2011-11-15T14:16:20-06:00 2010-12-31 990 2010-01-01 592170012 Adventist Health System Sunbelt Healthcare Corporation ADVE 4079753791 111 N Orlando Avenue Winter Park FL 32789 Lynn C Addiscott 4079751492 2011-11-15 2010 2016-03-07 17:11:31Z Don Jernigan 111 N Orlando Avenue Winter Park FL 32789 402753944 0 1071 X www.adventisthealthsystem.com X 1981 FL Provision of executive leadership and other professional support services to subsidiaries. 60 48 1174 0 854229 402862 11000 15600 237403300 271759270 145513234 130958092 150000 20982 383077534 402753944 1450414 12174111 0 0 156327309 163818310 0 0 0 231549946 233610267 389327669 409602688 -6250135 -6848744 3842177543 4206807275 3692760595 4055262556 149416948 151544719 Adventist Health System Sunbelt Healthcare Corporation and all of its subsidiary organizations were established by the Seventh-Day Adventist Church to bring a ministry of healing and health to the communities served. Our mission is to extend the healing ministry of Christ. 0 0 376245282 12174111 270926023 During 2010, the Corporation provided hospital management services to 23 wholly or partially owned tax-exempt hospital and nursing home corporations. These 22 corporations operate 43 acute-care hospitals, and provide management services to 16 nursing home facilities. 376245282 1 1 0 1 0 0 0 1 0 1 1 0 1 1 1 0 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 1355 0 1 1174 1 1 1 1 BD CJ 0 0 0 0 0 0 0 0 X 60 48 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X Terry D Shaw 4079751405 111 N Orlando Avenue Winter Park FL 327893675 X Allen Karen 1.00 X 0 0 0 Anderson PhD Eric 1.00 X 714 0 0 Andreasen PhD Niels-Erik 1.00 X 714 0 0 Baker PhD Delbert W 1.00 X 214 0 0 Barnett D Edward 1.00 X 793 0 0 Bietz DMIN Gordon 1.00 X 714 0 0 Biloff Niel L 1.00 X 714 0 0 Blair Mardian J 1.00 X 1584 0 0 Carlson Ronald 1.00 X 781 0 0 Cauley Michael F 1.00 X 714 0 0 Cazeau Rosemarie 1.00 X 714 0 0 Coridan Dean 1.00 X 714 0 0 Corkum Donald W 1.00 X 214 0 0 Cotton Sabrina 1.00 X 0 0 0 Davidson James R 1.00 X 714 0 0 Davis Jerome 1.00 X 714 0 0 Denslow Kenneth A 1.00 X 714 0 0 Dixon PhD Marguerite A 1.00 X 214 0 0 Drake III PhDCharles W 1.00 X 1400 0 0 Edge Mike 1.00 X 0 0 0 Edmond Dana C 1.00 X 714 0 0 Eisele Melvin K 1.00 X 714 0 0 Gallimore Jay 1.00 X 714 0 0 Green Samuel L 1.00 X 1754 0 0 Grove Rodney A 1.00 X 1754 0 0 Hagele Elaine 1.00 X 1754 0 0 Haley Steve 1.00 X 714 0 0 Hawkins Esq Judith W 1.00 X 714 0 0 Hayes Alta Sue 1.00 X 714 0 0 Henderschedt Robert R 50.00 X 961047 0 131668 Holley Leighton R 1.00 X 714 0 0 Houmann Lars 15.00 X 2708389 3091 213876 Howard Roscoe J III 2.00 X 19514 0 1283 Hurst Van G 1.00 X 714 0 0 Japas Carlos 1.00 X 0 0 0 Jernigan PhD Donald L 50.00 X X 1666391 0 287137 Johnson MD Mark 1.00 X 714 0 0 Johnson Sandra K 50.00 X 997375 0 81340 Just PhD Lois C 1.00 X 714 0 0 Knutson J Deryl 1.00 X 1754 0 0 Lemon Thomas L 2.00 X 1953 0 0 Livesay Donald 2.00 X 1953 0 0 Mendinghall Vanard J 1.00 X 714 0 0 Mitchell Charles 1.00 X 0 0 0 Morel Hubert 1.00 X 714 0 0 Moyer John 1.00 X 714 0 0 Orian Stephen 1.00 X 914 0 0 Pollard Leslie 1.00 X 0 0 0 PursleyMD Timothy 1.00 X 0 10000 0 Reed MD Monica P 1.00 X 502828 1434 116959 Reiner Richard 50.00 X 1173953 0 208519 Retzer Gordon 1.00 X 1953 0 0 Robinson Randy 1.00 X 1754 0 0 Salmons Joan 1.00 X 214 0 0 Scott Glynn C 1.00 X 1754 0 0 Shaw Terry 50.00 X X 1096656 0 219036 Smith PhD David C 1.00 X 714 0 0 Smith PhD Ron C 1.00 X 1754 0 0 Snyder Brent G 50.00 X 820878 0 111053 Stevens James L 1.00 X 714 0 0 Thurber Gary F 1.00 X 714 0 0 Trevino Max A 2.00 X 1953 0 0 Werner Thomas L 1.00 X 83791 0 8996 Wright Bill E 1.00 X 714 0 0 Wright Edward E 1.00 X 714 0 0 Schultz Michael 50.00 X 1751807 1408 138723 Jamerson Ellen Carlene 50.00 X 1137793 0 92742 Bunch James 1.00 X 1135535 0 89866 Meyers Dennis 1.00 X 886181 1071 68021 Crane David 1.00 X 877617 3906 150989 15866165 20910 1920208 317 0 1 0 Cerner Corporation PO Box 412702 Kansas City MO 64141 IT Serv/Support Fees 8547387 Executive Health Resources PO BOX 822688 Philadelphia PA 19182 Medical Compliance Consulting 4896679 Maxit Healthcare LLC PO Box 2589 Fort Wayne IN 46801 IT Staffing/Programming 4444175 Sungard Availability Services PO Box 91233 Chicago IL 60693 Data Recovery Services 3185573 Clover Systems of Orlando PO BOX 780062 Orlando FL 32878 IT Maintenance Services 2180732 102 15600 15600 Management Fees 541610 107152531 106756538 395993 Reimbursed Salaries & 561000 104694930 104694930 Reimbursed Pharmaceuti 446110 26815029 26815029 Centralized Services P 900099 19290917 19290917 Partnership Income Rel 900099 9444267 9007013 437254 4361596 4361596 271759270 130958092 130958092 Other Misc Income 900099 20982 20982 20982 402753944 270926023 854229 130958092 12147427 12147427 26684 26684 10744525 10744525 105587189 103761153 1826036 11684402 10379039 1305363 28930859 22031113 6899746 6871335 6232858 638477 1040551 1040551 1522620 1522620 16716791 16705449 11342 250 250 28846705 27511243 1335462 14679145 12004605 2674540 2828607 2828607 4556155 4290464 265691 364200 45672 318528 118139273 118139273 21758504 21758504 382039 382039 Maintenance/Repairs 10649396 10649396 Premier Rebate to facil 6768141 6768141 Bad Debt 659484 659484 State Street Rebate 305905 305905 Taxes - UBI 5147 5147 4387354 265 4387089 409602688 376245282 33357406 0 2429 2450 2647589 2408091 145157 216568 18850821 15612076 232268904 143036774 86253803 89232130 3327944891 3607694417 406332853 491641543 3842177543 4206807275 90000163 95774943 435372 419778 10655044 10543495 3591670016 3948524340 3692760595 4055262556 X 149416948 151544719 149416948 151544719 3842177543 4206807275 X -6848744 8976515 X 0 1 1 X 0 X X X 0 0 0 Adventist Health SystemSunbelt Inc 591479658 3 1 0 Adventist Health SystemGeorgia Inc 581425000 3 1 0 Jellico Community HospitalInc 620924706 3 1 0 Memorial Hospital Inc 610594620 3 1 0 Sunsystem Development Corporation 592219301 7 1 0 Florida Hospital Waterman Inc 593140669 3 1 0 Princeton Professional Services Inc 591191045 9 1 0 Florida Hospital Zephyrhills Inc 592108057 3 1 0 Fletcher HospitalInc 560543246 3 1 0 Memorial Health Systems Inc 590973502 3 0 0 Memorial Hospital - Flagler Inc 592951990 3 0 0 Memorial Hospital - West Volusia Inc 593256803 3 0 0 PorterCare Adventist Health System 840438224 3 0 0 Adventist Hinsdale Hospital 362276984 3 0 0 Adventist GlenOaks Hospital 363208390 3 0 0 Chippewa Valley Hospital & Oakview Care Centers Inc 391365168 3 0 0 Southwest Volusia Healthcare Corporation 593149293 3 0 0 Shawnee Mission Medical Center Inc 480637331 3 0 0 Adventist Bolingbrook Hospital 651219504 3 0 0 University Community Hospital Inc 591113901 3 0 0 Tarpon Springs Hospital Foundation Inc 590898901 3 0 0 Bert Fish Medical Center Inc 593306983 3 0 0 22 0 Schedule A, Part IV, Supplemental Information: Part I, Line 11h column (iv): The filing organization meets the requirements of Reg. Section 1.509(a)-4(d)(1) by virtue of satisfying the requirements set forth in 1.509(a)-4(d)(2) as discussed below: (1) The governing documents of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) demonstrate that it is operated, supervised, or controlled by the General Conference of Seventh-day Adventists in accordance with IRC Section 509(a)(3)(B)(i). (2) The Articles of Incorporation of AHSSHC require that it operate to further the health ministry of the Seventh-day Adventist Church and to provide management, consulting, and related services to educational institutions and health care facilities. All but one of the supported organizations listed in Part I, line 11(h) of Schedule A operate hospitals and/or other health care facilities and are wholly owned by AHSSHC. The remaining organization, also wholly owned by AHSSHC, serves as a fund-raising foundation organization in support of many of the hospital organizations listed in Part I, line 11(h). AHSSHC is operating to support the Seventh-day Adventist Church by carrying out its health ministry mission. Its Articles of Incorporation state that it will support the nonprofit corporations for which it is the sole member and provides a listing of some but not all of its wholly owned subsidiaries. Although not all of the supported organizations are designated by name, AHSSHC meets the requirements set forth in Reg. Section 1.509(a)-4(d)(2)(i)(b)(2) since it is operating to support one of the purposes of the Seventh-day Adventist Church. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 803083 803083 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: The corporation paid fees to retain the services of one consulting and one law firm and a public affairs company which performed lobbying activities on behalf of the corporation. The legislative consulting firm Forscey & Stinson and the law firm, Trauger & Tuke were paid a total of $713,083 during the year and the remaining $90,000 was paid to the Academy Advisor. 0 1 3591236 3591236 7032861 6324437 708424 191738271 136448297 55289974 29906536 264040 29642496 89232130 Long-Term Investments 21006720 C Money Market Funds 290017618 F Bonds 2351025723 F Equity Investments 405406194 F Hedge Funds 488788162 F Securities Lending Collateral 51450000 F 3607694417 Funds Held in Trust 334756785 Due From Related Parties and Affiliates 51015812 Other Non-current Assets 32143033 Other Current Receivable 3455038 Board Designated Funds-Current 70270875 491641543 Due to Related/Affiliated Entities 3453238138 Other Current Liabilities 87190050 Other Deferred Revenues 78462331 Other Liabilities 278183821 Securities Lending Payable 51450000 3948524340 402753944 409602688 -6848744 -26035089 35011604 8976515 2127771 7096885640 744781 6816488742 6817233523 279652117 123101827 123101827 402753944 6282105831 5995604970 5995604970 286500861 123101827 123101827 409602688 Part IV, Line 2b: A division of the filing organization conducts third-party administration type claims processing services on behalf of certain organizations. One of the programs for which claims processing is conducted is the Orange County Indigent Plan Program. Funding to assist in payment of claims under this program is partially funded by an unrelated 501(c)(3) hospital system located in the Greater Orlando area. The filing organization has established an escrow account to hold funds collected from the unrelated hospital system that will be used to pay for medical care for indigent patients under this program. Description of Uncertain Tax Positions Under FIN 48: Part X: 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. Part XI, Line 8 - Other Adjustments: Allocation of debt costs to tax-exempt subs 11,604. Transfer from tax exempt subs 35,000,000. Part XII, Line 2d - Other Adjustments: Revenue of Affiliated Organizations Included in Audited Financial Statements 6,816,488,742. Part XII, Line 4b - Other Adjustments: Reclass Expense 116,333,686. Premier Distribution Allocated to Subs 6,768,141. Part XIII, Line 2d - Other Adjustments: Expense of Affiliated Organizations Included in Audited Financial Statements 5,995,604,970. Part XIII, Line 4b - Other Adjustments: Reclass Expenses 116,333,686. Premier Distribution Allocated to Subs 6,768,141. Europe 0 0 Business Investment site visits Travel expense for investment company site visits 15892 Europe 0 0 Business Meetings 3300 North America 0 0 Board Meetings and Conference 1883 East Asia 0 0 Speakers 6962 South Asia 0 0 Speakers 3767 Sub-Saharan Africa 0 0 Speakers 5114 Central America & Caribbean 0 0 Speakers 2766 Central America & Caribbean 0 0 Business Meetings 2631 Central America & Caribbean 0 0 Passive Investments 0 Europe 0 0 Passive Investments 0 North America 0 0 Passive Investments 0 0 0 0 42315 0 42315 1 0 1 1 1 0 Method Used to Acccount for Expenditures: Schedule F, Part I, Line 3: All expenses relate to travel costs. 1 Adventist Health System Sunbelt Inc 111 N Orlando Avenue Winter Park FL 32789 591479658 501(c)(3) 20000 General Support Adventist Bolingbrook Hospital 500 Remington Blvd Bolingbrook IL 60440 651219504 501(c)(3) 10000 General Support Community Seventh-day Adventist Church PO Box 3549 Meridian MS 39303 020776702 501(c)(3) 38600 General Support Economic Development Commission of Mid Florida 301 E Pine St Suite 900 Orlando FL 32801 591767933 501(c)(6) 20000 General Support Emory-Adventist Inc 3949 S Cobb Drive Smyrna GA 30080 582171011 501(c)(3) 10000 General Support Florida Hospital College of Health Sciences 671 Winyah Dr Orlando FL 32803 593069793 501(c)(3) 19442 General Support Florida Hospital Waterman Foundation 1500 Waterman Way Tavares FL 32778 592330166 501(c)(3) 11500 General Support Floridians for Responsible Policy Inc PO Box 1967 Orlando FL 32802 264780484 Other 7500 General Support Forest Lake Academy 500 Education Loop Apopka FL 32703 590816443 501(c)(3) 60500 General Support Foundation for Shawnee Mission Medical Center 7315 Frontage Rd Ste221 Shawnee Mission KS 66204 480868859 501(c)(3) 10000 General Support GlenOaks Hospital Foundation 701 Winthrop Ave Glendale Heights IL 60139 363926044 501(c)(3) 10000 General Support Gods Helping Hands PO Box 1472 Loma Linda CA 92354 912083117 501(c)(3) 35000 General Support Helen Ellis Memorial Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs FL 34689 593690149 501(c)(3) 10000 General Support Hinsdale Hospital Foundation 120 N Oak St Hinsdale IL 60521 521466387 501(c)(3) 10000 General Support Huntsville Central SDA Church 3001 Whitesburg Drive South Huntsville AL 35802 631043864 501(c)(3) 50000 General Support Indiana Conference of Seventh-day Adventists 15250 N Meridian Street PO Box 1950 1950 Carmel IN 46082 350976759 501(c)(3) 50000 Annual General Support International Council for Corporate Health Inc 506 Braylon Circle Franklin TN 37064 264774241 501(c)(3) 50000 General Support Junior Achievement of Central Florida 2121 Camden Rd Orlando FL 32803 590972112 501(c)(3) 18118 General Support LaGrange Memorial Hospital Foundation 5101 S Willow Springs Rd La Grange IL 60525 300247776 501(c)(3) 10000 General Support Lake Union Conference of Seventh-Day Adventists PO Box C Berrien Springs MI 49103 381474933 501(c)(3) 235000 Annual General Support Michigan Conference of Seventh-Day Adventists dba Lifestyle Matters 320 W St Joseph Lansing MI 48933 381467642 501(c)(3) 34000 FACES Grant, Publication of Balance Magazine Markham Woods Church of Seventh-Day Adventists 505 Markham Woods Rd Longwood FL 32779 593095948 501(c)(3) 76250 General Support Memorial Health Systems Foundation Inc 875 Sterthaus Ave Ormond Beach FL 32176 311771522 501(c)(3) 10000 General Support Mid-America Union Conference of Seventh-Day Adventists PO Box 6128 Lincoln NE 68506 476006806 501(c)(3) 235000 Annual General Support North American Division of Seventh-Day Adventists 12501 Old Columbia Pike Silver Spring MD 20902 203164300 501(c)(3) 11700 General Support Oakwood College 7000 Adventist Blvd NW Huntsville AL 35896 630366652 501(c)(3) 100000 Annual General Support Rocky Mountain Adventist Healthcare Foundation 7995 E Prentice Ave 204 Greenwood Village CO 80111 840745018 501(c)(3) 40000 General Support Southern Union Conference of Seventh-Day Adventists PO Box 849 3978 Memorial Dr Decatur GA 30031 586002274 501(c)(3) 235000 Annual General Support Southwestern Union Conference of Seventh-Day Adventists PO Box 4000 777 Burleson Blvd Burleson TX 76097 750904016 501(c)(3) 243000 Annual General Support SunSystem Development Corporation 111 N Orlando Avenue Winter Park FL 32789 592219301 501(c)(3) 142450 General Support Takoma Regional Hospital Inc 401 Takoma Ave Greeneville TN 37743 510603966 501(c)(3) 10000 General Support US Dream Academy 10400 Little Patuxent Pkwy 300 Columbia MD 21044 593514841 501(c)(3) 10000 General Support Union College 3800 South 48th Street Lincoln NE 68506 470405319 501(c)(3) 15000 General Support University Community Hospital Foundation Inc 3100 E Fletcher Ave Tampa FL 33613 592554889 501(c)(3) 10010000 General Support 32 2 Medical School Scholarships 14 13900 SHARE Families 6 12784 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule 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. Accordingly, the filing organization has not established specific procedures for monitoring the use of grant funds in the United States as the filing organization does not have a grant making program that would necessitate such procedures. X X X X X X 1 1 X X X X 0 1 0 0 0 0 0 0 0 Henderschedt Robert R 573822 0 166156 0 221069 0 103853 0 27815 0 1092715 0 0 0 Houmann Lars 805019 0 232797 0 1670573 3091 171790 0 42086 0 2922265 3091 0 0 Jernigan PhD Donald L 903442 0 261600 0 501349 0 186905 0 100232 0 1953528 0 186046 0 Johnson Sandra K 370185 0 89695 0 537495 0 43106 0 38234 0 1078715 0 0 0 Reed MD Monica P 394740 0 92617 0 15471 1434 68429 0 48530 0 619787 1434 0 0 Reiner Richard 805019 0 232471 0 136463 0 162106 0 46413 0 1382472 0 0 0 Shaw Terry 805019 0 233100 0 58537 0 171790 0 47246 0 1315692 0 0 0 Snyder Brent G 507670 0 147000 0 166208 0 86753 0 24300 0 931931 0 0 0 Schultz Michael 540455 0 151199 0 1060153 1408 104598 0 34125 0 1890530 1408 0 0 Jamerson Ellen Carlene 326361 0 73428 0 738004 0 46683 0 46059 0 1230535 0 0 0 Bunch James 388523 0 111522 0 635490 0 49518 0 40348 0 1225401 0 0 0 Meyers Dennis 224826 0 54250 0 607105 1071 25369 0 42652 0 954202 1071 12321 0 Crane David 601950 0 173520 0 102147 3906 119760 0 31229 0 1028606 3906 0 0 Part I, Line 1a The filing organization is the top-tier parent of a 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 (including those who provide services at the filing organization and those who perform executive management services at AHS subsidiary organizations) are compensated by and on the payroll of the filing organization. However, for administrative ease, executive employees on the payroll of AHSSHC who provide services at AHS subsidiary organizations receive reimbursements of travel and other business-related expenses from the subsidiary organization. First-class or charter travel: Pursuant to the AHS system-wide general policy regarding business travel, no reimbursement will be provided for any additional cost incurred with respect to first-class or charter air travel beyond the cost of a regular coach airfare. As a means of providing additional business travel reimbursement for those members of the AHSSHC senior executive management team that travel frequently on behalf of AHS, a special annual travel allowance is provided for those executives. As AHS operates 43 hospitals and a number of other health care facilities in 10 states, the senior leadership of AHSSHC travel extensively and often visit multiple hospital locations in different states as a part of a single business trip. The special travel allowance has an annual cap of $24,000 for members of the AHS Corporate Management Committee (6 individual executives) and $15,000 for AHS Corporate Office Senior Vice Presidents (8 individual executives). The special travel allowance can provide reimbursements to the executive for such items as the purchase of air travel upgrade coupons, to cover the cost differential between coach and first-class travel, or to cover the cost of a charter flight. The special travel allowance benefit was originally authorized by and codified into a policy by the AHSSHC Board Strategy & Compensation Committee, an independent body of the AHSSHC Board of Directors, who also approves the annual cap on the amount of the allowance. Those executives who receive the special travel allowance are responsible for tracking the expenses reimbursable under the special travel allowance and must submit such expenses on their accountable plan expense report. Any taxable reimbursements made to executives under the special travel allowance arrangement are treated as taxable compensation to the executive. Travel for companions: AHSSHC has a Corporate Executive Policy that provides a benefit to allow for a traveling AHSSHC executive to have his or her spouse accompany the executive on 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; only three individuals currently have such arrangements and one other individual was provided with the housing benefit in the current year under a grandfather clause in a former policy). 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. Housing allowance or residence for personal use: AHSSHC has a Corporate Executive Policy that addresses assistance to executives who have been relocated by the company during the year. Relocation assistance provided to executives may include relocation allowances to assist with duplicate housing expenses. Relocation assistance is administered per AHSSHC policy by an external relocation company. Any taxable reimbursements made to executives in connection with relocation assistance are treated as wages to the executive and are subject to all payroll withholding and reporting requirements. Health or social club dues or initiation fees: AHSSHC has a Corporate Executive Policy that addresses business development expenditures. Under this policy, certain AHS eligible executives may be reimbursed for member dues and usage charges for a country club or other social club upon authorization. Club memberships must be recommended by the CEO of the AHS hospital organization and approved by the Chairman of the Board of Directors of the organization. In addition, the proposed membership must be approved annually by the AHSSHC Board Strategy & Compensation Committee, an independent committee of the Board of Directors of AHSSHC. Eligible executives are limited to certain senior level executives (hospital organization CEOs, the CEO of the nursing home division of AHS, senior vice presidents at three large hospital organizations, regional CEOs and CFOs and the president and senior vice presidents of AHSSHC). In the current year, for this filing organization, two executives were eligible to receive reimbursement for club fees. Each AHS executive who is approved for a club membership must submit an annual report to the AHSSHC Board Strategy & Compensation Committee that describes how the membership benefited their organization during the preceding year. Part I, Line 4b 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 pre-determined benefits annual amount 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. 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 $196,000. 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. SERP 457(f) Employer Contribution/ Contributions Payment Robert Henderschedt $107,010 $ 119,583 Lars Houmann $158,447 $1,617,645 Donald Jernigan $190,062 $ 0 Sandra Johnson $ 46,263 $ 497,066 Monica Reed $ 55,086 $ 0 Richard K. Reiner $165,263 $ 61,356 Terry D. Shaw $158,447 $ 0 Brent G. Snyder $ 89,910 $ 98,072 Michael Schultz $ 91,255 $ 995,981 Ellen Carlene Jamerson $ 44,453 $ 691,996 James Bunch $ 52,675 $ 598,998 Dennis Meyers $ 12,026 $ 547,018 David Crane $106,417 $ 0 Thomas Werner $ 0 $ 82,877 Supplemental Information Part III Part I, Question 3: As noted in our response to question 15 of Part VI of Form 990, the individual who serves as the CEO of the filing organization is compensated by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) for that individual's role in serving as the system-wide CEO of AHS. 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. Kevin Edgerton Family of Board Member 199419 Employee compensation 0 Suzanne Keller Family of Board Member 21796 Employee compensation 0 Tim Reiner Family of Board Member 238207 Employee compensation 0 Heidi Reiner Family of Board Member 56480 Employee compensation 0 Terry Owen Family of Board Member 650869 Employee compensation 0 Clifton Scott Family of Board Member 40137 Employee Compensation 0 Cynthia Rodgers Family of Board Member 20120 Employee Compensation 0 Form 990, Part VI, Section A, line 2 Gordon Bietz and Lars Houmann - Business Relationship Timothy J. Pursley, MD and Lars Houmann - Business Relationship Form 990, Part VI, Section A, line 4 During 2010, the Articles of Incorporation (AOI) and Bylaws of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) were revised to identify the membership of the organization. Prior to the revision, the membership of the organization consisted of 2 classes of membership. These classes were eliminated. Upon revision, the membership of AHSSHC is comprised of those individuals who sit on the Executive Committees of the Southern Union, Southwestern Union, Lake Union, and Mid-America Union Conferences of the Seventh-day Adventist Church and the Board of Directors of AHSSHC as of 10/1/2009. Additionally, in accordance with a Florida State law change, specific language was added to clarify the manner in which new members may be appointed as well as the process by which members may be removed. The definition of board officers was also modified to delete the appointment of a Treasurer as a board officer. Form 990, Part VI, Section A, line 6 The governing documents of the filing organization provide that the membership of the organization consists of those individuals who as of October 1, 2009 are duly elected members of at least one of the following: Executive Committee of the Southern Union Conference of Seventh-day Adventists, Executive Committee of the Southwestern Union Conference of Seventh-day Adventists, Executive Committee of the Lake Union Conference of Seventh-day Adventists, Executive Committee of the Mid-America Union Conference of Seventh-day Adventists and the Board of Directors of the filing organization. Form 990, Part VI, Section A, line 7a The Board of Directors of the filing organization are elected by the membership of the organization or are appointed by virtue of their employment with the organization itself or by virtue of their position within one of the Seventh-Day Adventist Conferences listed above. Form 990, Part VI, Section A, line 7b The membership 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 any amendment, restatement, or repealing of the Articles of Incorporation or Bylaws of the filing organization; and b) to appoint individuals to fill any vacancies on the Board of Directors of the Corporation. Form 990, Part VI, Section B, line 11 The filing organization's current year Form 990 was reviewed by the CEO, CFO and Senior Vice President of Finance prior to its filing with the IRS. The review conducted by the CEO, CFO and Senior Vice President of Finance did not include the review of any supporting workpapers that were used in preparation of the current year Form 990, but did include a review of the entire Form 990 and all supporting schedules. Form 990, Part VI, Section B, line 12c The Conflict of Interest Policy of the filing organization applies to members of its Board of Directors and its principal officers (to be known as Interested Persons). In connection with any actual or possible conflict of interests, any member of the Board of Directors of the filing organization or any principal officer of the filing organization (i.e. Interested Persons) must disclose the existence of any financial interest with the filing organization and must be given the opportunity to disclose all material facts concerning the financial interest/arrangement to the Board of Directors of the filing organization or to any members of a committee with board delegated powers that is considering the proposed transaction or arrangement. Subsequent to any disclosure of any financial interest/arrangement and all material facts, and after any discussion with the relevant Board member or principal officer, the remaining members of the Board of Directors or committee with board delegated powers shall discuss, analyze, and vote upon the potential financial interest/arrangement to determine if a conflict of interest exists. According to the filing organization's Conflict of Interest Policy, an Interested Person may make a presentation to the Board of Directors (or committee with board delegated powers), but after such presentation, shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that results in a conflict of interest. Each Interested Person, as defined under the filing organization's Conflict of Interest Policy, shall annually sign a statement which affirms that such person has received a copy of the Conflict of Interests policy, has read and understands the policy, has agreed to comply with the policy, and understands that the filing organization is a charitable organization that must primarily engage in activities which accomplish one or more of its exempt purposes. The filing organization's Conflict of Interest Policy also requires that periodic reviews shall be conducted to ensure that the filing organization operates in a manner consistent with its charitable purposes. Form 990, Part VI, Section B, line 15 Compensation and benefits provided to Adventist Health System Sunbelt Healthcare Corporation's (AHSSHC) CEO, CFO, Vice Presidents or key employees are determined pursuant to policies, procedures, and processes that are designed to ensure compliance with the intermediate sanctions laws as set forth in IRC Section 4958. AHSSHC has taken steps to ensure that processes are in place to satisfy the rebuttable presumption of reasonableness standard as set forth in Treasury Regulation 53.4958-6 with respect to its active executive-level positions. The AHSSHC Board Strategy and Compensation Committee (the Committee) serves as the governing body for all executive compensation matters. The Committee is composed of certain members of the Board of Directors (the Board) of AHSSHC. Voting members of the Committee include only individuals who serve on the Board as independent representatives of the community, who hold no employment positions with AHSSHC and who do not have relationships with any of the individuals whose compensation is under their review that impacts their best independent judgment as fiduciaries of AHSSHC. The Committee's role is to review and approve all components of the executive compensation plan of AHSSHC. As an independent governing body with respect to executive compensation, it should be noted that the Committee will often confer in executive sessions on matters of compensation policy and policy changes. In such executive sessions, no members of management of AHSSHC are present. The Committee is advised by an independent third party compensation advisor. This advisor prepares all the benchmark studies for the Committee. Compensation levels are benchmarked with a national peer group of other not-for-profit healthcare systems and hospitals of similar size and complexity to AHS and each of its affiliated entities. The following principles guide the establishment of individual executive compensation: - The salary of the President/CEO of AHS will not exceed the 40th percentile of comparable salaries paid by similarly situated organizations; and - Other executive salaries shall be established using market medians. The compensation philosophy, policies, and practices of AHSSHC are consistent with the organization's faith-based mission and conform to applicable laws, regulations, and business practices. As a faith-based organization sponsored by the Seventh-day Adventist Church (the Church), AHSSHC's philosophy and principles with respect to its executive compensation practices reflect the conservative approach of the Church's mission of service and were developed in counsel with the Church's leadership. Form 990, Part VI, Section C, line 19 The filing organization is the parent organization of a 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 Two members of the Board of Directors: Lars Houmann and Monica Reed, MD, and three of the highest paid employees: James Bunch, Dennis Meyers, and David Crane, 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 (D) and (F) on page 7 were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position for a subsidiary organization of the filing organization. These five individuals each devote approximately 50 hours per week in conjunction with serving in their respective executive leadership position for subsidiary hospital organizations. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -26,035,089. Allocation of debt costs to tax-exempt subs 11,604. Transfer from tax exempt subs 35,000,000. Total to Form 990, Part XI, Line 5: 8,976,515. Care for the Care Giver LLC 111 N Orlando Avenue Winter Park FL 32789 262666249 Inactive FL 0 0 Adventist Health System Sunbelt Healthcare Corporation Adventist Bolingbrook Hospital 500 Remington Blvd Bolingbrook IL 60440 651219504 Operation of Hospital & Related Services IL 501(c)(3) 170(b)(1)(A)(iii) Adventist Health SystemSunbelt Inc 0 Adventist Care Centers - Courtland Inc 730 Courtland Street Orlando FL 32804 205774723 Operation of Home for the Aged/Healthcare Delivery FL 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Adventist GlenOaks Hospital 701 Winthrop Avenue Glendale Heights IL 60139 363208390 Operation of Hospital & Related Services IL 501(c)(3) 170(b)(1)(A)(iii) Adventist Health SystemSunbelt Inc 0 Adventist Health Mid-America Inc 9100 W 74th Street Shawnee Mission KS 66204 521347407 Healthcare Related Services KS 501(c)(3) 509(a)(3) Type I Adventist Health SystemSunbelt Inc 0 Adventist Health Partners Inc 1000 Remington Blvd Ste 200 Bolingbrook IL 60440 364138353 Operate out-patient physician clinics IL 501(c)(3) 170(b)(1)(A)(iii) AHS Midwest Management Inc 0 Adventist Health System Affiliated Benefit Trust 111 N Orlando Avenue Winter Park FL 32789 266422966 Promotion of Healthcare FL 501(c)(3) 509(a)(3) Type I Adventist Health System Sunbelt Healthcare Corporation 1 Adventist Health System Sunbelt Healthcare Corporation 111 N Orlando Avenue Winter Park FL 32789 592170012 Management Services FL 501(c)(3) 509(a)(3) Type I N/A 0 Adventist Health SystemGeorgia Inc 1035 Red Bud Road Calhoun GA 30701 581425000 Operation of Hospital & Related Services GA 501(c)(3) 170(b)(1)(A)(iii) Adventist Health System Sunbelt Healthcare Corporation 1 Adventist Health SystemSunbelt Inc 111 N Orlando Avenue Winter Park FL 32789 591479658 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) Adventist Health System Sunbelt Healthcare Corporation 1 Adventist Health SystemTexas Inc 602 Courtland Street Orlando FL 32804 742578952 Inactive TX 501(c)(3) 509(a)(2) Adventist Health System Sunbelt Healthcare Corporation 1 Adventist Hinsdale Hospital 120 North Oak Street Hinsdale IL 60521 362276984 Operation of Hospital & Related Services IL 501(c)(3) 170(b)(1)(A)(iii) Adventist Health SystemSunbelt Inc 0 AHS Midwest Management Inc 1000 Remington Blvd Ste 200 Bolingbrook IL 60440 363354567 Operation of Occupational Hlth Clinic & Physician Practice Mgmt IL 501(c)(3) 509(a)(3) Type I Adventist Health SystemSunbelt Inc 0 AHSCentral Texas Inc 1301 Wonder World Drive San Marcos TX 78666 742621825 Provide Office Space - Medical Professionals TX 501(c)(3) 509(a)(3) Type III-F Adventist Health System Sunbelt Healthcare Corporation 1 Apopka Health Care Properties Inc 305 E Oak Street Apopka FL 32703 510605694 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 Battle Creek Adventist Hospital 1000 Remington Blvd Ste 200 Bolingbrook IL 60440 381359189 Operation of Hospital & Related Services MI 501(c)(3) 170(b)(1)(A)(iii) Adventist Health SystemSunbelt Inc 0 Bert Fish Medical Center Inc (10110-63011) 401 Palmetto Street New Smyrna Beach FL 32168 362276984 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) Adventist Health System Sunbelt Healthcare Corporation 1 Bolingbrook Hospital Foundation 1000 Remington Blvd N Entrance 2nd Bolingbrook IL 60440 900494445 Fund-raising for Tax-exempt hospital IL 501(c)(3) 170(b)(1)(A)(vi) Midwest Health Foundation 0 Bradford Heights Health & Rehab Center Inc 950 Highpoint Drive Hopkinsville KY 42240 205782342 Operation of Home for the Aged/Healthcare Delivery KY 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Burleson Nursing & Rehab Center Inc 301 Huguley Blvd Burleson TX 76028 205782243 Operation of Home for the Aged/Healthcare Delivery TX 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Caldwell Health Care Properties Inc 1333 West Main Princeton KY 42445 510605680 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 Central Texas Medical Center Foundation 1301 Wonder World Drive San Marcos TX 78666 742259907 Fund-raising for Tax-exempt hospital TX 501(c)(3) 170(b)(1)(A)(vi) Adventist Health SystemSunbelt Inc 0 Chickasaw Health Care Properties Inc 250 S Chickasaw Trail Orlando FL 32825 510605681 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 Chippewa Valley Hospital & Oakview Care Center Inc 1220 Third Avenue West Durand WI 54736 391365168 Operation of Hospital & Related Services WI 501(c)(3) 170(b)(1)(A)(iii) Adventist Health SystemSunbelt Inc 0 Cobb Medical Associates LLC 3949 South Cobb Drive SE Smyrna GA 300806342 582617089 Operation of Physician Practices & Medical Services GA 501(c)(3) 170(b)(1)(A)(iii) Emory-Adventist Inc 0 Courtland Health Care Properties Inc 730 Courtland Street Orlando FL 32804 510605682 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 Creekwood Place Nursing & Rehab Center Inc 683 E Third Street Russellville KY 42276 205782260 Operation of Home for the Aged/Healthcare Delivery KY 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Dairy Road Health Care Properties Inc 7350 Dairy Road Zephyrhills FL 33540 510605684 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 East Orlando Health & Rehab Center Inc 250 S Chickasaw Trail Orlando FL 32825 205774748 Operation of Home for the Aged/Healthcare Delivery FL 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Emory-Adventist Inc 3949 South Cobb Drive Smyrna GA 30080 582171011 Operation of Hospital & Related Svcs GA 501(c)(3) 170(b)(1)(A)(iii) Adventist Health SystemSunbelt Inc 0 Fletcher Hospital Inc 100 Hospital Drive Hendersonville NC 28792 560543246 Operation of Hospital & Related Svcs NC 501(c)(3) 170(b)(1)(A)(iii) Adventist Health System Sunbelt Healthcare Corporation 1 FLNC Inc 3355 E Semoran Blvd Apopka FL 32703 205774761 Operation of Home for the Aged/Healthcare Delivery FL 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Florida Hospital College of Health Sciences Inc (630 Year End) 671 Lake Winyah Drive Orlando FL 32803 593069793 Education/Operation of School FL 501(c)(3) 170(b)(1)(A)(ii) Adventist Health SystemSunbelt Inc 0 Florida Hospital DeLand Auxiliary Inc 701 West Plymouth Avenue Deland FL 32720 593425543 Volunteer support services FL 501(c)(3) 509(a)(3) Type III-F Memorial Hospital West Volusia Inc 0 Florida Hospital Waterman Inc 1000 Waterman Way Tavares FL 32778 593140669 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) Adventist Health System Sunbelt Healthcare Corporation 1 Florida Hospital Wesley Chapel Inc 2528 Bruce B Downs Blvd CR 581 S Wesley Chapel FL 33543 203965753 Inactive FL 501(c)(3) 509(a)(3) Type III-F Adventist Health System Sunbelt Healthcare Corporation 1 Florida Hospital Zephyrhills Inc 7050 Gall Blvd Zephyrhills FL 33541 592108057 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) Adventist Health SystemSunbelt Inc 0 Florida Physicians Medical Group Inc 900 Winderley Place Maitland FL 32751 593214635 Operation of Physician Practices & Medical Services FL 501(c)(3) 170(b)(1)(A)(iii) Adventist Health SystemSunbelt Inc 0 Foundation for Shawnee Mission Medical Center Inc 9100 W 74th Street Shawnee Mission KS 66204 480868859 Fund-raising for Tax-exempt hospital KS 501(c)(3) 509(a)(3) Type I Shawnee Mission Medical Center Inc 0 GlenOaks Hospital Foundation 701 Winthrop Avenue Glendale Heights IL 60139 363926044 Fund-raising for Tax-exempt hospital IL 501(c)(3) 170(b)(1)(A)(vi) Midwest Health Foundation 0 Hays Memorial Hospital Association of Seventh-Day Adventists 1301 Wonder World Drive San Marcos TX 78667 741362785 Lease of Hospital Personnel TX 501(c)(3) 509(a)(3) Type II Adventist Health System Sunbelt Healthcare Corporation 1 Helen Ellis Memorial Hospital Auxiliary Inc (51-123110) 1395 S Pinellas Ave Tarpon Springs FL 34689 592106043 Fund-raising for Tax-exempt hospital/foundation FL 501(c)(3) 509(a)(3) Type I Tarpon Springs Hospital Foundation Inc 0 Helen Ellis Memorial Hospital Foundation Inc (101-123110) 1395 S Pinellas Ave Tarpon Springs FL 34689 593690149 Fund-raising for Tax-exempt hospital FL 501(c)(3) 509(a)(3) Type I Tarpon Springs Hospital Foundation Inc 0 Hinsdale Hospital Foundation 7 Salt Creek Lane Suite 203 Hinsdale IL 60521 521466387 Fund-raising for Tax-exempt hospital IL 501(c)(3) 170(b)(1)(A)(vi) Midwest Health Foundation 0 In-Motion Rehab Inc 602 Courtland Street Ste 200 Orlando FL 32804 208023411 Therapy services to tax exempt nursing homes KS 501(c)(3) 509(a)(3) Type II Sunbelt Health Care Centers Inc 0 Jellico Community Hospital Inc 188 Hospital Lane Jellico TN 37762 620924706 Operation of Hospital & Related Services TN 501(c)(3) 170(b)(1)(A)(iii) Adventist Health System Sunbelt Healthcare Corporation 1 La Grange Memorial Hospital Foundation 5101 S Willow Springs Rd La Grange IL 60525 300247776 Fund-raising for Tax-exempt hospital IL 501(c)(3) 170(b)(1)(A)(vi) Midwest Health Foundation 0 Memorial Health Systems Foundation Inc 770 West Granada Blvd Ormond Beach FL 32174 311771522 Fund-raising for Tax-exempt hospital FL 501(c)(3) 170(b)(1)(A)(vi) Memorial Health Systems Inc 0 Memorial Health Systems Inc 301 Memorial Medical Parkway Daytona Beach FL 32117 590973502 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) Adventist Health SystemSunbelt Inc 0 Memorial Hospital - Flagler Inc 60 Memorial Medical Parkway Palm Coast FL 32164 592951990 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) Memorial Health Systems Inc 0 Memorial Hospital - West Volusia Inc 701 West Plymouth Avenue Deland FL 32720 593256803 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) Memorial Health Systems Inc 0 Memorial Hospital Inc 210 Marie Langdon Drive Manchester KY 40962 610594620 Operation of Hospital & Related Services KY 501(c)(3) 170(b)(1)(A)(iii) Adventist Health System Sunbelt Healthcare Corporation 1 Merriam Health Care Properties Inc 9700 West 62nd Street Merriam KS 66203 364595806 Lease to Related Organization KS 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 Metroplex Adventist Hospital Inc 2201 S Clear Creek Road Killeen TX 76549 742225672 Operation of Hospital & Related Services TX 501(c)(3) 170(b)(1)(A)(iii) Adventist Health System Sunbelt Healthcare Corporation 1 Metroplex Clinic Physicians Inc 2201 S Clear Creek Road Killeen TX 76549 113762050 Physician healthcare services to the community TX 501(c)(3) 170(b)(1)(A)(iii) Metroplex Adventist Hospital Inc 0 Midwest Health Foundation 120 North Oak Street Hinsdale IL 60521 352230515 Support of subsidiary Foundations IL 501(c)(3) 509(a)(3) Type II N/A 0 Mills Health & Rehab Center Inc 500 Beck Lane Mayfield KY 42066 205782320 Operation of Home for the Aged/Healthcare Delivery KY 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Mission Strategies Inc 602 Courtland Street Ste 200 Orlando FL 32804 205982365 Provision of support to the nursing home division KS 501(c)(3) 509(a)(3) Type II Sunbelt Health Care Centers Inc 0 Missouri Adventist Health Inc 9100 W 74th Street Shawnee Mission KS 66204 431224729 Support Health Care Services MO 501(c)(3) 509(a)(3) Type III-O Adventist Health Mid-America Inc 0 North Regional EMS Inc 188 Hospital Lane Jellico TN 37762 262653616 EMS Services TN 501(c)(3) 509(a)(2) Jellico Community Hospital Inc 0 Ormond Beach Memorial Hospital Auxiliary Inc 301 Memorial Medical Parkway Daytona Beach FL 32117 591721962 Volunteer support services FL 501(c)(3) 509(a)(3) Type III-F Memorial Health Systems Inc 0 Overland Park Nursing & Rehab Center Inc 6501 West 75th Street Overland Park KS 66204 205774821 Operation of Home for the Aged/Healthcare Delivery KS 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Paragon Health Care Properties Inc 950 Highpoint Drive Hopkinsville KY 42240 510605686 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 Portercare Adventist Health System (630 Year End) 2525 S Downing Street Denver CO 80210 840438224 Operation of Hospital & Related Services CO 501(c)(3) 170(b)(1)(A)(iii) Adventist Health System Sunbelt Healthcare Corporation 1 Portland Nursing & Rehab Center Inc 215 Highland Circle Drive Portland TN 37148 205774842 Operation of Home for the Aged/Healthcare Delivery TN 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Princeton Health & Rehab Center Inc 1333 West Main Princeton KY 42445 205782272 Operation of Home for the Aged/Healthcare Delivery KY 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Princeton Professional Services Inc 601 E Rollins Street Orlando FL 32803 591191045 Provision of Healthcare Services FL 501(c)(3) 509(a)(2) Adventist Health System Sunbelt Healthcare Corporation 1 Quality Circle for Healthcare Inc 111 N Orlando Avenue Winter Park FL 32789 263789368 Healthcare Quality Services FL 501(c)(3) 509(a)(3) Type III-F Adventist Health System Sunbelt Healthcare Corporation 1 Resource Personnel Inc 602 Courtland Street Ste 200 Orlando FL 32804 208040875 Provide administrative support to tax exempt nursing homes FL 501(c)(3) 509(a)(3) Type II Sunbelt Health Care Centers Inc 0 Rocky Mountain Adventist Healthcare Foundation (630 Year End) 2525 South Downing Street Denver CO 80210 840745018 Fund-raising for Tax-exempt hospital CO 501(c)(3) 170(b)(1)(A)(vi) PorterCare Adventist Health System 0 Rollins Bedford Corporation 602 Courtland Street Ste 200 Orlando FL 32804 370908840 Inactive FL 501(c)(3) 509(a)(3) Type II Sunbelt Health Care Centers Inc 0 Russellville Health Care Properties Inc 683 East Third Street Russellville KY 42276 510605691 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 San Marcos Health Care Properties Inc 1900 Medical Parkway San Marcos TX 78666 510605693 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 San Marcos Nursing & Rehab Center Inc 1900 Medical Parkway San Marcos TX 78666 205782224 Operation of Home for the Aged/Healthcare Delivery TX 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Shawnee Mission Health Care Inc 6501 West 75th Street Overland Park KS 66204 480952508 Lease to Related Organization KS 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 Shawnee Mission Medical Center Inc 9100 W 74th Street Shawnee Mission KS 66204 480637331 Operation of Hospital & Related Services KS 501(c)(3) 170(b)(1)(A)(iii) Adventist Health Mid-America Inc 0 South Central Nursing Homes Properties Inc 111 North Orlando Ave Winter Park FL 32789 593686109 Management Support GA 501(c)(3) 509(a)(3) Type III-O South Central Inc 0 South Central Nursing Homes Inc 602 Courtland Street Orlando FL 32804 611242373 Management Support KY 501(c)(3) 509(a)(3) Type III-O South Central Inc 0 South Central Properties III Inc 111 North Orlando Ave Winter Park FL 32789 593692860 Real Estate GA 501(c)(2) South Central Nursing Homes Properties Inc 0 South Central Properties IV Inc 111 North Orlando Ave Winter Park FL 32789 593692862 Real Estate GA 501(c)(2) South Central Nursing Homes Properties Inc 0 South Central Properties VI Inc 111 North Orlando Ave Winter Park FL 32789 593692857 Real Estate GA 501(c)(2) South Central Nursing Homes Properties Inc 0 South Central Properties Inc 111 North Orlando Ave Winter Park FL 32789 593651692 Real Estate GA 501(c)(2) South Central Nursing Homes Properties Inc 0 South Central Inc 602 Courtland Street Orlando FL 32804 593689740 Management Support GA 501(c)(3) 509(a)(3) Type III-F N/A 0 South Pasco Health Care Properties Inc 38250 A Avenue Zephyrhills FL 33542 510605679 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 Southwest Volusia Health Services Inc 1055 Saxon Blvd Orange City FL 327638468 593281591 Medical Office Building for Hospital FL 501(c)(3) 509(a)(3) Type I Southwest Volusia Healthcare Corporation 0 Southwest Volusia Healthcare Corporation 1055 Saxon Blvd Orange City FL 327638468 593149293 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) Adventist Health SystemSunbelt Inc 0 Specialty Physicians of Central Texas Inc 1301 Wonder World Drive San Marcos TX 78666 208814408 Physician healthcare services to the community TX 501(c)(3) 170(b)(1)(A)(iii) Adventist Health SystemSunbelt Inc 0 Spring View Health & Rehab Center Inc 718 Goodwin Lane Leitchfield KY 42754 205782288 Operation of Home for the Aged/Healthcare Delivery KY 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Sunbelt Health & Rehab Center - Apopka Inc 305 East Oak Street Apopka FL 32703 205774856 Operation of Home for the Aged/Healthcare Delivery FL 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Sunbelt Health Care Centers Inc 602 Courtland Street Ste 200 Orlando FL 32804 581473135 Management Services TN 501(c)(3) 509(a)(3) Type II Adventist Health System Sunbelt Healthcare Corporation 1 SunSystem Development Corporation 111 N Orlando Avenue Winter Park FL 32789 592219301 Fund Raising for Affiliated Tax-Exempt Hospitals FL 501(c)(3) 170(b)(1)(A)(vi) Adventist Health System Sunbelt Healthcare Corporation 1 Tarpon Springs Hosp Foundation Inc (101-123110) 1395 S Pinellas Ave Tarpon Springs FL 34689 590898901 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) University Community Hospital Inc 0 Tarrant County Health Care Properties Inc 301 Huguley Blvd Burleson TX 76028 510605677 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 Taylor Creek Health Care Properties Inc 718 Goodwin Lane Leitchfield KY 42754 510605678 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 The Volunteer Auxiliary of Florida Hospital - Flagler Inc 60 Memorial Medical Parkway Palm Coast FL 32164 592486582 Volunteer support services FL 501(c)(3) 509(a)(3) Type III-F Memorial Hospital Flagler Inc 0 Trinity Nursing & Rehab Center Inc 9700 West 62nd Street Merriam KS 66203 205774890 Operation of Home for the Aged/Healthcare Delivery KS 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 University Community Hospital Auxiliary Inc(101-123110) 3100 E Fletcher Ave Tampa FL 33613 237011345 Volunteer support services FL 501(c)(3) 509(a)(3) Type III-F University Community Hospital Inc 0 University Community Hospital Foundation Inc(101-123110) 3100 E Fletcher Ave Tampa FL 33613 592554889 Fund-raising for Tax-exempt hospital FL 501(c)(3) 509(a)(3) Type I University Community Hospital Inc 0 University Community Hospital Specialty Care Inc(101-123110) 3100 E Fletcher Ave Tampa FL 33613 593231322 Inactive FL 501(c)(3) 509(a)(3) University Community Hospital Inc 0 University Community Hospital Inc(101-123110) 3100 E Fletcher Ave Tampa FL 33613 591113901 Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) Adventist Health System Sunbelt Healthcare Corporation 1 West Kentucky Health Care Properties Inc 500 Beck Lane Mayfield KY 42066 510605676 Lease to Related Organization GA 501(c)(3) 509(a)(3) Type III-F Sunbelt Health Care Centers Inc 0 Zephyr Haven Health & Rehab Center Inc 38250 A Avenue Zephyrhills FL 33542 205774930 Operation of Home for the Aged/Healthcare Delivery FL 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Zephyrhills Health & Rehab Center Inc 7350 Dairy Road Zephyrhills FL 33540 205774967 Operation of Home for the Aged/Healthcare Delivery FL 501(c)(3) 509(a)(2) Sunbelt Health Care Centers Inc 0 Appalachian Therapy Services LLC 100 Hospital Drive Hendersonville NC 28792 202463851 Therapy Staffing NC N/A Clear Creek MOB Ltd 2201 S Clear Creek Rd Killeen TX 76549 742609195 Real Estate TX N/A Florida Hospital DMERT LLC 2450 Maitland Center Pkwy Ste 200 Maitland FL 32751 202392253 Medical Equipment FL N/A Florida Hospital Home Infusion 2450 Maitland Center Pkwy Ste 200 Maitland FL 32751 593142824 Home Infusion Services FL N/A KCCCSMMC Cancer Center LLC 9100 W 74th Street Shawnee Mission KS 66204 270909763 Equipment Rental KS N/A San Marcos MRI LP 1330 Wonder World Drive Ste 202 San Marcos TX 78666 770597972 Imaging & Testing TX N/A Shawnee Mission Open MRI LLC 9100 W 74th Street Box 2923 Shawnee Mission KS 66201 270011796 Imaging & Testing KS N/A Shawnee Mission Prairie Star Surgery Center LLC 23401 Prairie Star Parkway Lenexa KS 66227 364634843 Surgical Center KS N/A Shawnee Mission Surgery Center LLC PO Box 2923 Shawnee Mission KS 66201 481243914 Surgical Services KS N/A Skyland MRI LLC 100 Hospital Drive Hendersonville NC 28792 043646559 Imaging & Testing NC N/A Adventist Health Sys Sunbelt Healthcare Corp Employee Benefit Trust 111 N Orlando Avenue Winter Park FL 32789 581318939 Administration of Self-Insured Benefit Plans FL Adventist Health System Sunbelt Healthcare Corp T 1.00000 AHS Services Inc 11801 South Freeway Fort Worth TX 76028 752049583 Medical Equipment TX N/A C Altamonte Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 592855792 Condo Association FL N/A C Apopka Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando FL 32803 593000857 Condo Association FL N/A C Arapahoe Medical Building I Inc (630 Year End) 2525 S Downing Street Denver CO 80210 841574506 Real Estate Leasing CO N/A C Arapahoe Medical Building II Inc (630 Year End) 2525 S Downing Street Denver CO 80210 841574507 Real Estate Leasing CO N/A C CC MOB Inc 2201 S Clear Creek Road Killeen TX 76549 742616875 Real Estate Rental TX N/A C Central Texas Medical Associates 1301 Wonder World Drive San Marcos TX 78666 742729873 Physician Clinics TX N/A C Central Texas Provider's Network 1301 Wonder World Drive San Marcos TX 78666 742827652 Physician Hospital Org. TX N/A C Florida Hospital Flagler Medical Office Association Inc 60 Memorial Medical Parkway Palm Coast FL 32164 262158309 Condo Association FL N/A C Florida Hospital Healthcare System Inc 602 Courtland Street Orlando FL 32804 593215680 PHO/TPA FL N/A C Florida Medical Plaza Condo Association Inc 601 East Rollins Street Orlando FL 32803 592855791 Condo Association FL N/A C Florida Memorial Health Network Inc 770 W Granada Blvd Ste 317 Ormond Beach FL 32174 593403558 Physician Hospital Org. FL N/A C Harvard Park East Inc (630 Year End) 2525 S Downing Street Denver CO 80210 841574365 Real Estate Leasing CO N/A C Helen Ellis Memorial Hospital Real Estate Corp (101-123110) 1395 S Pinellas Ave Tarpon Springs FL 34689 593375731 Real Estate Rental FL N/A C Huguley Alliance Foundation 11801 South Freeway Fort Worth TX 76115 752642209 Inactive TX N/A C Huguley Medical Associates Inc 11801 South Freeway Burleson TX 76028 752547668 Physician Clinics TX N/A C Kissimmee Multispecialty Clinic Condominium Association Inc 201 Hilda Street Suite 30 Kissimmee FL 34741 593539564 Condo Association FL N/A C Midwest Management Services Inc 9100 West 74th Street Shawnee Mission KS 66204 480901551 Real Estate Rental KS N/A C Metroplex Adventist Hospital CRNA 2201 S Clear Creek Road Killeen TX 76549 260760794 Support hospital through the provision of allied health professionals TX N/A C North American Health Services Inc & Subs 111 N Orlando Avenue Winter Park FL 32789 621041820 Lessor/Holding Co. TN Adventist Health System Sunbelt Healthcare Corp C 2754004 23895504 1.00000 Ormond Professional Condo Association (430 Year End) 770 W Granada Blvd Ste 101 Ormond Beach FL 32174 592694434 Condo Association FL N/A C Park Ridge Property Owner's Association Inc 1 Park Place Naples Road Fletcher NC 28732 030380531 Condo Association NC N/A C Porter Affiliated Hlth Services Inc dba Diversified Affiliated Hlth Svcs 2525 S Downing Street Denver CO 80210 840956175 Healthcare Services CO N/A C Porter Medical Plaza Inc (630 Year End) 2525 S Downing Street Denver CO 80210 841574369 Real Estate Leasing CO N/A C Reflections Commercial Condominium Association Inc 875 Sterthaus Ave Ormond Beach FL 32174 593519055 Condo Association FL N/A C San Marcos Regional MRI Inc 1301 Wonder World Drive San Marcos TX 78666 770597968 Holding Company TX N/A C Southeast Volusia Medical Services Inc (10110-93011) 401 Palmetto Street New Smyrna Beach FL 32168 593287185 Inactive FL N/A C The Garden Retirement Community Inc 602 Courtland Street Ste 200 Orlando FL 32804 593414055 Real Estate Rental FL N/A C University Community Health Insurance Company SPC Ltd C/O AON Insurance Managers PO Box Grand Cayman CJ Captive Insurance CJ N/A C UCH Services Inc (101-123110) 3100 East Fletcher Ave Tampa FL 33613 593508454 Management Company FL N/A C West Coast Medical Group Inc (101-123110) 1395 S Pinellas Ave Tarpon Springs FL 34689 593537305 Physician Clinics FL N/A C 1 1 1 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 Fletcher Hospital Inc K 787352 % of subsidaries' operating exp. Jellico Community Hospital Inc K 236046 % of subsidaries' operating exp. Memorial Hospital Inc K 462286 % of subsidaries' operating exp. Adventist Hinsdale Hospital K 2391930 % of subsidaries' operating exp. Chippewa Valley Hospital & Oakview Care Center Inc K 101590 % of subsidaries' operating exp. Adventist Bolingbrook Hospital K 738747 % of subsidaries' operating exp. Adventist Health SystemSunbelt Inc K 34064823 % of subsidaries' operating exp. Adventist GlenOaks Hospital K 599181 % of subsidaries' operating exp. Metroplex Adventist Hospital Inc K 1028624 % of subsidaries' operating exp. Emory-Adventist Inc K 545342 % of subsidaries' operating exp. Adventist Health System Georgia Inc K 677501 % of subsidaries' operating exp. Shawnee Mission Medical Center Inc K 2842046 % of subsidaries' operating exp. Florida Hospital Zephyrhills Inc K 913800 % of subsidaries' operating exp. University Community Hospital Inc K 1410170 % of subsidaries' operating exp. Southwest Volusia Healthcare Corporation K 1218000 % of subsidaries' operating exp. Bert Fish Medical Center K 451144 % of subsidaries' operating exp. Memorial Hospital - West Volusia Inc K 1095649 % of subsidaries' operating exp. Florida Hospital Waterman Inc K 1725753 % of subsidaries' operating exp. Tarpon Springs Hospital Foundation Inc dba Helen Ellis Memorial Hospital K 255003 % of subsidaries' operating exp. Memorial Health Systems Inc K 2124613 % of subsidaries' operating exp. Memorial Hospital - Flagler Inc K 1172816 % of subsidaries' operating exp. Sunbelt Health Care Centers Inc K 516971 % of subsidaries' operating exp. PorterCare Adventist Health System K 5176456 % of subsidaries' operating exp. Fletcher Hospital Inc P 5845580 Cost Jellico Community Hospital Inc P 1555049 Cost Memorial Hospital Inc P 3696371 Cost Adventist Hinsdale Hospital P 17281490 Cost AHS Midwest Management Inc P 556760 Cost Adventist Health Partners Inc P 3160988 Cost Adventist Bolingbrook Hospital P 3449409 Cost Chippewa Valley Hospital & Oakview Care Center Inc P 488284 Cost Adventist GlenOaks Hospital P 3081978 Cost Adventist Health SystemSunbelt Inc P 111920271 Cost Huguley Medical Associates Inc P 210342 Cost Speciality Physicians of Central Texas Inc P 174161 Cost Metroplex Adventist Hospital Inc P 4273314 Cost Emory-Adventist Inc P 3409558 Cost Cobb Medical Associates LLC P 354589 Cost Adventist Health System Georgia Inc P 4383469 Cost PorterCare Adventist Health System P 2881085 Cost Shawnee Mission Medical Center Inc P 11491741 Cost Florida Physicians Medical Group P 10873184 Cost Memorial Hospital - West Volusia Inc P 6831980 Cost Southwest Volusia Healthcare Corporation P 5736447 Cost Memorial Hospital - Flagler Inc P 6550460 Cost Memorial Health Systems Inc P 11576226 Cost Florida Hospital Waterman Inc P 8571456 Cost Florida Hospital Zephyrhills Inc P 7302718 Cost Sunbelt Health Care Centers Inc P 5828772 Cost University Community Hospital Inc P 513284 Cost Midwest Management Services Inc P 882640 Cost Fletcher Hospital Inc C 494626 Actual Amount Received Memorial Hospital Inc C 272689 Actual Amount Received Chippewa Valley Hospital & Oakview Care Center Inc C 49225 Actual Amount Received Adventist GlenOaks Hospital C 298517 Actual Amount Received Adventist Hinsdale Hospital C 2080637 Actual Amount Received Adventist Bolingbrook Hospital C 250693 Actual Amount Received Adventist Health System Georgia Inc C 709027 Actual Amount Received PorterCare Adventist Health System C 5339711 Actual Amount Received Shawnee Mission Medical Center Inc C 2535699 Actual Amount Received Memorial Hospital - West Volusia Inc C 627318 Actual Amount Received Memorial Hospital - Flagler Inc C 1121890 Actual Amount Received Florida Hospital Waterman Inc C 1579976 Actual Amount Received Florida Hospital Zephyrhills Inc C 935773 Actual Amount Received Southwest Volusia Healthcare Corporation C 768211 Actual Amount Received Memorial Health Systems Inc C 1308843 Actual Amount Received Adventist Health SystemSunbelt Inc C 16627165 Actual Amount Received Adventist Health SystemSunbelt Inc O 897868 cost Emory-Adventist Inc A 2226 FMV Interest Rate Emory-Adventist Inc R 101554 Principle Payment Adventist Health SystemSunbelt Inc J 81626 FMV Rental Rate Adventist Hinsdale Hospital I 71070 FMV Rental Rate Memorial Hospital Inc I 68310 FMV Rental Rate Shawnee Mission Medical Center Inc I 56304 FMV Rental Rate University Community Hospital Foundation Inc B 10010000 Actual Amount Given SunSystem Development Corporation B 142450 Actual Amount Given