2013-07-30T11:03:49-05:00 2012-09-30 621517792 PERSHING YOAKLEY & ASSOCIATES PC 2963 GULF TO BAY BLVD STE 267 CLEARWATER FL 337594255 990 2011-10-01 030406130 Mid-Florida Medical Services Foundation Inc MID- 8632931121 200 Ave F NE Winter Haven FL 33881 Joel Thomas 8632931121 2013-07-30 1 Terry Haefner P01258953 7274427110 2011 2016-02-24 21:20:13Z Winter Haven Hospital Foundation Joel Thomas 200 Ave F NE Winter Haven FL 33881 3654725 0 X www.mfms.com X 2002 FL Mid-Florida Medical Services Foundation raises philanthropic funds to support Winter Haven Hospital's healthcare mission. 17 17 0 85 0 0 2989616 2157031 0 0 436482 321153 14159 -81535 3440257 2396649 2163061 1119859 0 0 12099 11919 0 0 83214 552505 291493 2727665 1423271 712592 973378 13462472 16905026 186022 1848366 13276450 15056660 Mid-Florida Medical Services Foundation raises philanthropic funds to support Winter Haven Hospital, Inc's healthcare mission. 0 0 1164654 1062861 92906 Mid-Florida Medical Services Foundation, Inc. (The "Foundation"), is a not-for-profit charitable organization whose primary purpose is to raise philanthropic funds to support Winter Haven Hospital, Inc.'s healthcare mission. The Foundation is currently administering a major gifts campaign designed to acquire funding for a number of hospital initiatives including:1. Support and upgrades for various hospital departments, including the Cassidy Cancer Center, Stroke Center, Bostick Heart Center and the Center for Urology.2. Expanding the number of physicians serving the community where shortages exist based on population need. 51498 The Foundation provides scholarships to employees and to members of the community. Employees of Winter Haven Hospital are awarded scholarships based on the needs of the organization. In order for an employee to receive a scholarship, applicants must have been employed by the hospital for two years, receive positive reference from their manager, attend an accredited school, and meet performance standards on their annual performance evaluation. 5500 The Foundation provides support for community organizations including the local nursing school to ensure continued excellence in the supply of nursing professionals and the American Cancer Society. 1164654 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 X 17 17 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Joel Thomas 8632931121 200 Avenue F NE Winter Haven FL 33881 Eric Adamson 2.00 X 0 0 0 Lynn Oakley 2.00 X 0 0 0 Bud Strang 2.00 X 0 0 0 William G Bill Burns 2.00 X 0 0 0 Steve Cassidy 2.00 X 0 0 0 Mike Compton 2.00 X 0 0 0 Dorothy Griffin 2.00 X 0 0 0 Alan Gustafson 2.00 X 0 0 0 Cindy Henry 2.00 X 0 0 0 Don Ingram 2.00 X 0 0 0 David Johnson 2.00 X 0 0 0 Charles W McPherson 2.00 X 0 0 0 Steve Saterbo 2.00 X 0 0 0 Lauren Schwenk 2.00 X 0 0 0 Richard Straughn 2.00 X 0 0 0 Brian Swain 2.00 X 0 0 0 Bet Tucker 2.00 X 0 0 0 Lance Anastasio 2.00 X 0 531933 27356 Dave MacDougall 2.00 X 0 298995 36819 Joel Thomas 2.00 X 0 153080 31405 John Parman 2.00 X 0 177066 23464 0 1161074 119044 0 0 1 0 0 664913 1492118 183424 2157031 293153 293153 1081995 1053995 28000 28000 28000 29640 664913 204081 -174441 -174441 Nursing Research 561000 77770 77770 Health Fairs 561000 15136 15136 92906 2396649 92906 0 146712 1068361 1068361 51498 51498 1887 868 1019 774 356 418 9258 4259 4999 142182 65404 76778 22000 22000 32759 32759 5085 5085 6128 6128 5038 5038 Nursing Research 32015 32015 Property Taxes 27618 27618 Bad Debt 6084 6084 Bank Charges 3669 3669 8915 6696 2219 1423271 1164654 175403 83214 447026 501105 266901 95033 2700000 2700000 28583 30026 4790139 9661 3002157 4780478 6733890 8493814 283915 304570 13462472 16905026 811 78550 1777570 107472 69985 186022 1848366 X 11444085 13035542 865966 1054719 966399 966399 13276450 15056660 13462472 16905026 X 973378 806832 X 0 1 1 X 0 X X X 0 0 0 Winter Haven Hospital Inc 590724462 3 1 1057656 1 1057656 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9435637 1154253 701525 51498 57246 214516 10968155 8780241 3015639 72400 58336 2041736 332571 9435637 4110450 128251 374157 13524 4599334 3324387 592125 245307 51369 4110450 0.81570 0.09620 0.08810 1 0 3000019 1700000 4700019 76690 3835 72855 6761 5826 935 6669 6669 4780478 Due to Winter Haven Hospital 69985 69985 2396649 1423271 973378 639293 167539 806832 1780210 2882114 607389 143669 751058 2131056 265593 265593 2396649 1458196 34925 34925 1423271 0 1423271 Description of Intended Use of Endowment Funds: Part V, Line 4: The endowment funds are used for both capital improvements and scholarships. Description of Uncertain Tax Positions Under FIN 48: Part X: Income taxes: The Foundation received tax-exempt status under Section 501(c)(3) of the Internal Revenue Code (the Code) on May 20, 2004. The Code provides for taxation of unrelated business income under certain circumstances. The Foundation has no unrelated business income. The Foundation files a Form 990 (Return of Organization Exempt from Income Tax) annually. When the return is filed, it is 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 foundations include such matters as the tax-exempt status of each entity and various positions relative to potential sources of unrelated business taxable income. Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more likely than not" recognition threshold are measured as the largest amount of tax benefit that is more than 50 percent likely to be realized on settlement with the applicable taxing authority. Upon the adoption of the FASB-issued guidance and as of September 30, 2012 and 2011, there were no unrecognized tax benefits identified and recorded as a liability. Tax returns for the years 2009 to 2011 are open to review by federal and state authorities. Part XI, Line 8 - Other Adjustments: Transfer from Winter Haven Hospital 167,539. Part XII, Line 2d - Other Adjustments: Satisfaction of Donor Restrictions 108,744. Revenue Netted with Expenses 34,925. Part XII, Line 4b - Other Adjustments: Contributions Included in Net Assets 194,643. Investment Income 31,938. Special Event Revenue 39,012. Part XIII, Line 2d - Other Adjustments: Expenses Netted with Revenues 34,925. Gala 627826 618826 9000 931 30043 30000 96846 Mountain Lake Golf Tournament 45316 27748 17568 4602 15600 3487 11235 1 21411 18339 3072 1440 2910 1961 5027 694553 664913 29640 4602 1440 19441 35491 30000 113108 204082 -174442 1 Winter Haven Hospital 200 Ave F NE Winter Haven FL 33881 590724462 501(c)(3) 1012860 To provide general support to Winter Haven Hospital. WJ Weiser & Associates 1100 E Woodfield Road Suite 520 Schaumburg IL 60173 363996411 50000 To provide support for RAMSES meeting 1 Scholarships 48 51498 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Mid-Florida Medical Services Foundation provides support to Winter Haven Hospital as part of its exempt purpose. These grants were used to purchase specialized equipment for the Winter Haven Hospital Stroke Center and also to support various other areas of the hospital. Mid-Florida Medical Services Foundation also provides scholarships to employees of Winter Haven Hospital that are awarded based on the needs of the organization. In order to receive a scholarship applicants must have been employed by the hospital for two years, receive positive reference from their manager, attend an accredited school, and meet performance standards on their annual performance evaluation. Mid-Florida Medical Services Foundation also provided other scholarships to members of the community. 1 X X X X 0 0 0 0 0 0 0 0 0 Lance Anastasio 0 465292 0 46900 0 19741 0 16270 0 11086 0 559289 0 0 Dave MacDougall 0 267662 0 27300 0 4033 0 15404 0 21415 0 335814 0 0 Joel Thomas 0 136412 0 14100 0 2568 0 10287 0 21118 0 184485 0 0 John Parman 0 175680 0 0 0 1386 0 12659 0 10805 0 200530 0 0 X 1 400 Cost X 1 135162 FMV X Various Gala Auction Items 76 47862 Cost 0 0 0 Form 990, Part VI, Section A, line 6 The sole member of Mid-Florida Medical Services Foundation, Inc. is Winter Haven Hospital, Inc. Form 990, Part VI, Section A, line 7a The Trustees of the Corporation shall be elected by the Officers of the Winter Haven Hospital, Inc., the sole member, at its annual meeting each year for staggered three (3) year terms. No Trustee shall serve more than two consecutive three year terms; however, a former Trustee shall again become eligible for Board membership following a lapse of one year after expiration of his last term of office. Form 990, Part VI, Section A, line 7b Any changes to the Bylaws or Articles of Incorporation of Mid-Florida Medical Services Foundation, Inc. must be approved by the Officers of the Board of Directors of Winter Haven Hospital, Inc. Furthermore the Board of Trustees of Winter Haven Hospital, Inc. have the authority to approve the annual operating budget of the Foundation. Form 990, Part VI, Section B, line 11 The Executive Director of Accounting and CFO of Mid-Florida Medical Services Foundation 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 finanical statements of Mid-Florida Medical Services Foundation, Inc. are made availabe 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: Net unrealized gains on investments: 639,293. Transfer from Winter Haven Hospital 167,539. Total to Form 990, Part XI, Line 5: 806,832. Mid-Florida Medical Services Inc 200 Ave F NE Winter Haven FL 33881 592486580 Support Organization FL 501(c)(3) 11A - Type 1 N/A 0 Winter Haven Hospital Inc 200 Ave F NE Winter Haven FL 33881 590724462 Medical Services FL 501(c)(3) 3 Mid-Florida Medical Services Inc 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 0