2012-08-06T12:36:47-05:00 2011-09-30 PERSHING YOAKLEY & ASSOCIATES PC 2963 GULF TO BAY BLVD STE 267 CLEARWATER FL 337594255 990 2010-10-01 592486580 Mid-Florida Medical Services Inc MID- 8632971899 200 Ave F NE Winter Haven FL 33881 Lance W Anastasio 8632971899 2012-08-06 1 Terry Haefner 7274427110 2010 2016-02-24 21:20:13Z Lance W Anastasio 200 Ave F NE Winter Haven FL 33881 4108140 0 X www.mfms.com X 1983 FL To provide strategic direction to the Hospital by identifying health trends and community needs. 8 8 9 8 0 0 0 0 3688871 4108140 0 0 0 0 3688871 4108140 75000 315000 0 0 2350603 3495325 0 0 0 2256798 2939575 4682401 6749900 -993530 -2641760 122841123 124143500 13370718 21059718 109470405 103083782 X 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 6594693 315000 4108140 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.Additionally, it serves as the holding company for the Winter Haven Hospital Foundation, which provides philanthropic support to Winter Haven Hospital. The Foundation funds support state-of-the art medical care, cutting-edge technology and equipment, top quality education, and the best and brightest personnel. 6594693 1 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 Tommy Oakley 2.00 X X 0 0 0 William G Burns 2.00 X X 0 0 0 Mark Bostick 2.00 X X 0 0 0 Todd Dantzler 2.00 X X 0 0 0 Brian K Swain 2.00 X X 0 0 0 Charles W McPherson 2.00 X X 0 0 0 Richard Straughn 2.00 X X 0 0 0 Robert Carter 2.00 X X 0 0 0 Lance Anastasio 40.00 X 486340 0 28804 Dave MacDougall 40.00 X 252109 0 39684 David Libby 40.00 X 163052 0 22843 Mary Jo Schreiber 40.00 X 182051 0 13077 John Parman 40.00 X 146593 0 22912 Donald Gale 40.00 X 114814 0 19409 Andrea Kaye Hixon 40.00 X 177301 0 9971 1522260 0 156700 8 0 1 0 0 Administrative Salary 561000 2006409 2006409 Medical Services 621990 1963187 1963187 Lease Income 531120 225000 225000 Net Income From Subsid 532000 -86456 -86456 4108140 4108140 4108140 0 0 315000 315000 1724871 1724871 1537739 1537739 35285 35285 49212 49212 148218 148218 7000 7000 32336 32336 77156 77156 6137 6137 39487 39487 Professional Fees 2333639 2331195 2444 Bad Debts 219036 219036 Miscellaneous 186513 107569 78944 Bank Fees 28346 28346 Medical Supplies 9925 9925 6749900 6594693 155207 0 17467 57086 242767 270456 1096598 2512797 2199138 1395266 726940 803872 116792674 116706218 3964677 3793071 122841123 124143500 272077 208605 13098641 20851113 13370718 21059718 X 107765987 101251417 738019 865966 966399 966399 109470405 103083782 122841123 124143500 X -2641760 -3744863 X 0 1 1 X 0 X X X 0 0 0 Winter Haven Hospital Inc 590724462 3 1 6594693 1 6594693 229417 229417 1159280 690739 468541 109741 109741 0 700700 594786 105914 803872 Investment in Winter Haven Hospital 103429767 F Investment in Mid-Florida Medical Services Fnd 13276451 F 116706218 Deferred Compensation 457(b) Plan Liability 3792683 Accrued Pension Liability 11921166 Due to Affiliates 5137264 20851113 4108140 6749900 -2641760 -3744863 -3744863 -6386623 4108140 0 4108140 0 4108140 6749900 0 6749900 0 6749900 Description of Uncertain Tax Positions Under FIN 48: Part X: Income taxes: 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, 2011 and 2010, 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, 2011 or 2010. 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. 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 that 50 percent likely to be realized on settlement with the applicable taxing authority. There were no unrecognized tax benefits identified and recorded as a liability as of September 30, 2011 and 2010. Part XI, Line 8 - Other Adjustments: Additional Pension Liability -3,744,863. 1 Florida Clinical Practice Association PO Box 100205 Gainesville FL 326100205 561680273 501(c)(3) 240000 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 Other Information: Part IV: Mid-Florida Medical Services provided support to Florida Clinical Practice Association and the University of Florida Foundation for medical research. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Lance Anastasio 465850 0 0 0 20490 0 17129 0 11675 0 515144 0 0 0 Dave MacDougall 248253 0 0 0 3856 0 17145 0 22539 0 291793 0 0 0 David Libby 156856 0 0 0 6196 0 11497 0 11346 0 185895 0 0 0 Mary Jo Schreiber 176378 0 0 0 5673 0 13077 0 0 0 195128 0 0 0 John Parman 143849 0 0 0 2744 0 11591 0 11321 0 169505 0 0 0 Andrea Kaye Hixon 173637 0 0 0 3664 0 9571 0 400 0 187272 0 0 0 Part I, Line 1a Lance Anastasio, President and CEO was provided social club dues for membership in the Lake Region Country Club in the amount of $543. This membership was used to entertain and hold meetings with business associates, board members and employee relations. However, the payment for his social club dues ceased in January 2010. The full amount of $543 was included in taxable wages. 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 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: Additional Pension Liability -3,744,863. Total to Form 990, Part XI, Line 5: -3,744,863. Mid-Florida Critical Care Physician Services LLC 200 Ave F NE Winter Haven FL 33881 421765832 Medical Services FL 231703 878 Mid-Florida OBGYN Hospitalist Physician Services LLC 200 Ave F NE Winter Haven FL 33881 421765830 Medical Services FL 840942 5245 Mid-Florida Oncology Physician Services LLC 200 Ave F NE Winter Haven FL 33881 611558556 Medical Services FL 160644 18364 Mid-Florida Urology Physician Services LLC 200 Ave F NE Winter Haven FL 33881 611558558 Medical Services FL 469718 315141 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 260179 71003 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 2006409 Cost