2019-11-14T20:47:55-06:00 2018-12-31 990 2018-01-01 593140669 FLORIDA HOSPITAL WATERMAN INC FLOR 3522533300 1000 WATERMAN WAY TAVARES FL 32778 Lynn C Addiscott Assistant Secretary 4073572317 2019-11-08 204.139.85.142 2019-11-08 10:27:27 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D3B0FA8F46BE33589AD20F8A51A7DE0DA87648FF 2018 2020-03-31 21:24:44Z Abel Biri 1000 WATERMAN WAY TAVARES FL 32778 271283691 0 1071 X www.adventhealth.com/hospital/ X 1992 FL Operate 269-bed acute care hospital 14 8 2300 220 259431 0 97315 67170 248129329 263523691 13407907 4807843 2049 0 261636600 268398704 0 0 0 0 108456084 113521340 0 0 0 114241919 119871023 222698003 233392363 38938597 35006341 493443853 520079524 121088524 127849872 372355329 392229652 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 218395322 263264260 All program services revenues and expenses relate to the operation of a 269-bed acute care hospital in Tavares, Florida. There were 15,161 admissions, 65,514 patient days and 115,260 outpatient visits. 218395322 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 X 0 0 2300 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X Terri Warren 3522533386 1000 Waterman Way Tavares FL 32778 X Ottati David A Dir./Chairman/Reg. CEO 9.50 40.50 X X 0 943603 169932 Biri Abel B Director/CEO 50.00 0.00 X X 0 453528 77520 Bryce MD Miguel Dir./Vice Chief of Staff 4.30 0.00 X 50750 0 0 Caddell DDS Susan Director (began 2/2018) 0.30 0.00 X 538 0 0 Carpenter Ken Director 0.40 0.00 X 538 0 0 Comfort Lynda Director 0.60 0.00 X 538 0 0 DeVos Cynthia Director (began 5/2018) 0.10 0.00 X 538 0 0 Gaylord Frank Director (ended 4/2018) 0.10 0.00 X 0 0 0 Hepner Thomas C Director (ended 12/2018) 0.40 0.00 X 538 0 0 Howard Barbara Director 0.40 0.00 X 538 0 0 Marzek MD Peter Director/Sec./Treas. 1.60 0.00 X 59725 0 0 Putigna DO Floriano Director/Chief of Staff (ended 12/2018) 7.20 0.00 X 800 0 0 Smith Stuart Director (ended 3/2018) 0.10 0.00 X 0 0 0 Thomas Debora H Dir./Sec./Regional CFO 9.50 40.50 X X 0 796853 116839 Weiss CPA David L Director 0.60 0.00 X 538 0 0 Werner Thomas L Director 0.40 0.00 X 538 3645 0 Celano Patricia Regional CCO 9.50 40.50 X 0 476945 96038 Crunk Frances CFO/Asst. Secretary (ended 8/2018) 50.00 0.00 X 0 541701 71593 Warren Terri J CFO (began 11/2018) 50.00 0.00 X 0 62476 6621 Young Anita J COO 50.00 0.00 X 0 315993 57552 Edmundson MD Ross B CMO 50.00 0.00 X 0 485618 63383 Kirman Lynn CNO (ended 5/2018) 50.00 0.00 X 0 156469 21139 Davis Adrienne Chief Medical Physicist 40.00 0.00 X 223697 0 11746 Kauffman April AVP Foundation 40.00 0.00 X 202142 0 33957 Barnes James R Director - Pharmacy 40.00 0.00 X 199877 0 23344 Hefley Russell Manager - Pharmacy 40.00 0.00 X 182713 0 16907 Longanecker Rebecca Director of Risk and Quality 40.00 0.00 X 179737 0 24497 Mattison Kenneth R Former - President 0.00 50.00 X 0 776006 46153 Mehindru MD Vinay K Former - CMO 0.00 50.00 X 0 522374 80663 1103745 5535211 917884 67 1 1 0 The Robins & Morton Group 400 Shades Creek Parkway Birmingham AL 35209 Construction Management Fee 4927762 AMN Healthcare 2735 Collections Center Drive Chicago IL 60693 Staffing Agency 2056121 US Anesthesia Partners - Florida 851 Trafalgar Court Ste 200E Maitland FL 32751 Anesthesia Service Fees 1250000 Gresham Smith & Partners 5220 Belfort Road Jacksonville FL 32256 Consulting Fees 985476 Crothall Healthcare 13028 Collection Center Drive Chicago IL 60693 Housekeeping Fees 856983 33 X 67170 67170 Net patient revenue 622110 259348093 259088662 259431 Cafeteria revenue 622110 1366343 1366343 Medical office building 622110 942784 942784 Reimb of exp-TE Affiliate 622110 834460 834460 Daycare revenue 622110 544847 544847 487164 487164 263523691 7679625 7679625 13205 2840505 44482 -2840505 -31277 -2871782 -2871782 268398704 263264260 259431 4807843 X 2918908 2918908 82004950 82004950 2806109 2761896 44213 19287925 19046042 241883 6503448 6400980 102468 224548 224548 68560 68560 1453169 1453169 32501573 27516582 4984991 1174571 1174571 4983701 3606942 1376759 9523478 8267233 1256245 3490309 3490309 205669 205669 362611 362611 2217231 2217231 10797580 10797580 975894 877288 98606 Medical Supplies 42249535 42249535 Repairs & maintenance 6187566 6187566 State Tax Indigent Asse 2970224 2970224 Licenses & Permits 229519 229519 255285 964 254321 233392363 218395322 14997041 0 X 10999 11299 290586551 292484787 36975637 29702228 4707558 4133907 7444119 8380051 319666982 164370798 123360982 155296184 26247220 27986178 157219 157219 3953568 1927671 493443853 520079524 17741987 21285964 232558 178724 103113979 106385184 121088524 127849872 X 344597547 362750117 27757782 29479535 372355329 392229652 493443853 520079524 X 35006341 -11498783 -3633235 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 3120 0 1 10207 13327 0 Part II-B, Line 1: Line (g): During the year salary expense was incurred for paid staff to attend public meetings and email legistlative officals. Salary expense of $3,120 was incurred for meetings and emails. Item (i): Dues were paid both to the American Hospital Association and the Florida Hospital Association who use a portion of the dues to conduct lobbying activities. 12058106 12058106 146274073 75435895 70838178 108182048 84774384 23407664 53152755 4160519 48992236 155296184 Investment in Foundation 27879535 C Investment in JV 106643 C 27986178 Due to related 12145440 Payable to third parties 3721762 Credit balances in A/R 2251438 Interco. Alloc. of TE Bond Proceeds 84954631 Leases payable 110649 Other liabilities 3201264 106385184 X Part X, Line 2: The Hospital is part of a consolidated audited financial statement. The consolidated audited financial statement includes the following FIN 48 (ASC 740) footnote - The Division follows the Income Taxes Topic of the ASC (ASC 740), which 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, 2018. 1 1 X 1 X 0 1 1 1 0 1 0 12178900 3509630 8669270 0.03710 27450929 13002972 14447957 0.06190 39629829 16512602 23117227 0.09900 586831 586831 0.00250 25488 25488 0.00010 612319 612319 0.00260 40242148 16512602 23729546 0.10160 87656 87656 0.00040 87656 87656 0.00040 1 14163159 2746584 92150809 90420527 1730282 X 1 1 1 1 Florida Hospital Waterman Inc 1000 Waterman Way Tavares FL 32778 www.adventhealth.com/hospital/adventhe 4409 X X X Florida Hospital Waterman Inc 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X See Part V, Page 8 X X 1 17 1 See Part V, Page 8 0 1 X 200.000000000000 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 Florida Hospital Waterman, Inc. Part V, Section B, Line 5: In 2016, Florida Hospital Waterman, Inc. d/b/a AdventHealth Waterman (the Hospital) was one of eight hospitals in the Central Florida Region of AdventHealth. The eight hospitals are in the Central Florida counties of Lake, Orange, Osceola, and Seminole. The Hospital is located in Lake County and its primary service area encompasses the northern part of Lake County and reaches into far northwest Orange County. The Central Florida Region conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) and a separate health needs assessment focused on each of the eight hospitalsThe 2016 CHNA conducted for the Hospital was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.The Hospital had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within the Hospital's community/service area. The following organizations participated in the Hospital's CHNAC and specifically represented low-income, minority and other medically underserved populations:Well Florida Council, Inc., an Internal Revenue Code section 501(c)(3) organization that is the state designated local health council for 16 counties in North Central Florida specializing in health-related consultancy for clients and projects throughout Florida;LifeStream Behavioral Health Center, Inc., an Internal Revenue Code section 501(c)(3) social services organization that provides behavioral health treatment, education, care management, and rehabilitation services in Central FloridaUmatilla Seventh-day Adventist Church;Lake Emergency Medical Services; andThe Department of Health in Lake County. To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants. Florida Hospital Waterman, Inc. Part V, Section B, Line 7d: The Hospital has adopted a policy that addresses the public posting requirements of the Community Health Needs Assessment. Under this policy, the Community Health Needs Assessment Reports must be posted on the Hospital's website at least until the date the Hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the Hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports. Florida Hospital Waterman, Inc. Part V, Section B, Line 11: The information provided below explains how the hospital facility addressed in 2018 the significant health needs identified in its 2016 Community Health Needs Assessment, and any such needs that were not addressed and the reasons why such needs were not addressed. The hospital facility conducted a Community Health Needs Assessment in 2016 and adopted an implementation strategy to address the significant health needs identified in the 2016 Community Health Needs Assessment in 2017 prior to May 15, 2017. Florida Hospital Waterman, Inc. d/b/a AdventHealth Waterman will be referred to in this document as AdventHealth Waterman or "The Hospital". In January of 2019, every wholly-owned entity across our organization adopted the AdventHealth system brand. Our identity has been unified to represent the full continuum of care our system offers. Throughout this report, we will refer to our hospital by AdventHealth Waterman. Any reference to our 2016 Community Health Needs Assessment (CHNA) or 2017 Community Health Plan (CHP) will utilize our new name for consistency.AdventHealth Waterman is part of the Central Florida Division - North Region of AdventHealth. The region includes six (6) hospital facilities in Flagler, Lake, and Volusia counties.This is the second-year update for AdventHealth Waterman's 2017-2019 Community Health Plan (Implementation Strategy). AdventHealth Waterman developed this Plan and posted it by May 15, 2017 as part of its 2016 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AdventHealth Waterman worked to define and address the needs of low-income, minority, and underserved populations in our service area. The 2016 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 we serve. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and hospital stakeholders, who then selected key issues for the Hospital to address in its 2017-2019 Community Health Plan. The second-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2016 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing.AdventHealth Waterman chose five (5) areas of focus for their 2017-2019 Community Health Plan: 1. Access to Care2. Obesity3. Heart Disease4. Diabetes5. Cancer: Cervical and ColonPriority 1: Access to CareFocusing on social determinants of health, including poverty, the uninsured and transportation; Access to care was selected due to the concerns regarding the rising cost of healthcare services and the ease of access to available resources.Underinsured and uninsured residents lack affordable, high quality, comprehensive, healthcare. Having access to care is important for promoting and maintaining health, preventing and managing disease, reducing unnecessary disability and premature death, and achieving health equity for all. Based on the findings from the 2016 Community Health Needs Assessment, AdventHealth Waterman chose to address this need to better eliminate health disparities and increase the quality and years of healthy life for all in Lake County. The inability to access quality healthcare contributes to varying social determinants, high cost of care and lack of/no insurance coverage.2018 Update: AdventHealth Waterman worked to help uninsured community residents and patients find regular sources of health care, and access care at the most appropriate level. The hospital operates a free family primary care health clinic which accepts and treats qualified patients based on their zip code and income less than 150 percent of federal poverty level. In 2018, the clinic provided scheduling assistance and no-cost medical care to 2,050 patients and transitioned 16 percent of the Emergency Department (ED) low-income patients (with non-acute or chronic health issues) to the Primary Health Clinic for post-discharge follow-up. In 2018, there was a focus on meeting the social service needs of patients by assisting with identification and enrollment with social service providers. The clinic's numbers continue to remain consistent, even with the loss of some providers in 2017. The clinic continues to see increasingly more complex patients that require more time per visit. The clinic is currently researching chronic care management coding to capture time more accurately for these complex patients. In addition, patients (from the hospital and/or the Family Health Clinic) who did not have a regular primary care provider were referred to a nearby Community Health Center (FQHC). Community Health Centers accept uninsured patients on a sliding fee scale basis as well as patients covered by insurance, Medicaid, and Medicare. AdventHealth Waterman regularly participates in a community health improvement planning focus group. This multidisciplinary focus group includes multiple community organizations with a similar goal of identifying key barriers and improving community access to health care. The focus group works to understand community priorities, raise awareness, and join action teams to implement strategies. The community health improvement process looks beyond the performance of individual organizations serving specific segments of our community and concentrates on the activities and contributions of many organizations or community members on the overall improvement of our health.Also, in 2018, the hospital maintained its transitional care program to reduce preventable readmissions for heart attacks, congestive heart failure, and pneumonia. Lake County has been designated as both a Health Resources Service Administration (HRSA) Medically Underserved Area (MUA) and Health Provider Shortage Area (HPSA) due to the lack of physician availability in the county. The hospital continues to recruit additional primary care providers to the increase access to care.Priority 2: ObesityLake County residents have a higher incidence of obesity than both the Healthy People 2020 goal as well as compared to the state overall. There is a strong community concern about the impact of obesity on both children and adults of all ethnicities.Obesity is a major health issue, contributing to several diseases, specifically increased risk of certain types of cancer, high blood pressure, coronary artery disease, type 2 diabetes, and stroke. It also has a significant increase in early mortality and economic costs. Based on the findings from the 2016 Community Health Needs Assessment, AdventHealth Waterman chose to address this need through the reduction of associated health risks and mortality. The fundamental cause of obesity is an imbalance between calories consumed and calories expended, although, other contributing factors can include poverty, limited/no access to healthy foods, and lack of exercise.2018 Update: AdventHealth Waterman offered creative programs to get people moving. The hospital hosted two walking activity events in 2018, including: a "Walk to the Moon" challenge with 466 participants walking to achieve enough miles to make it to the moon; and a Geo Cache a scavenger hunt in which clues where provided to all 372 participants who walked and searched to find the Geo Cache and learn about healthy lifestyle habits. Both programs resulted in a 100 percent completion rate and presented an increased understanding of practicing a healthy lifestyle to obtain and maintain a healthy weight. The hospital modified a program to engage local physicians to refer obese children and families to the CREATION Health program to increase attendance in the CREATION Health Bible School. We boosted attendance from 70 children in 2017 to 128 in 2018. The program included healthy snacks, exercise, and health education relating to nutrition and fitness. The hospital conducted 1,101 community health risk assessments (HRA's) which included BMI calculations to assess one's risk for disease related to obesity. Participants were educated on healthy eating and exercise habits and offered resources available in the community and through the hospital.(Continued) Part V, Section B, Line 7a The hospital facility's CHNA report was made widely available through the following website:https://www.adventhealth.com/community-health-needs-assessments Part V, Section B, Line 10 The hospital facility's most recently adopted implementation strategy was posted on the following website:https://www.adventhealth.com/community-health-needs-assessments Part V, Section B, Line 11 (Continued, Part I): The CREATION Health wellness and lifestyle message (based on the tenets of choice, rest, environment, activity, trust, interpersonal relationships, outlook, and nutrition) was deployed through media outlets to 20 percent of the service area. The hospital also offered multiple CREATION Health classes and other programs at the hospital and in community settings, including one affordable cooking class with 25 attendees and four CREATION Cooking classes with a total of 72 attendees. Program success is measured by post class surveys on healthy eating skills. Priority 3: Heart DiseaseHeart disease is the leading cause of death in the United States. Heart disease and other cardiovascular diseases are among the most widespread and costly health problems. Improving cardiovascular health improves quality of life and results in the reduction of deaths from heart disease. Based on the findings from the 2016 Community Health Needs Assessment, AdventHealth Waterman chose to address this need to reduce the burden of cardiovascular disease and eliminate disparities associated with heart disease and stroke. About half of all Americans have at least one risk factors for heart disease, including, but, not limited to high blood pressure, high cholesterol, and smoking. Heart disease is one of the top five causes of death in Lake County and is higher than the Healthy People 2020 goal. 2018 Update: AdventHealth Waterman provided 281 cardiac health assessments and screenings (blood pressure and cholesterol) in 2018. One hundred percent of those with high cholesterol or high blood pressure were referred to physicians at the hospital's Family Health Clinic or a nearby Community Health Center (FQHC) for follow-up care. The hospital also provided prevention and education tools via the Heart Center website to educate for Stroke, Heart, and Vascular at AdventHealthHeartWaterman.com. After ensuring that the Early Heart Attack Education (EHAC) handouts aligned with the standards for the national Chest Pain Center accreditation (by the Society of Chest Pain Centers), they were distributed to local employers, healthcare providers, community health/wellness event participants, all patients discharged from the Emergency Department, new employees, and cardiac support class participants. EHAC was also presented through Waterman Wellness magazine and TV reaching over 50 percent of the targeted audience. Blood pressure screening kiosks at Publix Supermarkets were discontinued in 2017. An alternate method of screening has not been established.Access to smoking cessation programs "Tools to Quit" (one-time class) and "Quit Smoking Now" (weekly class) was made available to the community, including all inpatients, emergency department patients, and cancer center patients identified as smokers. One hundred percent of the target population were provide with educational materials on the smoking cessation resources available to the community. Priority 4: Diabetes2016 Description of the Issue: Diabetes is one of the top 10 leading causes of death in the United States and is a very common disease affecting a diverse age range. People diagnosed with diabetes experience significant health concerns because the disease itself has proven to be the catalyst for other health problems such as lower-limb amputation, blindness, cardiovascular disease, and kidney failure. Based on the findings from the 2016 Community Health Needs Assessment, AdventHealth Waterman chose to address this need by reducing the number of new cases by early diagnosis and prevention awareness and education. Underlying causes of diabetes vary by type, although certain risk factors for developing diabetes at a later age include being overweight or obese, leading a sedentary lifestyle, and genetics. Diabetes is one of the leading causes of death in Lake County, and the percentage of adults with diagnosed diabetes in Lake County is higher than the Healthy People 2020 goal.2018 Update: AdventHealth Waterman provided 281 glucose screenings to the community meeting the 2018 goal. One hundred percent of people with elevated glucose levels were referred to a physician and/or diabetes education class. People without medical insurance were referred to the nearby Community Health Center (FQHC) that sees uninsured patients on a sliding fee scale basis. Offered in the Conry CREATION Health Center, the AdventHealth Waterman Diabetes Self-Management class educated participants on how to manage diabetes with everyday strategies focused on nutrition, exercise, and disease management. Thirteen community classes were completed with a total of 212 participants, exceeding the 2018 goal. AdventHealth Waterman also hosted 32 Diabetes Support Groups with 125 attendees for anyone diagnosed with pre-diabetes or diabetes. Attendees were educated on the disease, self-management strategies, and engaged in open discussion. Both the class and the support group were taught/led by a Certified Diabetes Educator, and attendees reported an increased understanding of how to more effectively manage blood sugars, medications, exercise, meals, and sick days. AdventHealth Waterman, in conjunction with the Lake County Department of Health, launched a new community service program in August 2017 to help expectant mothers manage gestational diabetes. More than 13 percent of expectant moms in Lake County will develop gestational diabetes, which can jeopardize the health of baby and mom and increase the likelihood of complications during delivery. The clinic provided 50 education classes in 2018 and testing supplies to 58 newly diagnosed moms while also offering ongoing monitoring for the term of the pregnancy. The CREATION Health wellness and lifestyle message (based on the tenets of choice, rest, environment, activity, trust, interpersonal relationships, outlook and nutrition) was deployed through media outlets to 20 percent of the service area. The hospital also offered multiple CREATION Health classes and other programs at the hospital and in community settings. Priority 5: Colorectal and Cervical CancerScreening rates for colorectal and cervical cancer in Lake County are lagging behind target rates set by the Healthy People 2020 program. Based on the findings from the 2016 Community Health Needs Assessment, AdventHealth Waterman chose to address colorectal and cervical cancer to better educate and inform the public of the importance of getting screened and the benefits of early detection. The data shows cancer is one of the top five causes of death in Lake County. Colon and cervical screenings are lower in the county than the Healthy People 2020 goal and certain minority had higher non-compliance rates.2018 Update:AdventHealth Waterman provided education on and screenings for cervical and colon cancer to increase awareness of the benefits of early detection and screening/prevention. In collaboration with the annual flu shot drive, 44 participants were screened by a registered nurse, and of those, two were identified as overdue for a colonoscopy and scheduled appointments with a gastroenterologist.The hospital conducted community outreach events at a food and personal care item distribution center and a low-income, primarily Spanish speaking housing community. The purpose of these events was to educate women in our community about HPV, cervical cancer, risk reduction, screening/early detection and to provide these women with gynecologic cancer prevention resources. A total of 74 providers were educated on cancer navigation services to ensure easier access, resources, survivorship care plan dissemination, and patient education. The hospital conducts free support groups for cancer patients/survivors, including those affected by gynecological cancers and breast cancer, and also offers a Men's Team Huddle for male cancer survivors. Part V, Section B, Line 11 (Continued, Part II): Community Needs Not Chosen by AdventHealth Waterman The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else or multiple groups in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? Based on this prioritization process, the Hospital did not choose the following community issues:The 2016 Community Health Needs Assessment also identified the following community health issues that AdventHealth Waterman will not address. The list below includes these issues and an explanation of why the hospital is not addressing them. 1. Mental Illness/Depression: Other local organizations such as Lifestream Behavioral Health are already working to address mental illness/depression. We are committed to working to improving the health and wellness of our communities, and fully support local government and wellness coalitions in their efforts to positively impact these issues.2. Poor Access to Food/Nutrition: A large portion of the county has a modified retail food environmental index score below 15 (low access, poor access, or no access to healthy retail food outlets). Additionally, the entire county is without a census tract with a score over 30, which would indicate high access. 3. Substance Abuse: Addiction is understood to be a component of poor mental health. Local behavioral health partners such as Lifestream Behavioral Health is in a better position to address substance abuse. We are committed to working to improve the health and wellness of our communities, and fully support local government and wellness coalitions in their efforts to positively impact these issues.4. Poor Birth Outcomes: While this issue appears to be an issue for Lake County, especially among black residents, other local organizations such as the Lake County Department of health are already working to address poor birth outcomes. Additionally, when compared to other nearby communities, the Florida Hospital Waterman community has overall lower birth rates.5. Poverty: Florida Hospital Waterman is already working with community partners such as local food banks and in many community outreach projects to help support and care for the underserved in our community.6. Asthma: While we have the means to treat the symptoms of asthma, the exact cause of asthma is unknown. The triggers for signs and symptoms are different from person to person and are generally based on environmental settings including pollen, mold, etc. If the community has access to preventative and primary care, this may improve symptom rates in Lake County.7. Falls: While the hospital has means to treat falls, it does not have the resources to effectively prevent them outside the hospital facility. Additionally, there are programs such as the Florida Department of Health's Injury Prevention Program that would be more suited to address this issue.8. HIV/AIDS: The HIV rate has increased in Lake County; however, it has consistently remained lower than the state level. Additionally, while the hospital has the means to treat STIs, it does not have the resources to effectively prevent them. If the community has access to preventative and primary care, this may help lower the rates of STIs.9. Drowning: The hospital does not have the resources to effectively prevent drownings. Additionally, there are existing programs such as the Florida Department of Health's Injury Prevention Program would be more suited to address this issue. We are committed to working to improving the health and wellness of our communities, and fully support local government and wellness coalitions in their efforts to positively impact these issues.10. Dental Care: While the hospital has means to treat specific dental problems, it does not have the resources to effectively address dental hygiene. Additionally, there are programs within the county that are more equipped to address the issue of proper dental care, or lack thereof. We are committed to working to improving the health and wellness of our communities, and fully support local government and wellness coalitions in their efforts to positively impact these issues. 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 1 1 - AdventHealth Waterman Community Primary 2300 Kurt Street Eustis FL 32726 Non-Emergent Health Care Services Part I, Line 6a: The filing organization was a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) during its current tax year. During the current year, AHSSHC served as a parent organization to 24 tax-exempt 501(c)(3) hospital organizations and a number of other health care facilities that operated in 10 states within the U.S. The system of organizations under the control and ownership of AHSSHC is known as "AdventHealth".All hospital organizations within AdventHealth collect, calculate, and report the community benefits they provide to the communities they serve. AdventHealth organizations exist solely to improve and enhance the local communities they serve. AdventHealth has a system-wide community benefits accounting policy that provides guidelines for its health care provider organizations to capture and report the costs of services provided to the underprivileged and to the broader community. Each AdventHealth hospital facility reports their community benefits to their Board of Directors and strives to communicate their community benefits to their local communities. Additionally, the filing organization's most recently conducted community health needs assessment and associated implementation strategy can be accessed on the filing organization's website. Part I, Line 7: The amounts of costs reported in the table in line 7 of Part I of Schedule H were determined by utilizing a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges, contained in the Schedule H instructions. Part II, Community Building Activities: The Hospital is committed to improving the health of its community and works with other organizations to reduce the need for healthcare services. The costs of community building activities reported on Part II of Schedule H primarily represent the costs associated with paid staff time and sponsorships related to community events. Part III, Line 2: The amount of bad debt expense reported on line 2 of Section A of Part III is recorded in accordance with Healthcare Financial Management Association Statement No. 15. Discounts and payments on patient accounts are recorded as adjustments to revenue, not bad debt expense. Part III, Line 3: Methodology for Determining the Estimated Amount of Bad Debt Expense that May Represent Patients who could Have Qualified under the Filing Organization's Financial Assistance Policy:Self-pay patients may apply for financial assistance by completing a Financial Assistance Application Form (FAA Form). If an individual does not submit a complete FAA Form within 240 days after the first post-discharge billing statement is sent to the individual, an individual may be considered for presumptive eligibility based upon a scoring tool that is designed to classify patients into groups of varying economic means. The scoring tool uses algorithms that incorporate data from credit bureaus, demographic databases, and hospital specific data to infer and classify patients into respective economic means categories. Individuals who earn a certain score on the scoring tool are considered to qualify as eligible for the most generous financial assistance under the filing organization's Financial Assistance Policy. As determined by the filing organization, a nominal amount of such a patient's bill is written off as bad debt expense, while the remaining portion of the patient's bill is considered non-state charity. The amount written off as bad debt expense for those patients who potentially qualify as non-state charity using the scoring tool is the amount shown on line 3 of Section A of Part III. Rationale for Including Certain Bad Debts in Community Benefit:The filing organization is dedicated to the view that medically necessary health care for emergency and non-elective patients should be accessible to all, regardless of age, gender, geographic location, cultural background, physician mobility, or ability to pay. The filing organization treats emergency and non-elective patients regardless of their ability to pay or the availability of third-party coverage. By providing health care to all who require emergency or non-elective care in a non-discriminatory manner, the filing organization is providing health care to the broad community it serves. As a 501(c)(3) hospital organization, the filing organization maintains a 24/7 emergency room providing care to all whom present. When a patient's arrival and/or admission to the facility begins within the Emergency Department, triage and medical screening are always completed prior to registration staff proceeding with the determination of a patient's source of payment. If the patient requires admission and continued non-elective care, the filing organization provides the necessary care regardless of the patient's ability to pay. The filing organization's operation of a 24/7 Emergency Department that accepts all individuals in need of care promotes the health of the community through the provision of care to all whom present. Current Internal Revenue Service guidance that tax-exempt hospitals maintain such emergency rooms was established to ensure that emergency care would be provided to all without discrimination. The treatment of all at the filing organization's Emergency Department is a community benefit. Under the filing organization's Financial Assistance Policy, every effort is made to obtain a patient's necessary financial information to determine eligibility for financial assistance. However, not all patients will cooperate with such efforts and a financial assistance eligibility determination cannot be made based upon information supplied by the individual. In this case, a patient's portion of a bill that remains unpaid for a certain stipulated time period is wholly or partially classified as bad debt. Bad debts associated with patients who have received care through the filing organization's Emergency Department should be considered community benefit as charitable hospitals exist to provide such care in pursuit of their purpose of meeting the need for emergency medical care services available to all in the community. Part III, Line 4: Financial Statement Footnote Related to Accounts Receivable and Allowance for Uncollectible Accounts:The financial information of the filing organization is included in a consolidated audited financial statement for the current year.The applicable footnote from the attached consolidated audited financial statements that addresses accounts receivable, the allowance for uncollectible accounts, and the provision for bad debts can be found on page 7 and 8. 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: Collection Policies:The hospital filing organization's collection practices are in conformity with the requirements set forth in the 2014 Final Regulations regarding the requirements of Internal Revenue Code Section 501(r)(4)-(r)(6). No extraordinary collection actions (ECA's) are initiated by the hospital filing organization in the 120-day period following the date after the first post-discharge billing statement is sent to the individual (or, if later, the specified deadline given in a written notice of actions that may be taken, as described below). Individuals are provided with at least one written notice (notice of actions that may be taken) and a copy of the filing organization's Plain Language Summary of the Financial Assistance Policy that informs the individual that the hospital filing organization may take actions to report adverse information to credit reporting agencies/bureaus if the individual does not submit a Financial Assistance Application Form (FAA Form) or pay the amount due by a specified deadline. The specified deadline is not earlier than 120 days after the first post-discharge billing statement is sent to the individual and is at least 30 days after the notice is provided. A reasonable attempt is also made to orally notify an individual about the filing organization's Financial Assistance Policy and how the individual may obtain assistance with the Financial Assistance application process. If an individual submits an incomplete FAA Form during the 240-day period following the date on which the first post-discharge billing statement was sent to the individual, the hospital filing organization suspends any reporting to consumer credit reporting agencies/bureaus (or ceases any other ECA's) and provides a written notice to the individual describing what additional information or documentation is needed to complete the FAA Form. This written notice contains contact information including the telephone number and physical location of the hospital facility's office or department that can provide information about the Financial Assistance Policy, as well as contact information of the hospital facility's office or department that can provide assistance with the financial assistance application process or, alternatively, a nonprofit organization or governmental agency that can provide assistance with the financial assistance application process if the hospital facility is unable to do so. If an individual submits a complete FAA Form within a reasonable time-period as set forth in the notice described above, the hospital filing organization will suspend any adverse reporting to consumer credit reporting agencies/bureaus until a financial assistance policy eligibility determination can be made. Part III, Section B, Line 8 Reconciliation of Schedule H Reported Medicare Surplus/(Shortfall) to Unreimbursed Medicare Costs Associated with the Provision of ServicesTo All Medicare Beneficiaries:The Medicare revenue and allowable costs of care reported in Section B of Part III of Schedule H are based upon the amounts reported in the filing organization's Medicare cost report in accordance with the IRS instructions for Schedule H. On an annual basis, the filing organization also determines its total unreimbursed costs associated with providing services to all Medicare patients. Unreimbursed costs are considered a community benefit to the elderly and are combined into an annual Community Benefit Statement prepared by Adventist Health System. The primary reconciling items between the Medicare surplus/(shortfall) shown on line 7 of Section B of Part III of Schedule H and the filing organization's unreimbursed costs of services provided to all Medicare patients are as follows:- Medicare surplus/(shortfall) shown on line 7 of Section B of Schedule H: $ 1,730,282- Difference in costing methodology: 401,052- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (6,382,057) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's communitybenefit reporting $ (4,250,723)As indicated above, the primary differences between the Medicare surplus/(shortfall) reported on Schedule H, Part III, Section B, line 7 and the filing organization's portion of the Company's annual community benefit statement is due to a difference in the costing methodology and differences in the population of Medicare patients within the calculation. The cost methodology utilized in calculating any Medicare surplus/(shortfall) for purposes of the annual community benefit reporting is based upon the cost-to-charge ratio outlined in Worksheet 2 of the Schedule H instructions. The same cost-to-charge ratio is used to determine the costs associated with services provided to charity care patients and Medicaid patients as reported in Schedule H, Part I, line 7. In addition, the Medicare cost report excludes services provided to Medicare patients for physician services, services provided to patients enrolled in Medicare HMOs, and certain services provided by outpatient departments of the filing organization that are reimbursed on a fee schedule. The Company's own community benefit statement captures the unreimbursed cost of providing services to all Medicare beneficiaries throughout the organization. Part VI, Line 2: The Hospital conducted community health needs assessments (CHNA) during 2013 and 2016. It's 2016 CHNA was adopted by its governing board by December 31, 2016, the end of the Hospital's taxable year in which it conducted the CHNA. The Hospital's 2016 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: Florida Hospital Waterman is Lake County's leading provider of acute services with more than 14,000 annual admissions and 115,000 outpatient visits. Florida Hospital Waterman is home to a comprehensive heart center including the area's only accredited Chest Pain Center, Cancer Institute, the region's only Joint Commission Accredited Joint Replacement Center, and Center for Women and Children. The hospital also offers rehabilitation, imaging, Home Care, and wound care and hyperbaric medicine. The Donald and Aubrey Conry CREATION Health Center includes a demonstration kitchen and fitness center for community health and wellness activities. The hospital is located in scenic Lake County in Central Florida, and primarily serves the Golden Triangle communities of Eustis, Mount Dora and Tavares. The hospital's primary service area includes portions of Leesburg and stretches into north west Orange County. It includes the following zip codes: 32726, 32736, 32757, 32776, 32778, 32784, 34748, 34788. Tavares, Florida is located in Lake County. Lake County has a population of approximately 300,000. High school graduates account for approximately 87.8% and college graduates account for approximately 21% of Lake County. Approximately 60.4% of the Hospital's patients during 2018 were Medicare patients, about 10.9% were Medicaid patients, about 7.5% were self-pay patients, and the remaining percentage were patients covered under commercial insurance. In 2018, about 86.7% of the hospital's in-patients were admitted through the hospital's Emergency Department. Part VI, Line 5: The provision of community benefit is central to Florida Hospital Waterman's mission of service and compassion. Restoring and promoting the health and quality of life of those in the communities served by the filing organization is a function of "extending the healing ministry of Christ and embodies the fiing organization's commitment to its values and principles. The filing organization commits substantial resources to provide a broad range of services to both the underprivileged as well as the broader community. In addition to the community benefit and community building information provided in Parts I, II and III of this Schedule H, the Hospital captures and reports the benefits provided to its community through faith-based care. Examples of such benefits include the cost associated with chaplaincy care programs and mission peer reviews and mission conferences. During the current year, the Hospital provided $331,525 of benefit with respect to the faith-based and spiritual needs of the community in conjunction with its operation of a community hospital. The filing organization 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 filing organization expended $42,732,782 in new capital improvements. As a faith-based mission-driven community hospital, the filing organization 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: Florida Hospital Waterman 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 44 hospitals throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC and its subsidiaries also operate 11 nursing home facilities and other ancillary health care provider facilities, such as ambulatory surgery centers and diagnostic imaging centers. As the parent organization of AdventHealth, AHSSHC provides executive leadership and other professional support services to its subsidiary organizations. Professional support services include among others IT, corporate compliance, legal, reimbursement, risk management, and tax as well as treasury functions. Certain support services, such as human resources, payroll, A/P, and supply chain management are provided pursuant to a shared services model by AHSSHC to its subsidiary organizations. The provision of these executive and support services on a centralized basis by AHSSHC provides an appropriate balance between providing each AdventHealth subsidiary hospital organization with mission-driven consistent leadership and support while allowing the hospital organization to focus its resources on meeting the specific health care needs of the community it serves. The reader of this Form 990 should keep in mind that this reporting entity may differ in certain areas from that of a stand-alone hospital organization due to its inclusion in a larger system of healthcare organizations. As a part of a system of hospital and other health care organizations, the filing organization benefits from reduced costs due to system efficiencies, such as large group purchasing discounts, and the availability of internal resources such as internal legal counsel. Each AdventHealth subsidiary pays a management fee to AHSSHC for the internal services provided by AHSSHC. As a result, management fee expense reported by an AdventHealth subsidiary organization may appear greater in relation to management fee expense that may be reported by a single stand-alone hospital. The single stand-alone hospital would likely report costs associated with management and other professional services on various expense line items in its statement of revenue and expense as opposed to reporting such costs in one overall management fee expense. As the reporting of the Form 990 is done on an entity by entity basis, there is no single Form 990 that captures the programs and operations of AdventHealth as a whole. The reader is directed to visit the web-site of AdventHealth at www.adventhealth.com to learn more about the mission and operations of AdventHealth. Part VI, Line 7 The filing organization does not file an annual community benefit report with any state agencies. 0 AdventHealth Waterman Foundation 1500 Waterman Way Tavares FL 32778 592330166 501(c)(3) 199065 Book Provision of general administrative support General Support Florida Conference of Seventh-Day Adventists 351 S State Road 434 Altamonte Springs FL 32714 590806975 501(c)(3) 10000 General Support 2 0 Part I, Line 2: Grants are generally made only to related organizations that are exempt from federal income tax under IRC Section 501(c)(3), or to other local charitable community organizations, or to other 501(c)(3) organizations that are a part of the group exemption ruling issued to the General Conference of Seventh-Day Adventists. Accordingly, the filing organization has not established specific procedures for monitoring the use of grant funds in the United States as the filing organization does not have a grant making program that would necessitate such procedures. X X X X X 1 1 0 1 0 0 0 0 0 0 0 Ottati David A Dir./Chairman/Reg. CEO 0 648153 0 203790 0 91660 0 120077 0 49855 0 1113535 0 48808 Biri Abel B Director/CEO 0 342913 0 62638 0 47977 0 27448 0 50072 0 531048 0 9531 Thomas Debora H Dir./Sec./Regional CFO 0 423518 0 166200 0 207135 0 64588 0 52251 0 913692 0 20900 Celano Patricia Regional CCO 0 354377 0 82134 0 40434 0 46847 0 49191 0 572983 0 22723 Crunk Frances CFO/Asst. Secretary (ended 8/2018) 0 291106 0 70080 0 180515 0 42328 0 29265 0 613294 0 25204 Young Anita J COO 0 246792 0 36604 0 32597 0 28830 0 28722 0 373545 0 14016 Edmundson MD Ross B CMO 0 277681 0 82221 0 125716 0 33867 0 29516 0 549001 0 18917 Kirman Lynn CNO (ended 5/2018) 0 98264 0 42437 0 15768 0 7573 0 13566 0 177608 0 0 Davis Adrienne Chief Medical Physicist 202437 0 4194 0 17066 0 10819 0 927 0 235443 0 0 0 Kauffman April AVP Foundation 170867 0 0 0 31275 0 10604 0 23353 0 236099 0 0 0 Barnes James R Director - Pharmacy 171702 0 0 0 28175 0 10008 0 13336 0 223221 0 0 0 Hefley Russell Manager - Pharmacy 163648 0 0 0 19065 0 9131 0 7776 0 199620 0 0 0 Longanecker Rebecca Director of Risk and Quality 149811 0 7647 0 22279 0 9109 0 15388 0 204234 0 0 0 Mattison Kenneth R Former - President 0 395790 0 161431 0 218785 0 14849 0 31304 0 822159 0 74178 Mehindru MD Vinay K Former - CMO 0 376924 0 0 0 145450 0 36195 0 44468 0 603037 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 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 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 44 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 (AdventHealth Cabinet 12 members) and $15,000 for AdventHealth Corporate Office Senior Vice Presidents, Regional CEO's and Division Chief Officers (generally 20-30 individual executives). The 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 reimbursed in part 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 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. 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: A nominal discretionary spending amount was provided in the current year to all eligible executives who attend the annual AdventHealth President's Council business meeting ($500 per executive) or the annual AdventHealth CFO Conference or CMO/CNO business meeting ($300 per executive). Other discretionary spending accounts may be provided in connection with other AdventHealth sponsored conferences but typically do not exceed $200 per participant. The payment provided to each executive was considered taxable compensation to the executive. Housing allowance or residence for personal use: AHSSHC has a Corporate Executive Policy that addresses assistance to executives who have been relocated by the company during the year. Relocation assistance provided to executives may include relocation allowances to assist with duplicate housing expenses. Relocation assistance is administered per AHSSHC policy by an external relocation company. Any taxable reimbursements made to executives in connection with relocation assistance are treated as wages to the executive and are subject to all payroll withholding and reporting requirements. 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 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 of the community, 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. 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 a healthcare system known as AdventHealth. In recognition of the contribution that each executive makes to the success of AdventHealth, AdventHealth provides to eligible executives participation in the AdventHealth Executive FLEX Benefit Program (the Plan). The purpose of the Plan is to offer eligible executives an opportunity to elect 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. The Plan provides eligible participants a pre-determined benefits allowance credit that is equal to a percentage of the executive's base pay from which is deducted the cost of mandatory and elective employee benefits. The pre-determined benefits allowance credit percentage is approved by the AHSSHC Board Compensation Committee, an independent committee of the Board of Directors of AHSSHC. Any funds that remain after the cost of mandatory and elective benefits are subtracted from the annual pre-determined benefits allowance are contributed, at the employee's option, 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 documents define an employee who is eligible to participate in the Plan to generally include the Chief Executive Officers of AdventHealth entities and Vice Presidents of all AdventHealth entities whose base salary is at least $250,000. 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 is forfeited by the executive upon a voluntary separation. In addition to the Plan, AdventHealth has instituted 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. Participation in the plan is offered to AdventHealth executives 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. This supplemental executive retirement plan (SERP) 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 the SERP and by the individual's year of entry to the AdventHealth Executive FLEX Benefit Program. Additionally, AdventHealth has adopted a Senior Executive Death Benefit (SEDB) Plan in recognition of the considerable age and service requirements in the SERP. The SEDB Plan provides a benefit in an amount equal to the amount the executive's benefit would have been under the SERP Plan assuming that, on the date of the executive's death (and not before), the executive satisfied the last of the eligibility requirements of the SERP Plan with present value recognizing an early benefit commencement. An eligible executive becomes a participant in the SEDB Plan if the executive dies prior to termination of employment, provided the executive has not satisfied all of the eligibility requirements of SERP as of the executive's date of death but would have satisfied all of those requirements within five (5) years following death had the executive lived and continued employment. The SEDB Plan was reviewed and approved by the AHSSHC Board Compensation Committee, an independent body of the AHSSHC Board of Directors. Flex Plan Flex Plan/ SERP 457(b) CY CY Employer CY Contrib./ Distributions* Contrib. Distributions* Payment ------------------------------------------------------- Ottati, David A. $105,873 $ 62,888 $ 0 $ 0 Biri, Abel B. $ 29,599 $ 9,643 $ 0 $ 0 Thomas, Debora H. $ 49,739 $ 21,143 $159,175 $ 0 Celano, Patricia $ 37,498 $ 25,598 $ 0 $ 0 Crunk, Frances $ 27,479 $ 31,652 $118,681 $ 0 Young, Anita J. $ 13,981 $ 17,531 $ 0 $ 0 Edmundson, MD, Ross B. $ 38,145 $ 24,194 $ 0 $ 0 Mattison, Kenneth R.$ 53,623 $118,567 $ 30,492 $ 0 Mehindru, Vinay K. $ 39,846 $ 0 $ 0 $ 0 * Including Investment Earnings X 3183 Cost X Care Mgmt. 10 0 Cost 0 1 0 Part V, Line 1a-1b The parent corporation and sole member of Florida Hospital Waterman, Inc. (the filing organization) is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). AHSSHC has established a shared service center to centralize the Accounts Payable (A/P) function for all AHSSHC subsidiary organizations. The filing organization has entered "0" in Part V, Line 1a because the filing organization no longer issues Form 1099 returns, rather, all such returns are filed by and under the name and EIN of AHSSHC as the payor subject to the information reporting requirements of Section 6041. The facts and circumstances support a position that AHSSHC, as a payor on behalf of its subsidiary organizations in a shared service environment, will have sufficient management and oversight in connection with the subsidiary organizations' payments to meet the standard set forth in Treas. Reg. Section 1.6041-1(e). AHSSHC will not merely be making payments at the direction of its subsidiary organizations. Accordingly, AHSSHC is considered the payor subject to the information reporting requirements of Section 6041. Form 990, Part VI, Section A, line 6 Florida Hospital Waterman, Inc. (the filing organization) has one member. The sole member of the filing organization is Adventist Health System Sunbelt Healthcare Corporation. Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). There are no other classes of membership in the filing organization. Form 990, Part VI, Section A, line 7a The sole member of the filing organization is AHSSHC. The Board of Directors of the filing organization are appointed by the sole member, AHSSHC, who has the right to elect, appoint or remove any member of the Board of Directors of the filing organization. Form 990, Part VI, Section A, line 7b AHSSHC, as the sole member of the filing organization, has certain reserved powers as set forth in the Bylaws of the filing organization. These reserved powers include the following: a) to approve and disapprove the executive and/or administrative leadership of the filing organization, and their salaries; b) to adopt, amend, restate, and repeal the Articles of Incorporation or Bylaws of the filing organization, and the Medical Staff Bylaws; c) to set limits and terms for the borrowing of funds; d) to approve or disapprove major building programs and/or purchase or sale of personal property or real property equal to or in excess of One Million dollars; e) to approve or disapprove the annual operating and capital budgets of the filing organization; f) to direct the placement of funds and capital of the filing organization; g) to establish general guiding policies, to implement quality assessment, improvement and utilization review programs; and h) to approve the appointment of an auditing firm and election of the fiscal year for the filing organization. Form 990, Part VI, Section B, line 11b The filing organization's current year Form 990 was reviewed by the Board Chairman, Board Finance Committee Chair, CEO and by the CFO prior to its filing with the IRS. The review conducted by the Board Chairman, Board Finance Committee Chair, CEO and the CFO did not include the review of any supporting workpapers that were used in preparation of the current year Form 990, but did include a review of the entire Form 990 and all supporting schedules. Form 990, Part VI, Section B, line 12c The Conflict of Interest Policy of the filing organization applies to members of its Board of Directors and its principal officers (to be known as Interested Persons). In connection with any actual or possible conflicts of interest, any member of the Board of Directors of the filing organization or any principal officer of the filing organization (i.e. Interested Persons) must disclose the existence of any financial interest with the filing organization and must be given the opportunity to disclose all material facts concerning the financial interest/arrangement to the Board of Directors of the filing organization or to any members of a committee with board delegated powers that is considering the proposed transaction or arrangement. Subsequent to any disclosure of any financial interest/arrangement and all material facts, and after any discussion with the relevant Board member or principal officer, the remaining members of the Board of Directors or committee with board delegated powers shall discuss, analyze, and vote upon the potential financial interest/arrangement to determine if a conflict of interest exists. According to the filing organization's Conflict of Interest Policy, an Interested Person may make a presentation to the Board of Directors (or committee with board delegated powers), but after such presentation, shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that results in a conflict of interest. Each Interested Person, as defined under the filing organization's Conflict of Interest Policy, shall annually sign a statement which affirms that such person has received a copy of the Conflict of Interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the filing organization is a charitable organization that must primarily engage in activities which accomplish one or more of its exempt purposes. The filing organization's Conflict of Interest Policy also requires that periodic reviews shall be conducted to ensure that the filing organization operates in a manner consistent with its charitable purposes. Form 990, Part VI, Section B, line 15 The filing organization's CEO, other officers and key employees are not compensated by the filing organization. Such individuals are compensated by the related top-tier parent organization of the filing organization. Please see the discussion concerning the process followed by the related top-tier parent organization in determining executive compensation in our response to Schedule J, Line 3. Form 990, Part VI, Section C, line 19 The filing organization is a part of the system of healthcare organizations known as AdventHealth. The audited consolidated financial statements of AdventHealth and of the AdventHealth "Obligated Group" are filed annually with the Municipal Securities Rulemaking Board (MSRB). The "Obligated Group" is a group of AHSSHC subsidiaries that are jointly and severally liable under a Master Trust Indenture that secures debt primarily issued on a tax-exempt basis. Unaudited quarterly financial statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) are also filed with MSRB for AdventHealth on a consolidated basis and for the grouping of AdventHealth subsidiaries comprising the "Obligated Group". The filing organization does not generally make its governing documents or conflict of interest policy available to the public. Part VII, Section A For those Board of Director members (not including physician members of the board), officer(s) and key employees who devote less than full-time to the filing organization (based upon the average number of hours per week shown in column (B) on page 7 of the return) the compensation amounts shown in columns (E) and (F) on page 7 were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position as an employee of Adventist Health System Sunbelt Healthcare Corporation. Physician members of the Board of Directors received compensation from related organizations as a result of providing various medical services to those related entities. Part VIII, Lines 7a, b and c: The amount shown in Part VIII, Line 7c(i) of the Form 990 represents an allocated share of capital gain/(loss) from a system wide, corporate administered, investment program. Form 990, Part IX, line 11g Payments to Healthcare Professional: Program service expenses 17,201,979. Management and general expenses 0. Fundraising expenses 0. Total expenses 17,201,979. Professional Fees: Program service expenses 2,786,333. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,786,333. Purchased Medical Services: Program service expenses 2,032,540. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,032,540. Environmental Services: Program service expenses 1,804,274. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,804,274. Transcription Services: Program service expenses 183,461. Management and general expenses 0. Fundraising expenses 0. Total expenses 183,461. Recruiting: Program service expenses 242,819. Management and general expenses 0. Fundraising expenses 0. Total expenses 242,819. Food Service Contracts: Program service expenses 671,496. Management and general expenses 0. Fundraising expenses 0. Total expenses 671,496. Miscellaneous Purchased Services: Program service expenses 2,593,680. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,593,680. AHS Management Fees: Program service expenses 0. Management and general expenses 4,759,272. Fundraising expenses 0. Total expenses 4,759,272. Billing & Collection Services: Program service expenses 0. Management and general expenses 225,719. Fundraising expenses 0. Total expenses 225,719. 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: Trandfer to Tax-Exempt Parent -5,056,916. Transfer to/from Affiliate -298,069. Change in Interest in Foundation 1,721,753. Rounding -3. AdventHealth Foundation Shawnee Mission 9100 W 74th Street Shawnee Mission KS 66204 480868859 Fund-raising for Tax-exempt hospital KS 501(c)(3) Line 7 Shawnee Mission Medical Center Inc 1 AdventHealth University Inc fka Adv Univ of Hlth Sciences Inc 671 Lake Winyah Drive Orlando FL 32803 593069793 Education/Operation of School FL 501(c)(3) Line 2 Adventist Hlth SystemSunbelt Inc 1 AdventHealth Ransom Memorial Inc (619-123118) 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 Adventist Bolingbrook Hospital 500 Remington Blvd Bolingbrook IL 60440 651219504 Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 Adventist Care Centers - Courtland Inc 730 Courtland Street Orlando FL 32804 205774723 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Adventist GlenOaks Hospital 701 Winthrop Avenue Glendale Heights IL 60139 363208390 Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Midwest Health 1 Adventist Hlth 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 Hlth Partners Inc 2601 Navistar Dr Bldg 4 Finance Lisle IL 60532 364138353 Operation of Physician Practices & Medical Services IL 501(c)(3) Line 3 AHS Midwest Management Inc 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 System Georgia Inc 1035 Red Bud Road Calhoun GA 30701 581425000 Operation of Hospital & Related Services GA 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Adventist Hlth SystemSunbelt Inc 900 Hope Way Altamonte Springs FL 32714 591479658 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Adventist Hlth SystemTexas Inc 11801 S Freeway Burleson TX 76028 742578952 Leasing Personnel to Affiliated Hospital TX 501(c)(3) Line 12c, III-FI Adventist Hlth System Sunbelt Hlthcare Corp 1 Adventist Midwest Health 120 North Oak Street Hinsdale IL 60521 362276984 Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 AHP Specialty Care NFP 2601 Navistar Dr Bldg 4 Finance Lisle IL 60532 811105774 Operation of Physician Practices & Medical Services IL 501(c)(3) Line 3 AHS Midwest Management Inc 1 AHS Midwest Management Inc 2601 Navistar Dr Bldg 4 Finance Lisle IL 60532 363354567 Operation of Physician Practice Mgmt IL 501(c)(3) Line 12a, I Adventist Midwest Health 1 AHSCentral Texas Inc 1301 Wonder World Drive San Marcos TX 78666 742621825 Provide Office Space - Medical Professionals TX 501(c)(3) Line 12c, III-FI Adventist Hlth System Sunbelt Hlthcare Corp 1 Apopka Hlth 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 Battle Creek Adventist Hospital 900 Hope Way Altamonte Springs FL 32714 381359189 Inactive MI 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Bolingbrook Hospital Foundation 500 Remington Blvd Bolingbrook IL 60440 900494445 Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation 0 Bradford Heights Hlth & Rehab Center Inc 950 Highpoint Drive Hopkinsville KY 42240 205782342 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Burleson Nursing & Rehab Center Inc 301 Huguley Blvd Burleson TX 76028 205782243 Operation of Home for the Aged/Hlthcare Delivery TX 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Caldwell Hlth Care Properties Inc 1333 West Main Princeton KY 42445 510605680 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Central Texas Hlthcare Collaborative 1301 Wonder World Drive San Marcos TX 78666 453739929 Support Operation of Hospital TX 501(c)(3) Line 12a, I Adventist Hlth SystemSunbelt Inc 1 Chickasaw Hlth 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 Courtland Hlth Care Properties Inc 730 Courtland Street Orlando FL 32804 510605682 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Creekwood Place Nursing & Rehab Center Inc 107 Boyles Drive Russellville KY 42276 205782260 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Dairy Road Hlth 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 Hlth & 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 Emory-Adventist Inc 900 Hope Way Altamonte Springs FL 32714 582171011 Inactive GA 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Fletcher Hospital Inc 100 Hospital Drive Hendersonville NC 28792 560543246 Operation of Hospital & Related Svcs 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 Svcs 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 Svcs 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 (222-123118) 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 485 North Keller Road 250 Maitland FL 32751 472180518 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 GlenOaks Hospital Foundation 701 Winthrop Avenue Glendale Heights IL 60139 363926044 Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation 0 Helen Ellis Memorial Hospital Auxiliary Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 592106043 Fund-raising for Tax-exempt hospital/foundation FL 501(c)(3) Line 12c, III-FI N/A 0 Helen Ellis Memorial Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 593690149 Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 7 N/A 0 Hinsdale Hospital Foundation 120 North Oak Street Hinsdale IL 60521 521466387 Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation 0 Hospice of the Comforter Inc 480 W Central Parkway Altamonte Springs FL 32714 592935928 Operation of Hospice FL 501(c)(3) Line 10 The Comforter Health Care Group Inc 1 Hospice of the Comforter Foundation Inc 480 W Central Parkway Altamonte Springs FL 32714 271858033 Inactive FL 501(c)(3) Line 7 The Comforter Health Care Group Inc 1 In-Motion Rehab Inc 485 North Keller Road 250 Maitland FL 32751 208023411 Therapy services to tax exempt nursing homes KS 501(c)(3) Line 12b, II Sunbelt Hlth Care Centers Inc 1 La Grange Memorial Hospital Foundation 5101 S Willow Springs Rd La Grange IL 60525 300247776 Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation 0 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 Hlth 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 Hlth 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 Merriam Hlth Care Properties Inc 9700 West 62nd Street Merriam KS 66203 364595806 Lease to Related Organization KS 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 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 Hlthcare services to the community TX 501(c)(3) Line 3 Metroplex Adventist Hospital Inc 1 Midwest Hlth Foundation 120 North Oak Street Hinsdale IL 60521 352230515 Support of subsidiary Foundations IL 501(c)(3) Line 12b, II N/A 0 Mills Hlth & Rehab Center Inc 500 Beck Lane Mayfield KY 42066 205782320 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Mission Strategies of Georgia Inc 485 North Keller Road 250 Maitland FL 32751 900866024 Provision of support to the nursing home division GA 501(c)(3) Line 12b, II Sunbelt Hlth Care Centers Inc 1 Missouri Adventist Hlth Inc 9100 W 74th Street Shawnee Mission KS 66204 431224729 Support Hlth Care Services MO 501(c)(3) Line 12d, III-O Adventist Hlth Mid-America Inc 1 Ormond Beach Memorial Hospital Auxiliary Inc 301 Memorial Medical Parkway Daytona Beach FL 32117 591721962 Volunteer support services FL 501(c)(3) Line 12c, III-FI N/A 0 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 Paragon Hlth Care Properties Inc 950 Highpoint Drive Hopkinsville KY 42240 510605686 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Pasco-Pinellas Hillsborough Community Hlth System Inc 2600 Bruce B Downs Blvd Wesley Chapel FL 33544 208488713 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Portercare Adventist Hlth System (630 Year End) 9100 E Mineral Circle Centennial CO 80112 840438224 Operation of Hospital & Related Services CO 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 Princeton Hlth & Rehab Center Inc 1333 West Main Princeton KY 42445 205782272 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Princeton Professional Services Inc 601 E Rollins Street Orlando FL 32803 591191045 Provision of Hlthcare Services FL 501(c)(3) Line 10 Adventist Hlth System Sunbelt Hlthcare Corp 1 Quality Circle for Hlthcare Inc 900 Hope Way Altamonte Springs FL 32714 263789368 Hlthcare Quality Services FL 501(c)(3) Line 12a, I Adventist Hlth System Sunbelt Hlthcare Corp 1 Resource Personnel Inc 485 North Keller Road 250 Maitland FL 32751 208040875 Provide administrative support to tax exempt nursing homes FL 501(c)(3) Line 12b, II Sunbelt Hlth Care Centers Inc 1 Rocky Mountain Adventist Hlthcare Foundation (630 Year End) 7995 E Prentice Ave 204 Greenwood Village CO 80111 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 Russellville Hlth Care Properties Inc 683 East Third Street Russellville KY 42276 510605691 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 San Marcos Hlth Care Properties Inc 1900 Medical Parkway San Marcos TX 78666 510605693 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 San Marcos Nursing & Rehab Center Inc 1900 Medical Parkway San Marcos TX 78666 205782224 Operation of Home for the Aged/Hlthcare Delivery TX 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Shawnee Mission Hlth Care 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 Hlth Care Properties Inc 485 North Keller Road 250 Maitland FL 32751 813914908 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Shawnee Mission 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 Hlth 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 Hlth 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 Hlthcare 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 Specialty Physicians of Central Texas Inc 1301 Wonder World Drive San Marcos TX 78666 208814408 Physician Hlthcare services to the community TX 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc 1 Spring View Hlth & Rehab Center Inc 718 Goodwin Lane Leitchfield KY 42754 205782288 Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Sunbelt Hlth & 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 Hlth 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 SunSystem Development Corp 900 Hope Way Altamonte Springs FL 32714 592219301 Fund Raising for Affiliated Tax-Exempt Hospitals FL 501(c)(3) Line 7 Adventist Hlth System Sunbelt Hlthcare Corp 1 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 Hlth 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 Taylor Creek Hlth Care Properties Inc 718 Goodwin Lane Leitchfield KY 42754 510605678 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 Lease to Related Organization FL 501(c)(3) Line 12c, III-FI Adventist Hlth System Sunbelt Hlthcare Corp 1 The Volunteer Auxiliary of Florida Hospital - Flagler Inc 60 Memorial Medical Parkway Palm Coast FL 32164 592486582 Volunteer support services FL 501(c)(3) Line 12c, III-FI N/A 0 Tri-County Nursing and Rehab Center Inc 485 North Keller Road 250 Maitland FL 32751 472219363 Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc 1 Trinity Nursing & Rehab Center Inc 9700 West 62nd Street Merriam KS 66203 205774890 Operation of Home for the Aged/Hlthcare Delivery KS 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 12a, I N/A 0 University Community Hospital Specialty Care Inc 3100 E Fletcher Ave Tampa FL 33613 593231322 Inactive FL 501(c)(3) Line 12a, I University Community Hospital Inc 1 University Community Hospital Inc 3100 E Fletcher Ave Tampa FL 33613 591113901 Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp 1 West Florida Health Inc 14055 Riveredge Drive Tampa FL 33637 471881744 Holding Company FL 501(c)(3) Line 10 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 West Florida Health Inc 1 West Kentucky Hlth Care Properties Inc 500 Beck Lane Mayfield KY 42066 510605676 Lease to Related Organization GA 501(c)(3) Line 12c, III-FI Sunbelt Hlth Care Centers Inc 1 Zephyr Haven Hlth & 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 Hlth & 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 Clear Creek MOB Ltd 2201 S Clear Creek Rd Killeen TX 76549 742609195 Real Estate TX N/A Florida Hospital DMERT LLC 500 Winderley Place Ste 324 Maitland FL 32751 202392253 Medical Equipment FL N/A Florida Hospital Home Infusion LLP 500 Winderley Place Ste 226 Maitland FL 32751 593142824 Home Infusion Services FL Princeton Prof ServsFH Waterman Related 45274 -198474 0 1 0.04900 Functional Neurosurgical Ambulatory Surgery Ctr LLC 11 W Dry Creek Circle 120 Littleton CO 80120 464426708 Surgery Center CO N/A Princeton Homecare Services LLC 1050 Forrer Blvd Kettering OH 45420 814196648 Operation of Home Health Agency FL N/A San Marcos MRI LP 1330 Wonder World Dr Ste 202 San Marcos TX 78666 770597972 Imaging & Testing TX N/A The Bariatric Center of Kansas City LLC (628-123118) 9100 W 74th Street Merriam KS 66204 823025378 Surgery Center KS N/A 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 Association Inc 601 East Rollins Street Orlando FL 32803 593000857 Condo Association FL N/A C 1 CC MOB Inc 2201 S Clear Creek Road Killeen TX 76549 742616875 Real Estate Rental TX N/A C 1 Central Texas Medical Associates 1301 Wonder World Drive San Marcos TX 78666 742729873 Inactive TX N/A C 1 Central Texas Providers Network 1301 Wonder World Drive San Marcos TX 78666 742827652 Physician Hospital Org. TX 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 101 Southhall Lane Ste 150 Maitland FL 32751 593215680 PHSO 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 Florida Memorial Health Network Inc 770 W Granada Blvd Ste 317 Ormond Beach FL 32174 593403558 Physician Hospital Org. 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 LN Health Partners Inc 550 E Rollins Street 6th Floor Orlando FL 32803 813556903 Inactive 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 Lessor/Holding Co. TN N/A C 1 Ormond Prof Associates Condo Assoc'n 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 Porter Affiliated Health Services Inc 2525 S Downing Street Denver CO 80210 840956175 Healthcare Services CO N/A C 1 San Marcos Regional MRI Inc 1301 Wonder World Drive San Marcos TX 78666 770597968 Holding Company TX 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 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 Adventist Health System Sunbelt Healthcare Corporation B 5056916 Amount Given Adventist Health System Sunbelt Healthcare Corporation M 1921397 % of Facility's Oper. Exp. Adventist Health System Sunbest Healthcare Corporation - Shared Services M 2067188 % of Facility's Oper. Exp. Adventist Health System Sunbelt Healthcare Corporation - AIT M 8644099 % of Facility's Oper. Exp. Adventist Health System Sunbelt Healthcare Corporation P 9485679 Cost Adventist Health SystemSunbelt Inc dba AdventHealth Orlando M 250092 Cost Plus Appropriate Margin Adventist Health SystemSunbelt Inc dba AdventHealth Orlando P 1010441 Cost Florida Hospital Medical Group Inc dba AdventHealth Medical Group Central A 515579 FMV Rent Florida Hospital Medical Group Inc dba AdventHealth Medical Group Central M 794096 Cost Plus Appropriate Margin Florida Hospital Medical Group Inc dba AdventHealth Medical Group Central R 6801599 Cost Memorial Health Systems Inc dba AdventHealth Daytona Beach P 1916099 Cost Florida Hospital Healthcare Partners Inc dba AdventHealth Medical Group E P 553344 Cost