2016-05-10T14:22:58-05:00 2015-06-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2014-07-01 590878982 LEESBURG REGIONAL MEDICAL CENTER LEES 3523235762 600 EAST DIXIE AVENUE LEESBURG FL 34748 DIANE HARDEN CFO 3523235002 2016-05-10 1 JOHN NORMAN P01506766 7049985200 2014 2016-08-17 19:52:53Z DON HENDERSON 600 EAST DIXIE AVENUE LEESBURG FL 34748 236213096 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 2165 189 0 -193144 200000 0 209849224 225875979 5507418 4389698 6639703 5947419 222196345 236213096 262524 156145 0 0 97799563 102418014 0 0 0 113665212 114893409 211727299 217467568 10469046 18745528 336416949 333139222 131986456 113026320 204430493 220112902 X TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE PATIENTS AND COMMUNITIES THE ORGANIZATION SERVES. 0 0 193286543 156145 231823398 LEESBURG REGIONAL MEDICAL CENTER, PART OF CENTRAL FLORIDA HEALTH ALLIANCE, IS A 316-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. 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. 193286543 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 68 0 1 2165 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 DON V HAHNFELDT CHAIRPERSON 2.00 X X 0 0 0 GREGORY LEWIS VICE CHAIRPERSON 2.00 X X 0 0 0 DIANE B SPENCER SECRETARY 2.00 X X 0 0 0 ROGER BEYERS TREASURER 2.00 X X 0 0 0 LINDSEY BLAISE 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 EVAN B RICHARDS BOARD MEMBER 2.00 X 0 0 0 KENNETH A SAMPONG MD BOARD MEMBER 2.00 X 0 0 0 ROGER W SHERMAN 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 825801 0 16626 DIANE HARDEN SVP/CFO 30.00 20.00 X 414133 0 14601 SAAD EHTISHAM SVP/COO 30.00 20.00 X 467531 0 18875 PHYLLIS BAUM VP/CQO 30.00 20.00 X 361871 0 16694 AMIE RICHASON VP OF HUMAN RESOURCES 30.00 20.00 X 284660 0 14942 DAVID STEELE VP/CIO 30.00 20.00 X 272916 0 17670 PHILIP BRAUN VP/CHIEF COUNSEL 30.00 20.00 X 231494 0 18386 WILLIAM PFINGSTEN VP OF AMBULATORY SERVICES 30.00 20.00 X 237928 0 16019 TED E WILLIAMS VP/FOUNDATION PRESIDENT 30.00 20.00 X 217838 0 11556 TERI KEEL VP/CCO 30.00 20.00 X 209779 0 5813 LEONEL EDWARDS PHYSICIAN 50.00 X 595938 0 0 M FIRAS SIOUFI PHYSICIAN 50.00 X 551049 0 14542 YIN LUK PHYSICIAN 50.00 X 417935 0 8289 ORLANDO ICAZA PHYSICIAN 50.00 X 383550 0 11016 DAVID RIZZUTO PHYSICIAN 50.00 X 379390 0 18761 5851813 0 203790 94 0 1 0 LAKE COUNTY ANESTHESIA ASSOCIATES PO BOX 491529 LEESBURG FL 34749 ANESTHESIA SERVICES 2753055 CARDIOVASCULAR ANESTHESIA ASSOCIATES PO BOX 3130 OCALA FL 34478 ANESTHESIA SERVICES 1191313 ANGELICA PO BOX 535122 ATLANTA GA 30353 LINEN SERVICES 1166384 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 554809146 LABORATORY TESTING 836988 LEESBURG CARDIOVASCULAR ASSOCIATES 1511 SW FIRST AVE SUITE 100 OCALA FL 34471 CARDIOVASCULAR CARE SERVICES 835755 42 NET PATIENT SERVICE REVENUE 621400 219774395 219774395 OTHER OPERATING REVENUE 621400 6101584 6101584 225875979 2606896 2606896 738563 0 738563 738563 738563 1773217 9585 0 0 1773217 9585 1782802 1782802 EHR PAYOUT 900099 2972448 2972448 DIETARY 900099 1083890 1083890 MEDICAL MINISTRY 900099 458424 458424 694094 694094 5208856 236213096 231823398 0 4389698 156145 156145 1693436 1693436 81277519 72389416 8888103 2703107 2351703 351404 11111175 9666722 1444453 5632777 4900516 732261 7740629 5206608 2534021 173948 86974 86974 199526 199526 55716 55716 664320 597888 66432 4130382 3593432 536950 81970 51853 30117 126634 52183 74451 2340051 2340051 13174968 11204901 1970067 2842845 2150314 692531 SUPPLIES 56773527 56074252 699275 PHYSICIANS AND OTHER ME 9996797 9280231 716566 EQUIPMENT RENTAL AND MA 6460235 5443417 1016818 UTILITIES 3937133 3346563 590570 6194728 4337658 1857070 217467568 193286543 24181025 0 23538507 25758211 5170231 2199749 0 25752342 27349914 5320383 5819786 4288038 5097551 301920914 220318406 84701708 81602508 143944568 139757082 47888658 41366935 336416949 333139222 34415984 39915549 7000 59564627 48765695 22424953 15580892 24338076 131986456 113026320 X 204430493 220112902 204430493 220112902 336416949 333139222 X 18745528 -168896 -3172525 278302 X X 0 1 X 1 0 X 0 0 0 0 0 0 1 12826 0 1 14864 27690 0 8610003 8610003 111154739 70525567 40629172 34557179 31357827 3199352 135939003 113126352 22812651 11659990 5308660 6351330 81602508 DUE FROM AFFILIATES 4444644 DEFERRED LOAN COST 388591 INV IN UNCCONSOLIDATED AFFILIATE 24566517 PHYSICIAN CONTRACTS INTANGIBLE ASSETS 2828413 ASSETS LIMITED AS TO USE 4623389 GOODWILL IN ALLIANCE LABS 1540000 GOODWILL IN PATHOLOGY SERVICES ALLIANCE 2973000 OTHER REC 2381 41366935 SWAP LIABILITY 2746117 MALPRACTICE IBNR 15894072 DUE TO AFFILIATES 5697887 24338076 X PART X, LINE 2: U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE THE ALLIANCE'S MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ALLIANCE AND RECOGNIZE A TAX LIABILITY IF THE ALLIANCE HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE ALLIANCE HAS ANALYZED THE TAX POSITIONS AND HAS CONCLUDED THAT AS OF JUNE 30, 2015 AND 2014, 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 ALLIANCE IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE ALLIANCE BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2010. 1 1 X 1 X 1 X 1 1 1 0 0 5994526 5994526 0.02760 22754703 21350414 1404289 0.00650 28749229 21350414 7398815 0.03410 153705 153705 0.00070 153705 153705 0.00070 28902934 21350414 7552520 0.03480 1 3171610 99320097 97522137 1797960 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 12 1 1 1 1 X WWW.CENTRALFLORIDAHEALTH.ORG/ABOUT-COMMUNITY-HEALTH.HTML X 1 12 1 HTTP://WWW.CFHALLIANCE.ORG/PDF/LRMC-IMPLEMENTATIONPLAN-2012.PDF 0 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X 1 X HTTP://WWW.CENTRALFLORIDAHEALTH.ORG/PATIENT-CHARITY.HTML 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 12 1 1 1 1 X WWW.CENTRALFLORIDAHEALTH.ORG/ABOUT-COMMUNITY-HEALTH.HTML X 1 12 1 HTTP://WWW.CFHALLIANCE.ORG/PDF/LRMC-IMPLEMENTATIONPLAN-2012.PDF 0 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X X 1 X HTTP://WWW.CENTRALFLORIDAHEALTH.ORG/PATIENT-CHARITY.HTML X HTTP://WWW.CENTRALFLORIDAHEALTH.ORG/PATIENT-CHARITY.HTML 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, WE LOOK AT THE POPULATION SERVED AT THE COMMUNITY MEDICAL CARE CENTER (A PRIMARY CARE CLINIC FOR THE UNINSURED OF WHICH CENTRAL FLORIDA HEALTH ALLIANCE HELPS SUPPORT FINANCIALLY AND WITH VOLUNTEERS), ANALYZE DATA PROVIDED BY AND WORK WITH THE LAKE COUNTY HEALTH DEPARTMENT, SERVE ON COMMUNITY TASK FORCES AND BOARD WITH OTHER HEALTH CARE PROVIDES, AND SURVEY PARTICIPANTS AT COMMUNITY OUTREACH HEALTH FAIRS, SCREENINGS, AND EVENTS. OUR COMMUNITY BENEFIT EFFORT IS A MEASURED APPROACH TO MEETING IDENTIFIED COMMUNITY HEALTH CARE NEEDS, PARTICULARLY IN THE UNINSURED AND UNDERSERVED POPULATIONS. THE COMMUNITY POPULATION IS PRIMARILY MEDICARE (~75%) WITH THE REMAINDER MEDICAID, SELF-PAY, AND OTHER. WE VERBALLY INFORM PATIENTS OF OUR CHARITY CARE PROGRAM; THERE IS VERBIAGE ON OUR WEBSITE AND STATEMENTS REGARDING THE CHARITY PROGRAM. ALSO, WE PROVIDE PATIENTS WITH THE "PATIENT CHARITY CARE POLICY" IF REQUEST. OTHER COMMUNITY OUTREACH ACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNITY INCLUDE - FREE DOC TALK PREVENTATIVE EDUCATION SERIES, FREE OR REDUCED HEALTHCARE SCREENINGS (BLOOD PRESSURE, CHOLESTEROL AND GLUCOSE CHECKS), HOSTING AND MAKING AVAILABLE (AT NO CHARGE) HOSPITAL SPEAKERS FOR A VARIETY OF SUPPORT GROUPS AND ORGANIZATIONS (AS WELL AS DONATED MEETING SPACE), PARTNERING AND AFFILIATING WITH OUTSIDE GROUPS TO IDENTIFY HEALTH PRIORITIES AND ENHANCE THE HEALTH AND QUALITY OF LIFE FOR THE COMMUNITIES WE SERVE, AND PROVIDING HEALTH HEROES (EMPLOYEE VOLUNTEERS) WHO CONTRIBUTE COUNTLESS HOURS TO THE COMMUNITY OUTSIDE OF OUR HOSPITALS BY PARTICIPATING IN MANY DIFFERENT PREVENTATIVE HEALTH EVENTS. IN ADDITION, MANY OF OUR LEADERS AND TEAM MEMBERS VOLUNTEER THEIR TIME TO A VARIETY OF COMMUNITY BOARDS AND ORGANIZATIONS. ADDITIONALLY, THE HOSPITAL GENERALLY MAINTAINS AN OPEN MEDICAL STAFF. 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, WE LOOK AT THE POPULATION SERVED AT THE COMMUNITY MEDICAL CARE CENTER (A PRIMARY CARE CLINIC FOR THE UNINSURED OF WHICH CENTRAL FLORIDA HEALTH ALLIANCE HELPS SUPPORT FINANCIALLY AND WITH VOLUNTEERS), ANALYZE DATA PROVIDED BY AND WORK WITH THE LAKE COUNTY HEALTH DEPARTMENT, SERVE ON COMMUNITY TASK FORCES AND BOARD WITH OTHER HEALTH CARE PROVIDES, AND SURVEY PARTICIPANTS AT COMMUNITY OUTREACH HEALTH FAIRS, SCREENINGS, AND EVENTS. OUR COMMUNITY BENEFIT EFFORT IS A MEASURED APPROACH TO MEETING IDENTIFIED COMMUNITY HEALTH CARE NEEDS, PARTICULARLY IN THE UNINSURED AND UNDERSERVED POPULATIONS. THE COMMUNITY POPULATION IS PRIMARILY MEDICARE (~75%) WITH THE REMAINDER MEDICAID, SELF-PAY, AND OTHER. WE VERBALLY INFORM PATIENTS OF OUR CHARITY CARE PROGRAM; THERE IS VERBIAGE ON OUR WEBSITE AND STATEMENTS REGARDING THE CHARITY PROGRAM. ALSO, WE PROVIDE PATIENTS WITH THE "PATIENT CHARITY CARE POLICY" IF REQUESTED. OTHER COMMUNITY OUTREACH ACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNITY INCLUDE - FREE DOC TALK PREVENTATIVE EDUCATION SERIES, FREE OR REDUCED HEALTHCARE SCREENINGS (BLOOD PRESSURE, CHOLESTEROL AND GLUCOSE CHECKS), HOSTING AND MAKING AVAILABLE (AT NO CHARGE) HOSPITAL SPEAKERS FOR A VARIETY OF SUPPORT GROUPS AND ORGANIZATIONS (AS WELL AS DONATED MEETING SPACE), PARTNERING AND AFFILIATING WITH OUTSIDE GROUPS TO IDENTIFY HEALTH PRIORITIES AND ENHANCE THE HEALTH AND QUALITY OF LIFE FOR THE COMMUNITIES WE SERVE, AND PROVIDING HEALTH HEROES (EMPLOYEE VOLUNTEERS) WHO CONTRIBUTE COUNTLESS HOURS TO THE COMMUNITY OUTSIDE OF OUR HOSPITALS BY PARTICIPATING IN MANY DIFFERENT PREVENTATIVE HEALTH EVENTS. IN ADDITION, MANY OF OURLEADERS AND TEAM MEMBERS VOLUNTEER THEIR TIME TO A VARIETY OF COMMUNITY BOARDS AND ORGANIZATIONS. ADDITIONALLY, THE HOSPITAL GENERALLY MAINTAINS AN OPEN MEDICAL STAFF. 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: LAKE COUNTY HEALTH DEPARTMENT LEESBURG REHABILITATION HOSPITAL PART V, SECTION B, LINE 6B: LAKE COUNTY HEALTH DEPARTMENT LEESBURG REGIONAL MEDICAL CENTER INC PART V, SECTION B, LINE 11: LEESBURG REGIONAL MEDICAL CENTER IS NOT ABLE TO ADDRESS ALL OF THE NEEDS OF THE COMMUNITY IDENTIFIED IN IT'S MOST RECENT COMMUNITY HEALTH NEEDSASSESSMENT DUE TO RESOURCE CONSTRAINTS. LEESBURG REGIONAL MEDICAL CENTERRECOGNIZES 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, DIABETES, AND UTILIZING VOLUNTEER WORKFORCE. LEESBURG REHABILITATION HOSPITAL PART V, SECTION B, LINE 11: LEESBURG REGIONAL MEDICAL CENTER 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 CENTERRECOGNIZES THAT OTHER COMMUNITY GROUPS HAVE MORE EXPERIENCE TO MEET THOSENEEDS. THE NEEDS IDENTIFIED THAT ARE BEING ADDRESSED BY OTHER ORGANIZATIONS ARE DENTAL CARE, AGING PROBLEMS, RESPIRATORY/LUNG DISEASE, MENTAL HEALTH, DIABETES, 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. 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 FACILITYHAS 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. 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 ADISCOUNT 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. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY LEESBURG REGIONAL MEDICAL CENTER INC PART V, SECTION B, LINE 16A WEBSITE: HTTP://WWW.CENTRALFLORIDAHEALTH.ORG/PATIENT-CHARITY.HTML LEESBURG REHABILITATION HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: HTTP://WWW.CENTRALFLORIDAHEALTH.ORG/PATIENT-CHARITY.HTML LEESBURG REHABILITATION HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: HTTP://WWW.CENTRALFLORIDAHEALTH.ORG/PATIENT-CHARITY.HTML 2 LRMC WELLNESS CENTER 700 NORTH PALMETTO ST LEESBURG FL 34748 WELLNESS SURGERY CENTER OF MOUNT DORA AMB 3710 LAKE CENTER DRIVE MT DORA FL 32757 SURGERY CENTER PART III, LINE 2: BAD DEBT EXPENSES ARE CALCULATED BY APPLYING THE COST TO PATIENT CHARGE RATIO TO THE GROSS PATIENT CHARGES WRITTEN OFF TO BAD DEBT. 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 HEART ASSOCIATION PO BOX 4002900 DESMOINES IA 503402900 135613797 501(C)(3) 12500 SPONSORSHIP AMERICAN CANCER SOCIETY PO BOX 102454 ATLANTA GA 30368 131788491 501(C)(3) 5500 SPONSORSHIP LEESBURG AREA CHAMBER OF COMMERCE PO BOX 490309 LEESBURG FL 347490309 590330175 501(C)(6) 5500 SPONSORSHIP LAKE SUMTER STATE COLLEGE FOUNDATION 9501 US HIGHWAY 441 LEESBURG FL 34788 591990323 501(C)(3) 100700 SPONSORSHIP TVRH AUXILIARY FOUNDATION 1501 N US HIGHWAY 441 THE VILLAGES FL 32159 550818419 501(C)(3) 11500 SPONSORSHIP 4 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 614288 0 199898 0 11615 0 10400 0 6226 0 842427 0 0 0 DIANE HARDEN SVP/CFO 321688 0 86574 0 5871 0 10400 0 4201 0 428734 0 0 0 SAAD EHTISHAM SVP/COO 366072 0 99963 0 1496 0 10053 0 8822 0 486406 0 0 0 PHYLLIS BAUM VP/CQO 302677 0 55956 0 3238 0 10400 0 6294 0 378565 0 0 0 AMIE RICHASON VP OF HUMAN RESOURCES 238754 0 44575 0 1331 0 8716 0 6226 0 299602 0 0 0 DAVID STEELE VP/CIO 227222 0 42634 0 3060 0 9419 0 8251 0 290586 0 0 0 PHILIP BRAUN VP/CHIEF COUNSEL 193597 0 36738 0 1159 0 10076 0 8310 0 249880 0 0 0 WILLIAM PFINGSTEN VP OF AMBULATORY SERVICES 192816 0 36643 0 8469 0 7447 0 8572 0 253947 0 0 0 TED E WILLIAMS VP/FOUNDATION PRESIDENT 176784 0 33169 0 7885 0 6715 0 4841 0 229394 0 0 0 TERI KEEL VP/CCO 166157 0 38002 0 5620 0 1577 0 4236 0 215592 0 0 0 LEONEL EDWARDS PHYSICIAN 399810 0 195438 0 690 0 0 0 0 0 595938 0 0 0 M FIRAS SIOUFI PHYSICIAN 384835 0 166018 0 196 0 9113 0 5429 0 565591 0 0 0 YIN LUK PHYSICIAN 215922 0 201840 0 173 0 6138 0 2151 0 426224 0 0 0 ORLANDO ICAZA PHYSICIAN 336570 0 45000 0 1980 0 6815 0 4201 0 394566 0 0 0 DAVID RIZZUTO PHYSICIAN 332410 0 45000 0 1980 0 10400 0 8361 0 398151 0 0 0 PART I, LINE 4B DON HENDERSON 457F CONTRIBUTION $89,505 DIANE HARDEN 457F CONTRIBUTION $37,500 SAAD EHTISHAM 457F CONTRIBUTION $43,750 PART I, LINE 7 THE ORGANIZATION AWARDS BONUSES ON THE BASIS OF QUALITY OF 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 20840000 20840000 2011 1 0 1 1 B 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 FORM 990, PART VI, SECTION A, LINE 6 CENTRAL FLORIDA HEALTH ALLIANCE ("CFHA") IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A CENTRAL FLORIDA HEALTH ALLIANCE ("CFHA") APPOINTS THE MEMBERS OF THE ORGANIZATIONS 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 CFHA APPROVAL. FORM 990, PART VI, SECTION B, LINE 11 DURING APRIL 2016, MANAGEMENT DISTRIBUTED A DRAFT OF THE 2014 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 COMMUNITY HOSPITAL CORPORATION 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 ORGNAIZATION'S ARTICLES OF INCORPORATION ARE PUBLICLY AVAILABLE THROUGH FLORIDA'S SECRETARY OF STATE WEBSITE. FORM 990, PART XI, LINE 9: EQUITY IN EARNINGS OF UNCONSOLIDATED AFFILIATES 850,184. CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS -100,995. LOSS ON EXT OF DEBT -470,887. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED EITHER ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. ALLIANCE LABS LLC 1456 WILLIAM STREET LEESBURG FL 34748 264322547 OUTREACH LAB FL 6101584 7390173 LRMC THE VILLAGES TRI-COUNTY MEDICAL CENTER 1451 EL CAMINO REAL THE VILLAGES FL 32159 593527036 MEDICAL SRVCS FL 501(C)(3) 3 CFHA 0 LEESBURG REGIONAL MEDICAL CTR FOUNDATION 600 EAST DIXIE AVENUE LEESBURG FL 34748 591800743 SUPPORT HOSP FL 501(C)(3) 11 CFHA 0 CENTRAL FLORIDA HEALTH ALLIANCE 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 CFHA 0 SURGERY CTR MT DORA 3710 LAKE CTR MT DORA FL 32757 262446297 HEALTHCARE SRVCS FL LRMC RELATED 104459 152035 0 0 0.51000 CF INPATIENT COMGT 600 EAST DIXIE AVENUE LEESBURG FL 34748 471165465 HEALTHCARE SRVCS FL N/A RELATED 166285 129368 0 1 0.26320 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 LEESBURG REGIONAL MEDICAL CENTER FOUNDATION C