TY 2018 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)
(1) Thurber Gary F...................................................................... Chairman/Director	2.00 ................. 3.00	X	0	2,395	0
(2) Aguilera Ronald...................................................................... Director	1.00 ................. 3.00	X	0	1,645	0
(3) Brown-Fraser PhD Sherine...................................................................... Director	1.00 ................. 3.00	X	0	1,595	0
(4) Carlson Ronald...................................................................... Director	1.00 ................. 3.00	X	0	1,645	0
(5) Cauley DMin Michael F...................................................................... Director (end 4/18)	1.00 ................. 3.00	X	0	200	0
(6) Craig Carlos...................................................................... Director	1.00 ................. 3.00	X	0	1,545	0
(7) Davidson James R...................................................................... Director	1.00 ................. 3.00	X	82	2,395	0
(8) Griffith Jr Buford...................................................................... Director	1.00 ................. 3.00	X	0	2,295	0
(9) Haffner PhD Randall L...................................................................... Director (end 9/18)	1.00 ................. 50.00	X	0	2,960,838	312,821
(10) Houmann Lars D...................................................................... Director	1.00 ................. 50.00	X	0	3,072,554	322,348
(11) Jernigan Donald L...................................................................... Director (beg 9/18)	1.00 ................. 18.00	X	0	413,513	16,296
(12) Johnson MD Mark...................................................................... Director	1.00 ................. 3.00	X	0	1,645	0
(13) Machado Allan...................................................................... Director (beg 6/18)	1.00 ................. 3.00	X	82	1,345	0
(14) Moore MDiv Larry R...................................................................... Vice Chairman/Director	2.00 ................. 3.00	X	0	2,395	0
(15) Page John...................................................................... Director	1.00 ................. 3.00	X	0	2,395	0
(16) Peoples Troy K...................................................................... Director	1.00 ................. 3.00	X	0	2,395	0
(17) Poenitz Steven N...................................................................... Director (beg 4/18)	1.00 ................. 3.00	X	0	2,395	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) Rathbun Paul........................................................................ Director (beg 9/18)/CFO	1.00 .......................50.00	X	X				0	1,706,765	242,345
(19) Robinson Randy........................................................................ Director	1.00 .......................3.00	X					82	2,395	0
(20) Scott Glynn CW........................................................................ Director	1.00 .......................3.00	X					0	2,295	0
(21) Shaw EdD Kenneth........................................................................ Director	1.00 .......................3.00	X					0	1,645	0
(22) Shaw Terry D........................................................................ Dir/President/CEO	1.00 .......................50.00	X	X				0	4,099,943	395,129
(23) Smith DMin PhD Ron C........................................................................ Vice Chairman/Sec/Dir	2.00 .......................3.00	X					82	2,395	0
(24) Tol Daryl L........................................................................ Dir (end 9/18)/CEO Centr FL Division	50.00 .......................1.00	X					0	1,808,679	264,775
(25) Valentine II MDiv Maurice R........................................................................ Director	1.00 .......................3.00	X					0	2,395	0
(26) Webb Gil........................................................................ Director	1.00 .......................3.00	X					0	2,395	0
(27) Werner Thomas L........................................................................ Director	1.00 .......................3.30	X					0	4,183	0
(28) Bradley Kenneth W........................................................................ SEO/SW Mkt & Adm AH Celebr(end 2/18)	50.00 .......................0.00			X			0	741,165	31,781
(29) Cook Timothy W........................................................................ CEO AH Alt & West Orange (beg 2/18)	50.00 .......................0.00			X			0	691,320	78,717
(30) Dodds Sheryl D........................................................................ Chief People Off Centr FL Div South Re	50.00 .......................0.00			X			0	689,197	29,639
(31) Goodman Todd A........................................................................ CFO Central FL Division	50.00 .......................0.00			X			0	1,792,349	144,021
(32) Harcombe Douglas W........................................................................ CEO AH Celebration & South Mkt	50.00 .......................0.00			X			0	622,646	106,634
(33) Hilliard Douglas W........................................................................ Sr VP/Sr Finance Officer AH Orlando	50.00 .......................0.00			X			0	740,025	125,861
(34) Moorhead MD John David........................................................................ Chief Clinical Off Centr FL Div South R	50.00 .......................0.00			X			0	1,100,178	45,987
(35) Owen Terry R........................................................................ SVP Amb Services Centr FL Div South	50.00 .......................0.00			X			0	746,942	95,876
(36) Reed MD Monica P........................................................................ SEO/Care Innov Cent FL Div(end 3/18)	50.00 .......................0.00			X			0	963,999	134,148
(37) Stevens Eric A........................................................................ CEO Orl/AH Women/Acute Care Srv South	50.00 .......................0.00			X			0	2,092,533	143,308
(38) Thompson Michael J........................................................................ CEO Integrated Hlth Serv Centr FL South	50.00 .......................0.00			X			0	620,461	122,866
(39) Zbaraschuk Amy L........................................................................ Sr VP/Sr Finance Off Central FL Div ision	50.00 .......................0.00			X			0	630,804	107,186
(40) Silvestry MD Scott........................................................................ Physician/Director AH Thoracic Transplant	95.00 .......................0.00				X		2,233,390	0	33,455
(41) Davis Jr MD Robert Duane........................................................................ Physician/Director AH Cardiovascular Institute	70.00 .......................0.00				X		1,543,348	0	14,849
(42) Botta MD Donald........................................................................ Physician/Director AH Heart Transplant	70.00 .......................0.00				X		1,191,694	0	37,085
(43) Shimshak MD Thomas M........................................................................ Physician	50.00 .......................0.00				X		985,514	0	21,256
(44) Shakar MD Simon F........................................................................ Physician AH Transplant Cardiologist	70.00 .......................0.00				X		936,965	0	35,139
(45) Banks David P........................................................................ Former Key Employee	0.00 .......................50.00					X	0	1,385,185	179,844
(46) Hagensicker Janice K........................................................................ Former Key Employee	50.00 .......................0.00					X	0	902,321	54,151
(47) Paradis J Brian........................................................................ Former Key Employee	0.00 .......................0.00					X	0	767,543	36,523
(48) Soler Eddie........................................................................ Former Key Employee	0.00 .......................50.00					X	0	1,502,312	183,336

(A) Name and business address	(B) Description of services	(C) Compensation
Brasfield & Gorrie LLC 941 W Morse Blvd Suite 200 Winter Park,FL32789	Design and Construction Services	62,125,056
Brown Parker & Demarinis Advertising In 1825 NW Corporate Blvd Suite 250 Boca Raton,FL33431	Advertising Services	23,154,948
PWC Holdings No 21 LLC DBA PO Box 932011 Atlanta,GA31193	Consulting Services	16,759,043
Crothall Healthcare Inc 13028 Collection Center Dr Chicago,IL60693	Environmental Services	8,600,923
WG Yates & Sons Construction Company 22 Century Blvd Suite 140 Nashville,TN37214	Design and Construction Services	7,782,675
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 459

- 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.
right arrow

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

Adventist Health SystemSunbelt Inc

Employer identification number

59-1479658

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. 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—2017. 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—2018. 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—2017. 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) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. 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—2017. 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) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2018

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) 2018

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 (explain in Part VI). 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) 2018

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 2018 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-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

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) 2018

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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

Adventist Health SystemSunbelt Inc

Employer identification number

59-1479658

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization Adventist Health SystemSunbelt Inc

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization Adventist Health SystemSunbelt Inc		Employer identification number 59-1479658

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization Adventist Health SystemSunbelt Inc			Employer identification number 59-1479658
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) (2018)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

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 Health SystemSunbelt Inc

Employer identification number

59-1479658

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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) 2018

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) 2015	(b) 2016	(c) 2017	(d) 2018	(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) 2018

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)? ........

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

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

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

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

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

Yes

3,295

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

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

Yes

139,700

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

142,995

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:	The corporation reimbursed traveling expenses and paid dues to the American Hospital Association, Florida Hospital Association, Texas Hospital Association, and Association of Organ Procurement who use a portion of the dues to conduct lobbying activities.

Schedule C (Form 990 or 990EZ) 2018

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Adventist Health SystemSunbelt Inc

Employer identification number

59-1479658

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 7/25/06, 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) 2018

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 ....	19,274,406	19,390,999	19,118,543	18,008,913	17,037,065
b	Contributions ...	100,000	166,685	568,450	530,000
c	Net investment earnings, gains, and losses	1,099,218	1,051,467	277,615	911,157	976,037
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	1,711	9,029	573,609	331,527	344,211
f	Administrative expenses ....
g	End of year balance ......	20,471,913	20,600,122	19,390,999	19,118,543	17,668,891

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

Board designated or quasi-endowment SchDMd Bullet

92.930 %

Permanent endowment SchDMd Bullet

7.070 %

Temporarily restricted endowment SchDMd Bullet

0 %

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)

Yes

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

Yes

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 .....	243,058,653		243,058,653
b	Buildings ....	1,587,838,488	657,041,916	930,796,572
c	Leasehold improvements
d	Equipment ....	2,665,769,714	1,603,655,828	1,062,113,886
e	Other .....	315,809,261	52,342,945	263,466,316
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				2,499,435,427

Schedule D (Form 990) 2018

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) Funds Held in Trust				2,695,383
(2) Due From Related Parties and Affiliates				60,762,190
(3) Long-term Investments				94,372,537
(4) Other Non-Current Assets				47,257,921
(5) Receivable - Interco Alloc of Tax-Exempt Bond Proceeds				1,903,492,518
(6) Receivable from Third Party				47,354,796
(7) Board Designated Funds				100
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				2,155,935,445

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 Party	59,984,093
Due to Related-Affiliated Entities	147,512,976
Other Current Liabilities	10,789,346
Other Non-Current Liabilities	108,236,707
Notes and Loans Payable	58,981
Leases Payable	372,560
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	326,954,663
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) 2018

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 V, Line 4:

All endowment funds are held by related 501(c)(3) exempt foundations. These endowment funds have been established for a variety of purposes in support of related tax-exempt hospitals. All of the foundation's permanently restricted endowment funds are required to be retained permanently either by explicit donor stipulation or by the Florida Uniform Prudent Management of Institutional Funds Act. Part V, line 1a, column (a) Current year - Explanation for change in opening balance: During 2018, it was determined that an Endowment in the amount of $1,325,716 received prior to 2018 should be reclassified from permanent endowment to a temporarily restricted asset. Part V, line 1a, column (c) Three years back - Explanation for change in opening balance: During year 2015, it came to the attention of the Foundation's management that an Endowment in the amount of $340,022 was mistakenly misclassified as of December 31, 2014. As a result, the Foundation restated beginning board-designated endowment funds in its 2015 tax year. Part V, line 1c, column (b) Two years back - During 2016, the Foundation agreed to a modification of a donor's endowment agreement, which resulted in an impairment of $722,928. This amount was netted with the Foundation's 2016 investment return.

Part X, Line 2:

The filing organization is a subsidiary organization within AdventHealth. The consolidated financial statements of AdventHealth contain the following FIN 48 (ASC 740) 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, 2018 and 2017. NAHS also has temporary deductible differences of approximately $53,000 and $55,700 at December 31, 2018 and 2017, respectively, primarily as a result of net operating loss carryforwards. At December 31, 2018, NAHS had net operating loss carryforwards of approximately $54,500, expiring beginning in 2022 through 2026. Deferred taxes have been provided for these amounts, resulting in a net deferred tax asset of approximately $13,400 and $14,100 at December 31, 2018 and 2017, respectively. NAHS remeasured its deferred tax assets and liabilities based on the rates at which they are expected to reverse in the future, which is generally 21%. A full valuation allowance has been provided at December 31, 2018 and 2017 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, 2018 and 2017. On December 22, 2017, the United States enacted tax reform legislation commonly known as the Tax Cuts and Jobs Act (Act), resulting in significant modifications to existing law. Certain provisions will impact tax-exempt organizations, including revisions to taxes on unrelated business activities, excise taxes on compensation of certain employees, and various other provisions. The regulations necessary to implement the law have not yet been promulgated, and the ultimate outcome of these regulations and the impact to the System cannot be determined presently. The System will continue to review and assess the impact of the legislation to the consolidated financial statements, but does not expect that the impact will be significant.

Schedule D (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization
Adventist Health SystemSunbelt Inc

Employer identification number

59-1479658

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in region	(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in region	(f) Total expenditures for and investments in region
	Central America and the Caribbean			Grantmaking		138,601
	Central America and the Caribbean			Meetings		11,349
	Central America and the Caribbean			Program Services	Mission Trips	415,350
	Central America and the Caribbean			Speakers		560
	East Asia and the Pacific			Meetings		57,886
	East Asia and the Pacific			Program Services	Mission Trips	127,860
	Europe (including Iceland and Greenland)			Meetings		80,025
	Middle East and North Africa			Program Services	Mission Trips	6,167
	Middle East and North Africa			Speakers		5,737
	North America (which includes Canada and Mexico, but not the U.S.)			Meetings		983
	North America (which includes Canada and Mexico, but not the U.S.)			Program Services	Mission Trips	102,380
	North America (which includes Canada and Mexico, but not the U.S.)			Speakers		1,722
	South America			Grantmaking		32,305
	South America			Program Services	Medical/Dental Clinics, Mission Trips	337,806
	South America			Speakers		295
	South Asia			Meetings		4,236
	Sub-Saharan Africa			Grantmaking		173,260
	Sub-Saharan Africa			Program Services	Mission Trips	230,929
3a	Sub-total .....	0	0			837,798
b	Total from continuation sheets to Part I ...					889,653
c	Totals (add lines 3a and 3b)	0	0			1,727,451

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2018

Schedule F (Form 990) 2018

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(g) Amount of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)
Central America and the Caribbean	Medical Supplies or Equipment	0	37,838	Medical Equipment	Other
Central America and the Caribbean	Medical Supplies or Equipment	0	40,330	Medical Equipment	Other
South America	Medical Supplies or Equipment	0	11,265	Medical Equipment	Other
Central America and the Caribbean	Medical Supplies or Equipment	0	6,913	Medical Equipment	Other
Central America and the Caribbean	Medical Supplies or Equipment	0	27,342	Medical Equipment	Other
Central America and the Caribbean	Medical Supplies or Equipment	0	5,084	Medical Equipment	Other
Central America and the Caribbean	Medical Supplies or Equipment	0	6,564	Medical Equipment	Other
South America	Medical Supplies or Equipment	0	21,040	Medical Equipment	Other
Central America and the Caribbean	General Support	0	10,980	Other	Other
Sub-Saharan Africa	General Support	173,160	0

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2018

Schedule F (Form 990) 2018Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of non-cash assistance	(g) Description of non-cash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2018

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2018

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

ReturnReference	Explanation
Part I, Line 2:	Foreign grants are generally non-cash donations of medical equipment and supplies to assist foreign health care providers in fulfilling their mission of providing health care services to the populations they serve. The foreign health care providers are often hospitals and/or clinics operated and/or sponsored by or affiliated with the Seventh-Day Adventist Church. The foreign hospitals/clinics may be located in remote and/or underserved villages and townships of developing countries. Grants are typically made to other U.S. charitable organizations or foreign entities recognized as charitable by the foreign country in which they are located. As a result of the nature of the grants as non-cash medical equipment and supplies and the fact that most grants are made indirectly through other U.S. or foreign charitable organizations, the filing organization has not established specific procedures for monitoring the use of grant funds outside the United States.

Schedule F (Form 990) 2018

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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Adventist Health SystemSunbelt Inc

Employer identification number

59-1479658

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

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) . . .	213,150,203		213,150,203	5.500 %
b	Medicaid (from Worksheet 3, column a) . . . . .	585,872,241	369,540,088	216,332,153	5.580 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	799,022,444	369,540,088	429,482,356	11.080 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	28,232,707	98,060	28,134,647	0.730 %
f	Health professions education (from Worksheet 5) . . .	45,378,187	9,573,937	35,804,250	0.920 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	2,755,737	2,066,304	689,433	0.020 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	16,314,180		16,314,180	0.420 %
j	Total. Other Benefits . .	92,680,811	11,738,301	80,942,510	2.090 %
k	Total. Add lines 7d and 7j .	891,703,255	381,278,389	510,424,866	13.170 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

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.

		(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	29,850,799	9,593,505	20,257,294	0.520 %
8	Workforce development	499,239	2,155	497,084	0.010 %
9	Other	126,550		126,550	0 %
10	Total	30,476,588	9,595,660	20,880,928	0.530 %

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. ......

186,790,830

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. ......

6,377,642

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).....

735,142,171

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

832,241,053

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

-97,098,882

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 %
11 San Marcos MRI LP	Imaging Center	60.000 %	0 %	40.000 %
22 Central Texas Ambulatory Endoscopy	Endoscopy Center	18.800 %	0 %	81.200 %
33 Surgery Management Associates of Kissimmee LLC	Management/Admin	30.000 %	0 %	70.000 %
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2018

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?11Name, 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)									Other (describe)	Facility reporting group
1	AdventHealth Orlando 601 E Rollins Street Orlando,FL32803 www.adventhealth.com/hospital/adventh 4369	X	X	X	X		X	X	Therapy Center, EPS Cath Lab	A
2	AdventHealth Altamonte Springs 601 E Altamonte Drive Altamonte Springs,FL32701 www.adventhealth.com/hospital/adventh 4369	X	X		X			X	Cancer Center, Therapy	A
3	AdventHealth Celebration 400 Celebration Place Celebration,FL34747 www.adventhealth.com/hospital/adventh 4369	X	X		X			X	Therapy Center	A
4	AdventHealth East Orlando 7727 Lake Underhill Road Orlando,FL32822 www.adventhealth.com/hospital/adventh 4369	X	X		X			X		A
5	AdventHealth Winter Park 200 N Lakemont Avenue Winter Park,FL32792 www.adventhealth.com/hospital/adventh 4369	X	X		X			X		A
6	AdventHealth Kissimmee 2450 North Orange Blossom Trail Kissimmee,FL34744 www.adventhealth.com/hospital/adventh 4369	X	X		X			X		A
7	AdventHealth Sebring 4200 Sun N Lake Blvd Sebring,FL33825 www.adventhealth.com/hospital/adventh 4171	X	X					X		B
8	AdventHealth Apopka 2100 Ocoee-Apopka Road Apopka,FL32703 www.adventhealth.com/hospital/adventh 4369	X	X		X			X		A
9	Central Texas Medical Center 1301 Wonder World Drive San Marcos,TX78666 www.ctmc.org 000556	X	X					X		A
10	AdventHealth Wauchula 735 S 5th Avenue Wauchula,FL33873 www.adventhealth.com/hospital/adventh 4239	X	X			X		X	Skilled Nursing	A
11	AdventHealth Lake Placid 1210 US Highway 27 North Lake Placid,FL33852 www.adventhealth.com/hospital/adventh 4171	X	X					X	Senior Behavioral Unit, Outpatient Physical Therapy	B

Schedule H (Form 990) 2018

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)

	Facility Reporting Group - A
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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

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

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 Part V, Page 8

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 17

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

Yes

If "Yes" (list url): See Part V, Page 8

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) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Facility Reporting Group - A
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)

Was widely publicized 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 Part V, Page 8

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

See Part V, Page 8

A plain language summary of the FAP was widely available on a website (list url):
See Part V, Page 8

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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	Facility Reporting Group - A
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

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)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

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

	Facility Reporting Group - A
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2018

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)

	Facility Reporting Group - B
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?........................

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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

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 Part V, Page 8

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 17

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

Yes

If "Yes" (list url): See Part V, Page 8

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

10b

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) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Facility Reporting Group - B
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

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)

Was widely publicized 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 Part V, Page 8

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

See Part V, Page 8

A plain language summary of the FAP was widely available on a website (list url):
See Part V, Page 8

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)

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	Facility Reporting Group - B
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

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

	Facility Reporting Group - B
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a prospective Medicare or Medicaid method

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) 2018

Page 8

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, 16j, 18e, 19e, 20e, 21c, 21d, 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
Part V, Section B	Facility Reporting Group A
Facility Reporting Group A consists of:	- Facility 1: AdventHealth Orlando, - Facility 2: AdventHealth Altamonte Springs, - Facility 3: AdventHealth Celebration, - Facility 4: AdventHealth East Orlando, - Facility 5: AdventHealth Winter Park, - Facility 6: AdventHealth Kissimmee, - Facility 9: Central Texas Medical Center, - Facility 8: AdventHealth Apopka, - Facility 10: AdventHealth Wauchula
Group A-Facility 1 -- AdventHealth Orlando Part V, Section B, line 5:	AdventHealth Orlando (AHO or the Hospital) is the flagship hospital of the seven hospital campuses that operate under a single hospital license. All seven campuses, collectively, are known as AdventHealth's Central Florida Division South Region. The Central Florida Division South Region's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. AHO is located in Orange County. AHO has become one of the most trusted and comprehensive hospitals in the region; as a result, the primary service area of the Orlando campus includes all of Orange, Osceola and Seminole Counties. AdventHealth Orlando conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Hospital campuses in the South Region. The 2016 CHNA conducted for AHO was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.AHO had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within AHO's community/service area. The following organizations participated in AHO's CHNAC and specifically represented low-income, minority and other medically underserved populations:Second Harvest Food Bank - a non-profit organization that operates a food bank throughout the six counties that make up most of Central Florida and provides a workforce development program for populations at risk for food insecurity;Aspire Health Partners - a non-profit health provider that works to provide behavioral health care services to individuals experiencing mental illness and issues of substance abuse within Orange and Seminole counties;Grace Medical Home - a patient-centered medical home that focuses on serving the clinically underserved through the provision of continuous and comprehensive primary care;Orange County Public Health Department, andSeminole County Health Department.To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Survey data was scanned for themes based only on the responses of those from the zip codes included in AHO's primary service area. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants.
Group A-Facility 1 -- AdventHealth Orlando 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 Reports must be posted on the Hospital's website at least until the date the hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports.
Group A-Facility 1 -- AdventHealth Orlando Part V, Section B, line 11:	The information provided below explains how AdventHealth Orlando (AHO or the Hospital) addressed in 2018 the significant health needs identified in its 2016 Community Health Needs Assessment, and any such needs that were not addressed and the reasons why such needs were not addressed. AHO conducted a Community Health Needs Assessment in 2016 and adopted an implementation strategy to address the significant health needs identified in the 2016 Community Health Needs Assessment in 2017 prior to May 15, 2017. Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth Orlando will be referred to in this document as AdventHealth Orlando (AHO) or "The Hospital". In January of 2019, every wholly-owned entity across the organization adopted the AdventHealth system brand. The identity has been unified to represent the full continuum of care the system has to offer. Throughout this report, the Hospital will be referred to as AdventHealth Orlando or AHO. Any reference to the 2016 Community Health Needs Assessment (CHNA) or 2017 Community Health Plan (CHP) will utilize the new name for consistency.AHO is part of the Central Florida Division South Region of the healthcare system known as AdventHealth. The South Region of AdventHealth's Central Florida Division includes seven hospital facilities. The South Region has several region wide initiatives that are implemented at every campus in its service areas. This work is captured by the indicator "The Region(al)" to highlight this is a regional initiative or service available at all campuses. There are also initiatives specific to the Orlando campus that are outlined below. This work is captured by the indicator "The Hospital" to highlight this work is specific to this campus and not available region wide. This is the second-year update for AHO's 2017-2019 Community Health Plan (Implementation Strategy). AHO developed this Plan and posted it by May 15, 2017 as part of its 2016 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AHO worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2016 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2017-2019 Community Health Plan. The second-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2016 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing.AHO chose two areas of focus for its 2017-2019 Community Health Plan: 1. Access to Care - Preventative; and2. Access to Care - Primary and Behavioral/Mental Health. Priority 1: Access to Care - Preventative 2016 Description of the Issue:AHO recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. The Hospital strives to increase access to care and create opportunities for community members to lead healthier lives, in part by addressing issues involving preventative care impacted by food insecurity, obesity and maternal and child health.2018 Update: The AHO Community Health Plan has six desired outcome statements under the Access to Care - Preventative priority. 1. Improve access to healthy and nutritious foods;2. Improve access to knowledge around healthy nutrition and wellness;3. Educate and empower the faith community to promote health within congregations in critical areas;4. Support and create opportunities for increased quality of life for residents of Orange County;5. Increase access to knowledge of chronic disease self-management practices; and6. Support opportunities that promote knowledge of chronic diseases within the primary service area.Outcome 1: Improve access to healthy and nutritious foodsThe first Regional strategy focuses on supporting food distribution programs within the targeted zip codes. The Region established a partnership in 2017 to help fund a local church program in order to increase its impact. The church had established a fresh food co-op which supplies food pantries throughout the Orange, Osceola, and Seminole tri-county area with healthier options. In 2018, the church partnered with one of the food pantries in the Hospital's targeted zip codes and has established a regular drop-off to provide fresh, nutritious food to the pantry and the people it serves. 3,000 individuals were served throughout 2018 through this initiative. The second Regional strategy began as a pilot at AHO. The AHO campus partnered with Second Harvest Food Bank, a local non-profit food bank, in 2017 to begin providing unused food from the AdventHealth Hospital campuses to Second Harvest so this food can be distributed throughout high need areas in the community. The number of meals provided from the Orlando campus was 22,000 in 2018. This Regional strategy will continue with additional facilities being added in the Central Florida Division South Region in 2019. Outcome 2: Improve access to knowledge around healthy nutrition and wellnessThere are two Regional strategies for this outcome. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy. Two schools in AHO's target zip codes received this program in 2018 meeting the goal. The second Regional strategy was to provide Nutrition Wellness classes to community members which would help with increasing access to knowledge around nutrition. This program was updated during 2018 and will be deployed in 2019.Outcome 3: Educate and empower the faith community to promote health within congregations in critical areasThe Regional strategy for this outcome is to create a network of faith partners that can promote health through congregational settings. This strategy is funded at a Regional level. The pilot was implemented at AHO. The AHO campus began developing and sharing best practices to be implemented across the South Region. AdventHealth Altamonte began establishing relationships with numerous faith partners in the Altamonte community and identified two potential churches to partner with in 2018. Three partnerships were finalized in 2018, with events and programming taking place at each location, meeting the goal for 2018.Outcome 4: Support and create opportunities for increased quality of life for residents of Orange CountyThe Regional strategy involved offering programming from Healthy Central Florida (HCF) to the service areas that AHO reaches. The goal of HCF is to make Central Florida communities the healthiest in the nation. This initiative began with three target communities Winter Park, Maitland and Eatonville. In 2018, HCF experienced staff and internal strategy changes. The program has been temporarily taken offline while it is retooled to have a greater focus on underserved populations. Although the program has been offered to individuals in the targeted areas before, the goal is to ensure that future efforts are more inclusive of the underserved populations. Outcome 5: Increase access to knowledge of chronic disease self-management practicesself-management practices The Regional strategy for this outcome is to fund and implement the evidence-based Stanford Chronic Disease Self-Management Program in its targeted zip codes throughout the Region. The original intention to create an internal pipeline for the program from Hospital patients was not successful. Although the program was offered through the Hospital, there were very few individuals who chose to enroll. The strategy was rethought and is now being offered through local community centers and churches. This seems to have increased participation, as 30 individuals were enrolled with a graduation rate of 93 percent. Although shy of the target, the Hospital is confident that shifting to community locations will continue to increase enrollment and participation. **see continuation of footnote
Group A-Facility 3 -- AdventHealth Celebration Part V, Section B, line 5:	AdventHealth Celebration (AHC or the Hospital) is one of seven campuses that operate under a single hospital license. All seven campuses, collectively, are known as AdventHealth's Central Florida Division South Region. The Central Floria Division South Region's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. AHC is located in Osceola County and it primarily serves residents from Osceola County, parts of Orange, Polk, and Lake Counties. AdventHealth Celebration conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Hospital campuses in the South Region. The 2016 CHNA conducted for AHC was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.AHC had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within AHC's community/service area. The following organizations participated in AHC's CHNAC and specifically represented low-income, minority and other medically underserved populations:Osceola Council of Aging - a non-profit organization with a focus on providing care and essential social services to seniors and families; Healthy Start of Osceola County - an organization that assists families with access to prenatal care and services for infants that promote healthy growth and development, focusing on the socioeconomically disadvantaged and populations that experience health disparities in birth outcomes; Community Vision of Osceola County - a community planning non-profit that works to convene regional stakeholders to create a shared vision for a healthy and prosperous Osceola County; Community Hope Center - a social service non-profit that works to connect socioeconomically disadvantaged families to essential services with the goal of helping them to become self-sustaining; andThe Osceola County Health Department.To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Survey data was scanned for themes based only on the responses of those from the zip codes included in AHC's primary service area. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants.
Group A-Facility 3 -- AdventHealth Celebration 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 Reports must be posted on the Hospital's website at least until the date the hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports.
Group A-Facility 3 -- AdventHealth Celebration Part V, Section B, line 11:	The information provided below explains how AdventHealth Celebration (AHC or the Hospital) addressed in 2018 the significant health needs identified in its 2016 Community Health Needs Assessment, and any such needs that were not addressed and the reasons why such needs were not addressed. AHC conducted a Community Health Needs Assessment in 2016 and adopted an implementation strategy to address the significant health needs identified in the 2016 Community Health Needs Assessment in 2017 prior to May 15, 2017. Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth Celebration will be referred to in this document as AdventHealth Celebration (AHC) or "The Hospital". In January of 2019, every wholly-owned entity across the organization adopted the AdventHealth system brand. The identity has been unified to represent the full continuum of care the system has to offer. Throughout this report, the Hospital will be referred to as AdventHealth Celebration or AHC. Any reference to the 2016 Community Health Needs Assessment (CHNA) or 2017 Community Health Plan (CHP) will utilize the new name for consistency.AHC is part of the Central Florida Division South Region of the healthcare system known as AdventHealth. The South Region of AdventHealth's Central Florida Division includes seven hospital facilities. The South Region has several Region wide initiatives that are implemented at every campus in its service areas. This work is captured by the indicator "The Region(al)" to highlight this is a Regional strategy or service available at all campuses. There are also strategies specific to the AHC campus that are outlined below. This work is captured by the indicator "The Hospital" to highlight these outcomes and initiatives which are serving the community in AHC's service area. This is the second-year update for AHC's 2017-2019 Community Health Plan (Implementation Strategy). AHC developed this Plan and posted it by May 15, 2017 as part of its 2016 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AHC worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2016 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2017-2019 Community Health Plan. The second-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2016 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing.AHC chose two areas of focus for their 2017-2019 Community Health Plan: 1. Access to Care - Preventative; and2. Access to Care - Primary and Behavioral/Mental Health. Priority 1: Access to Care - Preventative 2016 Description of the Issue:AHC recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. The Hospital strives to increase access to care and create opportunities for community members to lead healthier lives, in part by addressing issues involving preventative care impacted by food insecurity, obesity and maternal and child health.2018 Update:The AHC Community Health Plan has five desired outcome statements under the Access to Care - Preventative priority.1. Improve access to healthy and nutritious foods;2. Improve access to knowledge around healthy nutrition and wellness;3. Educate and empower the faith community to promote health within congregations in critical areas;4. Increase access to knowledge of chronic disease self-management practices; and5. Support opportunities that promote knowledge of chronic diseases within the primary service area.Outcome 1: Improve access to healthy and nutritious foodsThe first Regional strategy focuses on supporting food distribution programs within the targeted zip codes. The Region established a partnership in 2017 to help fund a local church program in order to increase its impact. The church had established a fresh food co-op which supplies food pantries throughout the Orange, Osceola, and Seminole tri-county area with healthier options. In 2018, the church partnered with one of the food pantries in the Hospital's targeted zip codes and has established a regular drop-off to provide fresh, nutritious food to the pantry and the people it serves.The second Regional strategy began as a pilot at another AdventHealth hospital in the Central Florida Division South Region, AdventHealth Orlando. The AdventHealth Orlando campus partnered with Second Harvest Food Bank, a local non-profit food bank, in 2017 to begin providing unused food from the AdventhHealth Hospital campuses to Second Harvest so this food can be distributed throughout high need areas in the community. For the facility-level contribution, the program expanded to AHC in mid-2018 and provided 347 meals. This Regional strategy will continue with AHC estimating a larger number served in future years. Outcome 2: Improve access to knowledge around healthy nutrition and wellnessThere are two Regional strategies for this outcome. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy. Two schools in AHC's target zip codes received this program in 2018, meeting the goal. The Mission: FIT Educators experienced reduced bandwidth to accommodate schools during 2018. The goal for 2019 will be adjusted to reflect the updated capacity to provide education across the Region.The second Regional strategy was to provide Nutrition Wellness classes to community members which would help with increasing access to knowledge around nutrition. This program was updated during 2018 and will be deployed in 2019.Outcome 3: Educate and empower the faith community to promote health within congregations in critical areasThe Regional strategy for this outcome is to create a network of faith partners that can promote health through congregational settings. This strategy is funded at a Regional level. The pilot was implemented at another AdventHealth hospital in the Central Florida Division South Region, AdventHealth Orlando. The AdventHealth Orlando campus began developing and sharing best practices to be shared across the South Region. AHC began establishing relationships with numerous faith partners in the Celebration community and identified two potential churches to partner with in 2018. Once a partnership agreement is finalized, AHC will measure the number of congregations in the faith network as well as the number of health promotion activities for the AHC target zip codes.Outcome 4: Increase access to knowledge of chronic disease self-management practicesThe Regional strategy for this outcome is to fund and implement the evidence-based Stanford Chronic Disease Self-Management Program in its targeted zip codes throughout the Region. As AHC planned to implement programming in Osceola County, it was determined that work was already being done in this space. To best allocate resources and not duplicate efforts, AHC has been working with a local non-profit to create a pipeline from its patient population to their existing programs. Coordination efforts exceeded the original timeline, but AHC believes that the partnership will be fully formed soon. Participation data will begin being tracked once the partnership is complete.**see continuation of footnote
Group A-Facility 2 -- AdventHealth Altamonte Springs Part V, Section B, line 5:	AdventHealth Altamonte (AHAlt or the Hospital) is one of seven campuses that operate under a single hospital license. All seven campuses, collectively, are known as AdventHealth's Central Florida Division South Region. The Central Florida Division South Region's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. AHAlt is located in Seminole County and its primary service area encompasses almost all of Seminole County. AdventHealth Altamonte conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Hospital campuses in the South Region. The 2016 CHNA conducted for AHAlt was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.AHAlt had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within AHAlt's community/service area. The following organizations participated in AHAlt's CHNAC and specifically represented low-income, minority and other medically underserved populations:Kids House - a local child abuse prevention and treatment organization that works with regional social service agencies, the criminal justice system, and local health systems to better the lives of Central Florida's children;Healthy Start of Seminole County - an organization that assists families with access to prenatal care and services for infants that promote healthy growth and development, focusing on the socioeconomically disadvantaged and populations that experience health disparities in birth outcomes; Seminole Prevention Coalition - a coalition of public and private stakeholders that collectively work to promote a safe and drug-free Seminole County through evidence-based prevention initiatives that focus on issues of substance abuse and mental health;True Health - a multi-county Federally Qualified Health Center that provides access to care for low-income, uninsured, underinsured and underserved populations in Seminole and Orange Counties regardless of ability to pay; and The Department of Health in Seminole County. To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants.
Group A-Facility 2 -- AdventHealth Altamonte Springs 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 Reports must be posted on the Hospital's website at least until the date the hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports.
Group A-Facility 2 -- AdventHealth Altamonte Springs Part V, Section B, line 11:	The information provided below explains how AdventHealth Altamonte (AHAlt or the Hospital) addressed in 2018 the significant health needs identified in its 2016 Community Health Needs Assessment, and any such needs that were not addressed and the reasons why such needs were not addressed. AHAlt conducted a Community Health Needs Assessment in 2016 and adopted an implementation strategy to address the significant health needs identified in the 2016 Community Health Needs Assessment in 2017 prior to May 15, 2017. Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth Altamonte will be referred to in this document as AdventHealth Altamonte (AHAlt) or "The Hospital". In January of 2019, every wholly-owned entity across the organization adopted the AdventHealth system brand. The identity has been unified to represent the full continuum of care the system has to offer. Throughout this report, the Hospital will be referred to as AdventHealth Altamonte or AHAlt. Any reference to the 2016 Community Health Needs Assessment (CHNA) or 2017 Community Health Plan (CHP) will utilize the new name for consistency.AHAlt is part of the Central Florida Division South Region of the healthcare system known as AdventHealth. The South Region of AdventHealth's Central Florida Division includes seven hospital facilities. The South Region has several Region wide initiatives that are implemented at every campus in its service areas, this work is captured by the indicator "The Region(al)" to highlight this is a Regional strategy or service available at all campuses. There are also strategies specific to the AHAlt campus that are outlined below. This work is captured by the indicator "The Hospital" to highlight the outcomes and initiatives which are serving the community in AHAlt's service area.This is the second-year update for AHAlt's 2017-2019 Community Health Plan (Implementation Strategy). AHAlt developed this Plan and posted it by May 15, 2017 as part of its 2016 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AHAlt worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2016 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2017-2019 Community Health Plan. The second-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2016 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing.AHAlt chose two areas of focus for their 2017-2019 Community Health Plan: 1. Access to Care - Preventative; and2. Access to Care- Primary and Mental Health. Priority 1: Access to Care - Preventative 2016 Description of the Issue: AHAlt recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. The Hospital strives to increase access to care and create opportunities for community members to lead healthier lives, in part by addressing issues involving preventative care impacted by food insecurity, obesity, and maternal and child health.2018 Update: The AHAlt Community Health Plan has six desired outcome statements under the Access to Care - Preventative priority. 1. Improve access to healthy and nutritious foods;2. Improve access to knowledge around healthy nutrition and wellness;3. Educate and empower the faith community to promote health within congregations in critical areas;4. Support and create opportunities for increased quality of life for residents of Seminole County;5. Increase access to knowledge of chronic disease self-management practices; and6. Support opportunities that promote knowledge of chronic diseases within the primary service area.Outcome 1: Improve access to healthy and nutritious foodsThe first Regional strategy focuses on supporting food distribution programs within the targeted zip codes. The Region established a partnership in 2017 to help fund a local church program in order to increase its impact. The church had established a fresh food co-op which supplies food pantries throughout the Orange, Osceola, and Seminole tri-county area with healthier options. In 2018, the church partnered with one of the food pantries in the Hospital's targeted zip codes and has established a regular drop-off to provide fresh, nutritious food to the pantry and the people it serves. The second Regional strategy began as a pilot at another AdventHealth hospital in the Central Florida Division South Region, AdventHealth Orlando. The AdventHealth Orlando campus partnered with Second Harvest Food Bank, a local non-profit food bank, in 2017 to begin providing unused food from the AdventHealth Hospital campuses to Second Harvest so this food can be distributed throughout high need areas in the community. For the facility-level contribution, AHAlt provided 2,448 meals from its inception through 2018, which exceeded the goal for the facility.Outcome 2: Improve access to knowledge around healthy nutrition and wellnessThere are two Regional strategies for this outcome. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy. One school in AHAlt's target zip codes received this program in 2018 which did not reach the goal of two schools. The Mission: FIT Educators experienced reduced bandwidth to accommodate schools during 2018. The goal for 2019 will be adjusted to reflect the updated capacity to provide education across the Region.The second Regional strategy was to provide Nutrition Wellness classes to community members which would help with increasing access to knowledge around nutrition. This program was updated during 2018 and will be deployed in 2019.Outcome 3: Educate and empower the faith community to promote health within congregations in critical areasThe Regional strategy for this outcome is to create a network of faith partners that can promote health through congregational settings. This strategy is funded at a Regional level. The pilot was implemented at another AdventHealth hospital in the Central Florida Division South Region, AdventHealth Orlando. The AdventHealth Orlando campus began developing and sharing best practices to be shared across the South Region. AHAlt began establishing relationships with numerous faith partners in the Altamonte community and identified two potential churches to partner with in 2018. Once a partnership agreement is finalized, AHAlt will measure the number of congregations in the faith network as well as the number of health promotion activities for the AHAlt community.Outcome 4: Support and create opportunities for increased quality of life for residents of Seminole CountyThe Regional strategy involved utilizing and expanding programming from Healthy Central Florida (HCF) throughout all the service areas that AHAlt reaches. HCF is a community-based partnership established to transform the Eatonville community into the healthiest in the nation. Its aim is to get people moving more, eating healthier, feeling better, and enjoying a more vibrant, energized life. HCF was taken offline during 2018 due to an internal strategy shift. It was decided that the time offline would enable partners to come together and identify ways to retool efforts to ensure a greater focus is placed on the underserved population. The program has historically served individuals in the target area, and the goal is for services to continue and be more inclusive of the underserved target population.**see continuation of footnote
Group A-Facility 4 -- AdventHealth East Orlando Part V, Section B, line 5:	AdventHealth East Orlando (AHEO or the Hospital) is one of seven campuses that operate under a single hospital license. All seven campuses, collectively, are known as AdventHealth's Central Florida Division South Region. The Central Florida Division South Region's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. AHEO is located in Orange County and primarily serves the residents of eastern Orange County. AdventHealth East Orlando conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Hospital campuses in the South Region. The 2016 CHNA conducted for AHEO was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.AHEO had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within AHEO's community/service area. The following organizations participated in AHEO's CHNAC and specifically represented low-income, minority and other medically underserved populations:True Health - a multi-county Federally Qualified Health Center that provides access to care for low-income, uninsured, underinsured and underserved populations in Seminole and Orange Counties regardless of ability to pay;Catholic Charities of Central Florida - this non-profit organization works to connect vulnerable populations to comprehensive social services;AHEO Community Advisory Council - an advisory council that brings together community leaders to acquire valuable input on the region;Latino Leadership - a grassroots organization dedicated to unique needs of the Hispanic community within the greater Central Florida area; andOrange County Public Health Department. To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Survey data was scanned for themes based only on the responses of those from the zip codes included in AHEO's primary service area. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants.
Group A-Facility 4 -- AdventHealth East Orlando 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 Reports must be posted on the Hospital's website at least until the date the hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports.
Group A-Facility 4 -- AdventHealth East Orlando Part V, Section B, line 11:	The information provided below explains how AdventHealth East Orlando (AHEO or the Hospital) addressed in 2018 the significant health needs identified in its 2016 Community Health Needs Assessment, and any such needs that were not addressed and the reasons why such needs were not addressed. AHEO conducted a Community Health Needs Assessment in 2016 and adopted an implementation strategy to address the significant health needs identified in the 2016 Community Health Needs Assessment in 2017 prior to May 15, 2017. Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth East Orlando will be referred to in this document as AdventHealth East Orlando (AHEO) or "The Hospital". In January of 2019, every wholly-owned entity across the organization adopted the AdventHealth system brand. The identity has been unified to represent the full continuum of care the system has to offer. Throughout this report, the Hospital will be referred to as AdventHealth East Orlando or AHEO. Any reference to the 2016 Community Health Needs Assessment (CHNA) or 2017 Community Health Plan (CHP) will utilize the new name for consistency.AHEO is part of the Central Florida Division South Region of the healthcare system known as AdventHealth. The South Region of AdventHealth's Central Florida Division includes seven hospital facilities. The South Region has several Region wide initiatives that are implemented at every campus in its service areas. This work is captured by the indicator "The Region(al)" to highlight this is a Regional strategy or service available at all campuses. There are also initiatives specific to the East Orlando campus that are outlined below. This work is captured by the indicator "The Hospital" to highlight the outcomes and initiatives which are serving the community in AHEO's service area.This is the second-year update for AHEO's 2017-2019 Community Health Plan (Implementation Strategy). AHEO developed this Plan and posted it by May,15 2017 as part of its 2016 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AHEO worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2016 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2017-2019 Community Health Plan. The second-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2016 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing.AHEO chose two areas of focus for their 2017-2019 Community Health Plan: 1. Access to Care - Preventative; and2. Access to Care - Primary and Behavioral/Mental Health. Priority 1: Access to Care - Preventative 2016 Description of the Issue: AHEO recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. The Hospital strives to increase access to care and create opportunities for community members to lead healthier lives, in part by addressing issues involving preventative care impacted by food insecurity, obesity and maternal and child health.2018 Update: The AHEO Community Health Plan has six desired outcome statements under the Access to Care - Preventative priority. 1. Improve access to healthy and nutritious foods;2. Improve access to knowledge around healthy nutrition and wellness;3. Educate and empower the faith community to promote health within congregations in critical areas;4. Support and create opportunities for increased quality of life for residents of Orange County; 5. Increase access to knowledge of chronic disease self-management practices; and 6. Support opportunities that promote knowledge of chronic diseases within the primary service area.Outcome 1: Improve access to healthy and nutritious foodsThe first Regional strategy focuses on supporting food distribution programs within the targeted zip codes. The Region established a partnership in 2017 to help fund a local church program in order to increase its impact. The church had established a fresh food co-op which supplies food pantries throughout the Orange, Osceola, and Seminole tri-county area with healthier options. In 2018, the church partnered with one of the food pantries in the Hospital's targeted zip codes and has established a regular drop-off to provide fresh, nutritious food to the pantry and the people it serves. There were several lessons learned in 2018, which have informed continued development of the program to expand and reach more targeted areas. In 2018, 2,356 meals were served to members of the tri-county area.Another program supported by the Region consisted of partnering with the Second Harvest Food Bank, a local non-profit food bank, to provide healthy food boxes to patients experiencing food insecurity who also have an elevated A1C. This program is funded at a Regional level and is offered at three campuses which are located in areas with a high number of food deserts as well as a demonstrated high utilization rate related to diabetes. The healthy food boxes will be provided twice a month to qualifying patients in the target areas. AHEO was selected as one of the campuses which worked on establishing the framework necessary to implement this program during 2018. Implementation is expected during the 2019 year and will include tracking the number of persons served as well as meal boxes provided through this new program.The second Regional strategy consisted of supporting a Second Harvest Food Bank program called Second Helpings. Through the Second Helpings program AHEO provided unused food from the Nutritional Services Department to Second Harvest, which was then distributed throughout high need areas in the community. This program was originally piloted at another hospital in the Central Florida Division South Region, AdventHealth Orlando. AHEO joined this initiative in 2018, providing 2,256 meals through the Second Helpings Program.Outcome 2: Improve access to knowledge around healthy nutrition and wellnessThere are two Regional strategies for this outcome. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy. Two schools in AHEO's target zip codes received this program in 2018, meeting the goal. The second Regional strategy was to provide Nutrition Wellness classes to community members which would help with increasing access to knowledge around nutrition. This program was updated during 2018 and will be deployed in 2019.Outcome 3: Educate and empower the faith community to promote health within congregations in critical areas The Regional strategy for this outcome is to create a network of faith partners that can promote health through congregational settings. This strategy is funded at a Regional level. The pilot was implemented at another AdventHealth hospital in the Central Florida Division South Region, AdventHealth Orlando. The AdventHealth Orlando campus began developing and sharing best practices to be shared across the South Region. AHEO began establishing relationships with numerous faith partners in the East Orlando community and will continue working to identify and establish church partners in the community. Once a partnership agreement is finalized, AHEO will measure the number of congregations in the faith network as well as the number of health promotion activities for the Hospital's target zip codes.**see continuation of footnote
Group A-Facility 5 -- AdventHealth Winter Park Part V, Section B, line 5:	AdventHealth Winter Park (AHWP or the Hospital) is one of seven campuses that operate under a single hospital license. All seven campuses, collectively, are known as AdventHealth's Central Florida Division South Region. The Central Florida Division South Region's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. AHWP is located in Orange County and it primarily serves the residents of northwestern and central Orange County and extends into southern Seminole County. AdventHealth Winter Park conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Hospital campuses in the South Region. The 2016 CHNA conducted for AHWP was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.AHWP had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within AHWP's community/service area. The following organizations participated in AHWP's CHNAC and specifically represented low-income, minority and other medically underserved populations:Healthy Start of Orange County - an organization that assists families with access to prenatal care and services for infants that promote healthy growth and development, focusing on the socioeconomically disadvantaged and populations that experience health disparities in birth outcomes; Healthy Central Florida - an organization that works to promote positive behavioral and connected communities through community based partnerships and activities;Hebni Nutrition Consultants - a community based organization that works to reduce health disparities through culturally appropriate nutrition education and health promotion; andOrange County Health Department.To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Survey data was scanned for themes based only on the responses of those from the zip codes included in AHWP's primary service area. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants.
Group A-Facility 5 -- AdventHealth Winter Park 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 Reports must be posted on the Hospital's website at least until the date the hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports.
Group A-Facility 5 -- AdventHealth Winter Park Part V, Section B, line 11:	The information provided below explains how AdventHealth Winter Park (AHWP or the Hospital) addressed in 2018 the significant health needs identified in its 2016 Community Health Needs Assessment, and any such needs that were not addressed and the reasons why such needs were not addressed. AHWP conducted a Community Health Needs Assessment in 2016 and adopted an implementation strategy to address the significant health needs identified in the 2016 Community Health Needs Assessment in 2017 prior to May 15, 2017. Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth Winter Park will be referred to in this document as AdventHealth Winter Park (AHWP) or "The Hospital". In January of 2019, every wholly-owned entity across the organization adopted the AdventHealth system brand. The identity has been unified to represent the full continuum of care the system has to offer. Throughout this report, the Hospital will be referred to as AdventHealth Winter Park or AHWP. Any reference to the 2016 Community Health Needs Assessment (CHNA) or 2017 Community Health Plan (CHP) will utilize the new name for consistency.AHWP is part of the Central Florida Division South Region of the healthcare system known as AdventHealth. The South Region of AdventHealth's Central Florida Division includes seven hospital facilities. The South Region has several Region wide initiatives that are implemented at every campus in its service areas. This work is captured by the indicator "The Region(al)" to highlight this is a Regional initiative or service available at all campuses. There are also initiatives specific to the Winter Park campus that are outlined below. This work is captured by the indicator "The Hospital" to highlight this work is specific to this campus and not available Region wide. This is the second-year update for AHWP's 2017-2019 Community Health Plan (Implementation Strategy). AHWP developed this Plan and posted it by May 15, 2017 as part of its 2016 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AHWP worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2016 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2017-2019 Community Health Plan. The second-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2016 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing.AHWP chose two areas of focus for their 2017-2019 Community Health Plan: 1. Access to Care - Preventative; and2. Access to Care - Primary and Behavioral/Mental Health. Priority 1: Access to Care - Preventative 2016 Description of the Issue: AHWP recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. The Hospital strives to increase access to care and create opportunities for community members to lead healthier lives, in part by addressing issues involving preventative care impacted by food insecurity, obesity and maternal and child health.2018 Update: The AHWP Community Health Plan has six desired outcome statements under the Access to Care - Preventative priority. 1. Improve access to healthy and nutritious foods;2. Improve access to knowledge around healthy nutrition and wellness;3. Educate and empower the faith community to promote health within congregations in critical areas;4. Support and create opportunities for increased quality of life for residents of Orange County;5. Increase access to knowledge of chronic disease self-management practices; and6. Support opportunities that promote knowledge of chronic diseases within the primary service area.Outcome 1: Improve access to healthy and nutritious foodsThe first Regional strategy focuses on supporting food distribution programs within the targeted zip codes. The Region established a partnership in 2017 to begin funding a local church program in order to increase its impact. The church established a fresh food co-op which supplies food pantries throughout the Orange, Osceola, and Seminole tri-county area with healthier options. In 2018, the church partnered with one of the food pantries in the Hospital's targeted zip codes and has established a regular drop-off to provide fresh, nutritious food to the pantry and the people it serves. This work will continue into 2019 to expand to target areas specific to AHWP.The second Regional strategy is to support a program called Second Helpings. Through the Second Helpings program AHWP provides unused food from the Nutritional Services Department to Second Harvest Food Bank, a local non-profit food bank. The donated food is then distributed throughout high need areas in the community. The number of meals provided from the AHWP campus was 1,697 in 2018. The Region is confident that the program will continue to grow and increase meals provided as best practices have been identified and shared throughout the Region. Outcome 2: Improve access to knowledge around healthy nutrition and wellnessThere are two strategies identified to achieve this outcome. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy. Two schools in AHWP's target zip codes received this program in 2018, meeting the goal. The second Regional strategy was to provide Nutrition Wellness classes to community members which would help with increasing access to knowledge around nutrition. This program was updated during 2018 and will be deployed in 2019.Outcome 3: Educate and empower the faith community to promote health within congregations in critical areasThe Regional strategy for this outcome is to create a network of faith partners that can promote health through congregational settings. This strategy is funded at a Regional level. The pilot was implemented in another AdventHealth hospital in the Central Florida Division South Region, AdventHealth Orlando. The AdventHealth Orlando campus began developing and sharing best practices to be implemented across the South Region. AHWP began establishing relationships with numerous faith partners in the Winter Park community and is continuing to identify potential churches to partner with in 2018. Once a partnership agreement is finalized, AHWP will measure the number of congregations in the faith network as well as the number of health promotion activities for the AdventHealth Winter Park target zip codes.Outcome 4: Support and create opportunities for increased quality of life for residents of Orange CountyThe Regional strategy involved offering programming from Healthy Central Florida (HCF) to the service areas that AHWP reaches. The goal of HCF is to make Central Florida communities the healthiest in the nation. This initiative began with three target communities - Winter Park, Maitland and Eatonville. In 2018, HCF experienced staff and internal strategy changes. The program has been temporarily taken offline while it is retooled to have a greater focus on underserved populations. Although the program has been offered to individuals in the targeted areas before, the goal is to ensure that future efforts are more inclusive of the underserved populations.Outcome 5: Increase access to knowledge of chronic disease self-management practicesThis is a Regional strategy, which initially rolled out with the expectation of Regional deployment and is funded at a Regional level. The strategy for this outcome is to implement the evidence-based Stanford Chronic Disease Self-Management Program in targeted areas. The program was offered through the Hospital and enrolled 50 students with a 100 percent graduation rate in 2018. As a Region, success was increased once programs were offered through local community centers and churches to increase accessibility for the target population. **see continuation of footnote
Group A-Facility 6 -- AdventHealth Kissimmee Part V, Section B, line 5:	AdventHealth Kissimmee (AHK or the Hospital) is one of seven campuses that operate under a single hospital license. All seven campuses, collectively, are known as AdventHealth's Central Florida Division South Region. The Central Florida Division South Region's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. AHK is located in Osceola County and it primarily serves residents throughout Osceola County with a primary service area of South Orlando, Kissimmee, and Poinciana. AdventHealth Kissimmee conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Hospital campuses in the South Region. The 2016 CHNA conducted for AHK was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.AHK had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within AHK's community/service area. The following organizations participated in AHK's CHNAC and specifically represented low-income, minority and other medically underserved populations:Osceola Council of Aging - a non-profit organization with a focus on providing care and essential social services to seniors and families; Healthy Start of Osceola County - an organization that assists families with access to prenatal care and services for infants that promote healthy growth and development, focusing on the socioeconomically disadvantaged and populations that experience health disparities in birth outcomes; Community Vision of Osceola County - a community planning non-profit that works to convene regional stakeholders to create a shared vision for a healthy and prosperous Osceola County; Community Hope Center - a social service non-profit that works to connect socioeconomically disadvantaged families to essential services with the goal of helping them to become self-sustaining; andThe Osceola County Health Department.To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Survey data was scanned for themes based only on the responses of those from the zip codes included in AHK's primary service area. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants.
Group A-Facility 6 -- AdventHealth Kissimmee 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 Reports must be posted on the Hospital's website at least until the date the hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports.
Group A-Facility 6 -- AdventHealth Kissimmee Part V, Section B, line 11:	The information provided below explains how AdventHealth Kissimmee (AHK or the Hospital) addressed in 2018 the significant health needs identified in its 2016 Community Health Needs Assessment, and any such needs that were not addressed and the reasons why such needs were not addressed. AHK conducted a Community Health Needs Assessment in 2016 and adopted an implementation strategy to address the significant health needs identified in the 2016 Community Health Needs Assessment in 2017 prior to May 15, 2017. Adventist Health System/Sunbelt, Inc d/b/a AdventHealth Kissimmee will be referred to in this document as AdventHealth Kissimmee (AHK) or "The Hospital". In January of 2019, every wholly-owned entity across the organization adopted the AdventHealth system brand. The identity has been unified to represent the full continuum of care the system has to offer. Throughout this report, the Hospital will be referred to as AdventHealth Kissimmee or AHK. Any reference to the 2016 Community Health Needs Assessment (CHNA) or 2017 Community Health Plan (CHP) will utilize the new name for consistency.AHK is part of the Central Florida Division South Region of the healthcare system known as AdventHealth. The South Region of AdventHealth's Central Florida Division includes seven hospital facilities. The South Region has several Region wide initiatives that are implemented at every campus in its service areas. This work is captured by the indicator "The Region(al)" to highlight this is a Regional initiative or service available at all campuses. There are also initiatives specific to the Kissimmee campus that are outlined below. This work is captured by the indicator "The Hospital" to highlight this work as specific to this campus and not available Region wide. This is the second-year update for AHK's 2017-2019 Community Health Plan (Implementation Strategy). AHK developed this Plan and posted it by May 15, 2017 as part of its 2016 Community Health Needs Assessment process. For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AHK worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2016 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2017-2019 Community Health Plan. The second-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2016 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing.AHK chose two areas of focus for their 2017-2019 Community Health Plan: 1. Access to Care - Preventative; and2. Access to Care - Primary and Behavioral/Mental Health. Priority 1: Access to Care - Preventative 2016 Description of the Issue: AHK recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. The Hospital strives to increase access to care and create opportunities for community members to lead healthier lives, in part by addressing issues involving preventative care impacted by food insecurity, obesity and maternal and child health. 2018 Update: The AHK Community Health Plan has five desired outcome statements under the Access to Care - Preventative priority. 1. Improve access to healthy and nutritious foods;2. Improve access to knowledge around healthy nutrition and wellness;3. Educate and empower the faith community to promote health within congregations in critical areas;4. Increase access to knowledge of chronic disease self-management practices; and5. Support opportunities that promote knowledge of chronic diseases within the primary service area.Outcome 1: Improve access to healthy and nutritious foodsThe first Regional strategy focuses on supporting food distribution programs within the targeted zip codes. The Region established a partnership in 2017 to help fund a local church program in order to increase its impact. The church had established a fresh food co-op which supplies food pantries throughout the Orange, Osceola, and Seminole tri-county area with healthier options. In 2018, the church partnered with one of the food pantries in the Hospital's targeted zip codes and has established a regular drop-off to provide fresh, nutritious food to the pantry and the people it serves.The second Regional strategy began as a pilot at another AdventHealth hospital in the Central Florida Division South Region, AdventHealth Orlando. The AdventHealth Orlando campus partnered with Second Harvest Food Bank, a local non-profit food bank, in 2017 to begin providing unused food from the AdventHealth Hospital campuses to Second Harvest so this food can be distributed throughout high need areas in the community. Plans are in place to expand the program to AHK in 2019. As a Region, 29,760 meals have been provided through the Second Helpings program in 2018. Outcome 2: Improve access to knowledge around healthy nutrition and wellnessThere are two Regional strategies for this outcome. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy. Two schools in AHK's target zip codes received this program in 2018 meeting the goal. The second Regional strategy was to provide Nutrition Wellness classes to community members which would help with increasing access to knowledge around nutrition. This program was updated during 2018 and will be deployed in 2019.Outcome 3: Educate and empower the faith community to promote health within congregations in critical areasThe Regional strategy for this outcome is to create a network of faith partners that can promote health through congregational settings. This strategy is funded at a Regional level. The pilot was implemented at another AdventHealth hospital in the Central Florida Division South Region, AdventHealth Orlando. The AdventHealth Orlando campus began developing and sharing best practices to be shared across the South Region. As AHK began to develop programming in Osceola County it was determined that work was already being done in this space. To best allocate resources and avoid duplicating efforts, AHK has been working with a local non-profit to create a pipeline from its patient population to the existing programs. Coordination efforts have exceeded the original timeline, but AHK believes that the partnership will be fully formed soon. Given the expanded timeline the metric was updated to reflect a 2019 deployment on year one reporting.Outcome 4: Increase access to knowledge of chronic disease self-management practicesThe Regional strategy for this outcome is to fund and implement the evidence-based Stanford Chronic Disease Self-Management Program in the targeted zip codes throughout the Region. As AHK planned to implement programming in Osceola County it was determined that work was already being done in this space. To best allocate resources and not duplicate efforts, AHK has been working with a local non-profit to create a pipeline from its patient population to the existing programs. Coordination efforts exceeded the original timeline, but the Hospital believes that the partnership will be fully formed soon. Participation data will begin being tracked once the partnership is complete. Outcome 5: Support opportunities that promote knowledge of chronic diseases within the primary service areaThe Regional strategy included monetary support for the American Heart Association for their disease education efforts. Funding continues to be provided at a Regional level of $500,000 over the course of three years. Since this strategy is implemented strictly as a funding donation on a Regional level, there is not a specific facility metric.**see continuation of footnote
Group A-Facility 9 -- Central Texas Medical Center Part V, Section B, line 5:	Central Texas Medical Center (CTMC or the Hospital) is a 170-bed hospital located in San Marcos, Texas. The Hospital's service area consists of Hays County, Caldwell County, and Comal County. In conducting its 2016 Community Health Needs Assessment (CHNA), primary and secondary health data was collected and analyzed. Primary data was gathered based upon input from individuals representing the broad community, as well as low-income, minority, and other medically underserved populations. Primary data input was primarily gathered through the establishment of a Community Health Needs Assessment Committee, community stakeholder surveys, and Public Health input and expertise. The Hospital formed a Community Health Needs Assessment Committee (CHNAC) that included representatives of the community and the Hospital, with a special focus on underserved populations. Many of the CHNAC members were selected because of their direct ties to the underserved and impoverished communities in the Hospitals' primary service area. Key members of the CHNAC included representatives from Texas State University, Student Health Center, the San Marcos Consolidated Independent School District, the San Marcos City Council, the Hays County Commission Court, EL Buen Pastor Methodist Church, and the Schieb Center, a non-profit organization providing mental health services mainly to those without insurance and those on Medicaid. CTMC also gathered primary data through focus groups, interviews, and an online survey. An external party conducted ten interviews and one focus group on behalf of the Hospital to gather input from individuals who represented the broad interests of the community. The key stakeholders included nonprofit leaders, health department authorities, public school leaders, healthcare providers or leaders, elected officials, researchers, people representing distinct geographic areas, and people representing certain ethic/racial groups.
Group A-Facility 9 -- Central Texas Medical Center 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 Reports must be posted on the Hospital's website at least until the date the hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports.
Group A-Facility 9 -- Central Texas Medical Center Part V, Section B, line 11:	The information provided below explains how Central Texas Medical Center (CTMC or the Hospital) addressed in 2018 the significant health needs identified in its 2016 Community Health Needs Assessment, and any such needs that were not addressed and the reasons why such needs were not addressed. CTMC conducted a Community Health Needs Assessment in 2016 and adopted an implementation strategy to address the significant health needs identified in the 2016 Community Health Needs Assessment in 2017 prior to May 15, 2017. Adventist Health System/Sunbelt, Inc., d/b/a Central Texas Medical Center, will be referred to in this document as Central Texas Medical Center (CTMC) or "the Hospital". Central Texas Medical Center is part of the Southwest Region of the healthcare system known as AdventHealth. The Southwest Region of AdventHealth includes four hospital facilities.This is the second-year update for Central Texas Medical Center's 2017-2019 Community Health Plan (Implementation Strategy). Central Texas Medical Center developed this Plan and posted it by May 15, 2017 as part of its 2016 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, Central Texas Medical Center worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2016 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2017-2019 Community Health Plan. The second-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2016 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing.Central Texas Medical Center chose six areas of focus for their 2017-2019 Community Health Plan: 1. Primary Care: Timely access (including afterhours care) to Healthcare Professionals, especially primary care; accessing care close to home when care is needed; 2. Healthier Management of Lifestyle: making good choices in the areas of nutrition, weight management and exercise;3. Management of Heart Disease/ Congestive Heart Failure (CHF) and Related Conditions: Prevalence and/or enhanced outpatient management of heart disease/congestive heart failure (CHF) and related conditions/risk factors such as hypertension;4. Management of Diabetes: Prevalence and/or enhanced outpatient management of diabetes; programs to address anticipated growth of diabetes and related conditions;5. Education: Educating the population to better understand the healthcare resources available to them through various channels including those provided by Central Texas Medical Center, Live Oak Health Partners, a physician practice related entity, and other entities and a commitment to helping people (including the underserved) navigate those resources; and 6. Management of Mental and Behavioral Healthcare: Prevalence and/or enhanced management of mental and behavioral healthcare options.Priority 1: Primary Care2016 Description of the Issue: In the Texas counties of Hays and Caldwell, low-income, uninsured adult residents have limited or few options for accessing primary care services. When healthcare is inaccessible, many individuals are forced to forego care or delay care which can lead to avoidable complications or overutilization of care via visits to hospital emergency departments (ED). This places a significant burden on hospital emergency departments within the counties. Patients that are medically screened and treated in an ED setting likely struggle with uncoordinated care and may not have the resources or funding to follow discharge instructions, including access to prescriptions and appropriate follow-up care. Our secondary data showed that Hays County had a significantly lower ratio of primary care physicians per 100,000 population (46.7) than the State of Texas (58.5) or the United States (74.5). As a result, access to primary care is challenging, especially for low-income residents. 2018 Update: CTMC's goal was to increase access to primary care physicians, especially for un/underinsured patients and Medicare and Medicaid beneficiaries. Our goal for 2018 was to recruit at least three primary care physicians to practice in the Live Oak Health Partners' clinics. Live Oak Health Partners is Central Texas Medical Center's employed physician group. Although we did not recruit three primary care physicians, we did recruit one nurse practitioner and expanded access at the Live Oak Health Partners' clinics. In 2018, there were 4,573 more Relative Value Units (RVU) in primary care than in 2017. The clinics were trained on redesigning physician schedule templates in order to create more bandwidth within their schedules. Visits were shortened from 30- or 60-minute time slots to all 20-minute slots making it easier to schedule patients. They also standardized scheduling rules across all the primary care clinics. The plans for 2019 are to add a physician at a clinic in San Marcos and add an Advanced Practice Provider (APP) to the clinic in Kyle for a total of 2 providers. The greatest challenges are staff and provider retention. Our second strategy was to increase capacity at Live Oak Health Partners' Community Clinic so Medicaid/low income/uninsured patients have access to primary care services. Our goal was to provide community outreach activities that increase awareness of the Community Clinic's services and have patients establish Live Oak Health Partners' Community Clinic as their medical home. Our goal in 2018 was to have 5,100 patient encounters at the Community Clinic and we exceeded this number with a total of 7,889 patient encounters. Our third strategy was to expand primary care access at the Live Oak Health Partners' Walk-In Clinic and increase the number of patients declaring the physician at Live Oak Health Partners' Walk-In Clinic as their primary care provider. There were some transitions within the Live Oak Walk-In Clinic, so we focused our efforts on patients establishing the Walk-In Clinic as their primary care home versus establishing with a specific provider. Our goal in 2018 was to have 300 new patients declaring the Live Oak Health Partners' Walk-In Clinic as their primary care home and we had a total of 1,213 new patients establish with the Clinic. Moving forward, we will measure the number of new patients establishing with the Walk-In Clinic versus establishing with a specific provider.Our fourth strategy was to improve access to those with limited mobility or lack of transportation. Our goal was to work with Texas State University to set-up a program using students to drive patients to medical appointments. Our 2018 goal was to expand this program to at least 2 service lines dependent on the results of the pilot program in 2017. At the conclusion of the pilot program, it was discovered that the grant for the program had been exhausted. The program originated within Central Texas Medical Center's Physical Therapy and Rehabilitation department and in 2018, Central Texas Medical Center's Physical Therapy and Rehabilitation department was not able to effectively manage the program. The Live Oak Health Partners' Community Clinic picked up the program and is working with Texas State University. However, it has been slow getting the program off the ground. The biggest challenge is a decrease in patients requesting rides to medical appointments. **see continuation of footnote
Group A-Facility 8 -- AdventHealth Apopka Part V, Section B, line 5:	AdventHealth Apopka (AHApk or the Hospital) is one of seven campuses that operate under a single hospital license. All seven campuses, collectively, are known as AdventHealth's Central Florida Division South Region. The Central Florida Division South Region's seven campuses are in the Central Florida counties of Seminole, Orange, and Osceola. AHApk is located in Orange County and its primary service area encompasses Northwest Orange County with the cities of Apopka and Zellwood as it main servicing jurisdictions. AdventHealth Apopka conducted its 2016 Community Health Needs Assessment (CHNA) in two parts: a regional health needs assessment for four counties in Central Florida (Lake, Orange, Osceola and Seminole) (a sister hospital is located in Lake County, Florida and was a participant in the regional health needs assessment) and a separate health needs assessment focused on each of the seven separate Hospital campuses in the South Region. The 2016 CHNA conducted for AHApk was built on input from people representing the broad and local community, as well as low-income, minority and other medically underserved populations. This input was solicited throughout 2016, and was gathered and considered in multiple ways as described below.AHApk had a Community Health Needs Assessment Committee (CHNAC) that included representatives from the Hospital and community with a special focus on underserved populations within AHApk's community/service area. The following organizations participated in AHApk's CHNAC and specifically represented low-income, minority and other medically underserved populations:Apopka Ministerial Alliance - an alliance that brings together the leadership from the faith communities that make up Apopka;City of Winter Garden - Winter Garden is adjacent to the city of Apopka;Matthew's Hope Ministries - a non-profit organization that works to transform the lives of individuals experiencing homelessness; and Shepard's Hope - a free and charitable clinic that provides care to the underinsured and uninsured. To solicit input from the broad community, primary data was also gathered through consumer surveys, provider surveys, and community conversations. Over 1,200 consumer surveys were compiled and analyzed. Survey data was scanned for themes based only on the responses of those from the zip codes included in AHApk's primary service area. Provider surveys were gathered from 145 participants. Six community conversation sessions took place during 2016 with a total of 102 participants.
Group A-Facility 8 -- AdventHealth Apopka 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 Reports must be posted on the Hospital's website at least until the date the hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports.
Group A-Facility 8 -- AdventHealth Apopka Part V, Section B, line 11:	The information provided below explains how AdventHealth Apopka (AHApk or the Hospital) addressed in 2018 the significant health needs identified in its 2016 Community Health Needs Assessment, and any such needs that were not addressed and the reasons why such needs were not addressed. AHApk conducted a Community Health Needs Assessment in 2016 and adopted an implementation strategy to address the significant health needs identified in the 2016 Community Health Needs Assessment in 2017 prior to May 15, 2017. Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth Apopka will be referred to in this document as AdventHealth Apopka (AHApk) or "The Hospital". In January of 2019, every wholly-owned entity across the organization adopted the AdventHealth system brand. The identity has been unified to represent the full continuum of care the system has to offer. Throughout this report, the Hospital will be referred to as AdventHealth Apopka. Any reference to the 2016 Community Health Needs Assessment (CHNA) or 2017 Community Health Plan (CHP) will utilize the new name for consistency.AHApk is part of the Central Florida Division South Region of AdventHealth. The South Region of AdventHealth's Central Florida Division includes seven hospital facilities. The South Region has several Region wide initiatives that are implemented at every campus in its service areas. This work is captured by the indicator "The Region(al)" to highlight this is a Regional strategy or service available at all campuses. There are also strategies specific to the Apopka campus that are outlined below. This work is captured by the indicator "The Hospital" to highlight the outcomes and initiatives which are serving the community in AHApk's service area.This is the second-year update for AHApk's 2017-2019 Community Health Plan (Implementation Strategy). AHApk developed this Plan and posted it by May 15, 2017 as part of its 2016 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan (Implementation Strategy), AHApk worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2016 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the needs assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2017-2019 Community Health Plan. The second-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2016 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing.AHApk chose two areas of focus for their 2017-2019 Community Health Plan: 1. Access to Care - Preventative; and2. Access to Care - Primary and Behavioral/Mental Health. Priority 1: Access to Care - Preventative 2016 Description of the Issue: AHApk recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. The Hospital strives to increase access to care and create opportunities for community members to lead healthier lives, in part by addressing issues involving preventative care impacted by food insecurity, obesity and maternal and child health.2018 Update: The AHApk Community Health Plan has five desired outcome statements under the Access to Care - Preventative priority. 1. Improve access to healthy and nutritious foods;2. Improve access to knowledge around healthy nutrition and wellness;3. Educate and empower the faith community to promote health within congregations in critical areas;4. Increase access to knowledge of chronic disease self-management practices; and5. Support opportunities that promote knowledge of chronic diseases within the primary service area.Outcome 1: Improve access to healthy and nutritious foodsThe first Regional strategy focuses on supporting food distribution programs within the targeted zip codes. The Region established a partnership in 2017 to help fund a local church program in order to increase its impact. The church had established a fresh food co-op which supplies food pantries throughout the Orange, Osceola, and Seminole tri-county area with healthier options. In 2018, the church partnered with one of the food pantries in the Hospital's targeted zip codes and has established a regular drop-off to provide fresh, nutritious food to the pantry and the people it serves. The second Regional strategy began as a pilot at another AdventHealth hospital in the Central Florida Division South Region, AdventHealth Orlando. The AdventHealth Orlando campus partnered with Second Harvest Food Bank, a local non-profit food bank, in 2017 to begin providing unused food from the AdventHealth Hospital campuses to Second Harvest so this food can be distributed throughout high need areas in the community. This initiative, entitled the "Second Helping" program, is being expanded across all campuses, including AHApk. For 2018, there are no specific metrics for the Apopka Campus. The program has provided meals for 29,760 people on a Regional level from 2017 through 2018, which has exceeded the Regional goal.Outcome 2: Improve access to knowledge around healthy nutrition and wellnessThere is one Regional strategy for this outcome. The Mission: FIT POSSIBLE program is a comprehensive wellness program which brings health and wellness education to schools, churches, and community centers. Health and wellness educators provide education during regular visits, as well as supplemental education for teachers and staff to engage kids in activities that teach them how to be physically and emotionally healthy. Three schools in AHApk's target zip codes received this program which surpassed the Hospital goal of two schools.Outcome 3: Educate and empower the faith community to promote health within congregations in critical areasThe Regional strategy for this outcome is to create a network of faith partners that can promote health through congregational settings. This strategy is funded at a Regional level. The pilot was implemented at another AdventHealth hospital in the Central Florida Division South Region, AdventHealth Orlando. The AdventHealth Orlando campus began developing and sharing best practices to be shared across the South Region of AdventHealth. AHApk began establishing relationships with numerous faith partners in the Apopka community and identified two potential churches to partner with in 2018. Once a partnership agreement is finalized, AHApk will measure the number of congregations in the faith network as well as the number of health promotion activities for the AHApk community.Outcome 4: Increase access to knowledge of chronic disease self-management practicesThe Regional strategy for this outcome is to fund and offer the evidence-based Stanford Chronic Disease Self-Management Program in targeted zip codes throughout the Region. AHApk worked to implement the program in mid-2018 for the Apopka community. There was a less than anticipated response even with attempts to create an internal pipeline for the program from Hospital patients. The strategy was adjusted to offer the program at local community centers and churches rather than on the Hospital campuses which has helped to increase participation.Outcome 5: Support opportunities that promote knowledge of chronic diseases within the primary service areaThe Regional strategy included monetary support for the American Heart Association for their disease education efforts. Funding continues to be provided at a Regional level of $500,000 over the course of three years. Since this strategy is implemented strictly as a funding donation on a Regional level, there is not a specific facility metric.As the Hospital looks at the successes and challenges that have come from its second year of implementation of the 2017 Community Health Plan, there are opportunities to better define strategies and expand outcomes to better serve its target populations. There are ongoing conversations and plans will be updated as needed. The Hospital collaborates with multiple community partners on the identified priorities. These partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities, and numerous non-profit entities. **see continuation of footnote
Group A-Facility 10 -- AdventHealth Wauchula Part V, Section B, line 5:	AdventHealth Sebring operates one hospital facility in Wauchula in Hardee County in Florida under a single license. AdventHealth Wauchula (AHW or the Hospital) is designated by the state of Florida as a Critical Access Hospital. The Hospitals' primary service area is comprised of three zip codes, two of which are located in Hardee County. In conducting its 2016 Community Health Needs Assessment (CHNA), primary and secondary health data was collected and analyzed. Primary data was gathered based upon input from individuals representing the broad community, as well as low-income, minority, and other medically underserved populations. Primary data input was primarily gathered through the establishment of a Community Health Needs Assessment Committee, community stakeholder surveys, and Public Health input and expertise. The Hospital formed a Community Health Needs Assessment Committee (CHNAC) that included representatives of the community and the Hospital, with a special focus on underserved populations. Many of the CHNAC members were selected because of their direct ties to the underserved and impoverished communities in the Hospitals' primary service area. Key members of the CHNAC included representatives from Central Florida Health Care, a local federally qualified health center, Nu-Hope Elder Care Services, Inc., a senior social service organization, Healthy Start Wauchula, Redlands Christian Migrant Association, an organization providing childcare and early education for children of migrant farm workers and rural, low-income families, Samaritan's Touch, a health clinic for the uninsured, Heartland Rural Health Network for low-income and minority populations, and the Hardee County Department of Health. AdventHealth Sebring also gathered primary data through the utilization of a stakeholder survey. This stakeholder survey was distributed to and completed by most of the members of the CHNAC and members of the community at large. Various sources of secondary data were reviewed to understand the larger issues plaguing the Hospitals' primary service area.
Group A-Facility 10 -- AdventHealth Wauchula 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 Reports must be posted on the Hospital's website at least until the date the hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports.
Group A-Facility 10 -- AdventHealth Wauchula Part V, Section B, line 11:	The information provided below explains how AdventHealth Wauchula (AdventHealth Wauchula or the Hospital) addressed in 2018 the significant health needs identified in its 2016 Community Health Needs Assessment, and any such needs that were not addressed and the reasons why such needs were not addressed. The Hospital conducted a Community Health Needs Assessment in 2016 and adopted an implementation strategy to address the significant health needs identified in the 2016 Community Health Needs Assessment in 2017 prior to May 15, 2017. Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth Wauchula will be referred to in this document as AdventHealth Wauchula or "The Hospital". In January of 2019, every wholly-owned entity across our organization adopted the AdventHealth system brand. Our identity has been unified to represent the full continuum of care our system offers. Throughout this report, we will refer to our hospital by AdventHealth Wauchula. Any reference to our 2016 Community Health Needs Assessment (CHNA) or 2017 Community Health Plan (CHP) will utilize our new name for consistency.AdventHealth Wauchula is part of the West Florida Division of AdventHealth. The West Florida Division includes 11 hospital facilities.This is the second-year update for AdventHealth Wauchula's 2017-2019 Community Health Plan (Implementation Strategy). AdventHealth Wauchula developed this plan and posted it by May 15, 2017 as part of its 2016 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AdventHealth Wauchula worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2016 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the Needs Assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2017-2019 Community Health Plan. The second-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2016 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital is not addressing.AdventHealth Wauchula chose five areas of focus for its 2017-2019 Community Health Plan: 1. Diabetes2. Obesity/Nutrition3. Access to Primary Care4. Heart Disease & Stroke (High Blood Pressure & Cholesterol)5. Teen Pregnancy PreventionPriority 1: Diabetes2016 Description of the Issue: 12.3 percent of the Hospital's primary service area (PSA) adults, aged 20 and older, have been diagnosed with diabetes. This is higher than the state of Florida average of 8.89 percent. The health department is no longer providing Diabetes Self-Management classes. Pre-Diabetes education is also lacking in Hardee County.2018 Update: The Morning Mile program is a before-school walking/running program sponsored by the American Diabetes Association (ADA), that gives children a chance to start each day in an active way.The intervention was a pilot program, to include Title 1 Schools in the Morning Mile (walking) program in collaboration with the ADA. This intervention aimed to increase activity level and nutrition education among students at Title 1 schools. The ADA in partnership with Fitzness International, LLC oversees the management of the Morning Mile (MM) program in SW Florida. The ADA implements and manages the program in schools on behalf of sponsors and adds a nutrition education component to increase its impact on school children. Hardee County struggled to identify a partner school for implementation in 2018. Moving forward, the West Florida Division will be re-evaluating this intervention and working to identify partners and better ways to track data.A second intervention, added in 2018, includes offering free, 3-hour Pre-diabetes classes at the Hospital and in the community. These classes are open to the public and offered by the Diabetes Center. Community partners have various offerings of diabetes self-management education for those already diagnosed, but no pre-diabetes programs. Lack of transportation to attend classes continues to be a concern, and it has been difficult, historically, to entice residents to attend health lectures or classes. In 2018, a total of two classes were held with a total of 13 attendees which was slightly less than the goal of three total classes. Classes were advertised in a new Hospital publication that lists all the classes and fitness group exercise offered at local AdventHealth Wellness Centers and distributed to local physician offices. As of May 2019, classes are listed on the website for our Hospital. Diabetes Center instructors also visited physician offices to speak with local health care providers about the program. Priority 2: Obesity/Nutrition2016 Description of the Issue: 34.6 percent of adults aged 18 and older self-report they have a body mass Index between 25.0 and 30.0 (overweight). In the PSA, 33.4 percent of adults aged 20 and older self-reported no leisure time for activity.2018 Update: Strategies for this goal included offering free CREATION Health class series to the community, increasing the number of staff members or others trained to teach the series, and continuing to offer the Food is Health (FIH) program. CREATION Health (CH) (based on the eight principles of Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook, and Nutrition) is a faith-based, 8-session, wellness program offering lifestyle seminars and training programs for those who want to live healthier and happier lives. These seminars were to be hosted by local faith congregations identified by existing professional relationships with the Chaplains at AdventHealth Wauchula. The Wauchula Seventh-Day Adventist (SDA) Church sent two delegates to the West Florida Division CREATION Health "Train the Trainer" Seminar hosted by the Mission and Ministry/Community Development departments. The delegates received a single CH Leadership kit valued at $350. The CH Kit contains CH Seminar Topic Power Point, CH Topic Videos, CH Leadership Manual, Small Group Discussion Guide, Seminar Personal Study Guide, and Participant Pre-Post Self Assessments. The AdventHealth West Florida Division also sponsors free pre- and post-bio-metric screenings (blood pressure, blood sugar, and body mass index) and nursing services for all CH programs that would in turn be implemented in the local congregations. No CREATION Health series were offered in Hardee County in 2018 due to the church completing a move into a new building during 2018. The Wauchula SDA Church has completed this transition into their new building and conversations have begun about offering classes in 2019.AdventHealth Wauchula partnered with Central Florida Health Care, the Florida Department of Health (Hardee County), the Senior Connection Center, the University of Florida IFAS, and the Health Services Advisory Group to implement the Food is Health program. Participants at each session received nutrition education and a ten-dollar voucher to redeem at the Hospital's Food is Medicine food truck, filled with fresh fruits and vegetables.The Food is Health program (formally known as Food is Medicine) has been greatly appreciated by the targeted population. Blood sugar levels were measured for each participant before and after each educational series and 66 percent of participants had reduced blood sugar levels following education. The Food is Health (FiH) program, during its planning stages, was a great way to bring together groups/agencies that offered programs to the community, but operated in silos, unaware of what other groups were doing. The FiH program continues to grow and will be moved to other underserved areas, as they are identified.In addition, the key to success of the FiH program has been partnerships. The Hospital cannot run this program without strong partnerships with health education providers, local fresh produce vendors, and other community-based organizations who are the boots on the ground addressing social determinants of health.**see continuation of footnote
Part V, Section B, Line 7a	Each hospital facility's CHNA report was made widely available through the following websites:Facility 1 -- AdventHealth Hospital Orlandohttps://www.adventhealth.com/community-health-needs-assessmentsFacility 2 -- AdventHealth Altamonte Springshttps://www.adventhealth.com/community-health-needs-assessmentsFacility 3 -- AdventHealth Celebrationhttps://www.adventhealth.com/community-health-needs-assessmentsFacility 4 -- AdventHealth East Orlandohttps://www.adventhealth.com/community-health-needs-assessmentsFacility 5 -- AdventHealth Winter Parkhttps://www.adventhealth.com/community-health-needs-assessmentsFacility 6 -- AdventHealth Kissimmeehttps://www.adventhealth.com/community-health-needs-assessmentsFacility 7 -- AdventHealth Sebringhttps://www.adventhealth.com/community-health-needs-assessmentsFacility 8 -- AdventHealth Apopkahttps://www.adventhealth.com/community-health-needs-assessmentsFacility 9 -- Central Texas Medical Centerhttp://www.ctmc.org/about-us/community-benefitFacility 10 -- AdventHealth Wauchulahttps://www.adventhealth.com/community-health-needs-assessmentsFacility 11 -- AdventHealth Lake Placidhttps://www.adventhealth.com/community-health-needs-assessments
Part V, Section B, Line 10a	Each hospital facility's most recently adopted implementation strategy was made widely available through the following websites:Facility 1 -- AdventHealth Hospital Orlandohttps://www.adventhealth.com/community-health-needs-assessmentsFacility 2 -- AdventHealth Altamonte Springshttps://www.adventhealth.com/community-health-needs-assessmentsFacility 3 -- AdventHealth Celebrationhttps://www.adventhealth.com/community-health-needs-assessmentsFacility 4 -- AdventHealth East Orlandohttps://www.adventhealth.com/community-health-needs-assessmentsFacility 5 -- AdventHealth Winter Parkhttps://www.adventhealth.com/community-health-needs-assessmentsFacility 6 -- AdventHealth Kissimmeehttps://www.adventhealth.com/community-health-needs-assessmentsFacility 7 -- AdventHealth Sebringhttps://www.adventhealth.com/community-health-needs-assessmentsFacility 8 -- AdventHealth Apopkahttps://www.adventhealth.com/community-health-needs-assessmentsFacility 9 -- Central Texas Medical Centerhttp://www.ctmc.org/about-us/community-benefitFacility 10 -- AdventHealth Wauchulahttps://www.adventhealth.com/community-health-needs-assessmentsFacility 11 -- AdventHealth Lake Placidhttps://www.adventhealth.com/community-health-needs-assessments
Part V, Section B, Line 16a-16c	Each hospital facility's FAP, FAP application form and plain language summary of the FAP was made widely available through the following websites:Facility 1 -- AdventHealth Orlandohttps://www.adventhealth.com/legal/financial-assistanceFacility 2 -- AdventHealth Altamonte Springshttps://www.adventhealth.com/legal/financial-assistanceFacility 3 -- AdventHealth Celebrationhttps://www.adventhealth.com/legal/financial-assistanceFacility 4 -- AdventHealth East Orlandohttps://www.adventhealth.com/legal/financial-assistanceFacility 5 -- AdventHealth Winter Park https://www.adventhealth.com/legal/financial-assistanceFacility 6 -- AdventHealth Kissimmeehttps://www.adventhealth.com/legal/financial-assistanceFacility 7 -- AdventHealth Sebringhttps://www.adventhealth.com/legal/financial-assistanceFacility 8 -- AdventHealth Apopkahttps://www.adventhealth.com/legal/financial-assistanceFacility 9 -- Central Texas Medical Centerhttps://www.ctmc.org/patients-visitors/after-my-stay/financial-assistanceFacility 10 -- AdventHealth Wauchulahttps://www.adventhealth.com/legal/financial-assistanceFacility 11 -- AdventHealth Lake Placidhttps://www.adventhealth.com/legal/financial-assistance
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 1 -- AdventHealth OrlandoDescription of CHNA Significant Needs ContinuedOutcome 6: Support opportunities that promote knowledge of chronic diseases within the primary service areaThe Regional strategy included monetary support for the American Heart Association for their disease education efforts. Funding continues to be provided at a Regional level of $500,000 over the course of three years. Since this strategy is implemented strictly as a funding donation on a Regional level, there is not a specific facility metric.As the Hospital looks at the successes and challenges that have come from its second year of implementation of the 2017 Community Health Plan, there are opportunities to better define strategies and expand outcomes to better serve its target populations. There are ongoing conversations and plans will be updated as needed. The Hospital collaborates with multiple community partners on the identified priorities. These partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities, and numerous non-profit entities. The biggest challenge that the Hospital has identified with this priority is aligning available programs with strong foundations and adequate resources for deployment.Priority 2: Access to Care - Primary and Behavioral/Mental Health 2016 Description of the Issue: AHO recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. The Hospital strives to increase access to primary and behavioral/mental health care. The approach for the priority involves addressing affordability and access to appropriate-level care utilizing care navigation and coordination.2018 Update: The AHO Community Health Plan has four desired outcomes under the Access to Care - Primary and Behavioral/Mental Health priority. 1. Increase access to primary care services in Orange County;2. To increase access to primary care in Orange County by supporting community partners;3. Participate in strategic processes that combat the heroin epidemic; and4. Provide behavioral health resources for the uninsured.Outcome 1: Increase access to primary care services in Orange CountyStrategies were developed on both a Regional and facility level to increase access to care. The first strategy involves maintaining the Orlando Community Medicine Clinic, a clinic run by AHO to serve uninsured residents in Orange County. The clinic is funded by The Region. The metric for this strategy has a goal of the number of patients seen. The Hospital exceeded the goal of serving 4,000 patients with a total of 5,785 patients seen in 2018. The second Regional strategy was to connect residents to the Community Care program. The Community Care Program is a Regional initiative which focuses on clinically stabilizing patients in the community environment while addressing root causes (often social determinant based) of uninsured high utilizers of care with complex diagnoses. The Region funds the Community Care Program which enrolled 61 patients from the target population in the AHO area, surpassing the goal of 37. Another aspect of increasing access, which was implemented in 2018, has been to utilize a Care Navigation team across the Region to connect uninsured patients to permanent medical homes through a partnership with local federally qualified healthcare clinics. The team assists with identifying and scheduling appointments for patients in order to ensure follow-up care is accessible. In 2018, 29,830 appointments were scheduled for Orange County residents, which surpassed the goal of 4,000.The Region has continued to fund the AdventHealth Transitions Clinic (also known as the Trina Hidalgo Heart Care Center). This clinic provides follow-up care for cardiac issues to the uninsured who lack primary care. All funding is provided at a Regional level. The clinic serves Orange, Osceola, Seminole, and Lake County residents. The current tracking structure for the clinic does not allow for extraction of metrics by county at this time. In 2018, 314 patients were seen for a total of 3,889 visits throughout the Region.The Region also continued to fund and staff the AdventHealth Transitions Lung Clinic. This clinic provides care for underinsured and uninsured who are impacted by respiratory issues. The current tracking structure for the clinic does not allow for extraction of metrics by county at this time. In 2018, 1,853 patients were served throughout the Region.Outcome 2: To increase access to primary care in Orange County by supporting community partnersThe Regional strategy for this outcome was to provide monetary support to three different organizations that provide health care to uninsured and underinsured residents of Orange and/or Seminole County. Although they only appear on the AHO plan, they do impact multiple AdventHealth facilities. AdventHealth provided funding to the following partners who are helping to provide care to the target population in Orange County as well as throughout the Region.1. Shepard's Hope received $100,000 toward operation of their free clinics to provide access to free high quality, compassionate medical care.2. Grace Medical Home received $110,000 toward operations to continue being a place for Central Florida's most underserved residents to enjoy the benefit of quality, comprehensive, ongoing healthcare. 3. Health Care Center for the Homeless received $100,000 toward operations to continue their commitment to providing for the health care needs of the homeless and uninsured residents of Orlando, Florida and surrounding areas.Outcome 3: Participate in strategic processes that combat the heroin epidemicThe Regional strategy for this outcome was to actively participate in the Orange County Heroin Task Force in collaboration with the Orange County Government. This collaboration resulted in a grant that is being used to fund two navigator positions in the county's busiest emergency departments. The focus of these navigators is to help establish and coordinate substance abuse treatment for individuals who are brought into the emergency departments. This one-year strategy is complete and the navigators have been established in the Hospital. Outcome 4: Provide behavioral health resources for the uninsuredThere are two Regional strategies for this outcome statement. Both are funded Regionally. The first is to provide sponsorship dollars to the Outlook Clinic for Depression and Anxiety. The Outlook Clinic for Depression and Anxiety is a collaboration with the Mental Health Association, Orange County Government, UCF Social Work Department and additional partners. AHO donated $450,000 in 2018 to help meet the needs of uninsured residents in Orange County. The Region provides an annual $1,440,663 donation to Aspire Behavioral Health. Aspire Behavioral Health provides a full range of behavioral healthcare services designed to meet the diverse needs of the community including both inpatient and outpatient services. The funding increases capacity for Aspire Behavioral Health to operate beds that would have been closed otherwise due to funding cuts. AHO collaborates with multiple community partners on the priorities identified. These partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities and numerous non-profit entities. The greatest challenge identified in the work for this priority has been to recognize and break down silos. Often, it has been found that multiple organizations are working on similar initiatives. The Hospital is striving to act as a convener between partners to create alignments to better utilize resources. Community Needs Not Chosen by AdventHealth Orlando:The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. The Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else - or multiple groups - in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? **see continuation of footnote
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 1 -- AdventHealth OrlandoDescription of CHNA Significant Needs Continued Based on this prioritization process, the Hospital did not choose the following community issues:1. High rates of substance abuse: This issue was not chosen because addiction is understood to be a component of mental health. If AHO can positively affect access to mental health services, a component of the top priority chosen, this may also affect rates of substance abuse.2. Homelessness: While homelessness is a serious issue in Central Florida, the issue was not chosen because AHO is already working with community partners, including the Regional Commission on Homelessness, on this issue. In late 2014, the Hospital donated $6 million to the Commission's Housing First initiative. 3. Lack of affordable housing: This issue was not chosen because the Hospital does not have the resources to effectively address this need. 4. Poverty: This issue was not chosen because the Hospital does not have the resources to effectively address this need.5. Asthma: While asthma did emerge as a serious health concern in the area assessed, the Hospital did not choose this as a top priority because if the community has access to preventative and primary care, a component of the top priority chosen, this may also affect the rates of asthma. 6. Sexually transmitted infections (STIs): This issue was not chosen as a top priority because while the Hospital has the means to treat STIs, it does not have the resources to effectively prevent them. Additionally, if the community has access to preventative and primary care, a component of the top priority chosen, this may affect the rates of STIs.7. Diabetes in specific populations: This issue was not chosen specifically because it falls in the category of chronic disease, which relates to the top priority chosen. As AHO develops its Community Health Plan, it will factor in the higher prevalence of diabetes in minority populations. 8. Infant mortality in specific populations: This issue was not chosen specifically because it falls in the category of maternal and child health, which relates to the top priority chosen. As AHO develops its Community Health Plan, it will factor in the higher prevalence of infant mortality in minority populations.
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 2 -- AdventHealth Altamonte SpringsDescription of CHNA Significant Needs Continued Outcome 5: Increase access to knowledge of chronic disease self-management practicesThe Regional strategy for this outcome is to fund and implement the evidence-based Stanford Chronic Disease Self-Management Program in its targeted zip codes throughout the Region. AHAlt worked to implement the program in mid-2018 for the target zip codes for the Hospital. There was a less than anticipated response even with attempts to create an internal pipeline for the program from Hospital patients. The strategy was adjusted to offer the program at local community centers and churches rather than on the Hospital campuses. This shift to community locations has increased participation, although still below the goal. This Regional strategy will continue in 2019 with this program being offered in community locations.Outcome 6: Support opportunities that promote knowledge of chronic diseases within the primary service areaThe Regional strategy included monetary support for the American Heart Association for their disease education efforts. Funding continues to be provided at a Regional level of $500,000 over the course of three years. Since this strategy is implemented strictly as a funding donation on a Regional level, there is not a specific facility metric.As the Hospital looks at the successes and challenges that have come from its second year of implementation of the 2017 Community Health Plan, there are opportunities to better define strategies and expand outcomes to better serve its target populations. There are ongoing conversations and plans will be updated as needed. The Hospital collaborates with multiple community partners on the identified priorities. These partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities, and numerous non-profit entities. The biggest challenge that the Hospital has identified with this priority is aligning available programs with strong foundations and adequate resources for deployment.Priority 2: Access to Care - Primary and Mental Health 2016 Description of the Issue: AHAlt recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. The Hospital strives to increase access to primary and mental health care. The approach for the priority involves addressing affordability and access to appropriate-level care utilizing care navigation and coordination.2018 Update: The AHAlt Community Health Plan has four desired outcomes under the Access to Care - Primary and Mental Health priority. 1. Increase access to primary care services in Seminole County;2. Reduce emergency department readmissions;3. Maintain access to behavioral health services for victims of child abuse; and4. Provide behavioral health resources for the uninsured.Outcome 1: Increase access to primary services in Seminole CountyThe Regional approach to increasing access has grown to include four Regional strategies due to the complexity of the issue. The first Regional strategy is to continue to fund the AdventHealth Transitions Clinic (also known as the Trina Hidalgo Heart Care Center). This clinic provides follow-up care for cardiac issues to the uninsured who lack primary care. All funding is provided at a Regional level. The clinic serves Orange, Osceola, Seminole, and Lake County residents. The current tracking structure for the clinic does not allow for extraction of metrics by county at this time. In 2018, 314 patients were seen for a total of 3,889 visits across the Region.The Region also continued its funding of the AdventHealth Transitions Lung Clinic. This clinic provides care for underinsured and uninsured who are impacted by respiratory issues. This funding is provided at the Regional level and will be tracked moving forward on the AdventHealth Orlando plan. In 2018, 1,853 patients were served throughout the Region.The Community Care Program is a Regional initiative which focuses on clinically stabilizing patients in the community environment while addressing root causes (often social determinant based) of uninsured high utilizers of care with complex diagnoses. The Region funds the Community Care Program which enrolled 28 patients from the target population across the AHAlt area in 2018. The program was introduced during the 2018 year, which included development and implementation. Although the program saw less patients than originally estimated (the goal being 37), the Region has predicted that goals will be met in future years based on the progress in 2018.Another aspect of increasing access which was implemented in 2018 has been to utilize a Care Navigation team across the Region to connect uninsured patients to permanent medical homes through a partnership with local federally qualified healthcare clinics. The team assists with identifying and scheduling appointments for patients in order to ensure follow-up care is accessible. In 2018, 5,983 appointments were scheduled for Seminole County residents, which surpassed the goal of 4,000.Outcome 2: Reduce Emergency Department ReadmissionsThe Region funded the Community Paramedic Program which has been implemented at the AHAlt facility. The Community Paramedic Program provides a paramedic to help navigate the care of chronic patients for thirty days after discharge. The metric measured is the reduction in percentage of visits from chronic patients. A reduction of visits was seen in 16.67 percent of patients, which was slightly less than the goal of 20 percent. The main challenge for 2018 was a shortage of staff to meet the needs of the target population. This initiative will continue with Regional support and continued implementation at the Hospital campus.Outcome 3: Maintain access to behavioral health services for victims of child abuse The Regional strategy for this priority focused on providing monetary support to the Kid's House. Kid's House strives to serve victims of child abuse through offering coordinated services in a safe, child-friendly environment from report and investigation through treatment and resolution. The Regional funding totaled $400,000 in 2018. AHAlt also provides additional support through in-kind support of Kid's House initiatives as the closest hospital in the Region to the organization. This partnership will continue on both a Regional and Hospital level in 2019.Outcome 4: Provide behavioral health resources for the uninsuredThis Regional strategy includes partnering with Aspire Health Partners (Aspire). Aspire is a nonprofit which provides a full continuum of behavioral healthcare services across Central Florida Counties. The Region provides funding to enhance the capacity of Aspire to serve the community. The funding has become a necessity in order for Aspire to continue servicing the community due to behavioral health funding cuts. Although measured on a Regional level, the funding helps to serve patients for all of the Region's hospitals, including AHAlt.AHAlt collaborates with multiple community partners on its identified priorities. Partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities and numerous non-profit entities. The greatest challenge the Hospital has identified in the work for this priority has been to recognize and break down silos. Often the Hospital has found that multiple organizations are working on similar initiatives. The Hospital is striving to act as a convener between partners to create alignments and better utilize resources.Community Needs Not Chosen by AdventHealth Altamonte The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else - or multiple groups - in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? **see continuation of footnote
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 2 -- AdventHealth Altamonte SpringsDescription of CHNA Significant Needs Continued Based on this prioritization process, the Hospital did not choose the following community issues:1. High rates of substance abuse: This issue was not chosen because addiction is understood to be a component of mental health. If AHAlt can positively affect access to mental health services, a component of the top priority chosen, this may also affect rates of substance abuse.2. Homelessness: While homelessness is a serious issue in Central Florida, the issue was not chosen because AHAlt is already working with community partners, including the Regional Commission on Homelessness, on this issue. In late 2014, the Hospital donated $6 million to the Commission's Housing First initiative. 3. Lack of affordable housing: This issue was not chosen because the Hospital does not have the resources to effectively address this need. 4. Poverty: This issue was not chosen because the Hospital does not have the resources to effectively address this need.5. Asthma: While asthma did emerge as a serious health concern in the area assessed, the Hospital did not choose this as a top priority because if the community has access to preventative and primary care, a component of the top priority chosen, this may also affect the rates of asthma. 6. Sexually transmitted infections (STIs): This issue was not chosen as a top priority because while the Hospital has the means to treat STIs, it does not have the resources to effectively prevent them. Additionally, if the community has access to preventative and primary care, a component of the top priority chosen, this may affect the rates of STIs.7. Diabetes in specific populations: This issue was not chosen specifically because it falls in the category of chronic disease, which relates to the top priority chosen. As AHAlt develops its Community Health Plan, it will factor in the higher prevalence of diabetes in minority populations. 8. Infant mortality in specific populations: This issue was not chosen specifically because it falls in the category of maternal and child health, which relates to the top priority chosen. As AHAlt develops its Community Health Plan, it will factor in the higher prevalence of infant mortality in minority populations.
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 3 -- AdventHealth CelebrationDescription of CHNA Significant Needs Continued Outcome 5: Support opportunities that promote knowledge of chronic diseases within the primary service areaThe Regional strategy included monetary support for the American Heart Association for their disease education efforts. Funding continues to be provided at a Regional level of $500,000 over the course of three years. Since this strategy is implemented strictly as a funding donation on a Regional level, there is not a specific facility metric.As the Hospital looks at the successes and challenges that have come from its second year of implementation of the 2017 Community Health Plan, there are opportunities to better define strategies and expand outcomes to better serve its target populations. There are ongoing conversations and plans will be updated as needed. The Hospital collaborates with multiple community partners on the identified priorities. These partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities, and numerous non-profit entities. Priority 2: Access to Care - Primary and Behavioral/Mental Health 2016 Description of the Issue: AHC recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. The Hospital strives to increase access to primary and mental health care. The approach for the priority involves addressing affordability and access to appropriate-level care utilizing care navigation and coordination. 2018 Update: The AHC Community Health Plan has six desired outcome statements under the Access to Care - Primary and Behavioral Health priority. 1. Increase access to primary care for uninsured and underinsured residents by supporting community partners;2. Increase dental care access for uninsured and underinsured adults;3. Build primary care and other medical capacity in Osceola County;4. Increase access to primary care in Osceola County;5. Improve access to primary care services through transportation strategies; and6. Provide behavioral health resources for the uninsured.Outcome 1: Increase access to primary care for uninsured and underinsured residents by supporting community partnersFunding was provided at a Regional level to support the Osceola Council of Aging Free Chronic Care Clinic. The clinic provides health care to the uninsured and underinsured residents of AHC's service area. The total grant funding of $500,000 over a three-year period beginning 2017 will continue to increase capacity of the clinic. Outcome 2: Increase dental care access for uninsured and underinsured adultsFunding was provided at a Regional level to support a pilot Mobile Dental Van in conjunction with the Osceola Health Department and a larger pilot program. The program funding ended in 2018 and will not be continued in 2019. Outcome 3: Build primary care and other medical capacity in Osceola CountyAHC committed to providing monetary support as well as actively participating in the Community Vision's Health Leadership Council. The Council is the County's convening agency for health and social issues and is comprised of safety net providers. AHC currently has a representative serving on the Leadership Council. The convening and participation has led to several opportunities for alignment due to the opportunity to develop and strengthen partnerships with other organizations with a shared mission to serve the residents of Osceola County. The funding for 2018 was allocated, but an invoice is still pending from the Council to ensure that funding can be dispersed based on the partnership agreement. AHC will continue to support the work of the Council both financially and through council participation.Outcome 4: Increase access to primary care in Osceola CountyStrategies were developed on both a Regional and Hospital facility level to increase access to care. The first Regional strategy was to connect residents to the Community Care program. The Community Care Program is a Regional initiative which focuses on clinically stabilizing patients in the community environment while addressing root causes (often social determinant based) of uninsured high utilizers of care with complex diagnoses. The Region funds the Community Care Program which enrolled 10 patients from the target population in the AHC area. The program was introduced during the 2018 year, which included development and implementation. Although the program saw less patients than originally estimated (the goal being 37), the Region has predicted that goals will be met in future years based on the progress in 2018. Another aspect of increasing access, which was implemented in 2018, has been to utilize a Care Navigation team across the Region to connect uninsured patients to permanent medical homes through a partnership with local federally qualified healthcare clinics. The team assists with identifying and scheduling appointments for patients in order to ensure follow-up care is accessible. In 2018, 7,812 appointments were scheduled for Osceola County residents, which surpassed the goal of 4,000. The third strategy is to provide primary and secondary care services to underserved residents who would otherwise not have access to care through the HAPPI program. This Regionally funded program was implemented specifically for the Osceola County area. A total of 666 unique underserved residents of Osceola County received primary and secondary care services in 2018, which significantly surpassed the goal of 175. The HAPPI program will continue serving residents of Osceola County in 2019.The Region has continued to fund the AdventHealth Transitions Clinic (also known as the Trina Hidalgo Heart Care Center). This clinic provides follow-up care for cardiac issues to the uninsured who lack primary care. All funding is provided at a Regional level. The clinic serves Orange, Osceola, Seminole, and Lake County residents. The current tracking structure for the clinic does not allow for extraction of metrics by county at this time. In 2018, 314 patients were seen for a total of 3,889 visits throughout the Region.The Region also continued to fund and staff the AdventHealth Transitions Lung Clinic. This clinic provides care for underinsured and uninsured who are impacted by respiratory issues. The current tracking structure for the clinic does not allow for extraction of metrics by county at this time. In 2018, 1,853 patients were served throughout the Region.Outcome 5: Improve access to primary care services through transportation strategiesAHC partnered with the Florida Department of Transportation on their Complete Streets Study. Complete Streets is a national initiative focused on building transportation infrastructure that is designed and operated to enable safe access for all users, including pedestrians, bicyclists, motorists and transit riders of all ages and abilities. The goal is to increase safety and ease for those crossing the street, walking to shops, and bicycling to work. In 2018, the Hospital participated in the study led by the Florida Department of Health, which also included another partner, the Federally Qualified Health Centers (FQHCs) in the Region. The hope is that the Hospital's participation will help to reduce transportation barriers which have been cited as especially prevalent amongst those vulnerable populations across the Region. Outcome 6: Provide behavioral health resources for the uninsuredThe Region provides an annual $250,000 donation to Park Place Behavioral Health. Park Place Behavioral Health provides a full range of behavioral healthcare services designed to meet the diverse needs of the community including both inpatient and outpatient services. The funding increases capacity for Park Place Behavioral Health to operate beds that would have been closed otherwise due to funding cuts. AHC collaborates with multiple community partners on the priorities it has identified. These partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities and numerous non-profit entities. The greatest challenge AHC has identified in the work for this priority has been to recognize and break down silos. Often, AHC has found that multiple organizations are working on similar initiatives. AHC is striving to act as a convener between partners to create alignments to better utilize resources. **see continuation of footnote
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 3 -- AdventHealth CelebrationDescription of CHNA Significant Needs Continued Community Needs Not Chosen by AdventHealth Celebration: The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else - or multiple groups - in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? Based on this prioritization process, the Hospital did not choose the following community issues:1. High rates of substance abuse: This issue was not chosen because addiction is understood to be a component of mental health. If AHC can positively affect access to mental health services, a component of the top priority chosen, this may also affect rates of substance abuse.2. Homelessness: While homelessness is a serious issue in Central Florida, the issue was not chosen because AHC is already working with community partners, including the Regional Commission on Homelessness, on this issue. In late 2014, the Hospital donated $6 million to the Commission's Housing First initiative. 3. Lack of affordable housing: This issue was not chosen because the Hospital does not have the resources to effectively address this need. 4. Poverty: This issue was not chosen because the Hospital does not have the resources to effectively address this need.5. Asthma: While asthma did emerge as a serious health concern in the area assessed, the Hospital did not choose this as a top priority because if the community has access to preventative and primary care, a component of the top priority chosen, this may also affect the rates of asthma. 6. Sexually transmitted infections (STIs): This issue was not chosen as a top priority because while the Hospital has the means to treat STIs, it does not have the resources to effectively prevent them. Additionally, if the community has access to preventative and primary care, a component of the top priority chosen, this may affect the rates of STIs.7. Diabetes in specific populations: This issue was not chosen specifically because it falls in the category of chronic disease, which relates to the top priority chosen. As AHC develops its Community Health Plan, it will factor in the higher prevalence of diabetes in minority populations. 8. Infant mortality in specific populations: This issue was not chosen specifically because it falls in the category of maternal and child health, which relates to the top priority chosen. As AHC develops its Community Health Plan, it will factor in the higher prevalence of infant mortality in minority populations.
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 4 -- AdventHealth East OrlandoDescription of CHNA Significant Needs ContinuedOutcome 4: Support and create opportunities for increased quality of life for residents of Orange County The Regional strategy involved offering programming from Healthy Central Florida (HCF) to the service areas that AHEO reaches. The goal of HCF is to make Central Florida communities the healthiest in the nation. This initiative began with three target communities - Winter Park, Maitland and Eatonville. In 2018, HCF experienced staff and internal strategy changes. The program has been temporarily taken offline while it is retooled to have a greater focus on underserved populations. Although the program has been offered to individuals in the targeted areas before, the goal is to ensure that future efforts are more inclusive of the underserved populations. Outcome 5: Increase access to knowledge of chronic disease self-management practices This is a Regional strategy, which initially rolled out with the expectation of Regional deployment and is funded at a Regional level. The strategy for this outcome is to implement the evidence-based Stanford Chronic Disease Self-Management Program in targeted areas. The original intention to create an internal pipeline for the program from Hospital patients was not successful. Although the program was offered through the Hospital, there were very few individuals who chose to enroll. The strategy was rethought due to challenges across the Region and is now being offered through local community centers and churches. This seems to have increased participation in other service areas the program is offered in. The same results were not seen in East Orlando, which has led to the decision to remove this program from the East Orlando plan. The program will still be offered through partner organizations in the area. The Hospital recognized that the minimum participation requirements through Stanford proved to be a barrier at every campus, especially East Orlando. The program will continue throughout the Region where minimum attendance requirements have been met. Outcome 6: Support opportunities that promote knowledge of chronic diseases within the primary service areaThe Regional strategy included providing monetary support for the American Heart Association for their disease education efforts. Funding continues to be provided at a Regional level of $500,000 over the course of three years. Since this strategy is implemented strictly as a funding donation on a Regional level, there is not a specific facility metric.As the Hospital looks at the successes and challenges that have come from its second year of implementation of the 2017 Community Health Plan, there are opportunities to better define strategies and expand outcomes to better serve its target populations. There are ongoing conversations and plans will be updated as needed. The Hospital collaborates with multiple community partners on the identified priorities. These partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities, and numerous non-profit entities. The biggest challenge that the Hospital has identified with this priority is aligning available programs with strong foundations, participation, and adequate resources for deployment.Priority 2: Access to Care - Primary and Behavioral/Mental Health 2016 Description of the Issue: AHEO recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. The Hospital strives to increase access to primary and mental health care. The approach for the priority involves addressing affordability and access to appropriate-level care utilizing care navigation and coordination.2018 Update: The AHEO Community Health Plan has two desired outcomes under the Access to Care - Primary and Behavioral/Mental Health priority. 1. Increase access to primary care services in Orange County; and2. Provide behavioral health resources for the uninsured.Outcome 1: Increase access to primary care services in Orange CountyThe Region has developed six strategies to accomplish the desired outcome. The first strategy involved maintaining the East Orlando Community Medicine Clinic, a clinic run by AHEO at the AHEO campus to serve uninsured residents in Orange County. The clinic is funded by the Region. The metric for this strategy has a goal of the number of patients seen. 5,785 patients were served throughout Orange County, surpassing the goal for the Region. The Region has continued to fund the AdventHealth Transitions Clinic (also known as the Trina Hidalgo Heart Care Center). This clinic provides follow-up care for cardiac issues to the uninsured who lack primary care. All funding is provided at a Regional level. The clinic serves Orange, Osceola, Seminole, and Lake County residents. The current tracking structure for the clinic does not allow for extraction of metrics by county at this time. In 2018, 314 patients were seen for a total of 3,889 visits throughout the Region.The Region also continued to fund and staff the AdventHealth Transitions Lung Clinic. This clinic provides care for underinsured and uninsured who are impacted by respiratory issues. The current tracking structure for the clinic does not allow for extraction of metrics by county at this time. In 2018, 1,853 patients were served throughout the Region.The fourth Regional strategy involved connecting uninsured patients to permanent medical homes. The strategy was developed by a partnership of the Care navigation team and local federally qualified healthcare clinics. The Care navigation team schedules appointments for the patients. This is part of an AdventHealth Regional initiative which originally only provided data at a Regional level, but are now able to be measured at a campus level. In 2018, 30,530 referrals were provided through this initiative at the AHEO campus which contributed to surpassing the goal on both a facility and Regional level. The fifth Regional strategy involved connecting residents to the Community Care program. All funding for this program is provided at the Regional level. The Community Care program focuses on clinically stabilizing the patient in the community environment and addressing root causes (often social determinant based) of utilization for high utilizers who are uninsured and complex patients. In 2018, 68 patients were enrolled which surpassed the goal of 37. This program will continue in 2019. The final strategy is a Hospital strategy to connect eligible residents to permanent medical homes via an employee from a local federally qualified healthcare clinic who is embedded in the Hospital. All funding for this program is provided at the Regional level. In 2018, 1,399 appointments were made which surpassed the goal of 800. The program will continue at AHEO in 2019. Outcome 2: Provide behavioral health resources for the uninsuredThe Regional strategy is to provide Aspire Health Partners with funding to operate beds that would have been closed otherwise due to funding cuts. Aspire Health Partners is committed to providing individuals and families of Central Florida with compassionate, comprehensive and cost-effective behavioral health care services that lead to successful living and healthy, responsible lifestyles. All funding for this program is provided at the Regional level. The Hospital collaborates with multiple community partners on its identified priorities. Partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities and numerous non-profit entities. The greatest challenge the Hospital has identified in the work for this priority has been to recognize and break down silos. Often, the Hospital has found that multiple organizations are working on similar initiatives. The Hospital is striving to act as a convener between partners to create alignments to better utilize resources.**see continuation of footnote
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 4 -- AdventHealth East OrlandoDescription of CHNA Significant Needs Continued Community Needs Not Chosen by AdventHealth East Orlando: The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else - or multiple groups - in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? Based on this prioritization process, the Hospital did not choose the following community issues:1. High rates of substance abuse: This issue was not chosen because addiction is understood to be a component of mental health. If AHEO can positively affect access to mental health services, a component of the top priority chosen, this may also affect rates of substance abuse.2. Homelessness: While homelessness is a serious issue in Central Florida, the issue was not chosen because AHEO is already working with community partners, including the Regional Commission on Homelessness, on this issue. In late 2014, the Hospital donated $6 million to the Commission's Housing First initiative. 3. Lack of affordable housing: This issue was not chosen because the Hospital does not have the resources to effectively address this need. 4. Poverty: This issue was not chosen because the Hospital does not have the resources to effectively address this need.5. Asthma: While asthma did emerge as a serious health concern in the area assessed, the Hospital did not choose this as a top priority because if the community has access to preventative and primary care, a component of the top priority chosen, this may also affect the rates of asthma. 6. Sexually transmitted infections (STIs): This issue was not chosen as a top priority because while the Hospital has the means to treat STIs, it does not have the resources to effectively prevent them. Additionally, if the community has access to preventative and primary care, a component of the top priority chosen, this may affect the rates of STIs.7. Diabetes in specific populations: This issue was not chosen specifically because it falls in the category of chronic disease, which relates to the top priority chosen. As AHEO develops its Community Health Plan, it will factor in the higher prevalence of diabetes in minority populations. 8. Infant mortality in specific populations: This issue was not chosen specifically because it falls in the category of maternal and child health, which relates to the top priority chosen. As AHEO develops its Community Health Plan, it will factor in the higher prevalence of infant mortality in minority populations.
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 5 -- AdventHealth Winter Park Description of CHNA Significant Needs Continued Outcome 6: Support opportunities that promote knowledge of chronic diseases within the primary service areaThe Regional strategy included providing monetary support for the American Heart Association for their disease education efforts. Funding continues to be provided at a Regional level of $500,000 over the course of three years. Since this strategy is implemented strictly as a funding donation on a Regional level, there is not a specific facility metric.As the Hospital looks at the successes and challenges that have come from its second year of implementation of the 2017 Community Health Plan, there are opportunities to better define strategies and expand outcomes to better serve its target populations. There are ongoing conversations and plans will be updated as needed. The Hospital collaborates with multiple community partners on the identified priorities. These partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities, and numerous non-profit entities. The biggest challenge that the Hospital has identified with this priority is aligning available programs with strong foundations, participation, and adequate resources for deployment.Priority 2: Access to Care - Primary and Behavioral/Mental Health 2016 Description of the Issue: AHWP recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. AHWP strives to increase access to primary and mental health care. The approach for the priority involves addressing affordability and access to appropriate-level care utilizing care navigation and coordination.2018 Update: The AHWP Community Health Plan has two desired outcomes under the Access to Care - Primary and Behavioral/Mental Health priority. 1. Increase access to primary care services in Orange County; and2. Provide behavioral health resources for the uninsured.Outcome 1: Increase access to primary care services in Orange CountyThere are five strategies associated with this outcome. The first strategy is to provide senior care navigation services for vulnerable seniors who have been identified in the Emergency Department. This program provides care plans after emergency department visits for seniors to minimize repeat visits. This program only runs and is funded through the AdventHealth Winter Park Campus. The Hospital met 95 percent of the set metric with 1,425 seniors receiving services in the target area in 2018. This initiative will continue in 2019.The second Regional strategy is to connect uninsured patients to permanent medical homes. The strategy was developed through a partnership between the care navigation team and local federally qualified healthcare clinics. The care navigation team schedules the appointments for the patients. This Regional program originally tracked data at the Regional level. Moving forward, the Hospital is now able to capture and report impact on a campus level. In 2018, 874 patients received referrals from AHWP which contributed to surpassing the Regional goal as well as the newly established Hospital goal. The third Regional strategy is to connect residents to the Community Care program. All funding for this program is provided at the Regional level. The Community Care program focuses on clinically stabilizing the patient in the community environment and addressing root causes (often social determinant based) of utilization for high utilizers who are uninsured and complex patients. During program deployment, it was determined that AHWP would offer the program on a referral only basis based on the available resources and area of need. The fourth strategy is a Regional strategy to continue funding the AdventHealth Transitions Clinic (also known as the Trina Hidalgo Heart Care Center). This clinic provides follow-up care for cardiac issues to the uninsured who lack primary care. All funding is provided at a Regional level. The clinic serves Orange, Osceola, Seminole, and Lake County residents. The current tracking structure for the clinic does not allow for extraction of metrics by county at this time. In 2018, 314 patients were seen for a total of 3,889 visits throughout the Region.The Region also continued to fund and staff the AdventHealth Transitions Lung Clinic. This clinic provides care for underinsured and uninsured who are impacted by respiratory issues. The current tracking structure for the clinic does not allow for extraction of metrics by county at this time. In 2018, 1,853 patients were served throughout the Region.Outcome 2: Provide behavioral health resources for the uninsured The Regional strategy is to provide Aspire Health Partners with funding to operate beds that would have been closed otherwise due to funding cuts. Aspire Health Partners is committed to providing individuals and families of Central Florida with compassionate, comprehensive and cost-effective behavioral health care services that lead to successful living and healthy, responsible lifestyles. All funding for this program is provided at the Regional level. The Hospital collaborates with multiple community partners on its identified priorities. Partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities and numerous non-profit entities. The greatest challenge the Hospital has identified in the work for this priority has been to recognize and break down silos. Often, the Hospital has found that multiple organizations are working on similar initiatives. The Hospital is striving to act as a convener between partners to create alignments to better utilize resources.Community Needs Not Chosen by AdventHealth Winter Park: The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else - or multiple groups - in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? Based on this prioritization process, the Hospital did not choose the following community issues:1. High rates of substance abuse: This issue was not chosen because addiction is understood to be a component of mental health. If AHWP can positively affect access to mental health services, a component of the top priority chosen, this may also affect rates of substance abuse.2. Homelessness: While homelessness is a serious issue in Central Florida, the issue was not chosen because AHWP is already working with community partners, including the Regional Commission on Homelessness, on this issue. In late 2014, the Hospital donated $6 million to the Commission's Housing First initiative. 3. Lack of affordable housing: This issue was not chosen because the Hospital does not have the resources to effectively address this need. 4. Poverty: This issue was not chosen because the Hospital does not have the resources to effectively address this need.5. Asthma: While asthma did emerge as a serious health concern in the area assessed, the Hospital did not choose this as a top priority because if the community has access to preventative and primary care, a component of the top priority chosen, this may also affect the rates of asthma. 6. Sexually transmitted infections (STIs): This issue was not chosen as a top priority because while the Hospital has the means to treat STIs, it does not have the resources to effectively prevent them. Additionally, if the community has access to preventative and primary care, a component of the top priority chosen, this may affect the rates of STIs.7. Diabetes in specific populations: This issue was not chosen specifically because it falls in the category of chronic disease, which relates to the top priority chosen. As AHWP develops its Community Health Plan, it will factor in the higher prevalence of diabetes in minority populations. 8. Infant mortality in specific populations: This issue was not chosen specifically because it falls in the category of maternal and child health, which relates to the top priority chosen. As AHWP develops its Community Health Plan, it will factor in the higher prevalence of infant mortality in minority populations.
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 6 -- AdventHealth KissimmeeDescription of CHNA Significant Needs Continued As the Hospital looks at the successes and challenges that have come from its second year of implementation of the 2017 Community Health Plan, there are opportunities to better define strategies and expand outcomes to better serve its target populations. There are ongoing conversations and plans will be updated as needed. The Hospital collaborates with multiple community partners on the identified priorities. These partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities, and numerous non-profit entities. Priority 2: Access to Care - Primary and Behavioral/Mental Health 2016 Description of the Issue: AHK recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. The Hospital strives to increase access to primary and mental health care. The approach for the priority involves addressing affordability and access to appropriate-level care, utilizing care navigation and coordination.2018 Update: The AHK Community Health Plan has six desired outcome statements under the Access to Care - Primary and Behavioral Health priority.1. Increase access to primary care for uninsured and underinsured residents by supporting community partners;2. Increase dental care access for uninsured and underinsured adults;3. Build primary care and other medical capacity in Osceola County;4. Increase access to primary care in Osceola County;5. Improve access to primary care services through transportation strategies; and6. Provide behavioral health resources for the uninsured.Outcome 1: Increase access to primary care for uninsured and underinsured residents by supporting community partnersFunding was provided at a Regional level to support the Osceola Council of Aging Free Chronic Care Clinic. The clinic provides health care to the uninsured and underinsured residents of AHK's service area. The total grant funding of $500,000 over a three-year period beginning 2017 will continue to increase capacity of the clinic. Outcome 2: Increase dental care access for uninsured and underinsured adultsFunding was provided at a Regional level to support a pilot Mobile Dental Van in conjunction with the Osceola Health Department and a larger pilot program. The program funding ended in 2018 and will not be continued in 2019. Outcome 3: Build primary care and other medical capacity in Osceola CountyAHK committed to providing monetary support as well as actively participating in the Community Vision's Health Leadership Council. The Council is the County's convening agency for health and social issues and is comprised of safety net providers. The Hospital currently has a representative serving on the Leadership Council. The convening and participation has led to several opportunities for alignment due to the opportunity to develop and strengthen partnerships with other organizations with a shared mission to serve the residents of Osceola County. The funding for 2018 was allocated, but an invoice is still pending from the Council to ensure that funding can be dispersed based on the partnership agreement. AHK will continue to support the work of the Council both financially and through council participation.Outcome 4: Increase access to primary care in Osceola CountyStrategies were developed on both a Regional and facility level to increase access to care. The first Regional strategy was to connect residents to the Community Care Program. The Community Care Program is a Regional initiative which focuses on clinically stabilizing patients in the community environment while addressing root causes (often social determinant based) of uninsured high utilizers of care with complex diagnoses. The Region funds the Community Care Program which enrolled 11 patients from the target population in the AHK area. The program was introduced during the 2018 year, which included development and implementation. Although the program saw less patients than originally estimated (the goal being 37), the Region has predicted that goals will be met in future years based on the progress in 2018. Another aspect of increasing access which was implemented in 2018 has been to utilize a Care Navigation team across the Region to connect uninsured patients to permanent medical homes through a partnership with local federally qualified healthcare clinics. The team assists with identifying and scheduling appointments for patients in order to ensure follow-up care is accessible. In 2018, 7,812 appointments were scheduled for Osceola County residents, which surpassed the goal of 4,000. The third strategy is to provide primary and secondary care services to underserved residents who would otherwise not have access to care through the HAPPI program. This Regionally funded program was implemented specifically for the Osceola County area. A total of 666 unique underserved residents of Osceola County received primary and secondary care services in 2018, which significantly surpassed the goal of 175. The HAPPI program will continue serving residents of Osceola County in 2019.The Region has continued to fund the AdventHealth Transitions Clinic (also known as the Trina Hidalgo Heart Care Center). This clinic provides follow-up care for cardiac issues to the uninsured who lack primary care. All funding is provided at a Regional level. The clinic serves Orange, Osceola, Seminole, and Lake County residents. The current tracking structure for the clinic does not allow for extraction of metrics by county at this time. In 2018, 314 patients were seen for a total of 3,889 visits throughout the Region.The Region also continued to fund and staff the AdventHealth Transitions Lung Clinic. This clinic provides care for underinsured and uninsured who are impacted by respiratory issues. The current tracking structure for the clinic does not allow for extraction of metrics by county at this time. In 2018, 1,853 patients were served throughout the Region.Outcome 5: Improve access to primary care services through transportation strategiesAHK partnered with AdventHealth Celebration and the Florida Department of Transportation on their Complete Streets Study. Complete Streets is a national initiative focused on building transportation infrastructure that is designed and operated to enable safe access for all users, including pedestrians, bicyclists, motorists and transit riders of all ages and abilities. The goal is to increase safety and ease for those crossing the street, walking to shops, and bicycling to work. In 2018, the Hospital participated in the study led by the Florida Department of Health, which also included another partner, the Federally Qualified Health Centers (FQHCs) in the Region. The hope is that the Hospital's participation will help to reduce transportation barriers which have been cited as especially prevalent amongst those vulnerable populations across the Region. Outcome 6: Provide behavioral health resources for the uninsuredThe Region provides an annual $250,000 donation to Park Place Behavioral Health. Park Place Behavioral Health provides a full range of behavioral healthcare services designed to meet the diverse needs of the community including both inpatient and outpatient services. The funding increases capacity for Park Place Behavioral Health to operate beds that would have been closed otherwise due to funding cuts. AHK collaborates with multiple community partners on the priorities it has identified. These partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities and numerous non-profit entities. The greatest challenge the Hospital has identified in the work for this priority has been to recognize and break down silos. Often, the Hospital has found that multiple organizations are working on similar initiatives. AHK is striving to act as a convener between partners to create alignments to better utilize resources. **see continuation of footnote
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 6 -- AdventHealth KissimmeeDescription of CHNA Significant Needs Continued Community Needs Not Chosen by AdventHealth Kissimmee: The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else - or multiple groups - in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? Based on this prioritization process, the Hospital did not choose the following community issues:1. High rates of substance abuse: This issue was not chosen because addiction is understood to be a component of mental health. If AHK can positively affect access to mental health services, a component of the top priority chosen, this may also affect rates of substance abuse.2. Homelessness: While homelessness is a serious issue in Central Florida, the issue was not chosen because AHK is already working with community partners, including the Regional Commission on Homelessness, on this issue. In late 2014, the Hospital donated $6 million to the Commission's Housing First initiative. 3. Lack of affordable housing: This issue was not chosen because the Hospital does not have the resources to effectively address this need. 4. Poverty: This issue was not chosen because the Hospital does not have the resources to effectively address this need.5. Asthma: While asthma did emerge as a serious health concern in the area assessed, the Hospital did not choose this as a top priority because if the community has access to preventative and primary care, a component of the top priority chosen, this may also affect the rates of asthma. 6. Sexually transmitted infections (STIs): This issue was not chosen as a top priority because while the Hospital has the means to treat STIs, it does not have the resources to effectively prevent them. Additionally, if the community has access to preventative and primary care, a component of the top priority chosen, this may affect the rates of STIs.7. Diabetes in specific populations: This issue was not chosen specifically because it falls in the category of chronic disease, which relates to the top priority chosen. As AHK develops its Community Health Plan, it will factor in the higher prevalence of diabetes in minority populations. 8. Infant mortality in specific populations: This issue was not chosen specifically because it falls in the category of maternal and child health, which relates to the top priority chosen. As AHK develops its Community Health Plan, it will factor in the higher prevalence of infant mortality in minority populations.
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 8 -- AdventHealth ApopkaDescription of CHNA Significant Needs Continued Priority 2: Access to Care - Primary and Behavioral/Mental Health 2016 Description of the Issue: AHApk recognizes the important impact that access, knowledge and lifestyle have in the health and well-being of an individual. The Hospital strives to increase access to primary and mental health care. The approach for the priority involves addressing affordability and access to appropriate-level care utilizing care navigation and coordination.2018 Update: The AHApk Community Health Plan has two desired outcomes under the Access to Care - Primary and Behavioral/Mental Health priority. 1. Increase access to primary care services in Orange County; and2. Provide behavioral health resources for the uninsured.Outcome 1: Increase access to primary care services in Orange CountyThe Regional approach to increasing access has grown to include six Regional strategies due to the complexity of the issue. The first Regional strategy is to continue to fund the AdventHealth Transitions Clinic (also known as the Trina Hidalgo Heart Care Center). The clinic provides follow-up care for cardiac issues to the uninsured who lack primary care. All funding is provided at a Regional level. The clinic serves Orange, Osceola, Seminole, and Lake County residents. The current tracking structure for the clinic does not allow for extraction of metrics by county at this time. In 2018, 314 patients were seen for a total of 3,889 visits across the Region. The Region also continued its funding of the AdventHealth Transitions Lung Clinic. This clinic provides care for underinsured and uninsured who are impacted by respiratory issues. This funding is provided at the Regional level and will be tracked moving forward on the AdventHealth Orlando plan. In 2018, 1,853 patients received treatment through the clinic throughout the AdventHealth Central Florida Division South Region.The Adventist University Hope Clinic is another resource funded at the Regional level. The clinic provides occupational and physical therapy as well as additional services to uninsured and underinsured individuals who experience financial barriers to care. Although the clinic is located in the AHApk area, it is able to serve patients from the entire Region's service area. In 2018, 84 patients received services during a total of 2,723 visits, which surpassed the annual goal.The Community Care Program is a Regional initiative which focuses on clinically stabilizing patients in the community environment while addressing root causes (often social determinant based) of uninsured high utilizers of care with complex diagnoses. The Region funds the Community Care Program which enrolled 30 patients from the target population across the Region in 2018. The program was introduced during the 2018 year, which included development and implementation. Although the program saw less patients than originally estimated (the goal being 37), the Region has predicted that goals will be met in future years based on the progress in 2018.Another aspect of increasing access which was implemented in 2018 has been to utilize a Care Navigation team across the Region to connect uninsured patients to permanent medical homes through a partnership with local federally qualified healthcare clinics. The team assists with identifying, and scheduling appointments for patients in order to ensure follow-up care is accessible. In 2018, 7,536 appointments were scheduled for Orange County residents, which surpassed the goal of 4,000.This Regional strategy was strengthened even further by embedding a Federally Qualified Health Center (FQHC) employee into multiple AdventHealth hospital campuses to work directly with patients in finding a medical home. AHApk and AdventHealth East Orlando both included the employee on their campuses to help assist with making appointments for the target population of Orange County residents who require a medical home. In 2018, 1,103 patients received appointments, which surpassed the goal of 800. Outcome 2: Provide behavioral health resources for the uninsuredThis Regional strategy includes partnering with Aspire Health Partners (Aspire). Aspire is a nonprofit which provides a full continuum of behavioral healthcare services across Central Florida Counties. The Region provides funding to enhance the capacity of Aspire to serve the community. The funding has become a necessity in order for Aspire to continue servicing the community due to behavioral health funding cuts. Although measured on a Regional level, the funding helps to serve patients for all of the Region's hospitals, including AHApk.AHApk collaborates with multiple community partners on its identified priorities. Partners include, but are not limited to, county health departments, federally qualified healthcare clinics, faith communities and numerous non-profit entities. The greatest challenge the Hospital has identified in the work for this priority has been to recognize and break down silos. Often, the Hospital has found that multiple organizations are working on similar initiatives. The Hospital is striving to act as a convener between partners to create alignments and better utilize resources.Issues that will not be addressed by AdventHealth Apopka HospitalThe primary and secondary data in the Community Health Needs Assessment identified multiple community issues. Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else - or multiple groups - in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? Based on this prioritization process, the Hospital did not choose the following community issues:1. High rates of substance abuse: This issue was not chosen because addiction is understood to be a component of mental health. If AHApk can positively affect access to mental health services, a component of the top priority chosen, this may also affect rates of substance abuse.2. Homelessness: While homelessness is a serious issue in Central Florida, the issue was not chosen because AHApk is already working with community partners, including the Regional Commission on Homelessness, on this issue. In late 2014, the Hospital donated $6 million to the Commission's Housing First initiative. 3. Lack of affordable housing: This issue was not chosen because the Hospital does not have the resources to effectively address this need. 4. Poverty: This issue was not chosen because the Hospital does not have the resources to effectively address this need.5. Asthma: While asthma did emerge as a serious health concern in the area assessed, the Hospital did not choose this as a top priority because if the community has access to preventative and primary care, a component of the top priority chosen, this may also affect the rates of asthma. 6. Sexually transmitted infections (STIs): This issue was not chosen as a top priority because while the Hospital has the means to treat STIs, it does not have the resources to effectively prevent them. Additionally, if the community has access to preventative and primary care, a component of the top priority chosen, this may affect the rates of STIs.7. Diabetes in specific populations: This issue was not chosen specifically because it falls in the category of chronic disease, which relates to the top priority chosen. As AHApk develops its Community Health Plan, it will factor in the higher prevalence of diabetes in minority populations. 8. Infant mortality in specific populations: This issue was not chosen specifically because it falls in the category of maternal and child health, which relates to the top priority chosen. As AHApk develops its Community Health Plan, it will factor in the higher prevalence of infant mortality in minority populations.
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 9 -- Central Texas Medical CenterDescription of CHNA Significant Needs Continued Priority 2: Healthier Management of Lifestyle2016 Description of the Issue: Hays and Caldwell Counties exceed the averages for a number of key health indicators most notably the lack of physical activity. In the Hospital's primary service area, 23 percent of adults aged 20 and older self-report no leisure time for activity, based on the question "during the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise"? This indicator is relevant because current behaviors are determinants of future health and this indicator may illustrate a cause of significant health issues such as obesity and poor cardiovascular health. 2018 Update: Our first outcome statement was to promote the ideals of healthy living by developing programs built on the AdventHealth CREATION Health principles. Our 2018 goal was to offer five CREATION Health workshops and we exceeded this expectation by offering eight workshops. We will continue collaborating with area organizations to offer CREATION Health seminars and trainings. Our second strategy was to increase participation in Central Texas Medical Center's CREATION Health Fitness Day which is offered free for the community. Our 2018 goal was to have 450 attendees and we exceeded with an attendance of 460 people. We will continue offering this event and providing education and resources for individuals and their families to learn about health and wellness.Our third strategy was to provide low income residents access to health screenings to provide a baseline for making healthier lifestyle choices. We collaborated with local organizations and distributed free vouchers to the annual Central Texas Medical Center HealthCheck. These vouchers provided free tests such as a lipid panel, complete blood cell count and complete metabolic panel. Our 2018 goal was to distribute 325 vouchers and have 60 vouchers redeemed. We exceeded this goal with a total of 450 vouchers distributed and 124 redeemed. We will continue offering these vouchers as part of the HealthCheck program. Priority 3: Management of Heart Disease/Congestive Heart Failure (CHF) and Related Conditions2016 Description of the Issue: Within the Hospital's report area, the rate of death due to coronary heart disease per 100,000 population is 167.25. In Caldwell County, it is 186.7 as compared to the state number of 175.7 and the national rate of 175. This indicator is relevant because heart disease is a leading cause of death in the United States. These statistics are especially revealing as many patients with cardiovascular disease generally have multiple chronic diseases including diabetes. 2018 Update: Our first outcome objective was to provide access to un/underinsured patients who qualified for outpatient cardiac rehab. Our goal was to increase the capacity of outpatient cardiac rehabilitation and provide services to at least five un/underinsured patients in 2018. We were able to extend this offer to nine patients and had one patient accept. We will continue to offer outpatient cardiac rehab for our un/underinsured patients. Our second strategy was to offer free blood pressure screenings at Central Texas Medical Center and throughout the community with education on hypertension and heart disease. Our goal for 2018 was to provide 425 blood pressure screenings and we provided 520 blood pressure screenings. We will continue offering free blood pressure screenings at Central Texas Medical Center and throughout the community.Our third strategy was to collaborate with local organizations to distribute vouchers for free carotid artery and peripheral arterial disease screenings, including education. Our goal in 2018 was to distribute 20 carotid artery vouchers and 20 peripheral arterial disease vouchers. We exceeded this goal by distributing 25 carotid artery vouchers and 25 peripheral arterial disease vouchers. We will continue distributing these vouchers to those in most need throughout our community.Priority 4: Management of Diabetes2016 Description of the Issue: It is projected that by 2040, 23.8 percent of Texans will have diabetes; 23.1 percent or 112,455 of Hays County residents and 25.2 percent or 12,436 of Caldwell County residents will be diagnosed with the disease. Research highlights that medical expenditures for people with diabetes is about 2.3 times higher than medical expenditures for those who are not diabetic. Expected population growth over the next several years is expected to exacerbate the prevalence of diabetes and associated complications, and consequently, the need for health care services and access to health care providers. 2018 Update: Our first outcome strategy was to increase awareness and early detection of diabetes by offering free monthly blood glucose screenings and diabetes risk assessments based on American Diabetes Association guidelines. Our 2018 goal was to average 54 blood glucose screenings and risk assessments and we exceeded this goal by averaging 73 per month. We will continue offering these free screenings to our community.Our second outcome objective was to improve compliance with short and long-term diabetes control and management. Our strategy was to provide all diabetes education class participants with up to four individualized follow-up visits with a Diabetes Educator focusing on lifestyle changes (over a 12-month period). Our 2018 goal was to have at least 43.8 percent of diabetes education participants receiving at least 2 follow-up visits over a 12-month period. We exceeded this goal by having 52 percent of diabetes education participants receiving at least 2 follow-up visits over a 12-month period. Our third outcome strategy was to provide individuals diagnosed with diabetes and their family members ongoing opportunities for education, accountability and encouragement to adopt and maintain successful diabetes management and control. Our strategy is to offer a free diabetes support group every two weeks. We averaged eight attendees throughout the year. Our main challenge is that there are other support groups that are taking place at CTMC that some of these same attendees also attend (i.e. weight loss support group). Transportation is another barrier for those interested in attending. Central Texas Medical Center will explore what can be done to improve our attendance. Priority 5: Education2016 Description of the Issue: According to participants in the primary data collection phase, a lack of education and economic inequalities lead to poor lifestyle decisions such as unhealthy diets and a lack of exercise. Diabetes is a significant health problem partly due to lack of access to healthy foods and lack of knowledge about healthy eating. Many health problems are exacerbated by the challenges of finding providers, navigating the health care system and managing medication. Assessment participants stressed the need for community-based strategies and interventions at early ages that promote healthy behaviors.**see continuation of footnote
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 9 -- Central Texas Medical CenterDescription of CHNA Significant Needs Continued2018 Update: Our first outcome strategy was improved management of hospitalized un/underinsured patients in an outpatient/home setting. We were able to provide 56 percent of un/underinsured patients a referral to a medical home prior to discharge from Central Texas Medical Center. We will continue to strive toward our goal of 80% of un/underinsured patients receiving referrals prior to discharge.Our second outcome strategy was to improve the community's understanding of healthcare resources provided through Central Texas Medical Center, Live Oak Health Partners, and associated clinics. Our strategy was to establish a Patient Family Advisory Council (PFAC) that will advocate for community resources based on their experience with Central Texas Medical Center, Live Oak Health Partners and other associated clinics. Our 2018 goal was for PFAC members to develop an action plan that will address at least two identified Central Texas Medical Center and community needs. PFAC exceeded this goal by identifying 3 needs and executing initiatives addressing these needs. Our third outcome strategy was to develop support groups for individuals facing cancer, especially for our Spanish speaking population. The strategy was to facilitate free breast cancer support groups with an emphasis on navigation of healthcare resources. Our 2018 goal was to provide 12 meetings. Due to transition with the navigator position, we did not meet this goal. The Navigator was hired November 2018 so there were not support groups being held in 2018. Central Texas Medical Center is working closely with the Navigator to provide support groups in 2019. Our fourth outcome strategy was to improve access to mammograms for low-income individuals. The strategy was to expand the timeframe to redeem free mammogram vouchers and conduct follow-ups to ensure that individuals accessed the screening. The 2018 goal was to have at least 80 vouchers redeemed and we exceeded this goal by having 102 vouchers redeemed. Priority 6: Management of Mental and Behavioral Health2016 Description of the Issue: Hays County specifically has a mental health provider shortage with 86 providers per 100,000 population as compared to the state average of 96.7 and the national average of 189. The County, hospital emergency rooms, police department and school counselors often have to respond to crises. There are very few mental and behavioral health care resources aimed at serving the mental health needs of the community, especially for children, before emergencies develop. Assessment participants raised concerns about residents with very serious mental health problems who often require extensive treatment and case management. 2018 Update: Our first outcome strategy was to increase coordination of community organizations to better meet the psychiatric needs of the community. The strategy was to develop a cross-functional community committee including law enforcement, Central Texas Medical Center, Texas State University, Live Oak Health Partners and local mental health providers. The 2018 goal was to provide two meetings and this goal was exceeded with a total of seven meetings being held. We also set a goal to provide family members ongoing opportunities for education and encouragement. Two support groups were offered for families with a loved one with mental/behavioral challenges. We will continue offering these services in 2019.The third outcome strategy was to educate the community residents about the mental and behavioral health care options available. The strategy was to offer free, educational presentations at local churches, businesses, civic groups, etc. CTMC hosted four presentations in 2018 and will continue this in 2019.Community Needs Not Chosen by Central Texas Medical Center:The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else or multiple groups in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? Based on this prioritization process, the Hospital did not choose the following community issues:Issues that will not be addressed by Central Texas Medical Center:1. Prevalence and/or enhanced outpatient management of chronic respiratory diseasesWhile this is an important initiative, beyond adding two pulmonologists to our medical staff in recent months, the committee determined that other needs were more acute and in need of additional focus and resources.2. Providing additional dental health resourcesWhile serious in nature, Central Texas Medical Center does not currently have the resources to materially impact this community need at this time.3. Education and information related to alcohol, tobacco and substance abuseThe Committee believed that current programs available in the community were better suited to address the needs related to alcohol, tobacco and substance abuse.
Part V, Section B, Line 11 Continuation of Footnote	Group A-Facility 10 -- AdventHealth WauchulaDescription of CHNA Significant Needs Continued Priority 3: Access to Primary Care2016 Description of the Issue: In Hardee County, Florida, 38.86 percent of adults aged 19 and older are uninsured while the state rate is 28.78 percent. The uninsured rate for children 18 and younger is 14.43 percent compared to the state average of 11.86 percent. 26.9 percent of adults self-report that they do not have a source for primary care. The rate of dentists per 100,000 population is only 29.1. Hardee County is a socio-economically disadvantaged, rural, agricultural county officially designated as a Health Professionals Shortage area by the US Department of Health and Human Services. Health Professionals Shortage Areas have shortages of primary medical care, dental or mental health providers. Hardee County has shortages in all three areas.2018 Update:Strategies for this priority included increasing community awareness of the availability of local health care services for the un/under-insured by continuing the CREATION Health Ministry Outreach program, providing monetary support by offering discounted home-supply prescriptions for low-income patients discharged from hospital care, supporting the Samaritan's Touch free clinic and providing the clinic with in-kind lab and imaging services for Samaritan's Touch patients. Samaritan's Touch is a free health care clinic for the uninsured population, serving Highlands and Hardee counties. The donation is funded partially by AdventHealth Wauchula, along with AdventHealth Sebring and AdventHealth Lake Placid. The outcomes for this goal exceeded expectations. A total of 65 CREATION Health volunteers participated in outreach activities, exceeding the goal of 45 volunteers. A total of $7,133 was applied to cover costs of home supply prescriptions for low income patients discharged from hospital care, exceeding the expected dollar amount of $1,250. In addition, both monetary donations for support of Samaritan's Touch (expected: $43,750 actual: $87,500) and in-kind donations of lab and imaging services to Samaritan's Touch patients (expected: $250,000 actual: $618,676), exceeded expected dollar amounts. The greatest challenge is knowing that the number of community residents needing these services continues to grow. AdventHealth Wauchula continues to recruit new physicians of all types to the area and has noted that since the opening of AdventHealth Wauchula at its new location, community use of the facility, including Emergency Department (ED) and Transitional Care, has increased. Priority 4: Heart Disease & Stroke (High Blood Pressure & Cholesterol)2016 Description of the Issue: With a higher than state average rate of high blood pressure (HBP), 29.6 percent of the PSA residents have been diagnosed with HPB. 56.01 percent of adults have high cholesterol. 10.9 percent of adults in the PSA have been diagnosed with Coronary Artery Disease.2018 Update: The interventions include offering free, evidence-based Stanford Chronic Disease Self- Management Program (CDSMP) 6-week class series to educate participants regarding chronic disease self-management. The outcome did not meet expectations as too few participants signed up to hold the classes (minimum class size requirements set by CDSMP). The instructor will need to be recertified, and the outcome will be included again for the next year, as the Hospital has now employed more transitional care (Care 360) specialists to recruit participants. Plans are to also hold these classes in the community at convenient locations for patients that have gone home from the Hospital. The greatest challenge is recruiting participants who will attend the entire series. Transportation continues to be a concern as Hardee County has no bus system and few taxis. A second intervention was to hold a Complete Health Improvement Program (CHIP) class series, a lifestyle enrichment program designed to reduce disease risk through better health habits and appropriate lifestyle modifications. Goals included lowering cholesterol, hypertension and blood sugar levels, reducing excess weight through improved dietary choices, enhancing daily exercise, increasing support systems and decreasing stress in an evidence-based program. This program has not been offered in Hardee County, due to the need for more trained facilitators and full-time employees (FTE). The series held in Lake Placid was advertised in Hardee County, however no Hardee residents attended. A Hospital employee completed training to teach the Corporate CHIP series in 2018.Priority 5: Teen Pregnancy Prevention2016 Description of the Issue: The teen birth rate is 88.4 per 1000 population compared with the state rate of 36.1 and the country's rate of 36.6. Previous grant funding for public school pregnancy prevention programs has ceased.2018 Update: The intervention chosen was to send a representative from the Hospital to attend the local Teen Pregnancy Prevention Association meetings. This has been accomplished. However, this goal and its interventions will be addressed/reviewed at the next Community Health Needs Assessment Committee meeting, as AdventHealth Wauchula does not have an Obstetrics (OB) department and the representative must travel from Highlands County to attend the meetings. Community Needs Not Chosen by AdventHealth Wauchula:The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else or multiple groups in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? Based on this prioritization process, the Hospital did not choose the following community issues:1. Cancer/Tobacco Use: This issue is already being addressed with tobacco cessation classes located at AdventHealth Wauchula.2. Access to Mental Health Services: The provider service area is designated as a Health Professionals Shortage Area. The Hospital refers patients to local resources as available. This is not a line of service the Hospital provides.
Part V, Section B	Facility Reporting Group B
Facility Reporting Group B consists of:	- Facility 7: AdventHealth Sebring, - Facility 11: AdventHealth Lake Placid
Facility Reporting Group - B Part V, Section B, line 5:	AdventHealth Sebring operates two hospital facilities in Highlands County under a single license, one in Sebring, Florida and one in Lake Placid, Florida (the Hospitals). The two Hospitals collaborated in 2016 to conduct a 2016 Community Health Needs Assessment as these two Hospitals share the same service area. The Hospitals' primary service area includes Highlands County and portions of Hardee County. In conducting its 2016 Community Health Needs Assessment (CHNA), primary and secondary health data was collected and analyzed. Primary data was gathered based upon input from individuals representing the broad community, as well as low-income, minority, and other medically underserved populations. Primary data input was primarily gathered through the establishment of a Community Health Needs Assessment Committee, community stakeholder surveys, and Public Health input and expertise. The Hospitals formed a Community Health Needs Assessment Committee (CHNAC) that included representatives of the community and the Hospitals, with a special focus on underserved populations. Many of the CHNAC members were selected because of their direct ties to the underserved and impoverished communities in the Hospitals' primary service area. Key members of the CHNAC included representatives from Central Florida Health Care, a local federally qualified health center, Nu-Hope Elder Care Services, Inc., a senior social service organization, Healthy Start-Wauchula, the Highlands County Board of County Commissioners, Redlands Christian Migrant Association, an organization providing childcare and early education for children of migrant farm workers and rural, low-income families, Samaritan's Touch, a health clinic for the uninsured, Heartland Rural Health Network for low-income and minority populations, the Highlands County Department of Health and the Hardee County Department of Health. AdventHealth Sebring also gathered primary data through the utilization of a stakeholder survey. This stakeholder survey was distributed to and completed by most of the members of the CHNAC and members of the community at large. Various sources of secondary data were reviewed to understand the larger issues plaguing the Hospitals' primary service area.
Facility Reporting Group - B Part V, Section B, line 6a:	AdventHealth Sebring and AdventHealth Lake Placid collaborated in conducting their Community Health Needs Assessments (CHNA) in 2016.
Facility Reporting Group - B 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 Reports must be posted on the Hospital's website at least until the date the hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports.
Facility Reporting Group - B Part V, Section B, line 11:	The information provided below explains how Adventist Health System/Sunbelt, Inc d/b/a AdventHealth Sebring and AdventHealth Lake Placid (The Hospitals) addressed in 2018 the significant health needs identified in their 2016 Community Health Needs Assessment, and any such needs that were not addressed and why such needs were not addressed. The Hospitals conducted a Community Health Needs Assessment in 2016 and adopted an implementation strategy to address the significant health needs identified in the 2016 Community Health Needs Assessment in 2017 prior to May 15, 2017.Adventist Health System/Sunbelt, Inc. d/b/a AdventHealth Sebring and AdventHealth Lake Placid will be referred to in this document as AdventHealth Sebring and AdventHealth Lake Placid or "The Hospitals". These two hospitals operate under a single hospital license.In January of 2019, every wholly-owned entity across our organization adopted the AdventHealth system brand. Our identity has been unified to represent the full continuum of care our system offers. Throughout this report, we will refer to the Hospitals as AdventHealth Sebring and AdventHealth Lake Placid. Any reference to our 2016 Community Health Needs Assessment (CHNA) or 2017 Community Health Plan (CHP) will utilize our new name for consistency.AdventHealth Sebring and AdventHealth Lake Placid are part of the West Florida Division of the healthcare system known as AdventHealth. The West Florida Division of AdventHealth includes 11 hospital facilities.This is the second-year update for AdventHealth Sebring and AdventHealth Lake Placid's 2017-2019 Community Health Plan (Implementation Strategy). AdventHealth Sebring and AdventHealth Lake Placid developed this Plan and posted it by May 15, 2017 as part of its 2016 Community Health Needs Assessment process. For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AdventHealth Sebring and AdventHealth Lake Placid worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2016 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospitals determine the health needs of the communities they serve. Once the data was gathered, the primary issues identified in the needs assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospitals to address in the 2017-2019 Community Health Plan. The second-year progress on the Community Health Plan is noted below. The narrative describes the issues identified in 2016 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospitals are not addressing.AdventHealth Sebring and AdventHealth Lake Placid chose five areas of focus for their 2017-2019 Community Health Plan: 1. Heart Disease/Stroke/High Blood Pressure/Cholesterol2. Diabetes3. Obesity/Nutrition4. Access to Care (Primary Care)5. Access to Care (Mental Health Services).Priority 1: Heart Disease/Stroke/High Blood Pressure/Cholesterol2016 Description of the Issue: Heart Disease is the second leading cause of death in the Primary Service Area (PSA). The service area also presents a higher than state average rate of high blood pressure and cholesterol.2018 Update: AdventHealth Sebring and AdventHealth Lake Placid implemented two interventions to address issues related to Heart Disease/Stroke/High Blood Pressure/Cholesterol in all adults with chronic disease residing in low income/low access communities throughout the communities in its primary service area. The first intervention includes offering free, evidence-based Stanford Chronic Disease Self- Management Program (CDSMP) 6-week class series to educate participants regarding chronic disease self-management both on site at the Hospitals and in community settings outside of the Hospitals (local health department locations, community senior centers, library locations, churches, etc.). In addition, efforts to recruit participants included partnering with other agencies to allow referrals to the class series and to share the costs associated with running the program. However, outcomes did not meet expectations as too few participants signed up to hold the classes. Some key challenges included a very strict minimum class size required by Chronic Disease Self-Management Program (CDSMP) standards to run the classes. Additionally, the Hospital system has completed implementation of its transitional care (Care 360) program model where specialists work with patients to make the transition from Hospital to home or other care facilities an easier connection. The Hospital plans to work with its Care 360 specialist to recruit participants and increase awareness of community benefit program availability. Since the greatest challenge was recruiting participants to reach the required class sizes, having access to the newly implemented Care 360 is a very hopeful opportunity to reach established outcome goals associated with this metric in order to impact the community in this area of health need.A second intervention was to hold a Complete Health Improvement Program (CHIP) class series, a lifestyle enrichment program designed to reduce disease risk through better health habits and appropriate lifestyle modifications. Goals included lowering cholesterol, hypertension and blood sugar levels, reducing excess weight through improved dietary choices, enhancing daily exercise, increasing support systems and decreasing stress in an evidence-based program. The program exceeded expectations of 50 percent of participants who experience improved biometric indices (program measures blood sugar levels, cholesterol, blood pressure, BMI and weight) by reaching 90 percent. AdventHealth Lake Placid contributed $2,183 toward the class series and Cardiopulmonary Rehab and Diabetes Center employees donated their time to teach classes in the series each week. Priority 2: Diabetes2016 Description of the Issue: Diabetes prevalence is higher than the state average of diabetes rates, and lower than average access to diabetes self-management and pre-diabetes education programs is a current disparity in the Primary Service Area (PSA).2018 Update: AdventHealth Sebring participated in the Morning Mile (MM) program in SW Florida to host a pilot before-school walking program at two Title I schools in the PSA for the 2018 - 2019 school year. The American Diabetes Association (ADA) in partnership with Fitzness International, LLC implements and manages the program in schools on behalf of sponsors and adds a nutrition education component to increase its impact on school children. AdventHealth Sebring sponsored one school for the school year Walker Memorial Adventist Academy. Year two goal met expectations with 65 percent of the student population participating in the program. In October 2018, the ADA reported their struggle to maintain consistent contact with the designated point-of-contact at schools sponsored by AdventHealth. This major challenge led to ADA's failure to report data for the first semester of the school year (August - December 2018). Other common challenges were associated with lack of program management by ADA. AdventHealth's Community Health Coordinator worked to help bridge the gaps in communication at each school and even scheduled site visits to all sponsored schools to re-establish contact and assist with struggles encountered when implementing and managing the Morning Mile program at sponsored schools. AdventHealth West Florida Division is currently working to replace the current program with a new initiative to address childhood obesity for year three.A second intervention, added this year, includes offering free, three-hour pre-diabetes classes at the Hospitals and in the community. These classes are open to the public. In collaboration with local community partners, the Hospitals are offering diabetes self-management education. AdventHealth Sebring exceeded its goal and implemented 22 classes, instead of 20 classes. Success in this outcome can be attributed to working closely with local community partners to promote the classes in the community setting. Priority 3: Obesity/Nutrition2016 Description of the Issue: 41 percent of residents in the PSA have low food access (food desert). 31.9 percent of adults aged 18 and older self-report that they have a Body Mass Index (BMI) in the "overweight" category. 34.7 percent of adults aged 20 and older self-report that they have a BMI in the "obese" category.**see continuation of footnote
Part V, Section B, Line 11 Continuation of Footnote	Group B-Facility 7 -- AdventHealth SebringGroup B-Facility 11 -- AdventHealth Lake PlacidDescription of CHNA Significant Needs Continued 2018 Update: AdventHealth Sebring and AdventHealth Lake Placid sponsored the CREATION Health (CH) program which is a faith-based holistic (mental, physical, and spiritual) wellness program with lifestyle seminars and training programs. It teaches eight universal principles of health (Choice, Rest, Environment, Activity, Trust, Interpersonal Relationships, Outlook, & Nutrition) for living a healthier and happier life. This 8-week seminar provides the best practices of whole person living based on Biblical principles and supported by evidence-based science. Two faith congregations were invited by the Chaplain to attend the AdventHealth West Florida Division CREATION Health "Train the Trainer" session hosted by the Mission and Ministry/Community Benefits departments. Town N' Country Seventh-day Adventist (SDA) Church attended and sent three delegates. The delegates received a CH Leadership kit valued at $350. The CH Kit contains CH Seminar Topic Power Point, CH Topic Videos, CH Leadership Manual, Small Group Discussion Guide, Seminar Personal Study Guide, and Participant Pre-Post Self Assessments. New strategies for this goal were implemented and included offering CREATION Health class series, increasing the number of staff members or others trained to teach the series, and building a framework to offer the Food Is Health (FIH) program. The Hospitals exceeded their goal of 30 program graduates, with an actual number of 40 graduates in 2018. Additionally, the Hospitals exceeded the goal of 80 percent of participants self-reporting improved lifestyle choices as measured by CREATION Health self-assessment forms by reaching 100 percent with this metric.A second strategy to reduce blood sugar levels is described below.AdventHealth Sebring and AdventHealth Lake Placid partnered with local community organizations to address the nutritional needs of those in communities designated as food deserts or low income/low access with the Food is Health program (formally known as Food is Medicine). This is accomplished by increasing health and lifestyle educational opportunities, biometric screenings, and access to healthy produce and dry goods. In year two, a total of 133 fresh produce vouchers were distributed to participants. Forty-eight percent of participants showed a decrease in blood sugar, which exceeded the goal of 10 percent of participants. A reduction in BMI was not reported.The major keys to success of the Food is Health program have been relationships with community partners. The Hospitals cannot run this program without strong partnerships with health education providers, local fresh produce vendors, and other community-based organizations who are the "boots on the ground" addressing social determinants of health.Priority 4: Access to Primary Care2016 Description of the Issue: The Hospitals' primary service area (PSA) is designated a Health Professionals Shortage Area (HPSA).2018 Update: Strategies implemented to increase community awareness and availability of local health care services for un/underinsured individuals included continuing the CREATION Health Ministry Outreach program, providing discounted home-supply prescriptions for low-income patients discharged from hospital care, providing monetary support to the Samaritan's Touch free clinic and providing the clinic with in-kind lab and imaging services for Samaritan's Touch patients. Samaritan's Touch is a free health care clinic for the uninsured population, serving Highlands and Hardee counties in Florida. The donation is funded partially by AdventHealth Sebring and AdventHealth Lake Placid, along with AdventHealth Wauchula.Each year, AdventHealth Sebring and AdventHealth Lake Placid continue to exceed outcome goals in each of the above-mentioned strategies to increase access to primary care in the designated primary service areas (PSA).Volunteer participation in the CREATION Health Ministry Outreach program continues to increase each year, with a total of 65 volunteers participating in this strategy. Monetary support for this strategy exceeded year two outcome goals in each category. Priority 5: Access to Care (Mental Health Services)2016 Description of the Issue: The PSA is designated as a Health Professionals Shortage Area (HPSA), with very few physicians/agencies offering mental health services.2018 Update: Strategies were implemented to increase community awareness and availability of local mental health care services for uninsured and underinsured individuals in the community. In 2018, the Hospitals started two grief and depression support groups. Support groups were hosted on site at AdventHealth Sebring and AdventHealth Lake Placid. Plans to partner to host additional support groups at community locations are also underway. Community Needs Not Chosen by AdventHealth Sebring and AdventHealth Lake Placid:The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else - or multiple groups - in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to work with community partners? Based on this prioritization process, the Hospital did not choose the following community issues:A. Cancer Incidence/Screening/Tobacco Cessation - the Hospitals already participate with the Area Health Education Center (AHEC) to offer community tobacco cessation classes. B. Poverty/Unemployment/Literacy Rates - The Hospitals do not have the capacity to address these social determinants. C. Chronic Obstructive Pulmonary Disease/Upper Respiratory Infection/Asthma - The Hospitals employ several pulmonologists and sponsor tobacco cessation classes. D. Lack of Transportation - The community lacks public transportation services, and the Hospitals do not have the capacity to address public transportation.

Schedule H (Form 990) 2018

Page 9

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?56
Name and address		Type of Facility (describe)
1	1 - AdventHealth Centra Care Lake Buena Vista 12500 South Apopka Vineland Rd Orlando,FL32836	Urgent Care Clinic
2	2 - AdventHealth Centra Care Corporate Office 2600 Westhall Lane Box 300 Maitland,FL32751	Corporate Services
3	3 - AdventHealth Centra Care Corporate Care So 2609 South Orange Ave Orlando,FL32806	Urgent Care Clinic & Employer Onsite Clinic
4	4 - AdventHealth Centra Care Waterford Lakes 250 North Alafaya Trail Suite 135 Orlando,FL32825	Urgent Care Clinic/Primary Care
5	5 - AdventHealth Medical Group OB GYN at Apopk 2100 Ocoee Apopka Rd Apopka,FL32703	Women's services
6	6 - AdventHealth Centra Care Winter Garden 3005 Daniels Road Winter Garden,FL34787	Urgent Care Clinic/Primary Care
7	7 - AdventHealth Centra Care Winter Park 3099 Aloma Avenue Winter Park,FL32792	Urgent Care Clinic
8	8 - AdventHealth Centra Care Sanford 4451 West 1st Street Sanford,FL32771	Urgent Care Clinic/Primary Care
9	9 - AdventHealth Centra Care Mt Dora 9015 US Highway 441 Mount Dora,FL32757	Urgent Care Clinic
10	10 - AdventHealth Centra Care Altamonte Springs 440 West Highway 436 Altamonte Springs,FL32714	Urgent Care Clinic
11	11 - AdventHealth Centra Care Orange Lake 8201 West Irlo Bronson Highway Kissimmee,FL34747	Urgent Care Clinic
12	12 - AdventHealth Centra Care Hunter's Creek 3293 Greenwald Way North Kissimmee,FL34741	Urgent Care Clinic/Primary Care
13	13 - AdventHealth Centra Care Port Orange 1208 Dunlawton Ave Port Orange,FL32127	Urgent Care Clinic
14	14 - AdventHealth Centra Care Clermont 15701 State Road 50 Suite 101 Clermont,FL34711	Urgent Care Clinic
15	15 - AdventHealth Centra Care St Cloud 4660 13th Street St Cloud,FL34769	Urgent Care Clinic/Primary Care
16	16 - SDOC Clinic 831 Simpson Rd Kissimmee,FL34744	Employer Clinic
17	17 - AdventHealth Centra Care Orange City 1360 Saxon Blvd Orange City,FL32763	Urgent Care Clinic
18	18 - AdventHealth Centra Care Lee Road 2540 Lee Road Winter Park,FL32789	Urgent Care Clinic
19	19 - AdventHealth Centra Care University 11550 University Blvd Orlando,FL32817	Urgent Care Clinic
20	20 - AdventHealth Centra Care Colonial Town 630 North Bumby Ave Orlando,FL32803	Urgent Care Clinic/Primary Care
21	21 - AdventHealth Centra Care DeLand 2293 South Woodland Blvd DeLand,FL32720	Urgent Care Clinic
22	22 - AdventHealth Centra Care Dr Phillip's 8014 Conroy-Windermere Rd Suite 104 Orlando,FL32835	Urgent Care Clinic
23	23 - AdventHealth Centra Care Oviedo 8010 Red Bug Road Oviedo,FL32765	Urgent Care Clinic
24	24 - AdventHealth Centra Care Brandon 10222 Bloomingdale Ave Riverview,FL33578	Urgent Care Clinic
25	25 - AdventHealth Centra Care Sand Lake Road 2301 Sand Lake Road Orlando,FL32809	Urgent Care Clinic
26	26 - AdventHealth Centra Care Azalea Park 509 South Semoran Blvd Orlando,FL32807	Urgent Care Clinic
27	27 - AdventHealth Centra Care Kissimmee 4320 West Vine Street Kissimmee,FL34746	Urgent Care Clinic
28	28 - AdventHealth Centra Care Daytona 1014 West International Speedway Blvd Daytona Beach,FL32114	Urgent Care Clinic
29	29 - AdventHealth Centra Care Leesburg 1103 North 14th Street Leesburg,FL34748	Urgent Care Clinic
30	30 - AdventHealth Centra Care Longwood 855 South US Highway 17-92 Longwood,FL32750	Urgent Care Clinic
31	31 - AdventHealth Centra Care Wesley Chapel 1127 Bruce B Downs Blvd Wesley Chapel,FL33544	Urgent Care Clinic
32	32 - AdventHealth Centra Care South Tampa 301 North Dale Mabry Hwy Tampa,FL33609	Urgent Care Clinic & Employer Onsite Clinic
33	33 - CTMC Hospice 1315 IH 35 North San Marcos,TX78666	Hospice Services
34	34 - AdventHealth Centra Care Temple Terrace 5802 East Fowler Avenue Temple Terrace,FL33617	Urgent Care Clinic
35	35 - AdventHealth Centra Care Palm Coast 1270 Palm Coast Parkway NW Palm Coast,FL32137	Urgent Care Clinic
36	36 - San Marcos MRI LP 1330 Wonder World Dr San Marcos,TX78666	Imaging Services
37	37 - AdventHealth Centra Care Conway 5810 South Semoran Blvd Orlando,FL32822	Urgent Care Clinic
38	38 - AdventHealth Centra Care Kids Lake Mary 105 South Country Club Road Lake Mary,FL32746	Urgent Care Clinic
39	39 - AdventHealth Centra Care Kids Winter Park 2325 West Fairbanks Ave Winter Park,FL32789	Urgent Care Clinic
40	40 - AdventHealth Centra Care Carrollwood 4001 West Linebaugh Ave Tampa,FL33624	Urgent Care Clinic
41	41 - AdventHealth Centra Care Lake Nona 9637 Lake Nona Village Place Orlando,FL32827	Urgent Care Clinic
42	42 - AdventHealth Centra Care Ormond Beach 1245 West Granada Blvd Ormond Beach,FL32174	Urgent Care Clinic
43	43 - AdventHealth Centra Care Citrus Park 6930 Gunn Highway Tampa,FL33625	Urgent Care Clinic
44	44 - CTMC Rehab Services 1340 Wonder World Dr San Marcos,TX78666	OP Rehab Services
45	45 - CTMC Home Health 2007 Medical Parkway San Marcos,TX78666	Home Health Services
46	46 - Darden Onsite 1000 Darden Center Drive Orlando,FL32837	Employer Onsite Clinic
47	47 - Siemens Onsite 4400 North Alafaya Trail MC Q1-240 Orlando,FL32826	Employer Onsite Clinic
48	48 - Wyndham Onsite Be Well Health Clinic 6277 Sea Harbor Dr Orlando,FL32821	Employer Onsite Clinic
49	49 - AdventHealth Medical Group Cardiology & Va 463 Carlton St Wauchula,FL33873	Outpatient Phys Clinic
50	50 - OCG Onsite 450 East South Street Orlando,FL32802	Employer Onsite Clinic
51	51 - AdventHealth Centra Care Lake Mary 2948 West Lake Mary Blvd Lake Mary,FL32746	Urgent Care Clinic
52	52 - AdventHealth Waterman Employee Clinic 1000 Waterman Way Tavares,FL32778	Employer Onsite Clinic
53	53 - AdventHealth Medical Group OB GYN at Wauch 526 W Carlton St Wauchula,FL33873	Outpatient Phys Clinic
54	54 - AdventHealth Medical Group OB GYN at Orlan 235 E Princeton Street Suite 200 Orlando,FL32804	Physician Clinics
55	55 - AdventHealth Medical Group Pediatric & Ado 2200 Fowler Grove Blvd Suite 220 Winter Garden,FL34787	Pediatric Center / Outpatient Services
56	56 - AdventHealth Medical Group Family Medicine 133 Benmore Drive Suite 200 Winter Park,FL32792	Physician Clinics, Medicine Specialists, Surgical Specialists

Schedule H (Form 990) 2018

Page 10

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 was a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) during its current tax year. During the current year, AHSSHC served as a parent organization to 24 tax-exempt 501(c)(3) hospital organizations and a number of other health care facilities that operated in 10 states within the U.S. The system of organizations under the control and ownership of AHSSHC is known as "AdventHealth".All hospital organizations within AdventHealth collect, calculate, and report the community benefits they provide to the communities they serve. AdventHealth organizations exist solely to improve and enhance the local communities they serve. AdventHealth 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. Each AdventHealth hospital facility reports their community benefits to their Board of Directors and strives to communicate their community benefits to their local communities. Additionally, the filing organization's most recently conducted community health needs assessment and associated implementation strategy can be accessed on the filing organization's websites.
Part I, Line 7:	The amounts of costs reported in the table in line 7 of Part I of Schedule H were determined by utilizing a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges, contained in the Schedule H instructions.
Part II, Community Building Activities:	The costs of community building activities reported on Part II of Schedule H primarily represent the costs associated with commercially sponsored research conducted by two of the organization's hospitals. These two hospitals participate in clinical drug and device research that is performed on patients who have a condition or disease for which the eventual commercial use of a drug or device is intended. This research is related to patient care and serves to expand scientific knowledge with respect to potential treatments and cures for various diseases and conditions.The costs of community building activities reported on Part II of Schedule H also include the costs associated with providing education for the filing organization's staff physicians and employees. The filing organization's provision of these educational programs/activities to staff physicians and employees provides an opportunity for health care professionals to enhance their skills and expertise and keep up-to-date with the latest advancements in medical procedures and technology. In addition, training opportunities are often provided on-site at the filing organization's hospital facilities, thereby allowing for health care professionals to be more readily available to assist in meeting immediate patient care needs. Education and training provided to each facility's workforce is vital in assisting health care professionals directly involved in patient care with keeping abreast of the latest developments in their respective areas of expertise, learning possible new and innovate ways of delivering care to patients, and understanding the newest technologies available for the treatment of patients.The remainder of the costs incurred stem from the hospitals' involvement in and support of various other community agencies in its service area that work collaboratively to help those in need and to improve the health and safety of the residents of the community. The organization's hospitals participate with a number of other community organizations to address the healthcare needs of the community. Both cash and in-kind donations are made annually to various local charitable organizations.
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 post-discharge 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 eligible for the most generous financial assistance under the filing organization's Financial Assistance Policy. As determined by the filing organization, a nominal amount of such a patient's bill is written off as bad debt expense, while the remaining portion of the patient's bill is considered 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 community benefit as charitable hospitals exist to provide such care in pursuit of their purpose of meeting the need for emergency medical care services available to all in the community.
Part III, Line 4:	Financial Statement Footnote Related to Accounts Receivable and Allowance for Uncollectible Accounts:The financial information of the filing organization is included in a consolidated audited financial statement for the current year. The applicable footnote from the attached consolidated audited financial statements that addresses accounts receivable, the allowance for uncollectible accounts, and the provision for bad debts can be found on pages 8-9. 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. Rationale for Including a Medicare Shortfall as Community Benefit:As a 501(c)(3) organization, the filing organization provides emergency and non-elective care to all regardless of ability to pay. All hospital services are provided in a non-discriminatory manner to patients who are covered beneficiaries under the Medicare program. As a public insurance program, Medicare provides a pre-established reimbursement rate/amount to health care providers for the services they provide to patients. In some cases, the reimbursement amount provided to a hospital may exceed its costs of providing a particular service or services to a patient. In other cases, the Medicare reimbursement amount may result in the hospital experiencing a shortfall of reimbursement received over costs incurred. In those cases where an overall shortfall is generated for providing services to all Medicare patients, the shortfall amount should be considered as a benefit to the community. Tax-exempt hospitals are required to accept all Medicare patients regardless of the profitability, or lack thereof, with respect to the services they provide to Medicare patients. The population of individuals covered under the Medicare program is sufficiently large so that the provision of services to the population is a benefit to the community and relieves the burdens of government. In those situations where the provision of services to the total Medicare patient population of a tax-exempt hospital during any year results in a shortfall of reimbursement received over the cost of providing care, the tax-exempt hospital has provided a benefit to a class of persons broad enough to be considered a benefit to the community. Despite a financial shortfall, a tax-exempt hospital must and will continue to accept and care for Medicare patients. Typically, tax-exempt hospitals provide health care services based upon an assessment of the health care needs of their community as opposed to their taxable counterparts where profitability often drives decisions about patient care services that are offered. Patient care provided by tax-exempt hospitals that results in Medicare shortfalls should be considered as providing a benefit to the community and relieving the burdens of government.Reconciliation of Schedule H Reported Medicare Surplus/(Shortfall) to Unreimbursed Medicare Costs Associated with the Provision of ServicesTo All Medicare Beneficiaries:The Medicare revenue and allowable costs of care reported in Section B of Part III of Schedule H are based upon the amounts reported in the filing organization's Medicare cost report in accordance with the IRS instructions for Schedule H. On an annual basis, the filing organization also determines its total unreimbursed costs associated with providing services to all Medicare patients. Unreimbursed costs are considered a community benefit to the elderly and are combined into an annual Community Benefit Statement prepared by AdventHealth. The primary reconciling items between the Medicare surplus/(shortfall) shown on line 7 of Section B of Part III of Schedule H and the filing organization's unreimbursed costs of services provided to all Medicare patients are as follows:- Medicare surplus/(shortfall) shown on line 7 of Section B of Schedule H: $ ( 97,098,882)- Difference in costing methodology: 13,289,670- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (180,175,309) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's communitybenefit reporting $(263,984,521)As indicated above, the primary differences between the Medicare surplus/(shortfall) reported on Schedule H, Part III, Section B, line 7 and the filing organization's portion of the Company's annual community benefit statement is due to a difference in the costing methodology and differences in the population of Medicare patients within the calculation. The cost methodology utilized in calculating any Medicare surplus/(shortfall) for purposes of the annual community benefit reporting is based upon the cost-to-charge ratio outlined in Worksheet 2 of the Schedule H instructions. The same cost-to-charge ratio is used to determine the costs associated with services provided to charity care patients and Medicaid patients as reported in Schedule H, Part I, line 7. In addition, the Medicare cost report excludes services provided to Medicare patients for physician services, services provided to patients enrolled in Medicare HMOs, and certain services provided by outpatient departments of the filing organization that are reimbursed on a fee schedule. The Company's own community benefit statement captures the unreimbursed cost of providing services to all Medicare beneficiaries throughout the organization.
Part III, Line 9b:	Collection Policies: The hospital filing organization's collection practices are in conformity with the requirements set forth in the 2014 Final 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 post-discharge 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) and a copy of the filing organization's Plain Language Summary of the Financial Assistance Policy 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 than 120 days after the first post-discharge billing statement is sent to the individual and is at least 30 days after the notice is provided. A reasonable attempt is also made to orally notify an individual about the filing organization's Financial Assistance Policy and how the individual may obtain assistance with the Financial Assistance application process. If an individual submits an incomplete FAA Form during the 240-day period following the date on which the first post-discharge billing statement was sent to the individual, the hospital filing organization suspends any reporting to consumer credit reporting agencies/bureaus (or ceases any other ECA's) and provides a written notice to the individual describing what additional information or documentation is needed to complete the FAA Form. This written notice contains contact information including the telephone number and physical location of the hospital facility's office or department that can provide information about the Financial Assistance Policy, as well as contact information of the hospital facility's office or department that can provide assistance with the financial assistance application process or, alternatively, a nonprofit organization or governmental agency that can provide assistance with the financial assistance application process if the hospital facility is unable to do so. If an individual submits a complete FAA Form within a reasonable time-period as set forth in the notice described above, 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, the filing organization's hospital facilities conducted their community health needs assessments (CHNAs) during 2013 and 2016. The 2016 CHNAs were adopted by all hospital governing boards by December 31, 2016, the end of the filing organization's taxable year in which the CHNAs were conducted. All of the filing organization's hospital facilities' 2016 CHNAs complied with the guidance set forth by the IRS in Final Regulation Section 1.501(r)-3. In addition to the CHNAs discussed above, a variety of practices and processes are in place to ensure that the filing organization is responsive to the health needs of all of its communities. Such practices and processes involve the following:1. Hospitals' operating/community boards 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 hospital communities; and 4. Collaboration with other local community groups to address the health care needs of the filing organization's hospital communities.
Part VI, Line 3:	The Financial Assistance Policy (FAP), Financial Assistance Application Form (FAA Form), and the Plain Language Summary of the Financial Assistance Policy (PLS) of the filing organization's hospital facilities are transparent and available to all individuals served at any point in the care continuum. The FAP, FAA Form, PLS, and contact information for the hospital facilities' financial counselors are prominently and conspicuously posted on the filing organization's hospital facilities' websites. Each hospital facility's website indicates that a copy of the FAP, FAA Form, and PLS is available and how to obtain such copies in the primary languages of any populations with limited proficiency in English that constitute the lesser of 1,000 individuals or 5% of the members of the community served by the relevant hospital facility (referred to below as LEP defined populations). Signage is displayed in public locations of the filing organization's hospital facilities, including at all points of admission and registration and the Emergency Department. The signage contains each hospital facility's website address where the FAP, FAA Form, and PLS can be accessed and the telephone number and physical location that individuals can call or visit to obtain copies of the FAP, FAA Form and PLS or to obtain more information about the hospital facility's FAP, FAA Form and PLS. Paper copies of each 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. Paper copies are made available in English and in the primary languages of any LEP defined populations. The filing organization's hospital facilities' financial counselors seek to provide personal financial counseling to all individuals admitted to the hospital facilities 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 paper copy of each hospital facility's PLS will be offered to every patient as a part of the intake or discharge process. 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 facilities' 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 facilities' FAP in all oral communications regarding the amount due for the individual's care. Copies of the PLS are distributed to members of each hospital facility's community in a manner reasonably calculated to reach those members of the community who are most likely to require financial assistance.
Part VI, Line 4:	In 2018, the filing organization operated 4 separately licensed hospitals that together encompassed 11 separate campus locations. The hospitals are located in Florida and Texas. A description of each of the hospital campuses is described below.Adventist Health System/Sunbelt, Inc. dba Central Texas Medical Center:Central Texas Medical Center (CTMC) is a 170-bed acute-care hospital providing a wide range of healthcare services in San Marcos, Texas and the neighboring communities within Hays and Caldwell counties, Texas. Special services offered at CTMC include a 24/7, Level 4 emergency and trauma center, state-of-the-art medical imaging and laboratory services, a new women's center featuring a Level 2 Neonatal Intensive Care Unit, newly renovated and expanded surgery suites--including two equipped with robotic capabilities--a Rehabilitation Institute, a center for advanced wound healing and hyperbaric medicine, and two cardiac catheterization labs. As a health resource for their community, CTMC's Creation Health Institute also annually hosts the oldest and largest health screening and fair event in Hays County, as well as a number of ongoing classes and workshops ranging in topics from diabetes prevention and management to heart disease, stroke, arthritis, self-help, nutrition and more. CTMC received accreditation as a certified chest pain center from the Society of Chest Pain Centers in 2011. The accreditation enhances CTMC's ability to receive and treat patients suffering from chest pain and/or a possible heart attack. The result is a focus on reduced time from symptom onset to diagnosis and treatment, getting patients treated more quickly during the critical window of time when the integrity of the heart muscle can be preserved, and monitoring of patients whose diagnosis is uncertain to ensure they are not sent home too quickly or admitted unnecessarily. CTMC remains the only hospital in the region that provides an inpatient Hospice unit. From 2010 through 2015, CTMC was named The Best Hospital in Hays County. In Fall 2015 and Spring 2016, CTMC was the first hospital between Austin and San Antonio to be awarded two consecutive "A" ratings by the Leapfrog Group recognizing outstanding achievement in hospital safety. In 2014, CTMC received awards and recognitions from the American Heart Association, American Stroke Association, The Joint Commission, Premier, Inc. and Healogics, Inc. related to the quality of care given to its patients. San Marcos, Texas is located in Hays County, Texas and is in close proximity to Austin and San Antonio. CTMC's primary service area has a population of approximately 111,700, with an estimated 13% over the age of 65. The per capita income in Hays County is approximately $27,080. It is estimated that 13% of the individuals residing in the primary service area live below 100% of the Federal Poverty Level. Approximately 44% of CTMC's patients during 2018 were Medicare patients, about 11% were Medicaid patients, about 14% were self-pay patients and the remaining percentage were patients covered under commercial insurance. In 2018, about 65% of CTMC's in-patients were admitted through the Emergency Department.Adventist Health System/Sunbelt, Inc. dba AdventHealth Sebring:AdventHealth Sebring is comprised of three separate hospital campuses with a total of 205 beds. Two of the hospital campuses are located in Highlands County, Florida and operate under a single hospital license and the third separately licensed campus is located in Hardee County, Florida. Highlands and Hardee counties are in the south central areas of Florida and are adjacent to each other. AdventHealth Sebring (Highlands County) - The main 147-bed hospital facility is located in north Sebring. The facility provides a wide range of healthcare services including Certified Stroke and Chest Pain Centers, the county's busiest emergency department, ACR-accredited imaging services, surgical services, Blessed Beginnings obstetrics, outpatient psychiatric and Tele ICU. Since 2012, the Heart & Vascular Center has added a third cath lab, expanded the emergency care department and renovated the lab services area. Sebring, Florida is located in Highlands County. AdventHealth Sebring's primary service area has a population of approximately 104,797, with an estimated 34% age 65 or over the age of 65. The per capita income in Highlands County is approximately $20,455. It is estimated that approximately 20% of the individuals residing in the primary service area live in poverty. AdventHealth Lake Placid (Highlands County) - This satellite facility houses 33 medical and surgical beds, the county's only 17-bed inpatient mental health unit and a wide range of services that are highly sophisticated for a small community hospital. This campus also specializes in inpatient geriatric psychiatric services within Highlands and Hardee counties. The need for behavioral health services is extreme in both counties since there is no other program closer than sixty miles. Since 2012, this campus has added a Tele-ICU program and its imaging services are ACR-accredited. Lake Placid, Florida is located in Highlands County. AdventHealth Lake Placid's primary service area has a population of approximately 66,574, with an estimated 34% age 65 or over the age of 65. The per capita income in Highlands County is approximately $20,455. It is estimated that approximately 20% of the individuals residing in the primary service area live in poverty. AdventHealth Wauchula (Hardee County) - This campus is licensed for 25 beds and specializes in emergency and outpatient care, while offering excellent medical inpatient services. The inpatient unit is mixed with both acutely ill patients and patients who need short-term rehabilitation (transitional care). This campus offers the only emergency care in Hardee County. In 2000, AdventHealth Wauchula became the first Critical Access Hospital in the state of Florida. Since 2012, this campus has added the county's only mammography program, updated the lab services area and its imaging services are ACR-accredited. Wauchula, Florida is located in Hardee County. AdventHealth Wauchula's primary service area has a population of approximately 27,159, with an estimated 14% age 65 or over the age of 65. The per capita income in Hardee County is approximately $15,366. It is estimated that 30% of the individuals residing in the primary service area live below 100% of the Federal Poverty Level and the unemployment rate is about 9.4. Uninsured in Hardee County is approximately 39%. For all three campuses of AdventHealth Sebring, approximately 66% of the Hospital's patients during 2018 were Medicare patients, about 14% were Medicaid patients, about 6% were self-pay patients and the remaining percentage were patients covered under commercial insurance. In 2018, about 74% of the Hospital's in-patients were admitted through the Emergency Department.Adventist Health System/Sunbelt, Inc.: AdventHealth's Central Florida Division South Region consists of a 3,427-bed hospital system in Central Florida with seven separate hospital campuses (the Hospitals) that operate under a single hospital license. The Hospitals serve the residents of Central Florida (primarily serving the residents of Orange, Osceola, Seminole and Lake County) but also draw patients from other parts of the Southeastern United States, the Caribbean and South America. The 7-campus health system is the largest healthcare provider in Central Florida with more than 2 million patient visits per year and is the nation's largest Medicare provider. It is the second largest employer in the area. The main campus of AdventHealth's Central Florida Division South Region is located in Orlando, Florida (Orange County) near the downtown area. The other 6 campuses are located in surrounding communities in the counties of Orange, Osceola, and Seminole. In addition to operating the 7 hospitals, it also operates 39 full-service urgent care clinics in convenient community settings. For all seven campuses, approximately 43% of the Hospitals' patients during 2018 were Medicare patients, about 15% were Medicaid patients, about 8% were self-pay patients and the remaining percentage were patients covered under commercial insurance. In 2018, about 68% of the Hospitals' in-patients were admitted through the Hospitals' Emergency Departments. ** see continuation of footnote
Part VI, Line 5:	The provision of community benefit is central to the filing organization's mission of service and compassion. Restoring and promoting the health and quality of life of those in the communities served by the filing organization is a function of "extending the healing ministry of Christ and embodies the filing organization's commitment to its values and principles. The filing organization commits substantial resources to provide a broad range of services to both the underprivileged as well as the broader community. In addition to the community benefit and community building information provided in Parts I, II and III of this Schedule H, the filing organization captures and reports the benefits provided to its community through faith-based care. Examples of such benefits include the cost associated with chaplaincy care programs and mission peer reviews and mission conferences. During the current year, the filing organization provided $7,426,463 of benefit with respect to the faith-based and spiritual needs of the communities it serves in conjunction with its operation of community hospitals. The filing organization also provides benefits to its communities' infrastructure by investing in capital improvements to ensure that facilities and technology provide the best possible care. During the current year, the filing organization expended $332,682,676 in new capital improvements. As faith-based mission-driven community hospitals, the filing organization is continually involved in monitoring its communities, 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 Hospitals are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its communities.
Part VI, Line 6:	The filing organization is a part of a faith-based healthcare system of organizations whose parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). The system is known as AdventHealth. AHSSHC is an organization exempt from federal income tax under IRC Section 501(c)(3). AHSSHC and its subsidiary organizations operate 44 hospitals throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC and its subsidiaries also operate 11 nursing home facilities and other ancillary health care provider facilities, such as ambulatory surgery centers and diagnostic imaging centers. As the parent organization of AdventHealth, AHSSHC provides executive leadership and other professional support services to its subsidiary organizations. Professional support services include among others IT, corporate compliance, legal, reimbursement, risk management, and tax as well as treasury functions. Certain support services, such as human resources, payroll, A/P, and supply chain management are provided pursuant to a shared services model by AHSSHC to its subsidiary organizations. The provision of these executive and support services on a centralized basis by AHSSHC provides an appropriate balance between providing each AdventHealth subsidiary hospital organization with mission-driven consistent leadership and support while allowing the hospital organization to focus its resources on meeting the specific health care needs of the community it serves. The reader of this Form 990 should keep in mind that this reporting entity may differ in certain areas from that of a stand-alone hospital organization due to its inclusion in a larger system of healthcare organizations. As a part of a system of hospital and other health care organizations, the filing organization benefits from reduced costs due to system efficiencies, such as large group purchasing discounts, and the availability of internal resources such as internal legal counsel. Each AdventHealth subsidiary pays a management fee to AHSSHC for the internal services provided by AHSSHC. As a result, management fee expense reported by an AdventHealth 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 AdventHealth as a whole. The reader is directed to visit the web-site of AdventHealth at www.adventhealth.com to learn more about the mission and operations of AdventHealth.
Part VI, Line 7	The filing organization does not file an annual community benefit report with any state agencies.
Part VI, Line 4 Continuation of Footnote	Description of Community Information - ContinuedA brief description of each of the 7 hospital campuses is described below:AdventHealth Orlando (Orange County) - At the core of AdventHealth's Central Florida Division South Region, AdventHealth Orlando (AHO) is a 1,900-bed acute-care tertiary hospital. AHO is home to nationally recognized Centers of Excellence for cancer, cardiology, children's health, diabetes, neuroscience, orthopedics, transplant and global robotics. AdventHealth Orlando houses one of the largest Emergency Departments and cardiac catheterization labs in the country and is one of the busiest hospitals in the nation, providing service excellence to more than 52,000 inpatients and 198,000 outpatients each year. The recent opening of a 15-story patient tower features 200 more beds and 500 new jobs. The campus also includes a state-of-the-art Cardiac Diagnostic Center featuring 15 Cath and electro physiology (EPS) Labs. The cardiology team currently treats 42,000+ individuals for chest pain and performs over 2,400 open heart surgeries each year making them first in the state for the number of surgeries performed. In 2018, two orthopedic floors in the patient tower were totally renovated. Additionally, AHO houses the Translational Research Institute, a 54,000 square-foot facility devoted to the study of obesity and metabolic origins of cardiovascular disease with the aim of developing new treatments to battle diabetes and obesity. AHO also serves as a teaching hospital for family medicine, allopathic and osteopathic tracts, emergency medicine, neuromusculoskeletal medicine, general surgery, podiatric medicine and surgery, and internal medicine. As one of the premier health systems in the nation, AHO sets the standard for innovation, quality and comprehensive care. The new AdventHealth for Women is a 12-story hospital located on the Orlando campus. The first floor houses the Center for Women's Wellness, which includes a high-risk breast cancer clinic, mammography services, lactation center, cardiac screenings and health classes. Ten of the 12 floors are complete, which include 72 mother-baby rooms and high-risk OB rooms, 14 labor and delivery suites, 13 operating rooms, 82 NICU and 104 oncology beds which include GYN oncology, medical oncology and an ICU capable BMT unit.Also located on the AHO Campus is the Walt Disney Pavilion at AdventHealth for Children. The Walt Disney Pavilion is not a stand-alone facility but rather a 7-story, 202-bed tower located on AHO's campus. It is a full-service facility served by more than 100 pediatric specialists and a highly trained pediatric team of more than 700 employees. The Walt Disney Pavilion at AdventHealth for Children delivers a complete range of pediatric health services for younger patients including advanced surgery, oncology, neurosurgery, cardiology and transplant services; full-service pediatrics; and an innovative health and obesity platform.AdventHealth Orlando is located in Orange County. Orange County, Florida is part of the Orlando-Kissimmee-Sanford Metropolitan Statistical Area (MSA). Orange County's median income was below the state of Florida level in 2015 for the first year since 2000. The County has also seen an 50% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place - a 42% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 72% of Orange County residents spent 30% or more of their income on rent and 47% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Orange County has fluctuated significantly since 2008. Four percent of Orange County's student population is homeless.AdventHealth Altamonte (Seminole County) - AdventHealth Altamonte is a 393-bed facility, which has recently doubled in size with a new patient tower to better serve a busy community. AdventHealth Altamonte was the first "satellite" hospital, built in 1973 on what was then pastureland, miles from the nearest business district. Located north of Orlando in fast-growing Seminole County, AdventHealth Altamonte is the largest satellite campus within AdventHealth's Central Florida Division South Region. AdventHealth Altamonte is home to the Center for Spine Health, the Baby Place, Heartburn and Acid Reflux Center, and the Breast Imaging Center of Excellence. AdventHealth Altamonte also operates the Martin Andersen Cancer Center (along with the region's only Cancer Resource Library), a recognized cardiac institute with a spectrum of diagnostic services and treatments. Other services include women's health, orthopedics, urology, inpatient rehabilitation, sleep services, digestive health, sports medicine and rehabilitation, as well as a robust surgery program and imaging services. Since 2000, Seminole County has had a median household income that is well above that of the state of Florida. However, the County has also seen a 74% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place - a 59% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 42% of Seminole County residents spent 35% or more of their income on rent and 41% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Seminole County has fluctuated significantly since 2008. Three percent of Seminole County's student population is homeless. AdventHealth Apopka (Orange County) - In 1975, AdventHealth Apopka became the second satellite hospital. For over four decades, AdventHealth Apopka has set the standard in hometown health care by providing high-tech, quality care with a personalized touch. It is a 120-licensed-bed hospital, which includes intensive care services, emergency medicine, endoscopy, outpatient services, diagnostic services, respiratory services and rehabilitation services. A replacement, 320,000 square foot facility has been built on a 71-acre site located approximately three miles from the existing facility. Five of the seven floors have been completed with the remaining two floors to be shelled in for future expansion. The new facility features 120 private patient rooms, advanced surgical suites and a diagnostic catheterization lab. Completion of this $203 million project took place in December 2017.AdventHealth Apopka is located in Orange County. Orange County, Florida is part of the Orlando-Kissimmee-Sanford Metropolitan Statistical Area (MSA). Orange County's median income was below the state of Florida level in 2015 for the first year since 2000. The County has also seen an 50% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place - a 42% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 72% of Orange County residents spent 30% or more of their income on rent and 47% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Orange County has fluctuated significantly since 2008. Four percent of Orange County's student population is homeless.** see continuation of footnote
Part VI, Line 4 Continuation of Footnote	Description of Community Information - Continued AdventHealth Celebration (Osceola County) - AdventHealth Celebration is a cornerstone of Disney's planned community in Celebration, Florida. Today, this 237-bed acute care hospital delivers a state-of-the-art healing environment to residents of Osceola, Orange, Polk and Lake Counties, as well as to visitors from across the United States and the world. From its creation AdventHealth Celebration has been about promoting health and wellness as well as healing. Inside the resort-style hospital there is a wellness center, complete with workout area, pool, and rehabilitation facility. AdventHealth Celebration also houses the Global Robotics Institute, which provides patients with access to some of the most experienced robotic surgeons in the world. The Nicholson Center for Surgical Advancement also is a location where surgeons from around the world travel to learn the latest robotic surgery techniques. In 2011, a 234,000 square-foot patient tower added 62 beds and housed the Interactive Patient Care Unit, which was the first of its kind in the nation. In 2013, a four-story medical office building was added in which the Women's Institute is situated. In 2014, a new 5th floor inpatient 32 bed state-of-the art medical/surgical unit was added. In 2018, two inpatient surgical cardiovascular OR's were added. AdventHealth Celebration offers services in cancer, digestive health, neuroscience, weight-loss services and surgery, orthopedic health, spine health, thoracic surgery, women's and men's health, robotic-assisted surgeries and imaging diagnostics. Osceola County has consistently had a median household income below the state of Florida average. The County has also seen an 80% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place - a 71% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 75% of Osceola County residents spent 30% or more of their income on rent and 50% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Osceola County has fluctuated significantly since 2008. Five percent of Osceola County's student population is homeless.AdventHealth East Orlando (Orange County) - AdventHealth East Orlando is an innovative local leader that fills a vital need in a fast-growing area. A recent 200,000 square-foot expansion project upgraded the Hospital to 295 beds, with a spacious patient tower and 80 new private rooms designed to enhance the holistic care experience. In 2014, a new expanded ED provided 60 new treatment rooms. AdventHealth East Orlando includes a teaching hospital with residencies in family medicine, podiatry and emergency medicine. The campus is also home to an outpatient surgery center, a hospital-based Center for Medical Simulation and Education, a Cancer Institute featuring state-of-the-art technology for radiation oncology and a dedicated infusion center, as well as a 12-bed Children's Emergency Center. Alongside having the largest emergency room in Central Florida, other services included cardiovascular, pulmonary and digestive health, orthopedics and rehabilitation, ear/nose/throat, andrology, and urology. AdventHealth East Orlando's primary service area includes approximately 10 zip codes located in east Orange County. Orange County, Florida is part of the Orlando-Kissimmee-Sanford Metropolitan Statistical Area (MSA). Orange County's median income was below the state of Florida level in 2015 for the first year since 2000. The County has also seen an 50% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place - a 42% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 72% of Orange County residents spent 30% or more of their income on rent and 47% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Orange County has fluctuated significantly since 2008. Four percent of Orange County's student population is homeless.AdventHealth Kissimmee (Osceola County) - AdventHealth Kissimmee is a 162-bed community-focused hospital, conveniently located near Walt Disney World. The team located at AdventHealth Kissimmee is dedicated to bringing mission-focused, faith-based care to residents and visitors of Osceola and Orange Counties. This facility has recently expanded to include a new medical office building, patient tower, new main entrance, expanded Emergency Department and a parking garage. The new three-story patient tower includes private patient rooms and a host of modern amenities and technologies. Services offered include cardiovascular services, orthopedics and rehabilitation, neuroscience, cancer, diabetes, gastroenterology, emergency services, urology, and imaging resources. Osceola County has consistently had a median household income below the state of Florida average. The County has also seen an 80% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place - a 71% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 75% of Osceola County residents spent 30% or more of their income on rent and 50% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Osceola County has fluctuated significantly since 2008. Five percent of Osceola County's student population is homeless.AdventHealth Winter Park (Orange County) - AdventHealth Winter Park is a 320-bed facility that is a model of community health and wellness. The facility boasts spacious patient care areas and a full spectrum of specialties and services, including the Dr. P. Phillips Baby Place (with Level II NICU), AdventHealth Orthopedic Institute, and state-of-the-art surgery, recovery and rehabilitation at the AdventHealth Cancer Institute. AdventHealth Winter Park has the Central Florida Region's only senior-friendly emergency room. Services offered at AdventHealth Winter Park include cancer, cardiovascular, digestive health, women's health, neuroscience, ophthalmology, orthopedics and rehabilitation, urology, and sports medicine. AdventHealth Winter Park's primary service area includes most of northwestern Orange County. Orange County, Florida is part of the Orlando-Kissimmee-Sanford Metropolitan Statistical Area (MSA). Orange County's median income was below the state of Florida level in 2015 for the first year since 2000. The County has also seen an 50% increase in the poverty level between 2000-2014. A similar increase in children living below the poverty level has taken place - a 42% increase between 2000 and 2013. It should be noted that this area's population is heavily employed within the tourism industry in Central Florida contributing to individuals who are underemployed or holding multiple part-time jobs versus full-time employment. In 2014, 72% of Orange County residents spent 30% or more of their income on rent and 47% reported being cost burdened or severely cost burdened by the cost of their housing. The number of homeless individuals in Orange County has fluctuated significantly since 2008. Four percent of Orange County's student population is homeless.

Schedule H (Form 990) 2018

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Adventist Health SystemSunbelt Inc

Employer identification number
59-1479658

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 noncash assistance	(h) Purpose of grant or assistance
(1) Adventist Care Centers - Courtland Inc 730 Courtland Street Orlando,FL32804	20-5774723	501(c)(3)	1,317,296	0			General Support
(2) Adventist Development and Relief Agency International 12501 Old Columbia Pike Silver Spring,MD20904	52-1314847	501(c)(3)	0	6,135	Book	Medical Supplies	General Support
(3) Adventist University of Health Sciences Inc 671 Winyah Drive Orlando,FL32803	59-3069793	501(c)(3)	125,067	0			General Support
(4) Advocates for World Health 13200 Belcher Road S Largo,FL33773	26-4695101	501(c)(3)	0	15,000	Book	Medical Supplies	Other
(5) African American Chamber of Commerce 3201 E Colonial Drive Orlando,FL32803	59-3314330	501(c)(6)	13,500	0			General Support
(6) American Diabetes Association Inc 1701 N Beauregard Street Alexandria,VA22311	13-1623888	501(c)(3)	122,500	0			General Support
(7) American Heart Association Inc 7272 Greenville Avenue Dallas,TX75231	13-5613797	501(c)(3)	328,442	0			General Support
(8) Aspire Health Partners Inc 5151 Adanson Street Orlando,FL32804	59-2301233	501(c)(3)	1,476,195	0			General Support
(9) Boggy Creek Gang IncCamp Boggy Creek 30500 Brantley Branch Road Eustis,FL32736	59-3012889	501(c)(3)	6,000	0			General Support
(10) Boy Scouts Of America Inc Central Florida Council 1951 S Orange Blossom Trail 102 Apopka,FL32703	59-0624376	501(c)(3)	18,000	0			General Support
(11) Boys Girls Club Of Central Florida PO Box 2987 Orlando,FL32802	59-0951887	501(c)(3)	15,000	0			General Support
(12) Building Us Inc dba Friend Talking Faith PO Box 3310 Winter Park,FL32790	45-5420165	501(c)(3)	35,000	0			General Support
(13) Celebration Foundation Inc 610 Sycamore Street Celebration,FL34747	59-3370753	501(c)(3)	40,000	0			General Support
(14) Center for Change Inc 6003 Silver Star Road Suite 3 Orlando,FL32808	20-3062727	501(c)(3)	91,667	0			General Support
(15) Center for Multicultural Wellness and Prevention Inc 641 N Rio Grande Ave Orlando,FL32805	59-3368679	501(c)(3)	5,000	0			General Support
(16) Central Florida Association for Physicians 6735 Conroy Road Suite 224 Orlando,FL32835	26-2077247	501(c)(3)	10,000	0			General Support
(17) Central Florida Chamber For Persons With Disabilities LLC 3201 E Colonial Drive Unit A20 Orlando,FL328035174	26-4201627	Other	7,500	0			General Support
(18) Central Florida Commission On Homelessness 255 S Orange Avenue Suite 108 Orlando,FL32801	46-0994106	501(c)(3)	150,000	0			General Support
(19) Central Florida Community Arts Inc 250 SW Ivanhoe Blvd Orlando,FL32805	45-2324172	501(c)(3)	5,000	0			General Support
(20) Central Florida Family Health Center Inc 4930 E Lake Mary Blvd Sanford,FL32771	59-1741286	501(c)(3)	110,000	0			General Support
(21) Central Florida Health Care Coalition Incorporated 5703 Red Bug Lake Road Suite 118 Winter Springs,FL32708	59-2500692	501(c)(3)	12,500	0			General Support
(22) Central Florida Young Men's Christian Association 433 N Mills Avenue Orlando,FL32803	59-0624430	501(c)(3)	10,000	0			General Support
(23) Central Texas Healthcare Collaborative 1301 Wonder World Drive San Marcos,TX78666	45-3739929	501(c)(3)	1,767,849	0			Other
(24) Central Texas Medical Center Foundation 1301 Wonder World Drive San Marcos,TX78666	74-2259907	501(c)(3)	0	97,342	Book	Other	General Support
(25) Christian Service Center for Central Florida Inc 808 W Central Blvd Orlando,FL32805	59-1353031	501(c)(3)	5,000	0			General Support
(26) Community Based Care of Central Florida Inc 4001 Pelee Street Orlando,FL32817	01-0631375	501(c)(3)	33,516	0			General Support
(27) Community Health Centers Inc 110 S Woodland Street Winter Garden,FL34747	59-1480970	501(c)(3)	579,170	0			General Support
(28) Community United Outreach Inc 2520 Hansrob Road Orlando,FL32804	45-3584062	501(c)(3)	209,553	0			General Support
(29) Cystic Fibrosis Foundation 1080 Woodcock Road Suite 245 Orlando,FL32803	13-1930701	501(c)(3)	5,000	0			General Support
(30) Daves House Inc PO Box 1466 Windermere,FL34786	27-0533943	501(c)(3)	10,000	0			General Support
(31) Debbie Turner Cancer Care Resources Inc 31138 Preswick Avenue Sorrento,FL32776	80-0499456	501(c)(3)	5,000	0			General Support
(32) East Orlando Health & Rehab Center Inc 250 South Chickasaw Trail Orlando,FL32825	20-5774748	501(c)(3)	2,292,773	0			General Support
(33) Edible Education Experience Inc 26 E King Street Orlando,FL32804	46-5655482	501(c)(3)	7,250	0			General Support
(34) FLNC Inc 3355 E Semoran Blvd Apopka,FL32703	20-5774761	501(c)(3)	3,533,991	0			General Support
(35) Florida Abolitionist Inc 195 South Westmonte Drive Altamonte Springs,FL32714	59-3178045	501(c)(3)	20,000	0			General Support
(36) Florida Baptist Children's Homes Inc PO Box 8190 Orphans Heart Lakeland,FL33802	59-0657326	501(c)(3)	9,175	0			General Support
(37) Florida Hospital Association Inc 307 Park Lake Circle Orlando,FL32803	59-0690327	501(c)(3)	15,000	0			General Support
(38) Florida Hospital Seventh-day Adventist Church 2800 N Orange Avenue Orlando,FL32804	59-3039667	501(c)(3)	14,500	0			General Support
(39) Forest City Spanish Seventh-day Adventist Church 7601 Forest City Road Orlando,FL32810	59-3291153	501(c)(3)	22,059	0			General Support
(40) Forest Lake Academy 500 Education Loop Apopka,FL327036176	59-0816443	501(c)(3)	22,500	0			General Support
(41) Forest Lake Education Center 1275 Learning Loop Longwood,FL32779	59-3143238	501(c)(3)	22,500	0			General Support
(42) Forest Lake Seventh-day Adventist Church 515 Harley Lester Lane Apopka,FL32703	59-2885433	501(c)(3)	6,000	0			General Support
(43) Foundation For Orange County Public Schools Inc 445 W Amelia Street Suite 901 Orlando,FL328011153	59-2788435	501(c)(3)	41,500	0			General Support
(44) Foundation For Seminole State College Of Florida Inc 1055 AAA Drive Suite 209 Heathrow,FL32746	23-7033822	501(c)(3)	250,250	0			General Support
(45) Give Kids the World Inc 210 S Bass Road Kissimmee,FL34746	59-2654440	501(c)(3)	5,000	0			General Support
(46) Grace Medical Home Inc 51 Pennsylvania Street Orlando,FL328062938	28-1817966	501(c)(3)	765,267	0			General Support
(47) Greater San Marcos Partnership 1340 Wonder World Drive 108 San Marcos,TX78666	80-0624502	501(c)(6)	20,000	0			General Support
(48) Harbor House of Central Florida Inc PO Box 680748 Orlando,FL32868	59-1712936	501(c)(3)	5,000	0			General Support
(49) Healing the Children-Florida Inc PO Box 608432 Orlando,FL32860	59-3503974	501(c)(3)	5,000	0			General Support
(50) Health Care Center For The Homeless Inc 232 N Orange Blossom Trail Orlando,FL32805	59-3185020	501(c)(3)	222,286	0			General Support
(51) Health Council of East Central Florida Inc 5931 Brick Court Suite 164 Winter Park,FL32792	59-2227752	501(c)(3)	47,500	0			General Support
(52) Healthy Start Coalition Of Osceola County Inc PO Box 701995 St Cloud,FL34770	59-3212535	501(c)(3)	15,000	0			General Support
(53) Heartland Triathlon Of Highlands County Inc 1200 Highlands Drive Lake Placid,FL33852	45-2232127	501(c)(3)	15,000	0			General Support
(54) Hispanic Business Initiative Fund Of Florida Inc 3201 E Colonial Drive Unit A20 Orlando,FL32803	59-3341405	501(c)(3)	29,200	0			General Support
(55) Hope Community Center Inc 1016 N Park Avenue Apopka,FL32712	56-2551312	501(c)(3)	5,000	0			General Support
(56) Hope Now International Inc PO Box 181173 Casselberry,FL327181173	27-4498303	501(c)(3)	10,000	0			General Support
(57) Iglesia Chistiana Pentecostal De Orlando Inc 5850 Clarona Ocoee Road Orlando,FL32810	59-3218454	501(c)(3)	15,000	0			General Support
(58) JDRF International 370 Center Pointe Cir Suite 1154 Altamonte Springs,FL32701	23-1907729	501(c)(3)	16,500	0			General Support
(59) Johns Hopkins All Childrens Hospital Inc 501 6th Avenue South Saint Petersburg,FL33701	59-0683252	501(c)(3)	10,000	0			General Support
(60) Kids Beating Cancer Inc 615 E Princeton Street Suite 400 Orlando,FL32803	59-3136203	501(c)(3)	12,500	0			General Support
(61) Kids House of Seminole Inc 5467 North Ronald Reagan Blvd Sanford,FL32773	59-3415005	501(c)(3)	10,000	0			General Support
(62) Lake Nona Institute Inc 6900 Tavistock Lakes Blvd Orlando,FL32827	27-3346737	501(c)(3)	166,666	0			General Support
(63) Latino Leadership Inc 8617 E Colonial Drive Suite 1200 Orlando,FL32817	59-3702613	501(c)(3)	15,500	0			General Support
(64) Leadership Florida Statewide Community Foundation Inc 215 S Monroe Street Suite 710 Tallahassee,FL32301	59-3201445	501(c)(3)	10,500	0			General Support
(65) Life Concepts Inc dba Quest Inc 500 E Colonial Drive Orlando,FL32803	59-2013160	501(c)(3)	10,000	0			General Support
(66) Lifework Leadership 1220 E Concord Street Orlando,FL328035453	37-1592618	501(c)(3)	10,000	0			General Support
(67) Lift Orlando 215 E Central Blvd Orlando,FL32801	46-3607865	501(c)(3)	200,000	0			General Support
(68) Living Heart Foundation Inc 98 Greenfield Court Little Silver,NJ07739	22-3796078	501(c)(3)	10,000	0			General Support
(69) Make A Wish Foundation Of Central And Northern Florida Inc 1020 N Orlando Avenue Suite 100 Maitland,FL32751	59-3235806	501(c)(3)	26,000	0			General Support
(70) March of Dimes Inc 1550 Crystal Dr Suite 1300 Arlington,VA22202	13-1846366	501(c)(3)	5,000	0			General Support
(71) Markham Woods Church of Seventh-day Adventists 505 Markham Woods Road Longwood,FL32779	59-3095948	501(c)(3)	7,000	0			General Support
(72) Matthews Hope Ministries Inc 523 S Woodland Street Winter Garden,FL34761	27-2245867	501(c)(3)	10,000	0			General Support
(73) Mental Health Association Of Central Florida Inc 1525 E Robinson Street Orlando,FL32801	59-0816432	501(c)(3)	164,560	0			General Support
(74) My Neighbor's Children PO Box 617218 Orlando,FL32861	26-0770494	501(c)(3)	19,000	0			General Support
(75) NAMI Greater Orlando Inc 5051 North Lane Suite 21 Orlando,FL32808	59-2600149	501(c)(3)	5,000	0			General Support
(76) Nathaniel's Hope Inc 2300 Jetport Drive Orlando,FL32809	59-3195534	501(c)(3)	5,000	0			General Support
(77) New Beginnings of Central Florida Inc PO Box 121129 Clermont,FL34712	26-0353679	501(c)(3)	10,000	0			General Support
(78) New Image Youth Center Inc 212 South Parramore Ave 214 Orlando,FL32805	56-2482818	501(c)(3)	5,000	0			General Support
(79) Oakwood University 7000 Adventist Blvd NW Huntsville,AL35896	63-0366652	501(c)(3)	6,000	0			General Support
(80) Orange County Board of Commissioners 201 South Rosalind Avenue Orlando,FL32801	59-6000773	Gov't	53,902	0			General Support
(81) Orange County School Readiness Coalition PO Box 540387 Orlando,FL32854	31-1759186	501(c)(3)	10,000	0			General Support
(82) Orlando Science Center Inc 777 E Princeton Street Orlando,FL32803	59-0896343	501(c)(3)	10,000	0			General Support
(83) Osceola County Council On Aging Inc 700 Generation Point Kissimmee,FL34744	59-1595398	501(c)(3)	153,778	0			General Support
(84) Osceola Mental Health Inc dba Park Place 206 Park Place Blvd Kissimmee,FL34741	59-1677912	501(c)(3)	250,000	0			General Support
(85) Primary Care Medical Services of Poinciana Inc 1875 Fortune Road Kissimmee,FL34744	75-3147007	501(c)(3)	152,465	0			Medical care
(86) Ronald McDonald House Charities Of Central Florida Inc 1030 N Orange Avenue Winter Park,FL327894709	59-3211250	501(c)(3)	50,000	15,310	Estimated	Other	General Support
(87) Runway To Hope Inc 189 S Orange Avenue Orlando,FL328013261	27-3272616	501(c)(3)	6,000	0			General Support
(88) Samaritan Touch Care Center Inc 3015 Herring Avenue Sebring,FL33870	02-0773338	501(c)(3)	160,417	0			General Support
(89) San Marcos Sights & Sounds Of Christmas Inc 630 E Hopkins San Marcos,TX78666	74-2759206	501(c)(3)	15,000	0			General Support
(90) School Board Of Orange County 901 N Lakemont Avenue Winter Park,FL32792	59-6000771	Gov't	7,575	0			General Support
(91) Seniors First Inc 5395 L B McLeod Road Orlando,FL32811	59-2759603	501(c)(3)	7,000	0			General Support
(92) Shepherds Hope Inc 4851 S Apopka Vineland Road Orlando,FL328193128	59-3420727	501(c)(3)	310,000	0			General Support
(93) South Florida State College 600 W College Drive Avon Park,FL33825	59-1218159	Gov't	75,000	0			Other
(94) SRP Behavioral Hospital of San Marcos LLC 1106 N Interstate 35 San Marcos,TX78666	46-5751523	Other	85,315	0			General Support
(95) Sunbelt Health & Rehab Center - Apopka Inc 305 East Oak Street Apopka,FL32703	20-5774856	501(c)(3)	612,045	0			General Support
(96) Sunsystem Development Corporation 900 Hope Way Altamonte Springs,FL32714	59-2219301	501(c)(3)	0	4,861,701	Book	Other	General Support
(97) Texas State University 601 University Drive San Marcos,TX72893	74-6002248	Gov't	60,028	0			General Support
(98) The 4R Foundation Inc 210 N Park Avenue Winter Park,FL32789	47-4062821	501(c)(3)	400,000	0			General Support
(99) The School Board Of Highlands County 426 School Street Sebring,FL33870	56-6000654	Gov't	10,000	0			Other
(100) Track Shack of Orlando Inc 1104 N Mills Avenue Orlando,FL32803	59-1754680	Other	230,958	0			General Support
(101) United Campus Ministry 510 N Guadalupe St San Marcos,TX78666	74-1334353	501(c)(3)	8,000	0			General Support
(102) United Cerebral Palsy of Central Florida Inc 3305 S Orange Avenue Orlando,FL32806	56-0799925	501(c)(3)	5,750	0			General Support
(103) United Global Outreach Inc 2301 N Orange Avenue Orlando,FL32804	03-0511875	501(c)(3)	190,260	0			General Support
(104) United Way - The Heart Of Florida 1940 Traylor Blvd Orlando,FL32804	59-0808854	501(c)(3)	30,000	0			General Support
(105) Universal Orlando Foundation 1000 Universal Studios Plaza Orlando,FL32819	59-3510383	501(c)(3)	15,000	0			General Support
(106) University Of Central Florida Foundation Inc 12424 Research Parkway Suite 140 Orlando,FL32826	59-6211832	501(c)(3)	25,000	0			General Support
(107) US Dream Academy 5950 Symphony Woods Road Columbia,MD21044	59-3514841	501(c)(3)	10,000	0			General Support
(108) Valencia College Foundation Inc PO Box 3028 Orlando,FL32802	23-7442785	501(c)(3)	250,000	0			General Support
(109) Walker Memorial Academy 1525 W Avon Blvd Avon Park,FL33825	42-1748753	501(c)(3)	126,250	0			Other
(110) West Orange Chamber of Commerce 12184 W Colonial Drive Winter Garden,FL34787	59-0576757	501(c)(6)	10,000	0			General Support

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

104

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) 2018

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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash 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) 2018

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Adventist Health SystemSunbelt Inc

Employer identification number

59-1479658

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 nonfixed
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) 2018

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)
1Haffner PhD Randall L Director (end 9/18)	(i) (ii)	0 ------------- 1,220,923	0 ------------- 745,145	0 ------------- 994,770	0 ------------- 265,119	0 ------------- 47,702	0 ------------- 3,273,659	0 ------------- 201,612
2Houmann Lars D Director	(i) (ii)	0 ------------- 1,219,528	0 ------------- 868,557	0 ------------- 984,469	0 ------------- 267,198	0 ------------- 55,150	0 ------------- 3,394,902	0 ------------- 202,341
3Jernigan Donald L Director (beg 9/18)	(i) (ii)	0 ------------- 172,661	0 ------------- 217,804	0 ------------- 23,048	0 ------------- 831	0 ------------- 15,465	0 ------------- 429,809	0 ------------- 0
4Rathbun Paul Director (beg 9/18)/CFO	(i) (ii)	0 ------------- 944,163	0 ------------- 547,788	0 ------------- 214,814	0 ------------- 195,240	0 ------------- 47,105	0 ------------- 1,949,110	0 ------------- 121,828
5Shaw Terry D Dir/President/CEO	(i) (ii)	0 ------------- 1,575,633	0 ------------- 1,020,145	0 ------------- 1,504,165	0 ------------- 336,233	0 ------------- 58,896	0 ------------- 4,495,072	0 ------------- 206,591
6Tol Daryl L Dir (end 9/18)/CEO Centr FL Division	(i) (ii)	0 ------------- 1,066,110	0 ------------- 542,335	0 ------------- 200,234	0 ------------- 208,259	0 ------------- 56,516	0 ------------- 2,073,454	0 ------------- 100,765
7Bradley Kenneth W SEO/SW Mkt & Adm AH Celebr(end 2/18)	(i) (ii)	0 ------------- 387,462	0 ------------- 155,103	0 ------------- 198,600	0 ------------- 6,404	0 ------------- 25,377	0 ------------- 772,946	0 ------------- 50,178
8Cook Timothy W CEO AH Alt & West Orange (beg 2/18)	(i) (ii)	0 ------------- 374,643	0 ------------- 144,930	0 ------------- 171,747	0 ------------- 34,648	0 ------------- 44,069	0 ------------- 770,037	0 ------------- 17,478
9Dodds Sheryl D Chief People Off Centr FL Div South	(i) (ii)	0 ------------- 398,214	0 ------------- 91,606	0 ------------- 199,377	0 ------------- 14,066	0 ------------- 15,573	0 ------------- 718,836	0 ------------- 96,362
10Goodman Todd A CFO Central FL Division	(i) (ii)	0 ------------- 604,692	0 ------------- 249,317	0 ------------- 938,340	0 ------------- 91,281	0 ------------- 52,740	0 ------------- 1,936,370	0 ------------- 47,048
11Harcombe Douglas W CEO AH Celebration & South Mkt	(i) (ii)	0 ------------- 408,900	0 ------------- 141,449	0 ------------- 72,297	0 ------------- 60,946	0 ------------- 45,688	0 ------------- 729,280	0 ------------- 35,793
12Hilliard Douglas W Sr VP/Sr Finance Officer AH Orlando	(i) (ii)	0 ------------- 471,880	0 ------------- 182,892	0 ------------- 85,253	0 ------------- 77,394	0 ------------- 48,467	0 ------------- 865,886	0 ------------- 48,754
13Moorhead MD John David Chief Clinical Off Centr FL Div Sout	(i) (ii)	0 ------------- 593,620	0 ------------- 156,740	0 ------------- 349,818	0 ------------- 14,849	0 ------------- 31,138	0 ------------- 1,146,165	0 ------------- 0
14Owen Terry R SVP Amb Services Centr FL Div South	(i) (ii)	0 ------------- 458,419	0 ------------- 127,117	0 ------------- 161,406	0 ------------- 65,584	0 ------------- 30,292	0 ------------- 842,818	0 ------------- 51,337
15Reed MD Monica P SEO/Care Innov Cent FL Div(end 3/18)	(i) (ii)	0 ------------- 512,511	0 ------------- 142,755	0 ------------- 308,733	0 ------------- 87,879	0 ------------- 46,269	0 ------------- 1,098,147	0 ------------- 73,089
16Stevens Eric A CEO Orl/AH Women/Acute Care Srv Sout	(i) (ii)	0 ------------- 630,315	0 ------------- 196,620	0 ------------- 1,265,598	0 ------------- 97,732	0 ------------- 45,576	0 ------------- 2,235,841	0 ------------- 44,787
17Thompson Michael J CEO Integrated Hlth Serv Centr FL So	(i) (ii)	0 ------------- 464,658	0 ------------- 114,012	0 ------------- 41,791	0 ------------- 74,835	0 ------------- 48,031	0 ------------- 743,327	0 ------------- 21,117
18Zbaraschuk Amy L Sr VP/Sr Finance Off Central FL Div	(i) (ii)	0 ------------- 402,479	0 ------------- 157,328	0 ------------- 70,997	0 ------------- 59,345	0 ------------- 47,841	0 ------------- 737,990	0 ------------- 34,237
19Silvestry MD Scott Physician/Director AH Thoracic Trans	(i) (ii)	1,236,229 ------------- 0	990,122 ------------- 0	7,039 ------------- 0	14,849 ------------- 0	18,606 ------------- 0	2,266,845 ------------- 0	0 ------------- 0
20Davis Jr MD Robert Duane Physician/Director AH Cardiovascular	(i) (ii)	1,233,566 ------------- 0	300,000 ------------- 0	9,782 ------------- 0	14,849 ------------- 0	0 ------------- 0	1,558,197 ------------- 0	0 ------------- 0
21Botta MD Donald Physician/Director AH Heart Transpla	(i) (ii)	711,612 ------------- 0	475,991 ------------- 0	4,091 ------------- 0	14,849 ------------- 0	22,236 ------------- 0	1,228,779 ------------- 0	0 ------------- 0
22Shimshak MD Thomas M Physician	(i) (ii)	838,134 ------------- 0	400 ------------- 0	146,980 ------------- 0	14,849 ------------- 0	6,407 ------------- 0	1,006,770 ------------- 0	0 ------------- 0
23Shakar MD Simon F Physician AH Transplant Cardiologist	(i) (ii)	493,227 ------------- 0	440,025 ------------- 0	3,713 ------------- 0	14,849 ------------- 0	20,290 ------------- 0	972,104 ------------- 0	0 ------------- 0
24Banks David P Former Key Employee	(i) (ii)	0 ------------- 666,542	0 ------------- 353,663	0 ------------- 364,980	0 ------------- 125,352	0 ------------- 54,492	0 ------------- 1,565,029	0 ------------- 87,082
25Hagensicker Janice K Former Key Employee	(i) (ii)	0 ------------- 433,051	0 ------------- 168,144	0 ------------- 301,126	0 ------------- 24,016	0 ------------- 30,135	0 ------------- 956,472	0 ------------- 91,960
26Paradis J Brian Former Key Employee	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 767,543	0 ------------- 0	0 ------------- 36,523	0 ------------- 804,066	0 ------------- 125,394
27Soler Eddie Former Key Employee	(i) (ii)	0 ------------- 727,875	0 ------------- 388,291	0 ------------- 386,146	0 ------------- 151,579	0 ------------- 31,757	0 ------------- 1,685,648	0 ------------- 112,743

Schedule J (Form 990) 2018

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 AdventHealth. 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 AdventHealth. 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. At the direction of AHSSHC, and in accordance with the reserved powers in the filing organization's governing documents, the executive team listed on Part VII provides services to the filing organization. First-class or charter travel: Pursuant to the AdventHealth system-wide general policy regarding business travel, no reimbursement will be provided for any additional cost incurred with respect to first-class or charter air travel beyond the cost of a regular coach airfare. As a means of providing additional business travel reimbursement for those members of the AHSSHC senior executive management team that travel frequently on behalf of AdventHealth, a special annual travel allowance is provided for those executives. As AdventHealth operates 44 hospitals in 9 states, the senior leadership of AHSSHC travel extensively and often visit multiple hospital locations in different states as a part of a single business trip. The special travel allowance can provide reimbursements to the executive for such items as the purchase of air travel upgrade coupons, to cover the cost differential between coach and first-class travel, or to cover the cost of a charter flight. The special travel allowance benefit was originally authorized by and codified into a policy by the AHSSHC Board Compensation Committee (the Committee), an independent body of the AHSSHC Board of Directors, who also approves the annual cap on the amount of the allowance. The special travel allowance has an annual cap of $24,000 for members of the Leadership Executive Team (AdventHealth Cabinet - 12 members) and $15,000 for AdventHealth Corporate Office Senior Vice Presidents, Regional CEO's and Division Chief Officers (generally 20-30 individual executives). The Divisional CEO for AdventHealth Central Florida Division is a member of the Board of Directors of the filing organization, and the Central Florida Divisional CFO, Central Florida CEO of Integrated Health Services, and CEO of AdventHealth Orlando are key employees of the filing organization. The Divisional CEO, Divisional CFO, CEO of Integrated Health Services and CEO of AdventHealth Orlando are considered common law employees of and are on the payroll of AHSSHC. While the special travel allowance benefit is an AHSSHC compensation policy and practice, the cost of providing this benefit is allocated to and reimbursed by the filing organization. Accordingly, the filing organization has checked the box in Schedule J, Part I, line 1a for first-class or charter travel since it has paid for the cost of providing this benefit. Those executives who receive the special travel allowance are responsible for tracking the expenses reimbursable under the special travel allowance and must submit such expenses on their accountable plan expense report. Any taxable reimbursements made to executives under the special travel allowance arrangement are treated as taxable compensation to the executive. Travel for companions: AHSSHC has a Corporate Executive Policy that provides a benefit to allow for a traveling AHSSHC executive to have his or her spouse accompany the executive on certain business trips each year. Typically, reimbursement is only provided to certain executive leaders and is usually limited to one business trip per year beyond the annual AdventHealth 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: AdventHealth 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 by 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 AdventHealth President's Council business meeting ($500 per executive) or the annual AdventHealth CFO Conference or CMO/CNO business meeting ($300 per executive). Other discretionary spending accounts may be provided in connection with other AdventHealth sponsored conferences but typically do not exceed $200 per participant. 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 AdventHealth 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 AdventHealth 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 region of AdventHealth, senior vice presidents at three large hospital organizations, regional CEOs and CFOs and the president and senior vice presidents of AHSSHC). In the current year, for this filing organization, two executives were eligible to receive reimbursement for club fees. Each AdventHealth 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 AdventHealth and each of its affiliated entities. The following principles guide the establishment of individual executive compensation: - The salary of the President/CEO of AdventHealth will not exceed the 50th 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, 2018, J. Brian Paradis received severance payments in the amount of $765,563. 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 AdventHealth. 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 AdventHealth. In recognition of the contribution that each executive makes to the success of AdventHealth, AdventHealth provides to eligible executives participation in the AdventHealth 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 a split dollar life insurance policy and long-term care insurance, 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 AHSSHC Board Compensation Committee, an independent committee of the Board of Directors of AHSSHC. Any funds that remain after the cost of mandatory and elective benefits are subtracted from the annual pre-determined benefits allowance are contributed, at the employee's option, to either an IRC 457(f) deferred compensation account or to an IRC 457(b) eligible deferred compensation plan. Upon attainment of age 65, all previous 457(f) deferred amounts are paid immediately to the participant and any future employer contributions are made quarterly from the Plan directly to the participant. The Plan documents define an employee who is eligible to participate in the Plan to generally include the Chief Executive Officers of AdventHealth entities and Vice Presidents of all AdventHealth entities whose base salary is at least $250,000. 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, AdventHealth has instituted a defined benefit, non-tax-qualified deferred compensation plan for certain executives who have provided lengthy service to AdventHealth and/or to other Seventh-day Adventist Church hospitals or health care institutions. Participation in the plan is offered to AdventHealth executives on a pro-rata schedule beginning with 20 years of service as an employee of AdventHealth 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 AdventHealth 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 AdventHealth Executive FLEX Benefit Program. Additionally, AdventHealth has adopted a Senior Executive Death Benefit (SEDB) Plan in recognition of the considerable age and service requirements in the SERP. The SEDB Plan provides a benefit in an amount equal to the amount the executive's benefit would have been under the SERP Plan assuming that, on the date of the executive's death (and not before), the executive satisfied the last of the eligibility requirements of the SERP Plan with present value recognizing an early benefit commencement. An eligible executive becomes a participant in the SEDB Plan if the executive dies prior to termination of employment, provided the executive has not satisfied all of the eligibility requirements of SERP as of the executive's date of death but would have satisfied all of those requirements within five (5) years following death had the executive lived and continued employment. The SEDB Plan was reviewed and approved by the AHSSHC Board Compensation Committee, an independent body of the AHSSHC Board of Directors. Flex Plan Flex Plan/ SERP 457(b) CY CY Employer CY Contrib./ Distr.* Contrib. Distr.* Payment ------------------------------------------------------------------------ Haffner, PhD, Randall L. $250,270 $267,057 $ 657,852 $ 0 Houmann, Lars D. $252,349 $237,888 $ 675,524 $ 0 Rathbun, Paul $180,391 $144,874 $ 0 $ 0 Shaw, Terry D. $339,884 $210,255 $1,206,501 $ 0 Tol, Daryl L. $211,910 $123,840 $ 0 $ 0 Bradley, Kenneth W. $ 3,170 $ 54,863 $ 16,751 $ 0 Cook, Timothy W. $ 38,299 $ 20,993 $ 97,137 $ 0 Dodds, Sheryl D. $ 65,610 $144,513 $ 0 $ 0 Goodman, Todd A. $ 94,932 $ 58,145 $ 837,551 $ 0 Harcombe, Douglas W. $ 46,097 $ 42,919 $ 0 $ 0 Hilliard, Douglas W. $ 62,545 $ 61,359 $ 0 $ 0 Moorhead, MD, John David $103,683 $103,683 $ 180,796 $ 0 Owen, Terry R. $ 69,235 $ 63,630 $ 44,916 $ 0 Reed MD, Monica P. $ 73,030 $ 74,015 $ 205,034 $ 0 Stevens, Eric A. $101,383 $ 55,706 $1,142,086 $ 0 Thompson, Michael J. $ 59,986 $ 21,378 $ 0 $ 0 Zbaraschuk, Amy L. $ 44,496 $ 38,752 $ 0 $ 0 Banks, David P. $110,503 $ 88,189 $ 235,945 $ 0 Hagensicker, Janice K. $ 62,909 $128,368 $ 106,613 $ 0 Soler, Eddie $136,730 $149,971 $ 208,166 $ 0 * Including Investment Earnings

Schedule J (Form 990) 2018

Additional Data

Software ID:
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- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Adventist Health SystemSunbelt Inc

Employer identification number
59-1479658

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Highlands County Health Facilities Authority	52-1313569	431022KK7	08-08-2007	366,445,000	2007A B C D, Expand/refurbish facilities, purchase equipment		X		X		X
B	Kansas Development Finance Authority	48-1066589	48542ABX8	07-08-2009	325,394,417	2009C, Ref 96/05&97/05 iss 1/13/05, 03A 1/16/03, 08B 12/19/08, exp facility	X			X		X
C	Kansas Development Finance Authority	48-1066589	48542ACY5	10-01-2009	102,271,154	2009D, Refund Highlands 07C, 8/8/07 & expand/refurbish facilities/purc equip	X			X		X
D	Highlands County Health Facilities Authority	52-1313569	431022SP8	11-16-2009	190,752,502	09E & 08B Conv, Ref Orange 91/01 10/11/01, 92/03 5/15/03, 08B 12/19/08	X			X		X
	Highlands County Health Facilities Authority	52-1313569	431022SG8	11-16-2009	178,936,632	2005I Conv, Refund Highlands 05I 12/22/05 & expand/refurbish facilities		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	12-22-2010	25,000,000	2010B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	12-22-2010	25,000,000	2010C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	NoneAvail	12-22-2010	25,000,000	2010D, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	11-16-2011	80,000,000	2011A, Expand/refurbish facilities		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	03-21-2012	294,985,000	2012A, AR Program - Refund 2009 A-F AR Program		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-25-2012	115,015,000	2012B, AR Program - Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	48542ADG3	08-29-2012	310,952,245	2012A - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TL6	08-29-2012	348,320,000	2012B-F - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	08-29-2012	125,000,000	2012G&H - Refund Highlands 2005I Conversion Bonds		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TR3	11-08-2012	232,125,000	2012I - Refunded Volusia 1994-A; Highlands 2004A, 2005E, 2005F, 2005G		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	09-18-2013	485,000,000	2013A B C, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-02-2014	110,000,000	2014A&D, Refund 2013C, expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-02-2014	50,000,000	2014B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-02-2014	30,000,000	2014C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648AT39	07-23-2014	82,501,800	2014E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FAB0	07-21-2016	235,724,616	2016 A&B, Adv ref portion 2009D, Exp/refurbish facilities, purchase equip		X		X		X
	Colorado Health Facilities Authority	84-0752932	1964745K2	08-17-2016	216,517,920	2016C, Refund 2006C, Expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-26-2017	44,750,000	2017A, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-26-2017	50,750,000	2017B, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-26-2017	45,250,000	2017C, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FCN2	07-26-2017	97,750,000	2017D, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FGN8	07-12-2018	375,008,542	2018A&B, Expand/refurbish facilities, purchase equipment		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	262,025,000		86,800,000		17,770,000		42,995,000
2 Amount of bonds legally defeased ..............			129,915,000		71,645,000		360,000
3 Total proceeds of issue ..................	372,572,414		325,394,417		102,271,154		190,752,502
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............
8 Credit enhancement from proceeds .............	5,560,382
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	367,012,032		12,004,967		21,844,721		25,008,355
11 Other spent proceeds .............	177,240,000		313,389,450		80,426,433		190,752,502
12 Other unspent proceeds .............
13 Year of substantial completion .............	2007		2009		2009		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X	X		X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X			X	X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.420 %		0.540 %		0.200 %		0.670 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........			0.070 %
6 Total of lines 4 and 5 .............	1.420 %		0.540 %		0.200 %		0.670 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..	0.370 %		0.140 %		0.140 %		0.370 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X		X		X		X
c No rebate due? .........		X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2007A B C D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Orange County Health Facilities Authority 2010B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Kansas Development Finance Authority 2010C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Colorado Health Facilities Authority 2010D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2013A-C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014A&D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014E: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part III, Line 8c	Highlands County Health Facilities Authority 2012A, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Kansas Development Finance Authority 2012A: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B-F: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.

Schedule K (Form 990) 2018

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Adventist Health SystemSunbelt Inc

Employer identification number
59-1479658

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Highlands County Health Facilities Authority	52-1313569	431022KK7	08-08-2007	366,445,000	2007A B C D, Expand/refurbish facilities, purchase equipment		X		X		X
B	Kansas Development Finance Authority	48-1066589	48542ABX8	07-08-2009	325,394,417	2009C, Ref 96/05&97/05 iss 1/13/05, 03A 1/16/03, 08B 12/19/08, exp facility	X			X		X
C	Kansas Development Finance Authority	48-1066589	48542ACY5	10-01-2009	102,271,154	2009D, Refund Highlands 07C, 8/8/07 & expand/refurbish facilities/purc equip	X			X		X
D	Highlands County Health Facilities Authority	52-1313569	431022SP8	11-16-2009	190,752,502	09E & 08B Conv, Ref Orange 91/01 10/11/01, 92/03 5/15/03, 08B 12/19/08	X			X		X
	Highlands County Health Facilities Authority	52-1313569	431022SG8	11-16-2009	178,936,632	2005I Conv, Refund Highlands 05I 12/22/05 & expand/refurbish facilities		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	12-22-2010	25,000,000	2010B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	12-22-2010	25,000,000	2010C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	NoneAvail	12-22-2010	25,000,000	2010D, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	11-16-2011	80,000,000	2011A, Expand/refurbish facilities		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	03-21-2012	294,985,000	2012A, AR Program - Refund 2009 A-F AR Program		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-25-2012	115,015,000	2012B, AR Program - Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	48542ADG3	08-29-2012	310,952,245	2012A - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TL6	08-29-2012	348,320,000	2012B-F - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	08-29-2012	125,000,000	2012G&H - Refund Highlands 2005I Conversion Bonds		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TR3	11-08-2012	232,125,000	2012I - Refunded Volusia 1994-A; Highlands 2004A, 2005E, 2005F, 2005G		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	09-18-2013	485,000,000	2013A B C, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-02-2014	110,000,000	2014A&D, Refund 2013C, expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-02-2014	50,000,000	2014B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-02-2014	30,000,000	2014C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648AT39	07-23-2014	82,501,800	2014E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FAB0	07-21-2016	235,724,616	2016 A&B, Adv ref portion 2009D, Exp/refurbish facilities, purchase equip		X		X		X
	Colorado Health Facilities Authority	84-0752932	1964745K2	08-17-2016	216,517,920	2016C, Refund 2006C, Expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-26-2017	44,750,000	2017A, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-26-2017	50,750,000	2017B, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-26-2017	45,250,000	2017C, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FCN2	07-26-2017	97,750,000	2017D, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FGN8	07-12-2018	375,008,542	2018A&B, Expand/refurbish facilities, purchase equipment		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	262,025,000		86,800,000		17,770,000		42,995,000
2 Amount of bonds legally defeased ..............			129,915,000		71,645,000		360,000
3 Total proceeds of issue ..................	372,572,414		325,394,417		102,271,154		190,752,502
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............
8 Credit enhancement from proceeds .............	5,560,382
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	367,012,032		12,004,967		21,844,721		25,008,355
11 Other spent proceeds .............	177,240,000		313,389,450		80,426,433		190,752,502
12 Other unspent proceeds .............
13 Year of substantial completion .............	2007		2009		2009		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X	X		X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X			X	X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.420 %		0.540 %		0.200 %		0.670 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........			0.070 %
6 Total of lines 4 and 5 .............	1.420 %		0.540 %		0.200 %		0.670 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..	0.370 %		0.140 %		0.140 %		0.370 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X		X		X		X
c No rebate due? .........		X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2007A B C D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Orange County Health Facilities Authority 2010B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Kansas Development Finance Authority 2010C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Colorado Health Facilities Authority 2010D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2013A-C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014A&D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014E: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part III, Line 8c	Highlands County Health Facilities Authority 2012A, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Kansas Development Finance Authority 2012A: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B-F: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.

Schedule K (Form 990) 2018

Additional Data

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Adventist Health SystemSunbelt Inc

Employer identification number
59-1479658

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Highlands County Health Facilities Authority	52-1313569	431022KK7	08-08-2007	366,445,000	2007A B C D, Expand/refurbish facilities, purchase equipment		X		X		X
B	Kansas Development Finance Authority	48-1066589	48542ABX8	07-08-2009	325,394,417	2009C, Ref 96/05&97/05 iss 1/13/05, 03A 1/16/03, 08B 12/19/08, exp facility	X			X		X
C	Kansas Development Finance Authority	48-1066589	48542ACY5	10-01-2009	102,271,154	2009D, Refund Highlands 07C, 8/8/07 & expand/refurbish facilities/purc equip	X			X		X
D	Highlands County Health Facilities Authority	52-1313569	431022SP8	11-16-2009	190,752,502	09E & 08B Conv, Ref Orange 91/01 10/11/01, 92/03 5/15/03, 08B 12/19/08	X			X		X
	Highlands County Health Facilities Authority	52-1313569	431022SG8	11-16-2009	178,936,632	2005I Conv, Refund Highlands 05I 12/22/05 & expand/refurbish facilities		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	12-22-2010	25,000,000	2010B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	12-22-2010	25,000,000	2010C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	NoneAvail	12-22-2010	25,000,000	2010D, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	11-16-2011	80,000,000	2011A, Expand/refurbish facilities		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	03-21-2012	294,985,000	2012A, AR Program - Refund 2009 A-F AR Program		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-25-2012	115,015,000	2012B, AR Program - Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	48542ADG3	08-29-2012	310,952,245	2012A - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TL6	08-29-2012	348,320,000	2012B-F - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	08-29-2012	125,000,000	2012G&H - Refund Highlands 2005I Conversion Bonds		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TR3	11-08-2012	232,125,000	2012I - Refunded Volusia 1994-A; Highlands 2004A, 2005E, 2005F, 2005G		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	09-18-2013	485,000,000	2013A B C, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-02-2014	110,000,000	2014A&D, Refund 2013C, expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-02-2014	50,000,000	2014B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-02-2014	30,000,000	2014C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648AT39	07-23-2014	82,501,800	2014E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FAB0	07-21-2016	235,724,616	2016 A&B, Adv ref portion 2009D, Exp/refurbish facilities, purchase equip		X		X		X
	Colorado Health Facilities Authority	84-0752932	1964745K2	08-17-2016	216,517,920	2016C, Refund 2006C, Expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-26-2017	44,750,000	2017A, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-26-2017	50,750,000	2017B, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-26-2017	45,250,000	2017C, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FCN2	07-26-2017	97,750,000	2017D, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FGN8	07-12-2018	375,008,542	2018A&B, Expand/refurbish facilities, purchase equipment		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	262,025,000		86,800,000		17,770,000		42,995,000
2 Amount of bonds legally defeased ..............			129,915,000		71,645,000		360,000
3 Total proceeds of issue ..................	372,572,414		325,394,417		102,271,154		190,752,502
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............
8 Credit enhancement from proceeds .............	5,560,382
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	367,012,032		12,004,967		21,844,721		25,008,355
11 Other spent proceeds .............	177,240,000		313,389,450		80,426,433		190,752,502
12 Other unspent proceeds .............
13 Year of substantial completion .............	2007		2009		2009		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X	X		X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X			X	X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.420 %		0.540 %		0.200 %		0.670 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........			0.070 %
6 Total of lines 4 and 5 .............	1.420 %		0.540 %		0.200 %		0.670 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..	0.370 %		0.140 %		0.140 %		0.370 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X		X		X		X
c No rebate due? .........		X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2007A B C D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Orange County Health Facilities Authority 2010B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Kansas Development Finance Authority 2010C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Colorado Health Facilities Authority 2010D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2013A-C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014A&D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014E: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part III, Line 8c	Highlands County Health Facilities Authority 2012A, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Kansas Development Finance Authority 2012A: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B-F: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Adventist Health SystemSunbelt Inc

Employer identification number
59-1479658

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Highlands County Health Facilities Authority	52-1313569	431022KK7	08-08-2007	366,445,000	2007A B C D, Expand/refurbish facilities, purchase equipment		X		X		X
B	Kansas Development Finance Authority	48-1066589	48542ABX8	07-08-2009	325,394,417	2009C, Ref 96/05&97/05 iss 1/13/05, 03A 1/16/03, 08B 12/19/08, exp facility	X			X		X
C	Kansas Development Finance Authority	48-1066589	48542ACY5	10-01-2009	102,271,154	2009D, Refund Highlands 07C, 8/8/07 & expand/refurbish facilities/purc equip	X			X		X
D	Highlands County Health Facilities Authority	52-1313569	431022SP8	11-16-2009	190,752,502	09E & 08B Conv, Ref Orange 91/01 10/11/01, 92/03 5/15/03, 08B 12/19/08	X			X		X
	Highlands County Health Facilities Authority	52-1313569	431022SG8	11-16-2009	178,936,632	2005I Conv, Refund Highlands 05I 12/22/05 & expand/refurbish facilities		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	12-22-2010	25,000,000	2010B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	12-22-2010	25,000,000	2010C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	NoneAvail	12-22-2010	25,000,000	2010D, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	11-16-2011	80,000,000	2011A, Expand/refurbish facilities		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	03-21-2012	294,985,000	2012A, AR Program - Refund 2009 A-F AR Program		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-25-2012	115,015,000	2012B, AR Program - Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	48542ADG3	08-29-2012	310,952,245	2012A - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TL6	08-29-2012	348,320,000	2012B-F - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	08-29-2012	125,000,000	2012G&H - Refund Highlands 2005I Conversion Bonds		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TR3	11-08-2012	232,125,000	2012I - Refunded Volusia 1994-A; Highlands 2004A, 2005E, 2005F, 2005G		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	09-18-2013	485,000,000	2013A B C, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-02-2014	110,000,000	2014A&D, Refund 2013C, expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-02-2014	50,000,000	2014B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-02-2014	30,000,000	2014C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648AT39	07-23-2014	82,501,800	2014E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FAB0	07-21-2016	235,724,616	2016 A&B, Adv ref portion 2009D, Exp/refurbish facilities, purchase equip		X		X		X
	Colorado Health Facilities Authority	84-0752932	1964745K2	08-17-2016	216,517,920	2016C, Refund 2006C, Expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-26-2017	44,750,000	2017A, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-26-2017	50,750,000	2017B, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-26-2017	45,250,000	2017C, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FCN2	07-26-2017	97,750,000	2017D, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FGN8	07-12-2018	375,008,542	2018A&B, Expand/refurbish facilities, purchase equipment		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	262,025,000		86,800,000		17,770,000		42,995,000
2 Amount of bonds legally defeased ..............			129,915,000		71,645,000		360,000
3 Total proceeds of issue ..................	372,572,414		325,394,417		102,271,154		190,752,502
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............
8 Credit enhancement from proceeds .............	5,560,382
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	367,012,032		12,004,967		21,844,721		25,008,355
11 Other spent proceeds .............	177,240,000		313,389,450		80,426,433		190,752,502
12 Other unspent proceeds .............
13 Year of substantial completion .............	2007		2009		2009		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X	X		X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X			X	X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.420 %		0.540 %		0.200 %		0.670 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........			0.070 %
6 Total of lines 4 and 5 .............	1.420 %		0.540 %		0.200 %		0.670 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..	0.370 %		0.140 %		0.140 %		0.370 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X		X		X		X
c No rebate due? .........		X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2007A B C D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Orange County Health Facilities Authority 2010B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Kansas Development Finance Authority 2010C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Colorado Health Facilities Authority 2010D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2013A-C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014A&D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014E: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part III, Line 8c	Highlands County Health Facilities Authority 2012A, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Kansas Development Finance Authority 2012A: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B-F: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.

Schedule K (Form 990) 2018

Additional Data

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Adventist Health SystemSunbelt Inc

Employer identification number
59-1479658

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Highlands County Health Facilities Authority	52-1313569	431022KK7	08-08-2007	366,445,000	2007A B C D, Expand/refurbish facilities, purchase equipment		X		X		X
B	Kansas Development Finance Authority	48-1066589	48542ABX8	07-08-2009	325,394,417	2009C, Ref 96/05&97/05 iss 1/13/05, 03A 1/16/03, 08B 12/19/08, exp facility	X			X		X
C	Kansas Development Finance Authority	48-1066589	48542ACY5	10-01-2009	102,271,154	2009D, Refund Highlands 07C, 8/8/07 & expand/refurbish facilities/purc equip	X			X		X
D	Highlands County Health Facilities Authority	52-1313569	431022SP8	11-16-2009	190,752,502	09E & 08B Conv, Ref Orange 91/01 10/11/01, 92/03 5/15/03, 08B 12/19/08	X			X		X
	Highlands County Health Facilities Authority	52-1313569	431022SG8	11-16-2009	178,936,632	2005I Conv, Refund Highlands 05I 12/22/05 & expand/refurbish facilities		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	12-22-2010	25,000,000	2010B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	12-22-2010	25,000,000	2010C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	NoneAvail	12-22-2010	25,000,000	2010D, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	11-16-2011	80,000,000	2011A, Expand/refurbish facilities		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	03-21-2012	294,985,000	2012A, AR Program - Refund 2009 A-F AR Program		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-25-2012	115,015,000	2012B, AR Program - Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	48542ADG3	08-29-2012	310,952,245	2012A - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TL6	08-29-2012	348,320,000	2012B-F - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	08-29-2012	125,000,000	2012G&H - Refund Highlands 2005I Conversion Bonds		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TR3	11-08-2012	232,125,000	2012I - Refunded Volusia 1994-A; Highlands 2004A, 2005E, 2005F, 2005G		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	09-18-2013	485,000,000	2013A B C, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-02-2014	110,000,000	2014A&D, Refund 2013C, expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-02-2014	50,000,000	2014B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-02-2014	30,000,000	2014C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648AT39	07-23-2014	82,501,800	2014E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FAB0	07-21-2016	235,724,616	2016 A&B, Adv ref portion 2009D, Exp/refurbish facilities, purchase equip		X		X		X
	Colorado Health Facilities Authority	84-0752932	1964745K2	08-17-2016	216,517,920	2016C, Refund 2006C, Expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-26-2017	44,750,000	2017A, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-26-2017	50,750,000	2017B, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-26-2017	45,250,000	2017C, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FCN2	07-26-2017	97,750,000	2017D, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FGN8	07-12-2018	375,008,542	2018A&B, Expand/refurbish facilities, purchase equipment		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	262,025,000		86,800,000		17,770,000		42,995,000
2 Amount of bonds legally defeased ..............			129,915,000		71,645,000		360,000
3 Total proceeds of issue ..................	372,572,414		325,394,417		102,271,154		190,752,502
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............
8 Credit enhancement from proceeds .............	5,560,382
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	367,012,032		12,004,967		21,844,721		25,008,355
11 Other spent proceeds .............	177,240,000		313,389,450		80,426,433		190,752,502
12 Other unspent proceeds .............
13 Year of substantial completion .............	2007		2009		2009		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X	X		X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X			X	X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.420 %		0.540 %		0.200 %		0.670 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........			0.070 %
6 Total of lines 4 and 5 .............	1.420 %		0.540 %		0.200 %		0.670 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..	0.370 %		0.140 %		0.140 %		0.370 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X		X		X		X
c No rebate due? .........		X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2007A B C D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Orange County Health Facilities Authority 2010B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Kansas Development Finance Authority 2010C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Colorado Health Facilities Authority 2010D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2013A-C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014A&D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014E: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part III, Line 8c	Highlands County Health Facilities Authority 2012A, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Kansas Development Finance Authority 2012A: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B-F: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Adventist Health SystemSunbelt Inc

Employer identification number
59-1479658

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Highlands County Health Facilities Authority	52-1313569	431022KK7	08-08-2007	366,445,000	2007A B C D, Expand/refurbish facilities, purchase equipment		X		X		X
B	Kansas Development Finance Authority	48-1066589	48542ABX8	07-08-2009	325,394,417	2009C, Ref 96/05&97/05 iss 1/13/05, 03A 1/16/03, 08B 12/19/08, exp facility	X			X		X
C	Kansas Development Finance Authority	48-1066589	48542ACY5	10-01-2009	102,271,154	2009D, Refund Highlands 07C, 8/8/07 & expand/refurbish facilities/purc equip	X			X		X
D	Highlands County Health Facilities Authority	52-1313569	431022SP8	11-16-2009	190,752,502	09E & 08B Conv, Ref Orange 91/01 10/11/01, 92/03 5/15/03, 08B 12/19/08	X			X		X
	Highlands County Health Facilities Authority	52-1313569	431022SG8	11-16-2009	178,936,632	2005I Conv, Refund Highlands 05I 12/22/05 & expand/refurbish facilities		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	12-22-2010	25,000,000	2010B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	12-22-2010	25,000,000	2010C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	NoneAvail	12-22-2010	25,000,000	2010D, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	11-16-2011	80,000,000	2011A, Expand/refurbish facilities		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	03-21-2012	294,985,000	2012A, AR Program - Refund 2009 A-F AR Program		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-25-2012	115,015,000	2012B, AR Program - Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	48542ADG3	08-29-2012	310,952,245	2012A - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TL6	08-29-2012	348,320,000	2012B-F - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	08-29-2012	125,000,000	2012G&H - Refund Highlands 2005I Conversion Bonds		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TR3	11-08-2012	232,125,000	2012I - Refunded Volusia 1994-A; Highlands 2004A, 2005E, 2005F, 2005G		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	09-18-2013	485,000,000	2013A B C, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-02-2014	110,000,000	2014A&D, Refund 2013C, expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-02-2014	50,000,000	2014B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-02-2014	30,000,000	2014C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648AT39	07-23-2014	82,501,800	2014E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FAB0	07-21-2016	235,724,616	2016 A&B, Adv ref portion 2009D, Exp/refurbish facilities, purchase equip		X		X		X
	Colorado Health Facilities Authority	84-0752932	1964745K2	08-17-2016	216,517,920	2016C, Refund 2006C, Expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-26-2017	44,750,000	2017A, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-26-2017	50,750,000	2017B, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-26-2017	45,250,000	2017C, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FCN2	07-26-2017	97,750,000	2017D, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FGN8	07-12-2018	375,008,542	2018A&B, Expand/refurbish facilities, purchase equipment		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	262,025,000		86,800,000		17,770,000		42,995,000
2 Amount of bonds legally defeased ..............			129,915,000		71,645,000		360,000
3 Total proceeds of issue ..................	372,572,414		325,394,417		102,271,154		190,752,502
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............
8 Credit enhancement from proceeds .............	5,560,382
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	367,012,032		12,004,967		21,844,721		25,008,355
11 Other spent proceeds .............	177,240,000		313,389,450		80,426,433		190,752,502
12 Other unspent proceeds .............
13 Year of substantial completion .............	2007		2009		2009		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X	X		X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X			X	X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.420 %		0.540 %		0.200 %		0.670 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........			0.070 %
6 Total of lines 4 and 5 .............	1.420 %		0.540 %		0.200 %		0.670 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..	0.370 %		0.140 %		0.140 %		0.370 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X		X		X		X
c No rebate due? .........		X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2007A B C D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Orange County Health Facilities Authority 2010B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Kansas Development Finance Authority 2010C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Colorado Health Facilities Authority 2010D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2013A-C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014A&D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014E: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part III, Line 8c	Highlands County Health Facilities Authority 2012A, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Kansas Development Finance Authority 2012A: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B-F: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.

Schedule K (Form 990) 2018

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Adventist Health SystemSunbelt Inc

Employer identification number
59-1479658

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Highlands County Health Facilities Authority	52-1313569	431022KK7	08-08-2007	366,445,000	2007A B C D, Expand/refurbish facilities, purchase equipment		X		X		X
B	Kansas Development Finance Authority	48-1066589	48542ABX8	07-08-2009	325,394,417	2009C, Ref 96/05&97/05 iss 1/13/05, 03A 1/16/03, 08B 12/19/08, exp facility	X			X		X
C	Kansas Development Finance Authority	48-1066589	48542ACY5	10-01-2009	102,271,154	2009D, Refund Highlands 07C, 8/8/07 & expand/refurbish facilities/purc equip	X			X		X
D	Highlands County Health Facilities Authority	52-1313569	431022SP8	11-16-2009	190,752,502	09E & 08B Conv, Ref Orange 91/01 10/11/01, 92/03 5/15/03, 08B 12/19/08	X			X		X
	Highlands County Health Facilities Authority	52-1313569	431022SG8	11-16-2009	178,936,632	2005I Conv, Refund Highlands 05I 12/22/05 & expand/refurbish facilities		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	12-22-2010	25,000,000	2010B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	12-22-2010	25,000,000	2010C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	NoneAvail	12-22-2010	25,000,000	2010D, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	11-16-2011	80,000,000	2011A, Expand/refurbish facilities		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	03-21-2012	294,985,000	2012A, AR Program - Refund 2009 A-F AR Program		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-25-2012	115,015,000	2012B, AR Program - Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	48542ADG3	08-29-2012	310,952,245	2012A - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TL6	08-29-2012	348,320,000	2012B-F - Refund Or-1995; H-02,03C,05H,06B,07B,07D,08A; C-2004B; K-2004C		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	08-29-2012	125,000,000	2012G&H - Refund Highlands 2005I Conversion Bonds		X		X		X
	Highlands County Health Facilities Authority	52-1313569	431022TR3	11-08-2012	232,125,000	2012I - Refunded Volusia 1994-A; Highlands 2004A, 2005E, 2005F, 2005G		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	09-18-2013	485,000,000	2013A B C, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-02-2014	110,000,000	2014A&D, Refund 2013C, expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-02-2014	50,000,000	2014B, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-02-2014	30,000,000	2014C, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648AT39	07-23-2014	82,501,800	2014E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FAB0	07-21-2016	235,724,616	2016 A&B, Adv ref portion 2009D, Exp/refurbish facilities, purchase equip		X		X		X
	Colorado Health Facilities Authority	84-0752932	1964745K2	08-17-2016	216,517,920	2016C, Refund 2006C, Expand/refurbish facilities, purchase equipment		X		X		X
	Orange County Health Facilities Authority	52-1378595	NoneAvail	07-26-2017	44,750,000	2017A, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Highlands County Health Facilities Authority	52-1313569	NoneAvail	07-26-2017	50,750,000	2017B, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Kansas Development Finance Authority	48-1066589	NoneAvail	07-26-2017	45,250,000	2017C, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FCN2	07-26-2017	97,750,000	2017D, Refund 2010A&E, Expand/refurbish facilities, purchase equipment		X		X		X
	Colorado Health Facilities Authority	84-0752932	19648FGN8	07-12-2018	375,008,542	2018A&B, Expand/refurbish facilities, purchase equipment		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	262,025,000		86,800,000		17,770,000		42,995,000
2 Amount of bonds legally defeased ..............			129,915,000		71,645,000		360,000
3 Total proceeds of issue ..................	372,572,414		325,394,417		102,271,154		190,752,502
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............
8 Credit enhancement from proceeds .............	5,560,382
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	367,012,032		12,004,967		21,844,721		25,008,355
11 Other spent proceeds .............	177,240,000		313,389,450		80,426,433		190,752,502
12 Other unspent proceeds .............
13 Year of substantial completion .............	2007		2009		2009		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X	X		X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X			X	X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.420 %		0.540 %		0.200 %		0.670 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........			0.070 %
6 Total of lines 4 and 5 .............	1.420 %		0.540 %		0.200 %		0.670 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..	0.370 %		0.140 %		0.140 %		0.370 %
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X		X		X		X
c No rebate due? .........		X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2007A B C D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Orange County Health Facilities Authority 2010B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Kansas Development Finance Authority 2010C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Colorado Health Facilities Authority 2010D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2013A-C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014A&D: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014B: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014C: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part II, Line 3, Total Proceeds of Issue	Highlands County Health Facilities Authority 2014E: The difference between Total Proceeds of Issue reported on Part II, Line 3 and the Issue Price reported on Part I, column (e) is attributed to investment earnings.
Part III, Line 8c	Highlands County Health Facilities Authority 2012A, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B, AR Program: A sale of bond-financed assets in 2006 was identified in early 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 25, 2013. A Closing Agreement was finalized with the IRS on February 11, 2015. A subsequent sale of assets occurred in 2014. Remedial action was taken as proscribed in Treasury Regulation Section 1.141-12 to preserve the tax-exempt status of the interest on the bonds.
Part III, Line 8c	Kansas Development Finance Authority 2012A: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.
Part III, Line 8c	Highlands County Health Facilities Authority 2012B-F: A sale of bond-financed assets in 2003 was identified in July 2013. The taxpayer has paid off the bonds related to this asset sale and filed a VCAP request pursuant to Notice 2008-31, 2008-11 IRB 592, on October 15, 2014. A Closing Agreement was finalized with the IRS on December 18, 2015.

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Adventist Health SystemSunbelt Inc

Employer identification number

59-1479658

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2018

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Karen Tilstra	Family of key employee	123,134	Consulting		No
(2) Dan Tilstra	Family of key employee	17,107	Professional Services		No
(3) Clifton Scott	Family of board member	163,622	Employee Compensation		No
(4) Kirsten Cutler	Family of board member	69,820	Employee Compensation		No
(5) Shelby Houmann	Family of board member	66,429	Employee Compensation		No
(6) Jacqueline Soler-Lemon	Family of former key employee	18,212	Employee Compensation		No
(7) Jeanette Vasquez	Family of former key employee	45,049	Employee Compensation		No
(8) Martin Shaw	Family of board member	42,206	Employee Compensation		No
(9) Mary Rathbun	Family of board member	82,242	Employee Compensation		No
(10) Meredith Banks	Family of former key employee	92,048	Employee Compensation		No
(11) Darlene Stevens	Family of key employee	43,856	Employee Compensation		No
(12) Martin Thompson	Family of key employee	138,760	Employee Compensation		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Adventist Health SystemSunbelt Inc

Employer identification number

59-1479658

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( Medical Equipment )	X	22	0	Replacement Cost
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which is not required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

Yes

If "Yes," describe in Part II.

If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2018)

Page 2

Part II

Supplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
Part I, Column (b):	The number of contributions reported in column (b) of Schedule M, Part I, represents the number of items received b the filing organization during the current year.
Part I, Line 32b:	The filing organization uses Sunsystem Development Corporation (SDC), a related organization, to solicit, process, or sell non-cash contributions. SDC is a charitable foundation organization that supports eleven related tax-exempt hospital organizations and one charitable hospice organization. In carrying out its philanthropic activities, SDC will occasionally engage third-parties to provide various consulting services. Such consulting services generally include donor/grant prospecting, assistance with grant-writing, fund-raising planning and organization, and planned giving services. Fees paid to any engaged consultants are at fair market value rates and the terms are always negotiated at arm's length.
Part I, Line 33:	Pursuant to the filing organization's Net Assets Accounting Policy, gifts of donated property are recorded by the filing organization to the unrestricted net assets (equity) account.

Schedule M (Form 990) (2018)

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

Adventist Health SystemSunbelt Inc

Employer identification number

59-1479658

Return Reference	Explanation
Part V, Line 1a	The parent corporation and sole top-tier member of Adventist Health System/Sunbelt, Inc. (the filing organization) is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). AHSSHC has established a shared service center to centralize the Accounts Payable (A/P) function for all AHSSHC subsidiary organizations. During 2018, some of the filing organization's hospitals transitioned their A/P function to AHSSHC. Accordingly, the number entered on line 1a represents the number reported on Box 3 of Form 1096 as filed by the filing organization for 2018. Subsequent to the transition of the A/P function for all hospitals to the AHSSHC shared service center, the filing organization will not enter any amount on Part V, line 1a. As a result of this transition, those hospitals no longer issue Form 1099 returns, rather, all such returns are filed by and under the name and EIN of AHSSHC as the payor subject to the information reporting requirements of Section 6041. The facts and circumstances support a position that AHSSHC, as a payor on behalf of its subsidiary organizations in a shared service environment, will have sufficient management and oversight in connection with the subsidiary organizations' payments to meet the standard set forth in Treas. Reg. Section 1.6041-1(e). AHSSHC will not merely be making payments at the direction of its subsidiary organizations. Accordingly, AHSSHC is considered the payor subject to the information reporting requirements of Section 6041.
Form 990, Part VI, Section A, line 2	Lars Houmann and Terry Owen - Family Relationship
Form 990, Part VI, Section A, line 6	Adventist Health System/Sunbelt, Inc. (the filing organization) has one member. The sole member of the filing organization is Adventist Health System Sunbelt Healthcare Corporation. Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). There are no other classes of membership in the filing organization.
Form 990, Part VI, Section A, line 7a	The sole member of the filing organization is AHSSHC. The Board of Directors of the filing organization are appointed by the sole member, AHSSHC, who has the right to elect, appoint or remove any member of the Board of Directors of the filing organization.
Form 990, Part VI, Section A, line 7b	AHSSHC, as the sole member of the filing organization, has certain reserved powers as set forth in the Bylaws of the filing organization. These reserved powers include the following: a) to approve and disapprove the executive and/or administrative leadership of the filing organization, and their salaries; b) to approve and disapprove the operating Bylaws of the filing organization; c) to set limits and terms for the borrowing of funds; d) to approve or disapprove major building programs and/or purchase or sale of personal property or real property equal to or in excess of One Million dollars; e) to approve or disapprove the annual operating and capital budgets of the filing organization; f) to direct the placement of funds and capital of the filing organization; and g) to establish general guiding policies.
Form 990, Part VI, Section B, line 11b	The filing organization's current year Form 990 was reviewed by the VP/Chief Accounting Officer prior to its filing with the IRS. The review conducted by the VP/Chief Accounting Officer 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 conflicts of interest, 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 Interest 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 AdventHealth. The audited consolidated financial statements of AdventHealth and of the AdventHealth "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 AdventHealth on a consolidated basis and for the grouping of AdventHealth 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 and officers 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 for Randall Haffner, Lars Houmann, Terry Shaw, and Paul Rathbun, were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position as an employee of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). Randall Haffner, Lars Houmann, Terry Shaw, and Paul Rathbun devote approximately 50 hours per week in conjunction with serving in their respective executive leadership position as an employee of Adventist Health System Sunbelt Healthcare Corporation.
Part VIII, Line 7c	The amount shown in Part VIII Line 7c(i) of the Form 990 represent an allocated share of capital gain/(loss) from a system wide, corporate administered, investment program.
Form 990, Part IX, line 11g	Payments to Healthcare Professionals: Program service expenses 261,606,614. Management and general expenses 0. Fundraising expenses 0. Total expenses 261,606,614. Professional Fees: Program service expenses 132,466,736. Management and general expenses 0. Fundraising expenses 0. Total expenses 132,466,736. Purchased Medical Services: Program service expenses 5,006,265. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,006,265. Environmental Services: Program service expenses 769,977. Management and general expenses 0. Fundraising expenses 0. Total expenses 769,977. Transcription Services: Program service expenses 319,198. Management and general expenses 0. Fundraising expenses 0. Total expenses 319,198. Recruiting: Program service expenses 1,384,394. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,384,394. Food Service Contracts: Program service expenses 1,795,446. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,795,446. Miscellaneous Purchased Services: Program service expenses 4,567,021. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,567,021. AdventHealth Management Fees: Program service expenses 0. Management and general expenses 35,531,418. Fundraising expenses 0. Total expenses 35,531,418. Billing & Collection Services: Program service expenses 0. Management and general expenses 23,557,367. Fundraising expenses 0. Total expenses 23,557,367. AdventHealth Shared Services Fee: Program service expenses 0. Management and general expenses 2,888,575. Fundraising expenses 0. Total expenses 2,888,575.
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.
Form 990, Part XI, line 9:	Transfer to tax-exempt affiliates -24,097,698. Transfer to tax-exempt parent -45,871,881. Donated Property 440,619. Allocations from Tax-exempt Parent with respect to Debt 5,801,489. Transfer for expenses -138,120. Gifts 12,714,457. Other -184,514. Income on Restriction 940. Rounding 1.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Adventist Health SystemSunbelt Inc

Employer identification number

59-1479658

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) IQ Orlando LLC 235 E Princeton Street Suite 220 Orlando,FL328045555 47-1121247	Design and innovation	FL	0	226,406	Adventist Hlth SystemSunbelt Inc

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(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)AdventHealth Foundation Shawnee Mission 9100 W 74th Street Shawnee Mission,KS66204 48-0868859	Fund-raising for Tax-exempt hospital	KS	501(c)(3)	Line 7	Shawnee Mission Medical Center Inc	Yes
(2)AdventHealth University Inc fka Adv Univ of Hlth Sciences Inc 671 Lake Winyah Drive Orlando,FL32803 59-3069793	Education/Operation of School	FL	501(c)(3)	Line 2	Adventist Hlth SystemSunbelt Inc	Yes
(3)AdventHealth Ransom Memorial Inc (619-123118) 1301 S Main Street Ottawa,KS66067 83-0976641	Operation of Hospital & Related Services	KS	501(c)(3)	Line 3	Adventist Hlth Mid-America Inc	Yes
(4)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
(5)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 10	Sunbelt Hlth Care Centers Inc	Yes
(6)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
(7)Adventist Hlth Mid-America Inc 9100 W 74th Street Shawnee Mission,KS66204 52-1347407	Support of Affiliated Hospital	KS	501(c)(3)	Line 12c, III-FI	Adventist Hlth SystemSunbelt Inc	Yes
(8)Adventist Hlth Partners Inc 2601 Navistar Dr Bldg 4 Finance Lisle,IL60532 36-4138353	Operation of Physician Practices & Medical Services	IL	501(c)(3)	Line 3	AHS Midwest Management Inc	Yes
(9)Adventist Hlth System Sunbelt Hlthcare Corp 900 Hope Way Altamonte Springs,FL32714 59-2170012	Management Services	FL	501(c)(3)	Line 12a, I	N/A		No
(10)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
(11)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
(12)Adventist Hlth SystemTexas Inc 11801 S Freeway Burleson,TX76028 74-2578952	Leasing Personnel to Affiliated Hospital	TX	501(c)(3)	Line 12c, III-FI	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(13)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
(14)AHP Specialty Care NFP 2601 Navistar Dr Bldg 4 Finance Lisle,IL60532 81-1105774	Operation of Physician Practices & Medical Services	IL	501(c)(3)	Line 3	AHS Midwest Management Inc	Yes
(15)AHS Midwest Management Inc 2601 Navistar Dr Bldg 4 Finance Lisle,IL60532 36-3354567	Operation of Physician Practice Mgmt	IL	501(c)(3)	Line 12a, I	Adventist Midwest Health	Yes
(16)AHSCentral Texas Inc 1301 Wonder World Drive San Marcos,TX78666 74-2621825	Provide Office Space - Medical Professionals	TX	501(c)(3)	Line 12c, III-FI	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(17)Apopka Hlth Care Properties Inc 305 E Oak Street Apopka,FL32703 51-0605694	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(18)Battle Creek Adventist Hospital 900 Hope Way Altamonte Springs,FL32714 38-1359189	Inactive	MI	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(19)Bolingbrook Hospital Foundation 500 Remington Blvd Bolingbrook,IL60440 90-0494445	Fund-raising for Tax-exempt hospital	IL	501(c)(3)	Line 7	Midwest Hlth Foundation		No
(20)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 10	Sunbelt Hlth Care Centers Inc	Yes
(21)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 10	Sunbelt Hlth Care Centers Inc	Yes
(22)Caldwell Hlth Care Properties Inc 1333 West Main Princeton,KY42445 51-0605680	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(23)Central Texas Hlthcare Collaborative 1301 Wonder World Drive San Marcos,TX78666 45-3739929	Support Operation of Hospital	TX	501(c)(3)	Line 12a, I	Adventist Hlth SystemSunbelt Inc	Yes
(24)Chickasaw Hlth Care Properties Inc 250 S Chickasaw Trail Orlando,FL32825 51-0605681	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(25)Chippewa Valley Hospital & Oakview Care Center Inc 1220 Third Avenue West Durand,WI54736 39-1365168	Operation of Hospital & Related Services	WI	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(26)Courtland Hlth Care Properties Inc 730 Courtland Street Orlando,FL32804 51-0605682	Lease to Related Organization	GA	501(c)(3)	Line 12c, 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 10	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 12c, 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 10	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 10	Sunbelt Hlth Care Centers Inc	Yes
(33)Florida Hospital Dade City Inc 13100 Fort King Road Dade City,FL33525 82-2567308	Operation of Hospital & Related Svcs	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(34)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
(35)Florida Hospital Medical Group Inc 2600 Westhall Lane 4th Floor Maitland,FL32751 59-3214635	Operation of Physician Practices & Medical Services	FL	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(36)Florida Hospital Ocala Inc 1500 SW 1st Avenue Ocala,FL34471 82-4372339	Operation of Hospital & Related Svcs	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(37)Florida Hospital Physician Group Inc 12470 Telecom Dr 100 Tampa,FL33637 46-2021581	Operation of Physician Practices & Medical Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(38)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
(39)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
(40)Florida Radiology Imaging at Lake Mary LLC (222-123118) 2600 Westhall Lane 4th Floor Maitland,FL32751 55-0789387	Imaging & Testing	FL	501(c)(3)	Line 3	Florida Hospital Medical Group Inc	Yes
(41)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 10	Sunbelt Hlth Care Centers Inc	Yes
(42)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
(43)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 12c, III-FI	N/A		No
(44)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	N/A		No
(45)Hinsdale Hospital Foundation 120 North Oak Street Hinsdale,IL60521 52-1466387	Fund-raising for Tax-exempt hospital	IL	501(c)(3)	Line 7	Midwest Hlth Foundation		No
(46)Hospice of the Comforter Inc 480 W Central Parkway Altamonte Springs,FL32714 59-2935928	Operation of Hospice	FL	501(c)(3)	Line 10	The Comforter Health Care Group Inc	Yes
(47)Hospice of the Comforter Foundation Inc 480 W Central Parkway Altamonte Springs,FL32714 27-1858033	Inactive	FL	501(c)(3)	Line 7	The Comforter Health Care Group Inc	Yes
(48)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 12b, II	Sunbelt Hlth Care Centers Inc	Yes
(49)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
(50)Lake County Health Care Properties Inc 485 North Keller Road 250 Maitland,FL32751 81-3923985	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(51)Memorial Hlth Systems Foundation Inc 305 Memorial Medical Pkwy 212 Daytona Beach,FL32117 31-1771522	Fund-raising for Tax-exempt hospital	FL	501(c)(3)	Line 7	N/A		No
(52)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
(53)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
(54)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
(55)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
(56)Merriam Hlth Care Properties Inc 9700 West 62nd Street Merriam,KS66203 36-4595806	Lease to Related Organization	KS	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(57)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
(58)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
(59)Midwest Hlth Foundation 120 North Oak Street Hinsdale,IL60521 35-2230515	Support of subsidiary Foundations	IL	501(c)(3)	Line 12b, II	N/A		No
(60)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 10	Sunbelt Hlth Care Centers Inc	Yes
(61)Mission Strategies of Georgia Inc 485 North Keller Road 250 Maitland,FL32751 90-0866024	Provision of support to the nursing home division	GA	501(c)(3)	Line 12b, II	Sunbelt Hlth Care Centers Inc	Yes
(62)Missouri Adventist Hlth Inc 9100 W 74th Street Shawnee Mission,KS66204 43-1224729	Support Hlth Care Services	MO	501(c)(3)	Line 12d, III-O	Adventist Hlth Mid-America 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 12c, III-FI	N/A		No
(64)Osceola Health Care Properties Inc 485 North Keller Road 250 Maitland,FL32751 81-3165729	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(65)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 10	Sunbelt Hlth Care Centers Inc	Yes
(66)Paragon Hlth Care Properties Inc 950 Highpoint Drive Hopkinsville,KY42240 51-0605686	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(67)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
(68)Portercare Adventist Hlth System (630 Year End) 9100 E Mineral Circle Centennial,CO80112 84-0438224	Operation of Hospital & Related Services	CO	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(69)Princeton Hlth & Rehab Center Inc 1333 West Main Princeton,KY42445 20-5782272	Operation of Home for the Aged/Hlthcare Delivery	KY	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(70)Princeton Professional Services Inc 601 E Rollins Street Orlando,FL32803 59-1191045	Provision of Hlthcare Services	FL	501(c)(3)	Line 10	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(71)Quality Circle for Hlthcare Inc 900 Hope Way Altamonte Springs,FL32714 26-3789368	Hlthcare Quality Services	FL	501(c)(3)	Line 12a, I	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(72)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 12b, II	Sunbelt Hlth Care Centers Inc	Yes
(73)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	N/A		No
(74)Rollins Brook Community Care Corp 2201 S Clear Creek Road Killeen,TX76549 46-1656773	Support Operation of Hospital	TX	501(c)(3)	Line 12a, I	Adventist Hlth SystemSunbelt Inc	Yes
(75)Russellville Hlth Care Properties Inc 683 East Third Street Russellville,KY42276 51-0605691	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(76)San Marcos Hlth Care Properties Inc 1900 Medical Parkway San Marcos,TX78666 51-0605693	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(77)San Marcos Nursing & Rehab Center Inc 1900 Medical Parkway San Marcos,TX78666 20-5782224	Operation of Home for the Aged/Hlthcare Delivery	TX	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(78)Shawnee Mission Hlth Care Inc 6501 West 75th Street Overland Park,KS66204 48-0952508	Lease to Related Organization	KS	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(79)Shawnee Mission Hlth Care Properties Inc 485 North Keller Road 250 Maitland,FL32751 81-3914908	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(80)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
(81)South Pasco Hlth Care Properties Inc 38250 A Avenue Zephyrhills,FL33542 51-0605679	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(82)Southeast Volusia Healthcare Corp 401 Palmetto Street New Smyrna Beach,FL32168 47-3793197	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(83)Southwest Volusia Hlth Services Inc 1055 Saxon Blvd Orange City,FL32763 59-3281591	Medical Office Building for Hospital	FL	501(c)(3)	Line 12a, I	Southwest Volusia Hlthcare Corp	Yes
(84)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
(85)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
(86)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 10	Sunbelt Hlth Care Centers Inc	Yes
(87)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 10	Sunbelt Hlth Care Centers Inc	Yes
(88)Sunbelt Hlth Care Centers Inc 485 North Keller Road 250 Maitland,FL32751 58-1473135	Management Services	TN	501(c)(3)	Line 12b, II	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(89)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
(90)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
(91)Tarrant County Hlth Care Properties Inc 301 Huguley Blvd Burleson,TX76028 51-0605677	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(92)Taylor Creek Hlth Care Properties Inc 718 Goodwin Lane Leitchfield,KY42754 51-0605678	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(93)The Comforter Health Care Group Inc 605 Montgomery Road Altamonte Springs,FL32714 27-1857940	Lease to Related Organization	FL	501(c)(3)	Line 12c, III-FI	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(94)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 12c, III-FI	N/A		No
(95)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 10	Sunbelt Hlth Care Centers Inc	Yes
(96)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 10	Sunbelt Hlth Care Centers Inc	Yes
(97)University Community Hospital Foundation Inc 3100 E Fletcher Ave Tampa,FL33613 59-2554889	Fund-raising for Tax-exempt hospital	FL	501(c)(3)	Line 12a, I	N/A		No
(98)University Community Hospital Specialty Care Inc 3100 E Fletcher Ave Tampa,FL33613 59-3231322	Inactive	FL	501(c)(3)	Line 12a, I	University Community Hospital Inc	Yes
(99)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
(100)West Florida Health Inc 14055 Riveredge Drive Tampa,FL33637 47-1881744	Holding Company	FL	501(c)(3)	Line 10	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(101)West Florida Health Home Care Inc 13601 Bruce B Downs Blvd Ste 110 Tampa,FL33613 59-3686109	Home Health Services	GA	501(c)(3)	Line 10	West Florida Health Inc	Yes
(102)West Kentucky Hlth Care Properties Inc 500 Beck Lane Mayfield,KY42066 51-0605676	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(103)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 10	Sunbelt Hlth Care Centers Inc	Yes
(104)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 10	Sunbelt Hlth Care Centers Inc	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2018

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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) Florida Hospital DMERT LLC 500 Winderley Place Ste 324 Maitland,FL32751 20-2392253	Medical Equipment	FL	N/A
(3) Florida Hospital Home Infusion LLP 500 Winderley Place Ste 226 Maitland,FL32751 59-3142824	Home Infusion Services	FL	N/A
(4) Functional Neurosurgical Ambulatory Surgery Ctr LLC 11 W Dry Creek Circle 120 Littleton,CO80120 46-4426708	Surgery Center	CO	N/A
(5) Princeton Homecare Services LLC 1050 Forrer Blvd Kettering,OH45420 81-4196648	Operation of Home Health Agency	FL	N/A
(6) San Marcos MRI LP 1330 Wonder World Dr Ste 202 San Marcos,TX78666 77-0597972	Imaging & Testing	TX	Adventist Hlth SystemSunbelt Inc	Related	108,102	506,983		No			No	60.000 %
(7) The Bariatric Center of Kansas City LLC (628-123118) 9100 W 74th Street Merriam,KS66204 82-3025378	Surgery Center	KS	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(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	Adventist Hlth SystemSunbelt Inc	C	146,722	615,650	61.440 %	Yes
(2) Apopka Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando,FL32803 59-3000857	Condo Association	FL	Adventist Hlth SystemSunbelt Inc	C	32,290	42,770	100.000 %	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	Adventist Hlth SystemSunbelt Inc	C			100.000 %	Yes
(5) Central Texas Providers Network 1301 Wonder World Drive San Marcos,TX78666 74-2827652	Physician Hospital Org.	TX	Adventist Hlth SystemSunbelt Inc	C	123,661	228,720	100.000 %	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 550 E Rollins Street 7th Floor Orlando,FL32803 82-1748255	Condo Association	FL	Adventist Hlth SystemSunbelt Inc	C			100.000 %	Yes
(8) Florida Hospital Healthcare System Inc 101 Southhall Lane Ste 150 Maitland,FL32751 59-3215680	PHSO	FL	Adventist Hlth SystemSunbelt Inc	C	14,584,730	18,770,648	100.000 %	Yes
(9) Florida Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando,FL32803 59-2855791	Condo Association	FL	Adventist Hlth SystemSunbelt Inc	C	687,245	3,684,349	85.000 %	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	Adventist Hlth SystemSunbelt Inc	C	71,539	108,954	55.000 %	Yes
(12) LN Health Partners Inc 550 E Rollins Street 6th Floor Orlando,FL32803 81-3556903	Inactive	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 year 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 Affiliated Health Services Inc 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	Adventist Hlth SystemSunbelt Inc	C	3,604	14,640	100.000 %	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	Adventist Hlth SystemSunbelt Inc	C	151,099	80,829	51.580 %	Yes

Schedule R (Form 990) 2018

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

Yes

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) ......................

Yes

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) ............................

Yes

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

Yes

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) AdventHealth University Inc	A	3,234,060	FMV Rental Rate
(2) AdventHealth University Inc	B	125,067	Actual Amount Given
(3) AdventHealth University Inc	Q	23,271,508	Cost
(4) AdventHealth University Inc	R	5,850,374	Actual Amount Given
(5) Adventist Health System Sunbelt Healthcare Corporation	A	1,534,440	FMV Rental Rate
(6) Adventist Health System Sunbelt Healthcare Corporation	B	45,871,879	Actual Amount Given
(7) Adventist Health System Sunbelt Healthcare Corporation	C	620,920	Actual Amount Received
(8) Adventist Health System Sunbelt Healthcare Corporation	M	34,396,402	% of Facility's Operating Exp
(9) Adventist Health System Sunbelt Healthcare Corporation - Shared Services	M	2,934,025	% of Facility's Operating Exp
(10) Adventist Health System Sunbelt Healthcare Corporation dba AIT	M	129,157,000	% of Facility's Operating Exp
(11) Adventist Health System Sunbelt Healthcare Corporation	P	323,202,495	Cost
(12) Adventist Health System Sunbelt Healthcare Corporation	S	3,297,382	Actual Amount Received
(13) AHSCentral Texas Inc	A	180,141	FMV Rental Rate
(14) Central Texas Healthcare Collaborative	B	1,767,849	Actual Amount Given
(15) East Orlando Health & Rehab Center Inc	B	2,292,773	Actual Amount Given
(16) FLNC Inc (Florida Living Nursing Center)	B	3,533,991	Actual Amount Given
(17) Florida Hospital Dade City Inc	R	1,038,000	Actual Amount Given
(18) Florida Hospital Healthcare System Inc	A	100,045	FMV Rental Rate
(19) Florida Hospital Healthcare System Inc	L	58,827	Cost Plus Appropriate %
(20) Florida Hospital Healthcare System Inc	P	244,529	Cost
(21) Florida Hospital Healthcare System Inc	R	24,230,450	Actual Amount Given
(22) Florida Hospital Medical Group Inc	A	10,668,598	FMV Rental Rate
(23) Florida Hospital Medical Group Inc	B	5,018,248	Actual Amount Given
(24) Florida Hospital Medical Group Inc	K	381,394	FMV Rental Rate
(25) Florida Hospital Medical Group Inc	L	461,609	Cost Plus Appropriate %
(26) Florida Hospital Medical Group Inc	M	138,682,866	Cost Plus Appropriate %
(27) Florida Hospital Medical Group Inc	P	31,580,719	Cost
(28) Florida Hospital Medical Group Inc	Q	46,838,630	Cost
(29) Florida Hospital Waterman Inc	L	987,865	Cost Plus Appropriate %
(30) Florida Hospital Zephyrhills Inc	L	134,368	Cost Plus Appropriate %
(31) Florida Hospital Zephyrhills Inc	S	380,622	Actual Amount Received
(32) Florida Radiology Imaging at Lake Mary LLC	A	824,628	FMV Rental Rate
(33) Florida Radiology Imaging at Lake Mary LLC	Q	4,630,293	Cost
(34) Hospice of the Comforter Inc	K	493,966	FMV Rental Rate
(35) Hospice of the Comforter Inc	L	57,819	Cost Plus Appropriate %
(36) Hospice of the Comforter Inc	P	54,000	Cost
(37) Hospice of the Comforter Inc	Q	1,214,802	Cost
(38) Memorial Health Systems Inc	K	87,460	FMV Rental Rate
(39) Memorial Health Systems Inc	L	1,170,616	Cost Plus Appropriate %
(40) Memorial Health Systems Inc	M	152,997	Cost Plus Appropriate %
(41) Memorial Health Systems Inc	P	540,868	Cost
(42) Memorial Health Systems Inc	S	6,184,029	Actual Amount Received
(43) Memorial Hospital - Flagler Inc	L	610,868	Cost Plus Appropriate %
(44) Memorial Hospital - Flagler Inc	Q	57,782	Cost
(45) Memorial Hospital - West Volusia Inc	L	686,024	Cost Plus Appropriate %
(46) Pasco-Pinellas Hillsborough Community Health System Inc	Q	124,078	Cost
(47) Princeton Professional Services Inc	A	52,570	FMV Rental Rate
(48) Princeton Professional Services Inc	M	689,562	Cost Plus Appropriate %
(49) Princeton Professional Services Inc	Q	147,398	Cost
(50) Shawnee Mission Medical Center Inc	Q	8,184,944	Cost
(51) Southeast Volusia Healthcare Corporation	Q	280,553	Cost
(52) Southwest Volusia Healthcare Corporation	L	983,116	Cost Plus Appropriate %
(53) Southwest Volusia Healthcare Corporation	S	1,480,683	Actual Amount Received
(54) Specialty Physicians of Central Texas Inc	B	5,153,716	Actual Amount GIven
(55) Sunbelt Health & Rehab Center - Apopka Inc	B	612,045	Actual Amount Given
(56) SunSystem Development Corporation	B	4,861,701	Actual Amount GIven
(57) SunSystem Development Corporation	C	28,314,920	Actual Amount Received
(58) SunSystem Development Corporation	Q	2,787,833	Cost
(59) Tarpon Springs Hospital Foundation Inc	Q	138,524	Cost
(60) University Community Hospital Inc	L	835,180	Cost Plus Appropriate %
(61) University Community Hospital Inc	P	2,995,408	Cost
(62) South Central Inc	C	2,060,704	Actual Amount Received

Schedule R (Form 990) 2018

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) 2018

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) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Operation of 11 acute-care hospitals & related healthcare services.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	24
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	18
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	30,105
6	Total number of volunteers (estimate if necessary) .............	6	2,690
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	20,618,673
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	2,712,965

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	8,151,058	21,817,289
9	Program service revenue (Part VIII, line 2g) .........	3,957,886,944	4,331,317,719
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	97,989,302	60,971,258
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	17,140,925	12,307,248
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	4,081,168,229	4,426,413,514
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	22,313,459	23,222,174
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)	1,614,161,414	1,682,310,367
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)....	1,909,064,016	2,170,733,626
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	3,545,538,889	3,876,266,167
19	Revenue less expenses. Subtract line 18 from line 12.......	535,629,340	550,147,347
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	7,633,849,846	8,117,641,825
21	Total liabilities (Part X, line 26).............	3,932,136,691	4,036,105,065
22	Net assets or fund balances. Subtract line 21 from line 20.....	3,701,713,155	4,081,536,760

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 3,514,646,643 including grants of $ 23,222,174 ) (Revenue $ 4,320,598,762 )
	Operation of 11 acute care hospitals with 148,887 patient admissions, 741,423 patient days and 1,417,169 outpatient visits in the current year. In addition to hospital operations, the corporation provides medical care through a number of other activities such as urgent care centers, physician clinics, home health services, hospice services, sleep centers, wound centers, therapy and rehab.

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 expenses3,514,646,643

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	6,891,239	30,095,260	3,315,376

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	19,161,533
e	Government grants (contributions)		1e	2,339,534

f	All other contributions, gifts, grants, and similar amounts not included above		1f	316,222

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		21,817,289

		Business Code
2a	Patient Revenue	622110	4,256,571,744	4,243,501,145	13,070,599
b	Cafeteria/Vending Rev.	622110	19,252,165	18,912,773	339,392
c	Rent from Exempt Affiliates	622110	17,011,954	17,011,954
d	Research	622110	8,884,122	8,884,122
e	Gift Shop	622110	6,761,477	6,731,089	30,388
f	All other program service revenue.		22,836,257	16,030,274	6,805,983
g	Total. Add lines 2a–2f ....		4,331,317,719

3 Investment income (including dividends, interest, and othersimilar amounts) ......			89,415,199			89,415,199
4 Income from investment of tax-exempt bond proceeds			-51,288			-51,288
5 Royalties...........			233,639			233,639
		(ii) Personal	(i) Real
6a	Gross rents	278,098	3,361,862
b	Less: rental expenses	41,346	1,052,410
c	Rental income or (loss)	236,752	2,309,452
d	Net rental income or (loss)......			2,546,204		372,311	2,173,893
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	5,001,409
b	Less: cost or other basis and sales expenses	3,998,498	29,395,564
c	Gain or (loss)	1,002,911	-29,395,564
d	Net gain or (loss).....			-28,392,653			-28,392,653
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	Equity earnings from related enti		622110	9,991,004	9,991,004
b	EHR Revenue		622110	268,965	268,965
c	Investment in Subs		622110	-732,564	-732,564
d	All other revenue ....
e	Total. Add lines 11a–11d ......			9,527,405
12	Total revenue. See Instructions......			4,426,413,514	4,320,598,762	20,618,673	63,378,790

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	22,870,213	22,870,213
2	Grants and other assistance to domestic individuals. See Part IV, line 22
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.	351,961	351,961
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	14,671,097		14,671,097
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	1,238,287,209	1,225,830,810	12,456,399
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	49,843,762	48,841,502	1,002,260
9	Other employee benefits .......	284,965,146	275,228,875	9,736,271
10	Payroll taxes ...........	94,543,153	92,593,445	1,949,708
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	3,851,440		3,851,440
c	Accounting ...........	753,649		753,649
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	15,038,427		15,038,427
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	469,893,011	407,915,651	61,977,360
12	Advertising and promotion ....	43,944,621		43,944,621
13	Office expenses .......	104,711,315	80,324,413	24,386,902
14	Information technology ......	122,553,017	103,449,726	19,103,291
15	Royalties ..
16	Occupancy ...........	75,613,100	75,613,100
17	Travel ............	5,730,677	3,462,022	2,268,655
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	1,830,943	925,523	905,420
20	Interest ...........	37,578,787	37,578,787
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	210,744,447	210,744,447
23	Insurance ...	48,378,348	47,348,122	1,030,226
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	686,329,635	686,329,635
b	Assessments	105,169,038	105,169,038
c	Repairs/Maintenance	68,168,722	68,168,722
d	UBI Tax	266,886		266,886
e	All other expenses	170,177,563	21,900,651	148,276,912
25	Total functional expenses. Add lines 1 through 24e	3,876,266,167	3,514,646,643	361,619,524	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 ........			112,111	1	101,384
2	Savings and temporary cash investments .........			2,380,510,462	2	2,749,161,344
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			583,715,210	4	547,174,284
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 ........			97,774,739	8	95,583,705
9	Prepaid expenses and deferred charges ......			25,899,800	9	34,710,051
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	4,812,476,116
b	Less: accumulated depreciation	10b	2,313,040,689	2,363,552,306	10c	2,499,435,427
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			6,841,768	12	6,023,522
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			30,533,805	14	29,516,663
15	Other assets. See Part IV, line 11 ...........			2,144,909,645	15	2,155,935,445
16	Total assets. Add lines 1 through 15 (must equal line 34)...			7,633,849,846	16	8,117,641,825

17	Accounts payable and accrued expenses .....	307,014,344	17	338,721,594
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	3,272,066,774	20	3,370,428,808
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	353,055,573	25	326,954,663
26	Total liabilities. Add lines 17 through 25..	3,932,136,691	26	4,036,105,065

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	3,700,264,912	27	4,080,199,116
28	Temporarily restricted net assets ...........	1,448,243	28	1,337,644
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 ...........	3,701,713,155	33	4,081,536,760
34	Total liabilities and net assets/fund balances ........	7,633,849,846	34	8,117,641,825

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No