SOUTH LAKE HOSPITAL INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
SOUTH LAKE HOSPITAL INC (EIN 59-3322533)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-08-12
IRS object ID
201132289349300843
Schema version
2009v1.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-08-12T10:22:08-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DRAFFIN & TUCKER LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 6AddressLine1
CityALBANYCity
StateGAState
ZIP Code317020006ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN593322533EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SOUTH LAKE HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSOUTNameControl
Phone3523944071Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11900 DON WICKHAM DRIVEAddressLine1
CityCLERMONTCity
StateFLState
ZIP Code34711ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLANCE SEWELLName
TitleCFOTitle
Phone3523944071Phone
Date Signed2011-08-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJACQUELINE G ATKINSName
Phone2298837878Phone
Date Prepared2011-08-12DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeXAddressChange
Name Of Principal Officer PersonLESLIE LONGACRE CEONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11900 DON WICKHAM DRIVEAddressLine1
CityCLERMONTCity
StateFLState
ZIP Code34711ZIPCode
FieldValueIRS element (for citing)
Gross Receipts137667957GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteHTTP://WWW.SOUTHLAKEHOSPITAL.COM/WebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1995YearFormation
State Legal DomicileFLStateLegalDomicile
Activity Or Mission DescriptionHEALTHCARE SERVICESActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees1241TotalNbrEmployees
Total Nbr Volunteers180TotalNbrVolunteers
Total Gross UBI2157985TotalGrossUBI
Net Unrelated Business Txbl Income-371244NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year7090810ContributionsGrantsPriorYear
Contributions Grants Current Year4806862ContributionsGrantsCurrentYear
Program Service Revenue Prior Year122121725ProgramServiceRevenuePriorYear
Program Service Revenue CY129201137ProgramServiceRevenueCY
Investment Income Prior Year945097InvestmentIncomePriorYear
Investment Income Current Year688494InvestmentIncomeCurrentYear
Other Revenue Prior Year2797845OtherRevenuePriorYear
Other Revenue Current Year2830054OtherRevenueCurrentYear
Total Revenue Prior Year132955477TotalRevenuePriorYear
Total Revenue Current Year137526547TotalRevenueCurrentYear
Grants And Similar Amnts CY65295GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year50048163SalariesEtcPriorYear
Salaries Etc Current Year50629485SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year142894TotalFundrsngExpCurrentYear
Other Expense Prior Year65397105OtherExpensePriorYear
Other Expenses Current Year71475338OtherExpensesCurrentYear
Total Expenses Prior Year115445268TotalExpensesPriorYear
Total Expenses Current Year122170118TotalExpensesCurrentYear
Revenues Less Expenses Prior Year17510209RevenuesLessExpensesPriorYear
Revenues Less Expenses CY15356429RevenuesLessExpensesCY
Total Assets BOY172464540TotalAssetsBOY
Total Assets EOY242093774TotalAssetsEOY
Total Liabilities BOY69389877TotalLiabilitiesBOY
Total Liabilities EOY123479822TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY103074663NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY118613952NetAssetsOrFundBalancesEOY
Mission DescriptionHEALTHCARE SERVICESMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense96468616Expense
Grants65295Grants
Revenue129201137Revenue
DescriptionOPERATION 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 EXCEEDED 29,900.Description
Total Program Service Expense96468616TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1241NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledFLStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonLANCE SEWELL CFONamePerson
Telephone Number3522417104TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11900 DON WICKHAM DRIVEAddressLine1
CityCLERMONTCity
StateFLState
ZIP Code34711ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
JOHN HILLENMEYER
VICE-PRESIDE2.00XX0998093232433
DR RICHARD HORNICK
BOARD MEMBER2.00X012040634563
CATHY HOECHST
TREASURER2.00XX000
SUSAN MCLEAN
PRESIDENT2.00XX000
ROBERT E BERENS JR
SECRETARY2.00XX000
DAVID BATMAN
BOARD MEMBER2.00X000
LESLIE LONGACRE
CEO40.00X017069745477
LANCE SEWELL
CFO40.00X012770939621
JOHN MOORE
COO40.00X012483441340
DEBORAH CORT
CNO40.00X011193328728
BAKKIAM SUBBIAH
PHYSICIAN40.00402064051462X
DOROTHY RICHARDSON
DIR USAT/NTC40.00183889026119X
THURMEN LILLARD
PHARMACIST40.00143295028135X
ROBERT DAVIS
PHARMACIST40.00138192015236X
ANISKA RICHARDSON
PHARMACIST40.00119849021083X
FieldValueIRS element (for citing)
Total Reportable Comp From Org987289TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1653672TotalReportableCompFrmRltdOrgs
Total Other Compensation564197TotalOtherCompensation
Number Individuals GT100 K13NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Business Name Line2NameOfContractor/NameBusiness/BusinessNameLine2Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SODEXHO INC
SODEXHO SERVICES FOOD9801 WASHINTONIAN BLVDGAITHERBURGMD20878MGMT SERVICES968969
TOSIBA AMERICA
2441 MICHELLE DRIVETUSTINCA92780MTNC & REPAIRS945734
ORIGIN INC
SHIFTWISE2501 SW 1ST AVENUE SUITE 200PORTLANDOR97201NURSE STAFFING449754
CROTHALL LINEN SERVICE INC
955 CHESTERBROOK BLVD STE 300WAYNEPA19087LAUNDRY SERVICE424478
RCOA IMAGING SERVICES INC
16110 JOG ROAD SUITE 200DELRAY BEACHFL33446DIAGNOSTIC IMAG387775
FieldValueIRS element (for citing)
Number Of Contractors GT100 K26NumberOfContractorsGT100K
Fundraising Events45000FundraisingEvents
Related Organizations4673276RelatedOrganizations
Government Grants2358GovernmentGrants
All Other Contributions86228AllOtherContributions
Total Contributions4806862TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPROGRAM SERVICE REVENUEDescription
Total Revenue Column129201137TotalRevenueColumn
Related Or Exempt Function Income129201137RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue129201137TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column688494TotalRevenueColumn
Exclusion$688,494ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real262374Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real118513Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real143861Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column143861TotalRevenueColumn
Exclusion$143,861ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events15067GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events45000CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses22897FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-7830TotalRevenueColumn
Exclusion-$7,830ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory28259GrossSalesOfInventory

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column28259TotalRevenueColumn
Exclusion$28,259ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
NATIONAL TRAINING CENTER71394021579852157985
MISCELLANEOUS476497$476,497
COMMUNITY EDUCATION25771$25,771

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column5511TotalRevenueColumn
Exclusion$5,511ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue2665764TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column137526547TotalRevenueColumn
Related Or Exempt Function Income129201137RelatedOrExemptFunctionIncome
Unrelated Business Revenue2157985UnrelatedBusinessRevenue
Exclusion$1,360,563ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total65295Total
Program Services65295ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total41320585Total
Program Services36720139ProgramServices
Management And General4526931ManagementAndGeneral
Fundraising73515Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1086612Total
Program Services965634ProgramServices
Management And General119045ManagementAndGeneral
Fundraising1933Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total5388458Total
Program Services4788532ProgramServices
Management And General590339ManagementAndGeneral
Fundraising9587Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2833830Total
Program Services2530726ProgramServices
Management And General297564ManagementAndGeneral
Fundraising5540Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total235978Total
Management And General235978ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total224256Total
Management And General224256ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total13689684Total
Program Services4685409ProgramServices
Management And General9004275ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total274167Total
Program Services2315ProgramServices
Management And General271852ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total23594593Total
Program Services23135255ProgramServices
Management And General440010ManagementAndGeneral
Fundraising19328Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total122159Total
Program Services28650ProgramServices
Management And General93509ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total3263122Total
Program Services1026404ProgramServices
Management And General2236718ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total139166Total
Program Services91554ProgramServices
Management And General47122ManagementAndGeneral
Fundraising490Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total70Total
Program Services70ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total2842456Total
Management And General2842456ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total6024321Total
Program Services5433335ProgramServices
Management And General590986ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1512363Total
Management And General1512363ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PROVISIONS FOR BAD DEBTS1497375314973753
REPAIRS AND MAINT16846501453931230719
LOSS ON BOND REFINANCING11773541177354
RECRUITING934903934903
COMMUNITY SUPPORT414702414702

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total367641Total
Program Services152912ProgramServices
Management And General182228ManagementAndGeneral
Fundraising32501Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total122170118Total
Program Services96468616ProgramServices
Management And General25558608ManagementAndGeneral
Fundraising142894Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY6228139BOY
EOY8155988EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY23915000BOY
EOY29199000EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY16823BOY
EOY15997EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY13787305BOY
EOY11623330EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY1160945BOY
EOY1142427EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2281612BOY
EOY2118081EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1033044BOY
EOY1108571EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis158297677LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec47181810LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY85704656BOY
EOY111115867EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY27673080BOY
EOY69121955EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY4519836BOY
EOY4272355EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY6144100BOY
EOY4220203EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY172464540BOY
EOY242093774EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY15199181BOY
EOY16677983EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY1854352BOY
EOY335843EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY50706771BOY
EOY102356650EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1629573BOY
EOY4109346EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY69389877BOY
EOY123479822EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY101848803BOY
EOY117217932EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1225860BOY
EOY1396020EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY103074663BOY
EOY118613952EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY172464540BOY
EOY242093774EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1123833InvestmentCostOrOtherBasis
Other Cost Or Other Basis9652800OtherCostOrOtherBasis
Book Value10776633BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis77904847OtherCostOrOtherBasis
Depreciation18580071Depreciation
Book Value59324776BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1851950OtherCostOrOtherBasis
Depreciation706236Depreciation
Book Value1145714BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis37336811OtherCostOrOtherBasis
Depreciation27895503Depreciation
Book Value9441308BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis30427436OtherCostOrOtherBasis
Book Value30427436BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings111115867TotalOfBookValueLandBuildings
Total Revenue137526547TotalRevenue
Total Expenses122170118TotalExpenses
Excess Or Deficit For Year15356429ExcessOrDeficitForYear
Other$39,287OtherAmount
Total Adjustments39287TotalAdjustments
Excess Or Deficit Per FS15395716ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt137707244TotRevenueEtcAuditedFinclStmt
Other Revenues310298OtherRevenues
Revenue Not Rptd F990310298RevenueNotRptdF990
Revenue Subtotal137396946RevenueSubtotal
Other Revenues Not Included129601OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt129601RevenueNotRptdOnFinStmt
Total Revenue Per Form990137526547TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt122311528TotExpensesEtcAuditedFinclStmt
Other Expenses Included141410OtherExpensesIncluded
Expenses Not Rptd F990141410ExpensesNotRptdF990
Expenses Subtotal122170118ExpensesSubtotal
Total Expenses Per Form990122170118TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
LIABILITY UNDER FIN 48 FOOTNOTESCHEDULE D, PAGE 3, PART XTHE 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. 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, 2010 AND 2009 OR FOR THE YEARS THEN ENDED. THE HOSPITAL'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2007-2009.
RECONCILIATION OF CHANGES - OTHERSCHEDULE D, PAGE 4, PART XI, LINE 8RENTAL EXPENSES 118,513 NET ASSETS RELEASED FROM RESTRICTIONS 65,295 SPECIAL EVENTS EXPENSES 22,897 UNREALIZE GAIN ON INVESTMENTS 103,593 CAPITAL CONTRIBUTIONS -129,601 RENTAL EXPENSES -118,513 SPECIAL EVENTS EXPENSES -22,897
REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHERSCHEDULE D, PAGE 4, PART XII, LINE 2DRENTAL EXPENSES 118,513 NET ASSETS RELEASED FROM RESTRICTIONS 65,295 SPECIAL EVENTS EXPENSES 22,897 UNREALIZE GAIN ON INVESTMENTS 103,593
REVENUE AMOUNTS INCLUDED ON RETURN - OTHERSCHEDULE D, PAGE 4, PART XII, LINE 4BCAPITAL CONTRIBUTIONS 129,601
EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHERSCHEDULE D, PAGE 4, PART XIII, LINE 2DRENTAL EXPENSES 118,513 SPECIAL EVENTS EXPENSES 22,897

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event160067GrossReceiptsEvent1
Charitable Contributions Event145000CharitableContributionsEvent1
Gross Revenue Event115067GrossRevenueEvent1
Non Cash Prizes Event17817NonCashPrizesEvent1
Rent Facility Costs Event15000RentFacilityCostsEvent1
Food And Beverage Event18866FoodAndBeverageEvent1
Other Direct Expenses Event11214OtherDirectExpensesEvent1
Gross Receipts Total60067GrossReceiptsTotal
Charitable Contributions Total45000CharitableContributionsTotal
Gross Revenue Total Events15067GrossRevenueTotalEvents
Non Cash Prizes Total Events7817NonCashPrizesTotalEvents
Rent Facility Costs Total Events5000RentFacilityCostsTotalEvents
Food And Beverage Total Events8866FoodAndBeverageTotalEvents
Other Direct Expenses Total Events1214OtherDirectExpensesTotalEvents
Direct Expense Summary Events22897DirectExpenseSummaryEvents
Net Income Summary-7830NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CarefalseFPGReferenceDiscountedCare
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense4731425TotalCommunityBenefitExpense
Net Community Benefit Expense4731425NetCommunityBenefitExpense
Percent Of Total Expense0.04460PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense5301109TotalCommunityBenefitExpense
Direct Offsetting Revenue5301109DirectOffsettingRevenue

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense2886209TotalCommunityBenefitExpense
Direct Offsetting Revenue2119868DirectOffsettingRevenue
Net Community Benefit Expense766341NetCommunityBenefitExpense
Percent Of Total Expense0.00720PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense12918743TotalCommunityBenefitExpense
Direct Offsetting Revenue7420977DirectOffsettingRevenue
Net Community Benefit Expense5497766NetCommunityBenefitExpense
Percent Of Total Expense0.05180PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense281069TotalCommunityBenefitExpense
Net Community Benefit Expense281069NetCommunityBenefitExpense
Percent Of Total Expense0.00270PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense137986TotalCommunityBenefitExpense
Direct Offsetting Revenue65295DirectOffsettingRevenue
Net Community Benefit Expense72691NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense31956TotalCommunityBenefitExpense
Net Community Benefit Expense31956NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense269766TotalCommunityBenefitExpense
Net Community Benefit Expense269766NetCommunityBenefitExpense
Percent Of Total Expense0.00250PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense720777TotalCommunityBenefitExpense
Direct Offsetting Revenue65295DirectOffsettingRevenue
Net Community Benefit Expense655482NetCommunityBenefitExpense
Percent Of Total Expense0.00620PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense13639520TotalCommunityBenefitExpense
Direct Offsetting Revenue7486272DirectOffsettingRevenue
Net Community Benefit Expense6153248NetCommunityBenefitExpense
Percent Of Total Expense0.05800PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$3,015,205BadDebtExpenseAmount
Amount Reimbursed By Medicare31111335AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare40668603CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-9557268MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1SOUTH LAKE HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11900 DON WICKHAM DRIVEAddressLine1
CityCLERMONTCity
StateFLState
ZIP Code34711ZIPCode
FieldValueIRS element (for citing)
Critical Access HospitalXCriticalAccessHospital

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Income Based CriteriaIF 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.IncomeBasedCriteria
Costing Method UsedTHE 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 AND PART III, SECTION A, LINE 2 WERE CALCULATED USING THE RCC CALCULATED IN WORKSHEET 2. OTHER COSTS WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS.CostingMethodUsed
Subsidized Health Services ExplnSUBSIDIZED HEALTH SERVICES REPRESENT THE OPERATIONAL COSTS FOR THE FREE CLINIC TO CARE FOR INDIGENT PATIENTS OF SOUTH LAKE COUNTY.SubsidizedHealthServicesExpln
Percent Of Total Expense ExplnIN 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 25 120,992,764 LESS: BAD DEBTS IN PART IX ( 14,973,753) ADD: EXPENSES REPORTED IN PART VIII 22,897 DENOMINATOR FOR COLUMN (F) 106,041,908PercentOfTotalExpenseExpln
Bad Debt FootnoteEXCERPT FROM AUDITED FINANCIAL STATEMENTS - ALLOWANCE FOR DOUBTFUL ACCOUNTS MANAGEMENT PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON AN EVALUATION OF THE OVERALL COLLECTIBILITY OF THE ACCOUNTS RECEIVABLE. AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE, THEY ARE CHARGED AGAINST THE ALLOWANCE. AMOUNTS ON PART III, LINES 2 AND 3 WERE CALCULATED USING THE RCC AS DEFINED IN WORKSHEET 2.BadDebtFootnote
Shortfall As Community BenefitMEDICARE 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.ShortfallAsCommunityBenefit
Debt Collection PolicyBOTH 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.DebtCollectionPolicy
Needs AssessmentSOUTH LAKE DOES NOT CURRENTLY CONDUCT A FORMAL ANNUAL HEALTH CARE NEEDS ASSESSMENT. HOWEVER, THE ORGANIZATION 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.NeedsAssessment
Patient Education AssistanceSOUTH 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.PatientEducationAssistance
Community InformationSOUTH 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 28,355. 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.CommunityInformation
Other InformationSOUTH 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.OtherInformation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantNURSING SCHOLARSHIPSTypeOfGrant
Number Of Recipients23NumberOfRecipients
Amount Of Cash Grant65295AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATESIdentifier
Return ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2ReturnReference
ExplanationNURSING 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgtrueCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
JOHN HILLENMEYER
74088124603911173219528129051230526
DR RICHARD HORNICK
1200853212031214251154969
LESLIE LONGACRE
1479941138011323390046473216174
LANCE SEWELL
1181009519902044319178167330
JOHN MOORE
11416310587842700814332166174
BAKKIAM SUBBIAH
40058413681124125010212453526
DOROTHY RICHARDSON
1825021368191224913870210008
THURMEN LILLARD
142951344754720588171430
ROBERT DAVIS
13797222069008336153428

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTSSCHEDULE J, PAGE 1, PART I, LINE 4JOHN HILLENMEYER 0 209,116 0 LESLIE LONGACRE 0 10,500 0 LANCE SEWELL 0 8,715 0 JOHN MOORE 0 8,400 0 DEBORAH CORT 0 7,560 0 BAKKIAM SUBBIAH 0 41,250 0 DOROTHY RICHARDSON 0 12,249 0
COMPENSATION CONTINGENT UPON REVENUES OF ORGANIZATIONSCHEDULE J, PAGE 1, PART I, LINE 5ADIRECTORS RECEIVE AN INCENTIVE FOR THE ACHIEVEMENT OF CERTAIN FINANCIAL, PERSONNEL, CUSTOMER SATISFACTION AND QUALITY GOALS.
OTHER ADDITIONAL INFORMATIONSCHEDULE J, PART IIITHE 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.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Business Name Line2IssuerName/BusinessNameLine2Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuer
SOUTH LAKE COUNTY HEALTH DISTRICT
2003 REVENUE BONDS593322533838640DB32003-09-0117900000CONSTRUCTION AND RENfalsetrue
SOUTH LAKE COUNTY HEALTH DISTRICT
593322533838640DC12010-01-0652335000CONSTRUCTION/RENOVATfalsefalse
SOUTH LAKE COUNTY HEALTH DISTRICT
593322533838640DS62010-04-0134330000REDEMPTION OF 1999 Bfalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount UnspentAmountUnspentAmount DefeasedAmountDefeased
164018061344763354415167210112004falsefalsetruetrue
519982225199822998399233980062011falsefalsefalsetrue22407507
339566226802622010truefalsetruetrue33276360

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersTotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsetruetruefalsetrue0.021500.02150true
falsetruetruefalsetruetrue
falsetruetruefalsetrue0.002600.00260true

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
MANAGEMENT DELEGATEDFORM 990, PAGE 6, PART VI, LINE 3ORLANDO HEALTH ("OH"), A RELATED ORGANIZATION, PROVIDES THE HOSPITAL'S CEO, CFO, COO AND CNO PURSUANT TO A MANAGEMENT AGREEMENT WITH THE HOSPITAL.
ELECTION OF MEMBERS AND THEIR RIGHTSFORM 990, PAGE 6, PART VI, LINE 7AFIFTY 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 990FORM 990, PAGE 6, PART VI, LINE 11THE 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 POLICYFORM 990, PAGE 6, PART VI, LINE 12CANNUALLY, 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.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ATHE PROCESS USED TO DETERMINE COMPENSATION IS ARRIVED BY THE COMPENSATION COMMITTEE BY OH. THE YEAR IN WHICH THIS PROCESS LAST TOOK PLACE WAS 2007 WITH THE EXECUTIVE RESTRUCTURING. THE EXECUTIVE DIRECTOR'S COMPENSATION IS DETERMINED BY OH AS PART OF THE MANAGEMENT AGREEMENT.
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BTHE PROCESS USED TO DETERMINE COMPENSATION IS ARRIVED BY THE COMPENSATION COMMITTEE BY OH. THE YEAR IN WHICH THIS PROCESS LAST TOOK PLACE WAS 2007 WITH THE EXECUTIVE RESTRUCTURING.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19FINANCIAL STATEMENTS ARE MADE AVAILABLE THROUGH CONTINUING DISCLOSURE AGREEMENT WITH DIGITAL ASSURANCE CORPORATION (DAC). GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST THROUGH THE SUNSHINE LAW.
ADDITIONAL INFORMATIONSCHEDULE OMANAGEMENT AGREEMENT ORLANDO HEALTH (OH) PROVIDED VARIOUS SERVICES PURSUANT TO THE MANAGEMENT AGREEMENT WITH THE HOSPITAL. DURING THE YEAR ENDED SEPTEMBER 30, 2010, OH PROVIDED SERVICES IN THE AMOUNT OF 5,732,000; HOWEVER, NO PAYMENT WAS REQUIRED ON 4,673,000 DUE TO AN AGREEMENT ASSOCIATED WITH THE INTERGOVERNMENTAL TRANSFER. THE COST OF THE SERVICES IS RECORDED IN OPERATING EXPENSES. CONVERSELY THE AMOUNT OF THE COST OF SERVICES CONTRIBUTED BY OH IS RECORDED AS A CONTRIBUTION. AS PER THE MANAGEMENT AGREEMENT WITH THE HOSPITAL, OH PROVIDES BILLING AND COLLECTION SERVICES. ADDITIONALLY, ORLANDO HEALTH FOUNDATION (AN AFFILIATE OF OH) HOLDS AND ADMINISTERS CERTAIN DONOR RESTRICTED FUNDS ON BEHALF OF THE HOSPITAL. THE AMOUNT HELD BY ORLANDO HEALTH FOUNDATION ON THE HOSPITAL'S BEHALF WAS 793,000 IN 2010 AND IS INCLUDED IN OTHER RECEIVABLES.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
ORLANDO HEALTH
1414 KUHL AVENUEORLANDOFL32806591726273HEALTHCAREFL5013NA
SOUTH LAKE COUNTY HOSPITAL DISTRICT
1900 DON WICKHAM DRIVECLERMONTFL34711590571600LEVY TAXFL5016NA
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgtruePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.