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← ADVENTHEALTH FAMILY MEDICINE RURAL HEALTH CLINICS INC

Form 990 for tax year 2023

Filed by ADVENTHEALTH FAMILY MEDICINE RURAL HEALTH CLINICS INC.

Totals

Total revenue
$5,741,785
Total expenses
$7,569,449
Contributions and grants received
$203,313
Grants paid
$0
Program service revenue
$5,530,500
Investment income
$7,972
Other revenue
$0
Total assets, end of year
$4,838,232
Total liabilities, end of year
$958,398
Net assets or fund balances, end of year
$3,879,834
Program services expenses (Part IX)
$6,766,932
Management and general expenses
$802,517
Fundraising expenses
$0
Program service expenses (Part III)
$6,766,932

Program services were 89.4% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1e · Government grants (contributions)

    $203,313

  • 2a · Program service revenue: Net Patient Revenue

    total $5,530,398 · related or exempt $5,530,398

  • 2f · All other program service revenue

    total $102 · related or exempt $102

  • 3 · Investment income

    total $13,516 · excluded $13,516

  • 7b · Less cost or other basis and sales expenses

    securities $5,544

  • 7c · Gain or loss

    securities -$5,544

  • 7d · Net gain or loss

    total -$5,544 · excluded -$5,544

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $371,599 · program services $311,082 · management and general $60,517

  • 7 · Other salaries and wages

    total $3,650,030 · program services $3,642,961 · management and general $7,069

  • 8 · Pension plan contributions

    total $130,489 · program services $128,521 · management and general $1,968

  • 9 · Other employee benefits

    total $590,321 · program services $580,772 · management and general $9,549

  • 10 · Payroll taxes

    total $253,450 · program services $249,628 · management and general $3,822

  • 11b · Fees: legal

    total $1,136 · management and general $1,136

  • 11f · Fees: investment management

    total $1,933 · management and general $1,933

  • 11g · Fees: other

    total $933,547 · program services $279,801 · management and general $653,746

  • 12 · Advertising and promotion

    total $250 · management and general $250

  • 13 · Office expenses

    total $128,430 · program services $72,089 · management and general $56,341

  • 14 · Information technology

    total $6,947 · program services $6,947

  • 16 · Occupancy

    total $513,124 · program services $513,124

  • 17 · Travel

    total $5,171 · management and general $5,171

  • 19 · Conferences, conventions and meetings

    total $1,611 · management and general $1,611

  • 20 · Interest

    total $3,053 · program services $3,053

  • 22 · Depreciation, depletion and amortization

    total $691,771 · program services $691,771

  • 23 · Insurance

    total $45,614 · program services $45,614

  • 24a · Other expenses: Medical Supplies

    total $230,537 · program services $230,537

  • 24b · Other expenses: Repairs & Maintenance

    total $9,295 · program services $9,295

  • 24c · Other expenses: UBI Taxes

    total -$1,313 · management and general -$1,313

  • 24e · All other expenses

    total $2,454 · program services $1,737 · management and general $717

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    end of year $1,000

  • 2 · Savings and temporary cash investments

    beginning of year $478,676 · end of year $494,745

  • 4 · Accounts receivable

    beginning of year $112,894 · end of year $197,550

  • 7 · Other notes and loans receivable

    end of year $14,747

  • 9 · Prepaid expenses and deferred charges

    beginning of year $9,783 · end of year $19,763

  • 10a · Land, buildings and equipment: cost or other basis

    $443,260

  • 10b · Land, buildings and equipment: accumulated depreciation

    $364,202

  • 10c · Land, buildings and equipment, net

    beginning of year $151,213 · end of year $79,058

  • 14 · Intangible assets

    beginning of year $4,335,772 · end of year $3,716,376

  • 15 · Other assets

    beginning of year $705,761 · end of year $314,993

  • 17 · Accounts payable and accrued expenses

    beginning of year $659,571 · end of year $492,854

  • 25 · Other liabilities

    beginning of year $927,585 · end of year $465,544

  • 27 · Net assets without donor restrictions

    beginning of year $4,206,943 · end of year $3,879,834

Mission and programs · 2023

Mission

Adventist Health System Sunbelt Healthcare Corporation and all its subsidiary organizations were established by the Seventh-Day Adventist Church to bring a ministry of healing and health to the communities served. Our mission is to extend the healing ministry of Christ.The hospital and healthcare system whose parent is Adventist Health System Sunbelt Healthcare Corporation is known as AdventHealth. AdventHealth seeks to be widely respected as a consumer-focused organization that engages individuals in their health by delivering wholistic, best practice care across a connected, comprehensive continuum of services. With Christ as our example, AdventHealth cares for and nurtures people: our employees, our communities, our healthcare professionals, and those who trust us for care and healing.

Activities or mission (Part I)

Provide family medicine services to the community through the operation of rural health clinics.

  • The primary mission of AdventHealth Family Medicine Rural Health Clinics, Inc. is to provide family medicine services to the local community through the operation of rural health clinics. There were 41,116 patient encounters during the current year.

    Expenses $6,766,932 · Revenue $5,530,500

As filed on the 2023 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Roberts Kevin

    Director/President/CEO

    Total calculated
    $650,061
    From this org
    $0
    From related orgs
    $584,862
    Other
    $65,199
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $386,655 related
    Bonus
    $0 + $99,401 related
    Other
    $0 + $98,806 related
    Deferred
    $0 + $44,582 related
    Nontaxable benefits
    $0 + $20,617 related
    Filer's total
    $0 + $650,061 related

  • Pridgen Parker

    Former Officer

    Total calculated
    $559,037
    From this org
    $0
    From related orgs
    $462,918
    Other
    $96,119
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $308,929 related
    Bonus
    $0 + $64,259 related
    Other
    $0 + $89,730 related
    Deferred
    $0 + $65,727 related
    Nontaxable benefits
    $0 + $30,392 related
    Filer's total
    $0 + $559,037 related

  • Jasinski Kelly

    Director/Vice Pres/Treas (End 11/23)

    Total calculated
    $332,224
    From this org
    $0
    From related orgs
    $290,577
    Other
    $41,647
    Hours/week
    15 + 35 related

    Schedule J breakdown matched by us

    Base
    $0 + $228,486 related
    Bonus
    $0 + $44,068 related
    Other
    $0 + $18,023 related
    Deferred
    $0 + $14,876 related
    Nontaxable benefits
    $0 + $26,771 related
    Filer's total
    $0 + $332,224 related

  • Cain MD James

    Director

    Total calculated
    $311,082
    From this org
    $275,737
    From related orgs
    $0
    Other
    $35,345
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $258,040
    Bonus
    $12,500
    Other
    $5,197
    Deferred
    $14,591
    Nontaxable benefits
    $20,754
    Filer's total
    $311,082

  • Garcia Janet

    Director/Vice Pres/CFO

    Total calculated
    $303,890
    From this org
    $0
    From related orgs
    $270,948
    Other
    $32,942
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $200,003 related
    Bonus
    $0 + $17,779 related
    Other
    $0 + $53,166 related
    Deferred
    $0 + $11,332 related
    Nontaxable benefits
    $0 + $21,610 related
    Filer's total
    $0 + $303,890 related

  • Go MD David

    Physician

    Total calculated
    $289,152
    From this org
    $258,329
    From related orgs
    $0
    Other
    $30,823
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $237,546
    Bonus
    $15,833
    Other
    $4,950
    Deferred
    $13,500
    Nontaxable benefits
    $17,323
    Filer's total
    $289,152

  • Chamberland MD Ashley

    Physician

    Total calculated
    $279,629
    From this org
    $239,799
    From related orgs
    $0
    Other
    $39,830
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $229,280
    Bonus
    $4,829
    Other
    $5,690
    Deferred
    $12,419
    Nontaxable benefits
    $27,411
    Filer's total
    $279,629

  • Allen Amanda

    Nurse Practitioner

    Total calculated
    $278,963
    From this org
    $247,101
    From related orgs
    $0
    Other
    $31,862
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $178,309
    Bonus
    $65,589
    Other
    $3,203
    Deferred
    $12,962
    Nontaxable benefits
    $18,900
    Filer's total
    $278,963

  • Dale Andrew

    Physician

    Total calculated
    $276,644
    From this org
    $263,876
    From related orgs
    $0
    Other
    $12,768
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $235,414
    Bonus
    $24,986
    Other
    $3,476
    Deferred
    $12,504
    Nontaxable benefits
    $264
    Filer's total
    $276,644

  • Vogel MD Stephen

    Physician

    Total calculated
    $257,629
    From this org
    $217,825
    From related orgs
    $0
    Other
    $39,804
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $217,027
    Bonus
    $0
    Other
    $798
    Deferred
    $11,627
    Nontaxable benefits
    $28,177
    Filer's total
    $257,629

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Part I, Line 3
The individual who serves as the CEO of the filing organization is appointed and compensated by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). Compensation and benefits provided to this individual are determined pursuant to policies, procedures, and processes of AHSSHC that are designed to ensure compliance with the intermediate sanctions laws as set forth in IRC Section 4958. AHSSHC has taken steps to ensure that processes are in place to satisfy the rebuttable presumption of reasonableness standard as set forth in Treasury Regulation Section 53.4958-6 with respect to its active executive-level positions. The AHSSHC Board Compensation Committee (the Committee) serves as the governing body for all executive compensation matters. The Committee is composed of certain members of the Board of Directors (the Board) of AHSSHC. Voting members of the Committee include only individuals who serve on the Board as independent representatives, who hold no employment positions with AHSSHC and who do not have relationships with any of the individuals whose compensation is under their review that impacts their best independent judgment as fiduciaries of AHSSHC. The Committee's role is to review and approve all components of the executive compensation plan of AHSSHC. As an independent governing body with respect to executive compensation, it should be noted that the Committee will often confer in executive sessions on matters of compensation policy and policy changes. In such executive sessions, no members of management of AHSSHC are present, other than the Chief People Officer, who remains at the request of the Chairman/committee to provide assistance/information as needed. The Committee is advised by an independent third-party compensation advisor. This advisor prepares all the benchmark studies for the Committee. Compensation levels are benchmarked with a national peer group of other not-for-profit healthcare systems and hospitals of similar size and complexity to AdventHealth and each of its affiliated entities. The following principles guide the establishment of individual executive compensation: - The salary of the President/CEO of AdventHealth will not exceed the 50th percentile of comparable salaries paid by similarly situated organizations; and - Other executive salaries shall be established using market medians. The compensation philosophy, policies, and practices of AHSSHC are consistent with the organization's faith-based mission and conform to applicable laws, regulations, and business practices. As a faith-based organization sponsored by the Seventh-day Adventist Church (the Church), AHSSHC's philosophy and principles with respect to its executive compensation practices reflect the conservative approach of the Church's mission of service and were developed in counsel with the Church's leadership.
Part I, Line 4b
Executives on the filing organization's management team that hold the position of Vice-President or above are compensated by and on the payroll of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), the parent organization of the healthcare system known as AdventHealth. In recognition of the contribution that each executive makes to the success of AdventHealth, AdventHealth provides supplemental executive retirement benefit plans to eligible executives. As the supplemental executive retirement benefit plans were updated in 2020 and certain individuals still participate as grand-fathered participants in certain plans, the narrative below discusses all plans in which there were any participants in 2023. The SERP III plan effectively replaces the prior SERP II plan, the Executive Flex Benefit Program Plan, and the Senior Executive Death Benefit Plan for qualified executives except for certain grandfathered executive employees. SERP III Plan: The SERP III plan provides eligible executives a percentage of their base pay, which is credited to a deferred compensation account. The plan also provides for compensation deferral and selection of life insurance coverage and long-term care insurance. To be eligible to participate in the SERP III plan, executives must be on the AHSSHC corporate payroll and be either a CEO of an AdventHealth entity, an AHSSHC Vice President (VP) or VP of an AdventHealth entity with a base salary of at least $330,000 in 2023 (adjusted annually by the same percentage as IRC Section 401(a)(17) limit increases), or other leader specifically approved by the AdventHealth President. Eligible executives do not include grandfathered executives, meaning those executives who would satisfy all the eligibility requirements of the SERP II plan prior to Dec 31, 2027, had the plan not been amended and restated as of Jan. 1, 2020. Contribution credits will be established and maintained by class year accounts for each participant using tiered contribution credit percentages of annual base compensation. Contribution credit percentages range between 15% and 19% of base compensation. Contribution credits will be made each quarter in 25% increments with reductions in contributions if the executive is also a grandfathered FLEX participant (see below). SERP III provides for a class year vesting and payment schedule (7 years for each class year) with respect to amounts accumulated in the executive's deferred compensation account. Upon attainment of a normal retirement age (age 62), or upon certain other circumstances as defined in the SERP III plan document, all deferred amounts are paid immediately to the participant. For any executives working beyond the normal retirement age, future employer contributions will be made quarterly from SERP III directly to the participant as a taxable cash bonus. SERP II Plan: The SERP II plan is a defined benefit, non-tax-qualified deferred compensation plan for certain executives who have provided lengthy service to AdventHealth and/or to other Seventh-day Adventist Church hospitals or health care institutions. Under the provisions of the SERP II plan, benefits are provided to qualifying executive participants on a pro-rata schedule beginning with 20 years of service as an employee of AdventHealth and/or another hospital or health care institution controlled by the Seventh-day Adventist Church and who satisfy certain other qualifying criteria. Eligible employees are restricted to those executives who, as of January 1, 2020, satisfied, or if employment continues, will satisfy the eligibility requirements of SERP II prior to December 31, 2027. This supplemental executive retirement plan (SERP II) was designed to provide eligible executives with the economic equivalent of an annual income beginning at normal retirement age equal to 60% of the average of the participant's three, five or seven highest years of base salary from AdventHealth active employment inclusive of income from all other Seventh-day Adventist Church healthcare employer-financed retirement income sources and investment income earned on those contributions through social security normal retirement age as defined in the plan. The number of years included in highest average compensation is determined by the individual's year of entry to SERP II and by the individual's year of entry to the AdventHealth Executive FLEX Benefit Program. FLEX Plan: The Flex Plan was originally designed to provide eligible executives an opportunity to select from among a variety of supplemental benefits, including a split dollar life insurance policy and long-term care insurance, to individually tailor a benefits program appropriate to each executive's needs. In 2020, the Flex Plan was amended to exclude employed executives who are hired or promoted after a certain date from being eligible to participate in the Flex Plan except for certain insurance coverage features of the plan. The Flex Plan provides eligible participants a pre-determined benefits allowance credit that is equal to a percentage of the executive's base pay from which the cost of mandatory and elective employee benefits is deducted. The benefits allowance credit percentage for any plan year shall not be greater than the maximum dollar amount or the percentage of compensation as determined by the AdventHealth Benefits Administration Committee. For grandfathered eligible employees, the annual pre-determined Flex allowance is contributed and any funds that remain after the cost of mandatory and elective benefits are subtracted are, at the employee's option, contributed to either an IRC 457(f) deferred compensation account or to an IRC 457(b) eligible deferred compensation plan. Upon attainment of age 65, all previous 457(f) deferred amounts are paid immediately to the participant and any future employer contributions are made quarterly from the Plan directly to the participant. The Plan provides for a class year vesting schedule (2 years for each class year) with respect to amounts accumulated in the executive's 457(f) deferred compensation account. Distributions could also be made from the executive's 457(f) deferred compensation account upon attainment of age 65 or upon an involuntary separation. The account will be forfeited by the executive upon a voluntary separation. With respect to grandfathered participants, the Flex Plan documents define eligible employees to include the Chief Executive Officers of AdventHealth entities and Vice Presidents of all AdventHealth entities whose base salary was at least equal to the Internal Revenue Code Section 401(a)(17) compensation limit each year. FLEX Plan FLEX Plan SERP III SERP III Contr. Distr.* Contr. Distr.* Roberts,Kevin $ 49,355 $ 31,054 $ 9,928 $ 9,928 Pridgen,Parker $ 19,332 $ 19,628 $ 28,669 $ 0 * Including Investment Earnings

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

Provenance

Return type
form_990
Tax year
2023
Filed
8 October 2024
IRS schema version
2023v5.1
Source object
202433049349302258

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