4A (Expenses $ 207391320 including grants of $ 104522) (Revenue $ 235786105)
THE ORGANIZATION'S EXEMPT PURPOSE INCLUDES THE PROVISION OF MEDICAL CARE TO THE SURROUNDING COMMUNITY THROUGH THE OPERATION OF A 257-BED INPATIENT FACILITY & A RELATED OUTPATIENT FACILITY PROVIDING AMBULATORY SURGERY, DIAGNOSTIC RADIOLOGY, (INCLUDING MRI AND CT SCANNERS), LABORATORY SERVICES AND PHYSICAL THERAPY. THERE WERE 9,631 PATIENT ADMISSIONS, 51,198 PATIENT DAYS, 103,011 OUTPATIENT VISITS, AND 92,281 PHYSICIAN PRACTICE PATIENT VISITS DURING THE CURRENT YEAR.

ADVENTHEALTH FISH MEMORIAL
PART V, SECTION B, LINE 5: SOUTHWEST VOLUSIA HEALTHCARE CORPORATION, D/B/A ADVENTHEALTH FISH MEMORIAL, (AHFM OR THE HOSPITAL) OPERATES A HOSPITAL IN VOLUSIA COUNTY, FLORIDA WITH A TOTAL OF 257 LICENSED BEDS. FOR PURPOSES OF ITS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL DEFINED ITS COMMUNITY AS ITS PRIMARY SERVICE AREA FROM WHICH 77% OF ITS PATIENTS COME. AS A PART OF ITS EFFORTS TO ENSURE BROAD COMMUNITY-BASED INPUT INTO THE CHNA PROCESS, THE HOSPITAL ESTABLISHED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) TO HELP GUIDE THE HOSPITAL THROUGH THE ASSESSMENT PROCESS. THE CHNAC INCLUDED REPRESENTATION FROM THE HOSPITAL, PUBLIC HEALTH EXPERTS AND THE BROAD COMMUNITY WITH INTENTIONAL REPRESENTATION FROM LOW-INCOME, MINORITY AND OTHER UNDERSERVED POPULATIONS. THE FOLLOWING ORGANIZATIONS WERE MEMBERS OF THE CHNAC. AZALEA HEALTH, A FEDERALLY QUALIFIED HEALTH CENTER,BETHUNE COOKMAN UNIVERSITYCOMMUNITY PARTNERSHIP FOR CHILDREN,DAYTONA BEACH CHAMBER OF COMMERCE,FAMILY HEALTH SOURCE MEDICAL CENTER,FLORIDA DEPARTMENT OF HEALTH - VOLUSIA,THE DEPARTMENT OF CHILDREN AND FAMILIES,THE EARLY LEARNING COALITION OF FLAGLER AND VOLUSIA COUNTIES,COUNTY OF VOLUSIA,HALIFAX HEALTH,HEALTHY START COALITION OF FLAGLER/VOLUSIA,LSF HEALTH SYSTEMS, INC.TEAM VOLUSIA,UNITED WAY OF VOLUSIA/FLAGLER,VOLUSIA COUNTY SCHOOLS,VOLUSIA/FLAGLER BEHAVIORAL HEALTH CONSORTIUM, ANDVOLUSIA/FLAGLER COALITION FOR THE HOMELESS.COMMUNITY INPUT WAS GATHERED THROUGH COMMUNITY SURVEYS ADMINISTERED BY THE VOLUSIA COUNTY DEPARTMENT OF HEALTH. THE INTERVIEWS WERE PRIMARILY INTERNET BASED AND WERE COMPLETED BY 3,692 INDIVIDUALS, INCLUDING 2608 VOLUSIA RESIDENTS.

ADVENTHEALTH FISH MEMORIAL
PART V, SECTION B, LINE 7D: THE HOSPITAL HAS ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS MUST BE POSTED ON THE HOSPITAL'S WEBSITE AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE WIDELY AVAILABLE ON ITS WEBSITE ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. THE HOSPITAL WILL ALSO MAKE A PAPER COPY OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST AND WITHOUT CHARGE, AT LEAST UNTIL THE DATE THE HOSPITAL FACILITY HAS MADE AVAILABLE FOR PUBLIC INSPECTION ITS TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.

ADVENTHEALTH FISH MEMORIAL
"PART V, SECTION B, LINE 11: SOUTHWEST VOLUSIA HEALTHCARE CORPORATION D/B/A ADVENTHEALTH FISH MEMORIAL WILL BE REFERRED TO IN THIS DOCUMENT AS ADVENTHEALTH FISH MEMORIAL OR ""THE HOSPITAL"".THE HOSPITAL IS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS THE 501(C)(3) PARENT ORGANIZATION OF A HOSPITAL AND HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. IN JANUARY 2019, EVERY WHOLLY OWNED ENTITY OF AHSSHC ADOPTED THE ADVENTHEALTH SYSTEM BRAND. OUR IDENTITY HAS BEEN UNIFIED TO REPRESENT THE FULL CONTINUUM OF CARE OUR SYSTEM OFFERS. ANY REFERENCES TO OUR PRIOR COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNAS) OR PRIOR COMMUNITY HEALTH PLANS (CHPS) WILL UTILIZE OUR NEW NAME FOR CONSISTENCY.ADVENTHEALTH FISH MEMORIAL IS PART OF THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH (THE DIVISION). IN 2020, THE CENTRAL FLORIDA DIVISION NORTH-REGION (CFD-N), WHICH INCLUDES ADVENTHEALTH DAYTONA BEACH, ADVENTHEALTH DELAND, ADVENTHEALTH FISH MEMORIAL, ADVENTHEALTH NEW SMYRNA, ADVENTHEALTH PALM COAST AND ADVENTHEALTH WATERMAN WAS COMBINED WITH THE CENTRAL FLORIDA DIVISION SOUTH-REGION (CFD-S), WHICH INCLUDES ADVENTHEALTH ALTAMONTE, ADVENTHEALTH APOPKA, ADVENTHEALTH CELEBRATION, ADVENTHEALTH EAST ORLANDO, ADVENTHEALTH HEART OF FLORIDA, ADVENTHEALTH KISSIMMEE, ADVENTHEALTH LAKE WALES, ADVENTHEALTH ORLANDO AND ADVENTHEALTH WINTER PARK TO UNIFY AS ONE UNDER THE CENTRAL FLORIDA DIVISION. THE COMBINATION INCLUDED SIX HOSPITALS FROM CFD-N AND NINE HOSPITALS FROM CFD-S. THE COMMUNITY HEALTH PLANS/IMPLEMENTATION STRATEGIES FOR BOTH REGIONS WERE FINALIZED BEFORE THE COMBINATION. THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH NOW INCLUDES 15 HOSPITALS.THIS IS THE SECOND-YEAR UPDATE FOR ADVENTHEALTH FISH MEMORIAL'S 2020-2022 COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY. THE HOSPITAL DEVELOPED THIS PLAN AND POSTED IT IN MAY 2020 AS PART OF ITS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS.FOR THE DEVELOPMENT OF BOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY, ADVENTHEALTH FISH MEMORIAL WORKED TO DEFINE AND ADDRESS THE NEEDS OF LOW-INCOME, MINORITY AND UNDERSERVED POPULATIONS IN ITS SERVICE AREA. THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT USED PRIMARY DATA INTERVIEWS AND SURVEYS; SECONDARY DATA FROM LOCAL, REGIONAL, AND NATIONAL HEALTH-RELATED SOURCES; AND HOSPITAL PREVALENCE DATA TO HELP THE HOSPITAL DETERMINE THE HEALTH NEEDS OF THE COMMUNITY IT SERVES.ONCE THE DATA WAS GATHERED, THE PRIMARY ISSUES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT WERE PRIORITIZED BY COMMUNITY AND HOSPITAL STAKEHOLDERS, WHO THEN SELECTED KEY ISSUES FOR THE HOSPITAL TO ADDRESS IN ITS 2020-2022 COMMUNITY HEALTH PLAN. THE SECOND-YEAR PROGRESS ON THE COMMUNITY HEALTH PLAN IS NOTED BELOW. THE NARRATIVE DESCRIBES THE PRIORITIZED ISSUES IDENTIFIED IN 2019 AND GIVES AN UPDATE ON THE STRATEGIES ADDRESSING THOSE ISSUES. THERE IS ALSO A DESCRIPTION OF THE IDENTIFIED ISSUES THAT THE HOSPITAL DID NOT ADDRESS. ADVENTHEALTH FISH MEMORIAL CHOSE FIVE PRIORITIES FOR ITS 2020-2022 COMMUNITY HEALTH PLAN: 1. ADULT & YOUTH BEHAVIORAL HEALTH 2. CARDIOVASCULAR DISEASES & DIABETES 3. BARRIERS TO ACCESSING HEALTH CARE SERVICES 4. HEALTHY EATING & PHYSICAL ACTIVITY 5. SOCIAL AND ECONOMIC ISSUES (SOCIAL DETERMINANTS OF HEALTH) PRIORITY 1: ADULT & YOUTH BEHAVIORAL HEALTH 2019 DESCRIPTION OF THE ISSUE:ALCOHOL USE - HEAVY/BINGE DRINKING HAS INCREASED SLIGHTLY FROM 2010 TO 2016. THE PERCENT IS HIGHEST FOR WHITE INDIVIDUALS. - VOLUSIA COUNTY ALCOHOL-SUSPECTED MOTOR VEHICLE CRASHES AND TRAFFIC CRASH INJURIES' RATES HAVE DECREASED SINCE 2014 BUT ARE SLIGHTLY HIGHER THAN FLORIDA. - ALCOHOL-SUSPECTED TRAFFIC CRASH DEATHS INCREASED BETWEEN 2015 AND 2016 IN VOLUSIA COUNTY AND THE VOLUSIA COUNTY RATE IS HIGHER THAN FLORIDA. - THE PERCENT OF STUDENT ALCOHOL USE HAS BEEN DECREASING SINCE 2008 BUT REMAINS SLIGHTLY HIGHER THAN FLORIDA. SMOKING AND SUBSTANCE MISUSE - VOLUSIA COUNTY'S RATE OF OPIOID-INVOLVED OVERDOSE HOSPITALIZATIONS INCREASED FROM 2015 TO 2017 AND IS HIGHER THAN FLORIDA'S. THE RATE OF DEATH FROM OPIOID OVERDOSES INCREASED IN THE LAST YEAR AND NOW EXCEEDS THE FLORIDA RATE. - THE PERCENT OF VOLUSIA COUNTY ADULTS WHO SMOKE IS HIGHER THAN FLORIDA. - THE PERCENT OF VOLUSIA COUNTY MIDDLE AND HIGH SCHOOL STUDENTS USING MARIJUANA DECREASED BETWEEN 2016 AND 2018 BUT REMAINS HIGHER THAN FLORIDA. - REPORTED CIGARETTE USE AMONG VOLUSIA COUNTY MIDDLE AND HIGH SCHOOL STUDENTS HAS DECLINED, BUT BOTH RATES REMAIN HIGHER THAN FLORIDA.MENTAL HEALTH- THE PERCENT OF VOLUSIA COUNTY ADULTS WHO HAD 14 OR MORE POOR MENTAL HEALTH DAYS IN THE LAST MONTH IS HIGHER THAN FLORIDA. - THE PERCENT OF VOLUSIA COUNTY ADULTS WITH A DEPRESSIVE DISORDER IS HIGHER THAN FLORIDA. - VOLUSIA COUNTY'S SUICIDE RATE IS INCREASING AND IS HIGHER THAN FLORIDA'S.- VOLUSIA COUNTY'S AGE 19-21 RATE OF HOSPITALIZATIONS FOR SELF-INFLICTED INJURIES HAS INCREASED BUT IS LOWER THAN FLORIDA'S.2021 UPDATE:THE ADVENTHEALTH FISH MEMORIAL COMMUNITY HEALTH PLAN HAS FIVE DESIRED GOAL STATEMENTS UNDER THE ADULT & YOUTH BEHAVIORAL HEALTH PRIORITY.1. ESTABLISH A MULTI-AGENCY REFERRAL AND COMMUNICATION MANAGEMENT SYSTEM IN VOLUSIA/FLAGLER COUNTY TO EFFECTIVELY CONNECT INDIVIDUALS IN NEED TO BEHAVIORAL HEALTH CARE SERVICES.2. PROVIDE SPECIAL PROGRAMS FOR AT-RISK STUDENTS IN THE DELTONA AREA. 3. PROVIDE ACCESS TO TOBACCO CESSATION SUPPORT. 4. PROVIDE ONE STOP CENTER FOR HEALTH AND HUMAN SERVICES IN DELTONA FOR BEHAVIORAL HEALTH. 5. ESTABLISH STRESS RESILIENCE WORKSHOP FOR YOUTH TO TEACH STRESS MANAGEMENT SKILLS THROUGH POSITIVE PSYCHOLOGICAL APPROACHES.GOAL 1: ESTABLISH A MULTI-AGENCY REFERRAL AND COMMUNICATION MANAGEMENT SYSTEM IN VOLUSIA/FLAGLER COUNTY TO EFFECTIVELY CONNECT INDIVIDUALS IN NEED TO BEHAVIORAL HEALTH CARE SERVICES.OBJECTIVE 1: THE FIRST OBJECTIVE IS A DIVISIONAL INITIATIVE AND APPEARS ON MULTIPLE COMMUNITY HEALTH PLANS OF HOSPITALS IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, THE SAME DIVISION AS THE REPORTING HOSPITAL. THE HOSPITALS PARTNERED ON THIS INITIATIVE BECAUSE OF A SHARED CHNA PRIORITY. THE OBJECTIVE IS TO SUPPORT THE DEVELOPMENT OF A PILOT PROJECT TO CONNECT HEALTH AND BEHAVIORAL HEALTH SYSTEMS THROUGH THE UTILIZATION OF A REFERRAL AND COMMUNICATION MANAGEMENT TECHNOLOGY SYSTEM TO BE LAUNCHED BY THE END OF YEAR TWO. THIS OBJECTIVE IS MANAGED AT A DIVISIONAL LEVEL AND OUTCOMES ARE REPORTED AT A DIVISIONAL LEVEL; HOWEVER, ALL FUNDING IS SPECIFIC TO THE REPORTING HOSPITAL. THE HOSPITAL'S SUPPORT PROVIDES FUNDING TO FLAGLER CARES, A LOCAL NOT-FOR-PROFIT, WHICH FOCUSES ON INCREASING CAPACITY AND COORDINATION FOR HEALTH AND HUMAN SERVICES PROGRAMS, FOR THE PLANNING AND IMPLEMENTATION OF A DIGITAL SOLUTION TO FACILITATE REFERRALS TO BEHAVIORAL HEALTH SERVICES, AND TO INCREASE ACCESS TO CARE AND IMPROVE HEALTH. THE DIVISION PROGRESSED ON ITS SET METRIC THROUGH THE LAUNCH OF A PLAN TO SUPPORT THE LARGER OBJECTIVE. FLAGLER CARES LAUNCHED THE LINC FLAGLER VOLUSIA REFERRAL MANAGEMENT SYSTEM IN AUGUST 2021 WITH AN INITIAL FOCUS ON BEHAVIORAL HEALTH SERVICES. BY THE END OF 2021, FOURTEEN ORGANIZATIONS WERE PARTICIPATING IN THE NETWORK AND 889 REFERRALS WERE SENT THROUGH THE SYSTEM.GOAL 2: PROVIDE SPECIAL PROGRAMS FOR AT-RISK STUDENTS IN THE DELTONA AREA. OBJECTIVE 1: THE FIRST OBJECTIVE IS TO SUPPORT A BEFORE-SCHOOL CLUB AT GALAXY MIDDLE SCHOOL, WHICH SERVES 30 AT-RISK MIDDLE SCHOOL YOUNG MEN ANNUALLY, WITH A FACULTY SPONSOR TO FOCUS ON PROVIDING YOUTH OPPORTUNITIES FOR SELF-DEVELOPMENT AND INSPIRE YOUTH TO GROW INTO HEALTHY WELL-BALANCED ADULTS. THIS OBJECTIVE IS MANAGED AT A DIVISIONAL LEVEL AND APPEARS ON SEVERAL COMMUNITY HEALTH PLANS IN THE DIVISION; HOWEVER, ALL FUNDING AND OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE HOSPITAL'S FINANCIAL SUPPORT PROVIDES ACCESS TO A FOCUSED YOUTH DEVELOPMENT PROGRAM FOR AT-RISK MIDDLE SCHOOL YOUTH. DUE TO COVID-19, THE PROGRAM WAS DELAYED. AS A RESULT OF THE CONTINUED PANDEMIC, ADVENTHEALTH HAS PIVOTED WHERE NECESSARY TO ADDRESS THE IMMEDIATE NEEDS OF OUR COMMUNITY. WE ARE WORKING TO IDENTIFY WAYS TO SUPPORT THE NEEDS ORIGINALLY IDENTIFIED IN OUR CHNAS, AS RESOURCES AND PUBLIC HEALTH RECOMMENDATIONS DEVELOP.SEE CONTINUATION 2"

ADVENTHEALTH FISH MEMORIAL
PART V, SECTION B, LINE 13H: EFFECTIVE MARCH 1, 2020, THE FILING ORGANIZATION'S HOSPITAL FACILITY (OR FACILITIES) AUGMENTED THEIR FINANCIAL ASSISTANCE POLICY WITH A COVID-19 FINANCIAL GRACE ADDENDUM. PURSUANT TO THE COVID-19 FINANCIAL GRACE ADDENDUM, UNINSURED PATIENTS TREATED FOR COVID-19 RELATED EVALUATIONS ARE TO RECEIVE FREE OR DISCOUNTED CARE DEPENDING ON THE PATIENT'S COOPERATION IN SUBMITTING NECESSARY FINANCIAL ASSISTANCE INFORMATION. INSURED PATIENTS TESTED FOR COVID-19 ARE NOT EXPECTED TO HAVE OUT-OF-POCKET EXPENSES BASED ON INSURANCE COMMUNITY RESPONSE TO WAIVE PATIENT FINANCIAL RESPONSIBILITY. IF A PAYER UNEXPECTEDLY FAILS TO WAIVE PATIENT RESPONSIBILITY FOR COVID-19 RELATED TESTING, THE FILING ORGANIZATION WILL NOT BALANCE BILL PATIENTS FOR ANY OUT-OF-POCKET EXPENSES RELATED TO COVID-19. IN ADDITION, PATIENTS WITH EXISTING PAYMENT PLANS ARE PROVIDED OPPORTUNITIES FOR REDUCING THEIR MONTHLY PAYMENTS.

PART V, SECTION B, LINE 11 CONTINUATION 2
GOAL 3: PROVIDE ACCESS TO TOBACCO CESSATION SUPPORT. OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE FREE TOOLS TO QUIT TOBACCO CESSATION PROGRAMS TO 50 INDIVIDUALS EACH YEAR. THE OBJECTIVE IS MANAGED BY THE DIVISION; HOWEVER, THE HOSPITAL PROVIDES IN-KIND RESOURCES AND ALL OUTCOMES REPORTED ARE SPECIFIC TO THE REPORTING HOSPITAL. THE NORTHEAST FLORIDA AREA HEALTH EDUCATION CENTER (NEFAHEC) TOBACCO CESSATION PROGRAMS PROVIDE FREE INTERVENTION THERAPIES TO QUIT SMOKING TOBACCO. THROUGH A PARTNERSHIP WITH NEFAHEC, A LOCAL CHAPTER OF THE NATIONAL AREA HEALTH EDUCATION CENTER (AHEC) ORGANIZATION, WE WILL INCREASE THE NUMBER OF INDIVIDUALS PARTICIPATING IN THE CLASSES BY PROVIDING CONNECTION POINTS TO NEFAHEC'S CLASSES THROUGH SOCIAL MEDIA POSTS AND INTERNAL RESOURCES. NEFAHEC IS A COMMUNITY FOCUSED ORGANIZATION THAT DEVELOPS AND IMPLEMENTS COMMUNITY-BASED HEALTH PROMOTION ACTIVITIES AND EDUCATION PROGRAMS, WHICH TARGETS THE UNDERSERVED. AS IT RELATES TO OUR RELATIONSHIP WITH NEFAHEC, WE ARE PARTNERING WITH NEFAHEC TO PROVIDE COMMUNITY MEMBERS THE TOOLS AND RESOURCES TO ASSIST WITH TOBACCO CESSATION. THE HOSPITAL DID NOT MEET ITS SET METRIC. THERE WAS 1 INDIVIDUAL REFERRED FOR CESSATION CLASSES. ADDITIONALLY, IN RESPONSE TO THE NEED IN THE COMMUNITY, THE HOSPITAL DISTRIBUTED NARCAN SPRAY THROUGH THE EMERGENCY DEPARTMENT TO 153 INDIVIDUALS, AND 11 INDIVIDUALS RECEIVED NARCAN THROUGH THE DELTONA ER. NARCAN IS A LIFE-SAVING MEDICATION FOR INDIVIDUALS WHO ARE OR WERE EXPERIENCING AN OPIOID-RELATED OVERDOSE.GOAL 4: PROVIDE ONE STOP CENTER FOR HEALTH AND HUMAN SERVICES IN DELTONA FOR BEHAVIORAL HEALTH. OBJECTIVE 1: THE FIRST OBJECTIVE IS A FUNDING INITIATIVE. THIS OBJECTIVE IS TO PARTNER WITH THE HOUSE NEXT DOOR, INC., A 501(C)(3) ORGANIZATION, TO CREATE A ONE STOP CENTER FOR HEALTH AND HUMAN SERVICES IN DELTONA. THE HOUSE NEXT DOOR PROVIDES FAMILY CENTERED PROGRAMS, INCLUDING COUNSELING, IN-HOME FAMILY SUPPORT AND AFTER SCHOOL SUPPORT/MENTORING, FAMILY COUNSELING, A CHILD CARE FOOD PROGRAM, PARENTING PROGRAMS, AND THE LITTLE HOUSE NEXT DOOR. THE INITIATIVE WOULD PROVIDE ACCESS TO AT LEAST FIVE PROGRAMS TO WEST VOLUSIA COUNTY RESIDENTS AND IS FUNDED SOLELY THROUGH THE REPORTING HOSPITAL. THE OBJECTIVE DOES NOT APPEAR ON OTHER COMMUNITY HEALTH PLANS WITHIN THE CENTRAL FLORIDA DIVISION. DUE TO A CHANGE IN STRATEGY BY THE HOUSE NEXT DOOR TO DEVELOP A NEW ONE-STOP LOCATION IN THE DELTONA COMMUNITY, THE HOSPITAL DID NOT MEET ITS SET METRIC OF PROVIDING FINANCIAL SUPPORT WITH ZERO DOLLARS PROVIDED. ADVENTHEALTH FISH MEMORIAL CONTINUES TO WORK TO IDENTIFY AN ALTERNATIVE APPROACH TO INCREASING ACCESS TO SOCIAL AND BEHAVIORAL HEALTH SERVICES IN DELTONA. GOAL 5: ESTABLISH STRESS RESILIENCE WORKSHOP FOR YOUTH TO TEACH STRESS MANAGEMENT SKILLS THROUGH POSITIVE PSYCHOLOGICAL APPROACHES. OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE AN 8-HOUR WORKSHOP DESIGNED FOR YOUTH TO DECREASE THEIR STRESS AND INCREASE THEIR RESILIENCY AND EMOTIONAL WELL-BEING AS MEASURED BY PRE- AND POST-TESTING THROUGH A PARTNERSHIP WITH VOLUSIA COUNTY SCHOOLS, FLORIDA UNITED METHODIST CHILDREN'S HOME, AND OTHER YOUTH-SERVING AGENCIES TO SPONSOR YOUTH WORKSHOPS. THE YOUTH STRESS WORKSHOP PROGRAM IS FUNDED AND DEPLOYED THROUGH ADVENTHEALTH FISH MEMORIAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE YOUTH STRESS WORKSHOP PROVIDES ACCESS TO 8-HOUR WORKSHOPS TO TEACH YOUTH STRESS REDUCTION AND RESILIENCY TECHNIQUES. THE HOSPITAL PROGRESSED ON ITS SET METRIC OF PROVIDING THE PROGRAM TO YOUTH IN THE COMMUNITY. IN 2021, ADVENTHEALTH FISH MEMORIAL WORKED TO ESTABLISH RELATIONSHIPS WITH IMPLEMENTING PARTNERS TO PLAN AND PREPARE FOR IMPLEMENTATION OF A VIRTUAL PROGRAM IN 2022. ADVENTHEALTH PROVIDED $15,000 TO CATALYST GLOBAL YOUTH INITIATIVES. THE ORGANIZATION IS COMMITTED TO CREATING PROGRAMS AND INITIATIVES THAT MOBILIZE ADULTS TO INSPIRE CHILDREN AND YOUTH TO GREATNESS. CATALYST IS AN ACRONYM FOR CHILDREN AND ADULTS TOGETHER ACHIEVING, LEADERSHIP, INSPIRATION, SUCCESS, AND TRUST. ADVENTHEALTH PROVIDED $15,000 FUNDING SUPPORT TO CATALYST GLOBAL YOUTH INITIATIVES FOR THE 2021 CATALYST SUMMER PROGRAM ATTENDED BY 109 YOUTH.PRIORITY 2: CARDIOVASCULAR DISEASES & DIABETES 2019 DESCRIPTION OF THE ISSUE:CARDIOVASCULAR DISEASES - THE YEARS OF POTENTIAL LIFE LOST (YPLL) RATE FOR VOLUSIA COUNTY INCREASED FROM 2014 TO 2017 AND IS HIGHER THAN FLORIDA. - THE VOLUSIA COUNTY DEATH RATE FOR HEART FAILURE IS HIGHER THAN FLORIDA. - VOLUSIA COUNTY'S HOSPITALIZATION RATE FOR CONGESTIVE HEART FAILURE IS HIGHER THAN FLORIDA'S AND THE RATE FOR BLACK INDIVIDUALS IS MUCH HIGHER. - THE VOLUSIA COUNTY HOSPITALIZATION RATE FOR CORONARY HEART DISEASE IS HIGHER THAN FLORIDA AND THE RATE FOR BLACK INDIVIDUALS IS HIGHER THAN THE RATE FOR ALL. - THE VOLUSIA COUNTY DEATH RATE FOR CORONARY HEART DISEASE IS HIGHER THAN FLORIDA. - THE VOLUSIA COUNTY HOSPITALIZATION RATE FOR STROKE IS HIGHER THAN FLORIDA AND THE RATE FOR BLACK INDIVIDUALS IS HIGHER THAN OTHER GROUPS.- THE VOLUSIA COUNTY DEATH RATE FOR STROKE IS HIGHER THAN FLORIDA AND THE RATE FOR BLACK INDIVIDUALS IS HIGHER THAN OTHER GROUPS. DIABETES - THE DEATH RATE FROM DIABETES INCREASED BETWEEN 2016 AND 2017 AND IS HIGHER IN VOLUSIA COUNTY THAN IN FLORIDA. THE RATE IS HIGHEST FOR BLACK INDIVIDUALS.- THE RATE OF PREVENTABLE HOSPITALIZATIONS FOR ADULTS UNDER 65 FROM DIABETES IS INCREASING AND HIGHER THAN FLORIDA.2021 UPDATE: THE ADVENTHEALTH FISH MEMORIAL COMMUNITY HEALTH PLAN HAS TWO DESIRED GOAL STATEMENTS UNDER THE CARDIOVASCULAR DISEASES & DIABETES PRIORITY. 1. REDUCE THE INCIDENCE OF DIABETES AMONG YOUTH2. PARTNER WITH THE ADVENTHEALTH FISH MEMORIAL FOUNDATION, COMMUNITY GARDENS, LOCAL GROWERS, AND FOOD PANTRIES TO DEVELOP A DISTRIBUTION NETWORK TO INCREASE THE AVAILABILITY OF FRESH PRODUCE PROVIDED THROUGH FOOD BANKS IN WEST VOLUSIAGOAL 1: REDUCE THE INCIDENCE OF DIABETES AMONG YOUTHOBJECTIVE 1: THE FIRST OBJECTIVE IS TO IMPLEMENT A DIABETES EDUCATION PROGRAM FOR 75% OF THIRD GRADERS IN IDENTIFIED ELEMENTARY SCHOOLS DURING THE 2020-2021 SCHOOL YEAR AND TO PROVIDE A NUTRITIONAL STUDENT EDUCATION PROGRAM IN ORANGE CITY/DELTONA. THIS OBJECTIVE IS MANAGED AT A DIVISIONAL LEVEL; HOWEVER, ALL FUNDING AND OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE SCHOOL-BASED DIABETES PROGRAM PROVIDES EDUCATIONAL PROGRAMMING TO THIRD GRADERS AT AN IDENTIFIED AT-RISK SCHOOL IN THE ORANGE CITY AREA. THE HOSPITAL DID NOT MEET ITS SET METRIC. DUE TO COVID-19, THE ORIGINAL PROGRAM WAS TAKEN OFFLINE, BUT THIS DID ALLOW FOR AN ALTERNATIVE VIRTUAL ALTERNATIVE TO BE DEVELOPED. THE DIVISION IDENTIFIED MISSION FIT, AN ADVENTHEALTH FOR CHILDREN PROGRAM, WHICH IS A COMPREHENSIVE CHILDREN'S WELLNESS INITIATIVE THAT EMPOWERS STUDENTS TO BE AGENTS OF HEALTH, AS A VIABLE ALTERNATIVE. THE PROGRAM APPROACHES EACH ASPECT OF PHYSICAL AND MENTAL WELL-BEING, NOT ONLY FOR CHILDREN AND TEENS, BUT ALSO FOR THE FAMILY UNIT, WHEN HOUSEHOLD SUPPORT IS NEEDED TO AFFECT CHANGE. SEVENTY STUDENTS ENROLLED IN MISSION FIT AT FOREST LAKE ELEMENTARY SCHOOL IN DELTONA DURING THE 2021 SPRING SEMESTER.GOAL 2: PARTNER WITH THE ADVENTHEALTH FISH MEMORIAL FOUNDATION, COMMUNITY GARDENS, LOCAL GROWERS, AND FOOD PANTRIES TO DEVELOP A DISTRIBUTION NETWORK TO INCREASE THE AVAILABILITY OF FRESH PRODUCE PROVIDED THROUGH FOOD BANKS IN WEST VOLUSIA. OBJECTIVE 1: THE FIRST OBJECTIVE IS TO IDENTIFY WEST VOLUSIA COMMUNITY GARDENS, PARTNERS AND FOOD PANTRIES AND COLLABORATE TO DEVELOP A DISTRIBUTION PLAN BY THE END OF YEAR ONE. TO ACHIEVE THIS THE HOSPITAL HAS FORMED THE FRESH PRODUCT PARTNERSHIP, AN INITIATIVE WHICH IS FUNDED AND DEPLOYED THROUGH ADVENTHEALTH FISH MEMORIAL WITH ALL OUTCOMES SPECIFIC TO THE REPORTING HOSPITAL. THE FRESH PRODUCT PARTNERSHIP INITIATIVE'S AIM IS TO PARTNER WITH COMMUNITY ORGANIZATIONS INCLUDING EXISTING COMMUNITY GARDENS AND FOOD PANTRIES AND TO CREATE A COLLABORATIVE APPROACH TO ADDRESSING FOOD INSECURITY BY DISTRIBUTING FRESH PRODUCE TO AREA RESIDENTS. THE HOSPITAL DID NOT MEET ITS SET METRIC WITH ZERO PARTNERS IDENTIFIED AND COMMITTED. SEE CONTINUATION 3

PART V, SECTION B, LINE 11 CONTINUATION 3
ADVENTHEALTH FISH MEMORIAL HAS RECOGNIZED THAT AN ALTERNATIVE STRATEGY WILL LEAD TO MORE SUCCESSFUL OUTCOMES TO ADDRESS THIS PRIORITY. THE HOSPITAL HAS WORKED TO IDENTIFY THE DIABETES UNDONE PROGRAM WHICH HAS BEEN SUCCESSFUL IN EAST VOLUSIA COUNTY; THIS PROGRAM WILL BE UTILIZED TO ADDRESS THIS PRIORITY IN PLACE OF THE ORIGINAL GOAL. THE DIVISION WILL MANAGE THE OBJECTIVE; HOWEVER, THE HOSPITAL WILL CONDUCT AND FUND THE OBJECTIVE. ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. AS THE PROGRAM AND THE OBJECTIVE CONTINUE TO BE DEVELOPED, THE HOSPITAL WILL IDENTIFY ADDITIONAL POTENTIAL OUTCOMES TO REPORT. TO SUPPORT THIS OBJECTIVE THE HOSPITAL WILL PROVIDE THE AMERICAN DIABETES SCREENING TOOL WHICH IS A PAPER SCREEN TO ALL PARTICIPANTS AND WILL ALSO WORK WITH DIABETES EDUCATORS. THE DIVISION HAS IDENTIFIED A LOCAL SEVENTH DAY ADVENTIST CHURCH, DEBARY-ORANGE CITY ADVENTIST CHURCH, LOCATED IN A VULNERABLE ZIP CODE, TO PARTNER WITH AS A SITE IN THE COMMUNITY TO HOST THE PROGRAM. THE HOSPITAL PROGRESSED ON IT SET METRIC TO OFFER DIABETES UNDONE WITH 18 PARTICIPANTS. THE HOSPITAL SUPPORTED THE CITY OF ORANGE CITY 2021 MAYOR FITNESS CHALLENGE. THE HOSPITAL DONATED $1,000 TO SUPPORT THE CITY OF ORANGE CITY 2021 MAYORS FITNESS CHALLENGE IN ADDITION TO PROVIDING IN-KIND SERVICES SUCH AS BIOMETRIC SCREENINGS. THE 130 MAYORS FITNESS CHALLENGE PARTICIPANTS COLLECTIVELY LOST A TOTAL OF 543 POUNDS.OBJECTIVE 2:THE SECOND OBJECTIVE IS TO INCREASE THE AVAILABILITY OF FRESH PRODUCE AT WEST VOLUSIA FOOD PANTRIES BY THE END OF YEAR TWO. THE INITIATIVE TO INCREASE ACCESS TO FRESH PRODUCT IS DEPLOYED THROUGH ADVENTHEALTH FISH MEMORIAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE INITIATIVE PLANNED FOR YEAR TWO WILL IMPROVE ACCESS TO THE FRESH PRODUCE AT LOCAL FOOD PANTRIES. THE HOSPITAL FELL SHORT OF ITS SET METRIC OF INCREASING THE VOLUME OF PRODUCE AVAILABLE THROUGH FOOD PANTRIES THROUGH THE IDENTIFICATION OF PARTNERS AND WILL IDENTIFY AN ALTERNATIVE STRATEGY TO INCREASE ACCESS TO FRESH PRODUCE IN THE AREA. THE DIVISION HAS IDENTIFIED AN ALTERNATIVE OBJECTIVE TO SUPPORT THIS GOAL. THE OBJECTIVE WILL BE MANAGED BY THE DIVISION; HOWEVER, IT WILL BE CONDUCTED BY THE HOSPITAL. ALL FUNDING AND OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE HOSPITAL PARTNERED WITH THE BACKPACK BUDDIES PROGRAM AND IN 2021, THE BACKPACK BUDDIES PROGRAM WITH OUR TWO STORIES, A LOCAL NON-PROFIT ORGANIZATION, SERVED 6,214 YOUTH AT ORANGE CITY ELEMENTARY, MANATEE COVE ELEMENTARY, AND MOST RECENTLY ADDED RIVER SPRINGS ELEMENTARY, ALL LOCATED IN ORANGE CITY. IN ADDITION, OUR TWO STORIES SERVED 3,464 INDIVIDUALS THROUGH THEIR FOOD PANTRY, 4,328 FOOD DROPS AND SERVED 4,959 INDIVIDUALS THROUGH THE KIDS PACK PROGRAM.PRIORITY 3: BARRIERS TO ACCESSING HEALTH CARE SERVICES2019 DESCRIPTION OF THE ISSUE:- VOLUSIA COUNTY RATE OF HEALTH RESOURCES PER POPULATION IS LOWER THAN FLORIDA IN THE CATEGORIES OF PHYSICIANS, INTERNISTS, OB/GYN AND PEDIATRICIANS. - VOLUSIA COUNTY HAS A HIGHER PERCENTAGE OF BIRTHS COVERED BY MEDICAID THAN FLORIDA. RATES FOR BLACK AND HISPANIC INDIVIDUALS ARE HIGHER. - THE PERCENT OF VOLUSIA COUNTY ADULTS WITH A PERSONAL DOCTOR IS LOWER THAN FLORIDA. - VOLUSIA COUNTY HAS A LOWER RATIO OF PRIMARY CARE PHYSICIANS, DENTISTS, AND MENTAL HEALTH PROVIDERS TO POPULATION THAN FLORIDA. 2021 UPDATE: THE ADVENTHEALTH FISH MEMORIAL COMMUNITY HEALTH PLAN HAS ONE DESIRED GOAL STATEMENT UNDER THE BARRIERS TO ACCESSING HEALTH CARE SERVICES PRIORITY. 1. IMPROVE HEALTH AND SOCIAL OUTCOMES FOR COMMUNITY CARE PROGRAM PARTICIPANTS.GOAL 1: IMPROVE HEALTH AND SOCIAL OUTCOMES FOR VULNERABLE PATIENTS AND COMMUNITY CARE PROGRAM PARTICIPANTS.OBJECTIVE 1: THE FIRST OBJECTIVE IS TO INCREASE THE CAPACITY OF THE COMMUNITY CARE PROGRAM TO DESIGN AND FACILITATE A PARTNERSHIP WITH FAMILY HEALTH SOURCE (WEST VOLUSIA FEDERALLY QUALIFIED HEALTH CENTER) TO INCREASE ACCESS TO CARE. THE COMMUNITY CARE PROGRAM AT THE HOSPITAL PROVIDES EDUCATION, SUPPORT AND CARE COORDINATION THROUGH AN INTERDISCIPLINARY TEAM SERVING THE MOST VULNERABLE PATIENTS. THE TEAM PROVIDES HOME VISITS AT NO CHARGE, FOCUSING ON EDUCATING PATIENTS AND FAMILIES ON PREVENTATIVE CARE AND REDUCING BARRIERS RELATED TO THE SOCIAL DETERMINANTS OF HEALTH. THE FAMILY HEALTH SOURCE PARTNERSHIP INITIATIVE IS DEPLOYED THROUGH ADVENTHEALTH FISH MEMORIAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE FAMILY HEALTH SOURCE PARTNERSHIP AIMS TO CREATE A NEW CONNECTION FOR COMMUNITY CARE PATIENTS TO FAMILY HEALTH SOURCE MEDICAL CARE AND TO ESTABLISH A NEW PRIMARY CARE HOME. THE HOSPITAL DID NOT MEET ITS SET METRIC WITH NO PARTNERSHIP FORMED. DUE TO COVID-19, THE INITIATIVE WAS DELAYED. AS A RESULT OF THE PANDEMIC, THE NEEDS AND RESOURCES IN OUR COMMUNITY HAVE CHANGED AND ADVENTHEALTH IS ATTENTIVE TO THAT. DURING THE PAST YEAR, WE HAVE PIVOTED WHERE NECESSARY TO ADDRESS THE IMMEDIATE NEEDS OF OUR COMMUNITY DURING THE PANDEMIC AND WILL CONTINUE TO DO SO. WE WILL WORK TO IDENTIFY WAYS TO SUPPORT OUR COMMUNITY AND THE COMMUNITY-BASED ORGANIZATIONS THAT AID IT, WHILE FINDING NEW WAYS TO MEET THE NEW AND EXISTING NEEDS IN IT. THE COMMUNITY CARE TEAM CONTINUED TO PROVIDE SERVICES THROUGHOUT COVID-19. IN 2021 THERE WERE 73 NEW PATIENTS ENROLLED IN COMMUNITY CARE.OBJECTIVE 2:THE SECOND OBJECTIVE IS TO IMPLEMENT A PILOT PROGRAM TO ESTABLISH REMOTE ACCESS TO FAMILY HEALTH SOURCE SERVICES FOR VULNERABLE HOSPITAL PATIENTS AND COMMUNITY CARE PROGRAM PARTICIPANTS. THE FAMILY HEALTH SOURCE PILOT PROJECT IS DEPLOYED THROUGH ADVENTHEALTH FISH MEMORIAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE FAMILY HEALTH SOURCE PILOT PROJECT AIMS TO CREATE A NEW CONNECTION THROUGH TELEHEALTH, FOR COMMUNITY CARE PATIENTS TO FAMILY HEALTH SOURCE MEDICAL CARE.DUE TO THE CHANGING NEEDS AND THE QUICK RESPONSE OF THE HEALTH CARE COMMUNITY BECAUSE OF COVID-19, THIS OBJECTIVE WAS ORGANICALLY FULFILLED. ALTHOUGH THE HOSPITAL HAD SOUGHT TO CREATE THIS CONNECTION AND PROVIDE AN ADDITIONAL AVENUE FOR ACCESS, THIS HAPPENED AS HEALTH CARE PIVOTED TO TELEHEALTH MODELS THROUGHOUT THE COUNTRY AS A RESPONSE TO THE PANDEMIC. THIS PIVOT ALSO INCLUDED THE COMMUNITY CARE PROGRAM FOR WHICH THIS INITIATIVE WAS DEVELOPED.PRIORITY 4: HEALTHY EATING & PHYSICAL ACTIVITY 2019 DESCRIPTION OF THE ISSUE:- OVER 70% OF VOLUSIA COUNTY MIDDLE AND HIGH SCHOOL STUDENTS LACK VIGOROUS PHYSICAL ACTIVITY AND THE PERCENT INCREASED FROM 2014 TO 2016. THE PERCENT IS BETTER THAN FLORIDA. - THE PERCENT OF VOLUSIA COUNTY ADULTS WHO ARE SEDENTARY INCREASED FROM 2007 TO 2016 AND IS NOW HIGHER THAN FLORIDA. - THE PERCENT OF VOLUSIA COUNTY MIDDLE AND HIGH SCHOOLERS WHO WERE OBESE INCREASED SIGNIFICANTLY FROM 2014 TO 2016. - THE PERCENT OF VOLUSIA COUNTY ADULTS WHO ARE OBESE INCREASED BETWEEN 2013 AND 2016 AND THE PERCENT IS NOW HIGHER THAN FLORIDA. - INJURY DEATHS ARE INCREASING AND HIGHER THAN FLORIDA. 2021 UPDATE: THE ADVENTHEALTH FISH MEMORIAL COMMUNITY HEALTH PLAN HAS ONE DESIRED GOAL STATEMENT UNDER THE HEALTHY EATING & PHYSICAL ACTIVITY PRIORITY.1. INCREASE PHYSICAL ACTIVITY AND HEALTHY EATING AMONG VULNERABLE RESIDENTS.GOAL 1: INCREASE PHYSICAL ACTIVITY AND HEALTHY EATING AMONG VULNERABLE RESIDENTS.OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE MENTORSHIP AND EDUCATION ABOUT HEALTHY EATING AND PHYSICAL ACTIVITY TO 75% OF BOYS & GIRLS CLUBS' MEMBERS AT TWO AREA CLUBS FOUR TIMES ANNUALLY. THIS OBJECTIVE, A DIVISIONAL INITIATIVE WHICH APPEARS ON MULTIPLE COMMUNITY HEALTH PLANS OF HOSPITALS IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, IS FUNDED AND DEPLOYED THROUGH ADVENTHEALTH FISH MEMORIAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THE BOYS & GIRLS CLUBS' EDUCATION INITIATIVE IS FOCUSED ON PROVIDING AT LEAST FOUR EDUCATION SESSIONS A YEAR TO CLUB PARTICIPANTS TO INCREASE THEIR UNDERSTANDING OF HEALTHY EATING AND PHYSICAL ACTIVITY. THE HOSPITAL MET ITS SET METRIC OF PROVIDING FOUR EDUCATION SESSIONS WITH FOUR SESSIONS PROVIDED TO 75% OF BOYS AND GIRLS CLUBS' MEMBERS AT TWO AREA CLUBS FOUR TIMES ANNUALLY. TWO EDUCATIONAL PROGRAMS ON PHYSICAL ACTIVITY WERE PROVIDED TO CLUB MEMBERS AT THE HARRIS SAXON BOYS & GIRLS CLUB AND THE MID-FLORIDA JEEP/LAKE HELEN BOYS & GIRLS CLUB. DURING THE 2021 WEEK OF CARING, 480 TRAIL MIX TO-GO BAGS WERE DELIVERED TO ALL EIGHT LOCATIONS OF THE BOYS & GIRLS CLUB VOLUSIA/FLAGLER. IN ADDITION TO THIS PARTNERSHIP WITH BOYS & GIRLS CLUBS, TRAIL MIX TO-GO BAGS WERE DELIVERED TO BACKPACK BUDDIES FOR 250 YOUTH IN THE BACKPACK BUDDIES PROGRAM AND TO FLORIDA UNITED METHODIST CHILDREN'S HOME FOR 160 YOUTH.SEE CONTINUATION 4

PART V, SECTION B, LINE 11 CONTINUATION 4
OBJECTIVE 2: THE SECOND OBJECTIVE IS A DIVISIONAL INITIATIVE AND APPEARS ON MULTIPLE COMMUNITY HEALTH PLANS OF HOSPITALS IN THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, THE SAME DIVISION AS THE REPORTING HOSPITAL. THE DIVISION CHOSE THIS INITIATIVE BECAUSE OF A SHARED CHNA PRIORITY. THIS OBJECTIVE IS TO PROVIDE $4,000 IN FINANCIAL SUPPORT ANNUALLY TO THE BOYS & GIRLS CLUBS, AS PART OF A STRATEGIC PARTNERSHIP, TO PROVIDE DAILY FRESH FRUIT AND WHOLE GRAIN SNACKS TO CLUB MEMBERS. THE OBJECTIVE IS FUNDED THROUGH THE HOSPITAL AND ALL OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL, HOWEVER THE INITIATIVE IS MANAGED BY THE DIVISION. THIS INITIATIVE PROVIDES FINANCIAL SUPPORT SO THAT YOUTH PARTICIPATING IN LOCAL BOYS & GIRLS CLUBS CAN HAVE ACCESS TO DAILY HEALTHY SNACKS. THE HOSPITAL MET ITS SET METRIC OF PROVIDING FUNDING SUPPORT WITH $4,000 DOLLARS PROVIDED. THE PROVIDED FUNDING WAS ABLE TO MAKE UP FOR A SHORTFALL IN THE USDA GRANT BOYS & GIRLS CLUBS OF VOLUSIA/FLAGLER USES TO PROVIDE HARRIS SAXON BOYS & GIRLS CLUB AND MID-FLORIDA JEEP/LAKE HELEN BOYS & GIRLS CLUB MEMBERS WITH DAILY FRESH FRUIT AND WHOLE GRAIN SNACKS. SNACKS WERE DISTRIBUTED TO CLUB MEMBER FAMILIES DURING COVID-19.PRIORITY 5: SOCIAL AND ECONOMIC ISSUES (SOCIAL DETERMINANTS OF HEALTH) 2019 DESCRIPTION OF THE ISSUE:- VOLUSIA COUNTY'S MEDIAN HOUSEHOLD INCOME IS LOWER THAN FLORIDA'S. - VOLUSIA COUNTY'S PERCENT OF INDIVIDUALS AND INDIVIDUALS BELOW AGE 18 BELOW POVERTY ARE BOTH SLIGHTLY HIGHER THAN FLORIDA'S. - THE VOLUSIA COUNTY PERCENT OF ELEMENTARY AND MIDDLE SCHOOL STUDENTS ELIGIBLE FOR FREE/REDUCED PRICE LUNCHES IS HIGHER THAN FLORIDA. (A PROXY MEASURE FOR LOW INCOME) - THE VOLUSIA COUNTY HIGH SCHOOL GRADUATION RATE IS LOWER THAN FLORIDA.- THE VOLUSIA COUNTY PERCENT OF ADULTS LIMITED BY PHYSICAL, MENTAL, OR EMOTIONAL PROBLEMS IS HIGHER THAN FLORIDA. (DIFFERENCE IS STATISTICALLY SIGNIFICANT) - VOLUSIA COUNTY'S FOOD INSECURITY RATE IS HIGHER THAN FLORIDA'S. - VOLUSIA COUNTY'S PER CAPITA INCOME IS LOWER THAN FLORIDA'S. - OVER 30% OF VOLUSIA COUNTY HOUSEHOLDS SPEND MORE THAN 30% OF THEIR INCOME ON HOUSING AND WORKERS IN 8 OF THE TOP 20 INDUSTRIES IN VOLUSIA COUNTY ARE ESTIMATED TO BE HOUSING BURDENED BASED ON AVERAGE HOURLY WAGE. - THE VOLUSIA COUNTY NUMBER OF INDIVIDUALS COUNTED DURING THE POINT-IN-TIME COUNT WAS HIGHER IN 2019 THAN IN 2018. - THE VOLUSIA COUNTY NUMBER OF HOMELESS STUDENTS HAS BEEN INCREASING SINCE 2016. - VOLUSIA COUNTY'S PERCENT OF SINGLE PARENT HOUSEHOLDS IS HIGHER THAN FLORIDA'S. 2021 UPDATE: THE ADVENTHEALTH FISH MEMORIAL COMMUNITY HEALTH PLAN HAS ONE DESIRED GOAL STATEMENT UNDER THE SOCIAL AND ECONOMIC ISSUES (SOCIAL DETERMINANTS OF HEALTH) PRIORITY.1. INCREASE ACCESS TO INCOME AND HEALTH INSURANCE COVERAGE FOR VULNERABLE INDIVIDUALS.GOAL 1: INCREASE ACCESS TO INCOME AND HEALTH INSURANCE COVERAGE FOR VULNERABLE INDIVIDUALS.OBJECTIVE 1:THE FIRST OBJECTIVE IS A SHARED INITIATIVE BETWEEN ADVENTHEALTH FISH MEMORIAL, ADVENTHEALTH DAYTONA BEACH AND ADVENTHEALTH NEW SMYRNA BEACH. THESE HOSPITALS ARE PART OF THE CENTRAL FLORIDA DIVISION OF ADVENTHEALTH, THE SAME DIVISION AS THE REPORTING HOSPITAL. THE HOSPITALS PARTNERED ON THIS INITIATIVE BECAUSE OF A SHARED CHNA PRIORITY. THIS OBJECTIVE IS TO ENHANCE THE SUPPORTS AVAILABLE TO VULNERABLE INDIVIDUALS TO APPLY FOR AND OBTAIN SUPPLEMENTAL SECURITY INCOME/SOCIAL SECURITY DISABILITY INSURANCE (SSI/SSDI) BENEFITS (INCLUDING INCOME AND MEDICAID/MEDICARE) THROUGH THE ESTABLISHMENT OF A COORDINATED NETWORK OF ADVOCATES. INCREASED CAPACITY IN THE COMMUNITY SETTING FOR SSI/SSDI OUTREACH, ACCESS, AND RECOVERY IS FUNDED THROUGH ALL HOSPITALS, HOWEVER REPORTED OUTCOMES ARE SPECIFIC TO THE REPORTING HOSPITAL. THIS INITIATIVE PROVIDES ACCESS TO A CERTIFIED SOAR (SSI/SSDI OUTREACH, ACCESS, AND RECOVERY) PROCESSOR WHO ASSISTS VULNERABLE PATIENTS OF THE COMMUNITY CARE PROGRAM TO APPLY FOR SSI/SSDI BENEFITS TO INCREASE THEIR INCOME AND OBTAIN MEDICAL COVERAGE. THE HOSPITAL MET ITS SET METRIC WITH THE SOAR PROGRAM LAUNCHING IN FEBRUARY 2021. ADVENTHEALTH REFERRED 23 INDIVIDUALS RESIDING ON THE WEST SIDE OF VOLUSIA COUNTY TO SOAR IN 2021.COMMUNITY NEEDS NOT CHOSEN BY ADVENTHEALTH FISH MEMORIAL:THE PRIMARY AND SECONDARY DATA IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED MULTIPLE COMMUNITY ISSUES. THE HOSPITAL AND COMMUNITY STAKEHOLDERS USED THE FOLLOWING CRITERIA TO NARROW THE LARGER LIST TO THE PRIORITY AREAS NOTED ABOVE:1. HOW ACUTE IS THE NEED? (BASED ON DATA AND COMMUNITY CONCERN)2. WHAT IS THE TREND? IS THE NEED GETTING WORSE?3. DOES THE HOSPITAL PROVIDE SERVICES THAT RELATE TO THE PRIORITY? 4. IS SOMEONE ELSE - OR MULTIPLE GROUPS - IN THE COMMUNITY ALREADY WORKING ON THIS ISSUE? 5. IF THE HOSPITAL WERE TO ADDRESS THIS ISSUE, ARE THERE OPPORTUNITIES TO WORK WITH COMMUNITY PARTNERS? BASED ON THIS PRIORITIZATION PROCESS, THE HOSPITAL DID NOT CHOOSE THE FOLLOWING COMMUNITY ISSUES:1. THE YEARS OF POTENTIAL AGING-RELATED ISSUES THE DATA COLLECTED FOR INDIVIDUALS 65 AND OLDER DID NOT DEMONSTRATE SIGNIFICANT NEGATIVE TRENDS OR NEGATIVE COMPARISON TO STATE DATA. THE ONLY INDICATOR OF CONCERN NOTED WAS SUICIDE RATE FOR INDIVIDUALS OVER 65 WHICH WILL BE ADDRESSED THROUGH THE PRIORITIZATION OF ADULT BEHAVIORAL HEALTH. THERE ARE NUMEROUS INITIATIVES IN PLACE TO PROVIDE SERVICES TO THIS TARGET POPULATION. 2. CHILD & ADOLESCENT ISSUES THE MOST SIGNIFICANT CHILDHOOD ISSUES ARE ADDRESSED THROUGH OTHER PRIORITY ISSUES (BEHAVIORAL HEALTH, ACCESS TO SERVICES, HEALTHY EATING, AND PHYSICAL ACTIVITY). 3. COMMUNICABLE & INFECTIOUS DISEASES THE DATA COLLECTED DID NOT DEMONSTRATE SIGNIFICANT NEGATIVE TRENDS OR COMPARISON DATA. MANY ISSUES NOTED IN THE INDICATORS OF CONCERN WILL BE ADDRESSED THROUGH THE PRIORITIZATION OF ACCESS TO HEALTH CARE SERVICES. 4. CRIME, DOMESTIC VIOLENCE & CHILD ABUSE THE DATA COLLECTED DID NOT DEMONSTRATE SIGNIFICANT NEGATIVE TRENDS OR NEGATIVE COMPARISON TO STATE DATA. MANY ISSUES NOTED IN THE INDICATORS OF CONCERN WILL BE ADDRESS THROUGH THE PRIORITIZATION OF SOCIAL AND ECONOMIC ISSUES. 5. EARLY CHILDHOOD THERE ARE SIGNIFICANT EFFORTS ALREADY IN PLACE TO ADDRESS THIS TARGET POPULATION. 6. WOMEN'S HEALTH, PRENATAL CARE & BIRTH OUTCOMES THERE ARE SIGNIFICANT EFFORTS ALREADY IN PLACE TO ADDRESS THIS TARGET POPULATION. MANY OF THE INDICATORS OF CONCERN WILL BE ADDRESSED THROUGH THE PRIORITIZATION OF ACCESS TO HEALTH CARE SERVICES.

SCHEDULE H, PART V, SECTION B, LINE 7A:
THE CHNA REPORT FOR ADVENTHEALTH FISH MEMORIAL CAN BE FOUND AT URL:HTTPS://WWW.ADVENTHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS

SCHEDULE H, PART V, SECTION B, LINE 10A:
THE HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND AT:HTTPS://WWW.ADVENTHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS

SCHEDULE H, PART V, SECTION B, LINE 16A,B,C:
THE FINANCIAL ASSISTANCE POLICY FOR THE HOSPITAL CAN BE FOUND AT URL:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCETHE FINANCIAL ASSISTANCE POLICY APPLICATION FOR THE HOSPITAL CAN BE FOUND AT:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCETHE PLAIN LANGUAGE SUMMARY FOR THE HOSPITAL IS AVAILABLE AT:HTTPS://WWW.ADVENTHEALTH.COM/LEGAL/FINANCIAL-ASSISTANCE

PART I, LINE 6A:
"THE FILING ORGANIZATION WAS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) DURING ITS CURRENT TAX YEAR. DURING THE CURRENT YEAR, AHSSHC SERVED AS A PARENT ORGANIZATION TO 30 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS AND A NUMBER OF OTHER HEALTH CARE FACILITIES THAT OPERATED IN 10 STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS ""ADVENTHEALTH"".ALL HOSPITAL ORGANIZATIONS WITHIN ADVENTHEALTH COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. ADVENTHEALTH ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. ADVENTHEALTH HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. EACH ADVENTHEALTH HOSPITAL FACILITY REPORTS THEIR COMMUNITY BENEFITS TO THEIR BOARD OF DIRECTORS AND STRIVES TO COMMUNICATE THEIR COMMUNITY BENEFITS TO THEIR LOCAL COMMUNITIES. ADDITIONALLY, THE FILING ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY CAN BE ACCESSED ON THE FILING ORGANIZATION'S WEBSITE."

PART I, LINE 7:
THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS.

PART III, LINE 2:
THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON LINE 2 OF SECTION A OF PART III IS RECORDED IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO REVENUE, NOT BAD DEBT EXPENSE.

PART III, LINE 3:
METHODOLOGY FOR DETERMINING THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT MAY REPRESENT PATIENTS WHO COULD HAVE QUALIFIED UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY:SELF-PAY PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE BY COMPLETING A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM). IF AN INDIVIDUAL DOES NOT SUBMIT A COMPLETE FAA FORM WITHIN 240 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL, AN INDIVIDUAL MAY BE CONSIDERED FOR PRESUMPTIVE ELIGIBILITY BASED UPON A SCORING TOOL THAT IS DESIGNED TO CLASSIFY PATIENTS INTO GROUPS OF VARYING ECONOMIC MEANS. THE SCORING TOOL USES ALGORITHMS THAT INCORPORATE DATA FROM CREDIT BUREAUS, DEMOGRAPHIC DATABASES, AND HOSPITAL SPECIFIC DATA TO INFER AND CLASSIFY PATIENTS INTO RESPECTIVE ECONOMIC MEANS CATEGORIES. INDIVIDUALS WHO EARN A CERTAIN SCORE ON THE SCORING TOOL ARE CONSIDERED TO QUALIFY AS ELIGIBLE FOR THE MOST GENEROUS FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. AS DETERMINED BY THE FILING ORGANIZATION, A NOMINAL AMOUNT OF SUCH A PATIENT'S BILL IS WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED NON-STATE CHARITY. THE AMOUNT WRITTEN OFF AS BAD DEBT EXPENSE FOR THOSE PATIENTS WHO POTENTIALLY QUALIFY AS NON-STATE CHARITY USING THE SCORING TOOL IS THE AMOUNT SHOWN ON LINE 3 OF SECTION A OF PART III. RATIONALE FOR INCLUDING CERTAIN BAD DEBTS IN COMMUNITY BENEFIT:THE FILING ORGANIZATION IS DEDICATED TO THE VIEW THAT MEDICALLY NECESSARY HEALTH CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS SHOULD BE ACCESSIBLE TO ALL, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, CULTURAL BACKGROUND, PHYSICIAN MOBILITY, OR ABILITY TO PAY. THE FILING ORGANIZATION TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THE AVAILABILITY OF THIRD-PARTY COVERAGE. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE FILING ORGANIZATION IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. AS A 501(C)(3) HOSPITAL ORGANIZATION, THE FILING ORGANIZATION MAINTAINS A 24/7 EMERGENCY ROOM PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION CANNOT BE MADE BASED UPON INFORMATION SUPPLIED BY THE INDIVIDUAL. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY.

PART III, LINE 4:
FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGE 8-9. PLEASE NOTE THAT DOLLAR AMOUNTS ON THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE IN THOUSANDS.

PART VI, LINE 7:
THE FILING ORGANIZATION DOES NOT FILE AN ANNUAL COMMUNITY BENEFIT REPORT WITH ANY STATE AGENCIES.

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 THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY, AS WELL AS CONTACT INFORMATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS OR, ALTERNATIVELY, A NONPROFIT ORGANIZATION OR GOVERNMENTAL AGENCY THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS IF THE HOSPITAL FACILITY IS UNABLE TO DO SO. IF AN INDIVIDUAL SUBMITS A COMPLETE FAA FORM WITHIN A REASONABLE TIME-PERIOD AS SET FORTH IN THE NOTICE DESCRIBED ABOVE, THE HOSPITAL FILING ORGANIZATION WILL SUSPEND ANY ADVERSE REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS UNTIL A FINANCIAL ASSISTANCE POLICY ELIGIBILITY DETERMINATION CAN BE MADE.

SUPPLEMENTAL SCHEDULE TO SCHEDULE H, PART III, SECTION B, LINE 8
RECONCILIATION OF SCHEDULE H REPORTED MEDICARE SURPLUS/(SHORTFALL) TO UNREIMBURSED MEDICARE COSTS ASSOCIATED WITH THE PROVISION OF SERVICESTO ALL MEDICARE BENEFICIARIES:THE MEDICARE REVENUE AND ALLOWABLE COSTS OF CARE REPORTED IN SECTION B OF PART III OF SCHEDULE H ARE BASED UPON THE AMOUNTS REPORTED IN THE FILING ORGANIZATION'S MEDICARE COST REPORT IN ACCORDANCE WITH THE IRS INSTRUCTIONS FOR SCHEDULE H. ON AN ANNUAL BASIS, THE FILING ORGANIZATION ALSO DETERMINES ITS TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS. UNREIMBURSED COSTS ARE CONSIDERED A COMMUNITY BENEFIT TO THE ELDERLY AND ARE COMBINED INTO AN ANNUAL COMMUNITY BENEFIT STATEMENT PREPARED BY ADVENTHEALTH. THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO ALL MEDICARE PATIENTS ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ (3,199,836)- DIFFERENCE IN COSTING METHODOLOGY: (4,463,612)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (10,094,672) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITYBENEFIT REPORTING $(17,758,120)AS INDICATED ABOVE, THE PRIMARY DIFFERENCES BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) REPORTED ON SCHEDULE H, PART III, SECTION B, LINE 7 AND THE FILING ORGANIZATION'S PORTION OF THE COMPANY'S ANNUAL COMMUNITY BENEFIT STATEMENT IS DUE TO A DIFFERENCE IN THE COSTING METHODOLOGY AND DIFFERENCES IN THE POPULATION OF MEDICARE PATIENTS WITHIN THE CALCULATION. THE COST METHODOLOGY UTILIZED IN CALCULATING ANY MEDICARE SURPLUS/(SHORTFALL) FOR PURPOSES OF THE ANNUAL COMMUNITY BENEFIT REPORTING IS BASED UPON THE COST-TO-CHARGE RATIO OUTLINED IN WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE SAME COST-TO-CHARGE RATIO IS USED TO DETERMINE THE COSTS ASSOCIATED WITH SERVICES PROVIDED TO CHARITY CARE PATIENTS AND MEDICAID PATIENTS AS REPORTED IN SCHEDULE H, PART I, LINE 7. IN ADDITION, THE MEDICARE COST REPORT EXCLUDES SERVICES PROVIDED TO MEDICARE PATIENTS FOR PHYSICIAN SERVICES, SERVICES PROVIDED TO PATIENTS ENROLLED IN MEDICARE HMOS, AND CERTAIN SERVICES PROVIDED BY OUTPATIENT DEPARTMENTS OF THE FILING ORGANIZATION THAT ARE REIMBURSED ON A FEE SCHEDULE. THE COMPANY'S OWN COMMUNITY BENEFIT STATEMENT CAPTURES THE UNREIMBURSED COST OF PROVIDING SERVICES TO ALL MEDICARE BENEFICIARIES THROUGHOUT THE ORGANIZATION.

PART VI, LINE 2:
THE HOSPITAL CONDUCTS COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) EVERY THREE YEARS. ITS 2019 CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2019, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S 2019 CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN FINAL REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY.SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY.

PART VI, LINE 3:
THE FINANCIAL ASSISTANCE POLICY (FAP), FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM), AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) OF THE FILING ORGANIZATION'S HOSPITAL FACILITY ARE TRANSPARENT AND AVAILABLE TO ALL INDIVIDUALS SERVED AT ANY POINT IN THE CARE CONTINUUM. THE FAP, FAA FORM, PLS, AND CONTACT INFORMATION FOR THE HOSPITAL FACILITY'S FINANCIAL COUNSELORS ARE PROMINENTLY AND CONSPICUOUSLY POSTED ON THE FILING ORGANIZATION'S HOSPITAL FACILITY'S WEBSITE. THE WEBSITE INDICATES THAT A COPY OF THE FAP, FAA FORM, AND PLS IS AVAILABLE AND HOW TO OBTAIN SUCH COPIES IN THE PRIMARY LANGUAGES OF ANY POPULATIONS WITH LIMITED PROFICIENCY IN ENGLISH THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY (REFERRED TO BELOW AS LEP DEFINED POPULATIONS). SIGNAGE IS DISPLAYED IN PUBLIC LOCATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, INCLUDING AT ALL POINTS OF ADMISSION AND REGISTRATION AND THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE HOSPITAL FACILITY'S WEBSITE ADDRESS WHERE THE FAP, FAA FORM, AND PLS CAN BE ACCESSED AND THE TELEPHONE NUMBER AND PHYSICAL LOCATION THAT INDIVIDUALS CAN CALL OR VISIT TO OBTAIN COPIES OF THE FAP, FAA FORM AND PLS OR TO OBTAIN MORE INFORMATION ABOUT THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS. PAPER COPIES OF THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. PAPER COPIES ARE MADE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGES OF ANY LEP DEFINED POPULATIONS. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A PAPER COPY OF THE HOSPITAL FACILITY'S PLS WILL BE OFFERED TO EVERY PATIENT AS A PART OF THE INTAKE OR DISCHARGE PROCESS. A CONSPICUOUS WRITTEN NOTICE IS INCLUDED ON ALL BILLING STATEMENTS SENT TO PATIENTS THAT NOTIFIES AND INFORMS RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, INCLUDING THE FOLLOWING: 1) THE TELEPHONE NUMBER OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND THE FAA FORM; AND 2) THE WEBSITE ADDRESS WHERE COPIES OF THE FAP, FAA FORM AND PLS MAY BE OBTAINED. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE. COPIES OF THE PLS ARE DISTRIBUTED TO MEMBERS OF THE COMMUNITY IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE.

PART VI, LINE 4:
ADVENTHEALTH FISH MEMORIAL IS A FAITH-BASED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION WITH A MISSION OF EXTENDING THE HEALING MINISTRY OF CHRIST WITH SKILL AND COMPASSION. IT IS A 257-BED FULL-SERVICE HOSPITAL PROVIDING INPATIENT AND OUTPATIENT SERVICES AS WELL AS 24-HOUR EMERGENCY AND CRITICAL CARE. IT IS A MEMBER OF ADVENTHEALTH, THE LARGEST PROTESTANT NOT-FOR-PROFIT HOSPITAL SYSTEM IN THE NATION AND WORKS TO PROVIDE EXCEPTIONAL, PATIENT-FOCUSED CARE TO THE DEBARY, DELTONA, ORANGE CITY AND SANFORD COMMUNITIES. THE HOSPITAL IS FULLY ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS. THE HOSPITAL HAS BEEN RECOGNIZED BY FMQAI - THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION FOR FLORIDA WITH THE FMQAI PERFORMANCE ACHIEVEMENT AWARD. THIS HONOR RECOGNIZES ADVENTHEALTH FISH MEMORIAL ON ITS WORK TO IMPROVE THE QUALITY OF HEALTH CARE FOR MEDICARE BENEFICIARIES DURING THE LAST THREE YEARS. THE HOSPITAL HAS ALSO BEEN RECOGNIZED FOR THE NINTH CONSECUTIVE YEAR AMONG THE 2013 ORLANDO SENTINEL'S TOP 100 COMPANIES FOR WORKING FAMILIES.IN 2012, THE HOSPITAL WAS AWARDED A THREE-YEAR TERM IN BOTH THE ACR GOLD STANDARD OF ACCREDIATION IN BREAST MAGNETIC RESONANCE IMAGING (MRI) AND THE AMERICAN ASSOCIATION OF CARDIOVASCULAR & PULMONARY REHABILITATION RECERTIFICATION FOR THEIR PULMONARY REHAB PROGRAM. ADDITIONALLY, THE HOSPITAL ADDED A THIRD HYPERBARIC OXYGEN CHAMBER TO MEET THE GROWING PATIENT DEMAND FOR TREATMENT AND IMPLEMENTED MEDICATION POSITIVE PATIENT IDENTIFICATION TO PROVIDE A SAFER AND MORE ACCURATE PROCESS FOR ADMINISTERING MEDICATION TO PATIENTS.DURING 2021, THE HOSPITAL'S PATIENT PERCENTAGE POPULATION WAS MADE UP OF THE BELOW PAYORS WITH THE REMAINING PERCENTAGE OF THE PATIENTS BEING COVERED UNDER COMMERCIAL INSURANCE. IN 2021, ABOUT 90.9% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. - MEDICARE PATIENTS 53.6% - MEDICAID PATIENTS 12.7% - SELF-PAY PATIENTS 4.8% THE DEMOGRAPHIC MAKEUP OF THE HOSPITAL'S COMMUNITY IS AS FOLLOWS: - POPULATION 135,869 - POPULATION OVER 65 24% - POVERTY (BELOW 100% FPL) 14.5% - UNEMPLOYMENT RATE 7.1% - VIOLENT CRIME RATE (PER 100,000 POP.) 426.5 - POP. AGE 25+ WITH NO HIGH SCHOOL DIPLOMA 10.7% - UNINSURED ADULTS 17.71% - UNINSURED CHILDREN 5.95% - FOOD INSECURITY RATE 16.2% - POP. WITH LOW FOOD ACCESS 36.02%

PART VI, LINE 5:
"THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO ADVENTHEALTH FISH MEMORIAL'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF ""EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT AND COMMUNITY BUILDING INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, THE HOSPITAL PROVIDED $372,159 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF A COMMUNITY HOSPITAL. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE HOSPITAL EXPENDED $21,854,039 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY."

PART VI, LINE 6:
THE FILING ORGANIZATION IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTHEALTH. AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 48 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 10 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AS THE PARENT ORGANIZATION OF ADVENTHEALTH, AHSSHC PROVIDES EXECUTIVE LEADERSHIP AND OTHER PROFESSIONAL SUPPORT SERVICES TO ITS SUBSIDIARY ORGANIZATIONS. PROFESSIONAL SUPPORT SERVICES INCLUDE AMONG OTHERS IT, CORPORATE COMPLIANCE, LEGAL, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. CERTAIN SUPPORT SERVICES, SUCH AS HUMAN RESOURCES, PAYROLL, A/P, AND SUPPLY CHAIN MANAGEMENT ARE PROVIDED PURSUANT TO A SHARED SERVICES MODEL BY AHSSHC TO ITS SUBSIDIARY ORGANIZATIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH ADVENTHEALTH SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. EACH ADVENTHEALTH SUBSIDIARY PAYS A MANAGEMENT FEE TO AHSSHC FOR THE INTERNAL SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY AN ADVENTHEALTH SUBSIDIARY ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY BY ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF ADVENTHEALTH AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEB-SITE OF ADVENTHEALTH AT WWW.ADVENTHEALTH.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF ADVENTHEALTH.