2013-11-14T11:07:50-06:00 2012-12-31 990 2012-01-01 742225672 METROPLEX ADVENTIST HOSPITAL INC METR 2545267523 2201 SOUTH CLEAR CREEK ROAD KILLEEN TX 76549 LYNN C ADDISCOTT 2545267523 2013-11-13 2012 2016-02-25 16:41:14Z CARLYLE WALTON 2201 SOUTH CLEAR CREEK ROAD KILLEEN TX 76549 133430089 0 X WWW.MPLEX.ORG X 1980 TX THE PROVISION OF MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF TWO HOSPITALS. 18 14 1457 200 108041 22899 0 0 132714014 130450990 244256 570624 900 2381535 132959170 133403149 266242 235135 0 0 64487062 65801468 0 0 0 56209063 57529735 120962367 123566338 11996803 9836811 115053227 124245335 15400006 16657150 99653221 107588185 ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION AND ALL OF 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. 0 0 116937103 235135 132697093 OPERATION OF METROPLEX HOSPITAL, A 220-BED ACUTE-CARE HOSPITAL AND ROLLINS BROOK COMMUNITY HOSPITAL, A 25-BED ACUTE-CARE HOSPITAL; 8,553 PATIENT ADMISSIONS, 31,254 PATIENT DAYS, AND 134,066 OUTPATIENT VISITS IN THE CURRENT YEAR. 116937103 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 141 0 1 1457 1 1 1 0 0 0 0 0 0 0 0 0 X 18 14 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 TX X ROBERT BROCK 2545198165 2201 S CLEAR CREEK ROAD KILLEEN TX 76549 X KENNETH FINCH 0.60 50.00 X 0 728572 117420 HENDERSON GARRETT 0.20 0.00 X 0 0 0 ERNIE BOVIO 0.30 0.00 X 0 0 0 ALLEN CLOUD 0.10 0.00 X 0 0 0 PHILLIP DAY MD 11.10 0.00 X 81096 0 0 GREG DEHMER MD 0.20 0.00 X 0 0 0 BUFORD GRIFFITH JR 0.20 0.00 X 0 0 0 MIKE HELM 0.20 0.00 X 0 0 0 PENNY JOHNSON 0.10 50.00 X 0 386891 68148 MARY KLIEWER 0.30 0.00 X 0 0 0 J DERYL KNUTSON 0.10 0.00 X 0 0 0 LES LEDGER 0.10 0.00 X 0 0 0 JAMES LINDLEY 0.30 0.00 X 0 0 0 PAULA LOHSE 0.20 0.00 X 0 0 0 RICHARD PROCTER 0.20 0.00 X 0 0 0 STEVE SIBBITT MD 0.20 0.00 X 0 0 0 BARRY SIEBENLIST MD 0.10 0.00 X 0 0 0 PAUL WEST MD 0.20 0.00 X 0 0 0 SUNDARAM SUKUMAR MD 0.20 0.00 X 0 0 0 CARLYLE WALTON 50.00 0.00 X 0 629363 72559 VICTOR LAWHORN 50.00 0.00 X 0 247875 42915 JEFFREY VILLANUEVA 50.00 0.00 X 0 369657 62742 VIRGINIA HENDERSON 50.00 0.00 X 0 211213 24379 FLOYD JORDAN 55.00 0.00 X 128798 0 6074 BRENDA COLEY 55.00 0.00 X 126167 0 19129 HUNG TRAN 41.40 0.00 X 123591 0 12809 WILLIAMS GRIMES 50.00 0.00 X 123461 0 6985 JONATHON RUTLEDGE 42.00 0.00 X 121375 0 25206 704488 2573571 458366 30 0 1 0 PEGASUS EMERGENCY GROUP 270 W KAGY BLVD STE E BOZEMAN MT 59715 ER PHYSICIAN STAFFING 2600000 SCOTT & WHITE HOSPITAL 2401 S 31ST STREET TEMPLE TX 76508 PHYSICIAN STAFFING 2488612 DIVERSIFIED CLINICAL SER PO BOX 850001 ORLANDO FL 32885 WOUND CARE STAFFING & MANAGEMENT 1634872 TEXAS HEALTH HUGULEY INC 11801 S FREEWAY BURLESON TX 76028 PATIENT FINANCE 544122 PHILLIPS MEDICAL SYSTEMS PO BOX 100355 ATLANTA GA 30384 EQUIPMENT MANINTENANCE 405565 28 NET PATIENT REVENUE 900099 127768382 127768382 CAFETERIA REVENUE 900099 1366260 1366260 MEDICAL OFFICE BLDG 531120 1039222 1039222 LAB REVENUE 621500 108041 108041 HEALTH EDUCATION 900099 24579 24579 144506 143363 1143 130450990 244976 244976 25596 26940 0 26940 25596 0 25596 25596 306830 18818 0 0 306830 18818 325648 325648 EHR REVENUE 900099 2355287 2355287 MISC. REVENUE-EXCLUDED 900099 652 652 2355939 133403149 132697093 108041 598015 X 235135 235135 1561633 1561633 48332286 48332286 1522056 1495689 26367 10365949 10231244 134705 4019544 3949912 69632 171597 171597 28382 28382 16810122 14859862 1950260 399612 399612 4770748 3920774 849974 4969252 4305311 663941 2829436 2829436 544049 544049 950 950 10273 10273 8318467 8318467 1765868 1751966 13902 MEDICAL SUPPLIES 16449980 16449980 REPAIRS & MAINTENANCE 246768 246768 SPECIAL EVENTS 119370 119370 UBI TAXES 572 572 94289 94289 123566338 116937103 6629235 0 3734 3683 17317944 28642416 16582792 16251875 3770488 4024802 563247 2179767 147362094 84231191 68431532 63130903 83137 89756 490897 449474 7809456 9472659 115053227 124245335 7888412 9445112 7511594 7212038 15400006 16657150 X 99653221 107588185 99653221 107588185 115053227 124245335 X 9836811 -1901847 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10872 10872 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: AMERICAN HOSPITAL ASSOCIATION DUES AND TEXAS HOSPITAL ASSOCIATION DUES 2246528 2246528 71825893 31922253 39903640 68836211 49783454 19052757 4453462 2525484 1927978 63130903 DUE FROM AFFILIATED 7340458 OTHER RECEIVABLES 300234 INVESTMENT IN SUBS 102250 RECEIVABLE FROM THIRD PARTIES 1729717 9472659 CREDIT BALANCES IN A/R 215307 OTHER CURRENT LIABILITIES 147781 OTHER NONCURRENT LIABILITIES 625891 DUE TO AFFILIATED 2509376 PAYABLE TO THIRD PARTIES 2704492 OTHER DEFERRED REVENUE 51611 NEGATIVE EQUITY - INVESTMENT IN SUB 957580 7212038 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: 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 SUBSIDIARIES (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. FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011, UNRELATED BUSINESS INCOME ACTIVITIES CONDUCTED BY HEALTHCARE CORPORATION AND ITS TAX-EXEMPT AFFILIATES DID NOT GENERATE A MATERIAL AMOUNT OF COMBINED FEDERAL, STATE AND LOCAL INCOME TAX. NAHS IS A WHOLLY OWNED, FOR-PROFIT SUBSIDIARY OF HEALTHCARE CORPORATION. NAHS AND ITS SUBSIDIARIES ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. NAHS FILES A CONSOLIDATED FEDERAL INCOME TAX RETURN AND, WHERE APPROPRIATE, CONSOLIDATED STATE INCOME TAX RETURNS. FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011, NAHS GENERATED TAXABLE INCOME OF APPROXIMATELY $2,400 AND $1,000, RESPECTIVELY. THIS TAXABLE INCOME WAS FULLY OFFSET BY NET OPERATING LOSS CARRYFORWARDS FOR FEDERAL INCOME TAX PURPOSES. ALTHOUGH ONE STATE IN WHICH NAHS CONDUCTS BUSINESS HAS SUSPENDED THE UTILIZATION OF NET OPERATING LOSS CARRYFORWARDS FOR THE YEAR ENDED DECEMBER 31, 2012, NO MATERIAL STATE INCOME TAX LIABILITY RESULTED. ACCORDINGLY, THERE IS NO PROVISION FOR CURRENT FEDERAL OR STATE INCOME TAX FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011. NAHS ALSO HAS TEMPORARY DEDUCTIBLE DIFFERENCES OF APPROXIMATELY $64,800 AND $67,500 AT DECEMBER 31, 2012 AND 2011, RESPECTIVELY, PRIMARILY AS A RESULT OF NET OPERATING LOSS CARRYFORWARDS. AT DECEMBER 31, 2012, NAHS HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $64,300 OF WHICH $21,000 WILL EXPIRE IN 2023, WITH THE REMAINING $43,300 EXPIRING BEGINNING IN 2018 THROUGH 2026. SOME OF THESE NET OPERATING LOSSES ARE SUBJECT TO THE SEPARATE RETURN LIMITATION YEAR RULES. DEFERRED TAXES HAVE BEEN PROVIDED FOR THESE AMOUNTS, RESULTING IN A NET DEFERRED TAX ASSET OF APPROXIMATELY $24,600 AND $25,600 AT DECEMBER 31, 2012 AND 2011, RESPECTIVELY. A FULL VALUATION ALLOWANCE HAS BEEN PROVIDED AT DECEMBER 31, 2012 AND 2011, RESPECTIVELY, 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 12961594 0 12961594 0.10490 15134965 10743950 4391015 0.03550 28096559 10743950 17352609 0.14040 180619 0 180619 0.00150 164694 0 164694 0.00130 345313 345313 0.00280 28441872 10743950 17697922 0.14320 79147 0 79147 0.00060 79147 79147 0.00060 1 4583740 2372294 42341130 40299380 2041750 X 1 1 1 CLEAR CREEK MOB LTD REAL ESTATE RENTAL 0.60800 0.00000 0.22600 2 1 METROPLEX ADVENTIST HOSPITAL

2201 S CLEAR CREEK ROAD KILLEEN TX 76549

X X X A 2 ROLLINS BROOK COMMUNITY HOSPITAL

608 N KEY AVENUE LAMPASAS TX 76550

X X X A GROUP A 3 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X 1 0 1 X 0 0 7 WOUND CARE & HYPERBARIC MEDICINE CENTER

2300 S CLEAR CREEK ROAD STE 101 KILLEEN TX 76549

OUTPATIENT WOUND CARE CLINIC METROPLEX BEHAVIORAL HEALTH CENTER

2407 S CLEAR CREEK ROAD KILLEEN TX 76549

BEHAVIORAL HEALTH METROPLEX OPEN MRI

5610 E CENTRAL TEXAS EXPWY KILLEEN TX 76543

OUTPATIENT MRI CLINIC METROPLEX ENDOSCOPY CENTER

2405 S CLEAR CREEK ROAD KILLEEN TX 76549

AMBULATORY SURGERY CENTER METROPLEX REHABILITATION CENTER

2300 S CLEAR CREEK ROAD STE 102 KILLEEN TX 76549

OUTPATIENT REHABILITATION CLINIC HOME CARE OF METROPLEX

806 E AVENUE D STE D COPPERAS COVE TX 76522

HOME HEALTH METROPLEX SLEEP CENTER

2111 S CLEAR CREEK ROAD KILLEEN TX 76549

SLEEP DISORDERS PART I, LINE 6A: THE FILING ORGANIZATION IS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC SERVES AS A PARENT ORGANIZATION TO 24 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS THAT OPERATE 43 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. ON AN ANNUAL BASIS, THE COMMUNITY BENEFITS OF ALL AHS ORGANIZATIONS ARE CONSOLIDATED AND REPORTED IN THE AHS ANNUAL REPORT DOCUMENT PREPARED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (EIN: 59-2170012). PART I, LINE 7: THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. PART II: THE FILING ORGANIZATION IS INVOLVED WITH AND SUPPORTIVE OF VARIOUS ACTIVITIES IN ITS SERVICE AREA THAT WORK COLLABORATIVELY TO HELP THOSE IN NEED AND TO IMPROVE THE HEALTH AND SAFETY OF THE RESIDENTS OF THE COMMUNITY. METROPLEX WELLNESS OFFERS VARIOUS HEALTH PROMOTION AND EDUCATIONAL PROGRAMS INCLUDING THE FOLLOWING: ARTHRITIS EXERCISE, LALECHE LEAGUE (ASSISTANCE TO MOTHERS WHO BREASTFEED THROUGH MOTHER-TO-MOTHER SUPPORT, ENCOURAGEMENT, AND EDUCATION), SENIOR EXCERCISE, GRIEF RECOVERY, DIABETES EDUCATION, ASTHMA EDUCATION, SMOKING CESSATION CLASSES, CANCER COSMETOLOGY CLASS AND SUPPORT GROUPS FOR THOSE AFFECTED BY CANCER. IN ADDITION TO THE ACTIVITIES LISTED ABOVE, THE FILING ORGANIZATION ALSO ORGANIZES HEALTH EVENTS & HEALTH FAIRS THAT PROVIDE HEALTH SCREENINGS ALONG WITH HEALTH INFORMATION, IMMUNIZATION CINICS, AND HEART CHECK (BLOOD PRESSURE MONITOR AND HEALTH EDUCATION PAMPHLETS) FREE TO THE PUBLIC. PART III, LINE 8: COSTING METHODOLOGY:MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. PART III, LINE 9B: AT THE TIME OF PATIENT REGISTRATION, NON-ELECTIVE SELF-PAY PATIENTS ARE INFORMED OF THE MINIMUM DISCOUNT AVAILABLE UNDER THE FILING ORGANIZATION'S SELF-PAY DISCOUNT POLICY. SUCH PATIENTS ARE ALSO INFORMED OF THE FILING ORGANIZATION'S CHARITY CARE POLICY AND TOLD THAT THEY WILL BE REQUIRED TO SUBMIT NECESSARY FINANCIAL DATA IN ORDER TO POTENTIALLY RECEIVE ANY ADDITIONAL DISCOUNTS. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, PERCENTAGE DISCOUNTS ARE APPLIED TO A PATIENT'S ACCOUNT BASED UPON AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE.UNDER THE FILING ORGANIZATION'S POLICIES, PAYMENT PLANS FOR PARTIAL CHARITY ACCOUNTS WILL BE INDIVIDUALLY DEVELOPED WITH THE PATIENT. PARTIAL CHARITY ACCOUNTS RESULT WHEN A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION ALLOWS FOR A PERCENTAGE REDUCTION BUT LEAVES THE PATIENT WITH A SELF-PAY BALANCE. IF THE PATIENT COMPLIES WITH THE AGREED-UPON PAYMENT PLAN, THE FILING ORGANIZATION DOES NOT PURSUE ANY COLLECTION ACTION WITH RESPECT TO THE PATIENT. HOWEVER, IF A PATIENT DOES NOT MAKE ANY PAYMENTS FOR THREE CONSECUTIVE MONTHS, THE ACCOUNT MAY BE REFERRED FOR FURTHER COLLECTION ACTIVITY. THE FILING ORGANIZATION DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR A 100% REDUCTION IN CHARGES UNDER ITS CHARITY CARE POLICY. 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 CHARITY CARE POLICY:SELF-PAY PATIENTS ARE REQUIRED TO COMPLETE A PATIENT FINANCIAL ASSISTANCE APPLICATION SHORT FORM (PFAA). IF THE PFAA IS NOT COMPLETED AFTER REASONABLE ATTEMPTS TO OBTAIN IT ARE EXHAUSTED, PATIENT INFORMATION IS PROCESSED THROUGH A SCORER PRODUCT. THE SCORER PRODUCT UTILIZES PUBLICLY AVAILABLE DATA, SUCH AS CREDIT REPORTS, TO ASSESS AN INDIVIDUAL PATIENT'S FINANCIAL VIABILITY. PATIENTS WHO EARN A CERTAIN SCORE ON THE SCORER PRODUCT ARE CONSIDERED TO QUALIFY AS NON-STATE CHARITY PATIENTS. AN AMOUNT UP TO $1,000 OF SUCH A PATIENT'S BILL IS WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED TO BE NON-STATE CHARITY. THE AMOUNT WRITTEN OFF AS BAD DEBT EXPENSE FOR THOSE PATIENTS WHO POTENTIALLY QUALIFY AS NON-STATE CHARITY USING THE SCORER PRODUCT 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 CHARITY CARE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR CHARITY CARE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A CHARITY CARE ELIGIBILITY DETERMINATION CAN NOT BE MADE. 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 TO BE COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGES 8 AND 9. PLEASE NOTE THAT DOLLAR AMOUNTS ON THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE IN THOUSANDS. PART VI, LINE 2: IN ACCORDANCE WITH IRC SECTION 501(R)(3), THE FILING ORGANIZATION HAS ADOPTED AND IMPLEMENTED A POLICY THAT SETS FORTH THE GENERAL REQUIREMENTS, PROCESSES AND PROCEDURES WITH RESPECT TO CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY. DURING 2012, THE FILING ORGANIZATION WAS IN THE PROCESS OF PLANNING FOR THEIR INITIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT IS TO BE COMPLETED BY 12/31/2013. IN ADDITION TO THE CHNA THAT IS BEING CONDUCTED, 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 ORGANIZATIONS COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATIONS COMMUNITY. PART VI, LINE 3: THE FILING ORGANIZATION HAS A PROCESS IN PLACE WHEREBY PATIENTS ARE INFORMED ABOUT THE HOSPITAL'S CHARITY CARE POLICY AND OTHER FORMS OF FINANCIAL ASSISTANCE, SUCH AS SELF-PAY DISCOUNTS. SIGNAGE IS POSTED IN THE EMERGENCY ROOM INDICATING THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR THOSE SELF-PAY PATIENTS MEETING ELIGIBILITY REQUIREMENTS. AFTER EMTALA MEDICAL SCREENING AND STABILIZATION REQUIREMENTS ARE MET, REGISTRATION PERSONNEL WILL SECURE FINANCIAL INFORMATION ON AS MANY SELF-PAY PATIENTS AS POSSIBLE AT THE TIME OF SERVICE. FOR THOSE WHO APPEAR TO QUALIFY FOR MEDICAID OR UNDER THE HOSPITAL'S CHARITY CARE POLICY, THE FINANCIAL COUNSELORS WILL CONTINUE TO WORK WITH THOSE PATIENTS UNTIL FINAL ACCOUNT RESOLUTION IS ACHIEVED. ALL OTHER SELF-PAY PATIENTS ARE COVERED UNDER THIS PROCESS. AT ANY TIME DURING THE PROCESS THAT DATA IS PROVIDED SHOWING THAT A PATIENT QUALIFIES FOR ASSISTANCE UNDER THE CHARITY CARE POLICY THE DISCOUNTS EXTENDED UNDER THAT POLICY WILL BE APPLIED.AS PART OF THE BILLING PROCESS, THE HOSPITAL INCLUDES THE APPLICATION FOR CHARITY CARE ASSISTANCE ALONG WITH THE INITIAL PATIENT BILL. THE HOSPITAL'S CHARITY CARE APPLICATION IS ALSO AVAILABLE TO PATIENTS ON THE HOSPITAL'S WEB-SITE IN BOTH AN ENGLISH AND SPANISH VERSION. ADDITIONALLY, THE HOSPITAL'S FINANCIAL COUNSELORS ARE AVAILABLE TO WORK WITH EVERY PATIENT DURING THE FIRST 120 DAYS OF THE BILLING PROCESS TO ASSIST THE PATIENT WITH COMPLETING CHARITY CARE APPLICATIONS AND INVESTIGATING OTHER POTENTIAL SOURCES OF THIRD-PARTY ASSISTANCE. THE DETERMINATION OF A PATIENT'S ELIGIBILITY FOR CHARITY CARE IS MADE ON A CASE-BY-CASE BASIS. VARIOUS FACTORS ARE CONSIDERED IN THAT DETERMINATION. EACH INDIVIDUAL PATIENT WHO IS IDENTIFIED AS POTENTIALLY BEING ELIGIBLE TO RECEIVE CHARITY CARE IS SEEN BY A FINANCIAL COUNSELOR AT THE HOSPITAL. THE FINANCIAL COUNSELOR WILL WORK WITH THE PATIENT TO MAKE SURE THAT OTHER SOURCES OF ASSISTANCE (PUBLIC OR OTHERWISE) HAVE BEEN SOUGHT TO THE FULLEST EXTENT POSSIBLE. WHEN OTHER FORMS OF ASSISTANCE ARE NOT AVAILABLE OR HAVE BEEN EXHAUSTED, THE HOSPITAL WILL GATHER CERTAIN FINANCIAL INFORMATION FROM THE PATIENT TO DETERMINE THE PATIENT'S ABILITY TO PAY BASED UPON LEVEL OF INCOME. PART VI, LINE 4: THE FILING ORGANIZATION CURRENTLY OPERATES 2 HOSPITAL FACILITIES, METROPLEX ADVENTIST HOSPITAL AND ROLLINS BROOK COMMUNITY HOSPITAL, IN THE NORTHERN HILL COUNTRY OF CENTRAL TEXAS. COMBINED, THESE FACILITIES ARE A MAJOR HEALTHCARE PROVIDER IN BELL, CORYELL, AND LAMPASAS COUNTIES.METROPLEX ADVENTIST HOSPITAL (MAH), LOCATED IN BELL COUNTY, IS LICENSED FOR 160 ACUTE-CARE BEDS AND 60 PSYCHIATRIC CARE BEDS. IN ADDITION, MAH ALSO OPERATES PHYSICIAN OFFICE BUILDINGS, REHABILITATIONS CENTERS, AND HOME CARE, AN ORGANIZATION WHICH PROVIDES HOME HEALTH SERVICES. AS THE SIXTH LARGEST EMPLOYER IN KILLEEN, TEXAS, MAH EMPLOYS APPROXIMATELY 1,400 AREA RESIDENTS AND CARES FOR MORE THAN 120,000 PATIENTS EACH YEAR. MAH IS LOCATED NEXT TO FORT HOOD, THE LARGEST MILITARY BASE IN THE COUNTRY WHICH MAKES THE COMMUNITY HEAVILY DEPENDENT ON THE POST AND THE SOLDIERS (AND THEIR FAMILIES) STATIONED THERE. ROLLINS BROOK COMMUNITY HOSPITAL (RBCH), LOCATED IN LAMPASAS COUNTY, TEXAS, IS LICENSED FOR 25 BEDS AND CARES FOR MORE THAN 16,000 PATIENTS EACH YEAR. BECAUSE OF ITS LOCATION AND POPULATION SERVED, RBCH IS A FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL. RBCH IS A CRUCIAL COMMUNITY AND REGIONAL ASSET. IT IS THE SOLE HOSPITAL FACILITY FOR THE LAMPASAS COMMUNITY. THE COUNTY OF LAMPASAS COVERS APPROXIMATELY 714 SQUARE MILES. SIMILAR TO BELL COUNTY, LAMPASAS COUNTY'S ECONOMY IS ALSO HEAVILY DEPENDENT ON THE SOLDIERS (AND THEIR FAMILIES) STATIONED AT FORT HOOD, LOCATED LESS THAN 25 MILES AWAY. THE MAIN CAMPUS OF THE FILING ORGANIZATION PRIMARILY SERVES CORYELL AND BELL COUNTIES. THIS PRIMARY MARKET HAS A POPULATION OF APPROXIMATELY 224,600, WITH AN ESTIMATED 13,200 OVER THE AGE OF 65. THE WEIGHTED AVERAGE HOUSEHOLD INCOME, BASED ON POPULATION, IN THE PRIMARY MARKET IS APPROXIMATELY $45,000. HIGH SCHOOL GRADUATES ACCOUNT FOR APPROXIMATELY 88% OF BELL COUNTY, WITH AN ESTIMATED 21.5% HAVING A BACHELOR'S DEGREE OR HIGHER. IT IS ESTIMATED THAT 14% OF THE INDIVIDUALS RESIDING IN BELL COUNTY LIVE BELOW THE POVERTY LEVEL AND THE UNEMPLOYMENT RATE IS ABOUT 7.9%. APPROXIMATELY 35.4% OF THE FILING ORGANIZATION'S PATIENTS DURING 2012 WERE MEDICARE PATIENTS, ABOUT 12.6% WERE MEDICAID PATIENTS, ABOUT 10.4% WERE SELF-PAY PATIENTS, AND THE REMAINING PERCENTAGE WERE PATIENTS COVERED UNDER COMMERCIAL INSURANCE. IN 2012, ABOUT 55% OF THE HOSPITALS IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITALS EMERGENCY DEPARTMENT. PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO THE FILING ORGANIZATION'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE FILING ORGANIZATION IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST" AND EMBODIES THE FIING ORGANIZATION'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE FILING ORGANIZATION COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, THE FILING ORGANIZATION PROVIDED $221,085 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF 2 COMMUNITY HOSPITALS. THE FILING ORGANIZATION ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE FILING ORGANIZATION EXPENDED $3,005,389 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE FILING ORGANIZATION IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. PART VI, LINE 6: THE FILING ORGANIZATION IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SEC. 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 43 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. AS THE PARENT ORGANIZATION OF THE AHS SYSTEM, AHSSHC PROVIDES EXECUTIVE LEADERSHIP AND OTHER PROFESSIONAL SUPPORT SERVICES TO ITS SUBSIDIARY ORGANIZATIONS. PROFESSIONAL SUPPORT SERVICES INCLUDE AMONG OTHERS CORPORATE COMPLIANCE, LEGAL, HUMAN RESOURCES, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH AHS SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. EACH AHS SUBSIDIARY PAYS A MANAGEMENT FEE TO AHSSHC FOR THE INTERNAL SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY A AHS SUBSIDIARY ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY BY ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF AHS AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEB-SITE OF AHS AT WWW.ADVENTISTHEALTHSYSTEM.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF AHS AND TO ACCESS AHS'S ANNUAL REPORT THAT CONTAINS FINANCIAL DATA AS WELL AS COMMUNITY BENEFIT REPORTING FOR THE ENTIRE SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 TX PART V, LINE 8 FACILITY REPORTING GROUP A SEE BELOW FACILITY 1 -- METROPLEX ADVENTIST HOSPITAL PART V, SECTION B, LINE 14G: METROPLEX ADVENTIST HOSPITAL (THE HOSPITAL) HAS DEVELOPED A PATIENT-FRIENDLY SUMMARY VERSION OF ITS FINANCIAL ASSISTANCE POLICY (FAP). THE FILING ORGANIZATION'S FAP PROVIDES THAT ITS HOSPITAL FACILITY WILL POST THE PATIENT-FRIENDLY SUMMARY VERSION OF ITS FAP ON THE HOSPITAL'S WEBSITE. IN ADDITION, THE FAP OF THE HOSPITAL FACILITY STATES THAT SIGNAGE REGARDING THE AVAILABILITY OF THE HOSPITAL FACILITY'S FAP WILL BE VISIBLE AT POINTS OF ADMISSION AND REGISTRATION, INCLUDING THE EMERGENCY DEPARTMENT. FACILITY 1 -- METROPLEX ADVENTIST HOSPITAL PART V, SECTION B, LINE 20D: IN DETERMINING THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE POLICY-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL USES THE FOLLOWING METHODOLOGY:THE HOSPITAL IDENTIFIES ALL COMMERCIAL PAYORS WHOSE VOLUME OF ACTIVITY WITH THE HOSPITAL EQUALS OR EXCEEDS $100,000 FOR THE TAXABLE YEAR. FOR THOSE IDENTIFIED COMMERCIAL PAYORS, AN AVERAGE OF THE NEGOTIATED COMMERCIAL INSURANCE RATES IS DETERMINED. THE AVERAGE OF ALL OF THE NEGOTIATED COMMERCIAL INSURANCE RATES FOR THOSE IDENTIFIED COMMERCIAL PAYORS DETERMINES THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. FACILITY 2 -- ROLLINS BROOK COMMUNITY HOSPITAL PART V, SECTION B, LINE 14G: ROLLINS BROOK COMMUNITY HOSPITAL (THE HOSPITAL) HAS DEVELOPED A PATIENT-FRIENDLY SUMMARY VERSION OF ITS FINANCIAL ASSISTANCE POLICY (FAP). THE FILING ORGANIZATION'S FAP PROVIDES THAT ITS HOSPITAL FACILITY WILL POST THE PATIENT-FRIENDLY SUMMARY VERSION OF ITS FAP ON THE HOSPITAL'S WEBSITE. IN ADDITION, THE FAP OF THE HOSPITAL FACILITY STATES THAT SIGNAGE REGARDING THE AVAILABILITY OF THE HOSPITAL FACILITY'S FAP WILL BE VISIBLE AT POINTS OF ADMISSION AND REGISTRATION, INCLUDING THE EMERGENCY DEPARTMENT. FACILITY 2 -- ROLLINS BROOK COMMUNITY HOSPITAL PART V, SECTION B, LINE 20D: IN DETERMINING THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE POLICY-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL USES THE FOLLOWING METHODOLOGY:THE HOSPITAL IDENTIFIES ALL COMMERCIAL PAYORS WHOSE VOLUME OF ACTIVITY WITH THE HOSPITAL EQUALS OR EXCEEDS $100,000 FOR THE TAXABLE YEAR. FOR THOSE IDENTIFIED COMMERCIAL PAYORS, AN AVERAGE OF THE NEGOTIATED COMMERCIAL INSURANCE RATES IS DETERMINED. THE AVERAGE OF ALL OF THE NEGOTIATED COMMERCIAL INSURANCE RATES FOR THOSE IDENTIFIED COMMERCIAL PAYORS DETERMINES THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. 1 GREATER KILLEEN FREE CLINIC INC 309 2ND STREET KILLEEN TX 76541 742724725 501(C)(3) 40334 8615 BOOK PHARMACEUTICALS MEDICAL CARE SUNSYSTEM DEVELOPMENT CORP DBA METROPLEX FOUNDATION 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 592219301 501(C)(3) 109720 COST GENERAL ADMINISTRATIVE SUPPORT PROVISION OF GENERAL ADMINISTRATIVE SUPPORT CENTRAL TEXAS COLLEGE FOUNDATION PO BOX 1800 KILLEEN TX 76540 742623554 501(C)(3) 18000 SCHOLARSHIPS TEXAS A&M UNIVERSITY - CENTRAL TEXAS 301 TARROW STREET 3RD FLOOR COLLEGE STATION TX 77840 260895118 501(C)(3) 10000 SCHOLARSHIPS, ACCELERATED PROGAMMATIC DEVELOPMENT, ADVANCE TECHNOLOGIES 4 0 IN ORDER TO MONITOR THE USE OF GRANT FUNDS PAID TO THE GREATER KILLEEN FREE CLINIC, INC. (GKFC), METROPLEX ADVENTIST HOSPITAL, INC. REVIEWS QUARTERLY REIMBURSABLE EXPENSE AND ANNUAL REPORTS FURNISHED BY GKFC. ALL OTHER GRANTS PAID DURING THE CURRENT YEAR WERE MONTIORED USING THE FOLLOWING PROCESS: 1) A COMMITEE OF 3-4 INDIVIDUALS CONSISTING OF EMPLOYEES AND DIRECTORS REVIEW THE PREVIOUS YEARS' CONTRIBUTION TO THE ORGANIZATION REQUESTING THE DONATION; 2) ASSESSES WHETHER THE MISSION OF THE ORGANIZATION REFLECTS THE MISSION AND VALUES OF ADVENTIST HEALTH SYSTEM; AND 3) ENSURES THAT THE REQUEST WILL NOT EXCEED THE BUDGETED AMOUNT 4) REQUESTS ABOVE $1,500 ARE ALSO REVIEWED AND APPROVED BY THE CEO X X X X X 1 1 0 1 0 0 0 0 0 0 0 KENNETH FINCH 0 429336 0 139875 0 159361 0 84366 0 33054 0 845992 0 51610 PENNY JOHNSON 0 263268 0 73305 0 50318 0 36337 0 31811 0 455039 0 0 CARLYLE WALTON 0 289204 0 88811 0 251348 0 42701 0 29858 0 701922 0 27960 VICTOR LAWHORN 0 175294 0 29982 0 42599 0 13580 0 29335 0 290790 0 0 JEFFREY VILLANUEVA 0 196189 0 50256 0 123212 0 17733 0 45009 0 432399 0 0 VIRGINIA HENDERSON 0 160216 0 46449 0 4548 0 11066 0 13313 0 235592 0 0 PART I, LINE 1A AS DISCUSSED IN OUR RESPONSE TO FORM 990, SECTION B, PART VI, QUESTION 15A & B, THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). MEMBERS OF THE FILING ORGANIZATION'S EXECUTIVE MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF AHS. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). THE FILING ORGANIZATION REIMBURSES AHSSHC FOR THE SALARY AND BENEFIT COST OF THOSE EXECUTIVES ON THE PAYROLL OF AHSSHC THAT PROVIDE SERVICES AND ARE ON THE MANAGEMENT TEAM OF THE FILING ORGANIZATION. TRAVEL FOR COMPANIONS: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING AHSSHC EXECUTIVE TO HAVE HIS OR HER SPOUSE ACCOMPANY THE EXECUTIVE ON CERTAIN BUSINESS TRIPS EACH YEAR. TYPICALLY, REIMBURSEMENT IS ONLY PROVIDED TO VICE PRESIDENTS AND ABOVE AND IS USUALLY LIMITED TO ONE BUSINESS TRIP PER YEAR BEYOND THE ANNUAL AHS PRESIDENT'S COUNCIL BUSINESS MEETING AND OTHER MEETINGS WHERE THE SPOUSE IS SPECIFICALLY INVITED. THE AHSSHC CORPORATE EXECUTIVE SPOUSAL TRAVEL POLICY WAS ORIGINALLY APPROVED AND REVIEWED BY THE AHSSHC BOARD STRATEGY & 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 BUSINESS MEETING ($300 PER EXECUTIVE). 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 STRATEGY & 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 STRATEGY & COMPENSATION COMMITTEE THAT DESCRIBES HOW THE MEMBERSHIP BENEFITED THEIR ORGANIZATION DURING THE PRECEDING YEAR. PART I, LINE 4B AS DISCUSSED IN LINE 1A ABOVE, EXECUTIVES ON THE FILING ORGANIZATION'S MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF A HEALTHCARE SYSTEM KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). IN RECOGNITION OF THE CONTRIBUTION THAT EACH EXECUTIVE MAKES TO THE SUCCESS OF AHS, AHS PROVIDES TO ELIGIBLE EXECUTIVES PARTICIPATION IN THE AHS EXECUTIVE FLEX BENEFIT PROGRAM (THE PLAN). THE PURPOSE OF THE PLAN IS TO OFFER ELIGIBLE EXECUTIVES AN OPPORTUNITY TO ELECT FROM AMONG A VARIETY OF SUPPLEMENTAL BENEFITS, INCLUDING 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 STRATEGY & 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 $210,000. 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 ------------------------------------------------------- KENNETH FINCH $70,767 $57,487 $62,820 $0 PENNY JOHNSON $22,738 $0 $0 $0 JEFFREY VILLANUEVA $ 4,135 $0 $0 $0 CARLYLE WALTON $34,102 $30,624 $187,754 $0 * INCLUDING INVESTMENT EARNINGS SUPPLEMENTAL INFORMATION PART III PART I, QUESTION 3: AS NOTED IN OUR RESPONSE TO QUESTION 15 OF PART VI OF FORM 990, THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) FOR THAT INDIVIDUAL'S ROLE IN SERVING AS THE CEO. COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC USES ALL OF THE FOLLOWING TO ESTABLISH COMPENSATION OF THE CEO: - COMPENSATION COMMITTEE; - INDEPENDENT COMPENSATION CONSULTANT; - COMPENSATION SURVEY OR STUDY; AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. LATHA SUKUMAR MD FAMILY MEMBER OF BOARD MEMBER 31680 PROFESSIONAL SERVICES 0 THOMAS LENZ FAMILY MEMBER OF KEY EMPLOYEE 25148 EMPLOYEE COMPENSATION 0 EILEEN CADDIES FAMILY MEMBER OF KEY EMPLOYEE 25081 EMPLOYEE COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS FOR METROPLEX ADVENTIST HOSPITAL, INC. IS COMPRISED OF TWO CLASSES OF MEMBERS WITH POWER TO VOTE ON MATTERS THAT MAY COME BEFORE THE GOVERNING BODY; THE BOARD OF DIRECTORS OF THE CORPORATION AND A COMMUNITY BOARD. THE COMMUNITY BOARD IS PRIMARILY RESPONSIBLE FOR REPORTING TO THE BOARD OF DIRECTORS ON MATTERS AT EACH HOSPITAL LOCATION INVOLVING MEDICAL STAFF APPOINTMENT, REAPPOINTMENT, QUALITY ASSURANCE AND ADMINISTRATION OF MEDICAL STAFF BYLAWS, AND RULES AND REGULATIONS AND POLICIES AND MATTERS INVOLVING THE JOINT COMMISSION. THE BOARD OF DIRECTORS RETAINS FINAL AUTHORITY REGARDING ALL COMMUNITY BOARD ACTIONS TO ENSURE THAT ITS ACTIONS ARE CONSISTENT WITH THE BEST INTERESTS OF THE CORPORATION. THE COMMUNITY BOARD IS COMPRISED OF INDIVIDUALS FROM THE COMMUNITY WHO ARE APPOINTED BY THE BOARD. THREE OF THE SIXTEEN MEMBERS OF THE COMMUNITY BOARD ARE MEMBERS OF THE GOVERNING BOARD. FORM 990, PART VI, SECTION A, LINE 2 JEFFREY VILLANUEVA AND BARRY SIEBENLIST, MD - FAMILY RELATIONSHIP STEVE SIBBITT, MD AND ERNIE BOVIO - BUSINESS RELATIONSHIP STEVE SIBBITT, MD AND GREG DEHMER, MD - BUSINESS RELATIONSHIP STEVE SIBBITT, MD AND PAUL WEST, MD - BUSINESS RELATIONSHIP PAULA LOHSE AND CARLYLE WALTON - BUSINESS RELATIONSHIP PAULA LOHSE AND JEFFREY VILLANUEVA - BUSINESS RELATIONSHIP PAULA LOHSE AND MARY KLIEWER - BUSINESS RELATIONSHIP PAULA LOHSE AND MIKE HELM - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 METROPLEX ADVENTIST HOSPITAL, INC. (MAH) HAS TWO MEMBERS. THE MEMBERS OF MAH ARE ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) AND SCOTT & WHITE MEMORIAL HOSPITAL AND SCOTT, SHERWOOD AND BRINDLEY FOUNDATION (SCOTT & WHITE). BOTH AHSSHC AND SCOTT & WHITE ARE NOT-FOR-PROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN MAH. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS (BOARD) OF MAH ARE APPOINTED BY AHSSHC (MAJORITY MEMBER) AND SCOTT & WHITE (MINORITY MEMBER). THE MAJORITY MEMBER IS ENTITLED TO ELECT FOUR DIRECTORS TO THE BOARD OF MAH AND THE MINORITY MEMBER IS ENTITILED TO ELECT TWO DIRECTORS TO THE BOARD. IN ADDITION, THE BOARD MAY APPOINT A COMMUNITY BOARD THAT IS RESPONSIBLE TO REPORT TO THE BOARD ON MATTERS AT EACH HOSPITAL INVOLVING MEDICAL STAFF APPOINTMENT, REAPPOINTMENT, QUALITY ASSURANCE AND ADMINISTRATION OF MEDICAL STAFF BYLAWS, RULES AND REGULATIONS AND POLICIES AND MATTERS INVOLVING THE JOINT COMMISSION. THE COMMUNITY BOARD SHALL CONSIST OF A MAXIMUM OF EIGHTEEN VOTING MEMBERS WHICH MAY BE APPOINTED OR REMOVED BY EACH MEMBER IN PROPORTION TO THE MEMBER'S MEMBERSHIP INTEREST IN MAH. FORM 990, PART VI, SECTION A, LINE 7B AHSSHC AND SCOTT & WHITE, AS THE SOLE MEMBERS OF MAH, HAVE CERTAIN RESERVED POWERS AS SET FORTH IN THE BYLAWS OF MAH. THESE RESERVED POWERS INCLUDE THE FOLLOWING: 1) TO ADD ADDITIONAL MEMBERS OR REQUIRE ADDITIONAL CAPITAL CONTRIBUTIONS FROM EITHER MEMBER; 2) TO AMEND, RESTATE, AND REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS; 3) TO SET LIMITS AND TERMS FOR THE BORROWING OF FUNDS; 4) TO DIRECT THE PLACEMENT OF FUNDS AND CAPITAL; 5) TO MERGE, CONSOLIDATE, REORGANIZE, LIQUIDATE, OR VOLUNTARILY DISSOLVE MAH; 6) TO SELL, TRANSFER, LEASE, DISPOSE, OR ENCUMBER ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF MAH. THOUGH NOT REQUIRING AN APPOROVAL BY THE MINORITY MEMBER, SCOTT & WHITE, THE MAJORITY MEMBER, AHSSHC, SHALL CONSULT WITH AND OBTAIN INPUT FROM THE MINORITY MEMBER PRIOR TO TAKING ANY ACTION INVOLVING: 1) AMENDMENT, RESTATEMENT, OR REPEAL OF THE CORPORATE COMPLIANCE POLICY; 2) APPOINTMENT OR REMOVAL OF THE PRESIDENT; 3) APPROVING OR ENTERING INTO LOANS TO, OR GUARANTEES FOR THE BENEFIT OF THIRD PARTIES IN AN AGGREGATE AMOUNT NOT TO EXCEED $100,000 IN ANY YEAR FORM 990, PART VI, SECTION B, LINE 11 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 TOP-TIER MAJORITY MEMBER OF THE FILING ORGANIZATION IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS THE PARENT ORGANIZATION OF A HEALTHCARE SYSTEM, KNOWN AS ADVENTIST HEALTH SYSTEM, THAT OPERATES HOSPITALS, NURSING HOME FACILITIES, AND OTHER HEALTHCARE PROVIDER ORGANIZATIONS. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3) PURSUANT TO A GROUP RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. THE INDIVIDUALS WHO SERVE AS THE CEO, CFO OR VICE PRESIDENT OF THE FILING ORGANIZATION ARE COMPENSATED BY AHSSHC. COMPENSATION AND BENEFITS PROVIDED TO THESE INDIVIDUALS IS DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC HAS TAKEN STEPS TO ENSURE THAT PROCESSES ARE IN PLACE TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS STANDARD AS SET FORTH IN TREASURY REGULATION 53.4958-6 WITH RESPECT TO ITS ACTIVE EXECUTIVE-LEVEL POSITIONS. THE AHSSHC BOARD STRATEGY AND COMPENSATION COMMITTEE (THE COMMITTEE) SERVES AS THE GOVERNING BODY FOR ALL EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE IS COMPOSED OF CERTAIN MEMBERS OF THE BOARD OF DIRECTORS (THE BOARD) OF AHSSHC. VOTING MEMBERS OF THE COMMITTEE INCLUDE ONLY INDIVIDUALS WHO SERVE ON THE BOARD AS INDEPENDENT REPRESENTATIVES OF THE COMMUNITY, WHO HOLD NO EMPLOYMENT POSITIONS WITH AHSSHC AND WHO DO NOT HAVE RELATIONSHIPS WITH ANY OF THE INDIVIDUALS WHOSE COMPENSATION IS UNDER THEIR REVIEW THAT IMPACTS THEIR BEST INDEPENDENT JUDGMENT AS FIDUCIARIES OF AHSSHC. THE COMMITTEE'S ROLE IS TO REVIEW AND APPROVE ALL COMPONENTS OF THE EXECUTIVE COMPENSATION PLAN OF AHSSHC. AS AN INDEPENDENT GOVERNING BODY WITH RESPECT TO EXECUTIVE COMPENSATION, IT SHOULD BE NOTED THAT THE COMMITTEE WILL OFTEN CONFER IN EXECUTIVE SESSIONS ON MATTERS OF COMPENSATION POLICY AND POLICY CHANGES. IN SUCH EXECUTIVE SESSIONS, NO MEMBERS OF MANAGEMENT OF AHSSHC ARE PRESENT. THE COMMITTEE IS ADVISED BY AN INDEPENDENT THIRD PARTY COMPENSATION ADVISOR. THIS ADVISOR PREPARES ALL THE BENCHMARK STUDIES FOR THE COMMITTEE. COMPENSATION LEVELS ARE BENCHMARKED WITH A NATIONAL PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS OF SIMILAR SIZE AND COMPLEXITY TO AHS AND EACH OF ITS AFFILIATED ENTITIES. THE FOLLOWING PRINCIPLES GUIDE THE ESTABLISHMENT OF INDIVIDUAL EXECUTIVE COMPENSATION: - THE SALARY OF THE PRESIDENT/CEO OF AHS WILL NOT EXCEED THE 40TH PERCENTILE OF COMPARABLE SALARIES PAID BY SIMILARLY SITUATED ORGANIZATIONS; AND - OTHER EXECUTIVE SALARIES SHALL BE ESTABLISHED USING MARKET MEDIANS. THE COMPENSATION PHILOSOPHY, POLICIES, AND PRACTICES OF AHSSHC ARE CONSISTENT WITH THE ORGANIZATION'S FAITH-BASED MISSION AND CONFORM TO APPLICABLE LAWS, REGULATIONS, AND BUSINESS PRACTICES. AS A FAITH-BASED ORGANIZATION SPONSORED BY THE SEVENTH-DAY ADVENTIST CHURCH (THE CHURCH), AHSSHC'S PHILOSOPHY AND PRINCIPLES WITH RESPECT TO ITS EXECUTIVE COMPENSATION PRACTICES REFLECT THE CONSERVATIVE APPROACH OF THE CHURCH'S MISSION OF SERVICE AND WERE DEVELOPED IN COUNSEL WITH THE CHURCH'S LEADERSHIP. FORM 990, PART VI, SECTION C, LINE 19 AS DISCUSSED IN OUR RESPONSE TO QUESTION 15A & B IN SECTION B OF THIS PART VI, THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). EACH YEAR, AHS PUBLISHES AN ANNUAL REPORT DOCUMENT THAT INCLUDES A FINANCIAL REPORT FOR THE RELEVANT YEAR AS WELL AS A COMMUNITY BENEFIT REPORT. THE FINANCIAL REPORT AND COMMUNITY BENEFIT REPORT ARE PRESENTED ON A CONSOLIDATED BASIS AND REPRESENT ALL OF THE ACTIVITIES, RESULTS OF OPERATIONS, AND FINANCIAL POSITION AT YEAR-END OF THE ENTIRE AHS SYSTEM. IN ADDITION, 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 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. OTHER FEES FORM 990, PART IX, LINE 11G PAYMENTS TO HEALTHCARE PROFESSIONAL : PROGRAM SERVICE EXPENSES 6,254,167. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,254,167. PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 1,493,007. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,493,007. PURCHASED MEDICAL SERVICES : PROGRAM SERVICE EXPENSES 3,046,917. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,046,917. ENVIRONMENTAL SERVICES : PROGRAM SERVICE EXPENSES 976,230. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 976,230. RECRUITING : PROGRAM SERVICE EXPENSES 504,893. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 504,893. MISCELLANEOUS PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 2,584,648. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,584,648. AHS MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,143,690. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,143,690. BILLING & COLLECTIONS SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 806,570. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 806,570. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: GIFTS 112,525. RELEASED FROM RESTRICTED -14,372. TRANSFER TO SCOTT & WHITE, TAX-EXEMPT MINORITY MEMBER OF THE FILING ORG. -2,000,000. PART X, LINE 2 THE AMOUNTS SHOWN ON LINE 2 OF PART X OF THIS RETURN INCLUDES THE FILING ORGANIZATION'S INTEREST IN A CENTRAL INVESTMENT POOL MAINTAINED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, THE FILING ORGANIZATION'S TOP-TIER MAJORITY MEMBER. THE INVESTMENTS IN THE CENTRAL INVESTMENT POOL ARE RECORDED AT MARKET VALUE. ADVENTIST BOLINGBROOK HOSPITAL 500 REMINGTON BLVD BOLINGBROOK IL 60440 651219504 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) 170(B)(1)(A)(III) ADVENTIST HLTH SYSTEMSUNBELT INC 0 ADVENTIST CARE CENTERS - COURTLAND INC 730 COURTLAND STREET ORLANDO FL 32804 205774723 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) 509(A)(2) SUNBELT HLTH CARE CENTERS INC 0 ADVENTIST GLENOAKS HOSPITAL 701 WINTHROP AVENUE GLENDALE HEIGHTS IL 60139 363208390 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) 170(B)(1)(A)(III) ADVENTIST HLTH SYSTEMSUNBELT INC 0 ADVENTIST HLTH MID-AMERICA INC 9100 W 74TH STREET SHAWNEE MISSION KS 66204 521347407 HLTHCARE RELATED SERVICES KS 501(C)(3) 509(A)(3) TYPE I ADVENTIST HLTH SYSTEMSUNBELT INC 0 ADVENTIST HLTH PARTNERS INC 1000 REMINGTON BLVD STE 200 BOLINGBROOK IL 60440 364138353 OPERATE OUT-PATIENT PHYSICIAN CLINICS IL 501(C)(3) 170(B)(1)(A)(III) AHS MIDWEST MANAGEMENT INC 0 ADVENTIST HLTH SYSTEM AFFILIATED BENEFIT TRUST 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 266422966 PROMOTION OF HLTHCARE FL 501(C)(3) 509(A)(3) TYPE I ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 0 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 592170012 MANAGEMENT SERVICES FL 501(C)(3) 509(A)(3) TYPE I N/A 0 ADVENTIST HLTH SYSTEMGEORGIA INC 1035 RED BUD ROAD CALHOUN GA 30701 581425000 OPERATION OF HOSPITAL & RELATED SERVICES GA 501(C)(3) 170(B)(1)(A)(III) ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 0 ADVENTIST HLTH SYSTEMSUNBELT INC 900 HOPE WAY ALTAMONTE SPRINGS FL 32714 591479658 OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) 170(B)(1)(A)(III) ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 0 ADVENTIST HLTH SYSTEMTEXAS INC 602 COURTLAND STREET ORLANDO FL 32804 742578952 LEASING PERSONNEL TO AFFILIATED HOSPITAL TX 501(C)(3) 509(A)(3) TYPE III ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 0 ADVENTIST HINSDALE HOSPITAL 120 NORTH OAK STREET HINSDALE IL 60521 362276984 OPERATION OF HOSPITAL & RELATED SERVICES IL 501(C)(3) 170(B)(1)(A)(III) ADVENTIST HLTH SYSTEMSUNBELT INC 0 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) 170(B)(1)(A)(II) ADVENTIST HLTH SYSTEMSUNBELT INC 0 AHS MIDWEST MANAGEMENT INC 1000 REMINGTON BLVD STE 200 BOLINGBROOK IL 60440 363354567 OPERATION OF PHYSICIAN PRACTICE MGMT IL 501(C)(3) 509(A)(3) TYPE I ADVENTIST HLTH SYSTEMSUNBELT INC 0 AHSCENTRAL TEXAS INC 1301 WONDER WORLD DRIVE SAN MARCOS TX 78666 742621825 PROVIDE OFFICE SPACE - MEDICAL PROFESSIONALS TX 501(C)(3) 509(A)(3) TYPE III-F ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 0 APOPKA HLTH CARE PROPERTIES INC 305 E OAK STREET APOPKA FL 32703 510605694 LEASE TO RELATED ORGANIZATION GA 501(C)(3) 509(A)(3) TYPE III-F SUNBELT HLTH CARE CENTERS INC 0 BATTLE CREEK ADVENTIST HOSPITAL 1000 REMINGTON BLVD STE 200 BOLINGBROOK IL 60440 381359189 INACTIVE MI 501(C)(3) 170(B)(1)(A)(III) ADVENTIST HLTH SYSTEMSUNBELT INC 0 BOLINGBROOK HOSPITAL FOUNDATION 1000 REMINGTON BLVD N ENTRANCE 2ND BOLINGBROOK IL 60440 900494445 FUND-RAISING FOR TAX-EXEMPT HOSPITAL IL 501(C)(3) 170(B)(1)(A)(VI) 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) 509(A)(2) SUNBELT HLTH CARE CENTERS INC 0 BURLESON NURSING & REHAB CENTER INC 301 HUGULEY BLVD BURLESON TX 76028 205782243 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY TX 501(C)(3) 509(A)(2) SUNBELT HLTH CARE CENTERS INC 0 CALDWELL HLTH CARE PROPERTIES INC 1333 WEST MAIN PRINCETON KY 42445 510605680 LEASE TO RELATED ORGANIZATION GA 501(C)(3) 509(A)(3) TYPE III-F SUNBELT HLTH CARE CENTERS INC 0 CENTRAL TEXAS HLTHCARE COLLABORATIVE 1301 WONDER WORLD DRIVE SAN MARCOS TX 78666 453739929 SUPPORT OPERATION OF HOSPITAL TX 501(C)(3) 509(A)(3) TYPE I ADVENTIST HLTH SYSTEMSUNBELT INC 0 CEDAR CRAG TERRACE INC (630 YEAR END) RT 5 BOX 900 MANCHESTER KY 40962 611120442 OPERATION OF HOME FOR THE ELDERLY-DISABLED KY 501(C)(3) 170(B)(1)(A)(VI) MEMORIAL HOSPITAL INC 0 CENTRAL TEXAS MEDICAL CENTER FOUNDATION 1301 WONDER WORLD DRIVE SAN MARCOS TX 78666 742259907 FUND-RAISING FOR TAX-EXEMPT HOSPITAL TX 501(C)(3) 170(B)(1)(A)(VI) ADVENTIST HLTH SYSTEMSUNBELT INC 0 CHICKASAW HLTH CARE PROPERTIES INC 250 S CHICKASAW TRAIL ORLANDO FL 32825 510605681 LEASE TO RELATED ORGANIZATION GA 501(C)(3) 509(A)(3) TYPE III-F SUNBELT HLTH CARE CENTERS INC 0 CHIPPEWA VALLEY HOSPITAL & OAKVIEW CARE CENTER INC 1220 THIRD AVENUE WEST DURAND WI 54736 391365168 OPERATION OF HOSPITAL & RELATED SERVICES WI 501(C)(3) 170(B)(1)(A)(III) ADVENTIST HLTH SYSTEMSUNBELT INC 0 COBB MEDICAL ASSOCIATES LLC 3949 SOUTH COBB DRIVE SE SMYRNA GA 300806342 582617089 OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES GA 501(C)(3) 170(B)(1)(A)(III) EMORY-ADVENTIST INC 0 COURTLAND HLTH CARE PROPERTIES INC 730 COURTLAND STREET ORLANDO FL 32804 510605682 LEASE TO RELATED ORGANIZATION GA 501(C)(3) 509(A)(3) TYPE III-F SUNBELT HLTH CARE CENTERS INC 0 CREEKWOOD PLACE NURSING & REHAB CENTER INC 683 E THIRD STREET RUSSELLVILLE KY 42276 205782260 OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY KY 501(C)(3) 509(A)(2) SUNBELT HLTH CARE CENTERS INC 0 DAIRY ROAD HLTH CARE PROPERTIES INC 7350 DAIRY ROAD ZEPHYRHILLS FL 33540 510605684 LEASE TO RELATED ORGANIZATION GA 501(C)(3) 509(A)(3) TYPE III-F SUNBELT HLTH CARE CENTERS INC 0 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) 509(A)(2) SUNBELT HLTH CARE CENTERS INC 0 EMORY-ADVENTIST INC 3949 SOUTH COBB DRIVE SMYRNA GA 30080 582171011 OPERATION OF HOSPITAL & RELATED SVCS GA 501(C)(3) 170(B)(1)(A)(III) ADVENTIST HLTH SYSTEMSUNBELT INC 0 FLETCHER HOSPITAL INC 100 HOSPITAL DRIVE HENDERSONVILLE NC 28792 560543246 OPERATION OF HOSPITAL & RELATED SVCS NC 501(C)(3) 170(B)(1)(A)(III) ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP 0 FLNC INC 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