2015-08-12T09:14:25-05:00 2014-09-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2013-10-01 593322533 SOUTH LAKE HOSPITAL INC SOUT 3523944071 1900 DON WICKHAM DRIVE CLERMONT FL 347111979 LANCE SEWELL CFO 3523944071 2015-08-17 true JACQUELINE G ATKINS P00861721 2298837878 2015-08-11 2013 2016-02-25 16:41:14Z JOHN A MOORE PRESIDENT 1900 DON WICKHAM DRIVE CLERMONT FL 347111979 173073432 false X WWW.SOUTHLAKEHOSPITAL.COM X 1995 FL TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE INDIVIDUALS AND COMMUNITIES IN SOUTH LAKE COUNTY. 6 3 1347 154 2714688 -793692 2576814 3834739 126791815 142949677 760171 807505 5862247 5262581 135991047 152854502 67251 1025456 0 61772983 63667495 0 0 66415364 71369421 128255598 136062372 7735449 16792130 258102524 279327846 104911404 108986569 153191120 170341277 TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE INDIVIDUALS AND COMMUNITIES IN SOUTH LAKE COUNTY. false false 111473400 1025456 144481757 OPERATION OF NOT-FOR-PROFIT HOSPITAL PROVIDING INPATIENT, OUTPATIENT, & EMERGENCY CARE FOR RESIDENTS OF SOUTHERN LAKE COUNTY FLORIDA. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. TOTAL PATIENT DAYS FOR THE FISCAL YEAR WAS APPROXIMATELY 35,000. 111473400 true true false true false false false false false true true false false false true true true false false false false false false false false false true true true true true true true false false false false false false true false false false false false false false true false false false true 188 0 1347 true true true false false false false false false false false false X 6 3 false true false false false true false true true false false true true true true true true false false false FL X LANCE SEWELL CFO 3522417104 1900 DON WICKHAM DRIVE CLERMONT FL 347111979 LUSHANTHA GUNASEKERA MD BOARD MEMBER 40.00 5.00 X 0 663997 50062 MILDRED BEAM VICE PRESIDE 40.00 5.00 X X 0 420108 75615 CARY D'ORTONA TREASURER 40.00 5.00 X X 0 151941 55311 SUSAN MCLEAN BOARD PRESID 2.00 X X 0 0 0 ROBERT E BERENS JR SECRETARY 2.00 X X 0 0 0 DAVID BATMAN BOARD MEMBER 2.00 1.00 X 0 0 0 JOHN MOORE HOSPITAL PRE 40.00 1.00 X 0 228748 79307 LANCE SEWELL CFO 40.00 1.00 X 0 150771 49583 LINDA WALTON CNO 40.00 X 0 120486 46496 PAUL JOHNS COO 40.00 X 0 109916 32190 ANDREW KAREN MD PHYSICIAN 40.00 X 399197 0 32172 JEROME STURM MD PHYSICIAN 40.00 X 297113 0 34454 DOROTHY RICHARDSON MED DIRECTOR 40.00 X 243172 0 28488 JOSE CARRAU MD PHYSICIAN 40.00 X 224924 0 16954 JACOB SINDU MD PHYSICIAN 40.00 X 198787 0 16954 SHERRIE SITARIK FORMER PRESI 0.00 0.00 X 0 1576882 241211 1363193 3422849 758797 23 true true false AVI FOOD SYSTEMS 2590 ELM ROAD NE WARREN OH 444832904 MGMT FOOD SVCS 1124290 ORIGIN DBA SHIFTWISE 2501 SW 1ST AVE PORTLAND OR 972014752 NURSE STAFFING 950626 BIG TEN LLC 2020 OAKLEY SEAVER DR CLERMONT FL 347111902 MGMT SURGICAL 901500 BOYKIN CONSTRUCTION 116 W CENTER STREET MINNEOLA FL 347157910 CONSTRUCTION 508211 MEDICAL CENTER RADIOLOGY 20 WEST KALEY AVE ORLANDO FL 328062931 RADIOLOGY SVCS 422130 39 3215389 538608 80742 3834739 PROGRAM SERVICE REVENUE 623000 142949677 142949677 142949677 1021115 1021115 294068 209319 84749 84749 84749 19750216 45785 19923331 86280 -173115 -40495 -213610 -213610 NATIONAL TRAINING CENTER 623000 2714688 2714688 EHR HOSPITAL 621990 1532080 1532080 FOOD AND BEVERAGE 722210 868731 868731 62333 62333 5177832 152854502 144481757 2714688 1823318 X 1000000 1000000 25456 25456 52595715 47408312 5187403 1335762 1204021 131741 6200813 5589252 611561 3535205 3193805 341400 693 693 285797 285797 285533 285533 4468 4468 19817405 10663821 9153584 325744 59418 266326 12979178 12248247 730931 79325 24955 54370 3002598 2906815 95783 163011 120102 42909 5051677 5051677 8964847 8678868 285979 1026715 1026715 MEDICAL SUPPLIES 13868964 13868964 REPAIRS AND MAINTENANCE 2131028 1833601 297427 PROVIDER FEES 1582901 1582901 RECRUITING 476883 476883 1322654 1060394 262260 136062372 111473400 24588972 0 93217 87427 33271000 51867127 15629939 17701205 928770 1024380 2070487 2481319 1123271 1150617 210861873 77888646 134678431 132973227 60341878 60784830 196056 51707 4504031 4504031 5265444 6701976 258102524 279327846 16643562 21379263 533560 423925 84657773 83185383 2267452 2108019 809057 1889979 104911404 108986569 X 151769449 168809549 1421671 1531728 153191120 170341277 258102524 279327846 X 16792130 -270597 628624 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 4468 4468 false SCHEDULE C, PART II-B, LINE 1 THE HOSPITAL PAYS MEMBERSHIP DUES TO A STATE HEALTHCARE ORGANIZATION. A PORTION OF THOSE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THE STATE HEALTHCARE ORGANIZATION PARTICIPATES. 1421671 181257 25456 45744 1531728 1322778 230518 67250 64375 1421671 1372263 227295 80246 196534 1322778 1330725 196127 4888 75235 84242 1372263 1225860 110737 96683 65295 37260 1330725 1.00000 true false 752000 9652800 10404800 135356565 35062009 100294556 3788070 1161133 2626937 59312878 41665504 17647374 1999560 1999560 132973227 RAC RESERVE 1092049 THIRD PARTY SETTLEMENTS 797930 1889979 X 150980872 -270597 249543 -21054 151001926 1852576 1852576 152854502 135246235 209319 209319 135036916 1025456 1025456 136062372 SCHEDULE D, PAGE 2, PART V, LINE 4 CAPTAIN HOMER N. ALLEN FUND FOR NURSING SCHOLARSHIPS PROVIDES SUPPORT FOR SCHOLARSHIPS FOR RESIDENTS OF SOUTH LAKE COUNTY AND/OR EMPLOYEES OF SOUTH LAKE HOSPITAL WHO WISH TO FURTHER THEIR EDUCATION IN THE FIELD OF NURSING. OTHER RESTRICTED FUNDS ARE AVAILABLE FOR THE ACQUISITION OF FIXED ASSETS AND OTHER OPERATING USES. SCHEDULE D, PAGE 3, PART X THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE HOSPITAL ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF SEPTEMBER 30, 2014 AND 2013 OR FOR THE YEARS THEN ENDED. FOR FEDERAL INCOME TAX PURPOSES THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. SCHEDULE D, PAGE 4, PART XI, LINE 2D RENTAL EXPENSES 209,319 NET ASSETS RELEASED FROM RESTRICTIONS 40,224 SCHEDULE D, PAGE 4, PART XI, LINE 4B CAPITAL CONTRIBUTIONS 480,743 GRANT EXPENSE NETTED AGAINST REVENUE 1,000,000 UNREALIZED IMPAIRMENT LOSS 371,833 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSE 209,319 SCHEDULE D, PAGE 4, PART XII, LINE 4B GRANT EXPENSE NETTED AGAINST REVENUE 1,000,000 SCHOLARSHIPS FROM NET ASSETS 25,456 true true X true X true X true true true false true true 5535938 5535938 0.04060 15455581 13112925 2342656 0.01720 20991519 13112925 7878594 0.05780 512020 512020 0.00380 80851 25456 55395 0.00040 245215 136646 108569 0.00080 1465506 1465506 0.01080 2303592 162102 2141490 0.01580 23295111 13275027 10020084 0.07360 true 16957665 12718249 36166148 36638066 -471918 X true true 1 1 SOUTH LAKE HOSPITAL 1900 DON WICKHAM DRIVE CLERMONT FL 347111979 WWW.SOUTHLAKEHOSPITAL.COM 4180 X X X SURG CTR, REHAB, MRI, HH SOUTH LAKE HOSPITAL 1 true X X X X X X X X 13 true false true X WWW.SOUTHLAKEHOSPITAL.COM X X X X X false false true true 200.000000000000 true 400.000000000000 true X X X true true X X true false X X X true X false false FACILITY 1, SOUTH LAKE HOSPITAL - PART V, LINE 3 IN ORDER TO DETERMINE THE COMMUNITY'S PERSPECTIVES ON PRIORITY COMMUNITY HEALTH ISSUES AND QUALITY OF LIFE ISSUES RELATED TO HEALTHCARE, TWO RESEARCH METHODS WERE USED: FOCUS GROUPS AND PROVIDERS SURVEYS. THE STEERING COMMITTEE WORKED WITH WELLFLORIDA COUNCIL TO DETERMINE FOCUS GROUP QUESTIONS AND PROVIDER SURVEY QUESTIONS. FOCUS GROUP PARTICIPANTS WERE RECRUITED BY COMMUNITY LEADERS AT ORGANIZATIONS AND AGENCIES HOSTING THE FOCUS GROUPS AS WELL AS BY FLYERS DISTRIBUTED THROUGHOUT THE COMMUNITY, PRESS RELEASES AND E-MAIL BLASTS DISTRIBUTED TO THE SOUTH LAKE HOSPITAL CONTACT LIST. IN TOTAL, 29 COMMUNITY MEMBERS PARTICIPATED IN THE FOCUS GROUPS. THE SOUTH LAKE HOSPITAL STEERING COMMITTEE, REPRESENTING SOUTH LAKE HOSPITAL, WORKED WITH WELLFLORIDA COUNCIL TO FORMULATE A PROVIDER SURVEY THAT WOULD TOUCH UPON SOME OF THE SAME TOPICS ADDRESSED DURING THE FOCUS GROUPS. WORKING IN COOPERATION WITH THE FACILITIES REPRESENTED BY STEERING COMMITTEE MEMBERS, THE SURVEYS WERE DISTRIBUTED TO LAKE COUNTY PROVIDERS IN MARCH 2013. RESPONDENTS COMPLETED THE SURVEY USING SURVEY MONKEY TO SUBMIT THEIR RESPONSES. TWENTY-NINE PROVIDERS SUBMITTED RESPONSES TO THE SURVEY. FACILITY 1, SOUTH LAKE HOSPITAL - PART V, LINE 7 THE SOUTH LAKE HOSPITAL CHNA IDENTIFIED ADDITIONAL NEEDS IN THE SERVICE AREA THAT ARE NOT ADDRESSED AS A PRIORITY IN THIS CURRENT IMPLEMENTATION PLAN. IN CONSIDERING WHAT NEEDS NOT TO ADDRESS, THE HOSPITAL COMMITTEE WEIGHED THE LEVEL AT WHICH THESE NEEDS ARE ALREADY BEING ADDRESSED BY OTHER COMMUNITY PARTNERS, THE HOSPITAL AND/OR WHETHER THE HOSPITAL HAD THE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED. TO THAT END, THE HOSPITAL WILL NOT ADDRESS SOME OF THE NEEDS IDENTIFIED IN THE 2013 ASSESSMENT BECAUSE: (1) THE HOSPITAL ADDRESSES THE NEED, BUT CURRENTLY HAS NO PLANS TO EXPAND SERVICES, (2) OTHER PROVIDERS ARE ALREADY ADDRESSING THE NEEDS AND (3) THE NEED IDENTIFIED IS BEYOND THE SCOPE OF THE HOSPITAL. 3 NATIONAL TRAINING CENTER 1935 DON WICKHAM DRIVE CLERMONT FL 347111979 WELLNESS CENTER SOUTH LAKE SURGICAL CENTER 1935 DON WICKHAM DRIVE CLERMONT FL 347111979 OUTPATIENT SURGERY SOUTH LAKE HOME HEALTH AGENCY 1935 DON WICKHAM DRIVE CLERMONT FL 347111979 HOME HEALTH PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE IF TOTAL OF ALL OPEN BILLS ACCOUNTS FOR MORE THAN 25% OF THEIR ANNUAL INCOME, DISCOUNT WILL BE APPLIED TO REACH THE 25% MARK, PROVIDED PATIENT'S INCOME DOES NOT EXCEED 400% OF THE FPG. PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION SUBSIDIZED HEALTH SERVICES REPRESENT THE OPERATIONAL COSTS FOR THE FREE CLINIC TO CARE FOR INDIGENT PATIENTS OF SOUTH LAKE COUNTY. PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN (F), THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25: FORM 990, PART IX, LINE 25 136,062,372 ADD: EXPENSES REPORTED IN PART VIII 209,319 DENOMINATOR FOR COLUMN (F) 136,271,691 PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008". SEE ALSO THE DESCRIPTION FOR PART III, LINE 4. COSTS FOR PART I, LINE 7A, AND 7B WERE CALCULATED USING THE RCC CALCULATED IN WORKSHEET 2. OTHER COSTS WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. THE AMOUNT INCLUDED ON PART III LINE 3 IS BASED ON HISTORICAL DATA FOR THOSE INDIVIDUALS WHO MAY HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S POLICY; HOWEVER, FAILED TO COMPLETE THE APPLICATION PROCESS. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD- PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED AGAINST CONTRACTUAL ALLOWANCES AND DISCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS DECREASED APPROXIMATELY 2% TO 90% OF SELF-PAY ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2014, FROM 92% AT SEPTEMBER 30, 2013. IN ADDITION, THE HOSPITAL'S SELF-PAY WRITEOFFS INCREASED 1,971,268 FROM 18,379,957 FOR FISCAL YEAR 2013 TO 20,351,225 FOR FISCAL YEAR 2014. THE TOTAL SELF-PAY ALLOWANCE DECREASED DUE TO ACCOUNTS WRITTEN OFF TO EXPENSE MORE QUICKLY WHICH ALSO RESULTED IN HIGHER WRITE-OFFS FOR FISCAL YEAR 2014. PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION BOTH DISCOUNTS AND PAYMENTS TO ACCOUNTS WILL REDUCE THE BAD DEBT EXPENSE, SHOULD THE ACCOUNT BE REPORTED AS BAD DEBT. THAT IS TO SAY, DISCOUNTS APPLIED TO ACCOUNTS ARE NOT REVERSED PRIOR TO DECLARING, ADJUSTING AND/OR WRITING OFF ACCOUNTS AS BAD DEBT. ALL ACCOUNTS WHICH ARE ADJUSTED TO, OR WRITTEN OFF TO, BAD DEBT ARE REVIEWED TO DETERMINE THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE. IF SUFFICIENT DOCUMENTATION WAS NOT PROVIDED BY THE ACCOUNT HOLDER, SOUTH LAKE USES PREDICTIVE ANALYTICS TO DETERMINE IF THE ACCOUNT WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE. THE PREDICTIVE ANALYTICS DESIGNED TO ASSESS FINANCIAL ASSISTANCE FOR ACCOUNTS ADJUSTED TO, OR WRITTEN OFF TO, BAD DEBT USES DATA DERIVED FROM THIRD PARTIES WHICH INCLUDE, BUT ARE NOT LIMITED TO DEMOGRAPHIC VERIFICATION, INCOME VERIFICATION, HOUSEHOLD SIZE VERIFICATION, PAYMENT HISTORY INFORMATION, PROPERTY OWNERSHIP INFORMATION, OCCUPATION INFORMATION, VEHICLE OWNERSHIP HISTORY AND VALUES AND HOME OWNERSHIP HISTORY AND VALUES. ONCE THIS DATA LOGIC IS APPLIED, IT BECOMES APPARENT IF THE ACCOUNT QUALIFIES FOR FINANCIAL ASSISTANCE. IF THE ACCOUNT DOES QUALIFY, PREVIOUS UNINSURED DISCOUNTS, BAD DEBT ADJUSTMENTS AND/OR WRITE OFFS ARE REVERSED AND THE NEW BALANCE REFLECTED IS RECLASSIFIED AS FINANCIAL ASSISTANCE OR CHARITY. PART VI, LINE 2 - NEEDS ASSESSMENT SOUTH LAKE DOES ASSESS THE SERVICES NEEDED AS PART OF OUR STRATEGY, PLANNING AND BUDGETING PROCESS AND HAS PROCESSES IN PLACE TO ENSURE THE ORGANIZATION IS REACTIVE TO COMMUNITY HEALTH NEEDS. EXAMPLES OF HOW SOUTH LAKE RESPONDS TO COMMUNITY NEEDS ARE AS FOLLOWS: 1. GOVERNING BOARDS ARE COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE; 2. PARTNERSHIP WITH LOCAL AREA GROUPS AND ASSOCIATES TO ATTEND TO THE HEALTH CARE NEEDS OF THE SOUTH LAKE COMMUNITY; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH FAIRS, COMMUNITY FITNESS, WELLNESS EVENTS AND OTHER OUTREACH EVENTS; AND 4. TRANSITION SERVICES POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS TO PREVENT UNNECESSARY ADMISSIONS AND POTENTIAL RE-ADMISSIONS. SOUTH LAKE MEETS THE NEEDS OF THE COMMUNITY THROUGH ITS EDUCATION, RESEARCH AND PATIENT CARE PROGRAMS. THE SPECIFIC NEEDS TARGETED BY THESE PROGRAMS HAVE BEEN IDENTIFIED BY THE EXPERIENCE OF COMMUNITY HOSPITAL ADVISORY COUNCILS, NEIGHBORHOOD OUTREACH AND THROUGH COMMUNITY NEEDS ASSESSMENTS THAT IDENTIFIED HEALTH PROBLEMS IN THE COMMUNITIES SERVED BY THE HOSPITAL. SOUTH LAKE SPONSORS A VARIETY OF PROGRAMS FOR AT-RISK POPULATIONS, FEDERALLY-DESIGNED MEDICALLY UNDERSERVED AREAS AND SPECIAL NEEDS GROUPS, AS WELL AS FOR THE BROADER COMMUNITY. DURING THE FISCAL YEAR 2013, THE ORGANIZATION, ALONG WITH THE EFFORTS OF WELLFLORIDA COUNCIL, INC., CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT. THE CHNA CAN BE FOUND AT HTTP://WWW.SOUTHLAKEHOSPITAL.COM/LINKCLICK.ASPX? FILETICKET=HTPVBVVSMBC%3D&TABID=56. THE IMPLEMENTATION STRATEGY PLAN CAN ALSO BE FOUND ON THE ORGANIZATION'S WEBSITE AT HTTP://WWW.SOUTHLAKEHOSPITAL.COM/LINKCLICK.ASPX?FILETICKET=7JBQ6Z26MUK %3D&TABID=56. PROGRESS ON CHNA INPLEMENTATION STRATEGIES 2013 - 2014: IN FISCAL YEAR 2014, SOUTH LAKE HOSPITAL FOCUSED ON ADDRESSING THE COMMUNITY HEALTH NEEDS IDENTIFIED IN OUR 2013 COMMUNITY HEALTH NEEDS ASSESSMENT. BELOW IS AN UPDATE ON THE VARIOUS EFFORTS MADE BY THE HOSPITAL THROUGHOUT THE FISCAL YEAR 2014 ON EACH IDENTIFIED NEED. DISPARITY OF NUMEROUS HEALTH FACTORS FOR GROVELAND RESIDENTS: THE GOAL IS TO EDUCATE THE RESIDENTS IN THE GROVELAND AREA ABOUT HOW TO PREVENT HEART DISEASE, IMPORTANT CANCER SCREENINGS, DIABETES PREVENTION AND MANAGEMENT AND PREVENTION OF CHRONIC LOWER RESPIRATORY DISEASE (CLRD). THIS IS TO BE ACHIEVED THROUGH HEALTH FAIRS WITH FAITH BASED ORGANIZATIONS AND COMMUNITY ORGANIZATIONS, WORKING WITH LOCAL LEADERS TO ENSURE THAT THEY ARE AWARE OF HEALTH RESOURCES FOR UNINSURED RESIDENTS AND WORKING IN THE SCHOOLS TO TEACH THE IMPORTANCE OF PREVENTION. IN FISCAL YEAR 2014, SOUTH LAKE HOSPITAL MADE EFFORTS TOWARD THIS GOAL BY: - HOSTING A HEALTH FAIR AT A LARGE FAITH BASED CHURCH IN GROVELAND AND OFFERING FREE CHOLESTEROL AND GLUCOSE SCREENING ALONG WITH EDUCATION ON PREVENTION AND RESULTS (IN TANDEM WITH A LOCAL PRIMARY CARE PHYSICIAN) TO GIVE RESIDENTS A BETTER UNDERSTANDING OF THEIR HEALTH RISKS. THE HOSPITAL REACHED OVER 40 RESIDENTS AND IS WORKING WITH THE ORGANIZATION TO ATTEND THE EVENT ANNUALLY AND LOOK INTO HOW THE HOSPITAL CAN PROVIDE ONGOING EDUCATION. THE MEMBERS WERE GIVEN INFORMATION ON THE HOSPITAL'S FREE SMOKING CESSATION PROGRAMS, FREE MAMMOGRAPHY SCREENING PROGRAM, FREE SOUTH LAKE HEALTH CLINIC AND OTHER EDUCATIONAL OPPORTUNITIES. - WORKED WITH THE LOCAL GROVELAND ELEMENTARY SCHOOL TO ALLOW THE HOSPITAL TO ATTEND THEIR AFTERCARE PROGRAM AND PROVIDE AN INTERACTIVE, EDUCATIONAL PROGRAM FOR THEIR STUDENTS. AN EXERCISE PHYSIOLOGIST PRESENTED ON NUTRITION, TEACHING THE CHILDREN ABOUT THE FOOD GROUPS AND HOW TO MAKE A HEALTHY, BALANCED MEAL. THE CHILDREN WERE THEN TASKED WITH PUTTING TOGETHER A BALANCED MEAL USING DIFFERENT FOOD CHOICES (FAKE FOOD MODELS). THEY WERE GIVEN SIMPLE, INEXPENSIVE RECIPES TO TAKE HOME TO ENCOURAGE THEIR PARENTS TO PREPARE BALANCED MEALS. THE STUDENTS THEN PARTICIPATED IN A FUN EXERCISE CLASS SET TO MUSIC TO SHOW THEM HOW EASY IT IS TO GET ACTIVE. THE THIRD PART OF THE PROGRAM TAUGHT THE IMPORTANCE OF HANDWASHING AND AN INTERACTIVE DEMONSTRATION WAS DONE TO ENSURE THE CHILDREN KNEW HOW TO PROPERLY SCRUB AND WASH THEIR HANDS. ALL PARTICIPANTS WERE ALSO SENT HOME WITH A PEDOMETER TO ENCOURAGE 10,000 STEPS PER DAY. - VISITED PHYSICIAN PRACTICES THROUGHOUT THE GROVELAND COMMUNITY, INCLUDING THE LARGE SLIDING SCALE CLINIC TO ENSURE THEY HAVE INFORMATION ABOUT SOUTH LAKE HOSPITAL'S EDUCATIONAL RESOURCES AND PROGRAMS FOR UNINSURED RESIDENTS. TEENAGE BIRTH RATES & LOW BIRTH RATES: THE GOAL IS TO REDUCE BOTH THE NUMBER OF TEENAGE BIRTH RATES AND THE NUMBER OF INFANT DEATHS FOR THE SERVICE AREA, PARTICULARLY IN THE AFRICAN AMERICAN POPULATION. INFANT DEATH RATES DIRECTLY CORRELATE WITH LOW BIRTH WEIGHTS SO THE FOCUS IS TO EDUCATION WOMEN ON PROPER PRENATAL CARE TO LEAD TO FULL TERM DELIVERIES. IN FISCAL YEAR 2014, SOUTH LAKE HOSPITAL MADE EFFORTS TOWARD THESE GOALS BY: - SOUTH LAKE HOSPITAL OFFERS NUMEROUS EDUCATION COURSES FOR EXPECTING MOMS THAT EDUCATE ABOUT PRENATAL CARE. THE HOSPITAL IDENTIFIED THAT MANY PARENTS THAT MAY BE AT RISK FOR LOW BIRTH RATES ARE UNABLE TO AFFORD THE CLASSES, WHICH ARE ALREADY AT A LOW RATE COMPARATIVELY IN THE CENTRAL FLORIDA MARKET. THE HOSPITAL FOUNDATION APPLIED FOR A GRANT THROUGH THE LOCAL MARCH OF DIMES CHAPTER FOR FUNDS TO PROVIDE EDUCATION ON PRENATAL CARE. THE GRANT WAS APPLIED FOR IN FISCAL YEAR 2014 AND WAS AWARDED AND WILL BE EXECUTED IN FISCAL YEAR 2015. THIS WILL ALLOW ALL RESIDENTS IN THE HOSPITAL'S SERVICE AREA FREE PRENATAL EDUCATION, REGARDLESS OF WHERE THEY CHOOSE TO DELIVER THEIR CHILD. - THE HOSPITAL IDENTIFIED THE NEED FOR PRENATAL EMERGENCY CARE AT THE LABOR AND DELIVERY DEPARTMENT AND IN FISCAL YEAR 2014 DEVELOPED AN OBSTETRICS EMERGENCY DEPARTMENT THROUGH AN OBSTETRICS/GYNECOLOGY HOSPITALIST PROGRAM THAT ALLOWS EXPECTING WOMEN IN THE COMMUNITY ACCESS TO AN OBSTETRIC PHYSICIAN 24 HOURS A DAY, SEVEN DAYS A WEEK TO TREAT PRENATAL EMERGENCIES. KNOWLEDGE OF AVAILABLE HEALTHCARE RESOURCES AND HEALTHCARE EDUCATION IN THE COMMUNITY: THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED THAT KEY STAKEHOLDERS LACKED THE INFORMATION NECESSARY TO UNDERSTAND WHAT HEALTH CARE RESOURCES ARE AVAILABLE IN THE SOUTH LAKE HOSPITAL SERVICE AREA AND THE COUNTY AS A WHOLE. THIS INCLUDES INFORMATION ON HOW TO ACCESS TRANSPORTATION SERVICES, AVAILABLE INDIGENT CARE FACILITIES, FINANCIAL ASSISTANCE PROGRAMS AND PHARMACEUTICAL PROGRAMS. IN FISCAL YEAR 2014, SOUTH LAKE HOSPITAL MADE EFFORTS TOWARD THIS GOAL BY: - SOUTH LAKE HOSPITAL WORKED WITH THE CENTRAL FLORIDA UNITED WAY 211 PROGRAM TO ENSURE THAT THEY HAVE ACCURATE INFORMATION ABOUT SOUTH LAKE HOSPITAL'S COMMUNITY EDUCATION PROGRAMMING AS WELL AS SERVICES FOR THE UNDER AND UNINSURED RESIDENTS. HOSPITAL STAFF MET WITH THE ORGANIZATION AND TOURED THEIR CENTRAL MESSAGING CENTER IN CENTRAL FLORIDA TO BETTER UNDERSTAND HOW THE ORGANIZATION OPERATES. THE HOSPITAL STAFF, INCLUDING CASE MANAGEMENT, WAS EDUCATED ON 211 AND HOW IT CAN BE UTILIZED BY BOTH HOSPITAL STAFF AND PATIENTS AND FAMILY MEMBERS FOR IDENTIFYING HEALTH CARE RESOURCES. - SOUTH LAKE HOSPITAL CONTINUES TO OUTREACH TO LOCAL SCHOOLS, THE LOCAL HEALTH DEPARTMENT, FAITH BASED ORGANIZATIONS AND SLIDING SCALE CLINICS TO PROVIDE INFORMATION ON HOW ACCESS THE RESOURCES PROVIDED BY THE HOSPITAL. DEVELOP PARTNERSHIP/COLLABORATION WITH COMMUNITY-BASED ORGANIZATIONS TO RAISE AWARENESS OF HEALTHY BEHAVIORS: THE COMMUNITY HEALTH NEEDS ASSESSMENT SHOWED THAT STAKEHOLDERS IDENTIFIED THE LACK OF COORDINATION AMONG COMMUNITY-BASED ORGANIZATIONS, NON-PROFITS, SENIOR CENTERS AND FAITH BASED COMMUNITIES TO DEVELOP A GRASS ROOTS APPROACH TO IMPROVING COMMUNICATIONS ABOUT SELF-AWARENESS OF HEALTHY BEHAVIORS. THE GOAL IS TO IMPROVE SUCH COLLABORATIONS SO THAT ALL ORGANIZATIONS SPEAK A SIMILAR MESSAGE ABOUT THE IMPORTANCE OF WELLNESS AND PREVENTION IN THE COMMUNITY. IN FISCAL YEAR 2014, SOUTH LAKE HOSPITAL MADE EFFORTS TOWARD THIS GOAL BY: - THE HOSPITAL RESTRUCTURED ITS COMMUNITY WELLNESS CENTER TO INCORPORATE ADDITIONAL OUTREACH PROGRAMMING TO PROMOTE HEALTHY LIFESTYLE HABITS IN THE HOSPITAL'S SERVICE AREA. THE FITNESS CENTER WAS REBRANDED FROM THE NATIONAL TRAINING CENTER, WHICH SERVES BOTH COMMUNITY RESIDENTS AND NATIONAL AND INTERNATIONAL ATHLETES, TO THE LIVEWELL FITNESS CENTER. THIS NAME CHANGE WAS TO STRENGTHEN PUBLIC AWARENESS ABOUT THE IMPORTANCE OF PREVENTION IN THE COMMUNITY. ATHLETES STILL UTILIZE THE FITNESS CENTER AND THE NATIONAL TRAINING CENTER'S SPORTS FACILITIES BUT THE LIVEWELL STAFF CREATED SEVERAL NEW PROGRAMS THAT GO BEYOND THE WALLS OF THE FITNESS CENTER. A COMMUNITY WELLNESS COORDINATOR WAS HIRED SPECIFICALLY TO WORK WITH LOCAL BUSINESSES, RETIREMENT COMMUNITIES, FAITH BASED ORGANIZATIONS, SCHOOLS AND OTHER COMMUNITY GROUPS TO EDUCATE ON PREVENTION. IN FISCAL YEAR 2014, THE LIVEWELL STAFF CONDUCTED FIVE HEALTH FAIRS IN THE COMMUNITY OFFERING CHOLESTEROL AND GLUCOSE SCREENI PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SOUTH LAKE FOLLOWS AN ESTABLISHED PROCESS TO INFORM ALL PATIENTS OF ITS CHARITY CARE AND UNINSURED DISCOUNT POLICIES. DURING PREADMISSION, AT REGISTRATION OR AT BEDSIDE, UNINSURED PATIENTS ARE INFORMED OF THE HOSPITAL'S CHARITY CARE POLICY AND OTHER FINANCIAL ASSISTANCE. FINANCIAL INFORMATION IS SECURED FOR ALL UNINSURED PATIENTS TO SCREEN FOR POSSIBLE ENROLLMENT IN FEDERAL, STATE AND LOCAL PROGRAMS. SOUTH LAKE HAS CONTRACTED DEDICATED ORGANIZATIONS THAT ASSIST THE PATIENT WITH THEIR ENROLLMENT PROCESS ALL THE WAY TO APPROVAL OR DENIAL BY THE RESPECTIVE AGENCIES. FOR UNINSURED PATIENTS THAT ARE DENIED COVERAGE OR DO NOT MEET THE COVERAGE CRITERION FOR A RESPECTIVE AGENCY, SOUTH LAKE THEN SCREENS THE PATIENT FOR CHARITY ELIGIBILITY. IT IS SOUTH LAKE'S OBJECTIVE TO PROVIDE CHARITY CARE TO OUR PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY. PART VI, LINE 4 - COMMUNITY INFORMATION SOUTH LAKE CURRENTLY OPERATES IN THE CENTRAL FLORIDA REGION, WHICH HAS OVER TWO MILLION RESIDENTS AND THOUSANDS OF INTERNATIONAL VISITORS ANNUALLY. SOUTH LAKE'S PRIMARY SERVICE AREA IS COMPRISED OF ORANGE, OSCEOLA, SEMINOLE AND LAKE COUNTIES. THE MEDIAN HOUSEHOLD INCOME IN THESE COUNTIES IS 59,710. TEN PERCENT OF HOUSEHOLDS IN CENTRAL FLORIDA ARE BELOW THE FEDERAL POVERTY GUIDELINE. THE PERCENT UNINSURED (AGE 0-64) FOR THE FOUR COUNTY AREAS ARE 23% AND THERE ARE ELEVEN FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS PRESENT IN THE COMMUNITY. COMMUNITY OUTREACH ACTIVITIES INCLUDE SPEAKER'S BUREAU, SUPPORT/EDUCATION GROUPS, WELLNESS ACTIVITIES, HEALTH FAIRS, CLINICAL SCREENINGS AND ASSESSMENTS, MEDICAL EDUCATION, RESEARCH, WOMEN, CHILDREN AND SENIOR HEALTH INITIATIVES, PUBLIC PROGRAM ENROLLMENT ASSISTANCE AND POST-ACUTE CARE FOR HOMELESS AND UNINSURED, SPONSORSHIPS, SCHOOL INITIATIVES, DONATED MEETING SPACE AND SPIRITUAL CARE. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH SOUTH LAKE HOSPITAL, INC. FURTHERS ITS EXEMPT PURPOSE BY REINVESTING SURPLUS FUNDS IN THE HOSPITAL, EXTENDING ADMITTING PRIVILEGES TO QUALIFYING PHYSICIANS IN THE COMMUNITY AND SURROUNDING AREAS, OPERATING A FREE CLINIC FOR RESIDENTS OF SOUTH LAKE WHO FALL BELOW THE MEDICAID GUIDELINES, OPERATING THE NATIONAL TRAINING CENTER FOR THE OVERALL HEALTH OF THE COMMUNITY AND ENCOURAGING OVERALL COMMUNITY INVOLVEMENT IN THE GOVERNING BODY OF THE ORGANIZATION. GOVERNING BOARDS ARE COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM SOUTH LAKE HOSPITAL, INC. (HOSPITAL) IS PART OF AN AFFILIATED HEALTH CARE SYSTEM WHICH ALSO INCLUDES ORLANDO HEALTH (OH), SOUTH LAKE HOSPITAL FOUNDATION (FOUNDATION), AND SOUTH LAKE COUNTY HOSPITAL DISTRICT (DISTRICT). THE HOSPITAL, LOCATED IN CLERMONT, FL, IS A NOT-FOR-PROFIT HOSPITAL PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SOUTHERN LAKE COUNTY, FL AND SURROUNDING AREAS. OH PROVIDES TRAUMA AND ACUTE CARE TO PATIENTS THROUGHOUT THE CENTRAL FLORIDA AREA AND OFFERS PEDIATRIC AND ADULT PATIENT SERVICES. THE FOUNDATION WAS FOUNDED AND OPERATES TO SUPPORT THE SERVICES OF SOUTH LAKE HOSPITAL. THE FOUNDATION OFFERS SUPPORT TO PATIENTS OF SOUTH LAKE HOSPITAL AS WELL AS THE CHILDREN IN THE COMMUNITY FOR WELLNESS. THE DISTRICT LEVIES AD VALOREM TAXES AND HAS USED THE TAXES COLLECTED TO SUPPORT THE HOSPITAL. true LAKE SUMTER STATE COLLEGE 9501 US HWY 441 LEESBURG FL 347883950 591210132 GOV 1000000 HEALTH ACADEMY 1 NURSING SCHOLARSHIPS 18 25456 SCHEDULE I, PAGE 1, PART I, LINE 2 LAKE SUMTER STATE COLLEGE HAS COLLABORATED WITH THE HOSPITAL AND OTHER ORGANIZATIONS TO CREATE THE HEALTH SCIENCES COLLEGIATE ACADEMY. THE COLLABORATION WILL PROVIDE COMMUNITY-WIDE SUPPORT FOR HIGH SCHOOL, COLLEGE AND GRADUATE STUDENTS WHO WANT A CAREER IN THE HEALTHCARE INDUSTRY. MULTIPLE PERSONS SIT ON THE OPERATIONAL COMMITTEE AND OTHER COMMITTEES TO ENSURE THE FUNDS ARE SPENT FOR THE INTENDED PURPOSE. NURSING SCHOLARSHIP POLICY IS TO PROVIDE TUITION REIMBURSEMENT FOR ANY APPLICANT WHO MEETS CERTAIN CRITERIA REGARDING EMPLOYMENT, GRADES AND QUALIFICATIONS AS WELL AS SUPERVISORY RECOMMENDATIONS. PROOF OF GRADE AND PAYMENT MUST BE PRESENTED AT THE TIME OF REIMBURSEMENT. true true false false false false false false false LUSHANTHA GUNASEKERA MD BOARD MEMBER 397999 264318 1680 28337 21725 714059 MILDRED BEAM VICE PRESIDENT 357376 62732 60760 14855 495723 48243 CARY D'ORTONA TREASURER 143481 8460 33346 21965 207252 JOHN MOORE HOSPITAL PRESIDENT 217733 11015 57312 21995 308055 LANCE SEWELL CFO 133079 5000 12692 26244 23339 200354 LINDA WALTON CNO 120276 210 31395 15101 166982 ANDREW KAREN MD PHYSICIAN 286997 111913 287 17500 14672 431369 JEROME STURM MD PHYSICIAN 282552 13352 1209 17500 16954 331567 DOROTHY RICHARDSON MED DIRECTOR NTC 218144 24600 428 15998 12490 271660 JOSE CARRAU MD PHYSICIAN 224709 215 16954 241878 JACOB SINDU MD PHYSICIAN 198601 186 16954 215741 SHERRIE SITARIK FORMER PRESIDENT 826876 750006 226110 15101 1818093 395463 SCHEDULE J, PAGE 1, PART I, LINE 3 NONE OF THE INDIVIDUAL BOARD MEMBERS OR OFFICERS ARE COMPENSATED BY THE FILING ORGANIZATION. THE FILING ORGANIZATION, INSTEAD, RELIES ON THE METHODS USED BY THE RELATED ORGANIZATION AND PROVIDER OF MANAGEMENT SERVICES, ORLANDO HEALTH INC., TO ESTABLISH COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. COMPENSATION DETERMINATION BY OH INCLUDES AN INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. SCHEDULE J, PAGE 1, PART I, LINE 4 MILDRED BEAM 0 57,573 0 CARY D'ORTONA 0 9,086 0 JOHN MOORE 0 31,500 0 LANCE SEWELL 0 9,918 0 LINDA WALTON 0 8,750 0 PAUL JOHNS 0 7,700 0 SHERRIE SITARIK 131,331 180,131 0 SCHEDULE J, PART III THE 457F DEFERRED COMPENSATION PLAN IS A RETENTION PLAN WHEREBY 7% OF THE EXECUTIVE'S BASE SALARY IS DEPOSITED INTO A LINCOLN ACCOUNT. EACH YEAR'S DEPOSIT IS SUBJECT TO A THREE YEAR VESTING SCHEDULE. UPON VESTING THE ACCOUNT IS TAXED AND PAID OUT LESS ANY 403B DEDUCTIONS. IF THE EXECUTIVE VOLUNTARILY SEPARATES FOR ANY REASON, ALL UNVESTED AMOUNTS ARE FORFEITED. BONUS PLAN DEPARTMENT DIRECTORS RECEIVE AN INCENTIVE FOR THE ACHIEVEMENT OF CERTAIN FINANCIAL, PERSONNEL, CUSTOMER SATISFACTION AND QUALITY GOALS. PHYSICIANS ARE ELIGIBLE FOR BONUS/INCENTIVE PAYMENTS. THESE PAYMENTS ARE BASED ON VARIOUS ORGANIZATIONAL GOALS OF WHICH RELATIVE VALUE UNIT (RVU) EXPECTATIONS MAKE UP ONE OF THE COMPONENTS. A SOUTH LAKE COUNTY HOSP HLTH DIST BOARD OF TRUSTEES 590571600 838640DL1 2010-01-06 52335000 CONSTRUCTION/RENOVATION false true false B SOUTH LAKE COUNTY HOSP HLTH DIST BOARD OF TRUSTEES 590571600 838640DX5 2010-06-03 34330000 REDEMPTION OF 1999 BONDS false true false A 1185000 51998222 5199822 998399 45800001 2011 false false false true B 1675000 33956621 33276360 680262 2010 true false true true A false true true true false false false true B false true true true false false false true A false false false false false false false false false B false false false false false false false false false ROBERT BERENS JR BOARD MEMBER 388000 BANK OFFICER; CASH false SCHEDULE L, PART V ROBERT E. BERENS, JR., CURRENTLY SERVING AS SECRETARY OF THE GOVERNING BOARD, IS THE AREA PRESIDENT AT BANKFIRST AND OWNS LESS THAN 1% OF THE BANK'S STOCK. THE BANK HOLDS A CD VALUED AT APPROXIMATELY 388,000 FOR THE FILING ENTITY. FORM 990, PAGE 6, PART VI, LINE 3 OH PROVIDES THE HOSPITAL'S PRESIDENT, CFO, COO AND CNO PURSUANT TO A MANAGEMENT AGREEMENT WITH THE HOSPITAL. FORM 990, PAGE 6, PART VI, LINE 7A FIFTY PERCENT OF THE BOARD MEMBERS ARE APPOINTED BY OH WHILE THE REMAINING MEMBERS ARE APPOINTED BY SOUTH LAKE MEMORIAL HOSPITAL, INC. ON BEHALF OF SOUTH LAKE COUNTY HOSPITAL DISTRICT ("DISTRICT"), A RELATED ORGANIZATION. THE DISTRICT LEVIES AD VALOREM TAXES AND HAS USED THE TAXES COLLECTED TO SUPPORT THE HOSPITAL. NEITHER RELATED ORGANIZATION HAS TECHNICAL CONTROL OF THE HOSPITAL. FORM 990, PAGE 6, PART VI, LINE 11B THE BOARD CHAIR WILL REVIEW THE FORM 990 WITH THE CFO WITH ALL QUESTIONS AND NEW SCHEDULES BEING REVIEWED AS WELL AS THE RECONCILIATION TO THE AUDITED FINANCIAL STATEMENTS PRIOR TO FILING WITH THE IRS. FORM 990, PAGE 6, PART VI, LINE 12C ANNUALLY, THE COMPLIANCE OFFICER FOR OH PROVIDES A QUESTIONNAIRE TO THE LEADERSHIP, BOARD OF DIRECTORS, DISTRICT BOARD OF TRUSTEES AND MEDICAL STAFF LEADERSHIP FOR DISCLOSURE IN REGARDS TO POTENTIAL CONFLICTS OF INTEREST. THE OH COMPLIANCE OFFICER EVALUATES EACH QUESTIONNAIRE AND WILL REQUEST ADDITIONAL INFORMATION SHOULD IT BE REQUIRED. ANY VOTING RIGHTS OR COMPENSATION RECEIVED IN RELATION TO ANY COMPETING ENTITIES IS QUESTIONED AS WELL AS OWNERSHIP IN ANY VENDOR STOCK DIRECTLY. IF ANY CONFLICT OF INTEREST OCCURS, THAT INDIVIDUAL IS RECUSED FROM THAT PORTION OF THE MEETING REGARDING THE CONFLICTED TRANSACTION. FORM 990, PAGE 6, PART VI, LINE 19 FINANCIAL STATEMENTS ARE MADE AVAILABLE THROUGH CONTINUING DISCLOSURE AGREEMENT WITH DIGITAL ASSURANCE CORPORATION (DAC). GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST THROUGH THE SUNSHINE LAW. FORM 990, PART IX, LINE 11G CONTRACT SERVICE 4,474,316 915,251 0 REFERENCE LAB 744,719 0 0 PROFESSIONAL FEES 3,998,958 0 0 OTHER FEES 487,259 14,956 0 PURCHASED SERVICES 409,585 5,262,775 0 COURIER 35,408 4,548 0 CONSULTING FEES 0 493,905 0 COLLECTION 178,108 2,462,149 0 UBTI - OTHER FEES 335,468 0 0 FORM 990, PART XI, LINE 9 RENTAL EXPENSES 209,319 NET ASSETS RELEASED FROM RESTRICTIONS 40,224 CAPITAL CONTRIBUTIONS -480,743 GRANT EXPENSE NETTED AGAINST REVENUE -1,000,000 UNREALIZED IMPAIRMENT LOSS -371,833 RENTAL EXPENSE -209,319 GRANT EXPENSE NETTED AGAINST REVENUE 1,000,000 SCHOLARSHIPS FROM NET ASSETS 25,456 FORM 990, PART XI, LINE 9 NET ASSETS RELEASED FROM RESTRICTIONS -40,224 CAPITAL CONTRIBUTIONS 480,743 CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 975,001 TOTAL INCREASE IN NET ASSETS 628,624 ORLANDO HEALTH 1414 KUHL AVENUE ORLANDO FL 328062008 591726273 HEALTHCARE FL 501C3 3 NA false SOUTH LAKE COUNTY HOSPITAL DISTRICT 1900 DON WICKHAM DRIVE CLERMONT FL 347111979 590571600 LEVY TAX FL 501C3 6 NA false SOUTH LAKE HOSPITAL FOUNDATION 1935 DON WICKHAM DRIVE CLERMONT FL 347111915 900805455 FUNDRAISIN FL 501C3 7 NA false HEALTHCARE PURCHASING ALLIANCE LLC 1417 S KUHL AVENUE SUITE 100 ORLANDO FL 328062010 591726273 PURCHASING FL OH ORLANDO HEALTH INC RELATED 411756 218140 false false 0.07640 false false true false true false false false false false true false true true true true false true true SCHEDULE R HEALTHCARE PURCHASING ALLIANCE, INC. IS OWNED 7% BY THE FILING ENTITY WITH THE REMAINING 93% OWNED BY ORLANDO HEALTH, INC., A RELATED ORGANIZATION.