2024-01-23T15:20:54-06:00 2022-12-31 990 2022-01-01 593256803 MEMORIAL HOSPITAL - WEST VOLUSIA INC MEMO 3869434522 701 WEST PLYMOUTH AVENUE DELAND FL 32720 LYNN C ADDISCOTT ASSISTANT SECRETARY 4079751492 2024-01-22 LYNN ADDISCOTT 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ADVENTHEALTH DELAND ERIC LUNDE 701 WEST PLYMOUTH AVENUE DELAND FL 32720 202954758 0 X WWW.ADVENTHEALTH.COM X 1994 FL THE PROVISION OF MEDICAL CARE TO THE COMMUNITY SERVED THROUGH THE OPERATION OF A 170 BED HOSPITAL. 15 6 1283 66 50417 26779 417333 505237 193931830 198575022 7702292 1606074 117358 154937 202168813 200841270 241364 316055 0 0 55600153 60164644 0 0 0 134497315 131550073 190338832 192030772 11829981 8810498 228877865 198633400 75971771 58597097 152906094 140036303 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 179763978 316055 198524605 OPERATION OF A 170-BED ACUTE CARE HOSPITAL LOCATED IN VOLUSIA COUNTY. IN THE CURRENT YEAR THERE WERE 8,216 PATIENT ADMISSIONS, 38,338 PATIENT DAYS, 116,818 OUTPATIENT VISITS, AND 103,130 PHYSICIAN CLINIC PATIENT VISITS. 179763978 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 1 1283 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X ARIEANNA POTTER 3869434455 701 WEST PLYMOUTH AVE DELAND FL 32720 X OTTATI DAVID FORMER DIR/CHAIR/AH CFN REG 0.00 50.00 X 0 3686151 220120 GOODMAN TODD DIRECTOR 0.20 50.00 X 0 1822857 204341 CELANO PATRICIA FORMER KEY EMPLOYEE/REGIONAL CCO 0.00 50.00 X 0 1713469 157405 GREGORY PHD AUDREY DIR/CHAIR/CEO CFN REG 6.00 44.00 X 0 1335554 231534 THOMAS DEBORA DIRECTOR (END 01/22) 0.00 50.00 X 0 817018 101436 PRADO MD MARTIN DIRECTOR 0.20 50.00 X 0 738931 41933 GHOSN C JOSEF DIRECTOR 0.20 50.00 X 0 676425 77817 DAVIS BRENT DIRECTOR/CFO - CFN REG 6.00 44.00 X 0 603791 137713 BROWN LORENZO CEO - W.VOLUSIA MKT 10.00 40.00 X 0 562472 125132 WEIS DAVID CEO - HOSPITAL FACILITY (END 08/22) 37.50 12.50 X X 0 523042 117147 HINDS NIGEL FORMER CFO 0.00 50.00 X 0 549070 72918 SMITH MD CHRISTOPHER FORMER CMO 0.00 50.00 X 0 470281 82674 SCOGGINS MD THOMAS CMO - HOSPITAL FACILITY 50.00 0.00 X 0 429014 110615 LUNDE ERIC DIR/CEO HOSP. FACILITY (BEG 09/22) 50.00 0.00 X X 0 370922 109691 GRIFFITH SUE ELLEN DIRECTOR (BEG 03/22) 0.20 50.00 X 0 424415 25431 GLASS KYLE CFO - HOSPITAL FACILITY (END 08/22) 15.00 35.00 X 0 356649 60853 LINDSEY CRAIG FORMER CNO 0.00 50.00 X 0 350710 46970 AGUERO SAMUEL FORMER COO 0.00 50.00 X 0 288878 53901 LEBRON MICHELE CNO - HOSPITAL FACILITY 50.00 0.00 X 0 243878 52266 BEJARANO NICHOLAS COO - HOSPITAL FACILITY (BEG 01/22) 50.00 0.00 X 0 221364 50961 STEPHAN KELLY AH DEL ADMIN SUPERVISOR 50.00 0.00 X 233838 0 22337 SANCHEZ ANGEL AH DEL ADMIN SUPERVISOR 50.00 0.00 X 211767 0 29154 HAGGERTY MARIA AH DEL ADMIN SUPERVISOR PRN 50.00 0.00 X 198726 0 18455 WELLS JEFFREY AH ASSISTANT NURSE MANAGER 50.00 0.00 X 191265 0 17875 WESTERBERG SAMANTHA AH DEL RN 50.00 0.00 X 205296 0 0 POTTER ARIEANNA CFO - HOSPITAL FACILITY (BEG 08/22) 50.00 0.00 X 91151 61448 44603 REINER RICHARD DIRECTOR 0.20 0.00 X 0 55914 0 BOUIE AL DIRECTOR 0.20 0.00 X 253 0 0 COURTHEYN DOREEN DIRECTOR 0.20 0.00 X 253 0 0 DIBELLO MD CHRISTOPHER DIRECTOR/CHIEF OF STAFF 0.20 0.00 X 253 0 0 FLOWERS W BEN DIRECTOR 0.20 0.00 X 253 0 0 HAGSTROM LORNA JEAN DIRECTOR 0.20 0.00 X 253 0 0 WEINER DO TRACY DIRECTOR 0.20 0.00 X 253 0 0 WOODS MICHAEL DIRECTOR 0.20 0.00 X 253 0 0 1133814 16302253 2213282 121 1 1 0 AMN HEALTHCARE INC 2735 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 AGENCY FEES 11522930 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 30368 MANAGEMENT FEES 2075481 RN NETWORK PO BOX 974088 DALLAS TX 75397 AGENCY FEES 1909807 USAP FLORIDA US ANESTHESIA PARTNERS 851 TRAFALGAR COURT STE 200E MAITLAND FL 32751 MEDICAL SERVICES - ANESTHESIOLOGY 1481575 CROTHALL HEALTHCARE INC 13028 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 EQUIPMENT SERVICES 1324672 63 X 409109 96128 505237 NET PATIENT REVENUE 622110 193614578 193564161 50417 REIMB OF EXP-TE AFFILIATE 622110 3511642 3511642 CAFETERIA REVENUE 622110 684858 684858 MEDICAL OFFICE BUILDING RENTALS 622110 405310 405310 GIFT SHOP REVENUE 622110 355974 355974 2660 2660 198575022 3651479 3651479 68083 2113488 0 -2113488 68083 -2045405 -2045405 154937 0 154937 154937 200841270 198524605 50417 1761011 X 316055 316055 2246713 2246713 41973016 41973016 1842400 1807149 35251 9753712 9462718 290994 4348803 4265597 83206 574696 574696 50949 50949 361779 361779 73865911 67755727 6110184 316446 316446 3227129 2297841 929288 10746661 10115584 631077 3652847 3652847 134922 134922 134862 134862 662004 662004 5659555 5659555 1463198 1393643 69555 MEDICAL SUPPLIES 22456853 22456853 REPAIRS & MAINTENANCE 4433852 4433852 STATE TAX INDIGENT ASSE 3420482 3420482 UBI TAXES 22226 22226 365701 91055 274646 192030772 179763978 12266794 0 4729 4637 143971812 107277270 20133677 24379865 2223513 2544846 6351855 7188883 164441548 112971791 49236387 51469757 99510 87146 6856382 5680996 228877865 198633400 25015424 20107811 50956347 38489286 75971771 58597097 X 152906094 140036303 152906094 140036303 228877865 198633400 X 8810498 -19518517 -2161772 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7073 7073 0 PART II-B, LINE 1: AMERICAN HOSPITAL ASSOCIATION, FLORIDA HOSPITAL ASSOCIATION, AND AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION DUES 5915832 5915832 84398773 56426739 27972034 69057768 54808812 14248956 5069175 1736240 3332935 51469757 DUE TO RELATED 7959172 PAYABLE TO THIRD PARTIES 989772 CREDIT BALANCES IN A/R 1199259 OTHER DEFERRED REVENUE 2190751 ACCRUED INTEREST PAYABLE 3574 INTERCO. ALLOC. OF TE BOND PROCEEDS 24108961 OPERATING LEASE LIABILITY 1932635 OTHER LIABILITIES 105162 38489286 X PART X, LINE 2: THE FILING ORGANIZATION IS A SUBSIDIARY ORGANIZATION WITHIN ADVENTHEALTH. THE CONSOLIDATED FINANCIAL STATEMENTS OF ADVENTHEALTH CONTAIN THE FOLLOWING FIN 48 (ASC 740) FOOTNOTE: PLEASE NOTE THAT DOLLAR AMOUNTS ARE IN THOUSANDS. HEALTHCARE CORPORATION AND ITS AFFILIATED ORGANIZATIONS, OTHER THAN NORTH AMERICAN HEALTH SERVICES, INC. AND ITS SUBSIDIARY (NAHS), ARE EXEMPT FROM STATE AND FEDERAL INCOME TAXES. ACCORDINGLY, HEALTHCARE CORPORATION AND ITS TAX-EXEMPT AFFILIATES ARE NOT SUBJECT TO FEDERAL, STATE OR LOCAL INCOME TAXES EXCEPT FOR ANY NET UNRELATED BUSINESS TAXABLE INCOME. NAHS IS A WHOLLY OWNED, FOR-PROFIT SUBSIDIARY OF HEALTHCARE CORPORATION. NAHS AND ITS SUBSIDIARY ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. NAHS FILES A CONSOLIDATED FEDERAL INCOME TAX RETURN AND, WHERE APPROPRIATE, CONSOLIDATED STATE INCOME TAX RETURNS. ALL TAXABLE INCOME WAS FULLY OFFSET BY NET OPERATING LOSS CARRYFORWARDS FOR FEDERAL INCOME TAX PURPOSES; AS SUCH, THERE IS NO PROVISION FOR CURRENT FEDERAL OR STATE INCOME TAX FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021. NAHS ALSO HAS TEMPORARY DEDUCTIBLE DIFFERENCES OF APPROXIMATELY $18,200 AND $33,000 AT DECEMBER 31, 2022 AND 2021, RESPECTIVELY, PRIMARILY AS A RESULT OF NET OPERATING LOSS CARRYFORWARDS. AT DECEMBER 31, 2022, NAHS HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $10,000, EXPIRING IN 2023 THROUGH 2026. DEFERRED TAXES HAVE BEEN PROVIDED FOR THESE AMOUNTS, RESULTING IN A NET DEFERRED TAX ASSET OF APPROXIMATELY $4,500 AND $8,100 AT DECEMBER 31, 2022 AND 2021, RESPECTIVELY. NAHS REMEASURED ITS DEFERRED TAX ASSETS AND LIABILITIES BASED ON THE RATES AT WHICH THEY ARE EXPECTED TO REVERSE IN THE FUTURE, WHICH IS GENERALLY 21%. A FULL VALUATION ALLOWANCE HAS BEEN PROVIDED AT DECEMBER 31, 2022 AND 2021 TO OFFSET THE DEFERRED TAX ASSET SINCE HEALTHCARE CORPORATION HAS DETERMINED THAT IT IS MORE LIKELY THAN NOT THAT THE BENEFIT OF THE NET OPERATING LOSS CARRYFORWARDS WILL NOT BE REALIZED IN FUTURE YEARS. THE INCOME TAXES TOPIC OF THE ACCOUNTING STANDARDS CODIFICATION (ASC) (ASC 740) PRESCRIBES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAX POSITIONS RECOGNIZED IN FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN, OR EXPECTED TO BE TAKEN, IN A TAX RETURN. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2022 AND 2021. 1 1 X 1 X 1 X 1 1 1 0 1 0 10503239 10503239 0.05470 25856215 11463355 14392860 0.07500 36359454 11463355 24896099 0.12970 32695 32695 0.00020 39378 39378 0.00020 72073 72073 0.00040 36431527 11463355 24968172 0.13010 1 11566724 1779892 31635829 33225341 -1589512 X 1 1 1 1 ADVENTHEALTH DELAND 701 W PLYMOUTH AVE DELAND FL 32720 WWW.ADVENTHEALTH.COM/HOSPITAL/ADVENTHE 4436 X X X MEMORIAL HOSPITAL - WEST VOLUSIA INC 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE PART V, PAGE 8 X X 1 20 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 MEMORIAL HOSPITAL - WEST VOLUSIA, INC. PART V, SECTION B, LINE 5: MEMORIAL HOSPITAL - WEST VOLUSIA, INC., D/B/A ADVENTHEALTH DELAND (AHD OR THE HOSPITAL) OPERATES A HOSPITAL IN VOLUSIA COUNTY, FLORIDA WITH A TOTAL OF 170 LICENSED BEDS. FOR PURPOSES OF ITS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL DEFINED ITS COMMUNITY AS ITS PRIMARY SERVICE AREA FROM WHICH 70% OF ITS PATIENTS COME. AS A PART OF ITS EFFORTS TO ENSURE BROAD COMMUNITY-BASED INPUT INTO THE CHNA PROCESS, THE HOSPITAL PARTICIPATED IN THE VOLUSIA/FLAGLER COUNTIES CHNA COLLABORATIVE (THE COLLABORATIVE) TO HELP GUIDE THE HOSPITAL THROUGH THE ASSESSMENT PROCESS. THE COLLABORATIVE INCLUDED REPRESENTATION FROM THE HOSPITAL, PUBLIC HEALTH EXPERTS AND THE BROAD COMMUNITY WITH INTENTIONAL REPRESENTATION FROM LOW-INCOME, MINORITY AND OTHER UNDERSERVED POPULATIONS. THE COLLABORATIVE COLLECTED INPUT DIRECTLY FROM THE COMMUNITY AND COMMUNITY STAKEHOLDERS, INCLUDING INDIVIDUALS WORKING IN ORGANIZATIONS THAT ADDRESS THE NEEDS AND INTERESTS OF THE COMMUNITY. PRIMARY DATA WAS COLLECTED THROUGH A COMMUNITY SURVEY, STAKEHOLDER INTERVIEWS, AND FOCUS GROUPS. A TOTAL OF 61 STAKEHOLDERS PARTICIPATED IN THE COLLABORATIVE AND INCLUDED THE FOLLOWING ORGANIZATIONS WHICH SPECIFICALLY ADDRESS THE NEEDS OF THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY MEMBERS OF THE HOSPITAL'S COMMUNITY. SMA HEALTHCARE, PROVIDING BEHAVIORAL HEALTH SERVICES,ADDICTION EDUCATION FOUNDATION,AFRICAN AMERICAN ENTREPRENEURS ASSOCIATION, INC.,BLACK HOMESCHOOLERS OF CENTRAL FLORIDA,CARVER CENTER,CATALYST GLOBAL YOUTH INITIATIVES, INC.,CHISHOLM COMMUNITY CENTER IN DELAND,DEPARTMENT OF HEALTH IN VOLUSIA COUNTY,DEPARTMENT OF HEALTH IN FLAGLER COUNTY,EARLY LEARNING COALITION OF FLAGLER AND VOLUSIA,EASTERSEALS NORTHEAST CENTRAL FLORIDA,FAMILY LIFE CENTER,FLAGLER CARES/ONE VOICE FOR VOLUSIA,FLAGLER COUNTY FREE CLINIC,FLAGLER COUNTY SCHOOL BOARD,FLAGLER NAACP,FLAGLER OARS,FLAGLER SHELTERING TREE,FOOD BRINGS HOPE,HALIFAX URBAN MINISTRIES,HEALTHY START COALITION OF FLAGLER AND VOLUSIA COUNTIES,JESUS CLINIC,UNITED WAY OF VOLUSIA/FLAGLER COUNTIES,VOLUSIA COUNTY SCHOOLS, ANDVOLUSIA/FLAGLER COALITION FOR THE HOMELESS. MEMORIAL HOSPITAL - WEST VOLUSIA, INC. PART V, SECTION B, LINE 7D: THE HOSPITAL HAS ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS MUST BE POSTED ON THE HOSPITAL'S WEBSITE AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE WIDELY AVAILABLE ON ITS WEBSITE ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. THE HOSPITAL WILL ALSO MAKE A PAPER COPY OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST AND WITHOUT CHARGE, AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE AVAILABLE FOR PUBLIC INSPECTION ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. MEMORIAL HOSPITAL - WEST VOLUSIA, INC. PART V, SECTION B, LINE 11: SEE LINE 11 FOOTNOTE BELOW. MEMORIAL HOSPITAL - WEST VOLUSIA, INC. PART V, SECTION B, LINE 13H: EFFECTIVE MARCH 1, 2020, THE FILING ORGANIZATION'S HOSPITAL FACILITY (OR FACILITIES) AUGMENTED THEIR FINANCIAL ASSISTANCE POLICY WITH A COVID-19 FINANCIAL GRACE ADDENDUM. PURSUANT TO THE COVID-19 FINANCIAL GRACE ADDENDUM, UNINSURED PATIENTS TREATED FOR COVID-19 RELATED EVALUATIONS ARE TO RECEIVE FREE OR DISCOUNTED CARE DEPENDING ON THE PATIENT'S COOPERATION IN SUBMITTING NECESSARY FINANCIAL ASSISTANCE INFORMATION. INSURED PATIENTS TESTED FOR COVID-19 ARE NOT EXPECTED TO HAVE OUT-OF-POCKET EXPENSES BASED ON INSURANCE COMMUNITY RESPONSE TO WAIVE PATIENT FINANCIAL RESPONSIBILITY. IF A PAYER UNEXPECTEDLY FAILS TO WAIVE PATIENT RESPONSIBILITY FOR COVID-19 RELATED TESTING, THE FILING ORGANIZATION WILL NOT BALANCE BILL PATIENTS FOR ANY OUT-OF-POCKET EXPENSES RELATED TO COVID-19. IN ADDITION, PATIENTS WITH EXISTING PAYMENT PLANS ARE PROVIDED OPPORTUNITIES FOR REDUCING THEIR MONTHLY PAYMENTS. SCHEDULE H, PART V, SECTION B, LINE 7A: THE CHNA REPORT CAN BE FOUND AT URL:HTTPS://WWW.ADVENTHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS SCHEDULE H, PART V, SECTION B, LINES 8-10A: CHNA IMPLEMENTATION STRATEGY:THE FILING ORGANIZATION ADOPTED A COMMUNITY HEALTH NEEDS ASSESSMENT REPORT BY 12/31/2022 AND WAS IN THE PROCESS OF DEVELOPING ITS COMMUNITY HEALTH NEEDS IMPLEMENTATION STRATEGY AT THAT TIME. THE FILING ORGANIZATION'S 2023-2025 COMMUNITY HEALTH NEEDS IMPLEMENTATION STRATEGY IS DOCUMENTED IN A WRITTEN REPORT CALLED THE "COMMUNITY HEALTH PLAN". THE COMMUNITY HEALTH PLAN (CHP) DESCRIBES HOW THE FILING ORGANIZATION PLANS TO MEET ITS IDENTIFIED PRIORITIZED HEALTH NEEDS OR IDENTIFIES THE HEALTH NEED AS ONE THE FILING ORGANIZATION DOES NOT INTEND TO SPECIFICALLY ADDRESS AND PROVIDES AN EXPLANATION AS TO WHY THE FILING ORGANIZATION DOES NOT INTEND TO ADDRESS THAT HEALTH NEED. THE FILING ORGANIZATION'S 2023-2025 CHP WAS ADOPTED BY MAY 15, 2023 AND IS POSTED ON THE HOSPITAL FACILITY'S WEBSITE. SCHEDULE H, PART V, SECTION B, LINE 10A:THE HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTPS://WWW.ADVENTHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS SCHEDULE H, PART V, SECTION B, LINE 11: MEMORIAL HOSPITAL - WEST VOLUSIA, INC., D/B/A ADVENTHEALTH DELAND, WILL BE REFERRED TO IN THIS DOCUMENT AS ADVENTHEALTH DELAND 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 DELAND IS INCLUDED IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH. CENTRAL FLORIDA DIVISION - NORTH REGION (THE DIVISION) INCLUDES ADVENTHEALTH DAYTONA BEACH, ADVENTHEALTH DELAND, ADVENTHEALTH FISH MEMORIAL, ADVENTHEALTH NEW SMYRNA BEACH, ADVENTHEALTH PALM COAST, AND ADVENTHEALTH WATERMAN. THE CENTRAL FLORIDA DIVISION INCLUDES 14 HOSPITALS. THIS IS THE THIRD-YEAR UPDATE FOR ADVENTHEALTH DELAND'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 DELAND 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 DELAND CHOSE FIVE PRIORITIES FOR ITS 2020-2022 COMMUNITY HEALTH PLAN: 1. ADULT & YOUTH BEHAVIORAL HEALTH2. CARDIOVASCULAR DISEASES & DIABETES3. BARRIERS TO ACCESSING HEALTH CARE SERVICES4. HEALTHY EATING & PHYSICAL ACTIVITY5. SOCIAL AND ECONOMIC ISSUES (SOCIAL DETERMINANTS OF HEALTH) PRIORITY 1: ADULT & YOUTH BEHAVIORAL HEALTH 2019 DESCRIPTION OF THE ISSUE: ALCOHOL USE- HEAVY/BINGE DRINKING HAS INCREASED SLIGHTLY FROM 2010 TO 2016. THE PERCENT IS HIGHEST FOR WHITE INDIVIDUALS.- VOLUSIA COUNTY'S ALCOHOL-SUSPECTED MOTOR VEHICLE CRASHES AND TRAFFIC CRASH INJURIES RATES HAVE DECREASED SINCE 2014 BUT ARE SLIGHTLY HIGHER THAN FLORIDA.- ALCOHOL-SUSPECTED TRAFFIC CRASH DEATHS INCREASED BETWEEN 2015 AND 2016 IN VOLUSIA COUNTY AND THE COUNTY'S RATE IS HIGHER THAN FLORIDA.- THE PERCENT OF STUDENT ALCOHOL USE HAS BEEN DECREASING SINCE 2008 BUT REMAINS SLIGHTLY HIGHER THAN FLORIDA. SMOKING AND SUBSTANCE MISUSE- VOLUSIA'S RATE OF OPIOID-INVOLVED OVERDOSE HOSPITALIZATIONS INCREASED FROM 2015 TO 2017 AND IS HIGHER THAN FLORIDA'S. THE RATE OF DEATH FROM OPIOID OVERDOSES INCREASED IN THE LAST YEAR AND NOW EXCEEDS THE FLORIDA RATE.- THE PERCENT OF VOLUSIA COUNTY ADULTS WHO SMOKE IS HIGHER THAN FLORIDA (THE DIFFERENCE IS STATISTICALLY SIGNIFICANT).- THE PERCENT OF VOLUSIA COUNTY MIDDLE AND HIGH SCHOOL STUDENTS USING MARIJUANA DECREASED BETWEEN 2016 AND 2018 BUT REMAINS HIGHER THAN FLORIDA.- REPORTED CIGARETTE USE AMONG VOLUSIA COUNTY MIDDLE AND HIGH SCHOOL STUDENTS HAS DECLINED, BUT BOTH RATES REMAIN HIGHER THAN FLORIDA. MENTAL HEALTH - THE PERCENT OF VOLUSIA COUNTY ADULTS WHO HAD 14 OR MORE POOR MENTAL HEALTH DAYS IN THE LAST MONTH IS HIGHER THAN FLORIDA.- THE PERCENT OF VOLUSIA COUNTY ADULTS WITH A DEPRESSIVE DISORDER IS HIGHER THAN FLORIDA (THE DIFFERENCE IS STATISTICALLY SIGNIFICANT FOR HISPANIC POPULATION).- VOLUSIA COUNTY'S SUICIDE RATE IS INCREASING AND IS HIGHER THAN FLORIDA'S. - VOLUSIA COUNTY'S AGE 19-21 RATE OF HOSPITALIZATIONS FOR SELF-INFLICTED INJURIES HAS INCREASED BUT IS LOWER THAN FLORIDA'S. 2022 UPDATE:THE ADVENTHEALTH DELAND COMMUNITY HEALTH PLAN HAS THREE DESIRED GOAL STATEMENTS UNDER THE ADULT & YOUTH BEHAVIORAL HEALTH PRIORITY. 1. ESTABLISH A HEALTHY EQUITY ZONE (HEZ) IN THE SPRING HILL NEIGHBORHOOD OF DELAND TO REDUCE HEALTH INEQUITIES AND PROVIDE ACCESS TO MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES.2. ESTABLISH A MULTI-AGENCY REFERRAL AND COMMUNICATION MANAGEMENT SYSTEM IN VOLUSIA/FLAGLER COUNTY TO EFFECTIVELY CONNECT INDIVIDUALS IN NEED TO BEHAVIORAL HEALTH CARE SERVICES.3. PROVIDE SPECIAL PROGRAMS FOR AT-RISK STUDENTS IN THE DELAND AREA. GOAL 1: ESTABLISH A HEALTHY EQUITY ZONE (HEZ) IN THE SPRING HILL NEIGHBORHOOD OF DELAND TO REDUCE HEALTH INEQUITIES AND PROVIDE ACCESS TO MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES. OBJECTIVE 1:THE FIRST OBJECTIVE IS TO WORK WITH COMMUNITY RESIDENTS AND COMMUNITY ORGANIZATIONS TO IDENTIFY SPECIFIC MENTAL HEALTH AND SUBSTANCE ABUSE SERVICE NEEDS WITHIN THE COMMUNITY THROUGH AN ENGAGEMENT PROCESS BY THE END OF YEAR ONE. THE OBJECTIVE IS FUNDED BY, AND ALL OUTCOMES ARE SPECIFIC TO THE HOSPITAL, ALTHOUGH THE OBJECTIVE IS MANAGED AT THE DIVISIONAL LEVEL. TO DRIVE THE OBJECTIVES FORWARD AND TO MEET THE GOALS ESTABLISHED AS PART OF THE 2020 CHP, THE HOSPITAL HAS PARTNERED WITH ORGANIZATIONS AND INDIVIDUALS TO DEVELOP THE HEALTH EQUITY ZONE (HEZ) INITIATIVE. THE HEZ INITIATIVE IS FUNDED AND DEPLOYED THROUGH ADVENTHEALTH DELAND, AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE HEZ INITIATIVE IS FOCUSED ON CREATING A COMPREHENSIVE AND COLLABORATIVE APPROACH TO LEVERAGE NEW AND EXISTING RESOURCES FOCUSED ON A SPECIFIC GEOGRAPHIC AREA, THE SPRING HILL NEIGHBORHOOD OF DELAND. THE SPRING HILL NEIGHBORHOOD IN DELAND HAS BEEN A COMMUNITY IN THE AREA WITH A CONSISTENTLY HIGH LEVEL OF POVERTY OVER THE LAST FOUR DECADES AND HAS BEEN IDENTIFIED IN COMMUNITY HEALTH ASSESSMENTS AS AN AREA OF HIGH NEED. BY ENGAGING RESIDENTS AND COMMUNITY ORGANIZATIONS TOGETHER, THE HEZ WILL FOCUS ON PROVIDING SERVICES AND SUPPORT FOR THIS VULNERABLE POPULATION WITH THE GOAL OF CREATING MEASURABLE HEALTH IMPROVEMENT. THE HOSPITAL MET ITS SET METRIC OF IDENTIFYING SPECIFIC METAL HEALTH AND SUBSTANCE ABUSE SERVICE NEEDS THROUGH DISCUSSIONS WITH COMMUNITY LEADERS. THE HOSPITAL, COLLABORATING WITH THE FLORIDA DEPARTMENT OF HEALTH IN VOLUSIA COUNTY, SPRING HILL RESOURCE CENTER, AND THE CITY OF DELAND, IDENTIFIED THE NEED TO BE PRESENT IN THE COMMUNITY FOR A SPRING HILL HEALTH DAY TO PROVIDE HEALTH SCREENINGS AND EDUCATION TO RESIDENTS. SPRING HILL HEALTH DAY WAS DELAYED DUE TO COVID AND THEN CANCELLED TWICE DUE TO HURRICANES IAN AND NICOLE IN 2022. THE HOSPITAL HAS RESCHEDULED THE EVENT FOR MAY 2023. OBJECTIVE 2:THE SECOND OBJECTIVE IS TO WORK WITH COMMUNITY PARTNERS TO INCREASE ACCESS FOR 15% OF HEZ NEIGHBORHOOD RESIDENTS TO OBTAIN IDENTIFIED SERVICES (IN HOME OR IN THE NEIGHBORHOOD) BY THE END OF YEAR THREE. THE OBJECTIVE TO INCREASE ACCESS TO NEEDED IDENTIFIED SERVICES IS DEPLOYED THROUGH ADVENTHEALTH DELAND AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. HOWEVER, THE HEZ INITIATIVE, THROUGH WHICH THIS OBJECTIVE IS DEPLOYED, IS MANAGED AT THE DIVISIONAL LEVEL. THE HOSPITAL DID NOT MEET ITS SET METRIC. COMMUNITY ORGANIZATIONS IN THE SPRING HILL COMMUNITY WERE IMPACTED BY THE COVID-19 PANDEMIC AND RECENT HURRICANES (IAN AND NICOLE). THIS LED TO A LIMITED AVAILABILITY OF RESOURCES FOR NEIGHBORHOOD RESIDENTS. ** SEE CONTINUATION SCHEDULE H, PART V, SECTION B, LINE 11 EXPLANATION CONTINUED: GOAL 2: ESTABLISH A MULTI-AGENCY REFERRAL AND COMMUNICATION MANAGEMENT SYSTEM IN VOLUSIA/FLAGLER COUNTY TO EFFECTIVELY CONNECT INDIVIDUALS IN NEED TO BEHAVIORAL HEALTH CARE SERVICES. OBJECTIVE 1:THE FIRST OBJECTIVE IS A DIVISIONAL INITIATIVE AND APPEARS ON MULTIPLE COMMUNITY HEALTH PLANS OF HOSPITALS IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, THE SAME DIVISION AS THE REPORTING HOSPITAL. THE HOSPITALS PARTNERED ON THIS INITIATIVE BECAUSE OF A SHARED CHNA PRIORITY. THE OBJECTIVE IS TO SUPPORT THE DEVELOPMENT OF A PILOT PROJECT TO CONNECT HEALTH AND BEHAVIORAL HEALTH SYSTEMS THROUGH THE UTILIZATION OF A REFERRAL AND COMMUNICATION MANAGEMENT TECHNOLOGY SYSTEM TO BE LAUNCHED BY THE END OF YEAR TWO. THIS OBJECTIVE IS MANAGED AT A DIVISIONAL LEVEL AND OUTCOMES ARE REPORTED AT A DIVISIONAL LEVEL; HOWEVER, ALL FUNDING IS SPECIFIC TO THE REPORTING HOSPITAL. THE HOSPITAL'S SUPPORT PROVIDES FUNDING TO FLAGLER CARES, A LOCAL NOT-FOR-PROFIT, WHICH FOCUSES ON INCREASING CAPACITY AND COORDINATION FOR HEALTH AND HUMAN SERVICES PROGRAMS AND FOR THE PLANNING AND IMPLEMENTATION OF A DIGITAL SOLUTION TO FACILITATE REFERRALS TO BEHAVIORAL HEALTH SERVICES TO INCREASE ACCESS TO CARE AND IMPROVE HEALTH. THE DIVISION MET ITS SET METRIC IN YEAR TWO. FLAGLER CARES LAUNCHED THE LINKING INDIVIDUALS TO NETWORK OF CARE (LINC) FLAGLER VOLUSIA REFERRAL MANAGEMENT SYSTEM IN AUGUST 2021 WITH AN INITIAL FOCUS ON BEHAVIORAL HEALTH SERVICES. BY THE END OF YEAR THREE, 28 ORGANIZATIONS PARTICIPATED IN THE NETWORK AND 999 REFERRALS WERE SENT THROUGH THE SYSTEM. GOAL 3: PROVIDE SPECIAL PROGRAMS FOR AT RISK STUDENTS IN THE DELAND AREA. OBJECTIVE 1:THE FIRST OBJECTIVE IS TO SUPPORT A BEFORE SCHOOL CLUB AT SOUTHWEST MIDDLE SCHOOL WITH AN INTERNAL FACULTY SPONSOR TO FOCUS ON PROVIDING YOUTH OPPORTUNITIES FOR SELF-DEVELOPMENT AND INSPIRE YOUTH TO GROW INTO HEALTHY WELL-BALANCED ADULTS. THIS OBJECTIVE IS MANAGED AT A DIVISIONAL LEVEL AND APPEARS ON SEVERAL COMMUNITY HEALTH PLANS IN THE DIVISION; HOWEVER, ALL FUNDING AND OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE HOSPITAL'S FINANCIAL SUPPORT PROVIDES ACCESS TO A FOCUSED YOUTH DEVELOPMENT PROGRAM FOR AT RISK MIDDLE SCHOOL YOUTH. DUE TO THE COVID-19 PANDEMIC, THIS OBJECTIVE WAS MODIFIED BECAUSE SOUTHWEST MIDDLE SCHOOL'S BEFORE SCHOOL CLUB WAS NOT ALLOWED TO OFFER IN-PERSON ACTIVITIES. THE NEW OBJECTIVE IS TO SUPPORT AT-RISK YOUTH IN THE DELAND COMMUNITY. THE HOSPITAL MET ITS MODIFIED OBJECTIVE BY SUPPORTING BLACK HOMESCHOOLERS OF CENTRAL FLORIDA, BACKPACK BUDDIES, AND SISTERS BUILD FOR GIRLS UNITY. THE HOSPITAL SUPPORTED BLACK HOMESCHOOLERS OF CENTRAL FLORIDA'S 6-WEEK WORKSHOP (WEST VOLUSIA) WITH $2,000 TO BENEFIT 11 HOMESCHOOLING PARENTS. THE ORGANIZATION SERVES 40-50 HOMESCHOOLING PARENTS EACH YEAR AND OVER 150 HOMESCHOOLING STUDENTS ANNUALLY. THE HOSPITAL PROVIDED $1,000 TO SISTERS BUILD NETWORK FOR GIRLS, INC. (WEST VOLUSIA) TO SUPPORT YOUNG WOMEN. THE ORGANIZATION'S PURPOSE IS TO BUILD A NETWORK OF DIVERSE YOUNG WOMEN, TO CREATE A SISTERHOOD THAT EMPOWERS ONE ANOTHER WHILE BUILDING A HEALTHY COMMUNITY. YOUNG GIRLS (11-14 AND 15-19) ARE MENTORED IN LEADERSHIP AND PERSONAL DEVELOPMENT. THE HOSPITAL PROVIDED $10,000 TO BACKPACK BUDDIES KIDS PACK PROGRAM WHICH PROVIDES FOOD TO STUDENTS IN WEST VOLUSIA. IN TOTAL, 746 STUDENTS WERE SERVED, AND 31,332 MEALS WERE PROVIDED. PRIORITY 2: CARDIOVASCULAR DISEASES & DIABETES 2019 DESCRIPTION OF THE ISSUE: CARDIOVASCULAR DISEASES- THE YEARS OF POTENTIAL LIFE LOST (YPLL) RATE FOR VOLUSIA COUNTY INCREASED FROM 2014 TO 2017 AND IS HIGHER THAN FLORIDA.- THE VOLUSIA COUNTY DEATH RATE FOR HEART FAILURE IS HIGHER THAN FLORIDA.- VOLUSIA COUNTY'S HOSPITALIZATION RATE FOR CONGESTIVE HEART FAILURE IS HIGHER THAN FLORIDA'S AND THE RATE FOR BLACK INDIVIDUALS IS MUCH HIGHER.- THE VOLUSIA COUNTY HOSPITALIZATION RATE FOR CORONARY HEART DISEASE IS HIGHER THAN FLORIDA AND THE RATE FOR BLACK INDIVIDUALS IS HIGHER THAN THE RATE FOR ALL.- THE VOLUSIA COUNTY DEATH RATE FOR CORONARY HEART DISEASE IS HIGHER THAN FLORIDA.- THE VOLUSIA COUNTY HOSPITALIZATION RATE FOR STROKE IS HIGHER THAN FLORIDA AND THE RATE FOR BLACK INDIVIDUALS IS HIGHER THAN OTHER GROUPS.- THE VOLUSIA COUNTY DEATH RATE FOR STROKE IS HIGHER THAN FLORIDA AND THE RATE FOR BLACK INDIVIDUALS IS HIGHER THAN OTHER GROUPS. DIABETES - THE DEATH RATE FROM DIABETES INCREASED BETWEEN 2016 AND 2017 AND IS HIGHER IN VOLUSIA COUNTY THAN IN FLORIDA. THE RATE IS HIGHEST FOR BLACK INDIVIDUALS.- THE RATE OF PREVENTABLE HOSPITALIZATIONS FOR ADULTS UNDER 65 FROM DIABETES IS INCREASING AND HIGHER THAN FLORIDA. 2022 UPDATE:THE ADVENTHEALTH DELAND COMMUNITY HEALTH PLAN HAS TWO DESIRED GOAL STATEMENTS UNDER THE CARDIOVASCULAR DISEASES & DIABETES PRIORITY. 1. ESTABLISH A HEALTHY EQUITY ZONE (HEZ) IN THE SPRING HILL NEIGHBORHOOD OF DELAND TO REDUCE HEALTH INEQUITIES AND PROVIDE HEALTH SERVICES TO REDUCE CARDIOVASCULAR DISEASES AND DIABETES.2. REDUCE THE ONSET OF DIABETES AMONG YOUTH. GOAL 1: ESTABLISH A HEALTHY EQUITY ZONE (HEZ) IN THE SPRING HILL NEIGHBORHOOD OF DELAND TO REDUCE HEALTH INEQUITIES AND PROVIDE HEALTH SERVICES TO REDUCE CARDIOVASCULAR DISEASES AND DIABETES. OBJECTIVE 1:THE FIRST OBJECTIVE IS TO WORK WITH COMMUNITY RESIDENTS AND COMMUNITY ORGANIZATIONS TO SCREEN 20% OF IDENTIFIED HEZ RESIDENTS FOR PRE-DIABETES/DIABETES, HIGH BLOOD PRESSURE AND OTHER RISK FACTORS FOR CHRONIC CONDITIONS. THE SCREENING INITIATIVE IS FUNDED AND DEPLOYED THROUGH ADVENTHEALTH DELAND, AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE SCREENING INITIATIVE IS FOCUSED ON PROVIDING OPPORTUNITIES IN THE NEIGHBORHOOD TO ENCOURAGE SCREENING AND REDUCE ACCESS BARRIERS FOR NEIGHBORHOOD RESIDENTS. DUE TO LIMITED COMMUNITY-BASED RESOURCES TO SCREEN 20% OF ALL RESIDENTS IN THE SPRING HILL NEIGHBORHOOD, THE OBJECTIVE WAS MODIFIED TO REACH AS MANY RESIDENTS AS POSSIBLE WITH AVAILABLE RESOURCES. THE HOSPITAL MET ITS MODIFIED OBJECTIVE OF PARTNERING WITH COMMUNITY ORGANIZATIONS TO PROVIDE HEALTH SCREENINGS. THROUGH PARTNERSHIPS, THE HOSPITAL PROVIDED SCREENINGS TO 175 INDIVIDUALS. OBJECTIVE 2:THE SECOND OBJECTIVE IS TO PROMOTE ADVENTHEALTH DELAND DIABETES EDUCATION RESOURCES TO HEZ RESIDENTS AND ENGAGE 50 RESIDENTS IN EDUCATIONAL OPPORTUNITIES BY THE END OF YEAR ONE. THIS OBJECTIVE IS MANAGED AT A DIVISIONAL LEVEL, HOWEVER ALL FUNDING AND OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE EDUCATION INITIATIVE WAS FOCUSED ON LEVERAGING EXISTING ADVENTHEALTH DELAND RESOURCES TO PROVIDE EDUCATIONAL OPPORTUNITIES, INCLUDING SUPPORT GROUPS AND EDUCATION CLASSES, IN THE NEIGHBORHOOD TO REDUCE ACCESS BARRIERS. THE OBJECTIVE WAS MODIFIED DUE TO THE COVID-19 PANDEMIC. THE MODIFIED OBJECTIVE IS TO PROVIDE DIABETES EDUCATION TO 50 RESIDENTS BY THE END OF YEAR THREE. THE HOSPITAL MET ITS MODIFIED OBJECTIVE AND METRIC. DIABETES EDUCATION WAS PROVIDED TO 196 RESIDENTS. THIS INCLUDED DIABETES COMMUNITY CLASSES, DIABETES LECTURES AT CONVIVA WELLNESS PROGRAM, AND DIABETES SCREENINGS AND HEALTH EDUCATION AT THE SEVENTH-DAY ADVENTIST HEALTH FAIR IN DELAND, STETSON UNIVERSITY AND DELAND CHAMBER OF COMMERCE-WEST VOLUSIA WELLNESS FAIR. GOAL 2: REDUCE THE ONSET OF DIABETES AMONG YOUTH. OBJECTIVE 1: THE FIRST OBJECTIVE IS TO IMPLEMENT A DIABETES EDUCATION PROGRAM FOR 75% OF THIRD GRADERS IN IDENTIFIED ELEMENTARY SCHOOLS DURING THE 2020-2021 SCHOOL YEAR AND TO PROVIDE A NUTRITIONAL STUDENT EDUCATION PROGRAM IN DELAND. THIS OBJECTIVE IS MANAGED AT A DIVISIONAL LEVEL; HOWEVER, ALL FUNDING AND OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE SCHOOL-BASED DIABETES PROGRAM PROVIDES EDUCATIONAL PROGRAMMING TO THIRD GRADERS AT AN IDENTIFIED AT-RISK SCHOOL IN THE DELAND AREA. THE HOSPITAL DID NOT MEET ITS SET METRIC. DUE TO COVID-19, THE ORIGINAL PROGRAM WAS TAKEN OFFLINE. AN ALTERNATIVE PROGRAM, MISSION FIT, WAS IDENTIFIED TO MEET THE COMMUNITY NEED. THE PROGRAM HAS RETURNED TO IN-PERSON PROGRAMMING, BUT IS NOT AVAILABLE FOR THE DELAND COMMUNITY. INSTEAD, THE HOSPITAL'S DIABETES EDUCATOR PROVIDED DIABETES EDUCATION AT THE DELAND BOYS & GIRLS CLUB ON CAREER DAY. PRIORITY 3: BARRIERS TO ACCESSING HEALTH CARE SERVICES 2019 DESCRIPTION OF THE ISSUE:- VOLUSIA COUNTY'S RATE OF HEALTH RESOURCES PER POPULATION ARE LOWER THAN FLORIDA IN THE CATEGORIES OF PHYSICIANS, INTERNISTS, OB/GYN AND PEDIATRICIANS. - VOLUSIA COUNTY HAS A HIGHER PERCENTAGE OF BIRTHS COVERED BY MEDICAID THAN FLORIDA. RATES FOR BLACK AND HISPANIC INDIVIDUALS ARE HIGHER. - THE PERCENT OF VOLUSIA COUNTY ADULTS WITH A PERSONAL DOCTOR IS LOWER THAN FLORIDA. - VOLUSIA COUNTY HAS A LOWER RATIO OF PRIMARY CARE PHYSICIANS, DENTISTS, AND MENTAL HEALTH PROVIDERS TO POPULATION THAN FLORIDA. ** SEE CONTINUATION SCHEDULE H, PART V, SECTION B, LINE 11 EXPLANATION CONTINUED: 2022 UPDATE: THE ADVENTHEALTH DELAND COMMUNITY HEALTH PLAN HAS THREE DESIRED GOAL STATEMENTS UNDER THE BARRIERS TO ACCESSING HEALTH CARE SERVICES PRIORITY. 1. ESTABLISH A HEALTHY EQUITY ZONE (HEZ) IN THE SPRING HILL NEIGHBORHOOD OF DELAND TO REDUCE HEALTH INEQUITIES AND PROVIDE ACCESS TO RESIDENT IDENTIFIED HEALTH AND SOCIAL SERVICES.2. INCREASE THE NUMBER OF INDIVIDUALS WHO HAVE ACCESS TO NECESSARY HEALTH CARE SERVICES.3. CREATE NEW ACCESS TO HEALTH SCREENINGS FOR AT RISK POPULATIONS IN THE DELAND AREA. GOAL 1: ESTABLISH A HEALTHY EQUITY ZONE (HEZ) IN THE SPRING HILL NEIGHBORHOOD OF DELAND TO REDUCE HEALTH INEQUITIES AND PROVIDE ACCESS TO RESIDENT IDENTIFIED HEALTH AND SOCIAL SERVICES. OBJECTIVE 1: THE FIRST OBJECTIVE IS TO WORK WITH AT LEAST 100 COMMUNITY RESIDENTS AND COMMUNITY ORGANIZATIONS TO IDENTIFY THREE SPECIFIC ACCESS BARRIERS TO HEALTH SERVICES BY THE END OF YEAR ONE. THE OBJECTIVE IS FUNDED BY, AND ALL OUTCOMES ARE SPECIFIC TO THE HOSPITAL, ALTHOUGH THE OBJECTIVE IS MANAGED AT THE DIVISION LEVEL. TO DRIVE THE OBJECTIVES FORWARD AND TO MEET THE GOALS ESTABLISHED AS PART OF THE 2020 CHP, THE HOSPITAL HAS PARTNERED WITH ORGANIZATIONS AND INDIVIDUALS TO DEVELOP THE HEALTH EQUITY ZONE INITIATIVE. THE HEZ INITIATIVE IS FUNDED AND DEPLOYED THROUGH ADVENTHEALTH DELAND, AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE OBJECTIVE WAS MODIFIED TO BE COMPLETED BY THE END OF YEAR THREE BECAUSE STAFF AND RESOURCES WERE REALLOCATED DURING YEAR ONE TO ADDRESS COVID-19. THE HOSPITAL CONDUCTED DISCUSSIONS WITH COMMUNITY LEADERS FROM THE FLORIDA DEPARTMENT OF HEALTH IN VOLUSIA COUNTY, SPRING HILL RESOURCE CENTER, AND THE CITY OF DELAND. DURING DISCUSSIONS, A NEED FOR HEALTH SCREENINGS AND EDUCATION WAS IDENTIFIED AND THE HOSPITAL AIMED TO FULFILL THE NEED DURING SPRING HILL HEALTH DAY. THE EVENT WAS SUBSEQUENTLY CANCELLED DUE TO HURRICANES IAN AND NICOLE. THE HOSPITAL DID NOT MEET THE OBJECTIVE BY THE END OF YEAR THREE. THE EVENT WAS RESCHEDULED FOR MAY 2023. OBJECTIVE 2:THE SECOND OBJECTIVE IS TO WORK WITH LOCAL COMMUNITY-BASED ORGANIZATIONS TO ESTABLISH NEEDED HEALTH SERVICES IN THE NEIGHBORHOOD OR ADDRESS BARRIERS IDENTIFIED BY COMMUNITY RESIDENTS DURING THE ASSESSMENT PROCESS AND PROVIDE SERVICE ACCESS TO 25% OF IDENTIFIED RESIDENTS BY THE END OF YEAR THREE. THE INITIATIVE TO INCREASE ACCESS TO HEALTH AND SOCIAL SERVICES IS DEPLOYED THROUGH ADVENTHEALTH DELAND AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE INITIATIVE PLANNED FOR YEAR THREE WILL IMPROVE ACCESS TO THE HEALTH SERVICES IDENTIFIED BY COMMUNITY RESIDENTS. THE HOSPITAL DID NOT MEET IT SET METRIC DUE TO THE IMPACT OF HURRICANES IAN AND NICOLE. STAFF TIME AND RESOURCES WERE RE-ALLOCATED TO SUPPORT IMMEDIATE RELIEF EFFORTS. INSTEAD, THE HOSPITAL PROVIDED $7,000 TO THE VOLUSIA COUNTY HISPANIC ASSOCIATION BACK TO SCHOOL FAIR TO SUPPORT WEST VOLUSIA STUDENTS. THE EVENT PROVIDES OVER 1,500 BACKPACKS AND SUPPLIES TO NEEDY STUDENTS. THE HOSPITAL ALSO PROVIDED HEALTH EDUCATION TO 300 STUDENTS AND FAMILIES DURING THE VOLUSIA COUNTY SCHOOLS FACT (FAMILIES AND COMMUNITY TOGETHER) FAIR AT DELAND HIGH SCHOOL. GOAL 2: INCREASE THE NUMBER OF INDIVIDUALS WHO HAVE ACCESS TO NECESSARY HEALTH CARE SERVICES. OBJECTIVE 1:THE FIRST OBJECTIVE IS TO EXPAND OPERATING HOURS TO INCLUDE EVENING AND WEEKEND HOURS AT WEST VOLUSIA MEDICAL ASSOCIATES TO INCREASE ACCESS TO CARE. THE PROGRAM EXPANSION INITIATIVE IS DEPLOYED THROUGH ADVENTHEALTH DELAND, AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE EXPANSION OF OPERATING HOURS OF VOLUSIA MEDICAL ASSOCIATES, WHICH SINCE THE WRITING OF THE COMMUNITY HEALTH PLAN HAS BEEN ACQUIRED AND REBRANDED AS THE ADVENTHEALTH MEDICAL GROUP INTERNAL MEDICINE AT DELAND, WAS IDENTIFIED AS A STRATEGY TO INCREASE ACCESS TO CARE. THE HOSPITAL MET ITS SET METRIC IN YEAR TWO. ADVENTHEALTH MEDICAL GROUP INTERNAL MEDICINE AT DELAND EXPANDED ITS HOURS BEGINNING JANUARY 4, 2021, TO MONDAY THROUGH FRIDAY FROM 7:00 AM TO 7:00 PM TO MEET THE NEEDS OF THE COMMUNITY. ADDITIONALLY, IN YEAR THREE THE HOSPITAL PROVIDED THE GOOD SAMARITAN CLINIC WITH $114,707 IN MEDICAL CARE SERVICES AS WELL AS A $15,000 CASH DONATION. ALSO, THE HOSPITAL'S COMMUNITY CARE PROGRAM PROVIDES EDUCATION, SUPPORT AND CARE COORDINATION THROUGH AN INTERDISCIPLINARY TEAM SERVING THE MOST VULNERABLE PATIENTS. THE TEAM PROVIDES HOME VISITS AT NO CHARGE, FOCUSING ON EDUCATING PATIENTS AND FAMILIES ON PREVENTATIVE CARE AND REDUCING BARRIERS RELATED TO SOCIAL DETERMINANTS OF HEALTH. THE HOSPITAL ENROLLED 73 NEW COMMUNITY CARE PATIENTS IN 2022. OBJECTIVE 2: THE SECOND OBJECTIVE IS TO INCREASE THE NUMBER OF INDIVIDUALS PARTICIPATING IN THE FREE TOOLS TO QUIT TOBACCO CESSATION PROGRAMS BY 10% OVER THE NUMBER OF PARTICIPANTS IN 2019. THE OBJECTIVE IS MANAGED BY THE DIVISION; HOWEVER, THE HOSPITAL PROVIDES IN-KIND RESOURCES AND ALL OUTCOMES REPORTED ARE SPECIFIC TO THE REPORTING HOSPITAL. THE NORTHEAST FLORIDA AREA HEALTH EDUCATION CENTER (NEFAHEC) TOBACCO CESSATION PROGRAMS PROVIDE FREE INTERVENTION THERAPIES TO QUIT SMOKING TOBACCO. THROUGH A PARTNERSHIP WITH NEFAHEC, A LOCAL CHAPTER OF THE NATIONAL AREA HEALTH EDUCATION CENTER (AHEC) ORGANIZATION, WE WILL INCREASE THE NUMBER OF INDIVIDUALS PARTICIPATING IN THE CLASSES BY PROVIDING CONNECTION POINTS TO NEFAHEC'S CLASSES THROUGH SOCIAL MEDIA POSTS AND INTERNAL RESOURCES. THE HOSPITAL MET ITS SET METRIC WITH 10 INDIVIDUALS REFERRED FOR SMOKING CESSATION SERVICES PROVIDED BY NEFAHEC IN 2022. GOAL 3: CREATE NEW ACCESS TO HEALTH SCREENINGS FOR AT RISK POPULATIONS IN THE DELAND AREA. OBJECTIVE 1:THE FIRST OBJECTIVE IS TO PROVIDE ACCESS TO VISION SCREENINGS FOR 75% OF YOUTH CLUB MEMBERS ANNUALLY AT THE LACEY FAMILY SPRING HILL BOYS & GIRLS CLUB. THE VISION SCREENING INITIATIVE IS DEPLOYED THROUGH ADVENTHEALTH DELAND, AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE VISION SCREENING INITIATIVE PROVIDES INCREASED ACCESS TO IMPORTANT VISION SCREENING FOR YOUTH LIVING IN THE SPRING HILL NEIGHBORHOOD. THE HOSPITAL DID NOT MEET ITS SET METRIC. AS A RESULT OF THE REALLOCATION OF RESOURCES DURING COVID-19, THE HOSPITAL WAS NOT ABLE TO PROVIDE THIS SERVICE AT THAT TIME. ADDITIONALLY, THE HOSPITAL RECOGNIZED THAT WITHOUT A COMMUNITY PARTNER TO PROVIDE NEEDED FOLLOW-UP CARE AFTER SCREENINGS IT WAS BETTER TO NOT MOVE THE OBJECTIVE FORWARD WITHOUT A STRATEGY IN PLACE. THEREFORE, THIS OBJECTIVE WAS RETIRED IN 2021. PRIORITY 4: HEALTHY EATING & PHYSICAL ACTIVITY 2019 DESCRIPTION OF THE ISSUE: - OVER 70% OF VOLUSIA COUNTY MIDDLE AND HIGH SCHOOL STUDENTS LACK VIGOROUS PHYSICAL ACTIVITY AND THE PERCENT INCREASED FROM 2014 TO 2016. THE PERCENT IS BETTER THAN FLORIDA.- THE PERCENT OF VOLUSIA COUNTY ADULTS WHO ARE SEDENTARY INCREASED FROM 2007 TO 2016 AND IS NOW HIGHER THAN FLORIDA.- THE PERCENT OF VOLUSIA COUNTY MIDDLE AND HIGH SCHOOLERS WHO WERE OBESE INCREASED SIGNIFICANTLY FROM 2014 TO 2016.- THE PERCENT OF VOLUSIA COUNTY ADULTS WHO ARE OBESE INCREASED BETWEEN 2013 AND 2016 AND THE PERCENT IS NOW HIGHER THAN FLORIDA.- INJURY DEATHS ARE INCREASING AND HIGHER THAN FLORIDA. 2022 UPDATE: THE ADVENTHEALTH DELAND COMMUNITY HEALTH PLAN HAS TWO DESIRED GOAL STATEMENTS UNDER THE HEALTHY EATING & PHYSICAL ACTIVITY PRIORITY. 1. ESTABLISH A HEALTHY EQUITY ZONE (HEZ) IN THE SPRING HILL NEIGHBORHOOD OF DELAND TO REDUCE HEALTH INEQUITIES AND PROVIDE ACCESS TO HEALTHY FOODS AND OPPORTUNITIES FOR PHYSICAL ACTIVITY.2. INCREASE PHYSICAL ACTIVITY AND HEALTHY EATING AMONG VULNERABLE RESIDENTS. GOAL 1: ESTABLISH A HEALTHY EQUITY ZONE (HEZ) IN THE SPRING HILL NEIGHBORHOOD OF DELAND TO REDUCE HEALTH INEQUITIES AND PROVIDE ACCESS TO HEALTHY FOODS AND OPPORTUNITIES FOR PHYSICAL ACTIVITY. ** SEE CONTINUATION SCHEDULE H, PART V, SECTION B, LINE 11 EXPLANATION CONTINUED: OBJECTIVE 1:THE FIRST OBJECTIVE IS TO WORK WITH AT LEAST 100 COMMUNITY RESIDENTS AND FIVE COMMUNITY ORGANIZATIONS TO ASCERTAIN CURRENT ACCESS TO HEALTHY FOODS AND OPPORTUNITIES FOR PHYSICAL ACTIVITY THROUGH AN ASSESSMENT PROCESS AND TO IDENTIFY GAPS AND MISSING RESOURCES BY THE END OF YEAR ONE. THE OBJECTIVE IS FUNDED BY, AND ALL OUTCOMES ARE SPECIFIC TO THE HOSPITAL, ALTHOUGH THE OBJECTIVE IS MANAGED AT THE DIVISION LEVEL. TO DRIVE THE OBJECTIVES FORWARD AND TO MEET THE GOALS ESTABLISHED AS PART OF THE 2020 CHP, THE HOSPITAL HAS PARTNERED WITH ORGANIZATIONS AND INDIVIDUALS TO DEVELOP THE HEALTH EQUITY ZONE INITIATIVE. THE HOSPITAL MODIFIED THE OBJECTIVE IN YEAR ONE BECAUSE STAFF AND RESOURCES WERE REALLOCATED TO ADDRESS COVID-19. THE MODIFIED OBJECTIVE IS TO CONDUCT AN ASSESSMENT TO IDENTIFY AND MAXIMIZE EXISTING COMMUNITY ASSETS TO INCREASE ACCESS FOR COMMUNITY RESIDENTS. THE HOSPITAL MET ITS MODIFIED OBJECTIVE IN 2022 WHERE EXISTING COMMUNITY ASSETS WERE FULLY LEVERAGED THROUGH COLLABORATIVE PARTNERSHIPS TO ADDRESS THE IMMEDIATE NEEDS OF OUR COMMUNITY. SEVERAL COMMUNITY PARTNERS WERE ENGAGED INCLUDING THE SPRING HILL RESOURCE CENTER AND LACEY FAMILY SPRING HILL BOYS AND GIRLS CLUB. OBJECTIVE 2:THE SECOND OBJECTIVE IS TO IMPLEMENT STRATEGIES TO INCREASE ACCESS TO HEALTHY FOODS AND CREATE NEW OPPORTUNITIES FOR PHYSICAL ACTIVITY, BASED ON THE GAPS IDENTIFIED DURING THE COMMUNITY ASSESSMENT, FOR 30% OF RESIDENTS BY THE END OF YEAR THREE. THE INITIATIVE TO INCREASE ACCESS TO HEALTHY FOOD AND PHYSICAL ACTIVITY IS DEPLOYED THROUGH ADVENTHEALTH DELAND AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE OBJECTIVE PLANNED FOR A YEAR THREE DEPLOYMENT WILL IMPROVE ACCESS TO THE HEALTHY FOOD AND PHYSICAL ACTIVITY NEEDS IDENTIFIED BY COMMUNITY RESIDENTS. THE HOSPITAL DID NOT MEET ITS SET METRIC. IN THE ABSENCE OF MEETING THE OBJECTIVE, THE HOSPITAL SUPPORTED THE BRIDGE INTERFAITH KITCHEN MINISTRY PARTNERSHIP, A LOCAL HOMELESS SHELTER ONCE A MONTH. TEAM MEMBERS PREPARED MEALS AND SERVED 60-70 HOMELESS INDIVIDUALS. GOAL 2: INCREASE PHYSICAL ACTIVITY AND HEALTHY EATING AMONG VULNERABLE RESIDENTS. OBJECTIVE 1:THE FIRST OBJECTIVE IS TO PROVIDE EDUCATION ABOUT HEALTHY EATING AND PHYSICAL ACTIVITY TO 75% OF BOYS & GIRLS CLUBS' MEMBERS FOUR TIMES ANNUALLY. THE BOYS & GIRLS CLUBS EDUCATION INITIATIVE IS FUNDED AND DEPLOYED THROUGH ADVENTHEALTH DELAND, AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE BOYS & GIRLS CLUBS EDUCATION INITIATIVE IS FOCUSED ON PROVIDING AT LEAST FOUR EDUCATION SESSIONS A YEAR TO CLUB PARTICIPANTS TO INCREASE THEIR UNDERSTANDING OF HEALTHY EATING AND PHYSICAL ACTIVITY. THE HOSPITAL MET ITS SET METRIC OF PROVIDING EDUCATION SESSIONS FOUR TIMES ANNUALLY, REACHING 75% OF CLUB PARTICIPANTS. FOUR EDUCATIONAL PROGRAMS ON MENTAL HEALTH, WATER CONSERVATION, RECYCLING, AND NUTRITION WERE PROVIDED TO CLUB MEMBERS AT THE LACEY FAMILY SPRING HILL BOYS & GIRLS CLUB. OBJECTIVE 2:THE SECOND OBJECTIVE IS A DIVISIONAL INITIATIVE AND APPEARS ON MULTIPLE COMMUNITY HEALTH PLANS OF HOSPITALS IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, THE SAME DIVISION AS THE REPORTING HOSPITAL. THE DIVISION CHOSE THIS INITIATIVE BECAUSE OF A SHARED CHNA PRIORITY. THIS OBJECTIVE, TO PROVIDE $4,000 IN FINANCIAL SUPPORT ANNUALLY TO THE BOYS & GIRLS CLUBS AS PART OF A STRATEGIC PARTNERSHIP, IS TO PROVIDE DAILY FRESH FRUIT AND WHOLE GRAIN SNACKS TO CLUB MEMBERS. THE OBJECTIVE IS FUNDED THROUGH THE HOSPITAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL, HOWEVER THE INITIATIVE IS MANAGED BY THE DIVISION. THIS INITIATIVE PROVIDES FINANCIAL SUPPORT SO THAT YOUTH PARTICIPATING IN LOCAL BOYS & GIRLS CLUBS CAN HAVE ACCESS TO DAILY HEALTHY SNACKS. THE HOSPITAL MET ITS SET METRIC OF PROVIDING FUNDING SUPPORT WITH $4,000 DOLLARS PROVIDED. THE PROVIDED FUNDING WAS ABLE TO MAKE UP FOR THE USDA GRANT SHORTFALL AND PROVIDE BOYS & GIRLS CLUB MEMBERS WITH DAILY FRESH FRUIT AND WHOLE GRAIN SNACKS. PRIORITY 5: SOCIAL AND ECONOMIC ISSUES (SOCIAL DETERMINANTS OF HEALTH) 2019 DESCRIPTION OF THE ISSUE: - VOLUSIA COUNTY'S MEDIAN HOUSEHOLD INCOME IS LOWER THAN FLORIDA'S.- VOLUSIA COUNTY'S PERCENT OF INDIVIDUALS AND INDIVIDUALS BELOW AGE 18 BELOW POVERTY ARE BOTH SLIGHTLY HIGHER THAN FLORIDA'S.- THE VOLUSIA COUNTY PERCENT OF ELEMENTARY AND MIDDLE SCHOOL STUDENTS ELIGIBLE FOR FREE/REDUCED PRICE LUNCHES IS HIGHER THAN FLORIDA (A PROXY MEASURE FOR LOW INCOME).- THE VOLUSIA COUNTY HIGH SCHOOL GRADUATION RATE IS LOWER THAN FLORIDA.- THE VOLUSIA COUNTY PERCENT OF ADULTS LIMITED BY PHYSICAL, MENTAL, OR EMOTIONAL PROBLEMS IS HIGHER THAN FLORIDA (DIFFERENCE IS STATISTICALLY SIGNIFICANT).- VOLUSIA COUNTY'S FOOD INSECURITY RATE IS HIGHER THAN FLORIDA'S.- VOLUSIA COUNTY'S PER CAPITA INCOME IS LOWER THAN FLORIDA'S.- OVER 30% OF VOLUSIA COUNTY HOUSEHOLDS SPEND MORE THAN 30% OF THEIR INCOME ON HOUSING AND WORKERS IN 8 OF THE TOP 20 INDUSTRIES IN VOLUSIA ARE ESTIMATED TO BE HOUSING BURDENED BASED ON AVERAGE HOURLY WAGE.- THE VOLUSIA COUNTY NUMBER OF INDIVIDUALS COUNTED DURING THE POINT-IN-TIME COUNT WAS HIGHER IN 2019 THAN IN 2018.- THE VOLUSIA COUNTY NUMBER OF HOMELESS STUDENTS HAS BEEN INCREASING SINCE 2016.- VOLUSIA COUNTY'S PERCENT OF SINGLE PARENT HOUSEHOLDS IS HIGHER THAN FLORIDA'S. 2022 UPDATE: THE ADVENTHEALTH DELAND COMMUNITY HEALTH PLAN HAS ONE DESIRED GOAL STATEMENT UNDER THE SOCIAL AND ECONOMIC ISSUES (SOCIAL DETERMINANTS OF HEALTH) PRIORITY. GOAL 1: ESTABLISH A HEALTHY EQUITY ZONE (HEZ) IN THE SPRING HILL NEIGHBORHOOD OF DELAND TO REDUCE HEALTH INEQUITIES AND PROVIDE ACCESS TO RESIDENT IDENTIFIED SUPPORTS TO IMPROVE THE ECONOMIC CONDITIONS OF THE NEIGHBORHOOD. OBJECTIVE 1:THE FIRST OBJECTIVE IS TO WORK WITH COMMUNITY RESIDENTS AND COMMUNITY ORGANIZATIONS TO IDENTIFY HOUSING, EMPLOYMENT, AND OTHER FINANCIAL STABILITY BARRIERS BY THE END OF YEAR ONE. THE OBJECTIVE IS FUNDED BY, AND ALL OUTCOMES ARE SPECIFIC TO THE HOSPITAL, ALTHOUGH THE OBJECTIVE IS MANAGED AT THE DIVISION LEVEL. TO DRIVE THE OBJECTIVES FORWARD AND TO MEET THE GOALS ESTABLISHED AS PART OF THE 2020 CHP, THE HOSPITAL HAS PARTNERED WITH ORGANIZATIONS AND INDIVIDUALS TO DEVELOP THE HEALTH EQUITY ZONE INITIATIVE. THE HOSPITAL MET ITS SET METRIC OF COLLABORATING WITH COMMUNITY RESIDENTS AND COMMUNITY ORGANIZATIONS TO IDENTIFY EMPLOYMENT AND OTHER FINANCIAL STABILITY BARRIERS. THE BARRIERS IDENTIFIED INCLUDE HOUSES IN POOR CONDITION AND AT-RISK DURING HURRICANE SEASON. ADDITIONALLY, HIGH UNEMPLOYMENT IS COMPLICATED FOR INDIVIDUALS WITH CRIMINAL RECORDS. THE HOSPITAL PARTNERED WITH RIPPLAFFECT AND BETHUNE COOKMAN UNIVERSITY TO PROVIDE HURRICANE RELIEF AT THE FEMA DISASTER CENTER AT THE DEPARTMENT OF HEALTH IN VOLUSIA COUNTY. RIPPLAFFECT IS AN ALL-VOLUNTEER NON-PROFIT HUMANITARIAN ORGANIZATION WITH A MISSION TO IMPROVE THE HEALTH AND WELL-BEING OF FAMILIES BY PROVIDING ACCESS TO CLEAN, SAFE DRINKING WATER WORLDWIDE AS WELL AS HERE AT HOME. THE HOSPITAL FUNDED HYGIENE KITS WHICH WERE DISTRIBUTED BY THE PARTNERING ORGANIZATIONS. OBJECTIVE 2:THE SECOND OBJECTIVE IS TO WORK WITH COMMUNITY PARTNERS TO DEVELOP A LONG-RANGE PLAN TO INCREASE RESIDENT'S FINANCIAL STABILITY BY THE END OF YEAR THREE. THE INITIATIVE TO INCREASE RESIDENT'S FINANCIAL STABILITY IS DEPLOYED THROUGH ADVENTHEALTH DELAND AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE INITIATIVE PLANNED FOR YEAR THREE WILL IMPROVE ACCESS TO SERVICES TO SUPPORT FINANCIAL STABILITY OF RESIDENTS IN THE SPRING HILL COMMUNITY. THE HOSPITAL MET ITS SET METRIC REFERRING 18 WEST VOLUSIA RESIDENTS TO SOAR IN 2022. THE SOAR PROCESSOR (SSI/SSDI OUTREACH, ACCESS, AND RECOVERY), THROUGH A PARTNERSHIP WITH FLAGLER CARES SOAR, ASSISTS ELIGIBLE PATIENTS TO APPLY FOR AND OBTAIN SSI/SSDI BENEFITS (TO INCLUDE INCOME AND MEDICAID/MEDICARE). ** SEE CONTINUATION SCHEDULE H, PART V, SECTION B, LINE 11 EXPLANATION CONTINUED: COMMUNITY NEEDS NOT CHOSEN BY ADVENTHEALTH DELAND:THE PRIMARY AND SECONDARY DATA IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED MULTIPLE COMMUNITY ISSUES. THE HOSPITAL AND COMMUNITY STAKEHOLDERS USED THE FOLLOWING CRITERIA TO NARROW THE LARGER LIST TO THE PRIORITY AREAS NOTED ABOVE: 1. HOW ACUTE IS THE NEED? (BASED ON DATA AND COMMUNITY CONCERN)2. WHAT IS THE TREND? IS THE NEED GETTING WORSE?3. DOES THE HOSPITAL PROVIDE SERVICES THAT RELATE TO THE PRIORITY?4. IS SOMEONE ELSE - OR MULTIPLE GROUPS - IN THE COMMUNITY ALREADY WORKING ON THIS ISSUE?5. IF THE HOSPITAL WERE TO ADDRESS THIS ISSUE, ARE THERE OPPORTUNITIES TO WORK WITH COMMUNITY PARTNERS? BASED ON THIS PRIORITIZATION PROCESS, THE HOSPITAL DID NOT CHOOSE THE FOLLOWING COMMUNITY ISSUES: 1. THE YEARS OF POTENTIAL AGING-RELATED ISSUES: THE DATA COLLECTED FOR INDIVIDUALS 65 AND OLDER DID NOT DEMONSTRATE SIGNIFICANT NEGATIVE TRENDS OR NEGATIVE COMPARISON TO STATE DATA. THE ONLY INDICATOR OF CONCERN NOTED WAS SUICIDE RATE FOR INDIVIDUALS OVER 65 WHICH WILL BE ADDRESSED THROUGH THE PRIORITIZATION OF ADULT BEHAVIORAL HEALTH. THERE ARE NUMEROUS INITIATIVES IN PLACE TO PROVIDE SERVICES TO THIS TARGET POPULATION. 2. CHILD & ADOLESCENT ISSUES: THE MOST SIGNIFICANT CHILDHOOD ISSUES ARE ADDRESSED THROUGH OTHER PRIORITY ISSUES (BEHAVIORAL HEALTH, ACCESS TO SERVICES, HEALTHY EATING, AND PHYSICAL ACTIVITY). 3. COMMUNICABLE & INFECTIOUS DISEASES: THE DATA COLLECTED DID NOT DEMONSTRATE SIGNIFICANT NEGATIVE TRENDS OR COMPARISON DATA. MANY ISSUES NOTED IN THE INDICATORS OF CONCERN WILL BE ADDRESSED THROUGH THE PRIORITIZATION OF ACCESS TO HEALTH CARE SERVICES. 4. CRIME, DOMESTIC VIOLENCE & CHILD ABUSE: THE DATA COLLECTED DID NOT DEMONSTRATE SIGNIFICANT NEGATIVE TRENDS OR NEGATIVE COMPARISON TO STATE DATA. MANY ISSUES NOTED IN THE INDICATORS OF CONCERN WILL BE ADDRESSED THROUGH THE PRIORITIZATION OF SOCIAL AND ECONOMIC ISSUES. 5. EARLY CHILDHOOD: THERE ARE SIGNIFICANT EFFORTS ALREADY IN PLACE TO ADDRESS THIS TARGET POPULATION. 6. WOMEN'S HEALTH, PRENATAL CARE & BIRTH OUTCOMES: THERE ARE SIGNIFICANT EFFORTS ALREADY IN PLACE TO ADDRESS THIS TARGET POPULATION. MANY OF THE INDICATORS OF CONCERN WILL BE ADDRESSED THROUGH THE PRIORITIZATION OF ACCESS TO HEALTH CARE SERVICES. SCHEDULE H, PART V, SECTION B, LINE 16A,B,C: THE FINANCIAL ASSISTANCE POLICY CAN BE FOUND AT URL:HTTPS://WWW.ADVENTHEALTH.COM/HOSPITAL/ADVENTHEALTH-DELAND/LEGAL/FINANCIAL-ASSISTANCETHE FINANCIAL ASSISTANCE POLICY APPLICATION CAN BE FOUND AT:HTTPS://WWW.ADVENTHEALTH.COM/HOSPITAL/ADVENTHEALTH-DELAND/LEGAL/FINANCIAL-ASSISTANCETHE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://WWW.ADVENTHEALTH.COM/HOSPITAL/ADVENTHEALTH-DELAND/LEGAL/FINANCIAL-ASSISTANCE 11 1 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 1070 NORTH STONE STREET SUITE A DELAND FL 32720 PHYSICIAN CLINIC 2 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 1070 NORTH STONE STREET SUITE D DELAND FL 32720 PHYSICIAN CLINIC 3 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 685 PEACHWOOD DRIVE DELAND FL 32720 PHYSICIAN CLINIC 4 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 1070 NORTH STONE STREET SUITE C DELAND FL 32720 PHYSICIAN CLINIC 5 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 151 VICTORIA COMMONS BLVD SUITE 104 DELAND FL 32720 PHYSICIAN CLINIC 6 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 151 VICTORIA COMMONS BLVD SUITE 102 DELAND FL 32720 PHYSICIAN CLINIC 7 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 1431 ORANGE CAMP ROAD SUITE 118/119 DELAND FL 32724 PHYSICIAN CLINIC 8 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 742 W PLYMOUTH AVENUE DELAND FL 32720 PHYSICIAN CLINIC 9 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 1070 NORTH STONE STREET SUITE E DELAND FL 32720 PHYSICIAN CLINIC 10 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 1061 MEDICAL CENTER DRIVE SUITE 201 ORANGE CITY FL 32763 PHYSICIAN CLINIC 11 - ADVENTHEALTH MEDICAL GROUP PHY CLINIC 230 E NEW YORK AVENUE DELAND FL 32724 PHYSICIAN CLINIC PART I, LINE 3C: UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY, AN INDIVIDUAL IS ELIGIBLE FOR A 100% REDUCTION FROM APPLICABLE CHARGES IF THE INDIVIDUAL'S HOUSEHOLD INCOME IS AT OR BELOW 200% OF THE CURRENT FEDERAL POVERTY GUIDELINES. ALTERNATIVELY, A PATIENT MAY ALSO QUALIFY FOR A 100% REDUCTION FROM CHARGES WHEN THE UNPAID PORTION OF A PATIENT'S BILL EXCEEDS 25% OF THE INDIVIDUAL'S ANNUAL HOUSEHOLD INCOME AND WHERE THE TOTAL ANNUAL HOUSEHOLD INCOME IS LESS THAN 500% OF THE FEDERAL POVERTY GUIDELINES. MEDICARE RECIPIENTS MAY ALSO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY DEPENDING UPON THE INDIVIDUAL'S INCOME AND RESOURCES. RESOURCES ARE GENERALLY DEFINED AS ASSETS SUCH AS MONEY IN CHECKING OR SAVINGS ACCOUNTS, STOCKS, AND BONDS. PART I, LINE 6A: THE FILING ORGANIZATION WAS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) DURING ITS CURRENT TAX YEAR. DURING THE CURRENT YEAR, AHSSHC SERVED AS A PARENT ORGANIZATION TO 30 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS AND A NUMBER OF OTHER HEALTH CARE FACILITIES THAT OPERATED IN 10 STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS "ADVENTHEALTH".ALL HOSPITAL ORGANIZATIONS WITHIN ADVENTHEALTH COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. ADVENTHEALTH ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. ADVENTHEALTH HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. EACH ADVENTHEALTH HOSPITAL FACILITY REPORTS THEIR COMMUNITY BENEFITS TO THEIR BOARD OF DIRECTORS AND STRIVES TO COMMUNICATE THEIR COMMUNITY BENEFITS TO THEIR LOCAL COMMUNITIES. ADDITIONALLY, THE FILING ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY CAN BE ACCESSED ON THE FILING ORGANIZATION'S WEBSITE. PART I, LINE 7: THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON LINE 2 OF SECTION A OF PART III IS RECORDED IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO REVENUE, NOT BAD DEBT EXPENSE. PART III, LINE 3: METHODOLOGY FOR DETERMINING THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT MAY REPRESENT PATIENTS WHO COULD HAVE QUALIFIED UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY:SELF-PAY PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE BY COMPLETING A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM). IF AN INDIVIDUAL DOES NOT SUBMIT A COMPLETE FAA FORM WITHIN 240 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL, AN INDIVIDUAL MAY BE CONSIDERED FOR PRESUMPTIVE ELIGIBILITY BASED UPON A SCORING TOOL THAT IS DESIGNED TO CLASSIFY PATIENTS INTO GROUPS OF VARYING ECONOMIC MEANS. THE SCORING TOOL USES ALGORITHMS THAT INCORPORATE DATA FROM CREDIT BUREAUS, DEMOGRAPHIC DATABASES, AND HOSPITAL SPECIFIC DATA TO INFER AND CLASSIFY PATIENTS INTO RESPECTIVE ECONOMIC MEANS CATEGORIES. INDIVIDUALS WHO EARN A CERTAIN SCORE ON THE SCORING TOOL ARE CONSIDERED TO QUALIFY AS ELIGIBLE FOR THE MOST GENEROUS FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. AS DETERMINED BY THE FILING ORGANIZATION, A NOMINAL AMOUNT OF SUCH A PATIENT'S BILL IS WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED NON-STATE CHARITY. THE AMOUNT WRITTEN OFF AS BAD DEBT EXPENSE FOR THOSE PATIENTS WHO POTENTIALLY QUALIFY AS NON-STATE CHARITY USING THE SCORING TOOL IS THE AMOUNT SHOWN ON LINE 3 OF SECTION A OF PART III. RATIONALE FOR INCLUDING CERTAIN BAD DEBTS IN COMMUNITY BENEFIT:THE FILING ORGANIZATION IS DEDICATED TO THE VIEW THAT MEDICALLY NECESSARY HEALTH CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS SHOULD BE ACCESSIBLE TO ALL, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, CULTURAL BACKGROUND, PHYSICIAN MOBILITY, OR ABILITY TO PAY. THE FILING ORGANIZATION TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THE AVAILABILITY OF THIRD-PARTY COVERAGE. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE FILING ORGANIZATION IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES.AS A 501(C)(3) HOSPITAL ORGANIZATION, THE FILING ORGANIZATION MAINTAINS A 24/7 EMERGENCY ROOM PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION CANNOT BE MADE BASED UPON INFORMATION SUPPLIED BY THE INDIVIDUAL. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS: THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR. THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGE 8-9. PLEASE NOTE THAT DOLLAR AMOUNTS ON THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE IN THOUSANDS. PART III, LINE 8: COSTING METHODOLOGY: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. RATIONALE FOR INCLUDING A MEDICARE SHORTFALL AS COMMUNITY BENEFIT:AS A 501(C)(3) ORGANIZATION, THE FILING ORGANIZATION PROVIDES EMERGENCY AND NON-ELECTIVE CARE TO ALL REGARDLESS OF ABILITY TO PAY. ALL HOSPITAL SERVICES ARE PROVIDED IN A NON-DISCRIMINATORY MANNER TO PATIENTS WHO ARE COVERED BENEFICIARIES UNDER THE MEDICARE PROGRAM. AS A PUBLIC INSURANCE PROGRAM, MEDICARE PROVIDES A PRE-ESTABLISHED REIMBURSEMENT RATE/AMOUNT TO HEALTH CARE PROVIDERS FOR THE SERVICES THEY PROVIDE TO PATIENTS. IN SOME CASES, THE REIMBURSEMENT AMOUNT PROVIDED TO A HOSPITAL MAY EXCEED ITS COSTS OF PROVIDING A PARTICULAR SERVICE OR SERVICES TO A PATIENT. IN OTHER CASES, THE MEDICARE REIMBURSEMENT AMOUNT MAY RESULT IN THE HOSPITAL EXPERIENCING A SHORTFALL OF REIMBURSEMENT RECEIVED OVER COSTS INCURRED. IN THOSE CASES WHERE AN OVERALL SHORTFALL IS GENERATED FOR PROVIDING SERVICES TO ALL MEDICARE PATIENTS, THE SHORTFALL AMOUNT SHOULD BE CONSIDERED AS A BENEFIT TO THE COMMUNITY. TAX-EXEMPT HOSPITALS ARE REQUIRED TO ACCEPT ALL MEDICARE PATIENTS REGARDLESS OF THE PROFITABILITY, OR LACK THEREOF, WITH RESPECT TO THE SERVICES THEY PROVIDE TO MEDICARE PATIENTS. THE POPULATION OF INDIVIDUALS COVERED UNDER THE MEDICARE PROGRAM IS SUFFICIENTLY LARGE SO THAT THE PROVISION OF SERVICES TO THE POPULATION IS A BENEFIT TO THE COMMUNITY AND RELIEVES THE BURDENS OF GOVERNMENT. IN THOSE SITUATIONS WHERE THE PROVISION OF SERVICES TO THE TOTAL MEDICARE PATIENT POPULATION OF A TAX-EXEMPT HOSPITAL DURING ANY YEAR RESULTS IN A SHORTFALL OF REIMBURSEMENT RECEIVED OVER THE COST OF PROVIDING CARE, THE TAX-EXEMPT HOSPITAL HAS PROVIDED A BENEFIT TO A CLASS OF PERSONS BROAD ENOUGH TO BE CONSIDERED A BENEFIT TO THE COMMUNITY. DESPITE A FINANCIAL SHORTFALL, A TAX-EXEMPT HOSPITAL MUST AND WILL CONTINUE TO ACCEPT AND CARE FOR MEDICARE PATIENTS. TYPICALLY, TAX-EXEMPT HOSPITALS PROVIDE HEALTH CARE SERVICES BASED UPON AN ASSESSMENT OF THE HEALTH CARE NEEDS OF THEIR COMMUNITY AS OPPOSED TO THEIR TAXABLE COUNTERPARTS WHERE PROFITABILITY OFTEN DRIVES DECISIONS ABOUT PATIENT CARE SERVICES THAT ARE OFFERED. PATIENT CARE PROVIDED BY TAX-EXEMPT HOSPITALS THAT RESULTS IN MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS PROVIDING A BENEFIT TO THE COMMUNITY AND RELIEVING THE BURDENS OF GOVERNMENT. PART III, LINE 9B: THE HOSPITAL FILING ORGANIZATION'S COLLECTION PRACTICES ARE IN CONFORMITY WITH THE REQUIREMENTS SET FORTH IN THE 2014 FINAL REGULATIONS REGARDING THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(R)(4) - (R)(6). NO EXTRAORDINARY COLLECTION ACTIONS (ECA'S) ARE INITIATED BY THE HOSPITAL FILING ORGANIZATION IN THE 120-DAY PERIOD FOLLOWING THE DATE AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL (OR, IF LATER, THE SPECIFIED DEADLINE GIVEN IN A WRITTEN NOTICE OF ACTIONS THAT MAY BE TAKEN, AS DESCRIBED BELOW). INDIVIDUALS ARE PROVIDED WITH AT LEAST ONE WRITTEN NOTICE (NOTICE OF ACTIONS THAT MAY BE TAKEN) AND A COPY OF THE FILING ORGANIZATION'S PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY THAT INFORMS THE INDIVIDUAL THAT THE HOSPITAL FILING ORGANIZATION MAY TAKE ACTIONS TO REPORT ADVERSE INFORMATION TO CREDIT REPORTING AGENCIES/BUREAUS IF THE INDIVIDUAL DOES NOT SUBMIT A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM) OR PAY THE AMOUNT DUE BY A SPECIFIED DEADLINE. THE SPECIFIED DEADLINE IS NOT EARLIER THAN 120 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL AND IS AT LEAST 30 DAYS AFTER THE NOTICE IS PROVIDED. A REASONABLE ATTEMPT IS ALSO MADE TO ORALLY NOTIFY AN INDIVIDUAL ABOUT THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FAA FORM DURING THE 240-DAY PERIOD FOLLOWING THE DATE ON WHICH THE FIRST POST-DISCHARGE BILLING STATEMENT WAS SENT TO THE INDIVIDUAL, THE HOSPITAL FILING ORGANIZATION SUSPENDS ANY REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS (OR CEASES ANY OTHER ECA'S) AND PROVIDES A WRITTEN NOTICE TO THE INDIVIDUAL DESCRIBING WHAT ADDITIONAL INFORMATION OR DOCUMENTATION IS NEEDED TO COMPLETE THE FAA FORM. THIS WRITTEN NOTICE CONTAINS CONTACT INFORMATION INCLUDING THE TELEPHONE NUMBER AND PHYSICAL LOCATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY, AS WELL AS CONTACT INFORMATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS OR, ALTERNATIVELY, A NONPROFIT ORGANIZATION OR GOVERNMENTAL AGENCY THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS IF THE HOSPITAL FACILITY IS UNABLE TO DO SO. IF AN INDIVIDUAL SUBMITS A COMPLETE FAA FORM WITHIN A REASONABLE TIME-PERIOD AS SET FORTH IN THE NOTICE DESCRIBED ABOVE, THE HOSPITAL FILING ORGANIZATION WILL SUSPEND ANY ADVERSE REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS UNTIL A FINANCIAL ASSISTANCE POLICY ELIGIBILITY DETERMINATION CAN BE MADE. SUPPLEMENTAL SCHEDULE TO SCHEDULE H, PART III, SECTION B, LINE 8: RECONCILIATION OF SCHEDULE H REPORTED MEDICARE SURPLUS/(SHORTFALL) TO UNREIMBURSED MEDICARE COSTS ASSOCIATED WITH THE PROVISION OF SERVICESTO ALL MEDICARE BENEFICIARIES:THE MEDICARE REVENUE AND ALLOWABLE COSTS OF CARE REPORTED IN SECTION B OF PART III OF SCHEDULE H ARE BASED UPON THE AMOUNTS REPORTED IN THE FILING ORGANIZATION'S MEDICARE COST REPORT IN ACCORDANCE WITH THE IRS INSTRUCTIONS FOR SCHEDULE H. ON AN ANNUAL BASIS, THE FILING ORGANIZATION ALSO DETERMINES ITS TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS. UNREIMBURSED COSTS ARE CONSIDERED A COMMUNITY BENEFIT TO THE ELDERLY AND ARE COMBINED INTO AN ANNUAL COMMUNITY BENEFIT STATEMENT PREPARED BY ADVENTHEALTH. THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO ALL MEDICARE PATIENTS ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ (1,589,512) - DIFFERENCE IN COSTING METHODOLOGY: (3,518,094)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (8,089,066) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITYBENEFIT REPORTING $(13,196,672) AS INDICATED ABOVE, THE PRIMARY DIFFERENCES BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) REPORTED ON SCHEDULE H, PART III, SECTION B, LINE 7 AND THE FILING ORGANIZATION'S PORTION OF THE COMPANY'S ANNUAL COMMUNITY BENEFIT STATEMENT IS DUE TO A DIFFERENCE IN THE COSTING METHODOLOGY AND DIFFERENCES IN THE POPULATION OF MEDICARE PATIENTS WITHIN THE CALCULATION. THE COST METHODOLOGY UTILIZED IN CALCULATING ANY MEDICARE SURPLUS/(SHORTFALL) FOR PURPOSES OF THE ANNUAL COMMUNITY BENEFIT REPORTING IS BASED UPON THE COST-TO-CHARGE RATIO OUTLINED IN WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE SAME COST-TO-CHARGE RATIO IS USED TO DETERMINE THE COSTS ASSOCIATED WITH SERVICES PROVIDED TO CHARITY CARE PATIENTS AND MEDICAID PATIENTS AS REPORTED IN SCHEDULE H, PART I, LINE 7. IN ADDITION, THE MEDICARE COST REPORT EXCLUDES SERVICES PROVIDED TO MEDICARE PATIENTS FOR PHYSICIAN SERVICES, SERVICES PROVIDED TO PATIENTS ENROLLED IN MEDICARE HMOS, AND CERTAIN SERVICES PROVIDED BY OUTPATIENT DEPARTMENTS OF THE FILING ORGANIZATION THAT ARE REIMBURSED ON A FEE SCHEDULE. THE COMPANY'S OWN COMMUNITY BENEFIT STATEMENT CAPTURES THE UNREIMBURSED COST OF PROVIDING SERVICES TO ALL MEDICARE BENEFICIARIES THROUGHOUT THE ORGANIZATION. PART VI, LINE 2: THE HOSPITAL WILL CONDUCT COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) EVERY THREE YEARS. ITS 2022 CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2022, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S 2022 CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN FINAL REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY.SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY. PART VI, LINE 3: THE FINANCIAL ASSISTANCE POLICY (FAP), FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM), AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) OF THE FILING ORGANIZATION'S HOSPITAL FACILITY ARE TRANSPARENT AND AVAILABLE TO ALL INDIVIDUALS SERVED AT ANY POINT IN THE CARE CONTINUUM. THE FAP, FAA FORM, PLS, AND CONTACT INFORMATION FOR THE HOSPITAL FACILITY'S FINANCIAL COUNSELORS ARE PROMINENTLY AND CONSPICUOUSLY POSTED ON THE FILING ORGANIZATION'S HOSPITAL FACILITY'S WEBSITE. THE WEBSITE INDICATES THAT A COPY OF THE FAP, FAA FORM, AND PLS IS AVAILABLE AND HOW TO OBTAIN SUCH COPIES IN THE PRIMARY LANGUAGES OF ANY POPULATIONS WITH LIMITED PROFICIENCY IN ENGLISH THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY (REFERRED TO BELOW AS LEP DEFINED POPULATIONS). SIGNAGE IS DISPLAYED IN PUBLIC LOCATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, INCLUDING AT ALL POINTS OF ADMISSION AND REGISTRATION AND THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE HOSPITAL FACILITY'S WEBSITE ADDRESS WHERE THE FAP, FAA FORM, AND PLS CAN BE ACCESSED AND THE TELEPHONE NUMBER AND PHYSICAL LOCATION THAT INDIVIDUALS CAN CALL OR VISIT TO OBTAIN COPIES OF THE FAP, FAA FORM AND PLS OR TO OBTAIN MORE INFORMATION ABOUT THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS. PAPER COPIES OF THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. PAPER COPIES ARE MADE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGES OF ANY LEP DEFINED POPULATIONS. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A PAPER COPY OF THE HOSPITAL FACILITY'S PLS WILL BE OFFERED TO EVERY PATIENT AS A PART OF THE INTAKE OR DISCHARGE PROCESS. A CONSPICUOUS WRITTEN NOTICE IS INCLUDED ON ALL BILLING STATEMENTS SENT TO PATIENTS THAT NOTIFIES AND INFORMS RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, INCLUDING THE FOLLOWING: 1) THE TELEPHONE NUMBER OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND THE FAA FORM; AND 2) THE WEBSITE ADDRESS WHERE COPIES OF THE FAP, FAA FORM AND PLS MAY BE OBTAINED. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE. COPIES OF THE PLS ARE DISTRIBUTED TO MEMBERS OF THE COMMUNITY IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. PART VI, LINE 4: THE FILING ORGANIZATION IS A PART OF ADVENTHEALTH, ONE OF THE NATION'S LARGEST NOT-FOR-PROFIT HEALTHCARE PROVIDERS WITH A MISSION OF EXTENDING THE HEALING MINISTRY OF CHRIST. ADVENTHEALTH DELAND PROVIDES WHOLE PERSON CARE TO HEAL THE BODY, MIND AND SPIRIT. ADVENTHEALTH DELAND OPERATES A 170-BED ACUTE CARE HOSPITAL LOCATED IN DELAND, FLORIDA AND IS FULLY ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTH CARE ORGANIZATIONS. THE HOSPITAL IS ONE OF 15 HOSPITALS THAT COMPRISE THE ADVENTHEALTH CENTRAL FLORIDA DIVISION. THE HOSPITAL DEFINES ITS COMMUNITY AS THE PRIMARY SERVICE AREA, THE AREA IN WHICH 75-80% OF ITS PATIENT POPULATION LIVES. THIS INCLUDES FIVE ZIP CODES ACROSS VOLUSIA COUNTY.FOR NEARLY 30 YEARS, ADVENTHEALTH DELAND HAS SERVED THE WEST VOLUSIA AREA AND SURROUNDING COMMUNITIES BY PROVIDING THE FOLLOWING COMPREHENSIVE HEALTH CARE SERVICES: CANCER CARE, DIABETES CARE, HEART AND VASCULAR CARE, HOME CARE, HOSPICE CARE, IMAGING SERVICES, LAB SERVICES, NUTRITIONAL AND DIETETIC SERVICES, ORTHOPEDIC CARE, SPORTS MEDICINE AND REHAB CARE, SLEEP CARE, SPINE CARE, SURGICAL CARE, TRANSITIONAL CARE, EMERGENCY AND URGENT CARE, AND WOUND CARE. DURING 2022, THE HOSPITAL'S PATIENT PERCENTAGE POPULATION WAS MADE UP OF THE BELOW PAYORS WITH THE REMAINING PERCENTAGE OF THE PATIENTS BEING COVERED UNDER COMMERCIAL INSURANCE. IN 2022, ABOUT 90.7% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. - MEDICARE PATIENTS 54.6% - MEDICAID PATIENTS 12.1% - SELF-PAY PATIENTS 6.6% THE DEMOGRAPHIC MAKEUP OF THE HOSPITAL'S COMMUNITY IS AS FOLLOWS: - POPULATION 153,438 - POPULATION OVER 65 21.4% - POVERTY (BELOW 100% FPL) 12.9% - HIGH SCHOOL GRADUATION RATE 89.7% - UNINSURED ADULTS 11.8% - FOOD INSECURITY RATE 15.5% - POP. WITH LOW FOOD ACCESS 58.3% PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO ADVENTHEALTH DELAND'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT AND COMMUNITY BUILDING INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, THE HOSPITAL PROVIDED $401,489 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF A COMMUNITY HOSPITAL. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE HOSPITAL EXPENDED $7,874,680 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. PART VI, LINE 6: ADVENTHEALTH DELAND IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTHEALTH. AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 49 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 10 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AS THE PARENT ORGANIZATION OF ADVENTHEALTH, AHSSHC PROVIDES EXECUTIVE LEADERSHIP AND OTHER PROFESSIONAL SUPPORT SERVICES TO ITS SUBSIDIARY ORGANIZATIONS. PROFESSIONAL SUPPORT SERVICES INCLUDE AMONG OTHERS IT, CORPORATE COMPLIANCE, LEGAL, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. CERTAIN SUPPORT SERVICES, SUCH AS HUMAN RESOURCES, PAYROLL, A/P, AND SUPPLY CHAIN MANAGEMENT ARE PROVIDED PURSUANT TO A SHARED SERVICES MODEL BY AHSSHC TO ITS SUBSIDIARY ORGANIZATIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH ADVENTHEALTH SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. EACH ADVENTHEALTH SUBSIDIARY PAYS A MANAGEMENT FEE TO AHSSHC FOR THE INTERNAL SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY AN ADVENTHEALTH SUBSIDIARY ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY BY ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF ADVENTHEALTH AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEB-SITE OF ADVENTHEALTH AT WWW.ADVENTHEALTH.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF ADVENTHEALTH. SCHEDULE H, PART VI, LINE 7: THE FILING ORGANIZATION DOES NOT FILE AN ANNUAL COMMUNITY BENEFIT REPORT WITH ANY STATE AGENCIES. 1 ADVENTHEALTH FOUNDATION INC DBA FLORIDA HOSPITAL DELAND FOUNDATION 701 W PLYMOUTH AVENUE DELAND FL 32720 592219301 501 (C)(3) 0 251706 COST GENERAL ADMINISTRATIVE SUPPORT PROVISION OF GENERAL ADMINISTRATIVE SUPPORT DELAND SEVENTH DAY ADVENTIST CHURCH 220 N KEPLER ROAD DELAND FL 32724 593120525 501 (C)(3) 10000 0 GENERAL SUPPORT GOOD SAMARITAN CLINIC OF WEST VOLUSIA INC 136 E PLYMOUTH AVENUE DELAND FL 32724 300408193 501 (C)(3) 15000 0 GENERAL SUPPORT FLAGLER CARES INC 160 CYPRESS POINT PARKWAY STE B302 PALM COAST FL 32164 474145174 501 (C)(3) 32049 0 GENERAL SUPPORT BOYS & GIRLS CLUBS OF VOLUSIA FLAGLER COUNTIES INC 101 N WOODLAND BOULEVARD STE 400 DELAND FL 32720 593158162 501 (C)(3) 7300 0 GENERAL SUPPORT 5 0 PART I, LINE 2: GRANTS ARE GENERALLY MADE ONLY TO RELATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3), OR TO OTHER LOCAL CHARITABLE COMMUNITY ORGANIZATIONS, OR TO OTHER 501(C)(3) ORGANIZATIONS THAT ARE A PART OF THE GROUP EXEMPTION RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES. X X X X X X 1 1 0 1 0 0 0 0 0 0 0 OTTATI DAVID FORMER DIR/CHAIR/AH CFN REG 0 990100 0 268500 0 2427551 0 166400 0 53720 0 3906271 0 104040 GOODMAN TODD DIRECTOR 0 860712 0 218316 0 743829 0 145900 0 58441 0 2027198 0 117093 CELANO PATRICIA FORMER KEY EMPLOYEE/REGIONAL CCO 0 586288 0 120334 0 1006847 0 109292 0 48113 0 1870874 0 52483 GREGORY PHD AUDREY DIR/CHAIR/CEO CFN REG 0 890725 0 0 0 444829 0 187400 0 44134 0 1567088 0 0 THOMAS DEBORA DIRECTOR (END 01/22) 0 478627 0 140091 0 198300 0 70810 0 30626 0 918454 0 48080 PRADO MD MARTIN DIRECTOR 0 412729 0 319224 0 6978 0 16400 0 25533 0 780864 0 0 GHOSN C JOSEF DIRECTOR 0 380607 0 90809 0 205009 0 44246 0 33571 0 754242 0 20839 DAVIS BRENT DIRECTOR/CFO - CFN REG 0 478024 0 110337 0 15430 0 90095 0 47618 0 741504 0 0 BROWN LORENZO CEO - W.VOLUSIA MKT 0 417649 0 99712 0 45111 0 67245 0 57887 0 687604 0 27035 WEIS DAVID CEO - HOSPITAL FACILITY (END 08/22) 0 406063 0 87239 0 29740 0 71453 0 45694 0 640189 0 13066 HINDS NIGEL FORMER CFO 0 335995 0 97179 0 115896 0 23503 0 49415 0 621988 0 18551 SMITH MD CHRISTOPHER FORMER CMO 0 369406 0 72800 0 28075 0 52218 0 30456 0 552955 0 0 SCOGGINS MD THOMAS CMO - HOSPITAL FACILITY 0 319694 0 0 0 109320 0 66322 0 44293 0 539629 0 0 LUNDE ERIC DIR/CEO HOSP. FACILITY (BEG 09/22) 0 324955 0 32230 0 13737 0 66535 0 43156 0 480613 0 0 GRIFFITH SUE ELLEN DIRECTOR (BEG 03/22) 0 246472 0 147898 0 30045 0 16400 0 9031 0 449846 0 0 GLASS KYLE CFO - HOSPITAL FACILITY (END 08/22) 0 288224 0 57115 0 11310 0 16400 0 44453 0 417502 0 0 LINDSEY CRAIG FORMER CNO 0 284542 0 54446 0 11722 0 16400 0 30570 0 397680 0 0 AGUERO SAMUEL FORMER COO 0 236314 0 42586 0 9978 0 14522 0 39379 0 342779 0 0 LEBRON MICHELE CNO - HOSPITAL FACILITY 0 196540 0 35308 0 12030 0 7681 0 44585 0 296144 0 0 BEJARANO NICHOLAS COO - HOSPITAL FACILITY (BEG 01/22) 0 195224 0 14429 0 11711 0 9934 0 41027 0 272325 0 0 STEPHAN KELLY AH DEL ADMIN SUPERVISOR 204633 0 21095 0 8110 0 11867 0 10470 0 256175 0 0 0 SANCHEZ ANGEL AH DEL ADMIN SUPERVISOR 174602 0 21886 0 15279 0 10688 0 18466 0 240921 0 0 0 HAGGERTY MARIA AH DEL ADMIN SUPERVISOR PRN 165918 0 20617 0 12191 0 9668 0 8787 0 217181 0 0 0 WELLS JEFFREY AH ASSISTANT NURSE MANAGER 153787 0 11626 0 25852 0 9241 0 8634 0 209140 0 0 0 WESTERBERG SAMANTHA AH DEL RN 197851 0 2109 0 5336 0 0 0 0 0 205296 0 0 0 POTTER ARIEANNA CFO - HOSPITAL FACILITY (BEG 08/22) 71080 59506 10996 0 9075 1942 4510 2898 26610 10585 122271 74931 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 EXECUTIVES LISTED IN PART VII THAT ARE ON THE PAYROLL OF AHSSHC. AT THE DIRECTION OF AHSSHC, AND IN ACCORDANCE WITH THE RESERVED POWERS IN THE FILING ORGANIZATION'S GOVERNING DOCUMENTS, THE EXECUTIVE TEAM LISTED ON PART VII PROVIDES SERVICES TO THE FILING ORGANIZATION. FIRST-CLASS OR CHARTER TRAVEL: PURSUANT TO THE ADVENTHEALTH SYSTEM-WIDE GENERAL POLICY REGARDING BUSINESS TRAVEL, NO REIMBURSEMENT WILL BE PROVIDED FOR ANY ADDITIONAL COST INCURRED WITH RESPECT TO FIRST-CLASS OR CHARTER AIR TRAVEL BEYOND THE COST OF A REGULAR COACH AIRFARE. AS A MEANS OF PROVIDING ADDITIONAL BUSINESS TRAVEL REIMBURSEMENT FOR THOSE MEMBERS OF THE AHSSHC SENIOR EXECUTIVE MANAGEMENT TEAM THAT TRAVEL FREQUENTLY ON BEHALF OF ADVENTHEALTH, A SPECIAL ANNUAL TRAVEL ALLOWANCE IS PROVIDED FOR THOSE EXECUTIVES. AS ADVENTHEALTH OPERATES 49 HOSPITALS IN 9 STATES, THE SENIOR LEADERSHIP OF AHSSHC TRAVEL EXTENSIVELY AND OFTEN VISIT MULTIPLE HOSPITAL LOCATIONS IN DIFFERENT STATES AS A PART OF A SINGLE BUSINESS TRIP. THE SPECIAL TRAVEL ALLOWANCE CAN PROVIDE REIMBURSEMENTS TO THE EXECUTIVE FOR SUCH ITEMS AS THE PURCHASE OF AIR TRAVEL UPGRADE COUPONS, TO COVER THE COST DIFFERENTIAL BETWEEN COACH AND FIRST-CLASS TRAVEL, OR TO COVER THE COST OF A CHARTER FLIGHT. THE SPECIAL TRAVEL ALLOWANCE BENEFIT WAS ORIGINALLY AUTHORIZED BY AND CODIFIED INTO A POLICY BY THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE), AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS, WHO ALSO APPROVES THE ANNUAL CAP ON THE AMOUNT OF THE ALLOWANCE. THE SPECIAL TRAVEL ALLOWANCE HAS AN ANNUAL CAP OF $24,000 FOR MEMBERS OF THE LEADERSHIP EXECUTIVE TEAM (13 ADVENTHEALTH CABINET MEMBERS AND THE ADVENTHEALTH MULTI-STATE CFO) AND $15,000 FOR ADVENTHEALTH CORPORATE OFFICE SENIOR VICE PRESIDENTS, REGIONAL CEO'S, AND DIVISION CHIEF OFFICERS (GENERALLY 50 - 55 INDIVIDUAL EXECUTIVES). A REGIONAL CEO FOR ADVENTHEALTH IS A MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION. THE REGIONAL CEO IS CONSIDERED A COMMON LAW EMPLOYEE OF AND IS ON THE PAYROLL OF AHSSHC. WHILE THE SPECIAL TRAVEL ALLOWANCE BENEFIT IS AN AHSSHC COMPENSATION POLICY AND PRACTICE, THE COST OF PROVIDING THIS BENEFIT IS ALLOCATED TO AND EITHER WHOLLY OR PARTIALLY REIMBURSED BY THE FILING ORGANIZATION. ACCORDINGLY, THE FILING ORGANIZATION HAS CHECKED THE BOX IN SCHEDULE J, PART I, LINE 1A FOR FIRST-CLASS OR CHARTER TRAVEL SINCE IT HAS WHOLLY OR PARTIALLY PAID FOR THE COST OF PROVIDING THIS BENEFIT. THOSE EXECUTIVES WHO RECEIVE THE SPECIAL TRAVEL ALLOWANCE ARE RESPONSIBLE FOR TRACKING THE EXPENSES REIMBURSABLE UNDER THE SPECIAL TRAVEL ALLOWANCE AND MUST SUBMIT SUCH EXPENSES ON THEIR ACCOUNTABLE PLAN EXPENSE REPORT. A REPORT ON CHARTER TRAVEL IS PROVIDED TO THE AHSSHC BOARD COMPENSATION COMMITTEE AT EACH MEETING. ANY TAXABLE REIMBURSEMENTS MADE TO EXECUTIVES UNDER THE SPECIAL TRAVEL ALLOWANCE ARRANGEMENT ARE TREATED AS TAXABLE COMPENSATION TO THE EXECUTIVE. TRAVEL FOR COMPANIONS: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING AHSSHC EXECUTIVE TO HAVE HIS OR HER SPOUSE ACCOMPANY THE EXECUTIVE ON CERTAIN BUSINESS TRIPS EACH YEAR. TYPICALLY, REIMBURSEMENT IS ONLY PROVIDED TO CERTAIN EXECUTIVE LEADERS AND IS USUALLY LIMITED TO ONE BUSINESS TRIP PER YEAR BEYOND THE ANNUAL ADVENTHEALTH PRESIDENT'S COUNCIL BUSINESS MEETING AND OTHER MEETINGS WHERE THE SPOUSE IS SPECIFICALLY INVITED. THE AHSSHC CORPORATE EXECUTIVE SPOUSAL TRAVEL POLICY WAS ORIGINALLY APPROVED AND REVIEWED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. ALL SPOUSAL TRAVEL COSTS REIMBURSED TO THE EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: ADVENTHEALTH HAS A SYSTEM-WIDE POLICY ADDRESSING GROSS-UP PAYMENTS PROVIDED IN CONNECTION WITH EMPLOYER-PROVIDED BENEFITS/OTHER TAXABLE ITEMS. UNDER THE POLICY, CERTAIN TAXABLE BUSINESS-RELATED REIMBURSEMENTS (I.E. TAXABLE BUSINESS-RELATED MOVING EXPENSES, TAXABLE ITEMS PROVIDED IN CONNECTION WITH EMPLOYMENT) PROVIDED TO ANY EMPLOYEE MAY BE GROSSED-UP AT A 25% RATE UPON APPROVAL BY THE FILING ORGANIZATION'S CEO AND CFO. ADDITIONALLY, EMPLOYEES AT THE DIRECTOR LEVEL AND ABOVE ARE ELIGIBLE FOR GROSS-UP PAYMENTS ON GIFTS RECEIVED FOR BOARD OF DIRECTOR SERVICES. DISCRETIONARY SPENDING ACCOUNT: OCCASIONAL DISCRETIONARY SPENDING AMOUNTS ARE PERIODICALLY PROVIDED TO ELIGIBLE EXECUTIVES WHO ATTEND ANNUAL BUSINESS MEETINGS SUCH AS THE ADVENTHEALTH PRESIDENT'S COUNCIL, CFO CONFERENCE OR THE CMO/CNO BUSINESS MEETING. PAYMENTS PROVIDED TO EACH EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES ASSISTANCE TO EXECUTIVES WHO HAVE BEEN RELOCATED BY THE COMPANY DURING THE YEAR. RELOCATION ASSISTANCE PROVIDED TO EXECUTIVES MAY INCLUDE RELOCATION ALLOWANCES TO ASSIST WITH DUPLICATE HOUSING EXPENSES. RELOCATION ASSISTANCE IS ADMINISTERED PER AHSSHC POLICY BY AN EXTERNAL RELOCATION COMPANY. ALL TAXABLE REIMBURSEMENTS MADE TO EXECUTIVES IN CONNECTION WITH RELOCATION ASSISTANCE ARE TREATED AS WAGES TO THE EXECUTIVE AND ARE SUBJECT TO ALL PAYROLL WITHHOLDING AND REPORTING REQUIREMENTS. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES BUSINESS DEVELOPMENT EXPENDITURES. UNDER THIS POLICY, TO ENCOURAGE EXECUTIVES TO ESTABLISH AND CULTIVATE STRONG WORKING RELATIONSHIPS WITH THE MEDICAL COMMUNITY AND OTHER LEADERS IN THE COMMUNITY AND INDUSTRY, CERTAIN ADVENTHEALTH EXECUTIVES MAY BE REIMBURSED FOR MEMBER DUES AND USAGE CHARGES FOR A COUNTRY CLUB OR OTHER SOCIAL CLUB UPON AUTHORIZATION. CLUB MEMBERSHIPS MUST BE APPROVED BY THE ADVENTHEALTH PRESIDENT/CEO INITIALLY AS WELL AS ON AN ANNUAL BASIS. EACH ADVENTHEALTH EXECUTIVE WHO IS APPROVED FOR A CLUB MEMBERSHIP MUST SUBMIT AN ANNUAL REPORT DESCRIBING HOW THEY USED THE MEMBERSHIP TO BENEFIT THEIR ORGANIZATION DURING THE PRECEDING YEAR SO THAT THE ADVENTHEALTH PRESIDENT/CEO CAN DETERMINE IF CONTINUANCE OF THE CLUB MEMBERSHIP FURTHERS THE BUSINESS INTERESTS OF ADVENTHEALTH. IN THE CURRENT YEAR, FOR THIS FILING ORGANIZATION, THE CEO OF THE WEST VOLUSIA MARKET LISTED IN PART VII RECEIVED REIMBURSEMENT FOR CLUB FEES. WHILE THE CLUB DUES MEMBERSHIP IS AN AHSSHC COMPENSATION POLICY AND PRACTICE, THE COST OF PROVIDING THIS BENEFIT IS ALLOCATED TO AND REIMBURSED IN WHOLE OR IN PART BY THE FILING ORGANIZATION. ACCORDINGLY, THE FILING ORGANIZATION HAS CHECKED THE BOX IN SCHEDULE J, PART I, LINE 1A FOR HEALTH OR SOCIAL CLUB DUES SINCE IT HAS WHOLLY OR PARTIALLY PAID FOR THE COST OF PROVIDING THIS BENEFIT. PART I, LINE 3 THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS APPOINTED AND COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC HAS TAKEN STEPS TO ENSURE THAT PROCESSES ARE IN PLACE TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS STANDARD AS SET FORTH IN TREASURY REGULATION SECTION 53.4958-6 WITH RESPECT TO ITS ACTIVE EXECUTIVE-LEVEL POSITIONS. THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE) SERVES AS THE GOVERNING BODY FOR ALL EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE IS COMPOSED OF CERTAIN MEMBERS OF THE BOARD OF DIRECTORS (THE BOARD) OF AHSSHC. VOTING MEMBERS OF THE COMMITTEE INCLUDE ONLY INDIVIDUALS WHO SERVE ON THE BOARD AS INDEPENDENT REPRESENTATIVES, WHO HOLD NO EMPLOYMENT POSITIONS WITH AHSSHC AND WHO DO NOT HAVE RELATIONSHIPS WITH ANY OF THE INDIVIDUALS WHOSE COMPENSATION IS UNDER THEIR REVIEW THAT IMPACTS THEIR BEST INDEPENDENT JUDGMENT AS FIDUCIARIES OF AHSSHC. THE COMMITTEE'S ROLE IS TO REVIEW AND APPROVE ALL COMPONENTS OF THE EXECUTIVE COMPENSATION PLAN OF AHSSHC. AS AN INDEPENDENT GOVERNING BODY WITH RESPECT TO EXECUTIVE COMPENSATION, IT SHOULD BE NOTED THAT THE COMMITTEE WILL OFTEN CONFER IN EXECUTIVE SESSIONS ON MATTERS OF COMPENSATION POLICY AND POLICY CHANGES. IN SUCH EXECUTIVE SESSIONS, NO MEMBERS OF MANAGEMENT OF AHSSHC ARE PRESENT, OTHER THAN THE CHIEF PEOPLE OFFICER, WHO REMAINS AT THE REQUEST OF THE CHAIRMAN/COMMITTEE TO PROVIDE ASSISTANCE/INFORMATION AS NEEDED. THE COMMITTEE IS ADVISED BY AN INDEPENDENT THIRD-PARTY COMPENSATION ADVISOR. THIS ADVISOR PREPARES ALL THE BENCHMARK STUDIES FOR THE COMMITTEE. COMPENSATION LEVELS ARE BENCHMARKED WITH A NATIONAL PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS OF SIMILAR SIZE AND COMPLEXITY TO ADVENTHEALTH AND EACH OF ITS AFFILIATED ENTITIES. THE FOLLOWING PRINCIPLES GUIDE THE ESTABLISHMENT OF INDIVIDUAL EXECUTIVE COMPENSATION: - THE SALARY OF THE PRESIDENT/CEO OF ADVENTHEALTH WILL NOT EXCEED THE 50TH PERCENTILE OF COMPARABLE SALARIES PAID BY SIMILARLY SITUATED ORGANIZATIONS; AND - OTHER EXECUTIVE SALARIES SHALL BE ESTABLISHED USING MARKET MEDIANS. THE COMPENSATION PHILOSOPHY, POLICIES, AND PRACTICES OF AHSSHC ARE CONSISTENT WITH THE ORGANIZATION'S FAITH-BASED MISSION AND CONFORM TO APPLICABLE LAWS, REGULATIONS, AND BUSINESS PRACTICES. AS A FAITH-BASED ORGANIZATION SPONSORED BY THE SEVENTH-DAY ADVENTIST CHURCH (THE CHURCH), AHSSHC'S PHILOSOPHY AND PRINCIPLES WITH RESPECT TO ITS EXECUTIVE COMPENSATION PRACTICES REFLECT THE CONSERVATIVE APPROACH OF THE CHURCH'S MISSION OF SERVICE AND WERE DEVELOPED IN COUNSEL WITH THE CHURCH'S LEADERSHIP. PART I, LINE 4B AS DISCUSSED IN LINE 1A ABOVE, EXECUTIVES ON THE FILING ORGANIZATION'S MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF THE HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. IN RECOGNITION OF THE CONTRIBUTION THAT EACH EXECUTIVE MAKES TO THE SUCCESS OF ADVENTHEALTH, ADVENTHEALTH PROVIDES SUPPLEMENTAL EXECUTIVE RETIREMENT BENEFIT PLANS TO ELIGIBLE EXECUTIVES. AS THE SUPPLEMENTAL EXECUTIVE RETIREMENT BENEFIT PLANS WERE UPDATED IN 2020 AND CERTAIN INDIVIDUALS STILL PARTICIPATE AS GRAND-FATHERED PARTICIPANTS IN CERTAIN PLANS, THE NARRATIVE BELOW DISCUSSES ALL PLANS IN WHICH THERE WERE ANY PARTICIPANTS IN 2022. THE SERP III PLAN EFFECTIVELY REPLACES THE PRIOR SERP II PLAN, THE EXECUTIVE FLEX BENEFIT PROGRAM PLAN, AND THE SENIOR EXECUTIVE DEATH BENEFIT PLAN FOR QUALIFIED EXECUTIVES EXCEPT FOR CERTAIN GRANDFATHERED EXECUTIVE EMPLOYEES. SERP III PLAN: THE SERP III PLAN PROVIDES ELIGIBLE EXECUTIVES A PERCENTAGE OF THEIR BASE PAY, WHICH IS CREDITED TO A DEFERRED COMPENSATION ACCOUNT. THE PLAN ALSO PROVIDES FOR COMPENSATION DEFERRAL AND SELECTION OF LIFE INSURANCE COVERAGE AND LONG-TERM CARE INSURANCE. TO BE ELIGIBLE TO PARTICIPATE IN THE SERP III PLAN, EXECUTIVES MUST BE ON THE AHSSHC CORPORATE PAYROLL AND BE EITHER A CEO OF AN ADVENTHEALTH ENTITY, AN AHSSHC VICE PRESIDENT (VP) OR VP OF AN ADVENTHEALTH ENTITY WITH A BASE SALARY OF AT LEAST $305,000 IN 2022 (ADJUSTED ANNUALLY BY THE SAME PERCENTAGE AS IRC SECTION 401(A)(17) LIMIT INCREASES), OR OTHER LEADER SPECIFICALLY APPROVED BY THE ADVENTHEALTH PRESIDENT. ELIGIBLE EXECUTIVES DO NOT INCLUDE GRANDFATHERED EXECUTIVES, MEANING THOSE EXECUTIVES WHO WOULD SATISFY ALL THE ELIGIBILITY REQUIREMENTS OF THE SERP II PLAN PRIOR TO DEC 31, 2027, HAD THE PLAN NOT BEEN AMENDED AND RESTATED AS OF JAN. 1, 2020. CONTRIBUTION CREDITS WILL BE ESTABLISHED AND MAINTAINED BY CLASS YEAR ACCOUNTS FOR EACH PARTICIPANT USING TIERED CONTRIBUTION CREDIT PERCENTAGES OF ANNUAL BASE COMPENSATION. CONTRIBUTION CREDIT PERCENTAGES RANGE BETWEEN 15% AND 19% OF BASE COMPENSATION. CONTRIBUTION CREDITS WILL BE MADE EACH QUARTER IN 25% INCREMENTS WITH REDUCTIONS IN CONTRIBUTIONS IF THE EXECUTIVE IS ALSO A GRANDFATHERED FLEX PARTICIPANT (SEE BELOW). SERP III PROVIDES FOR A CLASS YEAR VESTING AND PAYMENT SCHEDULE (7 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S DEFERRED COMPENSATION ACCOUNT. UPON ATTAINMENT OF A NORMAL RETIREMENT AGE (AGE 62), OR UPON CERTAIN OTHER CIRCUMSTANCES AS DEFINED IN THE SERP III PLAN DOCUMENT, ALL DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT. FOR ANY EXECUTIVES WORKING BEYOND THE NORMAL RETIREMENT AGE, FUTURE EMPLOYER CONTRIBUTIONS WILL BE MADE QUARTERLY FROM SERP III DIRECTLY TO THE PARTICIPANT AS A TAXABLE CASH BONUS. SERP II PLAN: THE SERP II PLAN IS A DEFINED BENEFIT, NON-TAX-QUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN EXECUTIVES WHO HAVE PROVIDED LENGTHY SERVICE TO ADVENTHEALTH AND/OR TO OTHER SEVENTH-DAY ADVENTIST CHURCH HOSPITALS OR HEALTH CARE INSTITUTIONS. UNDER THE PROVISIONS OF THE SERP II PLAN, BENEFITS ARE PROVIDED TO QUALIFYING EXECUTIVE PARTICIPANTS ON A PRO-RATA SCHEDULE BEGINNING WITH 20 YEARS OF SERVICE AS AN EMPLOYEE OF ADVENTHEALTH AND/OR ANOTHER HOSPITAL OR HEALTH CARE INSTITUTION CONTROLLED BY THE SEVENTH-DAY ADVENTIST CHURCH AND WHO SATISFY CERTAIN OTHER QUALIFYING CRITERIA. ELIGIBLE EMPLOYEES ARE RESTRICTED TO THOSE EXECUTIVES WHO, AS OF JANUARY 1, 2020, SATISFIED, OR IF EMPLOYMENT CONTINUES, WILL SATISFY THE ELIGIBILITY REQUIREMENTS OF SERP II PRIOR TO DECEMBER 31, 2027. THIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP II) WAS DESIGNED TO PROVIDE ELIGIBLE EXECUTIVES WITH THE ECONOMIC EQUIVALENT OF AN ANNUAL INCOME BEGINNING AT NORMAL RETIREMENT AGE EQUAL TO 60% OF THE AVERAGE OF THE PARTICIPANT'S THREE, FIVE OR SEVEN HIGHEST YEARS OF BASE SALARY FROM ADVENTHEALTH ACTIVE EMPLOYMENT INCLUSIVE OF INCOME FROM ALL OTHER SEVENTH-DAY ADVENTIST CHURCH HEALTHCARE EMPLOYER-FINANCED RETIREMENT INCOME SOURCES AND INVESTMENT INCOME EARNED ON THOSE CONTRIBUTIONS THROUGH SOCIAL SECURITY NORMAL RETIREMENT AGE AS DEFINED IN THE PLAN. THE NUMBER OF YEARS INCLUDED IN HIGHEST AVERAGE COMPENSATION IS DETERMINED BY THE INDIVIDUAL'S YEAR OF ENTRY TO SERP II AND BY THE INDIVIDUAL'S YEAR OF ENTRY TO THE ADVENTHEALTH EXECUTIVE FLEX BENEFIT PROGRAM. FLEX PLAN: THE FLEX PLAN WAS ORIGINALLY DESIGNED TO PROVIDE ELIGIBLE EXECUTIVES AN OPPORTUNITY TO SELECT FROM AMONG A VARIETY OF SUPPLEMENTAL BENEFITS, INCLUDING A SPLIT DOLLAR LIFE INSURANCE POLICY AND LONG-TERM CARE INSURANCE, TO INDIVIDUALLY TAILOR A BENEFITS PROGRAM APPROPRIATE TO EACH EXECUTIVE'S NEEDS. IN 2020, THE FLEX PLAN WAS AMENDED TO EXCLUDE EMPLOYED EXECUTIVES WHO ARE HIRED OR PROMOTED AFTER A CERTAIN DATE FROM BEING ELIGIBLE TO PARTICIPATE IN THE FLEX PLAN EXCEPT FOR CERTAIN INSURANCE COVERAGE FEATURES OF THE PLAN. THE FLEX PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS IS DEDUCTED. THE BENEFITS ALLOWANCE CREDIT PERCENTAGE FOR ANY PLAN YEAR SHALL NOT BE GREATER THAN THE MAXIMUM DOLLAR AMOUNT OR THE PERCENTAGE OF COMPENSATION AS DETERMINED BY THE ADVENTHEALTH BENEFITS ADMINISTRATION COMMITTEE. FOR GRANDFATHERED ELIGIBLE EMPLOYEES, THE ANNUAL PRE-DETERMINED FLEX ALLOWANCE IS CONTRIBUTED AND ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED ARE, AT THE EMPLOYEE'S OPTION, CONTRIBUTED TO EITHER AN IRC 457(F) DEFERRED COMPENSATION ACCOUNT OR TO AN IRC 457(B) ELIGIBLE DEFERRED COMPENSATION PLAN. UPON ATTAINMENT OF AGE 65, ALL PREVIOUS 457(F) DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT AND ANY FUTURE EMPLOYER CONTRIBUTIONS ARE MADE QUARTERLY FROM THE PLAN DIRECTLY TO THE PARTICIPANT. THE PLAN PROVIDES FOR A CLASS YEAR VESTING SCHEDULE (2 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT. DISTRIBUTIONS COULD ALSO BE MADE FROM THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT UPON ATTAINMENT OF AGE 65 OR UPON AN INVOLUNTARY SEPARATION. THE ACCOUNT WILL BE FORFEITED BY THE EXECUTIVE UPON A VOLUNTARY SEPARATION. WITH RESPECT TO GRANDFATHERED PARTICIPANTS, THE FLEX PLAN DOCUMENTS DEFINE ELIGIBLE EMPLOYEES TO INCLUDE THE CHIEF EXECUTIVE OFFICERS OF ADVENTHEALTH ENTITIES AND VICE PRESIDENTS OF ALL ADVENTHEALTH ENTITIES WHOSE BASE SALARY WAS AT LEAST EQUAL TO THE INTERNAL REVENUE CODE SECTION 401(A)(17) COMPENSATION LIMIT EACH YEAR. FLEX PLAN FLEX PLAN SERP II SERP III AHS457B CONTR. DISTR.* CONTR./DISTR. CONTR. DISTR.* OTTATI,DAVID $ 150,000 $ 140,915 $ 2,256,444 $ 0 $ 0 GOODMAN,TODD $ 150,000 $ 157,963 $ 532,684 $ 0 $ 0 CELANO,PATRICIA $ 92,892 $ 60,594 $ 913,228 $ 0 $ 0 GREGORY,AUDREY $ 0 $ 0 $ 0 $ 171,000 $ 0 THOMAS,DEBORA $ 74,910 $ 48,092 $ 102,171 $ 0 $ 0 GHOSN,C. JOSEF $ 48,346 $ 21,774 $ 136,059 $ 0 $ 0 DAVIS,BRENT $ 0 $ 0 $ 0 $ 73,695 $ 0 BROWN,LORENZO $ 50,845 $ 28,338 $ 0 $ 0 $ 0 WEIS,DAVID $ 45,712 $ 13,071 $ 0 $ 15,441 $ 0 HINDS,NIGEL $ 27,603 $ 22,482 $ 53,748 $ 0 $ 0 SMITH,CHRISTOPHER $ 47,330 $ 0 $ 0 $ 8,988 $ 0 SCOGGINS,THOMAS $ 0 $ 0 $ 0 $ 49,922 $ 0 LUNDE,ERIC $ 0 $ 0 $ 0 $ 50,135 $ 0 REINER,RICHARD $ 0 $ 0 $ 0 $ 0 $ 55,914 * INCLUDING INVESTMENT EARNINGS KIRSTEN L HAGSTROM-RODRIGUEZ FAMILY OF BOARD MEMBER 85730 EMPLOYEE COMPENSATION 0 MELISSA WOODS FAMILY OF BOARD MEMBER 24493 NON-EMPLOYEE COMPENSATION 0 FORM 990, PART V, LINE 1A: THE PARENT CORPORATION AND SOLE TOP-TIER MEMBER OF MEMORIAL HOSPITAL - WEST VOLUSIA, 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 6 MEMORIAL HOSPITAL-WEST VOLUSIA, INC. (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS MEMORIAL HEALTH SYSTEMS, INC. (MHS) MEMORIAL HEALTH SYSTEMS INC. 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 MHS. THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION ARE APPOINTED BY THE SOLE MEMBER, MHS, 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 MHS, AS THE SOLE MEMBER OF THE FILING ORGANIZATION, AND ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, AS THE TOP-TIER MEMBER OF THE FILING ORGANIZATION, HAVE 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 ADOPT, AMEND, RESTATE, AND REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS OF THE FILING ORGANIZATION; C) TO SET LIMITS AND TERMS FOR THE BORROWING OF FUNDS EXCEEDING $100,000; D) TO APPROVE OR DISAPPROVE THE PURCHASE OR SALE OF PERSONAL PROPERTY OR REAL PROPERTY EQUAL TO OR IN EXCESS OF CERTAIN DOLLAR AMOUNT THRESHOLDS; E) TO APPROVE OR DISAPPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS AND STRATEGIC PLANS OF THE FILING ORGANIZATION; F) TO APPROVE OR DISAPPROVE CAPITAL EXPENDITURES IN EXCESS OF $1,000,000; G) TO APPROVE OR DISAPPROVE PERFORMANCE/QUALITY IMPROVEMENT AND CASE MANAGEMENT PROGRAMS; H) TO APPROVE THE APPOINTMENT OF AN AUDITING FIRM AND ELECTION OF THE FISCAL YEAR FOR THE FILING ORGANIZATION; I) TO APPROVE OR DISAPPROVE MATERIAL CHANGES IN SERVICES OFFERED BY THE FILING ORGANIZATION; J) THE AUTHORITY TO REQUIRE THE FILING ORGANIZATION'S ADHERENCE TO POLICIES ADOPTED BY THE MEMBER OR AHSSHC; K) THE AUTHORITY TO SECURE NAMING RIGHTS AND TO DIRECT THE PLACEMENT OF FUNDS AND CAPITAL AND THE MAKING OF GIFTS, SPONSORSHIPS, DONATIONS, LOANS AND TRANSFERS OF FUNDS OR OTHER ASSETS BY THE FILING ORGANIZATION IN EXCESS OF $100,000; L) TO APPROVE OR DISAPPROVE THE SALE, PURCHASE, DONATION, OR OTHER CONVEYANCE OF PERSONAL PROPERTY WITH A VALUE IN EXCESS OF $1,000,000 NOT OTHERWISE APPROVED IN THE CURRENT CAPITAL OR OPERATING BUDGETS; M) TO APPROVE OR DISAPPROVE THE IMPLEMENTATION OF NON-TRADITIONAL, NON-HEALTHCARE RELATED ACTIVITIES; N) TO APPROVE OR DISAPPROVE THE SELECTION OF THE FILING ORGANIZATION'S GROUP PURCHASING ORGANIZATION(S); O) TO APPROVE OR DISAPPROVE ANY JOINT VENTURE OR PARTNERSHIP IN WHICH THE FILING ORGANIZATION WOULD BE A MEMBER OR PARTNER; P) TO APPROVE THE IT SYSTEMS USED BY THE FILING ORGANIZATION; AND Q) THE AUTHORITY TO REQUIRE THE FILING ORGANIZATION'S ADHERENCE TO THE SYSTEM-WIDE NAMING NOMENCLATURE ADOPTED BY THE MEMBER OR AHSSHC. FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND BY THE CFO PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND THE CFO DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR ANY PRINCIPAL OFFICER OF THE FILING ORGANIZATION (I.E. INTERESTED PERSONS) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTERESTS POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. FORM 990, PART VI, SECTION 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: FOR THOSE BOARD OF DIRECTOR MEMBERS (NOT INCLUDING PHYSICIAN MEMBERS OF THE BOARD), OFFICER(S) AND KEY EMPLOYEES WHO DEVOTE LESS THAN FULL-TIME TO THE FILING ORGANIZATION (BASED UPON THE AVERAGE NUMBER OF HOURS PER WEEK SHOWN IN COLUMN (B) ON PAGE 7 OF THE RETURN) THE COMPENSATION AMOUNTS SHOWN IN COLUMNS (E) AND (F) ON PAGE 7 WERE PROVIDED IN CONJUNCTION WITH THAT PERSON'S RESPONSIBILITIES AND ROLES IN SERVING IN AN EXECUTIVE LEADERSHIP POSITION AS AN EMPLOYEE OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION. PHYSICIAN MEMBERS OF THE BOARD OF DIRECTORS RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS AS A RESULT OF PROVIDING VARIOUS MEDICAL SERVICES TO THOSE RELATED ENTITIES. FORM 990, PART VIII, LINES 7A, B AND C: THE AMOUNT SHOWN IN PART VIII, LINE 7C(I) OF THE FORM 990 REPRESENTS AN ALLOCATED SHARE OF CAPITAL GAIN/(LOSS) FROM A SYSTEM WIDE, CORPORATE ADMINISTERED, INVESTMENT PROGRAM. FORM 990, PART IX, LINE 11G PAYMENTS TO HEALTHCARE PROFESSIONALS: PROGRAM SERVICE EXPENSES 37,444,181. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,444,181. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,271,715. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,271,715. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 22,932,340. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,932,340. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 381,869. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 381,869. TRANSCRIPTION SERVICES: PROGRAM SERVICE EXPENSES 35,189. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,189. RECRUITING: PROGRAM SERVICE EXPENSES 1,064,891. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,064,891. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,625,542. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,625,542. ADVENTHEALTH MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,508,083. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,508,083. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 876,666. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 876,666. ADVENTHEALTH SHARED SERVICES FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,725,435. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,725,435. FORM 990, PART XI, LINE 9: TRANSFER TO TOP-TIER TAX-EXEMPT PARENT -2,372,557. ALLOCATION FROM TAX-EXEMPT PARENT WITH RESPECT TO DEBT 210,785. FORM 990, PART XII, LINE 3B: THE TAXPAYER IS PART OF A CONTROLLED GROUP OF ORGANIZATIONS THAT COMPRISE A CONSOLIDATED FINANCIAL STATEMENT AUDIT. THE CONTROLLED GROUP'S PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), A 501(C)(3) ORGANIZATION. THE SYSTEM OF HEALTHCARE ENTITIES OWNED AND CONTROLLED BY AHSSHC IS KNOWN AS ADVENTHEALTH. FOR THE YEAR ENDED DECEMBER 31, 2022, ADVENTHEALTH WILL FILE A CONSOLIDATED SINGLE AUDIT WHICH WILL INCLUDE ALL ENTITIES THAT ARE PART OF THE CONTROLLED GROUP. ACCORDINGLY, THE TAXPAYER HAS CHECKED YES TO THE QUESTIONS ON PART XII, LINE 3A AND 3B. 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. 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 - 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