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← ADVENTHEALTH WEST FLORIDA AMBULATORY SERVICES INC

Form 990 for tax year 2023

Filed by ADVENTHEALTH WEST FLORIDA AMBULATORY SERVICES INC.

Totals

Total revenue
$5,112,207
Total expenses
$22,145,750
Contributions and grants received
$0
Grants paid
$5,000
Program service revenue
$5,111,576
Investment income
$631
Other revenue
$0
Total assets, end of year
$90,342,386
Total liabilities, end of year
$23,302,626
Net assets or fund balances, end of year
$67,039,760
Program services expenses (Part IX)
$11,147,529
Management and general expenses
$10,998,221
Fundraising expenses
$0
Program service expenses (Part III)
$11,147,529

Program services were 50.3% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • David Ottati

    Director/Pres/Chairman

    Total calculated
    $2,195,971
    From this org
    $0
    From related orgs
    $1,981,848
    Other
    $214,123
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,046,990 related
    Bonus
    $0 + $355,278 related
    Other
    $0 + $579,580 related
    Deferred
    $0 + $173,177 related
    Nontaxable benefits
    $0 + $40,946 related
    Filer's total
    $0 + $2,195,971 related

  • Bruce Bergherm

    Secretary/Director

    Total calculated
    $1,701,501
    From this org
    $0
    From related orgs
    $1,664,566
    Other
    $36,935
    Hours/week
    0.1 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $692,913 related
    Bonus
    $0 + $223,637 related
    Other
    $0 + $748,016 related
    Deferred
    $0 + $17,727 related
    Nontaxable benefits
    $0 + $19,208 related
    Filer's total
    $0 + $1,701,501 related

  • Jennifer Wandersleben

    Director

    Total calculated
    $1,381,811
    From this org
    $0
    From related orgs
    $1,220,343
    Other
    $161,468
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $680,694 related
    Bonus
    $0 + $216,920 related
    Other
    $0 + $322,729 related
    Deferred
    $0 + $121,227 related
    Nontaxable benefits
    $0 + $40,241 related
    Filer's total
    $0 + $1,381,811 related

  • Vadym Didenko

    Treasurer/Director

    Total calculated
    $1,082,929
    From this org
    $0
    From related orgs
    $930,780
    Other
    $152,149
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $627,726 related
    Bonus
    $0 + $177,428 related
    Other
    $0 + $125,626 related
    Deferred
    $0 + $117,466 related
    Nontaxable benefits
    $0 + $34,683 related
    Filer's total
    $0 + $1,082,929 related

  • John Johannessen

    Former Officer (End 04/23)

    Total calculated
    $865,323
    From this org
    $0
    From related orgs
    $827,752
    Other
    $37,571
    Hours/week
    2.5 + 47.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $151,743 related
    Bonus
    $0 + $161,097 related
    Other
    $0 + $514,912 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $37,571 related
    Filer's total
    $0 + $865,323 related

  • Robin McGuinness

    Director

    Total calculated
    $724,095
    From this org
    $0
    From related orgs
    $651,137
    Other
    $72,958
    Hours/week
    0.2 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $420,334 related
    Bonus
    $0 + $118,892 related
    Other
    $0 + $111,911 related
    Deferred
    $0 + $52,695 related
    Nontaxable benefits
    $0 + $20,263 related
    Filer's total
    $0 + $724,095 related

  • Clay Presswood

    Director

    Total calculated
    $518,958
    From this org
    $0
    From related orgs
    $424,406
    Other
    $94,552
    Hours/week
    2.4 + 47.6 related

    Schedule J breakdown matched by us

    Base
    $0 + $306,046 related
    Bonus
    $0 + $74,470 related
    Other
    $0 + $43,890 related
    Deferred
    $0 + $63,674 related
    Nontaxable benefits
    $0 + $30,878 related
    Filer's total
    $0 + $518,958 related

  • Jason Newmyer

    Director (Beg 01/23)

    Total calculated
    $469,545
    From this org
    $0
    From related orgs
    $378,761
    Other
    $90,784
    Hours/week
    2.4 + 47.6 related

    Schedule J breakdown matched by us

    Base
    $0 + $287,765 related
    Bonus
    $0 + $70,587 related
    Other
    $0 + $20,409 related
    Deferred
    $0 + $60,968 related
    Nontaxable benefits
    $0 + $29,816 related
    Filer's total
    $0 + $469,545 related

  • Michael Schultz

    Former Officer

    Total calculated
    $228,763
    From this org
    $0
    From related orgs
    $228,763
    Other
    $0
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0
    Other
    $0 + $228,763 related
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $228,763 related

  • Elin Boyd

    AVP Project Management

    Total calculated
    $208,995
    From this org
    $178,099
    From related orgs
    $0
    Other
    $30,896
    Hours/week
    10 + 30 related

    Schedule J breakdown matched by us

    Base
    $153,658
    Bonus
    $21,921
    Other
    $2,520
    Deferred
    $8,866
    Nontaxable benefits
    $22,030
    Filer's total
    $208,995

  • Kirsten Quinlan

    AVP Physician Recruiting

    Total calculated
    $205,297
    From this org
    $187,143
    From related orgs
    $0
    Other
    $18,154
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $168,512
    Bonus
    $16,780
    Other
    $1,851
    Deferred
    $9,038
    Nontaxable benefits
    $9,116
    Filer's total
    $205,297

  • Eugenia Evarts

    Director Outpatient Imaging

    Total calculated
    $192,708
    From this org
    $151,733
    From related orgs
    $0
    Other
    $40,975
    Hours/week
    10 + 30 related

    Schedule J breakdown matched by us

    Base
    $133,850
    Bonus
    $14,674
    Other
    $3,209
    Deferred
    $7,602
    Nontaxable benefits
    $33,373
    Filer's total
    $192,708

  • Jonathan Gilbert

    Director of Finance

    Total calculated
    $175,915
    From this org
    $152,021
    From related orgs
    $0
    Other
    $23,894
    Hours/week
    10 + 30 related

    Schedule J breakdown matched by us

    Base
    $138,285
    Bonus
    $11,429
    Other
    $2,307
    Deferred
    $6,874
    Nontaxable benefits
    $17,020
    Filer's total
    $175,915

  • Cheryl Dion

    Div Director of Marketing

    Total calculated
    $144,057
    From this org
    $137,723
    From related orgs
    $0
    Other
    $6,334
    Hours/week
    10 + 30 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 President/Board Member of the filing organization is appointed and compensated by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) for serving as the CEO of the West Florida Division of AdventHealth. AHSSHC is the 501(c)(3) parent organization of the healthcare system known as AdventHealth. 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, John Johannessen received severance payments in the amount of $347,496. 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 Contr. Distr.* Contr./Distr. Contr. Ottati,David $ 155,450 $ 142,998 $ 399,489 $ 0 Bergherm,Bruce $ 126,372 $ 103,872 $ 541,847 $ 0 Wandersleben,Jennifer $ 115,299 $ 82,132 $ 0 $ 10,702 Didenko,Vadym $ 99,739 $ 90,599 $ 0 $ 0 Johannessen,John $ 8,955 $ 91,569 $ 0 $ 14,249 FLEX Plan FLEX Plan SERP II SERP III Contr. Distr.* Contr./Distr. Contr. McGuinness,Robin $ 57,468 $ 36,267 $ 0 $ 6,645 Presswood,Clay $ 15,884 $ 21,331 $ 0 $ 30,064 Newmyer,Jason $ 0 $ 0 $ 0 $ 43,241 SERP III AHS 457(b) Distr.* Distr.* Johannessen,John $ 43,646 $ 0 McGuinness,Robin $ 6,645 $ 0 Schultz,Michael $ 0 $ 219,948 * 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
5 December 2024
IRS schema version
2023v5.1
Source object
202433529349300533

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