Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
A For the 2020 calendar year, or tax year beginning 01-01-2020 , and ending 12-31-2020
BCheck if applicable:
CName of organization
ADVENTIST GLENOAKS HOSPITAL
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
701 WINTHROP AVE
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
GLENDALE HEIGHTS, IL60139
D Employer identification number

36-3208390
E Telephone number

G Gross receipts $ 101,469,350
F Name and address of principal officer:
BRUCE CHRISTIAN
701 WINTHROP AVE
GLENDALE HEIGHTS,IL60139
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.AMITAHEALTH.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1982
M State of legal domicile: IL
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: THE PROVISION OF MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF A 143 BED HOSPITAL.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 9
5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) ...... 5 684
6 Total number of volunteers (estimate if necessary) ............. 6 59
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 118,151
b Net unrelated business taxable income from Form 990-T, line 39 ......... 7b 7,372
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 106,645 2,796,587
9 Program service revenue (Part VIII, line 2g) ......... 99,115,483 98,457,336
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 1,696 64,909
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -1,348 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 99,222,476 101,318,832
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 184,626 157,958
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) 41,182,933 42,244,949
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 51,400,349 57,243,795
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 92,767,908 99,646,702
19 Revenue less expenses. Subtract line 18 from line 12....... 6,454,568 1,672,130
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 64,154,017 69,099,079
21 Total liabilities (Part X, line 26)............. 36,306,706 39,936,731
22 Net assets or fund balances. Subtract line 21 from line 20..... 27,847,311 29,162,348
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2020)
Form 990 (2020)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION AND ALL ITS SUBSIDIARY ORGANIZATIONS WERE ESTABLISHED BY THE SEVENTH-DAY ADVENTIST CHURCH TO BRING A MINISTRY OF HEALING AND HEALTH TO THE COMMUNITIES SERVED. OUR MISSION IS TO EXTEND THE HEALING MINISTRY OF CHRIST.THE HOSPITAL AND HEALTHCARE SYSTEM WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION IS KNOWN AS ADVENTHEALTH. ADVENTHEALTH SEEKS TO BE WIDELY RESPECTED AS A CONSUMER-FOCUSED ORGANIZATION THAT ENGAGES INDIVIDUALS IN THEIR HEALTH BY DELIVERING WHOLISTIC, BEST PRACTICE CARE ACROSS A CONNECTED, COMPREHENSIVE CONTINUUM OF SERVICES. WITH CHRIST AS OUR EXAMPLE, ADVENTHEALTH CARES FOR AND NURTURES PEOPLE: OUR EMPLOYEES, OUR COMMUNITIES, OUR HEALTHCARE PROFESSIONALS, AND THOSE WHO TRUST US FOR CARE AND HEALING.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 89,579,771 including grants of $ 157,958 ) (Revenue $ 98,339,185 )
THE FILING ORGANIZATION DOES BUSINESS UNDER THE NAME AMITA HEALTH ADVENTIST MEDICAL CENTER GLENOAKS (AMITA HEALTH GLENOAKS, OR THE HOSPITAL). THE HOSPITAL, WHICH IS PART OF ADVENTHEALTH, IS A 143-BED ACUTE-CARE HOSPITAL IN GLENDALE HEIGHTS, ILLINOIS, THAT HAS SERVED THE HEALTHCARE NEEDS OF THE GLENDALE HEIGHTS COMMUNITY AND SURROUNDING AREAS SINCE 1980. LOCATED AT 701 WINTHROP AVENUE, THE HOSPITAL IS A FULL-SERVICE HOSPITAL THAT INCLUDES THE LAGATTUTA CENTER FOR HEALTH (THE CENTER), A TWO-STORY FACILITY THAT PROVIDES OUTPATIENT AND ONCOLOGY SERVICES. THE CENTER HOUSES TIME-SHARE PHYSICIAN OFFICES, ALLOWING THE HOSPITAL TO PROVIDE SUBSPECIALTY CARE ON ITS CAMPUS. SPECIALTY CARE AND OTHER SERVICES AVAILABLE AT THE HOSPITAL INCLUDE BEHAVIORAL HEALTHCARE, CARDIAC CATHETERIZATION, CARDIAC ELECTROPHYSIOLOGY, CARDIOLOGY/HEARTCARE, DIAGNOSTIC IMAGING, DIALYSIS, DIGITAL MAMMOGRAPHY, EMERGENCY MEDICAL CARE, GASTROENTEROLOGY, INTERVENTIONAL RADIOLOGY, LABORATORY, OBSTETRICS, OCCUPATIONAL AND PHYSICAL THERAPIES, ONCOLOGY, OPHTHALMOLOGY, ORTHOPEDICS, OUTPATIENT PHARMACY, PAIN MANAGEMENT, PODIATRY AND SURGERY. IN PARTNERSHIP WITH PT SOLUTIONS, THE HOSPITAL ALSO OPERATES THREE OUTPATIENT PHYSICAL REHABILITATION SITES IN BLOOMINGDALE, GLENDALE HEIGHTS AND WHEATON, ILLINOIS. IN 2018, THE HOSPITAL OPENED A HEPATITIS-C CLINIC DEDICATED TO THE DIAGNOSIS AND TREATMENT OF THE DISEASE, WHICH KILLS TENS OF THOUSANDS OF PEOPLE A YEAR.FROM NEW TECHNOLOGIES AND AESTHETIC UPDATES TO ALL-PRIVATE PATIENT ROOMS IN THE HOSPITAL'S MEDICAL/SURGICAL UNITS, RECENT RENOVATIONS AT THE HOSPITAL HAVE PLACED WORLD-CLASS MEDICAL SERVICES IN AN ENVIRONMENT CONDUCIVE TO PATIENTS' COMFORT AND CARE. THE RENOVATIONS ALSO HAVE RAISED THE HOSPITAL'S RECOGNITION LEVEL IN THE COMMUNITY AND HAVE ENHANCED THE HOSPITAL'S ABILITY TO ATTRACT HIGH-QUALITY PHYSICIANS.THE HOSPITAL'S ONGOING COMMITMENT TO SERVING COMMUNITY NEEDS IS BEST EXEMPLIFIED BY ITS THERAPEUTIC DAY SCHOOL (THE SCHOOL), WHICH WORKS WITH LOCAL SCHOOL DISTRICTS TO PROVIDE ACADEMIC EDUCATION AND THERAPIES AT THREE LOCATIONS (GLENDALE HEIGHTS, GLEN ELLYN, ILLINOIS, AND NORTH AURORA, ILLINOIS) FOR MORE THAN 200 THIRD- TO 12TH-GRADE STUDENTS WITH EMOTIONAL DISORDERS. THE SCHOOL ALSO OFFERS A TRANSITION PROGRAM FOR ITS GRADUATES AS THEY PREPARE FOR COLLEGE OR THE WORKFORCE. FOUNDED IN 1994, THE PROGRAM IS ONE OF THE MOST RESPECTED ALTERNATIVE SCHOOLS IN THE CHICAGO AREA.THE MODERNIZATION AND PERFORMANCE OF AMITA HEALTH GLENOAKS HAVE CAUGHT THE ATTENTION OF HEALTHCARE AUTHORITIES WHO MEASURE HOSPITAL QUALITY AND SAFETY. THE HOSPITAL IS CERTIFIED AS A PRIMARY STROKE CENTER BY THE JOINT COMMISSION AND THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION AND HAS RECEIVED NATIONAL QUALITY APPROVAL FROM THE JOINT COMMISSION. THE HOSPITAL ALSO HAS BEEN DESIGNATED AS A BLUE DISTINCTION CENTER+ BY THE BLUE CROSS AND BLUE SHIELD ASSOCIATION FOR DELIVERING SAFE, HIGH-QUALITY AND COST-EFFICIENT MATERNITY CARE. IN 2018, CRIBS FOR KIDS CERTIFIED THE HOSPITAL AS A GOLD SAFE SLEEP CHAMPION FOR ITS COMMITMENT TO REDUCING INFANT SLEEP-RELATED DEATHS THROUGH INFANT-SAFE-SLEEP BEST PRACTICES AND EDUCATION. ALSO IN 2018, AMINO, A SAN FRANCISCO-BASED HEALTHCARE DATA COMPANY, RANKED AMITA HEALTH GLENOAKS FOURTH IN THE COMPANY'S RANKINGS OF THE TOP FIVE LEAST-EXPENSIVE HOSPITALS IN THE CHICAGO AREA.IN 2020, THE HOSPITAL TREATED 4,935 INPATIENTS, PERFORMED 477 INPATIENT SURGERIES AND DELIVERED 333 BABIES. THE HOSPITAL'S MEDICAL STAFF INCLUDES OVER 300 PHYSICIANS REPRESENTING MORE THAN 27 MEDICAL AND SURGICAL SPECIALTIES.THE HOSPITAL PROVIDES CARE FOR ALL, INCLUDING THE FINANCIALLY DISADVANTAGED, UNINSURED, UNDERINSURED, HOMELESS AND THOSE WHO RECEIVE PUBLIC AID. IN 2020, THE HOSPITAL PROVIDED $2,529,153 OF CHARITY CARE AT COST. THIS WAS IN ADDITION TO $364,260 IN OTHER COMMUNITY BENEFITS SERVICES.ABOUT ADVENTIST MIDWEST HEALTHTHE HOSPITAL IS A SUBSIDIARY ORGANIZATION OF ADVENTIST MIDWEST HEALTH (AMH), A NETWORK OF FOUR NOT-FOR-PROFIT HOSPITALS AND THEIR OUTPATIENT-BASED HEALTHCARE FACILITIES IN CHICAGO'S WESTERN SUBURBS. AMH TAKES A HOLISTIC APPROACH TO WELLNESS, ADDRESSING THE PHYSICAL, MENTAL, SOCIAL AND SPIRITUAL NEEDS OF THE PEOPLE IT SERVES. AMH'S HOSPITALS AND OTHER FACILITIES ARE INTEGRAL TO THE FABRIC OF THEIR COMMUNITIES. AMH PARTNERS WITH LOCAL CIVIC ORGANIZATIONS AND BUSINESSES TO BRING STATE-OF-THE-ART TREATMENTS AND PREVENTIVE HEALTHCARE SERVICES CLOSE TO WHERE PEOPLE LIVE AND WORK. AS PART OF ADVENTHEALTH, THE LARGEST, NOT-FOR-PROFIT PROTESTANT HOSPITAL SYSTEM IN THE NATION, AMH IS GROUNDED IN CHRISTIAN VALUES AND COMMITTED TO EXTENDING THE HEALING MINISTRY OF CHRIST. AMH WELCOMES PATIENTS FROM ANY RELIGIOUS DENOMINATION AS WELL AS PATIENTS WHO DO NOT ASCRIBE TO ANY RELIGION.IN FEBRUARY 2015, AMH AND ALEXIAN BROTHERS HEALTH SYSTEM (ABHS) FORMED A JOINT OPERATING COMPANY (JOC). A JOC ALLOWS SEPARATE OWNERS TO INTEGRATE OPERATIONS TO ACHIEVE A COMMON GOAL WHILE MAINTAINING SEPARATE OWNERSHIP OF ASSETS. IT ALSO ALLOWS AMH AND ABHS TO WORK IN UNISON WHILE PRESERVING THE ADVENTIST AND CATHOLIC IDENTITIES AND MISSION PRIORITIES THAT DEFINE AMH AND ABHS, RESPECTIVELY. IN APRIL 2015, ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO., D/B/A AMITA HEALTH, WAS ANNOUNCED AS THE NEW NAME OF THE JOC. THE NAME AMITA IS INSPIRED BY THE MEANING IT HAS IN SEVERAL LANGUAGES -- FRIENDSHIP IN ITALIAN, HONESTY AND TRUTH IN HEBREW, AND SPIRITUAL LIGHT AND BOUNDLESSNESS IN HINDI. THE NAME REFLECTS AMITA HEALTH'S FAITH-BASED CALL TO HEALING, ITS CORE VALUES, AND THE COMPASSION AND DEDICATION THAT ITS CAREGIVERS SHOW EVERY DAY TO PATIENTS, THEIR FAMILIES AND EACH OTHER.AMITA HEALTH GLENOAKS SERVICES DIAGNOSTIC SERVICESAMITA HEALTH GLENOAKS' DIAGNOSTIC SERVICES INCLUDE THE LATEST TECHNOLOGY AND PRACTICES, WHICH ARE ACCREDITED BY NATIONALLY AND STATE RECOGNIZED AGENCIES AND ASSOCIATIONS, SUCH AS THE ILLINOIS EMERGENCY MANAGEMENT AGENCY, THE AMERICAN COLLEGE OF RADIOLOGY, THE COLLEGE OF AMERICAN PATHOLOGISTS, THE CLINICAL LABORATORY IMPROVEMENT AMENDMENTS AND THE JOINT COMMISSION.DIAGNOSTIC SERVICES OFFERED INCLUDE:-- DIAGNOSTIC IMAGING (GENERAL X-RAY, CT, MRI, ULTRASOUND, NUCLEAR MEDICINE)-- BREAST-CARE SERVICES (SCREENING, BREAST BIOPSY ULTRASOUND, BONE DENSITOMETRY, AND GENETIC COUNSELING) -- CARDIOLOGY (CARDIAC CATHETERIZATION, ELECTROPHYSIOLOGY, ELECTROCARDIOGRAMS [EKGS], STRESS TESTING, ECHOCARDIOGRAPHY, HOLTER MONITORING OF ARRHYTHMIAS)-- PULMONARY DIAGNOSTICS (ARTERIAL BLOOD GAS ANALYSIS)-- GASTROENTEROLOGY (COLONOSCOPY, BRONCHOSCOPY)-- LABORATORY/PATHOLOGY (CHEMISTRY, MICROBIOLOGY, HEMATOLOGY, HISTOLOGY, CYTOLOGY, PHLEBOTOMY, TRANSFUSION SERVICES)EMERGENCY DEPARTMENTEMERGENCY MEDICAL CARE IS PROVIDED 24/7 FOR ALL AGES AND TYPES OF PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY FOR SUCH SERVICES.OUTPATIENT SERVICES PERFORMED IN 2020: -- 1,146 OUTPATIENT SURGERIES-- 17,730 EMERGENCY ROOM VISITS.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet89,579,771
Form 990 (2020)
Form 990 (2020)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D,
Part IIIClick to see attachment..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D,
Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII
Click to see attachment......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2020)
Form 990 (2020)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
Form 990 (2020)
Form 990 (2020)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
684
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
Form 990 (2020)
Form 990 (2020)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
18
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
9
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
IL
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletJARED BROWN701 WINTHROP AVENUE   GLENDALE HEIGHTS,IL60139 (224) 273-0191
Form 990 (2020)
Form 990 (2020)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

See instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W-2/1099-MISC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) HAFFNER PHD RANDALL......................................................................
DIR/CHAIRMAN
0.30
.................
50.00
X           0 2,876,292 209,336
(2) CARROLL MD RICHARD......................................................................
VP/CMO BOLINGBROOK/GLENOAK
25.00
.................
25.00
      X     0 1,866,820 36,187
(3) SNYDER BRENT......................................................................
DIRECTOR
0.30
.................
50.00
X           0 1,244,833 191,435
(4) THORDARSON THOR......................................................................
DIR/PRES/SEC/EVP & COO
0.30
.................
50.00
X           0 948,281 35,319
(5) MURRILL MICHAEL......................................................................
FORMER COO
0.00
.................
50.00
          X 0 732,406 104,121
(6) BUCHANAN HERBERT......................................................................
DIRECTOR/REGION COO
2.50
.................
47.50
X           32,139 610,645 17,514
(7) CHRISTIAN BRUCE......................................................................
PRES/CEO BOLINGBROOK/GLENO
25.00
.................
25.00
    X       0 536,534 34,911
(8) MURPHY MARY......................................................................
FORMER REGIONAL CNO
0.00
.................
50.00
          X 0 391,101 29,144
(9) SCHIMEROWSKI DEBORAH......................................................................
CFO (END 3/20)
2.50
.................
47.50
    X       19,154 363,930 9,345
(10) RADIVOJEVIC VLADIMIR......................................................................
VP/COO BOLINGBROOK/GLENOAK
25.00
.................
25.00
      X     0 312,336 41,739
(11) PFIEFER CAROL......................................................................
CNO (END 8/20)
50.00
.................
0.00
      X     277,052 0 24,168
(12) BROWN JARED......................................................................
SR. DIR. FINANCE-BOLINGBROOK & GLENOAKS
25.00
.................
25.00
    X       0 228,155 30,144
(13) DE RAMOS DO DAVID......................................................................
DIRECTOR
0.30
.................
50.00
X           0 190,417 27,903
(14) SULIMA JAMES......................................................................
RN-CHARGE
58.00
.................
0.00
        X   182,584 0 18,001
(15) DOMINGIEZ MIGUEL......................................................................
RN DIR-NURSING
60.00
.................
0.00
        X   164,421 0 33,013
(16) ALBAUGH JOLENE......................................................................
RN DIR-SURGICAL SERVICES
60.00
.................
0.00
        X   170,066 0 27,201
(17) CALANZA FATIMA......................................................................
RN-CHARGE
55.00
.................
0.00
        X   168,711 0 22,677
Form 990 (2020)
Form 990 (2020)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W-2/1099-MISC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) NOTT LISA........................................................................
RN DIR-SURGICAL SERVICES
60.00
.......................0.00
        X   165,092 0 24,741
(19) GUTH MD SCOTT........................................................................
DIRECTOR
0.30
.......................8.53
X           0 62,225 0
(20) MARTINEZ MD CARLOS........................................................................
DIRECTOR
0.06
.......................3.53
X           0 20,375 0
(21) ZEISEL HENRY........................................................................
CFO (END 1/20)
2.50
.......................47.50
    X       14,625 0 237
(22) MURREY MD SUSAN........................................................................
DIRECTOR (BEG 1/20)
0.06
.......................2.00
X           0 10,313 0
(23) VALENTINE II MDIV MAURICE........................................................................
DIRECTOR/VICE CHAIR
0.30
.......................4.70
X           0 4,072 0
(24) SCOTT GLYNN........................................................................
DIRECTOR
0.30
.......................3.70
X           0 3,974 0
(25) AGUILERA RONALD........................................................................
DIRECTOR
0.30
.......................3.70
X           0 2,851 0
(26) ARQUILLA VENANZIO........................................................................
DIRECTOR
0.30
.......................0.60
X           0 0 0
(27) EASTMAN LINDA........................................................................
DIRECTOR
0.30
.......................0.60
X           0 0 0
(28) GRAY JR MARSHALL........................................................................
DIRECTOR
0.30
.......................0.60
X           0 0 0
(29) HAWKINS RONNIE........................................................................
DIRECTOR
0.30
.......................0.60
X           0 0 0
(30) HOLDER BILL........................................................................
DIRECTOR
0.30
.......................0.60
X           0 0 0
(31) O'CONNOR PETER........................................................................
DIRECTOR
0.30
.......................0.60
X           0 0 0
(32) WRIGHT JONATHAN........................................................................
DIRECTOR
0.30
.......................0.60
X           0 0 0
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 1,193,844 10,405,560 917,136
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet74
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
Yes
 
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
ALVERNO CLINICAL LABORATORIES LLC

2434 INTERSTATE PLAZA DRIVE
HAMMOND,IN46324
LAB SERVICES 3,105,005
COMPASS GROUP USA INC

PO BOX 102289
ATLANTA,GA30368
FOOD SERVICES & TOUCHPOINT ENVIRONMENTAL 3,049,237
PT SOLUTIONS HOLDINGS LLC

PO BOX 441146
KENNESAW,GA30160
THERAPY SERVICES 1,499,818
RILEY CONSTRUCTION COMPANY

5301 99TH AVENUE
KENOSHA,WI53144
CONSTRUCTION SERVICES 1,355,567
R1RCM INC

39918 TREASURY CENTER
CHICAGO,IL60694
REVENUE CYCLE SERVICE 1,203,731
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet19
Form 990 (2020)
Form 990 (2020)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 141,030
e Government grants (contributions)1e 2,621,063
f All other contributions, gifts, grants, and similar amounts not included above1f 34,494
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 2,796,587
 Program Service RevenueAmt Business Code
2a NET PATIENT REVENUE 622110 89,071,590 89,071,590    
b HEALTH EDUCATION PROGRAM 622110 7,951,567 7,951,567    
c PHARMACY REVENUE 622110 1,118,532 1,015,853 102,679  
d CAFETERIA REVENUE 622110 215,909 215,909    
e MEDICAL OFFICE BUILDING 622110 33,716 18,244 15,472  
f All other program service revenue. 66,022 66,022    
g Total. Add lines 2a–2f .....MediumBullet 98,457,336
 OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 43,427     43,427
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents     6a
b Less: rental expenses     6b
c Rental income or (loss)     6c
d Net rental income or (loss).......MediumBullet        
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 172,000   7a
b Less: cost or other basis and sales expenses 149,047 1,471 7b
c Gain or (loss) 22,953 -1,471 7c
d Net gain or (loss).........MediumBullet 21,482     21,482
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
10a  
b Less: cost of goods sold .. 10b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet  
12 Total revenue. See instructions.....MediumBullet 101,318,832 98,339,185 118,151 64,909
Form 990 (2020)
Form 990 (2020)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 157,958 157,958
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, lines 15 and 16. .............    
4 Benefits paid to or for members .......    
5 Compensation of current officers, directors, trustees, and key employees ........... 1,250,584   1,250,584  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........        
7 Other salaries and wages........ 30,706,178 28,499,615 2,206,563  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,198,660 1,073,346 125,314  
9 Other employee benefits ....... 6,488,124 5,896,482 591,642  
10 Payroll taxes ........... 2,601,403 2,329,439 271,964  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 407   407  
c Accounting ........... 63,106   63,106  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 7,617   7,617  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 27,632,946 22,823,862 4,809,084  
12 Advertising and promotion .... 81,586   81,586  
13 Office expenses ....... 2,633,324 2,505,754 127,570  
14 Information technology ...... 3,517,477 3,181,263 336,214  
15 Royalties ..        
16 Occupancy ........... 1,938,135 1,938,135    
17 Travel ............ 15,740   15,740  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 19,257 19,257    
20 Interest ........... 470,751 470,751    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 2,660,292 2,660,292    
23 Insurance ... 1,412,936 1,391,936 21,000  
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 10,393,815 10,393,815    
b STATE INDIGENT TAX ASSE 5,363,357 5,363,357    
c REPAIRS AND MAINTENANCE 691,061 691,061    
d
e All other expenses 341,988 183,448 158,540  
25 Total functional expenses. Add lines 1 through 24e 99,646,702 89,579,771 10,066,931 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2020)
Form 990 (2020)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 1,749 1 2,172
2 Savings and temporary cash investments .........   2 2,617,262
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 15,770,023 4 12,260,457
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
  6  
7 Notes and loans receivable, net ...........   7  
8 Inventories for sale or use ............ 1,802,999 8 1,973,945
9 Prepaid expenses and deferred charges ...... 1,922,980 9 1,552,683
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 99,013,740
b Less: accumulated depreciation 10b 69,088,198 28,971,899 10c 29,925,542
11 Investments—publicly traded securities .   11  
12 Investments—other securities. See Part IV, line 11 .....   12 929,020
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 15,684,367 15 19,837,998
16 Total assets. Add lines 1 through 15 (must equal line 33)... 64,154,017 16 69,099,079
Liabilities 17 Accounts payable and accrued expenses ..... 5,662,701 17 6,146,490
18 Grants payable ...   18  
19 Deferred revenue ......... 693 19 1,137,350
20 Tax-exempt bond liabilities .........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
  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 30,643,312 25 32,652,891
26 Total liabilities. Add lines 17 through 25.. 36,306,706 26 39,936,731
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 27,069,462 27 28,329,281
28 Net assets with donor restrictions ........... 777,849 28 833,067
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 27,847,311 32 29,162,348
33 Total liabilities and net assets/fund balances ........ 64,154,017 33 69,099,079
Form 990 (2020)
Form 990 (2020)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
101,318,832
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
99,646,702
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
1,672,130
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
27,847,311
5
Net unrealized gains (losses) on investments ...............
5
60,347
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-417,440
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
29,162,348
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2020)
Form 990 (2020)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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 instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
ADVENTIST GLENOAKS HOSPITAL
 
Employer identification number

36-3208390
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.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
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) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (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) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (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  
12
12
 
13
First 5 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
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
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) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose            
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge            
6 Total. Add lines 1 through 5            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support. (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
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.
1
 
 
2
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).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
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.
3b
 
 
c
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.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
 
b
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.
4b
 
 
c
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.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c 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).
5a
 
 
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
 
7
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) .
7
 
 
8
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).
8
 
 
9a
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.
9a
 
 
b
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.
9b
 
 
c
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.
9c
 
 
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
 
 
b
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) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in 11a above?
11b
 
 
c
A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, 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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
By reason of the relationship described in line 2 above, 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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
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.
2a
 
 
b
Did the activities described in line 2a, above 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.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
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?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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 0.015 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 0.035 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  
7
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
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 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity
2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI
). See instructions
8  
9 Distributable amount for 2020 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions
(ii)
Underdistributions
Pre-2020
(iii)
Distributable
Amount for 2020
1 Distributable amount for 2020 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI).
See instructions.
 
3 Excess distributions carryover, if any, to 2020:
a From 2015.......  
b From 2016.......  
c From 2017.......  
d From 2018.......  
e From 2019.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2020 distributable amount  
i Carryover from 2015 not applied (see
instructions)
 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2020 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2020 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2020, 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 2020. 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 2021. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a Excess from 2016.....  
b Excess from 2017.....  
c Excess from 2018.....  
d Excess from 2019.....  
e Excess from 2020.....  
Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020
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) 2020


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Name of the organization
ADVENTIST GLENOAKS HOSPITAL
 
Employer identification number

36-3208390
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that 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) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2
Name of organization
ADVENTIST GLENOAKS HOSPITAL
 
Employer identification number
36-3208390
Part I
Contributors
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


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

$  


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

$  


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

$  


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

$  


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

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Page 3
Name of organization
ADVENTIST GLENOAKS HOSPITAL
 
Employer identification number

36-3208390
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) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Page 4
Name of organization
ADVENTIST GLENOAKS HOSPITAL
 
Employer identification number

36-3208390
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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Additional Data


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

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
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 GLENOAKS HOSPITAL
 
Employer identification number

36-3208390
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

2
Political campaign activity expenditures (see instructions) ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities (see instructions) ..................................................................
 

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

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

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
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) 2020

Schedule C (Form 990 or 990-EZ) 2020
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ........................    
c Total lobbying expenditures (add lines 1a and 1b) ............................................................    
d Other exempt purpose expenditures ...............................................................................    
e Total exempt purpose expenditures (add lines 1c and 1d) ..................................................    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................................................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ...................................................................................................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in)
(a) 2017 (b) 2018 (c) 2019 (d) 2020 (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) 2020


Schedule C (Form 990 or 990-EZ) 2020
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|No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
18,279
j
Total. Add lines 1c through 1i ....................................................................................................
18,279
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, 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: DUES WERE PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE ILLINOIS HOSPITAL ASSOCIATION.
Schedule C (Form 990 or 990EZ) 2020


Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," 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 instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
ADVENTIST GLENOAKS HOSPITAL
 
Employer identification number

36-3208390
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 ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under FASB 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 $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2020

Schedule D (Form 990) 2020
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
1a Beginning of year balance ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ...
         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .......................
3a(i)
 
 
(ii) Related organizations .......................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" 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 .....   929,193 929,193
b Buildings ....   63,261,220 38,490,560 24,770,660
c Leasehold improvements        
d Equipment ....   32,920,638 29,330,412 3,590,226
e Other .....   1,902,689 1,267,226 635,463
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 29,925,542
Schedule D (Form 990) 2020

Schedule D (Form 990) 2020
Page 3
Part VII
Investments - Other 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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments - Program Related. Complete if the organization answered 'Yes' 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
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)DUE FROM RELATED 13,492,360
(2)OTHER RECEIVABLES 3,261,091
(3)RIGHT OF USE ASSET-OPERATING LEASE 2,979,159
(4)OTHER ASSETS 105,388
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 19,837,998
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  
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 32,652,891
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) 2020

Schedule D (Form 990) 2020
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1.................. 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a  
b Prior year adjustments ............ 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
PART X, LINE 2: THE FILING ORGANIZATION IS A SUBSIDIARY ORGANIZATION WITHIN 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, 2020 AND 2019. NAHS ALSO HAS TEMPORARY DEDUCTIBLE DIFFERENCES OF APPROXIMATELY $41,800 AND $46,500 AT DECEMBER 31, 2020 AND 2019, RESPECTIVELY, PRIMARILY AS A RESULT OF NET OPERATING LOSS CARRYFORWARDS. AT DECEMBER 31, 2020, NAHS HAD NET OPERATING LOSS CARRYFORWARDS OF APPROXIMATELY $43,500, EXPIRING BEGINNING IN 2022 THROUGH 2026. DEFERRED TAXES HAVE BEEN PROVIDED FOR THESE AMOUNTS, RESULTING IN A NET DEFERRED TAX ASSET OF APPROXIMATELY $10,200 AND $11,400 AT DECEMBER 31, 2020 AND 2019, 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, 2020 AND 2019 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 ACCOUNTING STANDARDS CODIFICATION (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, 2020 AND 2019. 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 IMPACT TAX-EXEMPT ORGANIZATIONS, INCLUDING REVISIONS TO TAXES ON UNRELATED BUSINESS ACTIVITIES, EXCISE TAXES ON COMPENSATION OF CERTAIN EMPLOYEES, AND VARIOUS OTHER PROVISIONS. THE IMPACT OF THESE PROVISIONS ON THE CONSOLIDATED FINANCIAL STATEMENTS IS NOT, AND IS NOT EXPECTED, TO BE SIGNIFICANT.
Schedule D (Form 990) 2020


Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" 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
2020
Open to Public Inspection
Name of the organization
ADVENTIST GLENOAKS HOSPITAL
 
Employer identification number

36-3208390
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the 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.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    2,529,153   2,529,153 2.540 %
b Medicaid (from Worksheet 3, column a) . . . . .     30,311,740 33,350,701 0 0 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     32,840,893 33,350,701 2,529,153 2.540 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     902   902 0 %
f Health professions education (from Worksheet 5) . . .     13,208   13,208 0.010 %
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .     34,775   34,775 0.030 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     76,078   76,078 0.080 %
j Total. Other Benefits . .     124,963   124,963 0.120 %
k Total. Add lines 7d and 7j .     32,965,856 33,350,701 2,654,116 2.660 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     14,089   14,089 0.010 %
4 Environmental improvements            
5 Leadership development and
training for community members
           
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     14,089   14,089 0.010 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
2,435,189
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
177,150
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
19,548,094
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
19,170,398
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
377,696
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
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?1Name, 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)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 ADVENTIST GLENOAKS HOSPITAL
701 WINTHROP AVE
GLENDALE HEIGHTS,IL60139
WWW.AMITAHEALTH.ORG/LOCATIONS/HOSPITAL
0003814
X X         X      
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
ADVENTIST GLENOAKS HOSPITAL
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 19
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 20
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE PART V, PAGE 8
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2020
Schedule H (Form 990) 2020
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
ADVENTIST GLENOAKS HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, PAGE 8
b
SEE PART V, PAGE 8
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 6
Part VFacility Information (continued)

Billing and Collections
ADVENTIST GLENOAKS HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
17 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?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
ADVENTIST GLENOAKS HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
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, 20a, 20b, 20c, 20d, 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
ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 5: ADVENTIST GLENOAKS HOSPITAL (AGH OR THE HOSPITAL) COLLABORATED WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS TO CONDUCT A JOINT CHNA IN 2019. ALL THE COLLABORATORS IN THE 2019 JOINT CHNA DEFINED THEIR COMMUNITY TO BE DUPAGE COUNTY, ILLINOIS. DUPAGE COUNTY, ILLINOIS HAS A POPULATION OF OVER 900,000. THE 2019 JOINT CHNA WAS A COLLABORATIVE EFFORT OF IMPACT DUPAGE. IMPACT DUPAGE IS A COALITION OF ORGANIZATIONS THAT WAS FORMED WITH THE PURPOSE OF CREATING A COMMON UNDERSTANDING OF COMMUNITY NEEDS, GAPS, AND PRIORITIES THAT WILL ADVANCE THE WELL-BEING OF THE DUPAGE COUNTY COMMUNITY. THE HOSPITAL IS A MEMBER OF THE STEERING COMMITTEE OF IMPACT DUPAGE AS A HOSPITAL ORGANIZATION OF AMITA HEALTH THAT SERVES THE RESIDENTS OF DUPAGE COUNTY. IMPACT DUPAGE UTILIZED A COMMUNITY DRIVEN, STRATEGIC PLANNING PROCESS IN DEVELOPING AND IMPLEMENTING EFFORTS AROUND THE PRIORITIZATION OF PUBLIC HEALTH ISSUES. AS A PART OF THE COMMUNITY HEALTH ASSESSMENT AND DATA COLLECTION EFFORTS, A SPECIFIC EFFORT WAS MADE TO INCLUDE INPUT FROM UNDERREPRESENTED POPULATION GROUPS AND PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. IMPACT DUPAGE CONDUCTED A SURVEY AMONG DUPAGE COUNTY RESIDENTS TO ASSESS THE COMMUNITY'S PERCEPTIONS, THOUGHTS AND OPINIONS OF HEALTH AND THE QUALITY OF LIFE IN THEIR COMMUNITY. THE SURVEY WAS OPEN TO ALL DUPAGE COUNTY RESIDENTS AND 1,577 SURVEYS WERE COLLECTED. THE SURVEY WAS CONDUCTED ONLINE AND BY PAPER. PRIOR TO THE SURVEY LAUNCH, COMMUNICATION TOOLS WERE DEVELOPED AND DISSEMINATED TO PROMOTE THE SURVEY. THE SURVEY CONTAINED QUESTIONS ON DUPAGE COUNTY'S GREATEST STRENGTHS, IMPORTANT HEALTH CONCERNS, RISKY BEHAVIORS, COMMUNITY AND PERSONAL HEALTH, AND WHERE THE COMMUNITY SHOULD FOCUS ITS ATTENTION TO MAKE THINGS BETTER IN DUPAGE COUNTY. USING ITS NETWORK OF COMMITTEE MEMBERS, INFORMATION REGARDING THE LAUNCH OF THE SURVEY WAS DISTRIBUTED TO THE FOLLOWING ORGANIZATIONS IN ORDER TO ENSURE REPRESENTATION FROM THE BROAD COMMUNITY OF DUPAGE COUNTY:ADDISON RESOURCES CONNECTBENEDICTINE UNIVERSITYDUPAGE CHIEFS OF POLICE ASSOCIATIONDUPAGE COUNTY BOARD OF HEALTHDUPAGE COUNTY HEALTH DEPARTMENT PUBLIC HEALTH CLINICSDUPAGE COUNTY JUVENILE JUSTICE COUNCILDUPAGE COUNTYDUPAGE EARLY CHILDHOOD COLLABORATIONDUPAGE MAYORS AND MANAGERS CONFERENCEFAMILY SHELTER SERVICE GLENDALE HEIGHTS YOUTH COMMISSIONHEALTHY LOMBARDIMPACT DUPAGE NETWORKSLOVE CHRISTIAN CLEARINGHOUSE NEWSLETTERMUNICIPAL PIOSNORTH CENTRAL COLLEGEOHSEM EOC TOUR GIRL SCOUT PARENTSPEOPLE'S RESOURCE CENTER WEEKLY EMAILSPREVENTION LEADERSHIP TEAMVIRTUAL BACKPACKSWALK IN MINISTRIESWEATHER SPOTTER TRAINING COURSE ATTENDEES, ANDWOODRIDGE PARK DISTRICT.PAPER SURVEYS WERE LOCATED AT MULTIPLE DUPAGE COUNTY HEALTH DEPARTMENT PUBLIC HEALTH CLINICS THROUGHOUT THE COUNTY. THE SURVEY WAS FEATURED IN VILLAGE NEWSLETTERS AND VARIOUS AGENCY WEBSITES AND SOCIAL MEDIA ACCOUNTS.
ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 6A: ADVENTIST GLENOAKS HOSPITAL (AGH OR THE HOSPITAL) COLLABORATED WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS TO CONDUCT A JOINT CHNA IN 2019. ALL THE COLLABORATORS IN THE 2019 JOINT CHNA DEFINED THEIR COMMUNITY TO BE DUPAGE COUNTY, ILLINOIS. DUPAGE COUNTY, ILLINOIS HAS A POPULATION OF OVER 900,000. THE 2019 JOINT CHNA WAS A COLLABORATIVE EFFORT OF IMPACT DUPAGE, A COLLABORATION OF PARTNERS FORMED WITH THE PURPOSE OF CREATING A COMMON UNDERSTANDING OF COMMUNITY NEEDS, GAPS AND PRIORITIES THAT WILL ADVANCE THE WELL-BEING OF THE DUPAGE COUNTY COMMUNITY. THE HOSPITAL, AS A PART OF AMITA HEALTH SYSTEM, WAS A MEMBER OF THE STEERING COMMITTEE OF IMPACT DUPAGE, ALONG WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS AND INCLUDING THE DUPAGE COUNTY HEALTH DEPARTMENT. THE OTHER HOSPITAL ORGANIZATION THAT PARTICIPATED IN THE 2019 JOINT CHNA AS A MEMBER OF THE STEERING COMMITTEE OF IMPACT DUPAGE WAS ADVOCATE AURORA HEALTH CARE.
ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 6B: ADVENTIST GLENOAKS HOSPITAL (AGH OR THE HOSPITAL) COLLABORATED WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS TO CONDUCT A JOINT CHNA IN 2019. ALL THE COLLABORATORS IN THE 2019 JOINT CHNA DEFINED THEIR COMMUNITY TO BE DUPAGE COUNTY, ILLINOIS. DUPAGE COUNTY, ILLINOIS HAS A POPULATION OF OVER 900,000. THE 2019 JOINT CHNA WAS A COLLABORATIVE EFFORT OF IMPACT DUPAGE, A COLLABORATION OF PARTNERS FORMED WITH THE PURPOSE OF CREATING A COMMON UNDERSTANDING OF COMMUNITY NEEDS, GAPS AND PRIORITIES THAT WILL ADVANCE THE WELL-BEING OF THE DUPAGE COUNTY COMMUNITY. THE HOSPITAL, AS A PART OF AMITA HEALTH SYSTEM, WAS A MEMBER OF THE STEERING COMMITTEE OF IMPACT DUPAGE, ALONG WITH OTHER HOSPITAL AND NON-HOSPITAL ORGANIZATIONS AND INCLUDING THE DUPAGE COUNTY HEALTH DEPARTMENT. THE OTHER NON-HOSPITAL ORGANIZATIONS THAT PARTICIPATED IN THE 2019 JOINT CHNA AS MEMBERS OF THE STEERING COMMITTEE OF IMPACT DUPAGE WERE COMMUNITY CONSOLIDATED SCHOOL DISTRICT 89, DUPAGE HEALTH COALITION, DUPAGE COUNTY COMMUNITY SERVICES, DUPAGE COUNTY HEALTH DEPARTMENT, DUPAGE COUNTY PUBLIC DEFENDER'S OFFICE, DUPAGE FEDERATION ON HUMAN SERVICES REFORM, DUPAGE FOUNDATION, DUPAGE PADS, FAMILY SHELTER SERVICE, LINDEN OAKS BEHAVIORAL HEALTH, METROPOLITAN FAMILY SERVICES DUPAGE, NORTHWESTERN MEDICINE, PEOPLE'S RESOURCE CENTER, PRAIRIE STATE LEGAL SERVICES, INC., WORKNET DUPAGE - DUPAGE COUNTY WORKFORCE DEVELOPMENT, AND UNITED WAY OF METRO CHICAGO.
ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 7D: THE HOSPITAL HAS ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT 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. COPIES OF THE CHNA REPORT WERE MAILED AND/OR E-MAILED TO COMMUNITY PARTNERS WHO PARTICIPATED IN THE CHNA PROCESS. PARTNERS WERE ALSO PROVIDED LINKS TO THE WEBSITE FOR DISSEMINATION TO THEIR MAILING LISTS AND RESPECTIVE CONSTITUENTS. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE AT AMITAHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT AND IS ALSO BROADLY DISTRIBUTED WITHIN OUR COMMUNITY TO STAKEHOLDERS INCLUDING COMMUNITY LEADERS, GOVERNMENT OFFICIALS, AND SERVICE ORGANIZATIONS.
ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 11: THE INFORMATION PROVIDED BELOW EXPLAINS HOW THE ADVENTIST GLENOAKS HOSPITAL (THE HOSPITAL) ADDRESSED IN 2020 THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN ITS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, AND ANY SUCH NEEDS THAT WERE NOT ADDRESSED AND THE REASONS WHY SUCH NEEDS WERE NOT ADDRESSED. THE HOSPITAL FACILITY CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT BY 12/31/19 AND ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT IN 2020 PRIOR TO MAY 15, 2020. IN CONNECTION WITH THE 2019 CHNA, ADVENTIST GLENOAKS HOSPITAL, TOGETHER WITH OUR COMMUNITY STAKEHOLDERS, IDENTIFIED THE FOLLOWING PRIORITIZED HEALTH NEEDS IN OUR COMMUNITY:BEHAVIORAL HEALTH, INCLUDING SUBSTANCE USE DISORDERS AS WELL AS MENTAL HEALTH WITH A FOCUS ON PREVENTION AND TREATMENT.HEALTH STATUS IMPROVEMENT, BUILDING A PERSON-CENTERED MODEL OF HEALTHCARE THAT IS EFFICIENT AND EFFECTIVE, CREATING MEANINGFUL ACCESS TO CARE FOR ALL AND DEMONSTRATIVELY IMPROVING HEALTH STATUS.AFFORDABLE HOUSING, DEVELOPING AFFORDABLE HOUSING THAT MEETS THE DEMOGRAPHIC PROFILE OF THE COUNTY THAT IS APPROPRIATE AND SAFE FOR ALL RESIDENTS NO MATTER THEIR ECONOMIC STATUS.TO BE SUCCESSFUL, ADVENTIST GLENOAKS HOSPITAL CONTINUED TO PARTNER WITH IMPACT DUPAGE TO ADOPT SHARED AND COMPLIMENTARY STRATEGIES AND LEVERAGE RESOURCES TO IMPROVE EFFICIENCIES AND INCREASE EFFECTIVENESS FOR OVERALL IMPROVEMENT. DATA SHARING ACROSS THE LOCAL PUBLIC HEALTH SYSTEM WAS INSTRUMENTAL IN DEVELOPING THE CHNA AND WILL CONTINUE TO BE AN IMPORTANT TOOL FOR ESTABLISHING, MEASURING, AND MONITORING OUTCOME OBJECTIVES. THE FOLLOWING PRIORITIZED HEALTH NEEDS WILL BE ADDRESSED IN THE 2020-2022 IMPLEMENTATION STRATEGY:BEHAVIORAL HEALTH PRIORITY OVERVIEW: BEHAVIORAL HEALTH CONTINUES TO BE A PRIMARY CONCERN IN DUPAGE COUNTY. ADDRESSING BEHAVIORAL HEALTH REQUIRES ATTENTION TO SUBSTANCE USE DISORDERS AS WELL AS MENTAL HEALTH. THE RECENT CHNA ALSO EMPHASIZED THE NEED FOR PREVENTION OF SUBSTANCE USE AT AN EARLY AGE AND THE REDUCTION OF STIGMA SURROUNDING BEHAVIORAL HEALTH. DRUG ABUSE AND MENTAL HEALTH ISSUES WERE THE TOP TWO CONCERNS ON THE COMMUNITY SURVEY DURING THE LAST ASSESSMENT.STRATEGY #1: MENTAL HEALTH FIRST AIDGOAL: INCREASE PERSONS TRAINED IN THE COMMUNITY ON MENTAL HEALTH FIRST AID (MHFA) TO INCREASE IDENTIFICATION OF THOSE IN A CRISIS AND REDUCE STIGMA ASSOCIATED WITH MENTAL HEALTH ISSUES.ANTICIPATED IMPACT: BY DECEMBER 2022, AMITA HEALTH ADVENTIST MEDICAL CENTER GLENOAKS AND ITS COMMUNITY PARTNERS WILL HAVE TRAINED 200 PERSONS IN MENTAL HEALTH FIRST AID. PROGRESS UPDATE: IN 2020, ADVENTIST GLENOAKS HOSPITAL BEGAN REACHING OUT TO EXTERNAL PARTNERS TO HOST TRAININGS. HOWEVER, DUE TO THE COVID-19 PANDEMIC, IN-PERSON TRAININGS WERE PUT ON HOLD. PLANNING ENSUED TO OFFER A MHFA TRAINING IN A VIRTUAL FORMAT. VIRTUAL TRAININGS BEGAN IN THE FINAL QUARTER OF 2020. ADVENTIST GLENOAKS SCHEDULED TRAININGS FOR ITS COMMUNITY FOR EARLY 2021.HEALTH STATUS IMPROVEMENTPRIORITY OVERVIEW: DATA FROM THE MOST RECENT CHNA INDICATED A NEED FOR CONTINUED FOCUS ON ISSUES INVOLVING RESIDENTS' ACCESS TO HEALTH AND MOVEMENT TOWARD MORE POSITIVE HEALTH OUTCOMES FOR DUPAGE RESIDENTS. ONE OF THE SOCIAL DETERMINANTS OF HEALTH CLOSELY ASSOCIATED WITH POSITIVE HEALTH OUTCOMES IS THE AVAILABILITY OF AFFORDABLE, HEALTHY FOODS. GOAL: INCREASE THE AVAILABILITY OF HEALTHY FOODS WITHIN THE LOW-INCOME COMMUNITY. STRATEGY #1: FOOD PANTRY PARTNERSHIPANTICIPATED IMPACT: BY DECEMBER 2022, A MONTHLY AVERAGE OF 200 HOUSEHOLDS WILL BE PROVIDED WITH FREE HEALTHY FOOD OPTIONS THROUGH OUR LOCAL FOOD PANTRY PARTNERSHIPS. PROGRESS UPDATE: IN 2020, ADVENTIST GLENOAKS HOSPITAL PROVIDED $10,200 IN CONTRIBUTION TO THE FOOD PANTRY PARTNERSHIP. IN ADDITION, ADVENTIST GLENOAKS HOSPITAL ADDED A 24/7 EMERGENCY FOOD PANTRY, CALLED A MICRO PANTRY TO THEIR CAMPUS. HOSPITAL STAFF & LEADERS COORDINATE THE PANTRY'S OFFERINGS TO THE COMMUNITY AS A COMMUNITY BENEFIT. THE HOSPITAL ALSO PARTNERED WITH NORTHERN ILLINOIS FOOD BANK TO HOST A MOBILE PANTRY FOR THE COMMUNITY THAT ASSISTED 403 PERSONS. PRIORITY OVERVIEW: DATA FROM THE MOST RECENT CHNA INDICATED A NEED FOR CONTINUED FOCUS ON ISSUES INVOLVING RESIDENTS' ACCESS TO HEALTH AND MOVEMENT TOWARD MORE POSITIVE HEALTH OUTCOMES FOR DUPAGE RESIDENTS. ACCESS TO HEALTH CARE AND HEALTH INSURANCE ESPECIALLY FOR THE LOW-INCOME PERSONS IN THE DUPAGE COMMUNITY CONTINUES TO BE AN ISSUE. EIGHTY-FIVE PERCENT OF DUPAGE COUNTY RESIDENTS REPORTED HAVING A USUAL HEALTH CARE PROVIDER WHILE A TOP "RISKY BEHAVIOR NOTED ON THE LAST ASSESSMENT RESIDENT SURVEY WAS NOT HAVING HEALTH INSURANCE. GOAL: INCREASE THE NUMBER OF PERSONS INSURED USING THE SILVER ACCESS PROGRAM. STRATEGY #2: PARTNERSHIP WITH ACCESS DUPAGE (DUPAGE HEALTH COALITION)ANTICIPATED IMPACT: BY DECEMBER 2022, THE SILVER ACCESS PROGRAM WILL MAINTAIN AN ANNUAL ENROLLMENT OF OVER 575 PERSONS IN THE DUPAGE COUNTY COMMUNITY. PROGRESS UPDATE: ADVENTIST GLENOAKS HOSPITAL PROVIDED FINANCIAL CONTRIBUTIONS TO ACCESS DUPAGE (DUPAGE HEALTH COALITION) IN 2020 OF $130,756. THIS FUNDING HELPS COORDINATE CARE FOR THE 4,997 PATIENTS WHO ARE UNINSURED IN DUPAGE COUNTY. THE SILVER ACCESS PROGRAM ASSISTED 842 PERSONS IN 2020, WHICH IS A 287% GROWTH IN THE LAST 5 YEARS.PRIORITY OVERVIEW: DATA FROM THE MOST RECENT CHNA INDICATED A NEED FOR CONTINUED FOCUS ON ISSUES INVOLVING RESIDENTS' ACCESS TO HEALTH AND MOVEMENT TOWARD MORE POSITIVE HEALTH OUTCOMES FOR DUPAGE RESIDENTS. ASSISTING PATIENTS AND COMMUNITY MEMBERS WITH ACCESS TO PROGRAMS AND SERVICES THAT CAN IMPROVE THEIR SOCIAL DETERMINANTS OF HEALTH ARE NEEDED. GOAL: INCREASE PATIENT AND COMMUNITY MEMBERS' CONNECTION TO SERVICES TO REDUCE SOCIAL DETERMINANTS OF HEALTH THROUGH THE PROVISION OF THE AMITA HEALTH COMMUNITY RESOURCE DIRECTORY (AUNT BERTHA). STRATEGY #3: AUNT BERTHA (SEARCH & CONNECT)ANTICIPATED IMPACT: BY DECEMBER 2022, 60% OF PATIENTS IN NEED WILL BE DIRECTLY REFERRED TO A LOCAL AGENCY FOR ASSISTANCE USING THE AMITA HEALTH COMMUNITY RESOURCE DIRECTORY (AUNT BERTHA). PROGRESS UPDATE: ADVENTIST GLENOAKS HOSPITAL ASSOCIATES UTILIZED THE SOCIAL DETERMINANTS OF HEALTH SOFTWARE, AUNT BERTHA, TO CONNECT AND REFER PATIENTS TO LOCAL RESOURCES SUCH AS FOOD PANTRIES, HEALTH CLINICS, UTILITIES SUPPORT AND MORE. ADDITIONALLY, AN EXTERNAL WEBSITE IS HOSTED FOR THE COMMUNITY AS A COMMUNITY BENEFIT TO SEARCH FOR THEIR OWN RESOURCES. IN 2020, ADDITIONAL COMMUNITY PARTNERS WERE ADDED TO THE RESOURCE PORTAL AND TRAININGS HAVE BEEN PLANNED FOR COMMUNITY BASED ORGANIZATIONS IN EARLY 2021.PRIORITY OVERVIEW: DATA FROM THE MOST RECENT CHNA INDICATED A NEED FOR CONTINUED FOCUS ON ISSUES INVOLVING RESIDENTS' ACCESS TO HEALTH AND MOVEMENT TOWARD MORE POSITIVE HEALTH OUTCOMES FOR DUPAGE RESIDENTS. ASSISTING PATIENTS AND COMMUNITY MEMBERS WITH ACCESS TO PROGRAMS AND SERVICES THAT CAN IMPROVE THEIR SOCIAL DETERMINANTS OF HEALTH ARE NEEDED ESPECIALLY IN COMMUNITY SETTINGS WHERE VULNERABLE POPULATIONS FREQUENT SUCH AS LIBRARIES AND CHURCHES. GOAL: INCREASE COMMUNITY MEMBERS' CONNECTION TO SERVICES TO REDUCE SOCIAL DETERMINANTS OF HEALTH THROUGH THE PROVISION OF THE AMITA HEALTH SOCIAL WORKER IN A LIBRARY PROGRAM.SEE CONTINUATION
ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 13H: THE FILING ORGANIZATION'S HOSPITAL FACILITY (OR FACILITIES) IMPLEMENTED A COVID-19 EMERGENCY FINANCIAL HARDSHIP POLICY IN WHICH UNINSURED PATIENTS WHO ARE TREATED FOR COVID-19 RELATED EVALUATION AND/OR TREATMENT WILL NOT BE BILLED. INSURED PATIENTS TESTED FOR COVID-19 ARE NOT EXPECTED TO HAVE OUT-OF-POCKET EXPENSES BASED ON INSURANCE COMMUNITY RESPONSE TO WAIVE PATIENT FINANCIAL RESPONSIBILITY. IF A PAYER UNEXPECTEDLY FAILS TO WAIVE PATIENT RESPONSIBILITY FOR COVID-19 RELATED TESTING, THE FILING ORGANIZATION WILL NOT BALANCE BILL PATIENTS FOR ANY OUT-OF-POCKET EXPENSES RELATED TO COVID-19. IN ADDITION, PATIENTS WITH EXISTING PAYMENT PLANS ARE PROVIDED OPPORTUNITIES FOR REDUCING THEIR MONTHLY PAYMENTS INCLUDING A REQUEST TO DEFER ANY PAYMENT PLAN PAYMENT FOR AN INITIAL PERIOD OF UP TO 120 DAYS.
ADVENTIST GLENOAKS HOSPITAL PART V, SECTION B, LINE 16J: THE FILING ORGANIZATION USES MULTIPLE METHODS OF COMMUNICATING ITS MISSION OF PROVIDING CARE TO ALL WHO NEED IT REGARDLESS OF ABILITY TO PAY. SIGNS POSTED AT REGISTRATION CLEARLY POINT OUT THAT CHARITY CARE OR FINANCIAL ASSISTANCE IS AVAILABLE. REGISTRATION IS EDUCATED ON PROVIDING FINANCIAL ASSISTANCE POLICY INFORMATION AND FORMS TO PATIENTS. THE MAIN WEBSITE FOR ALL SYSTEM HOSPITALS FEATURES INFORMATION ON HOW TO APPLY FOR FINANCIAL ASSISTANCE ON-LINE. IN THE HOSPITAL SETTING, WE EMPLOY FINANCIAL COUNSELORS WHO ARE AVAILABLE TO WORK WITH PATIENTS AND WE ALSO HAVE MEDICAID APPLICATION SPECIALISTS TO ASSIST PATIENTS THAT MAY QUALIFY. IN ADDITION, ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING FINANCIAL ASSISTANCE.
SCHEDULE H, PART V, SECTION B, LINE 11 - CONTINUATION: GOAL: INCREASE COMMUNITY MEMBERS' CONNECTION TO SERVICES TO REDUCE SOCIAL DETERMINANTS OF HEALTH THROUGH THE PROVISION OF THE AMITA HEALTH SOCIAL WORKER IN A LIBRARY PROGRAM.STRATEGY #4: SOCIAL WORKER IN A LIBRARY PROGRAMANTICIPATED IMPACT: BY DECEMBER 2022, 90% OF INDIVIDUALS WITH AN IDENTIFIED NEED WILL BE REFERRED TO APPROPRIATE SOURCES USING THE AMITA HEALTH COMMUNITY RESOURCE DIRECTORY (AUNT BERTHA). PROGRESS UPDATE: THE COVID-19 PANDEMIC STALLED EFFORTS TO DETERMINE THE FEASIBILITY OF THIS PROGRAM DUE TO LIBRARIES BEING CLOSED FOR MUCH OF 2020. ACTION TAKEN:THE FOLLOWING PRIORITIZED HEALTH NEED WILL NOT BE ADDRESSED IN THE 2020-2022 IMPLEMENTATION STRATEGY: AFFORDABLE HOUSINGWHILE CRITICALLY IMPORTANT TO OVERALL COMMUNITY HEALTH, FOR THE AREA NOT CHOSEN, THERE ARE SERVICE PROVIDERS IN THE COMMUNITY BETTER RESOURCED TO ADDRESS THESE PRIORITIES. ADVENTIST GLENOAKS HOSPITAL WILL WORK COLLABORATIVELY WITH THESE ORGANIZATIONS AS APPROPRIATE TO ENSURE OPTIMAL SERVICE COORDINATION AND UTILIZATION. ADDITIONALLY, THE PROVISION OF THE AMITA HEALTH COMMUNITY RESOURCE DIRECTORY (AUNT BERTHA) TO OUR ASSOCIATES AND PHYSICIANS WILL CONNECT THOSE IN NEED TO FREE OR REDUCED COST SERVICES SUCH AS MEDICAL CARE, FOOD, JOB TRAINING, TRANSPORTATION, HOUSING, LEGAL, AND MORE. THIS IMPLEMENTATION STRATEGY WAS APPROVED BY THE ADVENTIST MIDWEST HEALTH BOARD ON JANUARY 23, 2020. THE COLLECTIVE MONITORING, REPORTING PROGRESS AND REVISING WILL ENSURE THE PLAN REMAINS RELEVANT AND EFFECTIVE.IN 2020, THE ABOVE INDICATES THE PROGRESS MADE ON PROGRAMMING CONDUCTED TO ADDRESS THE IDENTIFIED HEALTH NEEDS OF THE HOSPITAL, BASED ON THE MOST RECENT CHNA FINDINGS. IN ADDITION TO THE STRATEGIC INITIATIVES BELOW, THE HOSPITAL PROVIDED ADDITIONAL HEALTH EDUCATION INITIATIVES, HEALTH FOCUSED EVENTS, IN-KIND SERVICES AND CASH DONATIONS TO SUPPORT AND RESPOND TO THE NEEDS OF THE COMMUNITY.
SCHEDULE H, PART V, SECTION B, LINE 7A THE CHNA REPORT CAN BE FOUND AT URL:HTTPS://WWW.AMITAHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT-AND-HEALTH-NEEDS-ASSESSMENT/COMMUNITY-BENEFIT-GLENOAKS
SCHEDULE H, PART V, SECTION B, LINE 10A: THE HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND AT:HTTPS://WWW.AMITAHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT-AND-HEALTH-NEEDS-ASSESSMENT/COMMUNITY-BENEFIT-GLENOAKS
SCHEDULE H, PART V, SECTION B, LINE 16A,B,C: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE AT:HTTPS://WWW.AMITAHEALTH.ORG/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE-FORMS-AND-POLICYTHE FINANCIAL ASSISTANCE POLICY APPLICATION CAN BE FOUND AT:HTTPS://WWW.AMITAHEALTH.ORG/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE-FORMS-AND-POLICYTHE PLAIN LANGUAGE SUMMARY IS AVAILABLE AT:HTTPS://WWW.AMITAHEALTH.ORG/PAY-YOUR-BILL/FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE-FORMS-AND-POLICY
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
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?4
Name and address Type of Facility (describe)
1 1 - THERAPEUTIC DAY SCHOOL PHEASANT RIDGE
43 E STEVENSON DRIVE
GLENDALE HEIGHTS,IL60139
BEHAVORIAL HEALTH
2 2 - THERAPEUTIC DAY SCHOOL NORTH CAMPUS
135 N BRANDON DRIVE
GLENDALE HEIGHTS,IL60139
BEHAVORIAL HEALTH
3 3 - THERAPEUTIC DAY SCHOOL WEST CAMPUS
940 MOOSEHEART ROAD
NORTH AURORA,IL60542
BEHAVORIAL HEALTH
4 4 - THERAPEUTIC DAY SCHOOL SOUTH CAMPUS
1N450 MAIN STREET
GLEN ELLYN,IL60139
BEHAVORIAL HEALTH
5
6
7
8
9
10
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
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 3C: EVERY UNINSURED PERSON, REGARDLESS OF INCOME, RECEIVES AN AUTOMATIC 15% DISCOUNT OFF OF CHARGES. PERSONS WHO EARN LESS THAN 600% OF THE FEDERAL POVERTY GUIDELINES ARE GIVEN MORE SIGNIFICANT DISCOUNTS, DEPENDING ON THEIR INDIVIDUAL SITUATIONS.FEDERAL POVERTY LEVEL - 0-200% UNINSURED PATIENT DISCOUNT - 95%FEDERAL POVERTY LEVEL - 201-300% UNINSURED PATIENT DISCOUNT - 75%FEDERAL POVERTY LEVEL - 301-600% UNINSURED PATIENT DISCOUNT - 74%FEDERAL POVERTY LEVEL - > 600% UNINSURED PATIENT DISCOUNT - 74%
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 29 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 WEBSITE.THE FILING ORGANIZATION IS INCLUDED IN THE SUBMISSION OF THE ANNUAL NONPROFIT HOSPITAL COMMUNITY BENEFIT PLAN REPORT WITH THE ATTORNEY GENERAL'S OFFICE OF THE STATE OF ILLINOIS. THIS REPORT IS PREPARED ON A CONSOLIDATED BASIS AND INCLUDES DATA FOR ADVENTIST MIDWEST HEALTH, ADVENTIST GLENOAKS HOSPITAL, AND ADVENTIST BOLINGBROOK HOSPITAL. THESE HOSPITAL ORGANIZATIONS ARE ALL RELATED ORGANIZATIONS.
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. - CHARITY AT COST - A COST TO CHARGE METHODOLOGY BASED ON THE MOST RECENTLY FILED MEDICARE COST REPORT WAS USED TO CALCULATE COSTS. - UNREIMBURSED MEDICAID - COSTS ARE CALCULATED USING THE MOST RECENTLY FILED MEDICAID COST REPORT. - OTHER BENEFITS - COSTS ARE DETERMINED BY ACTIVITY REPORTED IN ACCORDANCE WITH GUIDELINES PUBLISHED BY THE CATHOLIC HEALTH ASSOCIATION. COSTS COULD INCLUDE THE VALUE OF HOURLY WAGES, COSTS OF MATERIALS, VALUE OF SPACE LOANED TO COMMUNITY GROUPS FOR MEETINGS, AND INDIRECT COSTS WHERE APPLICABLE.
PART III, LINE 2: AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE FILING ORGANIZATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITHIN COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY AMITA HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE FILING ORGANIZATION'S POLICIES.
PART III, LINE 3: THE FILING ORGANIZATION PROACTIVELY WORKS TO PRESUMPTIVELY ASSESS AND GRANT CHARITY TO ALL UNINSURED PATIENTS. THE HOSPITAL SCREENS ALL UNINSURED PATIENTS AGAINST CREDIT SCORE DATA IN ORDER TO PRESUMPTIVELY APPLY ITS FINANCIAL ASSISTANCE POLICY. BASED ON THIS PROCESS, APPROXIMATELY 96% OF THE UNINSURED PATIENT POPULATION IS DEFINED AS ELIGIBLE FOR A PARTIAL CHARITY ADJUSTMENT ON THEIR ACCOUNTS. THE AVERAGE DISCOUNT GIVEN TO THE UNINSURED PATIENT POPULATION IS 81%. IN PRIOR YEARS, PROACTIVE EFFORTS WERE LIMITED TO ONLY THOSE ACCOUNTS WITH BALANCES > $5,000. UNDER THAT SCENARIO, IT WAS ESTIMATED THAT 1/3 OF OUR BAD DEBT PLACEMENTS MAY HAVE BEEN ELIGIBLE FOR CHARITY CARE DISCOUNTS. WITH A MORE COMPREHENSIVE PRESUMPTIVE CHARITY PROGRAM, MANY MORE ACCOUNTS ARE GRANTED CHARITY EARLIER IN THE PROCESS AND PRIOR TO BAD DEBT PLACEMENT. THEREFORE, IT IS ESTIMATED THAT APPROXIMATELY 10% OF OUR CURRENT BAD DEBT PLACEMENTS WOULD BE ELIGIBLE FOR ADDITIONAL CHARITY IF A FULL PRESUMPTIVE CHARITY PROCESS WAS CONDUCTED ACROSS 100% OF OUR SELF-PAY AFTER INSURANCE ACCOUNTS.DISCOUNTS AND PAYMENTS ARE NOT INCLUDED IN BAD DEBT EXPENSE IN THE FINANCIAL STATEMENTS UNLESS THE PAYMENT IS A RECOVERY OF AMOUNTS PREVIOUSLY WRITTEN OFF AS BAD DEBT. RECOVERIES ARE CLASSIFIED AS A DECREASE TO BAD DEBT EXPENSE.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.
PART III, LINE 9B: IT IS THE POLICY OF THE FILING ORGANIZATION TO OFFER PATIENTS A PAYMENT PLAN AND/OR CHARITY ASSISTANCE WHEN IT BECOMES KNOWN OR EVEN SUSPECTED THAT A PATIENT NEEDS FINANCIAL ASSISTANCE. SIGNS AND BROCHURES ARE POSTED IN FACILITY REGISTRATION AREAS. FINANCIAL COUNSELORS ARE NOTIFIED AND EVERY ATTEMPT IS MADE TO CONTACT AND WORK WITH THE PATIENT OR THEIR FAMILY TO HELP THEM COMPLETE A FINANCIAL ASSISTANCE APPLICATION WITH COMPASSION AND DIGNITY. FINANCIAL COUNSELORS WORK WITH PATIENTS TO HELP DETERMINE IF THERE ARE ANY THIRD-PARTY PAYORS WHICH MAY BE AVAILABLE TO HELP THE PATIENT MEET THEIR OBLIGATIONS. THE HOSPITAL WORKS WITH THE PATIENT TO DETERMINE IF THEY ARE ELIGIBLE FOR FEDERAL PROGRAMS INCLUDING MEDICAID, STATE FUNDED PROGRAMS INCLUDING CRIME VICTIMS, ALTERNATIVE INSURANCE INCLUDING COBRA, WORKER'S COMPENSATION AND OR OTHER SPECIALIZED GRANT PROGRAMS SUCH AS OUR MAMMOGRAPHY GRANT PROGRAM FOR LOW INCOME WOMEN. IN THE EVENT NO THIRD-PARTY PROGRAMS ARE IDENTIFIED, THE HOSPITAL THEN WORKS WITH THE PATIENT TO HELP THEM APPLY FOR FINANCIAL ASSISTANCE DISCOUNTS AND PAYMENT PLANS. IN ADDITION, ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING FINANCIAL ASSISTANCE.
SUPPLEMENTAL SCHEDULE TO SCHEDULE H, PART III, SECTION B, LINE 8 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: $ 377,696- DIFFERENCE IN COSTING METHODOLOGY: (1,873,912)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (2,025,951) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITYBENEFIT REPORTING $ (3,522,167)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 VI, LINE 2: THE HOSPITAL CONDUCTS COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) EVERY THREE YEARS. ITS 2019 CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2019, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S 2019 CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN FINAL REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY.SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY.
PART VI, LINE 3: THE FINANCIAL ASSISTANCE POLICY (FAP), FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM), AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) OF THE FILING ORGANIZATION'S HOSPITAL FACILITY 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 FACILITY'S FINANCIAL COUNSELORS ARE PROMINENTLY AND CONSPICUOUSLY POSTED ON THE FILING ORGANIZATION'S HOSPITAL FACILITY'S WEBSITE. THE 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 HOSPITAL FACILITY (REFERRED TO BELOW AS LEP DEFINED POPULATIONS). SIGNAGE IS DISPLAYED IN PUBLIC LOCATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, INCLUDING AT ALL POINTS OF ADMISSION AND REGISTRATION AND THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE 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 THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. PAPER COPIES ARE MADE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGES OF ANY LEP DEFINED POPULATIONS. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A PAPER COPY OF THE 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 FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND THE FAA FORM; AND 2) THE WEBSITE ADDRESS WHERE COPIES OF THE FAP, FAA FORM AND PLS MAY BE OBTAINED. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE. COPIES OF THE PLS ARE DISTRIBUTED TO MEMBERS OF THE 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: THE FILING ORGANIZATION IS LOCATED IN GLENDALE HEIGHTS, ILLINOIS. IT CURRENTLY OPERATES A HOSPITAL FACILITY AND IS LICENSED FOR 143 BEDS. THE HOSPITAL PROVIDES A FULL RANGE OF SERVICES, INCLUDING EMERGENCY CARE, SURGICAL, ONCOLOGY, OBSTETRICAL, CARDIOLOGY, INTERVENTIONAL RADIOLOGY, BEHAVIORAL HEALTH AND MORE. THE HOSPITAL OPERATES A THREE-CAMPUS THERAPEUTIC DAY SCHOOL WHERE STUDENTS IN 3RD GRADE THROUGH HIGH SCHOOL ARE PROVIDED AN ENVIRONMENT THAT BLENDS ACADEMIC EDUCATION WITH THERAPIES THAT NURTURE EACH STUDENT'S EMOTIONAL GROWTH AND INDEPENDENCE. THE HOSPITAL IS AN ACCREDITED CHEST PAIN CENTER AND CERTIFIED PRIMARY STROKE CENTER. AS THE ONLY DISPROPORTIONATE SHARE HOSPITAL IN DUPAGE COUNTY, THE HOSPITAL IS A SAFETY NET FOR THE MOST VULNERABLE AND UNDERSERVED POPULATIONS - PROVIDING CARE MANY PATIENTS CANNOT ACCESS ELSEWHERE.THE ADVENTIST GLENOAKS HOSPITAL COMMUNITY CONSISTS PRIMARILY OF GLENDALE HEIGHTS AND THE SURROUNDING AREA. WE DEFINE THE PRIMARY SERVICE AREA (PSA) AS THE COLLECTION OF ZIP CODES WHERE APPROXIMATELY 75% OF HOSPITAL PATIENTS RESIDE, AND WE FOCUS OUR COMMUNITY HEALTH IMPROVEMENT ON THIS SERVICE AREA. THE SERVICE AREA INCLUDES THE FOLLOWING ZIP CODES: 60172, 60148, 60188, 60108, 60137, 60101, AND 60139 .ACCORDING TO US CENSUS DATA (2018) THE POPULATION OF THIS SERVICE AREA IS 254,741. THE AVERAGE AGE IS 38.7 YEARS WITH AN AVERAGE FAMILY INCOME OF $73,360. THE AGE SPREAD OF THE PRIMARY SERVICE AREA IS SIMILAR TO DUPAGE COUNTY AND ILLINOIS. EIGHT PERCENT OF THOSE THAT RESIDE IN THIS SERVICE AREA ARE LIVING IN POVERTY. THE PRIMARY SERVICE AREA OF ADVENTIST GLENOAKS HOSPITAL HAS A SLIGHTLY HIGHER HISPANIC/LATINO POPULATION THAN DUPAGE COUNTY AND ILLINOIS. THE HOSPITAL IS THE ONLY MEDICAID DISPROPORTIONATE SHARE HOSPITAL IN DUPAGE COUNTY, ILLINOIS. THE FACILITY SERVES A DISPROPORTIONATE NUMBER OF STATE AND FEDERALLY FUNDED PATIENTS AS WELL AS A SIGNIFICANT NUMBER OF UNINSURED PATIENTS IN COMPARISON TO OTHER HOSPITAL FACILITIES IN DUPAGE COUNTY. DURING 2020, THE HOSPITAL'S PATIENT PERCENTAGE POPULATION WAS MADE UP OF THE BELOW PAYORS WITH THE REMAINING PERCENTAGE OF THE PATIENTS BEING COVERED UNDER COMMERCIAL INSURANCE. IN 2020, ABOUT 70.7% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. - MEDICARE PATIENTS 39.5% - MEDICAID PATIENTS 28.9% - SELF-PAY PATIENTS 6.4% THE DEMOGRAPHIC MAKEUP OF THE HOSPITAL'S DUPAGE COUNTY COMMUNITY IS AS FOLLOWS: - POPULATION 929,026 - POPULATION OVER 65 15.67% - POVERTY (BELOW 100% FPL) 6.8% - UNEMPLOYMENT RATE 5.2% - UNINSURED ADULTS 6.3%
PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO ADVENTIST GLENOAKS HOSPITAL'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT AND COMMUNITY BUILDING INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, THE HOSPITAL PROVIDED $343,428 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF A COMMUNITY HOSPITAL. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE HOSPITAL EXPENDED $3,566,593 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY.
PART VI, LINE 6: ADVENTIST GLENOAKS HOSPITAL IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTHEALTH. AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 48 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. THE FILING ORGANIZATION IS ALSO A COVERED AFFILIATE OF A JOINT OPERATING COMPANY THAT DOES BUSINESS UNDER THE NAME OF AMITA HEALTH. AMITA HEALTH HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT ORGANIZATION UNDER IRC SECTION 501(C)(3). AMITA HEALTH PROVIDES VARIOUS MANAGEMENT AND EXECUTIVE SUPPORT SERVICES TO THE FILING ORGANIZATION. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AMITA HEALTH AND BY ADVENTHEALTH PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING THE 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 AS A COVERED AFFILIATE OF AMITA HEALTH AND AS PART OF A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITALS AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY THE FILING 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 OR OF AMITA HEALTH 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 AND TO WWW.AMITHHEALTH.ORG TO LEARN MORE ABOUT THE VISION AND SERVICES PROVIDED BY ALL ITS HOSPITAL LOCATIONS.
PART VI, LINE 7, REPORTS FILED WITH STATES IL
Schedule H (Form 990) 2020
Additional Data


Software ID:  
Software Version:  

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

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
2020
Open to Public
Inspection
Name of the organization
ADVENTIST GLENOAKS HOSPITAL
 
Employer identification number
36-3208390
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to 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) DUPAGE HEALTH COALITION
511 THORNHILL DR SUITE M
CAROL STREAM,IL60188
36-4448208 501(C)(3) 130,758       GENERAL SUPPORT
(2) ICNA RELIEF USA PROGRAMS INC
8791 144TH STREET
JAMAICA,NY11435
04-3810161 501(C)(3) 7,200       GENERAL SUPPORT
(3) HINSDALE ADVENTIST ACADEMY
631 E HICKORY STREET
HINSDALE,IL60521
36-4090219 501(C)(3) 5,000       GENERAL SUPPORT
(4) VILLAGE OF GLENDALE HEIGHTS
300 CIVIC CENTER PLAZA
GLENDALE HEIGHTS,IL60139
36-6009547 GOV'T 5,000       GENERAL SUPPORT
(5) ANDREWS UNIVERSITY
4150 ADMINISTRATION DRIVE
BERRIEN SPRINGS,MI49104
38-1627600 501(C)(3) 10,000       GENERAL SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
5
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2020

Schedule I (Form 990) 2020
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) 2020



Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
ADVENTIST GLENOAKS HOSPITAL
 
Employer identification number

36-3208390
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
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:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2020

Schedule J (Form 990) 2020
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
(i) Base
compensation
(ii) Bonus & incentive
compensation
(iii) Other reportable compensation
1HAFFNER PHD RANDALL
DIR/CHAIRMAN
(i)

(ii)
0
-------------
1,301,578
0
-------------
485,357
0
-------------
1,089,357
0
-------------
165,320
0
-------------
44,016
0
-------------
3,085,628
0
-------------
250,270
2CARROLL MD RICHARD
VP/CMO BOLINGBROOK/GLENOAK
(i)

(ii)
0
-------------
399,489
0
-------------
54,873
0
-------------
1,412,458
0
-------------
18,525
0
-------------
17,662
0
-------------
1,903,007
0
-------------
0
3SNYDER BRENT
DIRECTOR
(i)

(ii)
0
-------------
788,098
0
-------------
256,954
0
-------------
199,781
0
-------------
165,201
0
-------------
26,234
0
-------------
1,436,268
0
-------------
120,820
4THORDARSON THOR
DIR/PRES/SEC/EVP & COO
(i)

(ii)
0
-------------
714,190
0
-------------
145,087
0
-------------
89,004
0
-------------
18,005
0
-------------
17,314
0
-------------
983,600
0
-------------
0
5MURRILL MICHAEL
FORMER COO
(i)

(ii)
0
-------------
489,930
0
-------------
88,742
0
-------------
153,734
0
-------------
70,031
0
-------------
34,090
0
-------------
836,527
0
-------------
0
6BUCHANAN HERBERT
DIRECTOR/REGION COO
(i)

(ii)
24,725
-------------
469,772
2,689
-------------
51,098
4,725
-------------
89,775
285
-------------
5,415
591
-------------
11,223
33,015
-------------
627,283
0
-------------
0
7CHRISTIAN BRUCE
PRES/CEO BOLINGBROOK/GLENO
(i)

(ii)
0
-------------
409,765
0
-------------
70,392
0
-------------
56,377
0
-------------
17,100
0
-------------
17,811
0
-------------
571,445
0
-------------
0
8MURPHY MARY
FORMER REGIONAL CNO
(i)

(ii)
0
-------------
318,528
0
-------------
37,448
0
-------------
35,125
0
-------------
18,525
0
-------------
10,619
0
-------------
420,245
0
-------------
0
9SCHIMEROWSKI DEBORAH
CFO (END 3/20)
(i)

(ii)
4,668
-------------
88,700
0
-------------
0
14,486
-------------
275,230
282
-------------
5,367
185
-------------
3,511
19,621
-------------
372,808
0
-------------
0
10RADIVOJEVIC VLADIMIR
VP/COO BOLINGBROOK/GLENOAK
(i)

(ii)
0
-------------
259,739
0
-------------
36,643
0
-------------
15,954
0
-------------
13,084
0
-------------
28,655
0
-------------
354,075
0
-------------
0
11PFIEFER CAROL
CNO (END 8/20)
(i)

(ii)
139,354
-------------
0
31,005
-------------
0
106,693
-------------
0
11,365
-------------
0
12,803
-------------
0
301,220
-------------
0
0
-------------
0
12BROWN JARED
SR. DIR. FINANCE-BOLINGBROOK & GLENO
(i)

(ii)
0
-------------
198,168
0
-------------
19,396
0
-------------
10,591
0
-------------
14,423
0
-------------
15,721
0
-------------
258,299
0
-------------
0
13DE RAMOS DO DAVID
DIRECTOR
(i)

(ii)
0
-------------
140,796
0
-------------
0
0
-------------
49,621
0
-------------
12,017
0
-------------
15,886
0
-------------
218,320
0
-------------
0
14SULIMA JAMES
RN-CHARGE
(i)

(ii)
98,187
-------------
0
6,471
-------------
0
77,926
-------------
0
10,069
-------------
0
7,932
-------------
0
200,585
-------------
0
0
-------------
0
15DOMINGIEZ MIGUEL
RN DIR-NURSING
(i)

(ii)
152,418
-------------
0
11,201
-------------
0
802
-------------
0
5,747
-------------
0
27,266
-------------
0
197,434
-------------
0
0
-------------
0
16ALBAUGH JOLENE
RN DIR-SURGICAL SERVICES
(i)

(ii)
158,156
-------------
0
11,063
-------------
0
847
-------------
0
11,266
-------------
0
15,935
-------------
0
197,267
-------------
0
0
-------------
0
17CALANZA FATIMA
RN-CHARGE
(i)

(ii)
85,305
-------------
0
10,352
-------------
0
73,054
-------------
0
7,762
-------------
0
14,915
-------------
0
191,388
-------------
0
0
-------------
0
18NOTT LISA
RN DIR-SURGICAL SERVICES
(i)

(ii)
152,099
-------------
0
10,470
-------------
0
2,523
-------------
0
8,714
-------------
0
16,027
-------------
0
189,833
-------------
0
0
-------------
0
Schedule J (Form 990) 2020

Schedule J (Form 990) 2020
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 CERTAIN 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 THE FILING ORGANIZATION'S PARENT. THE FILING ORGANIZATION AND ITS 501(C)(3) PARENT ARE PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTHEALTH. THE TOP-TIER PARENT OF ADVENTHEALTH IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AS PART OF ADVENTHEALTH, THE FILING ORGANIZATION ADHERES TO CERTAIN AHSSHC POLICIES REGARDING ITS EXECUTIVES. TRAVEL FOR COMPANIONS: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING 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: NOMINAL DISCRETIONARY SPENDING AMOUNTS ARE PERIODICALLY PROVIDED TO ELIGIBLE EXECUTIVES WHO ATTEND ANNUAL BUSINESS MEETINGS SUCH AS THE ADVENTHEALTH CFO CONFERENCE OR THE CMO/CNO BUSINESS MEETING ($300 OR LESS PER EXECUTIVE). PAYMENTS PROVIDED TO EACH EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE.
PART I, LINE 3 THE FILING ORGANIZATION IS A COVERED AFFILIATE OF THE JOINT OPERATING COMPANY, ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO. D/B/A AMITA HEALTH (AMITA). AMITA UTILIZES VARIOUS COMPARABILITY DATA IN ESTABLISHING COMPENSATION FOR THOSE EXECUTIVES THAT PERFORM SERVICES FOR AMITA AND FOR ONE OR MORE COVERED AFFILIATES. COMPARABILITY DATA UTILIZED INCLUDES COMPENSATION SURVEYS AND STUDIES AND THE FORMS 990 OF OTHER UNRELATED COMPARABLE ORGANIZATIONS. AMITA ALSO HAS A COMPENSATION COMMITTEE THAT APPROVES ALL RELEVANT EXECUTIVE COMPENSATION. THE COMPENSATION OF THE FILING ORGANIZATION'S CEO WAS DETERMINED AND APPROVED BY AMITA'S EXECUTIVE COMPENSATION COMMITTEE.
PART I, LINES 4A-B LINE 4A: DURING THE YEAR ENDING DECEMBER 31, 2020, DEBORAH SCHIMEROSKI, CFO, HENRY ZEISEL, CFO, AND CAROL PFEIFER, CNO, RECEIVED SEVERANCE PAYMENTS IN THE AMOUNT OF $237,544, $12,000, AND $88,001 RESPECTIVELY; IN CONNECTION WITH SERVICES RENDEREDTO THE FILING ORGANIZATION OR RELATED ORGANIZATIONS, BUT PAID BY AN UNRELATED ORGANIZATION. THE EXECUTIVES' SEVERANCE COMPENSATION WAS COMPENSATED BY PRESENCE CARE TRANSFORMATION CORPORATION AND/OR ALEXIAN BROTHERS HEALTH SYSTEM. SEE MORE INFORMATION BELOW IN LINE 4B CONTINUATION. LINE 4B: MICHAEL MURRILL, RANDALL HAFFNER, RICHARD CARROLL, MD, AND BRENT SNYDER RECEIVED COMPENSATION IN 2020 FROM ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE TOP-TIER PARENT OF THE FILING ORGANIZATION AND 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 SUPPLEMENTAL EXECUTIVE BENEFIT PLANS TO ELIGIBLE EXECUTIVES. IN 2020, ADVENTHEALTH RESTRUCTURED ITS EXECUTIVE SUPPLEMENTAL RETIREMENT AND BENEFIT PLANS TO REDUCE COMPLEXITY, TO INCREASE PREDICTABILITY OF BENEFITS AND TO CONSOLIDATE MULTIPLE SUPPLEMENTAL EXECUTIVE BENEFIT PLANS INTO ONE PLAN. EFFECTIVE 1/1/2020, A NEW SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP III) WAS ADOPTED AND THE THREE EXISTING PLANS, DESCRIBED BELOW, WERE AMENDED AND RESTATED. THE NEWLY ADOPTED SERP III PLAN, AS WELL AS THE AMENDED AND RESTATED PLANS, WERE REVIEWED AND APPROVED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. SERP III PLAN (EFFECTIVE 1/1/2020): TO RECOGNIZE THE CONTRIBUTION EACH EXECUTIVE MAKES TO THE SUCCESS OF ADVENTHEALTH AND TO RECOGNIZE THE LIMITATIONS AVAILABLE TO EXECUTIVES IN QUALIFIED RETIREMENT PLANS DUE TO COMPENSATION LIMITS SET ON SUCH PLANS, ADVENTHEALTH ADOPTED A NEW SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP III) IN 2020. THE SERP III PLAN EFFECTIVELY REPLACES THE PRIOR SERP II PLAN, THE EXECUTIVE FLEX BENEFIT PROGRAM PLAN, AND THE SENIOR EXECUTIVE DEATH BENEFIT PLAN FOR QUALIFIED EXECUTIVES EXCEPT FOR CERTAIN GRANDFATHERED EXECUTIVE EMPLOYEES. THE SERP III PLAN PROVIDES ELIGIBLE EXECUTIVES A PERCENTAGE OF THEIR BASE PAY, WHICH IS CREDITED TO A DEFERRED COMPENSATION ACCOUNT. THE PLAN ALSO PROVIDES FOR COMPENSATION DEFERRAL AND SELECTION OF LIFE INSURANCE COVERAGE AND LONG-TERM CARE INSURANCE. TO BE ELIGIBLE TO PARTICIPATE IN THE SERP III PLAN, EXECUTIVES MUST BE ON THE AHSSHC CORPORATE PAYROLL AND BE EITHER A CEO OF AN ADVENTHEALTH ENTITY, AN AHSSHC VICE PRESIDENT (VP) OR VP OF AN ADVENTHEALTH ENTITY WITH A BASE SALARY OF AT LEAST $285,000 IN 2020 (ADJUSTED ANNUALLY BY THE SAME PERCENTAGE AS IRC SECTION 401(A)(17) LIMIT INCREASES), OR OTHER LEADER SPECIFICALLY APPROVED BY THE ADVENTHEALTH PRESIDENT. ELIGIBLE EXECUTIVES DO NOT INCLUDE GRANDFATHERED EXECUTIVES, MEANING THOSE EXECUTIVES WHO WOULD SATISFY ALL THE ELIGIBILITY REQUIREMENTS OF THE SERP II PLAN PRIOR TO DEC 31, 2027, HAD THE PLAN NOT BEEN AMENDED AND RESTATED AS OF JAN. 1, 2020. CONTRIBUTION CREDITS WILL BE ESTABLISHED AND MAINTAINED BY CLASS YEAR ACCOUNTS FOR EACH PARTICIPANT USING TIERED CONTRIBUTION CREDIT PERCENTAGES OF ANNUAL BASE COMPENSATION. CONTRIBUTION CREDIT PERCENTAGES RANGE BETWEEN 15% AND 19% OF BASE COMPENSATION. CONTRIBUTION CREDITS WILL BE MADE EACH QUARTER IN 25% INCREMENTS WITH REDUCTIONS IN CONTRIBUTIONS IF THE EXECUTIVE IS ALSO A GRANDFATHERED FLEX PARTICIPANT (SEE BELOW). SERP III PROVIDES FOR A CLASS YEAR VESTING AND PAYMENT SCHEDULE (7 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S DEFERRED COMPENSATION ACCOUNT. UPON ATTAINMENT OF A NORMAL RETIREMENT AGE (AGE 62), OR UPON CERTAIN OTHER CIRCUMSTANCES AS DEFINED IN THE SERP III PLAN DOCUMENT, ALL DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT. FOR ANY EXECUTIVES WORKING BEYOND THE NORMAL RETIREMENT AGE, FUTURE EMPLOYER CONTRIBUTIONS WILL BE MADE QUARTERLY FROM SERP III DIRECTLY TO THE PARTICIPANT AS A TAXABLE CASH BONUS. SERP II PLAN (AMENDED AND RESTATED IN 2020): IN 2020, THE SERP II PLAN WAS AMENDED AND RESTATED TO PROVIDE THAT ELIGIBLE EMPLOYEES ARE RESTRICTED TO THOSE EXECUTIVES WHO, AS OF JANUARY 1, 2020, SATISFIED, OR IF EMPLOYMENT CONTINUES, WILL SATISFY THE ELIGIBILITY REQUIREMENTS OF SERP II PRIOR TO DECEMBER. 31, 2027. THE SERP II PLAN IS 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. UNDER THE PROVISIONS OF THE SERP II PLAN, BENEFITS ARE PROVIDED TO QUALIFYING EXECUTIVE PARTICIPANTS 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 II) 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 SERP II AND BY THE INDIVIDUAL'S YEAR OF ENTRY TO THE ADVENTHEALTH EXECUTIVE FLEX BENEFIT PROGRAM. FLEX PLAN (AMENDED AND RESTATED IN 2020): IN 2020, THE FLEX PLAN WAS AMENDED AND RESTATED TO EXCLUDE EMPLOYED EXECUTIVES WHO ARE HIRED OR PROMOTED AFTER A CERTAIN DATE FROM BEING ELIGIBLE TO PARTICIPATE IN THE FLEX PLAN EXCEPT FOR CERTAIN INSURANCE COVERAGE FEATURES OF THE PLAN. ADDITIONALLY, A PROVISION WAS ADDED TO PLACE A MAXIMUM LIMIT ON THE AMOUNT OF A PARTICIPANT'S ANNUAL FLEX ALLOWANCE TO NOT BE GREATER THAN A MAXIMUM DOLLAR AMOUNT OR PERCENTAGE OF COMPENSATION AS ESTABLISHED BY THE ADVENTHEALTH BENEFITS ADMINISTRATION COMMITTEE. THE FLEX PLAN WAS ORIGINALLY DESIGNED TO PROVIDE ELIGIBLE EXECUTIVES AN OPPORTUNITY TO SELECT 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 FLEX PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS IS DEDUCTED. THE BENEFITS ALLOWANCE CREDIT PERCENTAGE IS DETERMINED BY THE ADVENTHEALTH BENEFITS ADMINISTRATION COMMITTEE. FOR GRANDFATHERED ELIGIBLE EMPLOYEES, THE ANNUAL PRE-DETERMINED FLEX ALLOWANCE IS CONTRIBUTED AND ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED ARE, AT THE EMPLOYEE'S OPTION, CONTRIBUTED 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 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 WILL BE FORFEITED BY THE EXECUTIVE UPON A VOLUNTARY SEPARATION. WITH RESPECT TO GRANDFATHERED PARTICIPANTS, THE FLEX PLAN DOCUMENTS DEFINE ELIGIBLE EMPLOYEES TO INCLUDE THE CHIEF EXECUTIVE OFFICERS OF ADVENTHEALTH ENTITIES AND VICE PRESIDENTS OF ALL ADVENTHEALTH ENTITIES WHOSE BASE SALARY WAS AT LEAST EQUAL TO THE INTERNAL REVENUE CODE SECTION 401(A)(17) COMPENSATION LIMIT EACH YEAR.
SCHEDULE J, PART I, LINE 4B CONTINUATION: THE SEDB PLAN WAS ORIGINALLY DESIGNED TO PROVIDE A BENEFIT IN AN AMOUNT EQUAL TO THE AMOUNT THE EXECUTIVE'S BENEFIT WOULD HAVE BEEN UNDER THE SERP II 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 II PLAN WITH PRESENT VALUE RECOGNIZING AN EARLY BENEFIT COMMENCEMENT. IN CONJUNCTION WITH THE AMENDMENT AND RESTATEMENT OF THE SERP II PLAN, THE SEDB WAS SIMILARLY AMENDED IN 2020 TO LIMIT ELIGIBLE EMPLOYEES TO ONLY THOSE WHO EITHER SATISFY THE ELIGIBILITY REQUIREMENTS OF SERP II AS OF JANUARY 1 2020, OR REMAIN IN ACTIVE EMPLOYMENT AND WILL SATISFY THOSE REQUIREMENTS PRIOR TO DECEMBER 31, 2027. 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 THE ELIGIBILITY REQUIREMENTS OF SERP II AS OF THE EXECUTIVE'S DATE OF DEATH BUT WOULD HAVE SATISFIED ALL THOSE REQUIREMENTS WITHIN FIVE (5) YEARS FOLLOWING DEATH HAD THE EXECUTIVE LIVED AND CONTINUED EMPLOYMENT. THE SEDB PLAN WILL TERMINATE AUTOMATICALLY AFTER DECEMBER 31, 2027. FLEX PLAN FLEX PLAN SERP II SERP III CONTR. DISTR.* CONTR./DISTR. CONTR. RANDALL HAFFNER, PHD $ 150,000 $ 280,729 $ 740,512 $ 0 RICHARD CARROLL, MD $ 0 $ 0 $ 1,323,096 $ 0 BRENT SNYDER $ 149,881 $ 135,569 $ 0 $ 0 MICHAEL MURRILL $ 0 $ 0 $ 0 $ 49,977 * INCLUDING INVESTMENT EARNINGS DEBORAH SCHIMEROSWKI, CFO WAS COMPENSATED BY PRESENCE CARE TRANSFORMATION CORPORATION IN 2020 AND HERBERT BUCHANAN, REGIONAL COO, HENRY ZEISEL, CFO, AND CAROL PFIEFER, CNO WERE COMPENSATED BY ALEXIAN BROTHERS HEALTH SYSTEM IN 2020 FOR SERVICES PROVIDED TO THE FILING ORGANIZATION. PRESENCE CARE TRANSFORMATION CORPORATION AND ALEXIAN BROTHERS HEALTH SYSTEM ARE AFFILIATED WITH THE FILING ORGANIZATION. PLEASE SEE OUR RESPONSE TO FORM 990, PART VI, SECTION A, LINE 7B FOR A DISCUSSION CONCERNING THE FILING ORGANIZATION'S AFFILIATION WITH ALEXIAN BROTHERS HEALTH SYSTEM THROUGH THE JOINT OPERATING COMPANY KNOWN AS AMITA HEALTH. COMPENSATION FOR THESE INDIVIDUAL'S SERVICES PROVIDED TO THE FILING ORGANIZATION IS DISCLOSED IN PART VII, LINE 1A, AND SCHEDULE J, PART II.
Schedule J (Form 990) 2020

Additional Data


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

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

Complete to provide information for responses to specific questions on
Form 990 or 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
2020
Open to Public
Inspection
Name of the organization
ADVENTIST GLENOAKS HOSPITAL
 
Employer identification number

36-3208390
Return Reference Explanation
PART V, LINE 1A: THE PARENT CORPORATION OF ADVENTIST GLENOAKS HOSPITAL (THE FILING ORGANIZATION) IS ADVENTIST MIDWEST HEALTH (AMH). AMH IS AN ILLINOIS, NOT-FOR-PROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). AMH HAS ESTABLISHED A SHARED SERVICE CENTER TO CENTRALIZE THE ACCOUNTS PAYABLE (A/P) FUNCTION FOR ALL AMH SUBSIDIARY ORGANIZATIONS. THE FILING ORGANIZATION HAS ENTERED "0" IN PART V, LINE 1A BECAUSE THE FILING ORGANIZATION NO LONGER ISSUES FORM 1099 RETURNS, RATHER, ALL SUCH RETURNS ARE FILED BY AND UNDER THE NAME AND EIN OF AMH AS THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041. THE FACTS AND CIRCUMSTANCES SUPPORT A POSITION THAT AMH, 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). AMH WILL NOT MERELY BE MAKING PAYMENTS AT THE DIRECTION OF ITS SUBSIDIARY ORGANIZATIONS. ACCORDINGLY, AMH IS CONSIDERED THE PAYOR SUBJECT TO THE INFORMATION REPORTING REQUIREMENTS OF SECTION 6041.
FORM 990, PART VI, SECTION A, LINE 6 ADVENTIST GLENOAKS HOSPITAL (THE FILING ORGANIZATION) HAS ONE MEMBER. THE SOLE MEMBER OF THE FILING ORGANIZATION IS ADVENTIST MIDWEST HEALTH. ADVENTIST MIDWEST HEALTH IS AN ILLINOIS, 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 MEMBERS OF THE BOARD OF DIRECTORS (GOVERNING BOARD) OF THE FILING ORGANIZATION ARE APPOINTED BY THE CORPORATE MEMBER, AMH. THE CORPORATE MEMBER IS ENTITLED TO ELECT NOT LESS THAN EIGHTEEN (18) AND NO MORE THAN TWENTY THREE (23) VOTING MEMBERS TO THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION PURSUANT TO THE PROVISIONS OF THE BYLAWS, SUBJECT TO THE RATIFICATION OF THE AMITA HEALTH BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B THE FILING ORGANIZATION IS A COVERED AFFILIATE OF THE JOC KNOWN AS AMITA HEALTH. THE SOLE MEMBER OF THE FILING ORGANIZATION IS AMH. AMH IS ALSO ONE OF TWO MEMBERS IN AMITA HEALTH. THE OTHER MEMBER OF AMITA HEALTH IS ALEXIAN BROTHERS HEALTH SYSTEM. THE TOP-TIER PARENT OF AMH IS AHSSHC (SPONSOR). THE GOVERNING DOCUMENTS OF THE FILING ORGANIZATION PROVIDE FOR CERTAIN RESERVED POWERS TO EXERCISE FINANCIAL, MANAGERIAL, AND OPERATIONAL AUTHORITIES OVER THE FILING ORGANIZATION BY AHSSHC, AS SPONSOR, BY AMH AS MEMBER, BY BOTH MEMBERS OF THE JOC, NAMELY, AMH AND ALEXIAN BROTHERS HEALTH SYSTEM (MEMBERS), AND BY THE BOARD OF DIRECTORS OF THE JOC. CERTAIN GOVERNANCE POWERS ARE RESERVED TO AMH AS THE MEMBER OF THE FILING ORGANIZATION. THESE RESERVED POWERS INCLUDE THE ALTERATION, RESTATEMENT OR REPEAL OF THE ARTICLES OF INCORPORATION, BYLAWS OR MISSION STATEMENT OF THE FILING ORGANIZATION, PROVIDED THAT SUCH ACTIONS ARE NOT INCONSISTENT WITH THE JOC BYLAWS OR THE AFFILIATION AGREEMENT AND THE APPOINTMENT OF THE FILING ORGANIZATION'S BOARD OF DIRECTORS, SUBJECT TO THE RATIFICATION OF THE JOC BOARD OF DIRECTORS. FINANCIAL AUTHORITIES RESERVED TO THE SPONSOR, THE BOARD OF DIRECTORS OF THE JOC, AND BY BOTH MEMBERS OF THE JOC INCLUDE THE APPROVAL OF ANY DISPOSITION OF THE FILING ORGANIZATION'S ASSETS AND ANY INTERNAL TRANSFER OF THE FILING ORGANIZATION'S ASSETS. THE SPONSOR, THE BOARD OF DIRECTORS OF THE JOC, AND BOTH MEMBERS OF THE JOC MAY APPROVE SUCH DISPOSITIONS OR TRANSFERS UP TO ESTABLISHED ASSET DOLLAR VALUES AS SET FORTH IN THE BYLAWS OF THE FILING ORGANIZATION. ANNUAL OPERATING AND CAPITAL BUDGETS OF THE FILING ORGANIZATION MUST BE RATIFIED BY BOTH SPONSORS OF THE JOC. THE BOARD OF DIRECTORS OF THE JOC MUST APPROVE ANY CAPITAL EXPENDITURE TO BE MADE BY THE FILING ORGANIZATION IN EXCESS OF $10 MILLION. OPERATIONAL AUTHORITIES RESERVED TO THE BOARD OF DIRECTORS OF THE JOC INCLUDE THE DETERMINATION OF THE SERVICES TO BE PROVIDED BY THE FILING ORGANIZATION, INCLUDING THE AUTHORITY TO DIRECT THE EXPANSION, REDUCTION AND CONSOLIDATION OF CLINICAL PROGRAMS, PATIENT CARE SERVICES AND ADMINISTRATIVE CAPABILITIES OR OTHER MAJOR CHANGES IN THE OPERATION OF THE FILING ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD CHAIRMAN, CEO AND BY THE SR. FINANCE DIRECTOR PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD CHAIRMAN, CEO AND THE SR. FINANCE DIRECTOR 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. THE COMPENSATION PACKAGE FOR THESE INDIVIDUALS IS DETERMINED BY THE JOINT OPERATING COMPANY, ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO. DBA AMITA HEALTH. AS NOTED IN OUR RESPONSE TO PART VI, SECTION A, LINE 7B, THE FILING ORGANIZATION IS A COVERED AFFILIATE OF THE JOC KNOWN AS AMITA HEALTH. THE COMPENSATION OF THE CEO, CFO, COO, CMO AND CNO ARE ESTABLISHED AND APPROVED BY AMITA HEALTH. PLEASE SEE THE DISCUSSION CONCERNING THE PROCESS FOLLOWED BY AMITA HEALTH 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 (NOT INCLUDING PHYSICIAN MEMBERS OF THE BOARD), OFFICER(S) AND KEY EMPLOYEES WHO DEVOTE LESS THAN FULL-TIME TO THE FILING ORGANIZATION (BASED UPON THE AVERAGE NUMBER OF HOURS PER WEEK SHOWN IN COLUMN (B) ON PAGE 7 OF THE RETURN) THE COMPENSATION AMOUNTS SHOWN IN COLUMNS (E) AND (F) ON PAGE 7 WERE PROVIDED IN CONJUNCTION WITH THAT PERSON'S RESPONSIBILITIES AND ROLES IN SERVING IN AN EXECUTIVE LEADERSHIP POSITION WITHIN ADVENTHEALTH OR AMITA HEALTH. PHYSICIAN MEMBERS OF THE BOARD OF DIRECTORS RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS AS A RESULT OF PROVIDING VARIOUS MEDICAL SERVICES TO THOSE RELATED ENTITIES.
PART VIII, LINES 7A, B AND C: THE AMOUNT SHOWN IN PART VIII, LINE 7C(I) OF THE FORM 990 REPRESENTS 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 5,896,928. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,896,928. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 6,061,119. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,061,119. PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 591,272. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 591,272. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 1,862,196. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,862,196. FOOD SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 2,372,809. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,372,809. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 6,039,538. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,039,538. AHS MANAGEMENT FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 21,206. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,206. BILLING & COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,342,788. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,342,788. REGION SUPPORT SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,445,090. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,445,090.
FORM 990, PART XI, LINE 9: TRANSFER TO RELATED TOP-TIER TAX-EXEMPT PARENT -484,591. NET CHANGE IN INTEREST IN FOUNDATION 71,650. GIFTS 10,000. TRANSFER FROM RESTRICTED FOR OPERATIONS -14,500. ROUNDING 1.
FORM 990, PART XII, LINE 3B FOR THE 2020 FISCAL YEAR ENDING DECEMBER 31, 2020, ADVENTHEALTH WAS SUBJECT TO THE SINGLE AUDIT REQUIREMENTS, AS SET FORTH IN THE REGULATIONS AT 2 CFR PART 200, SUBPART F. AS A CALENDAR YEAR TAXPAYER, THE DEADLINE TO COMPLETE AND SUBMIT THE SINGLE AUDIT REPORTING PACKAGE TO THE FEDERAL AUDIT CLEARINGHOUSE, AS REQUIRED UNDER SUBPART F OF 2 CFR 200.501, IS SEPTEMBER 30, 2021. HOWEVER, ON MARCH 19TH, 2021, THE OFFICE OF MANAGEMENT AND BUDGET (OMB) ISSUED MEMORANDUM M21-20, WHICH OUTLINED THE OMB'S EFFORTS TO SUPPLEMENT THE SUPPORT IN THE AMERICAN RESCUE PLAN ACT OF 2021 (ARP), PROMOTE PUBLIC TRUST IN THE FEDERAL GOVERNMENT'S STEWARDSHIP OF TAXPAYER RESOURCES, AND ALLEVIATE SOME OF THE ADMINISTRATIVE CHALLENGES RELATED TO THE CORONAVIRUS PANDEMIC. AS PART OF THE ADMINISTRATIVE RELIEF INCLUDED IN MEMORANDUM M21-20, THE OMB PROVIDED A SIX-MONTH EXTENSION OF TIME TO COMPLETE AND SUBMIT THE SINGLE AUDIT REPORTING PACKAGE. THE EXTENDED REPORTING DEADLINE FOR CALENDAR YEAR TAXPAYERS IS MARCH 31, 2022.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2020


Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
ADVENTIST GLENOAKS HOSPITAL
 
Employer identification number

36-3208390
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity











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


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


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

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1)ADVENTHEALTH FAMILY MEDICINE RURAL HEALTH CLINICS INC
187 PR 4060

LAMPASAS,TX76550
27-1858033
OPERATION OF RURAL HEALTH CLINICS & MEDICAL SERVICES FL 501(C)(3) LINE 3 METROPLEX ADVENTIST HOSPITAL INC
 
Yes
 
(2)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
 
(3)ADVENTHEALTH HOME CARE EAST FLORIDA LLC
770 WEST GRANADA BLVD 319

ORMOND BEACH,FL32174
83-3768458
INACTIVE FL 501(C)(3) LINE 12A, I MEMORIAL HLTH SYSTEMS INC
 
Yes
 
(4)ADVENTHEALTH HOSPICE CARE EAST FLORIDA INC
770 WEST GRANADA BLVD 304

ORMOND BEACH,FL32174
83-3748461
INACTIVE FL 501(C)(3) LINE 12A, I MEMORIAL HLTH SYSTEMS INC
 
Yes
 
(5)ADVENTHEALTH NORTH POLK INC
3100 E FLETCHER AVE

TAMPA,FL33613
59-3231322
INACTIVE FL 501(C)(3) LINE 12A, I UNIVERSITY COMMUNITY HOSPITAL INC
 
Yes
 
(6)ADVENTHEALTH POLK NORTH INC
40100 US HIGHWAY 27 N

DAVENPORT,FL33837
84-1793121
OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP
 
Yes
 
(7)ADVENTHEALTH POLK SOUTH INC
410 SOUTH 11TH STREET

LAKE WALES,FL33853
83-4672945
OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP
 
Yes
 
(8)ADVENTHEALTH SENIOR CARE INC FKA AH OSCEOLA SOUTH INC
900 HOPE WAY

ALTAMONTE SPRINGS,FL32714
84-1817046
INACTIVE FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP
 
Yes
 
(9)ADVENTHEALTH SOUTH OVERLAND PARKINC FKA MERRIAM HLTH CARE PROP
7820 W 165TH STREET

OVERLAND PARK,KS66223
36-4595806
INACTIVE KS 501(C)(3) LINE 3 ADVENTIST HLTH MID-AMERICA INC
 
Yes
 
(10)ADVENTHEALTH RANSOM MEMORIAL INC
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
 
(11)ADVENTHEALTH UNIVERSITY INC
671 WINYAH DRIVE

ORLANDO,FL32803
59-3069793
EDUCATION/OPERATION OF SCHOOL FL 501(C)(3) LINE 2 ADVENTIST HLTH SYSTEMSUNBELT INC
 
Yes
 
(12)ADVENTHEALTH WEST FLORIDA AMBULATORY SVCS INC
14055 RIVEREDGE DRIVE STE 250

TAMPA,FL33637
47-1881744
OPERATION OF IMAGING CENTER & MEDICAL SERVICES FL 501(C)(3) LINE 10 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP
 
Yes
 
(13)ADVENTHEALTH WEST FLORIDA IMAGING INC
14055 RIVEREDGE DRIVE STE 250

TAMPA,FL33637
84-3225135
IMAGING & TESTING FL 501(C)(3) LINE 10 ADVENTHEALTH WEST FLORIDA AMBULATORY SERVICES INC
 
Yes
 
(14)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
 
(15)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
 
(16)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
 
(17)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
 
(18)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
 
(19)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
(20)ADVENTIST HLTH SYSTEM GEORGIA INC
1035 RED BUD ROAD NE

CALHOUN,GA30701
58-1425000
OPERATION OF HOSPITAL & RELATED SERVICES GA 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP
 
Yes
 
(21)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
 
(22)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
 
(23)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
 
(24)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
 
(25)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
 
(26)AHSCENTRAL TEXAS INC (11-12142020)
11801 S FREEWAY

BURLESON,TX76028
74-2621825
PROVIDE OFFICE SPACE - MEDICAL PROFESSIONALS TX 501(C)(3) LINE 12C, III-FI ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP
 
Yes
 
(27)ALEXIAN BROTHERS-AHS MIDWEST REGION HEALTH CO DBA AMITA HEALTH
2601 NAVISTAR DR BLDG 4 FINANCE

LISLE,IL60532
47-2360513
JOINT OPERATING COMPANY IL 501(C)(3) LINE 12B, II N/A
 
No
(28)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
 
(29)BATTLE CREEK ADVENTIST HOSPITAL
900 HOPE WAY

ALTAMONTE SPRINGS,FL32714
38-1359189
INACTIVE MI 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC
 
Yes
 
(30)BERT FISH MEDICAL CENTER AUXILIARY INC
401 PALMETTO STREET

NEW SMYRNA BEACH,FL32168
59-1054892
VOLUNTEER SUPPORT SERVICES FL 501(C)(3) LINE 10 N/A
 
No
(31)BRADFORD HEIGHTS HEALTH & REHAB CENTER INC
485 NORTH KELLER ROAD 250

MAITLAND,FL32751
20-5782342
INACTIVE KY 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC
 
Yes
 
(32)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
 
(33)CENTRAL TEXAS HLTHCARE COLLABORATIVE (11-3312020)
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
 
(34)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
 
(35)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
 
(36)COALITION FOR PHYSICIAN WELL-BEING INC (619 - 12312020)
900 HOPE WAY

ALTAMONTE SPRINGS,FL32714
46-3477012
PROVIDE SUPPORT FOR PHYSICIAN WELL-BEING. FL 501(C)(3) LINE 10 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP
 
Yes
 
(37)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
 
(38)CREEKWOOD PLACE NURSING & REHAB CENTER INC
485 NORTH KELLER ROAD 250

MAITLAND,FL32751
20-5782260
INACTIVE KY 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC
 
Yes
 
(39)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
 
(40)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
 
(41)EMORY-ADVENTIST INC
900 HOPE WAY

ALTAMONTE SPRINGS,FL32714
58-2171011
INACTIVE GA 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC
 
Yes
 
(42)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
 
(43)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
 
(44)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
 
(45)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
 
(46)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
 
(47)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
 
(48)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
 
(49)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
 
(50)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
 
(51)FLORIDA RADIOLOGY IMAGING AT LAKE MARY LLC
2600 WESTHALL LANE 4TH FLOOR

MAITLAND,FL32751
55-0789387
IMAGING & TESTING FL 501(C)(3) LINE 3 FLORIDA HOSPITAL MEDICAL GROUP INC
 
Yes
 
(52)FOUNTAIN INN NURSING & REHAB CENTER INC
4501 WATERMAN WAY

TAVARES,FL32778
47-2180518
OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC
 
Yes
 
(53)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
(54)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
(55)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
(56)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
 
(57)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
 
(58)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
 
(59)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
(60)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
 
(61)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
 
(62)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
 
(63)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
 
(64)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
 
(65)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
 
(66)MIDWEST HEALTH FOUNDATION
120 NORTH OAK STREET

HINSDALE,IL60521
35-2230515
SUPPORT OF SUBSIDIARY FOUNDATIONS IL 501(C)(3) LINE 7 N/A
 
No
(67)MILLS HEALTH & REHAB CENTER INC
485 NORTH KELLER ROAD 250

MAITLAND,FL32751
20-5782320
INACTIVE KY 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC
 
Yes
 
(68)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
 
(69)MISSOURI ADVENTIST HEALTH 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
 
(70)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
(71)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
 
(72)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
 
(73)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
 
(74)PORTERCARE ADVENTIST HEALTH SYSTEM (630 YE)
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
 
(75)PRINCETON HEALTH & REHAB CENTER INC
485 NORTH KELLER ROAD 250

MAITLAND,FL32751
20-5782272
INACTIVE KY 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC
 
Yes
 
(76)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
 
(77)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
 
(78)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
 
(79)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
(80)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
 
(81)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
 
(82)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
 
(83)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
 
(84)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
 
(85)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
 
(86)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
 
(87)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
 
(88)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
 
(89)SOUTHWEST VOLUSIA HLTHCARE CORP
1055 SAXON BLVD

ORANGE CITY,FL32763
59-3149293
OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEMSUNBELT INC
 
Yes
 
(90)SPECIALTY PHYSICIANS OF CENTRAL TEXAS INC (11-3312020)
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
 
(91)SPRING VIEW HLTH & REHAB CENTER INC
485 NORTH KELLER ROAD 250

MAITLAND,FL32751
20-5782288
INACTIVE KY 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC
 
Yes
 
(92)SUNBELT HLTH & REHAB CENTER - APOPKA INC
305 EAST OAK STREET

APOPKA,FL32703
20-5774856
OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC
 
Yes
 
(93)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
 
(94)SUNSYSTEM DEVELOPMENT CORP
900 HOPE WAY

ALTAMONTE SPRINGS,FL32714
59-2219301
FUND RAISING FOR AFFILIATED TAX-EXEMPT HOSPITALS FL 501(C)(3) LINE 7 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP
 
Yes
 
(95)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
 
(96)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
 
(97)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
 
(98)THE VOLUNTEER AUXILIARY OF FLORIDA HOSPITAL - FLAGLER INC
60 MEMORIAL MEDICAL PARKWAY

PALM COAST,FL32164
59-2486582
VOLUNTEER SUPPORT SERVICES FL 501(C)(3) LINE 12C, III-FI N/A
 
No
(99)TRI-COUNTY NURSING AND REHAB CENTER INC
1290 CELEBRATION BLVD

KISSIMMEE,FL34747
47-2219363
OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC
 
Yes
 
(100)TRINITY NURSING & REHAB CENTER INC (11-91020)
485 NORTH KELLER ROAD 250

MAITLAND,FL32751
20-5774890
OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY KS 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC
 
Yes
 
(101)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
(102)UNIVERSITY COMMUNITY HOSPITAL INC
3100 E FLETCHER AVE

TAMPA,FL33613
59-1113901
OPERATION OF HOSPITAL & RELATED SERVICES FL 501(C)(3) LINE 3 ADVENTIST HLTH SYSTEM SUNBELT HLTHCARE CORP
 
Yes
 
(103)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 ADVENTHEALTH WEST FLORIDA AMBULATORY SVCS INC
 
Yes
 
(104)ZEPHYR HAVEN HLTH & REHAB CENTER INC
38250 A AVENUE

ZEPHYRHILLS,FL33542
20-5774930
OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 10 SUNBELT HLTH CARE CENTERS INC
 
Yes
 
(105)ZEPHYRHILLS HLTH & REHAB CENTER INC
7350 DAIRY ROAD

ZEPHYRHILLS,FL33540
20-5774967
OPERATION OF HOME FOR THE AGED/HLTHCARE DELIVERY FL 501(C)(3) LINE 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) 2020
Schedule R (Form 990) 2020
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



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

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




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



(k)
Percentage
ownership


Yes No Yes No
(1) FLETCHER HOSPITAL SURGICAL VENTURES LLC

9131 ANSON WAY STE 304
RALEIGH,NC27615
86-1482646
INDIRECT INTEREST IN SURGERY CENTER NC N/A
        No     No  
(2) FLORIDA HOSPITAL DMERT LLC

500 WINDERLEY PLACE STE 324
MAITLAND,FL32751
20-2392253
MEDICAL EQUIPMENT FL N/A
        No   Yes    
(3) FLORIDA HOSPITAL HOME INFUSION LLP

500 WINDERLEY PLACE STE 226
MAITLAND,FL32751
59-3142824
HOME INFUSION SERVICES FL N/A
        No   Yes    
(4) FUNCTIONAL NEUROSURGICAL AMBULATORY SURGERY CTR LLC

11 W DRY CREEK CIRCLE 120
LITTLETON,CO80120
46-4426708
SURGERY CENTER CO N/A
        No     No  
(5) HEART OF FLORIDA SURGERY CENTER LLC (11 -10152020)

410 LIONEL WAY 100
DAVENPORT,FL33837
81-2235296
SURGERY CENTER DE N/A
        No   Yes    
(6) PAHS ONPOINT URGENT CARE LLC

9100 E MINERAL CIRCLE
CENTENNIAL,CO80112
83-2465331
URGENT CARE CENTER CO N/A
        No     No  
(7) PRINCETON HOMECARE SERVICES LLC

1050 FORRER BLVD
KETTERING,OH45420
81-4196648
OPERATION OF HOME HEALTH AGENCY FL N/A
        No     No  
(8) SAN MARCOS MRI LP

1330 WONDER WORLD DR STE 202
SAN MARCOS,TX78666
77-0597972
IMAGING & TESTING TX N/A
        No     No  
(9) THE BARIATRIC CENTER OF KANSAS CITY LLC

9100 W 74TH STREET
MERRIAM,KS66204
82-3025378
SURGERY CENTER KS N/A
        No     No  
(10) URGENT CARE CENTERS OF BREVARD COUNTY LLC (14-12312020)

2600 WESTHALL LANE
MAITLAND,FL32751
84-4261523
URGENT CARE CENTERS FL N/A
        No   Yes    
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) ALTAMONTE MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC

601 EAST ROLLINS STREET
ORLANDO,FL32803
59-2855792
CONDO ASSOCIATION FL N/A
C       Yes  
(2) APOPKA MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC

601 EAST ROLLINS STREET
ORLANDO,FL32803
59-3000857
CONDO ASSOCIATION FL N/A
C       Yes  
(3) CC MOB INC

2201 S CLEAR CREEK ROAD
KILLEEN,TX76549
74-2616875
REAL ESTATE RENTAL TX N/A
C       Yes  
(4) CENTRAL TEXAS MEDICAL ASSOCIATES

1301 WONDER WORLD DRIVE
SAN MARCOS,TX78666
74-2729873
INACTIVE TX N/A
C       Yes  
(5) CENTRAL TEXAS PROVIDERS NETWORK (11-3312020)

1301 WONDER WORLD DRIVE
SAN MARCOS,TX78666
74-2827652
PHYSICIAN HOSPITAL ORG. TX N/A
C       Yes  
(6) FLORIDA HOSPITAL FLAGLER MEDICAL OFFICES ASSOCIATION INC

60 MEMORIAL MEDICAL PARKWAY
PALM COAST,FL32164
26-2158309
CONDO ASSOCIATION FL N/A
C       Yes  
(7) FLORIDA HOSP HLTH VILLAGE PROPERTY OWNER'S ASSOC INC

550 E ROLLINS STREET 7TH FLOOR
ORLANDO,FL32803
82-1748255
CONDO ASSOCIATION FL N/A
C       Yes  
(8) FLORIDA HOSPITAL HEALTHCARE SYSTEM INC

101 SOUTHHALL LANE STE 150
MAITLAND,FL32751
59-3215680
PHSO FL N/A
C       Yes  
(9) FLORIDA MEDICAL PLAZA CONDOMINIUM ASSOCIATION INC

601 EAST ROLLINS STREET
ORLANDO,FL32803
59-2855791
CONDO ASSOCIATION FL N/A
C       Yes  
(10) KISSIMMEE MULTISPECIALTY CLINIC CONDOMINIUM ASSOCIATION INC

201 HILDA STREET SUITE 30
KISSIMMEE,FL34741
59-3539564
CONDO ASSOCIATION FL N/A
C       Yes  
(11) LN HEALTH PARTNERS INC (11 - 9102020)

550 E ROLLINS STREET 6TH FLOOR
ORLANDO,FL32803
81-3556903
INACTIVE FL N/A
C       Yes  
(12) MIDWEST MANAGEMENT SERVICES INC

9100 WEST 74TH STREET
SHAWNEE MISSION,KS66204
48-0901551
INACTIVE KS N/A
C       Yes  
(13) NORTH AMERICAN HEALTH SERVICES INC & SUB

900 HOPE WAY
ALTAMONTE SPRINGS,FL32714
62-1041820
LESSOR/HOLDING CO. TN N/A
C       Yes  
(14) 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  
(15) PARK RIDGE PROPERTY OWNER'S ASSOCIATION INC

1 PARK PLACE NAPLES ROAD
FLETCHER,NC28732
03-0380531
CONDO ASSOCIATION NC N/A
C       Yes  
(16) PORTER AFFILIATED HEALTH SERVICES INC

2525 S DOWNING STREET
DENVER,CO80210
84-0956175
HEALTHCARE SERVICES CO N/A
C       Yes  
(17) SAN MARCOS REGIONAL MRI INC (11-3312020)

1301 WONDER WORLD DRIVE
SAN MARCOS,TX78666
77-0597968
HOLDING COMPANY TX N/A
C       Yes  
(18) THE GARDEN RETIREMENT COMMUNITY INC

485 NORTH KELLER ROAD STE 250
MAITLAND,FL32751
59-3414055
REAL ESTATE RENTAL FL N/A
C       Yes  
(19) WINTER PARK MEDICAL OFFICE BUILDING I CONDO ASSOC INC

601 EAST ROLLINS STREET
ORLANDO,FL32803
45-2228478
CONDO ASSOCIATION FL N/A
C       Yes  
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) ADVENTIST MIDWEST HEALTH

Q 2,649,261 COST
(2) ADVENTIST MIDWEST HEALTH

P 30,867,221 COST
(3) ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION

M 832,466 % OF FACILITY'S OPERATING EXP.
(4) ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION

P 1,891,998 COST
(5) ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION

B 484,591 ACTUAL AMOUNT GIVEN
(6) ADVENTIST HEALTH PARTNERS INC

P 2,507,763 COST
(7) ADVENTIST BOLINGBROOK HOSPITAL

P 259,612 COST
(8) ADVENTIST BOLINGBROOK HOSPITAL

Q 1,089,200 COST
(9) ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION DBA AH IT

M 3,469,697 % OF FACILITY'S OPERATING EXP.
(10) MIDWEST HEALTH FOUNDATION

C 141,030 ACTUAL AMOUNT RECEIVED
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

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




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
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) 2020

Additional Data


Software ID:  
Software Version: