2021-05-17T11:57:16-05:00 2020-06-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2019-07-01 590878982 LEESBURG REGIONAL MEDICAL CENTER LEES 3523235676 600 EAST DIXIE AVENUE LEESBURG FL 34748 DIANE HARDEN CFO 3523235002 2021-05-17 1 JOHN NORMAN P01506766 7049985200 2019 2022-09-23 18:48:47Z UF HEALTH LEESBURG HOSPITAL DON HENDERSON 600 EAST DIXIE AVENUE LEESBURG FL 34748 255277302 0 X WWW.LEESBURGREGIONAL.ORG X 1961 FL TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE PATIENTS AND COMMUNITIES WE SERVE. 16 16 2194 171 1045599 0 775598 5743782 235793662 239546285 5119485 7387853 554002 2569254 242242747 255247174 42668 59128 0 0 103872689 108645328 0 0 0 128800601 133755785 232715958 242460241 9526789 12786933 364950412 413507047 78740870 116863181 286209542 296643866 X TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE PATIENTS AND COMMUNITIES WE SERVE. 0 0 222137376 59128 240595461 LEESBURG REGIONAL MEDICAL CENTER, INC, D/B/A UF HEALTH LEESBURG HOSPITAL, ACQUIRED BY UNIVERSITY OF FLORIDA HEALTH IN JANUARY 2020 HAS BEEN SERVING THE HEALTH CARE NEEDS OF THE LEESBURG COMMUNITY FOR 57 YEARS. THE 351-BED ACUTE CARE HOSPITAL IS LAKE COUNTY'S LARGEST TERTIARY CARE HOSPITAL AND OFFERS ADVANCED CARDIAC CARE WHICH INCLUDES ONE OF THE LARGEST OPEN-HEART PROGRAMS IN FLORIDA AT ITS HEART INSTITUTE. THE HEART INSTITUTE IS PIONEERING MANY GROUNDBREAKING PROCEDURES SUCH AS MINIMALLY-INVASIVE HEART VALVE SURGERY. THE AMERICAN COLLEGE OF CARDIOLOGY HAS RECOGNIZED UF HEALTH LEESBURG HOSPITAL FOR ITS DEMONSTRATED EXPERTISE AND COMMITMENT IN TREATING PATIENTS WITH CHEST PAIN BY AWARDING A CHEST PAIN CENTER ACCREDITATION WITH PRIMARY PCI AND RESUSCITATION - ITS HIGHEST LEVEL OF ACCREDITATION. THE HOSPITAL ALSO OFFERS ADVANCED ORTHOPEDIC CARE AT ITS DEDICATED INPATIENT JOINT CENTER, NEUROSURGERY, STROKE CARE, DIAGNOSTIC LABORATORY SERVICES, AND NATIONALLY-RECOGNIZED CANCER CARE. 222137376 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 107 0 2194 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 1 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 FL X DIANE HARDEN CFO 3523235002 600 E DIXIE AVE LEESBURG FL 34748 EDWARD JIMENEZ DIRECTOR (BEGINNING 1/1/20) 1.00 49.00 X X 0 1501817 41257 DAVID NELSON MD DIRECTOR (BEGINNING 1/1/20) 1.00 49.00 X X 0 1345265 35407 W KENT FUCHS PHD DIRECTOR (BEGINNING 1/1/20) 0.50 49.50 X 0 1126843 91368 DONALD HENDERSON PRESIDENT/CEO CENTRAL FLORIDA HEALTH, INC. 30.00 20.00 X 837714 0 129974 GILBERT UPCHURCH MD DIRECTOR (BEGINNING 1/1/20) 0.50 49.50 X 0 802835 36481 C PARKER GIBBS MD DIRECTOR (BEGINNING 1/1/20) 1.00 49.00 X 0 758673 43447 JAMES KELLY JR SVP/CFO/TREASURER, SHANDS 1.00 49.00 X 0 750266 36281 LI-MING SU MD DIRECTOR (BEGINNING 1/1/20) 0.50 49.50 X 0 710917 45822 JOSEPH TYNDALL MD DIRECTOR (BEGINNING 1/1/20) 0.50 49.50 X 0 648437 38945 DIANE HARDEN SVP/CFO CENTRAL FLORIDA HEALTH, INC. 30.00 20.00 X 506190 0 79974 RANDALL JENKINS SVP AND GEN. COUNS./SECRETARY 1.00 49.00 X 0 535898 32228 JULIE JOHNSON PHARMD DIRECTOR (BEGINNING 1/1/20) 0.50 49.50 X 0 488522 45003 SAMUEL BUNDZ PHYSICIAN 50.00 X 431545 0 42493 WILLIAM PFINGSTEN VP AMBULATORY SERVICES 30.00 20.00 X 406676 0 42266 PHYLLIS BAUM VP/CQO 30.00 20.00 X 381955 0 64413 MICHAEL MCKEE DIRECTOR (1/1/20 THROUGH 4/29/20) 0.50 49.50 X 0 336541 104334 ORLANDO ICAZA PHYSICIAN 50.00 X 364929 0 31738 DAVID RIZZUTO PHYSICIAN 50.00 X 362810 0 31617 AMIE RICHASON VP HUMAN RESOURCES 30.00 20.00 X 324091 0 69209 DAVID STEELE VP/CIO 30.00 20.00 X 322217 0 69110 SUSSANA OH PHYSICIAN 50.00 X 329106 0 42143 JEFFREY BALTZER PHYSICIAN 50.00 X 333340 0 20417 JOSHUA FLEMING VP/CCO & SITE ADMINSTRATOR 30.00 20.00 X 277538 0 68978 PHILIP BRAUN CHIEF COUNSEL 30.00 20.00 X 282056 0 59922 ALEXANDER CHANG VP SUPPORT SERVICES 30.00 20.00 X 242670 0 63000 SAAD EHTISHAM SVP/COO CENTRAL FLORIDA HEALTH, INC. 30.00 20.00 X 147444 0 11371 AMANDA J WETTSTEIN BOARD MEMBER 2.00 3.00 X 0 0 0 CHRISTOPHER BRIDGES BOARD MEMBER 2.00 3.00 X 0 0 0 DAVID SUSTARSIC MD BOARD MEMBER 2.00 3.00 X 0 0 0 DWARAK R BANALA MD BOARD MEMBER 2.00 3.00 X 0 0 0 GEORGE E KAINZ MD SECRETARY 2.00 3.00 X X 0 0 0 GEORGE MCCABE BOARD MEMBER 2.00 3.00 X 0 0 0 GREGORY R LEWIS TREASURER 2.00 3.00 X X 0 0 0 H MARLENE O'TOOLE BOARD MEMBER 2.00 3.00 X 0 0 0 LINDSEY M BLAISE VICE CHAIRPERSON 2.00 3.00 X X 0 0 0 LYNNE S WINKER BOARD MEMBER 2.00 3.00 X 0 0 0 MANUEL ALVARADO MD BOARD MEMBER 2.00 3.00 X 0 0 0 RICHARD COLE JR BOARD MEMBER 2.00 3.00 X 0 0 0 ROBERT Q WILLIAMS ESQ BOARD MEMBER 2.00 3.00 X 0 0 0 ROGER A BEYERS CHAIRPERSON 2.00 3.00 X X 0 0 0 RUSSELL J D'EMIDIO BOARD MEMBER 2.00 3.00 X 0 0 0 SHAHBAZ A CHEEMA MD BOARD MEMBER 2.00 3.00 X 0 0 0 ALAN WEST DIRECTOR (BEGINNING 1/1/20) 0.50 0.50 X 0 0 0 CAROLYN ROBERTS DIRECTOR (BEGINNING 1/1/20) 0.50 0.50 X 0 0 0 DAVID JASMUND DIRECTOR (BEGINNING 1/1/20) 0.50 0.50 X 0 0 0 EDMUND BEEBE DIRECTOR (BEGINNING 1/1/20) 0.50 0.50 X 0 0 0 GREGORY LEWIS DIRECTOR (BEGINNING 1/1/20) 0.50 0.50 X 0 0 0 JOHN PATTERSON DIRECTOR (BEGINNING 1/1/20) 0.50 0.50 X 0 0 0 MARSHA POWERS DIRECTOR (BEGINNING 1/1/20) 0.50 0.50 X 0 0 0 THOMAS KUNTZ DIRECTOR (BEGINNING 1/1/20) 0.50 0.50 X 0 0 0 TRACY CHAPMAN DIRECTOR (BEGINNING 1/1/20) 0.50 0.50 X 0 0 0 5550281 9006014 1377198 99 0 1 0 TEAMHEALTH ANESTHESIA 7111 FAIRWAY DRIVE SUITE 540 PALM BEACH GARDEN FL 33418 ANESTHESIA SERVICES 4746540 BERKELEY RESEARCH GROUP LLC 2300 POWELL STREET SUIT 1200 EMERYVILLE CA 94608 PROFESSIONAL SERVICES 4721692 CARDIOVASCULAR ANESTHESIA CONSULTANTS PO DRAWER 3130 OCALA FL 34478 ANESTHESIA SERVICES 1147500 LEESBURG CARDIOVASCULAR ASSOCIATES 700 DOCTORS COURT LEESBURG FL 34748 PROFESSIONAL SERVICES 1123481 COMPREHENSIVE CARE SERVICES INC 31330 SCHOOLCRAFT ROAD SUITE 200 LIVONIA MI 48150 PROFESSIONAL SERVICES 1029007 5 5743782 5743782 NET PATIENT SERVICE RE 621400 229313919 229313919 OTHER OPERATING REVENU 621400 6116607 6116607 ALLIANCE LABS REVENUE 621500 3657191 3070160 587031 CHILD CARE CENTER 812900 458568 458568 239546285 7283973 7283973 474479 0 474479 474479 474479 134008 30128 103880 103880 103880 LAKE MEDICAL IMAGING 900099 2044433 2044433 CARDIAC CO MGMT 900099 50342 50342 2094775 255247174 240595461 1045599 7862332 59128 59128 3801104 3801104 85288122 81110124 4177998 2063035 1721121 341914 11408440 10381680 1026760 6084627 5537011 547616 1875168 1591710 283458 455140 227570 227570 232963 232963 6027009 5244717 782292 1348966 1112961 236005 560676 409177 151499 4727389 3545542 1181847 3942427 3035669 906758 46304 23530 22774 138390 83222 55168 1638763 1638763 13297396 10266299 3031097 2462496 1899868 562628 SUPPLIES 56461563 55936879 524684 BAD DEBT 18349279 18349279 PHYSICIAN & MED SUPPLIE 12081105 12081105 EQUIPMENT RENTAL AND MA 5540120 4579068 961052 4570631 3302953 1267678 242460241 222137376 20322865 0 12644626 93398282 3227615 3076824 24518774 21956309 6907705 7416425 6278819 5789613 392115655 283917182 113890322 108198473 149689154 130973661 47793397 42697460 364950412 413507047 23316392 69566701 37087202 38179319 18337276 9117161 78740870 116863181 X 286209542 296643866 286209542 296643866 364950412 413507047 X 12786933 -2352609 X 0 1 X 1 0 X 0 0 0 0 0 0 1 68930 0 1 14723 83653 0 PART II-B, LINE 1: LOBBYING EXPENSES REPORTED ABOVE REPRESENT A COMBINATION OF HOSPITAL ASSOCIATION DUES ATTRIBUTABLE TO LOBBYING, AS WELL AS AMOUNTS PAID TO CAPITAL CITY CONSULTING FOR CERTAIN DIRECT LOBBYING ACTIVITIES. 9237971 9237971 191647486 128033253 63614233 181305895 150087688 31218207 9924303 5796241 4128062 108198473 DUE FROM AFFILIATES 8158374 INV IN UNCCONSOLIDATED AFFILIATE 23504439 DEFERRED OUTFLOWS ON DEBT REFUNDING 445152 DEFERRED OUTFLOWS ON SWAP VALUATION 2509247 REINSURANCE RECEIVABLE 2610711 RESTRICTED ASSETS FOR PROFESSIONAL LIABILITY TRUST 5104310 NOTE RECEIVABLE - PHYSICIAN GUARANTEES 365227 42697460 MALPRACTICE IBNR 9117161 9117161 X PART X, LINE 2: THE FOLLOWING IS THE TAX FOOTNOTE TAKEN FROM THE CONSOLIDATED FINANCIAL STATEMENTS OF CENTRAL FLORIDA HEATH ("UF CENTRAL FLORIDA") AND ITS AFFILIATED ENTITIES: UFHCF, UFHL, UFHV, UFHL FOUNDATION, AND UFHV FOUNDATION ARE NOT-FOR-PROFIT ORGANIZATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE AND CHAPTER 220.13 OF THE FLORIDA STATUTES, RESPECTIVELY. THE OTHER AFFILIATES ARE SINGLE MEMBER LLCS AND DISREGARDED ENTITIES FOR FEDERAL AND STATE TAX PURPOSES EXCEPT FOR SALES AND USE TAX ON NONMEDICAL PURCHASES. 1 1 X 1 X 1 X 1 1 1 0 1 1 7808333 266950 7541383 0.03370 19034521 12705552 6328969 0.02820 26842854 12972502 13870352 0.06190 26842854 12972502 13870352 0.06190 1 4812086 83254622 80258550 2996072 X 1 0 1 CENTRAL FLORIDA CARDIOVASCULAR CO-MANAGEMENT COMPANY LLC HEALTHCARE SERVICES 0.39130 0.50000 1 1 UF HEALTH LEESBURG HOSPITAL 600 EAST DIXIE AVENUE LEESBURG FL 34748 HTTP://WWW.LEESBURGREGIONAL.ORG X X X UF HEALTH LEESBURG HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X SEE PART V, SECTION C X 1 18 1 SEE PART V, SECTION C 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X 1 X 0 X X X X 1 X 0 0 UF HEALTH LEESBURG HOSPITAL PART V, SECTION B, LINE 5: IN GENERAL, INPUT WAS OBTAINED FROM THE FOLLOWING PERSONS REPRESENTING THE BROAD INTEREST OF THE COMMUNITY SERVED BY THE HOSPITALS: BUSINESS LEADERS, MEMBERS OF LOCAL CHURCHES, COMMUNITY NON-PROFIT ORGANIZATIONS, HEALTH DEPARTMENTS, AND REPRESENTATIVES FROM LOCAL NEIGHBORHOOD COMMUNITIES. THE CENTRAL FLORIDA HEALTH STEERING COMMITTEE AND WELLFLORIDA BASED THE 2019 CHNA EFFORT ON A NATIONALLY RECOGNIZED MODEL AND BEST PRACTICE FOR COMPLETING HEALTH ASSESSMENTS CALLED MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP). THERE ARE FOUR CORE MAPP ASSESSMENTS: COMMUNITY HEALTH STATUS ASSESSMENT, COMMUNITY THEMES AND STRENGTHS ASSESSMENT, FORCES OF CHANGE ASSESSMENT, AND LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT.THE CENTRAL FLORIDA HEALTH STEERING COMMITTEE, IN PARTNERSHIP WITH WELLFLORIDA COUNCIL, COLLABORATED TO FORMULATE TWO SIMILAR SURVEYS TO QUERY INDIVIDUALS ABOUT COMMUNITY HEALTH ISSUES AND THEIR PERSPECIVES ON HEALTHCARE. BOTH SURVEYS EMPLOYED A CONVENIENCE SAMPLING APPROACH (RESPONDENTS WERE SELECTED BASED ON THEIR CONVENIENT ACCESSIBILITY). THE CENTRAL FLORIDA HEALTH STEERING COMMITTEE ASSISTED WITH THE SURVEY DISSEMINATION THROUGH THEIR RESPECTIVE ORGANIZATIONS AND BY CONNECTING WELLFLORIDA TO KEY STAKEHOLDER AND COMMUNITY PARTNERS. THERE WERE A TOTAL OF 583 RESPONDENTS TO THE COMMUNITY SURVEY AND 106 TO THE PROFESSIONAL SURVEY. AFTER ELIMINATING THE INCOMPLETE AND INELIGIBLE SURVEYS, THERE WERE 392 COMMUNITY SURVEYS AND 23 HEALTHCARE PROFESSIONAL SURVEYS FOR ANALYSIS. UF HEALTH LEESBURG HOSPITAL PART V, SECTION B, LINE 6A: LEESBURG REGIONAL MEDICAL CENTERTHE VILLAGES TRI-COUNTY MEDICAL CENTER UF HEALTH LEESBURG HOSPITAL PART V, SECTION B, LINE 6B: WELLFLORIDA COUNCIL UF HEALTH LEESBURG HOSPITAL PART V, SECTION B, LINE 11: LEESBURG REGIONAL MEDICAL CENTER HAS IDENTIFIED THE FOUR FOLLOWING AREAS THAT IT PLANS TO ADDRESS OVER THE NEXT THREE YEARS:STRATEGIC PRIORITY 1: MATERNAL AND INFANT HEALTH OUTCOMESTHE ORGANIZATION WILL IMPROVE THE HEALTH OF WOMEN AND BABIES BY PROVIDING ACCESS TO HEALTH CARE SERVICES, RESOURCES, AND EDUCATION. OUTCOME OBJECTIVES INCLUDE LOWERING THE INFANT MORTALITY RATE FOR BIRTHS TO BLACK/AFRICAN AMERICAN WOMEN BY 10% BY JUNE 30, 2022. THE ORGANIZATION WILL ALSO INCREASE BREASTFEEDING INITIATION RATES BY 10% AND INCREASE THE PERCENTAGE OF WOMEN WHO RECEIVE PRENATAL CARE IN THEIR FIRST TRIMESTER BY JUNE 30, 2022. FINALLY, THE ORGANIZATION WILL WORK TO REDUCE PRIMARY CAESAREAN BIRTHS AMONG LOW RISK WOMEN BY 5% BY JUNE 30, 2022.STRATEGIC PRIORITY 2: AGE RELATED HEALTH ISSUESA. INCREASE ALZHEIMER'S DISEASE AWARENESSTHE ORGANIZATION WILL INCREASE AWARENESS OF ALZHEIMER'S DISEASE SIGN, SYMPTOM, AND CARE OPTIONS BY PROVIDING HEALTH EDUCATION AND INSTITUTING CLINICAL PROCESS CHANGE WITH A GOAL OF HOSTING THREE COMMUNITY HEALTH EDUCATION ACTIVITIES THAT FOCUS ON ALZHEIMER'S DISEASE AWARENESS BY DECEMBER 31, 2021. ALSO, TO INCREASE AWARENESS OF SIGNS AND SYMPTOMS OF ALZHEIMER'S DISEASE AND ALSO THE LINK BETWEEN CERTAIN MEDICATIONS AND INCREASED ALZHEIMER'S DISEASE RISK THROUGH PARTNERSHIP WITH THE LEESBURG REGIONAL MEDICAL CENTER PHARMACY AND MEDICAL STAFF BY PROVIDING EDUCATION TO 90 PERCENT OF ALL INPATIENTS ALONG WITH THEIR PRESCRIPTION.B. REDUCE UNINTENTIONAL INJURIES FROM FALLSTHE ORGANIZATION WILL REDUCE UNINTENTIONAL INJURIES FROM FALLS BY PROVIDING HEALTH EDUCATION, CONDUCTING PATIENT FALL RISK ASSESSMENTS PRIOR TO DISCHARGE, DOCUMENTING FALL RISK AND HISTORY ON EHR, AND PARTNERING WITH COMMUNITY AGENCIES TO INCREASE AWARENESS WITH THE GOAL OF IMPLEMENTING A SCREENING PROGRAM AS A PARTNERSHIP BETWEEN THE EMERGENCY DEPARTMENT AND REHABILITATION SERVICES TEAM TO IDENTIFY PATIENTS 65 YEARS OF AGE AND OLDER WHO PRESENT AS A HIGH FALL RISK AND REDUCE THE OVERALL INPATIENT FALL RISK BY 5% BY JUNE 30, 2022. ADDITIONALLY, THE PROGRAM WILL PROVIDE AT-RISK PATIENTS WITH THE TOOLS THEY NEED TO PREVENT FALLS WHILE IN THE HOSPITAL AND ONCE THEY RETURN HOME.STRATEGIC PRIORITY 3: PRIMARY AND SECONDARY PREVENTION OF CHRONIC DISEASES AND CONDITIONSA. PROMOTE EMPLOYEE WELLNESSTHE ORGANIZATION WILL ENHANCE AND EXPAND THE EMPLOYEE WELLNESS PROGRAM AND ADVOCATE FOR EMPLOYEE WELLNESS POLICY CHANGE (WITH A THREE YEAR OUTCOME GOAL OF INSTITUTING METHODOLOGY TO TRACK AND REPORT EMPLOYEE WELLNESS MEASURES, INCREASING THE PERCENTAGE OF EMPLOYEES WHO HAVE PARTICIPATED IN A PRIMARY PREVENTION WELLNESS ACTIVITY BY 10% AND ENGAGING 20% OF EMPLOYEES WHO HAVE BEEN SCREENED FOR PRE-DIABETES IN SECONDARY PREVENTION ACTIVITIES.)B. EXPAND HEALTH EDUCATION AND PHYSICAL ACTIVITY OPPORTUNITIES FOR CLIENTS WITH CHRONIC DISEASESTHE ORGANIZATION WILL EXPAND COMMUNITY PARTNERSHIPS FOR CHRONIC DISEASE PREVENTION (WITH A THREE YEAR OUTCOME GOAL OF INCREASING PARTICIPATION IN THE SILVER SNEAKERS PROGRAM HOSTED BY THE WELLNESS CENTER BY 15%, ESTABLISHING AN AMERICAN CANCER CENTER RESOURCE CENTER IN LRMC, AND PARTNERING WITH COMMUNITY ORGANIZATIONS TO BRING FOUR CHRONIC DISEASE PREVENTION ACTIVITIES TO COMMUNITIES IN THE LRMC SERVICE AREA)STRATEGIC PRIORITY 4: MENTAL AND BEHAVIORAL HEALTH AND WELLNESSA. PROMOTE SAFE PRESCRIPTION DRUG USETHE ORGANIZATION WILL PROVIDE HEALTH EDUCATION AND PROMOTION ACTIVITES AND SPONSOR COMMUNITY EDUCATION CAMPAIGNS (WITH A THREE YEAR OUTCOME GOAL OF HOSTING THREE SAFE DRUG USE EDUCATION ACTIVITIES FOR COMMUNITY MEMBERS IN THE LRMC SERVICE AREA AND REDUCING UNINTENTIONAL DEATHS BY DRUG POISONING BY 5%).B. IMPROVE COMMUNITY EDUCATION RESOURCES ON MENTAL AND BEHAVIORAL HEALTHTHE ORGANIZATION WILL PROMOTE COMMUNITY EDUCATION ON MENTAL AND BEHAVIORAL HEALTH WITH AN OUTCOME OBJECTIVE OF PARTNERING WITH COMMUNITY ORGANIZATIONS TO BRING FOUR MENTAL HEALTH FIRST AID COURSES TO COMMUNITIES IN THE LRMC SERVICE AREA BY DECEMBER 31, 2021.THE ORGANIZATION IS NOT ABLE TO ADDRESS ALL OF THE NEEDS OF THE COMMUNITY IDENTIFIED IN ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT DUE TO RESOURCE CONSTRAINTS. THE ISSUE RELATED TO HEALTH LITERACY AND WISER USE OF HEALTHCARE BENEFITS AND SERVICES WAS DISCUSSED IN SOME DETAIL. WHILE DEEMED A RECURRING PROBLEM FOR MANY IN THE CFH SERVICE AREAS, THE STEERING COMMITTEE MEMBERS CITED NUMBEROUS HEALTHCARE ORGANIZATIONS AND COMMUNITY PARTNERS ALREADY ENGAGED IN LOCAL INTERVENTIONS TO IMPROVE HEALTH LITERACY. AMONG THE PARTNER ORGANIZATIONS TACKLING THIS ISSUE INCLUDE THE AREA AGENCY ON AGING, ELDER OPTIONS, AND AMERICN ASSOCIATION OF RETIRED PEOPLE (AARP). UF HEALTH LEESBURG HOSPITAL PART V, SECTION B, LINE 16J: THE HOSPITAL FACILITY PUBLICIZES ITS WRITTEN FINANCIAL ASSISTANCE POLICY THROUGH ITS WEBSITE. COPIES ARE AVAILABLE AT THE PATIENT REGISTRATION DESKS AND FINANCIAL COUNSELORS ALSO HAVE IT FOR DISTRIBUTION TO PATIENTS. IT IS ALSO AVAILABLE UPON REQUEST. UF HEALTH LEESBURG HOSPITAL PART V, SECTION B, LINE 20E: ALL SELF PAY PATIENTS THAT COME THROUGH THE EMERGENCY DEPARTMENT OR ARE A DIRECT ADMIT AS URGENT OR EMERGENT ARE SEEN BY A FINANCIAL COUNSELOR/PATIENT DISCHARGE CASHIER AND/OR A REPRESENTATIVE FROM THE HOSPITAL FACILITY'S MEDICAID ELIGIBILITY COMPANY. THE HOSPITAL FACILITY ALWAYS ATTEMPTS TO COLLECT FROM A PATIENT FIRST BUT IF THEY STATE THEY ARE UNABLE TO PAY, WE LOOK FOR OTHER SOURCES OF FUNDING - MEDICAID OR FLORIDA'S HEALTH CARE RESPONSIBILITY ACT ("HCRA").THE HOSPITAL FACILITY HAS A DETAILED APPLICATION PROCESS FOR CHARITY. ALL OF THE HOSPITAL FACILITY'S COMMUNICATION WITH THE PATIENT/FAMILY IS DOCUMENTED IN ITS PATIENT HEALTH MANAGEMENT SYSTEM.THE HOSPITAL FACILITY WILL TAKE THE FOLLOWING ACTIONS BEFORE INITIATING ANY OF THE COLLECTION EFFORTS INDICATED IN LINE 18 AS FOLLOWS. THE FIRST STATEMENT IS SENT TO THE PATIENT FROM THE PATIENT ACCOUNTING SYSTEM AFTER THE ACCOUNT HAS BEEN FINAL BILLED. THREE SUBSEQUENT STATEMENTS ARE SENT ON A 30 DAY CYCLE PERIOD UNITL THE ACCOUNT REACHES 120 DAYS. AFTER WHICH IF THERE IS A BALANCE OUTSTANDING THE ACCOUNT IS PLACED WITH A BAD DEBT COLLECTION AGENCY. 2 1 - UF HEALTH LEESBURG HOSPITAL WELLNESS CEN 700 NORTH PALMETTO ST LEESBURG FL 34748 WELLNESS 2 - SURGERY CENTER OF MOUNT DORA AMB 3710 LAKE CENTER DRIVE MT DORA FL 32757 SURGERY CENTER PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 18,349,279. PART III, LINE 2: THE COST-TO-CHARGE RATIO FOR FISCAL YEAR 2020 WAS APPLIED AGAINST THE BAD DEBT CHARGES OF THE ORGANIZATION TO ARRIVE AT THE AMOUNT CALCULATED FOR PART III, LINE 2. PART III, LINE 4: THE FOOTNOTE FROM THE AUDITED FINANCIAL STATEMENTS RELATED TO BAD DEBT IS AS FOLLOWS: THE PROVISION FOR BAD DEBTS IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON THESE TRENDS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATION TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED UNDER UFHCF POLICIES. PART III, LINE 9B: THE HOSPITAL WORKS TO MAKE A DETERMINATION EXPEDIENTLY THAT THE PATIENT QUALIFIES FOR CHARITY CARE OR FINANCIAL ASSISTANCE, AND AS SUCH, SHOULD NOT BE PURSUED FOR COLLECTIONS. PART VI, LINE 2: THE CENTRAL FLORIDA HEALTH STEERING COMMITTEE AND WELLFLORIDA BASED THE 2019-2022 CHNA EFFORT ON A NATIONALLY RECOGNIZED MODEL AND BEST PRACTICE FOR COMPLETING HEALTH ASSESSMENTS AND IMPROVEMENT PLANS CALLED MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP). THE MAPP TOOL WAS DEVELOPED BY THE NATIONAL ASSOCIATION OF CITY AND COUNTY HEALTH OFFICIALS (NACCHO) IN COOPERATION WITH THE PUBLIC HEALTH PRACTICE PROGRAM OFFICE, CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC). NACCHO AND CDC'S VISION FOR IMPLEMENTING MAPP IS: "COMMUNITIES ACHIEVING IMPROVED HEALTH AND QUALITY OF LIFE BY MOBILIZING PARTNERSHIPS AND TAKING STRATEGIC ACTION." AT THE HEART OF THE MAPP PROCESS ARE THE FOUR CORE MAPP ASSESSMENTS. THESE ARE: - COMMUNITY HEALTH STATUS ASSESSMENT (CHSA) - COMMUNITY THEMES AND STRENGTHS ASSESSMENT (CTSA) - FORCES OF CHANGE ASSESSMENT (FCA) - LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT (LPHSA) PART VI, LINE 3: IN ADDITION TO SIGNAGE THROUGHOUT VARIOUS PARTS OF THE HOSPITAL AND WRITTEN INFORMATION PROVIDED TO PATIENTS DURING PRE-REGISTRATION, THE HOSPITAL PROVIDES THE FOLLOWING PATIENT EDUCATION:- FINANCIAL COUNSELING- WRITTEN ESTIMATES FOR HOSPITAL SERVICES - ITEMIZED BILLINGS (UPON REQUEST)- INFORMATION ABOUT EXTRAORDINARY COLLECTION ACTIONS THAT MAY BE USED AFTER REASONABLE COLLECTION EFFORTS HAVE TAKEN PLACE- A LIST OF SERVICE PROVIDERS THAT PROVIDE SERVICES UNDER THE FAP PART VI, LINE 4: POPULATIONPOPULATION GROWTH IS A KEY DETERMINANT OF THE HEALTHCARE SERVICES A COMMUNITY REQUIRES TO BE ABLE TO SUSTAIN POSITIVE HEALTH BEHAVIORS AND IMPROVED HEALTH OUTCOMES. THE LRMC SERVICE AREA PRIMARILY SERVES AN OLDER ADULT POPULATION GREATER THAN 55 YEARS OF AGE AT 61.3 PERCENT OF THE POPULATION, COMPARED TO 60.1 PERCENT IN THE CENTRAL FLORIDA HEALTH (CFH) SERVICE AREA AND 32.5 PERCENT IN FLORIDA AS A WHOLE.THE OVERWHELMING MAJORITY OF THE LRMC SERVICE AREA POPULATION IS WHITE (87.5 PERCENT) WHICH IS NEARLY THE SAME AS THE CFH SERVICE AREA AT 87.7 PERCENT BUT HIGHER THAN FOR FLORIDA AT 75.7 PERCENT WHITE. THE BLACK, AMERICAN INDIAN AND ALASKA NATIVE, ASIAN ONLY, AND NATIVE HAWAIIAN AND OTHER PACIFIC ISLANDER POPULATIONS COMPRISE 8.3, 0.4, 1.0, AND 0.07 PERCENT OF THE LRMC SERVICE AREA, RESPECTIVELY, WHILE 0.9 PERCENT IDENTIFY THEMSELVES AS ANOTHER RACE AND 1.7 PERCENT IDENTIFY AS HAVING TWO OR MORE RACES. BY 2013-2017 AMERICAN COMMUNITY SURVEY, U.S. CENSUS BUREAU ESTIMATES (ACS), 92.7 PERCENT OF THE POPULATION IN THE LRMC SERVICE AREA IDENTIFIED AS NON-HISPANIC OR LATINO, WHICH IS COMPARABLE TO THE 92.4 PERCENT IN THE CFH SERVICE AREA AND 93.5 PERCENT IN TVRH SERVICE AREA, BUT NOTABLY LARGER THAN IN FLORIDA AS A WHOLE AT 75.3 PERCENT.LIFE EXPECTANCYCONSIDERING ALL RACES AND ETHNICITIES, THE LONGEST LIFE EXPECTANCY FOR MALES IN 2010 WAS FOUND IN SUMTER COUNTY (78.3 YEARS) FOLLOWED BY LAKE COUNTY (75.8 YEARS), AND MARION COUNTY (74.3 YEARS), COMPARED TO FLORIDA (76.3 YEARS). FOR FEMALES, THE LONGEST LIFE EXPECTANCY FOR FEMALES IN 2010 WAS ALSO IN SUMTER COUNTY (82.5 YEARS), FOLLOWED BY LAKE COUNTY (81.3 YEARS), AND MARION COUNTY (80.3 YEARS), COMPARED TO FLORIDA (81.6 YEARS). AS OFTEN SEEN THROUGHOUT THE STATE OF FLORIDA, THERE WAS A DISPARITY IN LIFE EXPECTANCY IN THE BLACK POPULATION AS COMPARED TO THE WHITE POPULATION IN THE LRMC SERVICE AREA COUNTIES.ECONOMIC CHARACTERISTICSAT 12.1 PERCENT OF THE POPULATION, THE LRMC SERVICE AREA HAD A LOWER PERCENTAGE OF INDIVIDUALS HAVING LIVED IN POVERTY IN THE PAST 12 MONTHS WHEN COMPARED TO FLORIDA (15.5 PERCENT) ACCORDING TO 2013-2017 ACS DATA. THE CFH SERVICE AREA IS ALMOST THE SAME AT 12.2 PERCENT WHEREAS TVRH SERVICE AREA POPULATION FARES BETTER AT ONLY 10.6 PERCENT. WITHIN THE LRMC SERVICE AREA, THE ZIP CODES WHERE THIS INDICATOR OF POVERTY ARE HIGHEST INCLUDE EUSTIS (32726) AT 21.1 PERCENT, WEBSTER (33597) AT 17.5 PERCENT AND LAKE PANASOFFKEE (33538) AT 17.3 PERCENT WHILE THE VILLAGES (32162) WAS AT ONLY 5.4 PERCENT. ACROSS THE THREE COUNTIES IN THE LRMC SERVICE AREA FOR THIS SAME PERIOD, MARION COUNTY HAD THE HIGHEST PERCENTAGE OF INDIVIDUALS HAVING LIVED IN POVERTY IN THE PAST 12 MONTHS (17.6 PERCENT) WHICH IS HIGHER THAN THE STATE OF FLORIDA (15.5 PERCENT). LAKE COUNTY, AT 12.8 PERCENT AND SUMTER COUNTY AT 9.2 PERCENT WERE BOTH LOWER THAN FOR FLORIDA.GENDER DIFFERENCES CAN BE SEEN IN RATES OF POVERTY. FOR 2013-2017, THE PERCENTAGE OF MALES HAVING LIVED IN POVERTY IN THE PAST 12 MONTHS IN THE LRMC SERVICE AREA AT 9.8 PERCENT WAS THE SAME AS THE OVERALL CFH SERVICE AREA BUT HIGHER THAN TVRH SERVICE AREA AT 8.6 PERCENT. ALL WERE BELOW THE 12.3 PERCENT STATE RATE FOR FLORIDA. SIMILARLY, THE RATE OF 13.0 PERCENT OF FEMALES HAVING LIVED IN POVERTY IN THE LRMC SERVICE AREA WAS ON PAR WITH THE CFH SERVICE AREA AT 13.1 PERCENT AND HIGHER THAN TVRH RATE OF 11.5 PERCENT. ALTHOUGH THESE RATES FOR FEMALES WERE LOWER THAN THE STATE RATE OF 16.5 PERCENT, THE RATES WERE HIGHER THAN FOR MALES IN THE SAME GEOGRAPHIC AREAS. WHEN COMPARED BY SERVICE AREA COUNTY, BOTH MARION COUNTY MALES AT 13.9 PERCENT AND FEMALES AT 18.4 PERCENT HAD THE HIGHEST RATES FOR THIS POVERTY MEASURE WITH BOTH RATES EXCEEDING STATE RATES (12.3 AND 16.5 PERCENT, RESPECTIVELY). SUMTER COUNTY MALES AND FEMALES HAD THE LOWEST RATES AT 7.2 AND 10.2 PERCENT, RESPECTIVELY. LAKE COUNTY RATES WERE LOWER THAN STATE RATES BUT HIGHER THAN THE CFH SERVICE AREA RATE.POVERTY RATES FOR CHILDREN (0-17 YEARS OF AGE) EXCEEDED STATE RATES IN THE LRMC SERVICE AREA. DATA SHOW THAT FROM 2013-2017 IN THE LRMC SERVICE AREA 27.5 PERCENT OF CHILDREN LIVED IN POVERTY IN THE PAST 12 MONTHS COMPARED TO 26.6 PERCENT IN THE CFH SERVICE AREA AND 22.3 PERCENT STATEWIDE. FOR ADULTS 18-74 YEARS OF AGE POVERTY RATES WERE LOWER IN THE LRMC SERVICE AREA AT 11.0 PERCENT COMPARED TO 11.1 PERCENT FOR THE CFH SERVICE AREA AND 14.0 PERCENT FOR FLORIDA. THE PERCENTAGE OF OLDER ADULTS (75 YEARS OF AGE AND OLDER) HAVING LIVED IN POVERTY IN THE PAST 12 MONTHS WAS LOWER IN THE LRMC SERVICE AREA AT 7.3 PERCENT THAN THE CFH SERVICE AREA AT 7.4 PERCENT AND STATE RATE OF 11.0 PERCENT. AS SEEN IN FIGURE 3, THE GREATEST NUMBERS OF CHILDREN LIVING IN POVERTY WERE IN SUMTER COUNTY AND MARION COUNTY AT 31.4 AND 29.4 PERCENT, RESPECTIVELY, COMPARED TO LAKE COUNTY AT 21.4 PERCENT AND FLORIDA AT 23.6 PERCENT. THERE WAS A SMALLER PERCENTAGE OF ELDERLY (65 -74 YEARS OF AGE) LIVING IN POVERTY ACROSS LAKE, MARION, AND SUMTER COUNTY (6.6, 7.8, AND 3.9 PERCENT, RESPECTIVELY) COMPARED TO FLORIDA.FOR 2013-2017, THE ESTIMATED PERCENTAGE OF BLACKS HAVING LIVED IN POVERTY IN THE PAST 12 MONTHS IN THE LRMC SERVICE AREA WAS 31.0 PERCENT COMPARED TO 10.1 PERCENT FOR WHITES. THIS PERCENTAGE FOR BLACKS WAS HIGHER THAN THE CFH SERVICE AREA RATE OF 30.4 PERCENT AND THE 24.8 STATE RATE. STARK DIFFERENCES IN POVERTY RATES FOR WHITES AND BLACKS WERE SEEN IN THE CFH SERVICE AREA COUNTIES. THE PERCENTAGES OF THE BLACK POPULATION IN MARION COUNTY AT 30.5 PERCENT AND IN SUMTER COUNTY AT 26.3 PERCENT HAVING LIVED IN POVERTY IN THE PAST 12 MONTHS EXCEEDED THE STATE RATE OF 24.8 PERCENT. THE POVERTY RATE FOR WHITES IN MARION COUNTY AT 15.5 PERCENT ALSO EXCEEDED THE STATE RATE FOR WHITES OF 13.3 PERCENT.IN THE LRMC SERVICE AREA, SUMTER COUNTY PER CAPITA INCOME AND MEDIAN HOUSEHOLD INCOME EXCEEDED THE STATE FIGURES AS WELL AS THOSE FOR LAKE AND MARION COUNTIES FOR 2013-2017 FOR ALL RACES. THE SAME PERIOD, BLACKS IN LAKE COUNTY SHOWED HIGHER MEDIAN HOUSEHOLD INCOMES THAN FOR BLACKS STATEWIDE. WHITES IN SUMTER COUNTY RECORDED MEDIAN HOUSEHOLD INCOMES HIGHER THAN STATE AND SERVICE AREA COUNTIES. THE MEDIAN HOUSEHOLD INCOME FOR LAKE COUNTY HISPANICS AT $43,624 WAS THE HIGHEST AMONG THE LRMC SERVICE AREA COUNTIES BUT WAS STILL BELOW THE STATE FIGURE OF $44,196. EDUCATIONAL ATTAINMENTACCORDING TO ACS ESTIMATES FOR 2013-2017, THOSE IN THE LRMC SERVICE AREA 25 YEARS OF AGE AND OLDER WHOSE HIGHEST LEVEL OF EDUCATION COMPLETED WAS A HIGH SCHOOL DIPLOMA (INCLUDING EQUIVALENCY DIPLOMAS AND SOME COLLEGE BUT NO DEGREE) FOR ALL GENDERS WAS 56.5 PERCENT; THE COMPARABLE STATE RATE WAS 49.4 PERCENT. THOSE WITH A COLLEGE DEGREE (INCLUDING ASSOCIATE'S, BACHELOR'S, MASTER'S, PROFESSIONAL AND DOCTORATE DEGREES) FOR THE LRMC SERVICE AREA REPRESENTED 33.8 PERCENT OF THE POPULATION COMPARED TO 38.2 PERCENT FOR FLORIDA. FOR THE 2017-2018 SCHOOL YEAR, OF THE LRMC SERVICE AREA COUNTIES SUMTER COUNTY ACHIEVED THE BEST HIGH SCHOOL GRADUATION RATE AT 87.8 PERCENT WHICH EXCEEDED THE 86.1 STATE RATE AND OUTPACED LAKE COUNTY AT 84.1 PERCENT AND MARION COUNTY AT 81.8 PERCENT. SUMTER COUNTY ALSO RECORDED THE LOWEST HIGH SCHOOL DROPOUT RATE FOR THE SERVICE AREA FOR 2017-2018 AT 3.6 PERCENT, PERFORMING BETTER THAN THE STATE AT 4.0 PERCENT, AND LAKE AND MARION COUNTIES AT 6.1 AND 6.3 PERCENT, RESPECTIVELY.CAUSES OF DEATHTHE TOP FIVE LEADING CAUSES OF DEATH IN THE LRMC SERVICE AREA FOR ALL RACES IN 2015-2017 WERE CANCER, HEART DISEASE, UNINTENTIONAL INJURIES, CHRONIC LOWER RESPIRATORY DISEASE (CLRD) AND STROKE. FOR THE CFH SERVICE AREA AND THE STATE OF FLORIDA THE FIVE LEADING CAUSES OF DEATH WERE THE SAME AS FOR THE LRMC SERVICE AREA WITH A SLIGHT DIFFERENCE IN RANK ORDER. HEART DISEASE WAS THE LEADING CAUSE OF DEATH FOR THE CFH SERVICE AREA AND FLORIDA WHILE CANCER WAS AT THE TOP OF THE LIST FOR TVRH AND LRMC SERVICE AREAS. AGE-ADJUSTED DEATH RATES FOR THE TOP FIVE CAUSES OF DEATH IN TVRH, LRMC AND CFH SERVICE AREAS WERE SIMILAR WHEREAS VAST DIFFERENCES WERE EVIDENT WHEN COMPARED TO FLORIDA RATES. 1 UF HEALTH THE VILLAGES AUXILIARY FOUNDATION 1501 N US HWY 441 THE VILLAGES FL 32159 550818419 501(C)(3) 16500 GENERAL SUPPORT AMERICAN HEART ASSOCIATION 9900 9TH STREET NORTH ST PETERSBURG FL 33716 135613797 501(C)(3) 13750 GENERAL SUPPORT COMMUNITY DEVELOPMENT CORP OF LEESBURG AND VICINITY 311A PINE STREET LEESBURG FL 34748 593455505 501(C)(3) 5000 GENERAL SUPPORT LEESBURG CHAMBER OF COMMERCE PO BOX 490309 LEESBURG FL 34749 590330175 501(C)(6) 8500 GENERAL SUPPORT 3 1 PART I, LINE 2: THE GRANTS MADE BY THE ORGANIZATION WERE MADE TO PUBLIC CHARITIES AND OTHER ORGANIZATIONS THAT SUPORT THE COMMUNITY FOR THE USE IN THEIR EXEMPT MISSIONS. ACCORDINGLY, THE ORGANIZATION EXPECTS THE ORGANIZATIONS TO USE THE FUNDS FOR PROPER PURPOSES, AND AS SUCH, DOES NOT SUBSEQUENTLY MONITOR THE GRANT. X X X X X X 0 1 0 0 0 0 0 1 0 EDWARD JIMENEZ DIRECTOR (BEGINNING 1/1/20) 0 983557 0 311000 0 207260 0 19600 0 21657 0 1543074 0 186542 DAVID NELSON MD DIRECTOR (BEGINNING 1/1/20) 0 1002261 0 335040 0 7964 0 15269 0 20138 0 1380672 0 0 W KENT FUCHS PHD DIRECTOR (BEGINNING 1/1/20) 0 900595 0 163090 0 63158 0 71148 0 20220 0 1218211 0 0 DONALD HENDERSON PRESIDENT/CEO CENTRAL FLORIDA HEALTH 665261 0 155076 0 17377 0 109279 0 20695 0 967688 0 0 0 GILBERT UPCHURCH MD DIRECTOR (BEGINNING 1/1/20) 0 697096 0 100927 0 4812 0 14784 0 21697 0 839316 0 0 C PARKER GIBBS MD DIRECTOR (BEGINNING 1/1/20) 0 690383 0 59478 0 8812 0 23394 0 20053 0 802120 0 0 JAMES KELLY JR SVP/CFO/TREASURER, SHANDS 0 543735 0 132000 0 74531 0 19600 0 16681 0 786547 0 64531 LI-MING SU MD DIRECTOR (BEGINNING 1/1/20) 0 622459 0 88454 0 4 0 22954 0 22868 0 756739 0 0 JOSEPH TYNDALL MD DIRECTOR (BEGINNING 1/1/20) 0 644765 0 0 0 3672 0 14827 0 24118 0 687382 0 0 DIANE HARDEN SVP/CFO CENTRAL FLORIDA HEALTH, INC. 368261 0 72646 0 65283 0 57178 0 22796 0 586164 0 56269 0 RANDALL JENKINS SVP AND GEN. COUNS./SECRETARY 0 439077 0 78013 0 18808 0 16800 0 15428 0 568126 0 0 JULIE JOHNSON PHARMD DIRECTOR (BEGINNING 1/1/20) 0 438522 0 50000 0 0 0 24799 0 20204 0 533525 0 0 SAMUEL BUNDZ PHYSICIAN 429523 0 0 0 2022 0 11200 0 31293 0 474038 0 0 0 WILLIAM PFINGSTEN VP AMBULATORY SERVICES 213198 0 28775 0 164703 0 28956 0 13310 0 448942 0 150164 0 PHYLLIS BAUM VP/CQO 298591 0 39750 0 43614 0 41200 0 23213 0 446368 0 38052 0 MICHAEL MCKEE DIRECTOR (1/1/20 THROUGH 4/29/20) 0 324859 0 9000 0 2682 0 81779 0 22555 0 440875 0 0 ORLANDO ICAZA PHYSICIAN 350266 0 10000 0 4663 0 11200 0 20538 0 396667 0 0 0 DAVID RIZZUTO PHYSICIAN 350387 0 10000 0 2423 0 11200 0 20417 0 394427 0 0 0 AMIE RICHASON VP HUMAN RESOURCES 256317 0 35001 0 32773 0 35916 0 33293 0 393300 0 30656 0 DAVID STEELE VP/CIO 258446 0 34207 0 29564 0 35817 0 33293 0 391327 0 23971 0 SUSSANA OH PHYSICIAN 328824 0 0 0 282 0 11200 0 30943 0 371249 0 0 0 JEFFREY BALTZER PHYSICIAN 320388 0 10000 0 2952 0 0 0 20417 0 353757 0 0 0 JOSHUA FLEMING VP/CCO & SITE ADMINSTRATOR 242478 0 33246 0 1814 0 35185 0 33793 0 346516 0 0 0 PHILIP BRAUN CHIEF COUNSEL 223529 0 28844 0 29683 0 30549 0 29373 0 341978 0 27847 0 ALEXANDER CHANG VP SUPPORT SERVICES 211680 0 28398 0 2592 0 29032 0 33968 0 305670 0 0 0 SAAD EHTISHAM SVP/COO CENTRAL FLORIDA HEALTH, INC. 86148 0 0 0 61296 0 3538 0 7833 0 158815 0 60657 0 PART I, LINE 4B DONALD HENDERSON 457F $98,079 CONTRIBUTION DIANE HARDEN 457F $45,978 CONTRIBUTION PHYLLIS BAUM 457F $30,000 CONTRIBUTION AMIE RICHASON 457F $26,416 CONTRIBUTION DAVID STEELE 457F $25,817 CONTRIBUTION PHILIP BRAUN 457F $21,769 CONTRIBUTION EFFECTIVE JANUARY 1, 2020, SHANDS TEACHING HOSPITAL BECAME THE SOLE MEMBER OF CENTRAL FLORIDA HEALTH, WHICH IS THE SOLE MEMBER OF LEESBURG REGIONAL MEDICAL CENTER. SHANDS TEACHING HOSPITAL ALSO PROVIDES A SUPPLEMENTAL RETIREMENT PLAN FOR CERTAIN KEY EXECUTIVES. THE FOLLOWING INFORMATION RELATES TO KEY EXECUTIVES LISTED IN PART VIII AND SCHEDULE J, PART II THAT WERE EMPLOYED BY SHANDS TEACHING HOSPITAL AND SERVED ON THE LEESBURG REGIONAL MEDICAL CENTER BOARD: THE PURPOSE OF THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IS TO PROVIDE AN ANNUAL CONTRIBUTION BASED ON A PERCENTAGE OF THE PARTICIPANT'S ANNUAL SALARY, PAYABLE ON BEHALF OF THE PARTICIPANTS BY THE ORGANIZATION. THE CONTRIBUTION, LESS WITHHOLDING FOR TAXES USING THE APPLICABLE TAX RATE, IS PAYABLE BY THE ORGANIZATION TO AN ANNUITY CONTRACT(S) SELECTED BY THE PARTICIPANT, OR MAY BE PAID IN CASH AT THE DISCRETION OF THE ADMINISTRATOR OR THE PARTICIPANT. THE ANNUAL CONTRIBUTION, WHEN COUPLED WITH OTHER ORGANIZATION-PROVIDED RETIREMENT BENEFITS, IS INTENDED TO PROVIDE A MARKET COMPETITIVE LEVEL OF TOTAL RETIREMENT BENEFITS TO ATTRACT AND RETAIN EXECUTIVE TALENT. ALL AMOUNTS ARE APPROPRIATELY REPORTED IN COLUMN D OF PART VII AND COLUMN B(III) OF SCHEDULE J. LISTED PERSONS FROM SHANDS, AND PLAN AMOUNTS DISTRIBUTED DURING CALENDAR YEAR 2019, ARE AS FOLLOWS: EDWARD JIMENEZ $186,542 JAMES KELLY, JR. $64,531 PART I, LINE 7 THE ORGANIZATION AWARDS BONUSES ON THE BASIS OF QUALITY AND OTHER PERFORMANCE FACTORS. A CITY OF LEESBURG FL 596000362 2011-10-06 20840000 HOSPITAL REVENUE REFUNDING BONDS, SERIES 2011 0 0 0 A 7920000 20840000 20840000 2011 1 0 1 1 A 0 0 0 0 0.00020 0.00020 0 0 0 A 0 0 0 1 1 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S BYLAWS NOW REQUIRE THAT THE ORGANIZATION'S BOARD MEMBERS BE THE SAME INDIVIDUALS THAT SERVE AS MEMBERS OF THE SHANDS BOARD. THE ORGANIZATION'S ARTICLES AND BYLAWS WERE ALSO CHANGED TO MORE ALIGN WITH THE WAY THAT THE SHANDS BOARD OPERATES, SUCH AS THE TIMING OF BOARD MEETINGS, DETERMINATION OF VARIOUS COMMITTEE CHAIRS, AND THE AUTHORITY OF THE QUALITY COMMITTEE. CENTRAL FLORIDA HEALTH, INC., A FLORIDA NOT FOR PROFIT CORPORATION, REMAINS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 CENTRAL FLORIDA HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE ORGANIZATION'S BOARD SHALL BE THOSE SAME INDIVIDUALS WHO ARE SERVING, AT SUCH GIVEN TIME, AS MEMBERS OF THE BOARD OF DIRECTORS OF SHANDS TEACHING HOSPITAL AND CLINICS, INC., A RELATED FLORIDA NOT FOR PROFIT CORPORATION, UNLESS OTHERWISE DETERMINED BY THE UNIVERSITY OF FLORIDA PRESIDENT PURSUANT TO SECTION 1004.41 OF THE FLORIDA STATUTES. FORM 990, PART VI, SECTION B, LINE 11B A COMPLETE COPY OF THE FORM 990 WAS SENT TO ALL MEMBERS OF THE GOVERNING BODY BEFORE FILING THE FORM. A PRESENTATION REGARDING THE FORM 990 WAS ALSO MADE TO THE ADVISORY BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS ESTABLISHED A CONFLICT OF INTEREST POLICY WHICH HAS BEEN REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. THE ORGANIZATION'S POLICY REQUIRES CERTAIN INDIVIDUALS TO DISCLOSE PARTICIPATION IN ACTIVITIES OR CIRCUMSTANCES THAT MAY PRESENT A CONFLICT OF INTEREST ON AN ANNUAL BASIS OR IF AT ANY TIME SUCH INDIVIDUAL BECOMES AWARE OF CIRCUMSTANCES THAT MAY PRESENT A CONFLICT OF INTEREST. THESE DISCLOSURES ARE REVIEWED BY THE VP GENERAL COUNSEL AND CORPORATE COMPLIANCE DEPARTMENT WHO NOTIFY THE BOARD IF ANY CONCERNS ARISE. INDIVIDUALS COVERED BY THE CONFLICT OF INTEREST POLICY MUST ABSTAIN FROM DELIBERATIONS AND VOTING WITH RESPECT TO TRANSACTIONS WHEREIN A CONFLICT IS DEEMED TO EXIST. FORM 990, PART VI, SECTION B, LINE 15 MANAGEMENT ENGAGES AN INDEPENDENT FIRM ENGAGED IN THE DEVELOPMENT OF COMPENSATION SURVEYS ON EXECUTIVE PAY LEVELS ACROSS DIFFERENT INDUSTRIES PROVIDES COMPETITIVE DATA AND GUIDANCE ON DETERMINING APPROPRIATE AND REASONABLE RANGES AND SALARIES. THE THIRD PARTY WILL PROVIDE RECOMMENDED INCENTIVE COMPENSATION RANGES TO ENSURE TOTAL COMPENSATION IS ALSO REASONABLE AND WILL PERIODICALLY REVIEW ALL OTHER ASPECTS OF COMPENSATION INCLUDING ALL ELEMENTS OF SUPPLEMENTAL BENEFITS TO ENSURE THEY COMPARE WITH COMPETITIVE AND REASONABLE TOTAL REMUNERATION LEVELS. ALL EXECUTIVE, OFFICER, AND KEY EMPLOYEE POSITIONS ARE REVIEWED ANNUALLY TO ENSURE SALARY SCALES ARE IN LINE WITH COMPARABLE POSITIONS IN SIMILAR INSTITUTIONS BY AN INDEPENDENT FIRM. FORM 990, PART VI, SECTION C, LINE 19 GENERALLY, THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS, OR ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. HOWEVER, THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE PUBLICLY AVAILABLE THROUGH FLORIDA'S SECRETARY OF STATE WEBSITE. A COPY OF THE CONSOLIDATED FINANCIAL STATEMENT IS ATTACHED TO THIS 990, AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R). FORM 990, PART XI, LINE 9: WRITE OFF DEFERRED LOAN COSTS -310,009. DEFERRED OUTFLOWS - REFUNDING 511,141. DEFERRED OUTFLOWS - REFUNDING 1,987,687. OTHER CHANGES IN NET ASSETS -28,428. WRITE OFF GOODWILL -4,513,000. ALLIANCE LABS LLC 1456 WILLIAM STREET LEESBURG FL 34748 264322547 OUTREACH LABORATORY FL 3657191 730063 LEESBURG REGIONAL PHYSICIAN SERVICES 600 EAST DIXIE AVENUE LEESBURG FL 34748 263978727 BILLING SERVICE FL 0 0 WILDWOOD TRANSFER LLC 410 S CHILDS STREET LEESBURG FL 34748 823094394 LAND HOLDING FL 0 0 PATHOLOGY SERVICES ALLIANCE LLC 600 EAST DIXIE AVENUE LEESBURG FL 34748 270749750 PATHOLOGY FL 0 0 THE VILLAGES TRI-COUNTY MEDICAL CENTER 1451 EL CAMINO REAL THE VILLAGES FL 32159 593527036 MEDICAL SRVCS FL 501(C)(3) LINE 3 0 LEESBURG REGIONAL MEDICAL CTR FOUNDATION 600 EAST DIXIE AVENUE LEESBURG FL 34748 591800743 SUPPORT HOSP FL 501(C)(3) LINE 12A, I LRMC 1 CENTRAL FLORIDA HEALTH INC 600 EAST DIXIE AVENUE LEESBURG FL 34748 331197054 PARENT HOSP FL 501(C)(3) LINE 12B, II N/A 0 VILLAGES REGIONAL HOSPITAL AUXILIARY INC 1451 EL CAMINO REAL THE VILLAGES FL 32159 550818419 SUPPORT HOSP FL 501(C)(3) LINE 12A, I TVRH 0 SHANDS TEACHING HOSPITAL AND CLINICS INC PO BOX 100336 GAINESVILLE FL 32610 591943502 HOSPITAL FL 501(C)(3) LINE 3 0 UNIVERSITY OF FLORIDA 226 TIGERT HALL GAINESVILLE FL 32611 596002052 EDUCATION FL 115 0 CENTRAL FLORIDA CARDIOVASCULAR CO-MANAGEMENT 600 EAST DIXIE AVENUE LEESBURG FL 34748 HEALTHCARE FL RELATED 207752 120699 0 1 0.39130 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1