2016-08-15T16:52:57-05:00 2015-09-30 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2014-10-01 592496294 INDIAN RIVER MEMORIAL HOSPITAL INC INDI 7725674311 1000 36TH STREET VERO BEACH FL 32960 GREGORY GARDNER CFO 7725674311 2016-08-12 1 DAVID BILLER P01251566 3126343400 2014 2016-09-27 15:27:22Z INDIAN RIVER MEDICAL CENTER JEFFREY L SUSI 1000 36TH STREET VERO BEACH FL 32960 261174518 0 X WWW.INDIANRIVERMEDICALCENTER.COM X 1984 FL IRMC SERVES AS THE AREA'S LEADING PROVIDER OF COMPREHENSIVE HIGH QUALITY HEALTH AND MEDICAL SERVICES, AND IMPROVES THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITIES WE SERVE. 16 12 2133 499 337370 112830 7235770 14285206 214257346 244199078 4045060 1197708 1489861 1492526 227028037 261174518 0 0 0 0 108578340 125076320 0 0 0 109794192 120665058 218372532 245741378 8655505 15433140 188924681 210296939 59315171 77599123 129609510 132697816 X INDIAN RIVER MEDICAL CENTER SERVES AS THE AREA'S LEADING PROVIDER OF COMPREHENSIVE HIGH QUALITY HEALTH AND MEDICAL SERVICES, AND IMPROVES THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITIES WE SERVE. 0 0 180840336 244337138 INDIAN RIVER MEDICAL CENTER IS A 339-BED HOSPITAL IN VERO BEACH, FLORIDA. IN FISCAL YEAR 2015, THE HOSPITAL HAD 15,064 ADMISSIONS. SERVICES WERE PROVIDED FOR 64,181 PATIENT DAYS. THE HOSPITAL HAD 499 VOLUNTEERS WHO WORKED 74,497 HOURS DURING THE YEAR. MORE THAN 58,800 PEOPLE ARE SEEN EACH YEAR IN ITS STATE-OF-THE-ART EMERGENCY DEPARTMENT. THE MEDICAL CENTER'S THREE LARGEST PROGRAM SERVICES ARE HEART, CANCER AND ORTHOPEDICS. THE HEART CENTER, AFFILIATED WITH DUKE MEDICINE AND OPENED IN 2006, TREATED OVER 2,000 PATIENTS DURING THE YEAR. ITS OUTSTANDING SURGICAL OUTCOMES HAVE EARNED IT TOP RECOGNITION FROM THE SOCIETY OF THORACIC SURGEONS, WHO NAMED IT ONE OF THE BEST CARDIAC SURGERY PROGRAMS IN AMERICA. DR. STOWE, MEDICAL DIRECTOR OF CARDIOVASCULAR SURGERY SERVICES, IS RECOGNIZED AS ONE OF THE TOP 1% OF THORACIC SURGEONS IN THE UNITED STATES. THE CANCER PROGRAM AFFILIATED WITH DUKE MEDICINE IN 2012, WITH THE GOAL OF BRINGING WORLD CLASS CANCER TREATMENT CLOSE TO THE HOME OF PATIENTS WE SERVE. THE AFFILIATION WITH DUKE ALSO PROVIDES ACCESS TO SECOND OPINIONS WITH RECOGNIZED EXPERTS WHEN NEEDED. DURING THE YEAR, MORE THAN 500 PATIENTS WERE TREATED. THE ORTHOPEDIC PROGRAM PROVIDED MAJOR JOINT REPLACEMENTS TO MORE THAN 1,000 PATIENTS DURING THE YEAR. 180840336 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 363 0 1 2133 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 16 12 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X ARTHUR COMITO 7725674311 1000 36TH STREET VERO BEACH FL 32960 WAYNE HOCKMEYER PHD CHAIRMAN 5.00 2.00 X X 0 0 0 JOHN PASTOR VICE CHAIRMAN 5.00 2.00 X X 0 0 0 WILLIAM KELLEY MD SECRETARY 5.00 2.00 X X 0 0 0 JACK WEISBAUM TREASURER 5.00 2.00 X X 0 0 0 CHARLES CELANO MD CHIEF OF STAFF 5.00 2.00 X 81632 0 0 JOHN LINDENTHAL MD VICE CHIEF OF STAFF 5.00 2.00 X 58992 0 0 PRANAY RAMDEV MD MEDICAL STAFF REPRESENTATIVE - PARTIAL YEAR 5.00 2.00 X 0 0 0 THEODORE PERRY MD MEDICAL STAFF REPRESENTATIVE 5.00 2.00 X 170366 0 0 THOMAS SEGURA CHAIRMAN - PARTIAL YEAR 5.00 2.00 X X 0 0 0 KATHY HENDRIX MEMBER 5.00 2.00 X 0 0 0 HUGH MCCRYSTAL MD MEMBER 5.00 2.00 X 0 0 0 KEITH MORGAN MEMBER 5.00 2.00 X 0 0 0 FRAN ROSS ESQ MEMBER 5.00 2.00 X 0 0 0 ANTHONY C WOODRUFF MEMBER 5.00 7.00 X 0 0 0 MATTHEW REISER MEMBER 5.00 2.00 X 0 0 0 MARION KENNEDY RN MEMBER - PARTIAL YEAR 5.00 2.00 X 0 0 0 MICHAEL J HAMMES MEMBER - PARTIAL YEAR 5.00 2.00 X 0 0 0 GERRI SMITH MEMBER - PARTIAL YEAR 5.00 2.00 X 0 0 0 DONALD LAURIE MEMBER - PARTIAL YEAR 5.00 2.00 X 0 0 0 JEFFREY L SUSI PRESIDENT/CEO 50.00 4.00 X 1019889 0 58172 GREGORY GARDNER SR VP, CFO 50.00 1.00 X 502823 0 52638 STEVEN SAYLER SR VP, COO - PARTIAL YEAR 50.00 0.00 X 220897 0 6385 LYNN HUBBARD VP, CNO 50.00 0.00 X 267669 0 29133 VALERIE LARCOMBE SR VP, CLO 50.00 0.00 X 359239 0 52293 JANICE DONLAN VP FOUNDATION & COMMUNITY RELATIONS 15.00 35.00 X 0 229576 24216 CARY STOWE PHYSICIAN 50.00 0.00 X 829633 0 10651 RICHARD FRANCO PHYSICIAN 50.00 0.00 X 1024168 0 17471 SETH BAKER PHYSICIAN 50.00 0.00 X 1024699 0 13918 ARLEY PETER MD PHYSICIAN 50.00 0.00 X 859001 0 14088 FABIO ROBERTI MD PHYSICIAN 50.00 0.00 X 814618 0 14700 CYNTHIA VANEK SR VP, COO - FORMER 0.00 0.00 X 208310 0 6784 7441936 229576 300449 95 1 1 0 PROCTOR CONSTRUCTION COMPANY 2050 US HWY 1 VERO BEACH FL 32960 CONTRACTOR 4101325 BRASFIELD & GORRIE LLC 941 WEST MORSE BLVD STE 200 WINTER PARK FL 32789 GENERAL CONTRACTOR 2775791 ALL STAR RECRUITING PO BOX 823424 PHILADELPHIA PA 19182 LOCUMS SERVICES 1998238 ARRAY ARCHITECTS INC 1 W ELM ST STE 400 CONSHOHOCKEN PA 19428 ARCHITECTS 1167274 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 753972633 LOCUMS SERVICES 1098802 78 14285206 14285206 NET PATIENT REVENUE 621990 244199078 244199078 244199078 1197708 3778 1193930 CAFETERIA 722100 827363 827363 LABORATORY 621500 307189 307189 LIFELINE MEDICAL MONITORING 900099 193511 193511 164463 138060 26403 1492526 261174518 244337138 337370 2214804 3782197 3782197 103601263 86404395 17196868 2817141 2266672 550469 8303547 6681034 1622513 6572172 5287969 1284203 1117737 1117737 225002 225002 25281477 14956585 10324892 608221 418010 190211 2513675 1827875 685800 886678 713421 173257 12495210 6530900 5964310 7428174 291880 7136294 MEDICAL SUPPLIES 42713160 40683923 2029237 BAD DEBT 12967752 12967752 14427972 1809920 12618052 245741378 180840336 64901042 0 19029369 19046919 17239328 17394546 25700987 25202735 3630225 4614788 2228702 2936997 296473968 188639423 96134752 107834545 6397791 6391633 6926022 6820748 7286510 6848175 4350995 13205853 188924681 210296939 23267969 28029459 8324479 11105817 27722723 38463847 59315171 77599123 X 129399013 132487319 210497 210497 129609510 132697816 188924681 210296939 X 15433140 159884 -12504718 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 37763 37763 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO FLORIDA HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THOSE DUES ARE USED FOR LOBBYING. IN ADDITION, INDIAN RIVER MEDICAL CENTER HAS RETAINED SERVICES OF CONSULTANTS IN TALLAHASSEE FOR THE PURPOSE OF MONITORING LEGISLATIVE AND REGULATORY HEALTHCARE RELATED ISSUES THAT MIGHT AFFECT IT OR THE COMMUNITY IT SERVES AND COMMUNICATING THE MEDICAL CENTER'S VIEWS ON THOSE ISSUES TO ELECTED OFFICIALS. 779112 1150000 1929112 679112 100000 779112 567212 111900 679112 504497 62715 567212 504497 0 504497 1.00000 0 1 1 6871531 6871531 105937528 56060638 49876890 33823827 3612107 30211720 134729838 128966678 5763160 15111244 15111244 107834545 DUE TO RELATED PARTIES 6606028 INVESTMENTS IN JOINT VENTURES 1159998 INVESTMENT IN HEALTH SYSTEMS OF INDIAN RIVER 5400000 OTHER ASSETS 39827 13205853 SELF-INSURANCE LIABILITY 11961580 PENSION LIABILITY 19703385 INDIGENT FUND PAYABLE 591621 EST. THIRD PARTY PAYOR SETTLEMENT 1690243 DUE TO AFFILIATES 2756800 INTEREST RATE SWAPS 1760218 38463847 X PART V, LINE 4: A PORTION OF THE ENDOWMENT ASSETS ARE HELD BY INDIAN RIVER HOSPITAL FOUNDATION, INC. (A RELATED ORGANIZATION). THE ENDOWMENT ASSETS ARE HELD TO SUPPORT THE PROGRAMS OF THE HOSPITAL INCLUDING MAINTENANCE OF THE CRITICAL CARE UNIT AS WELL AS TO PROVIDE CLINICAL EXCELLENCE AWARDS. PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS A TAXEXEMPT ORGANIZATION BY THE INTERNAL REVENUE SERVICE ("IRS") PURSUANT TO SECTION 501(C)(3) OF THE CODE. INCOME EARNED IN FURTHERANCE OF IRMH'S TAX-EXEMPT PURPOSE IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. THE CODE PROVIDES FOR TAXATION OF UNRELATED BUSINESS INCOME UNDER CERTAIN CIRCUMSTANCES. IRMH HAS NO MATERIAL UNRELATED BUSINESS INCOME; HOWEVER, SUCH STATUS IS SUBJECT TO FINAL DETERMINATION UPON EXAMINATION OF THE RELATED INCOME TAX RETURNS BY THE APPROPRIATE TAXING AUTHORITY. U.S. GAAP PRESCRIBES RECOGNITION THRESHOLDS AND MEASUREMENT ATTRIBUTES FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. TAX BENEFITS WILL BE RECOGNIZED ONLY IF THE TAX POSITION IS MORE-LIKELY-THAN-NOT TO BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED WILL BE THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE MORE-LIKELY-THAN-NOT TEST, NO TAX BENEFIT WILL BE RECORDED. MANAGEMENT HAS CONCLUDED THAT THEY ARE UNAWARE OF ANY TAX BENEFITS OR LIABILITIES TO BE RECOGNIZED AT SEPTEMBER 30, 2015 AND 2014. THE HOSPITAL DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. DUE TO ITS TAX-EXEMPT STATUS, THE HOSPITAL IS NOT SUBJECT TO U.S. FEDERAL INCOME TAX OR STATE INCOME TAX, EXCEPT ON INCOME THAT IS UNRELATED TO ITS TAX-EXEMPT PURPOSE. IRMH'S SEPTEMBER 30, 2011 FEDERAL TAX RETURN WAS EXAMINED BY THE IRS. THE EXAMINATION WAS COMPLETED ON AUGUST 9, 2013. THE IRS HAS ACCEPTED AMENDED RETURNS AS FILED AND INDICATED THE ORGANIZATION CONTINUES TO QUALIFY FOR EXEMPTION FROM FEDERAL INCOME TAX. THE HOSPITAL RECOGNIZES INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE. THE HOSPITAL DID NOT HAVE ANY AMOUNTS ACCRUED FOR INTEREST AND PENALTIES AT SEPTEMBER 30, 2015 AND 2014. TAX RETURNS FILED BY THE HOSPITAL ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEARS ENDED SEPTEMBER 30, 2011 AND PRIOR. 1 1 X 1 X 0 1 1 1 0 0 8254255 6477510 1776745 0.00760 19963265 11191403 8771862 0.03770 28217520 17668913 10548607 0.04530 265178 158670 106508 0.00050 6276598 4538961 1737637 0.00750 6541776 4697631 1844145 0.00800 34759296 22366544 12392752 0.05330 1 13467752 3366938 104945349 102970956 1974393 X 1 1 1 1 INDIAN RIVER MEMORIAL HOSPITAL 1000 36TH STREET VERO BEACH FL 32960 WWW.INDIANRIVERMEDICALCENTER.COM 4029 X X X INDIAN RIVER MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X HTTPS://WWW.INDIANRIVERMEDICALCENTER.COM/ABOUT/PUBLIC-INFORMATION/ X 1 12 1 HTTPS://WWW.INDIANRIVERMEDICALCENTER.COM/ABOUT/PUBLIC-INFORMATION/ 0 0 1 X 150.000000000000 X X X X X X 1 1 X X X 1 X WWW.INDIANRIVERMEDICALCENTER.COM/WP-CONTENT/UPLOADS/2015/05/ X WWW.INDIANRIVERMEDICALCENTER.COM/WP-CONTENT/UPLOADS/2015/05/ X WWW.INDIANRIVERMEDICALCENTER.COM/WP-CONTENT/UPLOADS/2015/05/ X X X X X 1 X 0 X X X X 1 X 0 0 INDIAN RIVER MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: RANDOM TELEPHONE INTERVIEWS WERE CONDUCTED WITH 400 COMMUNITY RESIDENTS. TELEPHONE INTERVIEWS WERE CONDUCTED WITH 26 COMMUNITY LEADERS THAT REPRESENT HEALTHCARE PROVIDERS FOR LOW INCOME/INDIGENT POPULATIONS, GOVERNMENTAL ENTITIES, CHARITABLE ORGANIZATIONS THAT FUND OR DIRECTLY SERVE THE POOR AND THOSE WITH HEALTHCARE NEEDS, CHURCHES, CHAMBERS OF COMMERCE, MAJOR EMPLOYERS, AND VOLUNTEERS WHO SERVE ON COMMUNITY AND HEALTH-ORIENTED GROUPS. CANCER FOCUS GROUPS WERE CONDUCTED WITH COMMUNITY INDIVIDUALS WHO HAVE OR HAVE HAD CANCER OR WHO HAVE BEEN AFFECTED BY FAMILY MEMBERS WHO HAVE OR HAD CANCER. REFER TO PAGE 3 OF THE CHNA REPORT AT WWW.INDIANRIVERMEDICALCENTER.COM FOR LIST OF THE LEADERS INTERVIEWED. INDIAN RIVER MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE HOSPITAL FACILITY IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BY (A) ADOPTION OF AN IMPLEMENTATION STRATEGY THAT ADDRESSES EACH OF THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA, (B) EXECUTION OF THE IMPLEMENTATION STRATEGY, (C) PARTICIPATION IN THE DEVELOPMENT OF A COMMUNITY-WIDE PLAN, (D) PARTICIPATION IN THE EXECUTION OF A COMMUNITY-WIDE PLAN, (E) ADOPTION OF A BUDGET FOR PROVISION OF SERVICES THAT ADDRESS THE NEEDS IDENTIFIED IN THE CHNA, (F) PRIORITIZATION OF HEALTH NEEDS IN ITS COMMUNITY, AND (G) PRIORITIZATION OF SERVICES THAT THE HOSPITAL FACILITY WILL UNDERTAKE TO MEET HEALTH NEEDS IN ITS COMMUNITY. INDIAN RIVER MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: ALL UNINSURED PATIENTS THAT DO NOT QUALIFY FOR FREE CARE RECEIVE DISCOUNTED HEALTH SERVICES REGARDLESS OF INCOME OR ASSETS. INDIAN RIVER MEMORIAL HOSPITAL PART V, SECTION B, LINE 22D: PATIENTS WITH HOUSEHOLD INCOME BETWEEN 150% AND 400% OF THE FEDERAL POVERTY GUIDELINES AND HAVE A CATASTROPHIC MEDICAL ILLNESS, WITHOUT OTHER SUBSTANTIAL FINANCIAL RESOURCES, AND NOT ELIGIBLE FOR MEDICAID OR OTHER COVERAGE, WILL BE GRANTED 70% DISCOUNT. ALL UNINSURED PATIENTS THAT DO NOT QUALIFY FOR ONE OF THESE PROGRAMS WILL RECEIVE A 30% DISCOUNT WHICH IS CONSISTENT WITH PAYMENTS NEGOTIATED WITH INSURANCE COMPANIES. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY INDIAN RIVER MEMORIAL HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: WWW.INDIANRIVERMEDICALCENTER.COM/WP-CONTENT/UPLOADS/2015/05/ INDIAN RIVER MEMORIAL HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: WWW.INDIANRIVERMEDICALCENTER.COM/WP-CONTENT/UPLOADS/2015/05/ INDIAN RIVER MEMORIAL HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: WWW.INDIANRIVERMEDICALCENTER.COM/WP-CONTENT/UPLOADS/2015/05/ 21 INDIAN RIVER CARDIOLOGY 787 37TH STREET VERO BEACH FL 32960 PHYSICIAN OFFICE VERO RADIOLOGY ASSOCIATES 3725 11TH CIRCLE VERO BEACH FL 32960 PHYSICIAN OFFICE VERO GASTROENTEROLOGY 3745 11TH CIRCLE VERO BEACH FL 32960 PHYSICIAN OFFICE PARTNERS IN WOMENS' HEALTH 787 37TH STREET VERO BEACH FL 32960 PHYSICIAN OFFICE VERO INTERNAL MEDICINE 1155 35TH LANE VERO BEACH FL 32960 PHYSICIAN OFFICE SEBASTIAN URGENT CARE 801 WELLNESS WAY SEBASTIAN FL 32958 URGENT CARE CENTER IRMC CARDIOVASCULAR NORTH 13885 US HIGHWAY 1 SEBASTIAN FL 32958 PHYSICIAN OFFICE IRMC CARDIOVASCULAR DIAGNOSTIC CENTER 13060 US HIGHWAY 1 SEBASTIAN FL 32958 PHYSICIAN OFFICE INDIAN RIVER CARDIOVASCULAR 1040 37TH PLACE SUITE 101 VERO BEACH FL 32960 PHYSICIAN OFFICE INDIAN RIVER CARDIOLOGY NORTH 801 WELLNESS WAY SEBASTIAN FL 32958 PHYSICIAN OFFICE POINTE WEST URGENT CARE 1960 POINTE WEST DRIVE VERO BEACH FL 32960 URGENT CARE CENTER INDIAN RIVER UROLOGY 3745 11TH CIRCLE VERO BEACH FL 32960 PHYSICIAN OFFICE INDIAN RIVER NEUROSURGERY 1040 37TH PLACE VERO BEACH FL 32960 PHYSICIAN OFFICE POINTE WEST FAMILY MEDICINE 1960 POINTE WEST DRIVE VERO BEACH FL 32966 PHYSICIAN OFFICE PRIMARY CARE SOUTH 4165 9TH STREET VERO BEACH FL 32968 PHYSICIAN OFFICE FAMILY MEDICINE NORTH 801 WELLNESS WAY SEBASTIAN FL 32958 PHYSICIAN OFFICE BAREFOOT BAY INTERNAL MEDICINE 937 BAREFOOT BLVD BAREFOOT BAY FL 32976 PHYSICIAN OFFICE INDIAN RIVER GENERAL SURGERY 1040 37TH PLACE VERO BEACH FL 32960 PHYSICIAN OFFICE INDIAN RIVER CONCIERGE 1040 37TH PLACE VERO BEACH FL 32960 PHYSICIAN OFFICE INDIAN RIVER CARDIOLOGY DR CELANO 3607 15TH LANE VERO BEACH FL 32960 PHYSICIAN OFFICE INDIAN RIVER ENDOCRINOLOGY 880 37TH PLACE VERO BEACH FL 32960 PHYSICIAN OFFICE PART I, LINE 3C: PATIENTS WITH HOUSEHOLD INCOME BETWEEN 150% AND 400% OF THE FEDERAL POVERTY GUIDELINES AND HAVE A CATASTROPHIC MEDICAL ILLNESS, WITHOUT OTHER SUBSTANTIAL FINANCIAL RESOURCES, AND NOT ELIGIBLE FOR MEDICAID OR OTHER COVERAGE, WILL BE GRANTED A 70% DISCOUNT. ALL UNINSURED PATIENTS THAT DO NOT QUALIFY FOR ONE OF THESE PROGRAMS WILL RECEIVE A 30% DISCOUNT WHICH IS CONSISTENT WITH PAYMENTS NEGOTIATED WITH INSURANCE COMPANIES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 12,967,752. PART II, COMMUNITY BUILDING ACTIVITIES: INDIAN RIVER MEDICAL CENTER PROMOTES COMMUNITY HEALTH THROUGH A BROAD VARIETY OF APPROACHES THAT INCLUDES A COMMUNITY BASED BOARD OF DIRECTORS THAT ENSURES THAT WE PROVIDE ACCESS TO PATIENT CARE THROUGHOUT THE YEAR, FREE OR LOW COST HEALTH FAIRS TO PROMOTE DISEASE PREVENTION, FREE EDUCATIONAL SESSIONS AND NEWSLETTERS ON DISEASE PREVENTION, FREE SUPPORT GROUPS, PARTICIPATION ON NUMEROUS COMMUNITY HEALTHCARE COLLABORATIVE COMMITTEES THAT PROMOTE AND DEVELOP CARE COORDINATION FOR OUR RESIDENTS. A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. IN ADDITION, MEDICAL STAFF PRIVILEGES ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN OUR COMMUNITY. PART III, LINE 2: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED COLLECTIONS OF ACCOUNTS RECEIVABLE CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AND CHARGED TO THE PROVISION FOR BAD DEBTS AFTER COLLECTION EFFORTS HAVE BEEN MADE IN ACCORDANCE WITH THE HOSPITAL'S POLICIES. BAD DEBT IS REPORTED NET OF PAYMENTS AND HEALTH SERVICES DISCOUNTS. RECOVERIES ARE TREATED AS A REDUCTION TO THE PROVISION FOR PATIENT BAD DEBTS.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IS RECORDED ON THE BASIS OF HISTORIAL EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 3: THE ORGANIZATION HAS DETERMINED THAT APPROXIMATELY 25% OF BAD DEBT WRITE-OFFS ARE ATTRIBUTABLE TO PATIENTS WHO WOULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON HISTORICAL ANALYSIS AND EXPERTISE. PART III, LINE 4: SEE PAGE NUMBER 13 IN THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ORGANIZATION REPORTS MEDICARE REVENUE AND ALLOWABLE COSTS IN PART III, LINES 5 AND 6 USING THE MEDICARE COST REPORT INFORMATION AND HOSPITAL FINANCIAL INFORMATION. PART III, LINE 9B: UNDER CURRENT HOSPITAL POLICY, ONCE A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, NO COLLECTION IS ATTEMPTED ON THE BALANCE RELATED TO THE SERVICES PROVIDED TO THE PATIENT. PART VI, LINE 2: INDIAN RIVER MEDICAL CENTER FREQUENTLY EVALUATES THE HEALTHCARE NEEDS OF THE COMMUNITY THROUGH A VARIETY OF METHODS INCLUDING PHONE SURVEYS TO RANDOMLY CHOSEN RESIDENTS, INTERVIEWS WITH COMMUNITY LEADERS AND EXECUTIVES, REVIEWING PRIMARY AND SECONDARY DATA AVAILABLE FROM MULTIPLE SOURCES, AND COMMUNITY FOCUS GROUPS. IN ADDITION, QUANTITATIVE AND QUALITATIVE DATA IS USED TO DETERMINE HISTORICAL TRENDS AND TO PREDICT FUTURE NEEDS BASED ON THOSE TRENDS. BASED ON THE FINDINGS OF THE ASSESSMENTS, INDIAN RIVER MEDICAL CENTER HAS RECENTLY OPENED A HEART FAILURE CLINIC, TWO WALK-IN CLINICS, ASSISTED COMMUNITY PHYSICIANS WITH RECRUITING PHYSICIANS TO IMPROVE ACCESS TO CARE AND A 14-BED SURGICAL INTENSIVE CARE UNIT. AS A RESULT OF HEALTH ASSESSMENT FINDINGS, THE FUTURE WILL INCLUDE EXPANDING CANCER CARE, CHRONIC DISEASE MANAGEMENT, DIAGNOSTIC SCREENING, AND BEHAVIORAL HEALTH PROGRAMS. PART VI, LINE 3: ALL UNINSURED PATIENTS RECEIVE FINANCIAL COUNSELING SERVICES AFTER THEY RECEIVE THE APPROPRIATE MEDICAL CARE. FINANCIAL COUNSELING INCLUDES EDUCATION ABOUT ALL FINANCIAL ASSISTANCE PROGRAMS.INDIAN RIVER MEDICAL CENTER PROVIDES RESOURCES TO UNINSURED AND UNDERINSURED PATIENTS TO ASSIST THEM IN COMPLETING A FINANCIAL ASSISTANCE APPLICATION. OUR FINANCIAL COUNSELORS ATTEMPT TO MAKE DIRECT CONTACT WITH UNINSURED PATIENTS TO ASSIST THEM WITH THE APPLICATION PROCESS. IF DIRECT CONTACT IS NOT POSSIBLE, A LETTER IS SENT TO THE PATIENT WITH INSTRUCTIONS ON HOW TO APPLY FOR FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE APPLICATION AND POLICY ARE AVAILABLE ON THE INTERNET AS WELL AS IN THE ADMITTING OFFICE, EMERGENCY ROOM, AND OTHER REGISTRATION SITES. IN ADDITION, APPLICANTS CAN VISIT OUR FINANCIAL COUNSELORS AT THE MEDICAL CENTER TO OBTAIN AN APPLICATION OR TO RECEIVE ASSISTANCE WITH COMPLETING THE APPLICATION. PATIENTS ARE INFORMED ABOUT OUR FINACIAL ASSISTANCE PROCESS IN A NUMBER OF WAYS: (1) FINANCIAL COUNSELORS AND SOCIAL WORKERS ARE AVAILABLE TO PATIENTS DURING THEIR STAY. (2) PATIENT ACCESS SERVICES ATTEMPTS TO CONTACT SCHEDULED PATIENTS PRIOR TO SERVICES TO PROVIDE PATIENTS WITH THEIR EXPECTED AMOUNTS DUE AND DISCUSS PAYMENT/DISCOUNT OPTIONS. (3) DISCUSSIONS ABOUT FINANCIAL ASSISTANCE OCCUR WHEN SPEAKING TO PATIENTS ON THE PHONE ABOUT THEIR ACCOUNT BALANCES. (4) INFORMATION REGARDING OUR FINANCIAL ASSISTANCE POLICY IS LOCATED ON OUR WEBSITE. PART VI, LINE 4: INDIAN RIVER MEDICAL CENTER SERVES INDIAN RIVER COUNTY AND IS THE ONLY HOSPITAL WITHIN A 10-MILE RADIUS OF OUR LOCATION. THE COUNTY IS COMPRISED OF ALMOST 140,000 PEOPLE. IT HAS SEEN STEADY GROWTH OVER THE TEN-YEAR PERIOD BETWEEN THE 2000 CENSUS AND THE 2010 CENSUS CONDUCTED BY THE US CENSUS BUREAU. JUST OVER 27% OF THE POPULATION IS 65 AND OVER. ALMOST 50% OF THE COUNTY'S POPULATION IS 50 OR OLDER. THE LARGEST POPULATION INCREASE WAS IN THE 60-64 YEAR AGE GROUP, WHILE THE LARGEST DECREASE WAS IN THE 35-39 YEAR AGE GROUP. UNEMPLOYMENT HAS REMAINED HIGH IN THE COUNTY AT ALMOST 12%. THE LARGEST EMPLOYERS IN THE COUNTY ARE IN THE RETAIL AND HEALTHCARE INDUSTRIES. SLIGHTLY MORE THAN 10% OF ALL FAMILIES IN INDIAN RIVER COUNTY LIVE BELOW THE FEDERAL POVERTY LEVEL, WITH MORE THAN 27% BEING UNDER THE AGE OF 18. THERE HAS BEEN A STEADY INCREASE IN THE NUMBER OF PEOPLE RECEIVING PUBLIC ASSISTANCE IN INDIAN RIVER COUNTY. PART VI, LINE 5: INDIAN RIVER MEDICAL CENTER PROMOTES COMMUNITY HEALTH THROUGH A BROAD VARIETY OF APPROACHES THAT INCLUDES A COMMUNITY BASED BOARD OF DIRECTORS THAT ENSURES THAT WE PROVIDE ACCESS TO PATIENT CARE THROUGHOUT THE YEAR, FREE OR LOW COST HEALTH FAIRS TO PROMOTE DISEASE PREVENTION, FREE EDUCATIONAL SESSIONS AND NEWSLETTERS ON DISEASE PREVENTION, FREE SUPPORT GROUPS, PARTICIPATION ON NUMEROUS COMMUNITY HEALTHCARE COLLABORATIVE COMMITTEES THAT PROMOTE AND DEVELOP CARE COORDINATION FOR OUR RESIDENTS. A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. IN ADDITION, MEDICAL STAFF PRIVILEGES ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN OUR COMMUNITY. PART VI, LINE 6: INDIAN RIVER MEMORIAL HOSPITAL, INC. AND ITS AFFILIATES (INDIAN RIVER HOSPIAL FOUNDATION, INDIAN RIVER HEALTH SERVICES, HEALTH SYSTEMS OF INDIAN RIVER, AND INDIAN RIVER HOSPITAL AUXILIARY) WORK TOGETHER TO SERVE AS THE AREA'S LEADING PROVIDER OF COMPREHENSIVE HIGH QUALITY HEALTH AND MEDICAL SERVICES. THE ORGANIZATION AND ITS AFFILIATES ALSO STRIVE TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITIES THEY SERVE. X X X X X 1 1 0 0 0 0 0 0 0 THEODORE PERRY MD MEDICAL STAFF REPRESENTATIVE 170366 0 0 0 0 0 0 0 0 0 170366 0 0 0 JEFFREY L SUSI PRESIDENT/CEO 399969 0 40890 0 579030 0 44276 0 13896 0 1078061 0 579030 0 GREGORY GARDNER SR VP, CFO 260010 0 27377 0 215436 0 41643 0 10995 0 555461 0 215436 0 STEVEN SAYLER SR VP, COO - PARTIAL YEAR 206421 0 14476 0 0 0 156 0 6229 0 227282 0 0 0 LYNN HUBBARD VP, CNO 174647 0 17877 0 75145 0 19513 0 9620 0 296802 0 75145 0 VALERIE LARCOMBE SR VP, CLO 230177 0 0 0 129062 0 42753 0 9540 0 411532 0 129062 0 JANICE DONLAN VP FOUNDATION & COMMUNITY RELATIONS 0 214576 0 15000 0 0 0 10320 0 13896 0 253792 0 0 CARY STOWE PHYSICIAN 829633 0 0 0 0 0 2879 0 7772 0 840284 0 0 0 RICHARD FRANCO PHYSICIAN 838356 0 185812 0 0 0 3776 0 13695 0 1041639 0 0 0 SETH BAKER PHYSICIAN 978063 0 46636 0 0 0 223 0 13695 0 1038617 0 0 0 ARLEY PETER MD PHYSICIAN 511501 0 347500 0 0 0 393 0 13695 0 873089 0 0 0 FABIO ROBERTI MD PHYSICIAN 814618 0 0 0 0 0 804 0 13896 0 829318 0 0 0 CYNTHIA VANEK SR VP, COO - FORMER 9087 0 0 0 199223 0 1331 0 5453 0 215094 0 0 0 PART I, LINES 4A-B PART I, LINE 4A - SEVERANCE OR CHANGE-OF-CONTROL PAYMENT: EXECUTIVES ARE PAID SEVERANCE PURSUANT TO THE ORGANIZATION'S COMPENSATION POLICY. THE FOLLOWING SEVERANCE PAYMENTS WERE MADE DURING 2014: CYNTHIA VANEK - $199,223 PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: * THE ORGANIZATION MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) FOR A SELECT GROUP OF FULL-TIME MANAGEMENT. THE SERP PROVIDES FOR A TARGET LEVEL OF ANNUAL RETIREMENT INCOME, INCLUDING A 3 PERCENT COST-OF-LIVING INCREASE AFTER RETIREMENT. THE BENEFIT IS PAYABLE AS A LUMP SUM AT RETIREMENT WITH DISTRIBUTIONS DURING EMPLOYMENT FOR THE PURPOSE OF PAYING INCOME TAXES UPON REACHING THE VESTING DATE. EFFECTIVE MARCH 22, 2006, THE SERP WAS AMENDED AND RESTATED TO COMPLY WITH INTERNAL REVENUE CODE SECTION 409A. UNDER THE CURRENT PLAN, ANNUITIES WILL BE PURCHASED ANNUALLY BASED ON THE ACCRUED BENEFIT OR THE INCREASE IN ACCRUED BENEFIT, AS APPLICABLE. AN ANNUITY IS PURCHASED EQUAL TO 60 PERCENT OF THE ACCRUED BENEFIT (OR THE INCREASE IN ACCRUED BENEFIT, AS APPLICABLE) WITH THE REMAINING VALUE SET ASIDE FOR INCOME TAX WITHHOLDING. DURING THE YEAR ENDED SEPTEMBER 30, 2015, THE SERP'S INCREASE IN ACCRUED BENEFIT OF APPROXIMATELY $823,000 WAS PAID THROUGH ANNUITY PURCHASES AND INCOME TAX WITHHOLDINGS. AT SEPTEMBER 30, 2015, THE SERP HAD NO ACCUMULATED BENEFIT OBLIGATION. ALTHOUGH THE ANNUITY PURCHASE DOES NOT REFLECT ANTICIPATED FUTURE COMPENSATION LEVELS, THE RESULTING PROJECTED BENEFIT OBLIGATION IS IMMATERIAL. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OR STOCKHOLDERS ELECTING MEMBERS OF GOVERNING BODY: THE INDIAN RIVER COUNTY HOSPITAL DISTRICT IS ENTITLED TO DESIGNATE THREE (3) VOTING MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS REQUIRING APPROVAL BY MEMBERS OR STOCKHOLDERS: PURSUANT TO THE ORGANIZATION'S BYLAWS AND ITS LEASE WITH THE INDIAN RIVER COUNTY HOSPITAL DISTRICT, CERTAIN BYLAW PROVISIONS AS WELL AS THE ELIMINATIONS OF CERTAIN SERVICES AND PROGRAMS REQUIRE APPROVAL BY THE DISTRICT. IN ADDITION, THE DISTRICT-APPOINTED TRUSTEES ALSO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE IN THE FOLLOWING: 2 DISTRICT-APPOINTED TRUSTEES ARE ON THE NOMINATING COMMITTEE, 1 DISTRICT-APPOINTED TRUSTEE AND 1 DISTRICT-APPOINTED PERSON WHO IS NOT A TRUSTEE ARE ON THE FINANCE COMMITTEE, 1 DISTRICT-APPOINTED TRUSTEE IS ON THE INVESTMENT COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11 REVIEW OF FORM 990 BY GOVERNING BOARD: A COPY OF THE FORM 990 IS PROVIDED TO THE EXECUTIVE COMMITTEE PRIOR TO FILING UTILIZING A LINK TO A PASSWORD-PROTECTED WEBSITE ON WHICH THE ENTIRE FORM 990 CAN BE VIEWED. QUESTIONS REGARDING THE FORM 990 ARE DIRECTED TO THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, CHIEF LEGAL OFFICER OR OTHER LEADERSHIP MEMBERS AS APPROPRIATE. EXECUTIVE LEADERSHIP PROVIDES MEMBERS OF THE BOARD OF DIRECTORS (OR OF A SPECIFIED COMMITTEE WITH BOARD-DESIGNATED POWERS) WITH AN OVERVIEW OF THE FORM 990 FILED ON BEHALF OF THE ORGANIZATION AT A REGULARLY SCHEDULED BOARD MEETING FOLLOWING THE FILING OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE HOSPITAL HAS A COMPLIANCE DEPARTMENT WHO ANNUALLY COLLECTS A SIGNED ACKNOWLEDGEMENT FROM EACH PERSON AT THE LEVEL OF MANAGER AND ABOVE, STATING THAT THE INDIVIDUAL HAS AN UNDERSTANDING OF, AND IS FULLY IN COMPLIANCE WITH, THE HOSPITAL'S CONFLICT OF INTEREST POLICY. IF A CONFLICT OF INTEREST IS DISCLOSED, THE COMPLIANCE DEPARTMENT WILL FOLLOW UP WITH THE INDIVIDUAL FOR ADDITIONAL INFORMATION. THIS INFORMATION IS REVIEWED BY THE ORGANIZATION'S COMPLIANCE COMMITTEE. IF A MEMBER OF THE GOVERNING BODY HAS A POTENTIAL OR ACTUAL CONFLICT OF INTEREST, THE INDIVIDUAL WILL ABSTAIN FROM VOTING ON RELATED DECISIONS. FORM 990, PART VI, SECTION B, LINE 15 PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL: THE ORGANIZATION'S EXECUTIVE COMPENSATION PROGRAM IS ADMINISTERED BY THE COMPENSATION SUB-COMMITTEE (THE "COMPENSATION COMMITTEE") AND CORPORATE COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE MEETS AS NEEDED TO REVIEW THE EXECUTIVE COMPENSATION PROGRAM AND MAKE RECOMMENDATIONS FOR ANY CHANGES TO THE CORPORATE COMPLIANCE COMMITTEE AND THE BOARD OF DIRECTORS AS APPROPRIATE. THE COMPENSATION COMMITTEE DIRECTLY, AND INDEPENDENT OF EXECUTIVE MANAGEMENT, COMMISSIONS AN ANNUAL REVIEW BY ITS INDEPENDENT CONSULTING FIRM, SULLIVAN COTTER, TO EVAULATE THE ORGANIZATION'S EXECUTIVE COMPENSATION PROGRAM AGAINST THE COMPETITIVE MARKET UTILIZING DATA FROM COMPARABLE LOCAL ORGANIZATIONS, INCLUDING, BUT NOT LIMITED TO FORM 990 DATA AS WELL AS REGIONAL DATA FROM SIMILAR ORGANIZATIONS. THE COMPENSATION REVIEW IS CONDUCTED NOT LESS THAN ANNUALLY AND IS INTENDED TO ENSURE THAT THE COMPENSATION PROGRAM FALLS WITHIN A REASONABLE RANGE OF COMPETITIVE PRACTICES FOR COMPARABLE POSITIONS AMONG SIMILARLY SITUATED ORGANIZATIONS. FOLLOWING THIS REVIEW, THE COMPENSATION COMMITTEE REVIEWS AND RECOMMENDS FOR APPROVAL OF THE BOARD OF DIRECTORS THE GOALS, OBJECTIVES, AND SALARY OF THE CHIEF EXECUTIVES. THE COMPENSATION COMMITTEE ALSO APPROVES THE SALARIES AND BENEFITS FOR VICE-PRESIDENTS AND KEY EMPLOYEES. NOTE: COMPENSATION FOR ALL OTHER EMPLOYEES, INCLUDING DIRECTORS AND MANAGERS, IS REVIEWED AND APPROVED BY THE EXECUTIVE MANAGEMENT COMMITTEE BY UTILIZING COMPARABLE MARKET COMPENSATION DATA PROVIDED BY SULLIVAN COTTER OR OTHER INDEPENDENT COMPENSATION AND BENEFITS FIRM. FORM 990, PART VI, SECTION C, LINE 19 REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC: THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: PENSION LIABILITY ADJUSTMENT -10,744,500. CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS -1,760,218. VERO RADIOLOGY ASSOCIATES LLC 3725 11TH CIRCLE VERO BEACH FL 32960 592755370 RADIOLOGY SERVICES FL 14654231 14005017 INDIAN RIVER MEMORIAL HOSPITAL INDIAN RIVER HOSPITAL FOUNDATION INC 1000 36TH ST VERO BEACH FL 32960 590760215 FUND RAISING FL 501(C)(3) LINE 11A, I IRMH 1 INDIAN RIVER HEALTH SERVICES INC 1000 36TH ST VERO BEACH FL 32960 650029298 HEALTHCARE FL 501(C)(3) LINE 11A, I IRMH 1 HEALTH SYSTEMS OF INDIAN RIVER INC 1000 36TH ST VERO BEACH FL 32960 650705680 HEALTHCARE FL 501(C)(3) LINE 11B, II IRMH 1 HOSPITAL AUXILIARY OF THE IRMH INC 1000 36TH ST VERO BEACH FL 32960 591003707 SUPPORT FL 501(C)(3) LINE 11D, III-O IRMH 1 SAPPHIRE INSURANCE COMPANY SPC GRAND PAVILION CIR PO BOX 10073APO GRAND CAYMAN CJ INSURANCE CJ IRMH C 1.00000 1 0 0 1 1 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 INDIAN RIVER HOSPITAL FOUNDATION INC C 14254873 FMV INDIAN RIVER HEALTH SERVICES INC D 272112 FMV HEALTH SYSTEMS OF INDIAN RIVER INC D 15556733 FMV HEALTH SYSTEMS OF INDIAN RIVER INC K 919797 FMV