2015-08-12T14:47:49-05:00 2014-09-30 621517792 Pershing Yoakley & Associates P C One Cherokee Mills 2220 Sutherland Ave Knoxville TN 37919 990 2013-10-01 592650456 Lakeland Regional Medical Center Inc LAKE 8636871100 1324 Lakeland Hills Boulevard Lakeland FL 33805 Evan C Jones EVP/CFO 8636871100 2015-08-12 1 P01258953 8656730844 2013 2016-02-25 16:41:14Z Elaine C Thompson PHD 1324 Lakeland Hills Boulevard Lakeland FL 33805 738089300 0 X www.myLRH.org X 1914 FL The purpose of this organization is to operate a general acute care hospital for the provision of health care services to the residents of Central Florida. Lakeland Regional Medical Center, Inc. also conducts community seminars and counseling regarding health issues. 13 12 5366 265 28925 28925 1130591 1091063 702744170 736533202 25692 -294362 0 0 703900453 737329903 0 1333333 0 0 268531226 284970565 0 0 0 380382873 384674664 648914099 670978562 54986354 66351341 501272430 534743678 310830237 317876438 190442193 216867240 X Our Core Purpose/Mission is improving lives by delivering exceptional healthcare. 0 0 601515574 1333333 729524953 See Schedule O for Program Services Statement 601515574 1 1 0 1 0 0 0 0 0 1 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 0 1 0 0 0 1 142 0 1 5366 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 FL X Jon Boyette 8636871100 230 S Florida Ave 4th Floor Lakeland FL 33805 CJ Jack English III Director 1.00 X 0 0 0 Dale Dreyer Director 1.00 X 0 0 0 David Duncan Director 1.00 X 0 0 0 Frank Kendrick Director 1.00 X 0 0 0 Jack R Harrell Jr Chairman 1.00 X 0 0 0 James D Melton III MD Director 1.00 X 0 0 0 Jay Mulaney MD Vice Chairman 1.00 X 0 0 0 Laura J Hawley CFP Director 1.00 X 0 0 0 Lee Jackson Director 1.00 X 0 0 0 Weymon P Snuggs III Director 1.00 X 0 0 0 William Mutz Past Chairman 1.00 X 0 0 0 Ayanna Rolette Director 1.00 X 0 0 0 Clayton Hollis Director 1.00 X 0 0 0 Elaine Thompson PhD Chief Executive Officer 50.00 X 860366 0 263292 Evan C Jones EVP - Chief Financial Offi 50.00 X 464729 0 23593 Janet W Fansler EVP - Chief Nursing Execut 50.00 X 716633 0 96333 Wilton Reavis MD President/Chief Medical Of 50.00 X 866450 0 26964 Michael Spake VP- Chief Compliance Offic 50.00 X 272840 0 27548 Elizabeth Kerns AVP-Chief Technology Offic 45.00 X 200774 0 19609 Danielle Drummond SVP-Chief Strategy/Growth Officer 50.00 X 177418 0 4535 Terry L Boston Medical Physicist 45.00 X 228017 0 26497 William Bierschenk Former Director of Finance 50.00 X 205436 0 25383 Kim Walker Former AVP-Ambulatory Services 50.00 X 189502 0 14192 John R Hurst Pharmacist 50.00 X 177239 0 24696 Margaret E Voyles AVP-Perioperative Services 50.00 X 176642 0 23109 Hugh Autry Former VP - System Develop 50.00 X 304699 0 57122 Jeffery Payne Former VP- Human Resources 50.00 X 229991 0 19417 Mary C Ford Former EVP - Chief Information OFFICER 50.00 X 824571 0 16989 5895307 0 669279 169 1 1 0 Executive Health Resources Inc PO Box 822688 Philadelphia PA 19182 Medical 3538280 Watson Clinic LLC 1600 Lakeland Hills Blvd Lakeland FL 33804 Medical 3298797 Peterson & Myers PA 225 E Lemon Street Lakeland FL 33801 Legal 2511368 Stantec Consulting 2205 N 20th Street Tampa FL 33605 Facilities Consulting 1333278 Diversified Clinical Services PO Box 636981 Cincinnati OH 45263 Medical 1099336 35 700432 390631 1091063 Patient Service Revenue 621990 400110770 400110770 Medicare/Medicaid 621990 322346545 322346545 Contract Pharmacy and other Misce 621990 6656028 4764242 28925 1862861 Cafeteria Revenue 722210 4492795 4492795 Medicare EMR Incentive 621990 2297435 2297435 629629 5961 623668 736533202 465035 759397 -294362 -294362 -294362 737329903 729524953 28925 6684962 1333333 1333333 4326017 3639478 686539 221541233 186382639 35158594 8797780 7401572 1396208 34352450 28900716 5451734 15953085 13421330 2531755 1157142 973504 183638 1404215 1181366 222849 94703 79674 15029 25732 21648 4084 28480328 23960500 4519828 2338712 1967558 371154 4205895 3538419 667476 18175218 15290811 2884407 19761662 16625486 3136176 668549 562450 106099 8039864 6763938 1275926 39166071 32950416 6215655 9225553 7761458 1464095 Patient Supplies & Phar 127834551 127834551 Bad Debts 104110699 104110699 Repairs & Maintenance 10447535 8789511 1658024 HCCB Indigent Assessmen 7622220 6412574 1209646 1916015 1611943 304072 670978562 601515574 69462988 0 597768 456415 85028630 89459391 10729235 9995116 7266034 12625043 841299875 540635442 281606131 300664433 12676499 13718814 15998241 18133402 87369892 89691064 501272430 534743678 33258283 41649449 181470657 174253299 96101297 101973690 310830237 317876438 X 182623911 207787547 6280395 7541408 1537887 1538285 190442193 216867240 501272430 534743678 X 66351341 1221961 -41148255 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 25732 25732 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. 1537887 398 1538285 1537419 468 1537887 1536897 522 1537419 1521368 15529 1536897 1520810 558 1521368 1.00000 0 1 1 5320944 5320944 231602904 130181894 101421010 16229310 9821603 6407706 567973043 400631945 167341099 20173674 20173674 300664433 Other Receivables 5201550 Assets Limited to Use 79793743 Debt Issue Costs 1697063 Estimated Third Party Settlements 2998708 89691064 FL Medical Assistance Assessment 11355443 Employee Compensation 39220222 Malpractice Claims 30035479 Workers Compensation 2168657 Capital Lease Obligations 15084329 Other long term liabilities 1002029 Bond Interest Payable 3107531 101973690 X 633740733 1221961 1221961 632518772 104811131 104811131 737329903 566867863 0 566867863 104110699 104110699 670978562 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 interest in Lakeland Surgical and Diagnostic Center (the Surgical Center) are not material to the Health System. Accounting principles generally accepted in the United States of America require 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, 2014, there are no uncertain positions taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in 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 2009. Part XI, Line 4b - Other Adjustments: Bad Debts Netted with Revenue on Audited Financials 104,110,699. Contributions 700,432. Part XII, Line 4b - Other Adjustments: Bad Debts Netted with Revenue on audited Financials 104,110,699. 1 1 X 1 X 1 X 1 1 1 0 1 1 32465249 32465249 0.05730 101047712 74781860 26265852 0.04630 4847536 2096405 2751131 0.00490 138360497 76878265 61482232 0.10850 415652803 375150257 40502546 0.07140 415652803 375150257 40502546 0.07140 554013300 452028522 101984778 0.17990 12100000 12100000 0.02100 12100000 12100000 0.02100 1 20699230 145340465 152675643 -7335178 X 1 1 1 1 Lakeland Regional Medical Center 1324 Lakeland Hills Blvd Lakeland FL 33805 X X X Lakeland Regional Medical Center 1 1 X X X X X X X X X X 13 1 1 1 X mylrh.org X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X 1 1 X X X X 1 0 1 X 0 0 Lakeland Regional Medical Center Part V, Section B, Line 1j: During fiscal year 2014, previous CHNA activities were concluded and the 2014-2017 CHNA assessment was completed.The 2014-2017 CHNA was conducted as a collaborative multi-stage process that combined broad subjective and qualitative community input, a complete assessment using quantifiable data, consultation with government leaders with current data and/or other information relevant to 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 so LRMC looked at successful evidence-based initiatives used across the country to select programs that would best meet our community's area of need. The area of needs identified are: Disparities of health outcomes within the black community Access to quality, coordinated care Cancer screening and prevention Obesity Pre-conceptual and perinatal health Injury preventionThe previous CHNA assessment led to the prioritization of key community health improvement needs which included:The lack of access to high quality primary care for patients with limited resources. This need was met through the creation of the Family Health Center which serves uninsured and underinsured patients.The escalation of diabetes & childhood and adult obesity. This need was addressed through application for and receipt of grant dollars used to conduct targeted education programs in populations most needing and least likely to receive targeted counseling. The programs were implemented and are currently reaching underserved populations in the community.Cancer prevention and early detection. Efforts to provide community education programs and screening services at health fairs throughout the community were conducted in conjunction with programmatic submissions made for cancer center accreditation.Young maternal age, lack of prenatal care, low neonatal birth weight, and high neonatal mortality. Efforts to address these needs were consistently made through participation in County education programs and task force participation. In addition, LRMC conducted and successfully completed a perinatal safety initiative that produced a measurable impact on the health of our smallest and most vulnerable patients.Excessive motor-vehicle and pedestrian injury and fatalities. Efforts to address these needs were made through consistent participation in community organization and County sponsored programs providing community education.Extensive behavioral health related issues, including alcohol and drug abuse. Efforts to address these needs were made through continued behavioral health services provided to the community in both inpatient and outpatient settings including the Family Health Center.Lack of coordinated and effective care for patients with limited resources for managing complicated and complex co-morbidities. Efforts to address this need were made through the creation and success of the Family Health Center. Participation in County task forces assessing and coordinating services to this population was also regularly made.Economic depression and high unemployment rate. Efforts to address this need were made by becoming and remaining a significant community employer of choice. In fiscal year 2014, LRMC was recognized by the Gallup organization as a Great Place to Work, one of 36 in the world selected for this honor.Disparity of health outcomes for black residents. Efforts to address this need were made through the creation and success of the Family Health Center. Additional outreach to this community was made through interaction with City not-for-profit organizations and County focus groups and task forces gathered to assess resources available for this population. Lakeland Regional Medical Center Part V, Section B, Line 3: Experts consulted are detailed on page 18-19 of the CHNA document (copy attached.) Organizations consulted include:Career Source PolkCatholic CharitiesCentral Florida Development CouncilCentral Florida HealthcareEast 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 MedicineParker 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 ArmyTalbot 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 4: Lake Wales Medical Center Lakeland Regional Medical Center Part V, Section B, Line 7: A total of seven significant community health needs were identified through the CHNA process. It was determined that dental care would not be addressed in our Strategies for Change because Lakeland Volunteers in Medicine and the State of Florida Department of Health in Polk County are actively working to meet this area of need within our community. Lakeland Regional Medical Center Part V, Section B, Line 20d: To be eligible for a 100% reducton 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. If the patient's household income, adjusted for size, is between 200% and 400% of the FPG, the patient shall be eligibile for a 75% reduction from charges. An uninsured patient whose income is greater than 400% of the FPG will recieve a discount that is annually calculated using a "look back" method. By October 1st of each year claims that were paid in full from the previous 12 months from Medicare fee for service and all private health insurers paid to the hospital will be analyzed to compare the aggregate discount percentage. At no point will an individual be charged more for emergency care or other medically necessary care than those generally billed to individuals who have insurance coverage. 3 LRMC Oncology Services 3525 Lakeland Hills Blvd Lakeland FL 33805 Outpatient Clinic LRMC Family Health Center 300 Parkview Place Lakeland FL 33805 Outpatient Clinic Lakeland Regional Rehab & Sports Clinic 2125 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 care, Medicaid and other means-tested government programs. LRMC operates one of the busiest Emergency Departments in the Florida 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 $2.7 million in 2014. Part I, Ln 7 Col(f): There is $104,110,699 of bad debt expense which is included in Form 990, Part IX, Line 24(a). 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 Florida, offering essential medical care to many underserved residents in our community. On-going education programs for diabetes and cardiac rehab 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 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 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 body 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 of service, 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 whose purpose was to provide a medical home where the uninsured and underinsured low income populations can come from recurring medical care which will improve the quality of care while reducing visits to the emergency room. In the fall of 2012 and continuing through 2014, LRMC partnered with the Polk Healthcare 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 medial home within the I-4 corridor of Polk County. In 2014, the Family Health Center had over 20,000 visits (over 17,000 in 2013) 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/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 do 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 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 620,000 with 19% of residents being over the age of 65 and over 14% of residents living below the Federal Poverty Level. Children under 18 years of age make up 23% of the population compared to 21% 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 7.2% as of September 2014, compared to 6.1% for the state of Florida. Census data reflects a population that is 19.2% Hispanic, 15.1% Black and 4% 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, ordering 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. In 2012, LRMC opened a primary health clinic whose purpose was to provide a medical home where the uninsured and underinsured low income populations can come from recurring medical care which will improve the quality of care while reducing visits to the emergency room. In 2014, the Family Health Center provided primary care services of over 20,000 visits (17,000 in 2013) to the uninsured and underinsured providing them and their families a medical home. Also in 2012, LRMC partnered with the Polk Healthcare 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 medial home within the I-4 corridor of Polk County. In 2013 and 2014, this partnership continued and was expanded to to include services such as dental care and behavioral health screenings. 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. For 2014, the Health System lease payments totaled $12.1 million. 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 medical clinics which provide access to all residents, regardless of income, operate at a significant economic loss. In 2012, LRMC opened a primary health clinic whose purpose was to provide a medical home where the uninsured and underinsured low income populations can come for recurring medical care which will improve the quality of care while reducing visits to the emergency room. In 2014, the Family Health Center provided over 20,000 primary care visits (17,000 in 2013) for the uninsured and underinsured. 0 Florida Southern College 111 Lake Hollingsworth Drive Lakeland FL 338015698 590624401 501(c)(3) 200000 To support the nursing program of the College. X X X X X 1 1 0 0 0 0 0 0 0 Elaine Thompson PhD Chief Executive Officer 707207 0 146916 0 6243 0 250558 0 12734 0 1123658 0 0 0 Evan C Jones EVP - Chief Financial Offi 407106 0 55905 0 1718 0 16989 0 6604 0 488322 0 0 0 Janet W Fansler EVP - Chief Nursing Execut 410747 0 51277 0 254609 0 84818 0 11515 0 812966 0 0 0 Wilton Reavis MD President/Chief Medical Of 866450 0 0 0 0 0 15449 0 11515 0 893414 0 0 0 Michael Spake VP- Chief Compliance Offic 236312 0 36000 0 528 0 14813 0 12735 0 300388 0 0 0 Elizabeth Kerns AVP-Chief Technology Offic 188256 0 11634 0 884 0 13005 0 6604 0 220383 0 0 0 Danielle Drummond SVP-Chief Strategy/Growth Officer 162290 0 15128 0 0 0 0 0 4535 0 181953 0 0 0 Terry L Boston Medical Physicist 205649 0 500 0 21868 0 14982 0 11515 0 254514 0 0 0 William Bierschenk Former Director of Finance 187171 0 11615 0 6650 0 13868 0 11515 0 230819 0 0 0 Kim Walker Former AVP-Ambulatory Services 117900 0 10010 0 61592 0 6663 0 7529 0 203694 0 0 0 John R Hurst Pharmacist 163353 0 500 0 13386 0 11961 0 12735 0 201935 0 0 0 Margaret E Voyles AVP-Perioperative Services 158836 0 10518 0 7288 0 11594 0 11515 0 199751 0 0 0 Hugh Autry Former VP - System Develop 0 0 0 0 304699 0 57122 0 0 0 361821 0 0 0 Jeffery Payne Former VP- Human Resources 141323 0 37544 0 51124 0 12070 0 7347 0 249408 0 0 0 Mary C Ford Former EVP - Chief Information OFFIC 302054 0 43725 0 478792 0 16989 0 0 0 841560 0 375872 0 Part I, Lines 4a-b Hugh Autry - Former Vice President of System Development received severance pay of $304,699 that was included in his W2 for 2013. This amount is included in Part (B)(iii) compensation. He also participated in a supplemental nonqualified deferred compensation plan. He had an additional $57,122 of nontaxable benefits accrue during calendar year 2013. This amount is included in Part II Column C. Janet W. Fansler - Executive VP/Chief Nursing Executive/Chief Operating Officer participated in a supplemental nonqualified deferred compensation plan. She had $254,609 of taxable benefits during calender year 2013. This amount is included in Part (B)(iii) other compensation. She had an additional $67,528 of nontaxable benefits accrue during calendar year 2013. 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 $233,569 of nontaxable benefits accrue during calendar year 2013. This amount is included in Part II Column C. Mary C Ford - Chief Information Officer participated in a supplemental nonqualified deferred compensation plan. She had $469,497 of taxable benefits during calender year 2013. This amount is included in Part (B)(iii) other compensation. She received $375,872 of taxable benefits in calendar 2012. This amount is included in Column F. William Bierschenk received severance pay of $6,625 that was included in his W2 for 2013. This amount is included in Part (B)(iii) compensation. Kim Walker received severance pay of $60,010 that was included in her W2 for 2013. 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 0 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 A 116566404 1 1038389 0 1 1 1 B 81113524 1012480 0 1 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 1 0 0 0 0 0 B 1 0 0 0 0 0 A 0 B 0 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. 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 resources 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 meetings 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 to 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 who 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 with outside counsel to the organization or Committee-engaged 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: Transfer to Affiliates -42,656,154. Change in Interest in Net Assets of the Foundation 2,135,160. Other Changes in Net Assets 73,171. Contributions -700,432. 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 0Lakeland Regional Educational Production Inc 1324 Lakeland Hills Boulevard Lakeland FL 33805 200679492 Inactive FL Lakeland Regional Health Systems C 0 Lakeland Regional Health Ventures Inc 1324 Lakeland Hills Boulevard Lakeland FL 33805 592650902 Medical Services FL Lakeland Regional Health Systems C 0 Lakeland Regional Health Ventures Risk Purchasing Group Inc 1324 Lakeland Hills Boulevard Lakeland FL 33805 202843126 Inactive 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