Form990


Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
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OMB No. 1545-0047
2021
Open to Public Inspection
A For the 2021 calendar year, or tax year beginning 07-01-2022 , and ending 06-30-2023
BCheck if applicable:
CName of organization
Portercare Adventist Health System
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
6061 S Willow Drive
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Greenwood Village, CO80111
D Employer identification number

84-0438224
E Telephone number

G Gross receipts $ 1,539,602,702
F Name and address of principal officer:
Brett Spenst
6061 S Willow Drive
Greenwood Village,CO80111
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
https://www.adventhealth.com
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. See instructions.
H(c)
Group exemption number MediumBullet1071
K Form of organization:  
L Year of formation: 1930
M State of legal domicile: CO
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: Our company, a faith based organization, invests in charity care, community programs and sponsorships designed to nurture the health of the people of Colorado with a goal to keep them healthy.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 5
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 2
5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) ...... 5 6,878
6 Total number of volunteers (estimate if necessary) ............. 6 706
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 2,475,839
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 12,381,852 352,291
9 Program service revenue (Part VIII, line 2g) ......... 1,434,991,828 1,514,190,632
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 26,031,640 11,152,807
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 10,822,520 10,341,453
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 1,484,227,840 1,536,037,183
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,986,824 2,386,590
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) 522,499,302 571,928,748
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 845,590,567 894,231,813
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,370,076,693 1,468,547,151
19 Revenue less expenses. Subtract line 18 from line 12....... 114,151,147 67,490,032
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,937,409,919 1,992,859,331
21 Total liabilities (Part X, line 26)............. 503,031,555 499,722,731
22 Net assets or fund balances. Subtract line 21 from line 20..... 1,434,378,364 1,493,136,600
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2021)
Form 990 (2021)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: We extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 1,241,321,768 including grants of $ 2,386,589 ) (Revenue $ 1,522,056,246 )
Operation of 5 acute care hospitals with 34,115 patient admissions, 149,432 patient days and 302,938 outpatient visits in the current year. In addition to hospital operations, the corporation provides medical care through a number of other activities such as urgent care centers, physician clinics, home health services, hospice services, sleep centers, wound centers, therapy and rehab.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet1,241,321,768
Form 990 (2021)
Form 990 (2021)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment
List of Attached Documents:
// Content
.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. Click to see attachment
List of Attached Documents:
// Content
...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment
List of Attached Documents:
// Content
.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment
List of Attached Documents:
// Content
.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment
List of Attached Documents:
// Content
..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment
List of Attached Documents:
// Content
.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment
List of Attached Documents:
// Content
....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D,
Part IIIClick to see attachment
List of Attached Documents:
// Content
..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment
List of Attached Documents:
// Content
..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D,
Part VI. Click to see attachment
List of Attached Documents:
// Content
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment
List of Attached Documents:
// Content
.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment
List of Attached Documents:
// Content
.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment
List of Attached Documents:
// Content
............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
List of Attached Documents:
// Content
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
List of Attached Documents:
// Content
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII
Click to see attachment
List of Attached Documents:
// Content
......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
List of Attached Documents:
// Content
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
List of Attached Documents:
// Content
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
List of Attached Documents:
// Content
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
List of Attached Documents:
// Content
21
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
List of Attached Documents:
// Content
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
List of Attached Documents:
// Content
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I .... Click to see attachment
List of Attached Documents:
// Content
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................Click to see attachment
List of Attached Documents:
// Content
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part IIClick to see attachment
List of Attached Documents:
// Content
...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part IIIClick to see attachment
List of Attached Documents:
// Content
.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................Click to see attachment
List of Attached Documents:
// Content
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....Click to see attachment
List of Attached Documents:
// Content
28b
Yes
 
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
List of Attached Documents:
// Content
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
List of Attached Documents:
// Content
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
List of Attached Documents:
// Content
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
List of Attached Documents:
// Content
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
List of Attached Documents:
// Content
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
6,878
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. See instructions.
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2021)
Form 990 (2021)
Page 6
Part VI
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
5
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
2
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
No
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletJeremy Pittman6061 S Willow Drive   Greenwood Village,CO80111 (303) 643-1229
Form 990 (2021)
Form 990 (2021)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.

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

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

See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W-2/1099-MISC/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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Rathbun Paul......................................................................
Board Member / AH CFO
1.00
.................
50.00
X           0 2,536,010 211,956
(2) Bacon Kenneth......................................................................
Board Chairman/AH CEO Multi State
5.00
.................
45.00
X           0 1,621,638 290,272
(3) Houmann Lars......................................................................
Board Member
1.00
.................
1.00
X           0 682,872 13,112
(4) Thurber Gary......................................................................
Board Member
1.00
.................
3.00
X           0 6,063 0
(5) Thurber John Mic......................................................................
Board Member
1.00
.................
2.00
X           0 5,088 0
(6) Enderson Dan......................................................................
Secretary-Group President
5.00
.................
45.00
    X       0 1,659,367 256,943
(7) Gaasch Andrew......................................................................
Treasurer/CFO
5.00
.................
45.00
    X       0 1,263,429 215,974
(8) Goebel Michael......................................................................
CEO Parker Adventist Hospital
50.00
.................
0.00
      X     0 879,818 135,883
(9) Folkenberg Todd......................................................................
CEO Porter Adventist Hospital
50.00
.................
0.00
      X     0 759,525 134,932
(10) Sendros Isaac......................................................................
CEO Avista Adv Hosp(end 2/23)
50.00
.................
0.00
      X     0 550,929 107,665
(11) Pittman Jeremy......................................................................
CEO Castle Rock Adv Hospital
50.00
.................
0.00
      X     0 441,716 89,615
(12) Travis Carol......................................................................
CFO Avista Adv Hospital
50.00
.................
0.00
      X     0 353,151 36,569
(13) Ward Erin......................................................................
CFO Parker Adv Hospital
50.00
.................
0.00
      X     0 347,363 7,212
(14) Whitlock Andrew......................................................................
CFO Porter Adv Hosp(beg 12/22)
50.00
.................
0.00
      X     0 194,516 36,569
(15) Dodds Rick......................................................................
CEO Littleton Adv Hospital
50.00
.................
0.00
      X     0 794,364 76,509
(16) Gal Matt......................................................................
CFO Castle Rock Adv Hospital
50.00
.................
0.00
      X     0 272,573 8,095
(17) Still Danae......................................................................
CFO Littleton(beg 2/23)
50.00
.................
0.00
      X     0 230,466 40,111
Form 990 (2021)
Form 990 (2021)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W-2/1099-MISC/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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Miner MD Todd........................................................................
Orthopedic Surgeon
50.00
.......................0.00
        X   1,200,856 0 35,142
(19) Yang MD Charlie........................................................................
Orthopedic Surgeon
50.00
.......................0.00
        X   1,216,204 0 37,920
(20) Jennings MD Jason........................................................................
Orthopedic Surgeon
50.00
.......................0.00
        X   1,398,131 0 41,270
(21) Sanchez II MD Anthony........................................................................
Orthopedic Surgeon
50.00
.......................0.00
        X   1,107,538 0 37,656
(22) Rajpal Sharad........................................................................
Neuro Surgeon
50.00
.......................0.00
        X   1,004,601 0 11,942
(23) Banko Peter........................................................................
Former President CHC
0.00
.......................50.00
          X 0 3,734,177 771,093
(24) Dean Morre........................................................................
Former Officer/CIO
0.00
.......................0.00
          X 0 588,393 22,337
(25) Huenergardt Samuel........................................................................
Former Key Emp/CEO Mid-America
0.00
.......................50.00
          X 0 1,080,966 193,052
(26) McKinney Jillyan........................................................................
Former Key Emp/CEO AHMG Central FL
0.00
.......................0.00
          X 0 636,517 128,575
(27) Fisher Jonathan........................................................................
Former Key Emp/CFO Wesley
0.00
.......................50.00
          X 0 345,345 103,582
(28) Beckner Michelle........................................................................
Former CFO Littleton
0.00
.......................0.00
          X 0 319,429 31,708




1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 5,927,330 19,303,715 3,075,694
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet859
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
South Denver Cardiology Associates PC

1000 SouthPark Dr
Littleton,CO80120
Cardiology Services 31,560,728
Neurosurgery One

7780 S Broadway Ste 350
Littleton,CO80122
Neuro/Spine Services 10,011,094
HSS Security

1395 S Platte River Dr
Denver,CO80223
Security Services 5,659,856
Peak Gastroenterology Associates

2920 N Cascade 3rd Floor
Colorado Springs,CO80907
Gastroenterology Services 5,219,842
CHER LLC

PO Box 30
Denver,CO80201
Imaging Services 3,511,686
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet80
Form 990 (2021)
Form 990 (2021)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 352,291
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 352,291
 Program Service RevenueAmt Business Code
2a Net Patient Revenue 622110 1,500,378,035 1,500,378,035    
b Cafeteria Revenue 622110 3,664,670 3,664,670    
c Pharmacy Revenue 622110 3,641,381 1,450,063 2,191,318  
d Medical Office Building Rentals 622110 3,278,518 2,993,997 284,521  
e Ins Bus Interrupt - Fires 622110 1,575,003 1,575,003    
f All other program service revenue. 1,653,025 1,653,025    
g Total. Add lines 2a–2f .....MediumBullet 1,514,190,632
 OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 6,949,028     6,949,028
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   119,928 6a
b Less: rental expenses   19,575 6b
c Rental income or (loss)   100,353 6c
d Net rental income or (loss).......MediumBullet 100,353 100,353    
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 7,749,723   7a
b Less: cost or other basis and sales expenses 694,502 2,851,442 7b
c Gain or (loss) 7,055,221 -2,851,442 7c
d Net gain or (loss).........MediumBullet 4,203,779     4,203,779
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
10a  
b Less: cost of goods sold .. 10b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a Equity Earnings Subsidiaries 622110 10,241,100 10,241,100    
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 10,241,100
12 Total revenue. See instructions.....MediumBullet 1,536,037,183 1,522,056,246 2,475,839 11,152,807
Form 990 (2021)
Form 990 (2021)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 2,386,590 2,386,590
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ...........    
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............    
4 Benefits paid to or for members .......    
5 Compensation of current officers, directors, trustees, and key employees ........... 5,227,004   5,227,004  
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........ 462,575,622 428,871,693 33,703,929  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 16,201,326 14,873,157 1,328,169  
9 Other employee benefits ....... 56,320,519 51,224,167 5,096,352  
10 Payroll taxes ........... 31,604,277 29,013,390 2,590,887  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 175,810   175,810  
c Accounting ........... 452,111   452,111  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 825,764   825,764  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 347,307,805 183,893,004 163,414,801  
12 Advertising and promotion .... 3,151,870   3,151,870  
13 Office expenses ....... 23,314,091 18,473,234 4,840,857  
14 Information technology ...... 6,988,494 6,496,504 491,990  
15 Royalties ..        
16 Occupancy ........... 32,973,711 32,973,711    
17 Travel ............ 652,106 456,734 195,372  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 1,146,474   1,146,474  
20 Interest ........... 8,804,129 8,804,129    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 89,618,574 89,618,574    
23 Insurance ... 9,692,049 9,426,016 266,033  
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 252,424,132 252,424,132    
b State Assessment 85,625,872 85,625,872    
c Repairs and Maintenance 24,599,884 24,599,884    
d True Up w/related tax-e 3,037,113   3,037,113  
e All other expenses 3,441,824 2,160,977 1,280,847  
25 Total functional expenses. Add lines 1 through 24e 1,468,547,151 1,241,321,768 227,225,383 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2021)
Form 990 (2021)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 306,130 1 1,003,815
2 Savings and temporary cash investments ......... 22,477,017 2 124,258,532
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 236,517,398 4 239,805,770
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
  6  
7 Notes and loans receivable, net ........... 4,001,223 7 3,766,019
8 Inventories for sale or use ............ 39,200,742 8 38,911,389
9 Prepaid expenses and deferred charges ...... 19,089,282 9 17,645,096
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,637,969,756
b Less: accumulated depreciation 10b 932,276,073 697,119,769 10c 705,693,683
11 Investments—publicly traded securities .   11  
12 Investments—other securities. See Part IV, line 11 ..... 507,537,309 12 448,880,136
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ............... 66,309,429 14 58,030,231
15 Other assets. See Part IV, line 11 ........... 344,851,620 15 354,864,660
16 Total assets. Add lines 1 through 15 (must equal line 33)... 1,937,409,919 16 1,992,859,331
Liabilities 17 Accounts payable and accrued expenses ..... 88,786,792 17 101,057,961
18 Grants payable ...   18  
19 Deferred revenue ......... 1,470,293 19 916,807
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 412,774,470 25 397,747,963
26 Total liabilities. Add lines 17 through 25.. 503,031,555 26 499,722,731
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 1,434,274,508 27 1,493,032,744
28 Net assets with donor restrictions ........... 103,856 28 103,856
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 1,434,378,364 32 1,493,136,600
33 Total liabilities and net assets/fund balances ........ 1,937,409,919 33 1,992,859,331
Form 990 (2021)
Form 990 (2021)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
1,536,037,183
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
1,468,547,151
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
67,490,032
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
1,434,378,364
5
Net unrealized gains (losses) on investments ...............
5
2,277,871
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-11,009,667
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
1,493,136,600
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2021)
Form 990 (2021)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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
Portercare Adventist Health System
 
Employer identification number

84-0438224
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2022

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) right arrow (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) right arrow (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  
12
12
 
13
First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
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
b
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
b
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
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990) 2022

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) right arrow (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) right arrow (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.)..            
14
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
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
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
b
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
20
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

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
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
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).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined 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.
9b
 
 
c
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.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990) 2022

Schedule A (Form 990) 2022
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described on 11a above?
11b
 
 
c
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
No
1
Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described 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.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990) 2022

Schedule A (Form 990) 2022
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by 0.035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990) 2022

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:  
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2022
Name of the organization
Portercare Adventist Health System
 
Employer identification number

84-0438224
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990) (2022)
Schedule B (Form 990) (2022) Page 2
Name of organization
Portercare Adventist Health System
 
Employer identification number
84-0438224
Part I
Contributors
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
 
 
 
 
  ,    

$ RESTRICTED


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

$  


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

$  


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

$  


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

$  


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

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2022)
Schedule B (Form 990) (2022)
Page 3
Name of organization
Portercare Adventist Health System
 
Employer identification number

84-0438224
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
Portercare Adventist Health System
 
Employer identification number

84-0438224
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990) (2022)
Additional Data


Software ID:  
Software Version:  
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 BulletGo 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
Portercare Adventist Health System
 
Employer identification number

84-0438224
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

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

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

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

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

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990) 2021

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

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


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
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
27,732
j
Total. Add lines 1c through 1i ....................................................................................................
27,732
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures. See Instructions .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Part II-B, Line 1i, Lobbying Activities: American Hospital Association dues and Colorado Health Association dues.
Schedule C (Form 990) 2021


Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Portercare Adventist Health System
 
Employer identification number

84-0438224
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
1a Beginning of year balance .... 4,698,235 4,012,908 3,870,411 3,713,610 3,529,788
b Contributions ...   1,050,965     49,444
c Net investment earnings, gains, and losses 229,573 151,945 142,497 156,801 134,378
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ...
  517,583      
f Administrative expenses ....          
g End of year balance ...... 4,927,808 4,698,235 4,012,908 3,870,411 3,713,610
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet1.790 %
b
Permanent endowment SchDMd Bullet70.160 %
c
Term endowment SchDMd Bullet28.050 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
Yes
 
(ii) Related organizations .................
3a(ii)
Yes
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment)
(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....   134,786,913 134,786,913
b Buildings ....   935,718,205 533,087,764 402,630,441
c Leasehold improvements        
d Equipment ....   464,444,401 373,269,372 91,175,029
e Other .....   103,020,237 25,918,937 77,101,300
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 705,693,683
Schedule D (Form 990) 2021

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) Share of Parent Centralized Investment Pool
448,880,136 F
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 448,880,136
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.)Small Bullet  
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)Investment in Subsidiaries 141,888,153
(2)Other Receivables 144,290
(3)Due from Related 179,207,392
(4)Receivable from Third Parties 3,405,764
(5)Other Assets 1,576,602
(6)Right-of-Use Asset-Operating Lease 28,642,459
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 354,864,660
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.)Small Bullet 397,747,963
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

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: Rocky Mountain Adventist Healthcare Foundation (RMAHF), a related organization formed and maintained exclusively to further the exempt purpose of Portercare Adventist Health System (PAHS), held assets in temporary endowment and permanent endowment funds during the current tax year. RMAHF's endowment consists of individual donor restricted endowment funds and pledges receivable where the assets have been designated for endowment. Temporarily and Permanently restricted endowment funds are intended to benefit various programs and departments of the five Hospitals and its patients. The endowment funds held by RMAHF were inadvertently omitted from prior years' Form 990 of the taxpayer. Additional information became available in the current year that provided the amounts now reflected in Schedule D, Part V.
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:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 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
Portercare Adventist Health System
 
Employer identification number

84-0438224
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    18,601,139   18,601,139 1.270 %
b Medicaid (from Worksheet 3, column a) . . . . .     280,818,283 177,763,471 103,054,812 7.020 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     299,419,422 177,763,471 121,655,951 8.290 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     937,615 34,869 902,746 0.060 %
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) . . . .     17,506   17,506 0 %
j Total. Other Benefits . .     955,121 34,869 920,252 0.060 %
k Total. Add lines 7d and 7j .     300,374,543 177,798,340 122,576,203 8.350 %
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     233,619   233,619 0.020 %
9 Other            
10 Total     233,619   233,619 0.020 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
-15,936,980
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
7,556,924
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
179,678,536
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
219,483,030
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-39,804,494
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
11 Functional Neurosurgical Ambulatory Surgery Center LLC
 
Surgery Center 51.000 %   49.000 %
22 Crown Point Surgery Center LLC
 
Surgery Center 27.930 %   41.940 %
33 Flatirons Surgery Center LLC
 
Surgery Center 25.000 %   49.900 %
44 Harvard Park Surgery Center LLC
 
Surgery Center 25.000 %   48.500 %
55 South Denver Musculoskeletal Surgical Partners LLC
 
Surgery Center 26.850 %   46.200 %
66 Summit View Surgery Center LLC
 
Surgery Center 25.000 %   45.630 %
77 OnPoint OBGYN LLC
 
OBGYN Center 51.000 %   24.500 %
8
9
10
11
12
13
Schedule H (Form 990) 2022
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?5Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General Medical and Surgical Children's Hospital Teaching Hospital Critical Access Hospital Research Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 Parker Adventist Hospital
9395 Crown Crest Blvd
Parker,CO80138
https://www.adventhealth.com/hospital/
1005
X X         X     A
2 Porter Adventist Hospital
2525 S Downing St
Denver,CO80210
https://www.adventhealth.com/hospital/
1036
X X       X X     A
3 Littleton Adventist Hospital
7700 S Broadway
Littleton,CO80122
https://www.adventhealth.com/hospital/
1034
X X         X     A
4 Avista Adventist Hospital
100 Health Park Drive
Louisville,CO80027
https://www.adventhealth.com/hospital/
90831
X X         X     A
5 Castle Rock Adventist Health Campus
2350 Meadows Blvd
Castle Rock,CO80109
https://www.adventhealth.com/hospital/
01L581
X X         X     A
Schedule H (Form 990) 2022
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)
Facility Reporting Group A
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
 
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 21
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): See Part V, Page 8
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
Facility Reporting Group A
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
See Part V, Page 8
b
See Part V, Page 8
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page 6
Part VFacility Information (continued)

Billing and Collections
Facility Reporting Group A
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
Facility Reporting Group A
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2022
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
Part V, Section B Facility Reporting Group A
Facility Reporting Group A consists of: - Facility 1: Parker Adventist Hospital, - Facility 2: Porter Adventist Hospital, - Facility 3: Littleton Adventist Hospital, - Facility 4: Avista Adventist Hospital, - Facility 5: Castle Rock Adventist Health Campus
Facility Reporting Group A Part V, Section B, line 5: In order to assess the needs of the community while conducting its fiscal year 2022 Community Health Needs Assessment (CHNA), the Hospitals received input from community-based organizations focused on health and social determinants of health regarding medically underserved, low-income and minority populations in the service area. Each Hospital conducted Community Health Needs Assessment Advisory Subcommittee meetings with community-based organizations in their respective communities. Organizations were identified based upon their connection with the community, including those serving people who are medically underserved and at greater risk of poor health and those organizations with influence on overall health in the community. Stakeholders provided input in multiple meetings to rank and prioritize health issues, identify both community assets and gaps, and to identify strategies for the health priorities. Lastly, the Hospitals engaged in the local County Health Departments and the Hospital Transformation Program Community and Health Neighborhood Engagement process focusing on the Medicaid population through which both community and Medicaid data were analyzed and focus groups were conducted.
Schedule H, Part V, Section B, Line 7a, Hospital Facility CHNA Website Facility 1 - Parker Adventist Hospitalhttps://www.adventhealth.com/hospital/adventhealth-parker/community-health-needs-assessmentsFacility 2 - Porter Adventist Hospitalhttps://www.adventhealth.com/hospital/adventhealth-porter/community-health-needs-assessmentsFacility 3 - Littleton Adventist Hospitalhttps://www.adventhealth.com/hospital/adventhealth-littleton/community-health-needs-assessmentsFacility 4 - Avista Adventist Hospital https://www.adventhealth.com/hospital/adventhealth-avista/community-health-needs-assessmentsFacility 5 - Castle Rock Adentist Health Campushttps://www.adventhealth.com/hospital/adventhealth-castle-rock/community-health-needs-assessments
Schedule H, Part V, Section B, Line 10: Each hospital facility's most recently adopted implementation strategy was made widely available through the following websites:Facility 1 - Parker Adventist Hospitalhttps://www.adventhealth.com/hospital/adventhealth-parker/community-health-needs-assessmentsFacility 2 - Porter Adventist Hospitalhttps://www.adventhealth.com/hospital/adventhealth-porter/community-health-needs-assessmentsFacility 3 - Littleton Adventist Hospitalhttps://www.adventhealth.com/hospital/adventhealth-littleton/community-health-needs-assessmentsFacility 4 - Avista Adventist Hospital https://www.adventhealth.com/hospital/adventhealth-avista/community-health-needs-assessmentsFacility 5 - Castle Rock Adentist Health Campushttps://www.adventhealth.com/hospital/adventhealth-castle-rock/community-health-needs-assessments
Schedule H, Part V, Section B, Line 16a - c: Each hospital facility's FAP, FAP application form and plain language summary of the FAP was made widely available through the following websites:Facility 1 - Parker Adventist Hospitalhttps://www.mountain.commonspirit.org/patient-tools/billing-and-financial-servicesFacility 2 - Porter Adventist Hospitalhttps://www.mountain.commonspirit.org/patient-tools/billing-and-financial-servicesFacility 3 - Littleton Adventist Hospitalhttps://www.mountain.commonspirit.org/patient-tools/billing-and-financial-servicesFacility 4 - Avista Adventist Hospital https://www.mountain.commonspirit.org/patient-tools/billing-and-financial-servicesFacility 5 - Castle Rock Adentist Health Campushttps://www.mountain.commonspirit.org/patient-tools/billing-and-financial-services
Schedule H, Part V, Section B, Line 11: The information provided below explains how each Hospital facility addressed in the fiscal year 2022 (year ended June 30, 2023) the significant health needs identified in its fiscal year 2022 Community Health Needs Assessment, any such needs that were not addressed, and the reasons why such needs were not addressed.This is the first-year update for the filing organization's fiscal year 2022-2024 (Calendar year 2023-2025) Community Health Implementation Plan. The filing organization developed this Plan and posted it by November 15, 2022 as part of its fiscal year 2022 Community Health Needs Assessment process. The following narrative describes the issues identified in fiscal year 2021 by each Hospital facility and gives an update on the strategies addressing those issues. There is also a description of the identified issues that the facilities are not addressing.Facility 1 - Parker Adventist Hospital Parker Adventist Hospital (PKAH) conducted its FY 2021 Community Health Needs Assessment (CHNA) through a collaborative partnership with Castle Rock Adventist Hospital and the Tri-County Public Health Departments. Both qualitative and quantitative primary and secondary data were gathered, along with numerous health indicators, and were prioritized by using a form of the Hanlon Method for Prioritizing Health Problems. Each identified need was rated against a) size, b) severity, and c) alignment with PKAH and community existing efforts. Total scores were compiled and resulted in the identification of the following prioritized health issues: Suicide Prevention, Substance Use Prevention, and Food Security. PKAH recognizes that focusing on a few health issues leads to greater progress than dispersing efforts across many issues. For each issue, best practices for screening and treatment as well as prevention through environmental and behavioral changes were identified.During fiscal year 2022, the following actions were taken with respect to Suicide Prevention. PKAH implemented the Zero Suicide Framework, a best practice to screen for the risk of suicide attempts and refer people to resources. As part of this work, PKAH implemented a pathway to care for patients that screen low on the C-SSRS. Patients who scored low were fast-tracked and then seen by behavioral health before medical clearance using the Safe-T model to see if an additional assessment was needed. If it was not needed, patients were given behavioral resources. If an additional screening was necessary, patients were seen by a member of the Crisis Assessment Team for a full safety assessment. Furthermore, while we currently don't have a suicide care pathway fully developed yet, current procedure is quite comprehensive. For example, patients are universally screened with the C-SSRS and then depending on the risk level, are put on a suicide care management pathway. If a patient scores low or moderate, a behavioral health clinician will assess them using the Safe-T. If a higher risk level is not determined, the patient will be discharged with at least 2 resources, automatic enrollment to Caring Contacts for follow-up care, and a referral to RMCP hospital follow-up program (if patient accepts). If a patient scores high, the patient will have a full safety assessment completed including Safe-T, Audit C+ Two, SBIRT, CALM (Counseling Access to Lethal Means) and a Stanley Brown Safety Plan (if discharged). Patients will either be discharged home or sent to a crisis stabilization unit, an acute treatment unit, or inpatient behavioral health unit based on risk assessment. Patients that are discharged home will receive at least 2 referrals, automatic enrollment into our Caring Contacts program for follow-up care, and a referral to RMCP Hospital Follow-Up program (if patient accepts). We recently were able to give patients access to their safety plans in their patient portal, as well as the hard copy provided at discharge. Primary care doctors also have the availability to review patient safety plans when patients have follow-up appointments if they are within the Rocky Mountain Region network. During this reporting period, the Rocky Mountain Region screened a total of 3,194 people for suicide risk, and 3,194 received a safety assessment. During this reporting period, we were unable to differentiate the screening rates just for PKAH. In reporting year 2023, we will have an improved tracking method.We also understand that there needs to be a focus on training in evidence-based approaches to suicide prevention. In partnership with community-based organizations, 2,964 community clinical staff were trained, and 32 non-clinical community staff were trained. Training focused on the following programs: Assessing and Managing Suicide Risk (AMSR), Applied Suicide Intervention Skills Training (ASIST), Collaborative Assessment and Management of Suicidality (CAMS), Columbia Suicide Severity Rating Scale (CSSRS), Counseling on Access to Lethal Means (CALM), Dialectical Behavioral Therapy (DBT), LivingWorks Start or QPR, Mental Health First Aid (MHFA), Safety Planning, FAITH, VA Cultural Competency, VA Substance Abuse Training, Resiliency Training, and Gender Bias.For Substance Use Prevention, the Alternatives to Opioids (ALTO) program is being conducted by PKAH to help prevent opioid addiction. PKAH participated in the Let's Talk Campaign, done in partnership with other organizations in the community, to reduce the stigma associated with mental health and has established partnerships with other community-based organizations that reach black and LatinX communities. PKAH also participated in the Lift The Label Campaign. Lift The Label is a public awareness campaign that strives to remove damaging labels and stigmas that prevent those with opioid addiction from seeking effective treatment.With respect to the prioritized need of Food Security, the PKAH identified food insecurity risk in 117 households. These households were provided with local resources to help meet their unique needs. PKAH partnered to conduct Double Up Food Bucks outreach to increase the number of people using this program so that lower income families can purchase produce and increase the number of businesses offering the program. We also established a partnership with Nourish Colorado, an anti-hunger organization, to increase the number of stores accepting SNAP/WIC in communities. This program activated Community Health Navigators that focused on training and educating eligible bodegas on public assistance resources that would allow them to accept SNAP/WIC benefits.PKAH did not address the following identified health issues due to limited resources and the availability of other community organizations to address such needs: Intentional Injury, Access to Oral Health, and Access to Primary Care.See Continuation
Schedule H, Part V, Section B, Line 11: - continuation Facility 2 - Porter Adventist HospitalPorter Adventist Hospital (PAH) conducted its FY 2021 Community Health Needs Assessment (CHNA) through a collaborative partnership with Littleton Adventist Hospital and the Denver and Tri-County Public Health Departments. Both qualitative and quantitative primary and secondary data were gathered, along with numerous health indicators, and were prioritized by using a form of the Hanlon Method for Prioritizing Health Problems. Each identified need was rated against a) size, b) severity, and c) alignment with PAH and community existing efforts. Total scores were compiled and resulted in the identification of the following prioritized health issues: Suicide Prevention, Substance Use Prevention, and Food Security. PAH recognizes that focusing on a few health issues leads to greater progress than dispersing efforts across many issues. For each issue, best practices for screening and treatment as well as prevention through environmental and behavioral changes were identified.During fiscal year 2022, the following actions were taken with respect to Suicide Prevention. PAH implemented the Zero Suicide Framework, a best practice to screen for the risk of suicide attempts and refer people to resources. As part of this work, PAH implemented a pathway to care for patients who screen low on the C-SSRS. Patients who scored low were fast-tracked and then seen by behavioral health before medical clearance using the Safe-T model to see if an additional assessment was needed. If it was not needed, patients were given behavioral resources. If an additional screening was necessary, patients were seen by a member of the Crisis Assessment Team for a full safety assessment. Furthermore, while we currently don't have a suicide care pathway fully developed yet, the current procedure is quite comprehensive. For example, patients are universally screened with the C-SSRS and then depending on the risk level, are put on a suicide care management pathway. If a patient scores low or moderate, a behavioral health clinician will assess them using the Safe-T. If a higher risk level is not determined, the patient will be discharged with at least 2 resources, automatic enrollment to Caring Contacts for follow-up care, and a referral to RMCP hospital follow-up program (if patient accepts). If a patient scores high, the patient will have a full safety assessment completed including Safe-T, Audit C+ Two, SBIRT, CALM (Counseling Access to Lethal Means) and a Stanley Brown Safety Plan (if discharged). Patients will either be discharged home or sent to a crisis stabilization unit, an acute treatment unit, or inpatient behavioral health unit based on risk assessment. Patients that are discharged home will receive at least 2 referrals, automatic enrollment into our Caring Contacts program for follow-up care, and a referral to RMCP Hospital Follow-Up program (if patient accepts). We recently were able to give patients access to their safety plans in their patient portal, as well as the hard copy provided at discharge. Primary care doctors also have the availability to review patient safety plans when patients have follow-up appointments if they are within the Rocky Mountain Region network. During this reporting period, the Rocky Mountain Region screened a total of 3,194 people for suicide risk, and 3,194 received a safety assessment. During this reporting period, we were unable to differentiate the screening rates just for PAH. In reporting year 2023, we will have an improved tracking method.We also understand that there needs to be a focus on training in evidence-based approaches to suicide prevention. In partnership with community-based organizations, 2,964 community clinical staff were trained, and 32 non-clinical community staff were trained. The training focused on the following programs: Assessing and Managing Suicide Risk (AMSR), Applied Suicide Intervention Skills Training (ASIST), Collaborative Assessment and Management of Suicidality (CAMS), Columbia Suicide Severity Rating Scale (CSSRS), Counseling on Access to Lethal Means (CALM), Dialectical Behavioral Therapy (DBT), LivingWorks Start or QPR, Mental Health First Aid (MHFA), Safety Planning, FAITH, VA Cultural Competency, VA Substance Abuse Training, Resiliency Training, and Gender Bias.For Substance Use Prevention, the Alternatives to Opioids (ALTO) program is being conducted by PAH to help prevent opioid addiction. PAHS participated in the Let's Talk Campaign, done in partnership with other organizations in the community, to reduce the stigma associated with mental health and has established partnerships with other community-based organizations that reach black and LatinX communities. PAH also participated in the Lift The Label Campaign. Lift The Label is a public awareness campaign that strives to remove damaging labels and stigmas that prevent those with opioid addiction from seeking effective treatment.With respect to the prioritized need of Food Security, PAH identified food insecurity risk in 147 households by utilizing a social determinants of health screening tool. These households were provided local resources to help meet their unique needs. PAH also partnered to conduct Double Up Food Bucks outreach to increase the number of people using this program for lower income families to purchase produce and increase the number of businesses offering the program. We also established a partnership with Nourish Colorado, an anti-hunger organization, to increase the number of stores accepting SNAP/WIC in communities. This program activated Community Health Navigators that focused on training and educating eligible bodegas on public assistance resources that would allow them to accept SNAP/WIC benefits.PAH did not address intentional injury or health equity as prioritized identified health issues due to limited resources and the availability of other community organizations to address such needs.See continuation
Schedule H, Part V, Section B, Line 11: - continuation Facility 3 - Littleton Adventist HospitalLittleton Adventist Hospital (LAH) conducted its FY 2021 Community Health Needs Assessment (CHNA) through a collaborative partnership with Porter Adventist Hospital and the Denver and Tri-County Public Health Departments. Both qualitative and quantitative primary and secondary data were gathered, along with numerous health indicators, and were prioritized by using a form of the Hanlon Method for Prioritizing Health Problems. Each identified need was rated against a) size, b) severity, and c) alignment with LAH and community existing efforts. Total scores were compiled and resulted in the identification of the following prioritized health issues: -Suicide Prevention, Housing Stability, and Food Security. LAH recognizes that focusing on a few health issues leads to greater progress than dispersing efforts across many issues. For each issue, best practices for screening and treatment, as well as prevention through environmental and behavioral changes, were identified.During fiscal year 2022, the following actions were taken with respect to Suicide Prevention. LAH implemented the Zero Suicide Framework, a best practice to screen for the risk of suicide attempts and refer people to resources. As part of this work, LAH implemented a pathway to care for patients who screen low on the C-SSRS. Patients who scored low were fast-tracked and then seen by behavioral health before medical clearance using the Safe-T model to see if an additional assessment was needed. If it was not needed, patients were given behavioral resources. If an additional screening was necessary, patients were seen by a member of the Crisis Assessment Team for a full safety assessment. Furthermore, while we currently don't have a suicide care pathway fully developed yet, the current procedure is quite comprehensive. For example, patients are universally screened with the C-SSRS and then depending on the risk level, are put on a suicide care management pathway. If a patient scores low or moderate, a behavioral health clinician will assess them using the Safe-T. If a higher risk level is not determined, the patient will be discharged with at least 2 resources, automatic enrollment to Caring Contacts for follow-up care, and a referral to RMCP hospital follow-up program (if patient accepts). If a patient scores high, the patient will have a full safety assessment completed including Safe-T, Audit C+ Two, SBIRT, CALM (Counseling Access to Lethal Means) and a Stanley Brown Safety Plan (if discharged). Patients will either be discharged home or sent to a crisis stabilization unit, an acute treatment unit, or inpatient behavioral health unit based on risk assessment. Patients that are discharged home will receive at least 2 referrals, automatic enrollment into our Caring Contacts program for follow-up care, and a referral to RMCP Hospital Follow-Up program (if patient accepts). We recently were able to give patients access to their safety plans in their patient portal, as well as the hard copy provided at discharge. Primary care doctors also have the availability to review patient safety plans when patients have follow-up appointments if they are within the Rocky Mountain Region network. During this reporting period, the Rocky Mountain Region screened a total of 3,194 people for suicide risk, and 3,194 received a safety assessment. During this reporting period, we were unable to differentiate the screening rates just for LAH. In reporting year 2023, we will have an improved tracking method.We also understand that there needs to be a focus on training in evidence-based approaches to suicide prevention. In partnership with community-based organizations, 2,964 community clinical staff were trained, and 32 non-clinical community staff were trained. Training focused on the following programs: Assessing and Managing Suicide Risk (AMSR), Applied Suicide Intervention Skills Training (ASIST), Collaborative Assessment and Management of Suicidality (CAMS), Columbia Suicide Severity Rating Scale (CSSRS), Counseling on Access to Lethal Means (CALM), Dialectical Behavioral Therapy (DBT), LivingWorks Start or QPR, Mental Health First Aid (MHFA), Safety Planning, FAITH, VA Cultural Competency, VA Substance Abuse Training, Resiliency Training, and Gender Bias.With respect to the prioritized need of Housing Stability, LAH identified housing instability risk in 128 households by utilizing a social determinants of health screening tool. These households were provided local resources to help meet their unique needs. Furthermore, the Hospital partnered with a local housing coalition made up of 30+ housing organizations that aim to prevent homelessness, and coordinate services for eligible households.With respect to the prioritized need of Food Security, LAH identified food insecurity risk in 123 households by utilizing a social determinants of health screening tool. These households were provided with local resources to help meet their unique needs. LAH partnered to conduct Double Up Food Bucks outreach to increase the number of people using this program so that lower income families can purchase produce and increase the number of businesses offering the program. LAH also established a partnership with Nourish Colorado, an anti-hunger organization, to increase the number of stores accepting SNAP/WIC in communities. This program activated Community Health Navigators that focused on training and educating eligible bodegas on public assistance resources that would allow them to accept SNAP/WIC benefits.LAH did not address the following identified health issues due to limited resources and the availability of other community organizations to address such needs: Intentional Injury, Substance Abuse, and Access to Primary Care.See continuation
Schedule H, Part V, Section B, Line 11: - continuation Facility 4 - Avista Adventist HospitalAvista Adventist Hospital (AAH) conducted its FY 2021 Community Health Needs Assessment (CHNA) through a collaborative partnership with the Boulder County Public Health Department, Broomfield Public Health, and community stakeholders. Both qualitative and quantitative primary and secondary data were gathered, along with numerous health indicators, and were prioritized by using a form of the Hanlon Method for Prioritizing Health Problems. Each identified need was rated against a) size, b) severity, and c) alignment with AAH and community existing efforts. Total scores were compiled and resulted in the identification of the following prioritized health issues: Suicide Prevention, Housing Stability, and Food Security. AAH recognizes that focusing on a few health issues leads to greater progress than dispersing efforts across many issues. For each issue, best practices for screening and treatment as well as prevention through environmental and behavioral changes were identified.During fiscal year 2022, the following actions were taken with respect to Suicide Prevention. AAH implemented the Zero Suicide Framework, a best practice to screen for the risk of suicide attempts and refer people to resources. As part of this work, AAH implemented a pathway to care for patients who screen low on the C-SSRS. Patients who scored low were fast-tracked and then seen by behavioral health before medical clearance using the Safe-T model to see if an additional assessment was needed. If it was not needed, patients were given behavioral resources. If an additional screening was necessary, patients were seen by a member of the Crisis Assessment Team for a full safety assessment. Furthermore, while we currently don't have a suicide care pathway fully developed yet, the current procedure is quite comprehensive. For example, patients are universally screened with the C-SSRS and then depending on the risk level, are put on a suicide care management pathway. If a patient scores low or moderate, a behavioral health clinician will assess them using the Safe-T. If a higher risk level is not determined, the patient will be discharged with at least 2 resources, automatic enrollment to Caring Contacts for follow-up care, and a referral to RMCP hospital follow-up program (if patient accepts). If a patient scores high, the patient will have a full safety assessment completed including Safe-T, Audit C+ Two, SBIRT, CALM (Counseling Access to Lethal Means) and a Stanley Brown Safety Plan (if discharged). Patients will either be discharged home or sent to a crisis stabilization unit, an acute treatment unit, or inpatient behavioral health unit based on risk assessment. Patients that are discharged home will receive at least 2 referrals, automatic enrollment into our Caring Contacts program for follow-up care, and a referral to RMCP Hospital Follow-Up program (if patient accepts). We recently were able to give patients access to their safety plans in their patient portal, as well as the hard copy provided at discharge. Primary care doctors also have the availability to review patient safety plans when patients have follow-up appointments if they are within the Rocky Mountain Region network. During this reporting period, the Rocky Mountain Region screened a total of 3,194 people for suicide risk, and 3,194 received a safety assessment. During this reporting period, we were unable to differentiate the screening rates just for AAH. In the reporting year 2023, we will have an improved tracking method.We also understand that there needs to be a focus on training in evidence-based approaches to suicide prevention. In partnership with community-based organizations, 2,964 community clinical staff were trained, and 32 non-clinical community staff were trained. The training focused on the following programs: Assessing and Managing Suicide Risk (AMSR), Applied Suicide Intervention Skills Training (ASIST), Collaborative Assessment and Management of Suicidality (CAMS), Columbia Suicide Severity Rating Scale (CSSRS), Counseling on Access to Lethal Means (CALM), Dialectical Behavioral Therapy (DBT), LivingWorks Start or QPR, Mental Health First Aid (MHFA), Safety Planning, FAITH, VA Cultural Competency, VA Substance Abuse Training, Resiliency Training, and Gender Bias.With respect to the prioritized need of Housing Stability, the Hospital identified housing instability risk in 138 households by utilizing a social determinants of health screening tool. These households were provided local resources to help meet their unique needs.For Food Security, the Hospital identified food insecurity risk in 136 households by utilizing a social determinants of health screening tool. These households were provided with local resources to help meet their unique needs. AAH partnered to conduct Double Up Food Bucks outreach to increase the number of people using this program so that lower income families can purchase produce and increase the number of businesses offering the program. We also established a partnership with Nourish Colorado, an anti-hunger organization, to increase the number of stores accepting SNAP/WIC in communities. This program activated Community Health Navigators that focused on training and educating eligible bodegas on public assistance resources that would allow them to accept SNAP/WIC benefits.AAH did not address the identified health issue of Access to Primary Care due to limited resources and other organizations that address these needs.See continuation
Schedule H, Part V, Section B, Line 11: - continuation Facility 5 - Castle Rock Adventist HospitalCastle Rock Adventist Hospital (CRAH) conducted its FY 2021 Community Health Needs Assessment (CHNA) through a collaborative partnership with Parker Adventist Hospital and Tri-County Public Health Departments. Both qualitative and quantitative primary and secondary data were gathered, along with numerous health indicators, and were prioritized by using a form of the Hanlon Method for Prioritizing Health Problems. Each identified need was rated against a) size, b) severity, and c) alignment with CRAH and community existing efforts. Total scores were compiled and resulted in the identification of the following prioritized health issues: Suicide Prevention, Substance Use Prevention, and Food Security. CRAH recognizes that focusing on a few health issues leads to greater progress than dispersing efforts across many issues. For each issue, best practices for screening and treatment as well as prevention through environmental and behavioral changes were identified.During fiscal year 2022, the following actions were taken with respect to Suicide Prevention. CRAH implemented the Zero Suicide Framework, a best practice to screen for the risk of suicide attempts and refer people to resources. As part of this work, CRAH implemented a pathway to care for patients who screen low on the C-SSRS. Patients who scored low were fast-tracked and then seen by behavioral health before medical clearance using the Safe-T model to see if an additional assessment was needed. If it was not needed, patients were given behavioral resources. If an additional screening was necessary, patients were seen by a member of the Crisis Assessment Team for a full safety assessment. Furthermore, while we currently don't have a suicide care pathway fully developed yet, the current procedure is quite comprehensive. For example, patients are universally screened with the C-SSRS and then depending on the risk level, are put on a suicide care management pathway. If a patient scores low or moderate, a behavioral health clinician will assess them using the Safe-T. If a higher risk level is not determined, the patient will be discharged with at least 2 resources, automatic enrollment to Caring Contacts for follow-up care, and a referral to RMCP hospital follow-up program (if patient accepts). If a patient scores high, the patient will have a full safety assessment completed including Safe-T, Audit C+ Two, SBIRT, CALM (Counseling Access to Lethal Means) and a Stanley Brown Safety Plan (if discharged). Patients will either be discharged home or sent to a crisis stabilization unit, an acute treatment unit, or inpatient behavioral health unit based on risk assessment. Patients that are discharged home will receive at least 2 referrals, automatic enrollment into our Caring Contacts program for follow-up care, and a referral to RMCP Hospital Follow-Up program (if patient accepts). We recently were able to give patients access to their safety plans in their patient portal, as well as the hard copy provided at discharge. Primary care doctors also have the availability to review patient safety plans when patients have follow-up appointments if they are within the Rocky Mountain Region network. During this reporting period, the Rocky Mountain Region screened a total of 3,194 people for suicide risk, and 3,194 received a safety assessment. During this reporting period, we were unable to differentiate the screening rates just for CRAH. In reporting year 2023, we will have an improved tracking method.We also understand that there needs to be a focus on training in evidence-based approaches to suicide prevention. In partnership with community-based organizations, 2,964 community clinical staff were trained, and 32 non-clinical community staff were trained. The training focused on the following programs: Assessing and Managing Suicide Risk (AMSR), Applied Suicide Intervention Skills Training (ASIST), Collaborative Assessment and Management of Suicidality (CAMS), Columbia Suicide Severity Rating Scale (CSSRS), Counseling on Access to Lethal Means (CALM), Dialectical Behavioral Therapy (DBT), LivingWorks Start or QPR, Mental Health First Aid (MHFA), Safety Planning, FAITH, VA Cultural Competency, VA Substance Abuse Training, Resiliency Training, and Gender Bias.For Substance Use Prevention, the Alternatives to Opioids (ALTO) program is being conducted by CRAH to help prevent opioid addiction. CRAH participated in the Let's Talk Campaign, done in partnership with other organizations in the community, to reduce stigma associated with mental health and has established partnerships with other community-based organizations that reach black and LatinX communities. CRAH also participated in the Lift The Label Campaign. Lift The Label is a public awareness campaign that strives to remove damaging labels and stigmas that prevent those with opioid addiction from seeking effective treatment.With respect to the prioritized need of Food Security, the Hospital identified food insecurity risk in 77 households by utilizing a social determinants of health screening tool. These households were provided local resources to help meet their unique needs. CRAH partnered to conduct Double Up Food Bucks outreach to increase the number of people using this program for lower income families to purchase produce and increase the number of businesses offering the program. CRAH also established a partnership with Nourish Colorado, an anti-hunger organization, to increase the number of stores accepting SNAP/WIC in communities. This program activated Community Health Navigators that focused on training and educating eligible bodegas on public assistance resources that would allow them to accept SNAP/WIC benefits.CRAH did not address the following identified health issues due to limited resources and the availability of other community organizations to address such needs: Intentional Injury, Access to Oral Health, and Access to Primary Care.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?68
Name and address Type of Facility (describe)
1 1 - CHPG WOMENS HLTH AT Littleton
7720 S Broadway Ste 250
Littleton,CO801222634
Healthcare Services Clinic
2 2 - Southmoor ER and Urgent Care
7000 E Hampden Ave
Denver,CO80224
Healthcare Urgent Care Clinic
3 3 - OnPoint OBGYN LLC
7780 S Broadway Ste 280
Littleton,CO80122
Healthcare Services Clinic
4 4 - Centura Health Emergency And Urgent Care M
9949 S Oswego St Ste 100
Parker,CO80134
Healthcare Urgent Care Clinic
5 5 - Centura Orthopedic & Spine Primary Care
9949 S Oswego St Ste 200
Parker,CO80134
Healthcare Services Clinic
6 6 - CHPG Primary Care Southmoor
5570 DTC PARKWAY
Greenwood Village,CO80111
Healthcare Services Clinic
7 7 - CHPG RIDGEGATE OBGYN AT LONE TREE
9695 S Yosemite St Ste 255B
Lone Tree,CO80124
Healthcare Services Clinic
8 8 - CHPG NEUROSURGERY ONE
7780 S Broadway Ste 350
Littleton,CO801222633
Healthcare Services Clinic
9 9 - PINNACLE WOMEN'S HEALTHCARE AT PARKER
9403 Crown Crest Blvd Ste 200
Parker,CO80138
Healthcare Services Clinic
10 10 - Colorado Joint Replacement
2535 S Downing St Ste 100
Denver,CO80210
Healthcare Services Clinic
11 11 - INTEGRATED OBGYN AT PARKER
9403 Crown Crest Blvd Ste 200
Parker,CO80138
Healthcare Services Clinic
12 12 - Functional Neurosurgical Ambulatory Surger
11 W Dry Creek Circle Ste 120
Littleton,CO80120
Healthcare Services Clinic
13 13 - Centura Spine & Neurosurgical Associates L
90 Health Park Dr Ste 350
Louisville,CO800279742
Healthcare Services Clinic
14 14 - Centura Orthopedic & Spine
2352 Meadows Blvd Ste 300
Castle Rock,CO801098419
Healthcare Services Clinic
15 15 - PAHS OnPoint Urgent Care LLC
9205 S Broadway
Highlands Ranch,CO80129
Healthcare Urgent Care Clinic
16 16 - CHPG Primary Care Church Ranch
7233 Church Ranch Blvd Ste C
Westminster,CO800214094
Healthcare Services Clinic
17 17 - TIMBERVIEW CLINIC AT PARKER
9403 Crown Crest Blvd Ste 300
Parker,CO80138
Healthcare Services Clinic
18 18 - Primary Care (Harvard Park)
950 E Harvard Ave Ste 200
Denver,CO80210
Healthcare Services Clinic
19 19 - CAH HealthFit Medical Professionals & Fitn
2356 Meadows Blvd Ste 140B
Castle Rock,CO80109
Healthcare Services Clinic
20 20 - PORTER HOSPICE
5020 E ARAPAHOE RD
Centennial,CO80111
Hospice Services
21 21 - CHPG INTERNAL MEDICINE PARKER
9403 Crown Crest Blvd Ste 300
Parker,CO80138
Healthcare Services Clinic
22 22 - PAHS OnPoint Urgent Care LLC
24300 E Smoky Hill Rd
Aurora,CO80016
Healthcare Urgent Care Clinic
23 23 - CHPG NORTHWEST GASTROENTEROLOGYDIMENSION
80 Health Park Dr Ste 270
Louisville,CO800279584
Healthcare Services Clinic
24 24 - COLORADO ENT SPECIALISTS
9403 Crown Crest Blvd Ste 300
Parker,CO80138
Healthcare Services Clinic
25 25 - CHPG Women's Health Porter
2555 S Downing St 1st Floor
Denver,CO802105855
Healthcare Services Clinic
26 26 - CHPG Urology Castle Rock
2352 Meadows Blvd Ste 300 Urology
Castle Rock,CO80109
Healthcare Services Clinic
27 27 - Cornerstar Primary CareWomen's Health
15901 E Briarwood Cir Ste 200
Aurora,CO80016
Healthcare Services Clinic
28 28 - RIDGELINE FAMILY MEDICINE
2352 Meadows Blvd Ste 300
Castle Rock,CO801098419
Healthcare Services Clinic
29 29 - HIGHLANDS RANCH MEDICAL ASSOCIATES
9137 S Ridgeline Blvd Ste 100
Highlands Ranch,CO801292395
Healthcare Services Clinic
30 30 - PAHS OnPoint Urgent Care LLC
9695 S Yosemite St
Lone Tree,CO80124
Healthcare Urgent Care Clinic
31 31 - RIDGELINE FAMILY MEDICINE AT CASTLE PINES
250 Max Drive Ste 102
Castle Pines,CO801089518
Healthcare Services Clinic
32 32 - CHPG Primary Care Highlands
2490 W 26th Ave Ste A120
Denver,CO802115317
Healthcare Services Clinic
33 33 - Centura Gastroenterology Porter
2535 S Downing St Ste 410
Denver,CO802105850
Healthcare Services Clinic
34 34 - PAHS OnPoint Urgent Care LLC
10120 E Dry Creek Rd
Englewood,CO80112
Healthcare Urgent Care Clinic
35 35 - Castle Rock CMG Internal Medicine
2352 Meadows Blvd Ste 300
Castle Rock,CO80109
Healthcare Services Clinic
36 36 - GRACE FAMILY PRACTICE
6909 S Holly Cir Ste 100
Centennial,CO801126300
Healthcare Services Clinic
37 37 - Aspen Creek Family Medicine
19461 E Parker Square Drive Ste A
Parker,CO80134
Healthcare Services Clinic
38 38 - CHPG NEUROSURGERY ONE PARKER
9403 Crown Crest Blvd Ste 200
Parker,CO80138
Healthcare Services Clinic
39 39 - Centura Gastroenterology Castle Rock
2352 Meadows Blvd Ste 300 GI
Castle Rock,CO801098419
Healthcare Services Clinic
40 40 - PARKER PRIMARY CARE
9949 S Oswego St Ste 300
Parker,CO80134
Healthcare Services Clinic
41 41 - CHPG Colorado Comprehensive Spine
2535 S Downing Ste 180
Denver,CO80210
Healthcare Services Clinic
42 42 - SOUTH QUEBEC FAMILY MEDICINE
6081 S Quebec Street Ste 100
Centennial,CO80111
Healthcare Services Clinic
43 43 - SouthPark Internal Medicine
9088 South Ridgeline Blvd Ste 201
Highlands Ranch,CO80129
Healthcare Services Clinic
44 44 - AVISTA FAMILY MEDICINE ERIE
611 Mitchell Way 103
Erie,CO805165443
Healthcare Services Clinic
45 45 - CHPG COLORECTAL SURGERY AT PARKER
9403 Crown Crest Blvd Ste 200
Parker,CO80138
Healthcare Services Clinic
46 46 - CHPG Woodlands Primary Care
4345 Woodlands Blvd Ste 260
Castle Rock,CO80104
Healthcare Services Clinic
47 47 - Family Practice at Cherry Creek
425 S Cherry Street Suite 410
GLENDALE,CO80246
Healthcare Services Clinic
48 48 - PARKER GASTROENTEROLOGY MERIDIAN
9403 Crown Crest Blvd Ste 420
Parker,CO80138
Healthcare Services Clinic
49 49 - CHPG Gastroenterology Littleton
7780 S Broadway Ste 260
Littleton,CO801222633
Healthcare Services Clinic
50 50 - Centura Health Emergency and Urgent Care L
3280 S Wadsworth Blvd
Lakewood,CO80227
Healthcare Urgent Care Clinic
51 51 - SOUTH SUBURBAN INTERNAL MEDICINE
7750 S Broadway Ste 150
Littleton,CO801222630
Healthcare Services Clinic
52 52 - NeurosurgeryOne Castle Rock
9695 S Yosemite St Ste 377
Lone Tree,CO80124
Healthcare Services Clinic
53 53 - Colorado NEUROVASCULAR SPEC PHYS
7780 S Broadway Ste 340
Littleton,CO801222633
Healthcare Services Clinic
54 54 - CMG PRIMARY CARE ELIZABETH
240 Elizabeth Street Unit B
Elizabeth,CO80107
Healthcare Services Clinic
55 55 - CHPG Neurosurgical and Spine
850 E Harvard Ave Suite 255
Denver,CO80210
Healthcare Services Clinic
56 56 - Centura Pain Specialists Porter
2535 S Downing Ste 180F
Denver,CO80210
Healthcare Services Clinic
57 57 - PAHS OnPoint Imaging LLC
9205 S Broadway Ste 101
Highlands Ranch,CO80129
Healthcare Services Clinic
58 58 - CHPG Primary Care Lafayette
511 Crossing Drive Ste 202
Lafayette,CO800262629
Healthcare Services Clinic
59 59 - CASTLE ROCK AFFILIATED ENT
2352 Meadows Blvd Ste 300 ENT
Castle Rock,CO80109
Healthcare Services Clinic
60 60 - Primary Care at Green Valley Ranch
4809 Argonne St 200
Denver,CO80249
Healthcare Services Clinic
61 61 - Encompass Health Rehabilitation Hospital
1001 West Mineral Ave
Littleton,CO80120
Rehabilitation Services
62 62 - Colorado Joint Replacement Lone Tree
9695 S Yosemite St Ste 255C
Lone Tree,CO80124
Healthcare Services Clinic
63 63 - Portercare Health Professionals Billings
2900 12th Ave N 400
Billings,MT59707
Physician Clinic
64 64 - Portercare Health Professionals
315 N 25th St 201
Billings,MT59102
Physician Clinic
65 65 - Jason Jenings MD-Orthopedic Surgery
4028 Laramie Street
Cheyenne,WY82001
Physician Clinic
66 66 - PAHS Physician Clinic
1760 Praire Ave
Cheyenne,WY82009
Physician Clinic
67 67 - PAHS Physician Clinic
1141 Wilkins Circle
Casper,WY82601
Physician Clinic
68 68 - PAHS Physician Clinic
640 Flormann St
Rapid City,SD57701
Physician Clinic
Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Part I, Line 6a: The filing organization operates as a part of Centura Health Corporation (Centura), a joint operating company that integrally manages a number of hospital and other healthcare provider facilities. All hospital organizations within Centura collect, calculate, and report the community benefits they provide to the communities they serve. Centura organizations exist solely to improve and enhance the local communities they serve. Centura 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 Centura 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 are posted on the filing organization's website.
Part I, Line 7: Portercare Adventist Health System does not use a cost accounting system to determine the cost of charity care. The estimated cost of care is calculated as the ratio of each facility's total expenses to total gross revenue. Worksheet 2 was not used to develop the cost to charge ratio. There are no physician clinics included in subsidized health services.
Part II, Community Building Activities: The costs of community building activities reported on Part II of Schedule H primarily represent the costs associated with providing education for the filing organization's staff physicians and employees. The filing organization's provision of these educational programs/activities to staff physicians and employees provides an opportunity for health care professionals to enhance their skills and expertise and keep up-to-date with the latest advancements in medical procedures and technology. In addition, training opportunities are often provided on-site at the filing organization's hospital facilities, thereby allowing for health care professionals to be more readily available to assist in meeting immediate patient care needs. Education and training provided to each facility's workforce is vital in assisting health care professionals directly involved in patient care with keeping abreast of the latest developments in their respective areas of expertise, learning possible new and innovative ways of delivering care to patients, and understanding the newest technologies available for the treatment of patients.
Part III, Line 2: Portercare Adventist Health System (PAHS) uses the overall cost to gross charge ratio applicable to each facility to determine the costs in Part III Lines 2 and 3. PAHS automatically discounts all self pay patient accounts by 30% and also offers a prompt pay discount. This allowance is not included in the calculation of the cost of bad debts in instances where a patient does not pay his or her bill.
Part III, Line 3: 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 24/7 emergency rooms providing care to all whom present. When a patient's arrival and/or admission to a 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 24/7 Emergency Departments that accept 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 Departments 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 Departments should be considered community benefit as charitable hospitals exist to provide such care in pursuit of their purpose of meeting the need for emergency medical care services available to all in the community.
Part III, Line 4: The financial information of the filing organization is included in a consolidated audited financial statement for the current year.The applicable footnote from the attached consolidated audited financial statements that addresses accounts receivable, the allowance for uncollectible accounts, and the provision for bad debts can be found on pages 8-9. Please note that dollar amounts on the attached consolidated audited financial statements are in thousands.
Part III, Line 8: Costing Methodology: Medicare allowable costs were calculated using a cost-to-charge ratio.Rationale for Including a Medicare Shortfall as Community Benefit:As a 501(c)(3) organization, the filing organization provides emergency and non-elective care to all regardless of ability to pay. All hospital services are provided in a non-discriminatory manner to patients who are covered beneficiaries under the Medicare program. As a public insurance program, Medicare provides a pre-established reimbursement rate/amount to health care providers for the services they provide to patients. In some cases, the reimbursement amount provided to a hospital may exceed its costs of providing a particular service or services to a patient. In other cases, the Medicare reimbursement amount may result in the hospital experiencing a shortfall of reimbursement received over costs incurred. In those cases where an overall shortfall is generated for providing services to all Medicare patients, the shortfall amount should be considered as a benefit to the community. Tax-exempt hospitals are required to accept all Medicare patients regardless of the profitability, or lack thereof, with respect to the services they provide to Medicare patients. The population of individuals covered under the Medicare program is sufficiently large so that the provision of services to the population is a benefit to the community and relieves the burdens of government. In those situations where the provision of services to the total Medicare patient population of a tax-exempt hospital during any year results in a shortfall of reimbursement received over the cost of providing care, the tax-exempt hospital has provided a benefit to a class of persons broad enough to be considered a benefit to the community. Despite a financial shortfall, a tax-exempt hospital must and will continue to accept and care for Medicare patients. Typically, tax-exempt hospitals provide health care services based upon an assessment of the health care needs of their community as opposed to their taxable counterparts where profitability often drives decisions about patient care services that are offered. Patient care provided by tax-exempt hospitals that results in Medicare shortfalls should be considered as providing a benefit to the community and relieving the burdens of government.
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 than 120 days after the first post-discharge billing statement is sent to the individual and is at least 30 days after the notice is provided. A reasonable attempt is also made to orally notify an individual about the filing organization's Financial Assistance Policy and how the individual may obtain assistance with the Financial Assistance application process. If an individual submits an incomplete FAA Form during the 240-day period following the date on which the first post-discharge billing statement was sent to the individual, the hospital filing organization suspends any reporting to consumer credit reporting agencies/bureaus (or ceases any other ECA's) and provides a written notice to the individual describing what additional information or documentation is needed to complete the FAA Form. This written notice contains contact information including the telephone number and physical location of each hospital facility's office or department that can provide information about the Financial Assistance Policy, as well as contact information of each 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, Line 8: Reconciliation of Schedule H Reported Medicare Surplus/(Shortfall) to Unreimbursed Medicare Costs Associated with the Provision of ServicesTo All Medicare Beneficiaries:The Medicare revenue and allowable costs of care reported in Section B of Part III of Schedule H are based upon the amounts reported in the filing organization's Medicare cost report in accordance with the IRS instructions for Schedule H. On an annual basis, the filing organization also determines its total unreimbursed costs associated with providing services to all Medicare patients. Unreimbursed costs are considered a community benefit to the elderly and are combined into an annual Community Benefit Statement. The primary reconciling items between the Medicare surplus/(shortfall) shown on line 7 of Section B of Part III of Schedule H and the filing organization's unreimbursed costs of services provided to all Medicare patients are as follows:- Medicare surplus/(shortfall) shown on line 7 of Section B of Schedule H: $ (39,804,494)- Difference in costing methodology: (41,656,725)- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (90,595,416) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's communitybenefit reporting $ (172,056,635)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 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 filing organization's hospitals provide several services and resources to the communities they serve beyond the prioritized needs specifically identified in the Community Health Needs Assessments. They sponsor wellness events such as breast feeding education, asthma screenings, and financially support wellness initiatives of cities and public schools. They also provide transportation for low income patients and housing at no cost or very low cost for the families of low income patients of the hospitals that are far from their residence. They also support, financially and through volunteerism, initiatives such as soup kitchens and Meals on Wheels to provide food and nutrition education to address hunger issues. Hospital staff also volunteer to serve as preceptors for students of local health professional programs and serve on boards of local community organizations that provide social services to populations in need.
Part VI, Line 3: The Financial Assistance Policy (FAP), Financial Assistance Application Form (FAA Form), and the Plain Language Summary of the Financial Assistance Policy (PLS) of the filing organization's hospital facilities are transparent and available to all individuals served at any point in the care continuum. The FAP, FAA Form, PLS, and contact information for each hospital facility's financial counselors are prominently and conspicuously posted on each filing organization's hospital facility's website. The websites indicate 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 each hospital facility (referred to below as LEP defined populations). Signage is displayed in public locations of each filing organization's hospital facility, including at all points of admission and registration and the Emergency Department. The signage contains each hospital facility's website address where the FAP, FAA Form, and PLS can be accessed and the telephone number and physical location that individuals can call or visit to obtain copies of the FAP, FAA Form and PLS or to obtain more information about the hospital facility's FAP, FAA Form and PLS. Paper copies of 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. Each of 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 each hospital facility's PLS will be offered to every patient as a part of the intake or discharge process. A conspicuous written notice is included on all billing statements sent to patients that notifies and informs recipients about the availability of financial assistance under the filing organization's financial assistance policy, including the following: 1) the telephone number of the hospital 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: Littleton Adventist HospitalTo understand the profile of Littleton Adventist Hospital's community, we analyzed the demographic and health indicator data of the population within the defined service area. The demographic makeup of these communities is as follows: - Race: The population is 66% white, 7.1% black, 5.9% Asian, 0.4% Native American/Alaskan Native, 0.2% native Hawaiian/Pacific Islander, 17.4% some other race, and 3% multiple races.- Ethnicity: 17.3% Hispanic or Latino.Approximately 51.9% of the Hospital's patients during the tax year were Medicare patients, about 11.9% were Medicaid patients, about 2.3% were self-pay patients, and the remaining percentage were patients covered under commercial insurance. In the current tax year, about 63.9% of the Hospital's in-patients were admitted through the Hospital's Emergency Department.Porter Adventist HospitalTo understand the profile of Porter Adventist Hospital's community, we analyzed the demographic and health indicator data of the population within the defined service area. The demographic makeup of these communities is as follows: - Race: The population is 53.1% white, 10.4% black, 5.3% Asian, .5% Native American/Alaskan Native, .2% native Hawaiian/Pacific Islander, 27.3% some other race, and 3.1% multiple races. - Ethnicity: 27.1% Hispanic or Latino.Approximately 48.3% of the Hospital's patients during the tax year were Medicare patients, about 15.3% were Medicaid patients, about 4.0% were self-pay patients, and the remaining percentage were patients covered under commercial insurance. In the current tax year, about 52.7% of the Hospital's in-patients were admitted through the Hospital's Emergency Department.Parker Adventist HospitalTo understand the profile of Parker Adventist Hospital's community, we analyzed the demographic and health indicator data of the population within the defined service area. The demographic makeup of these communities is as follows: - Race: The population is 66% white, 7.1% black, 5.9% Asian, 0.4% Native American/Alaskan Native, 0.2% native Hawaiian/Pacific Islander, 17.4% some other race, and 3% multiple races.- Ethnicity: 17.3% Hispanic or Latino.Approximately 41.1% of the Hospital's patients during the tax year were Medicare patients, about 14.2% were Medicaid patients, about 3.0% were self-pay patients, and the remaining percentage were patients covered under commercial insurance. In the current tax year, about 69.7% of the Hospital's in-patients were admitted through the Hospital's Emergency Department.Avista Adventist HospitalTo understand the profile of Avista Adventist Hospital's community, we analyzed the demographic and health indicator data of the population within the defined service area. The demographic makeup of these communities is as follows: - Race: The population is 76.9% white, 1% black, 5.1% Asian, 0.4% Native American/Alaskan Native, 0.1% Native Hawaiian/Pacific Islander, 14.3% some other race, and 2.4% multiple races. - Ethnicity: 14.1% Hispanic or LatinoApproximately 30.9% of the Hospital's patients during the tax year were Medicare patients, about 16.7% were Medicaid patients, about 7.1% were self-pay patients, and the remaining percentage were patients covered under commercial insurance. In the current tax year, about 25.2% of the Hospital's in-patients were admitted through the Hospital's Emergency Department.Castle Rock Adventist HospitalTo understand the profile of Castle Rock Adventist Health Campus's community, we analyzed the demographic and health indicator data of the population within the defined service area. The demographic makeup of these communities is as follows: - Race: The population is 82% white, 1.3% black, 4.9% Asian, 0.3% Native American/Alaskan Native, 0.1% native Hawaiian/Pacific Islander, 9% some other race, and 2.4% multiple races.- Ethnicity: 8.9% Hispanic or Latino. Approximately 38.0% of the Hospital's patients during the tax year were Medicare patients, about 13.5% were Medicaid patients, about 4.3% were self-pay patients, and the remaining percentage were patients covered under commercial insurance. In the current tax year, about 60.7% of the Hospital's in-patients were admitted through the Hospital's Emergency Department.
Part VI, Line 5: The provision of community benefit is central to Portercare Adventist Health System's mission of service and compassion. Restoring and promoting the health and quality of life of those in the communities served by the filing organization is a function of "extending the healing ministry of Christ by caring for those who are ill and by nuturing the health of the people in our communities and embodies the filing organization's commitment to its values and principles. The filing organization commits substantial resources to provide a broad range of services to both the underprivileged as well as the broader community. In addition to the community benefit and community building information provided in Parts I, II and III of this Schedule H, the filing organization captures and reports the benefits provided to its community through faith-based care. Examples of such benefits include the cost associated with chaplaincy care programs and mission peer reviews and mission conferences. During the current year, the filing organization provided $1,388,213 of benefit with respect to the faith-based and spiritual needs of its communities in conjunction with its operation of community hospitals. The filing organization also provides benefits to each of 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 filing organization expended $87,412,560 in new capital improvements. As faith-based mission-driven community hospitals, the filing organization is continually involved in monitoring its communities, identifying unmet health care needs and developing solutions and programs to address those needs. In accordance with its conservative approach to fiscal responsibility, surplus funds of the filing organization are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its communities.
Part VI, Line 6: Portercare Adventist Health System is operated as part of Centura Health Corporation ("Centura"). Centura and its affiliated organizations are dedicated to extending the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities. Specifically, Centura has launched a system-wide strategic plan to improve the quality, consistency, availability, and affordability of health care to communities throughout Colorado. The three main components of this strategy are (1) to continue investing in technology advancements that improve the quality, costs, and coordination of care including the establishment of electronic health records linking our physicians, clinics, hospitals, long-term facilities and home care services; (2) providing wellness care, thereby potentially reducing health care costs by helping patients to maintain good health, growing the level of support and outreach provided to rural communities, and increasing access, affordability and quality of health care; and (3) coordinate and develop systems of care, looking to each facility and entity in Centura to share best practices and improve overall efficiency and communication system-wide from birth to home care.
Part VI, Line 7, Reports Filed With States CO
Schedule H (Form 990) 2022
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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2022
Open to Public
Inspection
Name of the organization
Portercare Adventist Health System
 
Employer identification number
84-0438224
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC section
(if applicable)
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
noncash assistance
(h) Purpose of grant
or assistance
(1) JEFFCO ACTION CENTER INC
8755 W 14th Ave
Lakewood,CO80215
23-7019679 501(c)(3) 17,500 0     General Support
(2) ADVOCATES FOR VICTIMS OF ASSAULT INC
PO Box 1859
Frisco,CO80443
84-0950954 501(c)(3) 17,500 0     General Support
(3) BARTON INSTITUTE FOR COMMUNITY ACTION
1114 W 7th Ave Ste 215
Denver,CO80204
83-4295300 501(c)(3) 17,500 0     General Support
(4) The Boulder Chamber of Commerce
2440 Pearl Street
Boulder,CO80302
84-0152700 501(c)(6) 7,225 0     General Support
(5) BREAK THE SILENCE INC
411 W Platte Ave Ste A Box 165
Fort Morgan,CO80701
84-3100049 501(c)(3) 15,827 0     General Support
(6) BROTHER JEFF'S CULTURAL CENTER
2836 WELTON ST
DENVER,CO80205
32-0034993 501(c)(3) 21,000 0     General Support
(7) CASTLE ROCK CHAMBER OF COMMERCE
420 Jerry St
Castle Rock,CO80104
84-0802658 501(c)(6) 15,000 0     General Support
(8) CASTLE ROCK SEVENTH DAY ADVENTIST CHURCH
2350 MEADOWS BLVD
Castle Rock,CO80109
81-5259884 501(c)(3) 10,000 0     General Support
(9) CATHOLIC CHARITIES OF CENTRAL COLORADO INC
228 NORTH CASCADE AVE
COLORADO SPRINGS,CO80903
84-0586169 501(c)(3) 17,500 0     General Support
(10) CENTER FOR AFRICAN AMERICAN HEALTH
3350 HUDSON ST
DENVER,CO80207
84-1477546 501(c)(3) 26,250 0     General Support
(11) THE CHANDA PLAN FOUNDATION
1630 CARR STREET
LAKEWOOD,CO80214
20-4358964 501(c)(3) 17,500 0     General Support
(12) NEW DANCE THEATRE INC Dba CLEO PARKER ROBINSON DANCE
119 Park Ave W
Denver,CO80205
84-0632111 501(c)(3) 29,750 0     General Support
(13) CLINICA CAMPESINA FAMILY HEALTH SERVICES
345 PLAZA COURT NORTH
LAFAYETTE,CO80026
84-0743432 501(c)(3) 15,950 0     General Support
(14) COAL CREEK MEALS ON WHEELS
455 N BURLINGTON AVE
LAFAYETTE,CO80026
84-0634856 501(c)(3) 8,750 0     General Support
(15) COLLEGE TRACK
112 Linden Street
Oakland,CA94607
94-3279613 501(c)(3) 35,000 0     General Support
(16) COLORADO CHANGEMAKERS COLLECTIVE
12075 45th Ave Ste 300
Denver,CO80239
83-2846355 501(c)(3) 24,500 0     General Support
(17) COMMUNITY COMPASSION OUTREACH
10 Town Plaza 315
Durango,CO81301
82-5001338 501(c)(3) 35,000 0     General Support
(18) COMMUNITY FOOD SHARE INC
650 S TAYLOR AVE
LOUISVILLE,CO80027
74-2227731 501(c)(3) 17,500 0     General Support
(19) COMMUNITY HEALTH PARTNERSHIP
121 South Tejon St
COLORADO SPRINGS,CO80903
84-1388331 501(c)(3) 26,250 0     General Support
(20) BOULDER COUNTY RSVP BOARD INC DBA CULTIVATE
6325 Gunpark Dr Ste F
Boulder,CO80301
84-0769724 501(c)(3) 8,750 0     General Support
(21) DOCTORS CARE
609 W Littleton Blvd Suite 100
Littleton,CO80120
84-1150815 501(c)(3) 30,000 0     General Support
(22) ERIE CHAMBER OF COMMERCE
235 Wells St
Erie,CO80516
84-1325423 501(c)(6) 5,450 0     General Support
(23) FACE IT TOGETHER INC
5020 S Tennis Lane 4
SIOUX FALLS,SD57108
27-2501220 501(c)(3) 26,250 0     General Support
(24) FINNEY COUNTY COMMUNITY HEALTH COALITION INC
310 E WALNUT ST 202
GARDEN CITY,KS67846
27-5247081 501(c)(3) 21,000 0     General Support
(25) FOCUS POINTS FAMILY RESOURCE CENTER
2501 E 48th Ave
Denver,CO80216
84-1353944 501(c)(3) 31,500 0     General Support
(26) FRIENDS OF BROOMFIELD INC
11851 Saulsbury Street
Broomfield,CO80020
84-1516104 501(c)(3) 52,500 0     General Support
(27) FRONT LINE FARMING
2830 Clayton Street
Denver,CO80205
83-3496361 501(c)(3) 35,000 0     General Support
(28) FRONT RANGE AREA HEALTH EDUCATION CENTER
PO Box 21886
Denver,CO80221
85-4209627 501(c)(3) 26,250 0     General Support
(29) HEART MIND HAVEN
6833 S MILLER ST
LITTLETON,CO80127
83-3158421 501(c)(3) 35,000 0     General Support
(30) HOMEWARD PIKES PEAK
2010 E BIJOU ST
COLORADO SPRINGS,CO80909
13-4242773 501(c)(3) 17,500 0     General Support
(31) IMPACT ON EDUCATION INC
721 Front Street Suite A
Louisville,CO80027
84-0943046 501(c)(3) 12,680 0     General Support
(32) INTERNATIONAL RESCUE COMMITTEE INC
1873 S BELLAIRE ST 500
DENVER,CO80222
13-5660870 501(c)(3) 35,000 0     General Support
(33) LATINA SAFEHOUSE INITIATIVE
PO Box 11174
Denver,CO80211
32-0298603 501(c)(3) 10,500 0     General Support
(34) LOUISVILLE CHAMBER OF COMMERCE
901 Main St
Louisville,CO80027
84-0892240 501(c)(6) 11,200 0     General Support
(35) DOWNTOWN BUSINESS ASSOCIATION OF LOUISVILLE INC
PO Box 311
Louisville,CO80027
84-1291020 501(c)(6) 5,000 0     General Support
(36) MANNA - THE DURANGO SOUP KITCHEN
PO Box 1196
Durango,CO81302
84-1004473 501(c)(3) 17,500 0     General Support
(37) MERCY HOUSING MOUNTAIN PLAINS
1600 Broadway Suite 2000
Denver,CO80202
20-1583332 501(c)(3) 23,570 0     General Support
(38) MID-AMERICA UNION CONFERENCE OF SEVENTH-DAY ADVENTISTS
8307 Pine Lake Rd
Lincoln,NE68516
47-6006806 501(c)(3) 10,225 0     General Support
(39) MILE HIGH ACADEMY
1733 DAD CLARK DRIVE
HIGHLANDS RANCH,CO80126
84-0525223 501(c)(3) 70,000 0     General Support
(40) MOUNTAIN RESOURCE CENTER
PO Box 425
Conifer,CO80433
84-1178699 501(c)(3) 24,686 0     General Support
(41) MUSLIM YOUTH FOR POSITIVE IMPACT
1880 Golden Eagle Court
Broomfield,CO80020
83-0998674 501(c)(3) 35,000 0     General Support
(42) NATIONAL KIDNEY Foundation Inc
30 E 33rd St
New York,NY10016
13-1673104 501(c)(3) 23,250 0     General Support
(43) NEWDAY ADVENTIST CHURCH
9030 MILLER RD
PARKER,CO80134
27-6167861 501(c)(3) 12,000 0     General Support
(44) NOURISH COLORADO
3532 Franklin St Suite F
Denver,CO80205
26-2464764 501(c)(3) 51,867 0     General Support
(45) Greater Parker Foundation
20120 E Mainstreet
PARKER,CO80138
26-3664272 501(c)(3) 5,000 0     General Support
(46) PARA TI MUJER
494 N Sheridan Blvd
Lakewood,CO80226
45-3584876 501(c)(3) 26,250 0     General Support
(47) PARKER TASK FORCE FOR HUMAN SERVICES
19105 Longs Way
Parker,CO80134
74-2494265 501(c)(3) 7,500 0     General Support
(48) PEER COACH ACADEMY COLORADO
2614 W Pikes Peak Ave
COLORADO SPRINGS,CO80904
81-3460352 501(c)(3) 28,375 0     General Support
(49) POSADA
827 East 4TH ST
PUEBLO,CO81001
74-2473501 501(c)(3) 26,250 0     General Support
(50) PROJECT ANGEL HEART
4950 Washington Street
Denver,CO80216
84-1199481 501(c)(3) 17,500 0     General Support
(51) PROJECT WORTHMORE
1666 ELMIRA ST
AURORA,CO80010
45-0933835 501(c)(3) 35,000 0     General Support
(52) RISE COLORADO
1595 Elmira Street
AURORA,CO80010
47-3566342 501(c)(3) 26,250 0     General Support
(53) Rocky Mountain Adventist Healthcare Foundation
960 E Harvard Avenue Ste 230
Denver,CO80210
84-0745018 501(c)(3) 512,075 0     General Support
(54) THE ROCKY MOUNTAIN CONFERENCE OF SEVENTH-DAY ADVENTISTS
2520 S DOWNING ST
DENVER,CO80210
27-4456014 501(c)(3) 18,000 0     General Support
(55) ROCKY MOUNTAIN SEED ALLIANCE INC
4785 N 1115 E
Buhl,ID83316
46-5661943 501(c)(3) 17,500 0     General Support
(56) ROSE ANDOM CENTER INC
1330 FOX ST
DENVER,CO80204
90-0990929 501(c)(3) 17,500 0     General Support
(57) SAFE SHELTER OF ST VRAIN VALLEY
PO Box 231
Longmont,CO80502
84-0781353 501(c)(3) 17,500 0     General Support
(58) SECOND CHANCE THROUGH FAITH
1551-1553 VAPOR TRAIL
COLORADO SPRINGS,CO80916
46-3236114 501(c)(3) 17,500 0     General Support
(59) LA RAZA SERVICES INC DBA SERVICIOS DE LA RAZA
3131 W 14th Avenue
Denver,CO80204
84-0625478 501(c)(3) 61,250 0     General Support
(60) SIDE BY SIDE CORPORATION
15700 RIVERDALE RD
BRIGHTON,CO80602
83-2678502 501(c)(3) 17,500 0     General Support
(61) SOLID ROCK COMMUNITY DEVELOPMENT CORPORATION
PO BOX 15631
COLORADO SPRINGS,CO80935
26-0381727 501(c)(3) 19,250 0     General Support
(62) LITTLETON TRANSPORTATION NETWORK DBA SOUTH METRO COMMUNITY FOUNDATION
PO BOX 401
Littleton,CO80160
82-5192442 501(c)(3) 17,500 0     General Support
(63) SOUTHERN COLORADO COMMUNITY ACTION AGENCY INC
535 Candelaria Drive
Ignacio,CO81137
84-0576978 501(c)(3) 35,000 0     General Support
(64) SOUTHWESTERN COLORADO AREA HEALTH EDUCATION CENTER
701 Camino Del Rio Ste 320
Durango,CO81301
27-2461746 501(c)(3) 31,500 0     General Support
(65) SUN VALLEY COMMUNITY CENTER
1260 Decatur Street
Denver,CO80204
47-4226132 501(c)(3) 21,000 0     General Support
(66) DOMESTIC VIOLENCE INITIATIVE FOR WOMEN WITH DISABILITIES DBA THE INITIATIVE
6825 E Tennessee Ave 475
Denver,CO80224
84-1068953 501(c)(3) 8,750 0     General Support
(67) PIKES PEAK JUSTICE & PRO BONO CENTER DBA THE JUSTICE CENTER
PO Box 429
COLORADO SPRINGS,CO80901
27-4331236 501(c)(3) 28,000 0     General Support
(68) THE PLACE
423 EAST CUCHARRAS ST
COLORADO SPRINGS,CO80903
84-1549702 501(c)(3) 28,000 0     General Support
(69) TRAILHEAD INSTITUTE
1999 Broadway Suite 600
Denver,CO80202
84-1267213 501(c)(3) 26,250 0     General Support
(70) TREELINE PASS
5910 S University Blvd C-18
Greenwood Village,CO80121
82-5279131 501(c)(3) 38,815 0     General Support
(71) TRI-LAKES CARES
PO Box 1301
Monument,CO80132
74-2501356 501(c)(3) 17,500 0     General Support
(72) VETERANS COMMUNITY PROJECT
8900 TROOST AVE
KANSAS CITY,MO64131
47-4960735 501(c)(3) 21,000 0     General Support
(73) VIVE
PO Box 11003
Denver,CO80211
81-4059452 501(c)(3) 35,000 0     General Support
(74) VUELA FOR HEALTH
3532 N Franklin Street
Denver,CO80205
84-1444277 501(c)(3) 49,666 0     General Support
(75) ARTHRITIS FOUNDATION INC
1355 Peachtree St Suite 600
Atlanta,GA30309
58-1341679 501(c)(3) 5,500 0     General Support
(76) WILD PLUM CENTER FOR YOUNG CHILDREN AND FAMILIES
82 21st Ave NO B
Longmont,CO80501
47-4709774 501(c)(3) 10,500 0     General Support
(77) Hunger Free Colorado
1355 S Colorado Blvd 201
Denver,CO80222
68-0551464 501(c)(3) 26,250 0     General Support
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
72
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
5
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2022

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


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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
Name of the organization
Portercare Adventist Health System
 
Employer identification number

84-0438224
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2022

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
(i) Base
compensation
(ii) Bonus & incentive
compensation
(iii) Other reportable compensation
1Banko Peter
Former President CHC
(i)

(ii)
0
-------------
1,824,268
0
-------------
1,743,952
0
-------------
165,957
0
-------------
741,441
0
-------------
29,652
0
-------------
4,505,270
0
-------------
0
2Rathbun Paul
Board Member / AH CFO
(i)

(ii)
0
-------------
1,218,839
0
-------------
421,406
0
-------------
895,765
0
-------------
166,400
0
-------------
45,556
0
-------------
2,747,966
0
-------------
150,000
3Enderson Dan
Secretary-Group President
(i)

(ii)
0
-------------
840,720
0
-------------
619,513
0
-------------
199,134
0
-------------
236,376
0
-------------
20,567
0
-------------
1,916,310
0
-------------
0
4Bacon Kenneth
Board Chairman/AH CEO Multi State
(i)

(ii)
0
-------------
1,226,644
0
-------------
338,892
0
-------------
56,102
0
-------------
243,332
0
-------------
46,940
0
-------------
1,911,910
0
-------------
0
5Gaasch Andrew
Treasurer/CFO
(i)

(ii)
0
-------------
732,691
0
-------------
520,620
0
-------------
10,118
0
-------------
182,073
0
-------------
33,901
0
-------------
1,479,403
0
-------------
0
6Jennings MD Jason
Orthopedic Surgeon
(i)

(ii)
1,134,773
-------------
0
263,358
-------------
0
0
-------------
0
10,675
-------------
0
30,595
-------------
0
1,439,401
-------------
0
0
-------------
0
7Huenergardt Samuel
Former Key Emp/CEO Mid-America
(i)

(ii)
0
-------------
751,872
0
-------------
196,309
0
-------------
132,785
0
-------------
144,531
0
-------------
48,521
0
-------------
1,274,018
0
-------------
85,211
8Yang MD Charlie
Orthopedic Surgeon
(i)

(ii)
1,107,436
-------------
0
108,768
-------------
0
0
-------------
0
7,175
-------------
0
30,745
-------------
0
1,254,124
-------------
0
0
-------------
0
9Miner MD Todd
Orthopedic Surgeon
(i)

(ii)
1,100,412
-------------
0
100,444
-------------
0
0
-------------
0
9,800
-------------
0
25,342
-------------
0
1,235,998
-------------
0
0
-------------
0
10Sanchez II MD Anthony
Orthopedic Surgeon
(i)

(ii)
933,400
-------------
0
174,138
-------------
0
0
-------------
0
10,675
-------------
0
26,981
-------------
0
1,145,194
-------------
0
0
-------------
0
11Rajpal Sharad
Neuro Surgeon
(i)

(ii)
964,601
-------------
0
40,000
-------------
0
0
-------------
0
0
-------------
0
11,942
-------------
0
1,016,543
-------------
0
0
-------------
0
12Goebel Michael
CEO Parker Adventist Hospital
(i)

(ii)
0
-------------
440,085
0
-------------
331,276
0
-------------
108,457
0
-------------
107,503
0
-------------
28,380
0
-------------
1,015,701
0
-------------
0
13Folkenberg Todd
CEO Porter Adventist Hospital
(i)

(ii)
0
-------------
425,510
0
-------------
215,362
0
-------------
118,653
0
-------------
99,358
0
-------------
35,574
0
-------------
894,457
0
-------------
0
14Dodds Rick
CEO Littleton Adv Hospital
(i)

(ii)
0
-------------
416,907
0
-------------
158,474
0
-------------
218,983
0
-------------
48,335
0
-------------
28,174
0
-------------
870,873
0
-------------
0
15McKinney Jillyan
Former Key Emp/CEO AHMG Central FL
(i)

(ii)
0
-------------
506,702
0
-------------
116,355
0
-------------
13,460
0
-------------
86,050
0
-------------
42,525
0
-------------
765,092
0
-------------
0
16Houmann Lars
Board Member
(i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
682,872
0
-------------
0
0
-------------
13,112
0
-------------
695,984
0
-------------
0
17Sendros Isaac
CEO Avista Adv Hosp(end 2/23)
(i)

(ii)
0
-------------
365,085
0
-------------
177,926
0
-------------
7,918
0
-------------
78,999
0
-------------
28,666
0
-------------
658,594
0
-------------
0
18Dean Morre
Former Officer/CIO
(i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
588,393
0
-------------
0
0
-------------
22,337
0
-------------
610,730
0
-------------
0
19Pittman Jeremy
CEO Castle Rock Adv Hospital
(i)

(ii)
0
-------------
331,890
0
-------------
106,664
0
-------------
3,162
0
-------------
56,472
0
-------------
33,143
0
-------------
531,331
0
-------------
0
20Fisher Jonathan
Former Key Emp/CFO Wesley
(i)

(ii)
0
-------------
291,209
0
-------------
40,361
0
-------------
13,775
0
-------------
61,382
0
-------------
42,200
0
-------------
448,927
0
-------------
0
21Travis Carol
CFO Avista Adv Hospital
(i)

(ii)
0
-------------
275,644
0
-------------
76,904
0
-------------
603
0
-------------
6,523
0
-------------
30,046
0
-------------
389,720
0
-------------
0
22Ward Erin
CFO Parker Adv Hospital
(i)

(ii)
0
-------------
276,882
0
-------------
69,888
0
-------------
593
0
-------------
7,212
0
-------------
0
0
-------------
354,575
0
-------------
0
23Beckner Michelle
Former CFO Littleton
(i)

(ii)
0
-------------
202,512
0
-------------
63,450
0
-------------
53,467
0
-------------
0
0
-------------
31,708
0
-------------
351,137
0
-------------
0
24Gal Matt
CFO Castle Rock Adv Hospital
(i)

(ii)
0
-------------
179,974
0
-------------
38,983
0
-------------
53,616
0
-------------
2,206
0
-------------
5,889
0
-------------
280,668
0
-------------
0
25Still Danae
CFO Littleton(beg 2/23)
(i)

(ii)
0
-------------
201,299
0
-------------
0
0
-------------
29,167
0
-------------
7,602
0
-------------
32,509
0
-------------
270,577
0
-------------
0
26Whitlock Andrew
CFO Porter Adv Hosp(beg 12/22)
(i)

(ii)
0
-------------
174,237
0
-------------
20,012
0
-------------
267
0
-------------
7,010
0
-------------
29,559
0
-------------
231,085
0
-------------
0
Schedule J (Form 990) 2022

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 As discussed in Part VI, Section B, Line 15, the filing organization's top management officials are compensated by Centura Health Corporation (CHC). All officers and key employees are compensated by CHC, who manages the daily activities of Portercare Adventist Health System under a joint operating agreement dated December 8, 1995 between Adventist Health System Sunbelt Healthcare Corp. and Common Spirit Health. As such, their salaries are paid to them by CHC, a related organization, for services rendered in their capacity as key employees or officers of PAHS. All of their reportable compensation is disclosed on Form 990, Schedule J, Part II, row (ii) and Form 990, Part VII, column (e) as compensation from related organizations. Travel for companions: CHC provides reimbursement for spousal travel when certain of its executives attend conferences sponsored by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is the tax-exempt top-tier parent of Portercare Adventist Health Systesm (PAHS). All spousal travel costs reimbursed to the executive are considered taxable compensation to the executive. Tax Indemnification and gross-up payments: CHC 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) provided to any employee may be grossed-up upon approval by the filing organization's CEO and CFO. Discretionary spending account: A cash discretionary spending account was provided in the current year to eligible executives in the form of a car allowance of $750 per month to help offset business travel expense. Other discretionary spending accounts may be provided in connection with attendance at conferences but typically do not exceed $300 per participant. Taxable travel and other spending accounts are considered taxable compensation to the executive. Housing allowance or residence for personal use: CHC has a Corporate Executive Policy that addresses assistance to executives who have been relocated by the company during the year. Relocation assistance is administered per CHC policy by an external relocation company. Any taxable reimbursements made to executives in connection with relocation assistance are treated as wages to the executive and are subject to all payroll withholding and reporting requirements.
Part I, Lines 4a-b Line 4a: During 2022, Lars Houmann received severance payments in the amount of $661,887 from Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) the top-tier 501(c)(3) parent of the filing organization. Pursuant to the AHSSHC Corporate Executive Policy governing executive severance, severance agreements for executives operating at the Vice President level and above are entered into upon eligibility to facilitate the transition to subsequent employment following an involuntary separation from employment with AdventHealth. During 2022, Morre Dean and Michelle Beckner received severance payments in the amount of $588,393 and $53,078 respectively from CHC. Pursuant to the CHC Corporate Executive Policy governing executive severance, severance agreements for executives operating at the Vice President level and above are entered into upon eligibility to facilitate the transition to subsequent employment following an involuntary separation from employment with CHC. Line 4b: As discussed in Line 1 above, the organization's top management officials' compensation is paid by Centura Health Corporation (CHC). All officers and key employees are compensated by CHC, who manages the daily activities of Portercare Adventist Health System (PAHS). As such, their salaries and all associated benefits are paid to them by CHC for services rendered in their capacity as key employees or officers of PAHS. All of their reportable compensation is disclosed on Form 990, Schedule J, Part II, row (ii) and Form 990, Part VII, column (e) as compensation from related organizations. Senior executives on the filing organization's management team that hold the position of Senior Vice-President or Hospital CEO are eligible to participate in the CHC EXECU-FLEX Benefit Plan (the Plan). In recognition of the contribution that each executive makes to the success of CHC, CHC provides for participation in the Plan to the eligible executives. The purpose of the Plan is to offer an opportunity to elect from among a variety of supplemental benefits to individually tailor a benefits program appropriate to each executive's needs. The executive is provided with a Flex allowance equivalent to 10% of base salary to purchase selected benefits and to contribute into a deferred non-qualified supplemental executive retirement plan. The Plan provides for a five-year cliff-vesting schedule with respect to amounts accumulated in the executive's deferred compensation account. CHC contributes into these deferred compensation accounts semi-annually and amounts are subject to a substantial risk of forfeiture with active participation required at time of vesting. In addition, CHC provides a Pension Restoration Benefit (PRB) to restore qualified plan contributions lost on income in excess of the current federal maximum allowable compensation to a qualified plan. The PRB provides contributions by restoring the amount that would have been contributed to the executive's retirement savings plan for compensation in excess of the legislative limits. Benefit amounts are added to the participant's flex allowance each year based on their total compensation from the prior year. The following received contributions to a non-qualified plan for the calendar year 2022: CY Employer CY Employer CY SERP CY PRB SERP Contr. PRB Contr. Distrib. Distrib. Peter Banko 387,101 344,401 104,983 47,166 Daniel Enderson 128,713 98,213 108,037 75,076 Andrew Gaasch 102,699 72,199 0 0 Michael Goebel 61,884 31,384 0 0 Todd Folkenberg 60,204 29,704 80,618 26,873 Rick Dodds 42,700 0 0 0 Isaac Sendros 49,412 18,912 0 0 Jeremy Pittman 46,632 12,132 0 0
Schedule J, Line 4b: Additionally, in calendar year 2022 Board members of the filing organization, L. Houmann, P. Rathbun, and K. Bacon were compensated by and on the payroll of Adventist Health System Sunbelt Healthcare Corporation (AHSSSHC), the parent organization of a healthcare system known as AdventHealth. Current employees Ken Finch and Danae Still as well as Former Key Employees S. Huenergardt, J. Fisher, J. McKinney, and B. Spenst, were also compensated by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) for a portion or for all of calendar year 2022. AdventHealth is exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code. 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.
Schedule J, Line 4b: continuation Flex Plan Flex Plan SERP II SERP III Contr. Distr.* Contr./Distr. Contr. ------------------------------------------------------- Paul Rathbun $ 150,000 $ 197,530 $ 607,786 $ 0 Kenneth Bacon $ 0 $ 0 $ 0 $226,932 Samuel Huenergardt $ 128,131 $ 115,142 $ 0 $ 0 Jillyan McKinney $ 0 $ 0 $ 0 $ 75,750 Jonathan Fisher $ 0 $ 0 $ 0 $ 45,073 * Including Investment Earnings
Schedule J (Form 990) 2022

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet 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.
MediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Portercare Adventist Health System
 
Employer identification number

84-0438224
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 (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
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?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
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
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?
Yes No
(1) Ryan Folkenberg Family of Key Employee 14,538 Employee Compensation   No
(2) Aaron Speegle Family of Officer 134,141 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:  




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
Portercare Adventist Health System
 
Employer identification number

84-0438224
Return Reference Explanation
Part V, Line 1a-1b Pursuant to an Affiliation Agreement between Adventist Health System Sunbelt Healthcare Corporation and Common Spirit Health, Portercare Adventist Health System (the filing organization) is managed by Centura Health Corporation (CHC), a joint operating company. CHC is a Colorado, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). CHC has established a shared service center to centralize the Accounts Payable (A/P) functions. The facts and circumstances support a position that CHC, as a payor on behalf of its managed organizations in a shared service environment, will have sufficient management and oversight in connection with the managed organizations' payments to meet the standard set forth in Treas. Reg. Section 1.6041-1(e). CHC will not merely be making payments at the direction of its managed organizations. Accordingly, CHC is considered the payor subject to the information reporting requirements of Section 6041. 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 CHC as the payor subject to the information reporting requirements of Section 6041.
Form 990, Part VI, Section A, line 1a Pursuant to Article IV of the Bylaws of Portercare Adventist Health System, the Board of Trustees may, by resolution or resolutions passed by a majority of the Trustees thereof, appoint an Executive Committee or such other Committees for any purpose and delegate to such committees any of the powers and authority of the Board of Trustees as is permitted by law. Colorado law precludes a committee of the Board from (I) authorizing distributions; (II) approving or proposing to the member actions that Articles 121-137 of Title 7 of the Colorado revised statutes require to be approved by the member; (III) amending the corporation's amended and restated Articles of Incorporation; (IV) adopting, amending or repealing the Bylaws; (V) approving a plan of merger not requiring approval of the member; or (VI) approving a sale, lease, exchange or other disposition of all, or substantially all, of its property, with or without good will, other than in the usual and regular course of business subject to approval of the member. Such Committees shall have the power to act only in intervals between meetings of the Board of Trustees and shall, at all times, be subject to the control of the Board of Trustees. The Board of Trustees, or if the Board does not act, the Committees, shall establish rules and regulations for meetings and shall meet at such times as are deemed necessary, provided that a reasonable notice of all meetings shall be given to Committee members. No act of a Committee shall be valid unless approved by the vote or written consent of a majority of its members. Committees shall keep regular minutes of proceedings and report the same to the Board from time to time as the Board may require.
Form 990, Part VI, Section A, line 2 Gary Thurber and John (Mic) Thurber - Family Relationship
Form 990, Part VI, Section A, line 6 Portercare Adventist Health System (the filing organization) has one member. The sole member of the filing organization is Adventist Health System Sunbelt Healthcare Corporation. Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). There are no other classes of membership in the filing organization.
Form 990, Part VI, Section A, line 7a The sole member of the filing organization is AHSSHC. The Board of Directors of the filing organization are appointed by the sole member, AHSSHC, who has the right to elect, appoint or remove any member of the Board of Directors of the filing organization.
Form 990, Part VI, Section A, line 7b The Corporate member, AHSSHC, acting through the Board of Directors, maintains all rights permitted to be exercised by Directors of a Colorado corporation except as limited by the organization's Articles, Bylaws, or Affiliation Agreement with Common Spirit Health (CSH), F/K/A Catholic Health Initiatives. The Agreement of both AHSSHC and CSH is required for certain significant decisions involving Centura facilities. In addition, pursuant to the Affiliation Agreement between CSH, Colorado Health Initiatives Colorado (CHIC), Centura Health Corporation, and Portercare Adventist Health System (PAHS), certain matters affecting PAHS must be approved by both PAHS and CHIC. Those items include: - The transfer of assets valued at over $3,000,000 - The issuance of a debt instrument in excess of $250,000 - The amendment of the organizing documents - The admission of a new sponsor - A merger or dissolution or reorganization - Settlement of legal proceedings in excess of $2,000,000 - Capital expenditures in excess of $5,000,000
Form 990, Part VI, Section B, line 11b The filing organization's current year Form 990 was reviewed by the CFO of the filing organization prior to its filing with the IRS. The review conducted by the CFO of the filing organization 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 Portercare Adventist Health System has adopted Centura Health's Conflict of Interest Policy: 1. Conflict of Interest Policy: 1.1 Consistent with Centura integrity standards, it is policy that each board of trustee member, corporate officer, and key employee act at all times in a manner that is consistent with Centura's mission and values-based service to the community and exercise care that he or she does not have any personal interest which might conflict with or appear to conflict with the interest of Centura or which might influence their judgment or actions in performing their duties. 1.1.1 In connection with an actual or possible transaction or arrangement involving Centura, any board member, corporate officer, or key employee who has a direct or indirect financial interest must disclose and be given the opportunity to share all material facts with the board considering the proposed transaction or arrangement. 1.1.2 Board members, corporate officers, and key employees are also required to disclose any possible conflicts on an annual basis through the conflict of interest questionnaire. 2. Procedure for disclosing and reviewing transactions or arrangements of potential conflict of interests: 2.1 Board members, corporate officers, and key employees that have a financial interest in any actual or possible transaction involving Centura are required to disclose the financial interest. 2.1.1 In order to determine if a conflict of interest exists, the individual who is considered to have a financial interest may make a presentation at the board or board committee meeting. After such presentation, the individual shall leave the meeting for discussion and a vote on the issue. 2.1.2 After exercising due diligence, the board or board committee shall determine whether Centura can obtain a more advantageous transaction with reasonable efforts from another person or entity. If a more advantageous transaction is not reasonably attainable, the board or board committee shall determine by a majority vote of the disinterested members whether the transaction is in Centura's best interest and is fair. 3. Procedure for disclosing and reviewing other potential conflicts of interest: 3.1 Board members, corporate officers, and key employees shall also disclose in advance to Centura leaders any non-transactional actions or relationships that have the potential to create a conflict of interest. 3.1.1 The board or board committee shall carefully review and scrutinize any potential conflict of interest. By a majority vote of the disinterested members, the board shall take whatever action is deemed appropriate with respect to the board member, corporate officer, or key employee under the circumstances, including possible corrective action, in order to best protect the interests of Centura. 3.1.2 On an annual basis, board members, corporate officers, and key employees will also be sent an email requesting they complete the board member and corporate officer conflict of interest questionnaire by the specified due date in the email. 3.1.3 The corporate responsibility department shall notify the chairperson of the board of any potential conflicts and the chairperson, or designee, shall perform further investigation as he or she deems appropriate. 4. Record of proceedings: 4.1 The minutes of the board and board committee shall contain: 4.1.1 The names of persons who disclosed or otherwise were found to have a financial interest and the nature of the financial interest. 4.1.2 The names of persons who were present for discussions and votes relating to any financial interest, the content of the discussion, including any alternatives, and a record of the board or board committee decision. 5. Violations of the conflicts of interest policy: 5.1 If the board or board committee has reasonable cause to believe that an individual has failed to disclose either an actual or potential conflict of interest, or all material facts surrounding an actual or possible conflict, the individual will be given a chance to explain. 5.1.1 After hearing the response, the board will conduct such additional investigation as appropriate. If the board determines that the individual has in fact failed to disclose as required by the conflict of interest policy, the board shall take appropriate disciplinary or corrective action.
Form 990, Part VI, Section B, line 15 The organization's top management officials' compensation is paid by Centura Health Corporation. All officers and key employees are compensated by Centura Health Corporation, who manages the daily activities of Portercare Adventist Health System under a joint operating agreement dated December 8, 1995 between Adventist Health System Sunbelt Healthcare Corp. and Common Spirit Health. As such, their salaries are paid to them by Centura Health Corporation, a related organization, for services rendered in their capacity as key employees or officers of PAHS. All of their reportable compensation is disclosed on Form 990, Schedule J, Part II, row (ii) and Form 990, Part VII, column (e) as compensation from related organizations. External consultants are engaged to provide market-based compensation studies to make recommendations to Centura Health Corporation's (CHC) Compensation Committee regarding the compensation of the filing organization's CEO and CFO. The Compensation Committee is appointed by the Board of Trustees of CHC. The Board of Trustees may remove at any time, with or without cause, any member of the Compensation Committee; provided the filing organization's members, Portercare Adventist Health System (PAHS) and Catholic Health Initiatives Colorado (CHIC), shall have exclusive authority to appoint or remove, with or without cause, any member it or they appoint to the Compensation Committee. The consultant's recommendations are presented to and deliberated by CHC's Compensation Committee. The Compensation Committee relies upon all available comparable compensation data in finalizing its decision concerning compensation for its senior executive positions. The Compensation Committee deliberations and decisions are documented appropriately. CHC's Human Resources department performs an annual analysis of the market to determine compensation ranges for the remainder of CHC's Executives which are reviewed and approved by CHC's senior leadership.
Form 990, Part VI, Section C, line 19 The organization's governing documents are available on the Colorado Secretary of State's website. 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 conflict of interest policy available to the public.
Form 990, Part VI, Line 16B, Joint Venture Policy: Portercare Adventist Health System has not formally adopted a written policy or written procedure regarding joint ventures. Practices are in place that require the filing organization to perform an analysis and evaluation of its participation in every joint venture in which the filing organization will have an ownership interest. The internal review and analysis ensures that the filing organization will not become a participant in any joint ventures that could potentially threaten the tax-exempt status of the filing organization.
Form line reference: Part VIII, Lines 7a, b and c: The amount shown in Part VIII, Line 7c(i) of the Form 990 represents an allocated share of capital gain/(loss) from a system wide, corporate administered, investment program.
Form 990, Part IX, line 11g Payments to Hlthcare Professionals: Program service expenses 107,442,883. Management and general expenses 0. Fundraising expenses 0. Total expenses 107,442,883. Professional Fees: Program service expenses 45,442,398. Management and general expenses 0. Fundraising expenses 0. Total expenses 45,442,398. Purchased Medical Services: Program service expenses 25,653,273. Management and general expenses 0. Fundraising expenses 0. Total expenses 25,653,273. Environmental Services: Program service expenses 4,791,578. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,791,578. Transcription Services: Program service expenses 347,628. Management and general expenses 0. Fundraising expenses 0. Total expenses 347,628. Recruiting: Program service expenses 215,244. Management and general expenses 0. Fundraising expenses 0. Total expenses 215,244. Management Fees: Program service expenses 0. Management and general expenses 156,524,721. Fundraising expenses 0. Total expenses 156,524,721. Billing and Collection Services: Program service expenses 0. Management and general expenses 6,890,080. Fundraising expenses 0. Total expenses 6,890,080.
Form 990, Part XI, line 9: Transfer to Tax-Exempt Parent -14,055,521. Joint Venture Equity Changes 320,068. Tax-Exempt Intercompany Debt Reconcilation -244,209. Allocation with Respect to Debt from Tax-Exempt Parent 1,449,937. Expenses for Affiliated Tax-Exempt Organization -490,568. Transfer to Related Tax-Exempt Organization 2,010,416. Rounding and other adjustment 210.
Form 990, Part XII, Line 3b 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:  
SCHEDULE R
(Form 990)

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

OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Portercare Adventist Health System
 
Employer identification number

84-0438224
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity

(1) HealthFit Family Medicine LLC
9100 E Mineral Circle
Centennial,CO80112
81-5310593
Medical Services - family practice (inactive) CO 0 0 Portercare Adventist Health System
 
(2) HealthFit Medical Professionals LLC
9100 E Mineral Circle
Centennial,CO80112
47-3561708
Medical Services - family practice (inactive) CO 0 0 Portercare Adventist Health System
 
(3) HealthFit Wellness Professionals LLC
9100 E Mineral Circle
Centennial,CO80112
81-5325418
Fitness Center (inactive) CO 0 0 Portercare Adventist Health System
 






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


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


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

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1)AdventHealth 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)Centura Health Corporation
9100 E Mineral Circle

Centennial,CO80112
84-1335382
Joint Operating Company CO 501(c)(3)    
 
No
(35)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
 
(36)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
 
(37)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
 
(38)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
 
(39)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
 
(40)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
 
(41)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
 
(42)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
 
(43)FLNC Inc
3355 E Semoran Blvd

Apopka,FL32703
20-5774761
Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc
 
Yes
 
(44)Florida Hospital Dade City Inc
13100 Fort King Road

Dade City,FL33525
82-2567308
Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
Yes
 
(45)Florida Hospital Healthcare Partners Inc
770 West Granada Blvd 101

Ormond Beach,FL32174
46-2354804
Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
Yes
 
(46)Florida Hospital Medical Group Inc
2600 Westhall Lane 4th Floor

Maitland,FL32751
59-3214635
Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
Yes
 
(47)Florida Hospital Ocala Inc
1500 SW 1st Avenue

Ocala,FL34471
82-4372339
Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
Yes
 
(48)Florida Hospital Physician Group Inc
12470 Telecom Dr 100

Tampa,FL33637
46-2021581
Operation of Physician Practices & Medical Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
Yes
 
(49)Florida Hospital Waterman Inc
1000 Waterman Way

Tavares,FL32778
59-3140669
Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
Yes
 
(50)Florida Hospital Zephyrhills Inc
7050 Gall Blvd

Zephyrhills,FL33541
59-2108057
Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth SystemSunbelt Inc
 
Yes
 
(51)Florida Radiology Imaging at Lake Mary LLC
2600 Westhall Lane 4th Floor

Maitland,FL32751
55-0789387
Imaging & Testing FL 501(c)(3) Line 3 Florida Hospital Medical Group Inc
 
Yes
 
(52)Fountain Inn Nursing & Rehab Center Inc
4501 Waterman Way

Tavares,FL32778
47-2180518
Operation of Home for the Aged/Hlthcare Delivery FL 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc
 
Yes
 
(53)Helen Ellis Memorial Hospital Auxiliary Inc
1395 S Pinellas Ave

Tarpon Springs,FL34689
59-2106043
Fund-raising for Tax-exempt hospital/foundation FL 501(c)(3) Line 12c, III-FI N/A
 
No
(54)Helen Ellis Memorial Hospital Foundation Inc
1395 S Pinellas Ave

Tarpon Springs,FL34689
59-3690149
Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 7 N/A
 
No
(55)Hinsdale Hospital Foundation
120 North Oak Street

Hinsdale,IL60521
52-1466387
Fund-raising for Tax-exempt hospital IL 501(c)(3) Line 7 Midwest Hlth Foundation
 
 
No
(56)Hospice of the Comforter Inc
480 W Central Parkway

Altamonte Springs,FL32714
59-2935928
Operation of Hospice FL 501(c)(3) Line 10 The Comforter Health Care Group Inc
 
Yes
 
(57)In-Motion Rehab Inc (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
 
(58)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
 
(59)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
(60)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
 
(61)Memorial Hospital - West Volusia Inc
701 West Plymouth Avenue

Deland,FL32720
59-3256803
Operation of Hospital & Related Services FL 501(c)(3) Line 3 Memorial Hlth Systems Inc
 
Yes
 
(62)Memorial Hospital Flagler Inc
60 Memorial Medical Parkway

Palm Coast,FL32164
59-2951990
Operation of Hospital & Related Services FL 501(c)(3) Line 3 Memorial Hlth Systems Inc
 
Yes
 
(63)Memorial Hospital Inc
210 Marie Langdon Drive

Manchester,KY40962
61-0594620
Operation of Hospital & Related Services KY 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
Yes
 
(64)Metroplex Adventist Hospital Inc
2201 S Clear Creek Road

Killeen,TX76549
74-2225672
Operation of Hospital & Related Services TX 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
Yes
 
(65)Metroplex Clinic Physicians Inc
2201 S Clear Creek Road

Killeen,TX76549
11-3762050
Physician Healthcare services to the community TX 501(c)(3) Line 3 Metroplex Adventist Hospital Inc
 
Yes
 
(66)Midwest Health Foundation
120 North Oak Street

Hinsdale,IL60521
35-2230515
Fund-Raising for Supported Exempt Hospitals IL 501(c)(3) Line 7 N/A
 
No
(67)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
 
(68)Mission Strategies of Georgia Inc
485 North Keller Road 250

Maitland,FL32751
90-0866024
Provision of support to the nursing home division GA 501(c)(3) Line 12b, II Sunbelt Hlth Care Centers Inc
 
Yes
 
(69)Missouri Adventist Health Inc
9100 W 74th Street

Shawnee Mission,KS66204
43-1224729
Support Health Care Services MO 501(c)(3) Line 12d, III-O Adventist Hlth Mid-America Inc
 
Yes
 
(70)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
 
(71)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
 
(72)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
 
(73)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
 
(74)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
 
(75)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
 
(76)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
 
(77)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
 
(78)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
 
(79)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
 
(80)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
(81)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
 
(82)San Marcos Nursing & Rehab Center Inc
1900 Medical Parkway

San Marcos,TX78666
20-5782224
Operation of Home for the Aged/Hlthcare Delivery TX 501(c)(3) Line 10 Sunbelt Hlth Care Centers Inc
 
Yes
 
(83)Shawnee Mission Hlth Care 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
 
(84)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
 
(85)Shawnee Mission Medical Center Inc
9100 W 74th Street

Shawnee Mission,KS66204
48-0637331
Operation of Hospital & Related Services KS 501(c)(3) Line 3 Adventist Hlth Mid-America Inc
 
Yes
 
(86)South Pasco 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
 
(87)Southeast Volusia Healthcare Corp
401 Palmetto Street

New Smyrna Beach,FL32168
47-3793197
Operation of Hospital & Related Services FL 501(c)(3) Line 3 Adventist Hlth System Sunbelt Hlthcare Corp
 
Yes
 
(88)Southwest Volusia 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
 
(89)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
 
(90)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
 
(91)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
 
(92)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
 
(93)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
 
(94)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
 
(95)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
 
(96)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
 
(97)University Community Hospital Foundation Inc
3100 E Fletcher Ave

Tampa,FL33613
59-2554889
Fund-raising for Tax-exempt hospital FL 501(c)(3) Line 7 N/A
 
No
(98)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
 
(99)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
 
(100)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
 
(101)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
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



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

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




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



(k)
Percentage
ownership


Yes No Yes No
(1) Fletcher Hospital Surgical Ventures LLC

9131 Anson Way Ste 304
Raleigh,NC27615
86-1482646
Indirect Interest in Surgery Center NC N/A
        No     No  
(2) Florida Hospital DMERT LLC

500 Winderley Place Ste 324
Maitland,FL32751
20-2392253
Medical Equipment FL N/A
        No   Yes    
(3) Florida Hospital Home Infusion LLP

500 Winderley Place Ste 226
Maitland,FL32751
59-3142824
Home Infusion Services FL N/A
        No   Yes    
(4) Functional Neurosurgical Ambulatory Surgery Ctr LLC

11 W Dry Creek Circle 120
Littleton,CO80120
46-4426708
Surgery Center CO Portercare Adventist Health System
 
Related 1,180,369 1,587,553   No     No 51.000 %
(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 Portercare Adventist Health System
 
Related -1,103,212 528,667   No     No 51.000 %
(7) PAHS OnPoint Imaging LLC

9205 S Broadway
Highlands Ranch,CO80129
83-3275105
Imaging Center CO Portercare Adventist Health System
 
Related -325,576 520,421   No     No 51.000 %
(8) PAHS OnPoint Urgent Care LLC

9100 E Mineral Circle
Centennial,CO80112
83-2465331
Urgent Care Center CO Portercare Adventist Health System
 
Related -1,484,947 9,392,109   No     No 54.000 %
(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?
Yes No
(1) AdventHealth Orlando Network Inc (11 - 41922)

900 Hope Way
Altamonte Springs,FL32714
86-2639185
Inactive FL N/A
C         No
(2) AdventHealth Professional Staffing Inc (11 - 12822)

900 Hope Way
Altamonte Springs,FL32714
88-0742779
INACTIVE FL N/A
C         No
(3) AdventHealth Tampa Network Inc (11 - 41922)

900 Hope Way
Altamonte Springs,FL32714
86-2666178
Inactive FL N/A
C         No
(4) AdventHealth Team Members Inc (11 - 12822)

900 Hope Way
Altamonte Springs,FL32714
88-0763664
INACTIVE FL N/A
C         No
(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         No
(6) Altamonte Medical Plaza Condominium Association Inc

601 East Rollins Street
Orlando,FL32803
59-2855792
Condo Association FL N/A
C         No
(7) Apopka Medical Plaza Condominium Association Inc

601 East Rollins Street
Orlando,FL32803
59-3000857
Condo Association FL N/A
C         No
(8) Battle Creek Adventist Hospital

900 Hope Way
Altamonte Springs,FL32714
38-1359189
Inactive MI N/A
C         No
(9) Florida Hospital Flagler Medical Offices Association Inc

60 Memorial Medical Parkway
Palm Coast,FL32164
26-2158309
Condo Association FL N/A
C         No
(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         No
(11) Florida Hospital Healthcare System Inc

2600 Lucien Way
Maitland,FL32751
59-3215680
PHSO / CIN FL N/A
C         No
(12) Florida Medical Plaza Condominium Association Inc

601 East Rollins Street
Orlando,FL32803
59-2855791
Condo Association FL N/A
C         No
(13) Kissimmee Multispecialty Clinic Condominium Association Inc

201 Hilda Street Suite 30
Kissimmee,FL34741
59-3539564
Condo Association FL N/A
C         No
(14) Midwest Management Services Inc

9100 West 74th Street
Shawnee Mission,KS66204
48-0901551
Inactive KS N/A
C         No
(15) North American Health Services Inc & Sub

900 Hope Way
Altamonte Springs,FL32714
62-1041820
Holding Co. TN N/A
C         No
(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         No
(17) Park Ridge Property Owner's Association Inc

1 Park Place Naples Road
Fletcher,NC28732
03-0380531
Condo Association NC N/A
C         No
(18) Park Ridge Condominium #1 Unit Owners Association Inc

1 Park Place Naples Road
Fletcher,NC28732
01-0584623
Condo Association NC N/A
C         No
(19) Surgicare of Rome Inc

501 Redmond Rd
Rome,GA30165
20-0376307
Holding Company GA N/A
C         No
(20) Redmond Park Health Services Inc

501 Redmond Rd
Rome,GA30165
62-1330078
Holding Company GA N/A
C         No
(21) The Garden Retirement Community Inc

485 North Keller Road Ste 250
Maitland,FL32751
59-3414055
Real Estate Rental FL N/A
C         No
(22) Winter Park Medical Office Building I Condo Assoc Inc

601 East Rollins Street
Orlando,FL32803
45-2228478
Condo Association FL N/A
C         No
Schedule R (Form 990) 2021
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
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) Adventist Health System Sunbelt Healthcare Corporation

B 13,617,184 Amount Given
(2) Adventist Health System Sunbelt Healthcare Corporation

M 11,406,557 % of Facility's Operating Expense
(3) Adventist Health System Sunbelt Healthcare Corporation

P 5,060,907 Cost
(4) Centura Health Corporation

M 122,101,376 % of Facility's Operating Exp/Rev
(5) Centura Health Corporation

P 47,981,707 Cost
(6) Rocky Mountain Adventist Healthcare Foundation

B 512,075 Amount Given
(7) Rocky Mountain Adventist Healthcare Foundation

C 1,935,088 Amount Received
Schedule R (Form 990) 2021
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)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

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




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


Yes No Yes No Yes No






























Schedule R (Form 990) 2021
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


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