ADVENTIST BOLINGBROOK HOSPITAL: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- ADVENTIST BOLINGBROOK HOSPITAL (EIN 65-1219504)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-13
- IRS object ID
- 201723179349303472
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-13T12:20:01-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 651219504 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Bolingbrook Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ADVE | BusinessNameControlTxt |
| Phone | 6303125000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 Remington Blvd | AddressLine1Txt |
| City | Bolingbrook | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60440 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Lynn C Addiscott | PersonNm |
| Person Title | Assistant Secretary | PersonTitleTxt |
| Phone | 4073572317 | PhoneNum |
| Signature | 2017-11-08 | SignatureDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 204.139.85.141 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-08 | IPDt |
| IP Tm | 12:23:58 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | E904DE6D4998E83E456D7371406A3E618825EF48 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 6F248CD6EFF84B1BE2234CC43AB797AE6C4F0CE1 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Bruce Christian | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 Remington Blvd | AddressLine1Txt |
| City | Bolingbrook | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60440 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $122,622,091 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 1071 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.amitahealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2003 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | Operation of a 138-bed acute-care hospital serving residents in & around Bolingbrook, IL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 21 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 831 | TotalEmployeeCnt |
| Total Volunteers | 226 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $123,865 | PYContributionsGrantsAmt |
| CY Contributions Grants | $126,758 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $123,006,295 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $122,495,333 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$228,151 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $50,050 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $122,952,059 | PYTotalRevenueAmt |
| CY Total Revenue | $122,622,091 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $269,380 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $251,011 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $42,386,820 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $47,785,743 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $76,084,654 | PYOtherExpensesAmt |
| CY Other Expenses | $78,137,697 | CYOtherExpensesAmt |
| PY Total Expenses | $118,740,854 | PYTotalExpensesAmt |
| CY Total Expenses | $126,174,451 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,211,205 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,552,360 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $127,821,502 | TotalAssetsBOYAmt |
| Total Assets EOY | $124,765,432 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $103,017,576 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $111,218,834 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $24,803,926 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $13,546,598 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $105,545,803 | ExpenseAmt |
| Grant | $251,011 | GrantAmt |
| Revenue | $122,495,333 | RevenueAmt |
| Desc | The filing organization does business under the name AMITA Health Adventist Medical Center Bolingbrook (ABH or the Hospital). ABH operates a 138-bed acute-care hospital in Bolingbrook, Illinois, that has served the healthcare needs of the Bolingbrook community and surrounding areas since the hospital opened in 2008. Located at 500 Remington Blvd., ABH is a full-service hospital that includes two medical office buildings on its campus in Bolingbrook, an ambulatory care site in Plainfield, Illinois, and seven outpatient physical rehabilitation sites in partnership with PT Solutions. Specialty care and other services available at the Hospital include bariatrics, a breast center, cancer care, cardiac care, a chronic disease center, emergency services, executive health, gastroenterology, geriatrics, home health, hospice, interventional radiology, neurology, a pain center, pediatrics, physical rehabilitation, radiology, sleep disorders, surgical services, and women's care. In 2015, the Hospital opened a 24-bed geropsychiatry unit to address a growing community need for mental health treatment for older adults. ABH has expanded its outpatient services steadily in recent years, offering outpatient services such as bariatric surgery, interventional pain management, a mobile PET/CT service, and wound care/hyperbaric services. Its ambulatory care site in Plainfield offers imaging, laboratory and rehabilitation services. The Hospital also has made interior design changes to make it easier for patients to access outpatient services and has expanded the hours of operation for outpatient diagnostic areas. The Hospital sponsors nearly 70 community outreach programs a year, including free health screenings and educational programs. In addition, ABH provides health services to local employers. In 2016, the Hospital received the American Heart Association's 2016 Mission: Lifeline BRONZE-PLUS Recognition Award for providing prompt, high-quality heart-attack care. ABH also was designated in 2016 as a Blue Distinction Center+ by the Blue Cross and Blue Shield Association for delivering safe, high-quality and cost-efficient maternity care. In addition, the Hospital has earned The Joint Commission's Gold Seal of Approval, a three-year accreditation for continuous compliance with The Joint Commission's rigorous quality standards. The Hospital also is certified as a primary stroke center by The Joint Commission and the American Heart Association/American Stroke Association. The Hospital's Women's Imaging Center has been designated by the American College of Radiology as a Breast Imaging Center of Excellence, and its Sleep Disorders Center has been accredited by the American Academy of Sleep Medicine. The Hospital also has received echocardiography accreditation from the Intersocietal Accreditation Commission. In 2016, ABH treated more than 5,996 inpatients, performed 895 inpatient surgeries and delivered 1,012 babies. The Hospital's medical staff includes about 511 physicians representing more than 53 medical and surgical specialties.ABH provides care for all, including the financially disadvantaged, uninsured, underinsured, homeless and those who receive public aid. In 2016, the Hospital provided $1,766,412 of charity care at cost. This was in addition to $94,189 in other community benefits services, $2,164,682 of unreimbursed Medicare costs to patients, $364,567 of bad debt expense at cost, and $12,950,174 of unreimbursed Medicaid at cost. About Adventist Midwest HealthThe Hospital is a subsidiary organization of Adventist Midwest Health (AMH), a network of four not-for-profit hospitals and their outpatient-based healthcare facilities in Chicago's western suburbs. AMH takes a holistic approach to wellness, addressing the physical, mental, social and spiritual needs of the people it serves. AMH's hospitals and other facilities are integral to the fabric of their communities. AMH partners with local civic organizations and businesses to bring state-of-the-art treatments and preventive healthcare services close to where people live and work. As part of Adventist Health System, the largest, not-for-profit Protestant hospital system in the nation, AMH is grounded in Christian values and committed to extending the healing ministry of Christ. AMH welcomes patients from any religious denomination as well as patients who do not ascribe to any religion.In February 2015, Adventist Midwest Health (AMH) and Alexian Brothers Health System (ABHS) formed a joint operating company (JOC). A JOC allows two separate owners to integrate operations to achieve a common goal while maintaining separate ownership of assets. It also allows AMH and ABHS to work in unison while preserving the Adventist and Catholic identities and mission priorities that define AMH and ABHS, respectively. In April 2015, Alexian Brothers-AHS Midwest Region Health Co., d/b/a AMITA Health, was announced as the new name of the JOC. The name AMITA is inspired by the meaning it has in several languages -- friendship in Italian, honesty and truth in Hebrew, and spiritual light and boundlessness in Hindi. The name reflects AMITA Health's faith-based call to healing, its core values, and the compassion and dedication that its caregivers show every day to patients, their families and each other.Services Diagnostic ServicesThe Hospital's diagnostic services include the latest technology and practices, which are accredited by nationally and state recognized agencies and associations, such as the Illinois Emergency Management Agency, The American College of Radiology, The College of American Pathologists, Clinical Laboratory Improvement Amendments and The Joint Commission.Diagnostic services offered include: -- Diagnostic imaging (general X-ray, CT, MRI [including open MRI], PET, ultrasound, nuclear medicine)-- Breast care services (screening and 3-D diagnostic mammography, breast biopsy ultrasound, stereotactic breast biopsy, bone densitometry, genetic counseling) -- Cardiology (cardiac catheterization, electrophysiology, electrocardiograms (EKGs), stress testing, echocardiography, Holter monitoring of arrhythmias)-- Pulmonary diagnostics (arterial blood gas analysis)-- Gastroenterology (colonoscopy, bronchoscopy)-- Laboratory/pathology (chemistry, microbiology, hematology, histology, cytology, phlebotomy, transfusion services)Emergency DepartmentEmergency medical care is provided 24/7 for all ages and types of patients, regardless of their ability to pay for such services.Outpatient services performed in 2016: - 3,180 outpatient surgeries- 64,092 diagnostic images, including general X-ray, CT, MRI, PET, ultrasound, nuclear medicine and others- 164,942 laboratory tests- 38,840 emergency room visits.Inpatient rehabilitation services performed in 2016: - 245 inpatients were treated | Desc |
| Total Program Service Expenses | $105,545,803 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 51 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 831 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 21 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Chase Aalborg | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6303126001 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 Remington Blvd | AddressLine1Txt |
| City | Bolingbrook | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60440 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (38 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Randall Haffner PhD | ||||||||||
| Dir/Chairman | 0.10 | 50.00 | Yes (X) | $0 | $1,707,541 | $265,682 | ||||
| Venanzio Arquilla | ||||||||||
| Director | 0.10 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| David L Crane | ||||||||||
| Pres/Sec (end 1/16) | 4.00 | 46.00 | Yes (X) | $0 | $1,120,682 | $56,645 | Yes (X) | |||
| Linda Eastman | ||||||||||
| Director | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | ||||
| Marshall Gray Jr | ||||||||||
| Director | 0.10 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| Larry C Gunn MD | ||||||||||
| Director (end 12/16) | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | ||||
| Ronnie Hawkins | ||||||||||
| Director | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | ||||
| Bill Holder | ||||||||||
| Director (beg 6/16) | 0.10 | 0.40 | Yes (X) | $0 | $0 | $0 | ||||
| Carlene Jamerson | ||||||||||
| Director (end 12/16) | 0.10 | 0.10 | Yes (X) | $0 | $2,092 | $28 | ||||
| Donald Livesay | ||||||||||
| Vice Chairman/Director | 0.10 | 4.00 | Yes (X) | $0 | $1,058 | $0 | ||||
| Patricia Madej MD | ||||||||||
| Director (beg 1/16) | 0.10 | 40.00 | Yes (X) | $0 | $79,533 | $396 | ||||
| Peter O'Connor | ||||||||||
| Director | 0.10 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| Ray Pichette | ||||||||||
| Director | 0.10 | 3.00 | Yes (X) | $0 | $1,058 | $0 | ||||
| Glynn Scott | ||||||||||
| Director | 0.10 | 3.00 | Yes (X) | $0 | $1,058 | $0 | ||||
| Greg Sharon MD | ||||||||||
| Director | 0.10 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| Christine Smith | ||||||||||
| Director | 0.10 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| Brent G Snyder | ||||||||||
| Treasurer/Director | 1.00 | 50.00 | Yes (X) | $0 | $1,226,585 | $180,885 | ||||
| Thor Thordarson | ||||||||||
| Dir/Pres/Sec (beg 12/16) | 7.50 | 42.50 | Yes (X) | $0 | $203,924 | $50,097 | ||||
| Maurice Valentine II MDiv | ||||||||||
| Director (beg 1/16) | 0.10 | 3.00 | Yes (X) | $0 | $1,333 | $0 | ||||
| Dino Vallera MD | ||||||||||
| Director | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | ||||
| Jonathan Wright | ||||||||||
| Director | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | ||||
| Eric Yang MD | ||||||||||
| Director (beg 1/16) | 0.10 | 50.00 | Yes (X) | $0 | $513,791 | $14,388 | ||||
| Rick Mace | ||||||||||
| CEO | 50.00 | 0.20 | $0 | $568,234 | $84,340 | Yes (X) | ||||
| Rebecca Mathis | ||||||||||
| CFO (end 9/16) | 5.00 | 45.00 | $0 | $394,914 | $49,680 | Yes (X) | ||||
| Chase Aalborg | ||||||||||
| CFO (beg 9/16) | 25.00 | 25.00 | $0 | $104,382 | $12,634 | Yes (X) | ||||
| Ron Wehtje | ||||||||||
| Regional CFO (end 3/16) | 6.50 | 43.50 | $0 | $191,666 | $14,325 | Yes (X) | ||||
| Michael Murrill | ||||||||||
| COO | 25.00 | 25.00 | $0 | $375,012 | $59,293 | Yes (X) | ||||
| Richard Roehr | ||||||||||
| COO (beg 8/16) | 25.00 | 25.00 | $0 | $225,426 | $31,960 | Yes (X) | ||||
| Jolene Albaugh | ||||||||||
| CNO | 50.00 | 0.00 | $0 | $244,074 | $51,982 | Yes (X) | ||||
| Mary Murphy | ||||||||||
| Regional CNO (end 7/16) | 7.50 | 42.50 | $0 | $377,541 | $46,727 | Yes (X) | ||||
| Richard Carroll MD | ||||||||||
| CMO-GlenOaks & Bolingbrook | 25.00 | 25.00 | $0 | $605,082 | $92,237 | Yes (X) | ||||
| Candice Washilewski | ||||||||||
| Admin Dir Nursing | 60.00 | 0.00 | $163,024 | $0 | $19,171 | Yes (X) | ||||
| Diane Leonard | ||||||||||
| Dir of Nursing | 60.00 | 0.00 | $158,749 | $0 | $22,817 | Yes (X) | ||||
| Kathleen Sievertsen | ||||||||||
| Dir Business Dev | 60.00 | 0.00 | $158,658 | $0 | $15,004 | Yes (X) | ||||
| Catherine Michalowicz | ||||||||||
| RN Charge | 60.00 | 0.00 | $145,563 | $0 | $7,176 | Yes (X) | ||||
| Cecille Truver | ||||||||||
| Regional Dir Radiology | 60.00 | 0.00 | $137,447 | $0 | $14,805 | Yes (X) | ||||
| George Mayzell MD | ||||||||||
| Former Regional CMO | 0.00 | 0.00 | $0 | $308,091 | $51,544 | Yes (X) | ||||
| Gary Lipinski MD | ||||||||||
| Former CMO | 0.00 | 50.00 | $0 | $108,247 | $2,307 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $763,441 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $8,361,324 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,144,123 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 30 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Touchpoint Support | |||||
| PO BOX 102289 | Atlanta | GA | 30368 | Food & Environmental Services | $4,871,461 |
| PT Solutions | |||||
| PO BOX 441146 | Kennesaw | GA | 30160 | Therapy Services | $4,328,174 |
| Law Offices of Neil Greene | |||||
| 250 Parkway Drive 160 | Lincolnshire | IL | 60069 | Debt Collection Services | $675,607 |
| Fresenius Management | |||||
| 16343 Collections Ctr Dr | Chicago | IL | 60693 | Dialysis Services | $342,568 |
| DuPage Neonatology Assoc | |||||
| PO BOX 487 | Hinsdale | IL | 60521 | Medical Services | $301,950 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 19 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $82,195 | RelatedOrganizationsAmt |
| Government Grants | $31,530 | GovernmentGrantsAmt |
| All Other Contributions | $13,033 | AllOtherContributionsAmt |
| Total Contributions | $126,758 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net patient revenue | 622110 | $121,200,318 | $121,200,318 |
| Cafeteria revenue | 622110 | $477,479 | $477,479 |
| Medical office building | 622110 | $373,962 | $373,962 |
| Health Education Programs | 622110 | $305,276 | $305,276 |
| Gift shop revenue | 622110 | $55,279 | $55,279 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $83,019 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $83,019 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $122,495,333 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $122,622,091 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $122,495,333 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $251,011 | TotalAmt |
| Program Services | $251,011 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,780,514 | TotalAmt |
| Management And General | $1,780,514 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,387,311 | TotalAmt |
| Program Services | $31,125,900 | ProgramServicesAmt |
| Management And General | $3,261,411 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,227,835 | TotalAmt |
| Program Services | $1,067,907 | ProgramServicesAmt |
| Management And General | $159,928 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,759,719 | TotalAmt |
| Program Services | $6,941,634 | ProgramServicesAmt |
| Management And General | $818,085 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,630,364 | TotalAmt |
| Program Services | $2,287,754 | ProgramServicesAmt |
| Management And General | $342,610 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,651 | TotalAmt |
| Management And General | $9,651 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,479 | TotalAmt |
| Management And General | $38,479 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,592,425 | TotalAmt |
| Program Services | $18,153,217 | ProgramServicesAmt |
| Management And General | $12,439,208 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,001 | TotalAmt |
| Management And General | $29,001 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,344,079 | TotalAmt |
| Program Services | $1,902,557 | ProgramServicesAmt |
| Management And General | $441,522 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,679,689 | TotalAmt |
| Program Services | $3,800,819 | ProgramServicesAmt |
| Management And General | $878,870 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,121,767 | TotalAmt |
| Program Services | $3,044,025 | ProgramServicesAmt |
| Management And General | $77,742 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,384 | TotalAmt |
| Management And General | $97,384 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,238,219 | TotalAmt |
| Program Services | $3,238,219 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,915,613 | TotalAmt |
| Program Services | $6,915,613 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,757,305 | TotalAmt |
| Program Services | $1,755,105 | ProgramServicesAmt |
| Management And General | $2,200 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $20,218,710 | $20,218,710 | |
| State Tax Indigent Asse | $3,102,997 | $3,102,997 | |
| Repairs & maintenance | $1,676,518 | $1,676,518 | |
| Purchased services | $161,241 | $161,241 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $154,619 | TotalAmt |
| Program Services | $63,817 | ProgramServicesAmt |
| Management And General | $90,802 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,174,451 | TotalAmt |
| Program Services | $105,545,803 | ProgramServicesAmt |
| Management And General | $20,628,648 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,219 | BOYAmt |
| EOY | $3,944 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$451,770 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,091,626 | BOYAmt |
| EOY | $23,163,506 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,033,350 | BOYAmt |
| EOY | $2,606,922 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,610,952 | BOYAmt |
| EOY | $2,675,055 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $174,194,461 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $82,807,299 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,274,784 | BOYAmt |
| EOY | $91,387,162 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,075,582 | BOYAmt |
| EOY | $1,267,457 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,181,759 | BOYAmt |
| EOY | $3,661,386 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $127,821,502 | BOYAmt |
| EOY | $124,765,432 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,470,282 | BOYAmt |
| EOY | $6,354,922 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $303,252 | BOYAmt |
| EOY | $311,929 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $95,244,042 | BOYAmt |
| EOY | $104,551,983 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,017,576 | BOYAmt |
| EOY | $111,218,834 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,207,517 | BOYAmt |
| EOY | $12,755,453 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $596,409 | BOYAmt |
| EOY | $791,145 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,803,926 | BOYAmt |
| EOY | $13,546,598 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $127,821,502 | BOYAmt |
| EOY | $124,765,432 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$3,552,360 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$2,406 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$7,702,562 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $1,500 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $39,160 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $40,660 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | Consulting fees of $5,700, and dues to the American Hospital Association and Illinois Hospital Association, and $1,500 to Will County Center for Economic Development. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,690,226 | OtherCostOrOtherBasisAmt |
| Book Value | $1,690,226 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $108,615,621 | OtherCostOrOtherBasisAmt |
| Depreciation | $34,213,989 | DepreciationAmt |
| Book Value | $74,401,632 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $63,576,579 | OtherCostOrOtherBasisAmt |
| Depreciation | $48,514,036 | DepreciationAmt |
| Book Value | $15,062,543 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $312,035 | OtherCostOrOtherBasisAmt |
| Depreciation | $79,274 | DepreciationAmt |
| Book Value | $232,761 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $91,387,162 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| Payable to third parties | $6,342,215 |
| Credit balances in A/R | $2,488,817 |
| Interco Alloc of TE Bond Proceeds | $81,596,470 |
| Other noncurrent liabilities | $2,375 |
| Due to Related | $14,122,106 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $104,551,983 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | The filing organization is a subsidiary organization within Adventist Health System (AHS). The consolidated financial statements of AHS contain the following FIN 48 footnote: Please note that dollar amounts are in thousands. Healthcare Corporation and its affiliated organizations, other than North American Health Services, Inc. and its subsidiary (NAHS), are exempt from state and federal income taxes. Accordingly, Healthcare Corporation and its tax-exempt affiliates are not subject to federal, state or local income taxes except for any net unrelated business taxable income. NAHS is a wholly owned, for-profit subsidiary of Healthcare Corporation. NAHS and its subsidiary are subject to federal and state income taxes. NAHS files a consolidated federal income tax return and, where appropriate, consolidated state income tax returns. All taxable income was fully offset by net operating loss carryforwards for federal income tax purposes; as such, there is no provision for current federal or state income tax for the years ended December 31, 2016 and 2015. NAHS also has temporary deductible differences of approximately $59,100 and $62,700 at December 31, 2016 and 2015, respectively, primarily as a result of net operating loss carryforwards. At December 31, 2016, NAHS had net operating loss carryforwards of approximately $59,600, expiring beginning in 2022 through 2026. Deferred taxes have been provided for these amounts, resulting in a net deferred tax asset of approximately $22,500 and $23,800 at December 31, 2016 and 2015, respectively. A full valuation allowance has been provided at December 31, 2016 and 2015 to offset the deferred tax asset since Healthcare Corporation has determined that it is more likely than not that the benefit of the net operating loss carryforwards will not be realized in future years. The Income Taxes Topic of the ASC (ASC 740) prescribes the accounting for uncertainty in income tax positions recognized in financial statements. ASC 740 prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken, or expected to be taken, in a tax return. There were no material uncertain tax positions as of December 31, 2016 and 2015. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 600.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,766,412 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,766,412 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01400 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $29,399,944 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,449,770 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,950,174 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10260 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $31,166,356 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,449,770 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,716,586 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11660 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,484 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $24,484 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $69,883 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $178 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $69,705 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $94,367 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $178 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $94,189 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $31,260,723 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,449,948 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,810,775 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11740 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $9,568,943 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $364,567 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $28,229,457 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $33,980,802 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$5,751,345 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Bolingbrook Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 Remington Blvd | AddressLine1Txt |
| City | Bolingbrook | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60440 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.keepingyouwell.com/abh | WebsiteAddressTxt |
| State License | 0005496 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Bolingbrook Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Statement | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Statement | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 600.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Statement | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Statement | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Statement | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Adventist Bolingbrook Hospital | Part V, Section B, Line 5: Adventist Bolingbrook Hospital (the Hospital or the filing organization) conducted a Community Health Needs Assessment in 2016. The Community Health Needs Assessment was conducted on behalf of the filing organization as part of a larger project sponsored by the Metropolitan Chicago Healthcare Council (MCHC) and done by Professional Research Consultants, Inc. (PRC). PRC is a nationally-recognized healthcare consulting firm with extensive experience conducting community health needs assessments. The Hospital's Community Health Needs Assessment gathered both quantitative and qualitative data. Qualitative data included primary research gathered through an Online Key Informant Survey of various community stakeholders. The Online Key Informant Survey was designed and executed to solicit input from those individuals who not only had a broad interest in the health needs of the Hospital's community, but also represented the needs of low-income, minority, and other medically under-served populations. Participants were chosen because of their ability to identify primary concerns of populations with whom they worked, as well as the community overall. Participants included representatives of the following organizations:- DuPage County Health Department- DuPage Federation on Human Services Reform- Elmhurst CUSD 205- Metropolitan Chicago Healthcare Council- Naperville School District 203- People's Resource Center- Village of Addison |
| Adventist Bolingbrook Hospital | Part V, Section B, Line 7d: The Hospital has adopted a policy that addresses the public posting requirements of the Community Health Needs Assessment. Under this policy, the Community Health Needs Assessment Reports must be posted on the Hospital's website at least until the date the hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports. |
| Adventist Bolingbrook Hospital | Part V, Section B, Line 11: The information provided below explains how the hospital facility addressed in 2016 the significant health needs identified in its 2013 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.Adventist Midwest Health is a network of four not-for-profit hospitals in Chicago's western and southwestern suburbs.As a part of Adventist Health System, Adventist Midwest Health brings a long tradition of health care to Illinois and Wisconsin. Adventist Health System's national network of 44 campuses in 10 states makes us part of the largest not-for-profit Protestant hospital system in the country. We take a holistic, "whole-person" approach to wellness, providing medical and spiritual support for our patients and their families.Adventist Midwest Health includes four hospitals in Chicago's western and southwestern suburbs: AMITA Health Adventist Medical Center Bolingbrook (AHB), AMITA Health Adventist Medical Center GlenOaks (AHG), AMITA Health Adventist Medical Center Hinsdale (AHH), and AMITA Health Adventist Medical Center La Grange (AHL) (collectively, the Hospitals), with more than 5,100 employees and more than 2,600 physicians on staff. These Hospitals, clinically integrated and tied by common Community, Mission, Vision, and Values, embarked on a Community Health Needs Assessment in 2013 to define and ultimately respond to the specific health needs of the Communities they serve.As not-for-profit health care organizations, the four hospitals in Adventist Midwest Health embrace a rich tradition of providing benefit to their communities, with the ultimate goal of improving community health and increasing access to care. All the net income (profit margin) generated by the Hospitals is reinvested back into hospital programs and services. This benefits the patients and communities we serve rather than individual owners or shareholders.Under new federal regulations that govern charitable hospital organizations, a Joint Community Health Needs Assessment ("CHNA") was conducted by the four Chicago-area Adventist Midwest Health hospitals to assist in identifying the most significant health needs of the community served. The Hospitals are in the same Metropolitan Service Area ("MSA") and collaborated to conduct a Joint Community Health Needs Assessment in 2013. The facilities worked together with the state and local health departments (three) and other partners in the MSA. The Joint Report identifies all of the collaborating hospital facilities by name on both the cover page and full report, and was approved by their respective Hospital Boards in December 2013. This is the third-year update for the 2013 CHNA. Priority 1: Access to Healthcare (lack of insurance)Access to comprehensive, quality health care services is essential for the achievement of health equity and for increasing the quality of life for every community member. It impacts overall physical, social and mental health status; prevention of disease and disability; detection and treatment of health conditions; quality of life; preventable death; and life expectancy. The following is a list of programs/activities undertaken to address identified significant needs and three year outcomes. All Adventist Midwest Hospitals worked with existing social service providers to refer eligible patients to ACA enrolling organizations. The ACA contributed to a steep reduction overall in the rate of uninsured, and support of programs such as federally qualified health centers (FQHCs) which provide access to undocumented persons has substantially improved access to care in our communities. -AHH and AHG contribute, on average, more than $350,000 per year to DuPage Health Coalition, an organization which provides primary care, behavioral health services, social services, subsidies to encourage better quality insurance on the ACA exchanges, and counseling to more than 6,000 clients per year. Through cooperating hospitals, federally qualified health centers, county health departments and social service agencies the county has reduced its uninsured rate and its reported lack of access to healthcare services substantially. The DuPage Health Coalition assists enrollment in whatever insurance is available to the client, and if they are ineligible (undocumented), primary care is provided on a sliding scale or at no cost. In 2012, the community reported 13.9% lack of access, in 2015 it was 8.1%. AHH also operates a Family Practice Residency Program open to all members of the community regardless of ability to pay. AHB partnered with the VNA FQHC by funding the build out of a clinic on the campus of Bolingbrook Hospital. This partnership has aided the community greatly by providing hundreds of low income and undocumented community members with nearby access to primary healthcare. Many residents were not aware of services available to them, but with the FQHC on the campus of the Hospital that awareness has been increased. We continue to work with our FQHC and county partners to try to find more specialty care access as this continues to be a problem for Will County. However, the rate of uninsured in the AHB area is 9.0% as compared to Illinois at 19.4%, so progress is being made. AHL has partnered with the Community Nurse Health Association, a FQHC, to help provide access to primary care. AHL also has a Family Practice Residency Program which provides clinic services to all members of the community regardless of ability to pay. In the AHL community, the uninsured rate has fallen from 21.6% in 2012 to 13.3% in 2015. Priority 2:Influenza Vaccination 18-64 years: Free flu vaccines were given at heavily marketed health fairs, flu clinics, and at the Family Residency Programs at AHH and AHL. Physicians provided community education at senior centers, libraries and other community forums to increase senior's knowledge of age-related medical needs including the flu vaccine. Twelve monthly sessions were held in 2015. Despite frequent educational sessions held throughout the communities served by each Hospital about the importance of flu vaccines especially for those at high risk and over 65 years, many people choose to go without a vaccine. This may be because for the last few years the flu virus has been less virulent than in other times, but the trend to not receive a vaccination seems widespread. Another factor may be that some persons believe that the flu vaccine is somehow dangerous, despite scientific evidence to the contrary. The Community Benefit task force will reassess its efforts and develop a response. In our service area, on average 69.3% of community members received flu vaccine in 2012, only 57.9% received a vaccine in 2015. This is in spite of great strides in providing access to primary care which should increase availability of vaccination opportunities. Priority 3:Pneumococcus Vaccine 65 years and older:Community education was provided on the importance of this vaccination in various forums by the Hospitals. Hinsdale Family Practice Medicine Clinic operated by AHH provided free vaccines for patients of all Adventist Midwest Hospitals which was well received by the community. A great deal of progress was made to increase the percent of seniors receiving this vaccine. In the AHB area, 79.7% of seniors received their vaccine as compared to 64.6% in Illinois. In the AHL service area, 51.9% of seniors received their vaccine in 2012, but 79.3% received one in 2015. AHG saw an increase from 59.3% in 2012 to 73.7% in 2015 and finally AHH saw 73.4% of seniors vaccinated in its service area as compared to 64.6% in Illinois. See continuation in supplemental section. |
| Schedule H, Part V, Section B, Line 11 - continuation: | Priority 4:Hypertension over 18 yearsSelf- reported hypertension in our service area is somewhat higher than in Illinois. This may be because there is ample access in our community to free blood pressure screenings at a variety of locations. However, it is important that those with hypertension are aware of the possible risks associated with high blood pressure such as heart attack and stroke. All the Hospitals provided free blood pressure screenings and in partnership with other agencies such as the YMCA and County Health Departments. Education was provided on Hospital websites as well as through printed newsletters. In all communities, the age-adjusted mortality for heart disease and stroke has decreased steadily since 2004 and is significantly lower than Illinois or the United States. Also, the prevalence of stroke and heart disease is slightly lower than Illinois or the United States. These results lead us to believe that although self-reported hypertension is somewhat more prevalent in our community that community members are seeking and receiving appropriate treatment for the condition, likely as a result of the ACA and our support and expansion of access to care in our community. Priorities Considered but Not Selected Access to Healthcare: Access to Primary and Secondary Services - AHBRationale: During this assessment period, AHB, in conjunction with VNA, opened a Federally Qualified Healthcare Center on the hospital campus, increasing healthcare access to primary and secondary health services for those community members with financial need.Prevention and Management of Chronic Care Issues : Heart Disease [blood cholesterol levels]Rationale: While this tested well on the Impact Analysis Matrix, using the Decision Tree, it was determined that this is a commonly available prevention measure at most surrounding providers. It is frequently a part of community health fairs and routine physician visits.Behavioral Health and Substance Abuse Rationale: Adventist Midwest Health provides comprehensive inpatient programs for behavioral health (AHG and AHH) and outpatient programs for both behavioral health and substance abuse (AHH). Serving the Adventist Midwest Health Community, the Hospital's support County initiatives to bring these necessary services to those in need. Prioritizing Access to Care as one of the selected Health Priorities will assist Adventist Midwest Health in extending services for those who currently lack such access. |
| Schedule H, Part V, Section B, Line 7a: | The CHNA report can be found at URL:https://www.amitahealth.org/about-us/community-benefit/adventist-bolingbrook |
| Schedule H, Part V, Section B, Line 10a: | The hospital's most recently adopted implementation strategy can be found at:https://www.amitahealth.org/about-us/community-benefit/adventist-bolingbrook |
| Schedule H, Part V, Section B, Line 16a,b,c: | The Financial Assistance Policy can be found at URL:https://www.keepingyouwell.com/abh/patients-visitors/billing-and-financial-services/financial-assistanceThe Financial Assistance Policy application can be found at:https://www.keepingyouwell.com/abh/patients-visitors/billing-and-financial-services/financial-assistanceThe plain language summary is available at:https://www.keepingyouwell.com/abh/patients-visitors/billing-and-financial-services/financial-assistance |
| Schedule H, Part V, Section B, Line 8 - 10a: | The filing organization adopted a Community Health Needs Assessment Report by 12/31/16 and was in the process of developing its Community Health Needs Implementation Strategy. The Community Health Needs Implementation Strategy will describe how the filing organization plans to meet its identified prioritized health needs or will identify the health need as one the filing organization does not intend to specifically address and provide an explanation as to why the filing organization does not intend to address that health need. In accordance with Final Regulation Section 1.501(r)-3(c)(5), the filing organization's 2017 Implementation Strategy was adopted no later than May 15, 2017 and is also posted on the hospital facility's website.As the hospital facility's 2017 Community Health Needs Implementation Strategy was not adopted by the end of the hospital organization's taxable year of December 31, 2016, Schedule H, Part V, Section B, line 9 indicates that 2014 was the tax year in which the hospital facility last adopted an implementation strategy. Schedule H, Part V, Section B, Line 10a reflects the website address for the hospital facility's 2014 Implementation Strategy since this is the most recently adopted Implementation Strategy. |
| Schedule H, Part V, Section B, Line 3i: | The following disclosure is made in accordance with the provisions set forth in Section 7 of Revenue Procedure 2015-21. Adventist Bolingbrook Hospital operates one hospital facility which currently does business under the name Adventist Bolingbrook Hospital d/b/a AMITA Health Adventist Medical Center Bolingbrook. (1) Description of the Failure:The 2016 Community Health Needs Assessment (CHNA) conducted by Adventist Bolingbrook Hospital (ABH or the Hospital) in 2015 and 2016, as originally posted on the website of ABH by December 31, 2016, included the elements set forth in Treas. Reg. Section 1.501(r)-3(b)(6)(A)(E), but inadvertently omitted the required information of subparagraph (F). Subparagraph (F) states that an evaluation of the impact of any actions that were taken, since the hospital facility finished conducting its immediately preceding CHNA, to address the significant health needs identified in the hospital facility's prior CHNA, must be included in a CHNA. The failure to include the required information found in subparagraph (F) of Treas. Reg. Section 1.501(r)-3(b)(6) was unintentional and was the result of a misunderstanding on the part of those individuals responsible for ensuring that the CHNA was appropriately posted on the website of ABH by December 31, 2016. ABH utilized an external consultant to assist with the conduct of its CHNA, including assistance with the preparation of its CHNA Report. While the externally prepared CHNA Report was reviewed and approved by Hospital personnel, it was the belief of Hospital personnel that all required elements were included in the CHNA Report as prepared by the external consultant. ABH's governing body adopted the CHNA Report preceding its posting on the Hospital's website prior to December 31, 2016. The failure to include the required information pursuant to Treas. Reg. Section 501(r)-3(b)(6)(F) in the Hospital's original 2016 CHNA Report as posted on the Hospital' website was discovered in April of 2017 because of a review of the Hospital's compliance with the requirements of IRC Section 501(r). The failure was unintentional and not willful or egregious. As soon as the Hospital became aware of the above-described deficiency, it took immediate action to correct the failure and evaluate its policies, procedures, and practices to minimize the likelihood of any future potential errors/omissions/failures. (2) Correction of the Failure:As soon as the failure described above was discovered in April of 2017, Hospital personnel took immediate steps to correct the failure. The information required by Treas. Reg. Section 501(r)-3(b)(6)(F) was included in an Addendum to the original CHNA Report. The Addendum was approved by the Hospital's governing body and posted to the Hospital's website in June of 2017. (3) New Practices and Procedures:ABH has taken steps to minimize the likelihood of the type of failure described above from reoccurring by establishing an Executive Steering Committee to oversee compliance with new or revised regulatory rules and regulations. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 2 - Plainfield Imaging & Outpatient Center | ||||
| 15728 S Route 59 | Plainfield | IL | 60544 | Imaging Center |
| 3 - Maternal Fetal Medicine Dept | ||||
| 396 Remington Blvd 231 | Bolingbrook | IL | 60440 | Maternal Fetal Medicine |
| 4 - Women's Imaging Center | ||||
| 396 Remington Blvd 235 | Bolingbrook | IL | 60440 | Imaging Center |
| 5 - Adventist Bolingbrook Hospital | ||||
| 420 Remington Blvd 135 | Bolingbrook | IL | 60440 | Outpatient Rehabilitation Facility |
| 6 - Adventist Plainfield Physical Therapy | ||||
| 15728 S Route 59 | Plainfield | IL | 60544 | Outpatient Rehabilitation Facility |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a: | The filing organization is a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) during its current year. AHSSHC serves as a parent organization to 22 tax-exempt 501(c)(3) hospital organizations that operate 44 hospitals in ten 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 III, Line 2: | The amount of bad debt expense, reported on line 2 of Section A of Part III is recorded in accordance with Healthcare Financial Management Association Statement No. 15. Discounts and payments on patient accounts are recorded as adjustments to revenue, not bad debt expense. |
| Part III, Line 3: | Methodology for Determining the Estimated Amount of Bad Debt Expense that May Represent Patients who Could Have Qualified under the Filing Organization's Financial Assistance Policy:Self-pay patients may apply for financial assistance by completing a Financial Assistance Application Form (FAA Form). If an individual does not submit a complete FAA Form within 240 days after the first post-discharge billing statement is sent to the individual, an individual may be considered for presumptive eligibility based upon a scoring tool that is designed to classify patients into groups of varying economic means. The scoring tool uses algorithms that incorporate data from credit bureaus, demographic databases, and hospital specific data to infer and classify patients into respective economic means categories. Individuals who earn a certain score on the scoring tool are considered to qualify as eligible for the most generous financial assistance under the filing organization's Financial Assistance Policy. As determined by the filing organization, a nominal amount of such a patient's bill is written off as bad debt expense, while the remaining portion of the patient's bill is considered non-state charity. The amount written off as bad debt expense for those patients who potentially qualify as non-state charity using the scoring tool is the amount shown on line 3 of Section A of Part III. Rationale for Including Certain Bad Debts in Community Benefit:The filing organization is dedicated to the view that medically necessary health care for emergency and non-elective patients should be accessible to all, regardless of age, gender, geographic location, cultural background, physician mobility, or ability to pay. The filing organization treats emergency and non-elective patients regardless of their ability to pay or the availability of third-party coverage. By providing health care to all who require emergency or non-elective care in a non-discriminatory manner, the filing organization is providing health care to the broad community it serves. As a 501(c)(3) hospital organization, the filing organization maintains a 24/7 emergency room providing care to all whom present. When a patient's arrival and/or admission to the facility begins within the Emergency Department, triage and medical screening are always completed prior to registration staff proceeding with the determination of a patient's source of payment. If the patient requires admission and continued non-elective care, the filing organization provides the necessary care regardless of the patient's ability to pay. The filing organization's operation of a 24/7 Emergency Department that accepts all individuals in need of care promotes the health of the community through the provision of care to all whom present. Current Internal Revenue Service guidance that tax-exempt hospitals maintain such emergency rooms was established to ensure that emergency care would be provided to all without discrimination. The treatment of all at the filing organization's Emergency Department is a community benefit. Under the filing organization's Financial Assistance Policy, every effort is made to obtain a patient's necessary financial information to determine eligibility for financial assistance. However, not all patients will cooperate with such efforts and a financial assistance eligibility determination cannot be made based upon information supplied by the individual. In this case, a patient's portion of a bill that remains unpaid for a certain stipulated time period is wholly or partially classified as bad debt. Bad debts associated with patients who have received care through the filing organization's Emergency Department should be considered community benefit as charitable hospitals exist to provide such care in pursuit of their purpose of meeting the need for emergency medical care services available to all in the community. |
| Part III, Line 4: | Financial Statement Footnote Related to Accounts Receivable and Allowance for Uncollectible Accounts:The financial information of the filing organization is included in a consolidated audited financial statement for the current year.The applicable footnote from the attached consolidated audited financial statements that addresses accounts receivable, the allowance for uncollectible accounts, and the provision for bad debts can be found on page 8. Please note that dollar amounts on the attached consolidated audited financial statements are in thousands. |
| Part III, Line 8: | Costing Methodology: Medicare allowable costs were calculated using a cost-to-charge ratio.Rationale for Including a Medicare Shortfall as Community Benefit:As a 501(c)(3) organization, the filing organization provides emergency and non-elective care to all regardless of ability to pay. All hospital services are provided in a non-discriminatory manner to patients who are covered beneficiaries under the Medicare program. As a public insurance program, Medicare provides a pre-established reimbursement rate/amount to health care providers for the services they provide to patients. In some cases, the reimbursement amount provided to a hospital may exceed its costs of providing a particular service or services to a patient. In other cases, the Medicare reimbursement amount may result in the hospital experiencing a shortfall of reimbursement received over costs incurred. In those cases where an overall shortfall is generated for providing services to all Medicare patients, the shortfall amount should be considered as a benefit to the community. Tax-exempt hospitals are required to accept all Medicare patients regardless of the profitability, or lack thereof, with respect to the services they provide to Medicare patients. The population of individuals covered under the Medicare program is sufficiently large so that the provision of services to the population is a benefit to the community and relieves the burdens of government. In those situations where the provision of services to the total Medicare patient population of a tax-exempt hospital during any year results in a shortfall of reimbursement received over the cost of providing care, the tax-exempt hospital has provided a benefit to a class of persons broad enough to be considered a benefit to the community. Despite a financial shortfall, a tax-exempt hospital must and will continue to accept and care for Medicare patients. Typically, tax-exempt hospitals provide health care services based upon an assessment of the health care needs of their community as opposed to their taxable counterparts where profitability often drives decisions about patient care services that are offered. Patient care provided by tax-exempt hospitals that results in Medicare shortfalls should be considered as providing a benefit to the community and relieving the burdens of government. |
| Part III, Line 9b: | The hospital filing organization's collection practices are in conformity with the requirements set forth in the 2014 Final Regulations regarding the requirements of Internal Revenue Code Section 501(r)(4) - (r)(6). No extraordinary collection actions (ECA's) are initiated by the hospital filing organization in the 120-day period following the date after the first post-discharge billing statement is sent to the individual (or, if later, the specified deadline given in a written notice of actions that may be taken, as described below). Individuals are provided with at least one written notice (notice of actions that may be taken) and a copy of the filing organization's Plain Language Summary of the Financial Assistance Policy that informs the individual that the hospital filing organization may take actions to report adverse information to credit reporting agencies/bureaus if the individual does not submit a Financial Assistance Application Form (FAA Form) or pay the amount due by a specified deadline. The specified deadline is not earlier than 120 days after the first post-discharge billing statement is sent to the individual and is at least 30 days after the notice is provided. A reasonable attempt is also made to orally notify an individual about the filing organization's Financial Assistance Policy and how the individual may obtain assistance with the Financial Assistance application process. If an individual submits an incomplete FAA Form during the 240-day period following the date on which the first post-discharge billing statement was sent to the individual, the hospital filing organization suspends any reporting to consumer credit reporting agencies/bureaus (or ceases any other ECA's) and provides a written notice to the individual describing what additional information or documentation is needed to complete the FAA Form. This written notice contains contact information including the telephone number and physical location of the hospital facility's office or department that can provide information about the Financial Assistance Policy, as well as contact information of the hospital facility's office or department that can provide assistance with the financial assistance application process or, alternatively, a nonprofit organization or governmental agency that can provide assistance with the financial assistance application process if the hospital facility is unable to do so. If an individual submits a complete FAA Form within a reasonable time-period as set forth in the notice described above, the hospital filing organization will suspend any adverse reporting to consumer credit reporting agencies/bureaus until a financial assistance policy eligibility determination can be made. |
| Part VI, Line 2: | The Hospital conducted community health needs assessments (CHNA) during 2013 and 2016. Its 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: | Adventist Bolingbrook Hospital (the Hospital) is a 138-bed state-of-the-art acute care hospital serving the residents of the Village of Bolingbrook, Illinois and surrounding communities. Bolingbrook is located in Will County, Illinois. The population for DuPage and Will County is approximately 1,602,491, with an estimated 11.1% age 65 or over the age of 65. The building of the Hospital was the result of a sustained, 27-year commitment by Adventist Health System to Bolingbrook and its service area. Prior to the building of the hospital, Adventist Midwest Health, an affiliate of the Hospital, operated a Free Standing Emergency Center in the Village of Bolingbrook. The Hospital is meeting a demand for acute care inpatient, outpatient, and emergency services in the communities it serves. The Hospital offers the latest technological advances and was designed to offer all family-friendly private patient rooms. Services offered at the Hospital include cardiac care, imaging services, a women's care center, including a Maternal Fetal Center, surgical services and interventional radiology. The Hospital offers other services not available at any other hospital in Will County. An example is an endoscopic ultrasound, a new, highly-detailed diagnostic test that combines endoscopy and ultrasonography to allow accurate imaging of tumors. The Hospital opened a new wound care center in 2013 and has also established an agreement with VNA Health Care to offer a Federally Qualified Health Center on the Hospital campus to provide care for the uninsured and underinsured. High school graduates account for approximately 91.4% of the Hospital's service area. It is estimated that 19.4% of the individuals residing in the Hospital's service area live below 200% of the federal poverty level and the unemployment rate is about 5.4%. Approximately 32.9% of the Hospital's patients during 2016 were Medicare patients, about 21.7% were Medicaid patients, about 3.9% were self-pay patients, and the remaining percentage were patients covered under commercial insurance. In 2016, about 61% 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 Adventist Bolingbrook Hospital's mission of service and compassion. Restoring and promoting the health and quality of life of those in the communities served by the Hospital is a function of "extending the healing ministry of Christ and embodies the Hospital's commitment to its values and principles. The Hospital commits substantial resources to provide a broad range of services to both the underprivileged as well as the broader community. In addition to the community benefit and community building information provided in Parts I, II and III of this Schedule H, the Hospital captures and reports the benefits provided to its community through faith-based care. Examples of such benefits include the cost associated with chaplaincy care programs and mission peer reviews and mission conferences. During the current year, Hospital provided $463,068 of benefit with respect to the faith-based and spiritual needs of the community in conjunction with its operation of a community hospital. The Hospital also provides benefits to its community's infrastructure by investing in capital improvements to ensure that facilities and technology provide the best possible care to the community. During the current year, the Hospital expended $2,283,949, in new capital improvements. As a faith-based mission-driven community hospital, the Hospital is continually involved in monitoring its community, identifying unmet health care needs and developing solutions and programs to address those needs. In accordance with its conservative approach to fiscal responsibility, surplus funds of the Hospital are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its community. |
| Part VI, Line 6: | Adventist Bolingbrook Hospital 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 44 hospitals in 10 states throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC and its subsidiaries also operate 16 nursing home facilities and other ancillary health care provider facilities, such as ambulatory surgery centers and diagnostic imaging centers. The filing organization is also a covered affiliate of a joint operating company that does business under the name of AMITA Health. AMITA Health has been recognized by the Internal Revenue Service as a tax-exempt organization under IRC Section 501(c)(3). AMITA Health provides various management and executive support services to the filing organization. The provision of these executive and support services on a centralized basis by AMITA Health and by AHSSHC provides an appropriate balance between providing the 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 as a covered affiliate of AMITA Health and as part of a larger system of healthcare organizations. As a part of a system of hospitals 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. As a result, management fee expense reported by the filing organization may appear greater in relation to management fee expense that may be reported by a single stand-alone hospital. The single stand-alone hospital would likely report costs associated with management and other professional services on various expense line items in its statement of revenue and expense as opposed to reporting such costs in one overall management fee expense. As the reporting of the Form 990 is done on an entity by entity basis, there is no single Form 990 that captures the programs and operations of AHS or of AMITA Health 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 and to access www.AMITAHEALTH.org to learn more about the vision and services provided by all its locations. |
| Part VI, Line 7, Reports Filed With States | IL |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc | Purpose Of GrantPurposeOfGrantTxt | Cash GrantCashGrantAmt |
|---|---|---|---|---|---|---|---|---|---|---|
| Bolingbrook Hospital Foundation | ||||||||||
| 500 Remington Blvd | Bolingbrook | IL | 60440 | 900494445 | 501(c)(3) | $163,261 | Cost | General Adminstrative Support | Provision of General Administrative Support | |
| Will County Center for Economic Development | ||||||||||
| 116 N Chicago St 101 | Joliet | IL | 60432 | 363772737 | 501(c)(6) | General Support | $15,000 | |||
| United Way of Will County | ||||||||||
| 54 N Ottawa Street 300 | Joliet | IL | 60432 | 362515625 | 501(c)(3) | General Support | $20,000 | |||
| Bolingbrook Seventh Day Adventist Church | ||||||||||
| 301 E Boughton Road | Bolingbrook | IL | 60440 | 362277365 | 501(c)(3) | General Support | $20,000 | |||
| Cresthill Christian Junior Academy | ||||||||||
| 21514 W Division St | Lockport | IL | 60441 | 264797031 | 501(c)(3) | General Support | $7,750 | |||
| VNA Healthcare | ||||||||||
| 400 N Highland Ave | Aurora | IL | 60506 | 362182095 | 501(c)(3) | General Support | $25,000 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 5 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Grants are generally made only to related organizations that are exempt from federal income tax under IRC Section 501(c)(3), or to other local charitable community organizations, or to other 501(c)(3) organizations that are a part of the group exemption ruling issued to the General Conference of Seventh-Day Adventists. Accordingly, the filing organization has not established specific procedures for monitoring the use of grant funds in the United States as the filing organization does not have a grant making program that would necessitate such procedures. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Discretionary Spending Acct | Yes (X) | DiscretionarySpendingAcctInd |
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (20 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Randall Haffner PhD | ||||||||||||||
| Dir/Chairman | $0 | $1,013,441 | $0 | $257,210 | $0 | $436,890 | $0 | $216,000 | $0 | $49,682 | $0 | $1,973,223 | $0 | $0 |
| David L Crane | ||||||||||||||
| Pres/Sec (end 1/16) | $0 | $64,096 | $0 | $0 | $0 | $1,056,586 | $0 | $14,388 | $0 | $42,257 | $0 | $1,177,327 | $0 | $253,421 |
| Brent G Snyder | ||||||||||||||
| Treasurer/Director | $0 | $684,795 | $0 | $242,602 | $0 | $299,188 | $0 | $125,381 | $0 | $55,504 | $0 | $1,407,470 | $0 | $103,749 |
| Thor Thordarson | ||||||||||||||
| Dir/Pres/Sec (beg 12/16) | $0 | $78,991 | $0 | $0 | $0 | $124,933 | $0 | $7,591 | $0 | $42,506 | $0 | $254,021 | $0 | $0 |
| Eric Yang MD | ||||||||||||||
| Director (beg 1/16) | $0 | $261,360 | $0 | $251,368 | $0 | $1,063 | $0 | $14,388 | $0 | $0 | $0 | $528,179 | $0 | $0 |
| Rick Mace | ||||||||||||||
| CEO | $0 | $314,313 | $0 | $104,105 | $0 | $149,816 | $0 | $50,981 | $0 | $33,359 | $0 | $652,574 | $0 | $37,912 |
| Rebecca Mathis | ||||||||||||||
| CFO (end 9/16) | $0 | $269,864 | $0 | $75,760 | $0 | $49,290 | $0 | $22,521 | $0 | $27,159 | $0 | $444,594 | $0 | $16,586 |
| Ron Wehtje | ||||||||||||||
| Regional CFO (end 3/16) | $0 | $99,322 | $0 | $0 | $0 | $92,344 | $0 | $5,359 | $0 | $8,966 | $0 | $205,991 | $0 | $36,561 |
| Michael Murrill | ||||||||||||||
| COO | $0 | $268,527 | $0 | $83,155 | $0 | $23,330 | $0 | $18,467 | $0 | $40,826 | $0 | $434,305 | $0 | $0 |
| Richard Roehr | ||||||||||||||
| COO (beg 8/16) | $0 | $181,853 | $0 | $40,213 | $0 | $3,360 | $0 | $0 | $0 | $31,960 | $0 | $257,386 | $0 | $0 |
| Jolene Albaugh | ||||||||||||||
| CNO | $0 | $200,641 | $0 | $36,125 | $0 | $7,308 | $0 | $13,047 | $0 | $38,935 | $0 | $296,056 | $0 | $0 |
| Mary Murphy | ||||||||||||||
| Regional CNO (end 7/16) | $0 | $250,230 | $0 | $72,883 | $0 | $54,428 | $0 | $27,948 | $0 | $18,779 | $0 | $424,268 | $0 | $26,584 |
| Richard Carroll MD | ||||||||||||||
| CMO-GlenOaks & Bolingbrook | $0 | $383,091 | $0 | $103,736 | $0 | $118,255 | $0 | $40,124 | $0 | $52,113 | $0 | $697,319 | $0 | $30,696 |
| Candice Washilewski | ||||||||||||||
| Admin Dir Nursing | $133,593 | $0 | $28,792 | $0 | $639 | $0 | $7,727 | $0 | $11,444 | $0 | $182,195 | $0 | $0 | $0 |
| Diane Leonard | ||||||||||||||
| Dir of Nursing | $127,232 | $0 | $28,058 | $0 | $3,459 | $0 | $8,051 | $0 | $14,766 | $0 | $181,566 | $0 | $0 | $0 |
| Kathleen Sievertsen | ||||||||||||||
| Dir Business Dev | $129,585 | $0 | $27,490 | $0 | $1,583 | $0 | $7,359 | $0 | $7,645 | $0 | $173,662 | $0 | $0 | $0 |
| Catherine Michalowicz | ||||||||||||||
| RN Charge | $84,848 | $0 | $29,040 | $0 | $31,675 | $0 | $7,086 | $0 | $90 | $0 | $152,739 | $0 | $0 | $0 |
| Cecille Truver | ||||||||||||||
| Regional Dir Radiology | $113,056 | $0 | $23,892 | $0 | $499 | $0 | $6,262 | $0 | $8,543 | $0 | $152,252 | $0 | $0 | $0 |
| George Mayzell MD | ||||||||||||||
| Former Regional CMO | $0 | $0 | $0 | $0 | $0 | $308,091 | $0 | $10,588 | $0 | $40,956 | $0 | $359,635 | $0 | $0 |
| Gary Lipinski MD | ||||||||||||||
| Former CMO | $0 | $7,233 | $0 | $0 | $0 | $101,014 | $0 | $2,287 | $0 | $20 | $0 | $110,554 | $0 | $62,696 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 1a | The filing organization is a part of the system of healthcare organizations known as Adventist Health System (AHS). Certain members of the filing organization's executive management team that hold the position of Vice-President or above are 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). 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. With respect to the AHS President's Council meeting, eligible executives may include AHSSHC Vice Presidents and above and all AHSSHC subsidiary organization CEOs and Regional CFOs. The payment provided to each executive was considered taxable compensation to the executive. Housing allowance or residence for personal use: AHSSHC has a Corporate Executive Policy that addresses assistance to executives who have been relocated by the company during the year. Relocation assistance provided to executives may include relocation allowances to assist with duplicate housing expenses. Relocation assistance is administered per AHSSHC policy by an external relocation company. Any taxable reimbursements made to executives in connection with relocation assistance are treated as wages to the executive and are subject to all payroll withholding and reporting requirements. Health or social club dues or initiation fees: AHSSHC has a Corporate Executive Policy that addresses business development expenditures. Under this policy, certain AHS eligible executives may be reimbursed for member dues and usage charges for a country club or other social club upon authorization. Club memberships must be recommended by the CEO of the AHS hospital organization and approved by the Chairman of the Board of Directors of the organization. In addition, the proposed membership must be approved annually by the AHSSHC Board Compensation Committee, an independent committee of the Board of Directors of AHSSHC. Eligible executives are limited to certain senior level executives (hospital organization CEOs, the CEO of the nursing home division of AHS, senior vice presidents at three large hospital organizations, regional CEOs and CFOs and the president and senior vice presidents of AHSSHC). In the current year, for this filing organization, one executive was eligible to receive reimbursement for club fees. Each AHS executive who is approved for a club membership must submit an annual report to the AHSSHC Board Compensation Committee that describes how the membership benefited their organization during the preceding year. |
| Part I, Line 3 | The filing organization is a covered affiliate of the joint operating company, Alexian Brothers-AHS Midwest Region Health Company, d/b/a AMITA Health (AMITA). AMITA utilizes various comparability data in establishing compensation for those executives that perform services for AMITA and for one or more covered affiliates. Comparability data utilized includes compensation surveys and studies and the Forms 990 of other unrelated comparable organizations. AMITA also has a Compensation Committee that approves all relevant executive compensation. The compensation of the filing organization's CEO was determined and approved by AMITA's Executive Compensation Committee. |
| Part I, Lines 4a-b | During the year ending December 31, 2016, George Mayzell, MD, and David Crane received severance payments in the amount of $295,647 and $665,684 respectively. Pursuant to the AHSSHC Corporate Executive Policy governing executive severance, severance agreements for executives operating at the Vice President level and above are entered into upon eligibility to facilitate the transition to subsequent employment following an involuntary separation from employment with AHS. As discussed in Line 1a above, executives on the filing organization's management team that hold the position of Vice-President or above are 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 deferred compensation benefits taxable under Internal Revenue Code (IRC) Section 457(f), 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 AHS 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 $236,000. 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. Flex Plan Flex Plan/ SERP 457(b) CY CY Employer CY Contrib./ Distributions* Contrib. Distributions* Payment ------------------------------------------------------- David L. Crane $ 8,870 $253,591 $ 24,325 $ 0 Randall Haffner, PhD $201,612 $ 0 $ 409,583 $ 0 Thor Thordarson $ 7,591 $ 0 $ 0 $ 0 Brent G. Snyder $128,994 $103,809 $ 126,308 $ 0 Rick Mace $ 36,593 $ 36,555 $ 77,511 $ 0 Michael Murrill $ 15,299 $ 0 $ 0 $ 0 Rebecca Mathis $ 26,134 $ 16,563 $ 0 $ 0 Gary R. Lipinski, MD $ 618 $ 35,241 $ 0 $ 0 Richard Carroll, MD $ 43,736 $ 29,311 $ 0 $ 0 Mary Murphy $ 31,561 $ 27,064 $ 0 $ 0 Ron Wehtje $ 7,707 $ 35,071 $ 0 $ 0 *Including Investment Earnings. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | Adventist Bolingbrook Hospital (the filing organization) has one member. The sole member of the filing organization is Adventist Midwest Health. Adventist Midwest Health (AMH) is an Illinois, 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 members of the Board of Directors (Governing Board) of the filing organization are appointed by the Corporate Member, AMH. The Corporate Member is entitled to elect not less than eighteen (18) and no more than twenty three (23) voting members to the Board of Directors of the filing organization pursuant to the provisions of the Bylaws, subject to the ratification of the AMITA Health Board of Directors. |
| Form 990, Part VI, Section A, line 7b | The filing organization is a Covered Affiliate of the JOC known as AMITA Health. The sole member of the filing organization is AMH. AMH is also one of two members in AMITA Health. The other member of AMITA Health is Alexian Brothers Health System. The top-tier parent of AMH is AHSSHC (Sponsor). The governing documents of the filing organization provide for certain reserved powers to exercise financial, managerial, and operational authorities over the filing organization by AHSSHC, as Sponsor, by AMH as Member, by both members of the JOC, namely, AMH and Alexian Brothers Health System (Members), and by the Board of Directors of the JOC. Certain governance powers are reserved to AMH as the Member of the filing organization. These reserved powers include the alteration, restatement or repeal of the Articles of Incorporation, bylaws or mission statement of the filing organization, provided that such actions are not inconsistent with the JOC Bylaws or the Affiliation Agreement and the appointment of the filing organization's Board of Directors, subject to the ratification of the JOC Board of Directors. Financial authorities reserved to the Sponsor, the Board of Directors of the JOC, and by both members of the JOC include the approval of any disposition of the filing organization's assets and any internal transfer of the filing organization's assets. The Sponsor, the Board of Directors of the JOC, and both members of the JOC may approve such dispositions or transfers up to established asset dollar values as set forth in the Bylaws of the filing organization. Annual operating and capital budgets of the filing organization must be ratified by both Sponsors of the JOC. The Board of Directors of the JOC must approve any capital expenditure to be made by the filing organization in excess of $10 million. Operational authorities reserved to the Board of Directors of the JOC include the determination of the services to be provided by the filing organization, including the authority to direct the expansion, reduction and consolidation of clinical programs, patient care services and administrative capabilities or other major changes in the operation of 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 conflict of interests, 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. The CEO and current CFO individuals are compensated by the related top-tier parent organization of the filing organization. As noted in our response to Part VI, Section A, Line 7b, the filing organization is a covered affiliate of the JOC known as AMITA Health. The compensation of the CEO and CFO is established and approved by AMITA Health. Please see the discussion concerning the process followed by AMITA Health 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 or AMITA Health. Physician members of the Board of Directors received compensation from related organizations as a result of providing various medical services to those related entities. |
| Form 990, Part IX, line 11g | Payments to Healthcare Professionals : Program service expenses 5,126,364. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,126,364. Professional Fees : Program service expenses 727,875. Management and general expenses 0. Fundraising expenses 0. Total expenses 727,875. Purchased Medical Services : Program service expenses 5,295,391. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,295,391. Environmental Services : Program service expenses 2,418,105. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,418,105. Food Service Contracts : Program service expenses 1,803,376. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,803,376. Miscellaneous Purchased Services : Program service expenses 2,782,106. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,782,106. AHS Management Fees : Program service expenses 0. Management and general expenses 998,510. Fundraising expenses 0. Total expenses 998,510. Billing & Collection Services : Program service expenses 0. Management and general expenses 661,492. Fundraising expenses 0. Total expenses 661,492. Region Support Services : Program service expenses 0. Management and general expenses 10,779,206. Fundraising expenses 0. Total expenses 10,779,206. |
| Form 990, Part XI, line 9: | Transfer to Top-Tier Tax-Exempt Parent -598,761. Allocations from Tax-exempt parent with respect to debt 56,198. Net Change in interest in Foundation 194,681. Transfer to Tax-Exempt Parent -1,457,378. Transfer to Tax-Exempt Related Organization -5,897,300. Rounding -2. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (102 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Adventist Bolingbrook Hospital | |||||||||||
| 500 Remington Blvd | Bolingbrook | IL | 60440 | 651219504 | Operation of Hospital & Related Services | IL | 501(c)(3) | Line 3 | Adventist Midwest Health | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
| Adventist Hlth Partners Inc | |||||||||||
| 3040 Salt Creek Lane | Arlington Heights | IL | 60005 | 364138353 | Operation of Physician Practices & Medical Services | IL | 501(c)(3) | Line 3 | AHS Midwest Management Inc | Yes (1) | |
| Adventist Hlth System Sunbelt Hlthcare Corp | |||||||||||
| 900 Hope Way | Altamonte Springs | FL | 32714 | 592170012 | Management Services | FL | 501(c)(3) | Line 12a, I | 0 | N/A | |
| 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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
| AHP Specialty Care NFP | |||||||||||
| 3040 Salt Creek Lane | Arlington Heights | IL | 60005 | 811105774 | Operation of Physician Practices & Medical Services | IL | 501(c)(3) | Line 3 | AHS Midwest Management Inc | Yes (1) | |
| AHS Midwest Management Inc | |||||||||||
| 1000 Remington Blvd Ste 200 | Bolingbrook | IL | 60440 | 363354567 | Operation of Physician Practice Mgmt | IL | 501(c)(3) | Line 12a, I | Adventist Midwest Health | Yes (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 | Yes (1) | |
| ALEXIAN BROTHERS-AHS MIDWEST REGION HLTH CO DBA AMITA HEALTH | |||||||||||
| 3040 W Salt Creek Lane | Arlington Heights | IL | 60005 | 472360513 | Joint Operating Company | IL | 501(c)(3) | Line 12b, II | 0 | ||
| 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 | Yes (1) | |
| Battle Creek Adventist Hospital | |||||||||||
| 1000 Remington Blvd Ste 200 | Bolingbrook | IL | 60440 | 381359189 | Inactive | MI | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Bolingbrook Hospital Foundation | |||||||||||
| 1000 Remington Blvd N Entrance 2nd | 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 | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
| Chickasaw Hlth Care Properties Inc | |||||||||||
| 250 S Chickasaw Trail | Orlando | FL | 32825 | 510605681 | Lease to Related Organization | GA | 501(c)(3) | Line 12c, III-FI | Sunbelt Hlth Care Centers Inc | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
| Emory-Adventist Inc | |||||||||||
| 900 Hope Way | Altamonte Springs | FL | 32714 | 582171011 | Inactive | GA | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
| Florida Hospital Medical Group Inc | |||||||||||
| 2600 Westhall Ln 4th Floor | Maitland | FL | 32751 | 593214635 | Operation of Physician Practices & Medical Services | FL | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | 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 | Tarpon Springs Hospital Foundation Inc | 0 | |
| Hinsdale Hospital Foundation | |||||||||||
| 7 Salt Creek Lane Suite 203 | 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 | Yes (1) | |
| Hospice of the Comforter Foundation Inc | |||||||||||
| 480 W Central Parkway | Altamonte Springs | FL | 32714 | 271858033 | Fund Raising for Affiliated Tax-Exempt Hospice | FL | 501(c)(3) | Line 7 | The Comforter Health Care Group Inc | Yes (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 | Yes (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 | Yes (1) | |
| Memorial Hlth Systems Foundation Inc | |||||||||||
| 770 West Granada Blvd | Ormond Beach | FL | 32174 | 311771522 | Fund-raising for Tax-exempt hospital | FL | 501(c)(3) | Line 7 | 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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
| Midwest Hlth Foundation | |||||||||||
| 120 North Oak Street | Hinsdale | IL | 60521 | 352230515 | Support of subsidiary Foundations | IL | 501(c)(3) | Line 12b, II | 0 | N/A | |
| 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 | Yes (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 | Yes (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 | Yes (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 | Sunbelt Hlth Care Centers Inc | 0 | |
| Osceola Health Care Properties Inc (620-123116) | |||||||||||
| 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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | 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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
| Shawnee Mission Hlth Care Properties Inc(98-123116) | |||||||||||
| 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 | Yes (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 | Yes (1) | |
| South Central Inc | |||||||||||
| 900 Hope Way | Altamonte Springs | FL | 32714 | 593689740 | Management Support | GA | 501(c)(3) | Line 12c, III-FI | 0 | N/A | |
| 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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
| Takoma Regional Hospital Inc (630 Year End)(7115-123116) | |||||||||||
| 401 Takoma Ave | Greeneville | TN | 37743 | 510603966 | Operation of Hospital & Related Services | TN | 501(c)(3) | Line 3 | Adventist Hlth SystemSunbelt Inc | Yes (1) | |
| Takoma Regional Hospital Foundation Inc | |||||||||||
| 401 Takoma Ave | Greeneville | TN | 37743 | 471334302 | Fund Raising for Affiliated Tax-Exempt Hospital | TN | 501(c)(3) | Line 7 | Takoma Regional Hospital Inc | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | 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 | Yes (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 | Yes (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 | 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 | Yes (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 | Yes (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 | Yes (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 | Yes (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 | Yes (1) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| Clear Creek MOB Ltd | |||||||
| 2201 S Clear Creek Rd | Killeen | TX | 76549 | 742609195 | Real Estate | TX | N/A |
| Endoscopy Center at Porter LLC (11-32916) | |||||||
| 1001 South Park Drive | Littleton | CO | 80120 | 205855038 | Medical Services | CO | 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 | N/A |
| Functional Neurosurgical Ambulatory Surgery Center LLC | |||||||
| 777 S Williams St | Denver | CO | 80209 | 464426708 | Surgery Center | CO | N/A |
| PAHSLarkin Ventures LLC | |||||||
| 9100 E Mineral Cir | Centennial | CO | 80112 | 474211060 | Medical Services | CO | N/A |
| PAHSUSP Surgery Centers LLC | |||||||
| 15305 Dallas Pkwy Ste 1600 LB 28 | Addison | TX | 75010 | 263057950 | Medical Services | CO | N/A |
| San Marcos MRI LP | |||||||
| 1330 Wonder World Dr Ste 202 | San Marcos | TX | 78666 | 770597972 | Imaging & Testing | TX | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (20 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| Altamonte Medical Plaza Condominium Association Inc | |||||||||
| 601 East Rollins Street | Orlando | FL | 32803 | 592855792 | Condo Association | FL | N/A | C | Yes (1) |
| Apopka Medical Plaza Condominium Association Inc | |||||||||
| 601 East Rollins Street | Orlando | FL | 32803 | 593000857 | Condo Association | FL | N/A | C | Yes (1) |
| CC MOB Inc | |||||||||
| 2201 S Clear Creek Road | Killeen | TX | 76549 | 742616875 | Real Estate Rental | TX | N/A | C | Yes (1) |
| Central Texas Medical Associates | |||||||||
| 1301 Wonder World Drive | San Marcos | TX | 78666 | 742729873 | Inactive | TX | N/A | C | Yes (1) |
| Central Texas Providers Network | |||||||||
| 1301 Wonder World Drive | San Marcos | TX | 78666 | 742827652 | Physician Hospital Org. | TX | N/A | C | Yes (1) |
| Florida Hospital Flagler Medical Offices Association Inc | |||||||||
| 60 Memorial Medical Parkway | Palm Coast | FL | 32164 | 262158309 | Condo Association | FL | N/A | C | Yes (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 | Yes (1) |
| Florida Hospital Healthcare System Inc | |||||||||
| 101 Southhall Lane Ste 150 | Maitland | FL | 32751 | 593215680 | PHSO | FL | N/A | C | Yes (1) |
| Florida Medical Plaza Condo Association Inc | |||||||||
| 601 East Rollins Street | Orlando | FL | 32803 | 592855791 | Condo Association | FL | N/A | C | Yes (1) |
| Florida Memorial Health Network Inc | |||||||||
| 770 W Granada Blvd Ste 317 | Ormond Beach | FL | 32174 | 593403558 | Physician Hospital Org. | FL | N/A | C | Yes (1) |
| Kissimmee Multispecialty Clinic Condominium Association Inc | |||||||||
| 201 Hilda Street Suite 30 | Kissimmee | FL | 34741 | 593539564 | Condo Association | FL | N/A | C | Yes (1) |
| LN Health Partners Inc (815-123116) | |||||||||
| 550 E Rollins Street 6th Floor | Orlando | FL | 32803 | 813556903 | Inactive | FL | N/A | C | Yes (1) |
| Midwest Management Services Inc | |||||||||
| 9100 West 74th Street | Shawnee Mission | KS | 66204 | 480901551 | Inactive | KS | N/A | C | Yes (1) |
| North American Health Services Inc & Sub | |||||||||
| 900 Hope Way | Altamonte Springs | FL | 32714 | 621041820 | Lessor/Holding Co. | TN | N/A | C | Yes (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 | Yes (1) |
| Park Ridge Property Owner's Association Inc | |||||||||
| 1 Park Place Naples Road | Fletcher | NC | 28732 | 030380531 | Condo Association | NC | N/A | C | Yes (1) |
| Porter Aff Hlth Svcs Inc dba Diversified Aff Hlth Svcs | |||||||||
| 2525 S Downing Street | Denver | CO | 80210 | 840956175 | Healthcare Services | CO | N/A | C | Yes (1) |
| San Marcos Regional MRI Inc | |||||||||
| 1301 Wonder World Drive | San Marcos | TX | 78666 | 770597968 | Holding Company | TX | N/A | C | Yes (1) |
| The Garden Retirement Community Inc | |||||||||
| 485 North Keller Road Ste 250 | Maitland | FL | 32751 | 593414055 | Real Estate Rental | FL | N/A | C | Yes (1) |
| Winter Park Medical Office Building I Condo Assoc Inc | |||||||||
| 601 East Rollins Street | Orlando | FL | 32803 | 452228478 | Condo Association | FL | N/A | C | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (16 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Adventist Midwest Health | ||
| P | $21,742,816 | COst |
| Adventist Midwest Health | ||
| Q | $7,018,356 | Cost |
| Adventist Health System Sunbelt Healthcare Corporation | ||
| B | $598,761 | actual Amount Given |
| Adventist Health System Sunbelt Healthcare Corporation | ||
| M | $998,510 | % of facility's operating exp. |
| Adventist Health System Sunbelt Healthcare Corporation | ||
| P | $6,574,379 | Cost |
| Bolingbrook Hospital Foundation | ||
| B | $163,261 | Actual Amount Given |
| Bolingbrook Hospital Foundation | ||
| C | $87,260 | Actual Amount Received |
| Adventist Glen Oaks Hospital | ||
| Q | $410,235 | COst |
| Adventist Health Partners Inc | ||
| P | $4,139,533 | COst |
| AHS Midwest Management Inc | ||
| P | $91,976 | COst |
| Adventist Glen Oaks Hospital | ||
| P | $301,790 | COst |
| Adventist Health System Sunbelt Healthcare Corporation dba AHS IS | ||
| M | $4,157,434 | % of facility's operating exp. |
| Adventist Health Partners Inc | ||
| B | $3,339,461 | Actual Amount Given |
| AHS Midwest Management Inc | ||
| B | $2,557,840 | Actual Amount Given |
| Adventist Midwest Health dba Adventist Hinsdale Hospital | ||
| B | $1,457,378 | Actual Amount Given |
| Adventist Midwest Health | ||
| M | $15,095,708 | Cost |
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