2024-11-01T08:25:05-05:00 2023-12-31 990 2023-01-01 391365168 CHIPPEWA VALLEY HOSPITAL AND OAKVIEW CARE CENTER INC CHIP 7156724211 1220 THIRD AVENUE WEST DURAND WI 54736 LYNN C ADDISCOTT ASST. SECRETARY 4079751492 2024-10-14 0 2023 2024-10-15 13:58:12Z ADVENTHEALTH DURAND DOUGLAS PETERSON 1220 THIRD AVENUE WEST DURAND WI 54736 19473349 0 X WWW.ADVENTHEALTH.COM/HOSPITAL/ADVENTHEALTH-DURAND X 1980 WI THE OPERATION OF A 25 BED ACUTE CARE HOSPITAL. 12 8 111 14 0 0 220738 77485 17146582 19222334 90643 100626 0 0 17457963 19400445 11571 131408 0 0 9294760 9991674 0 0 0 7453767 7346017 16760098 17469099 697865 1931346 9703703 13803480 6395751 8313392 3307952 5490088 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 15803934 131408 19222334 OPERATION OF A 25-BED ACUTE CARE HOSPITAL IN DURAND, WISCONSIN. DURING THE CURRENT YEAR THERE WERE 139 PATIENT ADMISSIONS RESULTING IN 464 PATIENT DAYS, 12,270 OUTPATIENT VISITS FOR THE YEAR, AND 8,259 PHYSICIAN PRACTICE PATIENT VISITS. 15803934 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 1 1 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 111 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X SHAWN PERRY 7852298309 1301 S MAIN STREET OTTAWA KS 66067 X HUENERGARDT SAMUEL CHAIRMAN/DIRECTOR 1.00 49.00 X X 0 1144140 165435 HEINRICH WILLIAM DIRECTOR 1.00 49.00 X 0 603560 94418 PETERSON DOUGLAS DIRECTOR/CEO 50.00 0.00 X X 0 310483 54656 HEIKE CHARLIE DIRECTOR 4.60 0.00 X 35890 0 0 BAUER LINDA DIRECTOR 1.00 0.00 X 150 0 0 BECHEL TODD DIRECTOR 1.00 0.00 X 150 0 0 BEST ROXANNE DIRECTOR 1.00 0.00 X 150 0 0 BOSS PECK SANDRA DIRECTOR 1.00 0.00 X 150 0 0 GILLES MARK DIRECTOR 1.00 0.00 X 150 0 0 NAFTANAILA TITUS DIRECTOR 1.00 1.00 X 150 5706 0 YINGST WILLIAM DIRECTOR 1.00 0.00 X 150 0 0 HEIKE JOHN DIRECTOR (BEG 9/23) 1.00 0.00 X 150 0 0 BEEBE HARMAT CFO (END 2/23) 5.00 45.00 X 0 427022 33461 PERRY SHAWN CFO (BEG 3/23) 5.00 45.00 X 0 146138 42099 RUCKER MD KENNETH PHYSICIAN 40.00 0.00 X 314191 0 42894 HUNT MD THOMAS PHYSICIAN 40.00 0.00 X 303376 0 46702 CASEY TIM CRNA 40.00 0.00 X 219607 0 43658 SNYDER MD JOHN PHYSICIAN 24.00 0.00 X 169737 0 8680 POESCHEL JANE NURSE PRACTITIONER 40.00 0.00 X 168972 0 28162 BACON KEN FORMER OFFICER (END 10/23) 0.00 50.00 X 0 1770929 273737 RANDOLPH KARSTEN FORMER OFFICER 0.00 50.00 X 0 2198983 169849 1212973 6606961 1003751 13 1 1 0 PHYSICAL THERAPY ASSOCIATES LTD PO BOX 173 DURAND WI 54736 PHYSICAL THERAPY SERVICES 921950 QUANTUM PLUS LLC PO BOX 634850 CINCINNATI OH 45263 EMERGENCY MEDICINE 736658 FOCUSPOINT HEALTHCARE INC 188 FRONT ST SUITE 116-137 FRANKLIN TN 37064 AGENCY STAFFING 214812 ALLIANCE RADIOLOGY PA PO BOX 804451 KANSAS CITY MO 46203 RADIOLOGY SERVICES 157539 MAYO CLINIC ROCHESTER 200 FIRST STREET SW ROCHESTER MN 55905 ECHOCARDIO SERVICES 137572 8 X 38923 38562 77485 NET PATIENT REVENUE 622110 18067325 18067325 OUTPATIENT PHARMACY 622110 1072786 1072786 RENTAL REVENUE 622110 55322 55322 CAFETERIA REVENUE 622110 12738 12738 14163 14163 19222334 150780 150780 22750 72904 0 -72904 22750 -50154 -50154 19400445 19222334 0 100626 X 56408 56408 75000 75000 463311 463311 6497157 6448436 48721 245325 230565 14760 2336952 2229429 107523 448929 421919 27010 250 250 16347 16347 25412 25412 3709079 3023223 685856 14051 14051 420347 308564 111783 909126 840532 68594 390861 390861 36699 36699 70 70 102743 102743 268580 268580 93975 57417 36558 MEDICAL SUPPLIES 958684 958684 REPAIRS & MAINTENANCE 376628 376628 23165 14945 8220 17469099 15803934 1665165 0 X 0 5962640 7552024 1678214 2672789 182917 172105 567247 716027 3425554 1037257 1080206 2388297 232479 302238 9703703 13803480 1263943 1888523 5131808 6424869 6395751 8313392 X 2692724 4874860 615228 615228 3307952 5490088 9703703 13803480 X 1931346 420388 -169598 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1750 1750 0 PART II-B, LINE 1I MEMBER DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE WISCONSIN HOSPITAL ASSOCIATION THAT REPRESENT LOBBYING ACTIVITIES CONDUCTED BY THESE TWO ASSOCIATIONS. 76556 76556 206829 73785 133044 2115492 935807 1179685 1026677 27665 999012 2388297 DUE TO RELATED 490108 PAYABLE TO THIRD PARTIES 1623548 CREDIT BALANCES IN A/R 19354 OTHER DEFERRED REVENUE 719234 ACCRUED INTEREST PAYABLE 166 INTERCO ALLOC OF TE BOND PROCEEDS 3422484 OPERATING LEASE LIABILITY 68035 OTHER LIABILITIES 81940 6424869 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. THE CURRENT YEAR PROVISION FOR FEDERAL AND STATE INCOME TAX FOR THE YEAR ENDED DECEMBER 31, 2023 IS APPROXIMATELY $1,140. THERE WAS NO CURRENT YEAR TAX PROVISION FOR THE YEAR ENDED DECEMBER 31, 2022 DUE TO THE UTILIZATION OF NET OPERATING LOSS CARRYFORWARDS IN 2022. THE INCOME TAXES TOPIC OF THE ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES (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, 2023 AND 2022. 1 SOUTH AMERICA 0 0 GRANTMAKING MEDICAL SUPPLIES OR EQUIPMENT 75000 0 0 0 0 0 0 75000 0 75000 SOUTH AMERICA MEDICAL SUPPLIES OR EQUIPMENT 75000 ELECTRONIC FUNDS 0 CASH 0 1 0 0 0 0 0 0 PART I, LINE 2: AS THE FILING ORGANIZATION DOES NOT GENERALLY MAKE GRANTS TO FOREIGN ORGANIZATIONS AND/OR INDIVIDUALS, A FORMAL GRANT MONITORING PROGRAM HAS NOT BEEN DEVELOPED BY THE FILING ORGANIZATION. 1 1 X 1 X 1 X 1 1 1 0 1 0 167550 167550 0.00960 1406845 810031 596814 0.03420 1574395 810031 764364 0.04380 1574395 810031 764364 0.04380 1 513820 13152 7325828 7253295 72533 X 1 1 1 1 CHIPPEWA VALLEY HOSPITAL AND OAKVIEW CARE CENTER INC 1220 THIRD AVE WEST DURAND WI 54736 WWW.ADVENTHEALTH.COM/HOSPITAL/ADVENTHE 1008 X X X X CHIPPEWA VALLEY HOSPITAL 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 23 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 CHIPPEWA VALLEY HOSPITAL PART V, SECTION B, LINE 5: CHIPPEWA VALLEY HOSPITAL AND OAKVIEW CARE CENTER, INC., D/B/A ADVENTHEALTH DURAND (AHD OR THE HOSPITAL), OPERATES A 25-BED CRITICAL ACCESS HOSPITAL IN PEPIN COUNTY, WISCONSIN. FOR PURPOSES OF ITS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL DEFINED ITS COMMUNITY AS ITS PRIMARY SERVICE AREA FROM WHICH 90% OF ITS PATIENTS COME. THIS INCLUDES SEVEN ZIP CODES ACROSS THE COUNTIES OF PEPIN, BUFFALO, DUNN, PIERCE, AND EAU CLAIRE. AS A PART OF ITS EFFORTS TO ENSURE BROAD COMMUNITY-BASED INPUT INTO THE CHNA PROCESS, THE HOSPITAL ESTABLISHED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) TO HELP GUIDE THE HOSPITAL THROUGH THE ASSESSMENT PROCESS. THE CHNAC INCLUDED REPRESENTATION FROM THE HOSPITAL, PUBLIC HEALTH EXPERTS AND THE BROAD COMMUNITY WITH INTENTIONAL REPRESENTATION FROM LOW-INCOME, MINORITY AND OTHER UNDERSERVED POPULATIONS. PARTICIPANTS IN THE CHNAC INCLUDED A REPRESENTATIVE FROM THE PEPIN COUNTY HEALTH DEPARTMENT AS WELL AS REPRESENTATIVES FROM THE DURAND FOOD PANTRY AND THE AGING AND DISABILITY RESOURCE CENTER OF BUFFALO AND PEPIN COUNTIES. AHD COLLECTED INPUT DIRECTLY FROM THE COMMUNITY AND FROM COMMUNITY STAKEHOLDERS. INPUT WAS COLLECTED THROUGH TWO DIFFERENT SURVEYS: THE COMMUNITY HEALTH SURVEY AND THE STAKEHOLDER SURVEY. THE COMMUNITY HEALTH SURVEY WAS PROVIDED TO ANYONE IN THE COMMUNITY AND WAS AVAILABLE IN ENGLISH AND SPANISH THROUGH WEBLINKS AND QR CODES. STAKEHOLDER SURVEYS WERE SENT TO INDIVIDUALS WORKING IN COMMUNITY ORGANIZATIONS, INCLUDING PUBLIC HEALTH ORGANIZATIONS, WITH A FOCUS ON STAKEHOLDERS WHO REPRESENTED AND SERVED COMMUNITIES THAT ARE UNDERSERVED, UNDERREPRESENTED, LOWER INCOME AND/OR WHO ARE MORE LIKELY TO BE IMPACTED BY THE SOCIAL DETERMINANTS OF HEALTH. CHIPPEWA VALLEY HOSPITAL 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. CHIPPEWA VALLEY HOSPITAL PART V, SECTION B, LINE 11: CHIPPEWA VALLEY HOSPITAL AND OAKVIEW CARE CENTER, INC., DBA ADVENTHEALTH DURAND, WILL BE REFERRED TO IN THIS DOCUMENT AS ADVENTHEALTH DURAND 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. THIS IS THE FIRST-YEAR UPDATE FOR THE HOSPITAL'S 2023-2025 COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY. THE HOSPITAL DEVELOPED THIS PLAN AND POSTED IT IN MAY 2023 AS PART OF ITS 2022 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. FOR THE DEVELOPMENT OF BOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY, ADVENTHEALTH DURAND WORKED TO DEFINE AND ADDRESS THE NEEDS OF LOW-INCOME, MINORITY AND UNDERSERVED POPULATIONS IN ITS SERVICE AREA. THE COMMUNITY HEALTH NEEDS ASSESSMENT USED PRIMARY DATA 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 HEALTH ISSUES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT WERE PRIORITIZED BY COMMUNITY AND HOSPITAL STAKEHOLDERS, WHO THEN SELECTED KEY PRIORITIES FOR THE HOSPITAL TO ADDRESS IN ITS COMMUNITY HEALTH PLAN. THE FIRST-YEAR PROGRESS ON THE COMMUNITY HEALTH PLAN IS NOTED BELOW. THE NARRATIVE DESCRIBES THE PRIORITIES IDENTIFIED IN 2022 AND GIVES AN UPDATE ON THE STRATEGIES ADDRESSING THOSE PRIORITIZED NEEDS. THERE IS ALSO A DESCRIPTION OF THE IDENTIFIED NEEDS THAT THE HOSPITAL DID NOT PRIORITIZE TO ADDRESS. THE HOSPITAL'S CHOSEN PRIORITIES ARE LISTED BELOW.1. NUTRITION AND HEALTHY EATING 2. PHYSICAL HEALTH AND ACTIVITY3. DIABETESPRIORITY 1: NUTRITION AND HEALTH EATING2022 DESCRIPTION OF THE PRIORITY:ACCORDING TO COMMUNITY SURVEY RESPONDENTS, 38.3% EAT FRUITS AND VEGETABLES LESS THAN TWO DAYS A WEEK. SECONDARY DATA SHOWS 5.6% OF RESIDENTS IN THE HOSPITAL'S COMMUNITY LIVE IN A LOW FOOD ACCESS AREA AND ALMOST 12% ARE FOOD INSECURE. NUTRITION IS KNOWN TO BE A CRITICAL INFLUENCER OF HEALTH. HEALTHIER EATING IMPROVES MATERNAL HEALTH AND HEALTH AT EVERY STAGE OF LIFE. IT BUILDS STRONGER IMMUNE SYSTEMS, LOWERS THE RISK OF CHRONIC DISEASES LIKE DIABETES AND CARDIOVASCULAR DISEASE, WHILE INCREASING LONGEVITY.2023 UPDATE:GOAL 1.1: PARTNER WITH LOCAL AGENCIES TO IMPROVE THE NUTRITION OF UNDERSERVED COMMUNITY MEMBERS.OBJECTIVE 1.1.1: PARTNER WITH PEPIN COUNTY DEPARTMENT OF HEALTH TO PROVIDE PROFESSIONAL EXPERTISE TO LOCAL GOVERNMENT AGENCIES WHO NEED THEIR NUTRITION MENUS REVIEWED FOR STATE AND FEDERAL COMPLIANCE. THE AGENCIES DIRECTLY SERVE OR FEED VULNERABLE COMMUNITY MEMBERS WHO CAN BENEFIT FROM A BALANCED AND HEALTHY DIET. BY THE END OF YEAR THREE, THE HOSPITAL'S REGISTERED DIETICIAN WILL PROVIDE 40 STAFF HOURS TO REVIEW THE NUTRITION MENUS TO ENSURE THEY MEET THE RECOMMENDED AMOUNTS OF KEY NUTRIENTS. IN 2023, THE HOSPITAL'S REGISTERED DIETICIAN COMPLETED 88 DIETICIAN CONSULTING AND 30 GLUCOSE MONITORING HOURS THAT WERE PROVIDED TO THE COMMUNITY. OBJECTIVE 1.1.2: PLAN AND HOST ONE FOOD DRIVE ANNUALLY ON BEHALF OF PEPIN COUNTY FOOD PANTRY TO INCREASE ACCESS TO NUTRITIOUS FOOD FOR UNDERSERVED COMMUNITY MEMBERS.IN 2023, THE HOSPITAL HELD A FOOD DRIVE FOR THE PEPIN COUNTY FOOD PANTRY. WITH THE HELP OF THE LOCAL MISSION AND MINISTRY DEPARTMENT, 140 POUNDS OF NON-PERISHABLE FOOD WAS DONATED TO THE PANTRY. PRIORITY 2: PHYSICAL HEALTH AND ACTIVITY2022 DESCRIPTION OF THE PRIORITY:IN THE HOSPITAL'S COMMUNITY, 35.6% OF RESIDENTS REPORT NOT ENGAGING IN PHYSICAL ACTIVITIES OUTSIDE OF THEIR JOBS ACCORDING TO SECONDARY DATA. THE COMMUNITY ALSO HAS A HIGHER PERCENTAGE, 12.7%, THAN BOTH THE STATE AND THE NATION OF RESIDENTS WHO REPORT 14 OR MORE DAYS IN THE LAST 30 DURING WHICH THEIR PHYSICAL HEALTH WAS NOT GOOD. COMMUNITY MEMBERS IN THE ASSESSMENT CITED A NEED FOR MORE LOW-COST FITNESS CENTERS AND ACCESSIBLE COMMUNITY SPACES FOR RECREATION PARTICULARLY IN THE WINTER MONTHS FOR FAMILIES AND SENIORS. 2023 UPDATE:GOAL 2.1: PROVIDE FREE EDUCATION AND COUNSELING ON PHYSICAL ACTIVITY GUIDELINES FOR COMMUNITY MEMBERS.OBJECTIVE 2.1.1: BY THE END OF YEAR THREE, PROVIDE FREE CONSULTATIONS TO EDUCATE COMMUNITY MEMBERS ON PHYSICAL ACTIVITY GUIDELINES FROM A BASELINE OF 100 CONSULTATIONS TO 300. COMMUNITY MEMBERS ARE REFERRED AND ACCEPTED FROM ANY AREA HEALTH CARE PROVIDER.IN 2023, THE HOSPITAL PROVIDED OUTPATIENT NUTRITIONAL CONSULTATIONS FOR PATIENTS WITH A REGISTERED DIETITIAN. SIXTY-THREE DIFFERENT COMMUNITY MEMBERS RECEIVED FREE CONSULTATIONS FOR A TOTAL OF 463 IN-KIND HOURS. SEE CONTINUATION PART V, SECTION B, LINE 11 - CONTINUATION 2 PRIORITY 3: DIABETES2022 DESCRIPTION OF THE PRIORITY:DIABETES IS SHOWN TO IMPACT 9.5% OF RESIDENTS IN THE HOSPITAL'S COMMUNITY ACCORDING TO PUBLIC DATA, WHILE 9.2% OF COMMUNITY SURVEY RESPONDENTS REPORT HAVING DIABETES. DIABETES RELATED CONDITIONS ARE ALSO SHOWN TO BE ONE OF THE TOP TEN CODES IN HOSPITAL VISITS BY UNINSURED PATIENTS AND DIABETES IS ONE OF THE TOP HEALTH PRIORITIES IDENTIFIED BY COMMUNITY STAKEHOLDERS.2023 UPDATE:GOAL 3.1: REDUCE THE BURDEN OF DIABETES AND IMPROVE QUALITY OF LIFE FOR ALL PEOPLE WHO HAVE, OR ARE AT RISK FOR, DIABETES IN THE COMMUNITY.OBJECTIVE 3.1.1: BY THE END OF YEAR THREE, PLAN AND IMPLEMENT A DIABETES EDUCATION PROGRAM WITH 40 PARTICIPANTS. THE PROGRAM WILL BE TAUGHT IN A GROUP SETTING WHERE PARTICIPANTS RECEIVE CONTINUOUS GLUCOSE MONITORING AS WELL AS PRE-AND POST-BIOMETRIC SCREENINGS TO EVALUATE THE IMPACT ON PARTICIPANTS' HEALTH.IN 2023, THE HOSPITAL WAS ABLE TO GET SIXTEEN NEW DIABETIC CONSULTANTS.PRIORITIES NOT ADDRESSED BY THE HOSPITAL: THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED MULTIPLE HEALTH NEEDS THROUGH THE COLLECTION OF PRIMARY AND SECONDARY DATA. AFTER REVIEWING THE DATA, THE HOSPITAL AND COMMUNITY STAKEHOLDERS CONDUCTED A PRIORITIZATION PROCESS. LISTED BELOW ARE THE PRIORITIES NOT ADDRESSED AND THE REASON WHY THEY WERE NOT SELECTED TO BE ADDRESSED.1. OBESITY: THE HOSPITAL DID NOT SELECT OBESITY AS A PRIORITY, AS IT IS NOT POSITIONED TO DIRECTLY ADDRESS THIS IN THE COMMUNITY AT LARGE. THE HOSPITAL DID CHOOSE NUTRITION AND HEALTHY EATING AND PHYSICAL HEALTH AND ACTIVITY HOWEVER AND HOPES TO HAVE AN INDIRECT IMPACT ON OBESITY THROUGH THESE EFFORTS.2. FOOD INSECURITY: THE HOSPITAL BELIEVES THAT OTHER ORGANIZATIONS ARE BETTER POSITIONED IN THE COMMUNITY TO ADDRESS THIS NEED DIRECTLY AND WILL SUPPORT THOSE EFFORTS WHEN ABLE. THE HOSPITAL HOPES TO INFORMALLY ADDRESS THIS NEED THROUGH THE NUTRITION AND HEALTHY EATING PRIORITY. 3. PREVENTATIVE CARE AND SCREENINGS: THE HOSPITAL DID NOT SELECT PREVENTATIVE CARE AND SCREENINGS AS A PRIORITY DUE TO A LACK OF RESOURCES. HOWEVER, THE HOSPITAL DID SELECT DIABETES AS A PRIORITY AND MAY USE PREVENTATIVE CARE STRATEGIES IN ADDRESSING IT.4. CANCER: THE HOSPITAL DID NOT CHOOSE CANCER AS A PRIORITY, INSTEAD FOCUSING ITS EFFORTS AND RESOURCES ON NUTRITION AND HEALTHY EATING AND PHYSICAL HEALTH AND ACTIVITY, WHERE THERE IS AN OPPORTUNITY TO INDIRECTLY IMPACT SEVERAL OF THE NEEDS IDENTIFIED IN THE ASSESSMENT, INCLUDING CANCER.5. DRUG MISUSE: ALTHOUGH THERE IS A LACK OF RESOURCES IN THE AREA FOR SUBSTANCE AND DRUG MISUSE, THE HOSPITAL DID NOT PERCEIVE THE ABILITY TO HAVE A MEASURABLE IMPACT ON THE ISSUE WITHIN THE THREE YEARS ALLOTTED FOR THE COMMUNITY HEALTH PLAN WITH THE CURRENT RESOURCES AVAILABLE TO THE COMMUNITY AND THE HOSPITAL AT THIS TIME.6. CARDIOVASCULAR DISEASES: THE HOSPITAL DID CHOOSE NUTRITION AND HEALTHY EATING KNOWING THAT HOW INDIVIDUALS EAT IS AN INTEGRAL STEP IN TREATING CARDIOVASCULAR DISEASES AND HOPES TO HAVE AN INDIRECT IMPACT THROUGH THESE EFFORTS. THE HOSPITAL ALSO SELECTED PHYSICAL HEALTH AND ACTIVITY WHICH WILL PROVIDE OPPORTUNITIES FOR LIFESTYLE CHANGES, AN IMPORTANT STEP IN ADDRESSING ALL CHRONIC CONDITIONS. PART V, SECTION B, LINE 10A URL FOR THE HOSPITAL FACILITY'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY: HTTPS://WWW.ADVENTHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS SCHEDULE H, PART V, SECTION B, LINE 16A,B,C: THE FINANCIAL ASSISTANCE POLICY CAN BE FOUND AT URL:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCETHE FINANCIAL ASSISTANCE POLICY APPLICATION CAN BE FOUND AT:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCETHE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 7A: URL FOR THE HOSPITAL FACILITY'S MOST RECENT CHNA: HTTPS://WWW.ADVENTHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS 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 OR PARTIALLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) DURING ITS CURRENT TAX YEAR. DURING THE CURRENT YEAR, AHSSHC SERVED AS A PARENT ORGANIZATION TO 33 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS AND OTHER SUBSIDIARY HEALTH CARE ORGANIZATIONS THAT OPERATED IN 12 STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS "ADVENTHEALTH".ALL HOSPITAL ORGANIZATIONS WITHIN ADVENTHEALTH COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. ADVENTHEALTH ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. ADVENTHEALTH HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. EACH ADVENTHEALTH HOSPITAL FACILITY REPORTS THEIR COMMUNITY BENEFITS TO THEIR BOARD OF DIRECTORS AND STRIVES TO COMMUNICATE THEIR COMMUNITY BENEFITS TO THEIR LOCAL COMMUNITIES. ADDITIONALLY, THE FILING ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY CAN BE ACCESSED ON THE FILING ORGANIZATION'S WEBSITE. PART I, LINE 7: THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON LINE 2 OF SECTION A OF PART III IS RECORDED IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO REVENUE, NOT BAD DEBT EXPENSE. PART III, LINE 3: METHODOLOGY FOR DETERMINING THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT MAY REPRESENT PATIENTS WHO COULD HAVE QUALIFIED UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY:SELF-PAY PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE BY COMPLETING A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM). IF AN INDIVIDUAL DOES NOT SUBMIT A COMPLETE FAA FORM WITHIN 240 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL, AN INDIVIDUAL MAY BE CONSIDERED FOR PRESUMPTIVE ELIGIBILITY BASED UPON A SCORING TOOL THAT IS DESIGNED TO CLASSIFY PATIENTS INTO GROUPS OF VARYING ECONOMIC MEANS. THE SCORING TOOL USES ALGORITHMS THAT INCORPORATE DATA FROM CREDIT BUREAUS, DEMOGRAPHIC DATABASES, AND HOSPITAL SPECIFIC DATA TO INFER AND CLASSIFY PATIENTS INTO RESPECTIVE ECONOMIC MEANS CATEGORIES. INDIVIDUALS WHO EARN A CERTAIN SCORE ON THE SCORING TOOL ARE CONSIDERED TO QUALIFY AS ELIGIBLE FOR THE MOST GENEROUS FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. AS DETERMINED BY THE FILING ORGANIZATION, A NOMINAL AMOUNT OF SUCH A PATIENT'S BILL IS WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED NON-STATE CHARITY. THE AMOUNT WRITTEN OFF AS BAD DEBT EXPENSE FOR THOSE PATIENTS WHO POTENTIALLY QUALIFY AS NON-STATE CHARITY USING THE SCORING TOOL IS THE AMOUNT SHOWN ON LINE 3 OF SECTION A OF PART III. RATIONALE FOR INCLUDING CERTAIN BAD DEBTS IN COMMUNITY BENEFIT:THE FILING ORGANIZATION IS DEDICATED TO THE VIEW THAT MEDICALLY NECESSARY HEALTH CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS SHOULD BE ACCESSIBLE TO ALL, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, CULTURAL BACKGROUND, PHYSICIAN MOBILITY, OR ABILITY TO PAY. THE FILING ORGANIZATION TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THE AVAILABILITY OF THIRD-PARTY COVERAGE. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE FILING ORGANIZATION IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. AS A 501(C)(3) HOSPITAL ORGANIZATION, THE FILING ORGANIZATION MAINTAINS ONE OR MORE 24/7 EMERGENCY ROOM(S) PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION CANNOT BE MADE BASED UPON INFORMATION SUPPLIED BY THE INDIVIDUAL. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGES 7-9. 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. 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 THAT 120 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL AND IS AT LEAST 30 DAYS AFTER THE NOTICE IS PROVIDED. A REASONABLE ATTEMPT IS ALSO MADE TO ORALLY NOTIFY AN INDIVIDUAL ABOUT THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FAA FORM DURING THE 240-DAY PERIOD FOLLOWING THE DATE ON WHICH THE FIRST POST-DISCHARGE BILLING STATEMENT WAS SENT TO THE INDIVIDUAL, THE HOSPITAL FILING ORGANIZATION SUSPENDS ANY REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS (OR CEASES ANY OTHER ECA'S) AND PROVIDES A WRITTEN NOTICE TO THE INDIVIDUAL DESCRIBING WHAT ADDITIONAL INFORMATION OR DOCUMENTATION IS NEEDED TO COMPLETE THE FAA FORM. THIS WRITTEN NOTICE CONTAINS CONTACT INFORMATION INCLUDING THE TELEPHONE NUMBER AND PHYSICAL LOCATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY, AS WELL AS CONTACT INFORMATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS OR, ALTERNATIVELY, A NONPROFIT ORGANIZATION OR GOVERNMENTAL AGENCY THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS IF THE HOSPITAL FACILITY IS UNABLE TO DO SO. IF AN INDIVIDUAL SUBMITS A COMPLETE FAA FORM WITHIN A REASONABLE TIME-PERIOD AS SET FORTH IN THE NOTICE DESCRIBED ABOVE, THE HOSPITAL FILING ORGANIZATION WILL SUSPEND ANY ADVERSE REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS UNTIL A FINANCIAL ASSISTANCE POLICY ELIGIBILITY DETERMINATION CAN BE MADE. PART VI, LINE 2: THE HOSPITAL CONDUCTS COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) EVERY THREE YEARS. ITS 2022 CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2022, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S 2022 CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN FINAL REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY.SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY. PART VI, LINE 3: THE FINANCIAL ASSISTANCE POLICY (FAP), FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM), AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) OF THE FILING ORGANIZATION'S HOSPITAL FACILITY ARE TRANSPARENT AND AVAILABLE TO ALL INDIVIDUALS SERVED AT ANY POINT IN THE CARE CONTINUUM. THE FAP, FAA FORM, PLS, AND CONTACT INFORMATION FOR THE HOSPITAL FACILITY'S FINANCIAL COUNSELORS ARE PROMINENTLY AND CONSPICUOUSLY POSTED ON THE FILING ORGANIZATION'S HOSPITAL FACILITY'S WEBSITE. THE WEBSITE INDICATES THAT A COPY OF THE FAP, FAA FORM, AND PLS IS AVAILABLE AND HOW TO OBTAIN SUCH COPIES IN THE PRIMARY LANGUAGES OF ANY POPULATIONS WITH LIMITED PROFICIENCY IN ENGLISH THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY (REFERRED TO BELOW AS LEP DEFINED POPULATIONS). SIGNAGE IS DISPLAYED IN PUBLIC LOCATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, INCLUDING AT ALL POINTS OF ADMISSION AND REGISTRATION AND THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE HOSPITAL FACILITY'S WEBSITE ADDRESS WHERE THE FAP, FAA FORM, AND PLS CAN BE ACCESSED AND THE TELEPHONE NUMBER AND PHYSICAL LOCATION THAT INDIVIDUALS CAN CALL OR VISIT TO OBTAIN COPIES OF THE FAP, FAA FORM AND PLS OR TO OBTAIN MORE INFORMATION ABOUT THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS. PAPER COPIES OF THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. PAPER COPIES ARE MADE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGES OF ANY LEP DEFINED POPULATIONS. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A PAPER COPY OF THE HOSPITAL FACILITY'S PLS WILL BE OFFERED TO EVERY PATIENT AS A PART OF THE INTAKE OR DISCHARGE PROCESS. A CONSPICUOUS WRITTEN NOTICE IS INCLUDED ON ALL BILLING STATEMENTS SENT TO PATIENTS THAT NOTIFIES AND INFORMS RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, INCLUDING THE FOLLOWING: 1) THE TELEPHONE NUMBER OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND THE FAA FORM; AND 2) THE WEBSITE ADDRESS WHERE COPIES OF THE FAP, FAA FORM AND PLS MAY BE OBTAINED. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE. COPIES OF THE PLS ARE DISTRIBUTED TO MEMBERS OF THE COMMUNITY IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. PART VI, LINE 4: THE FILING ORGANIZATION IS LOCATED IN RURAL DURAND, WISCONSIN. IT CURRENTLY OPERATES A HOSPITAL FACILITY AND IS LICENSED FOR 25 ACUTE CARE BEDS WHICH ARE APPROVED AS "SWING BEDS" FOR LONG TERM CARE. CHIPPEWA VALLEY HOSPITAL (THE HOSPITAL) IS A CRUCIAL COMMUNITY AND REGIONAL ASSET. IT IS THE ONLY HOSPITAL IN PEPIN COUNTY, WISCONSIN WITH THE CLOSEST HOSPITAL BEING 20 OR MORE MILES AWAY. DURING 2023, THE HOSPITAL'S PATIENT PERCENTAGE POPULATION WAS MADE UP OF THE BELOW PAYORS WITH THE REMAINING PERCENTAGE OF THE PATIENTS BEING COVERED UNDER COMMERCIAL INSURANCE. IN 2023, ABOUT 67.6% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. - MEDICARE PATIENTS 61.9% - MEDICAID PATIENTS 8.5% - SELF-PAY PATIENTS 1.8% THE DEMOGRAPHIC MAKEUP OF THE HOSPITAL'S SERVICE AREA IS AS FOLLOWS: - TOTAL POPULATION 16,689 - POPULATION OVER 65 20.40% - POVERTY (BELOW 100% FPL) 10.3% - HIGH SCHOOL GRADUATION RATE 90.6% - UNINSURED ADULTS 7.8% - FOOD INSECURITY RATE 11.8% - POP. WITH LOW FOOD ACCESS 5.6% PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO CHIPPEWA VALLEY HOSPITAL'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. 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 $1,576,670 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. PART VI, LINE 6: THE FILING ORGANIZATION IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTHEALTH. AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 50 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AS THE PARENT ORGANIZATION OF ADVENTHEALTH, AHSSHC PROVIDES EXECUTIVE LEADERSHIP AND OTHER PROFESSIONAL SUPPORT SERVICES TO ITS SUBSIDIARY ORGANIZATIONS. PROFESSIONAL SUPPORT SERVICES INCLUDE AMONG OTHERS IT, CORPORATE COMPLIANCE, LEGAL, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. CERTAIN SUPPORT SERVICES, SUCH AS HUMAN RESOURCES, PAYROLL, A/P, AND SUPPLY CHAIN MANAGEMENT ARE PROVIDED PURSUANT TO A SHARED SERVICES MODEL BY AHSSHC TO ITS SUBSIDIARY ORGANIZATIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH ADVENTHEALTH SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. THE FILING ORGANIZATION PAYS A MANAGEMENT FEE TO AHSSHC FOR THE SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY THE FILING ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY-BY-ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF ADVENTHEALTH AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEBSITE OF ADVENTHEALTH AT WWW.ADVENTHEALTH.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF THE FILING ORGANIZATION. PART VI, LINE 7: THE FILING ORGANIZATION DOES NOT FILE AN ANNUAL COMMUNITY BENEFIT REPORT WITH ANY STATE AGENCIES. 1 MID-AMERICA UNION CONFERENCE OF SDA 8307 PINE LAKE RD LINCOLN NE 68516 476006806 501(C)(3) 50000 0 GENERAL SUPPORT 1 0 PART I LINE 2 EXPLANATION GRANTS ARE GENERALLY MADE ONLY TO RELATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3), OR TO OTHER LOCAL CHARITABLE COMMUNITY ORGANIZATIONS, OR TO OTHER 501(C)(3) ORGANIZATIONS THAT ARE A PART OF THE GROUP EXEMPTION RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES. X X X X X 1 1 0 1 0 0 0 0 0 0 0 RANDOLPH KARSTEN FORMER OFFICER 0 731672 0 168601 0 1298710 0 137475 0 32374 0 2368832 0 73650 BACON KEN FORMER OFFICER (END 10/23) 0 1284422 0 424601 0 61906 0 244496 0 29241 0 2044666 0 0 HUENERGARDT SAMUEL CHAIRMAN/DIRECTOR 0 782935 0 180174 0 181031 0 128151 0 37284 0 1309575 0 125345 HEINRICH WILLIAM DIRECTOR 0 456376 0 77380 0 69804 0 63376 0 31042 0 697978 0 26804 BEEBE HARMAT CFO (END 2/23) 0 255470 0 28185 0 143367 0 14752 0 18709 0 460483 0 0 PETERSON DOUGLAS DIRECTOR/CEO 0 228414 0 41509 0 40560 0 26390 0 28266 0 365139 0 11095 RUCKER MD KENNETH PHYSICIAN 305667 0 0 0 8524 0 16924 0 25970 0 357085 0 0 0 HUNT MD THOMAS PHYSICIAN 294028 0 0 0 9348 0 16246 0 30456 0 350078 0 0 0 CASEY TIM CRNA 219057 0 0 0 550 0 11571 0 32087 0 263265 0 0 0 POESCHEL JANE NURSE PRACTITIONER 158743 0 0 0 10229 0 7789 0 20373 0 197134 0 0 0 PERRY SHAWN CFO (BEG 3/23) 0 136234 0 6936 0 2968 0 5839 0 36260 0 188237 0 0 SNYDER MD JOHN PHYSICIAN 169288 0 0 0 449 0 7967 0 713 0 178417 0 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 50 HOSPITALS IN 9 STATES, THE SENIOR LEADERSHIP OF AHSSHC TRAVEL EXTENSIVELY AND OFTEN VISIT MULTIPLE HOSPITAL LOCATIONS IN DIFFERENT STATES AS A PART OF A SINGLE BUSINESS TRIP. THE SPECIAL TRAVEL ALLOWANCE CAN PROVIDE REIMBURSEMENTS TO THE EXECUTIVE FOR SUCH ITEMS AS THE PURCHASE OF AIR TRAVEL UPGRADE COUPONS, TO COVER THE COST DIFFERENTIAL BETWEEN COACH AND FIRST-CLASS TRAVEL, OR TO COVER THE COST OF A CHARTER FLIGHT. THE SPECIAL TRAVEL ALLOWANCE BENEFIT WAS ORIGINALLY AUTHORIZED BY AND CODIFIED INTO A POLICY BY THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE), AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS, WHO ALSO APPROVES THE ANNUAL CAP ON THE AMOUNT OF THE ALLOWANCE. THE SPECIAL TRAVEL ALLOWANCE HAS AN ANNUAL CAP OF $24,000 FOR MEMBERS OF THE LEADERSHIP EXECUTIVE TEAM (15 ADVENTHEALTH CABINET MEMBERS AND THE ADVENTHEALTH MULTI-STATE CFO) AND $15,000 FOR ADVENTHEALTH CORPORATE OFFICE SENIOR VICE PRESIDENTS, REGIONAL CEO'S, AND DIVISION CHIEF OFFICERS (GENERALLY 45-55 INDIVIDUAL EXECUTIVES). A REGIONAL CEO FOR ADVENTHEALTH IS A MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION. THE REGIONAL CEO IS CONSIDERED A COMMON LAW EMPLOYEE OF AND IS ON THE PAYROLL OF AHSSHC. WHILE THE SPECIAL TRAVEL ALLOWANCE BENEFIT IS AN AHSSHC COMPENSATION POLICY AND PRACTICE, THE COST OF PROVIDING THIS BENEFIT IS ALLOCATED TO AND EITHER WHOLLY OR PARTIALLY REIMBURSED BY THE FILING ORGANIZATION. ACCORDINGLY, THE FILING ORGANIZATION HAS CHECKED THE BOX IN SCHEDULE J, PART I, LINE 1A FOR FIRST-CLASS OR CHARTER TRAVEL SINCE IT HAS WHOLLY OR PARTIALLY PAID FOR THE COST OF PROVIDING THIS BENEFIT. THOSE EXECUTIVES WHO RECEIVE THE SPECIAL TRAVEL ALLOWANCE ARE RESPONSIBLE FOR TRACKING THE EXPENSES REIMBURSABLE UNDER THE SPECIAL TRAVEL ALLOWANCE AND MUST SUBMIT SUCH EXPENSES ON THEIR ACCOUNTABLE PLAN EXPENSE REPORT. A REPORT ON CHARTER TRAVEL IS PROVIDED TO THE AHSSHC BOARD COMPENSATION COMMITTEE AT EACH MEETING. ANY TAXABLE REIMBURSEMENTS MADE TO EXECUTIVES UNDER THE SPECIAL TRAVEL ALLOWANCE ARRANGEMENT ARE TREATED AS TAXABLE COMPENSATION TO THE EXECUTIVE. TRAVEL FOR COMPANIONS: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING AHSSHC EXECUTIVE TO HAVE HIS OR HER SPOUSE ACCOMPANY THE EXECUTIVE ON CERTAIN BUSINESS TRIPS EACH YEAR. TYPICALLY, REIMBURSEMENT IS ONLY PROVIDED TO CERTAIN EXECUTIVE LEADERS AND IS USUALLY LIMITED TO ONE BUSINESS TRIP PER YEAR BEYOND THE ANNUAL ADVENTHEALTH PRESIDENT'S COUNCIL BUSINESS MEETING AND OTHER MEETINGS WHERE THE SPOUSE IS SPECIFICALLY INVITED. THE AHSSHC CORPORATE EXECUTIVE SPOUSAL TRAVEL POLICY WAS ORIGINALLY APPROVED AND REVIEWED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. ALL SPOUSAL TRAVEL COSTS REIMBURSED TO THE EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: ADVENTHEALTH HAS A SYSTEM-WIDE POLICY ADDRESSING GROSS-UP PAYMENTS PROVIDED IN CONNECTION WITH EMPLOYER-PROVIDED BENEFITS/OTHER TAXABLE ITEMS. UNDER THE POLICY, CERTAIN TAXABLE BUSINESS-RELATED REIMBURSEMENTS (I.E. TAXABLE BUSINESS-RELATED MOVING EXPENSES, TAXABLE ITEMS PROVIDED IN CONNECTION WITH EMPLOYMENT) PROVIDED TO ANY EMPLOYEE MAY BE GROSSED-UP AT A 25% RATE UPON APPROVAL BY THE FILING ORGANIZATION'S CEO AND CFO. ADDITIONALLY, EMPLOYEES AT THE DIRECTOR LEVEL AND ABOVE ARE ELIGIBLE FOR GROSS-UP PAYMENTS ON GIFTS RECEIVED FOR BOARD OF DIRECTOR SERVICES. DISCRETIONARY SPENDING ACCOUNT: OCCASIONAL DISCRETIONARY SPENDING AMOUNTS ARE PERIODICALLY PROVIDED TO ELIGIBLE EXECUTIVES WHO ATTEND ANNUAL BUSINESS MEETINGS SUCH AS THE ADVENTHEALTH PRESIDENT'S COUNCIL, CFO CONFERENCE OR THE CMO/CNO BUSINESS MEETING. PAYMENTS PROVIDED TO EACH EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES BUSINESS DEVELOPMENT EXPENDITURES. UNDER THIS POLICY, TO ENCOURAGE EXECUTIVES TO ESTABLISH AND CULTIVATE STRONG WORKING RELATIONSHIPS WITH THE MEDICAL COMMUNITY AND OTHER LEADERS IN THE COMMUNITY AND INDUSTRY, CERTAIN ADVENTHEALTH EXECUTIVES MAY BE REIMBURSED FOR MEMBER DUES AND USAGE CHARGES FOR A COUNTRY CLUB OR OTHER SOCIAL CLUB UPON AUTHORIZATION. CLUB MEMBERSHIPS MUST BE APPROVED BY THE ADVENTHEALTH PRESIDENT/CEO INITIALLY AS WELL AS ON AN ANNUAL BASIS. EACH ADVENTHEALTH EXECUTIVE WHO IS APPROVED FOR A CLUB MEMBERSHIP MUST SUBMIT AN ANNUAL REPORT DESCRIBING HOW THEY USED THE MEMBERSHIP TO BENEFIT THEIR ORGANIZATION DURING THE PRECEDING YEAR SO THAT THE ADVENTHEALTH PRESIDENT/CEO CAN DETERMINE IF CONTINUANCE OF THE CLUB MEMBERSHIP FURTHERS THE BUSINESS INTERESTS OF ADVENTHEALTH. IN THE CURRENT YEAR, FOR THIS FILING ORGANIZATION, TWO EXECUTIVES 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 2023. THE SERP III PLAN EFFECTIVELY REPLACES THE PRIOR SERP II PLAN, THE EXECUTIVE FLEX BENEFIT PROGRAM PLAN, AND THE SENIOR EXECUTIVE DEATH BENEFIT PLAN FOR QUALIFIED EXECUTIVES EXCEPT FOR CERTAIN GRANDFATHERED EXECUTIVE EMPLOYEES. SERP III PLAN: THE SERP III PLAN PROVIDES ELIGIBLE EXECUTIVES A PERCENTAGE OF THEIR BASE PAY, WHICH IS CREDITED TO A DEFERRED COMPENSATION ACCOUNT. THE PLAN ALSO PROVIDES FOR COMPENSATION DEFERRAL AND SELECTION OF LIFE INSURANCE COVERAGE AND LONG-TERM CARE INSURANCE. TO BE ELIGIBLE TO PARTICIPATE IN THE SERP III PLAN, EXECUTIVES MUST BE ON THE AHSSHC CORPORATE PAYROLL AND BE EITHER A CEO OF AN ADVENTHEALTH ENTITY, AN AHSSHC VICE PRESIDENT (VP) OR VP OF AN ADVENTHEALTH ENTITY WITH A BASE SALARY OF AT LEAST $330,000 IN 2023 (ADJUSTED ANNUALLY BY THE SAME PERCENTAGE AS IRC SECTION 401(A)(17) LIMIT INCREASES), OR OTHER LEADER SPECIFICALLY APPROVED BY THE ADVENTHEALTH PRESIDENT. ELIGIBLE EXECUTIVES DO NOT INCLUDE GRANDFATHERED EXECUTIVES, MEANING THOSE EXECUTIVES WHO WOULD SATISFY ALL THE ELIGIBILITY REQUIREMENTS OF THE SERP II PLAN PRIOR TO DEC 31, 2027, HAD THE PLAN NOT BEEN AMENDED AND RESTATED AS OF JAN. 1, 2020. CONTRIBUTION CREDITS WILL BE ESTABLISHED AND MAINTAINED BY CLASS YEAR ACCOUNTS FOR EACH PARTICIPANT USING TIERED CONTRIBUTION CREDIT PERCENTAGES OF ANNUAL BASE COMPENSATION. CONTRIBUTION CREDIT PERCENTAGES RANGE BETWEEN 15% AND 19% OF BASE COMPENSATION. CONTRIBUTION CREDITS WILL BE MADE EACH QUARTER IN 25% INCREMENTS WITH REDUCTIONS IN CONTRIBUTIONS IF THE EXECUTIVE IS ALSO A GRANDFATHERED FLEX PARTICIPANT (SEE BELOW). SERP III PROVIDES FOR A CLASS YEAR VESTING AND PAYMENT SCHEDULE (7 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S DEFERRED COMPENSATION ACCOUNT. UPON ATTAINMENT OF A NORMAL RETIREMENT AGE (AGE 62), OR UPON CERTAIN OTHER CIRCUMSTANCES AS DEFINED IN THE SERP III PLAN DOCUMENT, ALL DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT. FOR ANY EXECUTIVES WORKING BEYOND THE NORMAL RETIREMENT AGE, FUTURE EMPLOYER CONTRIBUTIONS WILL BE MADE QUARTERLY FROM SERP III DIRECTLY TO THE PARTICIPANT AS A TAXABLE CASH BONUS. SERP II PLAN: THE SERP II PLAN IS A DEFINED BENEFIT, NON-TAX-QUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN EXECUTIVES WHO HAVE PROVIDED LENGTHY SERVICE TO ADVENTHEALTH AND/OR TO OTHER SEVENTH-DAY ADVENTIST CHURCH HOSPITALS OR HEALTH CARE INSTITUTIONS. UNDER THE PROVISIONS OF THE SERP II PLAN, BENEFITS ARE PROVIDED TO QUALIFYING EXECUTIVE PARTICIPANTS ON A PRO-RATA SCHEDULE BEGINNING WITH 20 YEARS OF SERVICE AS AN EMPLOYEE OF ADVENTHEALTH AND/OR ANOTHER HOSPITAL OR HEALTH CARE INSTITUTION CONTROLLED BY THE SEVENTH-DAY ADVENTIST CHURCH AND WHO SATISFY CERTAIN OTHER QUALIFYING CRITERIA. ELIGIBLE EMPLOYEES ARE RESTRICTED TO THOSE EXECUTIVES WHO, AS OF JANUARY 1, 2020, SATISFIED, OR IF EMPLOYMENT CONTINUES, WILL SATISFY THE ELIGIBILITY REQUIREMENTS OF SERP II PRIOR TO DECEMBER 31, 2027. THIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP II) WAS DESIGNED TO PROVIDE ELIGIBLE EXECUTIVES WITH THE ECONOMIC EQUIVALENT OF AN ANNUAL INCOME BEGINNING AT NORMAL RETIREMENT AGE EQUAL TO 60% OF THE AVERAGE OF THE PARTICIPANT'S THREE, FIVE OR SEVEN HIGHEST YEARS OF BASE SALARY FROM ADVENTHEALTH ACTIVE EMPLOYMENT INCLUSIVE OF INCOME FROM ALL OTHER SEVENTH-DAY ADVENTIST CHURCH HEALTHCARE EMPLOYER-FINANCED RETIREMENT INCOME SOURCES AND INVESTMENT INCOME EARNED ON THOSE CONTRIBUTIONS THROUGH SOCIAL SECURITY NORMAL RETIREMENT AGE AS DEFINED IN THE PLAN. THE NUMBER OF YEARS INCLUDED IN HIGHEST AVERAGE COMPENSATION IS DETERMINED BY THE INDIVIDUAL'S YEAR OF ENTRY TO SERP II AND BY THE INDIVIDUAL'S YEAR OF ENTRY TO THE ADVENTHEALTH EXECUTIVE FLEX BENEFIT PROGRAM. FLEX PLAN: THE FLEX PLAN WAS ORIGINALLY DESIGNED TO PROVIDE ELIGIBLE EXECUTIVES AN OPPORTUNITY TO SELECT FROM AMONG A VARIETY OF SUPPLEMENTAL BENEFITS, INCLUDING A SPLIT DOLLAR LIFE INSURANCE POLICY AND LONG-TERM CARE INSURANCE, TO INDIVIDUALLY TAILOR A BENEFITS PROGRAM APPROPRIATE TO EACH EXECUTIVE'S NEEDS. IN 2020, THE FLEX PLAN WAS AMENDED TO EXCLUDE EMPLOYED EXECUTIVES WHO ARE HIRED OR PROMOTED AFTER A CERTAIN DATE FROM BEING ELIGIBLE TO PARTICIPATE IN THE FLEX PLAN EXCEPT FOR CERTAIN INSURANCE COVERAGE FEATURES OF THE PLAN. THE FLEX PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS IS DEDUCTED. THE BENEFITS ALLOWANCE CREDIT PERCENTAGE FOR ANY PLAN YEAR SHALL NOT BE GREATER THAN THE MAXIMUM DOLLAR AMOUNT OR THE PERCENTAGE OF COMPENSATION AS DETERMINED BY THE ADVENTHEALTH BENEFITS ADMINISTRATION COMMITTEE. FOR GRANDFATHERED ELIGIBLE EMPLOYEES, THE ANNUAL PRE-DETERMINED FLEX ALLOWANCE IS CONTRIBUTED AND ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED ARE, AT THE EMPLOYEE'S OPTION, CONTRIBUTED TO EITHER AN IRC 457(F) DEFERRED COMPENSATION ACCOUNT OR TO AN IRC 457(B) ELIGIBLE DEFERRED COMPENSATION PLAN. UPON ATTAINMENT OF AGE 65, ALL PREVIOUS 457(F) DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT AND ANY FUTURE EMPLOYER CONTRIBUTIONS ARE MADE QUARTERLY FROM THE PLAN DIRECTLY TO THE PARTICIPANT. THE PLAN PROVIDES FOR A CLASS YEAR VESTING SCHEDULE (2 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT. DISTRIBUTIONS COULD ALSO BE MADE FROM THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT UPON ATTAINMENT OF AGE 65 OR UPON AN INVOLUNTARY SEPARATION. THE ACCOUNT WILL BE FORFEITED BY THE EXECUTIVE UPON A VOLUNTARY SEPARATION. WITH RESPECT TO GRANDFATHERED PARTICIPANTS, THE FLEX PLAN DOCUMENTS DEFINE ELIGIBLE EMPLOYEES TO INCLUDE THE CHIEF EXECUTIVE OFFICERS OF ADVENTHEALTH ENTITIES AND VICE PRESIDENTS OF ALL ADVENTHEALTH ENTITIES WHOSE BASE SALARY WAS AT LEAST EQUAL TO THE INTERNAL REVENUE CODE SECTION 401(A)(17) COMPENSATION LIMIT EACH YEAR. FLEX PLAN FLEX PLAN SERP II SERP III CONTR. DISTR.* CONTR./DISTR. CONTR. RANDOLPH, KARSTEN $ 119,748 $ 74,817 $1,188,200 $ 0 BACON, KEN $ 0 $ 0 $ 0 $ 237,896 HUENERGARDT, SAMUEL $ 132,924 $ 128,296 $ 0 $ 0 HEINRICH, WILLIAM $ 53,174 $ 21,978 $ 0 $ 14,975 PETERSON, DOUGLAS $ 11,608 $ 11,271 $ 0 $ 0 * INCLUDING INVESTMENT EARNINGS PART V, LINE 1A: THE PARENT CORPORATION AND SOLE TOP-TIER MEMBER OF CHIPPEWA VALLEY HOSPITAL AND OAKVIEW CARE CENTER, INC. (THE FILING ORGANIZATION) IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS A FLORIDA, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). AHSSHC HAS ESTABLISHED A SHARED SERVICE CENTER TO CENTRALIZE THE ACCOUNTS PAYABLE (A/P) FUNCTION FOR ALL AHSSHC SUBSIDIARY ORGANIZATIONS. THE FILING ORGANIZATION HAS ENTERED "0" IN PART V, LINE 1A BECAUSE THE FILING ORGANIZATION NO LONGER ISSUES FORM 1099 RETURNS, RATHER, ALL SUCH RETURNS ARE FILED BY AND UNDER THE NAME AND EIN OF AHSSHC AS THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. THE FACTS AND CIRCUMSTANCES SUPPORT A POSITION THAT AHSSHC, AS A PAYOR ON BEHALF OF ITS SUBSIDIARY ORGANIZATIONS IN A SHARED SERVICE ENVIRONMENT, WILL HAVE SUFFICIENT MANAGEMENT AND OVERSIGHT IN CONNECTION WITH THE SUBSIDIARY ORGANIZATIONS' PAYMENTS TO MEET THE STANDARD SET FORTH IN TREAS. REG. SECTION 1.6041-1(E). AHSSHC WILL NOT MERELY BE MAKING PAYMENTS AT THE DIRECTION OF ITS SUBSIDIARY ORGANIZATIONS. ACCORDINGLY, AHSSHC IS CONSIDERED THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. FORM 990, PART VI, SECTION A, LINE 2 TODD BECHEL AND MARK GILLES - FAMILY RELATIONSHIP CHARLIE HEIKE AND JOHN HEIKE - FAMILY RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 CHIPPEWA VALLEY HOSPITAL AND OAKVIEW CARE CENTER, INC. (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS ADVENTIST HEALTH SYSTEM/SUNBELT, INC. ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI) 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 AHSSI. THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION ARE APPOINTED BY THE SOLE MEMBER, AHSSI, 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 AHSSI, AS THE SOLE MEMBER OF THE FILING ORGANIZATION, HAS CERTAIN RESERVED POWERS AS SET FORTH IN THE BYLAWS OF THE FILING ORGANIZATION. THESE RESERVED POWERS INCLUDE THE FOLLOWING: A) TO APPROVE AND DISAPPROVE THE EXECUTIVE AND/OR ADMINISTRATIVE LEADERSHIP OF THE FILING ORGANIZATION, AND THEIR SALARIES; B) TO 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; D) TO APPROVE OR DISAPPROVE MAJOR BUILDING PROGRAMS AND/OR A PURCHASE OR SALE OF PERSONAL PROPERTY OR REAL PROPERTY EQUAL TO OR IN EXCESS OF ONE MILLION DOLLARS; E) TO APPROVE OR DISAPPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION; F) TO DIRECT THE PLACEMENT OF FUNDS AND CAPITAL OF THE FILING ORGANIZATION; G) TO ESTABLISH GENERAL GUIDING POLICIES; H) TO APPROVE OR DISAPPROVE OPENING OR CLOSING OF THE FACILITIES OR MAJOR CHANGES IN OPERATION; AND I) TO ESTABLISH A PROCESS FOR ADDRESSING PATIENT GRIEVANCES. FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND BY THE CFO PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND THE CFO DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR ANY PRINCIPAL OFFICER OF THE FILING ORGANIZATION (I.E. INTERESTED PERSONS) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION'S CEO, OTHER OFFICERS AND CERTAIN KEY EMPLOYEES ARE NOT COMPENSATED BY THE FILING ORGANIZATION. SUCH INDIVIDUALS ARE COMPENSATED BY THE RELATED TOP-TIER PARENT ORGANIZATION OF THE FILING ORGANIZATION. PLEASE SEE THE DISCUSSION CONCERNING THE PROCESS FOLLOWED BY THE RELATED TOP-TIER PARENT ORGANIZATION IN DETERMINING EXECUTIVE COMPENSATION IN OUR RESPONSE TO SCHEDULE J, LINE 3. FORM 990, PART VI, SECTION C, LINE 19 THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTHEALTH. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF ADVENTHEALTH AND OF THE ADVENTHEALTH "OBLIGATED GROUP" ARE FILED ANNUALLY WITH THE MUNICIPAL SECURITIES RULEMAKING BOARD (MSRB). THE "OBLIGATED GROUP" IS A GROUP OF AHSSHC SUBSIDIARIES THAT ARE JOINTLY AND SEVERALLY LIABLE UNDER A MASTER TRUST INDENTURE THAT SECURES DEBT PRIMARILY ISSUED ON A TAX-EXEMPT BASIS. UNAUDITED QUARTERLY FINANCIAL STATEMENTS PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) ARE ALSO FILED WITH MSRB FOR ADVENTHEALTH ON A CONSOLIDATED BASIS AND FOR THE GROUPING OF ADVENTHEALTH SUBSIDIARIES COMPRISING THE "OBLIGATED GROUP". THE FILING ORGANIZATION DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. PART VII, SECTION A FOR THOSE BOARD OF DIRECTOR MEMBERS AND OFFICER(S) 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. PART VIII, LINES 7A, B AND 7C: THE AMOUNTS SHOWN IN PART VIII, LINES 7A(I), 7B(I) AND 7C(I) OF THE FORM 990 REPRESENT AN ALLOCATED SHARE OF CAPITAL GAIN/(LOSS) FROM A SYSTEM WIDE, CORPORATE ADMINISTERED, INVESTMENT PROGRAM. FORM 990, PART IX, LINE 11G PAYMENTS TO HEALTHCARE PROFESSIONALS: PROGRAM SERVICE EXPENSES 1,049,550. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,049,550. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,073,814. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,073,814. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 179,486. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 179,486. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 571. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 571. TRANSCRIPTION: PROGRAM SERVICE EXPENSES 4,583. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,583. RECRUITING: PROGRAM SERVICE EXPENSES 11,363. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,363. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 703,856. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 703,856. ADVENTHEALTH MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 434,776. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 434,776. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 71,983. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 71,983. ADVENTHEALTH SHARED SERVICE FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 179,097. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 179,097. PART X, LINE 2 THE AMOUNTS SHOWN ON LINE 2 OF PART X OF THIS RETURN INCLUDE THE FILING ORGANIZATION'S INTEREST IN A CENTRAL INVESTMENT POOL MAINTAINED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, THE FILING ORGANIZATION'S TOP-TIER PARENT. THE INVESTMENTS IN THE CENTRAL INVESTMENT POOL ARE RECORDED AT MARKET VALUE. FORM 990, PART XI, LINE 9: TRANSFER TO TAX-EXEMPT PARENT -169,678. TRANSFER FROM TAX-EXEMPT PARENT ORGANIZATION WITH RESPECT TO DEBT 77. ROUNDING 3. 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, 2023, ADVENTHEALTH WILL FILE A CONSOLIDATED SINGLE AUDIT WHICH WILL INCLUDE ALL ENTITIES THAT ARE PART OF THE CONTROLLED GROUP. ADVENTHEALTH ASHEVILLE INC 100 HOSPITAL DRIVE HENDERSONVILLE NC 28792 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 INC 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 PALM COAST PARKWAY INC 1 ADVENTHEALTH WAY PALM COAST FL 32137 882288563 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 PRIMARY CARE NETWORK INC (630-123123) 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 932208118 FUTURE OPERATION OF PHYSICIAN PRACTICES & MEDICAL 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 9330 US HIGHWAY 301 S 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 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 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 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 EMPLOYEE LEASING OF PERSONNEL TO AFFILIATED HOSPITALS TX 501(C)(3) LINE 12C, III-FI ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 AHS MIDWEST MANAGEMENT INC 500 REMINGTON BLVD BOLINGBROOK IL 60440 363354567 EMPLOYEE LEASING OF PERSONNEL TO SUPPORTED HOSPITALS IL 501(C)(3) LINE 12C, III-FI 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 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 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 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 LAKE COUNTY HEALTH CARE PROPERTIES INC 485 NORTH KELLER ROAD 250 MAITLAND FL 32751 813923985 LEASE TO RELATED ORGANIZATION GA 501(C)(3) LINE 12C, III-FI SUNBELT HLTH CARE CENTERS INC 1 MEMORIAL HEALTH SYSTEMS FOUNDATION INC 305 MEMORIAL MEDICAL PKWY 212 DAYTONA BEACH FL 32117 311771522 FUND-RAISING FOR TAX-EXEMPT HOSPITAL FL 501(C)(3) LINE 7 N/A 0 MEMORIAL HEALTH SYSTEMS INC 301 MEMORIAL MEDICAL PARKWAY DAYTONA BEACH FL 32117 590973502 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 MEMORIAL HOSPITAL - WEST VOLUSIA INC 701 WEST PLYMOUTH AVENUE DELAND FL 32720 593256803 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 MEMORIAL HLTH SYSTEMS INC 1 MEMORIAL HOSPITAL FLAGLER INC 60 MEMORIAL MEDICAL PARKWAY PALM COAST FL 32164 592951990 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 MEMORIAL HLTH SYSTEMS INC 1 MEMORIAL HOSPITAL INC 210 MARIE LANGDON DRIVE MANCHESTER KY 40962 610594620 OPERATION OF HOSPITAL & RELATED SERVICES KY 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 METROPLEX ADVENTIST HOSPITAL INC 2201 S CLEAR CREEK ROAD KILLEEN TX 76549 742225672 OPERATION OF HOSPITAL & RELATED SERVICES TX 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 METROPLEX CLINIC PHYSICIANS INC 2201 S CLEAR CREEK ROAD KILLEEN TX 76549 113762050 PHYSICIAN HEALTHCARE SERVICES TO THE COMMUNITY TX 501(C)(3) LINE 3 METROPLEX ADVENTIST HOSPITAL INC 1 MISSION STRATEGIES OF GEORGIA INC 485 NORTH KELLER ROAD 250 MAITLAND FL 32751 900866024 PROVISION OF SUPPORT TO THE NURSING HOME DIVISION GA 501(C)(3) LINE 12B, II SUNBELT HLTH CARE CENTERS INC 1 OSCEOLA HEALTH CARE PROPERTIES INC 485 NORTH KELLER ROAD 250 MAITLAND FL 32751 813165729 LEASE TO RELATED ORGANIZATION GA 501(C)(3) LINE 12C, III-FI SUNBELT HLTH CARE CENTERS INC 1 OVERLAND PARK NURSING & REHAB CENTER INC 6501 WEST 75TH STREET OVERLAND PARK KS 66204 205774821 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY KS 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC 1 PAHS SERVICE CORPORATION (49 - 123123) 6061 S WILLOW DRIVE GREENWOOD VILLAGE CO 80111 923398616 EMPLOYEE LEASING OF PERSONNEL TO RELATED HOSPITALS CO 501(C)(3) LINE 12C, III-FI PORTERCARE ADVENTIST HEALTH SYSTEM 1 PASCO-PINELLAS HILLSBOROUGH COMMUNITY HLTH SYSTEM INC 2600 BRUCE B DOWNS BLVD WESLEY CHAPEL FL 33544 208488713 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 PORTERCARE ADVENTIST HEALTH SYSTEM 6061 S WILLOW DRIVE GREENWOOD VILLAGE CO 80111 840438224 OPERATION OF HOSPITALS & RELATED SERVICES CO 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 PRINCETON HOMECARE SERVICES LLC 602 COURTLAND STREET 310 ORLANDO FL 32804 814196648 HOME HEALTH CARE SERVICES FL 501(C)(3) LINE 10 PRINCETON PROF SERVICES INC 1 PRINCETON PROFESSIONAL SERVICES INC 601 E ROLLINS STREET ORLANDO FL 32803 591191045 PROVISION OF HEALTHCARE SERVICES FL 501(C)(3) LINE 12C, III-FI ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 QUALITY CIRCLE FOR HEALTHCARE INC 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 263789368 HEALTHCARE QUALITY SERVICES FL 501(C)(3) LINE 12A, I ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 REDMOND PARK HOSPITAL LLC 501 REDMOND ROAD NW ROME GA 30165 581123037 OPERATION OF HOSPITAL & RELATED SERVICES GA 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 RESOURCE PERSONNEL INC 485 NORTH KELLER ROAD 250 MAITLAND FL 32751 208040875 PROVIDE ADMINISTRATIVE SUPPORT TO TAX EXEMPT NURSING HOMES FL 501(C)(3) LINE 12B, II SUNBELT HLTH CARE CENTERS INC 1 ROCKY MOUNTAIN ADVENTIST HLTHCARE FOUNDATION 950 E HARVARD AVENUE STE 230 DENVER CO 80210 840745018 FUND-RAISING FOR TAX-EXEMPT HOSPITAL CO 501(C)(3) LINE 7 N/A 0 ROLLINS BROOK COMMUNITY CARE CORP 2201 S CLEAR CREEK ROAD KILLEEN TX 76549 461656773 SUPPORT OPERATION OF HOSPITAL TX 501(C)(3) LINE 12A, I ADVENTIST HLTH SYSTEMSUNBELT INC 1 SAN MARCOS NURSING & REHAB CENTER INC 1900 MEDICAL PARKWAY SAN MARCOS TX 78666 205782224 INACTIVE - IN WIND DOWN TX 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC 1 SHAWNEE MISSION HLTH CARE PROPERTIES INC 485 NORTH KELLER ROAD 250 MAITLAND FL 32751 813914908 INACTIVE - IN WIND DOWN GA 501(C)(3) LINE 12C, III-FI SUNBELT HLTH CARE CENTERS INC 1 SHAWNEE MISSION HEALTH CARE INC 6501 WEST 75TH STREET OVERLAND PARK KS 66204 480952508 LEASE TO RELATED ORGANIZATION KS 501(C)(3) LINE 12C, III-FI SUNBELT HLTH CARE CENTERS INC 1 SHAWNEE MISSION MEDICAL CENTER INC 9100 W 74TH STREET SHAWNEE MISSION KS 66204 480637331 OPERATION OF HOSPITAL & RELATED SERVICES KS 501(C)(3) LINE 3 ADVENTIST HLTH MID-AMERICA INC 1 SOUTH PASCO HEALTH CARE PROPERTIES INC 38250 A AVENUE ZEPHYRHILLS FL 33542 510605679 LEASE TO RELATED ORGANIZATION GA 501(C)(3) LINE 12C, III-FI SUNBELT HLTH CARE CENTERS INC 1 SOUTHEAST VOLUSIA HEALTHCARE CORP 401 PALMETTO STREET NEW SMYRNA BEACH FL 32168 473793197 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 SOUTHWEST VOLUSIA HEALTH SERVICES INC 1055 SAXON BLVD ORANGE CITY FL 32763 593281591 MEDICAL OFFICE BUILDING FOR HOSPITAL FL 501(C)(3) LINE 12A, I SOUTHWEST VOLUSIA HLTHCARE CORP 1 SOUTHWEST VOLUSIA HEALTHCARE CORP 1055 SAXON BLVD ORANGE CITY FL 32763 593149293 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC 1 SUNBELT HEALTH & REHAB CENTER - APOPKA INC 305 EAST OAK STREET APOPKA FL 32703 205774856 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC 1 SUNBELT HEALTH CARE CENTERS INC 485 NORTH KELLER ROAD 250 MAITLAND FL 32751 581473135 MANAGEMENT SERVICES TN 501(C)(3) LINE 12B, II ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 TARPON SPRINGS HOSPITAL FOUNDATION INC 1395 S PINELLAS AVE TARPON SPRINGS FL 34689 590898901 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 UNIVERSITY COMMUNITY HOSPITAL INC 1 TARRANT COUNTY HEALTH CARE PROPERTIES INC 301 HUGULEY BLVD BURLESON TX 76028 510605677 LEASE TO RELATED ORGANIZATION GA 501(C)(3) LINE 12C, III-FI SUNBELT HLTH CARE CENTERS INC 1 THE COMFORTER HEALTH CARE GROUP INC 605 MONTGOMERY ROAD ALTAMONTE SPRINGS FL 32714 271857940 SUPPORT SERVICES TO RELATED HOSPICE FL 501(C)(3) LINE 12C, III-FI ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 TRI-COUNTY NURSING AND REHAB CENTER INC 1290 CELEBRATION BLVD KISSIMMEE FL 34747 472219363 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC 1 UNIVERSITY COMMUNITY HOSPITAL FOUNDATION INC 3100 E FLETCHER AVE TAMPA FL 33613 592554889 FUND-RAISING FOR TAX-EXEMPT HOSPITAL FL 501(C)(3) LINE 7 N/A 0 UNIVERSITY COMMUNITY HOSPITAL INC 3100 E FLETCHER AVE TAMPA FL 33613 591113901 OPERATION OF HOSPITALS & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 1 WEST FLORIDA HEALTH HOME CARE INC 13601 BRUCE B DOWNS BLVD STE 110 TAMPA FL 33613 593686109 HOME HEALTH SERVICES GA 501(C)(3) LINE 10 ADVENTHEALTH WEST FLORIDA AMBULATORY SERVICES INC 1 ZEPHYR HAVEN HEALTH & REHAB CENTER INC 38250 A AVENUE ZEPHYRHILLS FL 33542 205774930 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC 1 ZEPHYRHILLS HEALTH & REHAB CENTER INC 7350 DAIRY ROAD ZEPHYRHILLS FL 33540 205774967 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC 1 ADVENTHEALTH SURGERY CENTER DAYTONA BEACH LLC 103 MEMORIAL MEDICAL PKWY STE 300 DAYTONA BEACH FL 32117 922967648 SURGERY CENTER FL N/A 0 0 ADVENTHEALTH SURGERY CENTER INNOVATION TOWER LLC 265 E ROLLINS STREET ORLANDO FL 32804 882744377 SURGERY CENTER FL N/A 0 0 FLETCHER HOSPITAL SURGICAL VENTURES LLC 9131 ANSON WAY STE 304 RALEIGH NC 27615 861482646 INDIRECT INTEREST IN SURGERY CENTER NC N/A 0 0 FLORIDA HOSPITAL DMERT LLC 500 WINDERLEY PLACE STE 324 MAITLAND FL 32751 202392253 MEDICAL EQUIPMENT FL N/A 0 1 FLORIDA HOSPITAL HOME INFUSION LLP 500 WINDERLEY PLACE STE 226 MAITLAND FL 32751 593142824 HOME INFUSION SERVICES FL N/A 0 1 FUNCTIONAL NEUROSURGICAL AMBULATORY SURGERY CTR LLC 11 W DRY CREEK CIRCLE 120 LITTLETON CO 80120 464426708 SURGERY CENTER CO N/A 0 0 M&O ORLANDO MOB I LLC 1125 SANCTUARY PARKWAY STE 410 ALPHARETTA GA 30009 844259138 OPERATION OF MEDICAL OFFICE BUILDING DE N/A 0 0 ONPOINT OBGYN LLC 7780 S BROADWAY 280 LITTLETON CO 80122 873522453 HEALTHCARE SERVICES CO N/A 0 0 ORANGE CITY SURGICAL LLC 1053 MEDICAL CENTER DRIVE STE 201 ORANGE CITY FL 32763 208105013 SURGERY CENTER FL N/A 0 0 PAHS ONPOINT IMAGING LLC 9205 S BROADWAY HIGHLANDS RANCH CO 80129 833275105 IMAGING CENTER CO N/A 0 0 PAHS ONPOINT URGENT CARE LLC 9100 E MINERAL CIRCLE CENTENNIAL CO 80112 832465331 URGENT CARE CENTER CO N/A 0 0 SURGERY CENTER OF ROME LP 501 REDMOND ROAD NW ROME GA 30165 200390305 SURGERY CENTER GA N/A 0 0 SCA - ALLIANCE LLC 569 BROOKWOOD VILLAGE STE 901 BIRMINGHAM AL 35209 471807383 INDIRECT INTEREST IN SURGERY CENTER DE N/A 0 0 SCA-CENTRAL FLORIDA LLC 569 BROOKWOOD VILLAGE STE 901 BIRMINGHAM AL 35209 471535510 INDIRECT INTEREST IN SURGERY CENTER DE N/A 0 0 THE BARIATRIC CENTER OF KANSAS CITY LLC 9100 W 74TH STREET MERRIAM KS 66204 823025378 SURGERY CENTER KS N/A 0 0 URGENT CARE CENTERS OF BREVARD COUNTY LLC 2600 WESTHALL LANE STE 200 MAITLAND FL 32751 844261523 URGENT CARE CENTERS FL N/A 0 1 ADVENTHEALTH AT OVERLAND PARK-COLLEGE MOB CONDOMINIUM ASSOC 9119 W 74TH STREET STE 260 MERRIAM KS 66204 874353752 CONDO ASSOCIATION KS N/A C 1 ADVENTHEALTH CITY CENTER NORTH OWNERS' ASSOC INC (65-123123) 9119 W 74TH STREET STE 260 MERRIAM KS 66204 991471046 MAINTENANCE ASSOCIATION KS N/A C 1 ADVENTHEALTH PRIMARY CARE INC FKA AH NORTH POLK INC 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 593231322 INACTIVE FL N/A C 1 ADVENTHEALTH VALUE BASED BUNDLE MANAGEMENT LLC 2600 LUCIEN WAY MAITLAND FL 32751 873487910 MEDICAL CONTRACTING AND BILLING FL N/A C 1 ALTAMONTE MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC 601 EAST ROLLINS STREET ORLANDO FL 32803 592855792 CONDO ASSOCIATION FL N/A C 1 APOPKA MEDICAL PLAZA CONDOMINIUM ASSOC INC (11-123123) 601 EAST ROLLINS STREET ORLANDO FL 32803 593000857 CONDO ASSOCIATION FL N/A C 1 BATTLE CREEK ADVENTIST HOSPITAL 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 381359189 INACTIVE MI N/A C 1 FLORIDA HOSPITAL FLAGLER MEDICAL OFFICES ASSOCIATION INC 60 MEMORIAL MEDICAL PARKWAY PALM COAST FL 32164 262158309 CONDO ASSOCIATION FL N/A C 1 FLORIDA HOSP HLTH VILLAGE PROPERTY OWNER'S ASSOC INC 550 E ROLLINS STREET 7TH FLOOR ORLANDO FL 32803 821748255 CONDO ASSOCIATION FL N/A C 1 FLORIDA HOSPITAL HEALTHCARE SYSTEM INC 2600 LUCIEN WAY MAITLAND FL 32751 593215680 PHSO / CIN FL N/A C 1 FLORIDA MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC 601 EAST ROLLINS STREET ORLANDO FL 32803 592855791 CONDO ASSOCIATION FL N/A C 1 KISSIMMEE MULTISPECIALTY CLINIC CONDOMINIUM ASSOCIATION INC 201 HILDA STREET SUITE 30 KISSIMMEE FL 34741 593539564 CONDO ASSOCIATION FL N/A C 1 MIDWEST MANAGEMENT SERVICES INC 9100 WEST 74TH STREET SHAWNEE MISSION KS 66204 480901551 INACTIVE KS N/A C 1 NORTH AMERICAN HEALTH SERVICES INC & SUB 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 621041820 HOLDING CO. TN N/A C 1 ORMOND PROF ASSOCIATES CONDO ASSOC INC (430 YEAR END) 770 W GRANADA BLVD STE 101 ORMOND BEACH FL 32174 592694434 CONDO ASSOCIATION FL N/A C 1 PARK RIDGE PROPERTY OWNER'S ASSOCIATION INC 1 PARK PLACE NAPLES ROAD FLETCHER NC 28732 030380531 CONDO ASSOCIATION NC N/A C 1 PARK RIDGE CONDOMINIUM #1 UNIT OWNERS ASSOCIATION INC 1 PARK PLACE NAPLES ROAD FLETCHER NC 28732 010584623 CONDO ASSOCIATION NC N/A C 1 REDMOND PARK HEALTH SERVICES INC 501 REDMOND RD NW ROME GA 30165 621330078 HOLDING COMPANY GA N/A C 1 SURGICARE OF ROME INC 501 REDMOND RD NW ROME GA 30165 200376307 HOLDING COMPANY GA N/A C 1 THE GARDEN RETIREMENT COMMUNITY INC 485 NORTH KELLER ROAD STE 250 MAITLAND FL 32751 593414055 REAL ESTATE RENTAL FL N/A C 1 WINTER PARK MEDICAL OFFICE BUILDING I CONDO ASSOC INC 601 EAST ROLLINS STREET ORLANDO FL 32803 452228478 CONDO ASSOCIATION FL N/A C 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 SHAWNEE MISSION MEDICAL CENTER INC P 595260 COST ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION M 150613 % OF FACILITY'S OPERATING EXP. ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION DBA AIT M 548194 % OF FACILITY'S OPERATING EXP. ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION P 877086 COST ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION B 169678 ACTUAL AMOUNT GIVEN ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION SHARED SERVICES M 179097 % OF FACILITY'S OPERATING EXP.