2013-07-30T11:04:17-05:00 2012-09-30 621517792 PERSHING YOAKLEY & ASSOCIATES PC 2963 GULF TO BAY BLVD STE 267 CLEARWATER FL 337594255 990 2011-10-01 592486580 Mid-Florida Medical Services Inc MID- 8632971899 200 Ave F NE Winter Haven FL 33881 Lance W Anastasio 8632971899 2013-07-30 1 Terry Haefner P01258953 7274427110 2011 2016-02-24 21:20:13Z Lance W Anastasio 200 Ave F NE Winter Haven FL 33881 16225873 0 X www.mfms.com X 1983 FL To improve the health of the people in the community by providing the highest quality and most effective care and services--and return value to the people in our community. 8 8 9 8 0 0 0 0 4108140 16225873 0 0 0 0 4108140 16225873 315000 195000 0 0 3495325 4004358 0 0 0 2939575 2552059 6749900 6751417 -2641760 9474456 124143500 133176868 21059718 22735044 103083782 110441824 To improve the health of the people we serve, by providing the highest quality and most effective care and services--and to return value to the people in our communities. 0 0 6576861 195000 16225873 Mid-Florida Medical Services, Inc., ("Mid-Florida"), is a not-for-profit corporation located in Polk County, Florida. Mid-Florida serves as the holding company for Winter Haven Hospital, Inc., ("The Hospital"). Mid-Florida's purpose is to provide strategic direction to the Hospital by identifying health trends and community needs that the Hospital may be able to meet. The all-volunteer governing board of Mid-Florida is comprised of the Executive Committee of the Hospital board and several additional at-large board members experienced in healthcare.Mid-Florida Medical Services, Inc. is the holding company for Physician Service Entities in various specialties. 6576861 1 0 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 9 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Lance Anastasio 8632931121 200 Avenue F NE Winter Haven FL 33881 Mark Bostick 2.00 X 0 0 0 Brian Swain 2.00 X 0 0 0 Richard Straughn 2.00 X 0 0 0 Robert C Carter 2.00 X 0 0 0 Don Ingram 2.00 X 0 0 0 Eileen Holden 2.00 X 0 0 0 Williams Burns 2.00 X 0 0 0 William H Murrell 2.00 X 0 0 0 Lance Anastasio 40.00 X 531933 0 27356 David MacDougall 40.00 X 298995 0 36819 David Libby 40.00 X 183925 0 22627 Andrea Kaye Hixon 40.00 X 210374 0 11566 Mary Jo Schreiber 40.00 X 215718 0 13988 Joel Thomas 40.00 X 153080 0 31405 John Parman 40.00 X 0 177066 23464 Donald Gale 40.00 X 132364 0 25650 Celestino Vega 40.00 X 316531 0 36909 2042920 177066 229784 9 0 1 0 0 Net Income From Subsid 532000 11722438 11722438 Administrative Salary 561000 2433296 2433296 Medical Services 621990 1845139 1845139 Lease Income 531120 225000 225000 16225873 16225873 16225873 0 0 195000 195000 1876178 1876178 1876701 1876701 41515 41515 32235 32235 177729 177729 7500 7500 2685 2685 28902 28902 28971 28971 12752 12752 64282 64282 Professional Fees 2092282 2089999 2283 Bad Debts 179135 179135 Bank Fees 42288 42288 Medical Supplies 12431 12431 80831 80831 6751417 6576861 174556 0 57086 85387 270456 223762 2512797 2566766 1459548 803872 1107218 116706218 128428655 3793071 3331846 124143500 133176868 208605 306468 20851113 22428576 21059718 22735044 X 101251417 108420706 865966 1054719 966399 966399 103083782 110441824 124143500 133176868 X 9474456 -2116414 X 0 1 1 X 0 X X X 0 0 0 Winter Haven Hospital Inc 590724462 3 1 6576861 1 6576861 229417 229417 1159280 719721 439559 109741 109741 0 1068328 630086 438242 1107218 Investment in Winter Haven Hospital 113371998 F Investment in Mid-Florida Medical Services Fnd 15056657 F 128428655 Deferred Compensation 457(b) Plan Liability 3331846 Accrued Pension Liability 16163846 Due to Affiliates 2932884 22428576 16225873 6751417 9474456 -2116414 -2116414 7358042 16046742 0 16046742 179131 179131 16225873 6572286 0 6572286 179131 179131 6751417 Description of Uncertain Tax Positions Under FIN 48: Part X: All of the affiliate organizations are exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code (IRC) and from state income taxes under the provisions of Chapter 220.13 of the Florida Income Tax Code. Accordingly, no provision for income taxes is made in the accompanying consolidated financial statements. The IRC provides for taxation of unrelated business income under certain circumstances. During the years ended September 30, 2012 and 2011, Mid-Florida performed lab and laundry services for other hospitals, clinics and other health care providers in the community, which generated unrelated business income and resulted in no unrelated business income taxes. There are no significant gross deferred tax assets or liabilities at September 30, 2012 or 2011. Mid-Florida files a Form 990 (Return of Organization Exempt from Income Tax) annually. When the return is filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the following: the tax-exempt status of each entity, the continued tax-exempt status of bonds, and various positions relative to potential sources of unrelated business taxable income. Part XI, Line 8 - Other Adjustments: Additional Pension Liability -2,116,414. Part XII, Line 4b - Other Adjustments: Bad Debts Netted with Revenues 179,131. Part XIII, Line 4b - Other Adjustments: Bad Debts Netted with Revenues 179,131. 1 Florida Clinical Practice Association PO Box 100205 Gainesville FL 326100205 561680273 501(c)(3) 120000 To support medical research. University of Florida Foundation Inc PO Box 103594 Gainesville FL 326103594 590974739 501(c)(3) 75000 To support medical research. 2 Mid-Florida Medical Services provided support to Florida Clinical Practice Association and the University of Florida Foundation for medical research. X X X X 0 0 0 0 0 0 0 0 0 Lance Anastasio 465292 0 46900 0 19741 0 16270 0 11086 0 559289 0 0 0 David MacDougall 267662 0 27300 0 4033 0 15404 0 21415 0 335814 0 0 0 David Libby 161292 0 16500 0 6133 0 11855 0 10772 0 206552 0 0 0 Andrea Kaye Hixon 184023 0 18700 0 7651 0 11144 0 422 0 221940 0 0 0 Mary Jo Schreiber 194000 0 19400 0 2318 0 13988 0 0 0 229706 0 0 0 Joel Thomas 136412 0 14100 0 2568 0 10287 0 21118 0 184485 0 0 0 John Parman 0 175680 0 0 0 1386 0 12659 0 10805 0 200530 0 0 Donald Gale 130354 0 0 0 2010 0 14977 0 10673 0 158014 0 0 0 Celestino Vega 269985 0 27900 0 18646 0 15481 0 21428 0 353440 0 0 0 Form 990, Part VI, Section B, line 11 The Executive Director of Accounting and CFO of Mid-Florida Medical Services, Inc. intially reviewed Form 990. After their review was completed, the final Form 990 was then presented and made available to all Board Members including all voting members of the governing body. Form 990, Part VI, Section B, line 12c The Chairman of the Board of Directors inquires at least annually if there are any conflicts of interest. In addition all officers, directors, trustees and key employees are required to sign a conflict of interest statement annually. Form 990, Part VI, Section B, line 15 The Executive Compensation Committee of the Board of Directors sets compensation for the President and Vice Presidents of the hospital. The Executive Compensation Committee consists of four Board members, all of whom are independent. The Executive Compensation Committee has used the consulting firm of Sullivan and Cotter to advise them about executive compensation and to provide them with comparability data. Minutes of the Executive Compensation Committee meetings are kept and retained at the Hospital. Form 990, Part VI, Section C, line 19 The financial statements of Mid-Florida Medical Services, Inc. are made available to the public upon request. The organization's governing documents and conflict of interest policy are not made available to the public. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Additional Pension Liability -2,116,414. Total to Form 990, Part XI, Line 5: -2,116,414. Mid-Florida Critical Care Physician Services LLC 200 Ave F NE Winter Haven FL 33881 421765832 Medical Services FL -117 96 Mid-Florida OBGYN Hospitalist Physician Services LLC 200 Ave F NE Winter Haven FL 33881 421765830 Medical Services FL 832 27 Mid-Florida Oncology Physician Services LLC 200 Ave F NE Winter Haven FL 33881 611558556 Medical Services FL 181406 29477 Mid-Florida Urology Physician Services LLC 200 Ave F NE Winter Haven FL 33881 611558558 Medical Services FL 1165067 601276 Mid-Florida Physician Services LLC 200 Ave F NE Winter Haven FL 33881 611558557 Medical Services FL 0 0 Mid-Florida Interventional Cardiology Physician Services LLC 800 Ave F NE Winter Haven FL 33881 800641119 Medical Services FL 497946 93295 Mid-Florida Medical Services Foundation Inc 200 Ave F NE Winter Haven FL 33881 030406130 Fundraising FL 501(c)(3) 11A - Type 1 0 Winter Haven Hospital Inc 200 Ave F NE Winter Haven FL 33881 590724462 Medical Services FL 501(c)(3) 3 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 Winter Haven Hospital I 225000 Cost Winter Haven Hospital N 2433296 Cost