TY 2015 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) VENANZIO ARQUILLA...................................................................... DIRECTOR	0.10 ................. 0.50	X		0	0
(2) DAVID L CRANE...................................................................... PRESIDENT/SECRETARY	3.75 ................. 46.25	X	X	2,703,120	180,726
(3) LINDA EASTMAN...................................................................... DIRECTOR	0.10 ................. 0.50	X		0	0
(4) MARSHALL GRAY JR...................................................................... DIRECTOR (END 12/15)	0.10 ................. 0.50	X		0	0
(5) LARRY C GUNN MD...................................................................... DIRECTOR	0.10 ................. 0.50	X		0	0
(6) RANDALL HAFFNER PHD...................................................................... DIR/CHAIRMAN (BEG 6/15)	1.00 ................. 50.00	X		1,835,419	242,710
(7) RONNIE HAWKINS...................................................................... DIRECTOR	0.10 ................. 0.50	X		0	0
(8) CARLENE JAMERSON...................................................................... DIRECTOR (BEG 1/15)	0.50 ................. 0.90	X		130,319	604
(9) DONALD LIVESAY...................................................................... VICE CHAIRMAN/DIRECTOR	0.10 ................. 4.00	X		2,457	0
(10) PETER O'CONNOR...................................................................... DIRECTOR	0.10 ................. 0.50	X		0	0
(11) JOHN PAYNE MD...................................................................... DIRECTOR (END 12/15)	0.10 ................. 8.80	X		61,500	0
(12) RUSSELL M PETRAK MD...................................................................... DIRECTOR (END 12/15)	0.10 ................. 0.50	X		0	0
(13) PICHETTE RAY...................................................................... DIRECTOR	0.10 ................. 3.00	X		1,432	0
(14) RICHARD REINER...................................................................... CHAIRMAN (END 6/15)	1.00 ................. 50.00	X		1,084,868	62,839
(15) GLYNN SCOTT...................................................................... DIRECTOR	0.10 ................. 3.00	X		2,457	0
(16) GREG SHARON MD...................................................................... DIRECTOR (BEG 1/15)	0.10 ................. 0.50	X		0	0
(17) CHRISTINE SMITH...................................................................... DIRECTOR	0.10 ................. 0.50	X		0	0

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) BRENT G SNYDER........................................................................ TREASURER/DIRECTOR	1.00 .......................50.00	X					0	1,247,230	161,878
(19) GARY THURBER........................................................................ DIRECTOR	0.10 .......................3.00	X					0	2,182	0
(20) DINO VALLERA MD........................................................................ DIRECTOR	0.10 .......................0.50	X					0	0	0
(21) JONATHAN WRIGHT........................................................................ DIRECTOR	0.10 .......................0.50	X					0	0	0
(22) RICK MACE........................................................................ CEO	50.00 .......................0.00		X				0	594,767	85,110
(23) MICHAEL MURRILL........................................................................ CFO / COO	50.00 .......................0.00		X				0	332,182	53,894
(24) REBECCA MATHIS........................................................................ CFO (BEG 3/15)	15.00 .......................35.00		X				0	375,981	54,982
(25) JOLENE ALBAUGH........................................................................ CNO	50.00 .......................0.00			X			31	258,699	53,773
(26) MARY MURPHY........................................................................ REGIONAL CNO	10.00 .......................40.00			X			0	362,651	48,316
(27) RON WEHTJE........................................................................ REGIONAL CFO	6.25 .......................43.75			X			0	645,353	97,208
(28) GEORGE MAYZELL MD........................................................................ REGIONAL CMO (END 8/15)	6.00 .......................44.00			X			0	882,947	84,325
(29) RICHARD CARROLL MD........................................................................ CMO-GLENOAKS & BOLINGBROOK	25.00 .......................25.00			X			0	594,669	88,543
(30) ALEEM AZIZ........................................................................ DIR OF PHARMACY	60.00 .......................0.00				X		192,206	0	24,295
(31) CATHERINE MICHALOWICZ........................................................................ RN CHARGE	60.00 .......................0.00				X		179,056	0	9,043
(32) MICHAEL KOERTING........................................................................ DIR OF RADIOLOGY	60.00 .......................0.00				X		158,284	0	12,080
(33) FERNANDO GRUTA........................................................................ DIR OF SURGICAL SERVICES	60.00 .......................0.00				X		155,512	0	19,233
(34) DIANE LEONARD........................................................................ DIR OF NURSING	60.00 .......................0.00				X		148,144	0	30,452
(35) GARY LIPINSKI MD........................................................................ FORMER CMO	0.00 .......................50.00					X	0	534,358	86,138

(A) Name and business address	(B) Description of services	(C) Compensation
PT SOLUTIONS PO BOX 441146 KENNESAW,GA30160	THERAPY SERVICES	4,959,657
SODEXHO OPERATIONS LLC 4880 PAYSPHERE CHICAGO,IL60674	FOOD & ENVIRONMENTAL SERVICES	3,167,225
WALSH CONSTRUCTION 929 WEST ADAMS CHICAGO,IL60607	CONSTRUCTION SERVICES	1,003,204
HEALOGICS WOUND CARE 3087 MOMENTUM PLACE CHICAGO,IL60689	WOUND CARE & HYPERBARIC SERVICES	630,132
TOUCHPOINT SUPPORT PO BOX 102289 ATLANTA,GA30368	FOOD & ENVIRONMENTAL SERVICES	526,931
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 33

- TIN:

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.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

ADVENTIST BOLINGBROOK HOSPITAL

Employer identification number

65-1219504

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.)..
11	Total support. Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2015

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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

ADVENTIST BOLINGBROOK HOSPITAL

Employer identification number

65-1219504

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization ADVENTIST BOLINGBROOK HOSPITAL

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization ADVENTIST BOLINGBROOK HOSPITAL		Employer identification number 65-1219504

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization ADVENTIST BOLINGBROOK HOSPITAL			Employer identification number 65-1219504
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose 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

(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

(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

(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) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

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

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

ADVENTIST BOLINGBROOK HOSPITAL

Employer identification number

65-1219504

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

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-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ..............................................................................................................	Yes No

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(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) 2015

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

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:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Yes

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

1,500

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

59,813

Total. Add lines 1c through 1i ....................................................................................................

61,313

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

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

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

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."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	CONSULTING FEES OF $11,020, PAID STAFF TIME OF $19,517, AND DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND ILLINOIS HOSPITAL ASSOCIATION, AND $1,500 TO WILL COUNTY CENTER FOR ECONOMIC DEVELOPMENT.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

ADVENTIST BOLINGBROOK HOSPITAL

Employer identification number

65-1219504

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

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? ...........

Yes No

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? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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" on Form 990, Part IV, line 8.

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.

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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

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' on 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 ...	1,690,226		1,690,226
b	Buildings	106,940,396	31,190,604	75,749,792
c	Leasehold improvements
d	Equipment ...	62,017,886	44,956,067	17,061,819
e	Other ...	1,849,344	76,397	1,772,947
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				96,274,784

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on 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
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
PAYABLE TO THIRD PARTIES	7,730,393
CREDIT BALANCES IN A/R	1,214,525
INTERCO. ALLOC. OF TE BOND PROCEEDS	83,611,025
OTHER NONCURRENT LIABILITIES	2,375
DUE TO RELATED	2,685,724
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	95,244,042
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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on 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 (losses) 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' on 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 X, LINE 2:

THE FILING ORGANIZATION IS A SUBSIDIARY ORGANIZATION WITHIN ADVENTIST HEALTH SYSTEM (AHS). THE CONSOLIDATED FINANCIAL STATEMENTS OF AHS CONTAIN THE FOLLOWING FIN 48 FOOTNOTE: PLEASE NOTE THAT DOLLAR AMOUNTS ARE IN THOUSANDS. HEALTHCARE CORPORATION AND ITS AFFILIATED ORGANIZATIONS, OTHER THAN NORTH AMERICAN HEALTH SERVICES, INC. AND ITS SUBSIDIARY (NAHS), ARE EXEMPT FROM STATE AND FEDERAL INCOME TAXES. ACCORDINGLY, HEALTHCARE CORPORATION AND ITS TAX-EXEMPT AFFILIATES ARE NOT SUBJECT TO FEDERAL, STATE OR LOCAL INCOME TAXES EXCEPT FOR ANY NET UNRELATED BUSINESS TAXABLE INCOME. NAHS IS A WHOLLY OWNED, FOR-PROFIT SUBSIDIARY OF HEALTHCARE CORPORATION. NAHS AND ITS SUBSIDIARY ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. NAHS FILES A CONSOLIDATED FEDERAL INCOME TAX RETURN AND, WHERE APPROPRIATE, CONSOLIDATED STATE INCOME TAX RETURNS. ALL TAXABLE INCOME WAS FULLY OFFSET BY NET OPERATING LOSS CARRYFORWARDS FOR FEDERAL INCOME TAX PURPOSES; AS SUCH, THERE IS NO PROVISION FOR CURRENT FEDERAL OR STATE INCOME TAX FOR THE YEARS ENDED DECEMBER 31, 2015 AND 2014. NAHS ALSO HAS TEMPORARY DEDUCTIBLE DIFFERENCES OF APPROXIMATELY $62,700 AND $63,600 AT DECEMBER 31, 2015 AND 2014, RESPECTIVELY, PRIMARILY AS A RESULT OF NET OPERATING LOSS CARRYFORWARDS. AT DECEMBER 31, 2015, NAHS HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $62,500, EXPIRING BEGINNING IN 2022 THROUGH 2026. DEFERRED TAXES HAVE BEEN PROVIDED FOR THESE AMOUNTS, RESULTING IN A NET DEFERRED TAX ASSET OF APPROXIMATELY $23,800 AND $24,200 AT DECEMBER 31, 2015 AND 2014, RESPECTIVELY. A FULL VALUATION ALLOWANCE HAS BEEN PROVIDED AT DECEMBER 31, 2015 AND 2014 TO OFFSET THE DEFERRED TAX ASSET SINCE HEALTHCARE CORPORATION HAS DETERMINED THAT IT IS MORE LIKELY THAN NOT THAT THE BENEFIT OF THE NET OPERATING LOSS CARRYFORWARDS WILL NOT BE REALIZED IN FUTURE YEARS. THE INCOME TAXES TOPIC OF THE ASC (ASC 740) PRESCRIBES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAX POSITIONS RECOGNIZED IN FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN, OR EXPECTED TO BE TAKEN, IN A TAX RETURN. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2015 AND 2014.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

ADVENTIST BOLINGBROOK HOSPITAL

Employer identification number

65-1219504

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other %

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: . . . . . . . .

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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.

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"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

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? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	2,244,295		2,244,295	1.890 %
b	Medicaid (from Worksheet 3, column a) . . . . .	28,811,832	16,048,808	12,763,024	10.750 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	31,056,127	16,048,808	15,007,319	12.640 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .	16,009		16,009	0.010 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	52,459	178	52,281	0.040 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	68,468	178	68,290	0.050 %
k	Total. Add lines 7d and 7j .	31,124,595	16,048,986	15,075,609	12.690 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

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

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

7,759,400

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. ......

512,876

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

Enter total revenue received from Medicare (including DSH and IME).....

25,213,871

Enter Medicare allowable costs of care relating to payments on line 5.....

24,266,939

Subtract line 6 from line 5. This is the surplus (or shortfall)........

946,932

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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 .........................

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) 2015

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?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	ADVENTIST BOLINGBROOK HOSPITAL 500 REMINGTON BLVD BOLINGBROOK,IL60440 WWW.KEEPINGYOUWELL.COM/ABH 0005496	X	X	X

Schedule H (Form 990) 2015

Page 4

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)

	ADVENTIST BOLINGBROOK HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

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 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE STATEMENT

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 14

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE STATEMENT

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	ADVENTIST BOLINGBROOK HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of %

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE STATEMENT

The FAP application form was widely available on a website (list url):

SEE STATEMENT

A plain language summary of the FAP was widely available on a website (list url):
SEE STATEMENT

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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 all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	ADVENTIST BOLINGBROOK HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized 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?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

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? ...............................

If "Yes," explain in Section C.

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? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
ADVENTIST BOLINGBROOK HOSPITAL	PART V, SECTION B, LINE 5: ADVENTIST BOLINGBROOK HOSPITAL (THE HOSPITAL OR THE FILING ORGANIZATION) IS ONE OF FOUR NOT-FOR-PROFIT RELATED HOSPITAL ORGANIZATIONS LOCATED IN THE WESTERN AND SOUTHWESTERN SUBURBS OF CHICAGO. EACH OF THESE FOUR HOSPITALS IS A PART OF ADVENTIST HEALTH SYSTEM (AHS). AHS IS A HEALTH CARE SYSTEM PRIMARILY CONSISTING OF TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS THAT OPERATE 44 HOSPITALS IN 10 STATES WITHIN THE US. THE FOUR RELATED HOSPITAL ORGANIZATIONS LOCATED IN CHICAGO, COLLECTIVELY CALLED ADVENTIST MIDWEST REGION (AMR), ARE CLINICALLY INTEGRATED, SHARE OVERLAPPING COMMUNITIES, AND ARE TIED TOGETHER BY COMMON MISSION, VALUES, AND VISION. AS THE FOUR HOSPITALS ARE LOCATED IN THE SAME METROPOLITAN SERVICE AREA, THE HOSPITALS COLLABORATED IN 2013 TO CONDUCT A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE FOUR RELATED HOSPITAL ORGANIZATIONS ARE ADVENTIST GLENOAKS HOSPITAL, ADVENTIST MIDWEST HEALTH, ADVENTIST BOLINGBROOK HOSPITAL, AND ADVENTIST HEALTH SYSTEM/SUNBELT, INC., DBA ADVENTIST LA GRANGE MEMORIAL HOSPITAL. IN CONDUCTING ITS 2013 JOINT CHNA, THE FOUR AMR HOSPITALS COLLECTED PRIMARY AND SECONDARY DATA USING A NUMBER OF DATA COLLECTION METHODOLOGIES. ADVENTIST BOLINGBROOK HOSPITAL, LOCATED IN WILL COUNTY, ILLINOIS, PARTICIPATED ACTIVELY IN THE WILL COUNTY MAPP COLLABORATIVE WHICH HELPED TO PROVIDE A RICH BASE OF BOTH PRIMARY AND SECONDARY DATA USEFUL IN DETERMINING HEALTH PRIORITIES OF THE HOSPITAL'S COMMUNITY. MAPP IS A COMMUNITY-WIDE STRATEGIC PLANNING TOOL USED FOR IMPROVING PUBLIC HEALTH BY HELPING COMMUNITIES PRIORITIZE PUBLIC HEALTH ISSUES, IDENTIFYING RESOURCES FOR ADDRESSING THOSE ISSUES, AND TAKING ACTION. THE WILL COUNTY COLLABORATIVE IS A COUNTY-WIDE EFFORT WHICH INCLUDES MEMBERS FROM A VARIETY OF SECTORS, INCLUDING PUBLIC HEALTH, MEDICAL, BEHAVIORAL HEALTH, SOCIAL SERVICES, EDUCATION, BUSINESS, GOVERNMENT, FAITH BASED AND LAW ENFORCEMENT. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED THROUGH FOCUS GROUPS, AND THROUGH DISTRIBUTION OF WRITTEN SURVEYS. FOUR PRIMARY ASSESSMENTS WERE CONDUCTED THROUGH THE WILL COUNTY MAPP INITIATIVE: COMMUNITY HEALTH STATUS ASSESSMENT, FORCES OF CHANGE ASSESSMENT, LOCAL PUBLIC HEALTH SYSTEMS ASSESSMENT, AND THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT. 5,000 SURVEYS WERE SENT TO A RANDOM SAMPLE OF WILL COUNTY RESIDENTS. ADDITIONAL SURVEYS WERE DISTRIBUTED IN THE AFRICAN AMERICAN AND HISPANIC COMMUNITIES. CARE WAS TAKEN IN ALL DATA COLLECTION TO PROMOTE PARTICIPATION BY A REPRESENTATIVE SAMPLE OF THE COMMUNITY, INCLUDING MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS.
ADVENTIST BOLINGBROOK HOSPITAL	PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY ADVENTIST BOLINGBROOK HOSPITAL (THE HOSPITAL) WAS BASED UPON THE HOSPITAL'S INVOLVEMENT AND ENRICHMENT OF THOSE WHO LIVE WITHIN WILL COUNTY, ILLINOIS. THE CHNA WAS CONDUCTED IN CONJUNCTION WITH RELATED HOSPITALS IN THE CHICAGO METROPOLITAN AREA:ADVENTIST MIDWEST HEALTH, FKA ADVENTIST HINSDALE HOSPITALADVENTIST GLENOAKS HOSPITALADVENTIST HEALTH SYSTEM/SUNBELT, INC. DBA ADVENTIST LA GRANGE MEMORIAL HOSPITAL.THE FOUR COLLABORATING HOSPITALS WERE KNOWN AS ADVENTIST MIDWEST REGION IN 2014.
ADVENTIST BOLINGBROOK HOSPITAL	PART V, SECTION B, LINE 7D: THE HOSPITAL HAS ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT 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.
ADVENTIST BOLINGBROOK HOSPITAL	PART V, SECTION B, LINE 11: AS NOTED IN PART V, SECTION B, LINE 5 AND LINE 6, THE HOSPITAL (ABH) IS A PART OF ADVENTIST HEALTH SYSTEM AND CONDUCTED A JOINT CHNA WITH THE FOLLOWING RELATED AHS HOSPITALS IN 2013:-ADVENTIST MIDWEST HEALTH DBA ADVENTIST HINSDALE HOSPITAL (AHH)-ADVENTIST HEALTH SYSTEM/SUNBELT, INC. DBA ADVENTIST LA GRANGE MEMORIAL HOSPITAL (ALMH)-ADVENTIST BOLINGBROOK HOSPITAL (ABH)-ADVENTIST GLENOAKS HOSPITAL (AGO)THESE FOUR HOSPITALS ARE KNOWN COLLECTIVELY AS THE ADVENTIST MIDWEST REGION (AMR), AND AS A REGION, HAVE PRIORITIZED AND ADDRESSED THE SIGNIFICANT NEEDS WITHIN THEIR REGION AS A RESULT OF THE JOINT CHNA CONDUCTED AND OUTLINED BELOW.THE FOLLOWING IS A LISTING OF PROGRAMS/ACTIVITIES UNDERTAKEN TO ADDRESS IDENTIFIED SIGNIFICANT NEEDS:PRIORITY 1: ACCESS TO HEALTH CARE (LACK OF INSURANCE) - HEALTH INSURANCE EXCHANGE ENROLLMENT FOR 210 PEOPLE AHH/ALMH MADE THE DECISION TO REFER TO LOCAL NAVIGATORS IN 2014 AS THERE WERE DUPLICATIVE SERVICES AVAILABLE IN CONVENIENT LOCATIONS FOR LOCAL COMMUNITY MEMBERS. - MEDICAID ENROLLMENT FOR HOSPITAL PATIENTSTHE AMR HOSPITALS CONTRACTED FOR THE SERVICE OF A SERVICE PROVIDER TO ASSIST WITH THE ENROLLMENT OF MEDICAID PATIENTS AT AHH, ALMH, ABH, AND AGO. - LINKS WITH COMMUNITY PARTNERS (I.E. AGING CONNECTIONS) TO HELP PREVENT AVOIDABLE READMISSIONS - ABH - 13.8% DECREASE IN AVOIDABLE READMISSIONS. - FREE BREAST AND CERVICAL CANCER SCREENINGS - RESIDENTS OF ALMH FAMILY MEDICINE CLINICS DO PROVIDE FREE SERVICES THROUGH THE LA GRANGE COMMUNITY NURSES ASSOCIATION. IN 2015, APPROXIMATELY 338 PHYSICIAN HOURS WERE PROVIDED. - HELP PATIENTS MAKE APPOINTMENTS WITH LOCAL FQHCS (FEDERALLY QUALIFIED HEALTH CLINICS)AN FQHC ADMINISTERED BY THE VNA WAS ESTABLISHED IN THE CAMPUS OF ABH. A PROCESS IS IN PLACE AT BOTH THE ED AND REGISTRATION DEPARTMENTS TO HELP GUIDE ELIGIBLE PATIENTS TO MAKE AN APPOINTMENT AT THE FQHC AND ULTIMATELY FIND A MEDICAL HOME. AHH, ALMH, AND AGO ALSO PROVIDE INFORMATION ABOUT FQHCS IN THE AREA TO ANY PATIENTS WHO MAY BENEFIT. - PARTNER WITH THE AMERICAN KIDNEY FOUNDATION ON FREE KIDNEY DISEASE SCREENINGS FOR UNDERSERVED PEOPLE AT ADVENTIST MIDWEST HEALTH FACILITIES. IN 2015, THERE WERE SCREENINGS WITH THE KIDNEY MOBILE VAN IN LOMBARD, PLAINFIELD, AND BOLINGBROOK AREAS REACHING OVER 200 PEOPLE. - POST-DISCHARGE CHRONIC DISEASE MANAGEMENTOFFERED STANFORD CHRONIC DISEASE SELF-MANAGEMENT PROGRAM (SIX-WEEK POST DISCHARGE EDUCATIONAL PROGRAM) WITH PATIENTS FROM ALL 4 AMR HOSPITALS USING CREATION HEALTH PRINCIPLES. THE NUMBER OF PARTICIPANTS IN 2015 WAS 39. PRIORITY 2: INFLUENZA VACCINE (18-64 YEARS) - COMMUNITY EDUCATION PROGRAMS WERE HELD THROUGHOUT THE COMMUNITIES SERVED BY THE FOUR AMR HOSPITALS; AHH, ALMH, ABH, AND AGO. - FREE FLU VACCINES WERE GIVEN AT HEALTH FAIRS, FLU CLINICS, AND AT THE TWO FAMILY RESIDENCY PROGRAMS OF AHH & ALMH. THE ABH HEALTH FAIR ALONE GAVE 43 FREE FLU VACCINES.PHYSICIAN EDUCATION SESSIONS WERE PROVIDED TO THE COMMUNITY TO HELP SENIORS INCREASE THEIR KNOWLEDGE REGARDING AGE-RELATED MEDICAL NEEDS AND ALSO TO IMPROVE SENIORS' COMPLIANCE WITH THE RECOMMENDED ANNUAL FLU VACCINE. TWELVE MONTHLY SESSIONS WERE HELD IN 2015.PRIORITY 3: PNEUMOCOCCUS VACCINE (65 YEARS AND OLDER) - FREE PNEUMOCOCCUS VACCINATIONS WERE GIVEN AT THE HINSDALE FAMILY PRACTICE MEDICINE CLINIC FOR PATIENTS OF ALL AMR HOSPITALS. - COMMUNITY EDUCATION ON THE IMPORTANCE OF IMMUNIZATIONS WAS CONDUCTED AS WELL. PRIORITY 4: HYPERTENSION (OVER 18 YEARS) - THROUGHOUT AMR, FREE BLOOD PRESSURE SCREENINGS WERE CONDUCTED BY TEAMS FROM THE FOUR HOSPITALS.ADDITIONALLY, THERE WERE SOME SCREENINGS CONDUCTED IN PARTNERSHIP WITH VARIOUS HEALTH CARE PROVIDERS AND LOCAL YMCA'S THROUGHOUT THE SURROUNDING COMMUNITIES. - WEB SITE EDUCATION ON HYPERTENSION WAS PROVIDED - EDUCATION REGARDING HYPERTENSION WAS DISSEMINATED THROUGH SYSTEM WIDE NEWSLETTER. PRIORITIES CONSIDERED BUT NOT SELECTED ACCESS TO HEALTHCARE : ACCESS TO PRIMARY AND SECONDARY SERVICES - ADVENTIST BOLINGBROOK HOSPITALRATIONALE: DURING THIS ASSESSMENT PERIOD, ADVENTIST BOLINGBROOK HOSPITAL, IN CONJUNCTION WITH VNA, OPENED A FEDERALLY QUALIFIED HEALTHCARE CENTER ON THE HOSPITAL CAMPUS, INCREASING HEALTHCARE ACCESS TO PRIMARY AND SECONDARY HEALTH SERVICES FOR THOSE COMMUNITY MEMBERS WITH FINANCIAL NEED.PREVENTION AND MANAGEMENT OF CHRONIC CARE ISSUES : HEART DISEASE [BLOOD CHOLESTEROL LEVELS]RATIONALE: WHILE THIS TESTED WELL ON THE IMPACT ANALYSIS MATRIX, USING THE DECISION TREE, IT WAS DETERMINED THAT THIS IS A COMMONLY AVAILABLE PREVENTION MEASURE AT MOST SURROUNDING PROVIDERS. IT IS FREQUENTLY A PART OF COMMUNITY HEALTH FAIRS AND ROUTINE PHYSICIAN VISITS.BEHAVIORAL HEALTH AND SUBSTANCE ABUSE RATIONALE: ADVENTIST MIDWEST HEALTH PROVIDES COMPREHENSIVE INPATIENT PROGRAMS FOR BEHAVIORAL HEALTH (ADVENTIST GLENOAKS HOSPITAL AND ADVENTIST HINSDALE HOSPITAL) AND OUTPATIENT PROGRAMS FOR BOTH BEHAVIORAL HEALTH AND SUBSTANCE ABUSE (ADVENTIST HINSDALE HOSPITAL). SERVING THE ADVENTIST MIDWEST HEALTH COMMUNITY, THE HOSPITALS SUPPORT COUNTY INITIATIVES TO BRING THESE NECESSARY SERVICES TO THOSE IN NEED. PRIORITIZING ACCESS TO CARE AS ONE OF THE SELECTED HEALTH PRIORITIES WILL ASSIST ADVENTIST MIDWEST HEALTH IN EXTENDING SERVICES FOR THOSE WHO CURRENTLY LACK SUCH ACCESS.
ADVENTIST BOLINGBROOK HOSPITAL	PART V, SECTION B, LINE 22D: IN DETERMINING THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE POLICY-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL USED THE FOLLOWING METHODOLOGY IN 2015:THE HOSPITAL UTILIZED THE LOOK-BACK METHOD FOR DETERMINING ITS AMOUNTS GENERALLY BILLED (AGB) PERCENTAGE. IN CALCULATING ITS AGB PERCENTAGE, THE HOSPITAL INCLUDED CLAIMS ALLOWED DURING ITS PRIOR 12-MONTH PERIOD BY MEDICARE FEE-FOR-SERVICE (INCLUDING MEDICARE ADVANTAGE) AND ALL COMMERCIAL PAYORS THAT HAD ANY ACTIVITY WITH THE HOSPITAL DURING THE TAXABLE YEAR.
SCHEDULE H, PART V, SECTION B, LINE 7A	THE CHNA REPORT CAN BE FOUND AT URL:HTTP://WWW.KEEPINGYOUWELL.COM/PORTALS/34/DOCS/COMMUNITY%20BENEFITS/ADVENTIST%20BOLINGBROOK%20HOSPITAL%202013%20CHNA.PDF
SCHEDULE H, PART V, SECTION B, LINE 10A:	THE HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND AT:HTTP://WWW.KEEPINGYOUWELL.COM/PORTALS/3/DOCS/ABOUT%20US/COMMUNITY%20BENEFIT/ABH%2014-16%20COMMUNITY%20HEALTH%20PLAN.PDF
SCHEDULE H, PART V, SECTION B, LINE 16A,B,C:	THE FINANCIAL ASSISTANCE POLICY CAN BE FOUND AT URL:HTTPS://KEEPINGYOUWELL.COM/PORTALS/3/DOCS/FINANCIAL%20ASSISTANCE/2015%20UPDATES/PFS%2009%20CHARITY%20CARE%20POLICY%20IV%20MAR%209%202014%20CHANGES%20ACCEPTED.PDFTHE FINANCIAL ASSISTANCE POLICY APPLICATION CAN BE FOUND AT:HTTPS://WWW.KEEPINGYOUWELL.COM/ABH/PATIENTS-VISITORS/BILLING-AND-FINANCIAL-SERVICES/FINANCIAL-ASSISTANCE THE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://KEEPINGYOUWELL.COM/PORTALS/3/DOCS/FINANCIAL%20ASSISTANCE/2015%20UPDATES/FINANCIAL%20ASSISTANCE%202015%20MIDWEST%20-%20EN.PDF

Schedule H (Form 990) 2015

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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?5
Name and address		Type of Facility (describe)
1	2 - PLAINFIELD IMAGING & OUTPATIENT CENTER 15728 S ROUTE 59 PLAINFIELD,IL60544	IMAGING CENTER
2	3 - WOMEN'S IMAGING CENTER 396 REMINGTON BLVD 235 BOLINGBROOK,IL60440	IMAGING CENTER
3	4 - MATERNAL FETAL MEDICINE DEPT 396 REMINGTON BLVD 231 BOLINGBROOK,IL60440	MATERNAL FETAL MEDICINE
4	5 - ADVENTIST BOLINGBROOK HOSPITAL 420 REMINGTON BLVD 135 BOLINGBROOK,IL60440	OUTPATIENT REHABILITATION FACILITY
5	6 - ADVENTIST PLAINFIELD PHYSICAL THERAPY 15728 S ROUTE 59 PLAINFIELD,IL60544	OUTPATIENT REHABILITATION FACILITY
6
7
8
9
10

Schedule H (Form 990) 2015

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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
PART I, LINE 6A:	THE FILING ORGANIZATION IS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) DURING ITS CURRENT YEAR. AHSSHC SERVES AS A PARENT ORGANIZATION TO 23 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS THAT OPERATE 44 HOSPITALS IN TEN STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS "ADVENTIST HEALTH SYSTEM" (AHS).ALL HOSPITAL ORGANIZATIONS WITHIN AHS COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. AHS ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. AHS HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. ON AN ANNUAL BASIS, THE COMMUNITY BENEFITS OF ALL AHS ORGANIZATIONS ARE CONSOLIDATED AND REPORTED IN THE AHS ANNUAL REPORT DOCUMENT PREPARED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (EIN 59-2170012). ADDITIONALLY, THE FILING ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY ARE POSTED ON THE FILING ORGANIZATION'S WEBSITE.
PART I, LINE 7:	THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS.
PART III, LINE 2:	THE AMOUNT OF BAD DEBT EXPENSE, REPORTED ON LINE 2 OF SECTION A OF PART III IS RECORDED IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO REVENUE, NOT BAD DEBT EXPENSE.
PART III, LINE 3:	METHODOLOGY FOR DETERMINING THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT MAY REPRESENT PATIENTS WHO COULD HAVE QUALIFIED UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY:SELF-PAY PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE BY COMPLETING A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM). IF AN INDIVIDUAL DOES NOT SUBMIT A COMPLETE FAA FORM WITHIN 240 DAYS AFTER THE FIRST BILLING STATEMENT IS SENT TO THE INDIVIDUAL, AN INDIVIDUAL MAY BE CONSIDERED FOR PRESUMPTIVE ELIGIBILITY BASED UPON A SCORING TOOL THAT IS DESIGNED TO CLASSIFY PATIENTS INTO GROUPS OF VARYING ECONOMIC MEANS. THE SCORING TOOL USES ALGORITHMS THAT INCORPORATE DATA FROM CREDIT BUREAUS, DEMOGRAPHIC DATABASES, AND HOSPITAL SPECIFIC DATA TO INFER AND CLASSIFY PATIENTS INTO RESPECTIVE ECONOMIC MEANS CATEGORIES. INDIVIDUALS WHO EARN A CERTAIN SCORE ON THE SCORING TOOL ARE CONSIDERED TO QUALIFY AS NON-STATE CHARITY PATIENTS. AN AMOUNT UP TO $1,000 OF SUCH A PATIENT'S BILL IS WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED TO BE NON-STATE CHARITY. THE AMOUNT WRITTEN OFF AS BAD DEBT EXPENSE FOR THOSE PATIENTS WHO POTENTIALLY QUALIFY AS NON-STATE CHARITY USING THE SCORING TOOL IS THE AMOUNT SHOWN ON LINE 3 OF SECTION A OF PART III. RATIONALE FOR INCLUDING CERTAIN BAD DEBTS IN COMMUNITY BENEFIT:THE FILING ORGANIZATION IS DEDICATED TO THE VIEW THAT MEDICALLY NECESSARY HEALTH CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS SHOULD BE ACCESSIBLE TO ALL, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, CULTURAL BACKGROUND, PHYSICIAN MOBILITY, OR ABILITY TO PAY. THE FILING ORGANIZATION TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THE AVAILABILITY OF THIRD-PARTY COVERAGE. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE FILING ORGANIZATION IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. AS A 501(C)(3) HOSPITAL ORGANIZATION, THE FILING ORGANIZATION MAINTAINS A 24/7 EMERGENCY ROOM PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION CANNOT BE MADE BASED UPON INFORMATION SUPPLIED BY THE INDIVIDUAL. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED TO BE COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY.
PART III, LINE 4:	FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGE 9. PLEASE NOTE THAT DOLLAR AMOUNTS ON THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE IN THOUSANDS.
PART III, LINE 8:	COSTING METHODOLOGY: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO.
PART III, LINE 9B:	THE HOSPITAL FILING ORGANIZATION'S COLLECTION PRACTICES ARE IN CONFORMITY WITH THE REQUIREMENTS SET FORTH IN THE 2012 PROPOSED REGULATIONS REGARDING THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(R)(4) - (R)(6). NO EXTRAORDINARY COLLECTION ACTIONS (ECA'S) ARE INITIATED BY THE HOSPITAL FILING ORGANIZATION IN THE 120-DAY PERIOD FOLLOWING THE DATE AFTER THE FIRST BILLING STATEMENT IS SENT TO THE INDIVIDUAL (OR, IF LATER, THE SPECIFIED DEADLINE GIVEN IN A WRITTEN NOTICE OF ACTIONS THAT MAY BE TAKEN, AS DESCRIBED BELOW). INDIVIDUALS ARE PROVIDED WITH AT LEAST ONE WRITTEN NOTICE (NOTICE OF ACTIONS THAT MAY BE TAKEN) THAT INFORMS THE INDIVIDUAL THAT THE HOSPITAL FILING ORGANIZATION MAY TAKE ACTIONS TO REPORT ADVERSE INFORMATION TO CREDIT REPORTING AGENCIES/BUREAUS IF THE INDIVIDUAL DOES NOT SUBMIT A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM) OR PAY THE AMOUNT DUE BY A SPECIFIED DEADLINE. THE SPECIFIED DEADLINE IS NOT EARLIER THAT 120 DAYS AFTER THE FIRST BILLING STATEMENT IS SENT TO THE INDIVIDUAL AND IS AT LEAST 30 DAYS AFTER THE NOTICE IS PROVIDED. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FAA FORM DURING THE 240-DAY PERIOD FOLLOWING THE DATE ON WHICH THE FIRST BILLING STATEMENT WAS SENT TO THE INDIVIDUAL, THE HOSPITAL FILING ORGANIZATION SUSPENDS ANY REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS AND PROVIDES A WRITTEN NOTICE TO THE INDIVIDUAL DESCRIBING WHAT ADDITIONAL INFORMATION OR DOCUMENTATION IS NEEDED TO COMPETE THE FAA FORM. THIS WRITTEN NOTICE INCLUDES A COPY OF THE HOSPITAL FILING ORGANIZATION'S PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) AND INFORMS THE INDIVIDUAL THAT THE HOSPITAL FILING ORGANIZATION MAY ENGAGE IN ADVERSE REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS IF THE FAA FORM IS NOT COMPLETED BY A SPECIFIED DEADLINE WHICH IS NO EARLIER THAN THE 240-DAY PERIOD FOLLOWING THE DATE ON WHICH THE FIRST BILLING STATEMENT WAS SENT TO THE INDIVIDUAL OR, IF LATER, 30 DAYS AFTER THE WRITTEN NOTICE IS PROVIDED. IF AN INDIVIDUAL SUBMITS A COMPETE FAA FORM WITHIN THE 240-DAY PERIOD AFTER THE FIRST BILLING STATEMENT IS SENT, THE HOSPITAL FILING ORGANIZATION WILL SUSPEND ANY ADVERSE REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS UNTIL A FINANCIAL ASSISTANCE POLICY ELIGIBILITY DETERMINATION CAN BE MADE.
PART VI, LINE 2:	AS REPORTED IN SCHEDULE H, PART V, SECTION B, LINES 1-8, THE HOSPITAL CONDUCTED ITS INITIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING 2013. ITS INITIAL CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2013, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S INITIAL CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN PROPOSED REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY.SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY.
PART VI, LINE 3:	THE FINANCIAL ASSISTANCE POLICY (FAP) OF THE FILING ORGANIZATION'S HOSPITAL FACILITY IS TRANSPARENT AND AVAILABLE TO ALL INDIVIDUALS SERVED AT ANY POINT IN THE CARE CONTINUUM. THE FAP, THE FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM), THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS), AND CONTACT INFORMATION FOR THE HOSPITAL FACILITY'S FINANCIAL COUNSELORS ARE PROMINENTLY AND CONSPICUOUSLY POSTED ON THE FILING ORGANIZATION'S HOSPITAL FACILITY'S WEBSITE. SIGNAGE IS DISPLAYED IN THE FILING ORGANIZATION'S HOSPITAL FACILITY AT ALL POINTS OF ADMISSION AND REGISTRATION, INCLUDING THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE HOSPITAL FACILITY'S WEBSITE ADDRESS WHERE THE FAP AND THE FAA FORM CAN BE ACCESSED AND THE TELEPHONE NUMBER AND PHYSICAL LOCATION THAT INDIVIDUALS CAN CALL OR VISIT WITH ANY QUESTIONS ABOUT THE FAP OR THE APPLICATION PROCESS. PAPER COPIES OF THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A COPY OF THE HOSPITAL FACILITY'S PLS AND FAA FORM IS DISTRIBUTED TO EVERY INDIVIDUAL BEFORE DISCHARGE FROM THE HOSPITAL FACILITY. A CONSPICUOUS WRITTEN NOTICE IS INCLUDED ON ALL BILLING STATEMENTS SENT TO PATIENTS THAT NOTIFIES AND INFORMS RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, INCLUDING THE FOLLOWING: 1) THE TELEPHONE NUMBER OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND THE FAA FORM; AND 2) THE WEBSITE ADDRESS WHERE COPIES OF THE FAP, FAA FORM AND PLS MAY BE OBTAINED. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE.
PART VI, LINE 4:	ADVENTIST BOLINGBROOK HOSPITAL (THE HOSPITAL) IS A 138-BED STATE-OF-THE-ART ACUTE CARE HOSPITAL SERVING THE RESIDENTS OF THE VILLAGE OF BOLINGBROOK, ILLINOIS AND SURROUNDING COMMUNITIES. BOLINGBROOK IS LOCATED IN WILL COUNTY, ILLINOIS. THE POPULATION FOR DUPAGE AND WILL COUNTY IS APPROXIMATELY 1,602,491, WITH AN ESTIMATED 11% OVER THE AGE OF 65. THE BUILDING OF THE HOSPITAL WAS THE RESULT OF A SUSTAINED, 27-YEAR COMMITMENT BY ADVENTIST HEALTH SYSTEM TO BOLINGBROOK AND ITS SERVICE AREA. PRIOR TO THE BUILDING OF THE HOSPITAL, ADVENTIST MIDWEST HEALTH, AN AFFILIATE OF THE HOSPITAL, OPERATED A FREE STANDING EMERGENCY CENTER IN THE VILLAGE OF BOLINGBROOK. THE HOSPITAL IS MEETING A DEMAND FOR ACUTE CARE INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES IN THE COMMUNITIES IT SERVES. THE HOSPITAL OFFERS THE LATEST TECHNOLOGICAL ADVANCES AND WAS DESIGNED TO OFFER ALL FAMILY-FRIENDLY PRIVATE PATIENT ROOMS. SERVICES OFFERED AT THE HOSPITAL INCLUDE CARDIAC CARE, IMAGING SERVICES, A WOMEN'S CARE CENTER, INCLUDING A MATERNAL FETAL CENTER, SURGICAL SERVICES AND INTERVENTIONAL RADIOLOGY. THE HOSPITAL OFFERS OTHER SERVICES NOT AVAILABLE AT ANY OTHER HOSPITAL IN WILL COUNTY. AN EXAMPLE IS AN ENDOSCOPIC ULTRASOUND, A NEW, HIGHLY-DETAILED DIAGNOSTIC TEST THAT COMBINES ENDOSCOPY AND ULTRASONOGRAPHY TO ALLOW ACCURATE IMAGING OF TUMORS. THE HOSPITAL OPENED A NEW WOUND CARE CENTER IN 2013 AND HAS ALSO ESTABLISHED AN AGREEMENT WITH VNA HEALTH CARE TO OFFER A FEDERALLY QUALIFIED HEALTH CENTER ON THE HOSPITAL CAMPUS TO PROVIDE CARE FOR THE UNINSURED AND UNDERINSURED. HIGH SCHOOL GRADUATES ACCOUNT FOR APPROXIMATELY 91.4% OF THE HOSPITAL'S SERVICE AREA. IT IS ESTIMATED THAT 19.4% OF THE INDIVIDUALS RESIDING IN THE HOSPITAL'S SERVICE AREA LIVE BELOW 200% OF THE FEDERAL POVERTY LEVEL AND THE UNEMPLOYMENT RATE IS ABOUT 5.4%. APPROXIMATELY 31.3% OF THE HOSPITAL'S PATIENTS DURING 2015 WERE MEDICARE PATIENTS, ABOUT 21.7% WERE MEDICAID PATIENTS, ABOUT 4.1% WERE SELF-PAY PATIENTS, AND THE REMAINING PERCENTAGE WERE PATIENTS COVERED UNDER COMMERCIAL INSURANCE. IN 2015, ABOUT 66% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT.
PART VI, LINE 5:	THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO ADVENTIST BOLINGBROOK HOSPITAL'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT AND COMMUNITY BUILDING INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, HOSPITAL PROVIDED $366,807 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF A COMMUNITY HOSPITAL. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE HOSPITAL EXPENDED $3,547,124, IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY.
PART VI, LINE 6:	ADVENTIST BOLINGBROOK HOSPITAL IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 44 HOSPITALS IN 10 STATES THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 16 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AS THE PARENT ORGANIZATION OF THE AHS SYSTEM, AHSSHC PROVIDES EXECUTIVE LEADERSHIP AND OTHER PROFESSIONAL SUPPORT SERVICES TO ITS SUBSIDIARY ORGANIZATIONS. PROFESSIONAL SUPPORT SERVICES INCLUDE AMONG OTHERS CORPORATE COMPLIANCE, LEGAL, HUMAN RESOURCES, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH AHS SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITALS AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. EACH AHS SUBSIDIARY PAYS A MANAGEMENT FEE TO AHSSHC FOR THE INTERNAL SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY A AHS SUBSIDIARY ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY BY ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF AHS AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEB-SITE OF AHS AT WWW.ADVENTISTHEALTHSYSTEM.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF AHS AND TO ACCESS AHS'S ANNUAL REPORT THAT CONTAINS FINANCIAL DATA AS WELL AS COMMUNITY BENEFIT REPORTING FOR THE ENTIRE SYSTEM.
PART VI, LINE 7, REPORTS FILED WITH STATES	IL

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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," on 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

2015

Open to Public
Inspection

Name of the organization
ADVENTIST BOLINGBROOK HOSPITAL

Employer identification number
65-1219504

Part I

General Information on Grants and Assistance

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? ........................

Yes No

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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 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) BOLINGBROOK HOSPITAL FOUNDATION 500 REMINGTON BLVD BOLINGBROOK,IL60440	90-0494445	501(C)(3)		158,490	COST	GENERAL ADMINSTRATIVE SUPPORT	PROVISION OF GENERAL ADMINISTRATIVE SUPPORT
(2) JOLIET WILL COUNTY CENTER FOR ECONOMIC DEVELOPMENT 116 N CHICAGO ST 101 JOLIET,IL60432	36-3174683	501(C)(3)	15,000				GENERAL SUPPORT
(3) MARCH OF DIMES FOUNDATION 310 N HAMMES AVE 3006 JOLIET,IL60435	13-1846366	501(C)(3)	10,000				GENERAL SUPPORT
(4) BOLINGBROOK SEVENTH DAY ADVENTIST CHURCH 301 E BOUGHTON ROAD BOLINGBROOK,IL60440	36-2277365	501(C)(3)	36,400				VIDEO EQUIPMENT AND GENERAL SUPPORT
(5) CRESTHILL CHRISTIAN JUNIOR ACADEMY 21514 W DIVISION ST LOCKPORT,IL60441	26-4797031	501(C)(3)	5,000				GENERAL SUPPORT
(6) HEART HAVEN OUTREACH 201 CANTERBURY LANE SUITE C BOLINGBROOK,IL60440	20-1675860	501(C)(3)	5,000				GENERAL SUPPORT
(7) BOLINGBROOK PARK DISTRICT 201 RECREATION DRIVE BOLINGBROOK,IL60440	36-2731525	501(C)(3)	21,000				GENERAL SUPPORT
(8) LEMONT PARK DISTRICT 16028 127TH STREET LEMONT,IL60439	36-2647810	501(C)(3)	9,990				GENERAL SUPPORT
(9) SOF-IX PB OWNER LP DBA THE PROMENADE BOLINGBROOK 631 E BOUGHTON RD 220 BOLINGBROOK,IL60440	46-4639183		8,500				GENERAL SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)

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 IRC SECTION 501(C)(3), OR TO OTHER LOCAL CHARITABLE COMMUNITY ORGANIZATIONS, OR TO OTHER 501(C)(3) ORGANIZATIONS THAT ARE A PART OF THE GROUP EXEMPTION RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

ADVENTIST BOLINGBROOK HOSPITAL

Employer identification number

65-1219504

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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 .........

Yes

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? ..

Yes

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on 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 ............

Were any amounts reported on 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 .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

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 on 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 in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1DAVID L CRANEPRESIDENT/SECRETARY	(i) (ii)	0 ------------- 756,033	0 ------------- 236,919	0 ------------- 1,710,168	0 ------------- 135,272	0 ------------- 45,454	0 ------------- 2,883,846	0 ------------- 127,976
2RANDALL HAFFNER PHDDIR/CHAIRMAN (BEG 6/15)	(i) (ii)	0 ------------- 729,373	0 ------------- 0	0 ------------- 1,106,046	0 ------------- 156,563	0 ------------- 86,147	0 ------------- 2,078,129	0 ------------- 0
3RICHARD REINERCHAIRMAN (END 6/15)	(i) (ii)	0 ------------- 556,753	0 ------------- 330,569	0 ------------- 197,546	0 ------------- 14,388	0 ------------- 48,451	0 ------------- 1,147,707	0 ------------- 0
4BRENT G SNYDERTREASURER/DIRECTOR	(i) (ii)	0 ------------- 688,079	0 ------------- 224,700	0 ------------- 334,451	0 ------------- 127,852	0 ------------- 34,026	0 ------------- 1,409,108	0 ------------- 99,713
5RICK MACECEO	(i) (ii)	0 ------------- 322,799	0 ------------- 103,132	0 ------------- 168,836	0 ------------- 54,559	0 ------------- 30,551	0 ------------- 679,877	0 ------------- 36,920
6MICHAEL MURRILLCFO / COO	(i) (ii)	0 ------------- 262,079	0 ------------- 47,817	0 ------------- 22,286	0 ------------- 14,388	0 ------------- 39,506	0 ------------- 386,076	0 ------------- 0
7REBECCA MATHISCFO (BEG 3/15)	(i) (ii)	0 ------------- 275,254	0 ------------- 52,428	0 ------------- 48,299	0 ------------- 14,420	0 ------------- 40,562	0 ------------- 430,963	0 ------------- 10,660
8JOLENE ALBAUGHCNO	(i) (ii)	0 ------------- 206,255	0 ------------- 44,129	31 ------------- 8,315	0 ------------- 14,008	0 ------------- 39,765	31 ------------- 312,472	0 ------------- 0
9MARY MURPHYREGIONAL CNO	(i) (ii)	0 ------------- 258,346	0 ------------- 50,451	0 ------------- 53,854	0 ------------- 30,769	0 ------------- 17,547	0 ------------- 410,967	0 ------------- 22,864
10RON WEHTJEREGIONAL CFO	(i) (ii)	0 ------------- 422,500	0 ------------- 111,329	0 ------------- 111,524	0 ------------- 54,798	0 ------------- 42,410	0 ------------- 742,561	0 ------------- 38,614
11GEORGE MAYZELL MDREGIONAL CMO (END 8/15)	(i) (ii)	0 ------------- 339,275	0 ------------- 89,568	0 ------------- 454,104	0 ------------- 45,290	0 ------------- 39,035	0 ------------- 967,272	0 ------------- 37,967
12RICHARD CARROLL MDCMO-GLENOAKS & BOLINGBROOK	(i) (ii)	0 ------------- 396,346	0 ------------- 65,390	0 ------------- 132,933	0 ------------- 44,576	0 ------------- 43,967	0 ------------- 683,212	0 ------------- 28,353
13ALEEM AZIZDIR OF PHARMACY	(i) (ii)	85,224 ------------- 0	17,308 ------------- 0	89,674 ------------- 0	4,650 ------------- 0	19,645 ------------- 0	216,501 ------------- 0	0 ------------- 0
14CATHERINE MICHALOWICZRN CHARGE	(i) (ii)	75,846 ------------- 0	40,505 ------------- 0	62,705 ------------- 0	8,928 ------------- 0	115 ------------- 0	188,099 ------------- 0	0 ------------- 0
15MICHAEL KOERTINGDIR OF RADIOLOGY	(i) (ii)	84,788 ------------- 0	15,076 ------------- 0	58,420 ------------- 0	4,469 ------------- 0	7,611 ------------- 0	170,364 ------------- 0	0 ------------- 0
16FERNANDO GRUTADIR OF SURGICAL SERVICES	(i) (ii)	132,425 ------------- 0	22,571 ------------- 0	516 ------------- 0	7,430 ------------- 0	11,803 ------------- 0	174,745 ------------- 0	0 ------------- 0
17DIANE LEONARDDIR OF NURSING	(i) (ii)	131,908 ------------- 0	12,665 ------------- 0	3,571 ------------- 0	7,404 ------------- 0	23,048 ------------- 0	178,596 ------------- 0	0 ------------- 0
18GARY LIPINSKI MDFORMER CMO	(i) (ii)	0 ------------- 382,314	0 ------------- 74,937	0 ------------- 77,107	0 ------------- 41,185	0 ------------- 44,953	0 ------------- 620,496	0 ------------- 26,116

Schedule J (Form 990) 2015

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 OR CMO/CNO BUSINESS MEETING ($300 PER EXECUTIVE). OTHER DISCRETIONARY SPENDING ACCOUNTS MAY BE PROVIDED IN CONNECTION WITH OTHER AHS SPONSORED CONFERENCES BUT TYPICALLY DO NOT EXCEED $200 PER PARTICIPANT. WITH RESPECT TO THE AHS PRESIDENT'S COUNCIL MEETING, ELIGIBLE EXECUTIVES MAY INCLUDE AHSSHC VICE PRESIDENTS AND ABOVE AND ALL AHSSHC SUBSIDIARY ORGANIZATION CEOS AND REGIONAL CFOS. THE PAYMENT PROVIDED TO EACH EXECUTIVE WAS CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES BUSINESS DEVELOPMENT EXPENDITURES. UNDER THIS POLICY, CERTAIN AHS ELIGIBLE EXECUTIVES MAY BE REIMBURSED FOR MEMBER DUES AND USAGE CHARGES FOR A COUNTRY CLUB OR OTHER SOCIAL CLUB UPON AUTHORIZATION. CLUB MEMBERSHIPS MUST BE RECOMMENDED BY THE CEO OF THE AHS HOSPITAL ORGANIZATION AND APPROVED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS OF THE ORGANIZATION. IN ADDITION, THE PROPOSED MEMBERSHIP MUST BE APPROVED ANNUALLY BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF AHSSHC. ELIGIBLE EXECUTIVES ARE LIMITED TO CERTAIN SENIOR LEVEL EXECUTIVES (HOSPITAL ORGANIZATION CEOS, THE CEO OF THE NURSING HOME DIVISION OF AHS, SENIOR VICE PRESIDENTS AT THREE LARGE HOSPITAL ORGANIZATIONS, REGIONAL CEOS AND CFOS AND THE PRESIDENT AND SENIOR VICE PRESIDENTS OF AHSSHC). IN THE CURRENT YEAR, FOR THIS FILING ORGANIZATION, ONE EXECUTIVE WAS ELIGIBLE TO RECEIVE REIMBURSEMENT FOR CLUB FEES. EACH AHS EXECUTIVE WHO IS APPROVED FOR A CLUB MEMBERSHIP MUST SUBMIT AN ANNUAL REPORT TO THE AHSSHC BOARD COMPENSATION COMMITTEE THAT DESCRIBES HOW THE MEMBERSHIP BENEFITED THEIR ORGANIZATION DURING THE PRECEDING YEAR.
PART I, LINE 3	THE 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	DURING THE YEAR ENDING DECEMBER 31, 2015, GEORGE MAYZELL, MD RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $159,931. 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 THE AHS BOARD COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF AHSSHC. ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED FROM THE ANNUAL PRE-DETERMINED BENEFITS ALLOWANCE ARE CONTRIBUTED, AT THE EMPLOYEE'S OPTION, TO EITHER AN IRC 457(F) DEFERRED COMPENSATION ACCOUNT OR TO AN IRC 457(B) ELIGIBLE DEFERRED COMPENSATION PLAN. UPON ATTAINMENT OF AGE 65, ALL PREVIOUS 457(F) DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT AND ANY FUTURE EMPLOYER CONTRIBUTIONS ARE MADE QUARTERLY FROM THE PLAN DIRECTLY TO THE PARTICIPANT. THE PLAN DOCUMENTS DEFINE AN EMPLOYEE WHO IS ELIGIBLE TO PARTICIPATE IN THE PLAN TO GENERALLY INCLUDE THE CHIEF EXECUTIVE OFFICERS OF AHS ENTITIES AND VICE PRESIDENTS OF ALL AHS ENTITIES WHOSE BASE SALARY IS AT LEAST $230,000. THE PLAN PROVIDES FOR A CLASS YEAR VESTING SCHEDULE (2 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT. DISTRIBUTIONS COULD ALSO BE MADE FROM THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT UPON ATTAINMENT OF AGE 65 OR UPON AN INVOLUNTARY SEPARATION. THE ACCOUNT IS FORFEITED BY THE EXECUTIVE UPON A VOLUNTARY SEPARATION. IN ADDITION TO THE PLAN, AHS HAS INSTITUTED A DEFINED BENEFIT, NON-TAX-QUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN EXECUTIVES WHO HAVE PROVIDED LENGTHY SERVICE TO AHS AND/OR TO OTHER SEVENTH-DAY ADVENTIST CHURCH HOSPITALS OR HEALTH CARE INSTITUTIONS. PARTICIPATION IN THE PLAN IS OFFERED TO AHS EXECUTIVES ON A PRORATA SCHEDULE BEGINNING WITH 20 YEARS OF SERVICE AS AN EMPLOYEE OF AHS AND/OR ANOTHER HOSPITAL OR HEALTH CARE INSTITUTION CONTROLLED BY THE SEVENTH-DAY ADVENTIST CHURCH AND WHO SATISFY CERTAIN OTHER QUALIFYING CRITERIA. THIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WAS DESIGNED TO PROVIDE ELIGIBLE EXECUTIVES WITH THE ECONOMIC EQUIVALENT OF AN ANNUAL INCOME BEGINNING AT NORMAL RETIREMENT AGE EQUAL TO 60% OF THE AVERAGE OF THE PARTICIPANT'S THREE, FIVE OR SEVEN HIGHEST YEARS OF BASE SALARY FROM AHS ACTIVE EMPLOYMENT INCLUSIVE OF INCOME FROM ALL OTHER SEVENTH-DAY ADVENTIST CHURCH HEALTHCARE EMPLOYER-FINANCED RETIREMENT INCOME SOURCES AND INVESTMENT INCOME EARNED ON THOSE CONTRIBUTIONS THROUGH SOCIAL SECURITY NORMAL RETIREMENT AGE AS DEFINED IN THE PLAN. THE NUMBER OF YEARS INCLUDED IN HIGHEST AVERAGE COMPENSATION IS DETERMINED BY THE INDIVIDUAL'S YEAR OF ENTRY TO THE SERP AND BY THE INDIVIDUAL'S YEAR OF ENTRY TO THE AHS EXECUTIVE FLEX BENEFIT PROGRAM. FLEX PLAN FLEX PLAN/ SERP 457(B) CY CY EMPLOYER CY CONTRIB./ DISTRIBUTIONS CONTRIB. DISTRIBUTIONS* PAYMENT ------------------------------------------------------- DAVID L. CRANE $138,885 $128,053 $1,479,628 $ 0 RANDALL HAFFNER, PHD $142,176 $ 0 $ 998,147 $ 0 RICHARD K. REINER $109,965 $ 91,965 $ 0 $ 0 BRENT G. SNYDER $131,464 $ 99,771 $ 167,822 $ 0 RICK MACE $ 40,172 $ 37,553 $ 94,772 $ 0 MICHAEL MURRILL $ 11,539 $ 0 $ 0 $ 0 REBECCA MATHIS $ 18,032 $ 12,107 $ 0 $ 0 GARY R. LIPINSKI, MD $ 44,798 $ 29,320 $ 0 $ 0 RICHARD CARROLL, MD $ 48,188 $ 31,762 $ 0 $ 0 GEORGE MAYZELL, MD $ 48,903 $128,259 $ 0 $ 0 MARY MURPHY $ 34,382 $ 25,871 $ 0 $ 0 RON WEHTJE $ 58,411 $ 43,544 $ 0 $ 0 *INCLUDING INVESTMENT EARNINGS

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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 990-EZ 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

2015

Open to Public
Inspection

Name of the organization

ADVENTIST BOLINGBROOK HOSPITAL

Employer identification number

65-1219504

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 2	CARLENE JAMERSON AND RICK MACE - BUSINESS RELATIONSHIP
FORM 990, PART VI, SECTION A, LINE 4	THE ARTICLES OF INCORPORATION AND BYLAWS OF THE FILING ORGANIZATION WERE AMENDED IN 2015 TO REFLECT CERTAIN CHANGES TO THE PURPOSES, MEMBERSHIP, AND GOVERNANCE OF THE FILING ORGANIZATION AS A RESULT OF AN AFFILIATION AGREEMENT ENTERED INTO BETWEEN ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) AND ASCENSION HEALTH ON FEBRUARY 1, 2015. AHSSHC IS THE 501(C)(3) TOP-TIER PARENT ORGANIZATION OF THE FILING ORGANIZATION AND THE PARENT OF A SYSTEM OF HOSPITAL AND OTHER HEALTHCARE PROVIDER ORGANIZATIONS OPERATING IN TEN STATES. THE SYSTEM IS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). UNDER THE AFFILIATION AGREEMENT ENTERED INTO BETWEEN AHSSHC AND ASCENSION HEALTH, A JOINT OPERATING COMPANY, ALEXIAN BROTHERS - AHS MIDWEST REGION HEALTH CO., WAS FORMED. THE JOINT OPERATING COMPANY DOES BUSINESS UNDER THE NAME, AMITA HEALTH. ALEXIAN BROTHERS - AHS MIDWEST REGION HEALTH CO. (JOC OR AMITA HEALTH) HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT ORGANIZATION UNDER IRC SECTION 501(C)(3). THE JOC PROVIDES FOR THE HOSPITALS AND OTHER HEALTHCARE PROVIDER ORGANIZATIONS OWNED AND OPERATED IN THE NORTHWEST SUBURBS OF CHICAGO BY ALEXIAN BROTHERS HEALTH SYSTEM AND BY AHS TO INTEGRATE FINANCIALLY AND OPERATIONALLY TO ACHIEVE A MORE EFFECTIVE AND EFFICIENT SYSTEM OF DELIVERING HEALTHCARE AND HOSPITAL SERVICES TO THE RESIDENTS OF THE COMMUNITIES SERVED. THE JOC MANAGES AND OPERATES ITS "COVERED AFFILIATES". THE FILING ORGANIZATION IS ONE OF THE COVERED AFFILIATES OF THE JOC. THE MEMBERSHIP OF THE JOC IS HELD BY ADVENTIST MIDWEST HEALTH AND ALEXIAN BROTHERS HEALTH SYSTEM. ADVENTIST MIDWEST HEALTH (AMH) IS A 501(C)(3) SECOND-TIER SUBSIDIARY OF AHSSHC. ALEXIAN BROTHERS HEALTH SYSTEM IS ALSO EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). PRIOR TO THE COMMENCEMENT OF THE AFFILIATION AGREEMENT ON FEBRUARY 1, 2015, THE SOLE MEMBER OF THE FILING ORGANIZATION WAS ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI). AHSSI IS A 501(C)(3) FIRST-TIER SUBSIDIARY OF AHSSHC. AHSSI IS THE SOLE MEMBER OF AMH. IN CONJUNCTION WITH THE CLOSING OF THE AFFILIATION AGREEMENT OF FEBRUARY 1, 2015, A RESTRUCTURING OCCURRED WHEREBY THE MEMBERSHIP OF THE FILING ORGANIZATION WAS TRANSFERRED FROM AHSSI TO AMH. THE PURPOSES CLAUSE OF THE FILING ORGANIZATION'S BYLAWS WAS AMENDED IN 2015 TO REFLECT THE FILING ORGANIZATION'S STATUS AS A COVERED AFFILIATE OF THE NEW JOC KNOWN AS AMITA HEALTH. THE GOVERNANCE AND RESERVED POWERS ARTICLES OF THE BYLAWS WERE AMENDED TO SET FORTH THE RIGHTS AND RESERVED POWERS OVER THE FILING ORGANIZATION BY THE SPONSOR, AHSSHC, BY THE MEMBER, AMH, BY BOTH MEMBERS OF THE JOC, NAMELY, AMH AND ALEXIAN BROTHERS HEALTH SYSTEM, AND THE BOARD OF DIRECTORS OF AMITA HEALTH. PLEASE SEE OUR RESPONSE TO QUESTION 7B OF SECTION A OF PART VI OF FORM 990 FOR A LISTING OF THE POWERS RESERVED BY THE SPONSOR; BY AMH (MEMBER), BY BOTH AMH AND ALEXIAN BROTHERS HEALTH SYSTEM (MEMBERS), AND BY THE BOARD OF DIRECTORS OF AMITA HEALTH, THE JOC. PRIOR TO AMENDMENT OF THE FILING ORGANIZATION'S BYLAWS ON 2/1/15, THE PRESIDENT OF THE FILING ORGANIZATION WAS ELECTED BY THE MEMBER. THE BYLAWS, AS AMENDED, PROVIDE THAT THE PRESIDENT'S APPOINTMENT, RETENTION AND REMOVAL SHALL BE AT THE DISCRETION OF THE CEO OF THE JOC, SUBJECT TO THE SPONSOR'S APPROVAL.
FORM 990, PART VI, SECTION A, LINE 6	IN CONNECTION WITH THE AFFILIATION AGREEMENT DESCRIBED ABOVE IN PART VI, SECTION A, LINE 4, THE BOARD OF DIRECTORS OF AHSSI AND OF AHSSHC APPROVED A RESTRUCTURING WHEREBY AMH BECAME THE SOLE MEMBER OF THE FILING ORGANIZATION. PRIOR TO THE RESTRUCTURING, AHSSI WAS THE SOLE MEMBER OF THE FILING ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	THE MEMBERS OF THE BOARD OF DIRECTORS (GOVERNING BOARD) OF THE FILING ORGANIZATION ARE APPOINTED BY THE CORPORATE MEMBER, AMH. THE CORPORATE MEMBER IS ENTITLED TO ELECT NOT LESS THAN EIGHTEEN (18) AND NO MORE THAN TWENTY THREE (23) VOTING MEMBERS TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION PURSUANT TO THE PROVISIONS OF THE BYLAWS, SUBJECT TO THE RATIFICATION OF THE AMITA HEALTH BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	AS NOTED IN OUR RESPONSE TO PART VI, SECTION A, LINE 4, THE FILING ORGANIZATION IS A COVERED AFFILIATE OF THE JOC KNOWN AS AMITA HEALTH. THE SOLE MEMBER OF THE FILING ORGANIZATION IS AMH. AMH IS ALSO ONE OF TWO MEMBERS IN AMITA HEALTH. THE OTHER MEMBER OF AMITA HEALTH IS ALEXIAN BROTHERS HEALTH SYSTEM. THE TOP-TIER PARENT OF AMH IS AHSSHC (SPONSOR). THE GOVERNING DOCUMENTS OF THE FILING ORGANIZATION, AS AMENDED, PROVIDE FOR CERTAIN AUTHORITIES AND RESERVED POWERS OVER THE FILING ORGANIZATION BY AHSSHC, AS SPONSOR, BY AMH AS MEMBER, BY BOTH MEMBERS OF THE JOC, NAMELY, AMH AND ALEXIAN BROTHERS HEALTH SYSTEM (MEMBERS), AND BY THE BOARD OF DIRECTORS OF THE JOC AS FOLLOWS. AHSSHC, AS SPONSOR HAS THE FOLLOWING AUTHORITY WITH RESPECT TO THE FILING ORGANIZATION: A. TO DIRECT THE DISPOSITION OF THE FILING ORGANIZATION'S ASSETS WITH A VALUE NOT TO EXCEED THREE MILLION DOLLARS ($3,000,000). B. TO RATIFY, TOGETHER WITH THE OTHER SPONSOR OF THE JOC, THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION. C. TO DIRECT AN INTERNAL ASSET TRANSFER BETWEEN OR AMONG THE SPONSOR'S COVERED AFFILIATES (INCLUDING THE FILING ORGANIZATION) WITH A VALUE NOT IN EXCESS OF THREE MILLION DOLLARS ($3,000,000). D. TO DIRECT A SALE TO A THIRD PARTY OF PART OF THE FILING ORGANIZATION'S ASSETS MANAGED AND OPERATED BY THE JOC, OR A TRANSFER OF PART OF SPONSOR'S MEMBERSHIP INTEREST IN THE FILING ORGANIZATION TO A THIRD PARTY, SUBJECT TO A SUPERMAJORITY VOTE OF THE JOC BOARD OF DIRECTORS. CERTAIN GOVERNANCE POWERS ARE RESERVED TO AMH, AS THE MEMBER OF THE FILING ORGANIZATION. THE RESERVED POWERS OF AMH INCLUDE THE FOLLOWING: A. FAITH-BASED TENETS AND ETHICAL PRINCIPLES OF THE FILING ORGANIZATION. B. THE ALTERATION, RESTATEMENT OR REPEAL OF THE ARTICLES OF INCORPORATION, BYLAWS OR MISSION STATEMENT OF THE FILING ORGANIZATION, PROVIDED THAT SUCH ACTIONS ARE NOT INCONSISTENT WITH THE JOC BYLAWS OR THE AFFILIATION AGREEMENT. C. THE APPOINTMENT OF THE FILING ORGANIZATION'S BOARD OF DIRECTORS, SUBJECT TO THE RATIFICATION OF THE JOC BOARD OF DIRECTORS. D. THE APPROVAL OF ANY JOC BOARD RECOMMENDED WAIVER OR OTHER CLAIM OR ACTION AGAINST OR BROUGHT BY OR ON BEHALF OF THE FILING ORGANIZATION IF THE UNINSURED PORTION OF THE AMOUNT IN CONTROVERSY IS IN EXCESS OF SUCH THRESHOLD AMOUNT DESIGNATED IN SPONSOR POLICY AS REQUIRING MEMBER APPROVAL. POWERS RESERVED TO BOTH MEMBERS OF THE JOC: A. TO SELL, TRANSFER OR OTHERWISE DISPOSE OF ANY REAL ESTATE OR ANY ASSET OWNED BY THE FILING ORGANIZATION WITH A FAIR MARKET VALUE IN EXCESS OF TEN MILLION DOLLARS ($10,000,000). B. TO DIRECT ASSET TRANSFERS FROM THE FILING ORGANIZATION TO ANY OF THE ALEXIAN COVERED AFFILIATES (OR VICE VERSA) IN EXCESS OF TEN MILLION DOLLARS ($10,000,000). C. TO APPROVE ANY OPERATING LEASE UNDER WHICH THE FILING ORGANIZATION IS THE LESSEE, WHICH OPERATING LEASE SHALL BE CONSISTENT WITH THE OPERATING LEASE POLICIES OF ITS SPONSOR. D. OTHER THAN WITH RESPECT TO A COVERED AFFILIATE LEGACY LIABILITY OF THE MEMBER OR ITS SPONSOR, WHICH MATTER WILL BE HANDLED BY THE MEMBER AND ITS SPONSOR, TO APPROVE ENTERING INTO ANY CORPORATE INTEGRITY AGREEMENT OR SIMILAR AGREEMENT WITH A GOVERNMENT ENTITY OR AGENCY IMPOSING COMPLIANCE OBLIGATIONS ON THE JOC OR THE FILING ORGANIZATION. E. TO ACQUIRE ANY REAL ESTATE, PERSONAL PROPERTY, MEMBERSHIP, OWNERSHIP OR INVESTMENT INTEREST FOR THE FILING ORGANIZATION OR MAKE ANY CAPITAL EXPENDITURE WHETHER OR NOT PURSUANT TO AN ANNUAL BUDGET, OR SUBSTITUTIONS FOR CAPITAL EXPENDITURES WITHIN A CAPITAL BUDGET, WHICH EXCEED INDIVIDUALLY, OR IN THE AGGREGATE, TEN MILLION DOLLARS ($10,000,000) IN ANY FISCAL YEAR; PROVIDED, HOWEVER, THAT ANY CONTRIBUTION NECESSARY TO FUND UNBUDGETED EXPENDITURES BY THE JOC IS SUBJECT TO MEMBER APPROVAL. POWERS OF THE BOARD OF DIRECTORS OF THE JOC OVER THE FILING ORGANIZATION: A. TO ADOPT AND MODIFY THE ANNUAL (AND INTERIM IF DEEMED APPROPRIATE) OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION, WHICH BUDGETS WILL BE SUBJECT TO RATIFICATION BY EACH SPONSOR. B. TO ADOPT AND MODIFY A STRATEGIC PLAN FOR THE FILING ORGANIZATION AND APPROVE ANY UPDATE THEREOF. C. TO SELL, TRANSFER OR OTHERWISE DISPOSE OF ANY REAL ESTATE OR ANY OTHER ASSET OF THE FILING ORGANIZATION WITH A FAIR MARKET VALUE UP TO THE THRESHOLD OF TEN MILLION DOLLARS ($10,000,000). D. TO DIRECT ASSET TRANSFERS FROM THE FILING ORGANIZATION TO ANY OF THE ALEXIAN COVERED AFFILIATES (OR VICE VERSA) UP TO THE THRESHOLD OF TEN MILLION DOLLARS ($10,000,000). E. TO RECOMMEND FOR MEMBER APPROVAL ENTERING INTO ANY OPERATING LEASE IN WHICH THE FILING ORGANIZATION IS THE LESSEE CONSISTENT WITH THE OPERATING POLICIES OF THE SPONSOR. F. TO APPROVE ANY CONTRACT UNDER WHICH EITHER MEMBER OR ANY AFFILIATE OF A MEMBER WILL PROVIDE ITEMS OR SERVICES TO THE JOC OR A COVERED AFFILIATE OF THE OTHER MEMBER. G. TO RECOMMEND TO THE MEMBER ANY WAIVER, SETTLEMENT OR COMPROMISE OF ANY CLAIM AGAINST OR BROUGHT BY OR ON BEHALF OF THE FILING ORGANIZATION IF THE UNINSURED PORTION OF THE AMOUNT IN CONTROVERSY IS UP TO SUCH THRESHOLD AMOUNT AS DESIGNATED IN SPONSOR POLICY AS REQUIRING APPROVAL. H. TO MAKE ANY CAPITAL EXPENDITURE, INCLUDING BUT NOT LIMITED TO REAL ESTATE, PERSONAL PROPERTY, MEMBERSHIP, OWNERSHIP OR INVESTMENT INTEREST FOR THE FILING ORGANIZATION OR GOODWILL OR OTHER INTANGIBLE ASSETS WHICH ARE LESS THAN, INDIVIDUALLY OR IN THE AGGREGATE, TEN MILLION DOLLARS ($10,000,000) IN ANY FISCAL YEAR. I. TO DETERMINE THE SERVICES PROVIDED BY THE FILING ORGANIZATION, INCLUDING THE AUTHORITY TO DIRECT THE EXPANSION, REDUCTION AND CONSOLIDATION OF CLINICAL PROGRAMS, PATIENT CARE SERVICES AND ADMINISTRATIVE CAPABILITIES OR OTHER MAJOR CHANGES IN THE OPERATION OF THE FILING ORGANIZATION. J. TO ENTER INTO, ON BEHALF OF THE FILING ORGANIZATION, ANY RISK-BASED MANAGED CARE CONTRACT UNDER WHICH THE FILING ORGANIZATION WILL PROVIDE SERVICES. K. ANY CORPORATE COMPLIANCE POLICY APPLICABLE TO THE FILING ORGANIZATION AND ANY MODIFICATIONS THEREOF. L. TO MONITOR AND AUDIT THE FILING ORGANIZATION'S COMPLIANCE WITH THE DIRECTIVES OF THE MEMBERS ISSUED IN ACCORDANCE WITH THE AFFILIATION AGREEMENT. M. TO ADOPT CLINICAL INTEGRATION AND PERFORMANCE IMPROVEMENT PROGRAMS TO ENHANCE THE QUALITY AND COST-EFFECTIVENESS OF CLINICAL SERVICES AT THE FILING ORGANIZATION, INCLUDING BUT NOT LIMITED TO THROUGH CLINICAL PROTOCOLS, BEST PRACTICE STANDARDS, OUTCOMES MEASUREMENT MECHANISMS, POPULATION MANAGEMENT PROGRAMS AND COLLABORATION ON INFORMATION TECHNOLOGY INITIATIVES. N. TO APPROVE THE INTEGRATION OR PARTIAL INTEGRATION OF THE MEDICAL STAFFS OF ONE OR MORE FACILITIES OF THE FILING ORGANIZATION AND ANY OTHER COVERED AFFILIATES, AND ANY CREDENTIALING AND PRIVILEGING POLICY AND PROCEDURE RELATED THERETO PURSUANT TO SECTION 3.2 OF THE AFFILIATION AGREEMENT. O. TO RATIFY THE APPOINTMENT OF THE FILING ORGANIZATION'S BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11	THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND BY THE CFO PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, BOARD FINANCE COMMITTEE CHAIR, CEO AND THE CFO DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES.
FORM 990, PART VI, SECTION B, LINE 12C	THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTERESTS, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR ANY PRINCIPAL OFFICER OF THE FILING ORGANIZATION (I.E. INTERESTED PERSONS) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTERESTS POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES.
FORM 990, PART VI, SECTION B, LINE 15	THE FILING ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES ARE NOT COMPENSATED BY THE FILING ORGANIZATION. SUCH INDIVIDUALS ARE COMPENSATED BY THE RELATED TOP-TIER PARENT ORGANIZATION OF THE FILING ORGANIZATION. PLEASE SEE THE DISCUSSION CONCERNING THE PROCESS FOLLOWED BY THE RELATED TOP-TIER PARENT ORGANIZATION IN DETERMINING EXECUTIVE COMPENSATION IN OUR RESPONSE TO SCHEDULE J, LINE 3.
FORM 990, PART VI, SECTION C, LINE 19	THE FILING ORGANIZATION IS A PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). 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 (NOT INCLUDING PHYSICIAN MEMBERS OF THE BOARD), OFFICER(S) AND KEY EMPLOYEES WHO DEVOTE LESS THAN FULL-TIME TO THE FILING ORGANIZATION (BASED UPON THE AVERAGE NUMBER OF HOURS PER WEEK SHOWN IN COLUMN (B) ON PAGE 7 OF THE RETURN) THE COMPENSATION AMOUNTS SHOWN IN COLUMNS (E) AND (F) ON PAGE 7 WERE PROVIDED IN CONJUNCTION WITH THAT PERSON'S RESPONSIBILITIES AND ROLES IN SERVING IN AN EXECUTIVE LEADERSHIP POSITION WITHIN ADVENTIST HEALTH SYSTEM. PHYSICIAN MEMBERS OF THE BOARD OF DIRECTORS RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS AS A RESULT OF PROVIDING VARIOUS MEDICAL SERVICES TO THOSE RELATED ENTITIES.
FORM 990, PART IX, LINE 11G	PAYMENTS TO HEALTHCARE PROFESSIONAL: PROGRAM SERVICE EXPENSES 6,530,032. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,530,032. PURCHASED MEDICAL SERVICES : PROGRAM SERVICE EXPENSES 5,198,118. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,198,118. ENVIRONMENTAL SERVICES : PROGRAM SERVICE EXPENSES 2,467,172. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,467,172. RECRUITING : PROGRAM SERVICE EXPENSES 15,227. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,227. AHS MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 951,419. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 951,419. BILLING & COLLECTION SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 624,508. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 624,508. PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 1,823,484. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,823,484. EHR MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 19,539. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,539. MISCELLANEOUS PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 3,288,296. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,288,296. FOOD SERVICE CONTRACTS : PROGRAM SERVICE EXPENSES 1,427,302. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,427,302. REGION SUPPORT SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 6,999,698. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,999,698.
FORM 990, PART XI, LINE 9:	TRANSFER TO TAX-EXEMPT PARENT -289,626. ALLOCATIONS TO TAX-EXEMPT PARENT WITH RESPECT TO DEBT -75,581. TRANSFER TO TAX-EXEMPT RELATED ORGANIZATION -2,962,283. NET CHANGE IN INTEREST IN FOUNDATION 208,549. ROUNDING 2.
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) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

ADVENTIST BOLINGBROOK HOSPITAL

Employer identification number

65-1219504

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

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?
(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	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 MIDWEST HEALTH	Yes
(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	Yes
(3)ADVENTIST GLENOAKS HOSPITAL 701 WINTHROP AVENUE GLENDALE HEIGHTS,IL60139 36-3208390	OPERATION OF HOSPITAL & RELATED SERVICES	IL	501(C)(3)	LINE 3	ADVENTIST MIDWEST HEALTH	Yes
(4)ADVENTIST HLTH MID-AMERICA INC 9100 W 74TH STREET SHAWNEE MISSION,KS66204 52-1347407	SUPPORT OF AFFILIATED HOSPITAL	KS	501(C)(3)	LINE 11C, III-FI	ADVENTIST HLTH SYSTEMSUNBELT INC	Yes
(5)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	Yes
(6)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
(7)ADVENTIST HLTH SYSTEM GEORGIA 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	Yes
(8)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	Yes
(9)ADVENTIST HLTH SYSTEMTEXAS INC 11801 S FREEWAY BURLESON,TX36028 74-2578952	LEASING PERSONNEL TO AFFILIATED HOSPITAL	TX	501(C)(3)	LINE 11C, III-FI	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	Yes
(10)ADVENTIST MIDWEST HEALTH 120 NORTH OAK STREET HINSDALE,IL60521 36-2276984	OPERATION OF HOSPITAL & RELATED SERVICES	IL	501(C)(3)	LINE 3	ADVENTIST HLTH SYSTEMSUNBELT INC	Yes
(11)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	Yes
(12)AHP SPECIALTY CARE NFP (1230-123115) 3040 SALT CREEK LANE ARLINGTON HEIGHTS,IL60005 81-1105774	OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES	IL	501(C)(3)	LINE 3	AHS MIDWEST MANAGEMENT INC	Yes
(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 MIDWEST HEALTH	Yes
(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	Yes
(15)ALEXIAN BROTHERS-AHS MIDWEST REGION HLTH CO DBA AMITA HEALTH 3040 W SALT CREEK LANE ARLINGTON HEIGHTS,IL60005 47-2360513	JOINT OPERATING COMPANY	IL	501(C)(3)	LINE 11B, II	ADVENTIST MIDWEST HEALTH	Yes
(16)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	Yes
(17)BATTLE CREEK ADVENTIST HOSPITAL 1000 REMINGTON BLVD STE 200 BOLINGBROOK,IL60440 38-1359189	INACTIVE	MI	501(C)(3)	LINE 3	ADVENTIST HLTH SYSTEMSUNBELT INC	Yes
(18)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
(19)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	Yes
(20)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	Yes
(21)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	Yes
(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	Yes
(23)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	Yes
(24)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	Yes
(25)COBB MEDICAL ASSOCIATES LLC (11-122315) 900 HOPE WAY ALTAMONTE SPRINGS,FL32714 58-2617089	INACTIVE	GA	501(C)(3)	LINE 3	EMORY-ADVENTIST INC	Yes
(26)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	Yes
(27)CREEKWOOD PLACE NURSING & REHAB CENTER INC 107 BOYLES DRIVE RUSSELLVILLE,KY42276 20-5782260	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	KY	501(C)(3)	LINE 9	SUNBELT HLTH CARE CENTERS INC	Yes
(28)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	Yes
(29)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	Yes
(30)EMORY-ADVENTIST INC 900 HOPE WAY ALTAMONTE SPRINGS,FL32714 58-2171011	INACTIVE	GA	501(C)(3)	LINE 3	ADVENTIST HLTH SYSTEMSUNBELT INC	Yes
(31)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	Yes
(32)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	Yes
(33)FLORIDA HOSPITAL HEALTHCARE PARTNERS INC 770 WEST GRANADA BLVD 101 ORMOND BEACH,FL32174 46-2354804	OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES	FL	501(C)(3)	LINE 3	ADVENTIST HLTH SYSTEMSUNBELT INC	Yes
(34)FLORIDA HOSPITAL MEDICAL GROUP INC 2600 WESTHALL LN MAITLAND,FL32751 59-3214635	OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES	FL	501(C)(3)	LINE 3	ADVENTIST HLTH SYSTEMSUNBELT INC	Yes
(35)FLORIDA HOSPITAL PHYSICIAN GROUP INC 2700 HEALING WAY WESLEY CHAPEL,FL33545 46-2021581	OPERATION OF PHYSICIAN PRACTICES & MEDICAL SERVICES	FL	501(C)(3)	LINE 3	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	Yes
(36)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	Yes
(37)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	Yes
(38)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	Yes
(39)FOUNTAIN INN NURSING & REHAB CENTER INC 485 NORTH KELLER ROAD 250 MAITLAND,FL32751 47-2180518	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	FL	501(C)(3)	LINE 9	SUNBELT HLTH CARE CENTERS INC	Yes
(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			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 7	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)HOSPICE OF THE COMFORTER INC 480 W CENTRAL PARKWAY ALTAMONTE SPRINGS,FL32714 59-2935928	OPERATION OF HOSPICE	FL	501(C)(3)	LINE 9	THE COMFORTER HEALTH CARE GROUP INC	Yes
(45)HOSPICE OF THE COMFORTER FOUNDATION INC 480 W CENTRAL PARKWAY ALTAMONTE SPRINGS,FL32714 27-1858033	FUND RAISING FOR AFFILIATED TAX-EXEMPT HOSPICE	FL	501(C)(3)	LINE 7	THE COMFORTER HEALTH CARE GROUP INC	Yes
(46)IN-MOTION REHAB INC 485 NORTH KELLER ROAD 250 MAITLAND,FL32751 20-8023411	THERAPY SERVICES TO TAX EXEMPT NURSING HOMES	KS	501(C)(3)	LINE 11B, II	SUNBELT HLTH CARE CENTERS INC	Yes
(47)JELLICO COMMUNITY HOSPITAL INC (11-43015) 188 HOSPITAL LANE JELLICO,TN37762 62-0924706	OPERATION OF HOSPITAL & RELATED SERVICES	TN	501(C)(3)	LINE 3	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	Yes
(48)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
(49)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			No
(50)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	Yes
(51)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	Yes
(52)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	Yes
(53)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	Yes
(54)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	Yes
(55)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	Yes
(56)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	Yes
(57)METROPLEX HOSPITAL INC (11-6815) 900 HOPE WAY ALTAMONTE SPRINGS,FL32714 46-1256516	INACTIVE	FL	501(C)(3)	LINE 3	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	Yes
(58)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
(59)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	Yes
(60)MISSION STRATEGIES OF GEORGIA INC 900 HOPE WAY ALTAMONTE SPRINGS,FL32714 90-0866024	PROVISION OF SUPPORT TO THE NURSING HOME DIVISION	GA	501(C)(3)	LINE 11B, II	SUNBELT HLTH CARE CENTERS INC	Yes
(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	Yes
(62)NORTH REGIONAL EMS INC (11-41615) 188 HOSPITAL LANE JELLICO,TN37762 26-2653616	EMS SERVICES	TN	501(C)(3)	LINE 9	JELLICO COMMUNITY HOSPITAL INC	Yes
(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			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	Yes
(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	Yes
(66)PASCO-PINELLAS HILLSBOROUGH COMMUNITY HLTH SYSTEM INC 2600 BRUCE B DOWNS BLVD WESLEY CHAPEL,FL33544 20-8488713	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	LINE 3	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	Yes
(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	Yes
(68)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	Yes
(69)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	Yes
(70)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	Yes
(71)RESOURCE PERSONNEL INC 485 NORTH KELLER ROAD 250 MAITLAND,FL32751 20-8040875	PROVIDE ADMINISTRATIVE SUPPORT TO TAX EXEMPT NURSING HOMES	FL	501(C)(3)	LINE 11B, II	SUNBELT HLTH CARE CENTERS INC	Yes
(72)ROCKY MOUNTAIN ADVENTIST HLTHCARE FOUNDATION (630 YEAR END) 7995 E PRENTICE AVE 204 GREENWOOD VILLAGE,CO80111 84-0745018	FUND-RAISING FOR TAX-EXEMPT HOSPITAL	CO	501(C)(3)	LINE 7			No
(73)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	Yes
(74)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	Yes
(75)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	Yes
(76)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	Yes
(77)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	Yes
(78)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	Yes
(79)SOUTH CENTRAL INC 900 HOPE WAY ALTAMONTE SPRINGS,FL32714 59-3689740	MANAGEMENT SUPPORT	GA	501(C)(3)	LINE 11C, III-FI	N/A		No
(80)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	Yes
(81)SOUTHEAST VOLUSIA HEALTHCARE CORP (421-123115) 900 HOPE WAY ALTAMONTE SPRINGS,FL32714 47-3793197	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	LINE 3	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	Yes
(82)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	Yes
(83)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	Yes
(84)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	Yes
(85)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	Yes
(86)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	Yes
(87)SUNBELT HLTH CARE CENTERS INC 485 NORTH KELLER ROAD 250 MAITLAND,FL32751 58-1473135	MANAGEMENT SERVICES	TN	501(C)(3)	LINE 11B, II	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	Yes
(88)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	Yes
(89)TAKOMA REGIONAL HOSPITAL INC (630 YEAR END) 401 TAKOMA AVE GREENEVILLE,TN37743 51-0603966	OPERATION OF HOSPITAL & RELATED SERVICES	TN	501(C)(3)	LINE 3	ADVENTIST HLTH SYSTEMSUNBELT INC	Yes
(90)TAKOMA REGIONAL HOSPITAL FOUNDATION INC 401 TAKOMA AVE GREENEVILLE,TN37743 47-1334302	FUND RAISING FOR AFFILIATED TAX-EXEMPT HOSPITAL	TN	501(C)(3)	LINE 7	TAKOMA REGIONAL HOSPITAL INC	Yes
(91)TARPON SPRINGS HOSPITAL FOUNDATION INC 1395 S PINELLAS AVE TARPON SPRINGS,FL34689 59-0898901	OPERATION OF HOSPITAL & RELATED SERVICES	FL	501(C)(3)	LINE 3	UNIVERSITY COMMUNITY HOSPITAL INC	Yes
(92)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	Yes
(93)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	Yes
(94)THE COMFORTER HEALTH CARE GROUP INC 605 MONTGOMERY ROAD ALTAMONTE SPRINGS,FL32714 27-1857940	LEASE TO RELATED ORGANIZATION	FL	501(C)(3)	LINE 11C, III-FI	ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP	Yes
(95)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			No
(96)TRI-COUNTY NURSING AND REHAB CENTER INC 485 NORTH KELLER ROAD 250 MAITLAND,FL32751 47-2219363	OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY	FL	501(C)(3)	LINE 9	SUNBELT HLTH CARE CENTERS INC	Yes
(97)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	Yes
(98)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			No
(99)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
(100)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	Yes
(101)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	Yes
(102)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	Yes
(103)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	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

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	(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) CLEAR CREEK MOB LTD 2201 S CLEAR CREEK RD KILLEEN,TX76549 74-2609195	REAL ESTATE	TX	N/A
(2) ENDOSCOPY CENTER AT PORTER LLC 1001 SOUTH PARK DRIVE LITTLETON,CO80120 20-5855038	MEDICAL SERVICES	CO	N/A
(3) FLORIDA HOSPITAL DMERT LLC 2450 MAITLAND CENTER PKWY STE 200 MAITLAND,FL32751 20-2392253	MEDICAL EQUIPMENT	FL	N/A
(4) FLORIDA HOSPITAL HOME INFUSION LLP 2450 MAITLAND CENTER PKWY STE 200 MAITLAND,FL32751 59-3142824	HOME INFUSION SERVICES	FL	N/A
(5) FUNCTIONAL NEUROSURGICAL AMBULATORY SURGERY CENTER LLC 777 S WILLIAMS ST DENVER,CO80209 46-4426708	SURGERY CENTER	CO	N/A
(6) PAHSLARKIN VENTURES LLC 188 INVERNESS DR WEST 500 ENGLEWOOD,CO80112 47-4211060	MEDICAL SERVICES	CO	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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) ALTAMONTE MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC 601 EAST ROLLINS STREET ORLANDO,FL32803 59-2855792	CONDO ASSOCIATION	FL	N/A	C			Yes
(2) APOPKA MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC 601 EAST ROLLINS STREET ORLANDO,FL32803 59-3000857	CONDO ASSOCIATION	FL	N/A	C			Yes
(3) CC MOB INC 2201 S CLEAR CREEK ROAD KILLEEN,TX76549 74-2616875	REAL ESTATE RENTAL	TX	N/A	C			Yes
(4) CENTRAL TEXAS MEDICAL ASSOCIATES 1301 WONDER WORLD DRIVE SAN MARCOS,TX78666 74-2729873	INACTIVE	TX	N/A	C			Yes
(5) CENTRAL TEXAS PROVIDER'S NETWORK 1301 WONDER WORLD DRIVE SAN MARCOS,TX78666 74-2827652	PHYSICIAN HOSPITAL ORG.	TX	N/A	C			Yes
(6) FLORIDA HOSPITAL FLAGLER MEDICAL OFFICES ASSOCIATION INC 60 MEMORIAL MEDICAL PARKWAY PALM COAST,FL32164 26-2158309	CONDO ASSOCIATION	FL	N/A	C			Yes
(7) FLORIDA HOSP HLTH VILLAGE PROPERTY OWNER'S ASSOC INC EIN APPLIED FOR 550 E ROLLINS STREET 7TH FLOOR ORLANDO,FL32803	CONDO ASSOCIATION	FL	N/A	C			Yes
(8) FLORIDA HOSPITAL HEALTHCARE SYSTEM INC 602 COURTLAND STREET ORLANDO,FL32804 59-3215680	PHSO	FL	N/A	C			Yes
(9) FLORIDA MEDICAL PLAZA CONDO ASSOCIATION INC 601 EAST ROLLINS STREET ORLANDO,FL32803 59-2855791	CONDO ASSOCIATION	FL	N/A	C			Yes
(10) FLORIDA MEMORIAL HEALTH NETWORK INC 770 W GRANADA BLVD STE 317 ORMOND BEACH,FL32174 59-3403558	PHYSICIAN HOSPITAL ORG.	FL	N/A	C			Yes
(11) KISSIMMEE MULTISPECIALTY CLINIC CONDOMINIUM ASSOCIATION INC 201 HILDA STREET SUITE 30 KISSIMMEE,FL34741 59-3539564	CONDO ASSOCIATION	FL	N/A	C			Yes
(12) LAKE COUNTY HEALTH CARE PROPERTIES INC (END 123115) 485 NORTH KELLER ROAD STE 250 MAITLAND,FL32751 47-2179868	REAL ESTATE RENTAL	FL	N/A	C			Yes
(13) MIDWEST MANAGEMENT SERVICES INC 9100 WEST 74TH STREET SHAWNEE MISSION,KS66204 48-0901551	INACTIVE	KS	N/A	C			Yes
(14) NORTH AMERICAN HEALTH SERVICES INC & SUB 900 HOPE WAY ALTAMONTE SPRINGS,FL32714 62-1041820	LESSOR/HOLDING CO.	TN	N/A	C			Yes
(15) ORMOND PROF ASSOCIATES CONDO ASSOC'N INC (430 YR END) 770 W GRANADA BLVD STE 101 ORMOND BEACH,FL32174 59-2694434	CONDO ASSOCIATION	FL	N/A	C			Yes
(16) PARK RIDGE PROPERTY OWNER'S ASSOCIATION INC 1 PARK PLACE NAPLES ROAD FLETCHER,NC28732 03-0380531	CONDO ASSOCIATION	NC	N/A	C			Yes
(17) PORTER AFF HLTH SVCS INC DBA DIVERSIFIED AFF HLTH SVCS 2525 S DOWNING STREET DENVER,CO80210 84-0956175	HEALTHCARE SERVICES	CO	N/A	C			Yes
(18) SAN MARCOS REGIONAL MRI INC 1301 WONDER WORLD DRIVE SAN MARCOS,TX78666 77-0597968	HOLDING COMPANY	TX	N/A	C			Yes
(19) THE GARDEN RETIREMENT COMMUNITY INC 485 NORTH KELLER ROAD STE 250 MAITLAND,FL32751 59-3414055	REAL ESTATE RENTAL	FL	N/A	C			Yes
(20) WINTER PARK MEDICAL OFFICE BUILDING I CONDO ASSOC INC 601 EAST ROLLINS STREET ORLANDO,FL32803 45-2228478	CONDO ASSOCIATION	FL	N/A	C			Yes

Schedule R (Form 990) 2015

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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

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) ADVENTIST MIDWEST HEALTH DBA ADVENTIST HINSDALE HOSPITAL	P	5,075,372	COST
(2) ADVENTIST MIDWEST HEALTH DBA ADVENTIST HINSDALE HOSPITAL	Q	1,114,759	COST
(3) ADVENTIST MIDWEST HEALTH DBA ADVENTIST HINSDALE HOSPITAL	L	726,140	COST
(4) ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION	B	289,626	ACTUAL AMOUNT GIVEN
(5) ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION	M	951,419	% OF FACILITY'S OPERATING EXP.
(6) ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION	P	4,613,008	COST
(7) ADVENTIST MIDWEST HEALTH DBA LA GRANGE MEMORIAL HOSPITAL	Q	317,571	COST
(8) ADVENTIST MIDWEST HEALTH DBA LA GRANGE MEMORIAL HOSPITAL	P	1,088,267	COST
(9) BOLINGBROOK HOSPITAL FOUNDATION	B	158,490	ACTUAL AMOUNT GIVEN
(10) BOLINGBROOK HOSPITAL FOUNDATION	C	107,336	ACTUAL AMOUNT RECEIVED
(11) ADVENTIST GLEN OAKS HOSPITAL	Q	129,665	COST
(12) ADVENTIST HEALTH PARTNERS INC	P	5,953,379	COST
(13) AHS MIDWEST MANAGEMENT INC	P	854,073	COST
(14) ADVENTIST GLEN OAKS HOSPITAL	P	295,311	COST
(15) ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION DBA AHS IS	M	4,298,278	% OF FACILITY'S OPERATING EXP.
(16) ADVENTIST HEALTH SYSTEMSUNBELT INC	M	19,539	% OF FACILITY'S EHR REVENUE
(17) ADVENTIST HEALTH PARTNERS INC	B	2,524,048	ACTUAL AMOUNT GIVEN
(18) ADVENTIST MIDWEST HEALTH DBA ADVENTIST HINSDALE HOSPITAL	B	438,235	ACTUAL AMOUNT GIVEN

Schedule R (Form 990) 2015

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

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) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: OPERATION OF A 138-BED ACUTE-CARE HOSPITAL SERVING RESIDENTS IN & AROUND BOLINGBROOK, IL.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	20
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	14
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	809
6	Total number of volunteers (estimate if necessary) .............	6	175
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

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	410,720	123,865
9	Program service revenue (Part VIII, line 2g) .........	108,517,837	123,006,295
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-9,947	-228,151
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	613,144	50,050
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	109,531,754	122,952,059
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	223,493	269,380
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)	44,904,566	42,386,820
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	68,765,929	76,084,654
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	113,893,988	118,740,854
19	Revenue less expenses. Subtract line 18 from line 12.......	-4,362,234	4,211,205
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	133,561,961	127,821,502
21	Total liabilities (Part X, line 26).............	109,724,391	103,017,576
22	Net assets or fund balances. Subtract line 21 from line 20.....	23,837,570	24,803,926

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 105,150,206 including grants of $ 269,380 ) (Revenue $ 123,056,345 )
	ADVENTIST BOLINGBROOK HOSPITAL (ABH) OPERATES A 138 BED ACUTE CARE HOSPITAL IN BOLINGBROOK, ILLINOIS. IN THE CURRENT YEAR, THERE WERE 5,704 ADMISSIONS, 19,833 PATIENT DAYS AND 102,407 OUTPATIENT VISITS.

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 expenses105,150,206

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	833,233	11,652,591	1,396,149

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	107,336
e	Government grants (contributions)		1e	16,529

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		123,865

		Business Code
2a	NET PATIENT REVENUE	622110	122,164,129	122,164,129
b	MEDICAL OFFICE BUILDING	622110	348,929	348,929
c	HEALTH EDUCATION PROGRAMS	622110	187,025	187,025
d	CAFETERIA REVENUE	622110	177,241	177,241
e	GIFT SHOP REVENUE	622110	54,334	54,334
f	All other program service revenue.			74,637	74,637
g Total.Add lines 2a–2f.....			123,006,295

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			387,490			387,490
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss)......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		61,405,510
b	Less: cost or other basis and sales expenses		62,021,151
c	Gain or (loss)		-615,641
d	Net gain or (loss).....			-615,641			-615,641
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..
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..
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..
Business Code			Miscellaneous Revenue
11a	EHR REVENUE		622110	50,050	50,050
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			50,050
12	Total revenue. See Instructions......			122,952,059	123,056,345	0	-228,151

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	269,380	269,380
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 ....	2,162,753		2,162,753
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	30,189,260	29,521,610	667,650
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	814,762	750,028	64,734
9	Other employee benefits .......	6,902,760	6,603,244	299,516
10	Payroll taxes ...........	2,317,285	2,132,340	184,945
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	60,000		60,000
c	Accounting ...........	29,049		29,049
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	101,598		101,598
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	29,344,795	20,749,631	8,595,164
12	Advertising and promotion ....	193,011		193,011
13	Office expenses .......	2,112,416	1,811,088	301,328
14	Information technology ......	4,505,832	3,931,594	574,238
15	Royalties ..
16	Occupancy ...........	3,202,345	3,107,984	94,361
17	Travel ............	114,435		114,435
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	3,304,654	3,304,654
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	6,761,779	6,761,779
23	Insurance ...	1,696,447	1,675,360	21,087
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	18,035,614	18,035,614
b	STATE TAX INDIGENT ASSE	4,643,506	4,643,506
c	REPAIRS & MAINTENANCE	1,576,663	1,576,663
d	PURCHASED SERVICES	116,191		116,191
e	All other expenses	286,319	275,731	10,588
25	Total functional expenses. Add lines 1 through 24e	118,740,854	105,150,206	13,590,648	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			4,377	1	5,219
2	Savings and temporary cash investments .........			2,415,158	2	-451,770
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			20,403,109	4	21,091,626
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 ........			2,609,472	8	3,033,350
9	Prepaid expenses and deferred charges ......			2,263,934	9	2,610,952
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	172,497,852
b	Less: accumulated depreciation	10b	76,223,068	100,094,872	10c	96,274,784
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			759,698	12	1,075,582
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			5,011,341	15	4,181,759
16	Total assets. Add lines 1 through 15 (must equal line 34)...			133,561,961	16	127,821,502

17	Accounts payable and accrued expenses .....	8,661,600	17	7,470,282
18	Grants payable ...		18
19	Deferred revenue .........	366,940	19	303,252
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	100,695,851	25	95,244,042
26	Total liabilities. Add lines 17 through 25..	109,724,391	26	103,017,576

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	23,450,385	27	24,207,517
28	Temporarily restricted net assets ...........	387,185	28	596,409
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	23,837,570	33	24,803,926
34	Total liabilities and net assets/fund balances ........	133,561,961	34	127,821,502