2024-11-15T09:30:10-06:00 2023-12-31 420714325 RSM US LLP 30 South Wacker Dr Suite 3300 Chicago IL 606063392 990 2023-01-01 461876304 Atlantic Coast ASC GP1 Inc ATLA 9543024765 3109 Stirling Road 201 Ft Lauderdale FL 33312 Paul Sallwasser CEO 9543024765 2024-11-12 1 1 Rebekuh Eley P01247672 3126343400 2024-11-12 2023 2024-10-15 13:58:12Z Paul Sallwasser 3109 Stirling Road 201 Ft Lauderdale FL 33312 355594 0 X N/A X 2012 FL To serve the objectives and purposes of its parent, Atlantic Coast ASC Holding Company, Inc. in supporting and benefiting the South Broward Hospital District and its residents in furtherance of the health care mission of the district, enhancing the delivery of health care services and being responsive to the health needs of the residents of the district. Acquired and holding a 51% controlling general partner interest in Ambulatory Surgical Facility of South Florida LLLP, DBA Memorial Same Day Surgery Center (ASFSF). ASFSF operates ambulatory surgical facilities in the South Broward Hospital District, providing quality health services to the residents of the district at reasonable costs, and operating in accordance with the community benefit standards applicable to tax exempt healthcare organizations, including promoting health of the general public, providing charity and indigent care and participating in government payor programs on a nondiscriminatory basis. 2 2 0 2 0 0 0 0 1090547 355594 0 0 0 0 1090547 355594 0 0 0 0 264492 281292 0 0 0 338061 334548 602553 615840 487994 -260246 6692303 6741897 54496 160613 6637807 6581284 X To serve the objectives and purposes of its parent, Atlantic Coast ASC Holding Company, Inc. in supporting and benefiting Florida Community Health Network Corp/Memorial Foundation and the South Broward Hospital District and its residents through ownership of a 51% controlling interest in Ambulatory Surgical Facility of South Florida, LLLP, DBA Memorial Same Day Surgery Centers (ASFSF). ASFSF operates ambulatory surgical facilities in the hospital district providing quality health services to residents of the district at reasonable costs, operating in accordance with the community benefit standards of tax exempt healthcare organizations. 0 0 355594 Controlling interest in ASFSF, as described in detail on Schedule O, with the mission to provide efficient and reduced cost healthcare services to the community, in accordance with the policies of the district. 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 2 2 0 0 1 0 1 1 1 0 0 0 0 0 1 1 1 0 0 0 0 0 X Paul Sallwasser 9543024765 3109 Stirling Road 201 Ft Lauderdale FL 33312 Steve Einhorn Director 1.00 4.00 X 0 0 0 Scott Wester Director 1.00 4.00 X 0 0 0 Paul Sallwasser CEO 1.00 39.00 X 0 612115 0 0 612115 0 0 0 1 0 0 Ambulatory Surgical Fa 900003 355594 355594 355594 355594 355594 0 0 209619 209619 71673 71673 16676 16676 28334 28334 205 205 2120 2120 153000 153000 14203 14203 536 536 123 123 368 368 9194 9194 Purchased Services 102891 102891 Facilities 2948 2948 3950 3950 615840 0 615840 0 6692303 6741897 6692303 6741897 54496 160613 54496 160613 X 6637807 6581284 6637807 6581284 6692303 6741897 X -260246 203723 X X 0 1 X 1 0 X X X 1 Memorial Foundation Inc 592082218 7 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Part IV, Section B, line 1 The sole member of Atlantic Coast ASC GP1, Inc. is Atlantic Coast ASC Holding Company, Inc. The sole member of Atlantic Coast ASC Holding Company, Inc. is Florida Community Health Network. The sole member Florida Community Health Network is Memorial Foundation, the supported organization. Memorial Foundation indirectly controls Atlantic Coast ASC GP1, Inc. As provided in its articles of incorporation and its bylaws, and similarly that of its parent corporation: 1. The sole member (Atlantic Coast ASC Holding Company, Inc.) has exclusive authority to take action to ensure the corporation (Atlantic Coast ASC GP1, Inc.) serves its states purpose, ensure the corporation protects and promotes the community benefits served by the member and corporation, ensure the assets and income are used to service the community objectives of the member and corporation, maintain the federal tax exempt status of the member and the corporation. 2. Written consent of the member is required for any amendment, repeal, modification or restatement of the articles or bylaws, and the other actions as stated in that section. 3. The initial board consisted of four directors elected by the member for a term of one year. Following the initial one year term, all directors shall be elected by the directors then in office for a term of one year. 4. If the member determines that any director is not independent or has a conflict of interest, the member of board may remove that director. 5. The board may not take any action which is in contravention of: the stated purpose as set in the articles and bylaws, protecting and promoting the community benefits served by the member, directly or indirectly, ensuring the assets and income are used to serve the community objectives of the foundation and the corporation, and maintaining the tax exempt status of the member and the corporation. 6. If the member believes, based on the reasonable advice of counsel, the board has taken any action that jeopardized the federal tax exempt status of the member or the company (Atlantic Coast ASC GP1, Inc.), it may take any necessary action on behalf of the corporation including voiding and reversing the action of the board. If the board fails to take any action which the member believes, based on the reasonable advice of counsel, must be taken to maintain the federal tax exempt status of the member and the corporation, the member may take such action on behalf of the corporation. The chairman of the foundation's audit committee attends, or at least is invited to attend, the audit committee meetings of Florida Community Health Network. In addition, the CEO of Florida Community Health Network attends the foundation's board meetings to provide an update of Florida Community Health Network's activities and operations and respond to questions of the foundation's board. 0 Investment in Ambulatory Surgical Facillity of South Florida, LLLP 6741897 C 6741897 X Part X, Line 2: The Organization applies the provisions of FASB ASC Topic 740 for income taxes in accounting for uncertainty in income taxes. ASC 740 provides guidance on when tax positions are recognized in an entity's financial statements and how the values of these positions are determined. There is currently no impact on the Organization's consolidated financial statements as a result of the application of ASC 740. The Organization's income tax returns are subject to possible internal revenue examinations, generally for three years after they are filed. 0 0 0 0 0 0 0 0 0 Paul Sallwasser CEO 0 464353 0 83583 0 64179 0 0 0 0 0 612115 0 0 Part I, Line 3 The organization's CEO is compensated by a related 501(c)(3) tax-exempt organization, Florida Community Health Network Corp. The methods used by the related organization for determining the CEO's compensation include use of a compensation committee and approval by the board or compensation committee. Form 990, Part VI, Section A, line 4 The articles of incorporation were amended in 2023 to update number of individuals on the board of directors to three, change the designated supported organization from the Sole Member to Memorial Foundation, Inc., and replace the references to the Member with Memorial Foundation, Inc. in the dissolution clause. Form 990, Part VI, Section A, line 6 The Organization is a wholly owned subsidiary of Atlantic Coast ASC Holding Company, Inc., a 501(c)(3) public charity supporting and benefiting the South Broward Hospital District. Form 990, Part VI, Section A, line 7a The initial board shall consist of four directors elected by the member, Atlantic Coast ASC Holding Company, Inc., who shall each serve for a term of one year. Following the initial one year term, all directors shall be elected by the directors then in office for a term of one year, subject to the reserve powers of the sole member in ensuring the organization serves its charitable purpose. Form 990, Part VI, Section A, line 7b The sole member, Atlantic Coast ASC Holding Company, Inc., has authority to ensure the organization operates and serves its charitable purpose, and its assets and income are used to serve the community benefits of Memorial Foundation, Inc. and the South Broward Hospital District. Form 990, Part VI, Section A, line 8a The governing body did not hold any meetings nor undertake any written actions during the year. Form 990, Part VI, Section A, line 8b Neither the governing body nor any committees with authority to act on behalf of the governing body held any meetings nor undertook any written actions during the year. Form 990, Part VI, Section B, line 11b Management and the chairman of the board review and comment on the Form 990 before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The organization's board shall regularly and consistently monitor and enforce compliance with its conflict of interest policy by reviewing annual statements and taking such other actions as are necessary for effective oversight. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and consolidated financial statements available to public upon request. The financial statements are available for the same period of disclosure as set forth by IRC Section 6104(d). Form 990, Part XI, line 9: Intercompany Balances and Transactions have been 203,723. Recharacterized to Capital Contributions in Accordance with Board approval. Form 990, Part XII, Line 2c There has been no change from the prior year. Form 990, Part XI, Line 2 The organization is a wholly-owned subsidiary of Atlantic Coast ASC Holding Company, Inc., which is a wholly-owned subsidiary of Florida Community Health Network Corp. (FCHN). Certain expenses of FCHN have been allocated to the organization based upon a cost methodology which considers the organization's defined mission, use of resources, and relative benefits received during the period. Memorial Foundation Inc 3329 Johnson Street Hollywood FL 33021 592082218 Support Charitable Activities of South Broward Hospital District FL 501(c)(3) Line 7 N/A 0 Florida Community Health Network Corp 3109 Stirling Road Ste 201 Ft Lauderdale FL 33312 461405669 Support Charitable Activities of Memorial Foundation, Inc. FL 501(c)(3) Line 12a, I Memorial Foundation Inc 0 Atlantic Coast ASC Holding Company Inc 3109 Stirling Road Ste 201 Ft Lauderdale FL 33312 461875883 Support Charitable Activities of Florida Community Health Network Corp FL 501(c)(3) Line 12a, I Florida Community Health Network Corp 0 Joe DiMaggio Children's Hospital Foundation Inc 3329 Johnson Street Hollywood FL 33021 650492343 Support Charitable Activities of Joe DiMaggio Children's Hospital FL 501(c)(3) Line 7 Memorial Foundation Inc 0 Ambulatory Surgical Facility of South Florida LLLP 4470 Sheridan Street Hollywood FL 33021 592753716 Operating and/or managing Ambulatory Surgical Facility FL Atlantic Coast ASC GP1 Inc Related 631779 1601477 0 1 0.51000 SBE Holdings LLC 11011 Sheridan St Ste 106 Cooper City FL 33026 465454822 Member of South Broward Endoscopy, LLC FL N/A N/A 0 0 Cohen Medical Associates LLC 1300 Jog Rd Ste 205 Delray Beach FL 33446 043782956 Primary Care Medical Practice FL N/A N/A 0 0 Cypress Creek Outpatient Surgical Center Holding Company LLC 3109 Stirling Road Ste 201 Ft Lauderdale FL 33312 352596854 Holding Company FL N/A N/A 0 0 Amsurg FCHN ASC Ventures LLC 14 Burton Hills Blvd Nashville TN 37215 815071853 Holding Company FL N/A N/A 0 0 Hallandale Outpatient Surgery Center LTD 306 E Hallandale Beach Blvd Hallandale Beach FL 33009 200244303 Operate Ambulatory Surgery Center FL N/A N/A 0 0 MHS Staffing Resources LLC 1000 Sawgrass Corp Pkwy 100 Sunrise FL 33323 834468496 Temporary Staffing Services FL N/A N/A 0 0 Atlantic Coast Holdings Inc 3109 Stirling Road Ste 201 Ft Lauderdale FL 33312 463231265 Invest in Health Care ventures within or close to SBHD FL N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1