2017-08-11T10:23:40-04:00 2016-09-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2015-10-01 593322533 SOUTH LAKE HOSPITAL INC SOUT 3523944071 1900 DON WICKHAM DRIVE CLERMONT FL 347111979 LANCE SEWELL CFO 3523944071 2017-08-15 true JACQUELINE G ATKINS P00861721 2298837878 2017-08-09 2015 2021-01-29 14:40:06Z JOHN MOORE 1900 DON WICKHAM DR CLERMONT FL 347111979 213951957 false X WWW.SOUTHLAKEHOSPITAL.COM X 1995 FL TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE INDIVIDUALS AND COMMUNITIES IN SOUTH LAKE COUNTY. 6 3 1693 115 2464908 -823331 3541618 9195819 161834810 174728190 1540861 988663 4381988 4558915 171299277 189471587 56994 250216 0 75219981 83754642 0 0 79149563 89753358 154426538 173758216 16872739 15713371 298931701 309369465 111757267 106269065 187174434 203100400 TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE INDIVIDUALS AND COMMUNITIES IN SOUTH LAKE COUNTY. false false 142685483 250216 175762180 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 39,000. 142685483 true true false true 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 false false false false false false false true false false true false false false false true false false false true 148 0 1693 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 false true true true true true false false false FL X LANCE SEWELL CFO 3522417104 1900 DON WICKHAM DRIVE CLERMONT FL 347111979 LUSHANTHA GUNASEKERA MD BOARD MEMBER 42.00 X 0 715261 34418 MILDRED BEAM VICE PRESIDE 2.00 55.00 X X 0 554690 83023 CARY D'ORTONA TREASURER 2.00 55.00 X X 0 226748 45118 SUSAN MCLEAN BOARD PRESID 1.00 X X 0 0 0 ROBERT E BERENS JR SECRETARY 1.00 X X 0 0 0 DAVID BATMAN BOARD MEMBER 1.00 X 0 0 0 JOHN MOORE HOSPITAL PRE 55.00 1.00 X 0 312061 65652 LANCE SEWELL CFO 55.00 1.00 X 0 179606 40099 PAUL JOHNS COO 55.00 X 0 154720 34834 LINDA WALTON CNO 55.00 X 0 108665 26975 PAREKATTIL SIJO MD PHYSICIAN 40.00 X 522405 0 28663 JEROME STURM MD PHYSICIAN 40.00 X 515538 0 25877 BRAHMBHATT JAMIN MD PHYSICIAN 40.00 X 494092 0 24944 ANDREW KAREN MD PHYSICIAN 40.00 X 416420 0 23578 JACOB SINDU MD PHYSICIAN 40.00 X 203698 0 26163 SHERRIE SITARIK VICE PRESIDE 0.00 X 0 325552 5356 2152153 2577303 464700 41 true true false ORIGIN DBA SHIFTWISE 2501 SW 1ST AVE SUITET 200 PORTLAND OR 972014752 NURSE STAFFING 3095159 ROBINS & MORTON GROUP 400 SHADES CREEK PKWY BIRMINGHAM AL 352094454 CONSTRUCTION SV 2128629 OB HOSPITALIST GROUP 10 CENTIMETERS DRIVE MAULDIN SC 296623278 HEALTHCARE SVS 1498403 AVI FOOD SYSTEMS 2590 ELM ROAD NE WARREN OH 444832904 MGMT FOOD SVCS 1412013 BIG TEN LLC 2020 OAKLEY SEAVER DR CLERMONT FL 347111902 MGMT SURGICAL 1094270 47 5229796 3966023 3900000 9195819 PROGRAM SERVICE REVENUE 623000 174728190 174728190 174728190 1061545 1061545 536035 431233 104802 104802 104802 23939985 36270 24046204 2933 -106219 33337 -72882 -72882 NATIONAL TRAINING CENTER 623000 2464908 2464908 FOOD AND BEVERAGE 722210 955215 955215 EHR HOSPITAL 621990 923317 923317 110673 110673 4454113 189471587 175762180 2464908 2048680 X 250216 250216 66938791 60294316 6644475 1689363 1518210 171153 10592961 9519761 1073200 4533527 4092538 440989 1151 1151 450511 450511 316914 316914 27887699 15057569 12830130 298170 77814 220356 18665007 17830754 834253 100606 82975 17631 2992466 2781796 210670 158511 124170 34341 4891669 4891669 11558684 10744953 813731 691682 691682 MEDICAL SUPPLIES 15579038 15579038 REPAIRS AND MAINTENANCE 2622350 2252690 369660 PROVIDER FEES 1813641 1813641 RECRUITING 817210 817210 908049 665042 243007 173758216 142685483 31072733 0 41234584 47416181 19597131 18818308 1485863 1340941 2731861 2877304 1271353 1636063 248067714 97537859 146479059 150529855 72260571 73199039 77005 313378 7570655 7570655 6223619 5667741 298931701 309369465 25376914 22048908 442725 540173 81652993 80045604 1928603 1726701 2356032 1907679 111757267 106269065 X 185563306 201571679 1611128 1528721 187174434 203100400 298931701 309369465 X 15713371 136389 -152745 228951 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 11450 false true 4649 16099 false SCHEDULE C, PART II-B, LINE 1 THE HOSPITAL PAYS MEMBERSHIP DUES TO A STATE HEALTHCARE ORGANIZATION. A PORTION OF THOSE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THE STATE HEALTHCARE ORGANIZATION PARTICIPATES. ADDITIONALLY, THE DIRECTOR OF GOVERNMENT RELATIONS SPENDS APPROXIMATALY 10% OF HER TIME LOBBYING FOR THE ORGANIZATION. 1611128 271064 250215 103256 1528721 1531728 387542 56714 251428 1611128 1421671 181257 25456 45744 1531728 1322778 230518 67250 64375 1421671 1372263 227295 80246 196534 1322778 1.00000 true false 752000 16195071 16947071 148784631 45300871 103483760 5020454 1640390 3380064 72295438 50596598 21698840 5020120 5020120 150529855 THIRD PARTY SETTLEMENTS 1572776 RAC RESERVE 202693 OTHER LIABILITIES 132210 1907679 X 186043035 136389 681448 817837 185225198 4246389 4246389 189471587 174104727 596726 596726 173508001 250215 250215 173758216 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. OTHER RESTRICTED FUNDS ARE AVAILABLE FOR THE ACQUISITION OF FIXED ASSETS AND OTHER OPERATING USES. ORLANDO HEALTH FOUNDATION (AN AFFILIATE OF ORLANDO HEALTH, A RELATED ORGANIZATION) HOLDS AND ADMINISTERS CERTAIN DONOR RESTRICTED FUNDS ON BEHALF OF SOUTH LAKE HOSPITAL. THE AMOUNT HELD WAS 742,567 AS OF SEPTEMBER 30, 2016. SCHEDULE D, PAGE 3, PART X THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO 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, 2016 AND 2015 OR FOR THE YEARS THEN ENDED. FOR FEDERAL INCOME TAX PURPOSES THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. SCHEDULE D, PAGE 4, PART XI, LINE 2D RENTAL EXPENSES 431,233 NET ASSETS RELEASED FROM RESTRICTIONS 250,215 SCHEDULE D, PAGE 4, PART XI, LINE 4B CAPITAL CONTRIBUTIONS 4,093,644 CONTRIBUTED SERVICES 152,745 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSE 431,233 EQUITY ADJUSTMENT 165,493 SCHEDULE D, PAGE 4, PART XII, LINE 4B SCHOLARSHIPS RELEASED FROM RESTRICTION 250,215 true true X true X true X true true true false true true 5016926 5016926 0.02880 20718640 8534637 12184003 0.06990 25735566 8534637 17200929 0.09870 1380214 1380214 0.00790 150077 60744 89333 0.00050 244964 244964 0.00140 264505 264505 0.00150 2039760 60744 1979016 0.01130 27775326 8595381 19179945 0.11000 true 16243880 12182910 43167715 43796059 -628344 X true true 1 1 SOUTH LAKE HOSPITAL 1900 DON WICKHAM DRIVE CLERMONT FL 347111979 WWW.SOUTHLAKEHOSPITAL.COM 4180 X X X SURG CTR, REHAB, MRI, HH SOUTH LAKE HOSPITAL 1 false false true X X X X X X X X 16 true true true true X WWW.SOUTHLAKEHOSPITAL.COM X true 17 true WWW.SOUTHLAKEHOSPITAL.COM false false true X 200.000000000000 400.000000000000 true true X X X true X WWWSOUTHLAKEHOSPITALCOM X WWWSOUTHLAKEHOSPITALCOM X WWWSOUTHLAKEHOSPITALCOM X X X X true X true X X X true X false false FACILITY 1, SOUTH LAKE HOSPITAL - PART V, LINE 5 CONSUMER SURVEY THE SURVEY WAS DISTRIBUTED BOTH IN HARD COPY (1,407) AND ELECTRONICALLY VIA SURVEYMONKEY (291) WITH A TOTAL OF 1,698 RESPONSES. WHILE MOST RESPONDENTS COMPLETED THE SURVEY IN ENGLISH, 331 WERE COMPLETED IN SPANISH, SIX IN FRENCH AND THREE IN CREOLE. AFTER DATA SCREENING, 1,235 RESPONSES WERE ANALYZED. PROVIDER SURVEY THIS SURVEY, DISTRIBUTED ELECTRONICALLY, INCLUDED RESPONSES FROM 145 PARTICIPANTS. THE QUESTIONS WERE MOSTLY OPEN-ENDED AND EXPLORED RESPONDENTS' VIEWS ON THE COMMUNITY'S DEFICITS GIVEN A HOLISTIC DEFINITION OF A HEALTHY COMMUNITY, ISSUES RELATED TO HEALTHCARE SERVICES AND FORCES OF CHANGE IN THE COMMUNITY. STAKEHOLDER IN-DEPTH INTERVIEWS INTERVIEWS WERE CONDUCTED WITH 16 COMMUNITY STAKEHOLDERS. EACH INTERVIEW LASTED AN AVERAGE OF 65 MINUTES. COMMUNITY CONVERSATIONS SIX COMMUNITY CONVERSATION SESSIONS TOOK PLACE WITH A TOTAL OF 102 PARTICIPANTS. THESE CONVERSATIONS EMPLOYED THE WORLD CAFE/CROSS POLLINATION METHOD. EACH PARTICIPANT WAS SEATED AT A TABLE WITH OTHER PARTICIPANTS. EACH TABLE ENGAGED IN CONVERSATION, WRITING DOWN KEY THOUGHTS AND IDEAS ON CARDS OR SKETCHING THEM OUT ON PAPER. AFTER 20-30 MINUTES, PARTICIPANTS WERE ASKED TO CHANGE TABLES, CARRYING THOUGHTS FROM THEIR PREVIOUS TABLE TO THEIR NEW GROUP. THROUGHOUT THE PROCESS, A "TABLE HOST" STAYED BEHIND AT EACH TABLE TO SHARE THE INSIGHTS OF THEIR PREVIOUS DISCUSSION WITH THE NEW ARRIVALS. AFTER THESE SMALL-GROUP ROUNDS, ALL PARTICIPANTS CONVENED FOR A LARGE-GROUP CONVERSATION AND COLLECTIVE KNOWLEDGE WAS HARVESTED. HOSPITAL-SPECIFIC PRIORITIZATION AN INTERNAL ASSESSMENT TEAM CONVENED AT SOUTH LAKE HOSPITAL AND INCLUDED CASE MANAGEMENT, NURSING, MEDICAL STAFF, ADMINISTRATION, FINANCE, EDUCATION, AND OTHER CLINICAL AND NON-CLINICAL STRATEGY INDIVIDUALS. FACILITY 1, SOUTH LAKE HOSPITAL - PART V, LINE 6A FOUR NOT-FOR-PROFIT HOSPITALS-ORLANDO HEALTH, SOUTH LAKE HOSPITAL, IN AFFILIATION WITH ORLANDO HEALTH, FLORIDA HOSPITAL AND ASPIRE HEALTH PARTNERS -ALONGSIDE THE FLORIDA DEPARTMENT OF HEALTH IN LAKE, ORANGE, OSCEOLA AND SEMINOLE COUNTIES COLLABORATED IN 2015 AND 2016 TO CREATE A CHNA FOR LAKE, ORANGE, OSCEOLA AND SEMINOLE COUNTIES. FACILITY 1, SOUTH LAKE HOSPITAL - PART V, LINE 6B SEE RESPONSE TO 6A. FACILITY 1, SOUTH LAKE HOSPITAL - PART V, LINE 11 SOUTH LAKE HOSPITAL WILL INVOLVE NUMEROUS DEPARTMENTS THROUGHOUT THE ORGANIZATION AND COMMUNITY PARTNERS TO USE BEST-PRACTICES TO STRATEGICALLY ADDRESS THE NEEDS IN THE SOUTH LAKE COMMUNITY WHICH ARE HIGHLIGHTED IN THE 2016 IMPLEMENTATION PLAN. SOUTH LAKE HOSPITAL WILL FOCUS PREVENTION, DETECTION AND EDUCATION EFFORTS IN THE SPECIFIC NEEDS LISTED BELOW: HEART DISEASE DIABETES CHILDHOOD/STUDENT OBESITY INFANT MORTALITY THE SOUTH LAKE HOSPITAL CHNA IDENTIFIED ADDITIONAL NEEDS IN THE SERVICE AREA THAT ARE NOT ADDRESSED AS A PRIORITY IN THIS CURRENT IMPLEMENTATION STRATEGY PLAN. IN CONSIDERING WHAT NEEDS TO NOT ADDRESS, THE SLH COMMITTEE WEIGHED THE LEVEL AT WHICH THESE NEEDS ARE ALREADY BEING ADDRESSED BY OTHER COMMUNITY PARTNERS, THE HOSPITAL AND/OR WHETHER THE HOSPITAL HAD THE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED. THESE NEEDS INCLUDED THE FOLLOWING: MENTAL ILLNESS/DEPRESSION POVERTY SUBSTANCE ABUSE INAPPROPRIATE ER VISITS POOR ACCESS TO FOOD/NUTRITION CANCER HIV/AIDS DENTAL CARE BOTH THE 2016 CHNA AND IMPLEMENTATION PLAN ARE LOCATED ON THE ORGANIZATION'S WEBSITE AT THE FOLLOWING ADDRESS: HTTP://WWW.SOUTHLAKEHOSPITAL.COME/ABOUT-US/COMMUNITY-OUTREACH 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 PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE 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 PATIENT'S INCOME DOES NOT EXCEED 400% OF THE FPG. PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION SUBSIDIZED HEALTH SERVICES REPRESENT THE OPERATIONAL COSTS FOR THE FREE CLINIC TO CARE FOR INDIGENT PATIENTS OF SOUTH LAKE COUNTY. PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE 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 25 173,758,217 ADD: EXPENSES REPORTED IN PART VIII 431,233 DENOMINATOR FOR COLUMN (F) 174,189,450 PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE ORGANIZATION USES THE COST TO CHARGE RATIO USING THE IRS' RECOMMENDED FORMAT IN WORKSHEET 2. OTHER COSTS IN PART I, LINES 7E THROUGH 7I WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY 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 HOSPITAL'S POLICY; HOWEVER, FAILED TO COMPLETE THE APPLICATION PROCESS. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS SEE THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE ON PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 - MEDICARE EXPLANATION 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. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION 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 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. PART VI, LINE 2 - NEEDS ASSESSMENT SOUTH LAKE COMPLETED ITS ASSESSMENT AS PART OF OUR STRATEGY, PLANNING AND BUDGETING PROCESS AND HAS PROCESSES IN PLACE TO ENSURE THE ORGANIZATION IS REACTIVE TO THE COMMUNITY'S 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. DURING THE FISCAL YEAR 2016, THE ORGANIZATION, ALONG WITH THE EFFORTS OF IMPACT PARTNERS, LLC, CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT. THE CHNA CAN BE FOUND AT HTTP://WWW.SOUTHLAKEHOSPITAL.COM/ABOUT-US/COMMUNITY-OUTREACH. THE IMPLEMENTATION STRATEGY PLAN CAN ALSO BE FOUND ON THE ORGANIZATION'S WEBSITE AT HTTP://WWW.SOUTHLAKEHOSPITAL.COM/ABOUT-US/COMMUNITY-OUTREACH PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE 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 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. PART VI, LINE 4 - COMMUNITY INFORMATION SOUTH 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 AND LAKE COUNTIES. THE MEDIAN HOUSEHOLD INCOME IN THE AREA IS 53,840. APPROXIMATELY 19% OF THE SERVICE AREA IS OVER 64 WHILE APPROXIMATELY 23% IS 0-12. 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. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH 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 MEET CERTAIN INDIGENT 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. GOVERNING BOARDS ARE COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM 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 NOT-FOR-PROFIT 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. true NURSING SCHOLARSHIPS 18 250216 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. true true false false false false false false false LUSHANTHA GUNASEKERA MD BOARD MEMBER 397236 316309 1716 11262 23156 749679 MILDRED BEAM VICE PRESIDENT 385939 120441 48310 67226 15797 637713 47395 CARY D'ORTONA TREASURER 188360 28991 9397 21962 23156 271866 9238 JOHN MOORE HOSPITAL PRESIDENT 224970 56931 30160 42227 23425 377713 28985 LANCE SEWELL CFO 149721 18607 11278 15935 24164 219705 11147 PAUL JOHNS COO 131192 16315 7213 11409 23425 189554 6748 PAREKATTIL SIJO MD PHYSICIAN 470909 50998 498 28663 551068 JEROME STURM MD PHYSICIAN 311484 199976 4078 25877 541415 BRAHMBHATT JAMIN MD PHYSICIAN 474627 19066 399 24944 519036 ANDREW KAREN MD PHYSICIAN 328593 87484 343 23578 439998 JACOB SINDU MD PHYSICIAN 200743 2955 26163 229861 SHERRIE SITARIK VICE PRESIDENT/CEO 325552 5356 330908 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. (OH), TO ESTABLISH COMPENSATION OF THE PRESIDENT AND EXECUTIVE OFFICERS. COMPENSATION DETERMINATION BY OH INCLUDES AN INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. SCHEDULE J, PAGE 1, PART I, LINE 4 MILDRED BEAM 0 63,914 0 CARY D'ORTONA 0 13,300 0 JOHN MOORE 0 33,386 0 LANCE SEWELL 0 10,758 0 PAUL JOHNS 0 9,380 0 LINDA WALTON 0 9,324 0 SHERRIE SITARIK 325,552 0 0 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, AS WELL AS THE OFFICERS, RECEIVE AN INCENTIVE FOR THE ACHIEVEMENT OF CERTAIN FINANCIAL, PERSONNEL, CUSTOMER SATISFACTION, AND QUALITY GOALS. PHYSICIANS ARE ELIGIBLE FOR BONUS/INCENTIVE PAYMENTS. THESE PAYMENTS ARE BASED ON VARIOUS ORGANIZATIONAL GOALS OF WHICH RELATIVE VALUE UNIT (RVU) EXPECTATIONS MAKE UP ONE OF THE COMPONENTS. 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 3170000 51998222 5199822 998399 45800001 2011 false false false true B 4600000 33956621 33276360 680262 2010 true false true true A false true true true false false false true B false true true true 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 B false ROBERT BERENS JR BOARD MEMBER 388916 BANK OFFICER; CASH false SCHEDULE L, PART V ROBERT E. BERENS, JR., CURRENTLY SERVING AS SECRETARY OF THE GOVERNING BOARD, IS A VICE PRESIDENT AT SEACOAST NATIONAL BANK AND OWNS LESS THAN 1% OF THE BANK'S STOCK. THE BANK HOLDS A CD VALUED AT APPROXIMATELY 389,000 FOR THE FILING ENTITY. X 1 3900000 APPRAISAL 1 false false false FORM 990, PAGE 6, PART VI, LINE 3 ORLANDO HEALTH (OH) PROVIDES THE HOSPITAL'S PRESIDENT, CFO, COO AND CNO PURSUANT TO A MANAGEMENT AGREEMENT WITH THE HOSPITAL. 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. FORM 990, PAGE 6, PART VI, LINE 11B THE BOARD CHAIR REVIEWS THE FORM 990 WITH THE CFO IN DETAIL PAYING PARTICULAR ATTENTION TO ANY NEW SCHEDULES AND THE RECONCILIATION TO THE AUDITED FINANCIAL STATEMENTS PRIOR TO FILING WITH THE IRS. THE PUBLIC INSPECTION COPY (WITHOUT CONTRIBUTORS' NAMES AND ADDRESSES) IS THEN ELECTRONICALLY CIRCULATED TO THE CURRENT VOTING BOARD MEMBERS BY SURVEY MONKEY AS AN ATTACHMENT, PRIOR TO FILING WITH THE IRS. 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 RIGHTS OR COMPENSATION RECEIVED IN RELATION TO ANY 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. 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. FORM 990, PART IX, LINE 11G CONTRACT SERVICE 6,704,854 1,214,754 0 REFERENCE LAB 1,223,106 0 0 PROFESSIONAL FEES 4,974,213 0 0 OTHER FEES 669,215 10,979 0 PURCHASED SERVICES 680,717 7,458,219 0 COURIER 30,822 1,348 0 CONSULTING FEES 3,689 1,226,624 0 COLLECTION 283,433 2,918,206 0 UBTI - OTHER FEES 487,520 0 0 FORM 990, PART XI, LINE 9 NET ASSETS RELEASED FROM RESTRICTIONS 84,721 CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 144,230 TOTAL 228,951 TOTAL CHANGE IN NET ASSETS IS DETAILED ABOVE. 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 454843489 PURCHASING FL OH ORLANDO HEALTH INC RELATED 688398 377143 false false 0.08420 false false true false true false false true false false true false true true true true false true true 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.