2018-11-15T14:07:33-06:00 2017-12-31 990 2017-01-01 593140669 FLORIDA HOSPITAL WATERMAN INC FLOR 3522533300 1000 WATERMAN WAY TAVARES FL 32778 Lynn C Addiscott Officer/Asst. Secretary 4073572317 2018-11-01 204.139.85.142 2018-11-01 14:06:10 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 2D951D70D370B284B8357A24D7DC4FA93EDF4DEB 2017 2019-02-21 02:37:17Z Abel Biri 1000 WATERMAN WAY TAVARES FL 32778 261661394 0 1071 X www.floridahospital.com/waterman X 1992 FL Operate 269-bed acute care hospital 15 8 2205 251 271006 0 0 97315 236534475 248129329 1635176 13407907 0 2049 238169651 261636600 123000 0 0 0 105274447 108456084 0 0 0 110219985 114241919 215617432 222698003 22552219 38938597 440233931 493443853 120203373 121088524 320030558 372355329 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 Adventist Health System (AHS). AHS 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, AHS cares for and nurtures people: our employees, our communities, our healthcare professionals, and those who trust us for care and healing. 0 0 207662586 247860372 All program services revenues and expenses relate to the operation of a 269-bed acute care hospital in Tavares, Florida. There were 15,169 admissions, 66,578 patient days and 112,337 outpatient visits. 207662586 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 0 0 2205 1 1 1 0 0 0 0 0 0 0 0 0 X 15 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X Jennifer Ambs 3522533386 1000 Waterman Way Tavares FL 32778 X Tol Daryl L Director/Chairman (end 6/2017) 0.10 50.00 X 0 1328194 245784 Ottati David A Dir./Chairman/Reg. CEO 9.50 40.50 X X 0 702189 143654 Biri Abel B Director/CEO (beg 5/2017) 50.00 0.00 X X 0 337880 82464 Bryce MD Miguel Dir./Vice Chief of Staff 4.10 0.00 X 49100 0 0 Carpenter Ken Director 0.30 0.00 X 0 0 0 Comfort Lynda Director 0.40 0.00 X 0 0 0 Epaillard Janice Director 0.30 0.00 X 0 0 0 Gaylord Frank Director 0.30 0.00 X 0 0 0 Goodman Todd A Director (end 6/2017) 0.20 50.00 X 0 752877 139261 Hepner Thomas C Director 0.30 0.00 X 0 0 0 Howard Barbara Director 0.30 0.00 X 0 0 0 Marzek MD Peter Director/Sec./Treas. 1.40 0.00 X 67100 0 0 Putigna DO Floriano Director/Chief of Staff 7.20 0.00 X 4600 0 0 Smith Stuart Director 0.30 0.00 X 0 0 0 Thomas Debora H Dir./Sec. (beg 9/2017)/Reg. CFO 9.50 40.50 X X 0 1087902 98411 Weiss CPA David L Director 0.60 0.00 X 0 0 0 Werner Thomas L Director 0.30 0.00 X 0 50502 0 Celano Patricia Regional CCO 9.50 40.50 X 0 452999 71630 Crunk Frances CFO/Asst. Secretary 50.00 0.00 X 0 771161 75606 Young Anita J COO 50.00 0.00 X 0 283577 62348 Edmundson MD Ross B CMO 50.00 0.00 X 0 450654 72585 Kirman Lynn CNO 50.00 0.00 X 0 253365 40534 Davis Adrienne Chief Medical Physicist 40.00 0.00 X 208630 0 12552 Barnes James R Director - Pharmacy 40.00 0.00 X 191477 0 28829 Golab Richard J Director Diagnostic Service 40.00 0.00 X 176002 0 28359 Wood Heather D Director Surgical Services 40.00 0.00 X 174247 0 29234 Hefley Russell Manager - Pharmacy 40.00 0.00 X 173942 0 18266 Mattison Kenneth R Former - President 0.00 50.00 X 0 601995 98824 1045098 7073295 1248341 59 1 1 0 Gresham Smith & Partners 5220 Belfort Road Jacksonville FL 32256 Consulting Fees 1323422 GE Healthcare - Apt PO Box 96483 Chicago IL 60693 Service Contract 914817 Crothall Healthcare 13028 Collection Center Drive Chicago IL 60693 Housekeeping Fees 866893 The Robins & Morton Group 400 Shades Creek Parkway Birmingham AL 35209 Construction Management Fee 702973 Waterman Anesthesiology Group 861 Trafalgar Court Ste 200 Maitland FL 32751 Physician Fees 678142 39 X 97315 97315 Net patient revenue 622110 244755451 244484445 271006 Cafeteria revenue 622110 1228988 1228988 Medical office building 622110 889446 889446 Daycare revenue 622110 534671 534671 Medical records revenue 622110 397370 397370 323403 323403 248129329 6244286 6244286 7186413 2002 0 24794 7186413 -22792 7163621 7163621 EHR Revenue 622110 2049 2049 2049 261636600 247860372 271006 13407907 X 3036763 3036763 78293287 78293287 2681915 2638444 43471 18228681 18030240 198441 6215438 6114692 100746 276785 276785 71076 71076 1385020 1385020 26556241 21395808 5160433 1161588 1161588 3559821 2183593 1376228 8853570 7586796 1266774 3408883 3408883 342208 1084 341124 342562 342562 2888280 2888280 12790972 12790972 719948 647478 72470 Medical Supplies 41798323 41798323 Repairs & maintenance 7070815 7070815 State Tax Indigent Asse 2805201 2805201 UBI taxes 8545 8545 202081 8690 193391 222698003 207662586 15035417 0 8849 10999 252644445 290586551 32646205 36975637 3750644 4707558 10218876 7444119 277146614 153785632 118866528 123360982 19465491 26247220 157219 157219 2475674 3953568 440233931 493443853 14392391 17741987 251698 232558 105559284 103113979 120203373 121088524 X 300258196 344597547 19772362 27757782 320030558 372355329 440233931 493443853 X 38938597 10021011 3365163 X 0 1 X 1 0 X 0 0 0 0 0 0 1 4922 0 1 10118 15040 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 $4,922 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. 11924363 11924363 144887703 70748432 74139271 103474795 79168796 24305999 16859753 3868404 12991349 123360982 Investment in Foundation 26157782 C Investment in JV 89438 C 26247220 Due to related 6029876 Payable to third parties 4705781 Credit balances in A/R 1441294 Interco. Alloc. of TE Bond Proceeds 87709733 Leases payable 159991 Other liabilities 3067304 103113979 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 Accounting Standards Codification (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, 2017. 1 1 1 X 0 1 1 1 0 1 0 10834498 3059317 7775181 0.03490 29986294 14408426 15577868 0.07000 40820792 17467743 23353049 0.10490 555922 555922 0.00250 27325 27325 0.00010 583247 583247 0.00260 41404039 17467743 23936296 0.10750 56188 56188 0.00030 56188 56188 0.00030 1 14605848 1430386 90429494 86596908 3832586 X 1 1 1 1 Florida Hospital Waterman Inc 1000 Waterman Way Tavares FL 32778 www.floridahospital.com/waterman 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 statement X X 1 17 1 See statement 0 1 X 200.000000000000 X X X X 1 1 X X X X 1 X www.floridahospital.com/pateint-resources/billing/financial-assistance X www.floridahospital.com/pateint-resources/billing/financial-assistance X www.floridahospital.com/pateint-resources/billing/financial-assistance 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 (FHW or the Hospital) was one of eight hospitals in the Central Florida Region of Adventist Health System. The eight hospitals are in the Central Florida counties of Lake, Orange, Osceola, and Seminole. FHW 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 FHW 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.FHW had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within FHW's community/service area. The following organizations participated in FHW'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 2017 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 is currently part of the North Region of the Central Division of Adventist Health System which includes nine (9) hospital facilities.This is the first-year update for Florida Hospital Waterman's 2017-2019 Community Health Plan/Implementation Strategy. Florida Hospital Waterman developed this Plan and posted it May 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, Florida Hospital 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 first-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.Florida Hospital Waterman chose five (5) areas of focus for their 2017-2019 Community Health Plan: 1. Access to Care2. Colon and Cervical Cancer3. Obesity4. Heart Disease5. Diabetes Priority: Access to Care2016 Description of the Issue: Focusing 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.2017 Update: Florida Hospital 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 Health Clinic on its campus; the Clinic treats patients whose incomes are less than 150% of poverty line. The Clinic provided scheduling assistance and no-cost medical care to 2,118 patients and transitioned 11% of the ER's low-income patients (with non-acute or chronic health issues) to the Primary Health Clinic for post-discharge follow-up. We are increasing the social services appointment and assistance provided to patients. The clinic's numbers continue to remain consistent, even with the loss of some providers and the fact the clinic now sees more complex patients that require more time per visit (Researching chronic care management coding to capture time). In addition, patients (from the hospital and/or the Family Health Clinic) who did not have a regular primary care provider were referred to the nearby Leesburg Community Health Center (FQHC). The Community Health Center sees uninsured patients on a sliding fee scale basis; it also accepts Medicaid, Medicare and insurance. Florida Hospital Waterman spearheaded a multidisciplinary focus group, including the local Community Health Improvement Planning (CHIP) to identify key barriers and improve community access to health care. It was characterized that access to resource identification is compartmentalized, especially for non-insured people in the community. A focus of this group is to identify a resource platform with a comprehensive, up-to-date resource list based upon unique needs that people in need in our community, local charities and supportive organizations can access.The hospital maintains its transitional care program to reduce preventable readmissions for heart attacks, congestive heart failure, and pneumonia. Based on Lake County's physician shortage and its designation as both an HRSA-designated Medically Underserved Area (MUA) and Health Provider Shortage Area (HPSA), the hospital continues to recruit additional primary care providers to the county.Priority: Colon and Cervical Cancer2016 Description of the Issue: Focusing on all ethnicities ages 40 and older, these conditions were selected because data show cancer is in the top 5 causes of death in Lake County and colon and cervical screenings in Lake County are lower than the Healthy People 2020 goal and minority groups had higher non-compliance rates.2017 Update: Florida Hospital Waterman conducted two (2) community outreach events at a food and personal care item distribution center and one (1) community outreach event at a low-income housing community. All 3 events were to educate women in our community about HPV, cervical cancer, risk reduction, screening/early detection and to link women to gynecologic cancer prevention resources. In 2018 a new program will launch to educate providers on cancer navigation services and will include easier access, resources, survivorship care plan dissemination and patient education. The hospital conducts support groups for Cancer, GYN Cancers, Breast Cancer, Prostate Cancer and co-sponsors "Look Good Feel Better" with the American Cancer Society. There is no charge for these programs.Priority: Obesity2016 Description of the Issue: Focusing on all ethnicities and all age groups, this condition was selected because data shows the proportion of obese adults in Lake County is higher than the Healthy People 2020 goal, and there is a strong community concern about the impact of obesity on both children and adults.2017 Update: Florida Hospital Waterman worked to increase awareness and provide health education to children and families by developing a program to engage local Pediatricians to refer obese children and their families to the CREATION Health programs offered. In year one, the program was developed, and the hospital worked to identify potential physicians to engage with. This process will be finalized in 2018.The CREATION Health Bible School continued in 2017 and reached over 70 children and included health education relating to nutrition and fitness. 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% of the service area. The hospital also offered multiple CREATION Health classes and other program at the hospital and in community settings. Program success is measured by post class surveys on healthy eating skills. To increase awareness and education of obesity and its impact on overall health, FH Waterman provided BMI screenings and lifestyle education for obesity to adults over 18 in the community. In the first year, they provided 498 screenings. 100% of adults with BMIs over 40% were referred to a physician or healthy eating program.Priority: Heart Disease2016 Description of the Issue: Focusing on all ethnicities ages 40+ and older, this condition was selected because data shows that heart disease is one of the top five causes of death in Lake County and is higher than the Healthy People 2020 goal.(Continued) Part V, Section B, Line 7a The hospital facility's CHNA report was made widely available through the following website:https://www.floridahospital.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.floridahospital.com/community-health-needs-assessments Part V, Section B, Line 11 - Continued: 2017 Update: Florida Hospital Waterman provided 164 cardiac health assessments and screenings (blood pressure and cholesterol). 100% of those with high cholesterol or blood pressure were referred to physicians, the hospital's Family Health Clinic and/or the nearby Leesburg Community Health Center (FQHC) for follow-up care. Florida Hospital Waterman provided prevention and education tools via the Heart Center website to educate for Stroke, Heart, and Vascular at FHWatermanheart.com. Aligned with the standards for the national Chest Pain Center accreditation (by the Society of Chest Pain Centers), the Early Heart Attack Education (EHAC) handouts/pledge was distributed to local employers, providers, community health/wellness events, to all patients discharged from the Emergency Room, new employee orientation and cardiac support classes. EHAC was also presented through Waterman Wellness magazine and TV reaching > 50% of the targeted audience. Research was completed in 2017, to identify a potential new tool to the blood pressure kiosks at Publix Supermarkets which would be available to community members. Distribution and education for smoking cessation programs "Tools to Quit" (one-time class) and "Quit Smoking Now" (weekly class) was made available to employees, community, and all inpatients, emergency room patients, and cancer center patients identified as smokers. Priority: Diabetes2016 Description of the Issue: Focusing on all ethnicities ages 18+, this condition was selected because data shows that 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.2017 Update: Florida Hospital Waterman provided 164 glucose screenings to the community, meeting the 2017 goal. 100% of people with elevated glucose levels were referred to a physician and/or diabetes education classes. People without physicians were referred to the Leesburg Community Health Center (FQHC) that sees uninsured patients on a sliding fee scale basis. Florida Hospital Waterman provided prevention and education tools for diabetes at FHWatermanheart.comOffered in the Conry CREATION Health Center, the Florida Hospital Waterman Diabetes Self-Management class educated participants on how to manage diabetes using everyday strategies with a focus on nutrition, exercise and disease management. This class was open to the greater community, and met its goal with the completion of 7 classes and 116 participants. Florida Hospital Waterman also hosted twenty-two (22) Diabetes Support Groups with 84 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 was 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 manage sick days. Florida Hospital Waterman, in conjunction with the Lake County Department of Health, launched a new community service in August 2017 to help expecting mothers manage gestational diabetes. More than 13% of expecting 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 17 education classes and testing supplies to 35 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% of the service area. The hospital also offered multiple CREATION Health classes and other programs at the hospital and in community settings. Community Needs Not Chosen by Florida Hospital 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 Florida Hospital 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: This is a component of poor mental health. Other local organizations such as Lifestream Behavioral Health is working to and is in a better position to address substance abuse. 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, indicating 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 improving 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 in 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 would be more suited to address this issue.8. HIV/AIDS: The HIV rate has increased in Lake county, and 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 STI 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 additional programs more available in the county available 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. 1 1 - Community Primary Health Clinic 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 22 tax-exempt 501(c)(3) hospital organizations that operated 43 hospitals in nine states within the U.S. The system of organizations under the control and ownership of AHSSHC is known as "Adventist Health System" (AHS).All hospital organizations within AHS collect, calculate, and report the community benefits they provide to the communities they serve. AHS organizations exist solely to improve and enhance the local communities they serve. AHS 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 AHS 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 organizations most recently conducted community health needs assessment and associated implementation strategy are posted 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. 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 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: $ 3,832,586- Difference in costing methodology: (721,668)- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (6,140,410) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's communitybenefit reporting $ (3,029,492)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 116,000 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 86.9% and college graduates account for approximately 21% of Lake County. Approximately 58.4% of the Hospital's patients during 2017 were Medicare patients, about 12.7% were Medicaid patients, about 6.9% were self-pay patients, and the remaining percentage were patients covered under commercial insurance. In 2017, about 87.7% 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 $280,312 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 $17,285,426 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 Adventist Health System (AHS). AHSSHC is an organization exempt from federal income tax under IRC Section 501(c)(3). AHSSHC and its subsidiary organizations operate 43 hospitals throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC and its subsidiaries also operate 15 nursing home facilities and other ancillary health care provider facilities, such as ambulatory surgery centers and diagnostic imaging centers. As the parent organization of the AHS system, 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 AHS 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 AHS subsidiary pays a management fee to AHSSHC for the internal services provided by AHSSHC. As a result, management fee expense reported by an AHS 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 AHS as a whole. The reader is directed to visit the web-site of AHS at www.adventisthealthsystem.com to learn more about the mission and operations of AHS. Part VI, Line 7 The filing organization does not file an annual community benefit report with any state agencies. 0 Florida Hospital Waterman Foundation 1500 Waterman Way Tavares FL 32778 592330166 501(c)(3) 189387 0 Book Provision of general administrative support General Support 1 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 1 1 0 1 0 0 0 0 0 0 0 Tol Daryl L Director/Chairman (end 6/2017) 0 973114 0 228725 0 126355 0 187314 0 58470 0 1573978 0 69647 Ottati David A Dir./Chairman/Reg. CEO 0 531508 0 97517 0 73164 0 94017 0 49637 0 845843 0 50373 Biri Abel B Director/CEO (beg 5/2017) 0 290723 0 33223 0 13934 0 34030 0 48434 0 420344 0 0 Goodman Todd A Director (end 6/2017) 0 566406 0 113656 0 72815 0 84873 0 54388 0 892138 0 29839 Thomas Debora H Dir./Sec. (beg 9/2017)/Reg. CFO 0 411606 0 40903 0 635393 0 46359 0 52052 0 1186313 0 19916 Celano Patricia Regional CCO 0 348034 0 66020 0 38945 0 35996 0 35634 0 524629 0 10235 Crunk Frances CFO/Asst. Secretary 0 276264 0 51818 0 443079 0 40564 0 35042 0 846767 0 26257 Young Anita J COO 0 240309 0 32641 0 10627 0 30565 0 31783 0 345925 0 0 Edmundson MD Ross B CMO 0 324826 0 60795 0 65033 0 34671 0 37914 0 523239 0 19927 Kirman Lynn CNO 0 207912 0 39223 0 6230 0 13428 0 27106 0 293899 0 0 Davis Adrienne Chief Medical Physicist 205636 0 0 0 2994 0 10863 0 1689 0 221182 0 0 0 Barnes James R Director - Pharmacy 165370 0 0 0 26107 0 9517 0 19312 0 220306 0 0 0 Golab Richard J Director Diagnostic Service 143165 0 3000 0 29837 0 8300 0 20059 0 204361 0 0 0 Wood Heather D Director Surgical Services 150159 0 1250 0 22838 0 8575 0 20659 0 203481 0 0 0 Hefley Russell Manager - Pharmacy 155667 0 0 0 18275 0 8593 0 9673 0 192208 0 0 0 Mattison Kenneth R Former - President 0 396399 0 42889 0 162707 0 52533 0 46291 0 700819 0 37546 Part I, Line 1a The filing organization is a part of the system of healthcare organizations known as Adventist Health System (AHS). 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 AHS. 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 that provide services and are on the management team of the filing organization. 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 Vice Presidents and above and is usually limited to one business trip per year beyond the annual AHS 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: AHS 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 of 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 AHS President's Council business meeting ($500 per executive) or the annual AHS CFO Conference or CMO/CNO business meeting ($300 per executive). Other discretionary spending accounts may be provided in connection with other AHS sponsored conferences but typically do not exceed $200 per participant. The payment provided to each executive was considered taxable compensation to the executive. Part I, Line 3 The individual who serves as the CEO of the filing organization is compensated by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) for that individual's role in serving as the CEO. 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 AHS and each of its affiliated entities. The following principles guide the establishment of individual executive compensation: - The salary of the President/CEO of AHS will not exceed the 40th 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 Adventist Health System (AHS). In recognition of the contribution that each executive makes to the success of AHS, AHS provides to eligible executives participation in the AHS 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 AHS entities and Vice Presidents of all AHS entities whose base salary is at least $243,000. 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, AHS has instituted a defined benefit, non-tax-qualified deferred compensation plan for certain executives who have provided lengthy service to AHS and/or to other Seventh-day Adventist Church hospitals or health care institutions. Participation in the plan is offered to AHS executives on a prorata schedule beginning with 20 years of service as an employee of AHS 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 AHS 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 AHS Executive FLEX Benefit Program. Additionally, in 2017 AHS 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 ------------------------------------------------------- Tol, Daryl L. $190,752 $ 76,082 $ 0 $ 0 Ottati, David A. $ 79,455 $ 54,143 $ 0 $ 0 Biri, Abel B. $ 19,468 $ 0 $ 0 $ 0 Goodman, Todd A. $ 88,311 $ 32,813 $ 0 $ 0 Thomas, Debora H. $ 49,797 $ 20,019 $578,762 $ 0 Werner, Thomas L. $ 0 $ 0 $ 0 $ 50,502 Celano, Patricia $ 44,428 $ 10,926 $ 0 $ 0 Crunk, Frances $ 26,002 $ 28,879 $384,732 $ 0 Young, Anita J. $ 16,003 $ 0 $ 0 $ 0 Edmundson, MD, Ross B. $ 38,109 $ 22,574 $ 0 $ 0 Mattison, Kenneth R.$ 55,971 $ 41,979 $ 72,116 $ 0 * Including Investment Earnings X 4931 Cost X Items for Pediactrics 3 0 Cost 0 1 0 Form 990, Part VI, Section A, line 2 David L. Weiss, CPA and Thomas C. Hepner - Business Relationship 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 Interests policy, has read and understands the policy, has agreed to comply with the policy, and understands that the filing organization is a charitable organization that must primarily engage in activities which accomplish one or more of its exempt purposes. The filing organization's Conflict of Interest Policy also requires that periodic reviews shall be conducted to ensure that the filing organization operates in a manner consistent with its charitable purposes. Form 990, Part VI, Section B, line 15 The filing organization's CEO, other officers and key employees are not compensated by the filing organization. Such individuals are compensated by the related top-tier parent organization of the filing organization. Please see the discussion concerning the process followed by the related top-tier parent organization in determining executive compensation in our response to Schedule J, Line 3. Form 990, Part VI, Section C, line 19 The filing organization is a part of the system of healthcare organizations known as Adventist Health System (AHS). The audited consolidated financial statements of AHS and of the AHS "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 AHS on a consolidated basis and for the grouping of AHS 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 within Adventist Health System. 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 amounts shown in Part VIII, Lines 7a and 7c of the Form 990 represents an allocated share of capital gain/(loss) from a system wide, corporate administered, investment program. Form 990, Part IX, line 11g Payments to Healthcare Professionals: Program service expenses 7,136,211. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,136,211. Professional Fees: Program service expenses 2,232,660. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,232,660. Purchased Medical Services: Program service expenses 1,250,692. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,250,692. Environmental Services: Program service expenses 1,860,630. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,860,630. Transcription Services: Program service expenses 259,472. Management and general expenses 0. Fundraising expenses 0. Total expenses 259,472. Recruiting: Program service expenses 5,506,147. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,506,147. Food Service Contracts: Program service expenses 617,805. Management and general expenses 0. Fundraising expenses 0. Total expenses 617,805. Miscellaneous Purchased Services: Program service expenses 2,532,191. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,532,191. AHS Management Fees: Program service expenses 0. Management and general expenses 5,005,885. Fundraising expenses 0. Total expenses 5,005,885. Billing & Collection Services: Program service expenses 0. Management and general expenses 154,548. Fundraising expenses 0. Total expenses 154,548. Form 990, Part XI, line 9: Transfer to Tax-Exempt Parent -5,084,300. Transfer to/from Affiliate -27,375. Allocations from tax-exempt parent with respect to debt 183,228. Gifts -100,000. Change in Interest in Foundation 8,393,610. Allocations from tax-exempt parent Transfers to parent Change in interest in Foundation 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. 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. 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 Adventist University of Health Sciences Inc (630 Year End) 671 Lake Winyah Drive Orlando FL 32803 593069793 Education/Operation of School FL 501(c)(3) Line 2 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 Centura Health Corporation 9100 E Mineral Circle Centennial CO 80112 841335382 Joint Operating Company CO 501(c)(3) Line 12a, I N/A 0 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 (816-123117) 13100 Fort King Road Dade City FL 33525 822567308 Inactive 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 (1214-123117) 900 Hope Way Altamonte Springs FL 32714 824372339 Inactive 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 Foundation for Shawnee Mission Medical Center Inc 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 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 Central Inc 900 Hope Way Altamonte Springs FL 32714 593689740 Management Support GA 501(c)(3) Line 12c, III-FI N/A 0 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 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 324 Maitland FL 32751 593142824 Home Infusion Services FL Princeton Prof ServsFH Waterman Related 62728 196730 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 PAHSLarkin Ventures LLC 9100 E Mineral Cir Centennial CO 80112 474211060 Medical Services CO N/A Princeton Homecare Services LLC 600 Courtland Street Ste 300 Orlando FL 32804 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 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 5084301 Amount Given Adventist Health System Sunbelt Healthcare Corporation M 2325028 % of Facility's Oper. Exp. Adventist Health System Sunbest Healthcare Corporation - Shared Services M 1927350 % of Facility's Oper. Exp. Adventist Health System Sunbelt Healthcare Corp dba AHSIS M 7854178 % of Facility's Oper. Exp. Adventist Health System Sunbelt Healthcare Corporation P 7163926 Cost Adventist Health SystemSunbelt Inc dba Florida Hospital M 167209 Cost Plus Appropriate Margin Adventist Health SystemSunbelt Inc dba Florida Hospital P 1579719 Cost Florida Hospital Medical Group Inc A 462730 FMV Rent Florida Hospital Medical Group Inc M 820024 Cost Plus Appropriate Margin Florida Hospital Medical Group Inc R 5067454 Cost Memorial Health Systems Inc P 646808 Cost