2020-06-30T13:30:20-05:00 2019-12-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2019-01-01 582460001 SMHA HEALTHCARE INC SMHA 8475832804 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 MATTHEW RUBIN CFO 8475832804 2020-06-30 1 AMY BIBBY P00445891 8282542254 47.27.82.235 2020-06-30 08:50:12 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 BEC9594289F9DCBB4F655B5045764FC48E5A1487 2019 2020-04-17 16:48:07Z MATTHEW RUBIN 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 1479857 0 X N/A X 1997 GA TO SUPPORT SMHA HEALTHCARE CENTER (FORMERLY MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER, INC.) 7 7 0 0 3528 2159 0 0 0 0 341657811 0 1137701 1479857 342795512 1479857 0 0 0 0 0 0 0 0 0 14128387 6714741 14128387 6714741 328667125 -5234884 49405253 44563351 12605235 5681552 36800018 38881799 TO PROVIDE ADMINISTRATIVE SUPPORT BY ENGAGING IN SUCH OTHER ACTIVITIES THAT BENEFIT, PERFORM THE FUNCTIONS OF, OR CARRY OUT THE PURPOSES OF MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER, INC. AND AFFILIATES. 0 0 5068817 TO PROVIDE ADMINISTRATIVE SUPPORT BY ENGAGING IN SUCH OTHER ACTIVITIES THAT BENEFIT, PERFORM THE FUNCTIONS OF, OR CARRY OUT THE PURPOSES OF SMHA HEALTH, INC.JANUARY 31, 2018 THE ORGANIZATION CLOSED ON THE ASSET PURCHASE AGREEMENT WITH HOSPITAL CORPORATION OF AMERICA (HCA). DISCLOSURES AND ACTIVITIES REPORTED REPRESENT THIS TRANSACTION.THE ORGANIZATION SUPPORTS THE EXCLUDED ASSETS AND LIABILITIES ASSOCIATED WITH THE ASSET PURCHASE TRANSACTION AND THE WIND DOWN OF SUCH ACTIVITIES. 5068817 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 GA X X MATTHEW RUBIN 8475832804 425 W NEW ENGLAND AVE SUITE 300 WINTER PARK FL 32789 X BRUCE BARRAGAN CHAIRMAN JAN - NOV 1.00 3.00 X X 0 0 0 REX TEMPLETON NEW CHAIRMAN 1.00 3.00 X X 0 0 0 ISRAEL SMALL DIRECTOR 1.00 3.00 X 0 0 0 CHARLES MCMILLIAN DIRECTOR 1.00 3.00 X 0 0 0 CURTIS LEWIS DIRECTOR 1.00 3.00 X 0 0 0 SUSAN WILLETTS DIRECTOR 1.00 3.00 X 0 0 0 FRANK ROSSITER DIRECTOR 1.00 3.00 X 0 0 0 ARTHUR DANA DIRECTOR 1.00 3.00 X 0 0 0 0 0 0 0 0 0 0 0 RECOVERIES FROM SAVANNAH REHAB 900099 1168420 1168420 OTHER RECOVERIES 900099 300137 300137 MISCELLANEOUS INCOME 900099 11300 3528 7772 1479857 1479857 0 3528 1476329 X 750000 750000 2276990 2276990 607776 607776 800327 263434 536893 32327 32327 363783 363783 1247 1247 103763 103763 135 135 MEDICARE COST REPROT 1646357 1646357 BAD DEBT 106622 106622 SETTLEMENT 25000 25000 MISCELLANEOUS 414 414 6714741 5068817 1645924 0 29524234 22572467 13693943 15977594 6187076 6013290 49405253 44563351 4237437 589572 8367798 1942644 0 3149336 12605235 5681552 X 36800018 38881799 36800018 38881799 49405253 44563351 X -5234884 7316665 X 0 0 0 X X 1 SMHA HEALTHCARE CENTER 311126469 3 1 0 5068817 1 0 5068817 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 ASSETS FOR DISPOSITION 6013290 6013290 DUE TO HCA 3149336 3149336 FORM 990, PART VI, SECTION B, LINE 11B THE TAX RETURN IS PREPARED BY AN UNRELATED, INDEPENDENT ACCOUNTING FIRM AND THEN SUBMITTED TO MANAGEMENT FOR REVIEW BEFORE BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO UPDATE AND SUBMIT A NEW CONFLICT OF INTEREST STATEMENT ANNUALLY. THE CHAIRMAN OF THE BOARD SHALL BECOME FAMILIAR WITH THE STATEMENTS OF THE BOARD MEMBERS IN ORDER TO GUIDE THEIR CONDUCT SHOULD A CONFLICT ARISE AT SUCH TIMES AS ANY MATTER COMES BEFORE THE BOARD THAT MAY POTENTIALLY RESULT IN A CONFLICT OF INTEREST. THE AFFECTED BOARD MEMBER SHALL MAKE KNOWN THE POTENTIAL CONFLICT, WHETHER OR NOT DISCLOSED IN A WRITTEN STATEMENT. THE AFFECTED BOARD MEMBER MAY MAKE A PRESENTATION TO THE BOARD, BUT AFTER SUCH PRESENTATION, HE OR SHE MUST LEAVE THE MEETING DURING THE DISCUSSION OF AND THE VOTE ON THE TRANSACTION OR ARRANGEMENT CONSIDERED TO BE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 990 IS MADE AVAILABLE UPON REQUESTION. IN ADDITION, THE FORM 990 IS AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS OF THE ORGANIZATION ARE HELD AS PUBLIC RECORDS OF THE STATE OF GEORGIA SECRETARY OF STATE OFFICE. AS SUCH, THESE DOCUMENTS ARE OPEN TO THE PUBLIC. THE CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC AS THIS IS NOT A REQUIREMENT. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 263,434. MANAGEMENT AND GENERAL EXPENSES 274,963. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 538,397. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 261,930. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 261,930. FORM 990, PART XI, LINE 9: NET EQUITY TRANSFERS FROM AFFILIATES 7,316,665. SMHA CARDIOVASCULAR LLC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 473916622 PROVISION OF MEDICAL SERVICES GA MEMORIAL HEALTH INC MEMORIAL HEALTH UNIVERSITY PHYSICIANS LLC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 INACTIVE GA MEMORIAL HEALTH INC MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER FOUNDATION 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 581618486 SUPPORT OF MHUMC GA 501(C)(3) LINE 12A, I SMHA HEALTHCARE INC 1 SMHA HEALTHCARE CENTER INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 311126469 HEALTH CARE PROVIDER GA 501(C)(3) LINE 3 SMHA HEALTHCARE INC 1 SMHA PHYSICIANS GROUPS INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 474332277 PROVISION OF MEDICAL SERVICES GA 501(C)(3) LINE 10 SMHA HEALTHCARE INC 1 SMHA CARDIOLOGY INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 472872276 PROVISION OF MEDICAL SERVICES GA 501(C)(3) LINE 10 SMHA HEALTHCARE INC 1 PAULSEN STREET SURGERY CENTER LLC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 454517515 HEALTH CARE GA N/A 4600 WATERS AVE PROFESSIONAL CONDO ASSOCIATION INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 581990705 CONDO ASSOCIATION GA SMHA HEALTH SERVICES GROUP INC C 0.52000 1 SMHA HEALTH PARTNERS INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 581707311 MANAGED CARE GA SMHA HEALTH SERVICES GROUP INC C 1.00000 1 SMHA ANESTHETISTS INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 431985441 MEDICAL SERVICES GA SMHA HEALTH SERVICES GROUP INC C 1.00000 1 SMHA VENTURES INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 582162071 PHYSICIANS PRACTICE GA SMHA HEALTH SERVICES GROUP INC C 1.00000 1 SMHA HEALTH SERVICES GROUP INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 581611969 MEDICAL SERVICES/ CONSOLIDATING ENTITY GA SMHA HEALTH INC C 1.00000 1 PROVIDENT PROFESSIONAL BUILDING CONDO ASSOCIATION INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 581845972 CONDO ASSOCIATION GA SMHA HEALTH SERVICES GROUP INC C 0.69560 1 SMHA PROPERTIES INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 582537941 REAL ESTATE HOLDING GA SMHA HEALTH SERVICES GROUP INC C 1.00000 1 SMHACORPORATE SERVICES INC 425 W NEW ENGLAND AVE STE 300 WINTER PARK FL 32789 900963434 CORPORATE SERVICES GA SMHA HEALTH SERVICES GROUP INC C 1.00000 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0