2017-05-05T10:52:41-05:00 2016-06-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2015-07-01 590878982 LEESBURG REGIONAL MEDICAL CENTER LEES 3523235002 600 EAST DIXIE AVENUE LEESBURG FL 34748 DIANE HARDEN CFO 3523235002 2017-04-30 1 JOHN NORMAN P01506766 7049985200 2015 2021-01-29 14:40:06Z DON HENDERSON 600 EAST DIXIE AVENUE LEESBURG FL 34748 244224583 0 X WWW.LEESBURGREGIONAL.ORG X 1961 FL TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE PATIENTS AND COMMUNITIES THEY SERVE. 16 14 2284 189 222973 -618349 0 0 225875979 238271910 4389698 1723832 5947419 4228841 236213096 244224583 156145 168591 0 0 102418014 108665203 0 0 0 114893409 124365082 217467568 233198876 18745528 11025707 333139222 337389636 113026320 106207244 220112902 231182392 X TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE PATIENTS AND COMMUNITIES THE ORGANIZATION SERVES. 0 0 211848643 168591 242500750 LEESBURG REGIONAL MEDICAL CENTER, PART OF CENTRAL FLORIDA HEALTH ("CFH"), IS A 308-BED, ACUTE CARE HOSPITAL THAT OFFERS WORLD CLASS SERVICES CLOSE TO HOME IN LAKE, SUMTER, AND MARION COUNTIES. LOCATED JUST NORTH OF ORLANDO, FLORIDA, LEESBURG REGIONAL MEDICAL CENTER HAS GROWN FROM A SMALL, COMMUNITY HOSPITAL BUILT IN 1963 TO A COMPREHENSIVE MEDICAL CENTER. THE LEESBURG REGIONAL HEART INSTITUTE OFFERS PREMIER CARDIOVASCULAR SERVICES, AND IS RECOGNIZED FOR ITS CUTTING-EDGE TECHNOLOGY, OUTSTANDING OUTCOMES, AND CONSISTENTLY HIGH PATIENT SATISFACTION RATINGS. (SEE CONTINUATION ON SCHEDULE O)HOME TO ONE OF THE LARGEST OPEN HEART PROGRAMS IN THE STATE, THE LEESBURG REGIONAL HEART INSTITUTE IS PIONEERING MANY GROUNDBREAKING PROCEDURES SUCH AS MINIMALLY-INVASIVE HEART VALVE SURGERY. AT LEESBURG REGIONAL, WE ARE COMMITTED TO PROVIDING QUALITY CARE AND SERVICE EXCELLENCE. OUR HOSPITAL IS THE REGION'S FIRST DESIGNATED STROKE CENTER WITH THE JOINT COMMISSION SEAL OF APPROVAL, AND WE PROVIDE A MULTIDISCIPLINARY APPROACH TO NEUROSURGICAL CARE. THE JOINT CENTER AT LEESBURG REGIONAL OFFERS WORLD-CLASS ORTHOPEDIC SERVICES, SUCH AS HIP AND KNEE REPLACEMENTS, AND THE HOSPITAL ALSO FEATURES STATE OF THE ART DIAGNOSTIC IMAGING, EMERGENCY ROOM, LABOR AND DELIVERY, PEDIATRIC SERVICES, CANCER CARE AND SO MUCH MORE. 211848643 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 70 0 1 2284 1 1 1 0 0 0 0 0 0 0 0 0 0 X 16 14 0 0 0 0 1 1 1 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 GREGORY LEWIS CHAIRPERSON 2.00 X X 0 0 0 DIANE B SPENCER SECRETARY 2.00 X X 0 0 0 ROGER BEYERS VICE CHAIRPERSON 2.00 X X 0 0 0 LINDSEY BLAISE TREASURER 2.00 X X 0 0 0 DON V HAHNFELDT BOARD MEMBER 2.00 X 0 0 0 JANET BOLIVAR BOARD MEMBER 2.00 X 0 0 0 SHAHBAZ A CHEEMA MD BOARD MEMBER 2.00 X 0 0 0 RUSSELL J D'EMIDIO BOARD MEMBER 2.00 X 0 0 0 SHIVAKUMAR S HANUBAL MD BOARD MEMBER 2.00 X 0 0 0 GEORGE KAINZ MD BOARD MEMBER 2.00 X 0 0 0 GEORGE MCCABE BOARD MEMBER 2.00 X 0 0 0 KENNETH A SAMPONG MD BOARD MEMBER 2.00 X 0 0 0 DAVID L SUSTARSIC MD BOARD MEMBER 2.00 X 0 0 0 TERRY R UPTON BOARD MEMBER 2.00 X 0 0 0 AMANDA J WETTSTEIN BOARD MEMBER 2.00 X 0 0 0 ROBERT Q WILLIAMS ESQ BOARD MEMBER 2.00 X 0 0 0 DONALD HENDERSON PRESIDENT/CEO 30.00 20.00 X 830087 0 16579 DIANE HARDEN SVP/CFO 30.00 20.00 X 430007 0 14611 SAAD EHTISHAM SVP/COO 30.00 20.00 X 480870 0 19008 PHYLLIS BAUM VP/CQO 30.00 20.00 X 367814 0 16874 AMIE RICHASON VP OF HUMAN RESOURCES 30.00 20.00 X 289736 0 15653 DAVID STEELE VP/CIO 30.00 20.00 X 284178 0 17609 PHILIP BRAUN VP/CHIEF COUNSEL 30.00 20.00 X 238180 0 16014 WILLIAM PFINGSTEN VP OF AMBULATORY SERVICES 30.00 20.00 X 244434 0 16336 TED E WILLIAMS VP/FOUNDATION PRESIDENT 0.00 50.00 X 221676 0 12623 TERI KEEL VP/CCO 50.00 0.00 X 266987 0 12435 ALEXANDER CHANG VP, SUPPORT SERVICES 30.00 20.00 X 220177 0 9811 SAMUEL BUNDZ PHYSICIAN 50.00 X 372020 0 7287 ALI R EFFENDI PHYSICIAN 0.00 50.00 X 280799 0 5094 YIN LUK GENERAL SURGEON 0.00 50.00 X 446434 0 8273 ORLANDO ICAZA PHYSICIAN 0.00 50.00 X 336985 0 10711 DAVID RIZZUTO PHYSICIAN 0.00 50.00 X 336985 0 18633 5647369 0 217551 111 0 1 0 LAKE COUNTY ANESTHESIA ASSOCIATES PO BOX 491529 LEESBURG FL 34749 ANESTHESIA SERVICES 2765689 CARDIOVASCULAR ANESTHESIA CONSULTANTS PO BOX 3130 OCALA FL 34478 ANESTHESIA SERVICES 1252500 ANGELICA PO BOX 535122 ATLANTA GA 30353 LINEN SERVICES 1125797 MMODAL SERVICES LTD PO BOX 538504 ATLANTA GA 30353 TRANSCRIPTION SERVICES 1096797 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 554809146 LABORATORY TESTING 830762 44 NET PATIENT SERVICE REVENUE 621400 231855863 231855863 OTHER OPERATING REVENUE 621400 6416047 6193074 222973 238271910 1463382 1463382 412221 0 412221 412221 412221 258955 1495 0 0 258955 1495 260450 260450 NON OPERATING INCOME 900099 1827325 1827325 EHR PAYOUT 900099 1695998 1695998 293297 293297 3816620 244224583 241865557 222973 2136053 168591 168591 975079 975079 86787582 79829718 6957864 2140287 1862050 278237 13024218 11331070 1693148 5738037 4992092 745945 6662353 5132740 1529613 154691 77346 77345 188458 188458 755354 679819 75535 1372134 448615 923519 4834602 4206104 628498 3829379 3174861 654518 237123 149272 87851 1726931 1726931 13551383 11523917 2027466 1636646 994108 642538 SUPPLIES 58406835 58094661 312174 PHYSICIAN & MED SUPPLIE 10258122 9371794 886328 BAD DEBT 9664435 9664435 EQUIPMENT RENTAL AND MA 5829050 5224990 604060 5257586 3195529 2062057 233198876 211848643 21350233 0 25758211 20306530 2199749 1216478 27349914 31303112 5819786 5998480 5097551 6174531 318863559 233834807 81602508 85028752 143944568 146422699 41366935 40939054 333139222 337389636 39915549 36552678 7000 6042 48765695 44588571 24338076 25059953 113026320 106207244 X 220112902 231182392 220112902 231182392 333139222 337389636 X 11025707 43784 X X 0 1 X 1 0 X 0 0 0 0 0 0 1 33090 0 1 13545 46635 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 PRUSTMAN & ASSOCIATES AND CAPITAL CITY CONSULTING FOR CERTAIN DIRECT LOBBYING ACTIVITIES. 8610003 8610003 117181991 75019666 42162325 34311010 31614923 2696087 144099013 121680136 22418877 14661542 5520082 9141460 85028752 DUE FROM AFFILIATES 3809675 DEFERRED LOAN COST 353647 INV IN UNCCONSOLIDATED AFFILIATE 24194909 PHYSICIAN CONTRACTS INTANGIBLE ASSETS 3427300 ASSETS LIMITED AS TO USE 4632658 GOODWILL IN ALLIANCE LABS 1540000 GOODWILL IN PATHOLOGY SERVICES ALLIANCE 2973000 OTHER REC 7865 40939054 SWAP LIABILITY 3542021 MALPRACTICE IBNR 15255875 DUE TO AFFILIATES 6262057 25059953 X PART X, LINE 2: U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE THE ORGANIZATION'S MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE ORGANIZATION HAS ANALYZED THE TAX POSITIONS AND HAS CONCLUDED THAT AS OF JUNE 30, 2016 AND 2015, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 1 1 X 1 X 1 X 1 1 1 0 0 7032711 7032711 0.03020 22693454 15894389 6799065 0.02920 29726165 15894389 13831776 0.05940 29726165 15894389 13831776 0.05940 1 2145505 99901279 99835164 66115 X 1 0 2 1 LEESBURG REGIONAL MEDICAL 600 EAST DIXIE AVENUE LEESBURG FL 34748 HTTP://WWW.LEESBURGREGIONAL.ORG X X X 2 LEESBURG REHABILITATION HOSPITAL 700 N PALMETTO ST LEESBURG FL 34748 HTTP://WWW.LEESBURGREGIONAL.ORG X X LEESBURG REGIONAL MEDICAL CENTER INC 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X SEE PART V X 1 15 1 SEE PART V 0 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X 1 X SEE PART V X SEE PART V X SEE PART V X X X X X X 1 X 0 X X X X X 1 X 0 0 LEESBURG REHABILITATION HOSPITAL 2 0 0 1 X X X X X X X X X 15 1 1 1 1 X SEE PART V X 1 15 1 SEE PART V 0 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X X 1 X SEE PART V X SEE PART V X SEE PART V X X X X X X 1 X 0 X X X X X 0 X X 0 0 LEESBURG REGIONAL MEDICAL CENTER INC 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. MORE SPECIFICALLY, IN ASSESSING OUR COMMUNITIES' HEALTH CARE NEEDS, THE CENTRAL FLORIDA HEALTH STEERING COMMITTEE, IN PARTNERSHIP WITH WELLFLORIDA COUNCIL, COLLABORATED TO FORMULATE THREE SIMILAR, THOUGH SLIGHTLY DIFFERENT SURVEYS (BUSINESS LEADER, CITIZEN, AND PHYSICIAN) TO QUERY INDIVIDUALS ABOUT COMMUNITY HEALTH ISSUES AND HEALTHCARE SYSTEM PERSPECTIVES.A CONVENIENCE SAMPLING APPROACH (RESPONDENTS ARE SELECTED DUE TO THEIR CONVENIENT ACCESSIBILITY) WAS UTILIZED FOR ALL THREE SURVEYS. THE CFH STEERING COMMITTEE ASSISTED WITH THE DISSEMINATION OF SURVEYS THROUGH THEIR RESPECTIVE ORGANIZATIONS AND BY CONNECTING WELLFLORIDA TO KEY STAKEHOLDERS AND COMMUNITY PARTNERS. THERE WERE A TOTAL OF 380 RESPONDENTS TO THE VARIOUS SURVEYS. HOWEVER, ONLY 258 PARTICIPANTS COMPLETED THE VARIOUS SURVEYS IN ITS ENTIRETY (227 CITIZENS, 21 BUSINESS LEADERS, AND 10 PHYSICIANS).ONE OF THE MAIN ELEMENTS OF THE NEEDS ASSESSMENT PROCESS INCLUDED A FORCES OF CHANGE ASSESSMENT (FCA). THE FORCES OF CHANGE ASSESSMENT FOR CENTRAL FLORIDA HEALTH WAS CONDUCTED FOR BOTH HOSPITALS WITHIN THE HOSPITAL SYSTEM --THE VILLAGES REGIONAL HOSPITAL AND LEESBURG REGIONAL MEDICAL CENTER. THIS ASSESSMENT WAS AIMED AT IDENTIFYING FORCES SUCH AS TRENDS, FACTORS, OR EVENTS THAT ARE OR WILL BE INFLUENCING THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITY.ON FEBRUARY 9, 2016, THE STEERING COMMITTEE FOR THE CENTRAL FLORIDA HEALTH COMMUNITY HEALTH ASSESSMENT CONVENED A GROUP OF SEVERAL COMMUNITY LEADERS TO PARTICIPATE IN THIS FORCES OF CHANGE ASSESSMENT. PRIOR TO THE MEETING, WELLFLORIDA COUNCIL DISTRIBUTED A FORCES OF CHANGE BRAINSTORMING TOOL AS WELL AS A THREATS AND OPPORTUNITIES WORKSHEET AND ENCOURAGED INVITEES TO THE MEETING TO BEGIN TO BRAINSTORM THE POSSIBLE FORCES THAT MAY HINDER OR HELP THE COMMUNITY IN ITS QUEST FOR COMMUNITY HEALTH IMPROVEMENT. THE FORCES OF CHANGE FOR LRMC SUMMARIZES THE FORCES OF CHANGE IDENTIFIED FOR THE LRMC SERVICE AREA AND POSSIBLE OPPORTUNITIES AND/OR THREATS THAT MAY NEED TO BE CONSIDERED IN ANY STRATEGIC PLANNING PROCESS RESULTING FROM THIS ASSESSMENT. LEESBURG REHABILITATION 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. MORE SPECIFICALLY, IN ASSESSING OUR COMMUNITIES' HEALTH CARE NEEDS, THE CENTRAL FLORIDA HEALTH STEERING COMMITTEE, IN PARTNERSHIP WITH WELLFLORIDA COUNCIL, COLLABORATED TO FORMULATE THREE SIMILAR, THOUGH SLIGHTLY DIFFERENT SURVEYS (BUSINESS LEADER, CITIZEN, AND PHYSICIAN) TO QUERY INDIVIDUALS ABOUT COMMUNITY HEALTH ISSUES AND HEALTHCARE SYSTEM PERSPECTIVES.A CONVENIENCE SAMPLING APPROACH (RESPONDENTS ARE SELECTED DUE TO THEIR CONVENIENT ACCESSIBILITY) WAS UTILIZED FOR ALL THREE SURVEYS. THE CFH STEERING COMMITTEE ASSISTED WITH THE DISSEMINATION OF SURVEYS THROUGH THEIR RESPECTIVE ORGANIZATIONS AND BY CONNECTING WELLFLORIDA TO KEY STAKEHOLDERS AND COMMUNITY PARTNERS. THERE WERE A TOTAL OF 380 RESPONDENTS TO THE VARIOUS SURVEYS. HOWEVER, ONLY 258 PARTICIPANTS COMPLETED THE VARIOUS SURVEYS IN ITS ENTIRETY (227 CITIZENS, 21 BUSINESS LEADERS, AND 10 PHYSICIANS).ONE OF THE MAIN ELEMENTS OF THE NEEDS ASSESSMENT PROCESS INCLUDED A FORCES OF CHANGE ASSESSMENT (FCA). THE FORCES OF CHANGE ASSESSMENT FOR CENTRAL FLORIDA HEALTH WAS CONDUCTED FOR BOTH HOSPITALS WITHIN THE HOSPITAL SYSTEM --THE VILLAGES REGIONAL HOSPITAL AND LEESBURG REGIONAL MEDICAL CENTER. THIS ASSESSMENT WAS AIMED AT IDENTIFYING FORCES SUCH AS TRENDS, FACTORS, OR EVENTS THAT ARE OR WILL BE INFLUENCING THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITY.ON FEBRUARY 9, 2016, THE STEERING COMMITTEE FOR THE CENTRAL FLORIDA HEALTH COMMUNITY HEALTH ASSESSMENT CONVENED A GROUP OF SEVERAL COMMUNITY LEADERS TO PARTICIPATE IN THIS FORCES OF CHANGE ASSESSMENT. PRIOR TO THE MEETING, WELLFLORIDA COUNCIL DISTRIBUTED A FORCES OF CHANGE BRAINSTORMING TOOL AS WELL AS A THREATS AND OPPORTUNITIES WORKSHEET AND ENCOURAGED INVITEES TO THE MEETING TO BEGIN TO BRAINSTORM THE POSSIBLE FORCES THAT MAY HINDER OR HELP THE COMMUNITY IN ITS QUEST FOR COMMUNITY HEALTH IMPROVEMENT. THE FORCES OF CHANGE FOR LRMC SUMMARIZES THE FORCES OF CHANGE IDENTIFIED FOR THE LRMC SERVICE AREA AND POSSIBLE OPPORTUNITIES AND/OR THREATS THAT MAY NEED TO BE CONSIDERED IN ANY STRATEGIC PLANNING PROCESS RESULTING FROM THIS ASSESSMENT. LEESBURG REGIONAL MEDICAL CENTER INC PART V, SECTION B, LINE 6A: LEESBURG REGIONAL MEDICAL CENTERTHE VILLAGES TRI-COUNTY MEDICAL CENTER LEESBURG REHABILITATION HOSPITAL PART V, SECTION B, LINE 6A: LEESBURG REGIONAL MEDICAL CENTERTHE VILLAGES TRI-COUNTY MEDICAL CENTER LEESBURG REGIONAL MEDICAL CENTER INC PART V, SECTION B, LINE 6B: WELLFLORIDA COUNCIL LEESBURG REHABILITATION HOSPITAL PART V, SECTION B, LINE 6B: WELLFLORIDA COUNCIL LEESBURG REGIONAL MEDICAL CENTER INC PART V, SECTION B, LINE 11: LEESBURG REGIONAL MEDICAL CENTER HAS IDENTIFIED FIVE AREAS THAT IT PLANS TO ADDRESS OVER THE NEXT THREE YEARS:OBESITY IN ADULTS THE ORGANIZATION WILL CONTINUE PARTICIPATION IN THE ANNUAL CORPORATE WELLNESS CHALLENGE IN PARTNERSHIP WITH THE LEESBURG AND SUMTER COUNTY CHAMBER OF COMMERCE TO PROMOTE WEIGHT LOSS AND WELLNESS AMONG THE AREA'S LARGEST EMPLOYERS (WITH A THREE YEAR OUTCOME GOAL OF REDUCING BY THREE PERCENT THE COMBINED, CUMULATIVE WEIGHT AMONG CORPORATE WELLNESS CHALLENGE MEMBERS BY JULY 1, 2019). THE ORGANIZATION WILL ALSO PROVIDE FOUR NO-COST COMMUNITY HEALTH EDUCATION EVENTS (TARGETING RESIDENTS OF LEESBURG, FRUITLAND PARK, BUSHNELL, WILDWOOD AND SUMTERVILLE) EACH YEAR ADDRESSING NUTRITION AND EXERCISE IN LAKE AND SUMTER COUNTIES (WITH A THREE YEAR OUTCOME GOAL OF HAVING 15 PERCENT OF EVENT PARTICIPANTS LEARN THEIR CURRENT BODY MASS INDEX AND RECEIVE EDUCATION ABOUT HOW TO MAINTAIN A HEALTHY WEIGHT BY JULY 1, 2019).LACK OF PHYSICAL ACTIVITY THE ORGANIZATION WILL CONTINUE DEVELOPMENT OF THE COMMUNITY/TEAM MEMBER WELLNESS TRACK ON THE CAMPUS OF LEESBURG REGIONAL MEDICAL CENTER (WITH A THREE YEAR OUTCOME GOAL OF INCREASING BY 5 PERCENT THE NUMBER OF CENTRAL FLORIDA HEALTH TEAM MEMBERS WHO UTILIZE THE TRACK ON A WEEKLY BASIS BY JULY 1, 2019). THE ORGANIZATION WILL ALSO SPONSOR ANNUAL COMMUNITY WALK/YOUTH DANCE COMPETITION EVENTS IN LAKE AND SUMTER COUNTIES (TARGETING RESIDENTS OF LEESBURG, FRUITLAND PARK, BUSHNELL, WILDWOOD AND SUMTERVILLE) DESIGNED TO ENCOURAGE FAMILIES TO USE PRACTICAL ACTIVITIES TO INCORPORATE EXERCISE INTO THEIR DAILY LIVES (WITH A THREE YEAR OUTCOME GOAL OF HAVING 15 PERCENT OF EVENT PARTICIPANTS LEARN THEIR CURRENT BODY WEIGHT AND RECEIVE EDUCATION ABOUT HOW TO MAINTAIN A HEALTHY WEIGHT BY JULY 1, 2019).SHORTAGE OF HEALTH SERVICES THE ORGANIZATION WILL DEVELOP AN AWARENESS CAMPAIGN (TARGETING RESIDENTS OF LEESBURG AND FRUITLAND PARK) FOR THE COMMUNITY MEDICAL CARE CLINIC, A MEDICAL HOME OPERATED IN PARTNERSHIP WITH CENTRAL FLORIDA HEALTH THAT OFFERS NO-COST PRIMARY HEALTH CARE SERVICES, INCLUDING MAMMOGRAMS, MEDICATIONS AND DENTAL CARE TO UNDERSERVED RESIDENTS IN LAKE COUNTY (WITH A THREE YEAR OUTCOME GOAL OF INCREASING CLINIC VOLUMES BY 3 PERCENT BY JULY 1, 2019). THE ORGANIZATION WILL ALSO EXPAND ITS URGENT CARE CENTER PRESENCE TO MEET THE NEEDS OF ITS RAPIDLY GROWING POPULATION WITH THE ENTRANCE OF A THIRD LOCATION IN A YET-TO-BE-NAMED COMMUNITY (WITH A THREE YEAR OUTCOME GOAL OF REDUCING CAPACITY CONSTRAINTS BY FIVE PERCENT IN THE EMERGENCY DEPARTMENTS AT LEESBURG REGIONAL MEDICAL CENTER AND THE VILLAGES REGIONAL HOSPITAL). FINALLY, THE ORGANIZATION WILL CONTINUE TO RECRUIT NEEDED PHYSICIAN SPECIALISTS AND SUB-SPECIALISTS TO THE COMMUNITY BASED ON A BI-ANNUAL PHYSICIAN COMMUNITY NEEDS ANALYSIS (WITH A THREE YEAR OUTCOME GOAL OF THE SUCCESSFUL RECRUITMENT OF PHYSICIANS FROM EACH IDENTIFIED SPECIALTY, INCLUDING URGENT CARE, NEUROLOGY AND OTOLARYNGOLOGY (EAR, NOSE AND THROAT) BY JULY 1, 2019).INAPPROPRIATE USE OF EMERGENCY CARETHE ORGANIZATION WILL LAUNCH A PUBLIC AWARENESS CAMPAIGN THROUGHOUT LAKE AND SUMTER COUNTIES (TARGETING RESIDENTS OF LEESBURG, FRUITLAND PARK, BUSHNELL, WILDWOOD AND SUMTERVILLE) EDUCATING THE COMMUNITY ABOUT WHEN IT IS BEST TO UTILIZE THEIR PRIMARY CARE PHYSICIAN OR URGENT CARE CENTER AND WHEN MOST APPROPRIATE TO VISIT THEIR LOCAL EMERGENCY DEPARTMENT (WITH A THREE YEAR OUTCOME GOAL OF INCREASING BY FIVE PERCENT THE NUMBER OF PATIENTS WHO PRESENT TO CENTRAL FLORIDA HEALTH URGENT CARE CENTERS AND INDICATE THAT THEY LEARNED ABOUT URGENT CARE SERVICES THROUGH THE CAMPAIGN BY JULY 1, 2019). THE ORGANIZATION WILL ALSO IMPLEMENT A PHYSICIAN TRIAGE PROGRAM AT LEESBURG REGIONAL MEDICAL CENTER AND THE VILLAGES REGIONAL HOSPITAL TO OPTIMIZE SYMPTOM AND TREATMENT MANAGEMENTS FOR PATIENTS WHO ARRIVE AT THE EMERGENCY DEPARTMENT FOR CARE (WITH A THREE YEAR OUTCOME GOAL OF DECREASING BY FIVE PERCENT WAIT TIMES IN THE VILLAGES REGIONAL HOSPITAL AND LEESBURG REGIONAL MEDICAL CENTER EMERGENCY DEPARTMENTS BY JULY 1, 2019).OTHER IDENTIFIED HEALTHCARE ISSUESTHE ORGANIZATION WILL MAINTAIN ITS PARTNERSHIP PLEDGE WITH THE AMERICAN CANCER SOCIETY TO RAISE THE RATE OF COLON CANCER SCREENINGS TO 80 PERCENT BY THE YEAR 2018 (WITH A THREE YEAR OUTCOME GOAL OF REDUCING THE NUMBER OF COLON CANCER DEATHS BY TWO PERCENT IN ITS SERVICE AREA BY JULY 1, 2019). THE ORGANIZATION WILL ALSO CONTINUE ITS HIRING POLICY THAT EXCLUDES INDIVIDUALS WHO USE TOBACCO FROM BEING ELIGIBLE TO JOIN THE CENTRAL FLORIDA HEALTH TEAM (WITH A THREE YEAR OUTCOME GOAL OF REDUCING BY FIVE PERCENT THE NUMBER OF CENTRAL FLORIDA HEALTH EMPLOYEES WHO USE TOBACCO PRODUCTS BY JULY 1, 2019). FINALLY, THE ORGANIZATION WILL FURTHER DEVELOP PARTNERSHIPS WITH FAITH-BASED ORGANIZATIONS IN COMMUNITIES WHERE THERE ARE IDENTIFIED HEALTH DISPARITIES (PRIMARILY LEESBURG, FRUITLAND PARK, BUSHNELL, WILDWOOD AND SUMTERVILLE) TO PROVIDE DIABETES, HEART DISEASE AND CANCER EDUCATION AND SCREENINGS (WITH A THREE THREE YEAR OUTCOME GOAL OF HAVING 25 PERCENT OF EVENT PARTICIPANTS LEARN THEIR CURRENT GLUCOSE AND BLOOD PRESSURE LEVELS AND RECEIVE EDUCATION ABOUT HOW TO PREVENT AND/OR MANAGE HYPERTENSION AND DIABETES BY JULY 1, 2019).THE ORGANIZATION IS NOT ABLE TO ADDRESS ALL OF THE NEEDS OF THE COMMUNITY IDENTIFIED IN IT'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT DUE TO RESOURCE CONSTRAINTS. LEESBURG REGIONAL MEDICAL CENTER RECOGNIZES THAT OTHER COMMUNITY GROUPS HAVE MORE EXPERIENCE TO MEET THOSE NEEDS. THE NEEDS IDENTIFIED THAT ARE BEING ADDRESSED BY OTHER ORGANIZATIONS ARE DENTAL CARE, AGING PROBLEMS, RESPIRATORY/LUNG DISEASE, MENTAL HEALTH, NUTRITION AND UTILIZING VOLUNTEER WORKFORCE. LEESBURG REHABILITATION HOSPITAL PART V, SECTION B, LINE 11: LEESBURG REGIONAL MEDICAL CENTER HAS IDENTIFIED FIVE AREAS THAT IT PLANS TO ADDRESS OVER THE NEXT THREE YEARS:OBESITY IN ADULTS THE ORGANIZATION WILL CONTINUE PARTICIPATION IN THE ANNUAL CORPORATE WELLNESS CHALLENGE IN PARTNERSHIP WITH THE LEESBURG AND SUMTER COUNTY CHAMBER OF COMMERCE TO PROMOTE WEIGHT LOSS AND WELLNESS AMONG THE AREA'S LARGEST EMPLOYERS (WITH A THREE YEAR OUTCOME GOAL OF REDUCING BY THREE PERCENT THE COMBINED, CUMULATIVE WEIGHT AMONG CORPORATE WELLNESS CHALLENGE MEMBERS BY JULY 1, 2019). THE ORGANIZATION WILL ALSO PROVIDE FOUR NO-COST COMMUNITY HEALTH EDUCATION EVENTS (TARGETING RESIDENTS OF LEESBURG, FRUITLAND PARK, BUSHNELL, WILDWOOD AND SUMTERVILLE) EACH YEAR ADDRESSING NUTRITION AND EXERCISE IN LAKE AND SUMTER COUNTIES (WITH A THREE YEAR OUTCOME GOAL OF HAVING 15 PERCENT OF EVENT PARTICIPANTS LEARN THEIR CURRENT BODY MASS INDEX AND RECEIVE EDUCATION ABOUT HOW TO MAINTAIN A HEALTHY WEIGHT BY JULY 1, 2019).LACK OF PHYSICAL ACTIVITY THE ORGANIZATION WILL CONTINUE DEVELOPMENT OF THE COMMUNITY/TEAM MEMBER WELLNESS TRACK ON THE CAMPUS OF LEESBURG REGIONAL MEDICAL CENTER (WITH A THREE YEAR OUTCOME GOAL OF INCREASING BY 5 PERCENT THE NUMBER OF CENTRAL FLORIDA HEALTH TEAM MEMBERS WHO UTILIZE THE TRACK ON A WEEKLY BASIS BY JULY 1, 2019). THE ORGANIZATION WILL ALSO SPONSOR ANNUAL COMMUNITY WALK/YOUTH DANCE COMPETITION EVENTS IN LAKE AND SUMTER COUNTIES (TARGETING RESIDENTS OF LEESBURG, FRUITLAND PARK, BUSHNELL, WILDWOOD AND SUMTERVILLE) DESIGNED TO ENCOURAGE FAMILIES TO USE PRACTICAL ACTIVITIES TO INCORPORATE EXERCISE INTO THEIR DAILY LIVES (WITH A THREE YEAR OUTCOME GOAL OF HAVING 15 PERCENT OF EVENT PARTICIPANTS LEARN THEIR CURRENT BODY WEIGHT AND RECEIVE EDUCATION ABOUT HOW TO MAINTAIN A HEALTHY WEIGHT BY JULY 1, 2019).SHORTAGE OF HEALTH SERVICES THE ORGANIZATION WILL DEVELOP AN AWARENESS CAMPAIGN (TARGETING RESIDENTS OF LEESBURG AND FRUITLAND PARK) FOR THE COMMUNITY MEDICAL CARE CLINIC, A MEDICAL HOME OPERATED IN PARTNERSHIP WITH CENTRAL FLORIDA HEALTH THAT OFFERS NO-COST PRIMARY HEALTH CARE SERVICES, INCLUDING MAMMOGRAMS, MEDICATIONS AND DENTAL CARE TO UNDERSERVED RESIDENTS IN LAKE COUNTY (WITH A THREE YEAR OUTCOME GOAL OF INCREASING CLINIC VOLUMES BY 3 PERCENT BY JULY 1, 2019). THE ORGANIZATION WILL ALSO EXPAND ITS URGENT CARE CENTER PRESENCE TO MEET THE NEEDS OF ITS RAPIDLY GROWING POPULATION WITH THE ENTRANCE OF A THIRD LOCATION IN A YET-TO-BE-NAMED COMMUNITY (WITH A THREE YEAR OUTCOME GOAL OF REDUCING CAPACITY CONSTRAINTS BY FIVE PERCENT IN THE EMERGENCY DEPARTMENTS AT LEESBURG REGIONAL MEDICAL CENTER AND THE VILLAGES REGIONAL HOSPITAL). FINALLY, THE ORGANIZATION WILL CONTINUE TO RECRUIT NEEDED PHYSICIAN SPECIALISTS AND SUB-SPECIALISTS TO THE COMMUNITY BASED ON A BI-ANNUAL PHYSICIAN COMMUNITY NEEDS ANALYSIS (WITH A THREE YEAR OUTCOME GOAL OF THE SUCCESSFUL RECRUITMENT OF PHYSICIANS FROM EACH IDENTIFIED SPECIALTY, INCLUDING URGENT CARE, NEUROLOGY AND OTOLARYNGOLOGY (EAR, NOSE AND THROAT) BY JULY 1, 2019).INAPPROPRIATE USE OF EMERGENCY CARETHE ORGANIZATION WILL LAUNCH A PUBLIC AWARENESS CAMPAIGN THROUGHOUT LAKE AND SUMTER COUNTIES (TARGETING RESIDENTS OF LEESBURG, FRUITLAND PARK, BUSHNELL, WILDWOOD AND SUMTERVILLE) EDUCATING THE COMMUNITY ABOUT WHEN IT IS BEST TO UTILIZE THEIR PRIMARY CARE PHYSICIAN OR URGENT CARE CENTER AND WHEN MOST APPROPRIATE TO VISIT THEIR LOCAL EMERGENCY DEPARTMENT (WITH A THREE YEAR OUTCOME GOAL OF INCREASING BY FIVE PERCENT THE NUMBER OF PATIENTS WHO PRESENT TO CENTRAL FLORIDA HEALTH URGENT CARE CENTERS AND INDICATE THAT THEY LEARNED ABOUT URGENT CARE SERVICES THROUGH THE CAMPAIGN BY JULY 1, 2019). THE ORGANIZATION WILL ALSO IMPLEMENT A PHYSICIAN TRIAGE PROGRAM AT LEESBURG REGIONAL MEDICAL CENTER AND THE VILLAGES REGIONAL HOSPITAL TO OPTIMIZE SYMPTOM AND TREATMENT MANAGEMENTS FOR PATIENTS WHO ARRIVE AT THE EMERGENCY DEPARTMENT FOR CARE (WITH A THREE YEAR OUTCOME GOAL OF DECREASING BY FIVE PERCENT WAIT TIMES IN THE VILLAGES REGIONAL HOSPITAL AND LEESBURG REGIONAL MEDICAL CENTER EMERGENCY DEPARTMENTS BY JULY 1, 2019).OTHER IDENTIFIED HEALTHCARE ISSUESTHE ORGANIZATION WILL MAINTAIN ITS PARTNERSHIP PLEDGE WITH THE AMERICAN CANCER SOCIETY TO RAISE THE RATE OF COLON CANCER SCREENINGS TO 80 PERCENT BY THE YEAR 2018 (WITH A THREE YEAR OUTCOME GOAL OF REDUCING THE NUMBER OF COLON CANCER DEATHS BY TWO PERCENT IN ITS SERVICE AREA BY JULY 1, 2019). THE ORGANIZATION WILL ALSO CONTINUE ITS HIRING POLICY THAT EXCLUDES INDIVIDUALS WHO USE TOBACCO FROM BEING ELIGIBLE TO JOIN THE CENTRAL FLORIDA HEALTH TEAM (WITH A THREE YEAR OUTCOME GOAL OF REDUCING BY FIVE PERCENT THE NUMBER OF CENTRAL FLORIDA HEALTH EMPLOYEES WHO USE TOBACCO PRODUCTS BY JULY 1, 2019). FINALLY, THE ORGANIZATION WILL FURTHER DEVELOP PARTNERSHIPS WITH FAITH-BASED ORGANIZATIONS IN COMMUNITIES WHERE THERE ARE IDENTIFIED HEALTH DISPARITIES (PRIMARILY LEESBURG, FRUITLAND PARK, BUSHNELL, WILDWOOD AND SUMTERVILLE) TO PROVIDE DIABETES, HEART DISEASE AND CANCER EDUCATION AND SCREENINGS (WITH A THREE THREE YEAR OUTCOME GOAL OF HAVING 25 PERCENT OF EVENT PARTICIPANTS LEARN THEIR CURRENT GLUCOSE AND BLOOD PRESSURE LEVELS AND RECEIVE EDUCATION ABOUT HOW TO PREVENT AND/OR MANAGE HYPERTENSION AND DIABETES BY JULY 1, 2019).THE ORGANIZATION IS NOT ABLE TO ADDRESS ALL OF THE NEEDS OF THE COMMUNITY IDENTIFIED IN IT'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT DUE TO RESOURCE CONSTRAINTS. LEESBURG REGIONAL MEDICAL CENTER RECOGNIZES THAT OTHER COMMUNITY GROUPS HAVE MORE EXPERIENCE TO MEET THOSE NEEDS. THE NEEDS IDENTIFIED THAT ARE BEING ADDRESSED BY OTHER ORGANIZATIONS ARE DENTAL CARE, AGING PROBLEMS, RESPIRATORY/LUNG DISEASE, MENTAL HEALTH, NUTRITION AND UTILIZING VOLUNTEER WORKFORCE. LEESBURG REGIONAL MEDICAL CENTER INC PART V, SECTION B, LINE 16I: 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. LEESBURG REHABILITATION HOSPITAL PART V, SECTION B, LINE 16I: THE HOSPITAL FACILITY PUBLICIZES ITS WRITTEN FINANCIAL ASSISTANCE POLICY THROUGH ITS WEBSITE, COPIES AVAILABLE AT THE PATIENT REGISTRATION DESKS AND FINANCIAL COUNSELORS ALSO HAVE IT FOR DISTRIBUTION TO PATIENTS. IT IS ALSO AVAILABLE TO ANYONE WHO REQUESTS IT. LEESBURG REGIONAL MEDICAL CENTER INC 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. LEESBURG REHABILITATION HOSPITAL PART V, SECTION B, LINE 20E: ALL SELF PAY PATIENTS THAT COME THROUGH THE EMERGENCY DEPARTMENT OR ARE ADIRECT 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. LEESBURG REGIONAL MEDICAL CENTER INC PART V, SECTION B, LINE 22D: THE HOSPITAL DETERMINES THE AMOUNTS BILLED TO PATIENTS WHO DID NOT HAVE INSURANCE COVERING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE BY USING A DISCOUNT AGAINST GROSS CHARGES, USUALLY A 40% OR GREATER DISCOUNT, AT THE TIME OF SERVICE. LEESBURG REHABILITATION HOSPITAL PART V, SECTION B, LINE 22D: THE HOSPITAL DETERMINES THE AMOUNTS BILLED TO PATIENTS WHO DID NOT HAVE INSURANCE COVERING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE BY USING A DISCOUNT AGAINST GROSS CHARGES, USUALLY A 40% OR GREATER DISCOUNT, AT THE TIME OF SERVICE. SCH H, PT V, SECT B, LINES 7A & 10A -- BOTH FACILITIES WWW.LEESBURGREGIONAL.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 2 1 - LRMC WELLNESS CENTER 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 III, LINE 2: THE COST-TO-CHARGE RATIO FOR FISCAL YEAR 2016 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 ISAS FOLLOWS: ALLOWANCE FOR UNCOLLECTIBLE PATIENT ACCOUNTS ADDITIONS TO THEALLOWANCE FOR UNCOLLECTIBLE PATIENT ACCOUNTS ARE MADE BY MEANS OF THEPROVISION FOR BAD DEBTS. ACCOUNTS RECEIVABLE ARE WRITTEN-OFF AFTERCOLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE ALLIANCE'SPOLICIES. ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THEALLOWANCE FOR UNCOLLECTIBLE PATIENT ACCOUNTS, AND SUBSEQUENT RECOVERIESARE ADDED. THE AMOUNT OF THE PROVISION FOR BAD DEBTS IS BASED UPONMANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS,BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENTHEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICIES DO NOT CONTAIN PROVISIONS RELATING TO COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. 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. 0 AMERICAN CANCER SOCIETY PO BOX 102454 ATLANTA GA 30368 131788491 501(C)(3) 7500 SPONSORSHIP LEESBURG AREA CHAMBER OF COMMERCE PO BOX 490309 LEESBURG FL 347490309 590330175 501(C)(6) 11000 SPONSORSHIP BOYS & GIRLS CLUB OF LAKE AND SUMTER COUNTIES P O BOX 896179 LEESBURG FL 347896179 591524504 501(C)(3) 10000 SPONSORSHIP THE VILLAGES CHARTER SCHOOL 1350 TOTONKA TERRACE THE VILLAGES FL 32162 593597803 501(C)(3) 20000 SPONSORSHIP 3 1 FORM 990, SCHEDULE I, PART I, QUESTION 2 THE GRANTS MADE BY THE ORGANIZATION WERE MADE TO PUBLIC CHARITIES FOR USE IN THEIR EXEMPT MISSION. ACCORDINGLY, THE ORGANIZATION EXPECTS THE CHARITIES 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 DONALD HENDERSON PRESIDENT/CEO 610477 0 207952 0 11658 0 10600 0 5979 0 846666 0 0 0 DIANE HARDEN SVP/CFO 331918 0 89103 0 8986 0 10600 0 4011 0 444618 0 0 0 SAAD EHTISHAM SVP/COO 377168 0 101251 0 2451 0 10600 0 8408 0 499878 0 0 0 PHYLLIS BAUM VP/CQO 307498 0 57000 0 3316 0 10600 0 6274 0 384688 0 0 0 AMIE RICHASON VP OF HUMAN RESOURCES 241861 0 45689 0 2186 0 9674 0 5979 0 305389 0 0 0 DAVID STEELE VP/CIO 236378 0 44654 0 3146 0 9455 0 8154 0 301787 0 0 0 PHILIP BRAUN VP/CHIEF COUNSEL 199330 0 37655 0 1195 0 7973 0 8041 0 254194 0 0 0 WILLIAM PFINGSTEN VP OF AMBULATORY SERVICES 198826 0 37560 0 8048 0 7953 0 8383 0 260770 0 0 0 TED E WILLIAMS VP/FOUNDATION PRESIDENT 179979 0 33999 0 7698 0 7199 0 5424 0 234299 0 0 0 TERI KEEL VP/CCO 219955 0 38951 0 8081 0 8248 0 4187 0 279422 0 0 0 ALEXANDER CHANG VP, SUPPORT SERVICES 184620 0 34201 0 1356 0 2923 0 6888 0 229988 0 0 0 SAMUEL BUNDZ PHYSICIAN 350002 0 11199 0 10819 0 1077 0 6210 0 379307 0 0 0 ALI R EFFENDI PHYSICIAN 280799 0 0 0 0 0 0 0 5094 0 285893 0 0 0 YIN LUK GENERAL SURGEON 240444 0 205817 0 173 0 6225 0 2048 0 454707 0 0 0 ORLANDO ICAZA PHYSICIAN 335005 0 0 0 1980 0 6700 0 4011 0 347696 0 0 0 DAVID RIZZUTO PHYSICIAN 335005 0 0 0 1980 0 10600 0 8033 0 355618 0 0 0 PART I, LINE 4B DON HENDERSON 457F CONTRIBUTION $91,743 DIANE HARDEN 457F CONTRIBUTION $41,251 SAAD EHTISHAM 457F CONTRIBUTION $46,875 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 B CITY OF LEESBURG FL 596000362 2013-11-18 13120000 HOSPITAL REVENUE REFUNDING BONDS, SERIES 2013 0 0 0 A 2940000 20840000 20840000 2011 1 0 1 1 B 8335000 13120000 13120000 2013 1 0 1 1 A 0 0 1 1 0 0.01770 0.01770 0 0 0 B 0 0 1 1 0 0.01110 0.01110 0 0 0 A 0 0 0 0 1 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 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 CENTRAL FLORIDA HEALTH APPOINTS THE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B AS DEFINED IN THE ORGANIZATION'S BYLAWS, CERTAIN DECISIONS OF THE ORGANIZATION ARE SUBJECT TO CENTRAL FLORIDA HEALTH'S APPROVAL. FORM 990, PART VI, SECTION B, LINE 11 DURING APRIL 2017, MANAGEMENT DISTRIBUTED A DRAFT OF THE 2015 FORM 990 TO THE FINANCE COMMITTEE FOR ITS REVIEW. THE FINANCE COMMITTEE MEMBERS HAD AN OPPORTUNITY TO PROVIDE COMMENTS AND ASK QUESTIONS WITH RESPECT TO THE DRAFT. BASED ON FEEDBACK PROVIDED FROM THE COMMITTEE MEMBERS, MANAGEMENT UPDATED THE DRAFT FORM 990. UPON FINALIZATION OF THE RETURN, MANAGEMENT PROVIDED A FINALIZED COPY OF THE RETURN TO THE BOARD OF DIRECTORS 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 THE BOARD OF THE ORGANIZATION APPOINTS THE COMPENSATION COMMITTEE. THE INDIVIDUALS SERVING ON THE COMPENSATION COMMITTEE ALSO SERVE ON THE EXECUTIVE COMMITTEE OF THE ORGANIZATION. THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE COMPENSATION FOR THE PRESIDENT AND CEO AS WELL AS THE VICE PRESIDENTS AND SENIOR VICE PRESIDENTS. THE COMPENSATION COMMITTEE HAS A COMPENSATION CHARTER AND PHILOSOPHY. THE ORGANIZATION UTILIZES COMPARABLE COMPENSATION INFORMATION FROM SULLIVAN COTTER & ASSOCIATES, INC. AS ITS THIRD PARTY NEUTRAL SOURCE TO PREPARE AND GATHER MARKET INFORMATION FOR REVIEW BY THE COMPENSATION COMMITTEE. DETAILED MINUTES ARE KEPT OF ALL ACTIONS. 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: TRANSFER OF NET ASSETS 43,784. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED EITHER ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. LEESBURG REGIONAL PHYSICIAN SERVICES 600 EAST DIXIE AVENUE LEESBURG FL 34748 263978916 BILLING SERVICE FL ALLIANCE LABS LLC 1456 WILLIAM STREET LEESBURG FL 37348 264322547 OUTREACH LAB FL 4268407 7475269 THE VILLAGES TRI-COUNTY MEDICAL CENTER 1451 EL CAMINO REAL THE VILLAGES FL 32159 593527036 MEDICAL SRVCS FL 501(C)(3) 3 CFH 0 LEESBURG REGIONAL MEDICAL CTR FOUNDATION 600 EAST DIXIE AVENUE LEESBURG FL 34748 591800743 SUPPORT HOSP FL 501(C)(3) 11 CFH 0 CENTRAL FLORIDA HEALTH INC 600 EAST DIXIE AVENUE LEESBURG FL 34748 331197054 PARENT HOSP FL 501(C)(3) 11 N/A 0 VILLAGES REGIONAL HOSPITAL AUXILIARY INC 1451 EL CAMINO REAL THE VILLAGES FL 32159 550818419 SUPPORT HOSP FL 501(C)(3) 11 THE VILLAGES TRI-CO MED CTR 0 SURGERY CTR MT DORA 3710 LAKE CTR MT DORA FL 32757 262446297 HEALTHCARE SRVCS FL LRMC RELATED 238984 2055902 0 0 0.51000 CF INPATIENT COMGT 600 EAST DIXIE AVENUE LEESBURG FL 34748 471165465 HEALTHCARE SRVCS FL N/A RELATED 82902 0 1 0.26320 CF CARDIOVASCULAR COMGT 600 EAST DIXIE AVENUE LEESBURG FL 34748 270781065 HEALTHCARE SRVCS FL LRMC RELATED 495490 91277 0 1 0.37930 CF ONCOLOGY COMGT 600 EAST DIXIE AVENUE LEESBURG FL 34748 272818513 HEALTHCARE SRVCS FL LRMC RELATED 93381 26746 0 1 0.25000 VENTURE HEALTH CARE CORPORATION INC 600 EAST DIXIE AVENUE LEESBURG FL 34748 592689702 MANAGEMENT SRVCS FL N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1