Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 01-01-2013 , 2013, and ending 12-31-2013
BCheck if applicable:
CName of organization
University Community Hospital Inc
 
Doing Business As
Florida Hospital Tampa
 
Number and street (or P.O. box if mail is not delivered to street address)
3100 East Fletcher Avenue
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Tampa, FL336134688
D Employer identification number

59-1113901
E Telephone number

G Gross receipts $ 510,079,091
F Name and address of principal officer:
Brian Adams
3100 East Fletcher Avenue
Tampa,FL336134688
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.floridahospital.com/tampa
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1966
M State of legal domicile: FL
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: The provision of medical care to the community through the operation of two hospitals and a long-term acute care facility.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 23
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 15
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 4,340
6 Total number of volunteers (estimate if necessary) ............. 6 415
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 610,870 527,038
9 Program service revenue (Part VIII, line 2g) ......... 494,364,487 504,175,518
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 3,906,893 2,213,894
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 4,787,098 3,162,641
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 503,669,348 510,079,091
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 170,000 103,500
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 191,769,202 209,311,681
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 267,493,533 266,981,462
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 459,432,735 476,396,643
19 Revenue less expenses. Subtract line 18 from line 12....... 44,236,613 33,682,448
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 809,175,286 790,329,557
21 Total liabilities (Part X, line 26)............. 357,443,758 278,602,074
22 Net assets or fund balances. Subtract line 21 from line 20..... 451,731,528 511,727,483
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: 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.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 415,653,348 including grants of $ 103,500 ) (Revenue $ 507,338,159 )
Operation of Florida Hospital Tampa, a 381-bed general acute care hospital, Florida Hospital Carrollwood, a 120-bed general acute care hospital, Florida Hospital Pepin Heart Institute, a 94-bed facility, and a 50-bed Long-Term Acute Care Hospital. Combined these facilities generated 25,453 patient admissions, 138,462 patient days, and 158,613 outpatient visits during the current tax year.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet415,653,348
Form 990 (2013)
Form 990 (2013)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II.................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV..................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
327
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
4,340
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
23
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
15
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletTim Widdison3100 East Fletcher AvenueTampaFL336134688 (813) 971-6000
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Robert Anderson........................................................................
Chairman
 2.00
.......................0.00 		X           0 0 0
(2) Michael Schultz........................................................................
Vice Chairman
 2.00
.......................50.00 		X           0 1,430,716 157,109
(3) Art Berard........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(4) Scott Bronleewe MD........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(5) Jack Butcher........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(6) Jon Courson........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(7) Henry Ennis Jr........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(8) John Harding........................................................................
CEO/Director
 50.00
.......................0.00 		X   X       0 1,028,752 125,824
(9) Lars Houmann........................................................................
Director
 1.00
.......................50.00 		X           0 1,670,927 240,916
(10) David Jimenez........................................................................
Director (Beg 9/12/13)
 1.00
.......................0.00 		X           0 0 0
(11) Arthenia Joyner........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(12) Ken Lightfoot........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(13) Mary Mahon........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(14) Fred Meyer........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(15) Eric Newman........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(16) Brendan O'Malley MD........................................................................
Director
 50.00
.......................0.00 		X           240,168 0 43,699
(17) Thaddeus Parker IV........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
Form 990 (2013)
Form 990 (2013)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Sharad Patel MD........................................................................
Director
 9.40
.......................0.00 		X           62,833 0 0
(19) Tom Pepin........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(20) Charlie Robbins........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(21) Robert Rosequist MD........................................................................
Director (end 1/24/13)
 1.00
.......................0.00 		X           0 93,825 0
(22) Basil Scaglione........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(23) Kurt Stonesifer MD........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(24) Jose Vivero........................................................................
Director
 1.00
.......................0.00 		X           0 0 0
(25) Janice Hagensicker........................................................................
Regional CFO (End 8/13)
 50.00
.......................0.00 		    X       0 679,929 71,520
(26) Vadym Didenko........................................................................
CFO - Medical Center (Beg 9/13)
 50.00
.......................0.00 		      X     0 416,531 75,310
(27) Richard Tibbitts........................................................................
COO - Medical Center
 50.00
.......................0.00 		      X     0 454,297 51,305
(28) Brad Bjornstad MD........................................................................
CMO - Medical Center
 50.00
.......................0.00 		      X     0 392,038 53,292
(29) Kathleen Miller........................................................................
CNO - Medical Center
 50.00
.......................0.00 		      X     0 275,500 40,859
(30) Joel Johnson........................................................................
CEO-Carrollwood
 50.00
.......................0.00 		      X     0 509,357 76,166
(31) Shane Cox........................................................................
CFO - Carrollwood
 50.00
.......................0.00 		      X     0 223,278 33,511
(32) Robin McGuinness........................................................................
CNO - Carrollwood
 50.00
.......................0.00 		      X     0 187,650 38,758
(33) Brigitte Shaw........................................................................
COO - Pepin Heart Hosp
 50.00
.......................0.00 		      X     0 315,173 65,428
(34) Alexander Rosemurgy MD........................................................................
Physician
 45.00
.......................0.00 		        X   793,990 0 50,404
(35) Sharona Ross MD........................................................................
Physician
 45.00
.......................0.00 		        X   465,573 0 37,618
(36) Michael Harris MD........................................................................
Physician
 45.00
.......................0.00 		        X   448,380 0 33,679
(37) James Orlowski MD........................................................................
Physician
 45.00
.......................0.00 		        X   389,663 0 43,129
(38) Charles Lambert MD........................................................................
Physician
 45.00
.......................0.00 		        X   376,237 0 19,951
(39) Marvin Kurtz........................................................................
Former CFO - Med Ctr
 0.00
.......................0.00 		          X 0 100,219 7,154
(40) Mary Whillock........................................................................
Former - CNO Carrollwood
 0.00
.......................0.00 		          X 0 123,271 14,246
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,776,844 7,901,463 1,279,878
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet123
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Crothall Healthcare Inc13028 Collections Center DriveChicagoIL60693 Housekeeping 6,799,997
Hyperbaric & Wound Care Inc7171 N Dale Mabry HwyTampaFL33614 Management Services 3,724,414
General Electric Meds Systems Inc15724 COLLECTIONS CENTER DRChicagoIL60693 Service Contract - Med Equip 3,353,869
Select Medical Corp4714 Gettysburg RoadMechanicsburgPA17055 Management Services 1,768,176
Cross Country StaffingPO Box 404674AtlantaGA30384 Staffing 1,645,070
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet89
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 434,210
e Government grants (contributions)1e 92,828
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 527,038
Program Service RevenueAmt Business Code
2a Net Patient Revenue 900099 498,974,174 498,974,174    
b Cafeteria 900099 2,303,055 2,303,055    
c Research Fees 900099 746,625 746,625    
d Medical Office Building 531120 642,399 642,399    
e Gift Shop 900099 404,390 404,390    
f All other program service revenue . 1,104,875 1,104,875    
g Total. Add lines 2a–2f........MediumBullet 504,175,518
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 1,206,193     1,206,193
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 930,339 77,362
b Less: cost or other basis and sales expenses 0 0
c Gain or (loss) 930,339 77,362
d Net gain or (loss)..........MediumBullet 1,007,701     1,007,701
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a EHR Revenue 900099 3,162,641 3,162,641    
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 3,162,641
12 Total revenue. See Instructions......MediumBullet 510,079,091 507,338,159 0 2,213,894
Form 990 (2013)
Form 990 (2013)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 103,500 103,500
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 5,461,179 346,700 5,114,479  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 152,622,524 129,159,143 23,463,381  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 3,695,155 3,038,863 656,292  
9 Other employee benefits ....... 35,076,673 29,358,715 5,717,958  
10 Payroll taxes ........... 12,456,150 10,243,828 2,212,322  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 815,838   815,838  
c Accounting ........... 145,519   145,519  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 671,721   671,721  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 57,328,376 44,681,896 12,646,480  
12 Advertising and promotion .... 3,784,878   3,784,878  
13 Office expenses ....... 10,725,211 8,483,435 2,241,776  
14 Information technology ...... 21,009,050 17,921,176 3,087,874  
15 Royalties ..        
16 Occupancy ........... 7,518,116 7,518,116    
17 Travel ............ 775,400 775,400    
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings ....        
20 Interest ........... 7,582,789 7,582,789    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 35,561,772 35,561,772    
23 Insurance .............. 4,640,659 4,455,882 184,777  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Medical Supplies 94,676,512 94,676,512    
b Repairs & Maintenance 13,095,385 13,095,385    
c State Tax Indigent Asse 6,673,815 6,673,815    
d Bad Debt Expense 748,809 748,809    
e All other expenses 1,227,612 1,227,612    
25 Total functional expenses. Add lines 1 through 24e 476,396,643 415,653,348 60,743,295 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 9,935 1 14,426
2 Savings and temporary cash investments ......... 125,911,520 2 126,984,598
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 74,223,344 4 73,279,527
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 12,355,633 8 12,781,077
9 Prepaid expenses and deferred charges .......... 11,785,039 9 9,998,420
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 608,174,092
b Less: accumulated depreciation ..... 10b 111,444,145 468,700,490 10c 496,729,947
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ..... 25,000 12 25,000
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ............... 15,998,496 14 15,158,496
15 Other assets. See Part IV, line 11 ........... 100,165,829 15 55,358,066
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 809,175,286 16 790,329,557
Liabilities 17 Accounts payable and accrued expenses ......... 35,979,461 17 38,811,615
18 Grants payable .................   18  
19 Deferred revenue ................   19 173,090
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 321,464,297 25 239,617,369
26 Total liabilities. Add lines 17 through 25......... 357,443,758 26 278,602,074
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 434,397,567 27 490,253,055
28 Temporarily restricted net assets ........... 16,847,319 28 20,816,354
29 Permanently restricted net assets ........... 486,642 29 658,074
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 451,731,528 33 511,727,483
34 Total liabilities and net assets/fund balances ........ 809,175,286 34 790,329,557
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
510,079,091
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
476,396,643
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
33,682,448
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
451,731,528
5
Net unrealized gains (losses) on investments ...............
5
-16,412
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
26,329,919
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
511,727,483
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
University Community Hospital Inc
 
Employer identification number

59-1113901
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the organization
University Community Hospital Inc
 
Employer identification number

59-1113901
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
University Community Hospital Inc
  		Employer identification number

59-1113901
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

   
RESTRICTED
RESTRICTED
RESTRICTED, RESTRICTEDRESTRICTED

$RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
University Community Hospital Inc
  		Employer identification number

59-1113901
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
Name of organization
University Community Hospital Inc
  		Employer identification number

59-1113901
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
University Community Hospital Inc
 
Employer identification number

59-1113901
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2013

Schedule C (Form 990 or 990-EZ) 2013
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2013


Schedule C (Form 990 or 990-EZ) 2013
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
86,255
j
Total. Add lines 1c through 1i ...............................
86,255
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Part II-B, Line 1: Dues were paid to the American Hospital Association and Florida Hospital Association. 2 Outside Consultants were used during 2013 for lobbying on behalf of the filing organization with respect to legislative matters impacting the delivery of health as follows: 1. Mike Fasano - $16,923 2. RSA Consultants - $48,000
Schedule C (Form 990 or 990EZ) 2013

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
University Community Hospital Inc
 
Employer identification number

59-1113901
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 15,352,543 16,206,168 16,247,486 5,242,118 7,117,631
b Contributions ........ 1,108,676 1,019,381 426,688 10,131,589 2,259,714
c Net investment earnings, gains, and losses 858,180 642,968 194,446 32,188 -144,735
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		1,360,318 2,515,974 662,452 -892,786 3,990,492
f Administrative expenses ....       51,195  
g End of year balance ...... 15,959,081 15,352,543 16,206,168 16,247,486 5,242,118
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet3.000 %
c
Temporarily restricted endowment SchDMd Bullet97.000 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   24,506,000 24,506,000
b Buildings ................   399,485,882 49,785,826 349,700,056
c Leasehold improvements ............        
d Equipment ................   120,777,537 59,166,477 61,611,060
e Other .................   63,404,673 2,491,842 60,912,831
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 496,729,947
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Due from Affiliates 12,402,176
(2) Other Current Receivables 1,128,249
(3) Board Designated Funds 18,408,376
(4) Interest in VHA, Inc. 200,000
(5) Interest in UCH Foundation 21,474,428
(6) Receivable from Third Parties 1,744,837



Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 55,358,066
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
Capital Lease Obligations 1,924,104
Payable to Third Parties 5,537,071
Credit Balances in A/R 5,076,205
Other Noncurrent Liabilities 16,217,991
Other Current Liabilities 713,322
Interco. Alloc. of Tax Exempt Bond Proceeds 204,900,351
Due to Affiliates 5,248,325


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 239,617,369
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
Part V, Line 4: University Community Hospital Foundation, Inc. (UCHF), a related organization formed and maintained exclusively to further the exempt purpose of University Community Hospital, Inc. (the Hospital), held assets in temporary endowment and permanent endowment funds during the current tax year. UCHF's endowment consists of individual donor restricted endowment funds and pledges receivable where the assets have been designated for endowment established to support various purposes benefiting the Hospital and its patients.
Part X, Line 2: The Hospital is part of a consolidated audited financial statement. The consolidated audited financial statement includes the following FIN 48 footnote - The Division follows the Income Taxes Topic of the ASC (ASC 740), which prescribes the accounting for uncertainty in income tax positions recognized in financial statements. ASC 740 prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken, or expected to be taken, in a tax return.
Schedule D (Form 990) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
University Community Hospital Inc
 
Employer identification number

59-1113901
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    17,655,482 0 17,655,482 3.710 %
b Medicaid (from Worksheet 3,
column a) .... 		    63,559,018 28,317,322 35,241,696 7.400 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    81,214,500 28,317,322 52,897,178 11.110 %
Other Benefits
     15,477   15,477 0 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		           
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		           
j Total. Other Benefits ..     15,477   15,477  
k Total. Add lines 7d and 7j .     81,229,977 28,317,322 52,912,655 11.110 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
36,162,957
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
2,671,716
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
114,580,466
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
124,254,415
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-9,673,949
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?3
Name, address, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Florida Hospital Tampa
3100 E Fletcher Avenue
Tampa,FL33613
www.floridahospital.com/tampa
4035 		X X       X X      
2 Florida Hospital Carrollwood
7171 N Dale Mabry Hwy
Tampa,FL33614
www.floridahospital.com/carrollwood
4179 		X X         X      
3 FL Hosp at Connerton LTAC Hospital
9441 Health Center Drive
Land OLakes,FL34637
www.floridahospital.com/connerton
4499 		X X                
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Florida Hospital Tampa
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.......... 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Florida Hospital Carrollwood
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		2
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.......... 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
FL Hosp at Connerton LTAC Hospital
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		3
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1   No
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20  
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3    
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................ 4    
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5    
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7    
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a    
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.......... 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
Florida Hospital Tampa Part V, Section B, Line 3: University Community Hospital, Inc. d/b/a Florida Hospital Tampa, (FHT or the Hospital) is a 475-bed hospital facility located in Hillsborough County in Florida. The Hospital's primary service area is nestled in Hillsborough County and is primarily comprised of seven zip codes surrounding the Hospital. Several of the primary service area zip codes include communities that are fundamentally underserved. The Hospital's primary service area includes diverse micro-communities which vary in income, education level, and living conditions and are ethnically and culturally diverse. In conducting its 2013 Community Health Needs Assessment (CHNA), primary and secondary health data was collected and analyzed. Primary data collection efforts included key informant/stakeholder interviews, community member interviews, community surveys, and congregational surveys. Key stakeholders were identified to ensure broad representation of the community. Many of the key informants were selected because of their direct ties to the underserved and impoverished communities in the Hospital's primary service area. Key stakeholders included representatives from the local Haitian community, the Florida Council of Churches, the Hillsborough County Public Health Department, the Hillsborough County Sheriff's Department, Hillsborough County schools, a local free clinic for uninsured patients, the University Area Community Development Center, WIC, and a free clinic operated for the University of South Florida. FHT also gathered primary data through the utilization of two distinct survey instruments. The first one was developed by the Congregational Health Network sub-committee and was administered to four partners within the Hospital's congregational network. The second survey was a community member survey which was based upon the Congregational Health Network survey but included fewer questions. Various sources of secondary data were reviewed to understand the larger issues plaguing the Hospital's primary service area. As part of its efforts to ensure broad community-based input into the CHNA process, the Hospital established a Community Health Needs Assessment Committee (CHNAC). The CHNAC was intended to represent the needs of the general community with a particular focus on including representatives of the medically underserved, low-income and minority populations. Many of the same community groups that participated in the key stakeholder interviews were also represented on the CHNAC.
Florida Hospital Carrollwood Part V, Section B, Line 3: University Community Hospital, Inc., d/b/a Florida Hospital Carrollwood (FHCW or the Hospital), is a 120-bed community hospital specializing in Spine and Orthopedic Surgery, General Surgery, Cardiac Services, Neurological Services, General Medicine, Wound Healing, ENT, Diabetes Management, Metabolic and Bariatric Weight Loss Surgery, as well as other services that meet the Hospital's mission of healing the mind, body, and spirit. The Hospital's core service area is comprised of seven zip codes located in Hillsborough County, Florida. The total population in the Hospital's core service area is approximately 212,000. Median income in the Hospital's core service area is approximately $49,000 and about 14% of the population lives below the federal poverty level. In conducting its 2013 Community Health Needs Assessment (CHNA), primary and secondary data was collected through interviews and surveys along with secondary data from local, regional, and national health-related sources. As part of its efforts to ensure broad community-based input into the CHNA process, the Hospital established a Community Health Needs Assessment Committee (CHNAC). FHCW relied heavily on stakeholder input from the CHNAC, whose members represented a broad cross-section of the community, including vulnerable populations. In addition, FHCW turned to two specific local groups that have first-hand experience with the healthcare needs of the low-income population in the Hospital's community : The Judeo-Christian Coalition and Egypt Lake Elementary School. The Judeo Christian Coalition is the oldest, largest, and most dominant free clinic in Hillsborough County. Egypt Lake Elementary School is among the poorest in the Hillsborough County School District. The school has very high numbers of children in the free and reduced-fee lunch programs. In order to ensure input from representatives of low-income, minority and medically underserved populations, key informants/stakeholder were identified for interviews. Stakeholders who participated in the CHNA interview process included, among others, representatives from the Judeo Christian Coalition, Egypt Lake Elementary School, The Florida Department of Health, Suncoast United Way, Florida Association of Physicians of Indian Descent, several local churches, the University of South Florida Department of Public Health, and Tampa Family Health Center. In addition to key stakeholder interviews, FHCW selected CHNAC members who represented the broad needs of the community, including low-income, minority and underserved populations. The CHNAC consisted of 28 members and represented organizations such as the Hillsborough County Sheriff's Office, the University of South Florida Department of Public Health, the University Area Community Development Corporation, the local Haitian community, along with numerous church organizations.
Florida Hospital Tampa Part V, Section B, Line 5d: The Hospital has adopted a policy that addresses the public posting requirements of the Community Health Needs Assessment. Under this policy, the Community Health Needs Assessment Report must be posted on the Hospital's website by the end of the year in which it is conducted. The Hospital will make a copy of its Community Health Needs Assessment Report available upon request. The Hospital will also make a paper copy of the Community Health Needs Assessment Report available for public inspection at the Hospital facility.
Florida Hospital Carrollwood Part V, Section B, Line 5d: The Hospital has adopted a policy that addresses the public posting requirements of the Community Health Needs Assessment. Under this policy, the Community Health Needs Assessment Report must be posted on the Hospital's website by the end of the year in which it is conducted. The Hospital will make a copy of its Community Health Needs Assessment Report available upon request. The Hospital will also make a paper copy of the Community Health Needs Assessment Report available for public inspection at the Hospital facility.
Florida Hospital Tampa Part V, Section B, Line 6i: As a part of its Community Health Needs Assessment, the filing organization conducted an extensive and thorough analysis and prioritization of its significant identified health needs. Please see our discussion in Part V, Section B, line 7.The filing organization adopted its initial Community Health Needs Assessment by 12/31/13 and was in the process of developing its community health needs implementation strategy. The filing organization's implementation strategy will be documented in a written report called the "Community Health Plan". The Community Health Plan (CHP) will describe how the filing organization plans to meet its identified prioritized health needs or will identify the health need as one the filing organization does not intend to specifically address and provide an explanation as to why the filing organization does not intend to address that health need. In accordance with Proposed Regulation Section 1.501(r)-3(e)(2), the filing organization's CHP will be adopted no later than May 15, 2014.
Florida Hospital Carrollwood Part V, Section B, Line 6i: The filing organization adopted its initial Community Health Needs Assessment by 12/31/13 and was in the process of developing its community health needs implementation strategy. The filing organization's implementation strategy will be documented in a written report called the "Community Health Plan". The Community Health Plan (CHP) will describe how the filing organization plans to meet its identified prioritized health needs or will identify the health need as one the filing organization does not intend to specifically address and provide an explanation as to why the filing organization does not intend to address that health need. In accordance with Proposed Regulation Section 1.501(r)-3(e)(2), the filing organization's CHP will be adopted no later than May 15, 2014.
Florida Hospital Tampa Part V, Section B, Line 7: University Community Hospital, Inc. d/b/a Florida Hospital Tampa (FHT or the Hospital), formed a Community Health Needs Assessment Committee (CHNAC) to review primary and secondary data collected and to formulate the determination of health priorities. The CHNA assessment process employed the use of qualitative and quantitative methods derived from public health. This mixed method and interdisciplinary approach proved to be very successful in beginning to understand the diverse community serviced by FHT. The Hospital's findings from primary data (community interviews and surveys) and from secondary data (pre-existing regional health related data) guided the selection process for determining the top health needs of the Hospital's community. Based upon the primary and secondary data collected, a total of eleven health needs were initially identified. Discussions were held concerning the feasibility of addressing each of the health needs based on available resources and partners. The CHNAC represented the broad community including low-income, minority and underserved populations. The initial eleven health needs identified were as follows: mental health, lack of education and awareness, obesity, pediatric asthma, maternal and child health, lack of access to primary care, diabetes, rate of uninsured, teen pregnancy, respiratory related diseases, and heart disease. The CHNA narrowed down the initial eleven healthy priorities to four health priorities based upon how the CHNA perceived these conditions could be addressed by partnering with the Hospital. Upon final health needs priority selection, the CHNAC chose the following four health priorities:Mental health;Diabetes;Lack of access to Primary Care; andLack of education and awareness.
Florida Hospital Carrollwood Part V, Section B, Line 7: University Community Hospital, Inc., d/b/a Florida Hospital Carrollwood (FHCW or the Hospital), formed a Community Health Needs Assessment Committee (CHNAC) to review primary and secondary data collected and to formulate the determination of health priorities using a systematic approach that relied heavily on a decision tree priority selection process. The decision tree format assisted the CHNAC in focusing on those needs that the Hospital would have the ability to influence through the implementation or expansion of programs, services, or other actions, and that may be the focus of other community resources/organizations that may be already addressing the need in some way. The CHNAC used a Priority Selection Report tool to assist in the review of data collected and prioritization of the top areas of significant community need for the Hospital's community. Based upon the primary and secondary data collected, eleven health issues were initially identified for the Hospital's core service area. Based upon discussions and collaborative interactions, such as creating inventories of needs resources throughout the community, the CHNAC collectively determined that the top eleven health needs for FHCW were: Respiratory conditions, UTI, Gastrointestinal distress, Chest pain, Lack of access to free/affordable healthcare, Lack of primary care physicians/lack of access to primary care, Lack of access to specialized care, Diabetes, Lack of utilization, Mental Health, and High cholesterol/hypertension. In further prioritizing the eleven initially identified top health issues, the CHNAC considered the level of community need, the ability of the Hospital to provide services related to the need, the work already going on in the community, and the ability to collaborate with community partners. Through extensive dialogue and analysis, the CHNAC narrowed the list of issues to five, focusing on those upon which the Hospital could have the greatest positive impact. Upon final health needs priority selection, the CHNAC chose the following five priorities:Lack of Primary Care/Access to Primary Care Lack of Education High Cholesterol/Hypertension DiabetesAsthma/Respiratory Diseases. The CHNAC did not choose the following issues for the reasons stated below. Mental Health the Hospital does not provide mental health services and other community agencies are providing these services. Poverty/Unemployment The University Area Community Development Corporation is working to rejuvenate very low-income areas of the Tampa area. They are part of the CHNAC and are supported by the Hospital.Uninsured The Hospital and the Congregational Health Network will continue to support the area's free clinics and Federally Qualified Health Centers. The University of South Florida has received federal funding for Health Navigators to help Tampa residents enroll in insurance offered on the Federal Insurance Marketplace. This will help increase the coverage level of our community.
Florida Hospital Tampa Part V, Section B, Line 14g: 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.
Florida Hospital Carrollwood Part V, Section B, Line 14g: The filing organization 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.
FL Hosp. at Connerton LTAC Hospital Part V, Section B, Line 14g: 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.
Florida Hospital Tampa Part V, Section B, Line 20d: In determining the maximum amount that can be charged to financial assistance policy-eligible individuals for emergency or other medically necessary care, the Hospital uses the following methodology:The Hospital identifies all commercial payors that had any activity with the Hospital during 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.
Florida Hospital Carrollwood Part V, Section B, Line 20d: In determining the maximum amount that can be charged to financial assistance policy-eligible individuals for emergency or other medically necessary care, the Hospital uses the following methodology:The Hospital identifies all commercial payors that had any activity with the Hospital during 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.
FL Hosp. at Connerton LTAC Hospital Part V, Section B, Line 20d: In determining the maximum amount that can be charged to financial assistance policy-eligible individuals for emergency or other medically necessary care, the Hospital uses the following methodology:The Hospital identifies all commercial payors that had any activity with the Hospital during 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.
Supplemental Schedule to Schedule H, Part V, Section B: Hospital 3 Disclosure Statement Pursuant to Internal Revenue Service (IRS) Notice 2014-3:The filing organization operates three separately licensed hospital facilities. Two of these hospital facilities are general acute-care hospitals that offer general medical and surgical services and operate 24/7 emergency departments. The third facility, d/b/a Florida Hospital at Connerton Long Term Acute Care Hospital, is a long-term acute care facility that offers long-term care services for individuals with complex medical conditions, and does not operate an emergency department. Pursuant to IRS Notice 2014-3, the filing organization is seeking an excusal from its failure to conduct a community health needs assessment (CHNA) for Florida Hospital Connerton Long Term Acute Care Hospital for its tax year ended December 31, 2013. The failure was not willful or egregious. Additionally, steps are underway to correct the failure and this disclosure is being made in accordance with Section 6 of the Proposed Revenue Procedure set forth in IRS Notice 2014-3 as follows:(1) A description of the failure: The filing organization is a subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is the 501(c)(3) parent organization of a healthcare system known as Adventist Health System (AHS). As noted above, the filing organization operates two acute-care hospitals and one long-term acute care facility. In its 2013 tax year, the filing organization conducted two separate CHNAs for its two acute-care hospitals following extensive and detailed policies and procedures adopted and implemented by AHS on a system-wide basis. The failure to conduct a CHNA for the long-term care facility was the result of a determination (although later discovered to be erroneous) that because the long-term care facility did not operate an emergency department or provide traditional acute-care hospital services, it was not a hospital for purposes of Prop. Reg. Section 1.501(r)-1. The failure was not due to gross negligence, reckless disregard, or willful neglect. The filing organization was under the good-faith belief that a CHNA was not required for its long-term acute care facility. A CHNA was conducted for each of the other two general acute-care hospitals operated by the filing organization and both were made publicly available by posting the CHNAs on the filing organization's website by December 31, 2013. The filing organization is subject to an AHS system-wide policy that sets forth the requirements, and general processes and procedures to be followed by all AHS hospital facilities with respect to CHNAs and implementation strategies. (2) A description of the discovery: The filing organization's failure to conduct a CHNA for its long-term acute care facility was discovered in October of 2014 during the Form 990 preparation process. In the process of gathering hospital license numbers for purposes of reporting on Form 990, Schedule H, Part V, Section A, it was discovered that the license-type assigned to the long-term acute care facility was as a hospital. Further investigation followed and it was determined that the long-term acute care facility was licensed as a hospital under the State of Florida statutes. Accordingly, a CHNA should have been conducted for the long-term acute care facility for its 2013 tax year. (3) A description of the correction made: The correction of the failure to conduct a CHNA for the filing organization's long-term acute care facility for its 2013 tax year is to commence a CHNA process immediately, following the policies and procedures established by AHS. The filing organization will make every effort to complete the documentation of the CHNA in the form of a CHNA report, obtain Board of Director approval of the CHNA report, and make the CHNA report available to the public by posting it on the filing organization's web-site by December 31, 2014. All future CHNAs will be conducted by the long-term acute care facility in a timely fashion in accordance with the requirements set forth in IRC Section 501(r)(3).(4) A description of policies and procedures: As noted above, complete and extensive policies and procedures are currently in place for the AHS system of hospitals that set forth AHS's policy on compliance with IRC Section 501(r)(3). These policies mandate that CHNAs will be conducted by each AHS hospital facility and provide the general steps and processes that should be followed in the conduct of a CHNA. There is also an AHS system-wide policy that addresses the public posting requirements of each AHS hospital's CHNA. The filing organization's failure to conduct a CHNA for its long-term acute care facility was not due to incorrect or inadequate policies and procedures, but rather was due to the issue of the qualification of the long-term acute care facility as a hospital for purposes of IRC Section 501(r)(3).
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?4
Name and address Type of Facility (describe)
1 UCH Wound Healing Institute
3000 Medical Park Dr Ste 430
Tampa,FL33613 		Wound Care
2 Brandon Wound Care Clinic
205 S Moon Ave Ste 106
Brandon,FL33511 		Wound Care
3 UCH Home Health Care
13601 Bruce B Downs Blvd Ste 110
Tampa,FL33613 		Home Health
4 Carrollwood Occupational Health Clinic
7001 N Dale Mabry Hwy
Tampa,FL33613 		Occupational Health
5
6
7
8
9
10
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Florida Hospital Tampa Part V, Section B, Line 3: University Community Hospital, Inc. d/b/a Florida Hospital Tampa, (FHT or the Hospital) is a 475-bed hospital facility located in Hillsborough County in Florida. The Hospital's primary service area is nestled in Hillsborough County and is primarily comprised of seven zip codes surrounding the Hospital. Several of the primary service area zip codes include communities that are fundamentally underserved. The Hospital's primary service area includes diverse micro-communities which vary in income, education level, and living conditions and are ethnically and culturally diverse. In conducting its 2013 Community Health Needs Assessment (CHNA), primary and secondary health data was collected and analyzed. Primary data collection efforts included key informant/stakeholder interviews, community member interviews, community surveys, and congregational surveys. Key stakeholders were identified to ensure broad representation of the community. Many of the key informants were selected because of their direct ties to the underserved and impoverished communities in the Hospital's primary service area. Key stakeholders included representatives from the local Haitian community, the Florida Council of Churches, the Hillsborough County Public Health Department, the Hillsborough County Sheriff's Department, Hillsborough County schools, a local free clinic for uninsured patients, the University Area Community Development Center, WIC, and a free clinic operated for the University of South Florida. FHT also gathered primary data through the utilization of two distinct survey instruments. The first one was developed by the Congregational Health Network sub-committee and was administered to four partners within the Hospital's congregational network. The second survey was a community member survey which was based upon the Congregational Health Network survey but included fewer questions. Various sources of secondary data were reviewed to understand the larger issues plaguing the Hospital's primary service area. As part of its efforts to ensure broad community-based input into the CHNA process, the Hospital established a Community Health Needs Assessment Committee (CHNAC). The CHNAC was intended to represent the needs of the general community with a particular focus on including representatives of the medically underserved, low-income and minority populations. Many of the same community groups that participated in the key stakeholder interviews were also represented on the CHNAC.
Florida Hospital Carrollwood Part V, Section B, Line 3: University Community Hospital, Inc., d/b/a Florida Hospital Carrollwood (FHCW or the Hospital), is a 120-bed community hospital specializing in Spine and Orthopedic Surgery, General Surgery, Cardiac Services, Neurological Services, General Medicine, Wound Healing, ENT, Diabetes Management, Metabolic and Bariatric Weight Loss Surgery, as well as other services that meet the Hospital's mission of healing the mind, body, and spirit. The Hospital's core service area is comprised of seven zip codes located in Hillsborough County, Florida. The total population in the Hospital's core service area is approximately 212,000. Median income in the Hospital's core service area is approximately $49,000 and about 14% of the population lives below the federal poverty level. In conducting its 2013 Community Health Needs Assessment (CHNA), primary and secondary data was collected through interviews and surveys along with secondary data from local, regional, and national health-related sources. As part of its efforts to ensure broad community-based input into the CHNA process, the Hospital established a Community Health Needs Assessment Committee (CHNAC). FHCW relied heavily on stakeholder input from the CHNAC, whose members represented a broad cross-section of the community, including vulnerable populations. In addition, FHCW turned to two specific local groups that have first-hand experience with the healthcare needs of the low-income population in the Hospital's community : The Judeo-Christian Coalition and Egypt Lake Elementary School. The Judeo Christian Coalition is the oldest, largest, and most dominant free clinic in Hillsborough County. Egypt Lake Elementary School is among the poorest in the Hillsborough County School District. The school has very high numbers of children in the free and reduced-fee lunch programs. In order to ensure input from representatives of low-income, minority and medically underserved populations, key informants/stakeholder were identified for interviews. Stakeholders who participated in the CHNA interview process included, among others, representatives from the Judeo Christian Coalition, Egypt Lake Elementary School, The Florida Department of Health, Suncoast United Way, Florida Association of Physicians of Indian Descent, several local churches, the University of South Florida Department of Public Health, and Tampa Family Health Center. In addition to key stakeholder interviews, FHCW selected CHNAC members who represented the broad needs of the community, including low-income, minority and underserved populations. The CHNAC consisted of 28 members and represented organizations such as the Hillsborough County Sheriff's Office, the University of South Florida Department of Public Health, the University Area Community Development Corporation, the local Haitian community, along with numerous church organizations.
Florida Hospital Tampa Part V, Section B, Line 5d: The Hospital has adopted a policy that addresses the public posting requirements of the Community Health Needs Assessment. Under this policy, the Community Health Needs Assessment Report must be posted on the Hospital's website by the end of the year in which it is conducted. The Hospital will make a copy of its Community Health Needs Assessment Report available upon request. The Hospital will also make a paper copy of the Community Health Needs Assessment Report available for public inspection at the Hospital facility.
Florida Hospital Carrollwood Part V, Section B, Line 5d: The Hospital has adopted a policy that addresses the public posting requirements of the Community Health Needs Assessment. Under this policy, the Community Health Needs Assessment Report must be posted on the Hospital's website by the end of the year in which it is conducted. The Hospital will make a copy of its Community Health Needs Assessment Report available upon request. The Hospital will also make a paper copy of the Community Health Needs Assessment Report available for public inspection at the Hospital facility.
Florida Hospital Tampa Part V, Section B, Line 6i: As a part of its Community Health Needs Assessment, the filing organization conducted an extensive and thorough analysis and prioritization of its significant identified health needs. Please see our discussion in Part V, Section B, line 7.The filing organization adopted its initial Community Health Needs Assessment by 12/31/13 and was in the process of developing its community health needs implementation strategy. The filing organization's implementation strategy will be documented in a written report called the "Community Health Plan". The Community Health Plan (CHP) will describe how the filing organization plans to meet its identified prioritized health needs or will identify the health need as one the filing organization does not intend to specifically address and provide an explanation as to why the filing organization does not intend to address that health need. In accordance with Proposed Regulation Section 1.501(r)-3(e)(2), the filing organization's CHP will be adopted no later than May 15, 2014.
Florida Hospital Carrollwood Part V, Section B, Line 6i: The filing organization adopted its initial Community Health Needs Assessment by 12/31/13 and was in the process of developing its community health needs implementation strategy. The filing organization's implementation strategy will be documented in a written report called the "Community Health Plan". The Community Health Plan (CHP) will describe how the filing organization plans to meet its identified prioritized health needs or will identify the health need as one the filing organization does not intend to specifically address and provide an explanation as to why the filing organization does not intend to address that health need. In accordance with Proposed Regulation Section 1.501(r)-3(e)(2), the filing organization's CHP will be adopted no later than May 15, 2014.
Florida Hospital Tampa Part V, Section B, Line 7: University Community Hospital, Inc. d/b/a Florida Hospital Tampa (FHT or the Hospital), formed a Community Health Needs Assessment Committee (CHNAC) to review primary and secondary data collected and to formulate the determination of health priorities. The CHNA assessment process employed the use of qualitative and quantitative methods derived from public health. This mixed method and interdisciplinary approach proved to be very successful in beginning to understand the diverse community serviced by FHT. The Hospital's findings from primary data (community interviews and surveys) and from secondary data (pre-existing regional health related data) guided the selection process for determining the top health needs of the Hospital's community. Based upon the primary and secondary data collected, a total of eleven health needs were initially identified. Discussions were held concerning the feasibility of addressing each of the health needs based on available resources and partners. The CHNAC represented the broad community including low-income, minority and underserved populations. The initial eleven health needs identified were as follows: mental health, lack of education and awareness, obesity, pediatric asthma, maternal and child health, lack of access to primary care, diabetes, rate of uninsured, teen pregnancy, respiratory related diseases, and heart disease. The CHNA narrowed down the initial eleven healthy priorities to four health priorities based upon how the CHNA perceived these conditions could be addressed by partnering with the Hospital. Upon final health needs priority selection, the CHNAC chose the following four health priorities:Mental health;Diabetes;Lack of access to Primary Care; andLack of education and awareness.
Florida Hospital Carrollwood Part V, Section B, Line 7: University Community Hospital, Inc., d/b/a Florida Hospital Carrollwood (FHCW or the Hospital), formed a Community Health Needs Assessment Committee (CHNAC) to review primary and secondary data collected and to formulate the determination of health priorities using a systematic approach that relied heavily on a decision tree priority selection process. The decision tree format assisted the CHNAC in focusing on those needs that the Hospital would have the ability to influence through the implementation or expansion of programs, services, or other actions, and that may be the focus of other community resources/organizations that may be already addressing the need in some way. The CHNAC used a Priority Selection Report tool to assist in the review of data collected and prioritization of the top areas of significant community need for the Hospital's community. Based upon the primary and secondary data collected, eleven health issues were initially identified for the Hospital's core service area. Based upon discussions and collaborative interactions, such as creating inventories of needs resources throughout the community, the CHNAC collectively determined that the top eleven health needs for FHCW were: Respiratory conditions, UTI, Gastrointestinal distress, Chest pain, Lack of access to free/affordable healthcare, Lack of primary care physicians/lack of access to primary care, Lack of access to specialized care, Diabetes, Lack of utilization, Mental Health, and High cholesterol/hypertension. In further prioritizing the eleven initially identified top health issues, the CHNAC considered the level of community need, the ability of the Hospital to provide services related to the need, the work already going on in the community, and the ability to collaborate with community partners. Through extensive dialogue and analysis, the CHNAC narrowed the list of issues to five, focusing on those upon which the Hospital could have the greatest positive impact. Upon final health needs priority selection, the CHNAC chose the following five priorities:Lack of Primary Care/Access to Primary Care Lack of Education High Cholesterol/Hypertension DiabetesAsthma/Respiratory Diseases. The CHNAC did not choose the following issues for the reasons stated below. Mental Health the Hospital does not provide mental health services and other community agencies are providing these services. Poverty/Unemployment The University Area Community Development Corporation is working to rejuvenate very low-income areas of the Tampa area. They are part of the CHNAC and are supported by the Hospital.Uninsured The Hospital and the Congregational Health Network will continue to support the area's free clinics and Federally Qualified Health Centers. The University of South Florida has received federal funding for Health Navigators to help Tampa residents enroll in insurance offered on the Federal Insurance Marketplace. This will help increase the coverage level of our community.
Florida Hospital Tampa Part V, Section B, Line 14g: 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.
Florida Hospital Carrollwood Part V, Section B, Line 14g: The filing organization 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.
FL Hosp. at Connerton LTAC Hospital Part V, Section B, Line 14g: 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.
Florida Hospital Tampa Part V, Section B, Line 20d: In determining the maximum amount that can be charged to financial assistance policy-eligible individuals for emergency or other medically necessary care, the Hospital uses the following methodology:The Hospital identifies all commercial payors that had any activity with the Hospital during 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.
Florida Hospital Carrollwood Part V, Section B, Line 20d: In determining the maximum amount that can be charged to financial assistance policy-eligible individuals for emergency or other medically necessary care, the Hospital uses the following methodology:The Hospital identifies all commercial payors that had any activity with the Hospital during 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.
FL Hosp. at Connerton LTAC Hospital Part V, Section B, Line 20d: In determining the maximum amount that can be charged to financial assistance policy-eligible individuals for emergency or other medically necessary care, the Hospital uses the following methodology:The Hospital identifies all commercial payors that had any activity with the Hospital during 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.
Supplemental Schedule to Schedule H, Part V, Section B: Hospital 3 Disclosure Statement Pursuant to Internal Revenue Service (IRS) Notice 2014-3:The filing organization operates three separately licensed hospital facilities. Two of these hospital facilities are general acute-care hospitals that offer general medical and surgical services and operate 24/7 emergency departments. The third facility, d/b/a Florida Hospital at Connerton Long Term Acute Care Hospital, is a long-term acute care facility that offers long-term care services for individuals with complex medical conditions, and does not operate an emergency department. Pursuant to IRS Notice 2014-3, the filing organization is seeking an excusal from its failure to conduct a community health needs assessment (CHNA) for Florida Hospital Connerton Long Term Acute Care Hospital for its tax year ended December 31, 2013. The failure was not willful or egregious. Additionally, steps are underway to correct the failure and this disclosure is being made in accordance with Section 6 of the Proposed Revenue Procedure set forth in IRS Notice 2014-3 as follows:(1) A description of the failure: The filing organization is a subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is the 501(c)(3) parent organization of a healthcare system known as Adventist Health System (AHS). As noted above, the filing organization operates two acute-care hospitals and one long-term acute care facility. In its 2013 tax year, the filing organization conducted two separate CHNAs for its two acute-care hospitals following extensive and detailed policies and procedures adopted and implemented by AHS on a system-wide basis. The failure to conduct a CHNA for the long-term care facility was the result of a determination (although later discovered to be erroneous) that because the long-term care facility did not operate an emergency department or provide traditional acute-care hospital services, it was not a hospital for purposes of Prop. Reg. Section 1.501(r)-1. The failure was not due to gross negligence, reckless disregard, or willful neglect. The filing organization was under the good-faith belief that a CHNA was not required for its long-term acute care facility. A CHNA was conducted for each of the other two general acute-care hospitals operated by the filing organization and both were made publicly available by posting the CHNAs on the filing organization's website by December 31, 2013. The filing organization is subject to an AHS system-wide policy that sets forth the requirements, and general processes and procedures to be followed by all AHS hospital facilities with respect to CHNAs and implementation strategies. (2) A description of the discovery: The filing organization's failure to conduct a CHNA for its long-term acute care facility was discovered in October of 2014 during the Form 990 preparation process. In the process of gathering hospital license numbers for purposes of reporting on Form 990, Schedule H, Part V, Section A, it was discovered that the license-type assigned to the long-term acute care facility was as a hospital. Further investigation followed and it was determined that the long-term acute care facility was licensed as a hospital under the State of Florida statutes. Accordingly, a CHNA should have been conducted for the long-term acute care facility for its 2013 tax year. (3) A description of the correction made: The correction of the failure to conduct a CHNA for the filing organization's long-term acute care facility for its 2013 tax year is to commence a CHNA process immediately, following the policies and procedures established by AHS. The filing organization will make every effort to complete the documentation of the CHNA in the form of a CHNA report, obtain Board of Director approval of the CHNA report, and make the CHNA report available to the public by posting it on the filing organization's web-site by December 31, 2014. All future CHNAs will be conducted by the long-term acute care facility in a timely fashion in accordance with the requirements set forth in IRC Section 501(r)(3).(4) A description of policies and procedures: As noted above, complete and extensive policies and procedures are currently in place for the AHS system of hospitals that set forth AHS's policy on compliance with IRC Section 501(r)(3). These policies mandate that CHNAs will be conducted by each AHS hospital facility and provide the general steps and processes that should be followed in the conduct of a CHNA. There is also an AHS system-wide policy that addresses the public posting requirements of each AHS hospital's CHNA. The filing organization's failure to conduct a CHNA for its long-term acute care facility was not due to incorrect or inadequate policies and procedures, but rather was due to the issue of the qualification of the long-term acute care facility as a hospital for purposes of IRC Section 501(r)(3).
Schedule H (Form 990) 2013
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
University Community Hospital Inc
 
Employer identification number
59-1113901
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) American Cancer Society Inc
2006 W Kennedy Blvd
Tampa,FL33606 		59-0657320 501(c)(3) 13,500       General Support
(2) American Heart Association Inc
7272 Greenville Avenue
Dallas,TX75231 		13-5613797 501(c)(3) 15,000       General Support
(3) Junior Achievement of West Central Florida Inc
13805 58th Street N
Clearwater,FL33760 		59-1098499 501(c)(3) 25,000       General Support
(4) Tampa Bay Partnership For Regional Economic Development
4300 W Cypress Street Ste 700
Tampa,FL33607 		59-3248071 501(c)(6) 50,000       General Support
(5) University Community Hospital Foundation Inc
3100 E Fletcher Avenue
Tampa,FL33613 		59-2554889 501(c)(3)   61,950 Fair Market Value Contributed Facilities General Support
(6) University Community Hospital Foundation Inc
3100 E Fletcher Avenue
Tampa,FL33613 		59-2554889 501(c)(3) 25,000       General Support












2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
4
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2013

Schedule I (Form 990) 2013
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
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 non-profit community organizations. 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.
Schedule I (Form 990) 2013


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
University Community Hospital Inc
 
Employer identification number

59-1113901
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)Michael SchultzVice Chairman (i)
(ii)		 0
662,144 		0
193,658 		0
574,914 		0
114,208 		0
42,901 		0
1,587,825 		0
107,872
(2)John HardingCEO/Director (i)
(ii)		 0
493,063 		0
143,873 		0
391,816 		0
99,338 		0
26,486 		0
1,154,576 		0
82,377
(3)Lars HoumannDirector (i)
(ii)		 0
911,606 		0
302,898 		0
456,423 		0
197,919 		0
42,997 		0
1,911,843 		0
166,425
(4)Brendan O'Malley MDDirector (i)
(ii)		 197,598
0 		41,370
0 		1,200
0 		26,528
0 		17,171
0 		283,867
0 		0
0
(5)Janice HagensickerRegional CFO (End 8/13) (i)
(ii)		 0
336,676 		0
84,387 		0
258,866 		0
42,561 		0
28,959 		0
751,449 		0
28,362
(6)Vadym DidenkoCFO - Medical Center (Beg 9/13) (i)
(ii)		 0
258,006 		0
39,300 		0
119,225 		0
33,822 		0
41,488 		0
491,841 		0
10,863
(7)Richard TibbittsCOO - Medical Center (i)
(ii)		 0
271,778 		0
40,762 		0
141,757 		0
26,482 		0
24,823 		0
505,602 		0
8,294
(8)Brad Bjornstad MDCMO - Medical Center (i)
(ii)		 0
297,434 		0
47,466 		0
47,138 		0
35,493 		0
17,799 		0
445,330 		0
13,930
(9)Kathleen MillerCNO - Medical Center (i)
(ii)		 0
216,001 		0
33,879 		0
25,620 		0
13,079 		0
27,780 		0
316,359 		0
0
(10)Joel JohnsonCEO-Carrollwood (i)
(ii)		 0
284,594 		0
70,937 		0
153,826 		0
40,559 		0
35,607 		0
585,523 		0
33,447
(11)Shane CoxCFO - Carrollwood (i)
(ii)		 0
183,307 		0
29,904 		0
10,067 		0
11,842 		0
21,669 		0
256,789 		0
0
(12)Robin McGuinnessCNO - Carrollwood (i)
(ii)		 0
160,363 		0
23,191 		0
4,096 		0
9,234 		0
29,524 		0
226,408 		0
0
(13)Brigitte ShawCOO - Pepin Heart Hosp (i)
(ii)		 0
246,967 		0
41,398 		0
26,808 		0
30,683 		0
34,745 		0
380,601 		0
16,207
(14)Alexander Rosemurgy MDPhysician (i)
(ii)		 604,596
0 		186,169
0 		3,225
0 		27,560
0 		22,844
0 		844,394
0 		0
0
(15)Sharona Ross MDPhysician (i)
(ii)		 356,780
0 		108,373
0 		420
0 		16,272
0 		21,346
0 		503,191
0 		0
0
(16)Michael Harris MDPhysician (i)
(ii)		 370,662
0 		76,518
0 		1,200
0 		13,136
0 		20,543
0 		482,059
0 		0
0
(17)James Orlowski MDPhysician (i)
(ii)		 388,435
0 		28
0 		1,200
0 		21,100
0 		22,029
0 		432,792
0 		0
0
(18)Charles Lambert MDPhysician (i)
(ii)		 375,009
0 		28
0 		1,200
0 		0
0 		19,951
0 		396,188
0 		0
0
(19)Marvin KurtzFormer CFO - Med Ctr (i)
(ii)		 0
0 		0
0 		0
100,219 		0
4,618 		0
2,536 		0
107,373 		0
0
(20)Mary WhillockFormer - CNO Carrollwood (i)
(ii)		 0
108,304 		0
0 		0
14,967 		0
5,825 		0
8,421 		0
137,517 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
Part I, Line 1a The filing organization is a part of the system of healthcare organizations known as Adventist Health System (AHS). Members of the filing organization's executive management team that hold the position of Vice-President or above are compensated by and on the payroll of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), the parent organization of AHS. AHSSHC is exempt from federal income tax under IRC Section 501(c)(3). The filing organization reimburses AHSSHC for the salary and benefit cost of those executives on the payroll of AHSSHC that provide services and are on the management team of the filing organization. Travel for companions: AHSSHC has a Corporate Executive Policy that provides a benefit to allow for a traveling AHSSHC executive to have his or her spouse accompany the executive on certain business trips each year. Typically, reimbursement is only provided to Vice Presidents and above and is usually limited to one business trip per year beyond the annual AHS President's Council business meeting and other meetings where the spouse is specifically invited. The AHSSHC Corporate Executive Spousal Travel Policy was originally approved and reviewed by the AHSSHC Board Compensation Committee, an independent body of the AHSSHC Board of Directors. All spousal travel costs reimbursed to the executive are considered taxable compensation to the executive. Tax Indemnification and gross-up payments: AHS has a system-wide policy addressing gross-up payments provided in connection with employer-provided benefits/other taxable items. Under the policy, certain taxable business-related reimbursements (i.e. taxable business-related moving expenses, taxable items provided in connection with employment) provided to any employee may be grossed-up at a 25% rate upon approval of the filing organization's CEO and CFO. Additionally, employees at the Director level and above are eligible for gross-up payments on gifts received for board of director services. Discretionary spending account: A nominal discretionary spending amount was provided in the current year to all eligible executives who attend the annual AHS President's Council business meeting ($500 per executive) or the annual AHS CFO Conference business meeting ($300 per executive). Other discretionary spending accounts may be provided in connection with other AHS sponsored conferences but typically do not exceed $200 per participant. With respect to the AHS President's council meeting, eligible executives may include AHSSHC Vice Presidents and above and all AHSSHC subsidiary organization CEOs and Regional CFOs. The payment provided to each executive was considered taxable compensation to the executive. Housing allowance or residence for personal use: AHSSHC has a Corporate Executive Policy that addresses assistance to executives who have been relocated by the company during the year. Relocation assistance provided to executives may include relocation allowances to assist with duplicate housing expenses. Relocation assistance is administered per AHSSHC policy by an external relocation company. Any taxable reimbursements made to executives in connection with relocation assistance are treated as wages to the executive and are subject to all payroll withholding and reporting requirements.
Part I, Line 3 The individual who serves as the CEO of the filing organization is compensated by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) for that individual's role in serving as the CEO. Compensation and benefits provided to this individual are determined pursuant to policies, procedures, and processes of AHSSHC that are designed to ensure compliance with the intermediate sanctions laws as set forth in IRC Section 4958. AHSSHC has taken steps to ensure that processes are in place to satisfy the rebuttable presumption of reasonableness standard as set forth in Treasury Regulation 53.4958-6 with respect to its active executive-level positions. The AHSSHC Board Compensation Committee (the Committee) serves as the governing body for all executive compensation matters. The Committee is composed of certain members of the Board of Directors (the Board) of AHSSHC. Voting members of the Committee include only individuals who serve on the Board as independent representatives of the community, who hold no employment positions with AHSSHC and who do not have relationships with any of the individuals whose compensation is under their review that impacts their best independent judgment as fiduciaries of AHSSHC. The Committee's role is to review and approve all components of the executive compensation plan of AHSSHC. As an independent governing body with respect to executive compensation, it should be noted that the Committee will often confer in executive sessions on matters of compensation policy and policy changes. In such executive sessions, no members of management of AHSSHC are present. The Committee is advised by an independent third party compensation advisor. This advisor prepares all the benchmark studies for the Committee. Compensation levels are benchmarked with a national peer group of other not-for-profit healthcare systems and hospitals of similar size and complexity to AHS and each of its affiliated entities. The following principles guide the establishment of individual executive compensation: - The salary of the President/CEO of AHS will not exceed the 40th percentile of comparable salaries paid by similarly situated organizations; and - Other executive salaries shall be established using market medians. The compensation philosophy, policies, and practices of AHSSHC are consistent with the organization's faith-based mission and conform to applicable laws, regulations, and business practices. As a faith-based organization sponsored by the Seventh-day Adventist Church (the Church), AHSSHC's philosophy and principles with respect to its executive compensation practices reflect the conservative approach of the Church's mission of service and were developed in counsel with the Church's leadership.
Part I, Lines 4a-b Part I, Line 4a: During the year ending December 31, 2013, Mary Whillock and Marvin Kurtz received severance payments in the amounts of $12,585 and $100,385 respectively. Pursuant to the AHSSHC Corporate Executive Policy governing executive severance, severance agreements for executives operating at the Vice President level and above are entered into upon eligibility to facilitate the transition to subsequent employment following an involuntary separation from employment with AHS. As discussed in Line 1a above, executives on the filing organization's management team that hold the position of Vice-President or above are 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 AHSSHC Board Compensation Committee, an independent committee of the Board of Directors of AHSSHC. Any funds that remain after the cost of mandatory and elective benefits are subtracted from the annual pre-determined benefits allowance are contributed, at the employee's option, to either an IRC 457(f) deferred compensation account or to an IRC 457(b) eligible deferred compensation plan. Upon attainment of age 65, all previous 457(f) deferred amounts are paid immediately to the participant and any future employer contributions are made quarterly from the Plan directly to the participant. The Plan documents define an employee who is eligible to participate in the Plan to generally include the Chief Executive Officers of AHS entities and Vice Presidents of all AHS entities whose base salary is at least $218,000. The Plan provides for a class year vesting schedule (2 years for each class year) with respect to amounts accumulated in the executive's 457(f) deferred compensation account. Distributions could also be made from the executive's 457(f) deferred compensation account upon attainment of age 65 or upon an involuntary separation. The account is forfeited by the executive upon a voluntary separation. In addition to the Plan, AHS has instituted a defined benefit, non-tax-qualified deferred compensation plan for certain executives who have provided lengthy service to AHS and/or to other Seventh-Day Adventist Church hospitals or health care institutions. Participation in the plan is offered to AHS executives on a prorata schedule beginning with 20 years of service as an employee of AHS and/or another hospital or health care institution controlled by the Seventh-Day Adventist Church and who satisfy certain other qualifying criteria. This supplemental executive retirement plan (SERP) was designed to provide eligible executives with the economic equivalent of an annual income beginning at normal retirement age equal to 60% of the average of the participant's three, five or seven highest years of base salary from AHS active employment inclusive of income from all other Seventh-Day Adventist Church healthcare employer-financed retirement income sources and investment income earned on those contributions through social security normal retirement age as defined in the plan. The number of years included in highest average compensation is determined by the individual's year of entry to the SERP and by the individual's year of entry to the AHS Executive FLEX Benefit Program. Flex Plan Flex Plan/ SERP 457(b) CY CY Employer CY Contrib./ Distributions Contrib. Distributions* Payment ------------------------------------------------------- Brad Bjornstad, MD $ 39,144 $ 16,354 $0 $0 Vadym Dedinko $ 19,972 $ 11,678 $0 $0 Janice Hagensicker $ 46,211 $ 28,375 $174,831 $0 John Harding $ 85,488 $ 94,098 $277,917 $0 Lars Houmann $184,069 $186,831 $232,784 $0 Joel Johnson $ 26,709 $ 35,530 $106,949 $0 Michael Schultz $117,859 $124,294 $397,783 $0 Richard Tibbits $ 30,132 $ 9,863 $ 98,801 $0 Brigitte Shaw $ 16,834 $ 17,989 $0 $0 Kathleen Miller $ 14,956 * Including Investment Earnings
Schedule J (Form 990) 2013

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
University Community Hospital Inc
 
Employer identification number

59-1113901
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2013
Schedule L (Form 990 or 990-EZ) 2013
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) Jon L Courson III Family member of Board Member 28,795 Employee Compensation   No
(2) Cardiac Surgery Associates of Tampa
  		>5% owned by Board Member 406,403 Surgical Services   No
(3) Ravindra Patel MD Family member of Board Member 353,253 Surgical Services   No
(4) Advanced Cardiac Management LLC
  		>5% owned by Board Member 1,200,792 Physician Services   No
(5) Reliance Laboratory Partners LLC
  		>5% owned by Board Member 107,607 Lab Cytology Services   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
University Community Hospital Inc
 
Employer identification number

59-1113901
Return Reference Explanation
Form 990, Part VI, Section A, line 2 Jon Courson and Eric Newman - Family Relationship Mary Mahon and Jose Vivero - Business Relationship Art Bernard and Fred Meyer - Business Relationship
Form 990, Part VI, Section A, line 4 Article XI of the filing organization's Bylaws were amended in 2013 to provide that, for the period from January 1, 2013 to December 31, 2014, the President shall carry out such duties as assigned by the Member, who designee shall be the Executive Vice President of the Florida Division of Adventist Health System.
Form 990, Part VI, Section A, line 6 University Community Hospital, Inc. (the filing organization) has one member. The sole member of the filing organization is Adventist Health System Sunbelt Healthcare Corporation. Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). There are no other classes of membership in the filing organization.
Form 990, Part VI, Section A, line 7a The sole member of the filing organization is AHSSHC. AHSSHC appoints all voting members to the Board of Directors of UCH. Regular directors are nominated by the Board of Directors of UCH but must be appointed by the member.
Form 990, Part VI, Section A, line 7b AHSSHC, as the sole member of the filing organization, has certain reserved powers as set forth in the Bylaws of the filing organization. These reserved powers include the following: 1) The approval or disapproval of the Bylaws of the filing organization; 2) To set limits and terms for the borrowing of funds in excess of $100,000; 3) The approval or disapproval of single expenditures and/or the purchase or sale of real property in excess of one million dollars; 4) To direct the placement of funds and capital of the filing organization; 5) To establish general guiding policies; and 6) To approve the identity of an auditing firm and election of the fiscal year for the filing organization.
Form 990, Part VI, Section B, line 11 The filing organization's current year Form 990 was reviewed by the Board Vice Chairman, Regional CFO, CEO and by the CFO prior to its filing with the IRS. The review conducted by these individuals 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 Trustees/Directors, its officers, executive employees, physician employees, and officers of the medical staff (to be known as Interested Persons). In connection with any actual or possible conflict of interests, any member of the Board of Trustees/Directors of the filing organization or any other Interested Person of the filing organization 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 Trustees/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 Interested Person, the remaining members of the Board of Trustees/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 Trustees/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 C, line 19 The filing organization is a part of the system of healthcare organizations known as Adventist Health System (AHS). Each year, AHS publishes an annual report document that includes a financial report for the relevant year as well as a community benefit report. The financial report and community benefit report are presented on a consolidated basis and represent all of the activities, results of operations, and financial position at year-end of the entire AHS system. In addition, the audited consolidated financial statements of AHS and of the AHS "Obligated Group" are filed annually with the Municipal Securities Rulemaking Board (MSRB). The "Obligated Group" is a group of AHSSHC subsidiaries that are jointly and severally liable under a Master Trust Indenture that secures debt primarily issued on a tax-exempt basis. Unaudited quarterly financial statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) are also filed with MSRB for AHS on a consolidated basis and for the grouping of AHS subsidiaries comprising the "Obligated Group". The filing organization does not generally make its governing documents or conflict of interest policy available to the public.
Part VII, Section A For those Board of Director members who devote less than full-time to the filing organization (based upon the average number of hours per week shown in column (B) on page 7 of the return) the compensation amounts shown in columns (E) and (F) on page 7 were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position within Adventist Health System.
Form 990, Part IX, line 11g AHS Management Fees: Program service expenses 0. Management and general expenses 4,763,628. Fundraising expenses 0. Total expenses 4,763,628. EHR Management Fees: Program service expenses 0. Management and general expenses 2,015,382. Fundraising expenses 0. Total expenses 2,015,382. Billing & Collection Services: Program service expenses 0. Management and general expenses 5,867,470. Fundraising expenses 0. Total expenses 5,867,470. Payments to Healthcare Professionals: Program service expenses 23,718,100. Management and general expenses 0. Fundraising expenses 0. Total expenses 23,718,100. Miscellaneous Purchased Services: Program service expenses 11,055,076. Management and general expenses 0. Fundraising expenses 0. Total expenses 11,055,076. Environmental Services: Program service expenses 1,955,465. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,955,465. Recruiting: Program service expenses 1,534,452. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,534,452. Professional Fees: Program service expenses 6,418,803. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,418,803.
Form 990, Part XI, line 9: Allocation from Tax-Exempt Parent with respect to debt 745,294. Transfer to Tax Exempt Parent -1,988,350. Change in Interest in Foundation 2,711,925. Pension Related Changes 21,621,340. Investment in Tax Exempt Affiliate 2,540,043. Donated Property/Gifts 699,667.
Part X, Line 2 The amounts shown on line 2 of Part X of this return include the filing organization's interest in a central investment pool maintained by Adventist Health System Sunbelt Healthcare Corporation, the filing organization's top-tier parent. The investments in the central investment pool are recorded at market value.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
University Community Hospital Inc
 
Employer identification number

59-1113901
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity
(1) Boudreaux Realty LLC
401 East Jackson St Ste 2700
Tampa,FL33602
46-1450437 		Real Estate FL   51,000 University Community Hospital Inc
 
(2) Mason Florida Investments LLC
401 East Jackson St Ste 2700
Tampa,FL33602
59-1113901 		Real Estate FL     University Community Hospital Inc
 








Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) Adventist Bolingbrook Hospital

500 Remington Blvd

Bolingbrook,IL60440
65-1219504 		Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
 
No
(2) Adventist Care Centers - Courtland Inc

730 Courtland Street

Orlando,FL32804
20-5774723 		Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(3) Adventist GlenOaks Hospital

701 Winthrop Avenue

Glendale Heights,IL60139
36-3208390 		Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
 
No
(4) Adventist Hinsdale Hospital

120 North Oak Street

Hinsdale,IL60521
36-2276984 		Operation of Hospital & Related Services IL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
 
No
(5) Adventist Hlth Mid-America Inc

9100 W 74th Street

Shawnee Mission,KS66204
52-1347407 		Hlthcare Related Services KS 501(c)(3) Line 11a, I Adventist Hlth SystemSunbelt Inc
 
 
No
(6) Adventist Hlth Partners Inc

1000 Remington Blvd Ste 200

Bolingbrook,IL60440
36-4138353 		Operate out-patient physician clinics IL 501(c)(3) Line 3 AHS Midwest Management Inc
 
 
No
(7) Adventist Hlth System Affiliated Benefit Trust

900 Hope Way

Altamonte Springs,FL32714
26-6422966 		Promotion of Hlthcare FL 501(c)(3) Line 11a, I Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(8) Adventist Hlth System Sunbelt Hlthcare Corp

900 Hope Way

Altamonte Springs,FL32714
59-2170012 		Management Services FL 501(c)(3) Line 11a, I N/A
 
No
(9) Adventist Hlth SystemGeorgia Inc

1035 Red Bud Road

Calhoun,GA30701
58-1425000 		Operation of Hospital & Related Services GA 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(10) Adventist Hlth SystemSunbelt Inc

900 Hope Way

Altamonte Springs,FL32714
59-1479658 		Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(11) Adventist Hlth SystemTexas Inc

602 Courtland Street

Orlando,FL32804
74-2578952 		Leasing Personnel to Affiliated Hospital TX 501(c)(3) Line 11c, III-FI Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(12) Adventist University of Health Sciences Inc (630 Year End)

671 Lake Winyah Drive

Orlando,FL32803
59-3069793 		Education/Operation of School FL 501(c)(3) Line 2 Adventist Hlth SystemSunbelt Inc
 
 
No
(13) AHS Midwest Management Inc

1000 Remington Blvd Ste 200

Bolingbrook,IL60440
36-3354567 		Operation of Physician Practice Mgmt IL 501(c)(3) Line 11a, I Adventist Hlth SystemSunbelt Inc
 
 
No
(14) AHSCentral Texas Inc

1301 Wonder World Drive

San Marcos,TX78666
74-2621825 		Provide Office Space - Medical Professionals TX 501(c)(3) Line 11c, III-FI Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(15) Apopka Hlth Care Properties Inc

305 E Oak Street

Apopka,FL32703
51-0605694 		Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(16) Battle Creek Adventist Hospital

1000 Remington Blvd Ste 200

Bolingbrook,IL60440
38-1359189 		Inactive MI 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
 
No
(17) Bolingbrook Hospital Foundation

1000 Remington Blvd N Entrance 2nd

Bolingbrook,IL60440
90-0494445 		Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation
 
 
No
(18) Bradford Heights Hlth & Rehab Center Inc

950 Highpoint Drive

Hopkinsville,KY42240
20-5782342 		Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(19) Burleson Nursing & Rehab Center Inc

301 Huguley Blvd

Burleson,TX76028
20-5782243 		Operation of Home for the Aged/Hlthcare Delivery TX 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(20) Caldwell Hlth Care Properties Inc

1333 West Main

Princeton,KY42445
51-0605680 		Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(21) Cedar Crag Terrace Inc (630 Year End) (11-72213)

Rt 5 Box 900

Manchester,KY40962
61-1120442 		Operation of Home for the elderly-disabled KY 501(c)(3) Line 7 Memorial Hospital Inc
 
 
No
(22) Central Texas Hlthcare Collaborative

1301 Wonder World Drive

San Marcos,TX78666
45-3739929 		Support Operation of Hospital TX 501(c)(3) Line 11a, I Adventist Hlth SystemSunbelt Inc
 
 
No
(23) Central Texas Medical Center Foundation

1301 Wonder World Drive

San Marcos,TX78666
74-2259907 		Fund-raising for Tax-exempt hospital TX 501(c)(3) Line 7 Adventist Hlth SystemSunbelt Inc
 
 
No
(24) Chickasaw Hlth Care Properties Inc

250 S Chickasaw Trail

Orlando,FL32825
51-0605681 		Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(25) Chippewa Valley Hospital & Oakview Care Center Inc

1220 Third Avenue West

Durand,WI54736
39-1365168 		Operation of Hospital & Related Services WI 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
 
No
(26) Cobb Medical Associates LLC

3949 South Cobb Drive SE

Smyrna,GA30080
58-2617089 		Operation of Physician Practices & Medical Services GA 501(c)(3) Line 3 Emory-Adventist Inc
 
 
No
(27) Courtland Hlth Care Properties Inc

730 Courtland Street

Orlando,FL32804
51-0605682 		Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(28) Creekwood Place Nursing & Rehab Center Inc

683 E Third Street

Russellville,KY42276
20-5782260 		Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(29) Dairy Road Hlth Care Properties Inc

7350 Dairy Road

Zephyrhills,FL33540
51-0605684 		Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(30) East Orlando Hlth & Rehab Center Inc

250 S Chickasaw Trail

Orlando,FL32825
20-5774748 		Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(31) Emory-Adventist Inc

3949 South Cobb Drive

Smyrna,GA30080
58-2171011 		Operation of Hospital & Related Svcs GA 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
 
No
(32) Fletcher Hospital Inc

100 Hospital Drive

Hendersonville,NC28792
56-0543246 		Operation of Hospital & Related Svcs NC 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(33) FLNC Inc

3355 E Semoran Blvd

Apopka,FL32703
20-5774761 		Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(34) Florida Hospital Healthcare Partners Inc (130-123113)

301 Memorial Medical Parkway

Daytona Beach,FL32117
46-2354804 		Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
 
No
(35) Florida Hospital Medical Group Inc

900 Winderley Place

Maitland,FL32751
59-3214635 		Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
 
No
(36) Florida Hospital Physician Group Inc (21-123113)

14055 Riveredge Drive Ste 250

Tampa,FL33637
46-2021581 		Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(37) Florida Hospital Waterman Inc

1000 Waterman Way

Tavares,FL32778
59-3140669 		Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(38) Florida Hospital Zephyrhills Inc

7050 Gall Blvd

Zephyrhills,FL33541
59-2108057 		Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
 
No
(39) Foundation for Shawnee Mission Medical Center Inc

9100 W 74th Street

Shawnee Mission,KS66204
48-0868859 		Fund-raising for Tax-exempt hospital KS 501(c)(3) Line 11a, I Shawnee Mission Medical Center Inc
 
 
No
(40) GlenOaks Hospital Foundation

701 Winthrop Avenue

Glendale Heights,IL60139
36-3926044 		Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation
 
 
No
(41) Helen Ellis Memorial Hospital Auxiliary Inc

1395 S Pinellas Ave

Tarpon Springs,FL34689
59-2106043 		Fund-raising for Tax-exempt hospital/foundation FL 501(c)(3) Line 11c, III-FI Tarpon Springs Hospital Foundation Inc
 
 
No
(42) Helen Ellis Memorial Hospital Foundation Inc

1395 S Pinellas Ave

Tarpon Springs,FL34689
59-3690149 		Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 11c, III-FI Tarpon Springs Hospital Foundation Inc
 
 
No
(43) Hinsdale Hospital Foundation

7 Salt Creek Lane Suite 203

Hinsdale,IL60521
52-1466387 		Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation
 
 
No
(44) In-Motion Rehab Inc

602 Courtland Street Ste 200

Orlando,FL32804
20-8023411 		Therapy services to tax exempt nursing homes KS 501(c)(3) Line 11b, II Sunbelt Hlth Care Centers Inc
 
 
No
(45) Jellico Community Hospital Inc

188 Hospital Lane

Jellico,TN37762
62-0924706 		Operation of Hospital & Related Services TN 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(46) Johnson County Community Care Corporation (11-5613)

11801 South Freeway

Burleson,TX76028
45-2793120 		Support Operation of Hospital TX 501(c)(3) Line 11a, I Adventist Hlth SystemSunbelt Inc
 
 
No
(47) La Grange Memorial Hospital Foundation

5101 S Willow Springs Rd

La Grange,IL60525
30-0247776 		Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation
 
 
No
(48) Memorial Hlth Systems Foundation Inc

770 West Granada Blvd

Ormond Beach,FL32174
31-1771522 		Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 7 Memorial Hlth Systems Inc
 
 
No
(49) Memorial Hlth Systems Inc

301 Memorial Medical Parkway

Daytona Beach,FL32117
59-0973502 		Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
 
No
(50) Memorial Hospital - West Volusia Inc

701 West Plymouth Avenue

Deland,FL32720
59-3256803 		Operation of Hospital & Related Services FL 501(c)(3) Line 3 Memorial Hlth Systems Inc
 
 
No
(51) Memorial Hospital Flagler Inc

60 Memorial Medical Parkway

Palm Coast,FL32164
59-2951990 		Operation of Hospital & Related Services FL 501(c)(3) Line 3 Memorial Hlth Systems Inc
 
 
No
(52) Memorial Hospital Inc

210 Marie Langdon Drive

Manchester,KY40962
61-0594620 		Operation of Hospital & Related Services KY 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(53) Merriam Hlth Care Properties Inc

9700 West 62nd Street

Merriam,KS66203
36-4595806 		Lease to Related Organization KS 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(54) Metroplex Adventist Hospital Inc

2201 S Clear Creek Road

Killeen,TX76549
74-2225672 		Operation of Hospital & Related Services TX 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(55) Metroplex Clinic Physicians Inc

2201 S Clear Creek Road

Killeen,TX76549
11-3762050 		Physician Hlthcare services to the community TX 501(c)(3) Line 3 Metroplex Adventist Hospital Inc
 
 
No
(56) Metroplex Hospital Inc

900 Hope Way

Altamonte Springs,FL32714
46-1256516 		Future Operation of Hospital & Related Svcs FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(57) Midwest Hlth Foundation

120 North Oak Street

Hinsdale,IL60521
35-2230515 		Support of subsidiary Foundations IL 501(c)(3) Line 11b, II N/A
 
No
(58) Mills Hlth & Rehab Center Inc

500 Beck Lane

Mayfield,KY42066
20-5782320 		Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(59) Mission Strategies of Georgia Inc

3949 S Cobb Drive

Smyrna,GA30080
90-0866024 		Provision of support to the nursing home division GA 501(c)(3) Line 11b, II Sunbelt Hlth Care Centers Inc
 
 
No
(60) Mission Strategies Inc

602 Courtland Street Ste 200

Orlando,FL32804
20-5982365 		Provision of support to the nursing home division KS 501(c)(3) Line 11b, II Sunbelt Hlth Care Centers Inc
 
 
No
(61) Missouri Adventist Hlth Inc

9100 W 74th Street

Shawnee Mission,KS66204
43-1224729 		Support Hlth Care Services MO 501(c)(3) Line 11d, III-O Adventist Hlth Mid-America Inc
 
 
No
(62) North Regional EMS Inc

188 Hospital Lane

Jellico,TN37762
26-2653616 		EMS Services TN 501(c)(3) Line 9 Jellico Community Hospital Inc
 
 
No
(63) Ormond Beach Memorial Hospital Auxiliary Inc

301 Memorial Medical Parkway

Daytona Beach,FL32117
59-1721962 		Volunteer support services FL 501(c)(3) Line 11c, III-FI Memorial Hlth Systems Inc
 
 
No
(64) Overland Park Nursing & Rehab Center Inc

6501 West 75th Street

Overland Park,KS66204
20-5774821 		Operation of Home for the Aged/Hlthcare Delivery KS 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(65) Paragon Hlth Care Properties Inc

950 Highpoint Drive

Hopkinsville,KY42240
51-0605686 		Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(66) Pasco-Pinellas Hillsborough Community Hlth System Inc

2400 Bedford Road

Orlando,FL32803
20-8488713 		Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(67) Portercare Adventist Hlth System (630 Year End)

2525 S Downing Street

Denver,CO80210
84-0438224 		Operation of Hospital & Related Services CO 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(68) Portland Nursing & Rehab Center Inc (11-6513)

215 Highland Circle Drive

Portland,TN37148
20-5774842 		Operation of Home for the Aged/Hlthcare Delivery TN 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(69) Princeton Hlth & Rehab Center Inc

1333 West Main

Princeton,KY42445
20-5782272 		Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(70) Princeton Professional Services Inc

601 E Rollins Street

Orlando,FL32803
59-1191045 		Provision of Hlthcare Services FL 501(c)(3) Line 9 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(71) Quality Circle for Hlthcare Inc

900 Hope Way

Altamonte Springs,FL32714
26-3789368 		Hlthcare Quality Services FL 501(c)(3) Line 11a, I Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(72) Resource Personnel Inc

602 Courtland Street Ste 200

Orlando,FL32804
20-8040875 		Provide administrative support to tax exempt nursing homes FL 501(c)(3) Line 11b, II Sunbelt Hlth Care Centers Inc
 
 
No
(73) Rocky Mountain Adventist Hlthcare Foundation (630 Year End)

2525 South Downing Street

Denver,CO80210
84-0745018 		Fund-raising for Tax-exempt hospital CO 501(c)(3) Line 7 PorterCare Adventist Hlth System
 
 
No
(74) Rollins Brook Community Care Corp

2201 S Clear Creek Road

Killeen,TX76549
46-1656773 		Inactive TX 501(c)(3) Line 11a, I Adventist Hlth SystemSunbelt Inc
 
 
No
(75) Russellville Hlth Care Properties Inc

683 East Third Street

Russellville,KY42276
51-0605691 		Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(76) San Marcos Hlth Care Properties Inc

1900 Medical Parkway

San Marcos,TX78666
51-0605693 		Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(77) San Marcos Nursing & Rehab Center Inc

1900 Medical Parkway

San Marcos,TX78666
20-5782224 		Operation of Home for the Aged/Hlthcare Delivery TX 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(78) Shawnee Mission Hlth Care Inc

6501 West 75th Street

Overland Park,KS66204
48-0952508 		Lease to Related Organization KS 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(79) Shawnee Mission Medical Center Inc

9100 W 74th Street

Shawnee Mission,KS66204
48-0637331 		Operation of Hospital & Related Services KS 501(c)(3) Line 3 Adventist Hlth Mid-America Inc
 
 
No
(80) South Central Nursing Homes Properties Inc

900 Hope Way

Altamonte Springs,FL32714
59-3686109 		Management Support GA 501(c)(3) Line 11d, III-O South Central Inc
 
 
No
(81) South Central Nursing Homes Inc

602 Courtland Street

Orlando,FL32804
61-1242373 		Management Support KY 501(c)(3) Line 11d, III-O South Central Inc
 
 
No
(82) South Central Properties III Inc

900 Hope Way

Altamonte Springs,FL32714
59-3692860 		Real Estate GA 501(c)(2)   South Central Nursing Homes Properties Inc
 
 
No
(83) South Central Properties IV Inc

900 Hope Way

Altamonte Springs,FL32714
59-3692862 		Real Estate GA 501(c)(2)   South Central Nursing Homes Properties Inc
 
 
No
(84) South Central Properties VI Inc

900 Hope Way

Altamonte Springs,FL32714
59-3692857 		Real Estate GA 501(c)(2)   South Central Nursing Homes Properties Inc
 
 
No
(85) South Central Properties Inc

900 Hope Way

Altamonte Springs,FL32714
59-3651692 		Real Estate GA 501(c)(2)   South Central Nursing Homes Properties Inc
 
 
No
(86) South Central Inc

602 Courtland Street

Orlando,FL32804
59-3689740 		Management Support GA 501(c)(3) Line 11c, III-FI N/A
 
No
(87) South Pasco Hlth Care Properties Inc

38250 A Avenue

Zephyrhills,FL33542
51-0605679 		Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(88) Southwest Volusia Hlth Services Inc

1055 Saxon Blvd

Orange City,FL32763
59-3281591 		Medical Office Building for Hospital FL 501(c)(3) Line 11a, I Southwest Volusia Hlthcare Corp
 
 
No
(89) Southwest Volusia Hlthcare Corp

1055 Saxon Blvd

Orange City,FL32763
59-3149293 		Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
 
No
(90) Specialty Physicians of Central Texas Inc

1301 Wonder World Drive

San Marcos,TX78666
20-8814408 		Physician Hlthcare services to the community TX 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
 
No
(91) Spring View Hlth & Rehab Center Inc

718 Goodwin Lane

Leitchfield,KY42754
20-5782288 		Operation of Home for the Aged/Hlthcare Delivery KY 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(92) Sunbelt Hlth & Rehab Center - Apopka Inc

305 East Oak Street

Apopka,FL32703
20-5774856 		Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(93) Sunbelt Hlth Care Centers Inc

602 Courtland Street Ste 200

Orlando,FL32804
58-1473135 		Management Services TN 501(c)(3) Line 11b, II Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(94) SunSystem Development Corp

900 Hope Way

Altamonte Springs,FL32714
59-2219301 		Fund Raising for Affiliated Tax-Exempt Hospitals FL 501(c)(3) Line 7 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(95) Tarpon Springs Hospital Foundation Inc

1395 S Pinellas Ave

Tarpon Springs,FL34689
59-0898901 		Operation of Hospital & Related Services FL 501(c)(3) 170(b)(1)(A)(iii) University Community Hospital Inc
 
Yes
 
(96) Tarrant County Hlth Care Properties Inc

301 Huguley Blvd

Burleson,TX76028
51-0605677 		Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(97) Taylor Creek Hlth Care Properties Inc

718 Goodwin Lane

Leitchfield,KY42754
51-0605678 		Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(98) The Volunteer Auxiliary of Florida Hospital - Flagler Inc

60 Memorial Medical Parkway

Palm Coast,FL32164
59-2486582 		Volunteer support services FL 501(c)(3) Line 11c, III-FI Memorial Hospital Flagler Inc
 
 
No
(99) Trinity Nursing & Rehab Center Inc

9700 West 62nd Street

Merriam,KS66203
20-5774890 		Operation of Home for the Aged/Hlthcare Delivery KS 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(100) University Community Hospital Foundation Inc

3100 E Fletcher Ave

Tampa,FL33613
59-2554889 		Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 11a, I University Community Hospital Inc
 
Yes
 
(101) University Community Hospital Specialty Care Inc

3100 E Fletcher Ave

Tampa,FL33613
59-3231322 		Inactive FL 501(c)(3) Line 11a, I University Community Hospital Inc
 
Yes
 
(102) University Community Hospital Inc

3100 E Fletcher Ave

Tampa,FL33613
59-1113901 		Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
 
No
(103) West Kentucky Hlth Care Properties Inc

500 Beck Lane

Mayfield,KY42066
51-0605676 		Lease to Related Organization GA 501(c)(3) Line 11c, III-FI Sunbelt Hlth Care Centers Inc
 
 
No
(104) Zephyr Haven Hlth & Rehab Center Inc

38250 A Avenue

Zephyrhills,FL33542
20-5774930 		Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
(105) Zephyrhills Hlth & Rehab Center Inc

7350 Dairy Road

Zephyrhills,FL33540
20-5774967 		Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 9 Sunbelt Hlth Care Centers Inc
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) Appalachian Therapy Services LLC

100 Hospital Drive
Hendersonville,NC28792
20-2463851 		Therapy Staffing NC N/A
                  
(2) Clear Creek MOB Ltd

2201 S Clear Creek Rd
Killeen,TX76549
74-2609195 		Real Estate TX N/A
                  
(3) Endoscopy Center at Porter LLC

1001 South Park Drive
Littleton,CO80120
20-5855038 		Medical Services CO N/A
                  
(4) Florida Hospital DMERT LLC

2450 Maitland Center Pkwy Ste 200
Maitland,FL32751
20-2392253 		Medical Equipment FL N/A
                  
(5) Florida Hospital Home Infusion

2450 Maitland Center Pkwy Ste 200
Maitland,FL32751
59-3142824 		Home Infusion Services FL N/A
                  
(6) KCCCSMMC Cancer Center LLC (11-4813)

9100 W 74th Street
Shawnee Mission,KS66204
27-0909763 		Equipment Rental KS N/A
                  
(7) PAHSUSP Surgery Centers LLC

15305 Dallas Pkwy Ste 1600 LB 28
Addison,TX75010
26-3057950 		Medical Services CO N/A
                  
(8) San Marcos MRI LP

1330 Wonder World Dr Ste 202
San Marcos,TX78666
77-0597972 		Imaging & Testing TX N/A
                  
(9) Shawnee Mission Open MRI LLC

9100 W 74th Street Box 2923
Shawnee Mission,KS66201
27-0011796 		Imaging & Testing KS N/A
                  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Altamonte Medical Plaza Condominium Association Inc

601 East Rollins Street
Orlando,FL32803
59-2855792 		Condo Association FL N/A
 C         No
(2) Apopka Medical Plaza Condominium Association Inc

601 East Rollins Street
Orlando,FL32803
59-3000857 		Condo Association FL N/A
 C         No
(3) CC MOB Inc

2201 S Clear Creek Road
Killeen,TX76549
74-2616875 		Real Estate Rental TX N/A
 C         No
(4) Central Texas Medical Associates

1301 Wonder World Drive
San Marcos,TX78666
74-2729873 		Physician Clinics TX N/A
 C         No
(5) Central Texas Provider's Network

1301 Wonder World Drive
San Marcos,TX78666
74-2827652 		Physician Hospital Org. TX N/A
 C         No
(6) Florida Hospital Flagler Medical Offices Association Inc

60 Memorial Medical Parkway
Palm Coast,FL32164
26-2158309 		Condo Association FL N/A
 C         No
(7) Florida Hospital Healthcare System Inc

602 Courtland Street
Orlando,FL32804
59-3215680 		PHO/TPA FL N/A
 C         No
(8) Florida Medical Plaza Condo Association Inc

601 East Rollins Street
Orlando,FL32803
59-2855791 		Condo Association FL N/A
 C         No
(9) Florida Memorial Health Network Inc

770 W Granada Blvd Ste 317
Ormond Beach,FL32174
59-3403558 		Physician Hospital Org. FL N/A
 C         No
(10) Huguley Alliance Foundation

11801 South Freeway
Fort Worth,TX76115
75-2642209 		Inactive TX N/A
 C         No
(11) Kissimmee Multispecialty Clinic Condominium Association Inc

201 Hilda Street Suite 30
Kissimmee,FL34741
59-3539564 		Condo Association FL N/A
 C         No
(12) Midwest Management Services Inc

9100 West 74th Street
Shawnee Mission,KS66204
48-0901551 		Real Estate Rental KS N/A
 C         No
(13) Metroplex Adventist Hospital CRNA (11-111113)

2201 S Clear Creek Road
Killeen,TX76549
26-0760794 		Support hospital - provide allied health professionals TX N/A
 C         No
(14) North American Health Services Inc & Subs

111 N Orlando Avenue
Winter Park,FL32789
62-1041820 		Lessor/Holding Co. TN N/A
 C         No
(15) Ormond Professional Condo Association (430 Year End)

770 W Granada Blvd Ste 101
Ormond Beach,FL32174
59-2694434 		Condo Association FL N/A
 C         No
(16) Park Ridge Property Owner's Association Inc

1 Park Place Naples Road
Fletcher,NC28732
03-0380531 		Condo Association NC N/A
 C         No
(17) Porter Affiliated Hlth Services Inc dba Diversified Affiliated Hlth Svcs

2525 S Downing Street
Denver,CO80210
84-0956175 		Healthcare Services CO N/A
 C         No
(18) San Marcos Regional MRI Inc

1301 Wonder World Drive
San Marcos,TX78666
77-0597968 		Holding Company TX N/A
 C         No
(19) The Garden Retirement Community Inc

602 Courtland Street Ste 200
Orlando,FL32804
59-3414055 		Real Estate Rental FL N/A
 C         No
(20) University Community Health Insurance Company SPC Ltd (11-32813)

C/O AON Insurance Managers PO Box
  Grand Cayman  
CJ
Captive Insurance CJ University Community Hospital Inc
  		C     100.000 % Yes  
(21) UCH Services Inc (11-61213)

3100 East Fletcher Ave
Tampa,FL33613
59-3508454 		Management Company FL University Community Hospital Inc
  		C     100.000 % Yes  
(22) Winter Park Medical Office Building I Condo Assoc Inc

200 Lakemont Ave
Winter Park,FL32792
45-2228478 		Physician Clinics FL N/A
 C         No
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Pasco-Pinellas Hillsborough Community Health System Inc

 Q 2,380,163 Cost
(2) Tarpon Springs Hospital Foundation Inc

 Q 3,888,189 Cost
(3) University Community Hosp Foundation Inc

 Q 1,087,679 Cost
(4) University Community Hosp Foundation Inc

 B 61,950 Cost
(5) University Community Hosp Foundation Inc

 B 25,000 Actual Amount Given
(6) University Community Hosp Foundation Inc

 C 434,210 Actual Amount Received
(7) Adventist Health System Sunbelt Healthcare Corp

 B 1,988,350 Actual Amount Given
(8) Adventist Health System Sunbelt Healthcare Corp

 M 4,658,186 % of facility's operating exp.
(9) Adventist Health System Sunbelt Healthcare Corp dba AHS IS

 M 16,745,093 % of facility's operating exp.
(10) Adventist Health System Sunbelt Inc dba Florida Hospital

 P 238,596 Cost
(11) Adventist Health SystemSunbelt Inc

 M 2,015,382 % of Facility's EHR Revenue
(12) Florida Hospital Zephyrhills Inc

 Q 175,140 Cost
(13) Adventist Health System Sunbelt Healthcare Corp

 P 17,865,847 cost
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V?UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2013
Additional Data


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