2012-08-10T13:32:48-05:00 2011-09-30 PERSHING YOAKLEY & ASSOCIATES PC 2963 GULF TO BAY BLVD STE 267 CLEARWATER FL 337594255 990 2010-10-01 592890430 Citrus Memorial Health Foundation Inc CITR 3525606898 502 W Highland Blvd Inverness FL 344524720 Mark Williams 3525606898 2012-08-10 Terry Haefner 7274427110 2010 2016-02-24 21:20:13Z Ryan Beaty 502 W Highland Blvd Inverness FL 344524720 184914404 0 X www.citrusmh.com X 1987 FL The organization's primary purpose is to provide a wide range of healthcare services for the benefit of the citizens and residents of Citrus County. 8 6 1831 410 627 0 1689544 200168 171754870 177011889 1089843 264086 271056 3546696 174805313 181022839 0 0 0 0 73059287 76956388 0 0 207335 106749257 104162410 179808544 181118798 -5003231 -95959 143277438 141299059 94134824 107868469 49142614 33430590 X Citrus Memorial Health System exists to improve the health and quality of life of the people and communities we serve. 0 0 142301284 158693640 Citrus Memorial Hospital is a 198-bed, general short-term acute care hospital. The hospital's services include Same Day Surgery, 24-hour Emergency and Lab Services, Diagnostic Imaging, Rehabilitation, Cardiology and Catherization, Critical Care, Ear-Nose-Throat, Endoscopy, General Surgery, Gynecology and Obstetrics, Laparoscopic Surgery, Laser Surgery, Lithotripsy, Neurology, Opthalmology, Orthopedic, Pediatric Pulmonary, Radiation Therapy, Urology, Vascular Services and community education programs. Citrus Memorial Hospital was established as a general short-term acute care hospital in 1957. It is operated by the Citrus Memorial Health Foundation, Inc. The hospital charges each patient for services rendered; however, it is recognized that not all individuals have the ability to pay for these services. A determination is made to identify those persons that qualify for hospital sponsored care. The hospital follows the guidelines established by the State of Florida for qualifying hospital sponsored care. When an individual is qualified for hospital sponsored care, the bill is written off in most cases and partially written off in the remaining cases. When a patient does not have insurance, additional discounts are available. The total amount of uncompensated care absorbed by the hospital in 2011 was $45,242,090 including $13,636,847 of charity care, $23,640,104 of bad debt and $7,965,139 of self-pay discounts. The rate of reimbursement for Medicare and Medicaid payments is below the cost of providing such care. Thus, the hospital must recognize these amounts as necessary in meeting its mission.The following statistics show the level of care that was provided by the hospital in 2011, thus enhancing the quality of life in its service area: Annual Admissions 10,229Newborn Admissions 573Patient Days 41,021Newborn Days 1,025Operations Performed 6,070ER Visits 38,966Outpatient Registrations 158,255 The hospital has many other activities in keeping with its commitment to serve the healthcare needs of Citrus County:- Distributes a wide variety of literature that educates patients on topics ranging from emergency medical problems to Medicare benefits.- Sponsors a free Share Club for senior citizens to provide health care seminars and screenings, exercise programs, perscription cards, Medicare assistance and other opportunities to its over 14,000 members.- Provides some 200 educational programs annually that are available at no cost to the community, medical workers and physicians.- Operates walk-in and diagnostic imaging centers to provide health care to the residents in the center of the county.- Participates in and hosts health fairs throughout the county, offering health care screenings and information in order to foster health education in the community.- Sponsors various health awareness programs and seminars to educate the general public about various health topics.- Provides speakers for various civic organizations.- Sponsors free community resource service to provide information on health services, support groups and assistance programs available at the hospital and throughout the community.- Sponsors free 24/7 physician referral service for Citrus and Sumter counties to help increase accessibility to healthcare.- Offers monthly and periodic free or low-cost health exams and screenings such as blood pressure, cholesterol, hemoglobin and various cancer screenings, among others. This aids awareness of personal health and detects problems or possible problems.- Sponsors and participates in events such as local parades, safety fairs, Chamber of Commerce events and an annual county baby shower to increase community awareness of our services.- Provides organizational and operational skills and meeting facilities for numerous groups including but not limited to Ostomy Support Group, Diabetes Support Group, American Cancer Society, Mended Hearts, various cancer support groups, Stroke Support Group, American Heart Association and Breast Cancer Support Group.- Provides assistance to educators through our work with student nursing, radiology technologist and phlebotomist programs in the local community colleges and vocational training center. Also participates in local high school career fairs to increase awareness of career opportunities in healthcare. 15991905 19148446 Citrus Memorial maintains offsite external services for the community including family practice, internal medicine and rehab services. These clinics are located conveniently throughout the county. In addition, the offices participate in local health fairs, provide free physicals for various local student organizations and host educational seminars on a variety of healthcare related topics. 2641211 2525487 The Citrus Memorial Home Health Agency was establised to provide care to those that are homebound or need continuing post-hospital care. Services include skilled nursing, rehabiliation therapy, social and nutritional. This agency provides an alternative to hospitalization or nursing home placement. The home health agency is certified by the Joint Commission on accreditation of healthcare organizations. 160934400 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 0 1 80 0 1 1831 1 0 0 0 0 0 1 1 1 0 0 0 1 0 X 8 6 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 1 0 X X Mark Williams 3525606898 502 W Highland Blvd Inverness FL 34452 Robert Henigar 2.00 X X 0 0 0 James Sanders 10.00 X X 0 0 0 Robert Collins 2.00 X X 0 0 0 Sandra Chadwick 2.00 X 0 0 0 Joseph Brannen 3.00 X 0 0 0 Venugopala Reddy 2.00 X 0 0 0 David Langer 2.00 X 0 0 0 Sanjiv Shah 2.00 X 0 0 0 Ryan Beaty 60.00 X 431977 0 77522 Jerrald Deloach 60.00 X 208600 0 24058 Emery Hensley 60.00 X 214047 0 43323 Mark Williams 60.00 X 160462 0 11218 Linda McCarthy 60.00 X 202436 0 16925 Lee Glotzback 60.00 X 152851 0 22316 Eric Hirsch MD 60.00 X 474907 0 40780 Neil Katz MD 60.00 X 392832 0 4163 John Gelin MD 60.00 X 336490 0 75597 Julie Sudduth MD 60.00 X 261606 0 21697 Michael Brown MD 60.00 X 261823 0 21705 3098031 0 359304 40 0 1 0 Carlton Fields Attorney at Law PO Box 3239 Tampa FL 33601 legal services 2128587 Associated Radiologists of Inverness P 2325 Stonebridge Drive Flint MI 48532 radiology 1532926 LifeSouth Community Blood Centers Inc MSC 514 PO Box 830469 Birmingham AL 35283 blood bank services 1087067 Citrus Anesthesiology 131 S Citrus Avenue Inverness FL 34452 anesthesia 1023429 Robins & Morton Group 400 Shades Creek Parkway Suite 200 Birmingham AL 35209 general contractor 960235 32 158759 41409 32784 200168 Hospital Service Reven 621110 174157494 174157494 SMP-Florida Medicaid 621110 1602374 1602374 Citrus County Hospital 621110 833706 833706 Cafeteria Sales 900099 384610 384610 Miscellaneous Program 900099 33705 33705 177011889 444204 444204 294782 110256 184526 184526 184526 3533494 16350 3539114 190848 -5620 -174498 -180118 -180118 57206 158759 51347 5859 5859 Miscellaneous Revenue 900099 3355684 3355684 Catering 722320 627 627 3356311 181022839 179982963 627 839081 1091599 1091599 58106162 54044279 3922893 138990 2479488 2250012 221288 8188 11071714 8009979 3037379 24356 4207425 3858721 338684 10020 2254968 2254968 70200 70200 13493344 10290858 3196971 5515 393639 16439 374468 2732 37697372 37488898 197616 10858 3029948 3013717 16151 80 8484612 8410793 69276 4543 197469 179302 17503 664 26355 10287 15971 97 2830515 2830515 7146925 7146925 2039386 303109 1736277 Bad Debts 23640104 23640104 Indigent Assessment 1838694 1838694 Miscellaneous 843444 300720 541672 1052 Education 175435 131563 43632 240 181118798 160934400 19977063 207335 23338401 21483661 1000000 145871 172397 14295273 16499513 3455880 3793534 2742651 2665009 161165135 95011637 65532319 66153498 14070556 15215051 575604 4901000 3481436 25054843 143277438 141299059 22666890 19890870 58193072 56914451 986285 412381 12288577 30650767 94134824 107868469 X 47628625 31721478 1513989 1709112 49142614 33430590 143277438 141299059 X -95959 -15616065 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7217686 7217686 84595014 42255127 42339887 3670440 3188983 481457 64855430 49567527 15287903 826565 826565 66153498 Other Receivable 1408046 Third Party Settlements 124992 Other Assets 546524 Malpractice Funding Arrangement 2155941 Under Indenture Agreement 4125127 Deferred Bond Costs 495277 Assets Limited as to Use 16198936 25054843 Liability for Pension Benefits 23228950 CSI Recourse Liability 21903 Other Current Liabilities 4799465 Professional Liability 2600449 30650767 181022839 181118798 -95959 -16258 -15599807 -15616065 -15712024 181021768 0 181021768 1071 1071 181022839 181119243 445 445 181118798 0 181118798 Description of Uncertain Tax Positions Under FIN 48: Part X: The Foundation is exempt from income taxes under Section 501(c)(3) of the IRC. Accordingly, the financial statements do not reflect a provision for income taxes. At September 30, 2011, the Foundation does not have any uncertain tax positions that would require recognition or disclosure in the financial statements. The Foundation is no longer subject to federal or state income tax examinations by tax authorities for the years before 2007. Part XI, Line 8 - Other Adjustments: Contributions in Net Assets 242,499. Net Assts Released from Restrictions -47,376. Pension Plan Adjustments -15,793,414. Other Changes in Net Assets -1,516. Part XII, Line 4b: Other Revenue 1,071 Part XIII, Line 2d: Other Expenses 445 Golf Tournament 127079 93334 33745 1200 56 14163 7658 10884 Charity Ball 88886 65425 23461 11007 2500 3879 215965 158759 57206 1200 56 14163 18665 2500 14763 51347 5859 1 1 1 X 1 X 1 1 1 0 1 1 7325598 1602374 5723224 0.03630 16589226 12595408 3993818 0.02540 23914824 14197782 9717042 0.06170 583705 583705 0.00370 9585 9585 0.00010 81876 81876 0.00050 35181 35181 0.00020 710347 710347 0.00450 24625171 14197782 10427389 0.06620 1 6004586 61659347 73010623 -11351276 X 1 0 1 Nature Coast Development Group-Crystal River Rental 0.50000 0.00000 0.25000 2 Nature Coast Development Group-Meadowcrest Rental 0.50000 0.00000 0.50000 3 Citrus County Medical Group Rental 0.17000 0.00000 4 North Central Florida Health Partners Buying Group 0.50000 0.00000 1 1 Citrus Memorial Hospital

502 W Highland Blvd Inverness FL 34452

X Citrus Memorial Hospital 1 25 Citrus Orthopedic & Joint Institute

951 N Avalon Way Lecanto FL 34461

Rehabilitation Clinic Gulf Coast Aquatic & Rehab

819 Medical Court East Inverness FL 34452

Rehabilitation Clinic Inverness Surgical Associates

403 W Highland Blvd Inverness FL 34452

Surgical OP/IP Physician Clinic HomosassaSugarmill Woods Lab Coll Ctr

7945 S Suncoast Blvd Homosassa FL 34446

Laboratory Draw Station Gulf Coast Aquatic & Rehab

6043 W Nordling Loop Crystal River FL 34429

Rehabilitation Clinic Beverly Hills Laboratory Coll Ctr

8 Regina Blvd Beverly Hills FL 34465

Laboratory Draw Station Citrus Memorial Home Health Agency

502 W Highland Blvd Inverness FL 34452

Home Healthcare Sugarmill Woods Rehabilitation Center

7945 S Suncoast Blvd Homosassa FL 34446

Rehabilitation Clinic Beverly Hills Rehabilitation Center

3402 N Lecanto Hwy Suite B Beverly Hills FL 34465

Rehabilitation Clinic Sugarmill Woods Diagnostic Imaging

7945 S Suncoast Blvd Homosassa FL 34446

Diagnostic Imaging Center Citrus Hills Laboratory Coll Center

1978 N Prospect Avenue Lecanto FL 34461

Laboratory Draw Station Dunnellon Laboratory Coll Center

11352 N Williams Street Dunnellon FL 34432

Laboratory Draw Station Citrus Primary Care-Homosassa

7945 S Suncoast Blvd Homosassa FL 34446

Outpatient Physician Clinic Allen Ridge Family Care Center

540 N Lecanto Hwy Lecanto FL 34461

Outpatient Physician Clinic Allen Ridge Diagnostic Imaging Center

520 N Lecanto Hwy Lecanto FL 34461

Diagnostic Imaging Center Citrus Primary Care-Beverly Hills

450 W Roosevelt Blvd Beverly Hills FL 34465

Outpatient Physician Clinic Citrus Primary Care-Floral City

7648 S Florida Avenue Floral City FL 34436

Outpatient Physician Clinic Citrus Primary Care-Inverness

131 S Citrus Avenue Inverness FL 34452

Outpatient Physician Clinic Citrus Primary Care-Crystal River

700 SE 5th Terrace Suite 7 Crystal River FL 34429

Outpatient Physician Clinic Sugarmill Woods Family Care Center

7945 S Suncoast Blvd Homosassa FL 34446

Outpatient Physician Clinic Citrus Primary Care-Citrus Springs

10334 N Citrus Springs Blvd Citrus Springs FL 34434

Outpatient Physician Clinic CMH Orthopedic & Joint Specialists

3402 N Lecanto Hwy Suite C Beverly Hills FL 34465

Ortho Outpatient Physician Clinic Citrus Primary Care-Bushnell

417 Market Street 7 Bushnell FL 33513

Outpatient Physician Clinic Citrus Springs Rehabilitation Center

10489 N Florida Avenue Suite F Citrus Springs FL 34434

Rehabilitation Clinic West Florida Diagnostic Center

3533 N Lecanto Hwy Beverly Hills FL 34465

Diagnostic Imaging Center Part I, L7 Col(f): Bad debt expense included in Frm 990, part IX, line 25, column (a) is $23,640,104. The Hospital excluded the full amount, $23,640,104, for purposes of calculating the percentage in column (f), on part I, line 7. Part III, Line 8: Although we were not able to determine a dollar amount, we believe a portion of the Medicare shortfall could be considered community benefit since Medicare is such a predominant payor in our facility. For example, Citrus Memorial has an open heart program. This program does not generate positive contribution margins for the hospital; however we consider the program to be an integral benefit to the community. Without the heart program residents would be required to travel out of the county to receive services. It is estimated that this program loses over $1 million on an annual basis. Typically commercial or managed care providers make up the deficit of the governmental payors; unfortunately, we do not have the better paying population to make up for these deficits. Our tax exempt status allows CMHS to provide care at a level that would be impossible without this determination. The organization provides a vital service to the community for the insured as well as the uninsured alike. Part VI, Line 2: Citrus Memorial Health System personnel is actively involved with the community and strives to "feel the pulse" of the county's needs. CMH hosted a round table discussion with members of the community who represent the underserved including clergy, social workers, and the local food bank. An advisory group was then formed to brainstorm ideas to reach out to those in need. As a result, CMHS now sponsors a biweekly program where approximately 6 patients per week from a very impoverished area are transported to one of our primary care facilities for check-ups and treatment at no cost. Lifesaving surgeries and diagnostic testing have been performed to patients at no cost - otherwise they would have received no care. One patient told us that he had not seen a doctor since Vietnam! At our clinics, we turn away no patients based on their ability to pay. Many of these patients were referred to us by "for profit" physician practices. Our hospital also has an "Advisory Committee" where representatives from throughout the community discuss the best use of donated funds from our philanthropy endeavors. An education center, among other things, is being planned resulting from the discussions that ensued from those meetings.Citrus Memorial also develops a strategic plan based on the needs of the community. Consultants and community experts are utilized to determine the underserved programs and patients in our community. We then determine a "roadmap" to direct our activities in the best possible manner Part VI, Line 3: Citrus Memorial's financial counselors are well schooled in the area of financial assistance. Upon registration and once a need is determined, our patients are informed of possible Medicaid eligibility and charity care sponsorship. We are affiliated with a company that qualifies patients for Medicaid, and we also have recently opened a Medicaid service center in which community members can come to our center and complete paperwork to become eligible for this service. We have even partnered with other community agencies and conducted "healthcare fairs" to provide screenings and financial direction to patients. We provided information on our sponsorship program and provide information on Medicaid to the needy in the community. Part VI, Line 4: Citrus County is a rural area with a significant elderly and indigent population. Citrus County is the second oldest population in the state. According to the latest census, 31% of residents are older than 65 - Florida's average is 17.2% aged greater than 65. There is virtually no industry in the area, and most jobs are related to the "service industry". The per capita income in the county is $22,714 with the Florida average being $26,503. Citrus County residents have fewer years of education with only 16.7% of the population holding a bachelor's degree or higher with the Florida average being 25.6%. Citrus County has 141,236 residents with Citrus Memorial being the primary provider of hospital care in the county. There is a smaller for-profit hospital on the other side of the county that does not offer the array of services of CMHS and does not have the capacity to serve the volume of patients CMHS serves. Part VI, Line 6: Citrus Memorial Health System provides critical services to the citizens of Citrus County. Not only do we provide acute care hospital services, but also Home Health and primary care - all providing care to the indigent. We receive many indigent referrals from the other for-profit health establishments in the community including diagnostic imaging, infusion therapy, endoscopy, lab testing, and OP therapy. Please see schedule O for a more comprehensive list of our services. X X 0 1 X X X X X 1 0 0 0 0 0 0 0 0 Ryan Beaty 421131 0 0 0 10846 0 76843 0 679 0 509499 0 0 0 Jerrald Deloach 208600 0 0 0 0 0 19429 0 4629 0 232658 0 0 0 Emery Hensley 214047 0 0 0 0 0 41798 0 1525 0 257370 0 0 0 Mark Williams 160462 0 0 0 0 0 8482 0 2736 0 171680 0 0 0 Linda McCarthy 202436 0 0 0 0 0 13796 0 3129 0 219361 0 0 0 Lee Glotzback 152851 0 0 0 0 0 19687 0 2629 0 175167 0 0 0 Eric Hirsch MD 474907 0 0 0 0 0 38457 0 2323 0 515687 0 0 0 Neil Katz MD 392832 0 0 0 0 0 0 0 4163 0 396995 0 0 0 John Gelin MD 99761 0 236729 0 0 0 71968 0 3629 0 412087 0 0 0 Julie Sudduth MD 105164 0 156442 0 0 0 19068 0 2629 0 283303 0 0 0 Michael Brown MD 258709 0 0 0 3114 0 20583 0 1122 0 283528 0 0 0 Part I, Line 1b These amounts are paid in accordance with the employment contracts. There is no written policy regarding payment or provision of the benefits described above. Part I, Line 4a Emery Hensley, former CFO, received severance pay of $35,876. This amount is included in Part II, Column (B)(i). Citrus County Hospital Board 596017150 NoneAvail 2006-09-26 10000000 See Part V 0 0 0 Citrus County Hospital Board 596017150 NoneAvail 2008-09-01 10000000 See Part V 0 0 0 10000000 76169 9923861 2008 0 0 1 1 10000000 55189 9944811 2010 0 0 1 1 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 Part I, Line A, Column F, Description of Purpose: (1) Financing a portion of the construction of hospital facilities and equipment including, but not limited to: the bed tower and emergency services expansion and ancillary department renovation located at Citrus Memorial Health System. (2) Providing for reimbursement of capital expenditures and to finance future routine capital expenditures at Citrus Memorial Health System. (3) Paying certain costs of issuance. Part I, Line B, Column F, Description of Purpose: (1) Renovation of the emergency department located at Citrus Memorial Health System, including renovation of the existing space and 5,400 new square feet, an increase of 12 patient beds and an ability to improve patient flow. (2) Sugarmill Woods Diagnostic, Rehabilitation and Clinic facility, an approximately 21,400 square foot single store outpatient facility. (3) Renovations to patient elevators. (4) Paying certain costs of issuance. James T Sanders Board Member 14587 Mr. Sanders has a family member employed by the organization 0 X 3 674 Selling Price X 4570 Selling Price X 5079 Selling Price X 1 10800 Selling Price X 9 2050 Selling Price X Give Aways 68 5124 Selling Price X Gift Cards 8 1480 Selling Price X Trips 11 2732 Selling Price X Sports Memorabilia 3 275 Selling Price 0 0 0 Part I, Line 6: The number of volunteers was obtained through the Volunteer Works System which is used on a daily basis. The main purpose of the system is to maintain a personal profile on each volunteer and to be able to track volunteer service hours and assignments. It is also used for recognition awards and various reports that are needed throughout the year. The types of positions/services provided by the volunteers are as follows: Transporters; Couriers/Information Desk; Patient Care Partners (PCPs); ER Greeters/PCPs; Assistants to Cardiac Rehab, Chart Room, EVS, General Stores, Nutritional Services, Pharmacy and office assistants in various other departments; Gift Shop Buyers/Clerks; Lab Host/Hostess; Medical Records Messengers; newspaper delivery to the floors/departments; OB PCPs; Pre-Admit Host/Hostess and Stamping; Shuttle Drivers, Share Club Visitors, Surgery Host/Hostess and Wheelchair Repair. Form 990, Part VI, Section A, line 8b The Foundation has no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11 A copy of the Form 990 is provided to the Board of Directors prior to filing the return. Any questions or concerns are addressed as quickly as possible. In addition, the accounting staff review each section of the return upon receipt of the draft. The staff ensure that the statements contained in the Form 990 are accurate and the figures are true to the audited financial statements. The CFO also reviews the return to ensure it is complete and accurate. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers all members of the Board of Directors as well as all officers of the organization. Board members are required to abstain from voting on matters where a conflict of interest may exist. Form 990, Part VI, Section B, line 15 A national human resources firm was used to provide information regarding compensation for the following positions: Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Chief Nursing Officer and Chief Human Resources Officer. The firm used a combination of national and regional data to provide their comparisons. The results of the study, including recommended compensation, were approved by the Compensation Committee. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are all made available to the public upon request. The financial statements are also made available on our website (unaudited are posted monthly and the audited financials are posted upon receipt). Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -16,258. Contributions in Net Assets 242,499. Net Assts Released from Restrictions -47,376. Pension Plan Adjustments -15,793,414. Other Changes in Net Assets -1,516. Total to Form 990, Part XI, Line 5: -15,616,065. Citrus County Hospital Board PO Box 1030 Inverness FL 34451 596017150 hospital FL N/A 0 Citrus Memorial Hospital Auxiliary 502 W Highland Blvd Inverness FL 34452 592774537 hospital FL 501(c)(3) Line 3 N/A 1 Nature Coast Development Group-Crystal River 502 W Highland Blvd Inverness FL 34452 550907519 real estate FL N/A excluded 15632 221547 0 1 Nature Coast Development Group-Meadowcrest 502 W Highland Blvd Inverness FL 34452 203938808 real estate FL N/A excluded -9113 269026 0 0 CMH Foundation Managements Services Corporation 502 W Highland Blvd Inverness FL 344524720 650409040 management services FL N/A C 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0