| Part V, Line 1a |
The parent corporation and sole top-tier member of AdventHealth West Florida Imaging, Inc. (the filing organization) is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). AHSSHC has established a shared service center to centralize the Accounts Payable (A/P) function for all AHSSHC subsidiary organizations. The filing organization has entered "0" in Part V, Line 1a because the filing organization no longer issues Form 1099 returns, rather, all such returns are filed by and under the name and EIN of AHSSHC as the payor subject to the information reporting requirements of Section 6041. The facts and circumstances support a position that AHSSHC, as a payor on behalf of its subsidiary organizations in a shared service environment, will have sufficient management and oversight in connection with the subsidiary organizations' payments to meet the standard set forth in Treas. Reg. Section 1.6041-1(e). AHSSHC will not merely be making payments at the direction of its subsidiary organizations. Accordingly, AHSSHC is considered the payor subject to the information reporting requirements of Section 6041. |
| Form 990, Part VI, Section A, line 6 |
AdventHealth West Florida Imaging, Inc. (the filing organization) has one member. The sole member of the filing organization is AdventHealth West Florida Ambulatory Services, Inc. (AWFAS) AdventHealth West Florida Ambulatory Services, Inc. is a Florida not for profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). There are no other classes of membership in the filing organization. |
| Form 990, Part VI, Section A, line 7a |
The Board of Directors of the filing organization are appointed by the member(s) who has the right to elect, appoint or remove any member of the Board of Directors of the filing organization. |
| Form 990, Part VI, Section A, line 7b |
The membership of the filing organization has certain reserved powers as set forth in the Bylaws of the filing organization. These reserved powers include the following: (a) adopt, amend, modify or restate the Bylaws (subject to the provisions of Article X) and the Articles of Incorporation; (b) adopt any annual or long-term capital or operational budget for the Corporation, or any changes exceeding ten percent (10%) of the total annual budget; (c) adopt any new, or any changes to, existing long-term or master strategic plan for the Corporation; (d) authorize the Corporation to enter into any contract or engage in any transaction which is not provided for in an annual or long-term capital or operational budget approved by the Member where the amount involved exceeds one hundred thousand dollars ($100,000.00); (e) appoint and remove the members of the Corporation's Board of Directors; (f) approve the Corporation entering into a new service line; (g) approve the formation, modification, or dissolution of any partnership, limited liability company, joint venture in which the Corporation will be a shareholder, partner, member, joint venture or party to an affiliation; (h) enter into, modify, or terminate any affiliation agreement as to which the Corporation will be a party; (i) incur any long-term debt; (j) mortgage or otherwise grant a lien or security interest to be placed upon or a Uniform Commercial Code financing statement to be filed against any of the Corporation's assets; (k) merge the Corporation with or consolidate the Corporation into any other entity; (l) sell, assign or otherwise transfer all or substantially all of the Corporation's assets in one or more related transactions; (m) make any distribution permitted in accordance with Section 617.0505 of the Act, as amended; (n) make a call for additional contributions; (o) enter into any contract (regardless of the identity of the party and regardless of nature of the product/service acquired) at less than fair market value; (p) grant membership rights to any person or entity other than the Member; (q) enter into, modify, amend, revise, extend or renew any agreement for the management of the business of the Corporation by any person or entity, or terminate any such agreement if it is being performed by the manager thereunder in a manner inconsistent with the Corporation's exempt purposes; and (r) approve the voluntary dissolution of the Corporation. |
| Form 990, Part VI, Section B, line 11b |
The filing organization's current year Form 990 was reviewed by the Board Chairman, and by the Regional CEO and CFO of AdventHealth's West Florida Region Non-Acute Services prior to its filing with the IRS. The review conducted by the Board Chairman and the Regional CEO and CFO of AdventHealth's West Florida Region Non-Acute Services did not include the review of any supporting workpapers that were used in preparation of the current year Form 990, but did include a review of the entire Form 990 and all supporting schedules. |
| Form 990, Part VI, Section B, line 12c |
The Conflict of Interest Policy of the filing organization applies to members of its Board of Directors and its principal officers (to be known as Interested Persons). In connection with any actual or possible conflicts of interest, any member of the Board of Directors of the filing organization or any principal officer of the filing organization (i.e. Interested Persons) must disclose the existence of any financial interest with the filing organization and must be given the opportunity to disclose all material facts concerning the financial interest/arrangement to the Board of Directors of the filing organization or to any members of a committee with board delegated powers that is considering the proposed transaction or arrangement. Subsequent to any disclosure of any financial interest/arrangement and all material facts, and after any discussion with the relevant Board member or principal officer, the remaining members of the Board of Directors or committee with board delegated powers shall discuss, analyze, and vote upon the potential financial interest/arrangement to determine if a conflict of interest exists. According to the filing organization's Conflict of Interest Policy, an Interested Person may make a presentation to the Board of Directors (or committee with board delegated powers), but after such presentation, shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that results in a conflict of interest. Each Interested Person, as defined under the filing organization's Conflict of Interest Policy, shall annually sign a statement which affirms that such person has received a copy of the Conflict of Interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the filing organization is a charitable organization that must primarily engage in activities which accomplish one or more of its exempt purposes. The filing organization's Conflict of Interest Policy also requires that periodic reviews shall be conducted to ensure that the filing organization operates in a manner consistent with its charitable purposes. |
| Form 990, Part VI, Section B, line 15 |
The filing organization's President and other officers are not compensated by the filing organization. Such individuals are compensated by the related top-tier parent organization of the filing organization. Please see the discussion concerning the process followed by the related top-tier parent organization in determining executive compensation in our response to Schedule J, Line 3. |
| Form 990, Part VI, Section C, line 19 |
The filing organization is a part of the system of healthcare organizations known as AdventHealth. The audited consolidated financial statements of AdventHealth and of the AdventHealth "Obligated Group" are filed annually with the Municipal Securities Rulemaking Board (MSRB). The "Obligated Group" is a group of AHSSHC subsidiaries that are jointly and severally liable under a Master Trust Indenture that secures debt primarily issued on a tax-exempt basis. Unaudited quarterly financial statements prepared in accordance with Generally Accepted Accounting Principles (GAAP) are also filed with MSRB for AdventHealth on a consolidated basis and for the grouping of AdventHealth subsidiaries comprising the "Obligated Group". The filing organization does not generally make its governing documents or conflict of interest policy available to the public. |
| Part VII, Section A, Columns E & F |
For those Board of Director members who devote less than full-time to the filing organization (based upon the average number of hours per week shown in column (B) on page 7 of the return) the compensation amounts shown in columns (E) and (F) on page 7 were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position as an employee of Adventist Health System Sunbelt Healthcare Corporation. |
| Part VIII, Lines 7a, b and c |
The amount shown in Part VIII, Line 7c(i) of the Form 990 represents an allocated share of capital gain/(loss) from a system wide, corporate administered, investment program. |
| Form 990, Part IX, line 11g |
Payments to healthcare professionals: Program service expenses 268,103. Management and general expenses 0. Fundraising expenses 0. Total expenses 268,103. Professional fees: Program service expenses 20,765. Management and general expenses 0. Fundraising expenses 0. Total expenses 20,765. Purchased medical services: Program service expenses 93. Management and general expenses 0. Fundraising expenses 0. Total expenses 93. Environmental services: Program service expenses 12,925. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,925. Recruiting: Program service expenses 168. Management and general expenses 0. Fundraising expenses 0. Total expenses 168. Miscellaneous purchased services: Program service expenses 268,853. Management and general expenses 0. Fundraising expenses 0. Total expenses 268,853. AdventHealth management fees: Program service expenses 0. Management and general expenses 19,164. Fundraising expenses 0. Total expenses 19,164. Billing & collection services: Program service expenses 0. Management and general expenses 35,847. Fundraising expenses 0. Total expenses 35,847. AdventHealth shared services fees: Program service expenses 0. Management and general expenses 20,618. Fundraising expenses 0. Total expenses 20,618. |
| Form 990, Part XI, line 9: |
Transfer from related tax-exempt organizations 2,336,139. |
| Part XII, Line 3b |
For the 2020 fiscal year ending December 31, 2020, AdventHealth was subject to the Single Audit requirements, as set forth in the regulations at 2 CFR Part 200, Subpart F. As a calendar year taxpayer, the deadline to complete and submit the Single Audit Reporting Package to the Federal Audit Clearinghouse, as required under Subpart F of 2 CFR 200.501, is September 30, 2021. However, on March 19th, 2021, the Office of Management and Budget (OMB) issued Memorandum M21-20, which outlined the OMB's efforts to supplement the support in the American Rescue Plan Act of 2021 (ARP), promote public trust in the Federal Government's stewardship of taxpayer resources, and alleviate some of the administrative challenges related to the coronavirus pandemic. As part of the administrative relief included in Memorandum M21-20, the OMB provided a six-month extension of time to complete and submit the Single Audit Reporting Package. The extended reporting deadline for calendar year taxpayers is March 31, 2022. |
Attach to Form 990 or 990-EZ.