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← Fountain Inn Nursing & Rehabilitation Center Inc

Form 990 for tax year 2023

Filed by Fountain Inn Nursing & Rehabilitation Center Inc.

This return was superseded by a later amendment. matched by us It is kept because history is preserved rather than replaced.

What the amendment changed

Compared with the latest return for 2023 , filed 1 May 2025. matched by us Only the Part I totals and the names listed in Part VII are compared. We relate returns by organization, tax year and form, and order them by each return's own timestamp; the filer's own "amended return" checkbox is a separate fact.

Total revenue
$4,890,526 changed to $1,097,808
Total expenses
$7,345,243 changed to $77,035
Contributions and grants received
$23,545 changed to $0
Program service revenue
$7,217,814 changed to $311,514
Investment income
-$2,350,833 changed to $786,294
Total assets, end of year
$24,218,449 changed to $0
Total liabilities, end of year
$1,310,759 changed to $0
Net assets or fund balances, end of year
$22,907,690 changed to $0
Program services expenses
$6,401,572 changed to -$1,818
Management and general expenses
$943,671 changed to $78,853
Program service expenses (Part III)
$6,401,572 changed to -$1,818

Listed only on the earlier return

  • BeaulieuTimothy
  • JohnsonKent
  • McDonaldRaymond
  • ThompsonMichael
  • YoungAnita

Listed under a different title

  • BoyceKeith: Dir./Pres./CEO (End 07/23) then Former Officer
  • RodmanDavid: Director/Pres.(Beg 08/23)/CFO then Dirctor/President/CFO

Totals

Total revenue
$4,890,526
Total expenses
$7,345,243
Contributions and grants received
$23,545
Grants paid
$0
Program service revenue
$7,217,814
Investment income
-$2,350,833
Other revenue
$0
Total assets, end of year
$24,218,449
Total liabilities, end of year
$1,310,759
Net assets or fund balances, end of year
$22,907,690
Program services expenses (Part IX)
$6,401,572
Management and general expenses
$943,671
Fundraising expenses
$0
Program service expenses (Part III)
$6,401,572

Program services were 87.2% 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)

    $23,545

  • 2a · Program service revenue: Net patient revenue

    total $7,210,125 · related or exempt $7,210,125

  • 2b · Program service revenue: Cafeteria Revenue

    total $1,633 · related or exempt $1,633

  • 2f · All other program service revenue

    total $6,056 · related or exempt $6,056

  • 3 · Investment income

    total $170,369 · excluded $170,369

  • 7a · Gross sales of assets other than inventory

    other assets $22,367,010

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

    securities $82,530 · other assets $24,805,682

  • 7c · Gain or loss

    securities -$82,530 · other assets -$2,438,672

  • 7d · Net gain or loss

    total -$2,521,202 · excluded -$2,521,202

Functional expenses

Part IX, the statement of functional expenses.

  • 7 · Other salaries and wages

    total $2,963,003 · program services $2,812,857 · management and general $150,146

  • 8 · Pension plan contributions

    total $22,292 · program services $21,162 · management and general $1,130

  • 9 · Other employee benefits

    total $511,549 · program services $485,627 · management and general $25,922

  • 10 · Payroll taxes

    total $235,121 · program services $223,206 · management and general $11,915

  • 11f · Fees: investment management

    total $28,767 · management and general $28,767

  • 11g · Fees: other

    total $1,991,711 · program services $1,315,066 · management and general $676,645

  • 13 · Office expenses

    total $353,619 · program services $311,004 · management and general $42,615

  • 14 · Information technology

    total $2,305 · program services $2,305

  • 16 · Occupancy

    total $207,809 · program services $207,809

  • 17 · Travel

    total $3,040 · management and general $3,040

  • 19 · Conferences, conventions and meetings

    total $482 · management and general $482

  • 22 · Depreciation, depletion and amortization

    total $104,758 · program services $104,758

  • 23 · Insurance

    total $57,259 · program services $54,463 · management and general $2,796

  • 24a · Other expenses: Medical Supplies

    total $519,686 · program services $519,686

  • 24b · Other expenses: State Tax Indigent Asse

    total $279,838 · program services $279,838

  • 24c · Other expenses: Repairs & Maintenance

    total $59,984 · program services $59,984

  • 24d · Other expenses: Licenses & Permits

    total $3,807 · program services $3,807

  • 24e · All other expenses

    total $213 · management and general $213

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $1,500

  • 2 · Savings and temporary cash investments

    beginning of year $146,752 · end of year $23,371,713

  • 4 · Accounts receivable

    beginning of year $1,830,571 · end of year $20,402

  • 9 · Prepaid expenses and deferred charges

    beginning of year $65,722

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

    $0

  • 10c · Land, buildings and equipment, net

    beginning of year $24,520,060

  • 15 · Other assets

    beginning of year $98,602 · end of year $826,334

  • 17 · Accounts payable and accrued expenses

    beginning of year $791,617 · end of year $14,252

  • 21 · Escrow or custodial account liability

    beginning of year $10,443

  • 25 · Other liabilities

    beginning of year $974,637 · end of year $1,296,507

  • 27 · Net assets without donor restrictions

    beginning of year $24,886,510 · end of year $22,907,690

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 filing organization 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)

Operation of Home for the Aged/Healthcare Delivery.

  • Operation of a 120 bed nursing home that provides housing and medical care to elderly residents. There were 18,074 resident days in the current year.

    Expenses $6,401,572 · Revenue $7,214,814

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

Listed in Part VII

  • ThompsonMichael

    Director (End 07/23)

    Total calculated
    $1,487,155
    From this org
    $0
    From related orgs
    $1,343,101
    Other
    $144,054
    Hours/week
    0.1 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $695,764 related
    Bonus
    $0 + $212,727 related
    Other
    $0 + $434,610 related
    Deferred
    $0 + $106,792 related
    Nontaxable benefits
    $0 + $37,262 related
    Filer's total
    $0 + $1,487,155 related

  • StiltzBryan

    Board Chairman

    Total calculated
    $1,394,176
    From this org
    $0
    From related orgs
    $1,226,531
    Other
    $167,645
    Hours/week
    0.1 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $811,185 related
    Bonus
    $0 + $228,402 related
    Other
    $0 + $186,944 related
    Deferred
    $0 + $144,990 related
    Nontaxable benefits
    $0 + $22,655 related
    Filer's total
    $0 + $1,394,176 related

  • PettijohnKelly

    Director

    Total calculated
    $846,532
    From this org
    $0
    From related orgs
    $754,129
    Other
    $92,403
    Hours/week
    0.1 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $491,185 related
    Bonus
    $0 + $128,237 related
    Other
    $0 + $134,707 related
    Deferred
    $0 + $71,041 related
    Nontaxable benefits
    $0 + $21,362 related
    Filer's total
    $0 + $846,532 related

  • BoyceKeith

    Dir./Pres./CEO (End 07/23)

    Total calculated
    $724,473
    From this org
    $0
    From related orgs
    $659,382
    Other
    $65,091
    Hours/week
    4.5 + 45.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $250,757 related
    Bonus
    $0 + $101,374 related
    Other
    $0 + $307,251 related
    Deferred
    $0 + $33,063 related
    Nontaxable benefits
    $0 + $32,028 related
    Filer's total
    $0 + $724,473 related

  • JohnsonKent

    Former Officer

    Total calculated
    $560,036
    From this org
    $0
    From related orgs
    $497,834
    Other
    $62,202
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $374,030 related
    Bonus
    $0 + $68,475 related
    Other
    $0 + $55,329 related
    Deferred
    $0 + $25,476 related
    Nontaxable benefits
    $0 + $36,726 related
    Filer's total
    $0 + $560,036 related

  • HindsNigel

    Former Officer

    Total calculated
    $527,324
    From this org
    $0
    From related orgs
    $473,463
    Other
    $53,861
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $332,565 related
    Bonus
    $0 + $80,523 related
    Other
    $0 + $60,375 related
    Deferred
    $0 + $17,727 related
    Nontaxable benefits
    $0 + $36,134 related
    Filer's total
    $0 + $527,324 related

  • YoungAnita

    Director (End 07/23)

    Total calculated
    $498,342
    From this org
    $0
    From related orgs
    $432,813
    Other
    $65,529
    Hours/week
    0.1 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $309,757 related
    Bonus
    $0 + $65,521 related
    Other
    $0 + $57,535 related
    Deferred
    $0 + $37,169 related
    Nontaxable benefits
    $0 + $28,360 related
    Filer's total
    $0 + $498,342 related

  • RodmanDavid

    Director/Pres.(Beg 08/23)/CFO

    Total calculated
    $310,362
    From this org
    $0
    From related orgs
    $271,855
    Other
    $38,507
    Hours/week
    4.5 + 45.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $214,652 related
    Bonus
    $0 + $46,003 related
    Other
    $0 + $11,200 related
    Deferred
    $0 + $13,833 related
    Nontaxable benefits
    $0 + $24,674 related
    Filer's total
    $0 + $310,362 related

  • GivensMichelle

    Former Officer

    Total calculated
    $253,503
    From this org
    $0
    From related orgs
    $253,503
    Other
    $0
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0
    Other
    $0 + $253,503 related
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $253,503 related

  • BeaulieuTimothy

    Director (End 07/23)

    Total calculated
    $0
    Hours/week
    0.1 + 1 related

  • McDonaldRaymond

    Director (End 07/23)

    Total calculated
    $0
    Hours/week
    0.1 + 1 related

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

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 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 entire nursing home region 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, Lines 4a-b
During the year ending December 31, 2023, Keith Boyce and Michelle Givens received severance payments in the amount of $138,772 and $235,159, respectively. Pursuant to the AHSSHC Corporate Executive Policy governing executive severance, severance agreements for executives operating at the Vice President level and above are entered into upon eligibility to facilitate the transition to subsequent employment following an involuntary separation from employment with AdventHealth. 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 II SERP III SERP III CONTR. DISTR.* CONTR./DISTR. CONTR. DISTR.* Thompson,Michael $ 111,565 $ 72,543 $ 291,806 $ 0 $ 0 Stiltz,Bryan $ 149,763 $ 106,371 $ 22,812 $ 0 $ 0 Pettijohn,Kelly $ 75,814 $ 47,809 $ 15,667 $ 0 $ 0 Boyce,Keith $ 0 $ 0 $ 0 $26,973 $114,769 Johnson,Kent $ 30,249 $ 7,456 $ 0 $ 0 $ 0 Hinds,Nigel $ 19,797 $ 9,485 $ 8,077 $ 0 $ 0 Young,Anita $ 19,442 $ 20,448 $ 0 $ 0 $ 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.

Assets distributed on this return

Schedule N, as filed: what the organization did with its assets when it liquidated or dissolved, or disposed of more than a quarter of them, and who received them. A recipient with an EIN is usually a successor organization; filers also list expenses such as legal fees here.

Provenance

Return type
form_990
Tax year
2023
Filed
30 April 2025
IRS schema version
2023v6.0
Source object
202521209349303082

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