2017-08-09T12:52:17-05:00 2016-09-30 621517792 PERSHING YOAKLEY & ASSOCIATES PC 2202 N Westshore Blvd Ste 200 282 Tampa FL 33607 990 2015-10-01 592650456 Lakeland Regional Medical Center Inc LAKE 8636871100 1324 Lakeland Hills Boulevard Lakeland FL 33805 Evan C Jones EVP/CFO 8636871100 2017-08-08 1 Terry Haefner P01258953 7274427110 2015 2021-01-29 14:40:06Z Elaine C Thompson PHD 1324 Lakeland Hills Boulevard Lakeland FL 33805 790517886 0 X www.myLRH.org X 1914 FL See Schedule OLakeland Regional Health's strategic imperative is to develop as a nationally recognized, fiscally strong and growing collaborative regional health system that improves lives by offering safe, high quality, equitable and affordable healthcare, while demonstrating an equal commitment to the promotion of individual and community health, wellness and disease prevention. 14 14 5889 219 4406 0 712237 9695183 764523494 779311658 960849 -236511 0 1511929 766196580 790282259 0 0 0 0 303913706 307015406 0 0 0 393315310 398734931 697229016 705750337 68967564 84531922 751236510 805339987 512690813 475178714 238545697 330161273 X See Schedule OLakeland Regional Health's strategic imperative is to develop as a nationally recognized, fiscally strong and growing collaborative regional health system that improves lives by offering safe, high quality, equitable and affordable healthcare, while demonstrating an equal commitment to the promotion of individual and community health, wellness and disease prevention. 0 0 639483926 780587960 See Schedule O for Program Services Statement 639483926 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 135 0 1 5889 1 1 1 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 FL X Lance Green 8636871100 230 S Florida Ave 4th Floor Lakeland FL 33801 Anne Kerr PhD Director 1.00 1.00 X 0 0 0 Ayanna Rolette MD Director 1.00 1.00 X 0 0 0 Clayton Hollis Director 1.00 1.00 X 0 0 0 Cory Petcoff Director 1.00 1.00 X 0 0 0 Dale Dreyer Director 1.00 1.00 X 0 0 0 Frank Kendrick Director 1.00 1.00 X 0 0 0 Jack Harrell Jr Past Chair 1.00 1.00 X 0 0 0 James Melton MD Director 1.00 1.00 X 0 0 0 Jay Mulaney MD Chair 1.00 1.00 X 0 0 0 Laura Hawley CFP Vice Chair 1.00 1.00 X 0 0 0 Lee Jackson Director 1.00 1.00 X 0 0 0 Sylvia Blackmon-Roberts Director 1.00 1.00 X 0 0 0 Tracy Wilson Director 1.00 1.00 X 0 0 0 Weymon Snuggs Director 1.00 1.00 X 0 0 0 Elaine Thompson PhD Chief Executive Officer 50.00 X 1944956 0 29160 Evan C Jones EVP - Chief Financial Officer 50.00 X 527049 0 24800 Amy Barry SVP - Chief Human Resources Officer 50.00 X 382452 0 26780 Danielle Drummond EVP - Chief Operating Officer 50.00 X 384751 0 85320 Elizabeth Kerns SVP - Chief Information Officer 50.00 X 324777 0 73764 Janet W Fansler EVP - Chief Nursing Executive 50.00 X 797412 0 138716 Jonn Hoppe Chief Legal Officer 50.00 X 189319 0 6857 Michael Spake VP - Chief Compliance Officer 50.00 X 318925 0 79701 Timothy Regan Senior Chief Medical Information Officer 50.00 X 404022 0 90638 Wilton Reavis MD President - Chief Medical Officer 50.00 X 878372 0 29160 Carrie C Ogilvie AVP- Critical Care & Trauma Services 50.00 X 173487 0 22233 Jackie Yon AVP - Patient Care Services 50.00 X 199111 0 19140 John Hurst Pharmacist 50.00 X 187828 0 25289 Michael Hoppe Director of Pharmacy 50.00 X 189557 0 9831 Shannon Barlow Medical Physicist 50.00 X 206636 0 23123 Adil Khan Former VP Ambulatory Services & Director of Phys 50.00 X 234070 0 16015 7342724 0 700527 224 1 1 0 Hunton & Brady Architects PA 800 N Magnolia Ave Suite 600 Orlando FL 32803 Facility Design & Planning 7438513 University Medical Services PO Box 917492 Orlando FL 32891 Medical 4173539 Watson Clinic LLC 1600 Lakeland Hills Blvd Lakeland FL 33804 Medical 3850982 Peterson & Myers PA 225 E Lemon Street Lakeland FL 33801 Legal 2615193 Stantec Consulting Services Inc 13980 Collections Center Dr Chicago IL 60693 Project Management 1755998 30 9135248 423600 136335 9695183 Patient Service Revenu 621990 423789912 423789912 Medicare/Medicaid 621990 346241996 346241996 Cafeteria Revenue 722210 4724795 4724795 Contract Pharmacy and 561000 3907217 2686442 4406 1216369 Miscellaneous Revenue 453220 468946 4194 464752 178792 178792 779311658 -884 -884 235627 -235627 -235627 -235627 Early Extinguishment o 900099 1511929 1511929 1511929 790282259 778902433 4406 1680237 6612315 5679687 932628 235960973 202680079 33280894 10152780 8720791 1431989 37519296 32227422 5291874 16770042 14404727 2365315 -6000 -5154 -846 726208 623781 102427 240000 206149 33851 280179 240661 39518 32361095 27796755 4564340 543719 467031 76688 3562603 3060119 502484 20648907 17736501 2912406 22275240 19133450 3141790 309454 265807 43647 8408017 7222116 1185901 47022903 40390602 6632301 5950140 5110908 839232 Patient Supplies & Phar 147928358 147928358 Bad Debts 87994258 87994258 Repairs & Maintenance 9405388 8078814 1326574 HCCB Indigent Assessmen 8657868 7436727 1221141 2426594 2084337 342257 705750337 639483926 66266411 0 646509 1256909 95888175 95197110 10567256 11640944 13306312 8956379 1037139349 619860748 346663345 417278601 12380866 13283067 19967539 42204818 251816508 215522159 751236510 805339987 34725778 21318104 371922577 356779557 106042458 97081053 512690813 475178714 X 227211641 296354463 9795771 32268525 1538285 1538285 238545697 330161273 751236510 805339987 X 84531922 1012270 6071384 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 280179 280179 0 Part II-B, Line 1: Lakeland Regional Medical Center, Inc. provided payment to an independent lobbying firm to notify the Medical Center of any pending legislation that affects hospitals and healthcare. 1538285 1538285 1538285 1538285 1537887 398 1538285 1537419 468 1537887 1536897 522 1537419 1.00000 0 1 1 5320944 5320944 290811974 157763267 133048707 2267889 1085388 1182501 653741523 461012093 192729430 84997019 84997019 417278601 Investment in Net Assets of Foundation 42204818 F 42204818 Other Receivables 1336653 Assets Limited to Use 79819480 Project Fund 119681830 Estimated Third Party Settlement 284196 Lease Deposit 14400000 215522159 FL Medical Assistance Assessment 13036402 Employee Compensation 43060573 Malpractice Claims 29210009 Workers Compensation 2184611 Capital Lease Obligations 4382709 Other Long Term Liabilities 624441 Bond Interest Payable 4582308 97081053 X 696046967 1012270 2000000 3012270 693034697 97247562 97247562 790282259 617756079 0 617756079 87994258 87994258 705750337 Part V, Line 4: The purpose of the Organization's Endowment funds is to grow the corpus and use the unrestricted earnings from the invested endowment fund to support the Medical Center's mission. Part X, Line 2: The Parent, Medical Center, and Foundation have been recognized by the Internal Revenue Service as tax-exempt organizations as described in Section 501(c)(3) of the Internal Revenue Code of 1986. Income earned in furtherance of the organizations' tax-exempt purposes is exempt from federal and state income taxes. Income taxes related to Ventures, a taxable entity, and the Health System's ownership interests in joint ventures are not material to the Health System. U.S. GAAP requires the Health System's management to evaluate tax positions taken by the Health System and recognize a tax liability (or asset) if the Health System has taken an uncertain position that more likely than not would not be sustained upon examination by the Internal Revenue Service. The Health System has analyzed the tax positions and has concluded that as of September 30, 2016 and 2015, there are no uncertain positions taken or expected to be taken that would require recognition of a liability (or asset) in the consolidated financial statements or disclosure in the notes to the consolidated financial statements. The Health System is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The Health System believes it is no longer subject to income tax examinations for years prior to 2012. Part XI, Line 2d - Other Adjustments: Intercompany Contribution 2,000,000. Part XI, Line 4b - Other Adjustments: Bad Debts Netted with Revenue on Audited Financials 87,994,258. Related Transactions 9,135,248. Equity in Earnings 118,056. Part XII, Line 4b - Other Adjustments: Bad Debts Netted with Revenue on Audited Financials 87,994,258. 1 1 X 1 X 1 X 1 1 1 0 1 1 30338527 30338527 0.04300 107815304 64548276 43267028 0.06130 3829150 1523277 2305873 0.00330 141982981 66071553 75911428 0.10760 438357233 421451642 16905591 0.02400 438357233 421451642 16905591 0.02400 580340214 487523195 92817019 0.13160 13855000 13855000 0.01960 13855000 13855000 0.01960 1 87994258 146930489 157929168 -10998679 X 1 1 1 1 Lakeland Regional Medical Center 1324 Lakeland Hills Blvd Lakeland FL 33805 X X X Lakeland Regional Medical Center 1 0 0 1 X X X X X X X X X X 13 1 1 0 1 X mylrh.org X 1 13 1 mylrh.org 0 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X 1 X mylrh.org X mylrh.org X mylrh.org X X X X X 1 X 0 X X X X 1 X 0 0 Lakeland Regional Medical Center Part V, Section B, Line 3j: During fiscal year 2014, Community Health Needs Assessment ("CHNA") activities were conducted and the 2014-2017 CHNA assessment was completed. The 2014-2017 CHNA served as the foundation for many activities and programs at LRH conducted during fiscal years 2015 and 2016. The 2014-2017 CHNA was conducted as a collaborative, multi-stage process that combined qualitative community input, an analysis of quantifiable data, consultation with government leaders regarding the health needs of the community served by Lakeland Regional Medical Center (LRMC), and consultation with those with special knowledge or expertise in public health to determine and subsequently prioritize community health needs. Polk County performs worse than national, state and other local counties in many areas - as a result, LRMC looked at successful evidence-based initiatives used across the country to select programs that would best meet our community's area of need. Upon review of the data, the following areas of need were identified:1. Disparities of health outcomes within the black community2. Access to quality, coordinated care3. Cancer screening and prevention4. Obesity5. Pre-conceptual and perinatal health6. Injury preventionIn response to the identified areas of need, the following strategies for change and initiatives have been completed and/or are ongoing:Disparities of health outcomes within the black community: In FY 2015, the Congregational Health Partnership was created to support congregations as they seek to improve the health of their members by providing sustainable programs which leverage both mutual and community resources. In many cases programming involves healthful interventions such as health screenings (i.e., blood pressure checks, blood glucose screenings), providing interactive education experiences or having nurses who are part of the congregation contribute their skills to their faith communityAccess to quality, coordinated care: LRH is continuing work to gain approval from CMS for a GME program. Collaboration with community partners is under way to increase the level of primary care available, as is recruitment of physician and midlevel providers into the LRH physician practice group. At the Family Health Center, the Clinical Pharmacy Resource program was initiated to assist patients with diabetes, and the Integrated Behavioral Health program was initiated to aid patients dealing with mental health issues. At the hospital, the Care Transition Intervention program was started to coach high risk patients on how to better care for themselves and when to seek medical attention. In addition, the Integrated Care Team was developed, consisting of RNs, pharmacy technicians and health coaches who provide follow-up appointment scheduling, follow-up phone calls, and overall case management for high risk patients discharged from LRH. Finally, from an educational standpoint, a Pre-Diabetes Prevention program is being offered to the community through a CDC grant, and LRH also funds separate cohort for our team members. Education is also being provided on vaccinations to the community through the Polk County Immunization Coalition.Cancer screening and prevention: Community education programs on smoking cessation and cancer prevention have been provided at our Hollis Cancer Center, along with screening services at health fairs. These efforts also supported our cancer center accreditation efforts. In addition, assistance was provided to the YMCA in applying for the American Academy of Dermatology grant to build a sunshade over their playground area.Obesity: Lakeland Regional Health representatives are assisting Polk Vision programs in targeting this health issue. The "5210" program was piloted at the primary care facility located in Winter Haven. Additionally, the Congregational Health Partnership program educates partner congregations on living an active lifestyle, diet and nutrition as well as preventative care measures. Pre-conceptual and perinatal health: Participation and support for the Healthy Start Coalition and Teen Pregnancy Prevention Alliance programs have been undertaken. On-site space for a full-time Healthy Start coordinator was provided to improve care coordination and patient engagement. Education and screenings were provided at the Polk County School Board Parent University health fairs in 2014, 2015 and 2016. The Congregational Health Partnership is offering programs to congregations related to reducing teen pregnancy, and LRH began the process to seek state and grant funding to provide free HPV vaccinations to those at risk.Injury prevention: Efforts to address these needs were made through continued participation in the Coalition for Injury Prevention, Safe Kids, and Waterproof Florida. This work includes offering injury prevention programs related to falls, child passenger safety, and drowning prevention. Assessment of the Care Transition Intervention model was started to determine if it would benefit discharged trauma patients. Lakeland Regional Medical Center Part V, Section B, Line 5: Experts consulted are detailed on page 18-19 of the CHNA document. Organizations consulted include:Career Source PolkCatholic CharitiesCentral Florida Development CouncilCentral Florida HealthcareCity of LakelandEast Coast Migrant Head Start ProgramElder Point MinistriesFaith in ActionFlorida Department of Health in Polk CountyFlorida Polytechnic UniversityFlorida Southern CollegeHealthy Start CoalitionHeart of Florida Regional Medical CenterLake Wales Care CenterLakeland Area Chamber of CommerceLakeland Economic Development CouncilLakeland Housing AuthorityLakeland VisionLakeland Volunteers in MedicineLighthouse MinistriesParker Street MinistriesPeace River Behavioral Health ServicesPolk County Board of County CommissionersPolk County Government Health PlanPolk County School BoardPolk State CollegePolk VisionRath Senior ConNEXTions & Education CenterSalvation ArmySoutheastern UniversityTalbot House MinistriesTri-County Human ServicesUF/IFAS ExtensionUnited Way of Central FloridaUniversity of South FloridaValencia Hills Health and Rehabilitation CenterVolunteers in Service to the ElderlyWatson ClinicWatson Clinic FoundationYMCA of West Central Florida Lakeland Regional Medical Center Part V, Section B, Line 6a: Lake Wales Medical Center Lakeland Regional Medical Center Part V, Section B, Line 22d: To be eligible for a 100% reduction from charges, the patient's household income, adjusted for family size, must be less than or equal to 200% of the current Federal Poverty Guidelines ("FPG"). If the patient's household income, adjusted for size, is between 200% and 400% of the FPG, the patient shall be eligible for a 75% reduction from charges. An uninsured or medically needy patient whose income is greater than 400% of the FPG will receive a discount that is annually calculated using a "look back" method. By November 15th of each year, claims for services provided during the prior twelve month period ended September 30, which were paid in full by Medicare fee for service and all private health insurers, will be analyzed to compute the "look back" discount percentage. No individual eligible under the financial assistance policy will be given a discount which is less than the "look back" discount percentage adjusted by any charge increase implemented after September 30th of any year. 4 1 - Hollis Cancer Center 3525 Lakeland Hills Blvd Lakeland FL 33805 Outpatient Clinic 2 - LRMC Family Health Center 300 Parkview Place Lakeland FL 33805 Outpatient Clinic 3 - Lakeland Regional Rehab & Sports Clinic 3030 Harden Blvd Lakeland FL 33803 Outpatient Clinic 4 - Lakeland Reg Health Ctr for Wound Care 3030 Harden Blvd Lakeland FL 33803 Outpatient Clinic Part I, Line 7: Lakeland Regional Medical Center determines the cost of charity by calculating a ratio of cost to charges as derived from the Medicare Cost Report and then multiplying that ratio by the gross uncompensated charges associated with providing care to charity patients. Similarly, the cost of subsidized health services is based on the unreimbursed cost of caring for the patients' services less the cost associated with Bad Debt, Charity, Medicaid and other means-tested government programs. The actual expenses paid for providing community health improvements and community benefits operations less any payments received for those activities is reflected above. Part I, Line 7g: Subsidized health services are clinical services that are essential to meet the health care needs of the entire community and are provided with a financial loss to Lakeland Regional Medical Center (LRMC). The financial loss is measured after removing losses associated with Bad Debt, Charity, Medicaid and other means-tested government programs. LRMC operates one of the busiest Emergency Departments in the nation with over 200,000 emergency visits each year. We treat all patients regardless of their ability to pay for the care they receive. In addition, we staff a Level II Trauma Center to provide critical care access to residents of Lakeland and surrounding communities. The cost of providing emergency and trauma care 24 hours each day exceeds the payments LRMC receives for providing that care. LRMC also operates the only inpatient Behavioral Health Unit in Lakeland to provide care for the mentally ill population who have nowhere else to go for essential inpatient psychiatric care. The cost of operating the Behavioral Health Unit exceeds the amount we are paid for services. The loss incurred for providing these services was approximately $261,000 in fiscal year 2016. Part I, Ln 7 Col(f): There is $87,994,258 of bad debt expense which is included in Form 990, Part IX, Line 24(b). This amount was removed in the calculation of the Percent of Total Expense on Schedule H Line 7f. Part II, Community Building Activities: Lakeland Regional Medical Center is the only hospital in Lakeland and serves as a tertiary referral hospital serving the broader Polk County, Florida. As the only state-designated trauma center for Polk, Highlands, and Hardee counties, we provide critical access and care to the area's most seriously injured residents. A shortage of primary care physicians and mental health services has resulted in our ER becoming the highest volume ER in the nation, offering essential medical care to many underserved residents in our community.Ongoing education programs for diabetes and cardiac rehabilitation are designed to help patients with chronic conditions maintain their health and avoid repeated hospitalizations. Support groups assist those living with chronic and life-threatening illnesses to access resources and critical peer support. Education and screening programs have identified those at risk of various conditions, allowing them to seek treatment. Participation in and support of community events helps to ensure a vibrant community and a positive quality of life for our employees as well as our patient-base. Part III, Line 2: LRMC follows the guidance provided in the Healthcare Financial Management Association Principles and Practices Board "Statement 15: Valuation and Financial Statement Presentation of Charity Care and Bad Debts by Institutional Healthcare Providers" in determining bad debt expenses. Bad debt expense results when a patient who does not meet the criteria for Charity Care and who has been determined to have the financial capacity to pay for healthcare services and is unwilling to settle the claim. The hospital utilizes an overall ratio of cost to charges from the applicable Medicare cost report and this is applied to the bad debt expense. Part III, Line 4: The consolidated, audited financial statements of Lakeland Regional Health Systems, Inc. and Subsidiaries are attached to this return and contain language addressing Bad Debts on pages 9 thru 11. Part III, Line 8: The Medicare payment shortfall is not treated as a community benefit. Medicare allowable costs are determined using the approved standardized Medicare Cost Report methodology. The Medicare cost is derived using the Medicare Cost-to-Charge ratio from the Medicare cost report times the Medicare charges for service. Part III, Line 9b: The collection activities are described within the Financial Assistance Policy. LRMC will not engage in the following extraordinary collection activities ("ECA") before making reasonable efforts for any patients that qualify under LRMC's Financial Assistance Policy. An ECA is defined as any actions taken by the facility against an individual related to obtaining payment of a bill for care that requires legal or judicial process, including but not limited to: place a lien on an individual's property, foreclosure of an individual's real property, attach or seize an individual's bank account or any other personal property, commence a civil action against any individual, cause an individual's arrest, cause an individual to be subject to a writ of bodily attachment and garnish an individual's wages.LRMC or its representatives may report a patient to a credit bureau but, if it is determined that the patient is eligible for financial assistance within 240 days from the date the patient received the first billing statement for the care provided, any adverse information will be retracted. Patients are notified of the Financial Assistance Policy on admission, prior to discharge and in communications about the Financial Assistance Policy on patient statements. Part VI, Line 2: Lakeland Regional Medical Center collaborates with medical staff, community leaders and the Polk County Health Department to determine the health needs of the citizens of Lakeland and Polk County, Florida. LRMC sponsors various Medical Staff Committees where community health needs are frequently discussed. Our senior management and staff identify unmet community health needs through participation in community coalitions, partnerships, boards, committees, and advisory groups. Using available data on the demographics and service utilization for our primary and secondary markets, the LRMC executive team and Board develop a comprehensive annual Strategic Plan to address the healthcare needs of the community. In 2012, LRMC opened a primary health clinic to provide a medical home for the uninsured and underinsured population. This clinic is designed to both improve the quality of care for low income patients and also reduce visits to the emergency room. In the fall of 2012 and continuing through 2015, LRMC partnered with the Polk County Health Department, Peace River Center and the Polk Healthcare Plan as part of the state Low Income Pool for primary care to offer a patient-centered, primary care integrated medical home within the I-4 corridor of Polk County. In 2016, the Family Health Center had 21,746 visits (21,727 in 2015 and 20,535 in 2014) in which patients and their families were able to receive primary care. Part VI, Line 3: For scheduled admissions, LRMC conducts a pre-admission interview to discuss the financial plan with the patient, the guarantor, and/or his or her legal representative. If a pre-admission interview is not possible, this interview is conducted upon admission. In the case of an emergency admission, LRMC's evaluation of payment alternatives does not take place until the required stabilizing medical care has been provided. Identification of patients eligible for assistance can take place at any time during the rendition of services or during the patient account collection process (including bad debt).Those patients who may qualify for financial assistance from a government program are referred to the appropriate program, such as Medicaid or the Polk County Health Plan. LRMC provides on-site access to Medicaid eligibility specialists to assist patients in qualifying for governmental medical assistance programs. All patients identified as potential financial assistance recipients are offered the opportunity to apply for financial assistance. If this evaluation is not conducted until after the patient leaves, or in the case of outpatients or emergency patients, an LRMC representative mails a financial assistance application to the patient. For the first 120 days after the date of service, the hospital will notify an individual about the Financial Assistance Policy. The patient will receive at least three billing statements that include language about applying for financial assistance. The hospital will accept and process any financial assistance applications submitted by an individual for up to 240 days after the patient received the first billing statement for the care. Part VI, Line 4: The Lakeland Urban Area is considered the primary service area and the remainder of Polk County is considered the secondary/extended service area. Polk County has a population of over 630,000 with over 19% of residents being over the age of 65 and over 8% of residents living below the Federal Poverty Level. Children under 18 years of age make up approximately 23% of the population compared to over 20% for the State. Located between Orange and Hillsborough Counties, it is the fourth (4th) largest county in Florida consisting of 1,823 square miles. Lakeland is the largest city in Polk County and is located between Tampa and Orlando on busy Interstate 4. The unemployment rate for Polk County was 5.4% as of December 2016, compared to 4.7% for the state of Florida. Census data reflects a population that is 19.6% Hispanic, 15.7% Black and under 3% from other minorities. Part VI, Line 5: Lakeland Regional Medical Center's senior management, directors, managers, physicians and staff provide leadership and resources to equip local organizations with the skills needed to create a healthy community. Our staff participates on boards, advisory committees, and coalitions benefiting the community we serve without compensation for their time. Our leaders and physicians participate in educational programs, workshops and health fair events that are provided free to members of the community. We provide cancer screening services to the community for early detection of breast, skin and colon cancers. We participate and provide support for educational programs for healthcare workers in partnership with local colleges, universities and trade schools. Lakeland Regional Medical Center has a vibrant volunteer program, offering varied opportunities for service to the members of the community. The medical staff of Lakeland Regional Medical Center consists of over 500 physicians and is organized to promote the public interest of healthcare. No part of the income of LRMC inures to the benefit of any private individual, nor is any private interest being served. All surplus funds are reinvested into the facilities, equipment, programs and resources needed to continually improve the quality of patient care, expand our outreach, and advance the medical training and education of our staff. As noted above, the primary health clinic opened In 2012, and the Low Income Pool partnership clinic located on the I-4 corridor are excellent examples of LRH's commitment to community health promotion. Part VI, Line 6: Lakeland Regional Medical Center is a subsidiary of Lakeland Regional Health Systems, Inc., a not-for-profit system that reinvests its profits back into the community through programs that benefit the residents of Lakeland and Polk County, Florida. The Health System facilities are leased from the City of Lakeland and the operations of the Hospital and Health System directly benefit the citizens of the community. Annually, the Health System pays the City for use of the Medical Center buildings, and the City of Lakeland uses those funds to provide public services and facilities that directly benefit all of the members of the community. During 2016, the Health System's total payments made to the City under the arrangement totaled $39.1 million of which $13.2 million represented the required payments for fiscal year 2016.In addition, the Health System provides for the health of the community by directly employing physicians in underserved medical specialties, such as orthopedics, trauma surgery, oncology and behavioral health. The Health System's medical clinics provide access to all residents, regardless of income, and many operate at a loss. Despite this, LRH believes that the role these clinics provide in the community, and in the promotion and maintenance of health, is part of our mission and our significant contribution to the community. X X X X X 1 1 0 0 0 0 0 0 0 Elaine Thompson PhD Chief Executive Officer 776559 0 259948 0 908449 0 17645 0 11515 0 1974116 0 898866 0 Evan C Jones EVP - Chief Financial Officer 440222 0 83683 0 3144 0 17645 0 7155 0 551849 0 0 0 Amy Barry SVP - Chief Human Resources Officer 243800 0 57500 0 81152 0 16494 0 10286 0 409232 0 0 0 Danielle Drummond EVP - Chief Operating Officer 327816 0 56659 0 276 0 76250 0 9070 0 470071 0 0 0 Elizabeth Kerns SVP - Chief Information Officer 280273 0 43924 0 580 0 66609 0 7155 0 398541 0 0 0 Janet W Fansler EVP - Chief Nursing Executive 434755 0 83683 0 278974 0 127201 0 11515 0 936128 0 0 0 Jonn Hoppe Chief Legal Officer 177405 0 8750 0 3164 0 0 0 6857 0 196176 0 0 0 Michael Spake VP - Chief Compliance Officer 264886 0 52885 0 1154 0 66966 0 12735 0 398626 0 0 0 Timothy Regan Senior Chief Medical Information Off 349300 0 44722 0 10000 0 77903 0 12735 0 494660 0 0 0 Wilton Reavis MD President - Chief Medical Officer 878372 0 0 0 0 0 17645 0 11515 0 907532 0 0 0 Carrie C Ogilvie AVP- Critical Care & Trauma Services 155723 0 12945 0 4819 0 10718 0 11515 0 195720 0 0 0 Jackie Yon AVP - Patient Care Services 184442 0 14669 0 0 0 11985 0 7155 0 218251 0 0 0 John Hurst Pharmacist 157093 0 500 0 30235 0 12554 0 12735 0 213117 0 0 0 Michael Hoppe Director of Pharmacy 122922 0 13424 0 53211 0 2590 0 7241 0 199388 0 0 0 Shannon Barlow Medical Physicist 205373 0 500 0 763 0 14053 0 9070 0 229759 0 0 0 Adil Khan Former VP Ambulatory Services & Dire 148971 0 39482 0 45617 0 11061 0 4954 0 250085 0 0 0 Part I, Lines 4a-b Janet W. Fansler - Executive VP and Chief Nursing Executive participated in a supplemental nonqualified deferred compensation plan. She had $275,830 of taxable benefits during calendar year 2015. This amount is included in Part (B)(iii) other compensation. She had an additional $111,577 of nontaxable benefits accrue during calendar year 2015. This amount is included in Part II Column C. Elaine Thompson, Ph.D. - Chief Executive Officer participated in a supplemental nonqualified deferred compensation plan. She had $898,866 of taxable benefits during calendar year 2015. This amount is included in Part II Column (B)(iii). Timothy Regan - Senior Chief Medical Information Officer participated in a supplemental nonqualified deferred compensation plan. He had $60,258 of nontaxable benefits accrue during calendar year 2015. This amount is included in Part II Column C. Elizabeth Kerns - Senior VP and Chief Information Officer participated in a supplemental nonqualified deferred compensation plan. She had $48,964 of nontaxable benefits accrue during calendar year 2015. This amount is included in Part II Column C. Danielle Drummond - Executive VP and Chief Operating Officer participated in a supplemental nonqualified deferred compensation plan. She had $58,605 of nontaxable benefits accrue during calendar year 2015. This amount is included in Part II Column C. Michael Spake - Chief Compliance Officer participated in a supplemental nonqualified deferred compensation plan. He had $49,321 of nontaxable benefits accrue during calendar year 2015. This amount is included in Part II Column C. Amy Barry - Senior VP and Chief Human Resources Officer received severance pay of $51,785 that was included in her W2 for 2015. This amount is included in Part (B)(iii) compensation. A City of Lakeland Florida 596000354 511665HP9 2006-11-02 116566404 2006 Bonds refunded the 1999A & 2002 Bonds and pay the 2006 issuance costs 1 0 0 B City of Lakeland Florida 596000354 511665JE2 2011-07-28 81113255 2011 Bonds refunded the 96A, 97A, 97B & 99B Bonds & paid 2011 issuance costs 0 0 0 C City of Lakeland Florida 596000354 511665JN2 2015-02-05 205545053 2015 Hospital Revenue Bonds for capital projects 0 0 0 D City of Lakeland Florida 596000354 511665KFJ 2016-09-15 97381865 2016 Hospital Revenue Refunding Bonds 0 0 0 A 97360000 116566404 1 1038389 0 1 1 1 B 81113524 1012480 0 1 1 1 C 205545053 120752000 1892439 87369852 2018 0 0 1 1 D 97381865 99742693 937638 1 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 1 0 0 0 0 1 B 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 Form 990, Part III, Line 4a Lakeland Regional Medical Center provides free care to patients who meet the State of Florida charity care guidelines and who are not eligible for public assistance. Lakeland Regional Medical Center provided care to emergency patients, regardless of their ability to pay. In addition to the primary Emergency Department, specialty care for children was provided in the separate Pediatric Emergency unit and provides a walk-in center for those patients in need of primary care under non-emergent conditions. Lakeland Regional Medical Center additionally provided inpatient and outpatient mental health services to patients, regardless of their ability to pay. Comprehensive care was offered for a variety of illnesses, including clinical depression, anxiety and memory disorders, addiction recovery and various adolescent services. All services are provided in a distinct part unit within the hospital, and programs are directed by board-certified psychiatrists. Form 990, Part VI, Section A, line 6 Certain decisions of the governing body of Lakeland Regional Medical Center are subject to approval of the sole member Lakeland Regional Health Systems, Inc. Form 990, Part VI, Section A, line 7a The sole member of Lakeland Regional Medical Center, Inc. is Lakeland Regional Health Systems, Inc. Form 990, Part VI, Section A, line 7b Certain decisions of the governing board of Lakeland Regional Medical Center are subject to approval of the sole member Lakeland Regional Health Systems, Inc. Form 990, Part VI, Section B, line 11 The Form 990 is reviewed prior to filing by senior management, including the CEO and CFO. Additionally, the form and schedules related to compensation are reviewed by the Executive and Physician Compensation Committee of the Board and a copy of the Form 990 and schedules are provided to each member of the Board of Directors before filing with the IRS. Form 990, Part VI, Section B, line 12c Lakeland Regional Medical Center has a conflict of interest policy which is monitored by the Corporate Integrity Services department. All new hires, students, volunteers and contractors are trained on the ethics policy during general orientation. All staff is to comply with ethics training annually as part of their mandatory education requirements. Annually, a certification is required by all managers, directors, and officers who must acknowledge that the policy was read, understood and will be abided by. Lakeland Regional Medical Center also has a "Policy of the Board of Directors Regarding Board Members Doing Business with Lakeland Regional Medical Center or Lakeland Regional Health Systems". All Board Members are annually required to execute a "Corporate Compliance Acknowledgement and answer a comprehensive "Annual Conflict of Interest Questionnaire". Additionally, all Senior Corporate Management are annually required to answer a comprehensive "Annual Conflict of Interest Questionnaire". Form 990, Part VI, Section B, line 15 Lakeland Regional Medical Center, Inc. Executive and Physician Compensation Committee (the "Committee") of the Board is charged with determining, in advance, all compensation issues for all executive positions including the President & CEO, the CFO and all Vice Presidents of the organization. Only independent and "disinterested" persons may serve as members of the Committee and no member may be employed by the organization or any of its affiliates. Additionally, no physician on the medical staff of the organization may serve as a member of the Committee nor may any member have any business or financial relationships with the organization, either directly or indirectly through family members. The Committee engages an independent nationally recognized human resource management consulting firm which specializes in executive and employee compensation in the health care industry. This firm, among other things: a. Conducts a competitive executive total cash compensation analysis relative to comparable healthcare organizations nationally; and b. Conducts a competitive executive benefits analysis relative to comparable healthcare organizations; and c. Conducts a competitive executive total compensation analysis relative to comparable healthcare organizations; and d. Assists the Committee in ensuring compliance with regulatory requirements; and e. Provides guidance and counsel to the Committee and Board in matters relating to executive compensation; and f. Participates in Committee meeting and presents their findings and recommendations to the Committee and to the Board. In determining compensation, the Committee relies on the independent, reliable market data presented by the consulting firm to set all compensation levels and the consulting firm's opinion as to the reasonableness of total compensation to be paid the executives of the organization. The Committee fully documents the basis for all determinations and records, at a minimum, 1) the terms of the compensation agreement and the date on which it was approved; 2)the members of the Committee where were present during the discussion and those who voted on it; 3) the comparability data used and its source; and 4) the basis for the ultimate decision. In fulfilling its responsibility, the Committee has full authority to consult wit outside counsel, regarding the legality of the compensation and other legal issues which may be relevant to the Committee's responsibilities. Form 990, Part VI, Section C, line 19 The organization's Articles of Incorporation are public records and may be obtained from the State of Florida's Division of Corporations in Tallahassee, Florida. Additionally, the Lease & Transfer Agreement between the organization and the City of Lakeland, Florida, under which the organization operates, is recorded in the Public Records of Polk County, Florida, the County in which the organization is located. Financial statements and similar information, both audited and unaudited, are periodically furnished to the City of Lakeland, Florida, and various regulatory agencies within the State of Florida. As such, said financial statements and information are public records under the pertinent Florida public records laws. Form 990, Part XI, line 9: Intercompany Contribution 2,000,000. Intercompany Transfers -10,535,793. Change in Beneficial Interest in Foundation 22,237,279. Equity in Earnings -118,056. Other Adjustments -657. Related Transactions -9,135,248. Change in Benefit Obligation -1,347,028. Capital Grants 2,970,887. Lakeland Regional Medical Center Foundation Inc 1324 Lakeland Hills Boulevard Lakeland FL 33805 237134974 Fundraising FL 501(c)(3) 11a - Type 1 LAKELAND REGIONAL HEALTH SYSTEM INC 0 Lakeland Regional Health Systems Inc 1324 Lakeland Hills Boulevard Lakeland FL 33805 592650464 Support Other 501(c)(3) organizations FL 501(c)(3) 11a - Type 1 N/A 0 Lakeland Regional Health Ventures Inc 1324 Lakeland Hills Boulevard Lakeland FL 33805 592650902 Medical Services FL Lakeland Regional Health Systems C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0