ADVENTIST MIDWEST HEALTH: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ADVENTIST MIDWEST HEALTH (EIN 36-2276984)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-13
IRS object ID
201213189349302801
Schema version
2011v1.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-13T12:47:35-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN362276984EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Adventist Hinsdale HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlADVENameControl
Phone6308569000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1120 North Oak StreetAddressLine1
CityHinsdaleCity
StateILState
ZIP Code60521ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLynn C AddiscottName
TitleAssistant SecretaryTitle
Phone6308566001Phone
Date Signed2012-11-13DateSigned
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDavid CraneNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1120 North Oak StreetAddressLine1
CityHinsdaleCity
StateILState
ZIP Code60521ZIPCode
FieldValueIRS element (for citing)
Gross Receipts292199120GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number1071GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.keepingyouwell.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1904YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionThe provision of medical care to the community through the operation of a 302 bed hospital.ActivityOrMissionDescription
Nbr Voting Members Governing Body27NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees2893TotalNbrEmployees
Total Nbr Volunteers442TotalNbrVolunteers
Total Gross UBI3325404TotalGrossUBI
Net Unrelated Business Txbl Income890150NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1167691ContributionsGrantsPriorYear
Contributions Grants Current Year1048025ContributionsGrantsCurrentYear
Program Service Revenue Prior Year283246144ProgramServiceRevenuePriorYear
Program Service Revenue CY287903334ProgramServiceRevenueCY
Investment Income Prior Year5175083InvestmentIncomePriorYear
Investment Income Current Year2857246InvestmentIncomeCurrentYear
Other Revenue Prior Year270010OtherRevenuePriorYear
Other Revenue Current Year274397OtherRevenueCurrentYear
Total Revenue Prior Year289858928TotalRevenuePriorYear
Total Revenue Current Year292083002TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1315938GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1280673GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year130091406SalariesEtcPriorYear
Salaries Etc Current Year135181437SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year143143074OtherExpensePriorYear
Other Expenses Current Year140459008OtherExpensesCurrentYear
Total Expenses Prior Year274550418TotalExpensesPriorYear
Total Expenses Current Year276921118TotalExpensesCurrentYear
Revenues Less Expenses Prior Year15308510RevenuesLessExpensesPriorYear
Revenues Less Expenses CY15161884RevenuesLessExpensesCY
Total Assets BOY525831026TotalAssetsBOY
Total Assets EOY540430864TotalAssetsEOY
Total Liabilities BOY252489923TotalLiabilitiesBOY
Total Liabilities EOY253661618TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY273341103NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY286769246NetAssetsOrFundBalancesEOY
Mission DescriptionAdventist 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense229163501Expense
Grants1280673Grants
Revenue284674971Revenue
DescriptionOperation of acute care hospital totaling 302 beds with 12,842 patient admissions and 57,924 patient days in the current year.Description
Total Program Service Expense229163501TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096333NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees2893NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members27NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Rebecca MathisBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6308569000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1120 N Oak StreetAddressLine1
CityHinsdaleCity
StateILState
ZIP Code60521ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (42 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Richard K Reiner
Chairman1.00X0169308958944
Venanzio Arquilla
Director1.00X000
RoseMarie Cazeau
Director1.00X000
David L Crane
Regional CEO/Pres/Sec50.00X1678993882161249X
Kenneth A Denslow
Director (end 3/11)1.00X000
Linda M Eastman
Director1.00X000
Marshall Gray Jr
Director1.00X000
Rodney Grove
Director1.00X000
Larry C Gunn MD
Director2.50X1125000
James Hannigan MD
DIREctor1.50X400000
Ron Hawkins
DIRECTOR (beg 2/11)1.00X000
Robert R Henderschedt
Director1.00X01050296138146
Michael Korpics MD
DIRECTOR1.00X0300000
Joseph A Lagattuta MD
Director1.00X0602000
Martin H Malecki Jr
Director1.00X000
Peter O'Connor
Director1.00X000
Betty D O'Toole
Director1.00X000
Pichette Ray
Director (beg 6/11)1.00X000
Akram Y Razzouk MD
Director28.00X20100000
Margaret Wade MD
Director7.00X4500024644813372
Robert G Rettig
Director1.00X000
Glynn Scott
Director1.00X000
Christine Smith
Director1.00X000
Brent G Snyder
Treasurer/Director1.00X01014417122083
Judith Storfjell PhD
Director1.00X000
Theodore Suchy DO
Director1.00X000
Jonathan Wright
Director1.00X000
Donald Livesay
Vice Chairman1.00X000
Ronald Wehtje
Regional CFO50.00114055187083292X
Rebecca Mathis
CFO50.00457918476643792X
Michael Goebel
COO (end 09/11)/CEO (beg 10/11)50.0040235907081128X
Gary Lipinski MD
CMO11.00039593477189X
Richard Carroll MD
CMO11.00049409782840X
Shevawn Tyrrell
CNO50.00033850359431X
Alan Schneider
COO/Chief PSO (end 08/11)50.00026706744467X
William J Meyer MD
Physician60.00599751031208X
Megan L Koh MD
Physician60.00283378027839X
Clara Lynne Carls MD
Dir Fam Prac Res60.00211753041684X
Jack Overton Durley
Dir Pharm II50.00156103027798X
Leslie E Sleuwen
Assoc. Director-FPR60.00153984027937X
Janice Hagensicker
Former CFO0.00060666096509X
Susan Fowler
Former CNO0.00013614123127X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1674018TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs8422440TotalReportableCompFrmRltdOrgs
Total Other Compensation1242035TotalOtherCompensation
Number Individuals GT100 K103NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Bulley & Andrews LLC
75 Remittance Drive Ste 1709ChicagoIL60675Construction Services19160935
Humana Insurance Co
PO Box 533Carol StreamIL60132Management Fees1720853
Zizzogroup Healthcare
648 N Plankinton Avenue Ste 270MilwaukeeWI53203Advertising/Public Relations1352477
Navigant Consulting Inc
4511 Paysphere CircleChicagoIL60674Consulting Services1204418
Imperial Laundry Services
1236 13th StreetRacineWI53403Laundry Services1027893
FieldValueIRS element (for citing)
Number Of Contractors GT100 K69NumberOfContractorsGT100K
Related Organizations894415RelatedOrganizations
Government Grants153610GovernmentGrants
Total Contributions1048025TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Net patient revenue9000992826640462794669753197071
Pharmacy446110323588032296456235
Cafeteria revenue9000991029524101802811496
Prof. Office Building/531120264759264759
Health Educ/Community900099225499225499

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column483626TotalRevenueColumn
Related Or Exempt Function Income470065RelatedOrExemptFunctionIncome
Unrelated Business Revenue13561UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Program Service Revenue287903334TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1593733TotalRevenueColumn
Exclusion$1,593,733ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real278102Real
Personal112413Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real100746Real
Personal15372Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real177356Real
Personal97041Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column274397TotalRevenueColumn
Unrelated Business Revenue97041UnrelatedBusinessRevenue
Exclusion$177,356ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1091927Securities
Other171586Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1091927Securities
Other171586Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1263513TotalRevenueColumn
Exclusion$1,263,513ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column292083002TotalRevenueColumn
Related Or Exempt Function Income284674971RelatedOrExemptFunctionIncome
Unrelated Business Revenue3325404UnrelatedBusinessRevenue
Exclusion$3,034,602ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1280673Total
Program Services1280673ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total3596236Total
Management And General3596236ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total96704981Total
Program Services90699987ProgramServices
Management And General6004994ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total3542176Total
Program Services3228576ProgramServices
Management And General313600ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total23986776Total
Program Services12209539ProgramServices
Management And General11777237ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total7351268Total
Program Services6700393ProgramServices
Management And General650875ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total760Total
Management And General760ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total50160Total
Management And General50160ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total26514951Total
Program Services14485024ProgramServices
Management And General12029927ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total958620Total
Management And General958620ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total6453354Total
Program Services5975359ProgramServices
Management And General477995ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total10135593Total
Program Services8111119ProgramServices
Management And General2024474ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4937400Total
Program Services4184441ProgramServices
Management And General752959ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total938561Total
Management And General938561ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total6799536Total
Program Services6799536ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total14921072Total
Program Services14921072ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total2187612Total
Program Services1418449ProgramServices
Management And General769163ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical Supplies4660882546608825
State Tax Indigent Asse91020849102084
Purchased services6636176372906598886
Unrelated Business Inco520962520962

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total3693342Total
Program Services3401134ProgramServices
Management And General292208ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total276921118Total
Program Services229163501ProgramServices
Management And General47757617ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY6720BOY
EOY6190EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY158062762BOY
EOY134228583EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY37686922BOY
EOY40790308EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY8208668BOY
EOY8357312EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY20293116BOY
EOY15755671EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis393555350LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec244869682LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY109540581BOY
EOY148685668EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY837191BOY
EOY931353EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY2060833BOY
EOY1984985EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY189134233BOY
EOY189690794EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY525831026BOY
EOY540430864EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY30524780BOY
EOY33475082EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY4358524BOY
EOY4893461EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY217606619BOY
EOY215293075EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY252489923BOY
EOY253661618EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY261877065BOY
EOY276115494EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY10494481BOY
EOY9639730EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY969557BOY
EOY1014022EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY273341103BOY
EOY286769246EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY525831026BOY
EOY540430864EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses15161884ReconcilationRevenueExpenses
Reconcilation Other Changes-1733741ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management1PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$124,269OtherActivitiesAmount
Total Lobbying Expenditures IIB124269TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1:ReturnReference
ExplanationDues were paid to the American Hospital Association, Illinois Hospital Association, and Metropolitan Chicago Healthcare Council. Outside consultants William Filan and John Andrew Kane were paid in the current year, and salary expense of $29,878 was incurred for paid staff engaged in lobbying activities.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1631892BeginningOfYearBalance
Investment Earnings Or Losses59032InvestmentEarningsOrLosses
End Of Year Balance1690924EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1509248BeginningOfYearBalance
Investment Earnings Or Losses122644InvestmentEarningsOrLosses
End Of Year Balance1631892EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1345833BeginningOfYearBalance
Investment Earnings Or Losses180664InvestmentEarningsOrLosses
Other Expenditures17249OtherExpenditures
End Of Year Balance1509248EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1307249BeginningOfYearBalance
Investment Earnings Or Losses43434InvestmentEarningsOrLosses
Other Expenditures4850OtherExpenditures
End Of Year Balance1345833EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.94120BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.05880PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis6693967OtherCostOrOtherBasis
Book Value6693967BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis179267259OtherCostOrOtherBasis
Depreciation116252840Depreciation
Book Value63014419BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis149484956OtherCostOrOtherBasis
Depreciation127345715Depreciation
Book Value22139241BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis58109168OtherCostOrOtherBasis
Depreciation1271127Depreciation
Book Value56838041BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings148685668TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
Other receivables267015
Intercompany receivable173286620
Beneficial Interest in Foundation16137159
FieldValueIRS element (for citing)
Total Book Value Other Assets189690794TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (7 entries)

DescriptionDescriptionAmountAmount
Credit balances in A/R$757,003
Interco. Alloc. of TE Bond Proceeds$181,571,699
Payable to third parties$27,973,390
Other current liabilities$71,106
Leases payable$1,919,014
Other noncurrent liabilities$2,096,500
Due to affiliated$904,363
FieldValueIRS element (for citing)
Total Of Amounts215293075TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Intended Use of Endowment Funds:Part V, Line 4:Hinsdale Hospital Foundation (HHF), a related organization formed and maintained exclusively to further the exempt purpose of Adventist Hinsdale Hospital, Inc. (the Hospital), held assets in permanent endowment and quasi-endowment funds during the current year. HHF's endowment consists of two individual funds established to support the Hospital's Opler Cancer Center and funds designated by the Board of Directors to function as endowments to support various purposes benefiting the Hospital and its patients.
Description of Uncertain Tax Positions Under FIN 48:Part X:The filing organization is a subsidiary organization within Adventist Health System (AHS). The consolidated financial statements of AHS contain the following FIN 48 footnote - 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.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3037985TotalCommunityBenefitExpense
Net Community Benefit Expense3037985NetCommunityBenefitExpense
Percent Of Total Expense0.01100PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense29815959TotalCommunityBenefitExpense
Direct Offsetting Revenue17918352DirectOffsettingRevenue
Net Community Benefit Expense11897607NetCommunityBenefitExpense
Percent Of Total Expense0.04300PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense32853944TotalCommunityBenefitExpense
Direct Offsetting Revenue17918352DirectOffsettingRevenue
Net Community Benefit Expense14935592NetCommunityBenefitExpense
Percent Of Total Expense0.05400PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense948463TotalCommunityBenefitExpense
Direct Offsetting Revenue119244DirectOffsettingRevenue
Net Community Benefit Expense829219NetCommunityBenefitExpense
Percent Of Total Expense0.00300PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense8620135TotalCommunityBenefitExpense
Direct Offsetting Revenue3217361DirectOffsettingRevenue
Net Community Benefit Expense5402774NetCommunityBenefitExpense
Percent Of Total Expense0.01950PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense685918TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense685918NetCommunityBenefitExpense
Percent Of Total Expense0.00250PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense10254516TotalCommunityBenefitExpense
Direct Offsetting Revenue3336605DirectOffsettingRevenue
Net Community Benefit Expense6917911NetCommunityBenefitExpense
Percent Of Total Expense0.02500PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense43108460TotalCommunityBenefitExpense
Direct Offsetting Revenue21254957DirectOffsettingRevenue
Net Community Benefit Expense21853503NetCommunityBenefitExpense
Percent Of Total Expense0.07900PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense212148TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense212148NetCommunityBuildingExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Total Community Building Expense121159TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense121159NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense333307TotalCommunityBuildingExpense
Net Community Building Expense333307NetCommunityBuildingExpense
Percent Of Total Expense0.00120PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$4,858,089BadDebtExpenseAmount
Amount Attributable To901132AmountAttributableTo
Amount Reimbursed By Medicare80111376AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare90523877CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-10412501MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 Hinsdale Surgical Center LLCBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivitySurgical ServicesDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.32000OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership0.00000OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership0.46340PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Adventist Hinsdale HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1120 North Oak StreetAddressLine1
CityHinsdaleCity
StateILState
ZIP Code60521ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Adventist Hinsdale HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent400.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities21NumberOfOtherFacilities

Other Facilities OtherFacilities (21 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Adventist Heart & Vascular
11 Salt Creek LaneHinsdaleIL60521Vascular Intervention Center
DuPage Imaging Center
908 Elm Street Ste 401HinsdaleIL60521Imaging Center
Health Care at Home
5101 S Willow Springs Rd 2nd FloorLa GrangeIL60525Home Health
New Day Center for AddictionsOPTIONS
740 Pasquinelli Drive Ste 104WestmontIL60559Behavioral Health
Westmont Imaging Center
6311 S Cass AvenueWestmontIL60559Imaging Center
St Thomas Hospice & Palliative Care
119 E Ogden AvenueHinsdaleIL60521Hospice Care
Adventist Hinsdale Family Medicine Ctr
135 North Oak StreetHinsdaleIL60521Family Medicine Center
Adventist Lab Partners
908 N Elm Street Ste 102HinsdaleIL60521Lab Service Center
Adventist Lab Partners
333 Chestnut StreetHinsdaleIL60521Lab Service Center
Adventist Lab Partners
412 63rd StreetDowners GroveIL60516Lab Service Center
Adventist Lab Partners
5101 S Willow Springs Rd 2nd FloorLa GrangeIL60525Lab Service Center
Adventist Lab Partners
908 N Elm Street Ste 210HinsdaleIL60521Lab Service Center
Adventist Lab Partners
15720 South Route 59PlainfieldIL60544Lab Service Center
Adventist Lab Partners
396 Remington Blvd Ste 310ABolingbrookIL60440Lab Service Center
Adventist Lab Partners
5207 Main StreetDowners GroveIL60515Lab Service Center
Adventist Paulson Rehab Hinsdale
222 E Ogden AvenueHinsdaleIL60521Outpatient Rehabilitation Facility
Adventist Lab Partners
303 Army Trail Road Ste 400BloomingdaleIL60108Lab Service Center
Adventist Lab Partners
7425 Janes Avenue Ste 205WoodridgeIL60517Lab Service Center
Adventist Lab Partners
7234 W Ogden AvenueRiversideIL60546Lab Service Center
Adventist Lab Partners
2425 W 22nd Street Ste 104OakbrookIL60523Lab Service Center
Adventist Lab Partners
2450 Wolf Road Ste 2GWestchesterIL60154Lab Service Center

Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)

ExplanationExplanationReturn ReferenceReturnReferenceIdentifierIdentifier
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 22 tax-exempt 501(c)(3) hospital organizations that operate 42 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.
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: Adventist Hinsdale Hospital (the Hospital) is involved with and supportive of various other community agencies 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. The Hospital participates with a number of other community organizations to address the healthcare needs of the community, such as the DuPage Health Coalition. The Hospital is supportive of other health and wellness programs currently conducted in its community, such as the Wellness House, a charitable organization formed to encourage, educate, and provide support to surviving cancer patients. The Hospital also participates in clinical drug and device research that is performed on patients who have a condition or disease for which the eventual commercial use of a drug or device is intended. This research is related to patient care and serves to expand scientific knowledge with respect to potential treatments and cures for various diseases and conditions.
Part III, Line 4: Bad Debt Expense: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. 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. 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 consolidated audited financial statements that addresses accounts receivable, the allowance for uncollectible accounts, and the provision for bad debts is as follows: Please note that dollar amounts are in thousands.The System's patient acceptance policy is based on its mission statement and its charitable purposes. Accordingly, the System accepts patients in immediate need of care, regardless of their ability to pay. The System serves certain patients whose medical care costs are not paid at established rates. These patients include those sponsored under government programs such as Medicare and Medicaid, those sponsored under private contractual agreements, charity patients and other uninsured patients who have limited ability to pay. A patient is classified as a charity patient based on the established policies of the System, which require that the patient provide certain information to qualify for charity. Patients that qualify for charity are provided services for which no payment is due for all or a portion of the patient's bill from either the patient or other third parties. For financial reporting purposes, charity care is excluded from patient service revenue.For all other patients, patient service revenue is reported at estimated net realizable amounts for services rendered. The System recognizes patient service revenue associated with patients who have third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for charity care, revenue is recognized on the basis of discounted rates in accordance with the System's policy.Patient service revenue is reduced by the provision for bad debts and accounts receivable are reduced by an allowance for uncollectible accounts. These amounts are based on management's assessment of historical and expected net collections for each major payor source, considering business and economic conditions, trends in healthcare coverage and other collection indicators. Management regularly reviews collections data by major payor sources in evaluating the sufficiency of the allowance for uncollectible accounts. On the basis of historical experience, a significant portion of the System's self-pay patients will be unable or unwilling to pay for the services provided. Thus, the System records a significant provision for bad debts in the period services are provided related to self-pay patients. The System's allowance for uncollectible accounts for self-pay patients was 97% of self-pay accounts receivable as of December 31, 2011 and 2010. For receivables associated with patients who have third-party coverage, the System analyzes contractually due amounts and provides an allowance for uncollectible accounts and a provision for bad debts, if necessary. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies.Patient service revenue is not recognized for those patients that qualify for charity under the System's policies. For all other patients, patient service revenue, net of contractual allowances and self-pay discounts and before the provision for bad debts, recognized from major payor sources for the year ended December 31, 2011, is as follows:Third-party payors, net of contractual allowances $6,687,698Self-pay patients, net of discounts 235,895 ---------- $6,923,593The System changed its uninsured discount policy, effective January 1, 2011, as required by the Patient Protection and Affordable Care Act (Act). The Act has resulted in an increase in self-pay discounts, which are a reduction of patient service revenue, and a corresponding decrease in self-pay write-offs that are included in the provision for bad debts. Overall, the total of self-pay discounts and write-offs has not changed significantly for the year ended December 31, 2011. The System has not experienced significant changes in write-off trends and has not changed its charity care policy for the year ended December 31, 2011.The System has determined, based on an assessment at the reporting-entity level, that patient service revenue is primarily recorded prior to assessing the patient's ability to pay and as such, the entire provision for bad debts is recorded as a deduction from patient service revenue in the accompanying consolidated statements of operations and changes in net assets. *** see continuation of footnote ***
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: 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.
Reconciliation of Schedule H Reported Medicare Surplus/(Shortfall) to Unreimbursed Medicare Costs Associated with the Provision of ServicesTo All Medicare Beneficiaries:The Medicare revenue and allowable costs of care reported in Section B of Part III of Schedule H are based upon the amounts reported in the filing organization's Medicare cost report in accordance with the IRS instructions for Schedule H. On an annual basis, the filing organization also determines its total unreimbursed costs associated with providing services to all Medicare patients. Unreimbursed costs are reported as a community benefit to the elderly and are included in the consolidated Adventist Health System (AHS or the Company) Community Benefits Report contained in the AHS Annual Report document. The primary reconciling items between the Medicare surplus/(shortfall) shown on line 7 of Section B of Part III of Schedule H and the filing organization's unreimbursed costs of services provided to Medicare patients as reported in the AHS Community Benefit Report are as follows:- Medicare surplus/(shortfall) shown on line 7 of Section B of Schedule H: $(10,412,501)- Difference in costing methodology: 2,472,322- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (9,274,903) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's community benefit reporting: $(17,215,082) As indicated above, the primary differences between the Medicare surplus/(shortfall) reported on Schedule H, Part III, Section B, line 7 and the filing organization's portion of the Company's annual community benefit statement is due to a difference in the costing methodology and differences in the population of Medicare patients within the calculation. The cost methodology utilized in calculating any Medicare surplus/(shortfall) for purposes of the annual community benefit reporting is based upon the cost-to-charge ratio outlined in Worksheet 2 of the Schedule H instructions. The same cost-to-charge ratio is used to determine the costs associated with services provided to charity care patients and Medicaid patients as reported in Schedule H, Part I, line 7. In addition, the Medicare cost report excludes services provided to Medicare patients for physician services, services provided to patients enrolled in Medicare HMOs, and certain services provided by outpatient departments of the filing organization that are reimbursed on a fee schedule. The Company's own community benefit statement captures the unreimbursed cost of providing services to all Medicare beneficiaries throughout the organization.Supplemental Schedule to Schedule H, Part III, Section B
Revenue from the Medicare and Medicaid programs represents approximately 36% and 35% of the System's patient service revenue for the years ended December 31, 2011 and 2010, respectively. Laws and regulations governing the Medicare and Medicaid programs are extremely complex and subject to interpretation. As a result, there is at least a reasonable possibility that recorded estimates will change by a material amount in the near term. Other than the accounts receivable related to the Medicare and Medicaid programs, there are no significant concentrations of accounts receivable due from an individual payor at December 31, 2011 and 2010.The System is subject to retroactive revenue adjustments due to future audits, reviews and investigations. Retroactive adjustments are considered in the recognition of revenue on an estimated basis in the period the related services are rendered, and such amounts are adjusted in future periods as adjustments become known or as years are no longer subject to such audits, reviews and investigations. Adjustments to revenue related to prior periods increased patient service revenue by approximately $46,600 and $29,500 for the years ended December 31, 2011 and 2010, respectively.Part III, Line 4 continuation of footnote:
Part V, Section B, Line 13g: The filing organziation 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.Adventist Hinsdale Hospital
Part V, Section B, Line 19d: 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.Adventist Hinsdale Hospital
Part VI, Line 2: The filing organization does not currently conduct any formal annual health care needs assessment. However, 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: Adventist Hinsdale Hospital 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 is located in Hinsdale, Illinois. It currently operates a hospital facility and is licensed for 302 beds. In addition to operating a hospital, the filing organization also operates 2 imaging centers, 1 outpatient rehabilitation facility, 1 behavioral health center, 1 vascular intervention center, and 1 family health medicine center within DuPage County. Adventist Hinsdale Hospital (the Hospital) is a crucial community and regional asset. It is the only teaching hospital in DuPage County, Illinois. Many of the medical staff members hold teaching positions at Chicago's premier medical schools and academic medical centers, and participate in medical research studies and clinical trials.The filing organization is home to many of its service area's first and latest in medical technology and research. The Hospital's Opler Cancer Center is one of the few in Illinois to offer tertiary-level cancer services, such as autologous bone marrow transplants. The Hospital's sleep lab is the only program accredited by the American Sleep Disorder Association in DuPage County. As noted above, the Hospital is the site of DuPage County's only physician teaching program. There are three competing hospitals within a radius of less than 10 miles from the filing organization's hospital. DuPage County is primarily a residential community located in the suburbs of the greater Chicago area. The Hospital's primary market has a population of approximately 294,000, with an estimated 47,000 over the age of 65. The weighted average household income, based on population, in the primary market is approximately $76,400. High school graduates account for approximately 92% of DuPage County, with an estimated 29% having a bachelor's degree or higher. It is estimated that 6% of the individuals residing in DuPage County live below the poverty level and the unemployment rate is about 6%. Approximately 40% of the Hospital's patients during 2011 were Medicare patients, about 8% were medicaid patients, about 2% were self-pay patients, and the remaining percentage were patients covered under commercial insurance. In 2011, about 50% 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 Hinsdale 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 information provided in Parts I, II and III of this Schedule H, the Hospital captures and reports the benefits provided to its community through faith-based care. Examples of such benefits include the cost associated with chaplaincy care programs and mission peer reviews and mission conferences. During the current year, the Hospital provided $809,606 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 $55,941,664 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 Hinsdale 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 42 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 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. 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.
ILPart VI, Line 7Reports Filed With States

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistanceMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistance
DuPage Health Coalition
511 Thornhill Drive Ste MCarol StreamIL60188364448208501(c)(3)570000General Support
Rotary Club of Hinsdale Foundation
PO Box 395HinsdaleIL60522364285727501(c)(3)15000General Support
Community House
415 W 8th StreetHinsdaleIL60521362167735501(c)(3)20000General Support
American Cancer Society Inc Illinois Division Inc
225 North Michigan AvenueChicagoIL60601362167721501(c)(3)10000General Support
Hinsdale Hospital Foundation Inc
7 Salt Creek LaneHinsdaleIL60521521466387501(c)(3)Provision of General Administrative Support642298COSTGeneral Administrative Support
March of Dimes Foundation
111 W Jackson BlvdChicagoIL60604131846366501(c)(3)10000General Support
Lake Union Conference of Seventh Day Adventist
PO Box 287Berrien SpringsMI49103381474933501(c)(3)13375General Support
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants7TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: Grants are generally made only to related organizations that are exempt from Federal Income Tax under 501(c)(3), 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, or to other 501(c)(3) community organizations involved in health-related causes. 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Discretionary Spending AccountXDiscretionarySpendingAccount
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org1CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (20 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Richard K Reiner
084831302409740603802013343045601017520330292670
David L Crane
0652992016483816781760520131272029977167811551310102999
Robert R Henderschedt
058387601721470294273010589703224901188442087688
Akram Y Razzouk MD
000020100000000201000000
Margaret Wade MD
022216302368245000603013372004500025982000
Brent G Snyder
057243901523010289677010168302040001136500071170
Ronald Wehtje
03171350543921140180343032081051211114063516201734
Rebecca Mathis
4579161486023280000985844933485502822810900
Michael Goebel
03034250291094022653603974504138340244019800
Gary Lipinski MD
03113410402850443080383730388160473123022091
Richard Carroll MD
03675340410510855120368660459740576937025309
Shevawn Tyrrell
02647840347730389460422490171820397934013793
Alan Schneider
0190366025373051328012238032229031153404369
William J Meyer MD
4224510177300000133430178650630959000
Megan L Koh MD
231351052027000133430144960311217000
Clara Lynne Carls MD
196465015288000113790303050253437000
Jack Overton Durley
14507201103100081420196560183901000
Leslie E Sleuwen
153684030000083650195720181921000
Janice Hagensicker
033000006485202118080417050548040703169025430
Susan Fowler
0121648014366012702194201185015926800

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 1aAs 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 two business trips each year. Typically, reimbursement is only provided to Vice Presidents and above and is limited to one business trip per year and the annual AHS President's Council business meeting. 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). Eligible executives include all 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: The AHS executive compensation philosophy is designed and administered to compensate executives for duties performed irrespective of geographic market differences. Certain AHS hospitals are located in communities where the cost of housing is significantly greater than in other hospital locations in AHS. Accordingly, AHS provides housing assistance in the form of a shared equity interest in a residence to eligible executives who are expected to live within the immediate proximity of hospital facilities located in high-cost communities. Under the AHS system-wide policy governing the employer-provided housing assistance, only four individuals are eligible to receive the housing benefit (an AHS regional CEO and CFO and two hospital CEOs). As with all AHSSHC Corporate Executive Policies, the housing benefit policy was authorized and approved by the AHSSHC Board Strategy & Compensation Committee, an independent committee of the AHSSHC Board of Directors. The appropriate annual dollar amount of the housing benefit provided to the above-described eligible executives is treated as taxable compensation to the employee. AHS reviews the overall compensation of its executives on an annual basis to ensure that the total compensation package is reasonable. 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 4bAs 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 $204,000. 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 hospital 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 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. Flex Plan/ Flex Plan/ SERP 457(b) CY 457(f) CY 457(f) CY Contrib./ Distributions Employer Distributions Payment Contrib. ------------------------------------------------------- Richard K. Reiner $173,337 $476,453 $ 54,621 $0 David L. Crane $117,929 $103,345 $0 $0 Robert R. Henderschedt $109,054 $100,738 $104,326 $0 Brent G. Snyder $104,840 $ 71,369 $148,788 $0 Ronald Wehtje $ 40,138 $ 2,008 $0 $0 Gary Lipinski, MD $ 33,373 $ 26,379 $0 $0 Richard Carroll, MD$ 40,023 $ 30,966 $0 $0 Shevawn Tyrrell $ 28,906 $ 16,004 $0 $0 Alan Schneider $0 $ 5,119 $0 $0 Michael Goebel $ 31,302 $0 $0 $0 Janice Hagensicker $ 44,862 $ 25,492 $0 $0
Part I, Line 5The filing organization's physician compensation formula is designed to result in total compensation that would be reasonable for each physician. Since implementing the productivity-based incentive compensation model, the financial losses from the operations of organization's physician practices have significantly decreased, and established physician practices have generally become profitable. The filing organization utilizes national survey productivity, cost, and compensation data in formulating all aspects of the compensation plan. Physician compensation arrangements include a ceiling or reasonable maximum on the amount a physician may earn. The filing organization's employed physicians enter into a written agreement that requires the physicians to provide medical care to individuals who are referred by the filing organization. Pursuant to the agreement, an individual may not be rejected as a patient by a physician due to race, sex, age, color, creed, national origin or inability to pay. The filing organization's compensation arrangement does not use a method of compensation that is based upon a percentage of the organization's net income. Rather, under the compensation arrangement, physician base salary is set based on Fair Market Value benchmarks, and any additional compensation is based on a percentage of the practice/location net collections.
Part IIIPart 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.Supplemental Information

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Debra Rettig
Family member of board member56209Employee Compensation0
Maureen Trunk
Family member of board member51187Employee Compensation0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 2Peter O'Connor and David Crane - Business Relationship Peter O'Connor and Ronald Wehtje - Business Relationship
Form 990, Part VI, Section A, line 4The ByLaws were amended to provide that one of the responsibilities of the Board of Directors is to establish a process for addressing patient grievances, including resolving the grievance unless delegated by the Board to a Grievance committee or similar body.
Form 990, Part VI, Section A, line 6Adventist Hinsdale Hospital (the filing organization) has one member. The sole member of the filing organization is Adventist Health System/Sunbelt, Inc. (AHSSI). AHSSI is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). There are no other classes of membership in the filing organization.
Form 990, Part VI, Section A, line 7aThe sole member of the filing organization is AHSSI. The Board of Directors of the filing organization are appointed by the sole member, AHSSI, who has the right to elect, appoint or remove any member of the Board of Directors of the filing organization.
Form 990, Part VI, Section A, line 7bAHSSI, as the sole member of the filing organization, has certain reserved powers as set forth in the Bylaws of the filing organization. These reserved powers include the following: a) to approve or disapprove the executive and/or administrative leadership of the filing organization, and their salaries; b) to approve or disapprove the Bylaws of the filing organization; c) to set limits and terms for the borrowing of funds; d) to approve or disapprove major building programs and/or purchase or sale of personal property or real property equal to or in excess of one million dollars; e) to approve or disapprove the annual operating and capital budgets of the filing organization; f) to direct the placement of funds and capital of the filing organization; g) to establish general guiding policies; and h) to approve or disapprove opening or closing of facilities or major changes in operation of the filing organization.
Form 990, Part VI, Section B, line 11The 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 12cThe 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 15The top-tier parent 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 19As 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, Column (B)The members of the Board of Directors (not including physician members of the Board), officers, and key employees who received compensation from a related organization as shown in column (E) and (F) of Section A each devote approximately 50 hours per week in conjunction with serving in their respective executive leadership position within Adventist Health System. Physician members of the Board of Directors received compensation from related organizations as a result of providing various medical services to those related entities. The following physician members of the Board of Directors devoted the approximate number of hours per week below to related organizations: Dr. Korpics - 4.00; Dr. Lagattuta - 8.00; and Dr. Wade - 40.00
Form 990, Part XI, line 5:Net unrealized gains on investments: 30,316. Prior period adjustments: -925,145. Change in Interest from Foundation -738,708. Allocation from Tax-Exempt Parent with respect to debt 394,556. Transfer to Tax-Exempt Parent -1,803,081. Gifts 1,950,649. Released from Restricted -642,328. Total to Form 990, Part XI, Line 5: -1,733,741.Changes in Net Assets or Fund Balances:
Part VII, Section AFor those Board of Director members (not including physician members of the board), officer(s) and key employees who devote less than full-time to the filing organization (based upon the average number of hours per week shown in column (B) on page 7 of the return) the compensation amounts shown in columns (E) and (F) on page 7 were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position within Adventist Health System. Physician members of the Board of Directors received compensation from related organizations as a result of providing various medical services to those related entities.
Part X, Line 2The amounts shown on line 2 of Part X of this return include the filing organization's interest in a central investment pool maintained by Adventist Health System Sunbelt Healthcare Corporation, the filing organization's top-tier parent. The investments in the central investment pool are recorded at market value.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (107 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
Adventist Bolingbrook Hospital
500 Remington BlvdBolingbrookIL60440651219504Operation of Hospital & Related ServicesIL501(c)(3)170(b)(1)(A)(iii)Adventist Hlth SystemSunbelt Inc0
Adventist Care Centers - Courtland Inc
730 Courtland StreetOrlandoFL32804205774723Operation of Home for the Aged/Hlthcare DeliveryFL501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Adventist GlenOaks Hospital
701 Winthrop AvenueGlendale HeightsIL60139363208390Operation of Hospital & Related ServicesIL501(c)(3)170(b)(1)(A)(iii)Adventist Hlth SystemSunbelt Inc0
Adventist Hlth Mid-America Inc
9100 W 74th StreetShawnee MissionKS66204521347407Hlthcare Related ServicesKS501(c)(3)509(a)(3) Type IAdventist Hlth SystemSunbelt Inc0
Adventist Hlth Partners Inc
1000 Remington Blvd Ste 200BolingbrookIL60440364138353Operate out-patient physician clinicsIL501(c)(3)170(b)(1)(A)(iii)AHS Midwest Management Inc0
Adventist Hlth System Affiliated Benefit Trust
111 N Orlando AvenueWinter ParkFL32789266422966Promotion of HlthcareFL501(c)(3)509(a)(3) Type IAdventist Hlth System Sunbelt Hlthcare Corp0
Adventist Hlth System Sunbelt Hlthcare Corp
111 N Orlando AvenueWinter ParkFL32789592170012Management ServicesFL501(c)(3)509(a)(3) Type I0N/A
Adventist Hlth SystemGeorgia Inc
1035 Red Bud RoadCalhounGA30701581425000Operation of Hospital & Related ServicesGA501(c)(3)170(b)(1)(A)(iii)Adventist Hlth System Sunbelt Hlthcare Corp0
Adventist Hlth SystemSunbelt Inc
111 N Orlando AvenueWinter ParkFL32789591479658Operation of Hospital & Related ServicesFL501(c)(3)170(b)(1)(A)(iii)Adventist Hlth System Sunbelt Hlthcare Corp0
Adventist Hlth SystemTexas Inc
602 Courtland StreetOrlandoFL32804742578952InactiveTX501(c)(3)509(a)(2)Adventist Hlth System Sunbelt Hlthcare Corp0
Adventist Hinsdale Hospital
120 North Oak StreetHinsdaleIL60521362276984Operation of Hospital & Related ServicesIL501(c)(3)170(b)(1)(A)(iii)Adventist Hlth SystemSunbelt Inc0
AHS Midwest Management Inc
1000 Remington Blvd Ste 200BolingbrookIL60440363354567Operation of Physician Practice MgmtIL501(c)(3)509(a)(3) Type IAdventist Hlth SystemSunbelt Inc0
AHSCentral Texas Inc
1301 Wonder World DriveSan MarcosTX78666742621825Provide Office Space - Medical ProfessionalsTX501(c)(3)509(a)(3) Type III-FAdventist Hlth System Sunbelt Hlthcare Corp0
Apopka Hlth Care Properties Inc
305 E Oak StreetApopkaFL32703510605694Lease to Related OrganizationGA501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
Battle Creek Adventist Hospital
1000 Remington Blvd Ste 200BolingbrookIL60440381359189InactiveMI501(c)(3)170(b)(1)(A)(iii)Adventist Hlth SystemSunbelt Inc0
Bert Fish Medical Center Inc (10110-63011)
401 Palmetto StreetNew Smyrna BeachFL32168362276984Operation of Hospital & Related ServicesFL501(c)(3)170(b)(1)(A)(iii)Adventist Hlth System Sunbelt Hlthcare Corp0
Bolingbrook Hospital Foundation
1000 Remington Blvd N Entrance 2ndBolingbrookIL60440900494445Fund-raising for Tax-exempt hospitalIL501(c)(3)170(b)(1)(A)(vi)Midwest Hlth Foundation0
Bradford Heights Hlth & Rehab Center Inc
950 Highpoint DriveHopkinsvilleKY42240205782342Operation of Home for the Aged/Hlthcare DeliveryKY501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Burleson Nursing & Rehab Center Inc
301 Huguley BlvdBurlesonTX76028205782243Operation of Home for the Aged/Hlthcare DeliveryTX501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Caldwell Hlth Care Properties Inc
1333 West MainPrincetonKY42445510605680Lease to Related OrganizationGA501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
Central Texas Hlthcare Collaborative (112-123111)
1301 Wonder World DriveSan MarcosTX78666453739929Support Operation of HospitalTX501(c)(3)509(a)(3) Type IAdventist Hlth SystemSunbelt Inc0
Cedar Crag Terrace Inc (630 Year End)
Rt 5 Box 900ManchesterKY40962611120442Operation of Home for the elderly-disabledKY501(c)(3)170(b)(1)(A)(vi)Memorial Hospital Inc0
Central Texas Medical Center Foundation
1301 Wonder World DriveSan MarcosTX78666742259907Fund-raising for Tax-exempt hospitalTX501(c)(3)170(b)(1)(A)(vi)Adventist Hlth SystemSunbelt Inc0
Chickasaw Hlth Care Properties Inc
250 S Chickasaw TrailOrlandoFL32825510605681Lease to Related OrganizationGA501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
Chippewa Valley Hospital & Oakview Care Center Inc
1220 Third Avenue WestDurandWI54736391365168Operation of Hospital & Related ServicesWI501(c)(3)170(b)(1)(A)(iii)Adventist Hlth SystemSunbelt Inc0
Cobb Medical Associates LLC
3949 South Cobb Drive SESmyrnaGA300806342582617089Operation of Physician Practices & Medical ServicesGA501(c)(3)170(b)(1)(A)(iii)Emory-Adventist Inc0
Courtland Hlth Care Properties Inc
730 Courtland StreetOrlandoFL32804510605682Lease to Related OrganizationGA501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
Creekwood Place Nursing & Rehab Center Inc
683 E Third StreetRussellvilleKY42276205782260Operation of Home for the Aged/Hlthcare DeliveryKY501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Dairy Road Hlth Care Properties Inc
7350 Dairy RoadZephyrhillsFL33540510605684Lease to Related OrganizationGA501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
East Orlando Hlth & Rehab Center Inc
250 S Chickasaw TrailOrlandoFL32825205774748Operation of Home for the Aged/Hlthcare DeliveryFL501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Emory-Adventist Inc
3949 South Cobb DriveSmyrnaGA30080582171011Operation of Hospital & Related SvcsGA501(c)(3)170(b)(1)(A)(iii)Adventist Hlth SystemSunbelt Inc0
Fletcher Hospital Inc
100 Hospital DriveHendersonvilleNC28792560543246Operation of Hospital & Related SvcsNC501(c)(3)170(b)(1)(A)(iii)Adventist Hlth System Sunbelt Hlthcare Corp0
FLNC Inc
3355 E Semoran BlvdApopkaFL32703205774761Operation of Home for the Aged/Hlthcare DeliveryFL501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Florida Hospital College of Hlth Sciences Inc (630 Year End)
671 Lake Winyah DriveOrlandoFL32803593069793Education/Operation of SchoolFL501(c)(3)170(b)(1)(A)(ii)Adventist Hlth SystemSunbelt Inc0
Florida Hospital DeLand Auxiliary Inc (11-82411)
701 West Plymouth AvenueDelandFL32720593425543Volunteer support servicesFL501(c)(3)509(a)(3) Type III-FMemorial Hospital West Volusia Inc0
Florida Hospital Waterman Inc
1000 Waterman WayTavaresFL32778593140669Operation of Hospital & Related ServicesFL501(c)(3)170(b)(1)(A)(iii)Adventist Hlth System Sunbelt Hlthcare Corp0
Florida Hospital Zephyrhills Inc
7050 Gall BlvdZephyrhillsFL33541592108057Operation of Hospital & Related ServicesFL501(c)(3)170(b)(1)(A)(iii)Adventist Hlth SystemSunbelt Inc0
Florida Hospital Medical Group Inc
900 Winderley PlaceMaitlandFL32751593214635Operation of Physician Practices & Medical ServicesFL501(c)(3)170(b)(1)(A)(iii)Adventist Hlth SystemSunbelt Inc0
Foundation for Shawnee Mission Medical Center Inc
9100 W 74th StreetShawnee MissionKS66204480868859Fund-raising for Tax-exempt hospitalKS501(c)(3)509(a)(3) Type IShawnee Mission Medical Center Inc0
GlenOaks Hospital Foundation
701 Winthrop AvenueGlendale HeightsIL60139363926044Fund-raising for Tax-exempt hospitalIL501(c)(3)170(b)(1)(A)(vi)Midwest Hlth Foundation0
Hays Memorial Hospital Association of Seventh-Day Adventists
1301 Wonder World DriveSan MarcosTX78667741362785Lease of Hospital PersonnelTX501(c)(3)509(a)(3) Type IIAdventist Hlth System Sunbelt Hlthcare Corp0
Helen Ellis Memorial Hospital Auxiliary Inc
1395 S Pinellas AveTarpon SpringsFL34689592106043Fund-raising for Tax-exempt hospital/foundationFL501(c)(3)509(a)(3) Type ITarpon Springs Hospital Foundation Inc0
Helen Ellis Memorial Hospital Foundation Inc
1395 S Pinellas AveTarpon SpringsFL34689593690149Fund-raising for Tax-exempt hospitalFL501(c)(3)509(a)(3) Type ITarpon Springs Hospital Foundation Inc0
Hinsdale Hospital Foundation
7 Salt Creek Lane Suite 203HinsdaleIL60521521466387Fund-raising for Tax-exempt hospitalIL501(c)(3)170(b)(1)(A)(vi)Midwest Hlth Foundation0
Huguley Community Care Corp
11801 South FreewayBurlesonTX76028452793120Support Operation of HospitalTX501(c)(3)509(a)(3) Type IAdventist Hlth SystemSunbelt Inc0
In-Motion Rehab Inc
602 Courtland Street Ste 200OrlandoFL32804208023411Therapy services to tax exempt nursing homesKS501(c)(3)509(a)(3) Type IISunbelt Hlth Care Centers Inc0
Jellico Community Hospital Inc
188 Hospital LaneJellicoTN37762620924706Operation of Hospital & Related ServicesTN501(c)(3)170(b)(1)(A)(iii)Adventist Hlth System Sunbelt Hlthcare Corp0
La Grange Memorial Hospital Foundation
5101 S Willow Springs RdLa GrangeIL60525300247776Fund-raising for Tax-exempt hospitalIL501(c)(3)170(b)(1)(A)(vi)Midwest Hlth Foundation0
Memorial Hlth Systems Foundation Inc
770 West Granada BlvdOrmond BeachFL32174311771522Fund-raising for Tax-exempt hospitalFL501(c)(3)170(b)(1)(A)(vi)Memorial Hlth Systems Inc0
Memorial Hlth Systems Inc
301 Memorial Medical ParkwayDaytona BeachFL32117590973502Operation of Hospital & Related ServicesFL501(c)(3)170(b)(1)(A)(iii)Adventist Hlth SystemSunbelt Inc0
Memorial Hospital Flagler Inc
60 Memorial Medical ParkwayPalm CoastFL32164592951990Operation of Hospital & Related ServicesFL501(c)(3)170(b)(1)(A)(iii)Memorial Hlth Systems Inc0
Memorial Hospital - West Volusia Inc
701 West Plymouth AvenueDelandFL32720593256803Operation of Hospital & Related ServicesFL501(c)(3)170(b)(1)(A)(iii)Memorial Hlth Systems Inc0
Memorial Hospital Inc
210 Marie Langdon DriveManchesterKY40962610594620Operation of Hospital & Related ServicesKY501(c)(3)170(b)(1)(A)(iii)Adventist Hlth System Sunbelt Hlthcare Corp0
Merriam Hlth Care Properties Inc
9700 West 62nd StreetMerriamKS66203364595806Lease to Related OrganizationKS501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
Metroplex Adventist Hospital Inc
2201 S Clear Creek RoadKilleenTX76549742225672Operation of Hospital & Related ServicesTX501(c)(3)170(b)(1)(A)(iii)Adventist Hlth System Sunbelt Hlthcare Corp0
Metroplex Clinic Physicians Inc
2201 S Clear Creek RoadKilleenTX76549113762050Physician Hlthcare services to the communityTX501(c)(3)170(b)(1)(A)(iii)Metroplex Adventist Hospital Inc0
Midwest Hlth Foundation
120 North Oak StreetHinsdaleIL60521352230515Support of subsidiary FoundationsIL501(c)(3)509(a)(3) Type II0N/A
Mills Hlth & Rehab Center Inc
500 Beck LaneMayfieldKY42066205782320Operation of Home for the Aged/Hlthcare DeliveryKY501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Mission Strategies Inc
602 Courtland Street Ste 200OrlandoFL32804205982365Provision of support to the nursing home divisionKS501(c)(3)509(a)(3) Type IISunbelt Hlth Care Centers Inc0
Mission Strategies of Georgia Inc (1114-123111)
3949 S Cobb DriveSmyrnaGA30080900866024Provision of support to the nursing home divisionGA501(c)(3)509(a)(3) Type IISunbelt Hlth Care Centers Inc0
Missouri Adventist Hlth Inc
9100 W 74th StreetShawnee MissionKS66204431224729Support Hlth Care ServicesMO501(c)(3)509(a)(3) Type III-OAdventist Hlth Mid-America Inc0
North Regional EMS Inc
188 Hospital LaneJellicoTN37762262653616EMS ServicesTN501(c)(3)509(a)(2)Jellico Community Hospital Inc0
Ormond Beach Memorial Hospital Auxiliary Inc
301 Memorial Medical ParkwayDaytona BeachFL32117591721962Volunteer support servicesFL501(c)(3)509(a)(3) Type III-FMemorial Hlth Systems Inc0
Overland Park Nursing & Rehab Center Inc
6501 West 75th StreetOverland ParkKS66204205774821Operation of Home for the Aged/Hlthcare DeliveryKS501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Paragon Hlth Care Properties Inc
950 Highpoint DriveHopkinsvilleKY42240510605686Lease to Related OrganizationGA501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
Pasco-Pinellas Hillsborough Community Hlth System Inc
2400 Bedford RoadOrlandoFL32803208488713Operation of Hospital & Related ServicesFL501(c)(3)170(b)(1)(A)(iii)0N/A
Portercare Adventist Hlth System (630 Year End)
2525 S Downing StreetDenverCO80210840438224Operation of Hospital & Related ServicesCO501(c)(3)170(b)(1)(A)(iii)Adventist Hlth System Sunbelt Hlthcare Corp0
Portland Nursing & Rehab Center Inc
215 Highland Circle DrivePortlandTN37148205774842Operation of Home for the Aged/Hlthcare DeliveryTN501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Princeton Hlth & Rehab Center Inc
1333 West MainPrincetonKY42445205782272Operation of Home for the Aged/Hlthcare DeliveryKY501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Princeton Professional Services Inc
601 E Rollins StreetOrlandoFL32803591191045Provision of Hlthcare ServicesFL501(c)(3)509(a)(2)Adventist Hlth System Sunbelt Hlthcare Corp0
Quality Circle for Hlthcare Inc
111 N Orlando AvenueWinter ParkFL32789263789368Hlthcare Quality ServicesFL501(c)(3)509(a)(3) Type III-FAdventist Hlth System Sunbelt Hlthcare Corp0
Resource Personnel Inc
602 Courtland Street Ste 200OrlandoFL32804208040875Provide administrative support to tax exempt nursing homesFL501(c)(3)509(a)(3) Type IISunbelt Hlth Care Centers Inc0
Rocky Mountain Adventist Hlthcare Foundation (630 Year End)
2525 South Downing StreetDenverCO80210840745018Fund-raising for Tax-exempt hospitalCO501(c)(3)170(b)(1)(A)(vi)PorterCare Adventist Hlth System0
Rollins Bedford Corp
602 Courtland Street Ste 200OrlandoFL32804370908840InactiveFL501(c)(3)509(a)(3) Type IISunbelt Hlth Care Centers Inc0
Russellville Hlth Care Properties Inc
683 East Third StreetRussellvilleKY42276510605691Lease to Related OrganizationGA501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
San Marcos Hlth Care Properties Inc
1900 Medical ParkwaySan MarcosTX78666510605693Lease to Related OrganizationGA501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
San Marcos Nursing & Rehab Center Inc
1900 Medical ParkwaySan MarcosTX78666205782224Operation of Home for the Aged/Hlthcare DeliveryTX501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Shawnee Mission Hlth Care Inc
6501 West 75th StreetOverland ParkKS66204480952508Lease to Related OrganizationKS501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
Shawnee Mission Medical Center Inc
9100 W 74th StreetShawnee MissionKS66204480637331Operation of Hospital & Related ServicesKS501(c)(3)170(b)(1)(A)(iii)Adventist Hlth Mid-America Inc0
South Central Nursing Homes Properties Inc
111 North Orlando AveWinter ParkFL32789593686109Management SupportGA501(c)(3)509(a)(3) Type III-OSouth Central Inc0
South Central Nursing Homes Inc
602 Courtland StreetOrlandoFL32804611242373Management SupportKY501(c)(3)509(a)(3) Type III-OSouth Central Inc0
South Central Properties III Inc
111 North Orlando AveWinter ParkFL32789593692860Real EstateGA501(c)(2)South Central Nursing Homes Properties Inc0
South Central Properties IV Inc
111 North Orlando AveWinter ParkFL32789593692862Real EstateGA501(c)(2)South Central Nursing Homes Properties Inc0
South Central Properties VI Inc
111 North Orlando AveWinter ParkFL32789593692857Real EstateGA501(c)(2)South Central Nursing Homes Properties Inc0
South Central Properties Inc
111 North Orlando AveWinter ParkFL32789593651692Real EstateGA501(c)(2)South Central Nursing Homes Properties Inc0
South Central Inc
602 Courtland StreetOrlandoFL32804593689740Management SupportGA501(c)(3)509(a)(3) Type III-F0N/A
South Pasco Hlth Care Properties Inc
38250 A AvenueZephyrhillsFL33542510605679Lease to Related OrganizationGA501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
Southwest Volusia Hlth Services Inc
1055 Saxon BlvdOrange CityFL327638468593281591Medical Office Building for HospitalFL501(c)(3)509(a)(3) Type ISouthwest Volusia Hlthcare Corp0
Southwest Volusia Hlthcare Corp
1055 Saxon BlvdOrange CityFL327638468593149293Operation of Hospital & Related ServicesFL501(c)(3)170(b)(1)(A)(iii)Adventist Hlth SystemSunbelt Inc0
Specialty Physicians of Central Texas Inc
1301 Wonder World DriveSan MarcosTX78666208814408Physician Hlthcare services to the communityTX501(c)(3)170(b)(1)(A)(iii)Adventist Hlth SystemSunbelt Inc0
Spring View Hlth & Rehab Center Inc
718 Goodwin LaneLeitchfieldKY42754205782288Operation of Home for the Aged/Hlthcare DeliveryKY501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Sunbelt Hlth & Rehab Center - Apopka Inc
305 East Oak StreetApopkaFL32703205774856Operation of Home for the Aged/Hlthcare DeliveryFL501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Sunbelt Hlth Care Centers Inc
602 Courtland Street Ste 200OrlandoFL32804581473135Management ServicesTN501(c)(3)509(a)(3) Type IIAdventist Hlth System Sunbelt Hlthcare Corp0
SunSystem Development Corp
111 N Orlando AvenueWinter ParkFL32789592219301Fund Raising for Affiliated Tax-Exempt HospitalsFL501(c)(3)170(b)(1)(A)(vi)Adventist Hlth System Sunbelt Hlthcare Corp0
Tarpon Springs Hospital Foundation Inc
1395 S Pinellas AveTarpon SpringsFL34689590898901Operation of Hospital & Related ServicesFL501(c)(3)170(b)(1)(A)(iii)University Community Hospital Inc0
Tarrant County Hlth Care Properties Inc
301 Huguley BlvdBurlesonTX76028510605677Lease to Related OrganizationGA501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
Taylor Creek Hlth Care Properties Inc
718 Goodwin LaneLeitchfieldKY42754510605678Lease to Related OrganizationGA501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
Texas Hlth Huguley Inc (76-123111)
900 Hope WayAltamonte SpringsFL32714452694620Operation of Hospital & Related ServicesFL501(c)(3)170(b)(1)(A)(iii)Adventist Hlth SystemSunbelt Inc0
The Volunteer Auxiliary of Florida Hospital - Flagler Inc
60 Memorial Medical ParkwayPalm CoastFL32164592486582Volunteer support servicesFL501(c)(3)509(a)(3) Type III-FMemorial Hospital Flagler Inc0
Trinity Nursing & Rehab Center Inc
9700 West 62nd StreetMerriamKS66203205774890Operation of Home for the Aged/Hlthcare DeliveryKS501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
University Community Hospital Auxiliary Inc
3100 E Fletcher AveTampaFL33613237011345Volunteer support servicesFL501(c)(3)509(a)(3) Type III-FUniversity Community Hospital Inc0
University Community Hospital Foundation Inc
3100 E Fletcher AveTampaFL33613592554889Fund-raising for Tax-exempt hospitalFL501(c)(3)509(a)(3) Type IUniversity Community Hospital Inc0
University Community Hospital Specialty Care Inc
3100 E Fletcher AveTampaFL33613593231322InactiveFL501(c)(3)509(a)(3)University Community Hospital Inc0
University Community Hospital Inc
3100 E Fletcher AveTampaFL33613591113901Operation of Hospital & Related ServicesFL501(c)(3)170(b)(1)(A)(iii)Adventist Hlth System Sunbelt Hlthcare Corp0
West Kentucky Hlth Care Properties Inc
500 Beck LaneMayfieldKY42066510605676Lease to Related OrganizationGA501(c)(3)509(a)(3) Type III-FSunbelt Hlth Care Centers Inc0
Zephyr Haven Hlth & Rehab Center Inc
38250 A AvenueZephyrhillsFL33542205774930Operation of Home for the Aged/Hlthcare DeliveryFL501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0
Zephyrhills Hlth & Rehab Center Inc
7350 Dairy RoadZephyrhillsFL33540205774967Operation of Home for the Aged/Hlthcare DeliveryFL501(c)(3)509(a)(2)Sunbelt Hlth Care Centers Inc0

Form990 Schedule R Part III Form990ScheduleRPartIII (10 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
Appalachian Therapy Services LLC
100 Hospital DriveHendersonvilleNC28792202463851Therapy StaffingNCN/A
Central Texas Medical Center Bond LLC (11-111411)
1301 Wonder World DriveSan MarcosTX78666204314236InvestmentTXN/A
Clear Creek MOB Ltd
2201 S Clear Creek RdKilleenTX76549742609195Real EstateTXN/A
Florida Hospital DMERT LLC
2450 Maitland Center Pkwy Ste 200MaitlandFL32751202392253Medical EquipmentFLN/A
Florida Hospital Home Infusion
2450 Maitland Center Pkwy Ste 200MaitlandFL32751593142824Home Infusion ServicesFLN/A
KCCCSMMC Cancer Center LLC
9100 W 74th StreetShawnee MissionKS66204270909763Equipment RentalKSN/A
San Marcos MRI LP
1330 Wonder World Drive Ste 202San MarcosTX78666770597972Imaging & TestingTXN/A
Shawnee Mission Open MRI LLC
9100 W 74th Street Box 2923Shawnee MissionKS66201270011796Imaging & TestingKSN/A
Shawnee Mission Surgery Center LLC
PO Box 2923Shawnee MissionKS66201481243914Surgical ServicesKSN/A
Skyland MRI LLC
100 Hospital DriveHendersonvilleNC28792043646559Imaging & TestingNCN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (32 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityAddress Line1AddressForeign/AddressLine1Province Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryLegal Domicile Foreign CountryLegalDomicileForeignCountry
Adventist Hlth Sys Sunbelt Hlthcare Corp Empl Benefit Trust
111 N Orlando AvenueWinter ParkFL32789581318939Administration of Self-Insured Benefit PlansFLN/AT
AHS Services Inc
11801 South FreewayFort WorthTX76028752049583Medical EquipmentTXN/AC
Altamonte Medical Plaza Condominium Association Inc
601 East Rollins StreetOrlandoFL32803592855792Condo AssociationFLN/AC
Apopka Medical Plaza Condominium Association Inc
601 East Rollins StreetOrlandoFL32803593000857Condo AssociationFLN/AC
Arapahoe Medical Building I Inc (630 Year End)
2525 S Downing StreetDenverCO80210841574506Real Estate LeasingCON/AC
Arapahoe Medical Building II Inc (630 Year End)
2525 S Downing StreetDenverCO80210841574507Real Estate LeasingCON/AC
CC MOB Inc
2201 S Clear Creek RoadKilleenTX76549742616875Real Estate RentalTXN/AC
Central Texas Medical Associates
1301 Wonder World DriveSan MarcosTX78666742729873Physician ClinicsTXN/AC
Central Texas Provider's Network
1301 Wonder World DriveSan MarcosTX78666742827652Physician Hospital Org.TXN/AC
Florida Hospital Flagler Medical Offices Association Inc
60 Memorial Medical ParkwayPalm CoastFL32164262158309Condo AssociationFLN/AC
Florida Hospital Healthcare System Inc
602 Courtland StreetOrlandoFL32804593215680PHO/TPAFLN/AC
Florida Medical Plaza Condo Association Inc
601 East Rollins StreetOrlandoFL32803592855791Condo AssociationFLN/AC
Florida Memorial Health Network Inc
770 W Granada Blvd Ste 317Ormond BeachFL32174593403558Physician Hospital Org.FLN/AC
Harvard Park East Inc (630 Year End)
2525 S Downing StreetDenverCO80210841574365Real Estate LeasingCON/AC
Helen Ellis Memorial Hospital Real Estate Corp
1395 S Pinellas AveTarpon SpringsFL34689593375731Real Estate RentalFLN/AC
Huguley Alliance Foundation
11801 South FreewayFort WorthTX76115752642209InactiveTXN/AC
Huguley Medical Associates Inc
11801 South FreewayBurlesonTX76028752547668Physician ClinicsTXN/AC
Kissimmee Multispecialty Clinic Condominium Association Inc
201 Hilda Street Suite 30KissimmeeFL34741593539564Condo AssociationFLN/AC
Midwest Management Services Inc
9100 West 74th StreetShawnee MissionKS66204480901551Real Estate RentalKSN/AC
Metroplex Adventist Hospital CRNA
2201 S Clear Creek RoadKilleenTX76549260760794Support hospital - provide allied health professionalsTXN/AC
North American Health Services Inc & Subs
111 N Orlando AvenueWinter ParkFL32789621041820Lessor/Holding Co.TNN/AC
Ormond Professional Condo Association (430 Year End)
770 W Granada Blvd Ste 101Ormond BeachFL32174592694434Condo AssociationFLN/AC
Park Ridge Property Owner's Association Inc
1 Park Place Naples RoadFletcherNC28732030380531Condo AssociationNCN/AC
Porter Affiliated Hlth Services Inc dba Diversified Affiliated Hlth Svcs
2525 S Downing StreetDenverCO80210840956175Healthcare ServicesCON/AC
Porter Medical Plaza Inc (630 Year End)
2525 S Downing StreetDenverCO80210841574369Real Estate LeasingCON/AC
San Marcos Regional MRI Inc
1301 Wonder World DriveSan MarcosTX78666770597968Holding CompanyTXN/AC
Southeast Volusia Medical Services Inc (10110-63011)
401 Palmetto StreetNew Smyrna BeachFL32168593287185InactiveFLN/AC
The Garden Retirement Community Inc
602 Courtland Street Ste 200OrlandoFL32804593414055Real Estate RentalFLN/AC
University Community Health Insurance Company SPC Ltd
Captive InsuranceN/ACC/O AON Insurance Managers PO BoxGrand CaymanCJCJ
UCH Services Inc
3100 East Fletcher AveTampaFL33613593508454Management CompanyFLN/AC
West Coast Medical Group Inc
1395 S Pinellas AveTarpon SpringsFL34689593537305Physician ClinicsFLN/AC
Winter Park Medical Office Building I Condo Assoc Inc (330-123111)
200 Lakemont AveWinter ParkFL32792452228478Physician ClinicsFLN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (24 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Hinsdale Hospital Foundation
C1962675Actual Amount Received
Hinsdale Hospital Foundation
B642298Actual Amount Given
Chippewa Valley Hospital & Oakview Care Center Inc
O236565Cost
Chippewa Valley Hospital & Oakview Care Center Inc
K524765Cost Plus
Chippewa Valley Hospital & Oakview Care Center Inc
P1265691Cost
Adventist GlenOaks Hospital
L5701240Cost Plus
Adventist GlenOaks Hospital
O1730517Cost
Adventist GlenOaks Hospital
P7952815Cost
Adventist Bolingbrook Hospital
L6729413Cost Plus
Adventist Bolingbrook Hospital
O3796720Cost
Adventist Bolingbrook Hospital
K2247983Cost Plus
Adventist Bolingbrook Hospital
P10478699Cost
Adventist Health SystemSunbelt Inc dba La Grange Memorial Hospital
L10574687Cost Plus
Adventist Health SystemSunbelt Inc dba La Grange Memorial Hospital
O6411221Cost
Adventist Health SystemSunbelt Inc dba La Grange Memorial Hospital
P15703619Cost
North American Health Services Inc & Subs
P85200Cost
Adventist Health Partners
O6073609Cost
Adventist Health Partners
P3036590Cost
Adventist Health System Sunbelt Healthcare Corporation
L2606139% of Facility's Operating Expense
Adventist Health System Sunbelt Healthcare Corporation dba AHS IS
L9490255% of Facility's Operating Expense
Adventist Health System Sunbelt Healthcare Corporation
O12962904Cost
Adventist Health System Sunbelt Healthcare Corporation
B1803081Actual Amount Given
AHS Midwest Management Inc
L652395Cost Plus
Adventist Health SystemSunbelt Inc dba Florida Hospital
O90130Cost

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