4A (Expenses $ 310391554 including grants of $ 417852) (Revenue $ 355240328)
OPERATION OF 2 ACUTE CARE HOSPITALS WITH 16,725 PATIENT ADMISSIONS, 94,714 PATIENT DAYS, AND 152,112 OUTPATIENT VISITS IN THE CURRENT YEAR. BOTH HOSPITALS ARE LOCATED IN ORMOND BEACH AND DAYTONA BEACH, FLORIDA. UNFORTUNATELY, THE OCEANSIDE LOCATION HAD TO CLOSE DUE TO HURRICANE IRMA IN SEPTEMBER 2017.

FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER
PART V, SECTION B, LINE 5: MEMORIAL HEALTH SYSTEMS, INC., D/B/A FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER, (FHMMC OR THE HOSPITAL) OPERATES TWO HOSPITALS UNDER A SINGLE LICENSE IN VOLUSIA COUNTY, FLORIDA WITH A TOTAL OF 407 LICENSED BEDS. FOR PURPOSES OF ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL DEFINED ITS COMMUNITY AS ALL OF VOLUSIA COUNTY, FLORIDA. VOLUSIA COUNTY, FLORIDA HAS A TOTAL POPULATION OF OVER 500,000. ABOUT 18% OF THE POPULATION WAS UNDER AGE 18 AND 23% OF THE POPULATION WAS 65 YEARS OR OLDER. FHMMC JOINED WITH ITS FOUR AFFILIATED HOSPITALS IN VOLUSIA COUNTY AND WITH HALIFAX HEALTH, AN UNRELATED GOVERNMENTAL HOSPITAL IN VOLUSIA COUNTY, AND WITH THE VOLUSIA COUNTY DEPARTMENT OF HEALTH TO CONDUCT A COUNTY-WIDE COMMUNITY HEALTH NEEDS ASSESSMENT IN 2015-2016. ADDITIONALLY, THE HOSPITAL CONTRACTED WITH ONE VOICE FOR VOLUSIA, A LOCAL NON-PROFIT ORGANIZATION TO ASSIST IN PRIMARY DATA COLLECTION, COMPILATION AND ANALYSIS AND FACILITATION OF THE REVIEW AND PRIORITIZATION PROCESS FOR IDENTIFIED COMMUNITY HEALTH NEEDS. AS A PART OF ITS EFFORTS TO ENSURE BROAD COMMUNITY-BASED INPUT INTO THE CHNA PROCESS, THE HOSPITAL ESTABLISHED A LEADERSHIP TEAM THAT INCLUDED 45 LEADERS FROM 15 ORGANIZATIONS REPRESENTING KEY SECTORS OF THE PUBLIC HEALTH SYSTEM AS WELL AS LOW-INCOME, MINORITY AND OTHER UNDERSERVED POPULATIONS. IN ADDITION TO THE LEADERSHIP TEAM, THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS INCLUDED INPUT FROM PEOPLE REPRESENTING THE BROAD COMMUNITY, INCLUDING LOW-INCOME, MINORITY, AND OTHER MEDICALLY UNDERSERVED POPULATIONS. THIS INPUT WAS GATHERED THROUGH COMMUNITY SURVEYS (INTERNET AND PAPER) THAT REACHED 2,003 CONSUMERS AND STAKEHOLDERS AND TWO COMMUNITY MEETINGS THAT ENGAGED 120 COMMUNITY MEMBERS AND STAKEHOLDERS. THE FOLLOWING COMMUNITY-BASED ORGANIZATIONS WERE PARTICIPANTS ON THE LEADERSHIP TEAM. THESE ORGANIZATIONS SPECIFICALLY REPRESENTED THE NEEDS OF LOW-INCOME, MINORITY AND MEDICALLY UNDERSERVED POPULATIONS. THE VOLUSIA COUNTY HEALTH DEPARTMENT,THE JESUS CLINIC - A CLINIC PROVIDING FREE HEALTHCARE TO FAMILIES THAT DO NOT QUALIFY FOR MEDICAID AND ARE UNINSURED,FAMILY HEALTH SOURCE MEDICAL CENTERS,LUTHERAN SERVICES FLORIDA HEALTH SYSTEMS,VOLUSIA COUNTY SCHOOLS,STETSON UNIVERSITY,COUNCIL ON AGING,CAREER SOURCE FLAGLER/VOLUSIA,HEALTHY START COALITION OF FLAGLER AND VOLUSIA,EASTER SEALS,BETHUNE-COOKMAN UNIVERSITY,UNITED WAY OF VOLUSIA-FLAGLER COUNTIES; ANDSTEWART MARCHMAN ACT BEHAVIORAL HEALTHCARE - RECOVERY FOR MENTAL ILLNESS AND ADDICTION.

FLORIDA HOSPITAL OCEANSIDE
PART V, SECTION B, LINE 5: MEMORIAL HEALTH SYSTEMS, INC., D/B/A FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER, (FHMMC OR THE HOSPITAL) OPERATES TWO HOSPITALS UNDER A SINGLE LICENSE IN VOLUSIA COUNTY, FLORIDA WITH A TOTAL OF 407 LICENSED BEDS. FOR PURPOSES OF ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL DEFINED ITS COMMUNITY AS ALL OF VOLUSIA COUNTY, FLORIDA. VOLUSIA COUNTY, FLORIDA HAS A TOTAL POPULATION OF OVER 500,000. ABOUT 18% OF THE POPULATION WAS UNDER AGE 18 AND 23% OF THE POPULATION WAS 65 YEARS OR OLDER. FHMMC JOINED WITH ITS FOUR AFFILIATED HOSPITALS IN VOLUSIA COUNTY AND WITH HALIFAX HEALTH, AN UNRELATED GOVERNMENTAL HOSPITAL IN VOLUSIA COUNTY, AND WITH THE VOLUSIA COUNTY DEPARTMENT OF HEALTH TO CONDUCT A COUNTY-WIDE COMMUNITY HEALTH NEEDS ASSESSMENT IN 2015-2016. ADDITIONALLY, THE HOSPITAL CONTRACTED WITH ONE VOICE FOR VOLUSIA, A LOCAL NON-PROFIT ORGANIZATION TO ASSIST IN PRIMARY DATA COLLECTION, COMPILATION AND ANALYSIS AND FACILITATION OF THE REVIEW AND PRIORITIZATION PROCESS FOR IDENTIFIED COMMUNITY HEALTH NEEDS. AS A PART OF ITS EFFORTS TO ENSURE BROAD COMMUNITY-BASED INPUT INTO THE CHNA PROCESS, THE HOSPITAL ESTABLISHED A LEADERSHIP TEAM THAT INCLUDED 45 LEADERS FROM 15 ORGANIZATIONS REPRESENTING KEY SECTORS OF THE PUBLIC HEALTH SYSTEM AS WELL AS LOW-INCOME, MINORITY AND OTHER UNDERSERVED POPULATIONS. IN ADDITION TO THE LEADERSHIP TEAM, THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS INCLUDED INPUT FROM PEOPLE REPRESENTING THE BROAD COMMUNITY, INCLUDING LOW-INCOME, MINORITY, AND OTHER MEDICALLY UNDERSERVED POPULATIONS. THIS INPUT WAS GATHERED THROUGH COMMUNITY SURVEYS (INTERNET AND PAPER) THAT REACHED 2,003 CONSUMERS AND STAKEHOLDERS AND TWO COMMUNITY MEETINGS THAT ENGAGED 120 COMMUNITY MEMBERS AND STAKEHOLDERS. THE FOLLOWING COMMUNITY-BASED ORGANIZATIONS WERE PARTICIPANTS ON THE LEADERSHIP TEAM. THESE ORGANIZATIONS SPECIFICALLY REPRESENTED THE NEEDS OF LOW-INCOME, MINORITY AND MEDICALLY UNDERSERVED POPULATIONS. THE VOLUSIA COUNTY HEALTH DEPARTMENT,THE JESUS CLINIC - A CLINIC PROVIDING FREE HEALTHCARE TO FAMILIES THAT DO NOT QUALIFY FOR MEDICAID AND ARE UNINSURED,FAMILY HEALTH SOURCE MEDICAL CENTERS,LUTHERAN SERVICES FLORIDA HEALTH SYSTEMS,VOLUSIA COUNTY SCHOOLS,STETSON UNIVERSITY,COUNCIL ON AGING,CAREER SOURCE FLAGLER/VOLUSIA,HEALTHY START COALITION OF FLAGLER AND VOLUSIA,EASTER SEALS,BETHUNE-COOKMAN UNIVERSITY,UNITED WAY OF VOLUSIA-FLAGLER COUNTIES; ANDSTEWART MARCHMAN ACT BEHAVIORAL HEALTHCARE - RECOVERY FOR MENTAL ILLNESS AND ADDICTION.

FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER
PART V, SECTION B, LINE 6A: THE FILING ORGANIZATION PARTICIPATED IN A JOINT REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT INCLUDED THREE RELATED HOSPITAL ORGANIZATIONS, AN UNRELATED HOSPITAL ORGANIZATION, THE VOLUSIA COUNTY HEALTH DEPARTMENT AND A COMMUNITY NON-PROFIT ORGANIZATION. THESE COLLABORATORS ALL CONSIDERED VOLUSIA COUNTY TO BE THE PRIMARY SERVICE AREA FOR PURPOSES OF THE JOINT CHNA. ALL COLLABORATORS IN THE JOINT REGIONAL CHNA WERE AS FOLLOWS:RELATED COLLABORATORS:MEMORIAL HOSPITAL WEST VOLUSIA, INC., DBA FLORIDA HOSPITAL DELANDSOUTHWEST VOLUSIA HEALTHCARE CORPORATION, DBA FLORIDA HOSPITAL FISH MEMORIALSOUTHEAST VOLUSIA HEALTHCARE CORPORATION, DBA FLORIDA HOSPITAL NEW SMYRNA; MEMORIAL HEALTH SYSTEMS, INC., DBA FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER; ANDMEMORIAL HEALTH SYSTEMS, INC., DBA FLORIDA HOSPITAL OCEANSIDE;UNRELATED COLLABORATORS:HALIFAX HEALTH MEDICAL CENTER;THE VOLUSIA COUNTY HEALTH DEPARTMENT; AND ONE VOICE FOR VOLUSIA.

FLORIDA HOSPITAL OCEANSIDE
PART V, SECTION B, LINE 6A: THE FILING ORGANIZATION PARTICIPATED IN A JOINT REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT INCLUDED THREE RELATED HOSPITAL ORGANIZATIONS, AN UNRELATED HOSPITAL ORGANIZATION, THE VOLUSIA COUNTY HEALTH DEPARTMENT AND A COMMUNITY NON-PROFIT ORGANIZATION. THESE COLLABORATORS ALL CONSIDERED VOLUSIA COUNTY TO BE THE PRIMARY SERVICE AREA FOR PURPOSES OF THE JOINT CHNA. ALL COLLABORATORS IN THE JOINT REGIONAL CHNA WERE AS FOLLOWS:RELATED COLLABORATORS:MEMORIAL HOSPITAL WEST VOLUSIA, INC., DBA FLORIDA HOSPITAL DELANDSOUTHWEST VOLUSIA HEALTHCARE CORPORATION, DBA FLORIDA HOSPITAL FISH MEMORIALSOUTHEAST VOLUSIA HEALTHCARE CORPORATION, DBA FLORIDA HOSPITAL NEW SMYRNA; MEMORIAL HEALTH SYSTEMS, INC., DBA FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER; ANDMEMORIAL HEALTH SYSTEMS, INC., DBA FLORIDA HOSPITAL OCEANSIDE;UNRELATED COLLABORATORS:HALIFAX HEALTH MEDICAL CENTER;THE VOLUSIA COUNTY HEALTH DEPARTMENT; AND ONE VOICE FOR VOLUSIA.

FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER
PART V, SECTION B, LINE 6B: THE FILING ORGANIZATION PARTICIPATED IN A JOINT REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT INCLUDED THREE RELATED HOSPITAL ORGANIZATIONS, AN UNRELATED HOSPITAL ORGANIZATION, THE VOLUSIA COUNTY HEALTH DEPARTMENT AND A COMMUNITY NON-PROFIT ORGANIZATION. THESE COLLABORATORS ALL CONSIDERED VOLUSIA COUNTY TO BE THE PRIMARY SERVICE AREA FOR PURPOSES OF THE JOINT CHNA. ALL COLLABORATORS IN THE JOINT REGIONAL CHNA WERE AS FOLLOWS:RELATED COLLABORATORS:MEMORIAL HOSPITAL WEST VOLUSIA, INC., DBA FLORIDA HOSPITAL DELANDSOUTHWEST VOLUSIA HEALTHCARE CORPORATION, DBA FLORIDA HOSPITAL FISH MEMORIALSOUTHEAST VOLUSIA HEALTHCARE CORPORATION, DBA FLORIDA HOSPITAL NEW SMYRNA; MEMORIAL HEALTH SYSTEMS, INC., DBA FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER; ANDMEMORIAL HEALTH SYSTEMS, INC., DBA FLORIDA HOSPITAL OCEANSIDE;UNRELATED COLLABORATORS:HALIFAX HEALTH MEDICAL CENTER;THE VOLUSIA COUNTY HEALTH DEPARTMENT; AND ONE VOICE FOR VOLUSIA.

FLORIDA HOSPITAL OCEANSIDE
PART V, SECTION B, LINE 6B: THE FILING ORGANIZATION PARTICIPATED IN A JOINT REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT INCLUDED THREE RELATED HOSPITAL ORGANIZATIONS, AN UNRELATED HOSPITAL ORGANIZATION, THE VOLUSIA COUNTY HEALTH DEPARTMENT AND A COMMUNITY NON-PROFIT ORGANIZATION. THESE COLLABORATORS ALL CONSIDERED VOLUSIA COUNTY TO BE THE PRIMARY SERVICE AREA FOR PURPOSES OF THE JOINT CHNA. ALL COLLABORATORS IN THE JOINT REGIONAL CHNA WERE AS FOLLOWS:RELATED COLLABORATORS:MEMORIAL HOSPITAL WEST VOLUSIA, INC., DBA FLORIDA HOSPITAL DELANDSOUTHWEST VOLUSIA HEALTHCARE CORPORATION, DBA FLORIDA HOSPITAL FISH MEMORIALSOUTHEAST VOLUSIA HEALTHCARE CORPORATION, DBA FLORIDA HOSPITAL NEW SMYRNA; MEMORIAL HEALTH SYSTEMS, INC., DBA FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER; ANDMEMORIAL HEALTH SYSTEMS, INC., DBA FLORIDA HOSPITAL OCEANSIDE;UNRELATED COLLABORATORS:HALIFAX HEALTH MEDICAL CENTER;THE VOLUSIA COUNTY HEALTH DEPARTMENT; AND ONE VOICE FOR VOLUSIA.

FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER
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.

FLORIDA HOSPITAL OCEANSIDE
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.

FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER
"PART V, SECTION B, LINE 11: THE INFORMATION PROVIDED BELOW EXPLAINS HOW THE HOSPITAL FACILITY ADDRESSED IN 2017 THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, AND ANY SUCH NEEDS THAT WERE NOT ADDRESSED AND THE REASONS WHY SUCH NEEDS WERE NOT ADDRESSED. THE HOSPITAL FACILITY CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2016 AND ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT IN 2017 PRIOR TO MAY 15, 2017. MEMORIAL HEALTH SYSTEMS, INC., DBA FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER (FHMMC OR THE HOSPITAL), IS PART OF THE CENTRAL FLORIDA DIVISION-NORTH REGION OF ADVENTIST HEALTH SYSTEM. THE REGION INCLUDES 7 HOSPITAL FACILITIES.THIS IS THE FIRST-YEAR UPDATE FOR FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER'S 2017-2019 COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER DEVELOPED THIS PLAN AND POSTED IT IN MAY 2017 AS PART OF ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS.FOR THE DEVELOPMENT OF BOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY, FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER WORKED TO DEFINE AND ADDRESS THE NEEDS OF LOW-INCOME, MINORITY AND UNDERSERVED POPULATIONS IN ITS SERVICE AREA. THE 2016 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 NEEDS ASSESSMENT WERE PRIORITIZED BY COMMUNITY AND HOSPITAL STAKEHOLDERS, WHO THEN SELECTED KEY ISSUES FOR THE HOSPITAL TO ADDRESS IN ITS 2017-2019 COMMUNITY HEALTH PLAN. THE FIRST-YEAR PROGRESS ON THE COMMUNITY HEALTH PLAN IS NOTED BELOW. THIS NARRATIVE DESCRIBES THE ISSUES IDENTIFIED IN 2016 AND GIVES AN UPDATE ON THE STRATEGIES ADDRESSING THOSE ISSUES. THERE IS ALSO A DESCRIPTION OF THE IDENTIFIED ISSUES THAT THE HOSPITAL IS NOT ADDRESSING.FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER CHOSE FIVE AREAS OF FOCUS FOR THEIR 2017-2019 COMMUNITY HEALTH PLAN: ADULT BEHAVIORAL HEALTH; YOUTH MENTAL HEALTH AND BEHAVIORAL HEALTH; CHRONIC DISEASE: CARDIOVASCULAR AND DIABETES; BARRIERS TO ACCESSING HEALTH CARE SERVICES; AND HEALTHY EATING AND PHYSICAL ACTIVITY.PRIORITY: ADULT BEHAVIORAL HEALTH2016 DESCRIPTION OF THE ISSUE: BEHAVIORAL HEALTH IS A TERM THAT COVERS THE FULL RANGE OF MENTAL AND EMOTIONAL WELL-BEING - FROM COPING WITH DAILY LIFE CHALLENGES TO THE OFTEN COMPLEX TREATMENT OF MENTAL ILLNESSES, SUCH AS DEPRESSION OR PERSONALITY DISORDER, AS WELL AS SUBSTANCE USE DISORDER AND OTHER ADDICTIVE BEHAVIORS. NOW MORE THAN EVER, HEALTH EXPERTS ACROSS ALL FIELDS ARE RECOGNIZING THE IMPORTANT LINK BETWEEN GOOD BEHAVIORAL HEALTH AND GOOD OVERALL HEALTH. ACCORDING TO THE 2000+ RESPONDENTS OF THE VOLUSIA/FLAGLER COMMUNITY HEALTH SURVEY, BEHAVIORAL HEALTH RELATED ISSUES WERE THE TOP THREE UNHEALTHY BEHAVIORS VOLUSIA COUNTY RESIDENTS WERE MOST CONCERNED ABOUT (DRUG ABUSE, 56%, MENTAL HEALTH/STRESS 47% AND ALCOHOL ABUSE 45%). INJURIES AND DEATHS FROM ALCOHOL-SUSPECTED MOTOR VEHICLE CRASHES WERE HIGHER THAN THE FLORIDA RATES. DEATH RATES FROM CHRONIC LIVER DISEASE AND CIRRHOSIS HAVE INCREASED FOR ALL VOLUSIA RESIDENTS (15.4 PER 100,000 IN 2012-14). THE PERCENTAGE OF VOLUSIA RESIDENTS WHO SELF-REPORTED BEING CURRENT SMOKERS WAS 10.7% HIGHER THAN THE FLORIDA PERCENTAGE. THE HIGHEST PERCENTAGE OF SMOKERS WERE ADULTS WITH LESS THAN A HIGH SCHOOL EDUCATION AND THE LOWEST WAS ADULTS AGED 65 AND OLDER. THE PERCENTAGE OF VOLUSIA RESIDENTS WHO REPORTED HAVING ""POOR MENTAL HEALTH DAYS"" ON 14 OR MORE OF THE PAST 30 DAYS WAS HIGHER THAN THE FLORIDA PERCENTAGE. WOMEN REPORTED A HIGHER PERCENTAGE OF THESE DAYS THAN MEN.2017 UPDATE: MANY PARTNER ORGANIZATIONS ARE FOCUSED ON ADULT MENTAL HEALTH STRATEGIES AS PART OF THE COUNTYWIDE COMMUNITY HEALTH IMPROVEMENT PLAN. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER IMPLEMENTED TWO STRATEGIES FOCUSED ON ADULT BEHAVIORAL HEALTH: SMOKING CESSATION CLASSES AND LOW DOSE CT SCREENINGS FOR LUNG CANCER. 41 ADULTS COMPLETED SMOKING CESSATION EDUCATION CLASSES IN 2017, ONLY SLIGHTLY FEWER THAN THE GOAL OF 50 FOR 2017. ADDITIONALLY, 89 INDIVIDUALS WERE SCREENED THROUGH THE NEWLY ESTABLISHED LOW DOSE CT PROGRAM. BASED ON THE 2017 OUTCOMES FOR THESE STRATEGIES, NO ADJUSTMENTS OR ADDITIONS ARE PLANNED FOR 2018. COMMUNITY READINESS TO QUIT IS THE LARGEST CHALLENGE FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER FACES WHILE IMPLEMENTING THE SMOKING CESSATION CLASSES. ALTHOUGH WE MARKET THE CLASSES IN AS MANY MARKETING CHANNELS AS POSSIBLE, OUR CLASS REGISTRATIONS HAVE NOT INCREASED. WE WILL CONTINUE TO LOOK FOR OTHER WAYS TO REACH THE RIGHT INDIVIDUALS FOR THESE CLASSES.PRIORITY: YOUTH MENTAL HEALTH AND BEHAVIORAL HEALTH2016 DESCRIPTION OF THE ISSUE: IT IS ESTIMATED THAT 50 PERCENT OF MENTAL HEALTH CONDITIONS MANIFEST THEMSELVES DURING ADOLESCENCE. PREVENTING MENTAL AND/OR SUBSTANCE USE DISORDERS AND RELATED PROBLEMS IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS IS CRITICAL TO AMERICANS' BEHAVIORAL AND PHYSICAL HEALTH. IN 2012-14 THE VOLUSIA SUICIDE RATE WAS 8.5 PER 100,000--HIGHER THAN THE STATE RATE OF 4.9. DESPITE A DECLINE IN HIGH SCHOOL STUDENTS USING ALCOHOL IN THE LAST 30 DAYS, VOLUSIA'S RATE HAS BEEN CONSISTENTLY HIGHER THAN THE STATE RATE WITH 29.6% OF HIGH SCHOOLERS REPORTING ALCOHOL USE. VOLUSIA COUNTY RATES FOR SMOKING AND MARIJUANA USE ARE ALSO CONSISTENTLY HIGHER THAN THE STATE RATE.2017 UPDATE: AS WITH ADULT BEHAVIORAL HEALTH, YOUTH BEHAVIORAL HEALTH IS BEING ADDRESSED BY OTHER COMMUNITY PARTNERS SUPPORTING THE COUNTYWIDE COMMUNITY HEALTH IMPROVEMENT PLAN. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER IMPLEMENTED ONE PREVENTION-ORIENTED STRATEGY FOCUSED ON SCHOOL-AGED YOUTH IN PARTNERSHIP WITH THE AMERICAN DIABETES ASSOCIATION. MORNING MILE, A PROGRAM DESIGNED TO ENCOURAGE PHYSICAL ACTIVITY AMONG YOUTH, WAS INITIATED DURING THE 2017-2018 SCHOOL YEAR. INCREASED PHYSICAL ACTIVITY IS A PROVEN STRATEGY TO IMPROVE BOTH PHYSICAL AND MENTAL HEALTH AND 245 STUDENTS PARTICIPATED IN THE PROGRAM IN ITS FIRST YEAR OF IMPLEMENTATION. NO CHANGES IN STRATEGY OR ADDITIONAL OBJECTIVES ARE PLANNED FOR 2018. OUR LARGEST CHALLENGE WITH THIS INITIATIVE CONTINUES TO BE THE EARLY HOUR AT WHICH WE ARE ASKING THE PARENTS AND SCHOOLS TO WORK WITH THE CHILDREN. THIS CONSIDERED, THERE SEEMS TO BE AN ADJUSTMENT AND THE PROGRAM IS BEGINNING TO BE EMBRACED. SEE CONTINUATION"

FLORIDA HOSPITAL OCEANSIDE
"PART V, SECTION B, LINE 11: THE INFORMATION PROVIDED BELOW EXPLAINS HOW THE HOSPITAL FACILITY ADDRESSED IN 2017 THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, AND ANY SUCH NEEDS THAT WERE NOT ADDRESSED AND THE REASONS WHY SUCH NEEDS WERE NOT ADDRESSED. THE HOSPITAL FACILITY CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2016 AND ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT IN 2017 PRIOR TO MAY 15, 2017. FLORIDA HOSPITAL OCEANSIDE SCHEDULE H, PART V, SECTION B, LINE 11NOTE TO THE READER, THE IMPLEMENTATION PLAN WAS DONE FOR BOTH CAMPUSES, SO WHERE FLORIDA HOSPITAL MEDICAL CENTER IS MENTIONED, IT ALSO INCLUDES THE OCEANSIDE CAMPUS.MEMORIAL HEALTH SYSTEMS, INC., DBA FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER (FHMMC OR THE HOSPITAL), IS PART OF THE CENTRAL FLORIDA DIVISION-NORTH REGION OF ADVENTIST HEALTH SYSTEM. THE REGION INCLUDES 7 HOSPITAL FACILITIES.THIS IS THE FIRST-YEAR UPDATE FOR FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER'S 2017-2019 COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER DEVELOPED THIS PLAN AND POSTED IT IN MAY 2017 AS PART OF ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS.FOR THE DEVELOPMENT OF BOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY, FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER WORKED TO DEFINE AND ADDRESS THE NEEDS OF LOW-INCOME, MINORITY AND UNDERSERVED POPULATIONS IN ITS SERVICE AREA. THE 2016 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 NEEDS ASSESSMENT WERE PRIORITIZED BY COMMUNITY AND HOSPITAL STAKEHOLDERS, WHO THEN SELECTED KEY ISSUES FOR THE HOSPITAL TO ADDRESS IN ITS 2017-2019 COMMUNITY HEALTH PLAN. THE FIRST-YEAR PROGRESS ON THE COMMUNITY HEALTH PLAN IS NOTED BELOW. THIS NARRATIVE DESCRIBES THE ISSUES IDENTIFIED IN 2016 AND GIVES AN UPDATE ON THE STRATEGIES ADDRESSING THOSE ISSUES. THERE IS ALSO A DESCRIPTION OF THE IDENTIFIED ISSUES THAT THE HOSPITAL IS NOT ADDRESSING.FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER CHOSE FIVE AREAS OF FOCUS FOR THEIR 2017-2019 COMMUNITY HEALTH PLAN: ADULT BEHAVIORAL HEALTH; YOUTH MENTAL HEALTH AND BEHAVIORAL HEALTH; CHRONIC DISEASE: CARDIOVASCULAR AND DIABETES; BARRIERS TO ACCESSING HEALTH CARE SERVICES; AND HEALTHY EATING AND PHYSICAL ACTIVITY.PRIORITY: ADULT BEHAVIORAL HEALTH2016 DESCRIPTION OF THE ISSUE: BEHAVIORAL HEALTH IS A TERM THAT COVERS THE FULL RANGE OF MENTAL AND EMOTIONAL WELL-BEING - FROM COPING WITH DAILY LIFE CHALLENGES TO THE OFTEN COMPLEX TREATMENT OF MENTAL ILLNESSES, SUCH AS DEPRESSION OR PERSONALITY DISORDER, AS WELL AS SUBSTANCE USE DISORDER AND OTHER ADDICTIVE BEHAVIORS. NOW MORE THAN EVER, HEALTH EXPERTS ACROSS ALL FIELDS ARE RECOGNIZING THE IMPORTANT LINK BETWEEN GOOD BEHAVIORAL HEALTH AND GOOD OVERALL HEALTH. ACCORDING TO THE 2000+ RESPONDENTS OF THE VOLUSIA/FLAGLER COMMUNITY HEALTH SURVEY, BEHAVIORAL HEALTH RELATED ISSUES WERE THE TOP THREE UNHEALTHY BEHAVIORS VOLUSIA COUNTY RESIDENTS WERE MOST CONCERNED ABOUT (DRUG ABUSE, 56%, MENTAL HEALTH/STRESS 47% AND ALCOHOL ABUSE 45%). INJURIES AND DEATHS FROM ALCOHOL-SUSPECTED MOTOR VEHICLE CRASHES WERE HIGHER THAN THE FLORIDA RATES. DEATH RATES FROM CHRONIC LIVER DISEASE AND CIRRHOSIS HAVE INCREASED FOR ALL VOLUSIA RESIDENTS (15.4 PER 100,000 IN 2012-14). THE PERCENTAGE OF VOLUSIA RESIDENTS WHO SELF-REPORTED BEING CURRENT SMOKERS WAS 10.7% HIGHER THAN THE FLORIDA PERCENTAGE. THE HIGHEST PERCENTAGE OF SMOKERS WERE ADULTS WITH LESS THAN A HIGH SCHOOL EDUCATION AND THE LOWEST WAS ADULTS AGED 65 AND OLDER. THE PERCENTAGE OF VOLUSIA RESIDENTS WHO REPORTED HAVING ""POOR MENTAL HEALTH DAYS"" ON 14 OR MORE OF THE PAST 30 DAYS WAS HIGHER THAN THE FLORIDA PERCENTAGE. WOMEN REPORTED A HIGHER PERCENTAGE OF THESE DAYS THAN MEN.2017 UPDATE: MANY PARTNER ORGANIZATIONS ARE FOCUSED ON ADULT MENTAL HEALTH STRATEGIES AS PART OF THE COUNTYWIDE COMMUNITY HEALTH IMPROVEMENT PLAN. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER IMPLEMENTED TWO STRATEGIES FOCUSED ON ADULT BEHAVIORAL HEALTH: SMOKING CESSATION CLASSES AND LOW DOSE CT SCREENINGS FOR LUNG CANCER. 41 ADULTS COMPLETED SMOKING CESSATION EDUCATION CLASSES IN 2017, ONLY SLIGHTLY FEWER THAN THE GOAL OF 50 FOR 2017. ADDITIONALLY, 89 INDIVIDUALS WERE SCREENED THROUGH THE NEWLY ESTABLISHED LOW DOSE CT PROGRAM. BASED ON THE 2017 OUTCOMES FOR THESE STRATEGIES, NO ADJUSTMENTS OR ADDITIONS ARE PLANNED FOR 2018. COMMUNITY READINESS TO QUIT IS THE LARGEST CHALLENGE FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER FACES WHILE IMPLEMENTING THE SMOKING CESSATION CLASSES. ALTHOUGH WE MARKET THE CLASSES IN AS MANY MARKETING CHANNELS AS POSSIBLE, OUR CLASS REGISTRATIONS HAVE NOT INCREASED. WE WILL CONTINUE TO LOOK FOR OTHER WAYS TO REACH THE RIGHT INDIVIDUALS FOR THESE CLASSES.PRIORITY: YOUTH MENTAL HEALTH AND BEHAVIORAL HEALTH2016 DESCRIPTION OF THE ISSUE: IT IS ESTIMATED THAT 50 PERCENT OF MENTAL HEALTH CONDITIONS MANIFEST THEMSELVES DURING ADOLESCENCE. PREVENTING MENTAL AND/OR SUBSTANCE USE DISORDERS AND RELATED PROBLEMS IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS IS CRITICAL TO AMERICANS' BEHAVIORAL AND PHYSICAL HEALTH. IN 2012-14 THE VOLUSIA SUICIDE RATE WAS 8.5 PER 100,000 -- HIGHER THAN THE STATE RATE OF 4.9. DESPITE A DECLINE IN HIGH SCHOOL STUDENTS USING ALCOHOL IN THE LAST 30 DAYS, VOLUSIA'S RATE HAS BEEN CONSISTENTLY HIGHER THAN THE STATE RATE WITH 29.6% OF HIGH SCHOOLERS REPORTING ALCOHOL USE. VOLUSIA COUNTY RATES FOR SMOKING AND MARIJUANA USE ARE ALSO CONSISTENTLY HIGHER THAN THE STATE RATE.2017 UPDATE: AS WITH ADULT BEHAVIORAL HEALTH, YOUTH BEHAVIORAL HEALTH IS BEING ADDRESSED BY OTHER COMMUNITY PARTNERS SUPPORTING THE COUNTYWIDE COMMUNITY HEALTH IMPROVEMENT PLAN. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER IMPLEMENTED ONE PREVENTION-ORIENTED STRATEGY FOCUSED ON SCHOOL-AGED YOUTH IN PARTNERSHIP WITH THE AMERICAN DIABETES ASSOCIATION. MORNING MILE, A PROGRAM DESIGNED TO ENCOURAGE PHYSICAL ACTIVITY AMONG YOUTH, WAS INITIATED DURING THE 2017-2018 SCHOOL YEAR. INCREASED PHYSICAL ACTIVITY IS A PROVEN STRATEGY TO IMPROVE BOTH PHYSICAL AND MENTAL HEALTH AND 245 STUDENTS PARTICIPATED IN THE PROGRAM IN ITS FIRST YEAR OF IMPLEMENTATION. NO CHANGES IN STRATEGY OR ADDITIONAL OBJECTIVES ARE PLANNED FOR 2018. OUR LARGEST CHALLENGE WITH THIS INITIATIVE CONTINUES TO BE THE EARLY HOUR AT WHICH WE ARE ASKING THE PARENTS AND SCHOOLS TO WORK WITH THE CHILDREN. THIS CONSIDERED, THERE SEEMS TO BE AN ADJUSTMENT AND THE PROGRAM IS BEGINNING TO BE EMBRACED. SEE CONTINUATION"

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

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

SCHEDULE H, PART V, SECTION B, LINE 16A,B,C:
THE FINANCIAL ASSISTANCE POLICY FOR BOTH CAMPUSES CAN BE FOUND AT URL:HTTPS://WWW.FLORIDAHOSPITAL.COM/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE THE FINANCIAL ASSISTANCE POLICY APPLICATION FOR BOTH CAMPUSES CAN BE FOUND AT:HTTPS://WWW.FLORIDAHOSPITAL.COM/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE THE PLAIN LANGUAGE SUMMARY FOR BOTH CAMPUSES ARE AVAILABLE AT:HTTPS://WWW.FLORIDAHOSPITAL.COM/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE

CONTINUATION OF PART V, SECTION B, LINE 11 FOR ORMOND:
"PRIORITY: CHRONIC DISEASE: CARDIOVASCULAR AND DIABETES AND HEALTHY EATING AND PHYSICAL ACTIVITY2016 DESCRIPTION OF THE ISSUE: CHRONIC DISEASES AND CONDITIONS--SUCH AS HEART DISEASE, STROKE, CANCER, AND DIABETES--ARE AMONG THE MOST COMMON, COSTLY, AND PREVENTABLE OF ALL HEALTH PROBLEMS. THESE CONDITIONS SHORTEN LIVES, REDUCE QUALITY OF LIFE, AND CREATE CONSIDERABLE BURDEN FOR CAREGIVERS. IN 2013, THE PERCENTAGE OF VOLUSIA ADULTS SELF-REPORTING THAT THEY HAD EVER BEEN TOLD THEY HAD HIGH BLOOD CHOLESTEROL WAS HIGHER THAN THE FLORIDA PERCENTAGE. THE VOLUSIA RATE FOR HOSPITALIZATIONS FROM STROKES (274.0 PER 100,000) DECREASED SLIGHTLY OVER THE LAST FIVE YEARS REPORTED BUT RATES FOR BLACKS REMAINED HIGH. THE AGE-ADJUSTED DIABETES DEATH RATE FOR VOLUSIA COUNTY (27.4 PER 100,000) INCREASED OVER THE REPORTED YEAR AND WAS CONSISTENTLY HIGHER THAN THE FLORIDA RATE. REGULAR PHYSICAL ACTIVITY AND HEALTHY EATING CAN HELP PEOPLE MANAGE THEIR WEIGHT AS WELL AS REDUCE THEIR RISK FOR CHRONIC DISEASE. THE PERCENTAGE OF VOLUSIA ADULTS WHO SELF-REPORTED EATING FIVE OR MORE SERVINGS OF FRUITS AND VEGETABLES PER DAY WAS LOWER THAN THE FLORIDA PERCENTAGE IN 2013. 49.2% OF ADULTS SELF-REPORTED BEING INACTIVE OR INSUFFICIENTLY ACTIVE--WITH OVER 33.7% OF THE POPULATION BEING OVERWEIGHT AND 24.4% BEING OBESE. 82% OF VOLUSIA ADULTS REPORTED THAT THEIR OVERALL HEALTH WAS ""GOOD OR ""EXCELLENT"". 2017 UPDATE: FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER IMPLEMENTED SEVEN DISTINCT STRATEGIES FOCUSED ON THE PRIORITIES OF CARDIOVASCULAR DISEASE, DIABETES AND HEALTHY EATING AND PHYSICAL ACTIVITY. CREATION HEALTH, AN EIGHT-WEEK, FAITH-BASED WELLNESS PLAN WITH LIFESTYLE SEMINARS AND TRAINING BASED ON 8 PRINCIPLES: CHOICE, REST, ENVIRONMENT, ACTIVITY, TRUST, INTERPERSONAL RELATIONS, OUTLOOK AND NUTRITION, WAS PROVIDED TO 66 INDIVIDUALS IN 2017. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER ALSO PROVIDED EDUCATIONAL SEMINARS COVERING OTHER HEALTH TOPICS OF INTEREST TO 719 INDIVIDUALS, EXCEEDING THE TARGET OF 300. OUTREACH ACTIVITIES REACHED 2,715 INDIVIDUALS AND OVER 125 INDIVIDUALS RECEIVED A FREE HEALTH SCREENING SUCH AS CHOLESTEROL AND HBA1C (BLOOD SUGAR) SCREENINGS AND BLOOD PRESSURE SCREENINGS. ENROLLMENT REACHED 3,607 FOR THE CHANGE YOUR LIFE PROGRAM-- A SUCCESSFUL LIFESTYLE/HEALTH PROMOTION PROGRAM. ADDITIONALLY, FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER PROVIDED DIABETES EDUCATION CLASSES TO 10 PARTICIPANTS. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER ALSO SUCCESSFULLY IMPLEMENTED COMMUNITY CARE, A COMMUNITY-BASED CARE COORDINATION PROGRAM FOR HIGH RISK PATIENTS WITH A HISTORY OF PREVENTABLE ED VISITS AND INPATIENT ADMISSIONS. THE PROGRAM TARGETS THE UNDERSERVED PATIENTS IN THE COMMUNITY IN AN EFFORT TO PROVIDE BETTER AND MORE COORDINATED CARE TO HELP IMPROVE THEIR HEALTH OUTCOMES. 42 NEW INDIVIDUALS WERE ENROLLED AND SERVED THROUGH COMMUNITY CARE--EXCEEDING THE 2017 TARGET FOR THIS PROGRAM. THIS COMPLEMENTARY ARRAY OF STRATEGIES WILL BE IMPLEMENTED IN 2018 WITHOUT CHANGES OR ADDITIONS. PRIORITY: BARRIERS TO ACCESSING HEALTH CARE SERVICES2016 DESCRIPTION OF THE ISSUE: ACCESS TO COMPREHENSIVE QUALITY HEALTH CARE SERVICES IS IMPORTANT FOR THE ACHIEVEMENT OF HEALTH EQUITY AND FOR INCREASING THE QUALITY OF A HEALTHY LIFE FOR EVERYONE. ACCORDING TO THE VOLUSIA/FLAGLER COMMUNITY HEALTH SURVEY, THE TOP 3 BARRIERS TO GETTING HEALTH CARE WERE: LACK OF EVENING AND/OR WEEKEND SERVICES (22.6%); CAN'T PAY FOR DOCTOR/HOSPITAL VISITS (21.8%); AND LONG WAITS FOR APPOINTMENTS (21.3%). IN 2013, ONLY 79.8% OF VOLUSIA ADULTS HAD SOME TYPE OF HEALTH CARE COVERAGE AND ONLY 74.8% REPORTED HAVING A PERSONAL DOCTOR.2017 UPDATE: TO ADDRESS ACCESS TO HEALTH CARE SERVICES, FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER IMPLEMENTED SEVERAL STRATEGIES FOCUSED ON INDIVIDUAL'S RESIDING IN THE HOSPITAL'S AT-RISK ZIP CODES. THE HOSPITAL PROVIDED FINANCIAL SUPPORT TO THE JESUS CLINIC IN DAYTONA BEACH TO INCREASE ACCESS TO HEALTH SERVICES FOR UNINSURED INDIVIDUALS. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER ALSO OFFERED 8 SCHOLARSHIPS FOR NEWBORN AND LACTATION EDUCATION CLASSES IN 2017. THE HOSPITAL ALSO PROVIDED FREE MEETING SPACE TO 27 SUPPORT GROUPS OPERATING IN THE COMMUNITY. IN 2018, FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER WILL PARTNER WITH THE UNITED WAY OF VOLUSIA AND FLAGLER COUNTIES TO INCREASE ACCESS TO HEALTH RESOURCE INFORMATION THROUGH PROMOTION ON THE 2-1-1 CALL CENTER RESOURCE."

CONTINUATION OF PART V, SECTION B, LINE 11 FOR OCEANSIDE:
"PRIORITY: CHRONIC DISEASE: CARDIOVASCULAR AND DIABETES AND HEALTHY EATING AND PHYSICAL ACTIVITY2016 DESCRIPTION OF THE ISSUE: CHRONIC DISEASES AND CONDITIONS--SUCH AS HEART DISEASE, STROKE, CANCER, AND DIABETES--ARE AMONG THE MOST COMMON, COSTLY, AND PREVENTABLE OF ALL HEALTH PROBLEMS. THESE CONDITIONS SHORTEN LIVES, REDUCE QUALITY OF LIFE, AND CREATE CONSIDERABLE BURDEN FOR CAREGIVERS. IN 2013, THE PERCENTAGE OF VOLUSIA ADULTS SELF-REPORTING THAT THEY HAD EVER BEEN TOLD THEY HAD HIGH BLOOD CHOLESTEROL WAS HIGHER THAN THE FLORIDA PERCENTAGE. THE VOLUSIA RATE FOR HOSPITALIZATIONS FROM STROKES (274.0 PER 100,000) DECREASED SLIGHTLY OVER THE LAST FIVE YEARS REPORTED BUT RATES FOR BLACKS REMAINED HIGH. THE AGE-ADJUSTED DIABETES DEATH RATE FOR VOLUSIA COUNTY (27.4 PER 100,000) INCREASED OVER THE REPORTED YEAR AND WAS CONSISTENTLY HIGHER THAN THE FLORIDA RATE. REGULAR PHYSICAL ACTIVITY AND HEALTHY EATING CAN HELP PEOPLE MANAGE THEIR WEIGHT AS WELL AS REDUCE THEIR RISK FOR CHRONIC DISEASE. THE PERCENTAGE OF VOLUSIA ADULTS WHO SELF-REPORTED EATING FIVE OR MORE SERVINGS OF FRUITS AND VEGETABLES PER DAY WAS LOWER THAN THE FLORIDA PERCENTAGE IN 2013. 49.2% OF ADULTS SELF-REPORTED BEING INACTIVE OR INSUFFICIENTLY ACTIVE--WITH OVER 33.7% OF THE POPULATION BEING OVERWEIGHT AND 24.4% BEING OBESE. 82% OF VOLUSIA ADULTS REPORTED THAT THEIR OVERALL HEALTH WAS ""GOOD OR ""EXCELLENT"". 2017 UPDATE: FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER IMPLEMENTED SEVEN DISTINCT STRATEGIES FOCUSED ON THE PRIORITIES OF CARDIOVASCULAR DISEASE, DIABETES AND HEALTHY EATING AND PHYSICAL ACTIVITY. CREATION HEALTH, AN EIGHT-WEEK, FAITH-BASED WELLNESS PLAN WITH LIFESTYLE SEMINARS AND TRAINING BASED ON 8 PRINCIPLES: CHOICE, REST, ENVIRONMENT, ACTIVITY, TRUST, INTERPERSONAL RELATIONS, OUTLOOK AND NUTRITION, WAS PROVIDED TO 66 INDIVIDUALS IN 2017. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER ALSO PROVIDED EDUCATIONAL SEMINARS COVERING OTHER HEALTH TOPICS OF INTEREST TO 719 INDIVIDUALS, EXCEEDING THE TARGET OF 300. OUTREACH ACTIVITIES REACHED 2,715 INDIVIDUALS AND OVER 125 INDIVIDUALS RECEIVED A FREE HEALTH SCREENING SUCH AS CHOLESTEROL AND HBA1C (BLOOD SUGAR) SCREENINGS AND BLOOD PRESSURE SCREENINGS. ENROLLMENT REACHED 3,607 FOR THE CHANGE YOUR LIFE PROGRAM-- A SUCCESSFUL LIFESTYLE/HEALTH PROMOTION PROGRAM. ADDITIONALLY, FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER PROVIDED DIABETES EDUCATION CLASSES TO 10 PARTICIPANTS. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER ALSO SUCCESSFULLY IMPLEMENTED COMMUNITY CARE, A COMMUNITY-BASED CARE COORDINATION PROGRAM FOR HIGH RISK PATIENTS WITH A HISTORY OF PREVENTABLE ED VISITS AND INPATIENT ADMISSIONS. THE PROGRAM TARGETS THE UNDERSERVED PATIENTS IN THE COMMUNITY IN AN EFFORT TO PROVIDE BETTER AND MORE COORDINATED CARE TO HELP IMPROVE THEIR HEALTH OUTCOMES. 42 NEW INDIVIDUALS WERE ENROLLED AND SERVED THROUGH COMMUNITY CARE--EXCEEDING THE 2017 TARGET FOR THIS PROGRAM. THIS COMPLEMENTARY ARRAY OF STRATEGIES WILL BE IMPLEMENTED IN 2018 WITHOUT CHANGES OR ADDITIONS. PRIORITY: BARRIERS TO ACCESSING HEALTH CARE SERVICES2016 DESCRIPTION OF THE ISSUE: ACCESS TO COMPREHENSIVE QUALITY HEALTH CARE SERVICES IS IMPORTANT FOR THE ACHIEVEMENT OF HEALTH EQUITY AND FOR INCREASING THE QUALITY OF A HEALTHY LIFE FOR EVERYONE. ACCORDING TO THE VOLUSIA/FLAGLER COMMUNITY HEALTH SURVEY, THE TOP 3 BARRIERS TO GETTING HEALTH CARE WERE: LACK OF EVENING AND/OR WEEKEND SERVICES (22.6%); CAN'T PAY FOR DOCTOR/HOSPITAL VISITS (21.8%); AND LONG WAITS FOR APPOINTMENTS (21.3%). IN 2013, ONLY 79.8% OF VOLUSIA ADULTS HAD SOME TYPE OF HEALTH CARE COVERAGE AND ONLY 74.8% REPORTED HAVING A PERSONAL DOCTOR.2017 UPDATE: TO ADDRESS ACCESS TO HEALTH CARE SERVICES, FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER IMPLEMENTED SEVERAL STRATEGIES FOCUSED ON INDIVIDUAL'S RESIDING IN THE HOSPITAL'S AT-RISK ZIP CODES. THE HOSPITAL PROVIDED FINANCIAL SUPPORT TO THE JESUS CLINIC IN DAYTONA BEACH TO INCREASE ACCESS TO HEALTH SERVICES FOR UNINSURED INDIVIDUALS. FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER ALSO OFFERED 8 SCHOLARSHIPS FOR NEWBORN AND LACTATION EDUCATION CLASSES IN 2017. THE HOSPITAL ALSO PROVIDED FREE MEETING SPACE TO 27 SUPPORT GROUPS OPERATING IN THE COMMUNITY. IN 2018, FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER WILL PARTNER WITH THE UNITED WAY OF VOLUSIA AND FLAGLER COUNTIES TO INCREASE ACCESS TO HEALTH RESOURCE INFORMATION THROUGH PROMOTION ON THE 2-1-1 CALL CENTER RESOURCE."

CONTINUATION OF PART V, SECTION B, LINE 11 FOR ORMOND:
COMMUNITY NEEDS NOT CHOSEN BY FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER AND OCEANSIDE:THE PRIMARY AND SECONDARY DATA IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED MULTIPLE COMMUNITY ISSUES. 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? FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER AND OCEANSIDE CHOSE TO ADDRESS A COMPONENT OF EACH OF THE FIVE PRIORITY ISSUES IN THEIR COMMUNITY HEALTH PLAN AND WILL WORK IN PARTNERSHIP WITH MANY OTHER ORGANIZATIONS THAT ARE LEADING STRATEGIES INCLUDED IN THE COUNTYWIDE COMMUNITY HEALTH IMPROVEMENT PLAN.THE COUNTYWIDE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDED AN ADDITIONAL 8 ISSUES WHICH WERE EXPLORED DURING THIS PROCESS AND REMAIN AN IMPORTANT PART OF COMMUNITY HEALTH AND WELL-BEING. ALTHOUGH NOT SELECTED AS TOP PRIORITIES, THE ADDITIONAL SIGNIFICANT HEALTH NEEDS IDENTIFIED AND NOT ADDRESSED ARE INCLUDED WITH BRIEF DESCRIPTIONS BELOW.ADDITIONAL HEALTH ISSUES IDENTIFIED BY THE CHNA PARTNERSHIP INCLUDE:AGING-RELATED ISSUES: SEVERAL ISSUES WERE IDENTIFIED AMONGST THE AGING POPULATION OF VOLUSIA COUNTY, WHICH INCLUDED VACCINATIONS, MENTAL HEALTH, DEMENTIA, ALZHEIMER'S DISEASE, AND FALLS. THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE BELIEVED THAT THE TOP FIVE PRIORITIZED ISSUES WERE MORE IMPORTANT FOR THE COMMUNITY TO ADDRESS.CHILD/ADOLESCENT ISSUES: SPECIFIC ISSUES IDENTIFIED RELATED TO CHILD/ADOLESCENCE INCLUDED THE PHYSICAL ENVIRONMENT AND SAFETY, ESPECIALLY PREVENTION OF AVOIDABLE INJURIES AND DEATHS. EDUCATION AND THE AFFECT THAT EXPOSURE TO VIOLENCE AND/OR NEGATIVE PEER BEHAVIOR CAN HAVE WAS IDENTIFIED AS AN ISSUE. HEALTH CARE IN THE CHILD AND ADOLESCENT CATEGORY WAS ANOTHER CONCERN IDENTIFIED. THIS ISSUE WAS NOT ADDRESSED AS ACCIDENT AND INJURY PREVENTION ARE NOT COMPETENCIES OF THE HOSPITAL.CHRONIC DISEASE: CANCER/RESPIRATORY DISEASES: CHRONIC DISEASE, ESPECIALLY HEART DISEASE, STROKE, CANCER, AND DIABETES, ARE AMONG THE MOST COMMON, COSTLY AND PREVENTABLE OF ALL HEALTH PROBLEMS. DISPARITIES AMONGST RACE IN THE VOLUSIA COUNTY POPULATION WAS ALSO IDENTIFIED. THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE BELIEVED THAT THE TOP FIVE PRIORITIZED ISSUES WERE MORE IMPORTANT FOR THE COMMUNITY TO ADDRESS.COMMUNICABLE & INFECTIOUS DISEASES: HIV/AIDS, STDS, AND VACCINE PREVENTABLE DISEASES WERE ALL NOTED AS SPECIFIC ISSUES. THERE WAS ALSO A HIGHER INCIDENCE OF THESE TYPES OF DISEASE IN THE BLACK POPULATION OF VOLUSIA COUNTY. THIS ISSUE WAS NOT ADDRESSED AS THE LOCAL HEALTH DEPARTMENTS ARE WORKING ON THIS ISSUE.CRIME, DOMESTIC VIOLENCE, AND CHILD ABUSE: VOLUSIA RATES FOR DOMESTIC VIOLENCE WERE CONSISTENTLY HIGHER EACH YEAR THAN SURROUNDING COUNTIES. VOLUSIA, FLAGLER, AND PUTMAN COUNTY REPORTED 8,703 CHILD ABUSE RELATED PROTECTIVE INVESTIGATIONS IN 2015 ALONE AND 1,127 CHILDREN LIVING IN OUT OF HOME CARE IN 2016, WHICH INCREASES RISK FOR LONG TERM HEALTH ISSUES BASED ON THE ADVERSE CHILDHOOD EXPERIENCES (ACE) STUDY. VIOLENCE IN SCHOOL WAS ANOTHER ISSUE HIGHLIGHTED IN THIS REPORT, BASED ON SELF-REPORTED DATA. THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE BELIEVED THAT THE ABOVE TOP FIVE PRIORITIZED ISSUES WERE MORE IMPORTANT FOR THE COMMUNITY TO ADDRESS.EARLY CHILDHOOD: AMONGST THE YOUNGEST POPULATION, THERE WERE SEVERAL ISSUES HIGHLIGHTED, WHICH INCLUDED INFANT MORTALITY, ACCIDENTAL INJURIES, HEALTH INSURANCE, CHILDREN FULLY IMMUNIZED, AND SCHOOL READINESS. MANY OF THESE ISSUES CARRY INTO THE CHILD/ADOLESCENT YEARS. THIS ISSUE WAS NOT ADDRESSED AS ACCIDENT AND INJURY PREVENTION ARE NOT COMPETENCIES OF THE HOSPITAL.WOMEN'S HEALTH, PRENATAL CARE AND BIRTH OUTCOMES: WOMEN'S HEALTH INCLUDES HEALTH RISKS IN PREGNANCY, SOCIODEMOGRAPHIC FACTORS WHICH AFFECT PREGNANCY, INFANT, AND CHILD HEALTH, LOW BIRTH WEIGHT, FETAL AND INFANT MORTALITY, PRENATAL CARE, AND TEEN PREGNANCY. THIS ISSUE INCLUDES THE AVAILABILITY, COST AND LACK OF INSURANCE COVERAGE. THE HOSPITAL HAS FINANCIAL COUNSELORS WHO HELP PATIENTS QUALIFY FOR MEDICAID AND MAKE REFERRALS TO AREA MARKETPLACE NAVIGATORS WHO HELP PEOPLE ENROLL IN AFFORDABLE COVERAGE. FLORIDA DID NOT EXPAND MEDICAID COVERAGE UNDER THE AFFORDABLE CARE ACT, LEAVING MANY PEOPLE UNABLE TO AFFORD INSURANCE OR QUALIFY FOR PREMIUM SUBSIDIES. THIS ISSUE WAS NOT ADDRESSED AS THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE BELIEVED THAT THE TOP FIVE PRIORITIZED ISSUES WERE MORE IMPORTANT FOR THE COMMUNITY TO ADDRESS. SOCIO-DEMOGRAPHICS: SOCIAL FACTORS AND THE PHYSICAL ENVIRONMENT WERE AMONGST ISSUES IN THIS CATEGORY. THEY INCLUDED MEDIAN HOUSEHOLD INCOME, UNEMPLOYMENT, WAGES, HOUSING, POVERTY, AND EDUCATION. SOCIO-ECONOMIC ISSUES ARE NOT A COMPETENCY OF THE HOSPITAL.

CONTINUATION OF PART V, SECTION B, LINE 11 FOR OCEANSIDE:
COMMUNITY NEEDS NOT CHOSEN BY FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER AND OCEANSIDE:THE PRIMARY AND SECONDARY DATA IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED MULTIPLE COMMUNITY ISSUES. 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? FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER AND OCEANSIDE CHOSE TO ADDRESS A COMPONENT OF EACH OF THE FIVE PRIORITY ISSUES IN THEIR COMMUNITY HEALTH PLAN AND WILL WORK IN PARTNERSHIP WITH MANY OTHER ORGANIZATIONS THAT ARE LEADING STRATEGIES INCLUDED IN THE COUNTYWIDE COMMUNITY HEALTH IMPROVEMENT PLAN.THE COUNTYWIDE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDED AN ADDITIONAL 8 ISSUES WHICH WERE EXPLORED DURING THIS PROCESS AND REMAIN AN IMPORTANT PART OF COMMUNITY HEALTH AND WELL-BEING. ALTHOUGH NOT SELECTED AS TOP PRIORITIES, THE ADDITIONAL SIGNIFICANT HEALTH NEEDS IDENTIFIED AND NOT ADDRESSED ARE INCLUDED WITH BRIEF DESCRIPTIONS BELOW.ADDITIONAL HEALTH ISSUES IDENTIFIED BY THE CHNA PARTNERSHIP INCLUDE:AGING-RELATED ISSUES: SEVERAL ISSUES WERE IDENTIFIED AMONGST THE AGING POPULATION OF VOLUSIA COUNTY, WHICH INCLUDED VACCINATIONS, MENTAL HEALTH, DEMENTIA, ALZHEIMER'S DISEASE, AND FALLS. THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE BELIEVED THAT THE TOP FIVE PRIORITIZED ISSUES WERE MORE IMPORTANT FOR THE COMMUNITY TO ADDRESS.CHILD/ADOLESCENT ISSUES: SPECIFIC ISSUES IDENTIFIED RELATED TO CHILD/ADOLESCENCE INCLUDED THE PHYSICAL ENVIRONMENT AND SAFETY, ESPECIALLY PREVENTION OF AVOIDABLE INJURIES AND DEATHS. EDUCATION AND THE AFFECT THAT EXPOSURE TO VIOLENCE AND/OR NEGATIVE PEER BEHAVIOR CAN HAVE WAS IDENTIFIED AS AN ISSUE. HEALTH CARE IN THE CHILD AND ADOLESCENT CATEGORY WAS ANOTHER CONCERN IDENTIFIED. THIS ISSUE WAS NOT ADDRESSED AS ACCIDENT AND INJURY PREVENTION ARE NOT COMPETENCIES OF THE HOSPITAL.CHRONIC DISEASE: CANCER/RESPIRATORY DISEASES: CHRONIC DISEASE, ESPECIALLY HEART DISEASE, STROKE, CANCER, AND DIABETES, ARE AMONG THE MOST COMMON, COSTLY AND PREVENTABLE OF ALL HEALTH PROBLEMS. DISPARITIES AMONGST RACE IN THE VOLUSIA COUNTY POPULATION WAS ALSO IDENTIFIED. THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE BELIEVED THAT THE TOP FIVE PRIORITIZED ISSUES WERE MORE IMPORTANT FOR THE COMMUNITY TO ADDRESS.COMMUNICABLE & INFECTIOUS DISEASES: HIV/AIDS, STDS, AND VACCINE PREVENTABLE DISEASES WERE ALL NOTED AS SPECIFIC ISSUES. THERE WAS ALSO A HIGHER INCIDENCE OF THESE TYPES OF DISEASE IN THE BLACK POPULATION OF VOLUSIA COUNTY. THIS ISSUE WAS NOT ADDRESSED AS THE LOCAL HEALTH DEPARTMENTS ARE WORKING ON THIS ISSUE.CRIME, DOMESTIC VIOLENCE, AND CHILD ABUSE: VOLUSIA RATES FOR DOMESTIC VIOLENCE WERE CONSISTENTLY HIGHER EACH YEAR THAN SURROUNDING COUNTIES. VOLUSIA, FLAGLER, AND PUTMAN COUNTY REPORTED 8,703 CHILD ABUSE RELATED PROTECTIVE INVESTIGATIONS IN 2015 ALONE AND 1,127 CHILDREN LIVING IN OUT OF HOME CARE IN 2016, WHICH INCREASES RISK FOR LONG TERM HEALTH ISSUES BASED ON THE ADVERSE CHILDHOOD EXPERIENCES (ACE) STUDY. VIOLENCE IN SCHOOL WAS ANOTHER ISSUE HIGHLIGHTED IN THIS REPORT, BASED ON SELF-REPORTED DATA. THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE BELIEVED THAT THE ABOVE TOP FIVE PRIORITIZED ISSUES WERE MORE IMPORTANT FOR THE COMMUNITY TO ADDRESS.EARLY CHILDHOOD: AMONGST THE YOUNGEST POPULATION, THERE WERE SEVERAL ISSUES HIGHLIGHTED, WHICH INCLUDED INFANT MORTALITY, ACCIDENTAL INJURIES, HEALTH INSURANCE, CHILDREN FULLY IMMUNIZED, AND SCHOOL READINESS. MANY OF THESE ISSUES CARRY INTO THE CHILD/ADOLESCENT YEARS. THIS ISSUE WAS NOT ADDRESSED AS ACCIDENT AND INJURY PREVENTION ARE NOT COMPETENCIES OF THE HOSPITAL.WOMEN'S HEALTH, PRENATAL CARE AND BIRTH OUTCOMES: WOMEN'S HEALTH INCLUDES HEALTH RISKS IN PREGNANCY, SOCIODEMOGRAPHIC FACTORS WHICH AFFECT PREGNANCY, INFANT, AND CHILD HEALTH, LOW BIRTH WEIGHT, FETAL AND INFANT MORTALITY, PRENATAL CARE, AND TEEN PREGNANCY. THIS ISSUE INCLUDES THE AVAILABILITY, COST AND LACK OF INSURANCE COVERAGE. THE HOSPITAL HAS FINANCIAL COUNSELORS WHO HELP PATIENTS QUALIFY FOR MEDICAID AND MAKE REFERRALS TO AREA MARKETPLACE NAVIGATORS WHO HELP PEOPLE ENROLL IN AFFORDABLE COVERAGE. FLORIDA DID NOT EXPAND MEDICAID COVERAGE UNDER THE AFFORDABLE CARE ACT, LEAVING MANY PEOPLE UNABLE TO AFFORD INSURANCE OR QUALIFY FOR PREMIUM SUBSIDIES. THIS ISSUE WAS NOT ADDRESSED AS THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE BELIEVED THAT THE TOP FIVE PRIORITIZED ISSUES WERE MORE IMPORTANT FOR THE COMMUNITY TO ADDRESS. SOCIO-DEMOGRAPHICS: SOCIAL FACTORS AND THE PHYSICAL ENVIRONMENT WERE AMONGST ISSUES IN THIS CATEGORY. THEY INCLUDED MEDIAN HOUSEHOLD INCOME, UNEMPLOYMENT, WAGES, HOUSING, POVERTY, AND EDUCATION. SOCIO-ECONOMIC ISSUES ARE NOT A COMPETENCY OF THE HOSPITAL.

PART I, LINE 6A:
"THE FILING ORGANIZATION IS A WHOLLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) DURING ITS CURRENT TAX YEAR. AHSSHC SERVES AS A PARENT ORGANIZATION TO 22 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS THAT OPERATE 43 HOSPITALS IN NINE STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS ""ADVENTIST HEALTH SYSTEM"" (AHS).ALL HOSPITAL ORGANIZATIONS WITHIN AHS COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. AHS ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. AHS 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 AHS 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 ORGANIZATIONS MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY ARE POSTED 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 7. PLEASE NOTE THAT DOLLAR AMOUNTS ON THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE IN THOUSANDS.

PART III, LINE 8:
COSTING METHODOLOGY: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO.

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

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
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 ADVENTIST HEALTH SYSTEM. THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO MEDICARE PATIENTS AS REPORTED IN THE AHS COMMUNITY BENEFIT REPORT ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ 11,325,755- DIFFERENCE IN COSTING METHODOLOGY: (19,839,021)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (8,963,748) -------------TOTAL SURPLUS/(SHORTFALL) COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITY BENEFIT REPORTING: $ (17,477,014)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 HOSPITALS CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) DURING 2013 AND 2016. THE 2016 CHNAS WERE ADOPTED BY THE GOVERNING BOARD BY DECEMBER 31, 2016, THE END OF THE FILING ORGANIZATION'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNAS. THE HOSPITALS' 2016 CHNAS COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN FINAL REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNAS 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 COMMUNITIES.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 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 WEBSITES. THE WEBSITES 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 FACILITIES, INCLUDING AT ALL POINTS OF ADMISSION AND REGISTRATION AND THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE HOSPITAL FACILITY'S WEBSITE ADDRESS WHERE THE FAP, FAA FORM, AND PLS CAN BE ACCESSED AND THE TELEPHONE NUMBER AND PHYSICAL LOCATION THAT INDIVIDUALS CAN CALL OR VISIT TO OBTAIN COPIES OF THE FAP, FAA FORM AND PLS OR TO OBTAIN MORE INFORMATION ABOUT THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS. PAPER COPIES OF THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. PAPER COPIES ARE MADE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGES OF ANY LEP DEFINED POPULATIONS. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A PAPER COPY OF THE HOSPITAL FACILITY'S PLS WILL BE OFFERED TO EVERY PATIENT AS A PART OF THE INTAKE OR DISCHARGE PROCESS. A CONSPICUOUS WRITTEN NOTICE IS INCLUDED ON ALL BILLING STATEMENTS SENT TO PATIENTS THAT NOTIFIES AND INFORMS RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, INCLUDING THE FOLLOWING: 1) THE TELEPHONE NUMBER OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND THE FAA FORM; AND 2) THE WEBSITE ADDRESS WHERE COPIES OF THE FAP, FAA FORM AND PLS MAY BE OBTAINED. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE. COPIES OF THE PLS ARE DISTRIBUTED TO MEMBERS OF THE COMMUNITY IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE.

PART VI, LINE 4:
"THE FILING ORGANIZATION OPERATED 2 HOSPITALS IN VOLUSIA COUNTY, FLORIDA IN 2017; FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER (MEMORIAL), A 327-LICENSED BED FACILITY AND FLORIDA HOSPITAL OCEANSIDE (OCEANSIDE), A 80-LICENSED BED FACILITY. UNFORTUNATELY, DUE TO DAMAGED CAUSED BY HURRICANE IRMA IN SEPTEMBER 2017, OCEANSIDE HAD TO CLOSE ITS LOCATION IN 2017 AND THE OCEANSIDE BEDS WERE RELOCATED TO MEMORIAL. ADDITIONALLY, THE FILING ORGANIZATION SERVES ITS COMMUNITIES WITH IMAGING SERVICES, AND LABORATORY SERVICES THROUGHOUT EAST CENTRAL FLORIDA. MORE THAN 400 PHYSICIANS HOLD PRIVILEGES AT THE FILING ORGANIZATION'S FACILITIES AND COMBINED, THE FILING ORGANIZATION EMPLOYS MORE THAN 2800 INDIVIDUALS. THERE IS AN AFFILIATE HOSPITAL AND TWO OTHER HOSPITALS WITHIN A RADIUS OF 20 MILES OR LESS FROM MEMORIAL AND OCEANSIDE. APPROXIMATELY 62% OF THE FILING ORGANIZATION'S PATIENTS DURING 2017 WERE MEDICARE PATIENTS, ABOUT 9.9% WERE MEDICAID PATIENTS, 4.2% WERE SELF-PAY, AND THE REMAINING PERCENTAGE WERE PATIENTS COVERED UNDER COMMERCIAL INSURANCE. FOR 2017 ABOUT 59.3% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT.MEMORIAL IS VOLUSIA COUNTY'S NEWEST AND MOST COMPREHENSIVE FACILITY. ITS NEW FACILITY FEATURES THE AREA'S ONLY ENDOVASCULAR/HYBRID OPERATING ROOM WHERE PATIENTS ARE DIAGNOSED AND TREATED IN ONE LOCATION FOR A VARIETY OF HEART AND ENDOVASCULAR CONDITIONS; THE AREA'S ONLY SIEMENS SOMOTOM 64-SLICE CT SCANNER FOR FASTER, PAINLESS DIAGNOSES OF HEART CONDITIONS AND STROKES USING 50 PERCENT LESS RADIATION; AND A NEWLY EXPANDED EMERGENCY DEPARTMENT FEATURING ""NO WAIT"" SERVICES. VOLUSIA COUNTY, FLORIDA HAS A POPULATION OF OVER 500,000 PEOPLE, WITH AN ESTIMATED 23% AGE 65 OR OVER THE AGE OF 65. DAYTONA BEACH IS THE REGIONAL COMMERCIAL AND CULTURAL HUB OF THE DELTONA-DAYTONA BEACH-ORMOND BEACH AREA. THE CITY IS AN INTEGRAL SEGMENT OF THE INTERSTATE HIGHWAY 4 CORRIDOR WITH SPECIALIZED INDUSTRIES IN AEROSPACE, AUTOMOTIVE, AND MANUFACTURING. THE MEDIAN HOUSEHOLD INCOME, BASED ON POPULATION, IN VOLUSIA COUNTY IS APPROXIMATELY $40,818. HIGH SCHOOL GRADUATES ACCOUNT FOR APPROXIMATELY 88.9% OF VOLUSIA COUNTY WITH AN ESTIMATED 22.5% HAVING A BACHELOR'S DEGREE OR HIGHER. IT IS ESTIMATED THAT 11.7% OF THE FAMILIES RESIDING IN VOLUSIA COUNTY LIVE BELOW THE POVERTY LEVEL AND THE UNEMPLOYMENT RATE IS ABOUT 5%.OCEANSIDE HAS A LONG HISTORY OF COMMUNITY SUPPORT AND SERVICES WHICH INCLUDES MEDICAL/SURGICAL CARE AND THE OPERATION OF PENINSULA REHABILITATION CENTER, VOLUSIA COUNTY'S ONLY INPATIENT REHABILITATION CENTER. IT ALSO OFFERS AN OUTPATIENT REHAB UNIT, IMAGING SERVICES, LABORATORY SERVICES, AND CARDIOPULMONARY SERVICES. UNFORTUNATELY, DUE TO HURRICANE IRMA IN SEPTEMBER 2017, OCEANSIDE HAD TO CLOSE ITS LOCATION."

PART VI, LINE 5:
"THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO THE FILING ORGANIZATION'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 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 COMMUNITIES 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 $686,535 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF ITS COMMUNITIES IN CONJUNCTION WITH ITS OPERATION OF 2 COMMUNITY HOSPITALS. THE FILING ORGANIZATION 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 FILING ORGANIZATION EXPENDED $11,324,058 IN NEW CAPITAL IMPROVEMENTS. AS FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITALS, THE FILING ORGANIZATION 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 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:
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 ADVENTIST HEALTH SYSTEM (AHS). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 43 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 15 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AS THE PARENT ORGANIZATION OF THE AHS SYSTEM, 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 AHS SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. EACH AHS SUBSIDIARY PAYS A MANAGEMENT FEE TO AHSSHC FOR THE INTERNAL SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY AN AHS 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 AHS AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEB-SITE OF AHS AT WWW.ADVENTISTHEALTHSYSTEM.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF AHS.