Form 990 for tax year 2023

Revenue

Part VIII, the statement of revenue.

• 1d · Related organizations

  $212,053

• 1f · All other contributions, gifts and grants

  $15,000

• 2a · Program service revenue: Reimbursed Salaries & Wages from

  total $515,520,365 · related or exempt $507,127,939 · unrelated business $8,392,426

• 2b · Program service revenue: Management Fees

  total $465,336,188 · related or exempt $465,275,388 · unrelated business $60,800

• 2c · Program service revenue: Centralized Serv Purch by TE Affi

  total $269,242,624 · related or exempt $269,242,624

• 2d · Program service revenue: Reimbursed Pharmaceutical Costs f

  total $206,582,434 · related or exempt $201,692,311 · unrelated business $4,890,123

• 2e · Program service revenue: Reimbursement for Expenses

  total $166,915,977 · related or exempt $166,915,977

• 2f · All other program service revenue

  total $139,937,054 · related or exempt $139,337,471 · unrelated business $599,583

• 3 · Investment income

  total $195,752,987 · excluded $195,752,987

• 6a · Gross rents

  real property $799,693

• 6b · Less rental expenses

  real property $0

• 6c · Rental income or loss

  real property $799,693

• 6d · Net rental income or loss

  total $799,693 · excluded $799,693

• 7a · Gross sales of assets other than inventory

  other assets $2,703,763

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

  securities $97,368,112 · other assets $2,844,929

• 7c · Gain or loss

  securities -$97,368,112 · other assets -$141,166

• 7d · Net gain or loss

  total -$97,509,278 · excluded -$97,509,278

Functional expenses

Part IX, the statement of functional expenses.

• 1 · Grants to domestic organizations and governments

  total $15,188,060 · program services $15,188,060

• 2 · Grants to domestic individuals

  total $59,591 · program services $59,591

• 5 · Compensation of officers, directors and key employees

  total $22,645,913 · management and general $22,645,913

• 7 · Other salaries and wages

  total $647,579,791 · program services $449,687,673 · management and general $197,892,118

• 8 · Pension plan contributions

  total $48,799,820 · program services $34,326,475 · management and general $14,473,345

• 9 · Other employee benefits

  total $163,831,278 · program services $103,321,223 · management and general $60,510,055

• 10 · Payroll taxes

  total $48,521,918 · program services $34,130,994 · management and general $14,390,924

• 11b · Fees: legal

  total $9,214,963 · management and general $9,214,963

• 11c · Fees: accounting

  total $3,313,788 · management and general $3,313,788

• 11d · Fees: lobbying

  total $436,008 · program services $421,008 · management and general $15,000

• 11f · Fees: investment management

  total $31,671,849 · management and general $31,671,849

• 11g · Fees: other

  total $235,954,279 · program services $212,420,924 · management and general $23,533,355

• 12 · Advertising and promotion

  total $20,663,532 · management and general $20,663,532

• 13 · Office expenses

  total $14,787,681 · program services $3,960,275 · management and general $10,827,406

• 14 · Information technology

  total $198,303,484 · program services $198,303,484

• 16 · Occupancy

  total $7,268,216 · program services $7,268,216

• 17 · Travel

  total $13,425,507 · program services $12,652,011 · management and general $773,496

• 19 · Conferences, conventions and meetings

  total $6,389,239 · management and general $6,389,239

• 20 · Interest

  total $186,120,358 · program services $186,120,358

• 22 · Depreciation, depletion and amortization

  total $101,192,209 · program services $101,192,209

• 23 · Insurance

  total $13,117,108 · program services $11,675,752 · management and general $1,441,356

• 24a · Other expenses: Pharmaceutical Costs

  total $185,961,398 · program services $185,961,398

• 24b · Other expenses: Federal Income Tax

  total $18,583 · management and general $18,583

• 24c · Other expenses: Alloc of Invest Mgmt Fe

  total -$30,342,099 · program services -$30,342,099

• 24d · Other expenses: Alloc of Investment Gai

  total -$87,047,564 · program services -$87,047,564

• 24e · All other expenses

  total $14,701,165 · program services -$5,705,998 · management and general $20,407,163

Balance sheet

Part X, book values.

• 1 · Cash, non-interest-bearing

  beginning of year $1,500 · end of year $8,366

• 4 · Accounts receivable

  beginning of year $21,995,806 · end of year $31,827,236

• 8 · Inventories for sale or use

  beginning of year $3,253,489 · end of year $26,009,421

• 9 · Prepaid expenses and deferred charges

  beginning of year $60,713,455 · end of year $66,585,692

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

  $1,183,031,317

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

  $504,639,454

• 10c · Land, buildings and equipment, net

  beginning of year $695,297,597 · end of year $678,391,863

• 12 · Investments: other securities

  beginning of year $6,594,478,944 · end of year $8,529,456,825

• 13 · Investments: program-related

  beginning of year $12,582,567 · end of year $13,908,414

• 14 · Intangible assets

  beginning of year $11,326,000 · end of year $8,440,000

• 15 · Other assets

  beginning of year $789,353,235 · end of year $764,014,158

• 17 · Accounts payable and accrued expenses

  beginning of year $654,153,447 · end of year $727,026,554

• 23 · Secured mortgages and notes payable

  beginning of year $100,000,000 · end of year $100,000,000

• 25 · Other liabilities

  beginning of year $7,136,025,080 · end of year $8,919,139,780

• 27 · Net assets without donor restrictions

  beginning of year $298,824,066 · end of year $372,475,641

The filer's explanations (Part III)

Part I, Line 1a

The filing organization is the top-tier parent of a system of healthcare organizations known as AdventHealth. Members of the filing organization's executive management team that hold the position of Vice-President or above (including those who provide services at the filing organization and those who perform executive management services at AdventHealth subsidiary organizations) are compensated by and on the payroll of the filing organization. First-class or charter travel: Pursuant to the AdventHealth system-wide general policy regarding business travel, no reimbursement will be provided for any additional cost incurred with respect to first-class or charter air travel beyond the cost of a regular coach airfare. As a means of providing additional business travel reimbursement for those members of the AHSSHC senior executive management team that travel frequently on behalf of AdventHealth, a special annual travel allowance is provided for those executives. As AdventHealth operates 50 hospitals in 9 states, the senior leadership of AHSSHC travel extensively and often visit multiple hospital locations in different states as a part of a single business trip. The special travel allowance can provide reimbursements to the executive for such items as the purchase of air travel upgrade coupons, to cover the cost differential between coach and first-class travel, or to cover the cost of a charter flight. The special travel allowance benefit was originally authorized by and codified into a policy by the AHSSHC Board Compensation Committee (the Committee), an independent body of the AHSSHC Board of Directors, who also approves the annual cap on the amount of the allowance. The special travel allowance has an annual cap of $24,000 for members of the Leadership Executive Team (15 AdventHealth Cabinet members and the AdventHealth Multi-State CFO) and $15,000 for AdventHealth Corporate Office Senior Vice Presidents, Regional CEO's, and Division Chief Officers (generally 45-55 individual executives). A report on charter travel is provided to the AHSSHC Board Compensation Committee at each meeting. Those executives who receive the special travel allowance are responsible for tracking the expenses reimbursable under the special travel allowance and must submit such expenses on their accountable plan expense report. Any taxable reimbursements made to executives under the special travel allowance arrangement are treated as taxable compensation to the executive. Travel for companions: AHSSHC has a Corporate Executive Policy that provides a benefit to allow for a traveling AHSSHC executive to have his or her spouse accompany the executive on certain business trips each year. Typically, reimbursement is only provided to certain executive leaders and is usually limited to one business trip per year beyond the annual AdventHealth President's Council business meeting and other meetings where the spouse is specifically invited. The AHSSHC Corporate Executive Spousal Travel Policy was originally approved and reviewed by the AHSSHC Board Compensation Committee, an independent body of the AHSSHC Board of Directors. All spousal travel costs reimbursed to the executive are considered taxable compensation to the executive. Tax Indemnification and gross-up payments: AdventHealth has a system-wide policy addressing gross-up payments provided in connection with employer-provided benefits/other taxable items. Under the policy, certain taxable business-related reimbursements (i.e. taxable business-related moving expenses, taxable items provided in connection with employment) provided to any employee may be grossed-up at a 25% rate upon approval by the filing organization's CEO and CFO. Additionally, employees at the Director level and above are eligible for gross-up payments on gifts received for board of director services. Discretionary spending account: Occasional discretionary spending amounts are periodically provided to eligible executives who attend annual business meetings such as the AdventHealth President's Council, CFO Conference or the CMO/CNO business meeting. Payments provided to each executive are considered taxable compensation to the executive. Health or social club dues or initiation fees: AHSSHC has a Corporate Executive Policy that addresses business development expenditures. Under this policy, to encourage executives to establish and cultivate strong working relationships with the medical community and other leaders in the community and industry, certain AdventHealth executives may be reimbursed for member dues and usage charges for a country club or other social club upon authorization. Club memberships must be approved by the AdventHealth President/CEO initially as well as on an annual basis. Each AdventHealth executive who is approved for a club membership must submit an annual report describing how they used the membership to benefit their organization during the preceding year so that the AdventHealth President/CEO can determine if continuance of the club membership furthers the business interests of AdventHealth. In the current year, for this filing organization, six (6) executives listed in Part VII received reimbursement for club fees. Accordingly, the filing organization has checked the box in Schedule J, Part I, line 1a for health or social club dues since it has wholly or partially paid for the cost of providing this benefit.

Part I, Line 3

Please see the discussion concerning the process followed by the filing organization in determining executive compensation in our response to Part VI, Section B, Line 15a and b.

Part I, Lines 4a-b

During the year ending December 31, 2023, Michael Murrill received severance payments in the amount of $373,237. 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. Schedule J, Part I, Line 4b: 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.

Schedule J, Part I, Line 4 b Continued:

FLEX Plan FLEX Plan SERP II SERP III Contr. Distr.* Contr./Distr. Contr. Shaw, Terry D. $ 155,450 $ 132,569 $ 1,334,441 $ 0 Rathbun, Paul C. $ 155,450 $ 132,564 $ 632,721 $ 0 Haffner, Randall L. $ 155,450 $ 152,379 $ 0 $ 0 Banks, David $ 155,450 $ 152,379 $ 90,424 $ 0 Randolph, Karsten $ 119,748 $ 74,817 $ 1,188,200 $ 0 Ottati, David $ 155,450 $ 142,998 $ 399,489 $ 0 Bacon, Kenneth $ 0 $ 0 $ 0 $ 237,896 FLEX Plan FLEX Plan SERP II SERP III Contr. Distr.* Contr./Distr. Contr. Moorhead, MD, David $ 155,450 $ 132,950 $ 291,354 $ 0 Goodman, Todd $ 155,450 $ 114,532 $ 217,202 $ 0 Gregory, Audrey $ 0 $ 0 $ 0 $ 179,353 Bergherm, Bruce $ 126,372 $ 103,872 $ 541,847 $ 0 Zbaraschuk, Amy $ 55,471 $ 60,357 $ 828,437 $ 0 Bromme, Jeffrey $ 155,450 $ 125,676 $ 0 $ 17,994 Snyder, Brent G. $ 155,450 $ 132,950 $ 0 $ 0 Murrill, Michael $ 0 $ 0 $ 0 $ 25,962 Azevedo, Olesea $ 154,106 $ 87,530 $ 0 $ 7,895 Adams, Brian $ 148,620 $ 62,365 $ 0 $ 9,281 Stiltz, Bryan $ 149,763 $ 106,371 $ 22,812 $ 0 Celano, Patricia $ 95,757 $ 69,661 $ 229,323 $ 0 White, Vickie $ 62,090 $ 37,114 $ 0 $ 0 Johnson, Sandra K. $ 0 $ 112,200 $ 0 $ 0 Baker, Craig $ 0 $ 0 $ 0 $ 45,116 Soler, Eddie $ 600 $ 138,460 $ 0 $ 0 SERP III AHS 457b Distr.* Distr.* Bromme, Jeffrey $ 17,994 $ 0 Murrill, Michael $ 303,568 $ 0 Schultz, Michael $ 0 $ 219,948 * Including Investment Earnings

Related partnerships

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

• AdventHealth Surgery Center Daytona Beach LLC

  Surgery Center · FL

• AdventHealth Surgery Center Innovation Tower LLC

  Surgery Center · FL

• Fletcher Hospital Surgical Ventures LLC

  Indirect Interest in Surgery Center · NC

• Florida Hospital DMERT LLC

  Medical Equipment · FL · general or managing partner

• Florida Hospital Home Infusion LLP

  Home Infusion Services · FL · general or managing partner

• Functional Neurosurgical Ambulatory Surgery Ctr LLC

  Surgery Center · CO

• M&O Orlando MOB I LLC

  Operation of Medical Office Building · DE

• OnPoint OBGYN LLC

  Healthcare Services · CO

• Orange City Surgical LLC

  Surgery Center · FL

• PAHS OnPoint Imaging LLC

  Imaging Center · CO

• PAHS OnPoint Urgent Care LLC

  Urgent Care Center · CO

• Surgery Center of Rome LP

  Surgery Center · GA

• SCA - Alliance LLC

  Indirect Interest in Surgery Center · DE

• SCA-Central Florida LLC

  Indirect Interest in Surgery Center · DE

• The Bariatric Center of Kansas City LLC

  Surgery Center · KS

• Urgent Care Centers of Brevard County LLC

  Urgent Care Centers · FL · general or managing partner

Related corporations and trusts

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

• AdventHealth at Overland Park-College MOB Condominium Assoc

  C · Condo Association · KS · controlled entity

• AdventHealth City Center North Owners' Assoc Inc (65-123123)

  C · Maintenance Association · KS · controlled entity

• AdventHealth Primary Care Inc fka AH North Polk Inc

  C · Inactive · FL · 100% owned · controlled entity

  Directly controlled by Adventist Hlth System Sunbelt Hlthcare Corp

• AdventHealth Value Based Bundle Management LLC

  C · Medical Contracting and Billing · FL · controlled entity

• Altamonte Medical Plaza Condominium Association Inc

  C · Condo Association · FL · controlled entity

• Apopka Medical Plaza Condominium Assoc Inc (11-123123)

  C · Condo Association · FL · controlled entity

• Battle Creek Adventist Hospital

  C · Inactive · MI · controlled entity

• Florida Hosp Hlth Village Property Owner's Assoc Inc

  C · Condo Association · FL · controlled entity

• Florida Hospital Flagler Medical Offices Association Inc

  C · Condo Association · FL · controlled entity

• Florida Hospital Healthcare System Inc

  C · PHSO / CIN · FL · controlled entity

• Florida Medical Plaza Condominium Association Inc

  C · Condo Association · FL · controlled entity

• Kissimmee Multispecialty Clinic Condominium Association Inc

  C · Condo Association · FL · controlled entity

• Midwest Management Services Inc

  C · Inactive · KS · controlled entity

• North American Health Services Inc & Sub

  C · Holding Co. · TN · 100% owned · share of income $8,525,381 · share of assets $84,522,145 · controlled entity

  Directly controlled by Adventist Hlth System Sunbelt Hlthcare Corp

• Ormond Prof Associates Condo Assoc Inc (430 year end)

  C · Condo Association · FL · controlled entity

• Park Ridge Condominium #1 Unit Owners Association Inc

  C · Condo Association · NC · controlled entity

• Park Ridge Property Owner's Association Inc

  C · Condo Association · NC · controlled entity

• Redmond Park Health Services Inc

  C · Holding Company · GA · controlled entity

• Surgicare of Rome Inc

  C · Holding Company · GA · controlled entity

• The Garden Retirement Community Inc

  C · Real Estate Rental · FL · controlled entity

• Winter Park Medical Office Building I Condo Assoc Inc

  C · Condo Association · FL · controlled entity