2014-08-05T14:35:53-05:00 2013-09-30 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2012-10-01 593322533 SOUTH LAKE HOSPITAL INC SOUT 3523944071 1900 DON WICKHAM DRIVE CLERMONT FL 347111979 LANCE SEWELL 3523944071 2014-08-15 true JACQUELINE G ATKINS 2298837878 2014-08-04 2012 2015-11-30 17:44:51Z JOHN A MOORE CEO 1900 DON WICKHAM DRIVE CLERMONT FL 347111979 162316696 false X HTTP://WWW.SOUTHLAKEHOSPITAL.COM/ X 1995 FL HEALTHCARE SERVICES 6 3 1370 123 2959553 -502719 3143186 2576814 141764020 126791815 358929 760171 4448994 5862247 149715129 135991047 80246 67251 0 62033361 61772983 0 113694 77016721 66415364 139130328 128255598 10584801 7735449 267494661 258102524 123050438 104911404 144444223 153191120 HEALTHCARE SERVICES false false 104572083 67251 128830868 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 30,000. 104572083 true true false false false false false false false true true false false false true true true false false false false false false false false false true true false true true true true false false false false false false true false false false false false false false true false false false true 182 0 1370 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 SHERRIE SITARIK 2.00 40.00 X X 0 878868 226730 LUSHANTHA GUNASEKERA MD 40.00 2.00 X 0 671394 49401 MILDRED BEAM 40.00 X 0 436405 74010 SUSAN MCLEAN 2.00 X X 0 0 0 ROBERT E BERENS JR 2.00 X X 0 0 0 DAVID BATMAN 2.00 0.20 X 0 0 0 JOHN MOORE 40.00 0.25 X 0 228155 70508 LANCE SEWELL 40.00 0.25 X 0 151114 47870 AMY PATTERSON 40.00 X 0 109715 18989 PAUL JOHNS 40.00 X 0 105542 32495 DEBORAH CORT 40.00 X 0 25206 3531 LESLIE LONGACRE 40.00 0.25 X 0 15675 0 MANUEL HERRERA MD 40.00 X 408319 0 33783 ANDREW KAREN MD 40.00 X 267000 0 31172 JEROME STURM MD 40.00 X 254019 0 27220 DOROTHY RICHARDSON 40.00 X 227265 0 44051 JOSE CARRAU MD 40.00 X 207317 0 15248 1363920 2622074 675008 24 false true false AVI FOOD SYSTEMS 2590 ELM ROAD NE WARREN OH 444832904 MGMT FOOD SVCS 1133732 BIG TEN LLC 2020 OAKLEY SEAVER DRIVE CLERMONT FL 347111902 MGMT SURGICAL 1038500 TOSHIBA AMERICA 2441 MICHELLE DRIVE TUSTIN CA 927807047 MAINT & REPAIR 983775 ORIGIN INC DBA SHIFTWISE 2501 SW 1ST AVENUE SUITE 200 PORTLAND OR 972014752 NURSE STAFFING 934819 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 TEMP STAFFING 896107 39 2301544 133588 141682 2576814 PROGRAM SERVICE REVENUE 623000 126791815 126791815 126791815 851197 851197 445090 167989 277101 277101 277101 26042634 24000 26148364 9296 -105730 14704 -91026 -91026 NATIONAL TRAINING CENTER 623000 2959553 2959553 EHR HOSPITAL 621990 2039053 2039053 FOOD AND BEVERAGE 722210 881895 881895 -295355 -295355 5585146 135991047 128830868 2959553 1623812 X 67251 67251 48474123 44151204 4269429 53490 1161113 1057566 102266 1281 8797155 8012650 774798 9707 3340592 3015750 320898 3944 7836 7268 568 202761 202761 282968 282968 17826290 9232718 8593572 296738 23366 273372 11535470 10867148 666658 1664 68466 37442 31024 2878783 2776586 102197 264708 98579 165205 924 6152183 6152183 8658864 8351474 307390 275973 275973 MEDICAL SUPPLIES 12492215 12492215 REPAIRS AND MAINT 1979957 1629710 350247 PROVIDER FEES 1768743 1768743 RECRUITING 486409 486409 1237000 982413 211903 42684 128255598 104572083 23569821 113694 60091 93217 38578000 33271000 16355967 15629939 903557 928770 2140993 2070487 1202159 1123271 203611736 68933305 139596027 134678431 60755214 60341878 288480 196056 4504031 4504031 3110142 5265444 267494661 258102524 18077358 16643562 383385 533560 101805568 84657773 2409127 2267452 375000 809057 123050438 104911404 X 143326053 151702198 1118170 1488922 144444223 153191120 267494661 258102524 X 7735449 975893 35555 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 756936 120959 67251 810644 722260 114922 80246 756936 792607 4888 75235 722260 760648 97254 65295 792607 840953 29539 109844 760648 1.00000 true false 1123833 9652800 10776633 134923245 30237493 104685752 2956820 986789 1970031 54488527 37709023 16779504 466511 466511 134678431 THIRD PARTY SETTLEMENTS 550874 RAC RESERVE 258183 809057 X 137093244 975893 267986 1243879 135849365 141682 141682 135991047 128356349 168002 168002 128188347 67251 67251 128255598 INTENDED USES FOR ENDOWMENT FUNDS 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. LIABILITY UNDER FIN 48 FOOTNOTE SCHEDULE D, PAGE 3, PART X THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION, AND IS TAX-EXEMPT UNDER 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, 2013 AND 2012 OR FOR THE YEARS THEN ENDED. THE HOSPITAL'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2010-2012. REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 2D RENTAL EXPENSES 167,989 NET ASSETS RELEASED FROM RESTRICTIONS 99,984 INTERPRETATIVE SERVICES IN REVENUES 13 REVENUE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 4B CAPITAL CONTRIBUTIONS 141,682 EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 167,989 INTERPRETATIVE SERVICES IN REVENUES 13 EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 4B SCHOLARSHIPS FROM NET ASSETS 67,251 true true X true X true X true true false true true 3597765 3597765 0.02800 12263781 10430755 1833026 0.01430 15861546 10430755 5430791 0.04230 858137 858137 0.00670 117674 67950 49724 0.00040 207276 109800 97476 0.00080 434540 434540 0.00340 1617627 177750 1439877 0.01130 17479173 10608505 6870668 0.05360 true 16754223 12565667 31807234 33857416 -2050182 X true true 1 1 SOUTH LAKE HOSPITAL

1900 DON WICKHAM DRIVE CLERMONT FL 347111979

WWWSOUTHLAKEHOSPITALCOM 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 X X X X false false true true 200.0 true 400.0 true X X X true true X X true false X X X true X false false 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 OTHER TESTING METHODS FOR FREE OR DISCOUNTED CARE PART I LINE 3C 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 PATIENTS INCOME DOES NOT EXCEED 400 OF THE FPG SUBSIDIZED HEALTH SERVICES EXPLANATION PART I LINE 7G SUBSIDIZED HEALTH SERVICES REPRESENT THE OPERATIONAL COSTS FOR THE FREE CLINIC TO CARE FOR INDIGENT PATIENTS OF SOUTH LAKE COUNTY EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE PART I LINE 7 COLUMN F 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 XXX-XX-XXXX ADD EXPENSES REPORTED IN PART VIII 167989 DENOMINATOR FOR COLUMN F XXX-XX-XXXX COSTING METHODOLOGY EXPLANATION PART I LINE 7 THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATIONS 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 ORGANIZATIONS ACCOUNTING RECORDS BAD DEBT EXPENSE EXPLANATION PART III LINE 4 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 HOSPITALS POLICY HOWEVER FAILED TO COMPLETE THE APPLICATION PROCESS EXCERPT FROM AUDITED FINANCIAL STATEMENTS ALLOWANCE FOR DOUBTFUL ACCOUNTS 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 THIRDPARTY 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 SELFPAY PATIENTS WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLES AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL THE COMPANY 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 HOSPITALS ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELFPAY PATIENTS INCREASED APPROXIMATELY 6 TO 92 OF SELFPAY ACCOUNTS RECEIVABLE AT SEPTEMBER 30 2013 FROM 86 AT SEPTEMBER 30 2012 IN ADDITION THE HOSPITALS SELFPAY WRITEOFFS INCREASED 3903000 FROM 12525000 FOR FISCAL YEAR 2012 TO 16428000 FOR FISCAL YEAR 2013 THIS INCREASE IS THE RESULT OF AN INCREASE IN THE CHARGE MASTER AS WELL AS CHANGES IN THE CHARITY CARE POLICY WHICH RESULTED IN FEWER PEOPLE QUALIFYING AS CHARITY PATIENTS CHARITY CARE WRITEOFFS DECREASED 23 WHICH RESULTED IN ADDITIONAL SELFPAY WRITEOFFS BEING MAPPED TO PROVISION FOR BAD DEBTS MEDICARE EXPLANATION PART III LINE 8 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 COLLECTION PRACTICES EXPLANATION PART III LINE 9B 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 ANDOR 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 ANDOR WRITE OFFS ARE REVERSED AND THE NEW BALANCE REFLECTED IS RECLASSIFIED AS FINANCIAL ASSISTANCE OR CHARITY NEEDS ASSESSMENT PART VI 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 POSTDISCHARGE PATIENT FOLLOWUP RELATED TO THE ONGOING CARE AND TREATMENT OF PATIENTS TO PREVENT UNNECESSARY ADMISSIONS AND POTENTIAL READMISSIONS 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 ATRISK POPULATIONS FEDERALLYDESIGNED 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 HTTPWWWSOUTHLAKEHOSPITALCOMLINKCLICKASPX FILETICKETHTPVBVVSMBC3DTABID56 THE IMPLEMENTATION STRATEGY PLAN CAN ALSO BE FOUND ON THE ORGANIZATIONS WEBSITE AT HTTPWWWSOUTHLAKEHOSPITALCOMLINKCLICKASPXFILETICKET7JBQ6Z26MUK 3DTABID56 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI 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 HOSPITALS 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 LAKES OBJECTIVE TO PROVIDE CHARITY CARE TO OUR PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY COMMUNITY INFORMATION PART VI SOUTH LAKE CURRENTLY OPERATES IN THE CENTRAL FLORIDA REGION WHICH HAS OVER TWO MILLION RESIDENTS AND THOUSANDS OF INTERNATIONAL VISITORS ANNUALLY SOUTH LAKES PRIMARY SERVICE AREA IS COMPRISED OF ORANGE OSCEOLA SEMINOLE AND LAKE COUNTIES THE MEDIAN HOUSEHOLD INCOME IN THESE COUNTIES IS 59710 TEN PERCENT OF HOUSEHOLDS IN CENTRAL FLORIDA ARE BELOW THE FEDERAL POVERTY GUIDELINE THE PERCENT UNINSURED AGE 064 FOR THE FOUR COUNTY AREAS ARE 23 AND THERE ARE ELEVEN FEDERALLYDESIGNATED MEDICALLY UNDERSERVED AREAS PRESENT IN THE COMMUNITY COMMUNITY OUTREACH ACTIVITIES INCLUDE SPEAKERS BUREAU SUPPORTEDUCATION GROUPS WELLNESS ACTIVITIES HEALTH FAIRS CLINICAL SCREENINGS AND ASSESSMENTS MEDICAL EDUCATION RESEARCH WOMEN CHILDREN AND SENIOR HEALTH INITIATIVES PUBLIC PROGRAM ENROLLMENT ASSISTANCE AND POSTACUTE CARE FOR HOMELESS AND UNINSURED SPONSORSHIPS SCHOOL INITIATIVES DONATED MEETING SPACE AND SPIRITUAL CARE HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI 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 AFFILIATED HEALTH CARE INFORMATION PART VI 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 NOTFORPROFIT 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 SOUTH LAKE HOSPITAL LINE NUMBER 1 PART V LINE 3 PART V LINE 3 IN ORDER TO DETERMINE THE COMMUNITYS 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 EMAIL 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 TWENTYNINE PROVIDERS SUBMITTED RESPONSES TO THE SURVEY SOUTH LAKE HOSPITAL LINE NUMBER 1 PART V LINE 7 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 ANDOR 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 true NURSING SCHOLARSHIPS 8 67251 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES SCHEDULE I, PAGE 1, PART I, LINE 2 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. false true false false false false false false false SHERRIE SITARIK 783562 95306 212325 14405 1105598 LUSHANTHA GUNASEKERA MD 397382 272356 1656 27625 21776 720795 MILDRED BEAM 357525 78880 59688 14322 510415 JOHN MOORE 210398 5000 12757 49453 21055 298663 LANCE SEWELL 133492 5000 12622 25511 22359 198984 MANUEL HERRERA MD 269655 138400 264 17000 16783 442102 ANDREW KAREN MD 266755 245 16500 14672 298172 JEROME STURM MD 253426 593 9837 17383 281239 DOROTHY RICHARDSON 213234 13650 381 31560 12491 271316 JOSE CARRAU MD 207148 169 15248 222565 RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION 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. SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SCHEDULE J, PAGE 1, PART I, LINE 4 SHERRIE SITARIK 0 162,200 0 MILDRED BEAM 0 56,563 0 JOHN MOORE 0 24,208 0 LANCE SEWELL 0 9,218 0 AMY PATTERSON 0 9,520 0 PAUL JOHNS 0 6,392 0 OTHER ADDITIONAL INFORMATION 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. 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 585000 51998222 5199822 998399 45800001 2011 false false false true B 775000 33956621 33276360 680262 2010 true false true true A false true true true false false false false true B false true true true false false false false true A false false false false false false false false false B false false false false false false false false false A false ROBERT BERENS JR BOARD MEMBER 386000 BANK OFFICER; CASH false ADDITIONAL INFORMATION 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 BANKS STOCK THE BANK HOLDS A CD VALUED AT APPROXIMATELY 386000 FOR THE FILING ENTITY ADDITIONAL INFORMATION FORM 990, PART VI COMPENSATION PROCESS FOR OFFICERS THE PROCESS USED TO DETERMINE COMPENSATION IS ARRIVED BY THE COMPENSATION COMMITTEE OF ORLANDO HEALTH ("OH"), A RELATED ORGANIZATION. THE CEO AND CFO PAY WAS REVIEWED BY THE COMPENSATION COMMITTEE WITH THE MANAGEMENT TRANSITION IN JANUARY 2012. THE EXECUTIVE DIRECTOR'S COMPENSATION IS DETERMINED BY OH AS PART OF THE MANAGEMENT AGREEMENT. MANAGEMENT DELEGATED FORM 990, PAGE 6, PART VI, LINE 3 OH PROVIDES THE HOSPITAL'S CEO, CFO, COO AND CNO PURSUANT TO A MANAGEMENT AGREEMENT WITH THE HOSPITAL. ELECTION OF MEMBERS AND THEIR RIGHTS 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. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 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. ENFORCEMENT OF CONFLICTS POLICY 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 OR COMPENSATION RECEIVED FROM 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. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION 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. OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G CONTRACT SERVICE 4,198,653 780,140 0 REFERENCE LAB 895,191 0 0 PROFESSIONAL FEES 2,545,968 0 0 OTHER FEES 454,298 14,924 0 PURCHASED SERVICES 438,295 5,395,570 0 COURIER 33,071 4,485 0 CONSULTING FEES 678 173,712 0 COLLECTION 277,324 2,224,741 0 OTHER UBTI 389,240 0 0 RECONCILIATION OF CHANGES - OTHER FORM 990, PART XI, LINE 9 RENTAL EXPENSES 167,989 NET ASSETS RELEASED FROM RESTRICTIONS 99,984 INTERPRETATIVE SERVICES IN REVENUES 13 CAPITAL CONTRIBUTIONS -141,682 RENTAL EXPENSES -167,989 INTERPRETATIVE SERVICES IN REVENUES -13 SCHOLARSHIPS FROM NET ASSETS 67,251 OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 9 CHANGE IN INTEREST IN FOUNDATION NET ASSETS 82,715 CAPITAL CONTRIBUTIONS 141,682 EQUITY TRANSFER TO FOUNDATION -116,934 EQUITY TRANSFER TO FNDN FROM NET ASSETS -377,258 NET ASSETS RELEASED FROM RESTRICTION -94,339 IMPACT OF AMENDING PRIOR YEAR RETURN 374,136 TOTAL DECREASE IN NET ASSETS 35,555 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 274926 248265 false false 0.07000 false false true false true false false false false false true false true true true true false true true ADDITIONAL INFORMATION 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