TY 2022 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)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Bergherm Bruce...................................................................... Dir/Chair/SEO West FL Reg(end 7/22)	0.50 ................. 50.00	X	X			0	1,410,394	49,535
(2) Skula Erika...................................................................... Director/ CEO AH Ocala	0.50 ................. 50.00	X				0	1,209,081	98,949
(3) Didenko Vadym...................................................................... Dir/CFO West FL Division	2.78 ................. 47.22	X				0	910,346	146,851
(4) Wangsness Erik...................................................................... Director/ Chair (beg 7/22)	0.50 ................. 50.00	X				0	692,507	105,936
(5) Dunkel Jason...................................................................... Pres/CEO	29.17 ................. 20.83	X	X			0	628,371	94,730
(6) Quattlebaum Ryan...................................................................... Dir/Pres/CEO	12.50 ................. 37.50	X	X			0	376,156	71,936
(7) Arnold MD Paul...................................................................... Director	0.50 ................. 0.00	X				368	0	0
(8) Carson MD Thomas...................................................................... Director	0.50 ................. 0.00	X				368	0	0
(9) Kouskoutis N Michael...................................................................... Dir/Vice Chairman	0.50 ................. 0.00	X				368	0	0
(10) Pawson Jonathan...................................................................... Director	0.50 ................. 0.00	X				368	0	0
(11) Schiefer Mark...................................................................... Director	0.50 ................. 0.00	X				368	0	0
(12) Sellew Roger...................................................................... Dir/Treasurer	0.50 ................. 0.00	X				368	0	0
(13) Mayo Darrell...................................................................... Director	0.50 ................. 0.00	X				368	0	0
(14) Crunk Dan...................................................................... CFO	50.00 ................. 0.00		X			0	271,864	53,029
(15) Longley MD Michael...................................................................... CMO	50.00 ................. 0.00			X		0	432,096	110,947
(16) Segur Jennifer...................................................................... CNO	50.00 ................. 0.00			X		0	266,239	39,625
(17) Malone George...................................................................... Pharmacy Director	41.50 ................. 0.00				X	178,754	0	39,585

(A) Name and business address	(B) Description of services	(C) Compensation
AMN Healthcare Inc 1905 Corporate Blvd NW Boca Raton,FL33431	Medical Professional Services	3,374,663
AYA Healthcare Inc 5930 Cornerstone Ct W 300 San Diego,CA92121	Medical Professional Services	2,005,589
Polin Rutledge and Fischer MDPA 34637 US Hwy 19 North Palm Harbor,FL34684	Medical Professional Services	1,894,941
North Pinellas Anesthesia Assoc PA 7032 Collections Center Drive Chicago,IL60693	Anesthesia Services	1,324,502
Woundcare MD Inc 6989 E Fowler Ave Tampa,FL33617	Wound Care Services	907,767
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 38

- 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.
right arrow

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

OMB No. 1545-0047

2022

Open to Public
Inspection

Name of the organization

Tarpon Springs Hospital Foundation Inc

Employer identification number

59-0898901

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) 2022

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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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 2022 (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—2022. 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—2021. 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—2022. 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—2021. 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) 2022

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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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 2022 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2021 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2022 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2021 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2022. 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—2021. 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) 2022

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) 2022

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) 2022

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) 2022

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 2022 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-2022	(iii) Distributable Amount for 2022
1 Distributable amount for 2022 from Section C, line 6
2 Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2022:
a From 2017.......
b From 2018.......
c From 2019.......
d From 2020.......
e From 2021.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2022 distributable amount
i Carryover from 2017 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2022 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2022 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2022, 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 2022. 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 2023. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2018.....
b Excess from 2019.....
c Excess from 2020.....
d Excess from 2021.....
e Excess from 2022.....

Schedule A (Form 990) (2022)

Schedule A (Form 990) 2022

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) 2022

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

2022

Name of the organization

Tarpon Springs Hospital Foundation Inc

Employer identification number

59-0898901

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) (2022)

Schedule B (Form 990) (2022) Page 2

Name of organization Tarpon Springs Hospital Foundation 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) (2022)

Schedule B (Form 990) (2022)

Page 3

Name of organization Tarpon Springs Hospital Foundation Inc		Employer identification number 59-0898901

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) (2022)

Schedule B (Form 990) (2022)

Page 4


Name of organization Tarpon Springs Hospital Foundation Inc			Employer identification number 59-0898901
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) (2022)

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

Tarpon Springs Hospital Foundation Inc

Employer identification number

59-0898901

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

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

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

Yes

4,527

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

4,527

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:	Dues paid to American Hospital Association and Florida Hospital Association.

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

Tarpon Springs Hospital Foundation Inc

Employer identification number

59-0898901

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 ....	6,358,697	4,252,762	2,842,624	1,962,074	1,930,341
b	Contributions ...	1,851,374	3,196,867	1,265,831	991,915	20,578
c	Net investment earnings, gains, and losses	-574,797	-1,097,710	157,251	-103,171	14,964
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	3,935,813	-6,778	12,944	8,194	3,809
f	Administrative expenses ....
g	End of year balance ......	3,699,461	6,358,697	4,252,762	2,842,624	1,962,074

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

0 %

Term endowment SchDMd Bullet

100.000 %

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 .....	5,497,317		5,497,317
b	Buildings ....	47,317,222	9,435,543	37,881,679
c	Leasehold improvements
d	Equipment ....	61,510,291	28,312,170	33,198,121
e	Other .....	8,887,923	403,123	8,484,800
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				85,061,917

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)Other receivables				126,665
(2)Receivable from third parties				254,309
(3)Due from affiliated				1,068
(4)Other assets				12,692
(5)Right of Use Asset-Operating Lease				2,049,993
(6)Interest in Foundation				3,699,461
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				6,144,188

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
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	96,978,660
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
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

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

Return Reference

Explanation

Part V, Line 4:

Helen Ellis Memorial Hospital Foundation, Inc. (HEMHF), a related organization formed and maintained exclusively to further the exempt purpose of AdventHealth North Pinellas (the Hospital) held assets in temporary endowment funds during the current tax year. HEMHF's endowment consists of individual donor restricted endowment funds where the assets have been designated for endowment established to support various purposes benefiting the Hospital and its patients.

Part X, Line 2:

The filing organization is a subsidiary organization within AdventHealth. The consolidated financial statements of AdventHealth contain the following FIN 48 (ASC 740) footnote: Please note that dollar amounts are in thousands. Healthcare Corporation and its affiliated organizations, other than North American Health Services, Inc. and its subsidiary (NAHS), are exempt from state and federal income taxes. Accordingly, Healthcare Corporation and its tax-exempt affiliates are not subject to federal, state or local income taxes except for any net unrelated business taxable income. NAHS is a wholly owned, for-profit subsidiary of Healthcare Corporation. NAHS and its subsidiary are subject to federal and state income taxes. NAHS files a consolidated federal income tax return and, where appropriate, consolidated state income tax returns. All taxable income was fully offset by net operating loss carryforwards for federal income tax purposes; as such, there is no provision for current federal or state income tax for the years ended December 31, 2022 and 2021. NAHS also has temporary deductible differences of approximately $18,200 and $33,000 at December 31, 2022 and 2021, respectively, primarily as a result of net operating loss carryforwards. At December 31, 2022, NAHS had net operating loss carryforwards of approximately $10,000, expiring in 2023 through 2026. Deferred taxes have been provided for these amounts, resulting in a net deferred tax asset of approximately $4,500 and $8,100 at December 31, 2022 and 2021, respectively. NAHS remeasured its deferred tax assets and liabilities based on the rates at which they are expected to reverse in the future, which is generally 21%. A full valuation allowance has been provided at December 31, 2022 and 2021 to offset the deferred tax asset since Healthcare Corporation has determined that it is more likely than not that the benefit of the net operating loss carryforwards will not be realized in future years. The Income Taxes Topic of the Accounting Standards Codification (ASC) (ASC 740) prescribes the accounting for uncertainty in income tax positions recognized in financial statements. ASC 740 prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken, or expected to be taken, in a tax return. There were no material uncertain tax positions as of December 31, 2022 and 2021.

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 20a.
MediumBullet

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

Tarpon Springs Hospital Foundation Inc

Employer identification number

59-0898901

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? . . . . . .

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

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

Yes

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

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	5,804,921		5,804,921	3.480 %
b	Medicaid (from Worksheet 3, column a) . . . . .	18,657,537	5,105,186	13,552,351	8.120 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	24,462,458	5,105,186	19,357,272	11.600 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	861,787		861,787	0.520 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	681		681	0 %
j	Total. Other Benefits . .	862,468		862,468	0.520 %
k	Total. Add lines 7d and 7j .	25,324,926	5,105,186	20,219,740	12.120 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022

Schedule H (Form 990) 2022

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. ......

6,679,318

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. ......

823,396

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).....

24,736,081

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

33,842,900

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

-9,106,819

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2022

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	AdventHealth North Pinellas 1395 South Pinellas Avenue Tarpon Springs,FL34689 www.adventhealth.com/hospital/adventhe 4333	X	X	X

Schedule H (Form 990) 2022

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)

	AdventHealth North Pinellas
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 22

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

Yes

6 a

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

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

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

Yes

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

Hospital facility’s website (list url): See Part V, Page 8

Other website (list url):

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

Other (describe in Section C)

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

Yes

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

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

Yes

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

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2022

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	AdventHealth North Pinellas
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, Page 8

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

See Part V, Page 8

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

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

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

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

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

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

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

Other (describe in Section C)

Schedule H (Form 990) 2022

Page 6

Part VFacility Information (continued)

Billing and Collections

	AdventHealth North Pinellas
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) 2022

Page 7

Part VFacility Information (continued)

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

	AdventHealth North Pinellas
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) 2022

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
AdventHealth North Pinellas	Part V, Section B, Line 5: Tarpon Springs Hospital Foundation, Inc. d/b/a AdventHealth North Pinellas (AHNP or the Hospital) is a 168-bed hospital located in Pinellas County in Florida. AHWC's primary service area includes seven zip codes across Pinellas and Pasco Counties. In conducting its 2022 Community Health Needs Assessment (CHNA), the Hospital solicited input directly from the community and from individuals who represent the broad interests of the community, including medically underserved, low-income and minority community members. The Hospital partnered with local community organizations and stakeholders, including those in public health, to form the All4HealthFL Collaborative. The All4HealthFL Collaborative is a regional effort of local hospital systems and public health departments that work to improve community health. The Collaborative collected input directly from the community and from community stakeholders through a community survey and focus groups. The Collaborative met several times in 2021 and 2022 and reviewed primary and secondary data and helped to define the top health priority needs in the community. AHNP also formed a Community Health Needs Assessment Committee (CHNAC) that included representatives from organizations that serve low-income, low-access individuals and communities. The purpose of the CHNAC was to select the needs the Hospital would address from the findings in the community health needs assessment. Key CHNAC members that represented low-income and underserved populations were from the following organizations-Florida Department of Health in Pinellas County, UF/IFAS Extension of Pinellas, the Phoenix, National Alliance on Mental Illness Pinellas, Citizens Alliance for Progress, Mount Moriah AME Church, Tarpon Spring Elementary, St. Pete College, Live Tampa Bay, Peace4Tarpon, Tarpon Springs Shepherd Center, and the Gulfcoast North Area Health Education Center.
AdventHealth North Pinellas	Part V, Section B, Line 7d: The Hospital has adopted a policy that addresses the public posting requirements of the Community Health Needs Assessment. Under this policy, the Community Health Needs Assessment Reports must be posted on the Hospital's website at least until the date the hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports.
AdventHealth North Pinellas	Part V, Section B, Line 11: Tarpon Springs Hospital Foundation, Inc. d/b/a AdventHealth North Pinellas will be referred to in this document as AdventHealth North Pinellas or "the Hospital". The Hospital is a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is the 501(c)(3) parent organization of a hospital and healthcare system known as AdventHealth. In January 2019, every wholly owned entity of AHSSHC adopted the AdventHealth system brand. Our identity has been unified to represent the full continuum of care our system offers. Any references to our prior Community Health Needs Assessments (CHNAs) or prior Community Health Plans (CHPs) will utilize our new name for consistency. AdventHealth North Pinellas is part of the West Florida Division of AdventHealth (the Division). The Division includes 13 hospital facilities. This is the third-year update for AdventHealth North Pinellas's 2020-2022 Community Health Plan/Implementation Strategy. The Hospital developed this plan and posted it in May 2020 as part of its 2019 Community Health Needs Assessment process. For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, AdventHealth North Pinellas worked to define and address the needs of low-income, minority and underserved populations in its service area. The 2019 Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the primary issues identified in the community health needs assessment were prioritized by community and Hospital stakeholders, who then selected key issues for the Hospital to address in its 2020-2022 Community Health Plan. The third-year progress on the Community Health Plan is noted below. The narrative describes the prioritized issues identified in 2019 and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the Hospital did not address. AdventHealth North Pinellas chose five priorities for its 2020-2022 Community Health Plan: 1. Obesity2. High Blood Pressure/High Cholesterol/Heart Disease 3. Suicide/Depression (Medicare Population) 4. Tobacco Use 5. Alcohol ConsumptionPriority 1: Obesity2019 Description of the Issue:Obesity occurs when an individual's weight is higher than what is considered healthy. Obesity can be caused by behavioral and genetic factors. Other factors that contribute to obesity is the built environment, for example where you live and if you have access to healthy food and the ability to exercise outside. Obesity can cause serious health complications including high blood pressure, high cholesterol, heart disease, osteoarthritis and some cancers. From 2015-2016, obesity affected about 93 million adults and 13 million children in the U.S. In the AdventHealth North Pinellas primary service area (PSA), 27.2% of adults are obese (BMI greater than 30) which is higher than the state average of 26.6%. Additionally, 36% of adults in the PSA are considered overweight (BMI between 25 and 30). 2022 Update:The AdventHealth North Pinellas Community Health Plan has two desired goal statements under the Obesity priority. 1. Implement strategies that support existing community initiatives aimed to address the problem of obesity in the Hospital's Primary Service Area (PSA)2. Increase access to nutrition education by supporting community organizations and other community stakeholders offering health education and resourcesGoal 1: Implement strategies that support existing community initiatives aimed to address the problem of obesity in the Hospital's Primary Service Area (PSA) Objective 1: The first objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase new partnerships with local community organizations in the Food is Health program to six partners from a baseline of three partners by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. The Food is Health program is an AdventHealth West Florida Division program which increases access to health education and healthy foods to improve the overall health of the communities the Hospital serves. Through collaboration with community partners the program connects with low-income/low access communities and provides free health education, health screenings and produce vouchers which are used to purchase fresh fruits and vegetables.The Hospital met its set metric of recruiting six community partners in year two. In year one and two, the Hospital recruited The Hispanic Outreach Center, The Shepherd Center, Cops N Kids, Macedonia Church, UF/IFAS Extension of Pinellas, and Renardo Family Produce. In 2022, the Hospital also partnered with The Centre which provides a feeding program for seniors, Ahepa Apartments which is housing for low-income seniors, and Dube's Mobile Market to provide produce to program participants.Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase participation in the Food is Health program among low-income families in the Hospital's PSA by 50 participants from a baseline of seven by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. The Hospital met and exceeded its set metric of increasing participants from a baseline of seven to 50 by engaging 73 participants over the three-year plan. In 2022, there were two Food is Health classes serving a total of 43 participants.Objective 3:The third objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is, through the Food is Health program, to increase access to health screenings among adults living in food deserts or low-income/low access communities by 75 screenings from a baseline of 15 screenings by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. The Hospital did not meet its set metric of increasing health screenings among adults living in low-income/low access communities by 75 screenings. Health screenings were unavailable throughout the three-year plan to reduce the risk of spreading COVID-19. Furthermore, community health nursing staff members were redeployed to hospital facilities to assist with treating patients diagnosed with COVID-19. Attempts were made to recruit nurses from other departments, but staffing issues have been prevalent throughout the pandemic, making this metric unattainable. See Continuation 2
AdventHealth North Pinellas	Part V, Section B, Line 13h: Effective March 1, 2020, the filing organization's hospital facility (or facilities) augmented their Financial Assistance Policy with a COVID-19 Financial Grace Addendum. Pursuant to the COVID-19 Financial Grace Addendum, uninsured patients treated for COVID-19 related evaluations are to receive free or discounted care depending on the patient's cooperation in submitting necessary financial assistance information. Insured patients tested for COVID-19 are not expected to have out-of-pocket expenses based on insurance community response to waive patient financial responsibility. If a payer unexpectedly fails to waive patient responsibility for COVID-19 related testing, the filing organization will not balance bill patients for any out-of-pocket expenses related to COVID-19. In addition, patients with existing payment plans are provided opportunities for reducing their monthly payments.
Continuation of Part V, Section B, Line 11 - continuation 2	Goal 2: Increase access to nutrition education by supporting community organizations and other community stakeholders offering health education and resources Objective 1: The first objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to provide the Food is Health program to low-income families in the PSA by offering five class series from a baseline of one class by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. The Hospital met its set metric of holding five class series by the end of year three. There was a total of three class series in year one and two. In 2022, there was a class series held at The Centre and a class series held at Ahepa Apartments for a total of two class series for the year.Objective 2: The second objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase access to culturally appropriate nutritious food options among Food is Health program participants through 200 produce vouchers distributed from a baseline of 51 produce vouchers by the end of year three. This objective is managed at the Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. The Hospital met the objective of distributing 200 produce vouchers by the end of year three. In year 2022, there was a total of 229 vouchers distributed and redeemed. Each voucher is worth $10, so the total amount of money spent in 2022 was $2,290. There was a total of 278 vouchers redeemed by the end of year three for a total of $2,780.Objective 3: The third objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective, the Food is Health community employee volunteer initiative, will increase Hospital staff/team volunteer participation efforts with organizations addressing food security from a baseline of zero hours to 500 hours by the end of year three. The objective is managed at the Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. The Hospital provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations which are addressing this priority area. The Hospital did not meet its set metric of completing 500 paid volunteer hours with community organizations addressing food insecurity by the end of year three. Due to the COVID19 pandemic and social distancing requirements for safety, there were limited opportunities for in-person volunteering during the three-year plan, making it difficult to complete this objective. In total, the Hospital provided 30 paid volunteer staff hours, with two of those hours being completed in 2022. Priority 2: High Blood Pressure/High Cholesterol/Heart Disease 2019 Description of the Issue:Heart disease is the leading cause of death in the U.S. The major risk factors for heart disease are high blood pressure, high cholesterol, being overweight/obese and having an unhealthy diet. One in four deaths in the U.S. are due to heart disease. By managing blood pressure and cholesterol, eating a healthy diet and incorporating physical activity daily, the risk of developing heart disease could be greatly reduced. In the AdventHealth North Pinellas primary service area (PSA), the rate of death due to heart disease per 100,000 population is 152, which is higher than the state rate of 150. The percentage of adults in the PSA with high blood pressure is 29% and 46% of adults have high cholesterol.2022 Update:The AdventHealth North Pinellas Community Health Plan has two desired goal statements under the High Blood Pressure/High Cholesterol/Heart Disease priority. 1. Improve access to health education, early intervention programs and resources related to prevention of heart disease2. Enhance community to clinical linkages between community organizations and stakeholders to promote coordinated patient care strategies to control high blood pressure and high cholesterolGoal 1: Improve access to health education, early intervention programs and resources related to prevention of heart disease Objective 1: The first objective is a Divisional initiative and appears on multiple community health plans of Hospitals in the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. Their objective is to increase the number of Hospital sponsored American Heart Association (AHA) community Cardiopulmonary Resuscitation (CPR) out-of-Hospital bystander classes, also referred to as two-step Hands-Only CPR, for adults and youth from a baseline of zero to five by the end of year three. This objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. This initiative provides training to lay community members to be able to save the lives of individuals experiencing a cardiac event by administering the two-step Hands-Only CPR. The Hospital progressed on its set metric of five classes sponsored by December 31st, 2022. The Hospital did not meet its set metric of providing five American Heart Association hands-only CPR classes by the end of year three. The COVID19 pandemic made it difficult to provide in-person classes in year one and year two. In 2022, the Hospital was able to provide two hands-only CPR classes. Objective 2: The second objective is to increase the amount of paid staff time for Hospital staff/team members to volunteer with community organizations addressing heart disease and stroke from a baseline of zero hours to 250 hours by the end of year three. The initiative is conducted through AdventHealth North Pinellas and all outcomes are specific to the reporting Hospital. The Hospital provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations which are addressing this priority area. The Hospital did not meet its set metric of completing 250 paid volunteer hours with community organizations addressing heart disease and stroke by the end of year three. Due to the COVID19 pandemic and social distancing requirements for safety, there were limited opportunities for in-person volunteering during the three-year plan, making it difficult to complete this objective. In total, the Hospital provided 20 paid volunteer staff hours with all these hours being completed in 2022.Goal 2: Enhance community to clinical linkages between community organizations and stakeholders to promote coordinated patient care strategies to control high blood pressure and high cholesterol Objective 1: The first objective is to increase the number of underinsured/uninsured community members receiving linkages to follow up clinical care at Pioneer Medical Group by providing free biometric screenings and health education at a minimum of three Pioneer Medical Group free mobile clinic events for 150 patients from a baseline of zero patients by the end of year three. The initiative is managed by the Division; however, all outcomes are specific to the reporting Hospital. The initiative provides service to the community by connecting underinsured and uninsured individuals with free biometric screenings, primary care follow-up and routine care that they may otherwise not have access to. Pioneer Medical Group serves the homeless, refugee, uninsured and underinsured adult community by providing free health care access and hygiene supplies. The Hospital did not meet its set metric of providing three Pioneer Medical Group free mobile clinics for 150 patients by the end of year three. The Hospital was unable to support any mobile clinics in year one or year two due to social distancing requirements for the COVID19 pandemic. In 2022, the Hospital supported one mobile clinic event at Mt. Hermon Church for 20 people. Participants received several screenings including labs and blood pressure, as well as education on local resources for health care through community partners. See continuation 3
Continuation II of Part V, Section B, Line 11 - Continuation 3	Priority 3: Suicide/Depression (Medicare Population)2019 Description of the Issue: The burden of mental illness, such as depression and anxiety, in the United States is among the highest of all diseases. Mental disorders are among the most common causes of disability for adults, children and adolescents while suicide is the 10th leading cause of death in the U.S. When mental health disorders are untreated, those affected are at high risk for many unhealthy and unsafe behaviors, including alcohol or drug abuse, violent or self-destructive behavior and suicide. In the AdventHealth North Pinellas PSA, 22% of the Medicare population has depression, which is slightly higher than the state average of 19%. Furthermore, the suicide rate is 18.33 (per 100,000 population) which is higher than the state average of 14.09 per 100,000. 2022 Update:The AdventHealth North Pinellas Community Health Plan has two desired goal statements under the Suicide/Depression (Medicare Population) priority. 1. Reduce the stigma associated with mental illness in youth and adults by providing access to health education to help communities better understand and respond to signs of mental illness and substance use disorders2. Increase community-level partnerships to enhance existing efforts currently addressing social determinants of health that impact suicide/depression in youth and adultsGoal 1: Reduce the stigma associated with mental illness in youth and adults by providing access to health education to help communities better understand and respond to signs of mental illness and substance use disorders Objective 1: The first objective is to increase the number of Mental Health First Aid USA certification training classes provided for free to community members residing in the Hospital's PSA to three certification classes from a baseline of zero certification classes by the end of year three. The deployment of the Mental Health First Aid classes is a shared initiative between AdventHealth North Pinellas, AdventHealth Carrollwood, AdventHealth Dade City, AdventHealth Connerton, AdventHealth Zephyrhills, AdventHealth Tampa, AdventHealth Ocala, AdventHealth Wauchula, AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wesley Chapel. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The initiative is managed at the Divisional level and funded through the Hospital and all reported outcomes are specific to the reporting Hospital.The initiative provides Mental Health First Aid USA classes to the community for free. The class is a course that teaches you how to help someone who may be experiencing a mental health or substance use challenge. The training helps you identify, understand and respond to signs of addictions and mental illnesses. The Hospital did not meet its metric of providing three Mental Health First Aid (MHFA) classes by the end of year three. Division staff were unable to be certified as instructors until year two due to virtual trainings not being available prior to the COVID19 pandemic. The Hospital was able to complete two MHFA classes in 2022 for a total of 18 participants.Objective 2: The second objective is to increase the number of Pinellas County National Alliance on Mental Illness (NAMI) Nuts and Bolts education classes provided for free to community organizations in the Hospital's PSA by nine from a baseline of zero by the end of year three. The initiative is managed by the Division; however, all outcomes are specific to the reporting Hospital. The initiative provides service to the community by giving a general overview of who NAMI is and what they provide. It includes an overview of common mental health conditions and how one can "break stigma" around the discussion of mental health/mental illness.The Hospital did not meet this metric of conducting nine Nuts and Bolts NAMI presentations by the end of year three. NAMI was unable to provide classes in person during year one and two due to the COVID19 pandemic and had to restructure presentations to provide virtual classes. Attempts were made to provide virtual classes, but presentations had to be canceled due to low interest. Goal 2: Increase community-level partnerships to enhance existing efforts currently addressing social determinants of health that impact suicide/depression in youth and adults Objective 1: The first objective is a shared initiative between AdventHealth North Pinellas, AdventHealth Tampa, AdventHealth Carrollwood, AdventHealth Wesley Chapel, AdventHealth Zephyrhills and AdventHealth Dade City. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the number of Pinellas County NAMI Ending the Silence presentations provided for free to middle and high school-aged youth residing in the Hospital's PSA to six classes from a baseline of zero by the end of year three. The objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.For this initiative, the Hospital decided to partner with National Alliance on Mental Illness (NAMI) Pinellas, the local affiliate of the National Alliance on Mental Illness. NAMI's mission is to provide advocacy, education, support and public awareness so that all individuals and families affected by mental illness can build better lives. Ending the Silence is a presentation for middle and high school aged youth that helps destigmatize mental illness by providing community members with education to recognize signs and symptoms of an individual dealing with a mental health condition, along with the action steps to help the individual suffering from a mental health crisis. The Hospital did not meet this metric of providing six Ending the Silence presentations through NAMI by the end of year three. NAMI was unable to provide classes in person during year one and two due to the COVID19 pandemic and had to restructure presentations to provide virtual classes. Attempts were made to provide virtual classes, but presentations had to be canceled due to low interest.Objective 2: The second objective is a shared initiative between AdventHealth North Pinellas, AdventHealth Tampa and AdventHealth Carrollwood. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the number of Hillsborough County National Alliance on Mental Illness (NAMI) In Our Own Voice presentations provided for free to adults residing in the Hospital's PSA to six classes from a baseline of zero by the end of year three. The objective is managed at a Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.For this initiative, the Hospital decided to partner with National Alliance on Mental Illness (NAMI) Pinellas. NAMI's In Our Own Voice presentations change attitudes, assumptions and ideas about people with mental health conditions. NAMI's In Our Own Voice presentations are targeted towards adults. The Hospital did not meet this metric of conducting six In Our Own Voice NAMI presentations by the end of year three. The Hospital was unable to support any presentations in year one or year two due to constraints from the COVID19 pandemic limiting in-person presentations. In 2022, the Hospital was able to support one presentation at St. Pete College by providing boxed lunches for 30 participants and speakers.Objective 3: The third objective is to increase the amount of paid staff time for Hospital staff/team members to volunteer with community organizations addressing mental health from a baseline of zero hours to 250 hours by the end of year three. The initiative is conducted through AdventHealth North Pinellas and all outcomes are specific to the reporting Hospital. The Hospital provides a paid volunteerism program through which AdventHealth employees are paid at their normal rate to volunteer at community organizations which are addressing this priority area. The Hospital did not meet its set metric of providing 250 paid staff volunteer hours by the end of year three. Due to the COVID 19 pandemic and social distancing requirements for safety, there were limited opportunities for in-person volunteering during the three-year plan making it difficult to complete this objective. In total over the three-year plan, the Hospital provided 101 paid volunteer staff hours, with 21 of these hours being completed in 2022. See Continuation 4
Continuation II of Part V, Section B, Line 11 - Continuation 4	Priority 4: Tobacco Use2019 Description of the Issue:Since 1964, 20 million people in the U.S. have died from using tobacco. Tobacco use can cause a wide range of health issues including cancer, heart disease, diabetes, oral health diseases and harmful reproductive effects. More than 30 million adults in the U.S. smoke cigarettes and more than 50 million are exposed to secondhand smoke, which is just as harmful as smoking. Secondhand smoke can still cause heart disease and lung cancer as well as asthma, sudden infant death syndrome (SIDS) and other respiratory infections in infants and children. In the AdventHealth North Pinellas PSA, 23% of adults aged 18 and above smoke cigarettes, which is higher than the state average of 19%.2022 Update:The AdventHealth North Pinellas Community Health Plan has two desired goal statements under the Tobacco Use priority. 1. Decrease tobacco use among adults and youth residing in the Hospital's PSA2. Increase access to smoking cessation classes for adults by partnering with local community organizations to provide linkages to careGoal 1: Decrease tobacco use in adults and youth community members Objective 1: The first objective is to partner with Gulf Coast Area Health Education Center (AHEC) to increase community awareness of free programs and resources available for tobacco cessation by providing nine community lunch and learn sessions from a baseline of zero by the end of year three. The initiative is conducted through AdventHealth North Pinellas and all outcomes are specific to the reporting Hospital. Gulfcoast North Area Health Education Center (GNAHEC), a local chapter of the national Area Health Education Center (AHEC), is a community focused organization that develops and implements community-based health promotion activities and education programs that target the underserved. For this initiative, we are partnering with GNAHEC to provide community members the tools and resources to assist with tobacco cessation. The AHEC lunch and learns provide community members with knowledge of AHEC services and resources and connects individuals to free tobacco cessation classes.The Hospital did not meet its set metric of providing nine community lunch and learn sessions with GNAHEC by the end of year three. The Hospital was unable to provide any sessions in year one and year two due to the COVID19 pandemic and social distancing requirements for safety limiting opportunities for in-person sessions. In 2022, the Hospital was able to provide one lunch and learn session for five people.Objective 2: The second objective is a shared initiative between AdventHealth North Pinellas, AdventHealth Connerton, AdventHealth Lake Placid, AdventHealth Carrollwood, AdventHealth Sebring, AdventHealth Wauchula and AdventHealth Wesley Chapel. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase knowledge of free tobacco cessation programs and tobacco prevention/treatment resources for patients at discharge by partnering with Gulfcoast North Area Health Education Center (GNAHEC) to provide continuing education (CEU) classes to 200 team members (treating patients with tobacco use) from a baseline of zero by the end of year three. The objective is managed through all Hospitals, however reported outcomes and funding are specific to the reporting Hospital. This initiative provides educational classes that lead to an increase in knowledge for those AdventHealth team members who treat patients with tobacco use, or work with these patients at discharge, about tobacco cessation resources available thereby potentially improving patients' health through support for eliminating tobacco use. The Hospital did not meet its metric of providing 200 team members with CEUs through GNAHEC about treating patients with tobacco use by the end of year three. Due to the COVID-19 pandemic, staffing priorities shifted to providing essential services and educational programs were suspended. Ongoing challenges related to staffing for the Hospital interfered with achieving this metric.Goal 2: Increase access to smoking cessation classes for adults by partnering with local community organizations to provide linkages to care Objective 1: The first objective is a shared initiative between AdventHealth North Pinellas, AdventHealth Tampa, AdventHealth Carrollwood, AdventHealth Dade City, AdventHealth Zephyrhills, AdventHealth Ocala, AdventHealth Wauchula, AdventHealth Lake Placid, AdventHealth Sebring and AdventHealth Wesley Chapel. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. This objective is managed at the Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. The objective is to provide patient referrals at discharge to enroll in free Gulfcoast North Area Health Education Center (GNAHEC) tobacco cessation programs and receive free intervention therapies to quit smoking tobacco. Through a partnership with GNAHEC we will create an internal referral system to link adults residing in the Hospital's PSA, providing resources for 50 patients from a baseline of zero by end of year three. The Hospital did not meet its set metric of providing 50 discharge referrals for GNAHEC tobacco cessation programs by the end of year three. A formal referral system was launched in year two, but raising awareness about the referral system took time. There was an alternate option for referrals to another tobacco cessation resource in the system which competed with referrals for classes. The Hospital made 4 referrals for the three-year plan, with three of those referrals occurring in 2022. Objective 2: The second objective is to increase access to tobacco cessation classes for adults residing in the Hospital's PSA by 10 classes from a baseline of zero by the end of year three. This objective is managed at the Divisional level, however all funding and outcomes reported are specific to the reporting Hospital. We are partnering with GNAHEC to provide community members the tools and resources to assist with tobacco cessation. The GNAHEC tobacco cessation classes educate community members on the importance of quitting tobacco products. The classes are free, and participants can receive free nicotine replacement therapy products (ex. patches, gum, lozenges). The Hospital did not meet its set metric of conducting 10 tobacco cessation classes through GNAHEC by the end of year three. GNAHEC had difficulty providing in-person classes in year one and two due to social distancing restrictions of the COVID-19 pandemic. The Hospital agreed to sponsor virtual classes with Grub Hub vouchers as incentives, but there was no community interest. The Hospital supported a total of two classes with one of those classes occurring in 2022.Priority 5: Alcohol Consumption2019 Description of the Issue:Excessive use of alcohol can have immediate health effects, including unintentional injury, violence, alcohol poisoning, risky sexual behaviors and miscarriage among pregnant women. It can also have long-term health effects, including high blood pressure, heart disease, liver disease, dementia, depression and cancer. Underage drinking, or alcohol consumption by those under the age of 21, has been linked to death from alcohol poisoning, suicide, unintentional injury and alcohol dependence later in life. In the U.S., excessive alcohol use was the cause of one in ten deaths among adults between the ages of 20-64. In 2010, people under the age of 21 accounted for 189,000 ER visits for injuries and other conditions related to alcohol use. In the AdventHealth North Pinellas PSA, 20% of adults aged 18 and above drank excessively which is higher than the state average of 17%.2022 Update:The AdventHealth North Pinellas Community Health Plan has two desired goal statements under the Alcohol Consumption priority. 1. To increase access to treatment programs for substance misuse treatment, specifically for alcoholism, by creating partnerships with community organizations and stakeholders2. To increase education and awareness of substance misuse related to alcoholism by engaging community members, public schools, community organizations and other community stakeholdersGoal 1: To increase access to treatment programs for substance misuse treatment, specifically for alcoholism, by creating partnerships with community organizations and stakeholders See Continuation 5
Continuation II of Part V, Section B, Line 11 - Continuation 5	Objective 1: The first objective is to increase partnerships with local community organizations that provide resources, interventions and support to adults residing in the Hospital's PSA who are recovering from alcoholism by creating three partnerships from a baseline of zero partnerships by the end of year three. The initiative is conducted through AdventHealth North Pinellas and all outcomes are specific to the reporting Hospital. The initiative provides service to the community by improving access to resources that help to create a sober environment. The Hospital met its set metric of establishing three community partners that provide resources for those recovering from alcoholism by the end of year two. The three partnerships are Mothers Against Drunk Driving (MADD) West Central Florida Region, Alliance for Substance Addiction Prevention (ASAP) and The Phoenix Florida. In 2022, the Hospital also established a partnership with Recovery Epicenter, which helps individuals recovering from substance use including alcohol.Objective 2: The second objective is to increase access to community support groups for adults residing in the Hospital's PSA who are recovering from alcoholism by sponsoring three on-going support groups from a baseline of zero by the end of year three. The initiative is conducted through AdventHealth North Pinellas and all outcomes are specific to the reporting Hospital. The initiative provides service to the community by improving access to resources and support that help to create a sober environment for individuals recovering from alcoholism. The Hospital did not meet its set metric of providing ongoing support for three support groups for those recovering from alcoholism. The Hospital found that many organizations that support this initiative do not accept outside donations from other organizations and are funded from their own initiatives or private donations. Due to this, the Hospital decided to pivot and support Recovery Epicenter with a financial donation in 2022. Recovery Epicenter helps connect people recovering from substance use with resources including support groups as needed. The Hospital also made a financial donation for 100 participants for the Wellness Walkthrough event for ASAP in 2022.Goal 2: To increase education and awareness of substance misuse related to alcoholism by engaging community members, public schools, community organizations and other community stakeholdersObjective 1: The first objective is a shared initiative between AdventHealth North Pinellas and AdventHealth Connerton. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is that the initiative will increase the reach of the Pasco County Substance Abuse Taskforce (PCSAT) into West Pasco communities by co-hosting at least three meetings in West Pasco from a baseline of zero by end of year three. This objective is managed at the Hospital level and all funding and outcomes reported are specific to the reporting Hospital.The Pasco County Substance Abuse Taskforce began as an outreach by the AdventHealth Wesley Chapel Chaplain services. After several years, it was reimagined as a hybrid approach to both inpatient and community outreach. The taskforce's mission is to develop a partnership with community members focusing on awareness and increasing access to resources for patients suffering from substance misuse. Unfortunately, due to some fundamental shifts in the taskforce's leadership, the taskforce was placed on hold until late 2020.The Hospital did not meet its set metric of co-hosting three Pasco County Substance Abuse Taskforce meetings. Due to COVID-19, the Pasco County Substance Abuse Taskforce initiative was delayed. Staffing challenges in 2021 and 2022 put a pause on PCSAT meetings, but team members continued to collaborate with partner agencies on shared priorities of addressing substance misuse in Pasco County.Objective 2: The second objective is a shared initiative between AdventHealth North Pinellas and AdventHealth Connerton. These Hospitals are part of the West Florida Division of AdventHealth, the same division as the reporting Hospital. The Hospitals partnered on this initiative because of a shared CHNA priority. The objective is to increase the current reach of the Pasco County Substance Abuse Taskforce (PCSAT) into West Pasco communities by co-hosting at least one community forum in West Pasco from a baseline of zero by December 31, 2022. This objective is managed at the Divisional level, however all funding and outcomes reported are specific to the reporting Hospital.The Hospital met its set metric by combining Hospital resources with other AdventHealth Hospitals and making a financial donation to support 100 participants to participate in the Wellness Walkthrough Event in 2022. This event highlighted local services and resources for substance use prevention, treatment, and recovery.See Continuation 6
Continuation II of Part V, Section B, Line 11 - Continuation 6	Community Needs Not Chosen by AdventHealth North Pinellas:The primary and secondary data in the Community Health Needs Assessment identified multiple community issues. The Hospital and community stakeholders used the following criteria to narrow the larger list to the priority areas noted above:1. How acute is the need? (based on data and community concern)2. What is the trend? Is the need getting worse?3. Does the Hospital provide services that relate to the priority? 4. Is someone else - or multiple groups - in the community already working on this issue? 5. If the Hospital were to address this issue, are there opportunities to collaborate with community partners? 1. Unintentional Injury Deaths: Unintentional injuries were the third leading cause of death in the U.S for 2017. This includes deaths due to falls, motor vehicle accidents, fires, drownings and poisoning. In the AdventHealth North Pinellas PSA, the rate of death due to unintentional injury is 54 per 100,000 of the population. The issue should not be addressed as an individual problem but can be indirectly impacted positively by first addressing alcohol and tobacco use issues selected above by the Hospital Community Health Needs Assessment Committee (CHNAC). 2. Asthma: Asthma is a chronic condition when the airways in the lungs are always inflamed. The inflammation causes coughing, wheezing, chest tightness and shortness of breath. In the AdventHealth North Pinellas PSA, 14% of adults aged 18 and above have asthma. The CHNAC did not perceive the ability to have a measurable impact on the issue within the three years allotted for the Community Health Plan with the current resources available to the community and the Hospital at this time. 3. Uninsured Children: In 2018, 4.3 million children in the U.S. did not have health insurance. The largest decrease in insurance status was seen among children from low-income families using public programs like children's Medicaid or Children's Health Insurance Program (CHIP). In the AdventHealth North Pinellas PSA, 7% of the population under the age of 19 did not have health insurance. The CHNAC did not perceive the ability to have a measurable impact on the issue within the three years allotted for the Community Health Plan with the current resources available to the community and the Hospital at this time. 4. Cancer: Cancer is the second leading cause of death in the U.S. with more than 100 types. Many are preventable and research advances in detection and treatment have greatly improved survival rates. In the AdventHealth North Pinellas PSA, the rate of death due to cancer is 160 per 100,000 of the population. The issue should not be addressed as an individual problem but can be indirectly impacted positively by first addressing obesity, alcohol and tobacco use issues selected by the Hospital CHNAC. 5. Poor Dental Health: Many oral diseases can be prevented with routine care and regular dental checkups. The health of the teeth, the mouth and the surrounding craniofacial (skull and face) structures is central to a person's overall health and well-being. Lack of access to dental care for all ages remains a public health challenge. In the AdventHealth North Pinellas PSA, the access to dentists' rate per 100,000 of the population is 58 (in 2015), as compared to the state rate of 56. The CHNAC did not perceive the ability to have a measurable impact on the issue within the three years allotted for the Community Health Plan with the current resources available to the community and the Hospital at this time. 6. Infant Mortality: Infant mortality is the death of an infant before their first birthday. In 2017, more than 22,000 infants died in the U.S. The causes of infant mortality include birth defects, maternal pregnancy complications, sudden infant death syndrome, preterm birth and injuries such as suffocation. In the AdventHealth North Pinellas PSA, the infant mortality rate is 8 deaths per 1,000 births. The CHNAC did not perceive the ability to have a measurable impact on the issue within the three years allotted for the Community Health Plan with the current resources available to the community and the Hospital at this time.
Schedule H, Part V, Section B, Line 7a:	The CHNA report can be found at URL:https://www.adventhealth.com/community-health-needs-assessments
Schedule H, Part V, Section B, Line 10a:	The most recently adopted implementation strategy can be found at:https://www.adventhealth.com/community-health-needs-assessments
Schedule H, Part V, Section B, Line 16a,b,c:	The Financial Assistance Policy can be found at URL:https://www.adventhealth.com/legal/financial-assistanceThe Financial Assistance Policy application can be found at:https://www.adventhealth.com/legal/financial-assistanceThe plain language summary is available at:https://www.adventhealth.com/legal/financial-assistance
Part V, Section B, Line 8 - 10a CHNA Implementation Strategy	The filing organization adopted a Community Health Needs Assessment Report by 12/31/2022 and was in the process of developing its Community Health Needs Implementation Strategy at that time. The filing organization's 2023-2025 Community Health Needs Implementation Strategy is documented in a written report called the "Community Health Plan". The Community Health Plan (CHP) describes how the filing organization plans to meet its identified prioritized health needs or identifies the health need as one the filing organization does not intend to specifically address and provides an explanation as to why the filing organization does not intend to address that health need. The filing organization's 2023-2025 CHP was adopted by May 15, 2023 and is posted on the hospital facility's website.

Schedule H (Form 990) 2022

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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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2022

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Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 3c:	Under the Hospital facility's Financial Assistance Policy, an individual is eligible for a 100% reduction from applicable charges if the individual's household income is at or below 200% of the current Federal Poverty Guidelines. Alternatively, a patient may also qualify for a 100% reduction from charges when the unpaid portion of a patient's bill exceeds 25% of the individual's annual household income and where the total annual household income is less than 500% of the Federal Poverty Guidelines. Medicare recipients may also be eligible for financial assistance under the Hospital's Financial Assistance Policy depending upon the individual's income and resources. Resources are generally defined as assets such as money in checking or savings accounts, stocks, and bonds.
Part I, Line 6a:	The filing organization was a wholly owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) during its current tax year. During the current year, AHSSHC served as a parent organization to 30 tax-exempt 501(c)(3) hospital organizations and a number of other health care facilities that operated in 10 states within the U.S. The system of organizations under the control and ownership of AHSSHC is known as "AdventHealth".All hospital organizations within AdventHealth collect, calculate, and report the community benefits they provide to the communities they serve. AdventHealth organizations exist solely to improve and enhance the local communities they serve. AdventHealth has a system-wide community benefits accounting policy that provides guidelines for its health care provider organizations to capture and report the costs of services provided to the underprivileged and to the broader community. Each AdventHealth hospital facility reports their community benefits to their Board of Directors and strives to communicate their community benefits to their local communities. Additionally, the filing organization's most recently conducted community health needs assessment and associated implementation strategy can be accessed on the filing organization's website.
Part I, Line 7:	The amounts of costs reported in the table in line 7 of Part I of Schedule H were determined by utilizing a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges, contained in the Schedule H instructions.
Part III, Line 2:	The amount of bad debt expense reported on line 2 of Section A of Part III is recorded in accordance with Healthcare Financial Management Association Statement No. 15. Discounts and payments on patient accounts are recorded as adjustments to revenue, not bad debt expense.
Part III, Line 3:	Methodology for Determining the Estimated Amount of Bad Debt Expense that May Represent Patients who Could Have Qualified under the Filing Organization's Financial Assistance Policy:Self-pay patients may apply for financial assistance by completing a Financial Assistance Application Form (FAA Form). If an individual does not submit a complete FAA Form within 240 days after the first post-discharge billing statement is sent to the individual, an individual may be considered for presumptive eligibility based upon a scoring tool that is designed to classify patients into groups of varying economic means. The scoring tool uses algorithms that incorporate data from credit bureaus, demographic databases, and hospital specific data to infer and classify patients into respective economic means categories. Individuals who earn a certain score on the scoring tool are considered to qualify as eligible for the most generous financial assistance under the filing organization's Financial Assistance Policy. As determined by the filing organization, a nominal amount of such a patient's bill is written off as bad debt expense, while the remaining portion of the patient's bill is considered non-state charity. The amount written off as bad debt expense for those patients who potentially qualify as non-state charity using the scoring tool is the amount shown on line 3 of Section A of Part III. Rationale for Including Certain Bad Debts in Community Benefit:The filing organization is dedicated to the view that medically necessary health care for emergency and non-elective patients should be accessible to all, regardless of age, gender, geographic location, cultural background, physician mobility, or ability to pay. The filing organization treats emergency and non-elective patients regardless of their ability to pay or the availability of third-party coverage. By providing health care to all who require emergency or non-elective care in a non-discriminatory manner, the filing organization is providing health care to the broad community it serves. As a 501(c)(3) hospital organization, the filing organization maintains a 24/7 emergency room providing care to all whom present. When a patient's arrival and/or admission to the facility begins within the Emergency Department, triage and medical screening are always completed prior to registration staff proceeding with the determination of a patient's source of payment. If the patient requires admission and continued non-elective care, the filing organization provides the necessary care regardless of the patient's ability to pay. The filing organization's operation of a 24/7 Emergency Department that accepts all individuals in need of care promotes the health of the community through the provision of care to all whom present. Current Internal Revenue Service guidance that tax-exempt hospitals maintain such emergency rooms was established to ensure that emergency care would be provided to all without discrimination. The treatment of all at the filing organization's Emergency Department is a community benefit. Under the filing organization's Financial Assistance Policy, every effort is made to obtain a patient's necessary financial information to determine eligibility for financial assistance. However, not all patients will cooperate with such efforts and a financial assistance eligibility determination cannot be made based upon information supplied by the individual. In this case, a patient's portion of a bill that remains unpaid for a certain stipulated time period is wholly or partially classified as bad debt. Bad debts associated with patients who have received care through the filing organization's Emergency Department should be considered to be community benefit as charitable hospitals exist to provide such care in pursuit of their purpose of meeting the need for emergency medical care services available to all in the community.
Part III, Line 4:	Financial Statement Footnote Related to Accounts Receivable and Allowance for Uncollectible Accounts:The financial information of the filing organization is included in a consolidated audited financial statement for the current year.The applicable footnote from the attached consolidated audited financial statements that addresses accounts receivable, the allowance for uncollectible accounts, and the provision for bad debts can be found on page 8 and 9. Please note that dollar amounts on the attached consolidated audited financial statements are in thousands.
Part III, Line 8:	Costing Methodology:Medicare allowable costs were calculated using a cost-to-charge ratio.Rationale for Including a Medicare Shortfall as Community Benefit:As a 501(c)(3) organization, the filing organization provides emergency and non-elective care to all regardless of ability to pay. All hospital services are provided in a non-discriminatory manner to patients who are covered beneficiaries under the Medicare program. As a public insurance program, Medicare provides a pre-established reimbursement rate/amount to health care providers for the services they provide to patients. In some cases, the reimbursement amount provided to a hospital may exceed its costs of providing a particular service or services to a patient. In other cases, the Medicare reimbursement amount may result in the hospital experiencing a shortfall of reimbursement received over costs incurred. In those cases where an overall shortfall is generated for providing services to all Medicare patients, the shortfall amount should be considered as a benefit to the community. Tax-exempt hospitals are required to accept all Medicare patients regardless of the profitability, or lack thereof, with respect to the services they provide to Medicare patients. The population of individuals covered under the Medicare program is sufficiently large so that the provision of services to the population is a benefit to the community and relieves the burdens of government. In those situations where the provision of services to the total Medicare patient population of a tax-exempt hospital during any year results in a shortfall of reimbursement received over the cost of providing care, the tax-exempt hospital has provided a benefit to a class of persons broad enough to be considered a benefit to the community. Despite a financial shortfall, a tax-exempt hospital must and will continue to accept and care for Medicare patients. Typically, tax-exempt hospitals provide health care services based upon an assessment of the health care needs of their community as opposed to their taxable counterparts where profitability often drives decisions about patient care services that are offered. Patient care provided by tax-exempt hospitals that results in Medicare shortfalls should be considered as providing a benefit to the community and relieving the burdens of government.
Part III, Line 9b:	The hospital filing organization's collection practices are in conformity with the requirements set forth in the 2014 Final Regulations regarding the requirements of Internal Revenue Code Section 501(r)(4) - (r)(6). No extraordinary collection actions (ECA's) are initiated by the hospital filing organization in the 120-day period following the date after the first post-discharge billing statement is sent to the individual (or, if later, the specified deadline given in a written notice of actions that may be taken, as described below). Individuals are provided with at least one written notice (notice of actions that may be taken) and a copy of the filing organization's Plain Language Summary of the Financial Assistance Policy that informs the individual that the hospital filing organization may take actions to report adverse information to credit reporting agencies/bureaus if the individual does not submit a Financial Assistance Application Form (FAA Form) or pay the amount due by a specified deadline. The specified deadline is not earlier that 120 days after the first post-discharge billing statement is sent to the individual and is at least 30 days after the notice is provided. A reasonable attempt is also made to orally notify an individual about the filing organization's Financial Assistance Policy and how the individual may obtain assistance with the Financial Assistance application process. If an individual submits an incomplete FAA Form during the 240-day period following the date on which the first post-discharge billing statement was sent to the individual, the hospital filing organization suspends any reporting to consumer credit reporting agencies/bureaus (or ceases any other ECA's) and provides a written notice to the individual describing what additional information or documentation is needed to complete the FAA Form. This written notice contains contact information including the telephone number and physical location of the hospital facility's office or department that can provide information about the Financial Assistance Policy, as well as contact information of the hospital facility's office or department that can provide assistance with the financial assistance application process or, alternatively, a nonprofit organization or governmental agency that can provide assistance with the financial assistance application process if the hospital facility is unable to do so. If an individual submits a complete FAA Form within a reasonable time-period as set forth in the notice described above, the hospital filing organization will suspend any adverse reporting to consumer credit reporting agencies/bureaus until a financial assistance policy eligibility determination can be made.
Supplemental Schedule to Schedule H, Part III, Section B	Reconciliation of Schedule H Reported Medicare Surplus/(Shortfall) to Unreimbursed Medicare Costs Associated with the Provision of ServicesTo All Medicare Beneficiaries:The Medicare revenue and allowable costs of care reported in Section B of Part III of Schedule H are based upon the amounts reported in the filing organization's Medicare cost report in accordance with the IRS instructions for Schedule H. On an annual basis, the filing organization also determines its total unreimbursed costs associated with providing services to all Medicare patients. Unreimbursed costs are considered a community benefit to the elderly and are combined into an annual Community Benefit Statement prepared by AdventHealth. The primary reconciling items between the Medicare surplus/(shortfall) shown on line 7 of Section B of Part III of Schedule H and the filing organization's unreimbursed costs of services provided to Medicare patients are as follows:- Medicare surplus/(shortfall) shown on line 7 of Section B of Schedule H: $ (9,106,819)- Difference in costing methodology: 92,754- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (22,145,354) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's community benefit reporting: $ (31,159,419)As indicated above, the primary differences between the Medicare surplus/(shortfall) reported on Schedule H, Part III, Section B, line 7 and the filing organization's portion of the Company's annual community benefit statement is due to a difference in the costing methodology and differences in the population of Medicare patients within the calculation. The cost methodology utilized in calculating any Medicare surplus/(shortfall) for purposes of the annual community benefit reporting is based upon the cost-to-charge ratio outlined in Worksheet 2 of the Schedule H instructions. The same cost-to-charge ratio is used to determine the costs associated with services provided to charity care patients and Medicaid patients as reported in Schedule H, Part I, line 7. In addition, the Medicare cost report excludes services provided to Medicare patients for physician services, services provided to patients enrolled in Medicare HMOs, and certain services provided by outpatient departments of the filing organization that are reimbursed on a fee schedule. The Company's own community benefit statement captures the unreimbursed cost of providing services to all Medicare beneficiaries throughout the organization.
Part VI, Line 2:	The Hospital conducts community health needs assessments (CHNA) every three years. Its 2022 CHNA was adopted by its governing board by December 31, 2022, the end of the Hospital's taxable year in which it conducted the CHNA. The Hospital's 2022 CHNA complied with the guidance set forth by the IRS in Final Regulation Section 1.501(r)-3. In addition to the CHNA discussed above, a variety of practices and processes are in place to ensure that the filing organization is responsive to the health needs of its community.Such practices and processes involve the following:1. A hospital operating/community board composed of individuals broadly representative of the community, community leaders, and those with specialized medical training and expertise;2. Post-discharge patient follow-up related to the on-going care and treatment of patients who suffer from chronic diseases; 3. Sponsorship and participation in community health and wellness activities that reach a broad spectrum of the filing organization's community; and 4. Collaboration with other local community groups to address the health care needs of the filing organization's community.
Part VI, Line 3:	The Financial Assistance Policy (FAP), Financial Assistance Application Form (FAA Form), and the Plain Language Summary of the Financial Assistance Policy (PLS) of the filing organization's hospital facility are transparent and available to all individuals served at any point in the care continuum. The FAP, FAA Form, PLS, and contact information for the hospital facility's financial counselors are prominently and conspicuously posted on the filing organization's hospital facility's website. The website indicates that a copy of the FAP, FAA Form, and PLS is available and how to obtain such copies in the primary languages of any populations with limited proficiency in English that constitute the lesser of 1,000 individuals or 5% of the members of the community served by the hospital facility (referred to below as LEP defined populations). Signage is displayed in public locations of the filing organization's hospital facility, including at all points of admission and registration and the Emergency Department. The signage contains the hospital facility's website address where the FAP, FAA Form, and PLS can be accessed and the telephone number and physical location that individuals can call or visit to obtain copies of the FAP, FAA Form and PLS or to obtain more information about the hospital facility's FAP, FAA Form and PLS. Paper copies of the hospital facility's FAP, FAA Form and PLS are available upon request and without charge, both in public locations in the hospital facility and by mail. Paper copies are made available in English and in the primary languages of any LEP defined populations. The filing organization's hospital facility's financial counselors seek to provide personal financial counseling to all individuals admitted to the hospital facility who are classified as self-pay during the course of their hospital stay or at time of discharge to explain the FAP and FAA Form and to provide information concerning other sources of assistance that may be available, such as Medicaid. A paper copy of the hospital facility's PLS will be offered to every patient as a part of the intake or discharge process. A conspicuous written notice is included on all billing statements sent to patients that notifies and informs recipients about the availability of financial assistance under the filing organization's financial assistance policy, including the following: 1) the telephone number of the hospital facility's office or department that can provide information about the FAP and the FAA Form; and 2) the website address where copies of the FAP, FAA Form and PLS may be obtained. Reasonable attempts are made to inform individuals about the hospital facility's FAP in all oral communications regarding the amount due for the individual's care. Copies of the PLS are distributed to members of the community in a manner reasonably calculated to reach those members of the community who are most likely to require financial assistance.
Part VI, Line 4:	AdventHealth North Pinellas (AHNP), a 168-bed facility, situated on the west coast of central Florida along the Anclote River where the river meets the Gulf of Mexico, serves the residents of North Pinellas and surrounding communities with vital healthcare services. A Medical Staff of more than 430 physicians, including primary care and specialists, have privileges at AHNP. These doctors bring a tremendous resource of medical expertise to the hospital and the communities it serves.AdventHealth North Pinellas is a crucial community asset. In addition to operating a hospital facility, AHNP also operates 2 wound healing institutes, and 1 sleep center. AdventHealth North Pinellas also owns and operates a full service emergency room (ER) location in nearby Palm Harbor, Florida (Pinellas County). The Palm Harbor ER features 24 beds and overnight observation care, on-site imaging, lab and pharmacy services. It offers adult and pediatric emergency care. During 2022, the Hospital's patient percentage population was made up of the below payors with the remaining percentage of the patients being covered under commercial insurance. In 2022, about 82.9% of the Hospital's in-patients were admitted through the Hospital's Emergency Department. - Medicare Patients 57.6% - Medicaid Patients 10.5% - Self-Pay Patients 5.1% The demographic makeup of the Hospital's service area is as follows: - Population 154,351 - Population Over 65 26.8% - Poverty (Below 100% FPL) 12% - High School Graduation Rate 91.3% - Uninsured Adults 12.1% - Food Insecurity Rate 16.5% - Pop. with Low Food Access 72.5%
Part VI, Line 5:	The provision of community benefit is central to AdventHealth North Pinellas's mission of service and compassion. Restoring and promoting the health and quality of life of those in the communities served by the Hospital is a function of "extending the healing ministry of Christ and embodies the Hospital's commitment to its values and principles. The Hospital commits substantial resources to provide a broad range of services to both the underprivileged as well as the broader community. In addition to the community benefit and community building information provided in Parts I, II and III of this Schedule H, the Hospital captures and reports the benefits provided to its community through faith-based care. Examples of such benefits include the cost associated with chaplaincy care programs and mission peer reviews and mission conferences. During the current year, the Hospital provided $262,312 of benefit with respect to the faith-based and spiritual needs of the community in conjunction with its operation of a community hospital. The Hospital also provides benefits to its community's infrastructure by investing in capital improvements to ensure that facilities and technology provide the best possible care to the community. During the current year, the Hospital expended $9,265,127 in new capital improvements. As a faith-based mission-driven community hospital, the Hospital is continually involved in monitoring its community, identifying unmet health care needs and developing solutions and programs to address those needs. In accordance with its conservative approach to fiscal responsibility, surplus funds of the Hospital are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its community.
Part VI, Line 6:	AdventHealth North Pinellas is a part of a faith-based healthcare system of organizations whose parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). The system is known as AdventHealth. AHSSHC is an organization exempt from federal income tax under IRC Section 501(c)(3). AHSSHC and its subsidiary organizations operate 49 hospitals throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC and its subsidiaries also operate 10 nursing home facilities and other ancillary health care provider facilities, such as ambulatory surgery centers and diagnostic imaging centers. As the parent organization of AdventHealth, AHSSHC provides executive leadership and other professional support services to its subsidiary organizations. Professional support services include among others IT, corporate compliance, legal, reimbursement, risk management, and tax as well as treasury functions. Certain support services, such as human resources, payroll, A/P, and supply chain management are provided pursuant to a shared services model by AHSSHC to its subsidiary organizations. The provision of these executive and support services on a centralized basis by AHSSHC provides an appropriate balance between providing each AdventHealth subsidiary hospital organization with mission-driven consistent leadership and support while allowing the hospital organization to focus its resources on meeting the specific health care needs of the community it serves. The reader of this Form 990 should keep in mind that this reporting entity may differ in certain areas from that of a stand-alone hospital organization due to its inclusion in a larger system of healthcare organizations. As a part of a system of hospital and other health care organizations, the filing organization benefits from reduced costs due to system efficiencies, such as large group purchasing discounts, and the availability of internal resources such as internal legal counsel. Each AHS subsidiary pays a management fee to AHSSHC for the internal services provided by AHSSHC. As a result, management fee expense reported by an AdventHealth subsidiary organization may appear greater in relation to management fee expense that may be reported by a single stand-alone hospital. The single stand-alone hospital would likely report costs associated with management and other professional services on various expense line items in its statement of revenue and expense as opposed to reporting such costs in one overall management fee expense. As the reporting of the Form 990 is done on an entity by entity basis, there is no single Form 990 that captures the programs and operations of AdventHealth as a whole. The reader is directed to visit the web-site of AdventHealth at www.adventhealth.com to learn more about the mission and operations of AdventHealth.
Part VI, Line 7:	The filing organization does not file an annual community benefit report with any state agencies.

Schedule H (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

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

Schedule 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

2022

Open to Public
Inspection

Name of the organization
Tarpon Springs Hospital Foundation Inc

Employer identification number
59-0898901

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) Copperhead Charities Inc 36750 US 19 North Palm Harbor,FL34684	59-2319162	501(c)(3)	7,500	0			General Support
(2) Greater Tarpon Springs Chamber of Commerce 1 N Pinellas Ave Suite B Tarpon Springs,FL34689	59-0476455	501(c)(6)	15,000	0			General Support
(3) Helen Ellis Memorial Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs,FL34689	59-3690149	501(c)(3)	0	510,512	Book	Administrative Support	General Support
(4) City of Tarpon Springs PO Box 5004 Tarpon Springs,FL34688	59-6000437	City of Tarpon Sprin	12,500	0			General Support

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2022

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

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

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

Part I, Line 2:

Grants are generally made only to related organizations that are exempt from federal income tax under IRC Section 501(c)(3), or to other local charitable community organizations, or to other 501(c)(3) organizations that are a part of the group exemption ruling issued to the General Conference of Seventh-Day Adventists. Accordingly, the filing organization has not established specific procedures for monitoring the use of grant funds in the United States as the filing organization does not have a grant making program that would necessitate such procedures.

Schedule I (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

Tarpon Springs Hospital Foundation Inc

Employer identification number

59-0898901

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? ....

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2022

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)
1Bergherm Bruce Dir/Chair/SEO West FL Reg(end 7/22)	(i) (ii)	0 ------------- 673,281	0 ------------- 174,998	0 ------------- 562,115	0 ------------- 16,400	0 ------------- 33,135	0 ------------- 1,459,929	0 ------------- 0
2Skula Erika Director/ CEO AH Ocala	(i) (ii)	0 ------------- 400,986	0 ------------- 83,193	0 ------------- 724,902	0 ------------- 71,951	0 ------------- 26,998	0 ------------- 1,308,030	0 ------------- 35,184
3Didenko Vadym Dir/CFO West FL Division	(i) (ii)	0 ------------- 606,687	0 ------------- 162,689	0 ------------- 140,970	0 ------------- 93,915	0 ------------- 52,936	0 ------------- 1,057,197	0 ------------- 73,086
4Wangsness Erik Director/ Chair (beg 7/22)	(i) (ii)	0 ------------- 483,961	0 ------------- 115,637	0 ------------- 92,909	0 ------------- 63,278	0 ------------- 42,658	0 ------------- 798,443	0 ------------- 36,559
5McGuinness Robin Division CNO-Former Key Emp	(i) (ii)	0 ------------- 406,695	0 ------------- 94,539	0 ------------- 132,167	0 ------------- 56,683	0 ------------- 33,085	0 ------------- 723,169	0 ------------- 59,918
6Dunkel Jason Pres/CEO	(i) (ii)	0 ------------- 367,375	0 ------------- 69,743	0 ------------- 191,253	0 ------------- 52,290	0 ------------- 42,440	0 ------------- 723,101	0 ------------- 20,713
7Longley MD Michael CMO	(i) (ii)	0 ------------- 341,666	0 ------------- 54,020	0 ------------- 36,410	0 ------------- 69,191	0 ------------- 41,756	0 ------------- 543,043	0 ------------- 18,178
8Quattlebaum Ryan Dir/Pres/CEO	(i) (ii)	0 ------------- 295,982	0 ------------- 53,531	0 ------------- 26,643	0 ------------- 29,687	0 ------------- 42,249	0 ------------- 448,092	0 ------------- 0
9Crunk Dan CFO	(i) (ii)	0 ------------- 228,254	0 ------------- 33,536	0 ------------- 10,074	0 ------------- 13,659	0 ------------- 39,370	0 ------------- 324,893	0 ------------- 0
10Segur Jennifer CNO	(i) (ii)	0 ------------- 226,020	0 ------------- 34,542	0 ------------- 5,677	0 ------------- 14,000	0 ------------- 25,625	0 ------------- 305,864	0 ------------- 0
11Heinrich Caleb Former CFO	(i) (ii)	0 ------------- 155,931	0 ------------- 20,789	0 ------------- 4,104	0 ------------- 9,339	0 ------------- 31,780	0 ------------- 221,943	0 ------------- 0
12Malone George Pharmacy Director	(i) (ii)	160,028 ------------- 0	12,487 ------------- 0	6,239 ------------- 0	9,064 ------------- 0	30,521 ------------- 0	218,339 ------------- 0	0 ------------- 0
13Grzanowski Macye Nursing Director	(i) (ii)	148,482 ------------- 0	11,015 ------------- 0	5,429 ------------- 0	7,865 ------------- 0	27,471 ------------- 0	200,262 ------------- 0	0 ------------- 0
14Henderson Anna Team Lead Critical Care	(i) (ii)	144,624 ------------- 0	9,000 ------------- 0	9,133 ------------- 0	7,781 ------------- 0	8,857 ------------- 0	179,395 ------------- 0	0 ------------- 0
15Allgire Michele Clinical Pharmacist	(i) (ii)	165,745 ------------- 0	0 ------------- 0	574 ------------- 0	8,070 ------------- 0	2,871 ------------- 0	177,260 ------------- 0	0 ------------- 0
16Van OschMichelle Seasonal RN	(i) (ii)	163,254 ------------- 0	0 ------------- 0	50 ------------- 0	0 ------------- 0	0 ------------- 0	163,304 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2022

Page 3

Part III

Supplemental Information

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

Return Reference	Explanation
Part I, Line 1a	The filing organization is a part of the system of healthcare organizations known as AdventHealth. Members of the filing organization's executive management team that hold the position of Vice-President or above are compensated by and on the payroll of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), the parent organization of the healthcare system known as AdventHealth. AHSSHC is exempt from federal income tax under IRC Section 501(c)(3). The filing organization reimburses AHSSHC for the salary and benefit cost of those executives listed in Part VII that are on the payroll of AHSSHC. At the direction of AHSSHC, and in accordance with the reserved powers in the filing organization's governing documents, the executive team listed on Part VII provides services to the filing organization. First-class or charter travel: Pursuant to the AdventHealth system-wide general policy regarding business travel, no reimbursement will be provided for any additional cost incurred with respect to first-class or charter air travel beyond the cost of a regular coach airfare. As a means of providing additional business travel reimbursement for those members of the AHSSHC senior executive management team that travel frequently on behalf of AdventHealth, a special annual travel allowance is provided for those executives. As AdventHealth operates 49 hospitals in 9 states, the senior leadership of AHSSHC travel extensively and often visit multiple hospital locations in different states as a part of a single business trip. The special travel allowance can provide reimbursements to the executive for such items as the purchase of air travel upgrade coupons, to cover the cost differential between coach and first-class travel, or to cover the cost of a charter flight. The special travel allowance benefit was originally authorized by and codified into a policy by the AHSSHC Board Compensation Committee (the Committee), an independent body of the AHSSHC Board of Directors, who also approves the annual cap on the amount of the allowance. The special travel allowance has an annual cap of $24,000 for members of the Leadership Executive Team (13 AdventHealth Cabinet members and the AdventHealth Multi-State CFO) and $15,000 for AdventHealth Corporate Office Senior Vice Presidents, Regional CEO's, and Division Chief Officers (generally 50 - 55 individual executives). A Regional CEO for AdventHealth is a member of the Board of Directors of the filing organization. The Regional CEO is considered a common law employee of and is on the payroll of AHSSHC. While the special travel allowance benefit is an AHSSHC compensation policy and practice, the cost of providing this benefit is allocated to and either wholly or partially reimbursed by the filing organization. Accordingly, the filing organization has checked the box in Schedule J, Part I, line 1a for first-class or charter travel since it has wholly or partially paid for the cost of providing this benefit. Those executives who receive the special travel allowance are responsible for tracking the expenses reimbursable under the special travel allowance and must submit such expenses on their accountable plan expense report. A report on charter travel is provided to the AHSSHC Board Compensation Committee at each meeting. Any taxable reimbursements made to executives under the special travel allowance arrangement are treated as taxable compensation to the executive. Travel for companions: AHSSHC has a Corporate Executive Policy that provides a benefit to allow for a traveling AHSSHC executive to have his or her spouse accompany the executive on certain business trips each year. Typically, reimbursement is only provided to certain executive leaders and is usually limited to one business trip per year beyond the annual AdventHealth President's Council business meeting and other meetings where the spouse is specifically invited. The AHSSHC Corporate Executive Spousal Travel Policy was originally approved and reviewed by the AHSSHC Board Compensation Committee, an independent body of the AHSSHC Board of Directors. All spousal travel costs reimbursed to the executive are considered taxable compensation to the executive. Tax Indemnification and gross-up payments: AdventHealth has a system-wide policy addressing gross-up payments provided in connection with employer-provided benefits/other taxable items. Under the policy, certain taxable business-related reimbursements (i.e. taxable business-related moving expenses, taxable items provided in connection with employment) provided to any employee may be grossed-up at a 25% rate upon approval by the filing organization's CEO and CFO. Additionally, employees at the Director level and above are eligible for gross-up payments on gifts received for board of director services. Discretionary spending account: Occasional discretionary spending amounts are periodically provided to eligible executives who attend annual business meetings such as the AdventHealth President's Council, CFO Conference or the CMO/CNO business meeting. Payments provided to each executive are considered taxable compensation to the executive. Health or social club dues or initiation fees: AHSSHC has a Corporate Executive Policy that addresses business development expenditures. Under this policy, to encourage executives to establish and cultivate strong working relationships with the medical community and other leaders in the community and industry, certain AdventHealth executives may be reimbursed for member dues and usage charges for a country club or other social club upon authorization. Club memberships must be approved by the AdventHealth President/CEO initially as well as on an annual basis. Each AdventHealth executive who is approved for a club membership must submit an annual report describing how they used the membership to benefit their organization during the preceding year so that the AdventHealth President/CEO can determine if continuance of the club membership furthers the business interests of AdventHealth. In the current year, for this filing organization, two executives listed in Part VII received reimbursement for club fees. While the club dues membership is an AHSSHC compensation policy and practice, the cost of providing this benefit is allocated to and reimbursed in whole or in part by the filing organization. Accordingly, the filing organization has checked the box in Schedule J, Part I, line 1a for health or social club dues since it has wholly or partially paid for the cost of providing this benefit.
Part I, Line 3	The individual who serves as the CEO of the filing organization is appointed and compensated by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). Compensation and benefits provided to this individual are determined pursuant to policies, procedures, and processes of AHSSHC that are designed to ensure compliance with the intermediate sanctions laws as set forth in IRC Section 4958. AHSSHC has taken steps to ensure that processes are in place to satisfy the rebuttable presumption of reasonableness standard as set forth in Treasury Regulation Section 53.4958-6 with respect to its active executive-level positions. The AHSSHC Board Compensation Committee (the Committee) serves as the governing body for all executive compensation matters. The Committee is composed of certain members of the Board of Directors (the Board) of AHSSHC. Voting members of the Committee include only individuals who serve on the Board as independent representatives, who hold no employment positions with AHSSHC and who do not have relationships with any of the individuals whose compensation is under their review that impacts their best independent judgment as fiduciaries of AHSSHC. The Committee's role is to review and approve all components of the executive compensation plan of AHSSHC. As an independent governing body with respect to executive compensation, it should be noted that the Committee will often confer in executive sessions on matters of compensation policy and policy changes. In such executive sessions, no members of management of AHSSHC are present, other than the Chief People Officer, who remains at the request of the Chairman/committee to provide assistance/information as needed. The Committee is advised by an independent third-party compensation advisor. This advisor prepares all the benchmark studies for the Committee. Compensation levels are benchmarked with a national peer group of other not-for-profit healthcare systems and hospitals of similar size and complexity to AdventHealth and each of its affiliated entities. The following principles guide the establishment of individual executive compensation: - The salary of the President/CEO of AdventHealth will not exceed the 50th percentile of comparable salaries paid by similarly situated organizations; and - Other executive salaries shall be established using market medians. The compensation philosophy, policies, and practices of AHSSHC are consistent with the organization's faith-based mission and conform to applicable laws, regulations, and business practices. As a faith-based organization sponsored by the Seventh-day Adventist Church (the Church), AHSSHC's philosophy and principles with respect to its executive compensation practices reflect the conservative approach of the Church's mission of service and were developed in counsel with the Church's leadership.
Part I, Line 4b	As discussed in Line 1a above, executives on the filing organization's management team that hold the position of Vice-President or above are compensated by and on the payroll of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), the parent organization of the healthcare system known as AdventHealth. In recognition of the contribution that each executive makes to the success of AdventHealth, AdventHealth provides supplemental executive retirement benefit plans to eligible executives. As the supplemental executive retirement benefit plans were updated in 2020 and certain individuals still participate as grand-fathered participants in certain plans, the narrative below discusses all plans in which there were any participants in 2022. The SERP III plan effectively replaces the prior SERP II plan, the Executive Flex Benefit Program Plan, and the Senior Executive Death Benefit Plan for qualified executives except for certain grandfathered executive employees. SERP III Plan: The SERP III plan provides eligible executives a percentage of their base pay, which is credited to a deferred compensation account. The plan also provides for compensation deferral and selection of life insurance coverage and long-term care insurance. To be eligible to participate in the SERP III plan, executives must be on the AHSSHC corporate payroll and be either a CEO of an AdventHealth entity, an AHSSHC Vice President (VP) or VP of an AdventHealth entity with a base salary of at least $305,000 in 2022 (adjusted annually by the same percentage as IRC Section 401(a)(17) limit increases), or other leader specifically approved by the AdventHealth President. Eligible executives do not include grandfathered executives, meaning those executives who would satisfy all the eligibility requirements of the SERP II plan prior to Dec 31, 2027, had the plan not been amended and restated as of Jan. 1, 2020. Contribution credits will be established and maintained by class year accounts for each participant using tiered contribution credit percentages of annual base compensation. Contribution credit percentages range between 15% and 19% of base compensation. Contribution credits will be made each quarter in 25% increments with reductions in contributions if the executive is also a grandfathered FLEX participant (see below). SERP III provides for a class year vesting and payment schedule (7 years for each class year) with respect to amounts accumulated in the executive's deferred compensation account. Upon attainment of a normal retirement age (age 62), or upon certain other circumstances as defined in the SERP III plan document, all deferred amounts are paid immediately to the participant. For any executives working beyond the normal retirement age, future employer contributions will be made quarterly from SERP III directly to the participant as a taxable cash bonus. SERP II Plan: The SERP II plan is a defined benefit, non-tax-qualified deferred compensation plan for certain executives who have provided lengthy service to AdventHealth and/or to other Seventh-day Adventist Church hospitals or health care institutions. Under the provisions of the SERP II plan, benefits are provided to qualifying executive participants on a pro-rata schedule beginning with 20 years of service as an employee of AdventHealth and/or another hospital or health care institution controlled by the Seventh-day Adventist Church and who satisfy certain other qualifying criteria. Eligible employees are restricted to those executives who, as of January 1, 2020, satisfied, or if employment continues, will satisfy the eligibility requirements of SERP II prior to December 31, 2027. This supplemental executive retirement plan (SERP II) was designed to provide eligible executives with the economic equivalent of an annual income beginning at normal retirement age equal to 60% of the average of the participant's three, five or seven highest years of base salary from AdventHealth active employment inclusive of income from all other Seventh-day Adventist Church healthcare employer-financed retirement income sources and investment income earned on those contributions through social security normal retirement age as defined in the plan. The number of years included in highest average compensation is determined by the individual's year of entry to SERP II and by the individual's year of entry to the AdventHealth Executive FLEX Benefit Program. FLEX Plan: The Flex Plan was originally designed to provide eligible executives an opportunity to select from among a variety of supplemental benefits, including a split dollar life insurance policy and long-term care insurance, to individually tailor a benefits program appropriate to each executive's needs. In 2020, the Flex Plan was amended to exclude employed executives who are hired or promoted after a certain date from being eligible to participate in the Flex Plan except for certain insurance coverage features of the plan. The Flex Plan provides eligible participants a pre-determined benefits allowance credit that is equal to a percentage of the executive's base pay from which the cost of mandatory and elective employee benefits is deducted. The benefits allowance credit percentage for any plan year shall not be greater than the maximum dollar amount or the percentage of compensation as determined by the AdventHealth Benefits Administration Committee. For grandfathered eligible employees, the annual pre-determined Flex allowance is contributed and any funds that remain after the cost of mandatory and elective benefits are subtracted are, at the employee's option, contributed to either an IRC 457(f) deferred compensation account or to an IRC 457(b) eligible deferred compensation plan. Upon attainment of age 65, all previous 457(f) deferred amounts are paid immediately to the participant and any future employer contributions are made quarterly from the Plan directly to the participant. The Plan provides for a class year vesting schedule (2 years for each class year) with respect to amounts accumulated in the executive's 457(f) deferred compensation account. Distributions could also be made from the executive's 457(f) deferred compensation account upon attainment of age 65 or upon an involuntary separation. The account will be forfeited by the executive upon a voluntary separation. With respect to grandfathered participants, the Flex Plan documents define eligible employees to include the Chief Executive Officers of AdventHealth entities and Vice Presidents of all AdventHealth entities whose base salary was at least equal to the Internal Revenue Code Section 401(a)(17) compensation limit each year. FLEX Plan FLEX Plan SERP II SERP III SERP III Contr. Distr.* Contr/Distr Contr. Distr.* Bruce Bergherm $103,125 $ 82,625 $386,102 $ 0 $ 0 Erika Skula $ 55,551 $ 46,768 $651,508 $ 0 $ 0 Vadym Didenko $ 98,015 $ 101,582 $ 0 $ 0 $ 0 Erik Wangsness $ 67,378 $ 42,903 $ 0 $ 0 $ 0 Robin McGuinness $ 56,975 $ 57,069 $ 0 $ 4,953 $ 19,805 Jason Dunkel $ 38,310 $ 20,722 $ 0 $ 18,079 $ 0 Michel Longley, MD $ 32,050 $ 22,492 $ 0 $ 20,741 $ 0 Ryan Quattlebaum $ 0 $ 0 $ 0 $ 13,287 $ 0 * Including Investment Earnings

Schedule J (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

Tarpon Springs Hospital Foundation Inc

Employer identification number

59-0898901

Part I

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

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

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

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

Part II

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

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






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

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990) 2021

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Christine Longley	Family of Key Employee	112,777	Employee Compensation		No

Part V

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

Return Reference	Explanation

Schedule L (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

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

Tarpon Springs Hospital Foundation Inc

Employer identification number

59-0898901

Return Reference	Explanation
Part V, Line 1a	The parent corporation and sole top-tier member of Tarpon Springs Hospital Foundation, Inc. (the filing organization) is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). AHSSHC has established a shared service center to centralize the Accounts Payable (A/P) function for all AHSSHC subsidiary organizations. The filing organization has entered "0" in Part V, Line 1a because the filing organization no longer issues Form 1099 returns, rather, all such returns are filed by and under the name and EIN of AHSSHC as the payor subject to the information reporting requirements of Section 6041. The facts and circumstances support a position that AHSSHC, as a payor on behalf of its subsidiary organizations in a shared service environment, will have sufficient management and oversight in connection with the subsidiary organizations' payments to meet the standard set forth in Treas. Reg. Section 1.6041-1(e). AHSSHC will not merely be making payments at the direction of its subsidiary organizations. Accordingly, AHSSHC is considered the payor subject to the information reporting requirements of Section 6041.
Form 990, Part VI, Section A, line 6	Tarpon Springs Hospital Foundation, Inc., d/b/a AdventHealth North Pinellas (the filing organization) has one member. The sole member of the filing organization is University Community Hospital, Inc. (UCH). UCH is a Florida non-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) is the sole member of UCH. AHSSHC is the parent organization of a healthcare system that operates hospitals, nursing home facilities and other healthcare provider organizations. AHSSHC is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3).
Form 990, Part VI, Section A, line 7a	The Board of Directors of the filing organization is to consist of not less than 12 members. One half of the Board of Directors shall be composed of individuals who (i) have demonstrated knowledge and/or expertise in business or health care; (ii) are familiar with the communities served by the Hospital and/or are residents of the community served by the Hospital; and (iii) have a proven history of being able to participate effectively with others in order to fulfill the general stewardship responsibilities of a Director (the "Community Appointees"). The remaining one half of the Board of Directors are appointed to the Board by UCH as the Member.
Form 990, Part VI, Section A, line 7b	UCH, as the sole member of the filing organization, has certain reserved powers as set forth in the Bylaws of the filing organization. These reserved powers include the following: a) Approval of the selection of and removal of senior management of the filing organization; b) Approval of the filing organization's Articles of Incorporation; c) Approval of any material changes in services at the health care facilities; d) Approval of major building programs and purchases or sales of property in excess of $500,000 and sales/purchases of less than $500,000 when the filing organization's net revenues are not available for such purpose; e) Appointment of the Member Appointees and approval of the Community Appointees to the Board of Directors; and f) Approval of all operating and capital budgets and strategic plans of the filing organization. Adventist Health System Sunbelt Healthcare Corporation, as the 501(c)(3) top-tier member of the filing organization, has the following reserved powers: a) The authority to set limits and terms for all types of financial transactions exceeding $100,000; and b) The authority to secure naming rights and to direct the placement of funds and capital and the making of gifts, sponsorships, donations, loans, and transfers of funds or other assets by the filing organization in excess of $100,000.
Form 990, Part VI, Section B, line 11b	The filing organization's current year Form 990 was reviewed by the Board Chairman, Board Finance Committee Chair, CEO and by the CFO prior to its filing with the IRS. The review conducted by the Board Chairman, Board Finance Committee Chair, CEO and the CFO did not include the review of any supporting workpapers that were used in preparation of the current year Form 990, but did include a review of the entire Form 990 and all supporting schedules.
Form 990, Part VI, Section B, line 12c	The Conflict of Interest Policy of the filing organization applies to members of its Board of Trustees/Directors, its officers, executive employees, physician employees, and officers of the medical staff (to be known as Interested Persons). In connection with any actual or possible conflicts of interest, any member of the Board of Trustees/Directors of the filing organization or any other Interested Person of the filing organization must disclose the existence of any financial interest with the filing organization and must be given the opportunity to disclose all material facts concerning the financial interest/arrangement to the Board of Trustees/Directors of the filing organization or to any members of a committee with board delegated powers that is considering the proposed transaction or arrangement. Subsequent to any disclosure of any financial interest/arrangement and all material facts, and after any discussion with the relevant Interested Person, the remaining members of the Board of Trustees/Directors or committee with board delegated powers shall discuss, analyze, and vote upon the potential financial interest/arrangement to determine if a conflict of interest exists. According to the filing organization's Conflict of Interest Policy, an Interested Person may make a presentation to the Board of Trustees/Directors (or committee with board delegated powers), but after such presentation, shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that results in a conflict of interest. Each Interested Person, as defined under the filing organization's Conflict of Interest Policy, shall annually sign a statement which affirms that such person has received a copy of the Conflict of Interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the filing organization is a charitable organization that must primarily engage in activities which accomplish one or more of its exempt purposes. The filing organization's Conflict of Interest Policy also requires that periodic reviews shall be conducted to ensure that the filing organization operates in a manner consistent with its charitable purposes.
Form 990, Part VI, Section B, line 15	The filing organization's CEO, other officers and key employees are not compensated by the filing organization. Such individuals are compensated by the related top-tier parent organization of the filing organization. Please see the discussion concerning the process followed by the related top-tier parent organization in determining executive compensation in our response to Schedule J, Line 3.
Form 990, Part VI, Section C, line 19	The filing organization is a part of the system of healthcare organizations known as AdventHealth. The audited consolidated financial statements of AdventHealth and of the AdventHealth "Obligated Group" are filed annually with the Municipal Securities Rulemaking Board (MSRB). The "Obligated Group" is a group of AHSSHC subsidiaries that are jointly and severally liable under a Master Trust Indenture that secures debt primarily issued on a tax-exempt basis. Unaudited quarterly financial statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) are also filed with MSRB for AdventHealth on a consolidated basis and for the grouping of AdventHealth subsidiaries comprising the "Obligated Group". The filing organization does not generally make its governing documents or conflict of interest policy available to the public.
Part VII, Section A	For those Board of Director members who devote less than full-time to the filing organization (based upon the average number of hours per week shown in column (B) on page 7 of the return) the compensation amounts shown in columns (E) and (F) on page 7 were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position as an employee of Adventist Health System Sunbelt Healthcare Corporation.
Part VIII, Lines 7a, b and c:	The amount shown in Part VIII, Line 7c(i) of the Form 990 represent an allocated share of capital gain/(loss) from a system wide, corporate administered, investment program.
Form 990, Part IX, line 11g	Payments to Healthcare Professionals: Program service expenses 19,597,055. Management and general expenses 0. Fundraising expenses 0. Total expenses 19,597,055. Professional Fees: Program service expenses 4,405,165. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,405,165. Purchased Medical Services: Program service expenses 1,861,218. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,861,218. Environmental Services: Program service expenses 766,241. Management and general expenses 0. Fundraising expenses 0. Total expenses 766,241. Transcription Services: Program service expenses 17,336. Management and general expenses 0. Fundraising expenses 0. Total expenses 17,336. Recruiting: Program service expenses 121,719. Management and general expenses 0. Fundraising expenses 0. Total expenses 121,719. Food Service Contracts: Program service expenses 1,873. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,873. Miscellaneous Purchased Services: Program service expenses 10,266,864. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,266,864. AdventHealth Management Fees: Program service expenses 0. Management and general expenses 1,864,095. Fundraising expenses 0. Total expenses 1,864,095. Billing & Collection Services: Program service expenses 0. Management and general expenses 805,582. Fundraising expenses 0. Total expenses 805,582. AdventHealth Shared Services Fees: Program service expenses 0. Management and general expenses 1,442,622. Fundraising expenses 0. Total expenses 1,442,622.
Form 990, Part XI, line 9:	Transfer from Foundation 1,863,502. Transfer to Tax-Exempt Top-Tier Parent -616,779. Pension Liability adjustment -986,000. Transfer to Tax-Exempt Related Organization -178,579. Allocation to/from Tax-Exempt Parent with respect to debt 401,710. Change in Foundation Interest -2,659,235. Rounding -1.
Part XII, Line 3b OMB Circular A-133 Audit	Although the taxpayer is not required to undergo an audit as set forth in the Single Audit Act and OMB Circular A-133, the taxpayer is part of a controlled group of organizations that comprise a consolidated financial statement audit. The controlled group's parent is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), a 501(c)(3) organization. The system of healthcare entities owned and controlled by AHSSHC is known as AdventHealth. For the year ended December 31, 2022, AdventHealth will file a consolidated Single Audit which will include all entities that are part of the controlled group. Accordingly, the taxpayer has checked yes to the questions on Part XII, line 3a and 3b.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

Tarpon Springs Hospital Foundation Inc

Employer identification number

59-0898901

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)AdventHealth Ashville Inc (5922 - 123122) 900 Hope Way Altamonte Springs,FL32714 92-1144574	Future Operation of Hospital & Related Services	NC	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(2)AdventHealth Family Medicine Rural Health Clinics Inc 187 PR 4060 Lampasas,TX76550 27-1858033	Operation of Rural Health Clinics & Medical Services	FL	501(c)(3)	Line 3	Metroplex Adventist Hospital Inc	Yes
(3)AdventHealth Foundation fka SunSystem Development Corp 900 Hope Way Altamonte Springs,FL32714 59-2219301	Fund-Raising for Affiliated Tax-Exempt Hospitals	FL	501(c)(3)	Line 7	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(4)AdventHealth Home Care East Florida LLC 770 West Granada Blvd 319 Ormond Beach,FL32174 83-3768458	Inactive	FL	501(c)(3)	Line 10	Memorial Hlth Systems Inc	Yes
(5)AdventHealth Hospice Care East Florida Inc 770 West Granada Blvd 304 Ormond Beach,FL32174 83-3748461	Inactive	FL	501(c)(3)	Line 10	Memorial Hlth Systems Inc	Yes
(6)AdventHealth Kansas City Foundation 7315 E Frontage Road Merriam,KS66204 48-0868859	Fund-raising for Tax-exempt hospitals	KS	501(c)(3)	Line 7	Shawnee Mission Medical Center Inc	Yes
(7)AdventHealth North Polk Inc 3100 E Fletcher Ave Tampa,FL33613 59-3231322	Inactive	FL	501(c)(3)	Line 12a, I	University Community Hospital Inc	Yes
(8)AdventHealth Palm Coast Parkway Inc fka AH East Florida Inc 900 Hope Way Altamonte Springs,FL32714 88-2288563	Future Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(9)AdventHealth Polk North Inc 40100 US Highway 27 N Davenport,FL33837 84-1793121	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(10)AdventHealth Polk South Inc 410 South 11th Street Lake Wales,FL33853 83-4672945	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(11)AdventHealth Ransom Memorial Inc 1301 S Main Street Ottawa,KS66067 83-0976641	Operation of Hospital & Related Services	KS	501(c)(3)	Line 3	Adventist Hlth Mid-America Inc	Yes
(12)AdventHealth Riverview Inc 14055 Riveredge Drive Ste 150 Tampa,FL33637 87-0901094	Future Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(13)AdventHealth Senior Care Inc 900 Hope Way Altamonte Springs,FL32714 84-1817046	Operation of Physician Practices & Medical Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(14)AdventHealth South Overland Park Inc 7820 W 165th Street Overland Park,KS66223 36-4595806	Operation of Hospital & Related Services	KS	501(c)(3)	Line 3	Adventist Hlth Mid-America Inc	Yes
(15)AdventHealth University Inc 671 Winyah Drive Orlando,FL32803 59-3069793	Education/Operation of School	FL	501(c)(3)	Line 2	Adventist Hlth SystemSunbelt Inc	Yes
(16)AdventHealth West Florida Ambulatory Services Inc 14055 Riveredge Drive Ste 250 Tampa,FL33637 47-1881744	Support of Imaging Center & Home Health Subsidiaries	FL	501(c)(3)	Line 12b, II	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(17)AdventHealth West Florida Imaging Inc 14055 Riveredge Drive Ste 250 Tampa,FL33637 84-3225135	Imaging & Testing	FL	501(c)(3)	Line 3	AdventHealth West Florida Ambulatory Services Inc	Yes
(18)Adventist Bolingbrook Hospital 500 Remington Blvd Bolingbrook,IL60440 65-1219504	Operation of Hospital & Related Services	IL	501(c)(3)	Line 3	Adventist Midwest Health	Yes
(19)Adventist Care Centers - Courtland Inc 730 Courtland Street Orlando,FL32804 20-5774723	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(20)Adventist GlenOaks Hospital 701 Winthrop Avenue Glendale Heights,IL60139 36-3208390	Operation of Hospital & Related Services	IL	501(c)(3)	Line 3	Adventist Midwest Health	Yes
(21)Adventist Health Mid-America Inc 9100 W 74th Street Shawnee Mission,KS66204 52-1347407	Support of Affiliated Hospital	KS	501(c)(3)	Line 12c, III-FI	Adventist Hlth SystemSunbelt Inc	Yes
(22)Adventist Health Partners Inc 5101 S Willow Springs Rd Suite B101 La Grange,IL60525 36-4138353	Operation of Physician Practices & Medical Services	IL	501(c)(3)	Line 3	Adventist Midwest Health	Yes
(23)Adventist Health System Georgia Inc 1035 Red Bud Road NE Calhoun,GA30701 58-1425000	Operation of Hospital & Related Services	GA	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(24)Adventist Hlth System Sunbelt Hlthcare Corp 900 Hope Way Altamonte Springs,FL32714 59-2170012	Management Services	FL	501(c)(3)	Line 12a, I	N/A		No
(25)Adventist Hlth SystemSunbelt Inc 900 Hope Way Altamonte Springs,FL32714 59-1479658	Operation of Hospitals & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(26)Adventist Hlth SystemTexas Inc 11801 S Freeway Burleson,TX76028 74-2578952	Leasing Personnel to Affiliated Hospital	TX	501(c)(3)	Line 12c, III-FI	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(27)Adventist Midwest Health 120 North Oak Street Hinsdale,IL60521 36-2276984	Operation of Hospitals & Related Services	IL	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(28)AHP Specialty Care NFP 5101 S Willow Springs Rd Suite B101 La Grange,IL60525 81-1105774	Operation of Physician Practices & Medical Services	IL	501(c)(3)	Line 3	Adventist Midwest Health	Yes
(29)AHS Midwest Management Inc 500 Remington Blvd Bolingbrook,IL60440 36-3354567	Operation of Physician Practice Management	IL	501(c)(3)	Line 12a, I	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(30)Apopka Health Care Properties Inc 305 E Oak Street Apopka,FL32703 51-0605694	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(31)Bert Fish Medical Center Auxiliary Inc 401 Palmetto Street New Smyrna Beach,FL32168 59-1054892	Volunteer support services	FL	501(c)(3)	Line 10	Southeast Volusia Healthcare Corp		No
(32)Bradford Heights Health & Rehab Center Inc (11-122222) 485 North Keller Road 250 Maitland,FL32751 20-5782342	Inactive - Wind-Down	KY	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(33)Burleson Nursing & Rehab Center Inc 301 Huguley Blvd Burleson,TX76028 20-5782243	Operation of Home for the Aged/Hlthcare Delivery	TX	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(34)Chickasaw Health Care Properties Inc 250 S Chickasaw Trail Orlando,FL32825 51-0605681	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(35)Chippewa Valley Hospital & Oakview Care Center Inc 1220 Third Avenue West Durand,WI54736 39-1365168	Operation of Hospital & Related Services	WI	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(36)Coalition For Physician Well-Being Inc 900 Hope Way Altamonte Springs,FL32714 46-3477012	Provide support for Physician well-being	FL	501(c)(3)	Line 10	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(37)Courtland Health Care Properties Inc 730 Courtland Street Orlando,FL32804 51-0605682	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(38)Creekwood Place Nursing & Rehab Center Inc (11-12622) 485 North Keller Road 250 Maitland,FL32751 20-5782260	Inactive - Wind-Down	KY	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(39)Dairy Road Health Care Properties Inc 7350 Dairy Road Zephyrhills,FL33540 51-0605684	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(40)East Orlando Health & Rehab Center Inc 250 S Chickasaw Trail Orlando,FL32825 20-5774748	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(41)Fletcher Hospital Inc 100 Hospital Drive Hendersonville,NC28792 56-0543246	Operation of Hospital & Related Services	NC	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(42)FLNC Inc 3355 E Semoran Blvd Apopka,FL32703 20-5774761	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(43)Florida Hospital Dade City Inc 13100 Fort King Road Dade City,FL33525 82-2567308	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(44)Florida Hospital Healthcare Partners Inc 770 West Granada Blvd 101 Ormond Beach,FL32174 46-2354804	Operation of Physician Practices & Medical Services	FL	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(45)Florida Hospital Medical Group Inc 2600 Westhall Lane 4th Floor Maitland,FL32751 59-3214635	Operation of Physician Practices & Medical Services	FL	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(46)Florida Hospital Ocala Inc 1500 SW 1st Avenue Ocala,FL34471 82-4372339	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(47)Florida Hospital Physician Group Inc 12470 Telecom Dr 100 Tampa,FL33637 46-2021581	Operation of Physician Practices & Medical Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(48)Florida Hospital Waterman Inc 1000 Waterman Way Tavares,FL32778 59-3140669	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(49)Florida Hospital Zephyrhills Inc 7050 Gall Blvd Zephyrhills,FL33541 59-2108057	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(50)Florida Radiology Imaging at Lake Mary LLC 2600 Westhall Lane 4th Floor Maitland,FL32751 55-0789387	Imaging & Testing	FL	501(c)(3)	Line 3	Florida Hospital Medical Group Inc	Yes
(51)Fountain Inn Nursing & Rehab Center Inc 4501 Waterman Way Tavares,FL32778 47-2180518	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(52)Helen Ellis Memorial Hospital Auxiliary Inc 1395 S Pinellas Ave Tarpon Springs,FL34689 59-2106043	Fund-raising for Tax-exempt hospital/foundation	FL	501(c)(3)	Line 12c, III-FI	N/A		No
(53)Helen Ellis Memorial Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs,FL34689 59-3690149	Fund-raising for Tax-exempt hospital	FL	501(c)(3)	Line 7	N/A		No
(54)Hinsdale Hospital Foundation 120 North Oak Street Hinsdale,IL60521 52-1466387	Fund-raising for Tax-exempt hospital	IL	501(c)(3)	Line 7	Midwest Hlth Foundation		No
(55)Hospice of the Comforter Inc 480 W Central Parkway Altamonte Springs,FL32714 59-2935928	Operation of Hospice	FL	501(c)(3)	Line 10	The Comforter Health Care Group Inc	Yes
(56)In-Motion Rehab Inc (11-122722) 485 North Keller Road 250 Maitland,FL32751 20-8023411	Inactive	KS	501(c)(3)	Line 12b, II	Sunbelt Hlth Care Centers Inc	Yes
(57)Lake County Health Care Properties Inc (11-122822) 485 North Keller Road 250 Maitland,FL32751 81-3923985	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(58)Memorial Health Systems Foundation Inc 305 Memorial Medical Pkwy 212 Daytona Beach,FL32117 31-1771522	Fund-raising for Tax-exempt hospital	FL	501(c)(3)	Line 7	N/A		No
(59)Memorial Health Systems Inc 301 Memorial Medical Parkway Daytona Beach,FL32117 59-0973502	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(60)Memorial Hospital - West Volusia Inc 701 West Plymouth Avenue Deland,FL32720 59-3256803	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Memorial Hlth Systems Inc	Yes
(61)Memorial Hospital Flagler Inc 60 Memorial Medical Parkway Palm Coast,FL32164 59-2951990	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Memorial Hlth Systems Inc	Yes
(62)Memorial Hospital Inc 210 Marie Langdon Drive Manchester,KY40962 61-0594620	Operation of Hospital & Related Services	KY	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(63)Metroplex Adventist Hospital Inc 2201 S Clear Creek Road Killeen,TX76549 74-2225672	Operation of Hospital & Related Services	TX	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(64)Metroplex Clinic Physicians Inc 2201 S Clear Creek Road Killeen,TX76549 11-3762050	Physician Healthcare services to the community	TX	501(c)(3)	Line 3	Metroplex Adventist Hospital Inc	Yes
(65)Midwest Health Foundation 120 North Oak Street Hinsdale,IL60521 35-2230515	Fund-Raising for Supported Exempt Hospitals	IL	501(c)(3)	Line 7	N/A		No
(66)Mills Health & Rehab Center Inc(11-12622) 485 North Keller Road 250 Maitland,FL32751 20-5782320	Inactive - Wind-Down	KY	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(67)Mission Strategies of Georgia Inc 485 North Keller Road 250 Maitland,FL32751 90-0866024	Provision of support to the nursing home division	GA	501(c)(3)	Line 12b, II	Sunbelt Hlth Care Centers Inc	Yes
(68)Missouri Adventist Health Inc 9100 W 74th Street Shawnee Mission,KS66204 43-1224729	Support Health Care Services	MO	501(c)(3)	Line 12d, III-O	Adventist Hlth Mid-America Inc	Yes
(69)Osceola Health Care Properties Inc 485 North Keller Road 250 Maitland,FL32751 81-3165729	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(70)Overland Park Nursing & Rehab Center Inc 6501 West 75th Street Overland Park,KS66204 20-5774821	Operation of Home for the Aged/Hlthcare Delivery	KS	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(71)Pasco-Pinellas Hillsborough Community Hlth System Inc 2600 Bruce B Downs Blvd Wesley Chapel,FL33544 20-8488713	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(72)Portercare Adventist Health System (630 YE) 9100 E Mineral Circle Centennial,CO80112 84-0438224	Operation of Hospitals & Related Services	CO	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(73)Princeton Health & Rehab Center Inc (11-12622) 485 North Keller Road 250 Maitland,FL32751 20-5782272	Inactive - Wind-Down	KY	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(74)Princeton Homecare Services LLC (81 - 123122) 602 Courtland Street 310 Orlando,FL32804 81-4196648	Home Health Care Servcies	FL	501(c)(3)	Line 10	Princeton Prof Services Inc	Yes
(75)Princeton Professional Services Inc 601 E Rollins Street Orlando,FL32803 59-1191045	Provision of Healthcare Services	FL	501(c)(3)	Line 10	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(76)Quality Circle for Healthcare Inc 900 Hope Way Altamonte Springs,FL32714 26-3789368	Healthcare Quality Services	FL	501(c)(3)	Line 12a, I	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(77)Redmond Park Hospital LLC 501 Redmond Road NW Rome,GA30165 58-1123037	Operation of Hospital & Related Services	GA	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(78)Resource Personnel Inc 485 North Keller Road 250 Maitland,FL32751 20-8040875	Provide administrative support to tax exempt nursing homes	FL	501(c)(3)	Line 12b, II	Sunbelt Hlth Care Centers Inc	Yes
(79)Rocky Mountain Adventist Hlthcare Foundation (630 YE) 960 E Harvard Avenue Ste 230 Denver,CO80210 84-0745018	Fund-raising for Tax-exempt hospital	CO	501(c)(3)	Line 7	N/A		No
(80)Rollins Brook Community Care Corp 2201 S Clear Creek Road Killeen,TX76549 46-1656773	Support Operation of Hospital	TX	501(c)(3)	Line 12a, I	Adventist Hlth SystemSunbelt Inc	Yes
(81)San Marcos Nursing & Rehab Center Inc 1900 Medical Parkway San Marcos,TX78666 20-5782224	Operation of Home for the Aged/Hlthcare Delivery	TX	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(82)Shawnee Mission Hlth Care Properties Inc 485 North Keller Road 250 Maitland,FL32751 81-3914908	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(83)Shawnee Mission Health Care Inc 6501 West 75th Street Overland Park,KS66204 48-0952508	Lease to Related Organization	KS	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(84)Shawnee Mission Medical Center Inc 9100 W 74th Street Shawnee Mission,KS66204 48-0637331	Operation of Hospital & Related Services	KS	501(c)(3)	Line 3	Adventist Hlth Mid-America Inc	Yes
(85)South Pasco Health Care Properties Inc 38250 A Avenue Zephyrhills,FL33542 51-0605679	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(86)Southeast Volusia Healthcare Corp 401 Palmetto Street New Smyrna Beach,FL32168 47-3793197	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(87)Southwest Volusia Health Services Inc 1055 Saxon Blvd Orange City,FL32763 59-3281591	Medical Office Building for Hospital	FL	501(c)(3)	Line 12a, I	Southwest Volusia Hlthcare Corp	Yes
(88)Southwest Volusia Healthcare Corp 1055 Saxon Blvd Orange City,FL32763 59-3149293	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth SystemSunbelt Inc	Yes
(89)Spring View Health & Rehab Center Inc (11-122222) 485 North Keller Road 250 Maitland,FL32751 20-5782288	Inactive - Wind-Down	KY	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(90)Sunbelt Health & Rehab Center - Apopka Inc 305 East Oak Street Apopka,FL32703 20-5774856	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(91)Sunbelt Health Care Centers Inc 485 North Keller Road 250 Maitland,FL32751 58-1473135	Management Services	TN	501(c)(3)	Line 12b, II	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(92)Tarpon Springs Hospital Foundation Inc 1395 S Pinellas Ave Tarpon Springs,FL34689 59-0898901	Operation of Hospital & Related Services	FL	501(c)(3)	Line 3	University Community Hospital Inc	Yes
(93)Tarrant County Health Care Properties Inc 301 Huguley Blvd Burleson,TX76028 51-0605677	Lease to Related Organization	GA	501(c)(3)	Line 12c, III-FI	Sunbelt Hlth Care Centers Inc	Yes
(94)The Comforter Health Care Group Inc 605 Montgomery Road Altamonte Springs,FL32714 27-1857940	Support Services to Related Hospice	FL	501(c)(3)	Line 12c, III-FI	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(95)Tri-County Nursing and Rehab Center Inc 1290 Celebration Blvd Kissimmee,FL34747 47-2219363	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(96)University Community Hospital Foundation Inc 3100 E Fletcher Ave Tampa,FL33613 59-2554889	Fund-raising for Tax-exempt hospital	FL	501(c)(3)	Line 7	N/A		No
(97)University Community Hospital Inc 3100 E Fletcher Ave Tampa,FL33613 59-1113901	Operation of Hospitals & Related Services	FL	501(c)(3)	Line 3	Adventist Hlth System Sunbelt Hlthcare Corp	Yes
(98)West Florida Health Home Care Inc 13601 Bruce B Downs Blvd Ste 110 Tampa,FL33613 59-3686109	Home Health Services	GA	501(c)(3)	Line 10	AdventHealth West Florida Ambulatory Svcs Inc	Yes
(99)Zephyr Haven Health & Rehab Center Inc 38250 A Avenue Zephyrhills,FL33542 20-5774930	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes
(100)Zephyrhills Health & Rehab Center Inc 7350 Dairy Road Zephyrhills,FL33540 20-5774967	Operation of Home for the Aged/Hlthcare Delivery	FL	501(c)(3)	Line 10	Sunbelt Hlth Care Centers Inc	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 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) Fletcher Hospital Surgical Ventures LLC 9131 Anson Way Ste 304 Raleigh,NC27615 86-1482646	Indirect Interest in Surgery Center	NC	N/A				No			No
(2) Florida Hospital DMERT LLC 500 Winderley Place Ste 324 Maitland,FL32751 20-2392253	Medical Equipment	FL	N/A				No		Yes
(3) Florida Hospital Home Infusion LLP 500 Winderley Place Ste 226 Maitland,FL32751 59-3142824	Home Infusion Services	FL	N/A				No		Yes
(4) Functional Neurosurgical Ambulatory Surgery Ctr LLC 11 W Dry Creek Circle 120 Littleton,CO80120 46-4426708	Surgery Center	CO	N/A				No			No
(5) M&O Orlando MOB I LLC 1919 N Orange Ave Ste E Orlando,FL32804 84-4259138	Operation of Medical Office Building	DE	N/A				No			No
(6) OnPoint OBGYN LLC (21-123122) 7780 S Broadway 280 Littleton,CO80122 87-3522453	Healthcare Services	CO	N/A				No			No
(7) PAHS OnPoint Imaging LLC 9205 S Broadway Highlands Ranch,CO80129 83-3275105	Imaging Center	CO	N/A				No			No
(8) PAHS OnPoint Urgent Care LLC 9100 E Mineral Circle Centennial,CO80112 83-2465331	Urgent Care Center	CO	N/A				No			No
(9) Princeton Homecare Services LLC (11-8122) 602 Courtland Street 310 Orlando,FL32804 81-4196648	Operation of Home Health Agency	FL	N/A				No			No
(10) Surgery Center of Rome LP 501 Redmond Road NW Rome,GA30165 20-0390305	Surgery Center	GA	N/A				No			No
(11) The Bariatric Center of Kansas City LLC 9100 W 74th Street Merriam,KS66204 82-3025378	Surgery Center	KS	N/A				No			No
(12) Urgent Care Centers of Brevard County LLC 2600 Westhall Lane Maitland,FL32751 84-4261523	Urgent Care Centers	FL	N/A				No		Yes

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(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) AdventHealth Orlando Network Inc (11 - 41922) 900 Hope Way Altamonte Springs,FL32714 86-2639185	Inactive	FL	N/A	C				Yes
(2) AdventHealth Professional Staffing Inc (11 - 12822) 900 Hope Way Altamonte Springs,FL32714 88-0742779	INACTIVE	FL	N/A	C				Yes
(3) AdventHealth Tampa Network Inc (11 - 41922) 900 Hope Way Altamonte Springs,FL32714 86-2666178	Inactive	FL	N/A	C				Yes
(4) AdventHealth Team Members Inc (11 - 12822) 900 Hope Way Altamonte Springs,FL32714 88-0763664	INACTIVE	FL	N/A	C				Yes
(5) AdventHealth Value Based Bundle Management LLC (61-123122) 101 Southhall Lane Ste 150 Maitland,FL32751 87-3487910	Medical Contracting and Billing	FL	N/A	C				Yes
(6) Altamonte Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando,FL32803 59-2855792	Condo Association	FL	N/A	C				Yes
(7) Apopka Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando,FL32803 59-3000857	Condo Association	FL	N/A	C				Yes
(8) Battle Creek Adventist Hospital 900 Hope Way Altamonte Springs,FL32714 38-1359189	Inactive	MI	N/A	C				Yes
(9) Florida Hospital Flagler Medical Offices Association Inc 60 Memorial Medical Parkway Palm Coast,FL32164 26-2158309	Condo Association	FL	N/A	C				Yes
(10) Florida Hosp Hlth Village Property Owner's Assoc Inc 550 E Rollins Street 7th Floor Orlando,FL32803 82-1748255	Condo Association	FL	N/A	C				Yes
(11) Florida Hospital Healthcare System Inc 101 Southhall Lane Ste 150 Maitland,FL32751 59-3215680	PHSO / CIN	FL	N/A	C				Yes
(12) Florida Medical Plaza Condominium Association Inc 601 East Rollins Street Orlando,FL32803 59-2855791	Condo Association	FL	N/A	C				Yes
(13) Kissimmee Multispecialty Clinic Condominium Association Inc 201 Hilda Street Suite 30 Kissimmee,FL34741 59-3539564	Condo Association	FL	N/A	C				Yes
(14) Midwest Management Services Inc 9100 West 74th Street Shawnee Mission,KS66204 48-0901551	Inactive	KS	N/A	C				Yes
(15) North American Health Services Inc & Sub 900 Hope Way Altamonte Springs,FL32714 62-1041820	Holding Co.	TN	N/A	C				Yes
(16) Ormond Prof Associates Condo Assoc Inc (430 year end) 770 W Granada Blvd Ste 101 Ormond Beach,FL32174 59-2694434	Condo Association	FL	N/A	C				Yes
(17) Park Ridge Property Owner's Association Inc 1 Park Place Naples Road Fletcher,NC28732 03-0380531	Condo Association	NC	N/A	C				Yes
(18) Park Ridge Condominium #1 Unit Owners Association Inc 1 Park Place Naples Road Fletcher,NC28732 01-0584623	Condo Association	NC	N/A	C				Yes
(19) Surgicare of Rome Inc 501 Redmond Rd Rome,GA30165 20-0376307	Holding Company	GA	N/A	C				Yes
(20) Redmond Park Health Services Inc 501 Redmond Rd Rome,GA30165 62-1330078	Holding Company	GA	N/A	C				Yes
(21) The Garden Retirement Community Inc 485 North Keller Road Ste 250 Maitland,FL32751 59-3414055	Real Estate Rental	FL	N/A	C				Yes
(22) Winter Park Medical Office Building I Condo Assoc Inc 601 East Rollins Street Orlando,FL32803 45-2228478	Condo Association	FL	N/A	C				Yes

Schedule R (Form 990) 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 .....................

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

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

Yes

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

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

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

Yes

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

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

Yes

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

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Adventist Health System Sunbelt Healthcare Corp	M	1,347,415	% of facility's operating exp.
(2) Adventist Health System Sunbelt Healthcare Corp dba AH Info Technology	M	5,898,748	% of facility's operating exp.
(3) Adventist Health System Sunbelt Healthcare Corp-Shared Services	M	1,442,622	% of facility's operating exp.
(4) Adventist Health System Sunbelt Healthcare Corp	P	7,321,697	Cost
(5) Adventist Health System Sunbelt Healthcare Corp	B	616,779	Actual Amount Given
(6) AdventHealth West Florida Ambulatory Services Inc	R	178,579	Actual Amount Given
(7) University Community Hospital Inc	P	8,831,597	Cost
(8) Florida Hospital Physician Group Inc	P	5,586,571	Cost
(9) Helen Ellis Memorial Hospital Foundation Inc	B	510,512	Actual Amount Given
(10) Helen Ellis Memorial Hospital Foundation Inc	C	1,818,553	Actual Amount Received

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: The provision of medical care to the community through the operation of one general acute care hospital with a total of 168 beds.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	7
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	1,117
6	Total number of volunteers (estimate if necessary) .............	6	108
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	1,878
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) .........	4,103,398	50,984
9	Program service revenue (Part VIII, line 2g) .........	137,907,103	149,048,773
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	104,561	242,065
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	142,115,062	149,341,822
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	553,412	545,646
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)	55,784,960	71,499,221
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)....	88,573,884	94,771,241
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	144,912,256	166,816,108
19	Revenue less expenses. Subtract line 18 from line 12.......	-2,797,194	-17,474,286
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	116,633,238	121,424,106
21	Total liabilities (Part X, line 26).............	82,089,794	107,803,544
22	Net assets or fund balances. Subtract line 21 from line 20.....	34,543,444	13,620,562

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 156,895,097 including grants of $ 545,646 ) (Revenue $ 149,046,895 )
	Operation of acute care hospital totaling 168 beds with 6,384 patient admissions resulting in 36,902 patient days in the current year and 56,795 outpatient visits and 17,536 physician clinic patient visits.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses156,895,097

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) Grzanowski Macye........................................................................ Nursing Director	41.50 .......................0.00	X		164,926	0	35,336
(19) Henderson Anna........................................................................ Team Lead Critical Care	48.10 .......................0.00	X		162,757	0	16,638
(20) Allgire Michele........................................................................ Clinical Pharmacist	40.30 .......................0.00	X		166,319	0	10,941
(21) Van OschMichelle........................................................................ Seasonal RN	40.00 .......................0.00	X		163,304	0	0
(22) Heinrich Caleb........................................................................ Former CFO	0.00 .......................50.00		X	0	180,824	41,119
(23) McGuinness Robin........................................................................ Division CNO-Former Key Emp	2.78 .......................47.22		X	0	633,401	89,768

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	838,636	7,011,279	1,004,925

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	50,984

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.......		50,984

		Business Code
2a	Net patient revenue	622110	148,501,895	148,501,895
b	Cafeteria revenue	622110	389,085	389,085
c	Medical Office Building	622110	8,072	6,194	1,878
d
e
f	All other program service revenue.		149,721	149,721
g	Total. Add lines 2a–2f .....		149,048,773

3 Investment income (including dividends, interest, and othersimilar amounts) ......			277,005			277,005
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	102,925		7a
b	Less: cost or other basis and sales expenses	0	137,865	7b
c	Gain or (loss)	102,925	-137,865	7c
d	Net gain or (loss).........			-34,940			-34,940
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
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			149,341,822	149,046,895	1,878	242,065

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	545,646	545,646
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	1,813,572		1,813,572
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........	53,040,718	53,040,718
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,506,426	1,472,602	33,824
9	Other employee benefits .......	11,326,762	11,077,998	248,764
10	Payroll taxes ...........	3,811,743	3,726,158	85,585
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	2,127		2,127
c	Accounting ...........	85,046		85,046
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	23,599		23,599
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	41,149,770	37,037,471	4,112,299
12	Advertising and promotion ....	792,303		792,303
13	Office expenses .......	2,809,208	1,623,320	1,185,888
14	Information technology ......	8,986,364	8,475,929	510,435
15	Royalties ..
16	Occupancy ...........	4,114,503	4,114,503
17	Travel ............	116,839	11,220	105,619
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	306,715		306,715
20	Interest ...........	2,033,802	2,033,802
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	5,760,957	5,760,957
23	Insurance ...	2,096,153	1,992,784	103,369
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	20,621,142	20,621,142
b	Repairs & maintenance	3,776,946	3,776,946
c	State Tax Indigent Asse	1,583,766	1,583,766
d
e	All other expenses	512,001	135	511,866
25	Total functional expenses. Add lines 1 through 24e	166,816,108	156,895,097	9,921,011	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 ........			598	1	601
2	Savings and temporary cash investments .........				2	0
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			18,737,096	4	20,879,956
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7	0
8	Inventories for sale or use ............			3,413,945	8	4,442,220
9	Prepaid expenses and deferred charges ......			4,852,970	9	4,895,224
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	123,212,753
b	Less: accumulated depreciation	10b	38,150,836	81,551,747	10c	85,061,917
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			8,076,882	15	6,144,188
16	Total assets. Add lines 1 through 15 (must equal line 33)...			116,633,238	16	121,424,106

17	Accounts payable and accrued expenses .....	12,279,343	17	10,824,884
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	69,810,451	25	96,978,660
26	Total liabilities. Add lines 17 through 25..	82,089,794	26	107,803,544

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	28,184,747	27	9,921,100
28	Net assets with donor restrictions ...........	6,358,697	28	3,699,462
	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 ...........	34,543,444	32	13,620,562
33	Total liabilities and net assets/fund balances ........	116,633,238	33	121,424,106