2019-08-13T11:51:58-05:00 2018-09-30 ERNST & YOUNG US LLP 201 NORTH FRANKLIN ST SUITE 2400 TAMPA FL 33602 990 2017-10-01 593259553 Orlando Health Physician Group Inc % BERNADETTE SPONG ORLA 3218415078 1414 KUHL AVENUE MP8 ORLANDO FL 32806 BERNADETTE SPONG CFO 3218415078 2019-08-13 true MELANIE MCPEAK P01346034 8132254800 73.184.197.104 59521020192255000006 2019-08-13 P 9D5EEB42429821CBACA628CB88EB15E2B93F9A36 9D5EEB42429821CBACA628CB88EB15E2B93F9A36 2017 2019-02-21 02:37:17Z BERNADETTE SPONG 1414 KUHL AVENUE MP8 ORLANDO FL 32806 256091222 false X www.orlandohealth.com X 1994 FL OUTPATIENT AND PHYSICIAN SUPPORT SERVICES. PROVISION OF SPECIALTY PHYSICIAN SERVICES, OUTPATIENT PHYSICIAN BILLING SERVICES PROVIDED ON BEHALF OF EXEMPT AFFILIATES. 5 0 1927 0 -7798 104451 758543 515406 202192963 254322270 -54950 232002 -275 -7798 202896281 255061880 0 0 0 0 255509992 330995314 0 0 0 45260449 48536118 300770441 379531432 -97874160 -124469552 26673116 56252552 26231667 47016118 441449 9236434 X OUTPATIENT AND PHYSICIAN SUPPORT SERVICES. PROVISION OF SPECIALTY PHYSICIAN SERVICES, OUTPATIENT PHYSICIAN BILLING SERVICES PROVIDED ON BEHALF OF EXEMPT AFFILIATES. true false 362806550 0 254203919 ORLANDO HEALTH PHYSICIAN GROUP, INC. SERVES AS AN INTEGRAL COMPONENT OF ORLANDO HEALTH, INC.'S INTEGRATED DELIVERY SYSTEM THROUGH THE PROVISION OF HEALTH CARE SERVICES TO THE COMMUNITY, BY INCLUDING OCCUPATIONAL HEALTH SERVICES, REHABILITATION HEALTH SERVICES, AND BEHAVIORAL HEALTH SERVICES. TO MEET THE NEEDS OF ITS COMMUNITY, ORLANDO HEALTH PHYSICIAN GROUP, INC. HAS 366 FULLY INTEGRATED EMPLOYED PHYSICIANS THAT REPRESENT MORE THAN 30 SPECIALTIES LOCATED THROUGHOUT ORLANDO AND CENTRAL FLORIDA, IN ADDITION TO PROVIDING VALUABLE MEDICAL EDUCATION TRAINING TO ORLANDO HEALTH, INC.'S MEDICAL RESIDENCY PROGRAMS. THIS MULTI-SPECIALTY ORGANIZATION IS DESIGNED TO FACILITATE A CLINICALLY-INTEGRATED DELIVERY OF CARE BASED ON BEST PRACTICES AND EVIDENCE-BASED MEDICINE, ENSURING THE BEST CARE AVAILABLE FOR OUR PATIENTS. ORLANDO HEALTH'S PHYSICIAN STRATEGY IS DESIGNED TO CHANGE THE WAY CARE IS DELIVERED TO OUR PATIENTS. IN A NEW ERA OF HEALTHCARE REFORM, HEALTH SYSTEMS ARE QUICKLY RECOGNIZING THE NEED TO IMPROVE PERFORMANCE BY ENHANCING EFFICIENCY, ACCESS, QUALITY AND COST METRICS. CONSOLIDATING ALL EMPLOYED PHYSICIANS UNDER A SINGLE ENTITY AND TIN CREATES MANY EFFICIENCIES FOR THE ORGANIZATION AS IT RELATES TO THE BILLING AND COLLECTIONS PROCESS; STANDARDIZATION OF OPERATIONAL AND CLINICAL PROTOCOLS AND PROCESSES; IMPROVED REPORTING STRUCTURE; AND THE OVERALL COORDINATION OF PATIENT CARE AMONGST ALL OF OUR PHYSICIANS AND SPECIALISTS. THIS ENABLES AN ORGANIZATIONAL MECHANISM FOR DEVELOPING CLINICAL QUALITY STANDARDS, EMPLOYING AND MANAGING PHYSICIANS WHO PRACTICE WITHIN THOSE STANDARDS, AND CREATING PERFORMANCE IMPROVEMENT PROTOCOLS THAT DRIVE EFFICIENCY, QUALITY AND OVERALL VALUE TO PATIENTS WITHIN OUR COMMUNITY. ANNUAL VISITS: 27,291 BEHAVIORAL, 11,296 REHAB AND 1,300,555 PHYSICIAN. 362806550 true true false false false false false false false true true false false true true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 true 1927 true true true false false false false false false false false false X 5 0 true false false false true true true true true false false true true true true true true false false false X BERNADETTE SPONG 3218415078 1414 KUHL AVENUE MP8 ORLANDO FL 32806 Mark A Jones Director 2.0 56.0 X 0 701834 103889 Jamal A Hakim MD Director 2.0 61.0 X 0 1421937 144792 Curtis J Pattee BEG 92018 Director, Secretary, Treasurer 55.0 1.0 X X 322077 0 55324 Bernadette Spong END 92018 Director, Secretary, Treasurer 2.0 59.0 X X 0 982729 119668 Sunil Desai MD Chairman & President, OHPG 55.0 1.0 X X 0 480637 30656 Mark Allen Steiner MD Co-Med Dir OHI/Mngng PHYS OHC 55.0 0.0 X 1846337 0 38281 Robert P Dalton MD Interventional Cardiology 55.0 0.0 X 1640286 0 34964 Ronald R Domescek MD Interventional Cardiology 55.0 0.0 X 1639829 0 36527 Pavel A Guguchev MD Clinical Cardiac Electrophysio 55.0 0.0 X 1586062 0 13227 DEEPAK P VIVEK MD CARDIOLOGY INTERVENTIONALIST 55.0 0.0 X 1728423 0 34977 8763014 3587137 612305 557 false true false FLORIDA CLINICAL PRACTICE ASSOCIATI PO BOX 100205 GAINESVILLE FL 326100205 HEALTHCARE SERVICES 4795677 INTERNAL MEDICINE SPECIALISTS 3885 OAKWATER CIRCLE ORLANDO FL 32806 HEALTHCARE SERVICES 1577000 MEDSPEED LLC 655 WEST GRAND AVENUE SUITE 320 ELMHURST IL 60126 COURIER SERVICES 1180493 IQUANTIFIED MANAGEMENT SERVICES LL 2821 S PARKER ROAD SUITE 305 AURORA CO 80014 FINANCIAL SERVICES 1033633 EVOLENT HEALTH LLC 800 N GLEBE ROAD SUITE 500 ARLINGTON VA 22203 CONSULTING SERVICES 647000 29 0 485406 30000 0 515406 PHYSICIAN NET PATIENT SERVICE REVENUE 621990 202460126 202460126 0 0 ON CALL PAY 621990 50039566 50039566 0 0 BILLING REVENUE 561000 259375 259375 0 0 MANAGEMENT FEES 621990 1285236 1285236 0 0 OTHER PROGRAM SERVICE REVENUE 621990 277967 277967 0 0 254322270 87091 87091 0 0 36598 44396 -7798 0 -7798 -7798 1129857 984946 144911 144911 144911 0 0 0 0 0 0 0 0 0 0 255061880 254322270 -7798 232002 0 0 0 0 0 0 0 0 381312 381312 0 0 0 0 294115612 291579787 2535825 0 0 0 0 0 24097704 20171652 3926052 0 12400686 10533780 1866906 0 280556 0 280556 0 3619 0 3619 0 28140 0 28140 0 0 0 0 0 0 0 0 0 0 0 7830698 7382119 448579 0 430286 68211 362075 0 2685520 2246631 438889 0 4734791 1822218 2912573 0 0 0 0 0 13393265 12375508 1017757 0 1477748 1390673 87075 0 0 0 0 0 150091 9284 140807 0 0 0 0 0 0 0 0 0 2985445 1961075 1024370 0 9107479 8057309 1050170 0 MEDICAL SUPPLIES 3781187 3781187 0 0 PROFESSIONAL DUES 905451 875824 29627 0 RECRUITING EXPENSE 407422 342425 64997 0 OTHER EXPENSES 334420 208867 125553 0 379531432 362806550 16724882 0 4192 24396 0 0 0 65782 14783462 17331548 0 0 0 0 0 18541 0 0 0 0 44614983 28763408 8700053 15851575 0 0 0 0 0 0 0 0 3185409 22960710 26673116 56252552 17109995 19621314 0 0 0 941924 0 0 0 0 0 0 0 0 0 0 9121672 26452880 26231667 47016118 X 441449 745479 0 8251620 0 239335 441449 9236434 26673116 56252552 X -124469552 7546 0 0 0 133256991 X false true X true false X X 1 ORLANDO HEALTH INC 591726273 3 true 379531431 0 1 379531431 true false false false false false false false false false false false false false false true false 0 5221009 36217 5257226 0.00000 0.04550 0.95450 false false 9603 9603 2021372 1338640 682732 5596453 2345146 3251307 36258668 25079622 11179046 728887 0 728887 15851575 DUE FROM AFFILIATES 11676364 CASH SURRENDER VALUE LIFE INS 5681673 ACCUM/DEF COMP PHYSICIAN BENEF 5602673 22960710 0 DUE TO AFFILIATE 20850207 LT-LIAB CAP/ACCUM DEF COMP 5602673 26452880 X Schedule D, Part V, Line 4 Intended use of endowment funds PURSUANT TO A PLAN TO CENTRALIZE ALL EMPLOYED PHYSICIAN SPECIALISTS, ORLANDO CANCER CENTER, INC. (EIN: 59-3005020) TRANSFERRED ALL OF ITS ASSETS AS OF OCTOBER 1, 2017 TO ORLANDO HEALTH PHYSICIAN GROUP, INC., INCLUDING THE MANAGEMENT OF ORLANDO CANCER CENTER'S ENDOWMENT FUNDS. ENDOWMENT FUNDS ARE RESTRICTED AS TO PURPOSE, TIME OR BOTH IN ACCORDANCE WITH DONOR SPECIFICATIONS MADE AT TIME OF CONTRIBUTIONS. ORLANDO HEALTH PHYSICIAN GROUP TREATS ENDOWMENT FUND PRINCIPAL AS RESTRICTED AND UTILIZES THE NET EARNINGS ON ENDOWMENT MONIES FOR PROGRAM AND CAPITAL NEEDS OF ORLANDO HEALTH, INC. AND AFFILIATES IN ACCORDANCE WITH DONOR SPECIFICATIONS. SCHEDULE D, PART X, LINE 2 LIABILITY FOR UNCERTAIN TAX POSITIONS (ASC 740) FASB ASC Topic 740, Income Taxes, prescribes the accounting for uncertainty in income tax positions recognized in the financial statements. ASC Topic 740 provides guidance and measurement of a tax position taken or expected to be taken in a tax return. There were no material uncertain tax positions as of September 30, 2018 and 2017. false true false false false false false false false Mark A Jones Director 0 466328 0 181298 0 54208 0 83686 0 20203 0 805723 0 49593 Jamal A Hakim MD Director 0 810834 0 372382 0 238721 0 144792 0 0 0 1566729 0 233541 Curtis J Pattee BEG 92018 Director, Secretary, Treasurer 265328 0 44414 0 12335 0 29651 0 25673 0 377401 0 11715 0 Bernadette Spong END 92018 Director, Secretary, Treasurer 0 668244 0 308307 0 6178 0 111374 0 8294 0 1102397 0 0 Sunil Desai MD Chairman & President, OHPG 0 214677 0 212008 0 53952 0 26870 0 3786 0 511293 0 0 Mark Allen Steiner MD Co-Med Dir OHI/Mngng PHYS OHC 394374 0 598688 0 853275 0 11262 0 27019 0 1884618 0 0 0 Robert P Dalton MD Interventional Cardiology 392091 0 593534 0 654661 0 11262 0 23702 0 1675250 0 0 0 Ronald R Domescek MD Interventional Cardiology 390528 0 600082 0 649219 0 11262 0 25265 0 1676356 0 0 0 Pavel A Guguchev MD Clinical Cardiac Electrophysio 401288 0 694820 0 489954 0 10677 0 2550 0 1599289 0 0 0 DEEPAK P VIVEK MD CARDIOLOGY INTERVENTIONALIST 392078 0 673596 0 662749 0 11262 0 23715 0 1763400 0 0 0 Schedule J, Part I, Line 3 RELATED ORGANIZATION ORLANDO HEALTH, INC. IS A COMMON PAYMASTER AND COMMON PAY AGENT FOR ORLANDO CANCER CENTER, INC. (EIN: 59-3005020), ORLANDO HEALTH PHYSICIAN GROUP, INC. (EIN: 59-3259553), ORLANDO HEALTH FOUNDATION, INC. (EIN: 59-2244943), ORLANDO HEALTH CENTRAL, INC. (EIN: 80-0764192) AND ORLANDO PHYSICIANS NETWORK, INC. (EIN: 59-3110868) AND THEIR EMPLOYEES ARE INCLUDED ON THE ORLANDO HEALTH, INC. 941. THE ORLANDO HEALTH, INC. INDEPENDENT COMPENSATION COMMITTEE APPROVES ALL OFFICER COMPENSATION ARRANGEMENTS, WHICH REPORTS TO THE ORLANDO HEALTH BOARD OF DIRECTORS AND FOLLOWS IRS GUIDELINES. Schedule J, Part I, Line 4b THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL QUALIFIED RETIREMENT PLAN WHICH INCLUDED THE FOLLOWING DEPOSITS DURING 2017 THAT WERE PREVIOUSLY DEFERRED. DEFERRAL DEPOSITS: MARK A. JONES $ 72,424 JAMAL A. HAKIM, MD $133,530 CURTIS J. PATTEE $ 18,537 BERNADETTE SPONG $100,112 SUNIL DESAI, MD $ 26,870 DEFERRAL DISTRIBUTIONS: MARK A. JONES $ 49,593 JAMAL A. HAKIM, MD $233,541 CURTIS J. PATTEE $ 11,715 FORM 990, BOX C ORLANDO HEALTH PHYSICIAN GROUP, INC. WILL BE NAMED ORLANDO HEALTH MEDICAL GROUP EFFECTIVE MAY 2019. THIS CHANGE IS NOT REFLECTIVE ON THIS 990 REPORTING BUT WILL BE EFFECTIVE ON THE 2018 FORM 990 REPORTING. FORM 990, PART III, LINE 2 Description of New Services ORLANDO HEALTH PHYSICIAN GROUP, INC. IS A WHOLLY OWNED SUPPORT ORGANIZATION FOR ORLANDO HEALTH, INC. (EIN: 59-1726273), AN AFFILIATED HEALTHCARE SYSTEM SERVING THE CENTRAL FLORIDA COMMUNITY. IN A STRATEGIC EFFORT TO ALIGN OUR HEALTHCARE SYSTEM WITH THE NEW ERA OF THE ACCOUNTABLE CARE ORGANIZATION HEALTHCARE MODEL BY CREATING EFFICIENCIES AS IT RELATES TO THE BILLING AND COLLECTIONS PROCESS, PATIENT SCHEDULING, ACCOUNTING AND BUDGETING PROCESS, STANDARDIZATION OF OPERATIONAL AND CLINICAL PROTOCOLS AND PROCESSES, IMPROVED REPORTING STRUCTURE, AND THE OVERALL COORDINATION OF PATIENT CARE AMONGST ALL OF OUR PHYSICIANS AND SPECIALISTS, AS OF OCTOBER 1, 2017, ALL EMPLOYED PHYSICIANS OF ORLANDO CANCER CENTER, INC. (EIN: 59-3005020) BECAME EMPLOYEES OF AND WERE CREDENTIALED WITH ALL PAYERS UNDER ORLANDO HEALTH PHYSICIAN GROUP, INC. FORM 990, PART VI, LINE 2 Business relationships BERNADETTE SPONG, CURTIS PATTEE, JAMAL HAKIM, MD, SUNIL DESAI, MD AND MARK JONES HAD A BUSINESS RELATIONSHIP AS BOARD MEMBERS OF FOR PROFIT COMPANIES WHOLLY OWNED BY ORLANDO HEALTH, INC. FORM 990, PART VI, LINE 6 DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS THE SOLE VOTING MEMBER OF ORLANDO HEALTH PHYSICIAN GROUP, INC. IS ORLANDO HEALTH, INC. (FEIN: 59-1726273). FORM 990, PART VI, LINE 7A DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS ORLANDO HEALTH, INC., THE TAX EXEMPT PARENT ORGANIZATION, APPROVES THE ELECTION OF ALL BOARD MEMBERS. FORM 990, PART VI, LINE 7B Decisions SUBJECT TO APPROVAL ORLANDO HEALTH PHYSICIAN GROUP, INC. (OHPG) BOARD ELECTS MEMBERS WHO ARE THEN APPROVED BY THE PARENT ORGANIZATION ORLANDO HEALTH, INC. (OH) BOARD. THE OH BOARD ALSO APPROVES MAJOR CAPITAL PURCHASES IN ACCORDANCE WITH OH GUIDELINES AND THE ANNUAL BUDGET AS OHPG IS PART OF THE CONSOLIDATED OH BUDGET APPROVAL PROCESS. FORM 990, PART VI, LINE 11B PROCESS USED BY MANAGEMENT AND/OR GOVERNING BODY TO REVIEW 990 THE CFO AND THE FINANCE DEPARTMENT REVIEWED THE FORM 990 AND ANY REQUIRED CHANGES WERE MADE TO THE FORM 990. THE FINAL FORM 990 WAS THEN PROVIDED TO ALL MEMBERS OF THE BOARD TO REVIEW. ANY QUESTIONS ABOUT THE CONTENT WERE ANSWERED AND ANY CHANGES REQUIRED OF THE REVIEW WERE MADE. FORM 990, PART VI, LINE 12C CONFLICT OF INTEREST POLICY MONITORING AND ENFORCEMENT THE PARENT ORGANIZATION, ORLANDO HEALTH, INC., HAS A DEDICATED COMPLIANCE DEPARTMENT WITH AN ANONYMOUS HOTLINE FOR REPORTING. THE COMPLIANCE DEPARTMENT PERFORMS INTERNAL AUDITS AND MONITORS ALL ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES FOR ALL RELATED ORGANIZATIONS. BOARD MEMBERS ROUTINELY ANNOUNCE CONFLICTS AT BOARD MEETINGS AND LEAVE THE ROOM FOR THE DISCUSSION AND THE VOTE. FORM 990, PART VI, LINE 15A AND 15B OFFICES AND POSITIONS FOR WHICH COMPENSATION PROCESS WAS USED ALL COMPENSATION IS PAID BY PARENT, ORLANDO HEALTH, INC., WHICH HAS AN INDEPENDENT COMPENSATION COMMITTEE THAT REPORTS TO THE ORLANDO HEALTH BOARD OF DIRECTORS AND UTILIZES THE GUIDELINES CONSISTENT WITH THE IRS GUIDELINES ON INDEPENDENT ANALYSIS AND DOCUMENTATION OF COMPENSATION. THE PROCESS, WHICH IS USED FOR THE PRESIDENT, ALL OFFICERS, EXECUTIVE DIRECTORS AND DIRECTORS, AND WAS IMPLEMENTED PRIOR TO 10/01/2006, WAS UNDERTAKEN FOR THE CURRENT YEAR. FORM 990, PART VI, LINE 19 AVAILABILITY OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS TO THE PUBLIC THESE DOCUMENTS ARE MADE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST IN ACCORDANCE WITH FEDERAL TAX LAW PUBLIC INSPECTION REQUIREMENTS. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS EQUITY CONTRIBUTION FROM PARENT, ORLANDO HEALTH, INC. $125,000,000 (EIN: 59-1726273) NET EQUITY TRANSFER FROM ORLANDO CANCER CENTER, INC. $ 8,287,644 (EIN: 59-3005020) MISCELLANEOUS ROUNDING $ 653 NET ASSETS RELEASED FROM TEMP. RESTRICTION $ (30,000) ============= TOTAL $133,256,991 ORLANDO HEALTH INC 1414 KUHL AVENUE ORLANDO FL 32806 591726273 HEALTHCARE FL 501(c)(3) 3 NA false ORLANDO HEALTH FOUNDATION INC 3160 SOUTHGATE COMMERCE BLVD ORLANDO FL 32806 592244943 SUPPORT OH FL 501(c)(3) 7 OHI true ORLANDO HEALTH CENTRAL INC 10000 W COLONIAL DRIVE OCOEE FL 34761 800764192 HEALTHCARE FL 501(c)(3) 3 OHI true ORLANDO CANCER CENTER INC 1400 S ORANGE AVENUE ORLANDO FL 32806 593005020 CANCER CENTER FL 501(c)(3) 12a OHI true ORLANDO PHYSICIANS NETWORK INC 1414 KUHL AVENUE ORLANDO FL 32806 593110868 SUPPORT OH FL 501(c)(3) 12a OHI true WEST ORANGE HEALTHCARE INC 10000 W COLONIAL DRIVE OCOEE FL 34761 593269402 SUPPORT OHC FL 501(c)(3) 12a OHC true HEALTH CENTRAL FOUNDATION INC 10000 W COLONIAL DRIVE OCOEE FL 32806 592091206 SUPPORT OHC FL 501(c)(3) 7 OHF true GREATER ORLANDO CHILDREN'S MIRACLE NTWRK 3160 SOUTHGATE COMMERCE BLVD ORLANDO FL 32806 593452974 SUPPORT OHF FL 501(c)(3) 7 OHF true LAKELAND REGIONAL MEDICAL CTR FOUNDATION 1324 LAKELAND HILLS BOULEVARD LAKELAND FL 33805 237134974 FUNDRAISING FL 501(c)(3) 12a LRHS true LAKELAND REGIONAL MEDICAL CENTER INC 1324 LAKELAND HILLS BOULEVARD LAKELAND FL 33805 592650456 HEALTHCARE FL 501(c)(3) 3 LRHS true LAKELAND REGIONAL HEALTH SYSTEMS INC 1324 LAKELAND HILLS BOULEVARD LAKELAND FL 33805 592650464 SUPPORT OTHER FL 501(c)(3) 12a OHI true POLK STARLIGHT SLEEP LABS LLC 3003 S FLORIDA AVENUE LAKELAND FL 33803 202108795 TESTING FACILITY FL LRHS RELATED 0 0 false 0 false 0.00000 LIFT ORLANDO IMPACT INVESTMENT FUND LLC 2043 JACOBS PLACE ORLANDO FL 32805 814062133 REAL ESTATE FL OHI EXCLUDED 0 0 false 0 false HEALTHNET SERVICES INC & SUBS 1414 KUHL AVENUE ORLANDO FL 32806 592246203 MEDICAL SVCS FL OHI C Corp 0 0 0.00000 true ORANGE INDEMNITY LTD PO BOX 1159 KY CJ 980516252 CAPTIVE INS CJ OHI C Corp 0 0 0.00000 true COMMUNITY HEALTH OF FLORIDA INC 1414 KUHL AVENUE ORLANDO FL 32806 463171911 INSURANCE LIC FL OHI C Corp 0 0 0.00000 true LAKELAND REGIONAL HEALTH VENTURES INC 1324 LAKELAND HILLS BOULEVARD LAKELAND FL 33805 592650902 MEDICAL SVCS FL LRHS C CORP 0 0 0.00000 true false false true false false false false false false false true true true false true true false false true ORLANDO HEALTH INC c 117940 FMV ORLANDO HEALTH FOUNDATION INC c 367466 FMV ORLANDO HEALTH INC k 9749623 FMV ORLANDO PHYSICIANS NETWORK INC l 109698 FMV ORLANDO HEALTH INC m 2076932 FMV ORLANDO HEALTH INC o 311125268 FMV ORLANDO HEALTH INC p 43634521 FMV ORLANDO HEALTH INC s 125000000 FMV SCHEDULE R, PART III, LineS 1 AND 2 POLK STARLIGHT SLEEP LABS, LLC EIN: 20-2108795 ADDRESS: 3003 S. FLORIDA AVENUE, LAKELAND, FL 33803 NAME: LIFT ORLANDO IMPACT INVESTMENT FUND, LLC EIN: 81-4062133 ADDRESS: 2043 JACOBS PLACE, ORLANDO, FL 32805