TY 2021 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(1) TODD NEVILLE...................................................................... CHAIRMAN	1.00 ................. 0.00	X	X	0	0
(2) CHRIS KAMEINSKI...................................................................... VICE-CHAIRMAN	1.00 ................. 0.00	X	X	0	0
(3) WILLIAM BILL ABARE JR...................................................................... TREASURER	1.00 ................. 0.00	X	X	0	0
(4) FRED FRANKLIN JR...................................................................... SECRETARY	1.00 ................. 0.00	X	X	0	0
(5) FERRIS GEORGE MD...................................................................... DIRECTOR & FCHA PRESIDENT	1.00 ................. 0.00	X		0	0
(6) ASHFAQ KUDIA...................................................................... DIRECTOR & MEDICAL STAFF PRESIDENT	1.00 ................. 0.00	X	X	45,350	0
(7) GREGORY OXFORDDDM...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(8) ANDREW CRENESHAW...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(9) JOHN DELANEY...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(10) RAY MATUZA...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(11) SUSAN PONDER-STANSEL...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(12) STUART SOROKAMD...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(13) KAREN TAYLOR...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(14) LEN TUCKER...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(15) LEN WEEKS...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(16) CARLTON DEVOOGHT...................................................................... PRESIDENT/CEO	40.00 ................. 2.00		X	491,592	25,957
(17) JASON P BARRETT...................................................................... PRESIDENT/CEO	40.00 ................. 2.00		X	798,855	42,957

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) MIGUEL A MACHADO........................................................................ CMO	40.00 .......................0.00	X				558,904	2,403
(19) DAVID RICE MD........................................................................ EVP/CHIEF PHYSICIAN EXECUTIVE	40.00 .......................0.00	X				597,634	35,023
(20) ANGIE METCALF........................................................................ CHIEF ADMINISTRATIVE OFFICER	40.00 .......................2.00	X				336,228	6,501
(21) VINCENT JOHNSON........................................................................ EVP/COO	40.00 .......................2.00	X				461,821	39,048
(22) BRENDA BAKER........................................................................ EVP/CFO (PART YEAR)	40.00 .......................2.00	X				248,536	13,000
(23) TOM BAILEY........................................................................ INTERIM CFO/ ADMINISTRATOR	40.00 .......................2.00	X				0	0
(24) MELISSA CECIL........................................................................ CIO	40.00 .......................2.00	X				262,331	10,413
(25) JILL BERRY........................................................................ VP, CHIEF LEGAL OFFICER	40.00 .......................2.00	X				163,902	18,681
(26) KEVIN SWEENY........................................................................ VP GOVERNMENT AFFAIRS & FOUNDATION	40.00 .......................0.00	X				238,338	5,164
(27) TODD BATENHORST........................................................................ VP, CMO AMBULATORY CARE	40.00 .......................0.00		X			433,718	41,304
(28) JOHN FRANKS........................................................................ EVP, AMBULATORY ENTERPRISE	40.00 .......................0.00		X			287,043	5,528
(29) NANGELA PULSFUS........................................................................ EVP/COO	40.00 .......................0.00		X			339,314	30,907
(30) DONALD R CRIST........................................................................ VP OF OPERATIONS	40.00 .......................0.00		X			288,782	16,973
(31) MICHAEL HALL........................................................................ ADMINISTRATOR	40.00 .......................0.00		X			196,729	30,207
(32) DONNA WAGNER........................................................................ VP CNO	40.00 .......................0.00		X			217,093	1,224
(33) ACHAREEYA MARTWISET........................................................................ RN	40.00 .......................0.00			X		207,475	0
(34) MELANI CROSBY........................................................................ ASL INTERPRETER	40.00 .......................0.00			X		166,825	0
(35) JAMES D CARLISLE........................................................................ CLINICAL PHARMACIST	40.00 .......................0.00			X		158,253	7,442
(36) LYLE KOLNIK........................................................................ CLINICAL SPECIALIST	40.00 .......................0.00			X		152,727	0
(37) SHARON R MCDADE........................................................................ CHARGE RN	40.00 .......................0.00			X		150,268	5,321
(38) JOSEPH S GORDY........................................................................ CEO (FORMER)	0.00 .......................0.00				X	759,458	0
(39) JEFFREY A HURLEY........................................................................ CHIEF HUMAN RESOURCE OFFICER (FORMER)	0.00 .......................0.00				X	296,226	0

(A) Name and business address	(B) Description of services	(C) Compensation
FIRST COAST HEART & VASCULAR PA 3901 UNIVERSITY BLVD JACKSONVILLE,FL32216	MEDICAL SERVICES	20,922,153
STELLAR GROUP 2900 HARTLEY RD JACKSONVILLE,FL32257	CONSTRUCTION/ENGINEERING	18,187,790
MCKESSON DRUG CO PO BOX 409521 ATLANTA,GA30384	MEDICAL SERVICES	10,495,547
CARDINAL HEALTH CARE 7000 CARDINAL PLACE DUBLIN,OH43017	MEDICAL SERVICES	8,032,396
GREAT-WEST FINANCIAL PO BOX 173764 DENVER,CO80217	EMPLOYEE BENEFITS	6,920,387
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 282

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

FLAGLER HOSPITAL INC

Employer identification number

59-0675143

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

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

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

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

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

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

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

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

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

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

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990) 2021

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)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

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

First 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

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 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

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990) 2021

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

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

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

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

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

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

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

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

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

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer 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).

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

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

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

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

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

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

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

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

10a

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

10a

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

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on 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

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.

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

By reason of the relationship described in 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.

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

Activities Test. Answer lines 2a and 2b below.

Yes

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

Did the activities described on 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.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

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

Schedule A (Form 990) 2021

Page 6

Part V

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

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

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

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

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

Schedule A (Form 990) 2021

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 2021 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-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2021

Name of the organization

FLAGLER HOSPITAL INC

Employer identification number

59-0675143

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

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

Special Rules

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

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

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

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization FLAGLER HOSPITAL INC

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization FLAGLER HOSPITAL INC		Employer identification number 59-0675143

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) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization FLAGLER HOSPITAL INC			Employer identification number 59-0675143
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

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

OMB No. 1545-0047

2021

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

FLAGLER HOSPITAL INC

Employer identification number

59-0675143

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

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

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

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(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) 2021

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

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

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

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

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

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

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

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

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

Yes

788,286

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

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

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

788,286

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

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

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

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

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

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

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

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

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

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

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

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

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

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

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	DURING THE TAX YEAR, THE ORGANIZATION ENGAGED A PROFESSIONAL LOBBYIST TO MONITOR LEGISLATION DIRECTLY AFFECTING NOT-FOR-PROFIT HOSPITALS/RURAL COMMUNITY PROVIDERS.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

FLAGLER HOSPITAL INC

Employer identification number

59-0675143

Part I

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

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

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

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

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

Yes No

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

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

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under 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.

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

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:

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

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

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

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

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

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

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

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

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

1a	Beginning of year balance ....	4,064,275	4,064,225	4,064,200	4,655,297	4,391,344
b	Contributions ...		50	25	4,573
c	Net investment earnings, gains, and losses					271,053
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...				595,670	7,100
f	Administrative expenses ....
g	End of year balance ......	4,064,275	4,064,275	4,064,225	4,064,200	4,655,297

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

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

100.000 %

Term endowment SchDMd Bullet

0 %

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

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

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

Yes

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

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	45,792,726		45,792,726
b	Buildings ....	204,734,734	118,543,816	86,190,918
c	Leasehold improvements	6,799,396	5,546,416	1,252,980
d	Equipment ....	219,655,509	172,206,136	47,449,373
e	Other .....	59,651,004	7,765,004	51,886,000
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				232,571,997

Schedule D (Form 990) 2021

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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

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

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

Part IX

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

(a) Description				(b) Book value
(1)DUE FROM AFFILIATES				12,975,214
(2)LONG-TERM RECOVERIES				8,936,669
(3)RIGHT OF USE ASSETS				1,896,112
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				23,807,995

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
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	29,708,545
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) 2021

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	292,030,372
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-40,989,951
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	11,806,869
e	Add lines 2a through 2d .....................			2e	-29,183,082
3	Subtract line 2e from line 1..................			3	321,213,454
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	-228,189
c	Add lines 4a and 4b....................			4c	-228,189
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	320,985,265

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	333,741,918
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	275,671
e	Add lines 2a through 2d....................			2e	275,671
3	Subtract line 2e from line 1...................			3	333,466,247
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	12,680,217
c	Add lines 4a and 4b.....................			4c	12,680,217
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	346,146,464

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART V, LINE 4:	THE ORGANIZATION'S ENDOWMENT CONSISTS OF FOUR INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. THE ENDOWMENTS ARE ALL DONOR-RESTRICTED AND INTERNALLY CONTROLLED. FLAGLER HEALTH CARE FOUNDATION, A RELATED ORGANIZATION, HOLDS THESE ENDOWMENTS FOR BENEFIT OF FLAGLER HOSPITAL, INC. INVESTMENTS CONTAIN AMOUNTS TO BE HELD IN PERPETUITY, THE DIVIDEND AND INTEREST INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTHCARE SERVICES, AND THE REMAINING INVESTMENT INCOME, GAINS, AND LOSSES ARE TO ADJUST THE CORPUS.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	PROVISION FOR BAD DEBTS -12,680,217. GOODWILL IMPAIRMENT 24,439,604. MISC REVENUE CLASSIFICATION ADJUSTMENTS 47,482.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	RENTAL EXPENSES -228,189.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSES 228,189. MISC REVENUE CLASSIFICATION ADJUSTMENTS 47,482.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	PROVISION FOR BAD DEBTS 12,680,217.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

FLAGLER HOSPITAL INC

Employer identification number

59-0675143

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

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

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

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

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

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

Yes

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

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .			6,809,904	72,097	6,737,807	2.020 %
b	Medicaid (from Worksheet 3, column a) . . . . .			25,063,606	15,639,802	9,423,804	2.830 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			31,873,510	15,711,899	16,161,611	4.850 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	13	17,476	3,626,095	617,049	3,009,046	0.900 %
f	Health professions education (from Worksheet 5) . . .	27	2,222	1,208,419		1,208,419	0.360 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	1		215,649		215,649	0.060 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	5	277	793,651		793,651	0.240 %
j	Total. Other Benefits . .	46	19,975	5,843,814	617,049	5,226,765	1.560 %
k	Total. Add lines 7d and 7j .	46	19,975	37,717,324	16,328,948	21,388,376	6.410 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

12,680,217

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. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

89,247,407

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

100,280,677

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

-11,033,270

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 FLAGLER HOME CARE LLC	HOME HEALTH CARE	52.000 %	0 %	48.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

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)
1	FLAGLER HOSPITAL INC 400 HEALTH PARK BLVD ST AUGUSTINE,FL32086 WWW.FLAGLERHEALTH.ORG	X	X

Schedule H (Form 990) 2021

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)

	FLAGLER HOSPITAL
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

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

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

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

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

Yes

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

Yes

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

Hospital facility’s website (list url): SEE PART V

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22

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

Yes

If "Yes" (list url): SEE PART V

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

10b

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

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

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

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	FLAGLER HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

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

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

SEE PART V

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

SEE PART V

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

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

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

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

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

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

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

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	FLAGLER HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

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

	FLAGLER HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

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

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

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

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

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
FLAGLER HOSPITAL	PART V, SECTION B, LINE 5: THE YEAR-LONG PROCESS FOR THE 2020 COMMUNITY HEALTH NEEDS ASSESSMENT UTILIZED A COMMUNITY-WIDE STRATEGIC PLANNING PROCESS CALLED "MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS OR "MAPP", WHICH WAS DEVELOPED BY THE NATIONAL ASSOCIATION OF CITY AND COUNTY HEALTH OFFICIALS AND THE CENTERS FOR DISEASE CONTROL AND PREVENTION. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS PLANNED BY THE HEALTH LEADERSHIP COUNCIL AS A COLLECTION OF DATA GATHERED TO IDENTIFY AND ANALYZE HEALTH STATUS, HEALTH FACTORS AND HEALTH OUTCOMES WITHIN THE COMMUNITY. USING MAPP GUIDELINES, FOCUS GROUPS WERE FORMED TO DETERMINE HOW RESIDENTS FELT ABOUT THE QUALITY OF LIFE IN ST. JOHNS COUNTY. THESE FOCUS GROUPS WERE FACILITATED BY LEADERS OF THE HEALTH LEADERSHIP COUNCIL WITH THE INTENT OF COVERING A VARIETY OF GEOGRAPHIC AND DEMOGRAPHIC SECTORS OF THE COUNTY. SECOND, A SURVEY WAS DISPERSED COUNTY-WIDE AND MADE AVAILABLE ONLINE. THIS DATA AND DATA FROM THE NATIONAL AND STATE COUNTY HEALTH RANKINGS AND HEALTHY PEOPLE 2020, SERVED AS A BASIS FOR THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). NOTE: THE COMPLETE "COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN" IS PUBLISHED AND AVAILABLE ON THE FLAGLER HOSPITAL WEBSITE: HTTPS://WWW.FLAGLERHEALTH.ORG/PATIENTS-VISITORS.ASPX.IN TOTAL, FLAGLER HOSPITAL AND THE ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL FACILITATED 8 COMMUNTIY FOCUS GROUPS WITH A TOTAL OF 50 PARTICIPANTS TO GAIN A BETTER UNDERSTANDING OF PERCEPTIONS OF COMMUNTIY STRENGTHS, NEEDS AND HEALTH CONCERNS. A COMMUNITY-WIDE SURVEY WAS USED TO GATHER RESIDENTS' THOUGHTS AND CONCERNS ABOUT THE QUALITY OF LIFE AND HEALTHCARE SERVICES IN ST. JOHNS COUNTY. THE SURVEY WAS MADE WIDELY AVAILABLE THROUGH WEB-BASED SURVEYS WHICH WERE EMAILED AND PROMOTED ON SOCIAL MEDIA SOURCES THROUGH THE FLAGLER HEALTH+/FLAGLER HOSPITAL SOCIAL MEDIA OUTLETS. 517 SURVEYS WERE COMPLETED. THE FOCUS ON COVID-19 BY BOTH THE HOSPITAL AND THE DEPARTMENT OF HEALTH RESULTED IN FEWER RESOURCES WITH THE ABILITY TO DEVOTE TIME AND PERSONNEL TO GATHER INFORMATION IN PERSON. FURTHERMORE, THE PUBLIC GATHERINGS FOR FOCUS GROUPS ARE NOT ENCOURAGED AT THIS TIME. IN ADDITION TO THE COMMUNITY SURVEY, AGGREGATE DATA FROM CARE CONNECT+ IS USED TO DETERMINE COMMUNITY NEEDS AND GAPS IN SERVICES BASED ON THE NEEDS AND GOALS VOICED BY COMMUNITY CLIENTS.SURVEY RESPONDENTS REPRESENTED ALL ST. JOHNS COUNTY, FL ZIP CODES. THE HIGHEST PROPORTION OF SURVEYS WERE COMPLETED BY RESIDENTS OF THE 32084 (25%) AND 32086 (25%) ZIP CODES OF THE COUNTY. RESPONDENTS WERE MOSTLY HOME OWNERS (83%) AND THE MAJORITY HAD LIVED IN ST. JOHNS COUNTY FOR MORE THAN 10 YEARS (58%). THERE WERE NO SURVEY RESPONDENTS THAT REPORTED BEING HOMELESS HOWEVER 4 DID NOT ANSWER THE QUESTION, AND 6 ANSWERED "PREFER NOT TO ANSWER". USING MOSTLY A DIGITAL SURVEY, HINDERED OUR ABILITY TO REACH THE HOMELESS POPULATION, ALTHOUGH ATTEMPTS WERE MADE TO USE THE FREE CLINIC TO REACH THOSE WHO ARE UNDERSERVED. RESPONDENTS WERE OVERWHELMINGLY FEMALE (85%) AND MARRIED OR IN A DOMESTIC PARTNERSHIP (70%). AS MENTIONED ABOVE, ST JOHNS COUNTY IS NOT VERY RACIALLY DIVERSE. ABOUT 83% OF ST JOHNS COUNTY RESIDENTS ARE WHITE AND THE SURVEY REFLECTED ABOUT 92% OF RESPONDENTS ARE WHITE. ATTEMPTS WERE MADE TO SHARE THE SURVEY THROUGH SOCIAL MEDIA TO ALL MEMBERS OF THE COMMUNITY AND TO OBTAIN A DIVERSE OUTLOOK BUT DUE TO CONSTRAINTS WITH RESOURCES DUE TO COVID-19, THE RACIAL DIVERSITY OF SURVEY RESPONDENTS WAS LESS THAN IDEAL. INFORMATION GATHERED THROUGH CARE CONNECT+ PROVIDES A MORE DIVERSE ANALYSIS OF COMMUNITY NEEDS. ALSO REFLECTING THE COMMUNITY AT LARGE, ABOUT 60% OF RESPONDENTS ARE 18-64 (COMPARED TO POPULATION OF 58% 18-64). THE MEDIAN HOUSEHOLD INCOME OF ST. JOHNS COUNTY IS $82,252 WHICH IS REFLECTED IN OUR RESPONDENTS WHO MOSTLY MAKE OVER $50,000 (60%). 73% OF SURVEY RESPONDENTS REPORTED DEGREE FROM HIGHER EDUCATION (ASSOCIATES OR HIGHER) AND ABOUT 45% OF RESIDENTS OVER 25 HAVE A BACHELOR'S OR HIGHER. A NEW SURVEY AND RESULTING REPORT WERE CREATED IN DECEMBER OF 2020 WHICH WILL BE SHOWN IN TAX YEAR 2021. THE WEBSITE FOR THIS REPORT IS SHOWN HERE FOR REFERENCE: HTTPS://WWW.FLAGLERHEALTH.ORG/COMMUNITY-HEALTH-IMPROVEMENT/COMMUNITY-BENEFIT-PLANNING/ST-JOHNS-COUNTY-HEALTH-NEEDS-ASSESSMENT/.
FLAGLER HOSPITAL	PART V, SECTION B, LINE 6B: ANASTASIA MOSQUITO CONTROL DISTRICT- SJCAZALEA HEALTHBETTY GRIFFIN CENTERCHILDREN'S HOME SOCIETY OF FLORIDACLINTON HEALTH MATTERS INITIATIVECOMMUNITY HOSPICE AND PALLIATIVE CARECOMMUNITY MANAGEMENT & CONSULTINGEPIC BEHAVIORAL HEALTHCAREFLAGLER HOSPITALFLORIDA ARMY RESERVE NATIONAL GUARDFLORIDA DEPARTMENT OF HEALTH IN ST. JOHNS COUNTYGOOD SAMARITAN HEALTH CENTERS/WILDFLOWER CLINICHEALTH PLANNING COUNCIL OF NORTHEAST FLORIDAST JOHNS RIVER RURAL HEALTH NETWORKNEW MT. MORIAH CHRISTIAN MINISTRYNORTHEAST FLORIDA HEALTHY START COALITIONPACT PREVENTION COALITION OF ST. JOHNS COUNTYST. JOHNS COUNTY HEALTH AND HUMAN SERVICESST. AUGUSTINE BEACH POLICE DEPARTMENTST. AUGUSTINE YOUTH SERVICESST. JOHNS COUNTY ADMINISTRATIONST. JOHNS COUNTY BOARD OF COUNTY COMMISSIONERSST. JOHNS COUNTY COUNCIL ON AGINGST. JOHNS COUNTY EMERGENCY MANAGEMENTSJC HEALTH AND HUMAN SERVICES ADVISORY COUNCILST. JOHNS COUNTY MEDICAL SOCIETYST. JOHNS COUNTY SCHOOL DISTRICTSJC HEAD START PROGRAM/EARLY CHILDHOOD SERVICESST. JOHNS COUNTY SHERIFF'S OFFICEST. JOHNS RIVER STATE COLLEGEST. VINCENT'S MOBILE HEALTH OUTREACH MINISTRYSTEWART MARCHMAN - ACT BEHAVIORAL HEALTHCARETHE SONTAG FOUNDATIONTOBACCO FREE ST. JOHNSYMCA OF FLORIDA'S FIRST COAST
FLAGLER HOSPITAL	PART V, SECTION B, LINE 7D: FLAGLER HOSPITAL UTILIZED A VARIETY OF APPROACHES TO INFORM THE COMMUNITY ON THE RESULTS OF THE 2017 ST. JOHNS COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. FLAGLER HOSPITAL INVESTED IN PRINTING 300 HARD COPIES OF THE 147-PAGE PUBLICATION. THESE COPIES WERE PROVIDED TO ALL ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL MEMBERS AND DISPLAYED ON-SITE AT EACH MEMBER AGENCY. FLAGLER HOSPITAL ALSO PRINTED 50 LARGE-FONT VERSIONS OF THE CHNA FOR VISUALLY IMPAIRED COMMUNITY MEMBERS THAT WERE DISTRIBUTED TO THE ST. JOHNS COUNTY COUNCIL ON AGING AND LOCAL LIBRARIES.
FLAGLER HOSPITAL	PART V, SECTION B, LINE 11: REDUCE CHRONIC DISEASE MORBIDITY AND MORTALITYCANCER IS THE LEADING CAUSE OF DEATH IN ST. JOHNS COUNTY, WITH BREAST, COLON AND LUNG CANCER IDENTIFIED AS BEING THE MOST COMMON TYPES AMONG RESIDENTS. AMONG SURVEY RESPONDENTS, CANCER WAS GIVEN HIGH PRIORITY IN PERCEPTION OF CONCERN.TO RAISE AWARENESS ABOUT THE BENEFITS OF PREVENTION AND EARLY DETECTION OF CANCER, FLAGLER HOSPITAL PARTICIPATED IN OVER 25 HEALTH FAIRS, PROVIDING ST. JOHNS COUNTY RESIDENTS WITH UP-TO-DATE SCREENING GUIDELINES AND THE BENEFITS OF A HEALTHY LIFESTYLE. CANCER PREVENTION PROGRAMS INCLUDED PRESENTATIONS FOR LOCAL CHURCHES AND CIVIC GROUPS, LUNG CANCER AWARENESS EVENTS, COLORECTAL CANCER PREVENTION AND AWARENESS EVENTS AND A SKIN CANCER PREVENTION PROGRAM. IN ADDITION, FLAGLER HOSPITAL PARTNERED WITH OTHER COMMUNITY ORGANIZATIONS SUCH AS GOOD SAMARITAN, WILDFLOWER CLINIC, AMERICAN CANCER SOCIETY, LUNG CANCER ALLIANCE, PINK-UP THE PACE AND UNITY OUTREACH TO PROMOTE CANCER AWARENESS AND EARLY DETECTION THROUGHOUT THE COMMUNITY.BREAST CANCER PROGRAM:AS A NAPBC-ACCREDITED CENTER, FLAGLER HOSPITAL IS COMMITTED TO MAINTAINING LEVELS OF EXCELLENCE IN THE DELIVERY OF COMPREHENSIVE, PATIENT-CENTERED, MULTIDISCIPLINARY CARE RESULTING IN HIGH-QUALITY CARE FOR PATIENTS WITH BREAST DISEASE. PATIENTS CAN BE CONFIDENT THAT THEIR BREAST CARE TEAM INCLUDES HEALTH CARE PROFESSIONALS FROM A VARIETY OF DISCIPLINES WHO ARE COMMITTED TO WORKING TOGETHER TO PROVIDE THE BEST CARE AVAILABLE THROUGH THEIR ENTIRE COURSE OF TREATMENT. PATIENTS RECEIVING CARE AT A NAPBC-ACCREDITED CENTER ALSO HAVE ACCESS TO INFORMATION ON CLINICAL TRIALS AND NEW TREATMENT OPTIONS, GENETIC COUNSELING, AND PATIENT-CENTERED SERVICES INCLUDING PSYCHOSOCIAL SUPPORT, REHABILITATION SERVICES AND SURVIVORSHIP CARE. TO ASSIST PATIENTS THROUGH THEIR JOURNEY, THE FLAGLER BREAST CARE PROGRAM HAS AN ONCOLOGY NURSE NAVIGATOR WHO HELPS PATIENTS FROM THE TIME THERE IS A SUSPICION OF BREAST CANCER UNTIL TREATMENT IS CONCLUDED AND BEYOND TO SURVIVORSHIP. THE NAVIGATOR IS DEDICATED TO PROVIDING PATIENTS WITH KNOWLEDGEABLE AND COMPASSIONATE SUPPORT; FACILITATING COMMUNICATION BETWEEN THE PATIENT AND PHYSICIANS IN ORDER TO DECREASE FRAGMENTATION OF CARE; AND PROVIDING PATIENTS AND FAMILY MEMBERS WITH INFORMATION ON COMMUNITY-BASED RESOURCES. THE NAVIGATOR ALSO PARTICIPATES IN COMMUNITY EVENTS, EDUCATING WOMEN ON THE BENEFITS OF EARLY DETECTION AND PREVENTION. IN 2022 THE ONCOLOGY NURSE NAVIGATOR FOLLOWED 224 BREAST CANCER PATIENTS.CANCER PROGRAM:THE CANCER PROGRAM AT FLAGLER HOSPITAL IS ACCREDITED BY THE COMMISSION ON CANCER (COC), A QUALITY PROGRAM OF THE AMERICAN COLLEGE OF SURGEONS (ACS). TO EARN VOLUNTARY COC ACCREDITATION, A CANCER PROGRAM MUST MEET COC QUALITY CARE STANDARDS, BE EVALUATED EVERY THREE YEARS THROUGH A SURVEY PROCESS, AND MAINTAIN LEVELS OF EXCELLENCE IN THE DELIVERY OF COMPREHENSIVE PATIENT-CENTERED CARE. THE COC ACCREDITATION PROGRAM PROVIDES THE FRAMEWORK FOR FLAGLER HOSPITAL TO IMPROVE ITS QUALITY OF PATIENT CARE THROUGH VARIOUS CANCER-RELATED PROGRAMS THAT FOCUS ON THE FULL SPECTRUM OF CANCER CARE INCLUDING PREVENTION, EARLY DIAGNOSIS, CANCER STAGING, OPTIMAL TREATMENT, REHABILITATION, LIFE-LONG FOLLOW-UP FOR RECURRENT DISEASE, AND END-OF-LIFE CARE. WHEN PATIENTS RECEIVE CARE AT A COC FACILITY, THEY ALSO HAVE ACCESS TO INFORMATION ON CLINICAL TRIALS AND NEW TREATMENTS, GENETIC COUNSELING, AND PATIENT-CENTERED SERVICES INCLUDING PSYCHOSOCIAL SUPPORT, REHABILITATION SERVICES AND SURVIVORSHIP CARE. TO HELP GUIDE PATIENTS THROUGH THEIR JOURNEY FLAGLER HOSPITAL HAS ONCOLOGY NURSE NAVIGATORS THAT FOLLOW PATIENTS WITH LUNG CANCER, BREAST CANCER, PROSTATE CANCER, ESOPHAGEAL CANCER AND HEAD & NECK CANCERS. IN 2021 THE ONCOLOGY NURSE NAVIGATORS SUPPORTED 473 PATIENTS IN OUR COMMUNITY. FLAGLER HOSPITAL MAINTAINS A CANCER RESOURCE CENTER, OPEN TO ALL IN THE COMMUNITY, ALONG WITH A WIG AND PROSTHESIS CLOSET. THERE IS A FREE COMPUTER KIOSK FOR THE DISSEMINATION OF HEALTH INFORMATION. IT IS STAFFED BY OUR CANCER EDUCATION AND SUPPORT COORDINATOR AND VOLUNTEERS EACH WEEKDAY FROM 8:00 UNTIL 4:00. THE CANCER RESOURCE CENTER IS ALSO UTILIZED BY VARIOUS CANCER SUPPORT GROUPS. LUNG CANCER: RREALIZING THAT CIGARETTE SMOKING IS THE NUMBER ONE RISK FACTOR FOR LUNG CANCER, FLAGLER HOSPITAL CONTINUES TO MAINTAIN A SMOKE FREE FACILITY, INCLUDING PARKING LOTS AND LEASED PROPERTIES. FLAGLER HOSPITAL ALSO IMPLEMENTED A TOBACCO SCREENING PROTOCOL THROUGHOUT THE HOSPITAL. UPON ADMISSION, EACH PATIENT IS ASKED IF THEY SMOKE OR USE TOBACCO IN ANY OTHER FORM. THIS INFORMATION IS USED TO TRIGGER A CONSULTATION FROM THE CARDIOPULMONARY DEPARTMENT, FROM A MEMBER OF THE "QUIT TEAM". QUIT TEAM MEMBERS VERIFY THE PATIENTS WHO USE TOBACCO AND PROVIDE COUNSELING ON TOBACCO CESSATION. IF THE PATIENT IS INTERESTED IN QUITTING, THEY ARE GIVEN INFORMATION ON FREE TOBACCO CESSATION PROGRAMS OFFERED THROUGH FLAGLER HOSPITAL. THE QUIT TEAM ALSO EDUCATED FLAGLER STAFF AND MEDICAL PERSONNEL ON THE IMPORTANCE OF THE MESSAGE THAT CESSATION OPPORTUNITIES ARE BOTH VALUABLE AND EFFICACIOUS.FLAGLER HOSPITAL PARTNERS WITH NORTHEAST FLORIDA AREA HEALTH EDUCATION CENTER TO PROVIDE ACCESS TO THE "QUIT SMOKING NOW" SMOKING CESSATION PROGRAM. QUIT SMOKING NOW IS A FREE COURSE THAT CONSISTS OF GROUP SESSIONS FACILITATED BY THE CARDIOPULMONARY DEPARTMENT AND HELD IN THE FLAGLER HOSPITAL WELLNESS CENTER. CLASSES TAKE PLACE ONCE PER WEEK FOR ONE HOUR, OVER A FOUR-WEEK PERIOD.DURING 2021 THE TOOLS TO QUIT CLASS AT FLAGLER WAS ABLE TO SEE OVER 10 PARTICIPANTS WHO WERE PROVIDED WITH CESSATION EDUCATION COMBINED WITH SUPPORTIVE MEASURES TO STOP SMOKING. LOZENGES, PATCHES, AND GUMS ARE SOME OF THE THERAPIES PROVIDED IN ADDITION TO STRESS MANAGEMENT TECHNIQUES, EDUCATION REGARDING TRIGGERS TO USE, AND PERCEPTION EDUCATION TO SMOKING CESSATION.THE HOSPITAL PARTNERS WITH TOBACCO FREE ST. JOHNS, A COMMUNITY-WIDE LOCALLY ORGANIZED GROUP COLLECTIVELY WORKING TOWARDS ELIMINATING INITIATION AND USE OF TOBACCO AMONG ST. JOHNS COUNTY RESIDENTS, SUPPORTING POLICY CHANGE AND EDUCATING DECISION MAKERS ABOUT THE IMPACT OF TOBACCO ON THE LIVES OF ST. JOHNS COUNTY RESIDENTS AND VISITORS.SEE LATER PART OF SCHEDULE H, PART V FOR CONTINUATION.
FLAGLER HOSPITAL	PART V, SECTION B, LINE 15E: CONTACT INFORMATION IS IN THE PLAIN LANGUAGE SUMMARY LOCATED ON THE HOSPITAL WEBSITE: HTTPS://WWW.FLAGLERHOSPITAL.ORG/FINANCIAL-SERVICES/FAP-PLAIN-LANGUAGE-SUMMARY.ASPX: THERE ARE MANY WAYS TO FIND INFORMATION ABOUT THE FAP APPLICATION PROCESS, OR GET COPIES OF THE FAP OR FAP APPLICATION FORM. TO APPLY FOR FINANCIAL ASSISTANCE YOU MAY: DOWNLOAD THE INFORMATION ONLINE AT FLAGLERHOSPITAL.ORG, KEY WORDS FINANCIAL ASSISTANCE REQUEST THE INFORMATION IN WRITING BY MAIL OR BY VISITING THE FLAGLER HOSPITAL BUSINESS OFFICE AT 100 WHETSTONE PLACE, SUITE 100 ST. AUGUSTINE, FL 32086 REQUEST THE INFORMATION BY CALLING (904) 819-4539 AVAILABILITY OF TRANSLATIONSTHE FINANCIAL ASSISTANCE POLICY, APPLICATION FORM, AND THE PLAIN LANGUAGE SUMMARY ARE OFFERED IN ENGLISH AND SPANISH. FLAGLER HOSPITAL MAY ELECT TO FURNISH TRANSLATION AIDS, TRANSLATION GUIDES, OR PROVIDE ASSISTANCE THROUGH USE OF QUALIFIED BILINGUAL INTERPRETER BY REQUEST. FOR INFORMATION ABOUT FLAGLER HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND TRANSLATION SERVICES, PLEASE CALL A REPRESENTATIVE AT (904) 819-4539.
PART V, SECTION B, LINE 11 CONTINUED:	REDUCE SUBSTANCE ABUSE:FLAGLER HOSPITAL MAINTAINS A CANCER RESOURCE CENTER, OPEN TO ALL IN THE COMMUNITY, ALONG WITH A WIG AND PROSTHESIS CLOSET. THERE IS A FREE COMPUTER KIOSK FOR THE DISSEMINATION OF HEALTH INFORMATION. IT IS STAFFED BY OUR CANCER EDUCATION AND SUPPORT COORDINATOR AND VOLUNTEERS EACH WEEKDAY FROM 8:00 UNTIL 4:00. THE CANCER RESOURCE CENTER IS ALSO UTILIZED BY VARIOUS CANCER SUPPORT GROUPS.JUST AS WAS FOUND IN THE 2014 ST. JOHNS COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT, THE ISSUE OF SUBSTANCE ABUSE WAS LISTED AS THE #1 IMPORTANT HEALTH PROBLEMS BY SURVEY RESPONDENTS IN THE 2020 CHNA. THIS INCLUDES BINGE DRINKING, UNDERAGE DRINKING, CIGARETTE AND MARIJUANA AND OTHER DRUG USE. FLAGLER HOSPITAL'S DIRECTOR OF BEHAVIORAL HEALTH SERVICES WORKS CLOSELY WITH EPIC COMMUNITY SERVICES (EPIC WAS CREATED TO PROVIDE SUBSTANCE ABUSE PREVENTION, INTERVENTION, OUTPATIENT TREATMENT AND AFTERCARE SERVICES), PACT, (PREVENTION, ACTION, CHOICES AND TEAMWORK) PREVENTION SERVICES (WHICH ADVOCATES FOR PREVENTION FOR YOUTH), TOBACCO FREE ST. JOHNS AND OTHER GROUPS SUCH AS LAW ENFORCEMENT ON THIS ISSUE. ST. JOHNS COUNTY CONTINUES TO RANK IN THE TOP 5 COUNTIES IN FLORIDA FOR BINGE DRINKING. THE ST. JOHNS COUNTY BEHAVIORAL HEALTH CONSORTIUM CONTINUES TO WORK TOWARDS FINDING A WAY TO GET THESE IMPORTANT HEALTH SERVICES AVAILABLE FOR REFERRAL IN OUR SERVICE AREA. FLAGLER HOSPITAL CONTINUES TO PROVIDE A YEARLY $150,000 DONATION IN SUPPORT OF EPIC BEHAVIORAL HEALTHCARE'S 26-BED RECOVERY CENTER.THE EPIC RECOVERY CENTER (ERC) OPENED IN JANUARY 2014, FILLING THE NEED FOR AN INPATIENT TREATMENT CENTER IN ST. JOHNS COUNTY. THE ERC OFFERS SEVERAL TYPES OF SUBSTANCE USE DISORDER TREATMENT SERVICES INCLUDING DETOXIFICATION, OUTPATIENT THERAPY, RESIDENTIAL TREATMENT, AND THE MARS (MEDICALLY-ASSISTED RECOVERY SERVICES) PROGRAM. IN THE PAST 7.5 YEARS, THE ERC HAS HAD 6,763 ADMISSIONS AND IN THE PAST FEW YEARS, 38% OF ALL DETOX ADMISSIONS WERE RELATED TO OPIATE USE.THE MAJORITY OF EPIC RECOVERY CENTER'S PATIENTS LIVE IN POVERTY (84%), HAVE NO INSURANCE, OR INSURANCE WITH POOR BEHAVIORAL HEALTH BENEFITS, WHICH MAKES FLAGLER HOSPITAL'S SUPPORT ESSENTIAL TO PROVIDING THIS MUCH NEEDED SERVICE TO THE COMMUNITY.DISCHARGE/TRANSITION PLANS ARE DEVELOPED WITH EACH INDIVIDUAL IN THE INPATIENT UNIT THAT INCLUDES REFERRAL TO OUTPATIENT TREATMENT, REFERRAL FOR PRIMARY CARE MEDICAL SERVICES, SOBER LIVING OR OTHER HOUSING PLACEMENT, CARE COORDINATION REGARDING VARIOUS SOCIAL DETERMINATES OF HEALTH MATTERS, AND ONGOING PEER RECOVERY SUPPORT SERVICES.THE EPIC RECOVERY CENTER HAS BECOME THE CORNERSTONE OF THE ADDICTION TREATMENT SYSTEM OF CARE IN ST. JOHNS COUNTY SERVING SOME OF THE MOST VULNERABLE FLORIDIANS UNINSURED, HOMELESS, THOSE INVOLVED IN THE CHILD WELFARE SYSTEM, CRIMINALLY JUSTICE INVOLVED, AND/OR SUFFERING FROM MULTIPLE CHRONIC HEALTH CONDITIONS.INCREASE ACCESS TO DENTAL CARE:ACCESS TO DENTAL CARE HAS LONG BEEN AN ISSUE IN ST. JOHNS COUNTY, AS IT IS ACROSS THE STATE. RESPONDENTS OF THE 2020 ST. JOHNS COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT REPORTED DENTAL/ORAL CARE AS ONE OF THE TOP HEALTH SERVICES THAT IS DIFFICULT TO OBTAIN. A MAJOR THEME OF ALL FOCUS GROUPS WAS A NEED FOR IMPROVED ACCESS TO DENTAL CARE. TO ADDRESS THIS NEED, FLAGLER HOSPITAL, THE WILDFLOWER CLINIC, AND THE ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL WORKED TOGETHER TO PROVIDE SOLUTIONS. DURING THE ASSESSMENT YEAR 640 DENTAL CASES CAME TO THE FLAGLER HOSPITAL EMERGENCY DEPARTMENT FOR DENTAL CARE, HIGHLIGHTING THE NEED. THE GOOD SAMARITAN WILDFLOWER CLINIC IS THE ONLY CLINIC OFFERING BOTH FREE DENTAL AND FREE HEALTH CARE IN ST. JOHNS COUNTY. FLAGLER CONTINUES TO BE A MAJOR CORPORATE SPONSOR OF THE WILDFLOWER CLINIC AND WORKS CLOSELY WITH THE CLINIC TO SHORTEN THE TIME BETWEEN THE INITIAL CRISES (FLAGLER ER VISIT) AND FOLLOW UP CARE. WITH THE HELP OF GRANTS FROM FLAGLER HOSPITAL, AND OTHER COMMUNITY ORGANIZATIONS, THE WILDFLOWER CLINIC STAFF HAS BEGUN OFFERING REGULARLY SCHEDULED DENTAL APPOINTMENTS IN ADDITION TO DENTAL WALK-IN CLINICS EVERY WEEK.WITH CONTINUED COLLABORATION BETWEEN THE WILDFLOWER CLINIC AND FLAGLER HOSPITAL'S EMERGENCY DEPARTMENT ON COORDINATING CARE BETWEEN UNINSURED ST. JOHNS COUNTY RESIDENTS, FLAGLER HOSPITAL EMERGENCY ROOM VISITS FOR DENTAL EMERGENCIES HAVE CONTINUED TO DROP BY OVER 10% EACH FISCAL YEAR. DURING 2022, WILDFLOWER CLINIC SAW 1,028 DENTAL PATIENTS. BUILDING ON THIS SUCCESSFUL PARTNERSHIP, FH+ AND WILDFLOWER CONTINUE TO OPTIMIZE THIS TRANSITION AND FOLLOW-UP PROCESS FROM THE HOSPITAL EMERGENCY ROOM TO THE WILDFLOWER DENTAL CLINIC.FLAGLER HOSPITAL HAS ALSO PLACED MEDICAL TELEHEALTH KIOSKS IN TWO OF ST. JOHNS COUNTY'S ELEMENTARY SCHOOLS THAT ARE IN TRADITIONALLY UNDERSERVED NEIGHBORHOODS. SOUTH WOODS ELEMENTARY AND THE WEBSTER SCHOOL HAVE A LARGE NEED FOR MEDICAL SERVICES TO BE EMBEDDED IN THE SCHOOLS, WHICH ARE SEEN AS THE HUBS OF THOSE COMMUNITIES. FLAGLER HOSPITAL PURCHASED THE KIOSKS AND FULLY STAFFS THEM WITH A WELLNESS COORDINATOR TO ALLOW FOR THE COMMUNITY TO USE THE KIOSK FREE OF CHARGE. MANY OF THE APPOINTMENTS THAT ARE SEEN AT THE KIOSKS ARE DUE TO DENTAL ISSUES, IN WHICH FLAGLER HOSPITAL DOCTORS CAN PRESCRIBE THE NECESSARY MEDICATION FOR AT THE KIOSK OR MAKE A REFERRAL TO A SPECIALIST. THE WELLNESS COORDINATORS THAT THE HOSPITAL PROVIDES HELP TO CLOSE ANY GAPS IN SERVICES, WHICH FREQUENTLY INVOLVES CONNECTING FAMILIES TO DENTAL SERVICES.INCREASE ACCESS TO MENTAL HEALTH CARE:WITH DEPRESSION AND ANXIETY RANKED AS THE #2 HEALTH PROBLEMS IN ST. JOHNS COUNTY, THE 2020 CHNA REVEALED THAT ACCESS TO MENTAL HEALTH SERVICES CONTINUES TO BE AN ISSUE. IN ADDITION, MENTAL HEALTH COUNSELING WAS REPORTED TO BE THE #1 MOST DIFFICULT TO OBTAIN SERVICE BY SURVEY RESPONDENTS.IN RESPONSE TO AN IDENTIFIED CRITICAL NEED FOR OUTPATIENT MENTAL HEALTH SERVICES IN ST. JOHNS COUNTY, FLAGLER HOSPITAL INTRODUCED AN INTENSIVE OUTPATIENT PROGRAM. THIS PROGRAM WAS SPECIFICALLY DESIGNED TO SUPPORT PATIENTS AFTER BEING RELEASED FROM INPATIENT CARE. THE PROGRAM'S PRIMARY GOAL OF IMPROVING QUALITY OF LIFE AND REDUCING SYMPTOMS TO PREVENT RELAPSE IS ACCOMPLISHED THROUGH GROUP THERAPY, MEDICATION AND SYMPTOM MANAGEMENT AND INDIVIDUAL PSYCHOTHERAPY.ALL NEW PATIENTS PARTICIPATE IN A FORMAL CLINICAL EVALUATION PERFORMED BY A MULTI-DISCIPLINARY TEAM. THIS EVALUATION HELPS THE TEAM DEVELOP A TREATMENT PLAN THAT REFLECTS EACH PATIENT'S INDIVIDUAL STRENGTHS, LIMITATIONS AND GOALS FOR TREATMENT. EVERY PATIENT'S GOALS ARE REVIEWED AND UPDATED WEEKLY IN TEAM MEETINGS AND INDIVIDUAL SESSIONS. MEDICAL STAFF FROM THE INTENSIVE OUTPATIENT PROGRAM ATTEND COMMUNITY EVENTS TO RAISE AWARENESS ABOUT MENTAL HEALTH AND TO INFORM THE COMMUNITY ABOUT AVAILABLE RESOURCES. A SCHOLARSHIP IS AVAILABLE FOR EACH SESSION, TO ENSURE THAT ACCESS TO MENTAL HEALTH SERVICES IS NEVER DEPENDENT UPON A PATIENT'S ABILITY TO PAY.FLAGLER HOSPITAL IS COMMITTED TO COLLABORATION WITH COMMUNITY PARTNERS TO ADDRESS EACH NEED IDENTIFIED DURING THE 2020 CHNA. TO INCREASE ACCESS TO MENTAL HEALTH CARE, THIS COLLABORATION CENTERS ON COORDINATION AND LINKAGE OF MENTAL HEALTH SERVICES BETWEEN FLAGLER HOSPITAL AND COMMUNITY OUTPATIENT PROVIDERS.FLAGLER HOSPITAL CONTINUES TO WORK WITH ST. AUGUSTINE YOUTH SERVICES (SAYS) TO SUPPORT THE COUNTY-WIDE MOBILE RESPONSE TEAM (MRT). THE MOBILE RESPONSE TEAM PROVIDES 24 HOUR/7 DAYS PER WEEK CRISIS SUPPORT FOR ANYONE AGED 6 TO 25 NEEDING A BEHAVIORAL HEALTH INTERVENTION/ASSESSMENT. AFTER EACH ASSESSMENT, FOLLOW-UP IS PROVIDED TO ENSURE THE YOUTH OR YOUNG ADULT HAS ACCESS TO NEEDED SERVICES. SAYS PARTNERS WITH FLAGLER HEALTH TO ASSIST IN THESE FOLLOW UP EFFORTS WHENEVER NEEDED.THE TEAM'S MISSION IS TO PROVIDE AN ASSESSMENT AT THE FIRST SIGNS OF CHILD BEHAVIORAL RISK TO PREVENT SERIOUS MENTAL ISSUES FROM DEVELOPING. THE TEAM ALSO PROVIDES IMMEDIATE ACCESS TO MENTAL HEALTH SERVICES AND ALLOWS THE OPPORTUNITY FOR FAMILIES TO SELECT A SOLUTION THAT WORKS BEST FOR THEM.THE ULTIMATE GOAL OF THE MOBILE CRISIS RESPONSE TEAM PROGRAM IS TO DIVERT CHILDREN FROM COSTLY EMERGENCY SERVICES AND ESTABLISH GREATER COORDINATION OF CARE THAT WILL SERVE THE FAMILY BEYOND THE INITIAL CRISIS. DURING FY 2022 MRT COMPLETED 491 ASSESSMENTS. OF THOSE 491 ASSESSMENTS, 79 RESULTED IN BAKER ACTS. WITH 84% OF POTENTIAL BAKER ACTS DIVERTED, COSTING APPROXIMATELY $3,900 EACH STAY, THAT MEANS A TOTAL OF $ 1,608,516 IN POTENTIAL SPENDING ON BAKER ACTS WAS SAVED IN FY 2022.IN MAY OF 2022, FLAGLER HOSPITAL OPENED THE CAIR (CRISIS, ASSESSMENT, INTERVENTION AND REFERRAL) CENTER IN RESPONSE TO AN IDENTIFIED NEED IN THE COMMUNITY FOR A LOW BARRIER ENTRY POINT FOR MENTAL HEALTH SERVICES. WORKING WITH PARTNERS IN THE COMMUNITY, THE CAIR CENTER AIMS TO REDUCE UNNECESSARY BAKER ACT ADMISSIONS, INCREASE DIVERSION FROM THE CRIMINAL JUSTICE SYSTEM, AND REDUCE RECIDIVISM TO HOSPITALS WHILE PROVIDING THOSE IN MENTAL HEALTH CRISIS A SUPPORTIVE AND APPROACHABLE ENVIRONMENT TO RECE
PART V, SECTION B, LINE 11 CONTINUED:	INCREASE USE OF AVAILABLE TRANSPORTATION:FROM THE FOCUSES GROUPS CONDUCTED AS PART OF THE 2020 COMMUNITY HEALTH NEEDS ASSESSMENT, LACK OF TRANSPORTATION WAS IDENTIFIED AS A DIRECT BARRIER TO HEALTHCARE. FURTHERMORE, SURVEY RESULTS SHOWED A NEGATIVE INCREASE IN THE PERCENTAGE OF RESPONDENTS THAT RANKED TRANSPORTATION AS A BARRIER TO CARE, FROM 12.2% IN 2017 TO 10.69% IN 2020. TRANSPORTATION HAS BEEN A FOCUS IN ST. JOHNS COUNTY FOR OVER 15 YEARS. THE 2005 ST. JOHNS COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED IMPROVING ACCESS TO HEALTH SERVICES IN OUTLYING AREAS OF ST. JOHNS COUNTY THROUGH COORDINATION OF PUBLIC TRANSPORTATION AS A HIGH-PRIORITY COMMUNITY NEED. SINCE THAT TIME, A COMMUNITY-WIDE EFFORT TO IMPROVE PUBLIC TRANSPORTATION IN ST. JOHNS COUNTY HAS PICKED UP MOMENTUM. THE ST. JOHNS COUNTY COUNCIL ON AGING, INC. (COA) SERVES AS THE COMMUNITY TRANSPORTATION COORDINATOR FOR ST. JOHNS COUNTY. THE COA PROVIDES DOOR-TO-DOOR NON-EMERGENCY MEDICAL TRANSPORTATION SERVICES TO AMBULATORY, AND WHEELCHAIR BOUND CLIENTS WITHIN THE ST. JOHNS COUNTY SERVICE AREA. THE SUNSHINE BUS COMPANY (A DIVISION OF THE COA) IS ST. JOHNS COUNTY'S PUBLIC BUS SERVICE. SINCE ITS INCEPTION IN 2006, THE SUNSHINE BUS COMPANY HAS CONTINUED TO EXPAND ITS SERVICES TO BETTER SERVE THE COMMUNITY, WITH THE ADDITION OF NEW ROUTES AND AN INCREASED NUMBER OF DAILY TRIPS. THE 2020 ST. JOHNS COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT FEEDBACK SHOWED THE CONTINUED NEED FOR A FOCUS ON TRANSPORTATION. IN 2019, FLAGLER HOSPITAL SUPPORTED THE STRATEGIC OBJECTIVE OF "INCREASE USE OF AVAILABLE TRANSPORTATION OPTIONS" BY PARTNERING WITH THE ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL TO PROVIDE TRANSPORTATION TRAINING TO 14 COMMUNITY ORGANIZATIONS. THIS EDUCATION IS OFFERED TO COMMUNITY MEMBERS AND HEALTHCARE PROVIDERS TO RAISE AWARENESS AND INCREASE UTILIZATION. IN ADDITION TO SUPPORTING PUBLIC TRANSPORTATION INITIATIVES, FLAGLER HEALTH+ HAS ALSO PARTNERED WITH UBER HEALTH TO PROVIDE TRANSPORTATION TO AND FROM DOCTORS' APPOINTMENTS. THIS SERVICE IS AVAILABLE TO COMMUNITY RESIDENTS, REGARDLESS OF WHETHER OR NOT THE DOCTOR IS AFFILIATED WITH FLAGLER HEALTH+. IN FY22, CARE CONNECT PAID FOR OVER $28,000 IN UBER OR TAXI RIDES TO MEDICAL APPOINTMENTS FOR THE COMMUNITY.INCREASE ACCESS TO TAILORED PHYSICAL AND NUTRITIONAL EDUCATION:ADULT OBESITY IS THE THIRD LARGEST CONCERN ACCORDING TO RESPONDENTS OF THE 2020 COMMUNITY HEALTH ASSESSMENT. ALTHOUGH ST. JOHNS COUNTY RANKS IN THE TOP OF FLORIDA'S HEALTHIEST COUNTIES, THE NEED IS STILL PERCEIVED BY THE COMMUNITY, AS WELL AS DESIRED GIVEN A GROWING POPULATION. 56% OF ST. JOHNS COUNTY RESIDENTS ARE BETWEEN THE AGES OF 20-64, WHILE 19% ARE OVER THE AGE OF 65. FOR THIS REASON, ST. JOHNS COUNTY SHOWED PROMISE IN BENEFITING FROM TAILORED FITNESS COURSES MADE AVAILABLE AT FLAGLER HOSPITAL. CURRENTLY, BEGINNER'S TAI-CHI, YOGA FOR YOUNG ONES, CHAIR YOGA, AND RESTORATIVE YOGA ARE ALL OFFERED TO COMMUNITY MEMBERS. IN ADDITION, FLAGLER HAS PROVIDED MANY OTHER EDUCATIONAL OPPORTUNITIES IN THE FORM OF COOKING DEMONSTRATIONS, DIABETES EDUCATION, AND NUTRITION WORKSHOPS.SINCE 2020, ST. JOHNS COUNTY HAS INCREASED TO RANK SECOND HIGHEST IN THE STATE FOR HEALTH BEHAVIORS AS WELL AS SHOWN IMPROVEMENT IN PHYSICAL ENVIRONMENT. CARE CONNECT - CONNECTING PEOPLE TO RESOURCES:CARE CONNECT+ IS A PROGRAM OF THE HOSPITAL THAT WAS STARTED IN 2017. THIS COMMUNITY ALLIANCE WAS ESTABLISHED TO CONNECT AREA RESIDENTS IN NEED WITH AVAILABLE SERVICE AND ADDRESS SOCIAL DETERMINANTS OF HEALTH IN A COORDINATED WAY THROUGHOUT ALL OF ST JOHNS COUNTY. BY ALIGNING COMMUNITY RESOURCES INTO A SINGLE ACCESS POINT, CARE CONNECT INCREASES COORDINATION AND ACCESS OF AVAILABLE RESOURCES. THE PROGRAM HELPS CONNECT PEOPLE TO PRIMARY CARE SERVICE, DENTAL SERVICE, PRESCRIPTION ASSISTANCE, RENTAL AND UTILITY ASSISTANCE, TRANSPORTATION ASSISTANCE, HOMELESS PREVENTION SERVICES, ACCESS TO LOCAL FOOD BANKS AND COMMUNITY RESOURCE NAVIGATION AND CASE MANAGEMENT SERVICES. RATHER THAN SIMPLY REFER PEOPLE TO SERVICES, CARE CONNECT COMMUNITY HEALTH ASSOCIATES, FOLLOW EACH CLIENT UNTIL ALL NEEDS HAVE BEEN MET. IF SERVICES ARE NOT AVAILABLE IN THE COMMUNITY, CARE CONNECT TRACKS GAPS IN SERVICE TO DEVELOP THOSE SERVICES WITH COMMUNITY PARTNERS. CARE CONNECT INCREASES ACCESS TO HEALTH PROVIDERS, DENTAL PROVIDERS, MENTAL HEALTH PROVIDERS, SOCIAL SERVICES AND TRANSPORTATION THROUGH A COORDINATED HUB. IN FISCAL YEAR 2022, 5,924 CLIENTS WERE PART OF THE CARE CONNECT HUB AND WERE MATCHED WITH SERVICES, WHILE 7,517 SERVICES WERE PROVIDED IN TOTAL. IN SEPTEMBER OF 2019, FLAGLER HEALTH+ IMPLEMENTED AN INNOVATIVE MODEL TO INCREASE ACCESS TO BEHAVIORAL HEALTH PROVIDERS FOR STUDENTS ACROSS ST. JOHNS COUNTY THROUGH A PARTNERSHIP WITH THE ST. JOHNS COUNTY SCHOOL DISTRICT. THE B.R.A.V.E. PROGRAM STANDS FOR BEING RESILIENT AND VOICING EMOTIONS. THROUGH BRAVE, CARE CONNECT+ SERVES AS THE HUB FOR STUDENT HEALTH REFERRALS FOR THE ST JOHNS, CLAY, NASSAU AND PUTNAM SCHOOL DISTRICTS. DURING FY 2022, THERE WAS A 66% DECREASE IN THE LENGTH OF TIME FROM REFERRAL TO FIRST APPOINTMENT AND A 157% INCREASE IN THE NUMBER OF STUDENTS CONNECTED TO A BEHAVIORAL HEALTH PROVIDER. DURING THE SPRING AND SUMMER MONTHS OF 2020, WHEN THE COVID PANDEMIC AFFECTED IN-PERSON PROVIDER APPOINTMENTS, CARE CONNECT FINANCIALLY AND ADMINISTRATIVELY SUPPORTED THE LAUNCH OF A TELEMEDICINE PLATFORM WITH PROVIDERS TO MAINTAIN STUDENT AND ADULT MENTAL HEALTH APPOINTMENTS. CARE CONNECT HAS CONTINUED THIS INITIATIVE THROUGH THE YEAR 2022.PLUS BUS:FLAGLER HOSPITAL HAS ALSO MADE IT POSSIBLE TO REACH UNDERSERVED POPULATIONS WITHIN THE COMMUNITY WHO DO NOT NECESSARILY HAVE ACCESS TO CARE. THROUGH THE USE OF THEIR MOBILE HEALTH UNIT, OR PLUS BUS, A NUMBER OF PATIENTS WHO WOULD NOT HAVE BEEN SEEN WERE PROVIDED WITH A WIDE ARRAY OF SERVICES THAT ADDRESSED DIFFERENT ASPECTS OF THEIR HEALTH. IN ADDITION, THESE INDIVIDUALS WERE OFFERED CARE COORDINATION SUCH AS TRANSPORTATION ASSISTANCE. THE PLUS BUS HAS OPERATED IN PARTNERSHIP WITH OTHER COMMUNITY AGENCIES, AS WELL AS INDEPENDENTLY SEEKING OPPORTUNITIES TO AID PATIENTS WHO ARE LOW INCOME, AT HIGH-RISK, HOMELESS, OR THOSE WHO DO NOT HAVE ADEQUATE ACCESS TO CARE. WITH THIS DEMOGRAPHIC IN MIND, THE FOLLOWING CLINICS WERE PUT IN PLACE ON A MONTHLY ROTATING SCHEDULE:DINING WITH DIGNITY FLORIDA IS HOME TO THE THIRD LARGEST HOMELESS POPULATION IN THE UNITED STATES PER THE FLORIDA COALITION TO END HOMELESSNESS. ACCORDING TO THE CONTINUUM OF CARE, HOMELESSNESS IN ST. JOHNS COUNTY IS UP 2% SINCE 2018. MANY OF THESE INDIVIDUALS (ABOUT 14%) ARE ALSO EXPERIENCING LONG-TERM DISABILITY AND NEED ACCESS TO MEDICAL CARE. FOR THIS REASON, THE PLUS BUS VISITED DINING WITH DIGNITY EACH MONTH. IN PARTNERSHIP WITH WILDFLOWER CLINIC AND HOME AGAIN, HOMELESS INDIVIDUALS ARE FED HOT MEALS AND SEEN ONCE A MONTH ON THE BUS FOR PRIMARY CARE. RESOURCE COORDINATION IS PROVIDED AS WELL. HASTINGS FOOD BANK THE PLUS BUS AT FLAGLER HOSPITAL HAS ALSO TEAMED UP WITH WILDFLOWER CLINIC TO PROVIDE WEEKLY WALK-UP SERVICES IN HASTINGS, FL. THIS SERVICE IS PROVIDED IN COMBINATION WITH A LOCAL FOOD DISTRIBUTION PROGRAM AND PROVIDES PRIMARY CARE FOR UNDERINSURED PATIENTS IN THE MOST RURAL PARTS OF ST. JOHNS COUNTY. EPIC CURE FOOD DISTRIBUTION - DURING THE 2021-2022 YEAR, THE PLUS BUS (MOBILE HEALTH CLINIC) STAFF IDENTIFIED A NEED AT THE EPICCURE FOOD RESCUE PROGRAM IN ST. AUGUSTINE. HEALTH SCREENINGS WHICH INCLUDE BLOOD PRESSURE MONITORING, LIPID PANELS, AND GLUCOSE MONITORING WERE PROVIDED TO PATRONS WHO WERE PRESENT TWICE A MONTH TO RECEIVE FOOD AT EPICCURE'S WAREHOUSE.FAMILY WORSHIP CENTER - THE FOOD INSECURITY RATE IN ST. JOHNS COUNTY IS AT 20.6% FOR CHILDREN AND 13.5% OVERALL ACCORDING TO FEEDING NORTHEAST FLORIDA. FOR THIS REASON, THE PLUS BUS COMBINED PRIMARY HEALTH WITH A LARGE FOOD DISTRIBUTION AT FAMILY WORSHIP CENTER IN ST. AUGUSTINE, FL. THIS CLINIC WAS HELD MONTHLY. WILDFLOWER CLINIC TREATED WALK-ONS AND SCHEDULED PATIENTS. IN TOTAL, THE PLUS BUS TREATED OVER 300 PATIENTS DURING 2022 FOR PRIMARY CARE IN COMBINATION WITH WILDFLOWER CLINIC. A VAST MAJORITY OF THESE PATIENTS WERE UNDERINSURED, WERE HOMELESS, WERE AT HIGH RISK FOR HOMELESSNESS, LOW SOCIOECONOMIC STATUS, OR EXPERIENCE CHRONIC DISEASE. SOME OF THESE PATIENTS WERE SEEN MULTIPLE TIMES ON THE PLUS BUS, WHICH MAINTAINED ITS GOAL OF THWARTING UNNECESSARY USE OF THE ER AS PRIMARY CARE.
PART V, SECTION B, LINE 11 CONTINUED:	INCREASE ACCESS TO MENTAL HEALTH CARE:WITH DEPRESSION AND ANXIETY RANKED AS THE #2 HEALTH PROBLEMS IN ST. JOHNS COUNTY, THE 2020 CHNA REVEALED THAT ACCESS TO MENTAL HEALTH SERVICES CONTINUES TO BE AN ISSUE. IN ADDITION, MENTAL HEALTH COUNSELING WAS REPORTED TO BE THE #1 MOST DIFFICULT TO OBTAIN SERVICE BY SURVEY RESPONDENTS.IN RESPONSE TO AN IDENTIFIED CRITICAL NEED FOR OUTPATIENT MENTAL HEALTH SERVICES IN ST. JOHNS COUNTY, FLAGLER HOSPITAL INTRODUCED AN INTENSIVE OUTPATIENT PROGRAM. THIS PROGRAM WAS SPECIFICALLY DESIGNED TO SUPPORT PATIENTS AFTER BEING RELEASED FROM INPATIENT CARE. THE PROGRAM'S PRIMARY GOAL OF IMPROVING QUALITY OF LIFE AND REDUCING SYMPTOMS TO PREVENT RELAPSE IS ACCOMPLISHED THROUGH GROUP THERAPY, MEDICATION AND SYMPTOM MANAGEMENT AND INDIVIDUAL PSYCHOTHERAPY.ALL NEW PATIENTS PARTICIPATE IN A FORMAL CLINICAL EVALUATION PERFORMED BY A MULTI-DISCIPLINARY TEAM. THIS EVALUATION HELPS THE TEAM DEVELOP A TREATMENT PLAN THAT REFLECTS EACH PATIENT'S INDIVIDUAL STRENGTHS, LIMITATIONS AND GOALS FOR TREATMENT. EVERY PATIENT'S GOALS ARE REVIEWED AND UPDATED WEEKLY IN TEAM MEETINGS AND INDIVIDUAL SESSIONS. MEDICAL STAFF FROM THE INTENSIVE OUTPATIENT PROGRAM ATTEND COMMUNITY EVENTS TO RAISE AWARENESS ABOUT MENTAL HEALTH AND TO INFORM THE COMMUNITY ABOUT AVAILABLE RESOURCES. A SCHOLARSHIP IS AVAILABLE FOR EACH SESSION, TO ENSURE THAT ACCESS TO MENTAL HEALTH SERVICES IS NEVER DEPENDENT UPON A PATIENT'S ABILITY TO PAY.FLAGLER HOSPITAL IS COMMITTED TO COLLABORATION WITH COMMUNITY PARTNERS TO ADDRESS EACH NEED IDENTIFIED DURING THE 2020 CHNA. TO INCREASE ACCESS TO MENTAL HEALTH CARE, THIS COLLABORATION CENTERS ON COORDINATION AND LINKAGE OF MENTAL HEALTH SERVICES BETWEEN FLAGLER HOSPITAL AND COMMUNITY OUTPATIENT PROVIDERS.FLAGLER HOSPITAL CONTINUES TO WORK WITH ST. AUGUSTINE YOUTH SERVICES (SAYS) TO SUPPORT THE COUNTY-WIDE MOBILE RESPONSE TEAM (MRT). THE MOBILE RESPONSE TEAM PROVIDES 24 HOUR/7 DAYS PER WEEK CRISIS SUPPORT FOR ANYONE AGED 6 TO 25 NEEDING A BEHAVIORAL HEALTH INTERVENTION/ASSESSMENT. AFTER EACH ASSESSMENT, FOLLOW-UP IS PROVIDED TO ENSURE THE YOUTH OR YOUNG ADULT HAS ACCESS TO NEEDED SERVICES. SAYS PARTNERS WITH FLAGLER HEALTH TO ASSIST IN THESE FOLLOW UP EFFORTS WHENEVER NEEDED.THE TEAM'S MISSION IS TO PROVIDE AN ASSESSMENT AT THE FIRST SIGNS OF CHILD BEHAVIORAL RISK TO PREVENT SERIOUS MENTAL ISSUES FROM DEVELOPING. THE TEAM ALSO PROVIDES IMMEDIATE ACCESS TO MENTAL HEALTH SERVICES AND ALLOWS THE OPPORTUNITY FOR FAMILIES TO SELECT A SOLUTION THAT WORKS BEST FOR THEM.THE ULTIMATE GOAL OF THE MOBILE CRISIS RESPONSE TEAM PROGRAM IS TO DIVERT CHILDREN FROM COSTLY EMERGENCY SERVICES AND ESTABLISH GREATER COORDINATION OF CARE THAT WILL SERVE THE FAMILY BEYOND THE INITIAL CRISIS. DURING FY 2022 MRT COMPLETED 491 ASSESSMENTS. OF THOSE 491 ASSESSMENTS, 79 RESULTED IN BAKER ACTS. WITH 84% OF POTENTIAL BAKER ACTS DIVERTED, COSTING APPROXIMATELY $3,900 EACH STAY, THAT MEANS A TOTAL OF $ 1,608,516 IN POTENTIAL SPENDING ON BAKER ACTS WAS SAVED IN FY 2022.IN MAY OF 2022, FLAGLER HOSPITAL OPENED THE CAIR (CRISIS, ASSESSMENT, INTERVENTION AND REFERRAL) CENTER IN RESPONSE TO AN IDENTIFIED NEED IN THE COMMUNITY FOR A LOW BARRIER ENTRY POINT FOR MENTAL HEALTH SERVICES. WORKING WITH PARTNERS IN THE COMMUNITY, THE CAIR CENTER AIMS TO REDUCE UNNECESSARY BAKER ACT ADMISSIONS, INCREASE DIVERSION FROM THE CRIMINAL JUSTICE SYSTEM, AND REDUCE RECIDIVISM TO HOSPITALS WHILE PROVIDING THOSE IN MENTAL HEALTH CRISIS A SUPPORTIVE AND APPROACHABLE ENVIRONMENT TO RECEIVE SUPPORT.
PART V, SECTION B, LINE 7A:	HTTPS://WWW.FLAGLERHEALTH.ORG/PATIENTS-VISITORS/
PART V, SECTION B, LINE 7B:	HTTPS://WWW.FLAGLERHEALTH.ORG/COMMUNITY-HEALTH-IMPROVEMENT/COMMUNITY-BENEFIT-PLANNING/ST-JOHNS-COUNTY-HEALTH-NEEDS-ASSESSMENT/
PART V, SECTION B, LINE 10A	HTTPS://WWW.FLAGLERHEALTH.ORG/PATIENTS-VISITORS/
PART V, SECTION B, LINE 16A:	HTTPS://WWW.FLAGLERHEALTH.ORG/FINANCIAL-SERVICES/FINANCIAL-ASSISTANCE-POLICY-APPLICATION/
PART V, SECTION B, LINE 16B:	HTTPS://WWW.FLAGLERHEALTH.ORG/FINANCIAL-SERVICES/FINANCIAL-COUNSELING-FINANCIAL-ASSISTANCE-POLICY/
PART V, SECTION B, LINE 16C:	HTTPS://WWW.FLAGLERHEALTH.ORG/FINANCIAL-SERVICES/FAP-PLAIN-LANGUAGE-SUMMARY/

Schedule H (Form 990) 2021

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Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?1
Name and address		Type of Facility (describe)
1	1 - FLAGLER OUTPATIENT LAB 156-316 ST HWY 312 260-264 ST AUGUSTINE,FL32086	OUTPATIENT LAB SATELLITE DRAW STATION
2
3
4
5
6
7
8
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10

Schedule H (Form 990) 2021

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 7:	EXPENSES WERE CALCULATED USING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2.
PART I, LN 7 COL(F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $12,680,217. OF THIS TOTAL, FLAGLER HOSPITAL'S PORTION OF BAD DEBT EXPENSE IS $12,680,217 AND OUTPATIENT SURGERY CENTER OF ST. AUGUSTINE, LLC'S PORTION OF BAD DEBT EXPENSE IS $0.
PART II, COMMUNITY BUILDING ACTIVITIES:	HEALTH PROFESSIONS EDUCATIONFLAGLER HOSPITAL DONATED PAID STAFF HOURS IN ONE-ON-ONE PROGRAMS TO PRECEPT NURSING STUDENTS AND ARNP STUDENTS FROM ST. JOHNS RIVER STATE COLLEGE, FIRST COAST TECHNICAL COLLEGE, JACKSONVILLE UNIVERSITY, UNIVERSITY OF ST. AUGUSTINE, UNIVERSITY OF NORTH FLORIDA, AND UNIFORMED SERVICES UNIVERSITY.ADDITIONALLY, STUDENTS IN THE FIELDS OF EMT AND PARAMEDIC TRAINING, PHYSICAL THERAPY, LAB SCIENCES, SOCIAL WORK, HEALTH ADMINISTRATION, PUBLIC HEALTH, RADIOLOGY, RESPIRATORY, SPEECH PATHOLOGY, AMERICAN SIGN LANGUAGE, AND DIETARY WERE TRAINED WITH ONE-ON-ONE CONTACT WITH STAFF AT FLAGLER HOSPITAL.FLAGLER HOSPITAL HAS TWO FULL TIME STAFF MEMBERS DEDICATED TO OFFERING CONTINUING MEDICAL EDUCATION (CME) TO ALL PHYSICIANS AND CLINICAL PROVIDERS IN THE ST. JOHNS COUNTY COMMUNITY, REGARDLESS OF THEIR AFFILIATION WITH THE HOSPITAL. THIS HELPS ENSURE THAT OUR LOCAL RESIDENTS HAVE ACCESS TO PHYSICIANS AND CLINICAL PROVIDERS WHO ARE UP TO DATE ON THE LATEST ADVANCEMENTS IN MEDICAL CARE. THE CME COORDINATOR FACILITATED 51 PROGRAMS CONSISTING OF GRAND ROUNDS, WEBCASTS AND ONLINE COMPUTER ACTIVITIES FOR PHYSICIANS AND CLINICAL PROVIDERS DURING THIS FISCAL YEAR.RESEARCHFLAGLER HOSPITAL EMPLOYS TWO FULL-TIME EMPLOYEES TO MANAGE A CANCER PATIENT DATABASE, LOG INFORMATION THAT CAN BE USED TO DETECT CANCER EARLIER, IMPROVE TREATMENTS AND ULTIMATELY, INCREASE CANCER SURVIVAL RATE. REGISTRARS DETERMINE A PATIENT'S ELIGIBILITY FOR THE CANCER REGISTRY, RECORD THE PATIENT'S DIAGNOSIS, AND TRACK THEIR TREATMENT PLAN. BY COLLECTING, TRACKING AND EVALUATING THIS DATA, WE ARE ABLE TO ADVANCE OUR KNOWLEDGE ON RISK FACTORS FOR CERTAIN CANCERS. BECAUSE DATA ENTERED IN THE CANCER REGISTRY IS AVAILABLE TO THE PUBLIC, OUTCOMES AND TREATMENT PLANS FOR PATIENTS IN ST. JOHNS COUNTY HAVE AN IMPACT NATION-WIDE.FINANCIAL AND IN-KIND CONTRIBUTIONSFLAGLER HOSPITAL MADE FINANCIAL AND IN-KIND CONTRIBUTIONS TO MANY AREA NON-PROFIT ORGANIZATIONS THAT FOCUS ON PROVIDING HEALTH PROGRAMS TARGETING COMMUNITY HEALTH NEEDS THAT WERE IDENTIFIED THROUGH THE ST. JOHNS COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT.ONE OF THE BIGGEST DETERMINANTS OF HEALTH THAT COMMUNITY ORGANIZATIONS HAVE INFLUENCE ON IS ACCESS TO HEALTHCARE. DURING THIS LAST FISCAL YEAR, FLAGLER HOSPITAL GAVE A $50,000 GRANT TO THE ST. JOHNS COUNCIL ON AGING TO PROVIDE STAFF TO ASSIST SENIOR CITIZENS IN ST. JOHNS COUNTY IN APPLYING FOR FREE OR REDUCED RATE PRESCRIPTION DRUGS FROM PHARMACEUTICAL COMPANIES. THIS PROGRAM CONTINUES TO SERVE OVER 275 SENIORS. BECAUSE THE GRANT PROVIDED PAID STAFF TO RUN THIS PROGRAM, COUNCIL ON AGING VOLUNTEERS WERE ABLE TO FOCUS VOLUNTEER HOURS ON COUNSELING, CLIENT NOTIFICATION AND DOCTOR'S OFFICE VISITS TO HELP EXPEDITE PAPERWORK. COA WAS ALSO ABLE TO UTILIZE GRANT MONEY TO FUND THEIR MEALS ON WHEELS PROGRAM AND PRESCRIPTION DRUG PROGRAM FOR THE YEARS OF 2021 AND 2022.FLAGLER HOSPITAL ALSO DONATED MEETING ROOMS AND IN SOME CASES FOOD/CATERING CHARGES FOR VARIOUS NON-PROFIT, SUPPORT AND SELF-HELP GROUPS IN THE COMMUNITY. THIS TOTALED OVER $8,000 USING A $3/HOUR CHARGE FOR EACH MEETING SPACE, A FIGURE BASED ON SQUARE FOOTAGE.COMMUNITY BUILDING ACTIVITIESFLAGLER HOSPITAL DONATED PAID STAFF TIME FOR EMPLOYEES WHO SERVED ON VARIOUS BOARDS FOR COMMUNITY EVENTS AND COMMITTEES WHICH OFFERED COMMUNITY SUPPORT, COALITION BUILDING WITH OTHER AGENCIES AND HEALTH AND WELFARE PROVIDERS, AND COMMUNITY HEALTH IMPROVEMENT ADVOCACY.THROUGH A PARTNERSHIP WITH THE HOSPITAL, THE ST. JOHNS COUNTY SCHOOL DISTRICT CREATED THE FLAGLER HOSPITAL ACADEMY OF MEDICAL AND HEALTH CAREERS AT PEDRO MENENDEZ HIGH SCHOOL IN 2007-2008. IT IS OPEN TO STUDENTS THROUGHOUT THE SCHOOL SYSTEM. IT FOCUSES ON PROVIDING SKILLS AND EXPERIENCE NECESSARY TO ATTAIN ENTRY LEVEL JOBS IN HEALTH, MEDICAL AND RELATED FIELDS, AND PROVIDES ACADEMIC PREPARATION TO CONTINUE TRAINING THROUGH CLINICAL EXPERIENCE, COMMUNITY COLLEGE AND UNIVERSITY PROGRAMS. THE ACADEMY HAD OVER 250 STUDENTS WITH OVER 75 FOURTH YEAR STUDENTS ROTATING THROUGH VARIOUS DEPARTMENTS AT THE HOSPITAL FOR TRAINING. THE LIFE INSTITUTE WORKS CLOSELY WITH THE SCHOOL DISTRICT TO ADMINISTER THE ACADEMY. A SCHOLARSHIP WAS DONATED TO A STUDENT IN THE PROGRAM FOR FURTHER EDUCATION, GIVEN WITH NO EXPECTATION OF THE STUDENT HAVING TO WORK FOR FLAGLER HOSPITAL UPON COMPLETION OF SCHOOL. COMMUNITY SUPPORTCARE CONNECT+ VOLUNTEERS IS A PROGRAM THAT IS NOW HOUSED WITHIN THE COMMUNITY HEALTH IMPROVEMENT DEPARTMENT. IN JUNE 2019, THE NON-PROFIT STATUS WAS DISSOLVED AND THE PROGRAM WAS ABSORBED BY FLAGLER HOSPITAL. CARE CONNECT+ VOLUNTEERS HOSTS A WEBSITE THAT CONNECTS VOLUNTEERS TO NON-PROFIT VOLUNTEER OPPORTUNITIES IN THE COUNTY. CARE CONNECT+ VOLUNTEERS HAS 93 NONPROFIT PARTNERS, 3,744 USERS AND OVER 150 VOLUNTEER OPPORTUNITIES.IN ADDITION, FLAGLER HOSPITAL DEDICATES A ROOM NEAR THE EMERGENCY DEPARTMENT AVAILABLE 24/7/365 ONLY FOR RAPE VICTIMS AND CHILD PROTECTION CASE INTERVIEW, STAFFED BY BETTY GRIFFIN CENTER. EXAMS ARE PROVIDED BY SEXUAL ASSAULT NURSE EXAMINERS, TRAINED IN THE FORENSIC COLLECTION OF EVIDENCE WHILE PROVIDING COMPASSIONATE MEDICAL CARE TO RAPE VICTIMS. THIS INITIATIVE INVOLVED MEMBERS OF THE ST. JOHNS COUNTY TASK FORCE AGAINST DOMESTIC AND SEXUAL VIOLENCE, INCLUDING FLAGLER HOSPITAL, ST. JOHNS COUNTY SHERIFF'S OFFICE, ST. AUGUSTINE POLICE DEPARTMENT, ST. AUGUSTINE BEACH POLICE DEPT., FL SCHOOL OF THE DEAF AND BLIND POLICE DEPARTMENT, 7TH JUDICIAL CIRCUIT STATE ATTORNEY'S OFFICE AND BETTY GRIFFIN CENTER, A PUBLIC/PRIVATE PARTNERSHIP.ALONG WITH THE PLUS BUS, THE COMMUNITY HEALTH IMPROVEMENT DEPARTMENT AND ITS OUTREACH STAFF CONTINUED VACCINATION PROGRAMS AT VARIOUS LOCATIONS THROUGHOUT 2022. THESE CLINICS INCLUDED VACCINE BOOSTERS. VACCINATION CLINICS WERE CONDUCTED AT BOTH MT. MORIAH BAPTIST CHURCH AND FOR EMPLOYEES OF NORTHRUP GRUMMAN IN ST. AUGUSTINE. COMMUNITY BENEFIT OPERATIONSFLAGLER HOSPITAL HAS A FULL TIME EXECUTIVE DIRECTOR OF CARE CONNECT+ THAT OVERSEES THE COMMUNITY HEALTH IMPROVEMENT DEPARTMENT, AND A MANAGER OF CONTRACTS AND GRANTS TO HELP COORDINATE HOSPITAL-WIDE COMMUNITY BENEFIT FUNCTIONS IN ACCORDANCE WITH NATIONAL STANDARDS AND PUBLIC REPORTING REQUIREMENTS. THE EXECUTIVE DIRECTOR OF CARE CONNECT+ AND THE MANAGER OF CONTRACTS AND GRANTS USE CBISA SOFTWARE TO TRACK AND REPORT COMMUNITY BENEFIT ACTIVITIES AND PROVIDE AN ANNUAL REPORT ON COMMUNITY BENEFIT NUMBERS TO THE DIRECTOR OF ACCOUNTING FOR THE HOSPITAL'S 990 SCHEDULE H.
PART III, LINE 3:	BASED ON COMPILED HOSPITAL BAD DEBT DATA FOR THE FISCAL YEAR, WE ARE ESTIMATING THAT 50% OF THE TOTAL CHARGES FOR PATIENT ACCOUNTS THAT WENT TO BAD DEBT AND SCORED BETWEEN 201% - 400% (OR THAT WERE NOT SCORED) WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE IF PATIENT WOULD HAVE COMPLIED WITH THE HOSPITALS FINANCIAL ASSISTANCE POLICY OR HAD BEEN ABLE TO BE PRESUMPTIVELY SCORED. 50% OF THE CHARGES MULTIPLIED BY THE AVERAGE AGB (24%) EQUAL THE ESTIMATED COST.
PART II, COMMUNITY BUILDING ACTIVITIES	COMMUNITY HEALTH IMPROVEMENT SERVICES:IN ADDITION TO NEEDS ASSESSED BY THE HEALTH LEADERSHIP COUNCIL, FLAGLER HOSPITAL IS IN A POSITION TO KNOW THE OTHER HEALTH ISSUES WHICH COST THE COMMUNITY AND ITS CITIZENS THE MOST TIME AND MONEY. WHILE DEATH FROM DIABETES IS ON THE DECLINE, INCIDENCE OF DIABETES IS RISING, DUE TO OBESITY CAUSED BY DIET AND LIFESTYLE. FLAGLER HOSPITAL CONTINUED TO PARTNER WITH THE WILDFLOWER CLINIC, A NON-PROFIT DEDICATED TO PROVIDING FREE MEDICAL AND DENTAL CARE TO QUALIFYING ST. JOHNS COUNTY RESIDENTS, TO ESTABLISH WILDFLOWER CHRONIC CARE CLINIC (CCC). THE CHRONIC CARE CLINIC PROVIDES INVALUABLE CARE TO UNINSURED, CHRONICALLY ILL, LOW-INCOME RESIDENTS OF ST. JOHNS COUNTY. THE FLAGLER CCC FOCUSES ON CHRONIC DISEASE MANAGEMENT, WITH AN EMPHASIS ON DIABETES MANAGEMENT. THIS CLINIC IS AVAILABLE TO ANY PATIENT WITH AN UNMANAGED, CHRONIC CONDITION WHO MEETS THE GOOD SAMARITAN HEALTH CENTERS PATIENT QUALIFICATIONS. PATIENTS RECEIVE SERVICES FREE OF CHARGE.THE CHRONIC CARE CLINIC IS STAFFED WITH A NURSE PRACTITIONER, WHO IS AVAILABLE BY PHONE, PAGER, AND EMAIL, 24 HOURS A DAY/7 DAYS A WEEK. ALL CHRONIC CARE CLINIC PATIENTS ARE PROVIDED WITH HER CONTACT INFORMATION AND INSTRUCTED TO CONTACT HER DIRECTLY IF THEY HAVE ANY QUESTIONS OR CONCERNS BETWEEN VISITS, ESPECIALLY IF THEY ARE NOT FEELING WELL. THROUGH TELEMEDICINE OR ADDITIONAL VISITS BETWEEN SCHEDULED APPOINTMENTS, THE NURSE PRACTITIONER CAN ADD OR ADJUST MEDICATIONS, ORDER LAB WORK, AND MANAGE ANY SITUATIONS FOR WHICH A PATIENT MAY HAVE OTHERWISE RESORTED TO THE FLAGLER HOSPITAL EMERGENCY CARE CENTER FOR A NON-EMERGENT VISIT. BY PAIRING 24-HOUR ACCESS TO A NURSE PRACTITIONER WITH ACCESS TO MEDICATIONS THAT WOULD BE OTHERWISE UNAFFORDABLE AND EDUCATION ABOUT THEIR CHRONIC ILLNESSES, THE WILDFLOWER CHRONIC CARE CLINIC HAS EFFECTIVELY KEPT COUNTLESS PATIENTS FROM SEEKING CARE IN THE FLAGLER HOSPITAL EMERGENCY CARE CENTER. IN ADDITION, PER THE 2020 COMMUNITY HEALTH ASSESSMENT, ACCESS TO CARE ON EVENING AND WEEKEND WAS LISTED AS THE SECOND HIGHEST BARRIER TO CARE. WILDFLOWER CONDUCTS CLINICS DURING BOTH WEEKEND AND EVENING HOURS TO ADDRESS THIS ISSUE. IN 2022 WILDFLOWER CLINIC HAS PROVIDED WELL OVER 4,000 DIFFERENT INTERACTIONS IN THE FORM OF MEDICAL SERVICES TO ITS PATIENTS. SERVICES INCLUDE PLUS BUS CLINICS, CARDIOLOGY SERVICES, LABORATORY SERVICES, PATHOLOGY, MAMMOGRAPHY, PHARMACEUTICAL, PATHOLOGY, THERAPY, AND RADIOLOGY SERVICES COMBINED. DURING THE LAST FISCAL YEAR, FLAGLER HOSPITAL HAS PROVIDED THE WILDFLOWER CLINIC WITH $855,725 IN FREE LABORATORY SERVICES.THE HEART CENTER AT FLAGLER HOSPITAL PROVIDES A CRITICAL SERVICE TO RESIDENTS OF ST. JOHNS COUNTY AND THE SURROUNDING AREAS. FLAGLER HOSPITAL'S STATE-OF-THE-ART HEALTHCARE ENCOMPASSES THE ENTIRE CONTINUUM OF CARE FOR HEART PATIENTS, INCLUDING CLOSE COLLABORATION WITH ST. JOHNS COUNTY FIRE RESCUE, WITH TRANSMISSION OF EKGS DIRECTLY FROM AMBULANCE TO HOSPITAL, CARDIAC CATHETER LABS, WORLD-CLASS PHYSICIANS AND STAFF, QUALITY ASSURANCE PLANS, AND COMMUNITY OUTREACH AND EDUCATION PROGRAMS. ONCE A PATIENT IS DISCHARGED WITH A DIAGNOSIS OF HEART FAILURE, A NURSE CARE COORDINATOR FOLLOWS UP WITH THE PATIENT TO REVIEW DISCHARGE MEDICATIONS, VITAL SIGNS, THE IMPORTANCE OF WEIGHT MANAGEMENT AND FLUID RESTRICTIONS. ONCE IN THE HOME, THE NURSE PRACTITIONER REVIEWS THE FOODS THAT ARE IN THE PATIENT'S HOMES AND DISCUSSES HOW THAT FOOD SHOULD BE USED IN THE DIET OR NOT USED AT ALL. SHE USES CUPS THAT ARE ALREADY IN THE PATIENT'S HOME TO SHOW HOW MUCH FLUID SHOULD GO IN AND HOW MANY A DAY SHOULD BE USED. THIS OFFERS THE PATIENT A PRACTICAL APPROACH TO CARING FOR THEMSELVES AT HOME. THIS SERVICE COMES AT NO CHARGE TO THE PATIENT AND HELPS THEM UNDERSTAND WHAT THE DOCTOR EXPECTS FROM THEM. THIS SERVICE GOES BEYOND HOSPITAL EDUCATION AND IS TRUE COMMUNITY/HOME EDUCATION.FLAGLER HOSPITAL ALSO PARTNERED WITH THE CITY OF ST. AUGUSTINE AND BOLT TO LAUNCH AN E-BIKER SERVICE IN DOWNTOWN ST. AUGUSTINE DURING 2021. IN AN EFFORT TO ADVANCE PHYSICAL HEALTH AND ECONOMIC HEALTH, FLAGLER HELPED PURCHASE 110 ELECTRIC BIKES THAT CAN BE RENTED BY VISITORS AND RESIDENTS ALIKE. THE PROGRAM ALSO ASSISTS WITH THE HEAVY MOBILITY PROBLEMS ASSOCIATED WITH ST. AUGUSTINE.
PART III, LINE 4:	SEE AUDITED FINANCIAL STATEMENTS PAGE 11
PART III, LINE 8:	THE MEDICARE REVENUE AND ALLOWABLE COSTS ON LINES 5 AND 6, RESPECTIVELY, WERE TAKEN FROM THE MEDICARE COST REPORT. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE REIMBURSEMENT ALLOWED, BEFORE REDUCTION OF CO-PAY AMOUNTS, LESS SEQUESTRATION AND ANY OTHER REDUCTIONS ASSOCIATED WITH VALUE BASED PURCHASING REDUCTIONS AS PER THE COST REPORT WORKSHEETS E PART A AND B. MEDICARE ALLOWABLE COSTS RELATING TO PAYMENTS ARE TAKEN FROM THE PART A AND PART B EXPENSES AS DETERMINED BY THE COST REPORT STEP DOWN AND COST APPORTIONMENT METHODOLOGY ON WORKSHEETS D-1 AND D PART V, PLUS THE 65% REDUCTION APPLIED TO MEDICARE BAD DEBTS. THE ENTIRE SHORTFALL IS REPORTED AS COMMUNITY BENEFIT. WE DO NOT RECEIVE ENOUGH IN MEDICARE REIMBURSEMENTS TO COVER OUR COSTS ASSOCIATED WITH THE PROVISION OF THESE SERVICES, YET WE CONTINUE TO PROVIDE MEDICARE SERVICES TO OUR COMMUNITY REGARDLESS OF THE REIMBURSEMENT LEVELS. THEREFORE, WE FEEL JUSTIFIED IN REPORTING THIS AS PART OF OUR COMMUNITY BENEFIT.
PART III, LINE 9B:	1.) FLAGLER HOSPITAL BUSINESS OFFICE STAFF REVIEW UNPAID PATIENT ACCOUNTS ON A REGULAR BASIS TO IDENTIFY THOSE ACCOUNTS THAT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. ATTEMPTS TO CLASSIFY THESE PARTICULAR INDIVIDUALS START AT THE TIME THAT THEY ARE STILL IN-HOUSE. PATIENTS ARE ALSO CONTACTED AFTER DISCHARGE THROUGH PHONE CALLS OR MAIL. COMPLIANT INDIVIDUALS WHO MEET THE HOSPITAL'S FINANCIAL ASSISTANCE GUIDELINES ARE GRANTED THE APPROPRIATE DISCOUNT BASED ON WHERE THEY FALL IN RELATION TO THE FEDERAL POVERTY GUIDELINES. MANY PATIENTS DUE TO FAILURE TO PRODUCE THE APPROPRIATE DOCUMENTATION RECEIVE A REDUCED NON-COMPLIANT HOSPITAL ADJUSTMENT. THESE PARTICULAR INDIVIDUALS MAY HAVE RECEIVED A HIGHER WRITE-OFF IF THEY WERE IN FACT COMPLIANT. 2.) REGARDLESS OF THE PATIENTS' FINANCIAL CLASS OR STATUS, IF A BILL REMAINS UNPAID FOR MORE THAN 120 DAYS FROM THE DATE IT WAS FIRST MAILED TO THE PATIENT, AND REASONABLE COLLECTION ATTEMPTS HAVE FAILED, THE DEBT IS SENT TO A PRIMARY BAD DEBT COLLECTION AGENCY FOR FURTHER COLLECTION EFFORTS.
PART VI, LINE 2:	ST. JOHNS COUNTY IS FORTUNATE TO HAVE STRONG AND PROACTIVE LEADERSHIP WITHIN ITS PUBLIC HEALTH SYSTEM, AND A HISTORY OF SUCCESSFUL COLLABORATION. CHAMPIONED BY FLAGLER HOSPITAL AND THE FLORIDA DEPARTMENT OF HEALTH IN ST. JOHNS COUNTY, THE ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL WAS ESTABLISHED IN 2010 FOR THE SPECIFIC PURPOSE OF BRINGING TOGETHER KEY LEADERS FROM THE LOCAL COMMUNITY TO ASSESS AND ADDRESS THE HEALTH NEEDS OF OUR RESIDENTS. IN MAY 2014, THE ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL ACHIEVED NATIONAL ROLE MODEL STATUS, WHEN IT WAS SELECTED BY THE UNIVERSITY OF KENTUCKY (UK) COLLEGE OF PUBLIC HEALTH TO BE INCLUDED IN A NATION-WIDE STUDY OF HIGHLY SUCCESSFUL PUBLIC HEALTH COLLABORATIVE. THE PURPOSE OF THE UK STUDY WAS TO IDENTIFY, COMPARE AND CONTRAST EXCEPTIONAL MODELS OF COLLABORATION INVOLVING COMMUNITY HOSPITALS, PUBLIC HEALTH DEPARTMENTS AND OTHER STAKEHOLDERS, WHO SHARE A COMMITMENT TO IMPROVING COMMUNITY HEALTH, AND TO DETERMINE THE KEY LESSONS LEARNED FROM THEIR EXPERIENCES. THE ST. JOHNS COUNTY HEALTH LEADERSHIP COUNCIL WAS ONE OF ONLY TWELVE COLLABORATIVES SELECTED BY THE UK STUDY TEAM FROM OVER 150 NATIONAL APPLICATIONS. FLAGLER HOSPITAL'S CEO, VP OF MARKETING AND STRATEGY, AND ADMINISTRATOR OF COMMUNITY HEALTH IMPROVEMENT, ALONG WITH REPRESENTATIVES FROM 41 OTHER AGENCIES PARTICIPATED IN THIS HIGHLY COLLABORATIVE EFFORT WITH FLAGLER HOSPITAL IN THE FOREFRONT OF EVERY PHASE FROM DEVELOPING SURVEY QUESTIONS, CREATING SURVEY TOOLS, IDENTIFYING FOCUS GROUPS, ANALYZING DATA, ESTABLISHING ACTION PLANS AND REVIEWING RESULTS. SEE NARRATIVE ON PART V FOR PART V, SECTION B, LINE 6B FOR A LISTING OF THE MEMBERSHIP ORGANIZATIONS AND REPRESENTATIVES.TO IMPLEMENT THE FINDINGS AND GOALS DETERMINED THROUGH THE CHNA, THE MAPP PROCESS USES A THREE YEAR CYCLE WITH EACH IDENTIFIED NEED HAVING AN "OWNER" TO TRACK PROGRESS. WHILE VARIOUS MEMBERS OF THE HEALTH LEADERSHIP COUNCIL TOOK "OWNERSHIP" OF VARIOUS ASPECTS OF THE HEALTH NEEDS ASSESSMENT'S IMPLEMENTATION, FLAGLER HOSPITAL PARTICIPATES IN EACH PART OF IMPLEMENTATION. THE SHARED VISION AND COMMON VALUES OF MEMBERS PROVIDE A FRAMEWORK FOR PURSUING THE LONG RANGE GOALS, SO FLAGLER HOSPITAL IS PROUD TO PARTNER WITH MANY MEMBERS OF THE HEALTH LEADERSHIP COUNCIL, IN ORDER TO BROADEN COMMUNITY PARTICIPATION. FLAGLER HOSPITAL ACKNOWLEDGES AND AGREES WITH THE SPECIFIED GOALS OF THE CHNA. A COMMUNITY BALANCED SCORECARD WAS CREATED TO TRACK AND EVALUATE EACH OF THE STRATEGIC OBJECTIVES AND ACTS AS THE COMMUNITY HEALTH IMPROVEMENT PLAN. THE CRITERIA AND RATIONALE FOR EACH OF THE OBJECTIVES AND GOALS IS CONTAINED ON PAGE 21 OF THE PUBLISHED "2022 COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN".
PART VI, LINE 3:	THE HOSPITAL COMMUNICATES ITS CHARITY CARE POLICY, OR PATIENT-FRIENDLY SUMMARY THEREOF, IN THE FOLLOWING WAYS:- POSTED ON THE FLAGLER HOSPITAL WEBSITE - POSTED AT THE RECEPTION DESKS IN ALL REGISTRATION AREAS - POSTED AT ALL FINANCIAL COUNSELORS' DESKSWHEN UNINSURED OR UNDERINSURED PATIENTS ARE ADMITTED TO THE HOSPITAL, THEY ARE SCREENED FOR FINANCIAL ASSISTANCE. AT THE TIME OF SCREENING, THE PATIENT IS PROVIDED A FINANCIAL ASSISTANCE APPLICATION TO COMPLETE. THEY ARE THEN ASKED TO SUBMIT THE REQUIRED FINANCIAL DOCUMENTS (I.E., BANK STATEMENTS, PAY STUBS, TAX RETURNS, ETC.). THOSE PATIENTS DISCHARGED PRIOR TO SCREENING ARE CALLED BY THE BUSINESS OFFICE AND ARE SCREENED OVER THE PHONE. THE PATIENT IS INFORMED OF THE ELIGIBILITY REQUIREMENTS AND THE FINANCIAL DOCUMENTS NEEDED FOR VERIFICATION. UNINSURED PATIENTS TREATED IN THE EMERGENCY DEPARTMENT WHO MEET CERTAIN CRITERIA ARE SCREENED BY PHONE BY THE BUSINESS OFFICE. THE PATIENT IS INFORMED OF THE ELIGIBILITY REQUIREMENTS AND THE FINANCIAL DOCUMENTS NEEDED. A SEPARATE SCREENING IS PERFORMED TO DETERMINE ELIGIBILITY FOR COUNTY PROGRAMS AND MEDICAID. IN ADDITION, THE HOSPITAL UTILIZES A THIRD-PARTY VENDOR TO SCREEN SELF-PAY PATIENTS FOR POSSIBLE DISCOUNTS AND FINANCIAL ASSISTANCE OPTIONS. FOR DETAILS, PLEASE SEE THE RESPONSE TO PART I, LINE 3C ABOVE.
PART VI, LINE 4:	ST. JOHNS COUNTY IS PART OF THE JACKSONVILLE METROPOLITAN AREA AND ENCOMPASSES APPROXIMATELY 680 SQUARE MILES OF LAND IN NORTHEAST FLORIDA, SITUATED BETWEEN THE ST. JOHNS RIVER AND MORE THAN 40 MILES OF BEACHES ALONG THE ATLANTIC COAST. AT THE TIME OF PUBLICATION FOR THIS REPORT, THE U.S. CENSUS BUREAU 2019 POPULATION ESTIMATE FOR ST. JOHNS COUNTY, FL IS 264,762. SINCE 2010, ST. JOHNS COUNTY IS ASCRIBED AS THE HEALTHIEST COUNTY OF 67 COUNTIES IN FLORIDA FOR OVERALL HEALTH FACTORS AND HEALTH OUTCOMES IN THE 2020 COUNTY HEALTH RANKINGS REPORT. ST. JOHNS COUNTY SCHOOL DISTRICT RANKS FIRST OF 67 DISTRICTS IN FLORIDA IN TOTAL FLORIDA COMPREHENSIVE ASSESSMENT TEST POINTS. THE CITY OF ST. AUGUSTINE, THE COUNTY SEAT AND NATION'S "OLDEST CITY," ATTRACTED ABOUT 6.3 MILLION VISITORS TO THE COUNTY IN 2017.POPULATION AND AGE DISTRIBUTIONST. JOHNS COUNTY'S POPULATION NEARLY TRIPLED BETWEEN THE YEARS 1990 AND 2016, THIS BEING A POPULATION INCREASE OF OVER 180%. GROWTH FOR ST. JOHNS COUNTY IS OCCURRING AT A RATE THREE TIMES FASTER THAN FLORIDA AND ALMOST SIX TIMES FASTER THAN THE NATION. THE U.S. CENSUS BUREAU ESTIMATES ST. JOHNS COUNTY'S POPULATION FOR 2016 TO BE 235,087 (51.2% FEMALE), AN ESTIMATED 3.7% HIGHER THAN THE 2015 ESTIMATE. ST. JOHNS COUNTY, FL WAS ASCRIBED THE 15TH FASTEST GROWING COUNTY AMONG THE 100 FASTEST GROWING COUNTIES WITH 10,000 OR MORE POPULATION IN THE NATION BETWEEN 2010 AND 2016. USING 2016 ESTIMATES, THE U.S. BUREAU OF ECONOMIC AND BUSINESS RESEARCH PROJECTS ST. JOHNS COUNTY'S POPULATION WILL GROW TO 287,027 BY 2025.ST. JOHNS COUNTY AND FLORIDA HAVE SIMILAR POPULATION AGE DISTRIBUTIONS. HOWEVER, WHEN COMPARED TO THE STATE, ST. JOHNS COUNTY HAS A SLIGHTLY HIGHER PROPORTION OF PEOPLE WITHIN THE GROUP OF PEOPLE FROM 10 YEARS OF AGE TO 19 YEARS OF AGE AND THE ALSO WITHIN THE GROUP OF PEOPLE FROM 35 YEARS OF AGE TO 69 YEARS OF AGE. COMPARING THE 2010 AND 2016 POPULATION AGE DISTRIBUTION ESTIMATES REVEALS AN AGING POPULATION; BETWEEN 2010 AND 2016, ST. JOHNS COUNTY EXPERIENCED HIGHEST POPULATION GROWTH AMONG PEOPLE 65 YEARS OF AGE TO 69 YEARS OF AGE (2.4%), FOLLOWED BY PEOPLE 50 YEARS OF AGE TO 54 YEARS OF AGE (1.1%) AND 40 YEARS OF AGE TO 44 YEARS OF AGE (1.0%). ACCORDING TO THE U.S. CENSUS BUREAU, APPROXIMATELY 19.3% OF ST. JOHNS COUNTY'S POPULATION WAS 65 YEARS OF AGE OR OLDER IN 2016, A SLIGHTLY LOWER PROPORTION THAN THE STATE (19.9%) BUT HIGHER THAN THE NATION (15.2%).VULNERABLE POPULATIONS PERSONS WITH ACCESS AND FUNCTIONAL NEEDS INCLUDE PERSONS WITH PHYSICAL, COGNITIVE, OR DEVELOPMENTAL DISABILITIES, PERSONS WITH LIMITED ENGLISH PROFICIENCY, GEOGRAPHICALLY OR CULTURALLY ISOLATED PERSONS, AND MEDICALLY OR CHEMICALLY DEPENDENT PERSONS. RECENT DISASTERS HAVE SHOWN THE NEED TO BETTER DEVELOP STRATEGIES FOR MEETING THE NEEDS OF MOST AT-RISK POPULATIONS TO PREVENT ADVERSE HEALTH OUTCOMES DURING OR FOLLOWING A DISASTER.
PART VI, LINE 6:	THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

Schedule H (Form 990) 2021

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
FLAGLER HOSPITAL INC

Employer identification number
59-0675143

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) BEACHSIDE ATHLETIC BOOSTERS INC 200 GREAT BARRACUDA WAY ST JOHNS,FL32259	88-1823803		25,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(2) BOYS & GIRLS CLUB OF NE FLORIDA 555 W 25TH ST JACKSONVILLE,FL32206	59-6167630	501(C)(3)	131,250	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(3) JACKSONVILLE FC INC 2850 HODGES BLVD JACKSONVILLE,FL32224	59-2881219	501(C)(3)	6,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(4) M2 32081 LLC 48 GULFSTREAM WAY PONTE VEDRA BEACH,FL32081	84-3846475		150,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(5) PALM COAST REGIONAL CHAMBER OF COMMERCE 145 CITY PLACE SUITE 301 PALM COAST,FL32164	85-2141868	501(C)(6)	12,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(6) ROCAR MOBILITY LLC 9941 NW 94TH CT PLANTATION,FL33324	85-1595181		100,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(7) K9S FOR WARRIORS INC 114 CAMP K9 RD PONTE VEDRA,FL32081	27-5219467	501(C)(3)	85,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(8) ST JOHNS COUNTY CHAMBER OF COMMERCE 100 SOUTHPARK BLVD STE 405/406 ST AUGUSTINE,FL32086	59-0432275	501(C)(6)	37,400	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(9) PINK UP THE PACE PO BOX 840219 ST AUGUSTINE,FL32080	27-2012490	501(C)(3)	8,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(10) HALL OF FAME HEALTH LLC 2121 GEARGE HALAS DR NW CANTON,OH44708	85-3983217		100,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(11) GOOD LAD SOCCER 409 SPANISH CREEK DR PONTE VEDRA BEACH,FL32081	83-2249321		6,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(12) SHE IS FIERCE LLC 24 S DIXIE HWY ST AUGUSTINE,FL32084	47-4695657		40,500	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(13) CAPITAL BIZ GROUPLLC 1023 RED OAK DRIVE CHERRY HILL,NJ08003	46-5287051	501(C)(3)	13,500	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(14) ALL AMERICAN AIR CHARITABLE 425 TRADE WIND LN ST AUGUSTINE,FL32080	27-4254657	501(C)(3)	10,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(15) ROSCOLUSA LLC 1611 WOODLAND ST NASHVILLE,TN37206	46-2971411		85,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(16) PGA TOUR INC PO BOX 206 PONTE VEDRA BEACH,FL32004	52-0999206	501(C)(6)	170,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(17) FLAGLER CO EDUCATION FOUNDATION 1769 EAST MOODY BLVD BLDG 2 BUNNELL,FL32110	59-3006312	501(C)(3)	11,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(18) ST FRANCIS HOUSE 70 WSHINGTON ST ST AUGUSTINE,FL32084	59-2475614	501(C)(3)	10,850	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(19) GLOBAL GOOD FUND 3066 HOBBS RAD GLENWOOD,MD21738	46-1495972	501(C)(3)	29,484	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(20) EPIC BEHAVIORAL HEALTHCARE 17 ST JOHNS MEDICAL PARK DR ST AUGUSTINE,FL32086	59-1502582	501(C)(3)	150,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE
(21) INVESTING IN KIDS (INK) 40 ORANGE ST ST AUGUSTINE,FL32084	59-3221115	501(C)(3)	15,000	OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2021

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:	THE FLAGLER HEALTH CARE FOUNDATION, A SUPPORTING ORGANIZATION OF THE HOSPITAL, REPORTS ITS FINANCIAL ACTIVITIES TO THE CFO OF FLAGLER HOSPITAL. THE HOSPITAL HAS A COMMUNITY BENEFITS GROUP THAT WORKS WITH ST. JOHNS COUNTY TO DETERMINE GRANT RECIPIENTS AND MONITOR THE USE OF FUNDS.

Schedule I (Form 990) 2021

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

FLAGLER HOSPITAL INC

Employer identification number

59-0675143

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes 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 .....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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

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

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

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

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

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

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

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

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

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

Cat. No. 50053T

Schedule J (Form 990) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JASON P BARRETT PRESIDENT/CEO	(i) (ii)	586,206 ------------- 0	171,900 ------------- 0	40,749 ------------- 0	0 ------------- 0	0 ------------- 42,957	798,855 ------------- 42,957	0 ------------- 0
2JOSEPH S GORDY CEO (FORMER)	(i) (ii)	114,967 ------------- 0	0 ------------- 0	644,491 ------------- 0	0 ------------- 0	0 ------------- 0	759,458 ------------- 0	0 ------------- 0
3DAVID RICE MD EVP/CHIEF PHYSICIAN EXECUTIVE	(i) (ii)	451,880 ------------- 0	145,754 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 35,023	597,634 ------------- 35,023	0 ------------- 0
4MIGUEL A MACHADO CMO	(i) (ii)	467,904 ------------- 0	91,000 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 2,403	558,904 ------------- 2,403	0 ------------- 0
5CARLTON DEVOOGHT PRESIDENT/CEO	(i) (ii)	392,215 ------------- 0	99,377 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 25,957	491,592 ------------- 25,957	0 ------------- 0
6VINCENT JOHNSON EVP/COO	(i) (ii)	364,642 ------------- 0	96,579 ------------- 0	600 ------------- 0	0 ------------- 0	0 ------------- 39,048	461,821 ------------- 39,048	0 ------------- 0
7TODD BATENHORST VP, CMO AMBULATORY CARE	(i) (ii)	358,718 ------------- 0	75,000 ------------- 0	0 ------------- 0	0 ------------- 0	41,304 ------------- 0	475,022 ------------- 0	0 ------------- 0
8NANGELA PULSFUS EVP/COO	(i) (ii)	262,084 ------------- 0	76,565 ------------- 0	665 ------------- 0	0 ------------- 0	30,907 ------------- 0	370,221 ------------- 0	0 ------------- 0
9ANGIE METCALF CHIEF ADMINISTRATIVE OFFICER	(i) (ii)	284,975 ------------- 0	50,653 ------------- 0	600 ------------- 0	0 ------------- 0	0 ------------- 6,501	336,228 ------------- 6,501	0 ------------- 0
10DONALD R CRIST VP OF OPERATIONS	(i) (ii)	234,037 ------------- 0	47,844 ------------- 0	6,901 ------------- 0	0 ------------- 0	16,973 ------------- 0	305,755 ------------- 0	0 ------------- 0
11JEFFREY A HURLEY CHIEF HUMAN RESOURCE OFFICER (FORMER	(i) (ii)	45,635 ------------- 0	0 ------------- 0	250,591 ------------- 0	0 ------------- 0	0 ------------- 0	296,226 ------------- 0	0 ------------- 0
12JOHN FRANKS EVP, AMBULATORY ENTERPRISE	(i) (ii)	228,678 ------------- 0	51,638 ------------- 0	6,727 ------------- 0	0 ------------- 0	5,528 ------------- 0	292,571 ------------- 0	0 ------------- 0
13MELISSA CECIL CIO	(i) (ii)	214,978 ------------- 0	44,000 ------------- 0	3,353 ------------- 0	0 ------------- 0	10,413 ------------- 0	272,744 ------------- 0	0 ------------- 0
14BRENDA BAKER EVP/CFO (PART YEAR)	(i) (ii)	182,284 ------------- 0	65,977 ------------- 0	275 ------------- 0	0 ------------- 0	13,000 ------------- 0	261,536 ------------- 0	0 ------------- 0
15KEVIN SWEENY VP GOVERNMENT AFFAIRS & FOUNDATION	(i) (ii)	193,639 ------------- 0	44,699 ------------- 0	0 ------------- 0	0 ------------- 0	5,164 ------------- 0	243,502 ------------- 0	0 ------------- 0
16MICHAEL HALL ADMINISTRATOR	(i) (ii)	176,275 ------------- 0	18,015 ------------- 0	2,439 ------------- 0	0 ------------- 0	30,207 ------------- 0	226,936 ------------- 0	0 ------------- 0
17DONNA WAGNER VP CNO	(i) (ii)	188,350 ------------- 0	28,383 ------------- 0	360 ------------- 0	0 ------------- 0	1,224 ------------- 0	218,317 ------------- 0	0 ------------- 0
18ACHAREEYA MARTWISET RN	(i) (ii)	172,275 ------------- 0	35,200 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	207,475 ------------- 0	0 ------------- 0
19JILL BERRY VP, CHIEF LEGAL OFFICER	(i) (ii)	163,402 ------------- 0	500 ------------- 0	0 ------------- 0	0 ------------- 0	18,681 ------------- 0	182,583 ------------- 0	0 ------------- 0
20MELANI CROSBY ASL INTERPRETER	(i) (ii)	166,825 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	166,825 ------------- 0	0 ------------- 0
21JAMES D CARLISLE CLINICAL PHARMACIST	(i) (ii)	148,450 ------------- 0	1,613 ------------- 0	8,190 ------------- 0	0 ------------- 0	7,442 ------------- 0	165,695 ------------- 0	0 ------------- 0
22SHARON R MCDADE CHARGE RN	(i) (ii)	129,579 ------------- 0	16,300 ------------- 0	4,389 ------------- 0	0 ------------- 0	5,321 ------------- 0	155,589 ------------- 0	0 ------------- 0
23LYLE KOLNIK CLINICAL SPECIALIST	(i) (ii)	151,002 ------------- 0	1,725 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	152,727 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 1A	THE ORGANIZATION PROVIDES GROSS UP PAYMENTS FOR THE VALUE OF THE DISABILITY INSURANCE POLICY PREMIUMS TO CERTAIN OFFICERS, REPORTED ON THE OFFICERS' FORM W-2.
PART I, LINE 4B	THE ORGANIZATION CONTRIBUTED $221,923 IN TOTAL TO A 457(F)/(B) PLAN FOR DON CHRIST, MELISSA CECIL, CARLTON DEVOUGHT, MIGUEL MACHADO & DAVID RICE.
PART I, LINE 7	BONUSES ARE BASED ON PERFORMANCE METRICS SET AT THE BEGINNING OF THE PERFORMANCE YEAR. THE BOARD HAS APPROVAL RIGHTS FOR THE FINAL AMOUNT PAID AT THE END OF THE PERFORMANCE YEAR.

Schedule J (Form 990) 2021

Additional Data

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

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
FLAGLER HOSPITAL INC

Employer identification number
59-0675143

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	ST JOHNS COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY	59-2146640		09-28-2017	71,400,000	SEE PART VI		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	71,400,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	338,361
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	592,158
11 Other spent proceeds .............	53,517,222
12 Other unspent proceeds .............	16,952,259
13 Year of substantial completion .............	2019
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X
16 Has the final allocation of proceeds been made? ..........		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %
6 Total of lines 4 and 5 .............	0 %
7 Does the bond issue meet the private security or payment test? ...		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X
b Exception to rebate? ........		X
c No rebate due? .........		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X

Part Ⅴ

Procedures To Undertake Corrective Action

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

Part Ⅵ

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

Return Reference	Explanation
PART I, LINE A, COLUMN F:	CURRENT REFUNDING OF SERIES 2010A AND SERIES 2010B BONDS, FINANCING OF FACILITIES IMPROVEMENT PROJECTS AND EQUIPMENT ACQUISITIONS.
PART I, LINE B, COLUMN F:	CURRENT REFUNDING OF SERIES 2012B AND ADVANCE REFUNDING OF SERIES 2017A BONDS, EXTINGUISHING THE 2014 BANK LOAN, FINANCING OF FACILITIES IMPROVEMENT PROJECTS AND EQUIPMENT ACQUISITIONS.

Schedule K (Form 990) 2021

Additional Data

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SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

FLAGLER HOSPITAL INC

Employer identification number

59-0675143

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTANT AND REVIEWED AND APPROVED BY INTERNAL MANAGEMENT AND SHARED WITH EACH BOARD MEMBER PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	THE ORGANIZATION REQUIRES ALL TRUSTEES TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY. ANY CONFLICTS THAT DEVELOP AFTER SUBMISSION MUST BE DISCLOSED IN WRITING TO BOARD OF TRUSTEES. EXISTING CONFLICTS OF INTEREST MAY REQUIRE ABSTAINING FROM DISCUSSING OR VOTING UPON MATTERS RELATED TO OR AFFECTED BY THE CONFLICT, OR RECUSING ONESELF FROM PARTICIPATING IN RELATED MATTERS.
FORM 990, PART VI, SECTION B, LINE 15	THE COMPENSATION PACKAGE FOR THE CEO POSITION IS SET AND APPROVED BY THE COMPENSATION COMMITTEE, WHICH CONSISTS OF THE CURRENT AND PAST CHAIRPERSONS OF THE HOSPITAL, FLAGLER HEALTH CARE SYSTEM, AND FLAGLER HEALTH SERVICES BOARDS. INDEPENDENT SALARY SURVEYS ARE OBTAINED FROM INDUSTRY EXPERTS TO DETERMINE COMPENSATION AND BENEFITS. THOSE INDEPENDENT SALARY SURVEYS ARE ALSO USED TO DEVELOP COMPENSATION PACKAGES FOR THE SENIOR MANAGEMENT TEAM. THE COMPENSATION COMMITTEE EVALUATES THE DATA, THEN DEBATES AND DOCUMENTS ITS RECOMMENDATION OF REASONABLE COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19	PHOTOCOPIES OF THE ORGANIZATION'S FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICES. THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G	PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 39,621,354. MANAGEMENT AND GENERAL EXPENSES 18,856,178. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 58,477,532. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 14,239,884. MANAGEMENT AND GENERAL EXPENSES 689,777. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,929,661.
FORM 990, PART XI, LINE 9:	TRANSFERS TO AFFILIATES -61,449,202.
FORM 990, PART XII, LINE 2C:	THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PART XII, LINE 3B	THE REQUIRED SINGLE AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 HAS NOT BEEN COMPLETED YET FOR THE YEAR-END 9/30/22, BUT PLANS TO BE COMPLETED BY THE EXTENDED DUE DATE AS ESTABLISHED IN THE RELEVANT OMB GUIDANCE.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

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SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

FLAGLER HOSPITAL INC

Employer identification number

59-0675143

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) OUTPATIENT SURGERY CENTER OF ST AUGUSTINE LLC 1 ORTHOPAEDIC PL ST AUGUSTINE,FL32086 20-2047704	OUTPATIENT SURGERY	FL	-28,475	411,517	FLAGLER HEALTH ENTERPRISE
(2) FLAGLER HEALTH NETWORK LLC 400 HEALTH PARK BLVD ST AUGUSTINE,FL32086 82-1579477	INVESTMENT HOLDING	FL	-181,112	-218,138	FLAGLER HOSPITAL INC
(3) FLAGLER HEALTH ENTERPRISES LLC 400 HEALTH PARK BLVD ST AUGUSTINE,FL32086 82-1588529	INVESTMENT HOLDING	FL	-34,920	453,094	FLAGLER HOSPITAL INC

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)FLAGLER HEALTH CARE FOUNDATION INC 400 HEALTH PARK BLVD ST AUGUSTINE,FL32086 59-2440537	SUPPORTING ORGANIZATION	FL	501(C)(3)	LINE 12A, I	FLAGLER HOSPITAL	Yes
(2)FLAGLER HOME CARE LLC 301 HEALTH PARK BLVD ST AUGUSTINE,FL32086 82-1562462	HOME CARE SERVICES	FL	501(C)(3)	LINE 10	FLAGLER HEALTH NETWORK LLC	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) CF MANAGEMENT ADMINISTRATIVE COMPANY LLC 30 TURIN TERRACE ST AUGUSTINE,FL32092 84-3559295	HEALTHCARE	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?
(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	Yes	No
(1) FLAGLER HEALTH SERVICES INC 400 HEALTH PARK BLVD ST AUGUSTINE,FL32086 59-2484352	REAL ESTATE LEASING	FL	FLAGLER HOSPITAL INC	C	1,491,104	2,604,465	100.000 %	Yes
(2) HEALTH PARK OWNERS ASSOCIATION 400 HEALTH PARK BLVD ST AUGUSTINE,FL32086 59-2869538	PROPERTY MANAGEMENT	FL	FLAGLER HOSPITAL INC	C	6,559	571,511	100.000 %	Yes
(3) ANDERSON GIBBS CONDOMINIUM ASSOC 400 HEALTH PARK BLVD ST AUGUSTINE,FL32086 59-3223458	PROPERTY MANAGEMENT	FL	FLAGLER HOSPITAL INC	C			100.000 %	Yes
(4) FLAGLER PROFESSIONAL HEALTH CARE SERVICES INC 400 HEALTH PARK BLVD ST AUGUSTINE,FL32086 36-4860252	HEALTHCARE	FL	FLAGLER HOSPITAL INC	C	27,664,286	13,475,526	100.000 %	Yes

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

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

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

Yes

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

Yes

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

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

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

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

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

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

Yes

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

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

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

Yes

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

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

Yes

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

Yes

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

Yes

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

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

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) FLAGLER HEALTH CARE FOUNDATION INC	C	149,520	FMV
(2) FLAGLER HEALTH SERVICES INC	K	551,472	FMV
(3) FLAGLER HEALTH CARE FOUNDATION INC	M	705,910	FMV
(4) FLAGLER HEALTH SERVICES INC	Q	26,376	FMV
(5) FLAGLER PROFESSIONAL HEALTH SERVICES INC	P	42,553,868	FMV
(6) FLAGLER HEALTH CARE FOUNDATION INC	A	44,487	FMV
(7) FLAGLER HEALTH CARE FOUNDATION INC	Q	127,613	FMV
(8) FLAGLER HOME CARE LLC	P	1,663,456	FMV
(9) FLAGLER PROFESSIONAL HEALTH SERVICES INC	A	1,124,127	FMV

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: BECOME A TOTAL CARE ENTERPRISE THAT ADVANCES THE PHYSICAL, SOCIAL, AND ECONOMIC HEALTH OF THE COMMUNITIES WE SERVE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	14
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	2,335
6	Total number of volunteers (estimate if necessary) .............	6	158
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	8,911
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,635,141	2,764,564
9	Program service revenue (Part VIII, line 2g) .........	339,904,712	315,098,629
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,938,056	-901,190
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,810,416	4,023,262
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	350,288,325	320,985,265
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	542,810	1,209,987
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)	119,541,852	125,553,537
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	205,928,028	219,382,940
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	326,012,690	346,146,464
19	Revenue less expenses. Subtract line 18 from line 12.......	24,275,635	-25,161,199
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	567,915,770	422,455,902
21	Total liabilities (Part X, line 26).............	327,899,992	310,040,476
22	Net assets or fund balances. Subtract line 21 from line 20.....	240,015,778	112,415,426

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 256,336,717 including grants of $ 1,209,987 ) (Revenue $ 315,098,629 )
	SINCE ITS FOUNDING IN 1889, OUR PRIVATE, NOT-FOR-PROFIT FACILITY HAS GROWN INTO A DIVERSE CLINICAL ENTERPRISE THAT IS CONSISTENTLY RECOGNIZED NATIONALLY FOR CLINICAL EXCELLENCE BY HEALTHGRADES, TRUVEN, AND OTHER COMPARATIVE QUALITY DATA ORGANIZATIONS. HOSPITAL SERVICES ARE PROVIDED TO INPATIENTS AND OUTPATIENTS, INCLUDING CHARITY CARE TO THE INDIGENT AND OTHER PATIENTS. PLEASE SEE SCHEDULE H FOR DETAILS ON COMMUNITY BENEFITS.

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 expenses256,336,717

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	7,857,402	0	338,053

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	149,520
e	Government grants (contributions)		1e	2,615,044

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

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		2,764,564

		Business Code
2a	NET PATIENT SERVICE REVENUE	623000	306,104,796	306,104,796
b	ANCILLARY SERVICES	623000	9,022,308	9,022,308
c	OSC REVENUE	623000	-28,475	-28,475
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		315,098,629

3 Investment income (including dividends, interest, and othersimilar amounts) ......			-792,400			-792,400
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		3,792,012	6a
b	Less: rental expenses		228,189	6b
c	Rental income or (loss)		3,563,823	6c
d	Net rental income or (loss).......			3,563,823			3,563,823
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses	108,790		7b
c	Gain or (loss)	-108,790		7c
d	Net gain or (loss).........			-108,790			-108,790
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..
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..
10a	Gross sales of inventory, less returns and allowances ..
			10a	131,506
b	Less: cost of goods sold ..		10b	69,675
c	Net income or (loss) from sales of inventory..			61,831			61,831
Business Code			Miscellaneous Revenue
11a	NON OPERATING REV OTHER		561499	202,773			202,773
b	PATIENT RECORD TRANSCRIPTION		561000	185,924			185,924
c	QUEST LAB TESTS		541380	8,911		8,911
d	All other revenue ....
e	Total. Add lines 11a–11d ......			397,608
12	Total revenue. See instructions.....			320,985,265	315,098,629	8,911	3,113,161

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	1,209,987	1,209,987
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 ...........	5,920,822		5,920,822
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........	95,671,180	80,482,663	15,188,517
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,970,855	3,490,644	480,211
9	Other employee benefits .......	11,848,423	11,323,817	524,606
10	Payroll taxes ...........	8,142,257	6,849,613	1,292,644
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,402,781	515,696	887,085
c	Accounting ...........	196,500		196,500
d	Lobbying ...........	788,286		788,286
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	73,407,193	53,861,238	19,545,955
12	Advertising and promotion ....	1,878,122	300,614	1,577,508
13	Office expenses .......	4,275,247	1,766,956	2,508,291
14	Information technology ......	8,026,411		8,026,411
15	Royalties ..
16	Occupancy ...........	8,711,351	3,293,173	5,418,178
17	Travel ............	243,219	59,488	183,731
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	8,135,874	5,857,641	2,278,233
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	23,722,920		23,722,920
23	Insurance ...	4,335,015	4,281,515	53,500
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	49,160,166	48,965,298	194,868
b	BAD DEBT EXPENSE	12,680,217	12,680,217
c	MINOR EQUIPMENT	2,746,652	2,335,343	411,309
d	OSC EXPENSES	35,416	24,469	10,947
e	All other expenses	19,637,570	19,038,345	599,225
25	Total functional expenses. Add lines 1 through 24e	346,146,464	256,336,717	89,809,747	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			42,942,428	1	8,039,519
2	Savings and temporary cash investments .........			40,779,394	2	29,789,894
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			45,101,354	4	36,369,359
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 ...........			4,170,356	7	4,757,540
8	Inventories for sale or use ............			7,728,056	8	7,356,939
9	Prepaid expenses and deferred charges ......			3,927,648	9	3,204,964
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	536,633,369
b	Less: accumulated depreciation	10b	304,061,372	227,713,730	10c	232,571,997
11	Investments—publicly traded securities .			103,409,312	11	64,597,127
12	Investments—other securities. See Part IV, line 11 .....			3,660,856	12	4,194,542
13	Investments—program-related. See Part IV, line 11 ..			6,026,056	13	7,766,026
14	Intangible assets ...............			24,439,604	14	0
15	Other assets. See Part IV, line 11 ...........			58,016,976	15	23,807,995
16	Total assets. Add lines 1 through 15 (must equal line 33)...			567,915,770	16	422,455,902

17	Accounts payable and accrued expenses .....	44,680,339	17	49,518,104
18	Grants payable ...		18
19	Deferred revenue .........	3,722,457	19	3,600,224
20	Tax-exempt bond liabilities .........	219,884,486	20	216,846,979
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 ..	14,981,106	23	10,366,624
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	44,631,604	25	29,708,545
26	Total liabilities. Add lines 17 through 25..	327,899,992	26	310,040,476

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	240,015,778	27	112,415,426
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here 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 ...........	240,015,778	32	112,415,426
33	Total liabilities and net assets/fund balances ........	567,915,770	33	422,455,902