2013-08-09T09:58:13-05:00 2012-09-30 621517792 PERSHING YOAKLEY & ASSOCIATES PC 2963 GULF TO BAY BLVD STE 267 CLEARWATER FL 337594255 990 2011-10-01 592650464 Lakeland Regional Health Systems Inc LAKE 8636871100 1324 Lakeland Hills Boulevard Lakeland FL 33805 Evan C Jones 8636871100 2013-08-09 1 Terry Haefner P01258953 7274427110 2011 2016-02-24 21:20:13Z Elaine C Thompson PhD 1324 Lakeland Hills Boulevard Lakeland FL 33805 41126833 0 X www.lrmc.com X 1986 FL Promotion of continued development of high quality, cost effective health care services, including providing cancer diagnostics and treatment. 13 11 60 20 1914354 1808263 0 706478 11012871 9922491 7206489 25939570 -1651620 4558294 16567740 41126833 968815 676574 0 0 21382678 20804680 0 0 0 5461037 5595543 27812530 27076797 -11244790 14050036 333161882 380588445 77989963 71804783 255171919 308783662 Promotion of continued development of high quality, cost effective health care services, including providing cancer diagnostics and treatment. 0 0 25070381 676574 9922491 Promotion of continued development of high quality, cost effective health care services, including providing cancer diagnostics and treatment. 25070381 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 20 0 1 60 1 1 1 1 CJ CA VI 0 0 0 0 0 0 0 0 X 13 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Bill Bierschenk 8636871102 230 S Florida Ave Suite 400 Lakeland FL FL 33805 Lee Jackson 1.00 X 0 0 0 David Duncan 1.00 X 0 0 0 Robert W Andrew 1.00 X 0 0 0 Jack English III 1.00 X 0 0 0 A Andy Hernandez 1.00 X 0 0 0 Jack R Harrell Jr 1.00 X 0 0 0 William Mutz 1.00 X 0 0 0 Frank Kendrick 1.00 X 0 0 0 Weymon P Snuggs III 1.00 X 0 0 0 Jay Mulaney MD 1.00 X 0 0 0 Laura J Hawley CFP 1.00 X 0 0 0 James D Melton III MD 1.00 X 0 0 0 Dale Dreyer 1.00 X 0 0 0 Elaine Thompson PhD 50.00 X 0 833177 182886 Evan C Jones 50.00 X 0 114707 1149 Mark Munson MD 45.00 X 565690 0 33035 Todd Hall MD 45.00 X 634881 0 26629 Michael A Campanelli MD 45.00 X 1569324 0 32957 Donald I Serot 45.00 X 640331 0 31742 Matthew Smith MD 45.00 X 688487 0 33802 Paul A Powers 0.00 X 0 606315 31742 4098713 1554199 373942 5 1 1 0 Vista Staffing Solutions 275 East 200 South Salt Lake City UT 84111 Medical 263867 Frank Russell Company 1301 Second Avenue 18th Floor Seattle WA 98101 Investment 248840 Peterson & Myers PA PO Box 24628 Lakeland FL 33802 Legal 215430 Radiology and Imaging Specialists of Lak 2120 Lakeland Hills Blvd Lakeland FL 33805 Medical & Imaging 183925 Highland Associates PO Box 55469 Birmingham AL 35255 Investment 137162 8 706478 706478 Net Patient Services 621990 9558645 9558645 Rental Income 531120 363846 363846 9922491 25939455 25939455 115 0 115 115 115 Equity in Earn. Inv Fu 532000 2504026 -114955 2618981 Investment in LSDC/WIC 900099 2029309 2029309 Other Income 900099 24959 24959 4558294 41126833 9922491 1914354 28583510 676574 676574 18763174 17337173 1426001 320962 296569 24393 1160595 1072390 88205 559949 517393 42556 225567 208424 17143 80000 73920 6080 259604 239874 19730 1104752 1020791 83961 243580 225068 18512 91472 84520 6952 113664 105026 8638 134938 124683 10255 651629 602105 49524 1911729 1766438 145291 Equipment Rental/Lease 270890 250302 20588 Supplies & Pharmaceutic 227862 210544 17318 Dues and Subscriptions 129683 119827 9856 Taxes, Licenses and Fee 67409 62286 5123 82764 76474 6290 27076797 25070381 2006416 0 57588698 37507100 2033705 1730502 355720 356852 22873055 3273700 21950203 19599355 115153241 314330629 130138958 5289818 5403462 651539 1660545 333161882 380588445 1096637 1196475 76893326 70608308 77989963 71804783 X 254594919 308206662 577000 577000 255171919 308783662 333161882 380588445 X 14050036 39561707 X 0 1 1 X 0 X X X 0 0 0 Lakeland Regional Medical Center Inc 592650456 3 1 24393807 1 24393807 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9976774 9976774 9763134 1381364 8381770 711773 551939 159834 2404609 1340397 1064212 16765 16765 19599355 Due to Affiliate 68534154 Employee Compensation and Benefits 2074154 70608308 41126833 27076797 14050036 -6726610 46288317 39561707 53611743 33105000 -6726610 297 -6726313 39831313 1295520 1295520 41126833 27078000 1203 1203 27076797 0 27076797 Description of Uncertain Tax Positions Under FIN 48: Part X: 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 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, 2012, 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 2008. Part XI, Line 8 - Other Adjustments: Transfer from Affiliates 47,584,068. Contributions in Net Assets -706,478. Book/Tax Difference LSDC -585,583. Book/Tax Difference WIC -3,459. Other Adjustment -231. Total to Schedule D, Part XI, Line 8: 46,288,317. Part XII, Line 2d - Other Adjustments: Rounding 297. Part XII, Line 4b - Other Adjustments: Investment in Women's Imaging Center 3,459. Investment in Lakeland Surgical Diagnostic Center 585,583. Contributions in Net Assets 706,478. Part XIII, Line 2d - Other Adjustments: Rounding 1,203. 1 Lakeland Regional Medical Center Foundation Inc 1324 Lakeland Hills Boulevard Lakeland FL 33805 237134974 501(c)(3) 581972 To support Fundraising activities. 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Lakeland Regional Health Systems provided support to Lakeland Regional Medical Center Foundation a related 501(c)(3) organization. This assistance was used to support fundraising activities on behalf of Lakeland Regional Medical Center a 501(c)(3) organization that is supported by Lakeland Regional Health Systems. 1 X X X X X 1 1 0 0 0 0 0 0 0 Elaine Thompson PhD 0 619916 0 207018 0 6243 0 182886 0 0 0 1016063 0 0 Mark Munson MD 488549 0 0 0 77141 0 19160 0 13875 0 598725 0 0 0 Todd Hall MD 634856 0 0 0 25 0 19160 0 7469 0 661510 0 0 0 Michael A Campanelli MD 1567983 0 0 0 1341 0 19082 0 13875 0 1602281 0 0 0 Donald I Serot 485136 0 0 0 155195 0 19160 0 12582 0 672073 0 0 0 Matthew Smith MD 688462 0 0 0 25 0 19160 0 14642 0 722289 0 0 0 Paul A Powers 0 394246 0 90373 0 121696 0 19160 0 12582 0 638057 0 0 Part I, Lines 4a-b Elaine Thompson, Ph.D. - Chief Executive Officer participated in a supplemental nonqualified deferred compensation plan. She had $182,886 of nontaxable benefits accrue during calendar year 2011. This amount is included in Part II Column C. Form 990, Part VI, Section B, line 11 The Form 990 and supporting schedules are reviewed prior to filing by senior management, including the CEO and CFO. The Form and supporting schedules are also reviewed in detail prior to filing by outside legal counsel to the organization. Additionally, the form and schedules 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 Health System 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 Health Systems also has a "Policy of the Board of Directors Regarding Board Members Doing Business with Lakeland Regional Medical Center or Lakeland Regional Health Systems", that all Board Members are annually required to execute a "Corporate Compliance Acknowledgement", that all Board Members are annually required to answer a comprehensive "Annual Conflict of Interest Questionnaire", and that all Senior Corporate Management are annually required to answer a comprehensive "Annual Conflict of Interest Questionnaire". Form 990, Part VI, Section B, line 15 The Executive and Physician Compensation Committee (the "Committee") of the Board is charged with determining, in advance, all compensation issues for all executive positions including the President & CEO, the CFO and all Vice Presidents of the organization. Only independent and "disinterested" persons may serve as members of the Committee and no member may be employed by the organization or any of its affiliates. Additionally, no physician on the medical staff of the organization may serve as a member of the Committee nor may any member have any business or financial relationships with the organization, either directly or indirectly through family members. The Committee engages an independent nationally recognized human 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 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. The financial statements and information are public records under the pertinent Florida public records law. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -6,726,610. Transfer from Affiliates 47,584,068. Contributions in Net Assets -706,478. Book/Tax Difference LSDC -585,583. Book/Tax Difference WIC -3,459. Other Adjustment -231. Total to Form 990, Part XI, Line 5: 39,561,707. Lakeland Regional Medical Center Foundation Inc 1324 Lakeland Hills Boulevard Lakeland FL 33805 Fundraising FL 501(c)(3) 11a - Type 1 Lakeland Regional Medical Center Inc 0 Lakeland Regional Medical Center Inc 1324 Lakeland Hills Boulevard Lakeland FL 33805 Providing hospital services FL 501(c)(3) 3 1 Women's Imaging Center LLC 2120 Lakeland Hills Blvd Lakeland FL 33805 113830470 Medical Imaging Services FL Related -44591 282134 0 1 Lakeland Regional Educational Production Inc 1324 Lakeland Hills Boulevard Lakeland FL 33805 200679492 Inactive FL C 1.00000 Lakeland Regional Health Ventures Inc 1324 Lakeland Hills Boulevard Lakeland FL 33805 592650902 Medical Services FL C 8239 588093 1.00000 Lakeland Regional Health Ventures Risk Purchasing Group Inc 1324 Lakeland Hills Boulevard Lakeland FL 33805 202843126 Inactive FL C 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 Lakeland Regional Medical Center Inc R 47005897 Cash Value Lakeland Regional Medical Center Inc N 3850446 Cash Value Lakeland Surg & Diagn Center LLP 115 S Missouri Avenue Lakeland FL 33815 593346125 Medical Services FL 0 2079085 2522215 0 1 0.43750