2013-07-26T12:34:02-05:00 2012-09-30 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2011-10-01 593322533 SOUTH LAKE HOSPITAL INC SOUT 3523944071 1900 DON WICKHAM DRIVE CLERMONT FL 34711 LANCE SEWELL 3523944071 2013-08-15 true JACQUELINE G ATKINS 2298837878 2013-07-26 2011 2016-02-24 21:20:13Z X JOHN A MOORE CEO 1900 DON WICKHAM DRIVE CLERMONT FL 34711 210242675 false X HTTP://WWW.SOUTHLAKEHOSPITAL.COM/ X 1995 FL HEALTHCARE SERVICES 6 4 1115 141 2861223 -413387 231726 3210375 138788989 141764020 618234 358929 2997544 4450951 142636493 149784275 75235 80246 0 58964571 62033361 0 241240 66572373 77030119 125612179 139143726 17024314 10640549 260407376 267868797 126080905 123050442 134326471 144818355 HEALTHCARE SERVICES false false 113647369 80246 142339303 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 29,000. 113647369 true true false false false false false false false true true false false false true true true false false false false false false false true false true true false true true true false false false false false false false true false false false false false false false true false false false false true 198 0 1115 true true true false false false false true true false false false false X 6 4 false true false false false true false true true false false true true true true true true true true false FL X LANCE SEWELL CFO 3522417104 1900 DON WICKHAM DRIVE CLERMONT FL 34711 X SHERRIE SITARIK 2.00 X X 0 897533 223100 MICHAEL HOWELL MD 2.00 X 0 284277 51801 CATHY HOECHST 2.00 X X 0 0 0 SUSAN MCLEAN 2.00 X X 0 0 0 ROBERT E BERENS JR 2.00 X X 0 0 0 DAVID BATMAN 2.00 X 0 0 0 LESLIE LONGACRE 40.00 X 0 183474 53441 JOHN MOORE 40.00 X 0 149226 47372 LANCE SEWELL 40.00 X 0 134857 45205 DEBORAH CORT 40.00 X 0 110399 26226 BAKKIAM SUBBIAH 40.00 X 364800 0 78077 MANUEL HERRERA MD 40.00 X 237409 0 31586 ANDREW KAREN MD 40.00 X 209530 0 13966 DOROTHY RICHARDSON 40.00 X 191036 0 24807 PAUL SCHMIDT MD 40.00 X 179266 0 8891 1182041 1759766 604472 22 false true false ORIGIN INC DBA SHIFTWISE 2501 SW 1ST AVENUE SUITE 200 PORTLAND OR 97201 NURSE STAFFING 1631549 TOSHIBA AMERICA 2441 MICHELLE DRIVE TUSTIN CA 92780 MTNC & REPAIRS 1231926 SODEXO INC & AFFILIATES 9801 WASHINGTONIAN BLVD GAITHERSBURG MD 20878 DIETARY MGMT SV 916526 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 TEMP STAFFING 647999 MEDICAL CENTER RADIOLOGY GROUP 20 WEST KALEY AVENUE ORLANDO FL 32806 RADIOLOGY SVS 474056 32 30000 2666345 216589 297441 3210375 PROGRAM SERVICE REVENUE 623000 141764020 141764020 141764020 710454 710454 149378 107484 41894 41894 41894 57910475 2064969 58313725 2013244 -403250 51725 -351525 -351525 25904 30000 23947 1957 1957 134 134 134 NATIONAL TRAINING CENTER 623000 2861223 2861223 FOOD AND BEVERAGE 621990 902696 902696 EHR HOSPITAL 722210 575283 575283 67764 67764 4406966 149784275 142339303 2861223 1373374 80246 80246 51086660 46514022 4483140 89498 1269182 1143021 123938 2223 6278225 5654209 613017 10999 3399294 3056278 335190 7826 159563 159563 305793 305793 18306798 8385570 9921228 394607 46477 348130 12430867 11759726 612369 58772 146064 56835 89229 2887380 2784012 103368 252517 154008 98437 72 6235388 6235388 8064986 7776260 288726 238747 238747 MEDICAL SUPPLIES 12593611 12593611 PROVISIONS FOR BAD DEBTS 11244510 11244510 REPAIRS AND MAINT 1876933 1568489 308444 RECRUITING 726918 726918 1165437 830095 263492 71850 139143726 113647369 25255117 241240 20639 60091 35524000 38578000 13136172 16355967 1376699 903557 2562405 2140993 1209276 1202159 200139681 60543654 135306964 139596027 61566745 60755214 288480 4272354 4504031 5432122 3484278 260407376 267868797 20756950 18077362 322795 383385 102091132 101805568 2535028 2409127 375000 375000 126080905 123050442 X 132954208 143495578 1372263 1322777 134326471 144818355 260407376 267868797 X 10640549 -148665 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false 722260 114922 80246 756936 792607 4888 75235 722260 760648 97254 65295 792607 840953 29539 109844 760648 1.00000 true false false 1123833 9652800 10776633 129774298 25449509 104324789 1966929 858350 1108579 55432920 34235795 21197125 2188901 2188901 139596027 RAC RESERVE 375000 375000 149784275 139143726 10640549 -112770 -112770 10527779 149802936 303876 303876 149499060 285215 285215 149784275 139275157 131431 131431 139143726 139143726 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, 2012 AND 2011 OR FOR THE YEARS THEN ENDED. THE HOSPITAL'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2009-2011. RECONCILIATION OF CHANGES - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 8 RENTAL EXPENSES 107,484 NET ASSETS RELEASED FROM RESTRICTIONS 172,445 SPECIAL EVENTS EXPENSES 23,947 CAPITAL CONTRIBUTIONS -227,294 NET UNREALIZED LOSS ON INVESTMENTS -57,921 RENTAL EXPENSES -107,484 SPECIAL EVENTS EXPENSES -23,947 REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 107,484 NET ASSETS RELEASED FROM RESTRICTIONS 172,445 SPECIAL EVENTS EXPENSES 23,947 REVENUE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 4B CAPITAL CONTRIBUTIONS 227,294 NET UNREALIZED LOSS ON INVESTMENTS 57,921 EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XIII, LINE 2D RENTAL EXPENSES 107,484 SPECIAL EVENTS EXPENSES 23,947 GOLF TOURNAMENT 55904 30000 25904 4113 17102 2732 55904 30000 25904 4113 17102 2732 23947 1957 true true X true X true X true true false true true 4793864 4793864 0.03740 11409200 8029780 3379420 0.02640 5455858 4539876 915982 0.00720 21658922 12569656 9089266 0.07100 681148 681148 0.00530 216572 80246 136326 0.00110 209375 129352 80023 0.00060 379226 379226 0.00300 1486321 209598 1276723 0.01000 23145243 12779254 10365989 0.08100 true 11244510 8433383 32320409 33728910 -1408501 X true true 1 1 SOUTH LAKE HOSPITAL

1900 DON WICKHAM DRIVE CLERMONT FL 34711

X X X SURG CTR, REHAB, MRI, HH SOUTH LAKE HOSPITAL 1 true true 200.0 true 400.0 true X X X true true X X true false true X false false 3 NATIONAL TRAINING CENTER

1935 DON WICKHAM DRIVE CLERMONT FL 34711

WELLNESS CENTER SOUTH LAKE SURGICAL CENTER

1935 DON WICKHAM DRIVE CLERMONT FL 34711

OUTPATIENT SURGERY SOUTH LAKE HOME HEALTH AGENCY

1935 DON WICKHAM DRIVE CLERMONT FL 34711

HOME HEALTH 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 LESS BAD DEBTS IN PART IX 11244510 ADD EXPENSES REPORTED IN PART VIII 131431 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 7B AND 7C 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 EXCERPT FROM AUDITED FINANCIAL STATEMENTS ALLOWANCE FOR DOUBTFUL ACCOUNTS MANAGEMENT PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON AN EVALUATION OF THE OVERALL COLLECTIBILITY OF THE ACCOUNTS RECEIVABLE AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE THEY ARE CHARGED AGAINST THE ALLOWANCE 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 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 NOT CURRENTLY CONDUCT A FORMAL ANNUAL HEALTH CARE NEEDS ASSESSMENT HOWEVER THE ORGANIZATION 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 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 true NURSING SCHOLARSHIPS 24 80246 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES SCHEDULE I, PAGE 1, PART I, LINE 2 NURSING SCHOLARSHIP POLICY IS TO PROVIDE TUITION REIMBURSEMENT FOR ANY APPLICANT WHO MEETS CERTAIN CRITERIA REGARDING EMPLOYMENT, GRADES AND QUALIFICATIONS AS WELL AS SUPERVISORY RECOMMENDATIONS. PROOF OF GRADE AND PAYMENT MUST BE PRESENTED AT THE TIME OF REIMBURSEMENT. false true false false false false false true false SHERRIE SITARIK 711086 179055 7392 207866 15234 1120633 MICHAEL HOWELL MD 264258 18900 1119 31250 20551 336078 LESLIE LONGACRE 159708 11110 12656 45989 7452 236915 JOHN MOORE 139278 8775 1173 30839 16533 196598 LANCE SEWELL 124725 9044 1088 23483 21722 180062 BAKKIAM SUBBIAH 208251 156100 449 72977 5100 442877 34477 MANUEL HERRERA MD 224419 12774 216 16500 15086 268995 ANDREW KAREN MD 209332 198 13966 223496 DOROTHY RICHARDSON 171441 19250 345 12626 12181 215843 PAUL SCHMIDT MD 179266 8891 188157 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 0 158,953 0 JOHN MOORE 0 8,641 0 LANCE SEWELL 0 8,956 0 DEBORAH CORT 0 5,200 0 BAKKIAM SUBBIAH 0 16,500 0 NON-FIXED PAYMENTS PROVIDED SCHEDULE J, PAGE 1, PART I, LINE 7 THE COMPENSATION OF SHERRIE SITARIK, DIRECTOR OF SOUTH LAKE HOSPITAL, INC., INCLUDES A BOARD APPROVED, NON-FIXED PAYMENT OF 34,000 TO REFLECT THE INCENTIVE STRUCTURE OF MRS. SITARIKS TRANSITION DURING THE YEAR FROM EXECUTIVE VICE PRESIDENT TO CHIEF EXECUTIVE OFFICER OF ORLANDO HEALTH, INC. THE BOARD APPROVED NON-FIXED PAYMENT WAS BASED ON DEFINED METRICS AND WITHIN THE LIMITS SET FORTH BY ORLANDO HEALTH EXECUTIVE INCENTIVE PLAN. 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. SOUTH LAKE COUNTY HOSP HLTH DIST BOARD OF TRUSTEES 590571600 838640DB3 2003-09-01 17900000 CONSTRUCTION AND RENOVATION false true false SOUTH LAKE COUNTY HOSP HLTH DIST BOARD OF TRUSTEES 590571600 838640DL1 2010-01-06 52335000 CONSTRUCTION/RENOVATION false true false SOUTH LAKE COUNTY HOSP HLTH DIST BOARD OF TRUSTEES 590571600 838640DX5 2010-06-03 34330000 REDEMPTION OF 1999 BONDS false true false 2084595 17819436 1344763 878779 354415 15191975 49504 2004 false false true true 51998222 5199822 998399 45800001 2011 false false false true 33956621 33276360 680262 2010 true false true true false true true true false true 0.01620 0.01620 true false true true true false true true false true true true false true 0.00260 0.00260 true false false false false false false false false false false false false false false false false false false ROBERT BERENS JR BOARD MEMBER 386459 BANK OFFICER; CASH false ADDITIONAL INFORMATION SCHEDULE L PART V 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 386459 FOR THE FILING ENTITY MANAGEMENT DELEGATED FORM 990, PAGE 6, PART VI, LINE 3 ORLANDO HEALTH ("OH"), A RELATED ORGANIZATION, 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. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A THE PROCESS USED TO DETERMINE COMPENSATION IS ARRIVED BY THE COMPENSATION COMMITTEE BY OH. 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. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B THE PROCESS USED TO DETERMINE COMPENSATION IS ARRIVED BY THE COMPENSATION COMMITTEE BY OH. THE CFO PAY WAS REVIEWED BY THE COMPENSATION COMMITTEE WITH THE TRANSITION OF MANAGEMENT IN JANUARY 2012. 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. RELATED ORGANIZATIONS FORM 990, PAGE 7, PART VII AVERAGE WEEKLY HOURS DEVOTED TO RELATED ORGANIZATIONS SHERRIE SITARIK - 40 HOURS OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 5 NET ASSETS RELEASED FROM RESTRICTIONS ( 90,744) UNREALIZED LOSS ON INVESTMENTS ( 57,921) TOTAL DECREASE IN NET ASSETS ( 148,665) ORLANDO HEALTH 1414 KUHL AVENUE ORLANDO FL 32806 591726273 HEALTHCARE FL 501C3 3 NA false SOUTH LAKE COUNTY HOSPITAL DISTRICT 1900 DON WICKHAM DRIVE CLERMONT FL 34711 590571600 LEVY TAX FL 501C3 6 NA false HEALTHCARE PURCHASING ALLIANCE LLC 1417 S KUHL AVENUE SUITE 100 ORLANDO FL 32806 591726273 PURCHASING FL OH ORLANDO HEALTH INC RELATED false false 0.07000 false false true false true false true false false true false true true true true false true true ADDITIONAL INFORMATION SCHEDULE R HEALTHCARE PURCHASING ALLIANCE INC IS OWNED 7 BY THE FILING ENTITY WITH THE REMAINING 93 OWNED BY ORLANDO HEALTH INC A RELATED ORGANIZATION NO FINANCIAL INFORMATION IS AVAILABLE AT THIS DATE