villanueva Jeffrey CEO AH East Orlando & East Market 0 454778 0 101425 0 758689 0 72620 0 46972 0 1434484 0 36453 Thompson Michael CEO IHS Central FL Div-South Region 0 638734 0 197706 0 387487 0 96504 0 50341 0 1370772 0 58923 Adams Brian CEO Central FL Div. South Region 0 736878 0 158876 0 257632 0 130406 0 52409 0 1336201 0 52409 Finkler MD Neil Chief Clinical Officer AH Central FL 0 689063 0 156223 0 380016 0 16400 0 26776 0 1268478 0 171073 Hilliard Douglas Sr Finance Officer AH Orlando 0 605619 0 162383 0 238456 0 90400 0 48080 0 1144938 0 51130 Wandersleben Jennifer Former CEO AH CFD So Acute Care S 0 649654 0 180378 0 119238 0 114611 0 55833 0 1119714 0 59424 Deininger Robert CEO AH Orlando 0 547187 0 123750 0 66026 0 92862 0 47326 0 877151 0 20120 Harcombe Douglas CEO AH Celebration & South Market 0 490120 0 113042 0 89447 0 81383 0 50877 0 824869 0 51223 Cook Timothy CEO AH Altamonte & Seminole Market 0 459242 0 134089 0 104571 0 77615 0 46916 0 822433 0 47890 Zbaraschuk Amy Sr Fin Off. Central FL Div-South Reg 0 468436 0 132293 0 79507 0 75918 0 46082 0 802236 0 48981 Tol Daryl Former SEVP/CEO Central FL Div 0 0 0 0 0 792032 0 0 0 104 0 792136 0 0 Moorhead Sheryl Chief People Off. AH Central FL Div. 0 481561 0 131228 0 136018 0 16400 0 19512 0 784719 0 0 Vargas Karilynn CEO AH Winter Garden & West Market 0 411728 0 101483 0 63078 0 45268 0 50143 0 671700 0 21775 Owen Terry R Former SVP Partnering Strategy CFD 0 0 0 0 0 305559 0 0 0 16138 0 321697 0 0 Bradley Kenneth W Former Key Emp/AH Dir Emerging Leade 0 158577 0 21765 0 13206 0 9165 0 25102 0 227815 0 0 Part I, Line 1a The filing organization is a part of the system of healthcare organizations known as AdventHealth. Members of the filing organization's executive management team that hold the position of Vice-President or above are compensated by and on the payroll of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), the parent organization of the healthcare system known as AdventHealth. AHSSHC is exempt from federal income tax under IRC Section 501(c)(3). The filing organization reimburses AHSSHC for the salary and benefit cost of those executive 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). The CEO, CFO, Chief Clinical Officer and Chief People Officer of the AdventHealth Central FL Division, the Central FL-South Region CEO and the CEO of the IHS Division in Central FL South Region are officers or key employees of the filing organization. The CEO, CFO, Chief Clinical Officer and Chief People Officer of the AdventHealth Central FL Division, the Central FL-South Region CEO and the CEO of the IHS Division in Central FL South Region are considered common law employees of and are on the payroll of AHSSHC. While the special travel allowance benefit is an AHSSHC compensation policy and practice, the cost of providing this benefit is allocated to and either wholly or partially reimbursed by the filing organization. Accordingly, the filing organization has checked the box in Schedule J, Part I, line 1a for first-class or charter travel since it has wholly or partially paid for the cost of providing this benefit. Those executives who receive the special travel allowance are responsible for tracking the expenses reimbursable under the special travel allowance and must submit such expenses on their accountable plan expense report. A report on charter travel is provided to the AHSSHC Board Compensation Committee at each meeting. Any taxable reimbursements made to executives under the special travel allowance arrangement are treated as taxable compensation to the executive. Travel for companions: AHSSHC has a Corporate Executive Policy that provides a benefit to allow for a traveling AHSSHC executive to have his or her spouse accompany the executive on certain business trips each year. Typically, reimbursement is only provided to certain executive leaders and is usually limited to one business trip per year beyond the annual AdventHealth President's Council business meeting and other meetings where the spouse is specifically invited. The AHSSHC Corporate Executive Spousal Travel Policy was originally approved and reviewed by the AHSSHC Board Compensation Committee, an independent body of the AHSSHC Board of Directors. All spousal travel costs reimbursed to the executive are considered taxable compensation to the executive. Tax Indemnification and gross-up payments: AdventHealth has a system-wide policy addressing gross-up payments provided in connection with employer-provided benefits/other taxable items. Under the policy, certain taxable business-related reimbursements (i.e. taxable business-related moving expenses, taxable items provided in connection with employment) provided to any employee may be grossed-up at a 25% rate upon approval by the filing organization's CEO and CFO. Additionally, employees at the Director level and above are eligible for gross-up payments on gifts received for board of director services. Discretionary spending account: Occasional discretionary spending amounts are periodically provided to eligible executives who attend annual business meetings such as the AdventHealth President's Council, CFO Conference or the CMO/CNO business meeting. Payments provided to each executive are considered taxable compensation to the executive. Housing allowance or residence for personal use: AHSSHC has a Corporate Executive Policy that addresses assistance to executives who have been relocated by the company during the year. Relocation assistance provided to executives may include relocation allowances to assist with duplicate housing expenses. Relocation assistance is administered per AHSSHC policy by an external relocation company. All taxable reimbursements made to executives in connection with relocation assistance are treated as wages to the executive and are subject to all payroll withholding and reporting requirements. 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, for this filing organization, one executive listed in Part VII received reimbursement for club fees. While the club dues membership is an AHSSHC compensation policy and practice, the cost of providing this benefit is allocated to and reimbursed in whole or in part by the filing organization. Accordingly, the filing organization has checked the box in Schedule J, Part I, line 1a for health or social club dues since it has wholly or partially paid for the cost of providing this benefit. Part I, Line 3 The individual who serves as the CEO of the filing organization is 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, Lines 4a-b During the year ending December 31, 2022, Daryl Tol and Terry Owen received severance payments in the amount of $776,484 and $290,319, respectively. Pursuant to the AHSSHC Corporate Executive Policy governing executive severance, severance agreements for executives operating at the Vice President level and above are entered into upon eligibility to facilitate the transition to subsequent employment following an involuntary separation from employment with AdventHealth. 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. Schedule J, Part I, Line 4 b continued: FLEX PLAN FLEX PLAN SERP II SERP III CONTR. DISTR.* CONTR./DISTR. CONTR. Shaw, Terry D. $ 150,000 $ 130,205 $1,369,868 $ 0 Rathbun, Paul C. $ 150,000 $ 197,530 $ 607,786 $ 0 Haffner, Randall $ 150,000 $ 221,968 $ 0 $ 0 Goodman, Todd $ 150,000 $ 157,963 $ 532,684 $ 0 FLEX PLAN FLEX PLAN SERP II SERP III CONTR. DISTR.* CONTR./DISTR. CONTR. Moorhead, MD, David $ 150,000 $ 129,500 $ 251,506 $ 0 Villanueva, Jeffery $ 56,220 $ 46,826 $ 691,096 $ 0 Thompson, Michael $ 100,604 $ 58,939 $ 278,689 $ 0 Adams, Brian $ 130,775 $ 52,422 $ 0 $ 3,731 Finkler, Neil $ 127,597 $ 289,889 $ 0 $ 0 Hilliard, Douglas $ 94,500 $ 64,040 $ 129,257 $ 0 Wandersleben, Jennifer $ 108,827 $ 60,800 $ 0 $ 9,884 Deininger, Robert $ 78,654 $ 25,469 $ 0 $ 18,308 Harcombe, Douglas $ 64,983 $ 63,738 $ 0 $ 0 Cook, Timothy $ 61,215 $ 63,038 $ 0 $ 0 Zbaraschuk, Amy $ 59,518 $ 56,510 $ 0 $ 0 Moorhead, Sheryl $ 84,858 $ 64,358 $ 0 $ 0 Vargas, Karilynn $ 49,368 $ 25,621 $ 0 $ 0 * Including Investment Earnings A Highlands County Health Facilities Authority 521313569 431022KK7 2007-08-08 366445000 2007A B C D, Expand/refurbish facilities, purchase equipment 0 0 0 B Highlands County Health Facilities Authority 521313569 NoneAvail 2012-03-21 294985000 2012A, AR Program - Refund 2009 A-F AR Program 0 0 0 C Highlands County Health Facilities Authority 521313569 NoneAvail 2012-07-25 115015000 2012B, AR Program - Expand/refurbish facilities, purchase equipment 0 0 0 D Highlands County Health Facilities Authority 521313569 431022TL6 2012-08-29 348320000 2012B-F - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C 0 0 0 A 281555000 372572414 5560382 367012032 2007 0 0 1 1 B 210000000 294985000 294985000 2004 1 0 1 1 C 115015000 115015000 2012 0 0 1 1 D 258665000 348320000 348320000 2008 1 0 1 1 A 0 1 1 1 1 1 0.01420 0.01420 0 0 1 B 0 0 1 1 1 1 0 1 0.00140 0 1 C 0 0 1 1 1 1 0 1 0.00140 0 1 D 0 1 1 1 1 1 0.00500 0.00500 0 1 0.00370 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 D 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 Part II, Line 3, Total Proceeds of Issue Highlands County Health Facilities Authority 2007A B C D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part II, Line 3, Total Proceeds of Issue Highlands County Health Facilities Authority 2013A-C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part II, Line 3, Total Proceeds of Issue Highlands County Health Facilities Authority 2014A&D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part II, Line 3, Total Proceeds of Issue Highlands County Health Facilities Authority 2014B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part II, Line 3, Total Proceeds of Issue Highlands County Health Facilities Authority 2014C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part II, Line 3, Total Proceeds of Issue Highlands County Health Facilities Authority 2014E: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings. Part III, Line 8c Highlands County Health Facilities Authority 2012A, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds. Part III, Line 8c Highlands County Health Facilities Authority 2012B, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds. Part III, Line 8c Highlands County Health Facilities Authority 2012B-F: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015. A Highlands County Health Facilities Authority 521313569 NoneAvail 2012-08-29 125000000 2012G&H - Refund Highlands 2005I Conversion Bonds 0 0 0 B Highlands County Health Facilities Authority 521313569 431022TR3 2012-11-08 232125000 2012I - Refunded Volusia 1994-A; Highlands 2004A, 2005E, 2005F, 2005G 0 0 0 C Highlands County Health Facilities Authority 521313569 NoneAvail 2013-09-18 485000000 2013A B C, Expand/refurbish facilities, purchase equipment 0 0 0 D Highlands County Health Facilities Authority 521313569 NoneAvail 2014-07-02 110000000 2014A&D, Refund 2013C, expand/refurbish facilities, purchase equipment 0 0 0 A 69945000 125000000 125000000 2005 1 0 1 1 B 30435000 232125000 232125000 2005 1 0 1 1 C 297345000 485340528 485340528 2013 0 0 1 1 D 42528339 110068380 50068380 60000000 2015 1 0 1 1 A 0 1 1 1 1 1 0.00900 0.00900 0 0 1 B 0 1 1 1 1 1 0.00200 0.00200 0 0 1 C 0 0 1 1 1 1 0 0 1 D 0 0 1 1 1 1 0 1 0.00090 1 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 D 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 A Orange County Health Facilities Authority 521378595 NoneAvail 2014-07-02 50000000 2014B, Expand/refurbish facilities, purchase equipment 0 0 0 B Kansas Development Finance Authority 481066589 NoneAvail 2014-07-02 30000000 2014C, Expand/refurbish facilities, purchase equipment 0 0 0 C Colorado Health Facilities Authority 840752932 19648AT39 2014-07-23 82501800 2014E, Expand/refurbish facilities, purchase equipment 1 0 0 D Colorado Health Facilities Authority 840752932 19648FAB0 2016-07-21 235724616 2016 A&B, Adv ref portion 2009D, Exp/refurbish facilities, purchase equip 1 0 0 A 28333339 50068380 50068380 2015 0 0 1 1 B 17000000 30041050 30041050 2015 0 0 1 1 C 2800000 82616012 82616012 2015 0 0 1 1 D 9810000 8535000 235724616 169561866 66162750 2016 0 1 1 1 A 0 0 1 1 1 1 0 1 0.00080 1 1 B 0 0 1 1 1 1 0 1 0.00080 1 1 C 0 0 1 1 1 1 0 1 0.00110 1 1 D 0 0 1 1 1 1 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 D 0 0 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 A Colorado Health Facilities Authority 840752932 1964745K2 2016-08-17 216517920 2016C, Refund 2006C, Expand/refurbish facilities, purchase equipment 1 0 0 B Colorado Health Facilities Authority 840752932 19648FGN8 2018-07-12 375008542 2018A&B, Expand/refurbish facilities, purchase equipment 0 0 0 C Colorado Health Facilities Authority 840752932 19648FJG0 2019-08-20 550011892 2019A&B, Refund 05I, 09C, 09D, 09E&08B, 13B; expand/refurb fac, purch equip 1 0 0 D Colorado Health Facilities Authority 840752932 19648FSJ4 2021-07-01 579966540 2021A, Refund 2010D, 2017D; Expand/refurbish facilities, purchase equipment 0 0 0 A 22900000 216517920 63248816 153269104 2016 1 0 1 1 B 375008542 375008542 2018 0 1 1 1 C 33200000 11250000 550011892 146365717 403646175 2019 1 0 1 1 D 30000000 579966540 481966540 98000000 2021 1 1 1 1 A 0 1 1 1 1 1 0.00250 0.00070 0.00320 0 0 1 B 0 1 1 1 1 1 0 0 1 C 0 1 1 1 1 1 0.00840 0.00840 0 0 1 D 0 1 1 1 1 1 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 1 1 0 1 0 0 0 1 C 0 1 1 0 1 0 0 0 1 D 0 1 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 A Kansas Development Finance Authority 481066589 48542AFE6 2021-07-01 238025567 2021B, Refund 2010C, 2017C; Expand/refurbish facilities 1 0 0 B Orange County Health Facilities Authority 521378595 68450LGB5 2021-07-01 62003621 2021C, Refund 2010B, 2017A; Expand/refurbish facilities 1 0 0 C Highlands County Health Facilities Authority 521313569 431022UJ9 2021-07-01 200000000 2021D, Refund 2011A, 2012G, 2017B; Expand/refurbish facilities 0 0 0 D Highlands County Health Facilities Authority 521313569 NoneAvail 2022-06-01 335007000 2022A-C, Refund 2012A, 2012C; Expand/refurbish facilities 0 0 0 A 10745000 238025567 182025567 56000000 2021 1 1 1 1 B 3025000 62003621 6503621 55500000 2021 1 1 1 1 C 12045000 200000000 13700000 186300000 2021 1 0 1 1 D 335007000 39000000 296007000 2022 1 0 1 1 A 0 1 1 1 1 1 0 0 1 B 0 1 1 1 1 1 0 0 1 C 0 1 1 1 1 1 0 0 1 D 0 1 1 1 1 1 0 0 1 A 0 1 1 0 1 0 0 0 1 B 0 1 1 0 1 0 0 0 1 C 0 1 1 0 1 0 0 0 1 D 0 1 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 Amy Litzenberger Family of key employee 80676 Employee Compensation 0 Bailey Ringering Family of officer 116028 Employee Compensation 0 Jacob Cook Family of key employee 87487 Employee Compensation 0 Jeannette Carey Family of key employee 169159 Employee Compensation 0 Justin Cook Family of key employee 58819 Employee Compensation 0 Karis Zbaraschuk Family of key employee 84146 Employee Compensation 0 Martin Shaw Family of board member 91959 Employee Compensation 0 Martin Thompson Family of key employee 178733 Employee Compensation 0 Mary Rathbun Family of officer 33187 Employee Compensation 0 Vivian Cook Family of key employee 52404 Employee Compensation 0 Form 990, Part V, Line 1a: The parent corporation and sole top-tier member of Adventist Health System/Sunbelt, Inc. (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 2 Family Relationship - Gary F. Thurber and John (Mic) Thurber Form 990, Part VI, Section A, line 6 Adventist Health System/Sunbelt, Inc. (the filing organization) has one member. The sole member of the filing organization is Adventist Health System Sunbelt Healthcare Corporation. Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). There are no other classes of membership in the filing organization. Form 990, Part VI, Section A, line 7a The sole member of the filing organization is AHSSHC. The Board of Directors of the filing organization are appointed by the sole member, AHSSHC, who has the right to elect, appoint or remove any member of the Board of Directors of the filing organization. Form 990, Part VI, Section A, line 7b AHSSHC, as the sole member of the filing organization, has certain reserved powers as set forth in the Bylaws of the filing organization. These reserved powers include the following: a) to approve and disapprove the executive and/or administrative leadership of the filing organization, and their salaries; b) to approve and disapprove the operating Bylaws of the filing organization; c) to set limits and terms for the borrowing of funds; d) to approve or disapprove major building programs and/or purchase or sale of personal property or real property equal to or in excess of One Million dollars; e) to approve or disapprove the annual operating and capital budgets of the filing organization; f) to direct the placement of funds and capital of the filing organization, and the authority to secure naming rights; g) the authority to require adherence to policies adopted; h) to approve or disapprove the implementation of non-traditional, non-healthcare related activities; i) to approve or disapprove performance/quality improvement, revenue cycle and case management programs; j) to approve or disapprove the selection of the auditing firm retained to audit the books; k) to approve or disapprove the election of the fiscal year; l) to approve or disapprove the selection of the 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 or disapprove the IT systems and other shared services used; o) the authority to require adherence to the system-wide naming nomenclature and service standards apopted; p) to set and enforce policies for physician compensation including commercial reasonableness and fair market value; and o) to exercise such other powers as are necessary in connection with the foregoing. Form 990, Part VI, Section B, line 11b The filing organization's current year Form 990 was reviewed by the Senior VP/Chief Accounting Officer prior to its filing with the IRS. The review conducted by the Senior VP/Chief Accounting Officer 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. Form 990, Part VII, Section A, Column (E) & (F): For those Board of Director members, officers, 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. Form 990, Part VIII, Lines 7a, b and c: The amounts shown in Part VIII, Lines 7a(i), 7b(i) and 7c(i) of the Form 990 represent an allocated share of capital gain/(loss) from a system wide, corporate administered, investment program. Form 990, Part IX, line 11g Payments to Healthcare Professionals: Program service expenses 678,229,361. Management and general expenses 0. Fundraising expenses 0. Total expenses 678,229,361. Professional Fees: Program service expenses 108,645,516. Management and general expenses 0. Fundraising expenses 0. Total expenses 108,645,516. Purchased Medical Services: Program service expenses 23,011,732. Management and general expenses 0. Fundraising expenses 0. Total expenses 23,011,732. Environmental Services: Program service expenses 10,116,964. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,116,964. Transcription Services: Program service expenses 1,520,385. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,520,385. Recruiting: Program service expenses 6,568,882. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,568,882. Food Service Contracts: Program service expenses 6,426. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,426. Miscellaneous Purchased Services: Program service expenses 8,034,012. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,034,012. AdventHealth Management Fees: Program service expenses 0. Management and general expenses 121,663,144. Fundraising expenses 0. Total expenses 121,663,144. Billing & Collection Services: Program service expenses 0. Management and general expenses 41,504,237. Fundraising expenses 0. Total expenses 41,504,237. AdventHealth Shared Services Fee: Program service expenses 0. Management and general expenses 58,977,195. Fundraising expenses 0. Total expenses 58,977,195. Form 990, Part X, Line 2: The amounts shown on line 2 of Part X of this return include the filing organization's interest in a central investment pool maintained by Adventist Health System Sunbelt Healthcare Corporation, the filing organization's top-tier parent. The investments in the central investment pool are recorded at market value. Form 990, Part XI, line 9: Transfer from tax-exempt parent 76,492,442. Transfer from tax-exempt affiliate 2,000,000. Debt costs allocated to tax-exempt affiliates -14,800,358. Transfer to operations -140,653. Gifts 61,086. Transfer from supporting tax-exempt foundation 2,472,666. Carrying value of deconsolidated subsidiary pursuant to ASC 810 (GLR) 394,917,930. Change in intercompany allocation of tax-exempt bond proceeds -347,527,647. IQ Orlando LLC 550 E Rollins St Orlando FL 32803 471121247 Design and innovation FL 0 0 Adventist Hlth SystemSunbelt Inc AdventHealth Ashville Inc (5922 - 123122) 900 Hope Way Altamonte Springs FL 32714 921144574 Future Operation of Hospital & Related Services NC 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth Family Medicine Rural Health Clinics Inc 187 PR 4060 Lampasas TX 76550 271858033 Operation of Rural Health Clinics & Medical Services FL 501(c)(3) Line 3 Metroplex Adventist Hospital Inc 1 AdventHealth Foundation fka SunSystem Development Corp 900 Hope Way Altamonte Springs FL 32714 592219301 Fund-Raising for Affiliated Tax-Exempt Hospitals FL 501(c)(3) Line 7 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth Home Care East Florida LLC 770 West Granada Blvd 319 Ormond Beach FL 32174 833768458 Inactive FL 501(c)(3) Line 10 Memorial Hlth Systems Inc 1 AdventHealth Hospice Care East Florida Inc 770 West Granada Blvd 304 Ormond Beach FL 32174 833748461 Inactive FL 501(c)(3) Line 10 Memorial Hlth Systems Inc 1 AdventHealth Kansas City Foundation 7315 E Frontage Road Merriam KS 66204 480868859 Fund-raising for Tax-exempt hospitals KS 501(c)(3) Line 7 Shawnee Mission Medical Center Inc 1 AdventHealth North Polk Inc 3100 E Fletcher Ave Tampa FL 33613 593231322 Inactive FL 501(c)(3) Line 12a, I University Community Hospital Inc 1 AdventHealth Palm Coast Parkway Inc fka AH East Florida Inc 900 Hope Way Altamonte Springs FL 32714 882288563 Future Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth Polk North Inc 40100 US Highway 27 N Davenport FL 33837 841793121 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth Polk South Inc 410 South 11th Street Lake Wales FL 33853 834672945 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth Ransom Memorial Inc 1301 S Main Street Ottawa KS 66067 830976641 Operation of Hospital & Related Services KS 501(c)(3) Line 3 Adventist Hlth Mid-America Inc 1 AdventHealth Riverview Inc 14055 Riveredge Drive Ste 150 Tampa FL 33637 870901094 Future Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth Senior Care Inc 900 Hope Way Altamonte Springs FL 32714 841817046 Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth South Overland Park Inc 7820 W 165th Street Overland Park KS 66223 364595806 Operation of Hospital & Related Services KS 501(c)(3) Line 3 Adventist Hlth Mid-America Inc 1 AdventHealth University Inc 671 Winyah Drive Orlando FL 32803 593069793 Education/Operation of School FL 501(c)(3) Line 2 Adventist Hlth SystemSunbelt Inc 1 AdventHealth West Florida Ambulatory Services Inc 14055 Riveredge Drive Ste 250 Tampa FL 33637 471881744 Support of Imaging Center & Home Health Subsidiaries FL 501(c)(3) Line 12b, II Adventist Hlth System Sunbelt Hlthcare Corp 1 AdventHealth West Florida Imaging Inc 14055 Riveredge Drive Ste 250 Tampa FL 33637 843225135 Imaging & Testing FL 501(c)(3) Line 3 AdventHealth West Florida Ambulatory Services Inc 1 Adventist Bolingbrook Hospital 500 Remington Blvd Bolingbrook IL 60440 651219504 Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 Adventist Care Centers - Courtland Inc 730 Courtland Street Orlando FL 32804 205774723 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Adventist GlenOaks Hospital 701 Winthrop Avenue Glendale Heights IL 60139 363208390 Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 Adventist Health Mid-America Inc 9100 W 74th Street Shawnee Mission KS 66204 521347407 Support of Affiliated Hospital KS 501(c)(3) Line 12c, III-FI Adventist Hlth SystemSunbelt Inc 1 Adventist Health Partners Inc 5101 S Willow Springs Rd Suite B101 La Grange IL 60525 364138353 Operation of Physician Practices & Medical Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 Adventist Health System Georgia Inc 1035 Red Bud Road NE Calhoun GA 30701 581425000 Operation of Hospital & Related Services GA 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Adventist Hlth System Sunbelt Hlthcare Corp 900 Hope Way Altamonte Springs FL 32714 592170012 Management Services FL 501(c)(3) Line 12a, I N/A 0 Adventist Hlth SystemSunbelt Inc 900 Hope Way Altamonte Springs FL 32714 591479658 Operation of Hospitals & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Adventist Hlth SystemTexas Inc 11801 S Freeway Burleson TX 76028 742578952 Leasing Personnel to Affiliated Hospital TX 501(c)(3) Line 12c, III-FI Adventist Hlth System Sunbelt Hlthcare Corp 1 Adventist Midwest Health 120 North Oak Street Hinsdale IL 60521 362276984 Operation of Hospitals & Related Services IL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 AHP Specialty Care NFP 5101 S Willow Springs Rd Suite B101 La Grange IL 60525 811105774 Operation of Physician Practices & Medical Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 AHS Midwest Management Inc 500 Remington Blvd Bolingbrook IL 60440 363354567 Operation of Physician Practice Management IL 501(c)(3) Line 12a, I Adventist Hlth System Sunbelt Hlthcare Corp 1 Apopka Health Care Properties Inc 305 E Oak Street Apopka FL 32703 510605694 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Bert Fish Medical Center Auxiliary Inc 401 Palmetto Street New Smyrna Beach FL 32168 591054892 Volunteer support services FL 501(c)(3) Line 10 Southeast Volusia Healthcare Corp 0 Bradford Heights Health & Rehab Center Inc (11-122222) 485 North Keller Road 250 Maitland FL 32751 205782342 Inactive - Wind-Down KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Burleson Nursing & Rehab Center Inc 301 Huguley Blvd Burleson TX 76028 205782243 Operation of Home for the Aged/Hlthcare Delivery TX 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Chickasaw Health Care Properties Inc 250 S Chickasaw Trail Orlando FL 32825 510605681 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Chippewa Valley Hospital & Oakview Care Center Inc 1220 Third Avenue West Durand WI 54736 391365168 Operation of Hospital & Related Services WI 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Coalition For Physician Well-Being Inc 900 Hope Way Altamonte Springs FL 32714 463477012 Provide support for Physician well-being FL 501(c)(3) Line 10 Adventist Hlth System Sunbelt Hlthcare Corp 1 Courtland Health Care Properties Inc 730 Courtland Street Orlando FL 32804 510605682 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Creekwood Place Nursing & Rehab Center Inc (11-12622) 485 North Keller Road 250 Maitland FL 32751 205782260 Inactive - Wind-Down KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Dairy Road Health Care Properties Inc 7350 Dairy Road Zephyrhills FL 33540 510605684 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 East Orlando Health & Rehab Center Inc 250 S Chickasaw Trail Orlando FL 32825 205774748 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Fletcher Hospital Inc 100 Hospital Drive Hendersonville NC 28792 560543246 Operation of Hospital & Related Services NC 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 FLNC Inc 3355 E Semoran Blvd Apopka FL 32703 205774761 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Florida Hospital Dade City Inc 13100 Fort King Road Dade City FL 33525 822567308 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Florida Hospital Healthcare Partners Inc 770 West Granada Blvd 101 Ormond Beach FL 32174 462354804 Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Florida Hospital Medical Group Inc 2600 Westhall Lane 4th Floor Maitland FL 32751 593214635 Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Florida Hospital Ocala Inc 1500 SW 1st Avenue Ocala FL 34471 824372339 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Florida Hospital Physician Group Inc 12470 Telecom Dr 100 Tampa FL 33637 462021581 Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Florida Hospital Waterman Inc 1000 Waterman Way Tavares FL 32778 593140669 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Florida Hospital Zephyrhills Inc 7050 Gall Blvd Zephyrhills FL 33541 592108057 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Florida Radiology Imaging at Lake Mary LLC 2600 Westhall Lane 4th Floor Maitland FL 32751 550789387 Imaging & Testing FL 501(c)(3) Line 3 Florida Hospital Medical Group Inc 1 Fountain Inn Nursing & Rehab Center Inc 4501 Waterman Way Tavares FL 32778 472180518 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Helen Ellis Memorial Hospital Auxiliary Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 592106043 Fund-raising for Tax-exempt hospital/foundation FL 501(c)(3) Line 12c, III-FI N/A 0 Helen Ellis Memorial Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 593690149 Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 7 N/A 0 Hinsdale Hospital Foundation 120 North Oak Street Hinsdale IL 60521 521466387 Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation 0 Hospice of the Comforter Inc 480 W Central Parkway Altamonte Springs FL 32714 592935928 Operation of Hospice FL 501(c)(3) Line 10 The Comforter Health Care Group Inc 1 In-Motion Rehab Inc (11-122722) 485 North Keller Road 250 Maitland FL 32751 208023411 Inactive KS 501(c)(3) Line 12b, II Sunbelt Hlth Care Centers Inc 1 Lake County Health Care Properties Inc (11-122822) 485 North Keller Road 250 Maitland FL 32751 813923985 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Memorial Health Systems Foundation Inc 305 Memorial Medical Pkwy 212 Daytona Beach FL 32117 311771522 Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 7 N/A 0 Memorial Health Systems Inc 301 Memorial Medical Parkway Daytona Beach FL 32117 590973502 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Memorial Hospital - West Volusia Inc 701 West Plymouth Avenue Deland FL 32720 593256803 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Memorial Hlth Systems Inc 1 Memorial Hospital Flagler Inc 60 Memorial Medical Parkway Palm Coast FL 32164 592951990 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Memorial Hlth Systems Inc 1 Memorial Hospital Inc 210 Marie Langdon Drive Manchester KY 40962 610594620 Operation of Hospital & Related Services KY 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Metroplex Adventist Hospital Inc 2201 S Clear Creek Road Killeen TX 76549 742225672 Operation of Hospital & Related Services TX 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Metroplex Clinic Physicians Inc 2201 S Clear Creek Road Killeen TX 76549 113762050 Physician Healthcare services to the community TX 501(c)(3) Line 3 Metroplex Adventist Hospital Inc 1 Midwest Health Foundation 120 North Oak Street Hinsdale IL 60521 352230515 Fund-Raising for Supported Exempt Hospitals IL 501(c)(3) Line 7 N/A 0 Mills Health & Rehab Center Inc(11-12622) 485 North Keller Road 250 Maitland FL 32751 205782320 Inactive - Wind-Down KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Mission Strategies of Georgia Inc 485 North Keller Road 250 Maitland FL 32751 900866024 Provision of support to the nursing home division GA 501(c)(3) Line 12b, II Sunbelt Hlth Care Centers Inc 1 Missouri Adventist Health Inc 9100 W 74th Street Shawnee Mission KS 66204 431224729 Support Health Care Services MO 501(c)(3) Line 12d, III-O Adventist Hlth Mid-America Inc 1 Osceola Health Care Properties Inc 485 North Keller Road 250 Maitland FL 32751 813165729 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Overland Park Nursing & Rehab Center Inc 6501 West 75th Street Overland Park KS 66204 205774821 Operation of Home for the Aged/Hlthcare Delivery KS 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Pasco-Pinellas Hillsborough Community Hlth System Inc 2600 Bruce B Downs Blvd Wesley Chapel FL 33544 208488713 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Portercare Adventist Health System (630 YE) 9100 E Mineral Circle Centennial CO 80112 840438224 Operation of Hospitals & Related Services CO 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Princeton Health & Rehab Center Inc (11-12622) 485 North Keller Road 250 Maitland FL 32751 205782272 Inactive - Wind-Down KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Princeton Homecare Services LLC (81 - 123122) 602 Courtland Street 310 Orlando FL 32804 814196648 Home Health Care Servcies FL 501(c)(3) Line 10 Princeton Prof Services Inc 1 Princeton Professional Services Inc 601 E Rollins Street Orlando FL 32803 591191045 Provision of Healthcare Services FL 501(c)(3) Line 10 Adventist Hlth System Sunbelt Hlthcare Corp 1 Quality Circle for Healthcare Inc 900 Hope Way Altamonte Springs FL 32714 263789368 Healthcare Quality Services FL 501(c)(3) Line 12a, I Adventist Hlth System Sunbelt Hlthcare Corp 1 Redmond Park Hospital LLC 501 Redmond Road NW Rome GA 30165 581123037 Operation of Hospital & Related Services GA 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Resource Personnel Inc 485 North Keller Road 250 Maitland FL 32751 208040875 Provide administrative support to tax exempt nursing homes FL 501(c)(3) Line 12b, II Sunbelt Hlth Care Centers Inc 1 Rocky Mountain Adventist Hlthcare Foundation (630 YE) 960 E Harvard Avenue Ste 230 Denver CO 80210 840745018 Fund-raising for Tax-exempt hospital CO 501(c)(3) Line 7 N/A 0 Rollins Brook Community Care Corp 2201 S Clear Creek Road Killeen TX 76549 461656773 Support Operation of Hospital TX 501(c)(3) Line 12a, I Adventist Hlth SystemSunbelt Inc 1 San Marcos Nursing & Rehab Center Inc 1900 Medical Parkway San Marcos TX 78666 205782224 Operation of Home for the Aged/Hlthcare Delivery TX 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Shawnee Mission Hlth Care Properties Inc 485 North Keller Road 250 Maitland FL 32751 813914908 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Shawnee Mission Health Care Inc 6501 West 75th Street Overland Park KS 66204 480952508 Lease to Related Organization KS 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Shawnee Mission Medical Center Inc 9100 W 74th Street Shawnee Mission KS 66204 480637331 Operation of Hospital & Related Services KS 501(c)(3) Line 3 Adventist Hlth Mid-America Inc 1 South Pasco Health Care Properties Inc 38250 A Avenue Zephyrhills FL 33542 510605679 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Southeast Volusia Healthcare Corp 401 Palmetto Street New Smyrna Beach FL 32168 473793197 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Southwest Volusia Health Services Inc 1055 Saxon Blvd Orange City FL 32763 593281591 Medical Office Building for Hospital FL 501(c)(3) Line 12a, I Southwest Volusia Hlthcare Corp 1 Southwest Volusia Healthcare Corp 1055 Saxon Blvd Orange City FL 32763 593149293 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Spring View Health & Rehab Center Inc (11-122222) 485 North Keller Road 250 Maitland FL 32751 205782288 Inactive - Wind-Down KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Sunbelt Health & Rehab Center - Apopka Inc 305 East Oak Street Apopka FL 32703 205774856 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Sunbelt Health Care Centers Inc 485 North Keller Road 250 Maitland FL 32751 581473135 Management Services TN 501(c)(3) Line 12b, II Adventist Hlth System Sunbelt Hlthcare Corp 1 Tarpon Springs Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 590898901 Operation of Hospital & Related Services FL 501(c)(3) Line 3 University Community Hospital Inc 1 Tarrant County Health Care Properties Inc 301 Huguley Blvd Burleson TX 76028 510605677 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 The Comforter Health Care Group Inc 605 Montgomery Road Altamonte Springs FL 32714 271857940 Support Services to Related Hospice FL 501(c)(3) Line 12c, III-FI Adventist Hlth System Sunbelt Hlthcare Corp 1 Tri-County Nursing and Rehab Center Inc 1290 Celebration Blvd Kissimmee FL 34747 472219363 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 University Community Hospital Foundation Inc 3100 E Fletcher Ave Tampa FL 33613 592554889 Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 7 N/A 0 University Community Hospital Inc 3100 E Fletcher Ave Tampa FL 33613 591113901 Operation of Hospitals & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 West Florida Health Home Care Inc 13601 Bruce B Downs Blvd Ste 110 Tampa FL 33613 593686109 Home Health Services GA 501(c)(3) Line 10 AdventHealth West Florida Ambulatory Svcs Inc 1 Zephyr Haven Health & Rehab Center Inc 38250 A Avenue Zephyrhills FL 33542 205774930 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Zephyrhills Health & Rehab Center Inc 7350 Dairy Road Zephyrhills FL 33540 205774967 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Fletcher Hospital Surgical Ventures LLC 9131 Anson Way Ste 304 Raleigh NC 27615 861482646 Indirect Interest in Surgery Center NC N/A 0 0 Florida Hospital DMERT LLC 500 Winderley Place Ste 324 Maitland FL 32751 202392253 Medical Equipment FL N/A 0 1 Florida Hospital Home Infusion LLP 500 Winderley Place Ste 226 Maitland FL 32751 593142824 Home Infusion Services FL N/A 0 1 Functional Neurosurgical Ambulatory Surgery Ctr LLC 11 W Dry Creek Circle 120 Littleton CO 80120 464426708 Surgery Center CO N/A 0 0 M&O Orlando MOB I LLC 1919 N Orange Ave Ste E Orlando FL 32804 844259138 Operation of Medical Office Building DE Adventist Hlth SystemSunbelt Inc Related 780245 87748473 0 0 0.82150 OnPoint OBGYN LLC (21-123122) 7780 S Broadway 280 Littleton CO 80122 873522453 Healthcare Services CO N/A 0 0 PAHS OnPoint Imaging LLC 9205 S Broadway Highlands Ranch CO 80129 833275105 Imaging Center CO N/A 0 0 PAHS OnPoint Urgent Care LLC 9100 E Mineral Circle Centennial CO 80112 832465331 Urgent Care Center CO N/A 0 0 Princeton Homecare Services LLC (11-8122) 602 Courtland Street 310 Orlando FL 32804 814196648 Operation of Home Health Agency FL N/A 0 0 Surgery Center of Rome LP 501 Redmond Road NW Rome GA 30165 200390305 Surgery Center GA N/A 0 0 The Bariatric Center of Kansas City LLC 9100 W 74th Street Merriam KS 66204 823025378 Surgery Center KS N/A 0 0 Urgent Care Centers of Brevard County LLC 2600 Westhall Lane Maitland FL 32751 844261523 Urgent Care Centers FL Adventist Hlth SystemSunbelt Inc Related -466525 5111652 0 1 0.51000 AdventHealth Orlando Network Inc (11 - 41922) 900 Hope Way Altamonte Springs FL 32714 862639185 Inactive FL N/A C 1 AdventHealth Professional Staffing Inc (11 - 12822) 900 Hope Way Altamonte Springs FL 32714 880742779 INACTIVE FL N/A C 1 AdventHealth Tampa Network Inc (11 - 41922) 900 Hope Way Altamonte Springs FL 32714 862666178 Inactive FL N/A C 1 AdventHealth Team Members Inc (11 - 12822) 900 Hope Way Altamonte Springs FL 32714 880763664 INACTIVE FL N/A C 1 AdventHealth Value Based Bundle Management LLC (61-123122) 101 Southhall Lane Ste 150 Maitland FL 32751 873487910 Medical Contracting and Billing FL N/A C 1 Altamonte Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 592855792 Condo Association FL Adventist Hlth SystemSunbelt Inc C 229553 1547770 0.64060 1 Apopka Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 593000857 Condo Association FL Adventist Hlth SystemSunbelt Inc C 4306 58218 1.00000 1 Battle Creek Adventist Hospital 900 Hope Way Altamonte Springs FL 32714 381359189 Inactive MI Adventist Hlth SystemSunbelt Inc C 1.00000 1 Florida Hospital Flagler Medical Offices Association Inc 60 Memorial Medical Parkway Palm Coast FL 32164 262158309 Condo Association FL N/A C 1 Florida Hosp Hlth Village Property Owner's Assoc Inc 550 E Rollins Street 7th Floor Orlando FL 32803 821748255 Condo Association FL Adventist Hlth SystemSunbelt Inc C 1.00000 1 Florida Hospital Healthcare System Inc 101 Southhall Lane Ste 150 Maitland FL 32751 593215680 PHSO / CIN FL Adventist Hlth SystemSunbelt Inc C 56669854 40032068 1.00000 1 Florida Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 592855791 Condo Association FL Adventist Hlth SystemSunbelt Inc C 1142468 6728792 0.87110 1 Kissimmee Multispecialty Clinic Condominium Association Inc 201 Hilda Street Suite 30 Kissimmee FL 34741 593539564 Condo Association FL Adventist Hlth SystemSunbelt Inc C 62219 44675 0.54400 1 Midwest Management Services Inc 9100 West 74th Street Shawnee Mission KS 66204 480901551 Inactive KS N/A C 1 North American Health Services Inc & Sub 900 Hope Way Altamonte Springs FL 32714 621041820 Holding Co. TN N/A C 1 Ormond Prof Associates Condo Assoc Inc (430 year end) 770 W Granada Blvd Ste 101 Ormond Beach FL 32174 592694434 Condo Association FL N/A C 1 Park Ridge Property Owner's Association Inc 1 Park Place Naples Road Fletcher NC 28732 030380531 Condo Association NC N/A C 1 Park Ridge Condominium #1 Unit Owners Association Inc 1 Park Place Naples Road Fletcher NC 28732 010584623 Condo Association NC N/A C 1 Surgicare of Rome Inc 501 Redmond Rd Rome GA 30165 200376307 Holding Company GA N/A C 1 Redmond Park Health Services Inc 501 Redmond Rd Rome GA 30165 621330078 Holding Company GA N/A C 1 The Garden Retirement Community Inc 485 North Keller Road Ste 250 Maitland FL 32751 593414055 Real Estate Rental FL N/A C 1 Winter Park Medical Office Building I Condo Assoc Inc 601 East Rollins Street Orlando FL 32803 452228478 Condo Association FL Adventist Hlth SystemSunbelt Inc C 175487 315939 0.51580 1 1 1 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 AdventHealth Senior Care Inc A 116240 FMV AdventHealth University Inc A 3470147 FMV Florida Hospital Medical Group Inc A 5361643 FMV Florida Radiology Imaging at Lake Mary LLC A 614380 FMV AdventHealth Foundation Inc B 6804745 Actual Amount Given AdventHealth University Inc B 5704719 Actual Amount Given Adventist Health System Sunbelt Healthcare Corporation B 58633791 Actual Amount Given AdventHealth Foundation Inc C 13486038 Actual Amount Received Florida Hospital Medical Group Inc K 207672 FMV Hospice of the Comforter Inc K 559311 FMV AdventHealth Foundation Inc L 4580201 Cost Fletcher Hospital Incorporated L 105457 Cost Plus Appropriate % Florida Hospital Medical Group Inc L 558295 Cost Plus Appropriate % Florida Hospital Medical Group Inc L 500890 Cost Plus Appropriate % Florida Hospital Physician Group Inc L 71932 Cost Plus Appropriate % Florida Hospital Waterman Inc L 86412 Cost Plus Appropriate % Memorial Health Systems Inc L 87271 Cost Plus Appropriate % Shawnee Mission Medical Center Inc L 827343 Cost Plus Appropriate % AdventHealth Polk North Inc M 203751 % of Facility's Operating Exp Adventist Health System Sunbelt Healthcare Corporation M 113152717 % of Facility's Operating Exp Adventist Health System Sunbelt Healthcare Corporation dba AIT M 200467545 % of Facility's Operating Exp Florida Hospital Medical Group Inc M 280324276 % of Facility's Operating Exp Florida Hospital Medical Group Inc O 34152097 Cost Allocation AdventHealth Polk North Inc P 3641174 Cost AdventHealth Polk South Inc P 721418 Cost AdventHealth Riverview Inc P 227125 Cost AdventHealth Senior Care Inc P 443101 Cost AdventHealth University Inc P 658661 Cost AdventHealth West Florida Ambulatory Services Inc P 628558 Cost Adventist Care Centers - Courtland Inc P 1240913 Cost Adventist Health System Georgia Inc P 63708 Cost Adventist Health System Sunbelt Healthcare Corporation P 242957040 Cost Adventist Health System Sunbelt Healthcare Corporation dba AIT P 3282810 Cost Adventist Midwest Health P 27689121 Cost East Orlando Health & Rehab Center Inc P 3336243 Cost Fletcher Hospital Incorporated P 135455 Cost FLNC Inc (Florida Living Nursing Center) P 11057850 Cost Florida Hospital Dade City Inc P 65132 Cost Florida Hospital Healthcare System Inc P 19047583 Cost Florida Hospital Medical Group Inc P 12947429 Cost Florida Hospital Ocala Inc P 270122 Cost Florida Hospital Physician Group Inc P 89247 Cost Florida Hospital Waterman Inc P 730942 Cost Florida Hospital Zephyrhills Inc P 234449 Cost Florida Radiology Imaging at Lake Mary LLC P 8814579 Cost Hospice of the Comforter Inc P 1154810 Cost Memorial Health Systems Inc P 20619461 Cost Memorial Hospital - Flagler Inc P 1808309 Cost Memorial Hospital - West Volusia Inc P 781094 Cost Memorial Hospital Inc P 630611 Cost Pasco-Pinellas Hillsborough Community Health System Inc P 709266 Cost Pasco-Pinellas Hillsborough Community Health System Inc P 567942 Cost Princeton Professional Services Inc P 91752 Cost Redmond Park Hospital LLC P 69803 Cost Shawnee Mission Medical Center Inc P 517468 Cost Southeast Volusia Healthcare Corporation P 2782782 Cost Southwest Volusia Healthcare Corporation P 851686 Cost Sunbelt Health & Rehab Center - Apopka Inc P 1074829 Cost Tarpon Springs Hospital Foundation Inc P 76985 Cost Tri-County Nursing Rehabilitation Center Inc P 210168 Cost University Community Hospital Inc P 12143708 Cost AdventHealth Polk North Inc Q 2737575 Cost AdventHealth Polk South Inc Q 929878 Cost AdventHealth Polk South Inc Q 66104 Cost AdventHealth University Inc Q 25718201 Cost Fletcher Hospital Incorporated Q 1119390 Cost Florida Hospital Dade City Inc Q 213970 Cost Florida Hospital Medical Group Inc Q 6298359 Cost Florida Hospital Ocala Inc Q 967444 Cost Florida Hospital Waterman Inc Q 2544586 Cost Florida Hospital Zephyrhills Inc Q 441776 Cost Florida Radiology Imaging at Lake Mary LLC Q 42857767 Cost Hospice of the Comforter Inc Q 1621930 Cost Memorial Health Systems Inc Q 19929567 Cost Memorial Hospital - Flagler Inc Q 2649668 Cost Memorial Hospital - West Volusia Inc Q 1649634 Cost Princeton Professional Services Inc Q 277154 Cost Shawnee Mission Medical Center Inc Q 4096397 Cost Southeast Volusia Healthcare Corporation Q 2768860 Cost Southwest Volusia Healthcare Corporation Q 1307389 Cost Tarpon Springs Hospital Foundation Inc Q 348742 Cost University Community Hospital Inc Q 1914913 Cost West Florida Health Home Care Inc Q 105961 Cost AdventHealth Polk North Inc R 200149 Actual Amount Given Hospice of the Comforter Inc S 2000000 Actual Amount Received