SOUTH LAKE HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SOUTH LAKE HOSPITAL INC (EIN 59-3322533)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-05
- IRS object ID
- 201422179349301262
- Schema version
- 2012v2.3
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-05T14:35:53-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DRAFFIN & TUCKER LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 71309 | AddressLine1 |
| City | ALBANY | City |
| State | GA | State |
| ZIP Code | 317081309 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 593322533 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTH LAKE HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SOUT | NameControl |
| Phone | 3523944071 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1900 DON WICKHAM DRIVE | AddressLine1 |
| City | CLERMONT | City |
| State | FL | State |
| ZIP Code | 347111979 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LANCE SEWELL | Name |
| Title | CFO | Title |
| Phone | 3523944071 | Phone |
| Date Signed | 2014-08-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JACQUELINE G ATKINS | Name |
| Phone | 2298837878 | Phone |
| Date Prepared | 2014-08-04 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOHN A MOORE CEO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1900 DON WICKHAM DRIVE | AddressLine1 |
| City | CLERMONT | City |
| State | FL | State |
| ZIP Code | 347111979 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 162316696 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | HTTP://WWW.SOUTHLAKEHOSPITAL.COM/ | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1995 | YearFormation |
| State Legal Domicile | FL | StateLegalDomicile |
| Activity Or Mission Description | HEALTHCARE SERVICES | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 3 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1370 | TotalNbrEmployees |
| Total Nbr Volunteers | 123 | TotalNbrVolunteers |
| Total Gross UBI | 2959553 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -502719 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 3143186 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2576814 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 141764020 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 126791815 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 358929 | InvestmentIncomePriorYear |
| Investment Income Current Year | 760171 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 4448994 | OtherRevenuePriorYear |
| Other Revenue Current Year | 5862247 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 149715129 | TotalRevenuePriorYear |
| Total Revenue Current Year | 135991047 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 80246 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 67251 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 62033361 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 61772983 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 113694 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 77016721 | OtherExpensePriorYear |
| Other Expenses Current Year | 66415364 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 139130328 | TotalExpensesPriorYear |
| Total Expenses Current Year | 128255598 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 10584801 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 7735449 | RevenuesLessExpensesCY |
| Total Assets BOY | 267494661 | TotalAssetsBOY |
| Total Assets EOY | 258102524 | TotalAssetsEOY |
| Total Liabilities BOY | 123050438 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 104911404 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 144444223 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 153191120 | NetAssetsOrFundBalancesEOY |
| Mission Description | HEALTHCARE SERVICES | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 104572083 | Expense |
| Grants | 67251 | Grants |
| Revenue | 128830868 | Revenue |
| Description | 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 30,000. | Description |
| Total Program Service Expense | 104572083 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | true | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | true | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 182 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 1370 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 3 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | false | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | FL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | LANCE SEWELL CFO | NamePerson |
| Telephone Number | 3522417104 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1900 DON WICKHAM DRIVE | AddressLine1 |
| City | CLERMONT | City |
| State | FL | State |
| ZIP Code | 347111979 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| SHERRIE SITARIK | ||||||||
| PAST PRESIDE | 2.00 | 40.00 | X | X | 0 | 878868 | 226730 | |
| LUSHANTHA GUNASEKERA MD | ||||||||
| BOARD MEMBER | 40.00 | 2.00 | X | 0 | 671394 | 49401 | ||
| MILDRED BEAM | ||||||||
| BOARD MEMBER | 40.00 | X | 0 | 436405 | 74010 | |||
| SUSAN MCLEAN | ||||||||
| PRESIDENT | 2.00 | X | X | 0 | 0 | 0 | ||
| ROBERT E BERENS JR | ||||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | ||
| DAVID BATMAN | ||||||||
| BOARD MEMBER | 2.00 | 0.20 | X | 0 | 0 | 0 | ||
| JOHN MOORE | ||||||||
| CEO | 40.00 | 0.25 | X | 0 | 228155 | 70508 | ||
| LANCE SEWELL | ||||||||
| CFO | 40.00 | 0.25 | X | 0 | 151114 | 47870 | ||
| AMY PATTERSON | ||||||||
| CNO | 40.00 | X | 0 | 109715 | 18989 | |||
| PAUL JOHNS | ||||||||
| COO | 40.00 | X | 0 | 105542 | 32495 | |||
| DEBORAH CORT | ||||||||
| CNO | 40.00 | X | 0 | 25206 | 3531 | |||
| LESLIE LONGACRE | ||||||||
| FORMER CEO | 40.00 | 0.25 | X | 0 | 15675 | 0 | ||
| MANUEL HERRERA MD | ||||||||
| PHYSICIAN | 40.00 | 408319 | 0 | 33783 | X | |||
| ANDREW KAREN MD | ||||||||
| PHYSICIAN | 40.00 | 267000 | 0 | 31172 | X | |||
| JEROME STURM MD | ||||||||
| PHYSICIAN | 40.00 | 254019 | 0 | 27220 | X | |||
| DOROTHY RICHARDSON | ||||||||
| DIR USAT/NTC | 40.00 | 227265 | 0 | 44051 | X | |||
| JOSE CARRAU MD | ||||||||
| PHYSICIAN | 40.00 | 207317 | 0 | 15248 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1363920 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2622074 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 675008 | TotalOtherCompensation |
| Number Individuals GT100 K | 24 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| AVI FOOD SYSTEMS | |||||
| 2590 ELM ROAD NE | WARREN | OH | 444832904 | MGMT FOOD SVCS | 1133732 |
| BIG TEN LLC | |||||
| 2020 OAKLEY SEAVER DRIVE | CLERMONT | FL | 347111902 | MGMT SURGICAL | 1038500 |
| TOSHIBA AMERICA | |||||
| 2441 MICHELLE DRIVE | TUSTIN | CA | 927807047 | MAINT & REPAIR | 983775 |
| ORIGIN INC DBA SHIFTWISE | |||||
| 2501 SW 1ST AVENUE SUITE 200 | PORTLAND | OR | 972014752 | NURSE STAFFING | 934819 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 753972633 | TEMP STAFFING | 896107 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 39 | NumberOfContractorsGT100K |
| Related Organizations | 2301544 | RelatedOrganizations |
| Government Grants | 133588 | GovernmentGrants |
| All Other Contributions | 141682 | AllOtherContributions |
| Total Contributions | 2576814 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PROGRAM SERVICE REVENUE | Description |
| Business Code | 623000 | BusinessCode |
| Total Revenue Column | 126791815 | TotalRevenueColumn |
| Related Or Exempt Function Income | 126791815 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 126791815 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 851197 | TotalRevenueColumn |
| Exclusion | $851,197 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 445090 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 167989 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 277101 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 277101 | TotalRevenueColumn |
| Exclusion | $277,101 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 26042634 | Securities |
| Other | 24000 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 26148364 | Securities |
| Other | 9296 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -105730 | Securities |
| Other | 14704 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -91026 | TotalRevenueColumn |
| Exclusion | -$91,026 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| NATIONAL TRAINING CENTER | 623000 | 2959553 | 2959553 | ||
| EHR HOSPITAL | 621990 | 2039053 | 2039053 | ||
| FOOD AND BEVERAGE | 722210 | 881895 | $881,895 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -295355 | TotalRevenueColumn |
| Exclusion | -$295,355 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 5585146 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 135991047 | TotalRevenueColumn |
| Related Or Exempt Function Income | 128830868 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 2959553 | UnrelatedBusinessRevenue |
| Exclusion | $1,623,812 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 67251 | Total |
| Program Services | 67251 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48474123 | Total |
| Program Services | 44151204 | ProgramServices |
| Management And General | 4269429 | ManagementAndGeneral |
| Fundraising | 53490 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1161113 | Total |
| Program Services | 1057566 | ProgramServices |
| Management And General | 102266 | ManagementAndGeneral |
| Fundraising | 1281 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8797155 | Total |
| Program Services | 8012650 | ProgramServices |
| Management And General | 774798 | ManagementAndGeneral |
| Fundraising | 9707 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3340592 | Total |
| Program Services | 3015750 | ProgramServices |
| Management And General | 320898 | ManagementAndGeneral |
| Fundraising | 3944 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7836 | Total |
| Program Services | 7268 | ProgramServices |
| Management And General | 568 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 202761 | Total |
| Management And General | 202761 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 282968 | Total |
| Management And General | 282968 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17826290 | Total |
| Program Services | 9232718 | ProgramServices |
| Management And General | 8593572 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 296738 | Total |
| Program Services | 23366 | ProgramServices |
| Management And General | 273372 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11535470 | Total |
| Program Services | 10867148 | ProgramServices |
| Management And General | 666658 | ManagementAndGeneral |
| Fundraising | 1664 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68466 | Total |
| Program Services | 37442 | ProgramServices |
| Management And General | 31024 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2878783 | Total |
| Program Services | 2776586 | ProgramServices |
| Management And General | 102197 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 264708 | Total |
| Program Services | 98579 | ProgramServices |
| Management And General | 165205 | ManagementAndGeneral |
| Fundraising | 924 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6152183 | Total |
| Management And General | 6152183 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8658864 | Total |
| Program Services | 8351474 | ProgramServices |
| Management And General | 307390 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 275973 | Total |
| Management And General | 275973 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 12492215 | 12492215 | |
| REPAIRS AND MAINT | 1979957 | 1629710 | 350247 |
| PROVIDER FEES | 1768743 | 1768743 | |
| RECRUITING | 486409 | 486409 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1237000 | Total |
| Program Services | 982413 | ProgramServices |
| Management And General | 211903 | ManagementAndGeneral |
| Fundraising | 42684 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 128255598 | Total |
| Program Services | 104572083 | ProgramServices |
| Management And General | 23569821 | ManagementAndGeneral |
| Fundraising | 113694 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60091 | BOY |
| EOY | 93217 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38578000 | BOY |
| EOY | 33271000 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16355967 | BOY |
| EOY | 15629939 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 903557 | BOY |
| EOY | 928770 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2140993 | BOY |
| EOY | 2070487 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1202159 | BOY |
| EOY | 1123271 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 203611736 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 68933305 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 139596027 | BOY |
| EOY | 134678431 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60755214 | BOY |
| EOY | 60341878 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 288480 | BOY |
| EOY | 196056 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4504031 | BOY |
| EOY | 4504031 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3110142 | BOY |
| EOY | 5265444 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 267494661 | BOY |
| EOY | 258102524 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18077358 | BOY |
| EOY | 16643562 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 383385 | BOY |
| EOY | 533560 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 101805568 | BOY |
| EOY | 84657773 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2409127 | BOY |
| EOY | 2267452 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 375000 | BOY |
| EOY | 809057 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 123050438 | BOY |
| EOY | 104911404 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 143326053 | BOY |
| EOY | 151702198 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1118170 | BOY |
| EOY | 1488922 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 144444223 | BOY |
| EOY | 153191120 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 267494661 | BOY |
| EOY | 258102524 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 7735449 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 975893 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 35555 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 756936 | BeginningOfYearBalance |
| Contributions | 120959 | Contributions |
| Grants Or Scholarships | 67251 | GrantsOrScholarships |
| End Of Year Balance | 810644 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 722260 | BeginningOfYearBalance |
| Contributions | 114922 | Contributions |
| Grants Or Scholarships | 80246 | GrantsOrScholarships |
| End Of Year Balance | 756936 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 792607 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 4888 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 75235 | GrantsOrScholarships |
| End Of Year Balance | 722260 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 760648 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 97254 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 65295 | GrantsOrScholarships |
| End Of Year Balance | 792607 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 840953 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 29539 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 109844 | GrantsOrScholarships |
| End Of Year Balance | 760648 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment EOY Balance | 1.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | true | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 1123833 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 9652800 | OtherCostOrOtherBasis |
| Book Value | 10776633 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 134923245 | OtherCostOrOtherBasis |
| Depreciation | 30237493 | Depreciation |
| Book Value | 104685752 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2956820 | OtherCostOrOtherBasis |
| Depreciation | 986789 | Depreciation |
| Book Value | 1970031 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 54488527 | OtherCostOrOtherBasis |
| Depreciation | 37709023 | Depreciation |
| Book Value | 16779504 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 466511 | OtherCostOrOtherBasis |
| Book Value | 466511 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 134678431 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| THIRD PARTY SETTLEMENTS | $550,874 |
| RAC RESERVE | $258,183 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 809057 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 137093244 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 975893 | NetUnrealizedGainsInvestments |
| Other Revenues | 267986 | OtherRevenues |
| Revenue Not Rptd F990 | 1243879 | RevenueNotRptdF990 |
| Revenue Subtotal | 135849365 | RevenueSubtotal |
| Other Revenues Not Included | 141682 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 141682 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 135991047 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 128356349 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 168002 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 168002 | ExpensesNotRptdF990 |
| Expenses Subtotal | 128188347 | ExpensesSubtotal |
| Other Expenses Not Included | 67251 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 67251 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 128255598 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| INTENDED USES FOR ENDOWMENT FUNDS | 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. |
| LIABILITY UNDER FIN 48 FOOTNOTE | SCHEDULE D, PAGE 3, PART X | THE 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. 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, 2013 AND 2012 OR FOR THE YEARS THEN ENDED. THE HOSPITAL'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2010-2012. |
| REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER | SCHEDULE D, PAGE 4, PART XI, LINE 2D | RENTAL EXPENSES 167,989 NET ASSETS RELEASED FROM RESTRICTIONS 99,984 INTERPRETATIVE SERVICES IN REVENUES 13 |
| REVENUE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XI, LINE 4B | CAPITAL CONTRIBUTIONS 141,682 |
| EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER | SCHEDULE D, PAGE 4, PART XII, LINE 2D | RENTAL EXPENSES 167,989 INTERPRETATIVE SERVICES IN REVENUES 13 |
| EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XII, LINE 4B | SCHOLARSHIPS FROM NET ASSETS 67,251 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3597765 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3597765 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02800 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12263781 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 10430755 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1833026 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01430 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15861546 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 10430755 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5430791 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04230 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 858137 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 858137 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00670 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 117674 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 67950 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 49724 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 207276 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 109800 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 97476 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 434540 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 434540 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00340 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1617627 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 177750 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1439877 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01130 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17479173 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 10608505 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6870668 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05360 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $16,754,223 | BadDebtExpenseAmount |
| Amount Attributable To | 12565667 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 31807234 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 33857416 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2050182 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTH LAKE HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1900 DON WICKHAM DRIVE | AddressLine1 |
| City | CLERMONT | City |
| State | FL | State |
| ZIP Code | 347111979 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWWSOUTHLAKEHOSPITALCOM | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | SURG CTR, REHAB, MRI, HH | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTH LAKE HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Needs Assessment Conducted | 13 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | false | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | false | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200.0 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 400.0 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| 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 |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| OTHER TESTING METHODS FOR FREE OR DISCOUNTED CARE | PART I LINE 3C | 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 PATIENTS INCOME DOES NOT EXCEED 400 OF THE FPG |
| SUBSIDIZED HEALTH SERVICES EXPLANATION | PART I LINE 7G | SUBSIDIZED HEALTH SERVICES REPRESENT THE OPERATIONAL COSTS FOR THE FREE CLINIC TO CARE FOR INDIGENT PATIENTS OF SOUTH LAKE COUNTY |
| EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE | PART I LINE 7 COLUMN F | 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 XXX-XX-XXXX ADD EXPENSES REPORTED IN PART VIII 167989 DENOMINATOR FOR COLUMN F XXX-XX-XXXX |
| COSTING METHODOLOGY EXPLANATION | PART I LINE 7 | THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATIONS 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 WERE CALCULATED USING THE RCC CALCULATED IN WORKSHEET 2 OTHER COSTS WERE OBTAINED FROM THE ORGANIZATIONS ACCOUNTING RECORDS |
| BAD DEBT EXPENSE EXPLANATION | PART III LINE 4 | 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 HOSPITALS POLICY HOWEVER FAILED TO COMPLETE THE APPLICATION PROCESS EXCERPT FROM AUDITED FINANCIAL STATEMENTS ALLOWANCE FOR DOUBTFUL ACCOUNTS ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRDPARTY COVERAGE THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IF NECESSARY FOR EXAMPLE FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY FOR RECEIVABLES ASSOCIATED WITH SELFPAY PATIENTS WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLES AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL THE COMPANY RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE THE DIFFERENCE BETWEEN THE STANDARD RATES OR THE DISCOUNTED RATES IF NEGOTIATED AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED AGAINST CONTRACTUAL ALLOWANCES AND DISCOUNTS THE HOSPITALS ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELFPAY PATIENTS INCREASED APPROXIMATELY 6 TO 92 OF SELFPAY ACCOUNTS RECEIVABLE AT SEPTEMBER 30 2013 FROM 86 AT SEPTEMBER 30 2012 IN ADDITION THE HOSPITALS SELFPAY WRITEOFFS INCREASED 3903000 FROM 12525000 FOR FISCAL YEAR 2012 TO 16428000 FOR FISCAL YEAR 2013 THIS INCREASE IS THE RESULT OF AN INCREASE IN THE CHARGE MASTER AS WELL AS CHANGES IN THE CHARITY CARE POLICY WHICH RESULTED IN FEWER PEOPLE QUALIFYING AS CHARITY PATIENTS CHARITY CARE WRITEOFFS DECREASED 23 WHICH RESULTED IN ADDITIONAL SELFPAY WRITEOFFS BEING MAPPED TO PROVISION FOR BAD DEBTS |
| MEDICARE EXPLANATION | PART III LINE 8 | 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 |
| COLLECTION PRACTICES EXPLANATION | PART III LINE 9B | 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 ANDOR 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 ANDOR WRITE OFFS ARE REVERSED AND THE NEW BALANCE REFLECTED IS RECLASSIFIED AS FINANCIAL ASSISTANCE OR CHARITY |
| NEEDS ASSESSMENT | PART VI | SOUTH LAKE 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 POSTDISCHARGE PATIENT FOLLOWUP RELATED TO THE ONGOING CARE AND TREATMENT OF PATIENTS TO PREVENT UNNECESSARY ADMISSIONS AND POTENTIAL READMISSIONS 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 ATRISK POPULATIONS FEDERALLYDESIGNED MEDICALLY UNDERSERVED AREAS AND SPECIAL NEEDS GROUPS AS WELL AS FOR THE BROADER COMMUNITY DURING THE FISCAL YEAR 2013 THE ORGANIZATION ALONG WITH THE EFFORTS OF WELLFLORIDA COUNCIL INC CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT THE CHNA CAN BE FOUND AT HTTPWWWSOUTHLAKEHOSPITALCOMLINKCLICKASPX FILETICKETHTPVBVVSMBC3DTABID56 THE IMPLEMENTATION STRATEGY PLAN CAN ALSO BE FOUND ON THE ORGANIZATIONS WEBSITE AT HTTPWWWSOUTHLAKEHOSPITALCOMLINKCLICKASPXFILETICKET7JBQ6Z26MUK 3DTABID56 |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI | 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 HOSPITALS 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 LAKES OBJECTIVE TO PROVIDE CHARITY CARE TO OUR PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY |
| COMMUNITY INFORMATION | PART VI | SOUTH LAKE CURRENTLY OPERATES IN THE CENTRAL FLORIDA REGION WHICH HAS OVER TWO MILLION RESIDENTS AND THOUSANDS OF INTERNATIONAL VISITORS ANNUALLY SOUTH LAKES PRIMARY SERVICE AREA IS COMPRISED OF ORANGE OSCEOLA SEMINOLE AND LAKE COUNTIES THE MEDIAN HOUSEHOLD INCOME IN THESE COUNTIES IS 59710 TEN PERCENT OF HOUSEHOLDS IN CENTRAL FLORIDA ARE BELOW THE FEDERAL POVERTY GUIDELINE THE PERCENT UNINSURED AGE 064 FOR THE FOUR COUNTY AREAS ARE 23 AND THERE ARE ELEVEN FEDERALLYDESIGNATED MEDICALLY UNDERSERVED AREAS PRESENT IN THE COMMUNITY COMMUNITY OUTREACH ACTIVITIES INCLUDE SPEAKERS BUREAU SUPPORTEDUCATION GROUPS WELLNESS ACTIVITIES HEALTH FAIRS CLINICAL SCREENINGS AND ASSESSMENTS MEDICAL EDUCATION RESEARCH WOMEN CHILDREN AND SENIOR HEALTH INITIATIVES PUBLIC PROGRAM ENROLLMENT ASSISTANCE AND POSTACUTE CARE FOR HOMELESS AND UNINSURED SPONSORSHIPS SCHOOL INITIATIVES DONATED MEETING SPACE AND SPIRITUAL CARE |
| HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE | PART VI | 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 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 |
| AFFILIATED HEALTH CARE INFORMATION | PART VI | 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 NOTFORPROFIT 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 |
| SOUTH LAKE HOSPITAL LINE NUMBER 1 PART V LINE 3 | PART V LINE 3 | IN ORDER TO DETERMINE THE COMMUNITYS PERSPECTIVES ON PRIORITY COMMUNITY HEALTH ISSUES AND QUALITY OF LIFE ISSUES RELATED TO HEALTHCARE TWO RESEARCH METHODS WERE USED FOCUS GROUPS AND PROVIDERS SURVEYS THE STEERING COMMITTEE WORKED WITH WELLFLORIDA COUNCIL TO DETERMINE FOCUS GROUP QUESTIONS AND PROVIDER SURVEY QUESTIONS FOCUS GROUP PARTICIPANTS WERE RECRUITED BY COMMUNITY LEADERS AT ORGANIZATIONS AND AGENCIES HOSTING THE FOCUS GROUPS AS WELL AS BY FLYERS DISTRIBUTED THROUGHOUT THE COMMUNITY PRESS RELEASES AND EMAIL BLASTS DISTRIBUTED TO THE SOUTH LAKE HOSPITAL CONTACT LIST IN TOTAL 29 COMMUNITY MEMBERS PARTICIPATED IN THE FOCUS GROUPS THE SOUTH LAKE HOSPITAL STEERING COMMITTEE REPRESENTING SOUTH LAKE HOSPITAL WORKED WITH WELLFLORIDA COUNCIL TO FORMULATE A PROVIDER SURVEY THAT WOULD TOUCH UPON SOME OF THE SAME TOPICS ADDRESSED DURING THE FOCUS GROUPS WORKING IN COOPERATION WITH THE FACILITIES REPRESENTED BY STEERING COMMITTEE MEMBERS THE SURVEYS WERE DISTRIBUTED TO LAKE COUNTY PROVIDERS IN MARCH 2013 RESPONDENTS COMPLETED THE SURVEY USING SURVEY MONKEY TO SUBMIT THEIR RESPONSES TWENTYNINE PROVIDERS SUBMITTED RESPONSES TO THE SURVEY |
| SOUTH LAKE HOSPITAL LINE NUMBER 1 PART V LINE 7 | PART V LINE 7 | THE SOUTH LAKE HOSPITAL CHNA IDENTIFIED ADDITIONAL NEEDS IN THE SERVICE AREA THAT ARE NOT ADDRESSED AS A PRIORITY IN THIS CURRENT IMPLEMENTATION PLAN IN CONSIDERING WHAT NEEDS NOT TO ADDRESS THE HOSPITAL COMMITTEE WEIGHED THE LEVEL AT WHICH THESE NEEDS ARE ALREADY BEING ADDRESSED BY OTHER COMMUNITY PARTNERS THE HOSPITAL ANDOR WHETHER THE HOSPITAL HAD THE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED TO THAT END THE HOSPITAL WILL NOT ADDRESS SOME OF THE NEEDS IDENTIFIED IN THE 2013 ASSESSMENT BECAUSE 1 THE HOSPITAL ADDRESSES THE NEED BUT CURRENTLY HAS NO PLANS TO EXPAND SERVICES 2 OTHER PROVIDERS ARE ALREADY ADDRESSING THE NEEDS AND 3 THE NEED IDENTIFIED IS BEYOND THE SCOPE OF THE HOSPITAL |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | NURSING SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 8 | NumberOfRecipients |
| Amount Of Cash Grant | 67251 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES | Identifier |
| Return Reference | SCHEDULE I, PAGE 1, PART I, LINE 2 | ReturnReference |
| Explanation | 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| TitleTitle | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Bonus Related OrgsBonusRelatedOrgs | Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SHERRIE SITARIK | ||||||||||||
| PAST PRESIDENT | 783562 | 95306 | 212325 | 14405 | 1105598 | |||||||
| LUSHANTHA GUNASEKERA MD | ||||||||||||
| BOARD MEMBER | 397382 | 1656 | 27625 | 21776 | 720795 | 272356 | ||||||
| MILDRED BEAM | ||||||||||||
| BOARD MEMBER | 357525 | 78880 | 59688 | 14322 | 510415 | |||||||
| JOHN MOORE | ||||||||||||
| CEO | 210398 | 12757 | 49453 | 21055 | 298663 | 5000 | ||||||
| LANCE SEWELL | ||||||||||||
| CFO | 133492 | 12622 | 25511 | 22359 | 198984 | 5000 | ||||||
| MANUEL HERRERA MD | ||||||||||||
| PHYSICIAN | 269655 | 138400 | 264 | 17000 | 16783 | 442102 | ||||||
| ANDREW KAREN MD | ||||||||||||
| PHYSICIAN | 266755 | 245 | 16500 | 14672 | 298172 | |||||||
| JEROME STURM MD | ||||||||||||
| PHYSICIAN | 253426 | 593 | 9837 | 17383 | 281239 | |||||||
| DOROTHY RICHARDSON | ||||||||||||
| DIR USATNTC | 213234 | 13650 | 381 | 31560 | 12491 | 271316 | ||||||
| JOSE CARRAU MD | ||||||||||||
| PHYSICIAN | 207148 | 169 | 15248 | 222565 | ||||||||
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION | 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., TO ESTABLISH COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. COMPENSATION DETERMINATION BY OH INCLUDES AN INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. |
| SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS | SCHEDULE J, PAGE 1, PART I, LINE 4 | SHERRIE SITARIK 0 162,200 0 MILDRED BEAM 0 56,563 0 JOHN MOORE 0 24,208 0 LANCE SEWELL 0 9,218 0 AMY PATTERSON 0 9,520 0 PAUL JOHNS 0 6,392 0 |
| OTHER ADDITIONAL INFORMATION | 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 RECEIVE AN INCENTIVE FOR THE ACHIEVEMENT OF CERTAIN FINANCIAL, PERSONNEL, CUSTOMER SATISFACTION AND QUALITY GOALS. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Bond ReferenceBondReferenceCd | Business Name Line2IssuerName/BusinessNameLine2 | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|---|---|
| SOUTH LAKE COUNTY HOSP HLTH DIST | |||||||||
| A | BOARD OF TRUSTEES | 590571600 | 838640DL1 | 2010-01-06 | 52335000 | CONSTRUCTION/RENOVATION | false | true | false |
| SOUTH LAKE COUNTY HOSP HLTH DIST | |||||||||
| B | BOARD OF TRUSTEES | 590571600 | 838640DX5 | 2010-06-03 | 34330000 | REDEMPTION OF 1999 BONDS | false | true | false |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Bond ReferenceBondReferenceCd | Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Refunding EscrowRefundingEscrow |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 585000 | 51998222 | 5199822 | 998399 | 45800001 | 2011 | false | false | false | true | |
| B | 775000 | 33956621 | 680262 | 2010 | true | false | true | true | 33276360 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Engage Bond Counsel ContractsEngageBondCounselContracts | Any Research AgreementsAnyResearchAgreements | Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest | Change In Use Bond Financed PropChangeInUseBondFinancedProp | Remedial Action TakenRemedialActionTaken | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs |
|---|---|---|---|---|---|---|---|---|---|
| A | false | true | true | true | false | false | false | false | true |
| B | false | true | true | true | false | false | false | false | true |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Rebate Not Due YetRebateNotDueYet | Exception To RebateExceptionToRebate | No Rebate DueNoRebateDue | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Written Proc To Monitor ReqsWrittenProcToMonitorReqs |
|---|---|---|---|---|---|---|---|---|---|
| A | false | false | false | false | false | false | false | false | false |
| B | false | false | false | false | false | false | false | false | false |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | false | ProcToUndertkCorrectiveAction |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | ROBERT BERENS JR | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | BOARD MEMBER | Relationship |
| Amount Of Transaction | 386000 | AmountOfTransaction |
| Description Of Transaction | BANK OFFICER; CASH | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE L PART V | ReturnReference |
| Explanation | ROBERT E BERENS JR CURRENTLY SERVING AS SECRETARY OF THE GOVERNING BOARD IS THE AREA PRESIDENT AT BANKFIRST AND OWNS LESS THAN 1 OF THE BANKS STOCK THE BANK HOLDS A CD VALUED AT APPROXIMATELY 386000 FOR THE FILING ENTITY | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ADDITIONAL INFORMATION | FORM 990, PART VI | COMPENSATION PROCESS FOR OFFICERS THE PROCESS USED TO DETERMINE COMPENSATION IS ARRIVED BY THE COMPENSATION COMMITTEE OF ORLANDO HEALTH ("OH"), A RELATED ORGANIZATION. THE CEO AND CFO PAY WAS REVIEWED BY THE COMPENSATION COMMITTEE WITH THE MANAGEMENT TRANSITION IN JANUARY 2012. THE EXECUTIVE DIRECTOR'S COMPENSATION IS DETERMINED BY OH AS PART OF THE MANAGEMENT AGREEMENT. |
| MANAGEMENT DELEGATED | FORM 990, PAGE 6, PART VI, LINE 3 | OH PROVIDES THE HOSPITAL'S CEO, CFO, COO AND CNO PURSUANT TO A MANAGEMENT AGREEMENT WITH THE HOSPITAL. |
| ELECTION OF MEMBERS AND THEIR RIGHTS | 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. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE 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 POLICY | 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 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. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | 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. |
| OTHER FEES FOR SERVICES | FORM 990, PART IX, LINE 11G | CONTRACT SERVICE 4,198,653 780,140 0 REFERENCE LAB 895,191 0 0 PROFESSIONAL FEES 2,545,968 0 0 OTHER FEES 454,298 14,924 0 PURCHASED SERVICES 438,295 5,395,570 0 COURIER 33,071 4,485 0 CONSULTING FEES 678 173,712 0 COLLECTION 277,324 2,224,741 0 OTHER UBTI 389,240 0 0 |
| RECONCILIATION OF CHANGES - OTHER | FORM 990, PART XI, LINE 9 | RENTAL EXPENSES 167,989 NET ASSETS RELEASED FROM RESTRICTIONS 99,984 INTERPRETATIVE SERVICES IN REVENUES 13 CAPITAL CONTRIBUTIONS -141,682 RENTAL EXPENSES -167,989 INTERPRETATIVE SERVICES IN REVENUES -13 SCHOLARSHIPS FROM NET ASSETS 67,251 |
| OTHER CHANGES IN NET ASSETS EXPLANATION | FORM 990, PART XI, LINE 9 | CHANGE IN INTEREST IN FOUNDATION NET ASSETS 82,715 CAPITAL CONTRIBUTIONS 141,682 EQUITY TRANSFER TO FOUNDATION -116,934 EQUITY TRANSFER TO FNDN FROM NET ASSETS -377,258 NET ASSETS RELEASED FROM RESTRICTION -94,339 IMPACT OF AMENDING PRIOR YEAR RETURN 374,136 TOTAL DECREASE IN NET ASSETS 35,555 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEALTHCARE PURCHASING ALLIANCE LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1417 S KUHL AVENUE SUITE 100 | AddressLine1 |
| City | ORLANDO | City |
| State | FL | State |
| ZIP Code | 328062010 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 591726273 | EIN |
| Primary Activity | PURCHASING | PrimaryActivity |
| Legal Domicile State | FL | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OH | BusinessNameLine1 |
| Business Name Line2 | ORLANDO HEALTH INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | 274926 | ShareOfTotalIncome |
| Share Of EOY Assets | 248265 | ShareOfEOYAssets |
| Disproportionate Allocations | false | DisproportionateAllocations |
| General Or Managing Partner | false | GeneralOrManagingPartner |
| Percentage Ownership | 0.07000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | true | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE R | ReturnReference |
| Explanation | HEALTHCARE PURCHASING ALLIANCE INC IS OWNED 7 BY THE FILING ENTITY WITH THE REMAINING 93 OWNED BY ORLANDO HEALTH INC A RELATED ORGANIZATION | Explanation |