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Nonprofiteer
← MEMORIAL HOSPITAL INC

Form 990 for tax year 2022

Filed by MEMORIAL HOSPITAL INC.

Totals

Total revenue
$74,509,151
Total expenses
$80,763,946
Contributions and grants received
$927,940
Grants paid
$181,981
Program service revenue
$73,531,759
Investment income
$49,452
Other revenue
$0
Total assets, end of year
$54,963,511
Total liabilities, end of year
$42,489,365
Net assets or fund balances, end of year
$12,474,146
Program services expenses (Part IX)
$74,204,123
Management and general expenses
$6,559,823
Fundraising expenses
$0
Program service expenses (Part III)
$74,204,123

Program services were 91.9% 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)

    $927,940

  • 2a · Program service revenue: Net Patient Revenue

    total $72,579,933 · related or exempt $72,487,847 · unrelated business $92,086

  • 2b · Program service revenue: Pharmacy Revenue

    total $415,556 · related or exempt $415,556

  • 2c · Program service revenue: Cafeteria Revenue

    total $279,452 · related or exempt $279,452

  • 2d · Program service revenue: Gift Shop Revenue

    total $147,360 · related or exempt $147,360

  • 2e · Program service revenue: Education

    total $50,878 · related or exempt $50,878

  • 2f · All other program service revenue

    total $58,580 · related or exempt $58,580

  • 3 · Investment income

    total $130,624 · excluded $130,624

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

    securities $81,172

  • 7c · Gain or loss

    securities -$81,172

  • 7d · Net gain or loss

    total -$81,172 · excluded -$81,172

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $181,981 · program services $181,981

  • 5 · Compensation of officers, directors and key employees

    total $2,997,723 · program services $1,680,409 · management and general $1,317,314

  • 7 · Other salaries and wages

    total $31,308,633 · program services $31,308,633

  • 8 · Pension plan contributions

    total $1,018,488 · program services $998,364 · management and general $20,124

  • 9 · Other employee benefits

    total $7,839,308 · program services $7,588,018 · management and general $251,290

  • 10 · Payroll taxes

    total $2,281,182 · program services $2,236,108 · management and general $45,074

  • 11b · Fees: legal

    total $78,317 · management and general $78,317

  • 11c · Fees: accounting

    total $15,483 · management and general $15,483

  • 11f · Fees: investment management

    total $13,895 · management and general $13,895

  • 11g · Fees: other

    total $11,248,055 · program services $8,178,645 · management and general $3,069,410

  • 12 · Advertising and promotion

    total $462,704 · management and general $462,704

  • 13 · Office expenses

    total $2,367,673 · program services $1,915,516 · management and general $452,157

  • 14 · Information technology

    total $3,917,262 · program services $3,693,874 · management and general $223,388

  • 16 · Occupancy

    total $2,081,704 · program services $2,081,704

  • 17 · Travel

    total $195,916 · program services $25,836 · management and general $170,080

  • 19 · Conferences, conventions and meetings

    total $189,560 · management and general $189,560

  • 20 · Interest

    total $340,290 · program services $340,290

  • 22 · Depreciation, depletion and amortization

    total $2,920,764 · program services $2,920,764

  • 23 · Insurance

    total $1,905,991 · program services $1,726,226 · management and general $179,765

  • 24a · Other expenses: Medical Supplies

    total $6,841,876 · program services $6,841,876

  • 24b · Other expenses: Repairs & Maintenance

    total $1,759,519 · program services $1,759,519

  • 24c · Other expenses: State Tax Indigent Asse

    total $670,459 · program services $670,459

  • 24d · Other expenses: Dues & Memberships

    total $65,303 · management and general $65,303

  • 24e · All other expenses

    total $61,860 · program services $55,901 · management and general $5,959

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $4,780 · end of year $4,780

  • 2 · Savings and temporary cash investments

    beginning of year $11,563,024 · end of year $148,029

  • 4 · Accounts receivable

    beginning of year $6,014,480 · end of year $7,000,532

  • 7 · Other notes and loans receivable

    end of year $51

  • 8 · Inventories for sale or use

    beginning of year $893,024 · end of year $868,696

  • 9 · Prepaid expenses and deferred charges

    beginning of year $1,730,609 · end of year $1,723,117

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

    $75,459,272

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

    $32,489,574

  • 10c · Land, buildings and equipment, net

    beginning of year $36,695,810 · end of year $42,969,698

  • 15 · Other assets

    beginning of year $1,739,963 · end of year $2,248,608

  • 17 · Accounts payable and accrued expenses

    beginning of year $7,195,228 · end of year $6,609,044

  • 19 · Deferred revenue

    beginning of year $58,011 · end of year $56,508

  • 25 · Other liabilities

    beginning of year $31,972,704 · end of year $35,823,813

  • 27 · Net assets without donor restrictions

    beginning of year $19,017,296 · end of year $12,222,646

  • 28 · Net assets with donor restrictions

    beginning of year $398,451 · end of year $251,500

Mission and programs · 2022

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)

The provision of medical care to the community through the operation of a 49 bed hospital.

  • Operation of acute care hospital totaling 49 beds with 1,482 patient admissions, 7,632 patient days, 61,854 outpatient visits, and 141,443 physician clinic patient visits in the current year.

    Expenses $74,204,123 · Grants $181,981 · Revenue $73,439,673

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Johnson Sandra

    Chairperson (Beg. 9/22)

    Total calculated
    $1,112,951
    From this org
    $0
    From related orgs
    $1,055,911
    Other
    $57,040
    Hours/week
    0.1 + 28 related

    Schedule J breakdown matched by us

    Base
    $0 + $608,691 related
    Bonus
    $0 + $271,601 related
    Other
    $0 + $175,619 related
    Deferred
    $0 + $17,895 related
    Nontaxable benefits
    $0 + $39,145 related
    Filer's total
    $0 + $1,112,951 related

  • Murrill Michael

    Chairperson (End 7/22)/Dir./Reg. CEO

    Total calculated
    $1,086,556
    From this org
    $0
    From related orgs
    $898,843
    Other
    $187,713
    Hours/week
    7.5 + 42.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $711,303 related
    Bonus
    $0 + $168,833 related
    Other
    $0 + $18,707 related
    Deferred
    $0 + $142,054 related
    Nontaxable benefits
    $0 + $45,659 related
    Filer's total
    $0 + $1,086,556 related

  • Randolph Karsten

    Charperson (Interim)/CFO Multi-State Div

    Total calculated
    $1,011,332
    From this org
    $0
    From related orgs
    $838,897
    Other
    $172,435
    Hours/week
    0.1 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $639,762 related
    Bonus
    $0 + $140,919 related
    Other
    $0 + $58,216 related
    Deferred
    $0 + $122,737 related
    Nontaxable benefits
    $0 + $49,698 related
    Filer's total
    $0 + $1,011,332 related

  • Wilkens MD Gregory

    Director/ Physician

    Total calculated
    $740,879
    From this org
    $697,903
    From related orgs
    $0
    Other
    $42,976
    Hours/week
    69.1

    Schedule J breakdown matched by us

    Base
    $454,028
    Bonus
    $235,930
    Other
    $7,945
    Deferred
    $16,400
    Nontaxable benefits
    $26,576
    Filer's total
    $740,879

  • SelfChristopher

    Former COO/CEO

    Total calculated
    $732,207
    From this org
    $0
    From related orgs
    $629,703
    Other
    $102,504
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $352,785 related
    Bonus
    $0 + $67,113 related
    Other
    $0 + $209,805 related
    Deferred
    $0 + $60,374 related
    Nontaxable benefits
    $0 + $42,130 related
    Filer's total
    $0 + $732,207 related

  • Maxey MD Jackie

    Family Practice Physician

    Total calculated
    $731,564
    From this org
    $681,518
    From related orgs
    $0
    Other
    $50,046
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $194,476
    Bonus
    $467,633
    Other
    $19,409
    Deferred
    $16,400
    Nontaxable benefits
    $33,646
    Filer's total
    $731,564

  • Guyton Alan

    Director/Reg. CFO

    Total calculated
    $691,873
    From this org
    $0
    From related orgs
    $560,777
    Other
    $131,096
    Hours/week
    9.15 + 40.85 related

    Schedule J breakdown matched by us

    Base
    $0 + $433,022 related
    Bonus
    $0 + $86,923 related
    Other
    $0 + $40,832 related
    Deferred
    $0 + $80,641 related
    Nontaxable benefits
    $0 + $50,455 related
    Filer's total
    $0 + $691,873 related

  • Gupta MD Giriraj

    Director (Beg. 1/22)/Physician

    Total calculated
    $491,095
    From this org
    $446,750
    From related orgs
    $0
    Other
    $44,345
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $309,157
    Bonus
    $131,069
    Other
    $6,524
    Deferred
    $16,400
    Nontaxable benefits
    $27,945
    Filer's total
    $491,095

  • Gorden MD Shawn

    OB/GYN Physician

    Total calculated
    $460,670
    From this org
    $422,364
    From related orgs
    $0
    Other
    $38,306
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $371,748
    Bonus
    $42,747
    Other
    $7,869
    Deferred
    $10,300
    Nontaxable benefits
    $28,006
    Filer's total
    $460,670

  • Naval Srinivas MD Rajiv

    Director/Chief of Staff (End 12/22)

    Total calculated
    $446,993
    From this org
    $421,602
    From related orgs
    $0
    Other
    $25,391
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $207,133
    Bonus
    $174,340
    Other
    $40,129
    Deferred
    $16,400
    Nontaxable benefits
    $8,991
    Filer's total
    $446,993

  • Yumang MD Emmanuel

    Physician - Internal Medicine

    Total calculated
    $410,275
    From this org
    $376,850
    From related orgs
    $0
    Other
    $33,425
    Hours/week
    44

    Schedule J breakdown matched by us

    Base
    $321,267
    Bonus
    $49,229
    Other
    $6,354
    Deferred
    $16,400
    Nontaxable benefits
    $17,025
    Filer's total
    $410,275

  • Jacob Sissel

    Director/CEO (Beg. 3/22)

    Total calculated
    $373,951
    From this org
    $0
    From related orgs
    $305,842
    Other
    $68,109
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $186,875 related
    Bonus
    $0
    Other
    $0 + $118,967 related
    Deferred
    $0 + $37,127 related
    Nontaxable benefits
    $0 + $30,982 related
    Filer's total
    $0 + $373,951 related

  • BellKaren

    Former CNO

    Total calculated
    $372,452
    From this org
    $0
    From related orgs
    $321,664
    Other
    $50,788
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $208,725 related
    Bonus
    $0 + $34,796 related
    Other
    $0 + $78,143 related
    Deferred
    $0 + $11,430 related
    Nontaxable benefits
    $0 + $39,358 related
    Filer's total
    $0 + $372,452 related

  • Anand MD Ashwini

    Cardiology Interventional Physician

    Total calculated
    $366,852
    From this org
    $358,898
    From related orgs
    $0
    Other
    $7,954
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $297,585
    Bonus
    $51,096
    Other
    $10,217
    Deferred
    $0
    Nontaxable benefits
    $7,954
    Filer's total
    $366,852

  • Hays MD Jeremie

    Physician - Internal Medicine

    Total calculated
    $361,559
    From this org
    $320,007
    From related orgs
    $0
    Other
    $41,552
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $295,547
    Bonus
    $18,303
    Other
    $6,157
    Deferred
    $10,300
    Nontaxable benefits
    $31,252
    Filer's total
    $361,559

  • Cornett MD Anita

    CMO

    Total calculated
    $360,657
    From this org
    $313,589
    From related orgs
    $0
    Other
    $47,068
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $282,789
    Bonus
    $0
    Other
    $30,800
    Deferred
    $16,400
    Nontaxable benefits
    $30,668
    Filer's total
    $360,657

  • StimsonMichael

    Former CNO

    Total calculated
    $348,181
    From this org
    $0
    From related orgs
    $293,218
    Other
    $54,963
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $236,977 related
    Bonus
    $0 + $45,349 related
    Other
    $0 + $10,892 related
    Deferred
    $0 + $15,583 related
    Nontaxable benefits
    $0 + $39,380 related
    Filer's total
    $0 + $348,181 related

  • Weber Peter

    Interim CEO (End 3/22)

    Total calculated
    $306,127
    From this org
    $0
    From related orgs
    $300,059
    Other
    $6,068
    Hours/week
    20

    Schedule J breakdown matched by us

    Base
    $0 + $127,401 related
    Bonus
    $0
    Other
    $0 + $172,658 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $6,068 related
    Filer's total
    $0 + $306,127 related

  • Nelson James

    CNO (Beg. 8/22)

    Total calculated
    $300,518
    From this org
    $0
    From related orgs
    $259,990
    Other
    $40,528
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $147,962 related
    Bonus
    $0 + $27,061 related
    Other
    $0 + $84,967 related
    Deferred
    $0 + $8,693 related
    Nontaxable benefits
    $0 + $31,835 related
    Filer's total
    $0 + $300,518 related

  • Camacho Daniel

    CFO

    Total calculated
    $299,667
    From this org
    $0
    From related orgs
    $247,525
    Other
    $52,142
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $200,667 related
    Bonus
    $0 + $36,062 related
    Other
    $0 + $10,796 related
    Deferred
    $0 + $12,801 related
    Nontaxable benefits
    $0 + $39,341 related
    Filer's total
    $0 + $299,667 related

  • Jones Angela

    Interim CNO (End 8/22)

    Total calculated
    $181,742
    From this org
    $161,373
    From related orgs
    $0
    Other
    $20,369
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $146,937
    Bonus
    $9,508
    Other
    $4,928
    Deferred
    $4,399
    Nontaxable benefits
    $15,970
    Filer's total
    $181,742

  • Stone Charles

    Director (End 12/22)

    Total calculated
    $180
    From this org
    $180
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.1

  • Shepherd Luke

    Director

    Total calculated
    $180
    From this org
    $180
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.1

  • Samples Reecia

    Director

    Total calculated
    $180
    From this org
    $180
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.1

  • Phillips James

    Director

    Total calculated
    $180
    From this org
    $180
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.1

  • House Marshall

    Director

    Total calculated
    $180
    From this org
    $180
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.1

  • Hewitt Mike

    Dir./VP for KY/TN SDA Conf.(Beg.1/22)

    Total calculated
    $180
    From this org
    $180
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.1

  • Hancock Jennifer

    Director

    Total calculated
    $180
    From this org
    $180
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.1

  • Gabbard Shane

    Director

    Total calculated
    $180
    From this org
    $180
    From related orgs
    $0
    Other
    $0
    Hours/week
    0.1

  • Dunzweiler John

    Director (End 2/22)

    Total calculated
    $0
    Hours/week
    0.1

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

  • 1a · First-class or charter travel
  • 1a · Travel for companions
  • 1a · Tax indemnification and gross-up payments
  • 1a · Discretionary spending account
  • 1a · Housing allowance or residence for personal use
  • 1a · Health or social club dues or initiation fees
  • 1b · Written policy on the line-1a expenses
  • 2 · Substantiation required before reimbursing expenses
  • 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 1a
The filing organization is a part of the 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 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. AHSSHC is exempt from federal income tax under IRC Section 501(c)(3). The filing organization reimburses AHSSHC for the salary and benefit cost of those executives on the payroll of AHSSHC. At the direction of AHSSHC, and in accordance with the reserved powers in the filing organization's governing documents, the executive team listed on Part VII provides services to 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 49 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 (13 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 50 - 55 individual executives). A Regional CEO for AdventHealth is a member of the Board of Directors of the filing organization. The Regional CEO is considered a common law employee of and is on the payroll of AHSSHC. While the special travel allowance benefit is an AHSSHC compensation policy and practice, the cost of providing this benefit is allocated to and either wholly or partially reimbursed by the filing organization. Accordingly, the filing organization has checked the box in Schedule J, Part I, line 1a for first-class or charter travel since it has wholly or partially paid for the cost of providing this benefit. 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. A report on charter travel is provided to the AHSSHC Board Compensation Committee at each meeting. 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. Housing allowance or residence for personal use: AHSSHC has a Corporate Executive Policy that addresses assistance to executives who have been relocated by the company during the year. Relocation assistance provided to executives may include relocation allowances to assist with duplicate housing expenses. Relocation assistance is administered per AHSSHC policy by an external relocation company. All taxable reimbursements made to executives in connection with relocation assistance are treated as wages to the executive and are subject to all payroll withholding and reporting requirements. 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,two (2) executives listed in Part VII received reimbursement for club fees. While the club dues membership is an AHSSHC compensation policy and practice, the cost of providing this benefit is allocated to and reimbursed in whole or in part by the filing organization. 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
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
As discussed in Line 1a above, 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 2022. 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 $305,000 in 2022 (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 AHS 457b Contr. Distr.* Contr. Distr.* Distr.* Johnson,Sandra $ 1,495 $ 154,319 $ 0 $ 0 $ 0
Line 4b (Continued):
FLEX Plan FLEX Plan SERP III SERP III AHS 457b Contr. Distr.* Contr. Distr.* Distr.* Murrill,Michael $ 0 $ 0 $ 125,654 $ 0 $ 0 Randolph,Karsten $ 106,337 $ 28,763 $ 0 $ 0 $ 0 Self,Christopher $ 34,672 $ 15,558 $ 19,551 $ 0 $ 0 Guyton,Alan $ 50,988 $ 26,463 $ 13,253 $ 0 $ 0 Jacob,Sissel $ 0 $ 0 $ 27,519 $ 0 $ 0 Weber,Peter $ 0 $ 37,019 $ 0 $ 0 $ 107,233 * 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

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
2022
Filed
14 November 2023
IRS schema version
2022v5.0
Source object
202323199349319152

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