2012-08-06T12:35:45-05:00 2011-09-30 PERSHING YOAKLEY & ASSOCIATES PC 2963 GULF TO BAY BLVD STE 267 CLEARWATER FL 337594255 990 2010-10-01 590724462 Winter Haven Hospital Inc WINT 8632931121 200 Ave F NE Winter Haven FL 33881 Lance Anastasio 8632931121 2012-08-06 1 Terry Haefner 7274427110 2010 2016-02-24 21:20:13Z Lance Anastasio 200 Ave F NE Winter Haven FL 33881 286373695 0 X www.winterhavenhospital.com X 1926 FL To provide hospital and healthcare services. 16 16 2689 328 817149 0 3447508 5121071 271607748 256334293 2735788 3891619 -2596543 594724 275194501 265941707 0 0 0 0 127607606 127611178 0 0 0 147668177 133704661 275275783 261315839 -81282 4625868 250298873 248636308 146056152 145206541 104242721 103429767 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 178424589 256384765 The Community Benefit contributions of Winter Haven Hospital and the Winter Haven Hospital Foundation include programs and activities that improve access to healthcare and improve health in our communities. Winter Haven Hospital is a not-for-profit organization that is the leading healthcare provider in eastern Polk County, dedicated to the mission of improving 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. Our history of fulfilling this mission and providing access to medical excellence close to home began in 1926. Since that time we have remained dedicated to meeting the healthcare needs of individuals and businesses in central Florida.This statement of program service accomplishments is organized using the HERO methodology; Healthcare, Education, Research, Outreach.HealthcareEstablished in 1926, Winter Haven Hospital serves as the major medical center for eastern Polk County and the U.S. Highway 27/Ridge corridor. Since that time, the local population has grown substantially with over 660,000 people living within 25 miles of the hospital and over 3 million within 50 miles. The hospital is a division of Mid-Florida Medical Services, a locally owned and operated 501(C)(3), not-for-profit organization, which is governed by an independent Board of Trustees made up of local business and civic leaders who serve without pay. With 527 licensed beds, Winter Haven Hospital main campus is the larger of the two inpatient facilities in our healthcare system, followed by our Regency Center for Women and Infants. With approximately 2,400 employees, Winter Haven Hospital is the largest private employer in eastern Polk County. The hospital is fully accredited by the Joint Commission and has more than 300 board-certified physicians on its medical staff representing every major specialty. Winter Haven Hospital is affiliated with the University of Florida College of Medicine/Shands Healthcare in the areas of emergency medicine, oncology and urology. The hospital is also a member of the American Hospital Association, Florida Hospital Association, the Premier Alliance, and the West Central Florida Hospital Council.Hospital based services include:- The Bostick Heart Center- The Cassidy Cancer Center- Three 12-bed intensive care units for medical, surgical and coronary care- A Nationally recognized Stroke Center- The Nationally accredited Joy-Fuller Rehabilitation Center- The Regency Center for Women and Infants- Center for Robotic SurgeryWith community based facilities located throughout eastern Polk County, Winter Haven Hospital offers numerous specialty programs and units:- State-of-the-art OB/GYN women's facility- Level II neonatal intensive care- Comprehensive physical rehabilitation inpatient and outpatient centers accredited by the Commission on Accreditation of Rehabilitation Facilities, which are also state-designated for brain injury- Three cardiac catheterization laboratories- Clinical lab and regional Blood Bank- Ambulatory Surgery and Diagnostic Center including new operating rooms, endoscopy procedure rooms and prep and recovery areas. - Emergency Department- Seven primary care offices (Auburndale, Bartow, Dundee, Haines City, Lake Wales, Winter Haven (two))- Inpatient Center for Psychiatry/outpatient behavioral health services - Diabetes Care CenterWith approximately 17,000 total admissions last year, over 1,600 births and over 60,000 emergency and urgent care visits, Winter Haven Hospital continually seeks to fulfill its mission: 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.Winter Haven Hospital's Regency Center for Women and Infants received the Premier Quality award for being one of the best Women's Hospitals in the country. Also in June 2011, Heathgrades awarded the Regency the Maternity Care Excellence Award.The Joy-Fuller Rehabilitation Center earned its seventh-consecutive 3-year Commission on Accreditation of Rehabilitation Facilities in December 2010. It is the only CARF-accredited inpatient rehabilitation center in Polk, Highlands and Hardee Counties. The Bostick Heart Care Center was given a three-star rating by Consumer Reports magazine for 3 years running with the latest published in April 2012. This designation for the Bostick Heart Center's heart-bypass program ranks it as among the top 50 such programs in the nation. Only two other Florida hospitals were given this designation. 2011 also marked the fourth year in a row that the Bostick Heart Center received the top rating of 3 stars from the Society of Thoracic Surgeons. In December 2008 the Hospital was awarded Magnet Status which is the highest level of recognition from the American Nurses Credentialing Center. Characteristics that define nursing services in a Magnet organization emphasize high-quality patient care, clinical autonomy and responsibility, participatory decision-making, strong nurse leaders, effective use of resources, and high levels of job satisfaction.The hospital was one of 60 hospitals to achieve the Gold Elite Award from the American Stroke Association acknowledging at least 2 years of 85% or higher adherence to all performance measures for stroke care with the most recent award coming in January 2009. The hospital program for the continuum of stroke care was initially certified by the Joint Commission in July 2005. The program received its second Joint Commission designation in December 2007 and its fourth designation in December 2011.Winter Haven Hospital is committed to the highest quality of compassionate patient care by adhering to the following nursing philosophy:- We believe there is a potential inherent in every human being for self-actualization that can be empowered through the caring nurse-patient relationship.- We value diversity of human experience and expression by accepting the person not only as he or she is now, but as what he or she may become.- We believe that we have an ethical and social responsibility to both individuals and society to protect human dignity and preserve humanity.- We are committed to teamwork and collaboration in which individuals engage in genuine communication, put aside individual and discipline agendas, and put the patient and the patient's social support systems first.- We actualize these beliefs by promoting and rewarding clinical, administrative, research, and education activities which maintain an exceptional caring relationship with those we are privileged to serve.Winter Haven Hospital meets the organizational description for tax exemption as evidenced by:- Operating a 24 hour emergency room that is open to all persons regardless of the ability to pay.- Having an open medical staff with privileges available to all qualified physicians in the area.- Having a governing body comprised of independent persons representative of the community.- Participating in Medicare, Medicaid, Champus, and other government sponsored healthcare programs.- Providing charity care to the indigent as more fully described below.Winter Haven Hospital offers financial assistance policies that help the low income and uninsured members of the community. All self-pay patients are screened for funding sources at the time of admission or in the pre-admission process. Patients are screened for qualification with federal, state, or county funded programs or the hospital's charity care policy. If the patient qualifies, the Financial Counseling staff assists the patient in the application process. If he or she does not qualify, the hospital offers a variety of payment plans to help accommodate the patient. Uninsured patients receive an automatic 40% discount on their bills. The hospital's charity care policy complies with Florida's Agency for Health Care Administration charity guidelines which enables us to provide healthcare to patients that are unable to pay due to financial hardship. This policy includes:- 100% write-off of charges for families whose income for the 12 months preceding the determination is below 200% of the current Federal poverty guidelines.- A sliding scale write-off of charges for families whose income for the 12 months preceding the determination is between 201% and 300% of the current Federal poverty guidelines.- A sliding scale write-off of charges for catastrophic cases where the bill exceeds 25% of family annual income. 178424589 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 373 0 1 2689 1 1 1 0 0 0 0 0 0 0 0 0 X 16 16 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Dave MacDougall 8632971899 200 Avenue F NE Winter Haven FL 33881 Richard Straughn 2.00 X X 0 0 0 Mark Bostick 2.00 X X 0 0 0 Charles W McPherson 2.00 X 0 0 0 Todd Dantzler 2.00 X X 0 0 0 David K Speyerer 2.00 X 0 0 0 Chip Tucker 2.00 X 0 0 0 Tommy Oakley 2.00 X X 0 0 0 Albert Cassidy 2.00 X 0 0 0 Kelly Gray-Eurom MD 2.00 X 0 0 0 Brian K Swain 2.00 X X 0 0 0 William G Burns 2.00 X X 0 0 0 Eric Adamson 2.00 X 0 0 0 Ben Hill Griffin III 2.00 X 0 0 0 Eileen Holden 2.00 X 0 0 0 William H Murrell 2.00 X 0 0 0 Robert C Carter 2.00 X 0 0 0 Lance Anastasio 40.00 X 0 486340 28804 David MacDougall 40.00 X 0 252109 39684 David Libby 40.00 X 0 163052 22843 Mary Jo Schreiber 40.00 X 0 182051 13077 Iftikhar Rasul MD 40.00 X 257207 0 38425 George Winney MD 40.00 X 251799 0 41660 Joseph Lynch MD 40.00 X 336839 0 22807 Majd Alsamman MD 40.00 X 377685 0 23169 Takkallapelli D Tao MD 40.00 X 233066 0 21106 1456596 1083552 251575 60 0 1 0 Sodexo Inc & Affiliates PO Box 536922 Atlanta GA 303536922 Management Services 4504805 Doster Construction Co Inc 8529 South Park Circle Suite 130 Orlando FL 32819 Construction 1898894 OB Hospitalist Group LLC 10 Centimeters Drive Mauldin SC 29662 Physicians 1386902 Florida Clinical Practice PO Box 100247 Gainesville FL 32610 Physicians 1045212 Winter Haven Cardiovascular PO Box 3130 Ocala FL 344783130 Physicians 820753 34 2026657 3087899 6515 5121071 Patient Services 621990 152549553 152549553 Medicare/Medicaid Paym 621990 98309829 98309829 Other Services 621990 4775608 3028653 240 1746715 Medicare/Medicaid Paym 621500 492178 492178 Lab Outreach 621500 207125 207125 256334293 2044467 2817 2041650 488050 58587 429463 429463 429463 22211132 9421 20298802 74599 1912330 -65178 1847152 1847152 Contract Rev - Linen 812300 114789 114789 Other Revenue 621990 50472 50472 165261 265941707 253938507 817149 6064980 110635493 84344118 26291375 3845887 2862620 983267 4989283 337915 4651368 8140515 5987889 2152626 1549429 1549429 1235672 1235672 235977 235977 334637 334637 9560317 4522173 5038144 563614 53471 510143 1358868 118762 1240106 4671529 4671529 316448 176394 140054 99367 45344 54023 3808105 3808105 16974009 16974009 3648211 3648211 Supplies 48132847 44977363 3155484 Bad Debt 26686802 26686802 Equipment Rental & Main 9095990 4101013 4994977 Indigent Fund 2677299 2677299 Contract Labor 1681657 1473145 208512 1073883 60281 1013602 261315839 178424589 82891250 0 11656 11871 24635048 26717156 40535320 42081796 5090948 5930240 5022175 4888590 275491506 166421049 110236585 109070457 56358300 48931109 8408841 11005089 250298873 248636308 28616785 28965683 82644483 80808817 9245650 6363826 2700000 2700000 22849234 26368215 146056152 145206541 X 104242721 103429767 104242721 103429767 250298873 248636308 X 4625868 -5438822 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4164198 4164198 93058725 45508624 47550101 4146612 2977748 1168864 156448777 107466682 48982095 17673194 10467995 7205199 109070457 Professional Liability and Workmens Comp 9945341 Other Liabilities 2230741 Swap Agreements 14192133 26368215 265941707 261315839 4625868 -2932754 -2506068 -5438822 -812954 260926858 -2932754 726497 -2206257 263133115 2808592 2808592 265941707 260727062 0 260727062 588777 588777 261315839 Description of Uncertain Tax Positions Under FIN 48: Part X: The Hospital is 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, the Hospital 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. The Hospital 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 health systems include such matters as 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 than 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: Change in Value of Swap Liability -2,213,896. Transfer to Mid-Florida Medical Services Foundation, Inc. -286,253. Income from Investments in Partnerships -5,919. Part XII, Line 2d - Other Adjustments: Investment in Subsidiary 726,497 Part XII, Line 4b - Other Adjustments: Change in Value of Swap Liability 2,213,896 Income from Investment Partnerships 5,919 Expenses Netted with Revenues 588,777 Total 2,808,592 Part XIII, Line 4b - Other Adjustments: Expenses Netted with Revenues 588,777 1 1 X 1 X 1 X 1 1 0 1 1 9987961 9987961 0.04260 34362268 25863917 8498351 0.03620 1998401 970886 1027515 0.00440 46348630 26834803 19513827 0.08320 318469 318469 0.00140 328365 328365 0.00140 63330 63330 0.00030 710164 710164 0.00310 47058794 26834803 20223991 0.08630 242933 242933 0.00100 250000 250000 0.00110 492933 492933 0.00210 0 6050427 65764787 84150685 -18385898 X 1 1 2 1 Winter Haven Hospital Inc

200 Ave F NE Winter Haven FL 33881

X X 2 Regency Medical Center

101 Avenue O NE Winter Haven FL 33880

X Winter Haven Hospital Inc 1 Regency Medical Center 2 9 Blood Banks of Mid-Florida Medical Svcs

460 First Street North Winter Haven FL 33881

Blood Bank Family Health Center - Auburndale

2028 Highway 92 West Auburndale FL 33823

Outpatient Physician Clinic Family Health Center - Bartow

1625 North Carpenter Ave Bartow FL 33830

Outpatient Physician Clinic Family Health Center - Dundee

5999 Dundee Road Suite 750 Dundee FL 33884

Outpatient Physician Clinic Family Health Center - Haines City

36245 Highway 27 Haines City FL 33844

Outpatient Physician Clinic Family Health Center - Lake Wales

201 SR 60 West Lake Wales FL 33853

Outpatient Physician Clinic Family Health Center - Winter Haven

100 Avenue I NE Winter Haven FL 33881

Outpatient Physician Clinic Family Health Center - SE Winter Haven

6035 Cypress Gardens Blvd Winter Haven FL 33884

Outpatient Physician Clinic Center for Beh Health - Polk County

1201 First Street South Winter Haven FL 33880

Outpatient Beh Hlth Center Part I, Line 7: Charity Care and Means-Tested Government Programs costs (lines a through d) are determined using a Cost-to-Charge ratio. Other Benefits were calculated based on actual cost (lines e through j). Part I, L7 Col(f): There is $26,686,802 of bad debt expense which is included in Form 990, Part IX, Line 25. This amount was removed in the calculation of the Percent of Total Expense on Schedule H Line 7f. Part II: The Hospital helps build the community in two major ways as mentioned above. First, if the hospital finds that there is a shortage in a certain health care specialty, it works to recruit those types of physicians to the area. In the past, the hospital has commissioned a Manpower study to determine what the community's needs are. Additionally, the hospital subsidizes the cost of anesthesia for women giving birth at the Regency Center for Women and Infants. This benefits the community by allowing those who are less fortunate to have access to anesthesia services. Part III, Line 4: The organization's financial statements do not include a footnote that describes bad debt expense. Bad debt expense at cost was calculated by multiplying bad debt expense by the Cost to Charge Ratio.Although the Hospital has excluded Bad Debt Expense from the calculation of community benefit found in Schedule H Part 1 in accordance with IRS instructions, Winter Haven Hospital considers Bad Debt as a community benefit because a large percentage of a Hospital's bad debt is really undocumented charity care. Hospital Bad Debt is different from other businesses' bad debt because hospitals continue to provide life saving services to people who cannot or will not pay. Part III, Line 8: A large percentage of the local community is elderly which results in a large amount of Medicare Shortfall. Winter Haven Hospital considers this a community benefit because it is committed to providing first class care to the elderly even though it is at a loss due to underpayment by the federal government. The hospital uses the Cost to Charge ratio method. Part III, Line 9b: At any time in the collection process the account can be determined to meet the criteria of medical indigency as defined by the Federal Poverty Guidelines and all further collection efforts may be suspended. Documentation of such criteria will be retained in the files. Part VI, Line 2: The hospital assesses the health care needs of the community by participating in several community organizations that develop community strategic plans such as Winter Haven's "Our Future by Design". The Hospital also works with the Polk County Health Department in order to conduct studies and help set priorities. Additionally, the Hospital works with and utilizes several community health surveys conducted by Polk Healthcare Alliance. Part VI, Line 3: All self-pay patients are screened for funding sources (Medicaid, Polk Health Care, Charity, etc.) at the time of admission or in the pre-admission process. The Hospital's Financial Counselors review the patient's family size, income, and estimated hospital bill to determine if the patient is eligible for any assistance. If he or she is not, the hospital offers a variety of payment plans to help accommodate the patient. Part VI, Line 4: Winter Haven is the second largest of 17 municipalities located in Polk County Florida. Over 3.5 million people live within 50 miles of Winter Haven Hospital, with 719,851 living within 25 miles. Of Polk County's citizens, 18% are under 15 years old, 10% are aged 15-24, 35% are 25-54, 10% are 54-64, and 27% are over 65 years old. Part VI, Line 6: Besides the previously mentioned benefits, the Hospital also benefits the community by providing the following:1. Scholarships to high school students2. Timely initiatives to address the community's emerging problems. (For instance, after the Polk Healthcare Alliance identified that African American infants die at a rate of 4 times the rate of white infants, the hospital developed the Pre Natal Passport which assists pregnant women in tracking their care and worked closely with the Healthy Start Coalition to provide education and portable cribs to new moms that can't afford them.)3. A corporate culture that motivates its employees to volunteer in the community.4. An active Speakers Bureau that provides free lectures to the community.5. Free meeting space for a variety of support groups such as epilepsy, grief, caregivers, lupus, leukemia, brain injury, AIDS, Alzheimers, and domestic violence.6. Sponsorship and fund raising for many other community organizations and events, such as: American Heart Association "Heart Walk" and the American Cancer Society "Relay for Life".7. Numerous free and/or at cost health screenings at health fairs in the community, with each fair specializing in men, women, cardiac or diabetic health issues. These screenings include screens for blood pressure, stress assessments, breast exams, prostate cancer, diet and exercise. Part VI, Line 7: The Hospital is affiliated with the University of Florida Medical School and continually draws on its expertise. Emergency Department physicians and the physician director of the Cancer Center are from the University of Florida. The University of Florida staff plays a significant role in providing continuing education for medical and nursing staff. This continuing education allows the hospital to improve the way it cares for patients. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Lance Anastasio 0 465850 0 0 0 20490 0 17129 0 11675 0 515144 0 0 David MacDougall 0 248253 0 0 0 3856 0 17145 0 22539 0 291793 0 0 David Libby 0 156856 0 0 0 6196 0 11497 0 11346 0 185895 0 0 Mary Jo Schreiber 0 176378 0 0 0 5673 0 13077 0 0 0 195128 0 0 Iftikhar Rasul MD 152660 0 103190 0 1357 0 10605 0 27820 0 295632 0 0 0 George Winney MD 211485 0 39130 0 1184 0 13708 0 27952 0 293459 0 0 0 Joseph Lynch MD 330761 0 0 0 6078 0 11063 0 11744 0 359646 0 0 0 Majd Alsamman MD 296040 0 0 0 81645 0 16987 0 6182 0 400854 0 0 0 Takkallapelli D Tao MD 143149 0 88450 0 1467 0 9902 0 11204 0 254172 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. Polk County Industrial Development Authority 591292108 NoneAvail 2009-03-26 19000000 Capital Expenditures 0 0 0 Polk County Industrial Development Authority 591292108 NoneAvail 2010-05-13 26100000 Capital Expenditures 0 0 0 Polk County Industrial Development Authority 591292108 7311B2AA5 2010-05-13 26100000 Capital Expenditures 0 0 0 Polk County Industrial Development Authority 591292108 73112BAB3 2010-05-13 14600000 Capital Expenditures 0 0 0 19000000 72311 205775 18794225 1 0 1 1 26100000 67 170868 24240615 1688517 1 0 0 0 26100000 83 264989 24239355 1595656 1 0 0 0 14600000 8 144700 14303700 151600 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 1 0 NA 0 NA 0 0 0 1 1 Morgan Stanley 24.500000000000 1 0 0 NA 0 0 0 1 1 Morgan Stanley/Goldman 24.500000000000 1 0 0 NA 0 0 0 1 1 Goldman Sachs 30.250000000000 1 0 0 NA 0 0 Program Service Accomplishments Continuation of Form 990, Part III, Line 4a Additionally, the hospital offers discounts for patients who are underinsured and whose insurance has minimal benefits and/or limited coverage. In order to ensure that everyone in the community has access to quality care, the hospital subsidizes the cost of various critical community healthcare needs such as: - Anesthesia for Medicaid and indigent patients at its Regency Center for Women and Infants - The cost of OB/GYN Hospitalists for Medicaid and indigent patients without a primary Obstetrician - The outpatient mental health programs offered at the Hospital's Center for Behavioral Health. Education: Community education - Working directly with the community to promote better health by educating them on a variety of topics taught by physicians or other licensed medical professionals, including but not limited to nutrition lectures, diabetes, stroke awareness, safe babysitting and behavioral disorders. A comprehensive listing of our education programs and support groups is published and distributed to 85,000 residents semi-annually in a publication entitled Here's to Your Health and can be found on our website www.winterhavenhospital.org. Some examples of our community education offerings include: - Health Connection - A service available to the community providing physician referrals, health information, and referrals to the many Hospital sponsored programs and events. - Speaker's Bureau - The Hospital provides speakers to community organizations on a range of medical topics at no charge. The hospital's Center for Behavioral Health offers lectures on mental health topics open to the public free of charge. - Medical Library - The hospital maintains a medical library that is open to the public. The library is available at the main campus of Winter Haven Hospital as well as an additional library at the Regency Medical Center and offers books, tapes and online clinical research tools. The Medical library also has an onsite Research Information Specialist who is trained by the National Library of Medicine and the Medical Library Association to assist with internet researches. - Diabetes Self-Management Education - The hospital offers low cost education for people with or at risk for developing Diabetes. The classes help these individuals gain the knowledge and skills needed to modify behavior and successfully self-manage the disease and its related conditions. Endowed Chair in Nursing - The Hospital is also committed to improving the education of nurses in the local area. In 2010, the Winter Haven Hospital Foundation made a substantial donation to Polk State College to create an endowed chair in nursing. This donation helped to underwrite a new teaching position at Polk State College and augment the college's efforts to add a bachelor's degree in nursing program. Watson Caring Science Institute & Jean Watson International Caritas Consortium - The hospital became an official Watson Caring Science Institute Affiliate in 2010. The Watson Caring Science Institute is a non-profit foundation that advances philosophies, theories, and practices of human caring. Additionally, the hospital became the first hospital to begin data collection for the International Watson Caritas Comparative Database which is database that collects and evaluates nurse caring behavior. In April 2011, the hospital had the privilege of hosting the International Caritas Consortium. The consortium is a forum for sharing original scholarship, discussing caring research, and mentoring Caritas Coaches. Attendants come from all over the world to join in the forum. Research: Research Council - The multidisciplinary team helps to identify and review potential research projects for Winter Haven Hospital. Additionally, they track research currently in progress and ensure that all policy, procedures and federal mandates are followed. Institutional Review Board - The purpose of the Institutional Review Board is to review, approve or disapprove the initiation of, and conduct periodic review of, biomedical research involving human subjects. The primary purpose of such review is to ensure the protection of the rights and welfare of human subjects. It further will serve as liaison between physicians, investigators, and all other interested parties, and ensure compliance with applicable federal laws and regulations regarding biomedical research involving human subjects. The Institutional Review Board includes engagement of physicians, nurses, board members, administration, pharmacy and three seats for members of the community. Research Studies - The Hospital's commitment to constant improvement has lead to its involvement in several research studies. A few examples from 2011 include research on the prevalence of postpartum depression in community hospitals as well as research on Coronary Intervention in women and new uses of Cardiac Stents. Annual Nursing Research Seminar - The hospital invites nurses from around central Florida to its exceptional Research Seminar where nationally known speakers educate and challenge the staff. In 2010, over 80 nurses from various hospitals attended the annual nursing research seminar. Memory Clinic - In 2012, the Hospital's Center for Behavioral Health launched a memory clinic in collaboration with the University of South Florida Polytechnic Applied Neuro Lab. The Memory Clinic assists elderly pre-dementia patients to delay onset of memory loss. Robotics - In 2010, the Hospital formed its Center for Robotics with initial focus on improving patient outcomes in the area of urology and gynecological surgery. In 2011, the hospital hosted the Ramses Robotic Surgery Conference to show care to other physicians across the county the patient care benefits of an effective robotic surgery program. Outreach: Community health screenings - Numerous free and/or at cost health screenings were performed at Health fairs in the community, with each fair specializing in women, cardiac or diabetic health issues. These screenings include screens for blood pressure, stress assessments, breast exams, prostate cancer, diet and exercise. Community Partnerships Our community partners are critical to helping us improve the health and well-being of eastern Polk County. Together, we combine resources and strengths, positively impacting the greatest number of people. By working closely with community leaders, we also build a greater sense of community and a shared commitment toward our common goal of improving the community's health. We're proud of working with the following community partners: I. Polk Healthcare Alliance - A senior hospital employee serves as the liaison with the Polk Healthcare Alliance. As a member of a five person Executive Committee for the Polk Healthcare Alliance, the Liaison reviews progress toward the organization's Community Health Improvement Plan (CHIP). II. The Polk County Health Department - The Hospital jointly collaborated with the Polk County Health Department for the provision of maternity services to Medicaid patients. The Hospital guaranteed their access to maternity services by subsidizing and arranging for obstetrical physician services. The Polk County Health Department was selected to receive $1,950,000 over three years from the state Low Income Pool (LIP) program. These funds provide payments to health care safety net providers who serve the uninsured. Partnering with others they are seeking to link uninsured and underinsured individuals to healthcare coverage and a medical home. They are also seeking to expand access to primary care physicians and medications. Finally, they are assisting people with chronic health conditions in managing their diseases. They are working closely with hospital emergency departments to help ensure that low income individuals find a medical home. The funds were available up through July 2011. III. Haley Center - The Hospital was instrumental in the development of a free clinic in Winter Haven called the Haley Center. The First Baptist Church of Winter Haven asked for assistance and the health departments, the hospital, the country's Community Health and Social Services Department and others came together to ensure the free clinic's success. It has been operational since December 2005 and the hospital provides free Lab, X-ray and pulmonary function testing. Haley Center and Hospital volunteer staff has helped share their expertise with the Parkview Christian Church (Baptist) in Haines City which is now providing free services in their community. Program Service Accomplishments Continuation of Form 990, Part III, Line 4a IV. We Care - The Hospital participates in the Polk County Medical Association's We Care program. Through a network of 215 medical specialists, We Care helps provide specialty medical care for low income, uninsured residents of Polk County. V. Angel Care Center of Eloise- The Hospital participates in the local church based program called the Angel Care Center of Eloise. This center offers a free diabetic clinic the second Wednesday of each month for persons whose income doesn't exceed 200 percent of the federal poverty level, who are not eligible for Medicaid or Medicare and who do not have private medical insurance. Hospital volunteers also provide their time to assist with free medical attention. VI. Polk Health Care Plan - The Hospital participates and accepts the Polk Healthcare Plan. Polk HealthCare Plan is a public/private partnership that allows for a comprehensive managed health care program for eligible Polk County residents. The Plan provides an integrated system of health care and social services through a wide range of primary and preventive medical care, specialty medical care, hospitalization, diagnostic testing, ancillary services and pharmaceuticals. In essence, the Plan functions as a County-operated HMO for qualified Polk County residents. A senior hospital employee attends the Citizen Oversight Committee, an Advisory body on health issues for the Polk Healthcare Plan. In 2010, the hospital joined with Polk Healthcare and another area hospital to start an initiative that would bring an additional $1 million worth of primary care services to low income residents of Polk County. VII. Physician Recruitment - The hospital has a full-time physician recruiter and actively recruits physicians in primary care and specialty care areas where it has identified a community need. The hospital also works closely with physician groups to assist them in recruiting new physicians to our area. Sponsored community events - Winter Haven Hospital and its employees provided sponsorship and fund raising for these and many other community organizations and events: I. Heart Smart Days: A luncheon, health fair and lecture series focused on heart health education II. Citrus Classic: Features a 5k run, three-mile walk and Kindergarten Dash. III. Heart Walk: A three-mile walk benefiting the American Heart Association. IV. Relay for Life: An 18-24 hour relay walk benefiting the American Cancer Society. V. Baby-to-be and Up-to-three: A fun and informative health fair for expecting parents and young children which includes exhibits, child ID fingerprinting, fire safety, bike helmet fittings, and free immunizations for children. VI. Just Culture Community Seminar: The hospital sponsored a seminar hosted by world-renowned expert Sidney Dekker which was part of the Hospital's ongoing effort to heighten awareness about safety issues in the work place. VII. Neighborhood Services Center: The Hospital maintains a Neighborhood Services Center and employs a full time director in order to coordinate speakers, entertainment and health fairs primarily for senior citizens. VIII. One Team One Goal: The One Team One Goal campaign provides employees with the opportunity to make a pledge to any combination of seven different charities and funds, including two Winter Haven Hospital Foundation funds and five external charities. The hospital also sponsors and offers free meeting space for a variety of support groups such as cancer, epilepsy, grief, caregivers, lupus, leukemia, brain injury, AIDS, Alzheimers, and domestic violence. Peer Recovery Program - The Hospital facilitates the Peer Recovery Program which provides education, socialization, employment skills, and support to consumers who have a mental health diagnosis. Membership and participation is free and open to everyone in the community. Community Leadership - The Hospital enables its leaders to participate in organizations that benefit the well being of the community including for example: The United Way, Girls, Inc., the Women's Resource Center, and the Chamber of Commerce for several local communities, and the American Heart Association. Volunteer Services Department The hospital has an active and important volunteer department with over 317 active members serving throughout the hospital for over 27,450 hours. The hospital volunteers have spent hours serving the community with a Patient I.D. Fair, HIM Bake Off, Polk Heartwalk, Heart Smart Day and the Women's Health Fair. They also provide special Christmas stockings for infants going home on Christmas and sponsor the Christmas Angel Tree program. Community Benefit Quantification The following financial information represents a quantification of Winter Haven Hospital's community benefit for the fiscal year ended September 30, 2011. This quantification was developed using the principals set forth under IRS Schedule H. The hospital will file IRS Schedule H with its 2010 Form 990 as required by IRS regulations for Fiscal Year ending September 30, 2011. 2011 Charity and Medicaid Cases: Charity Medicaid Emergency Department 5,206 8,967 Inpatient 532 2,171 Other 1,001 1,649 Total 6,739 12,787 Charity Care and Certain Other Community Benefits at Cost: Charity Care - at cost $ 9,987,961 Direct Community Based Healthcare Programs $ 440,419 Unreimbursed Cost of Medicaid Programs $ 8,498,351 Unreimbursed Cost of County Indigent Care Program $ 587,096 Donations and Community Groups $ 63,330 Education/Health Fairs $ 176,569 Enrollment Assistance in Government Programs $ 141,900 Health Professionals Education $ 328,365 Total Charity Care and Certain Other Community Benefits at Cost $ 20,223,991 Community Building Activities: Physician Recruitment $ 242,933 Subsidized Cost of Regency Anesthesia $ 250,000 Total Community Building Activities $ 492,933 Total Quantifiable Community Benefit $ 20,716,924 The Community Benefit Quantification shown above does not include the following additional important demonstrations of the Hospital's community support - Cost of Uncompensated Care to Patients above the poverty line $ 6,050,427 - Shortfall of Medicare Funding for Patient Care* $ 18,385,898 - Scholarship for Workforce Development $ 42,039 Total $ 24,478,364 *From Medicare Cost Report Excludes other Medicare (HMO, PPO, etc.) shortfall of $10,596,128 Form 990, Part VI, Section A, line 2 Mark Bostick and William H. Murrell, Board Members, have a family relationship. Form 990, Part VI, Section A, line 6 The sole member of Winter Haven Hospital, Inc. is Mid-Florida Medical Services, Inc. Form 990, Part VI, Section A, line 7a The Trustees of the Winter Haven Hospital, Inc. shall be elected by the Sole Member, Mid Florida Medical Services, Inc., at its annual meeting each year for staggered three year terms. Form 990, Part VI, Section A, line 7b As stated in the Bylaws of Winter Haven Hospital - The Board of Trustees shall not, without the prior approval of the Sole Member of the Corporation: 1. Amend the Bylaws or the Articles of Incorporation of Winter Haven Hospital. 2. Approve a plan of dissolution of Winter Haven Hospital. 3. Approve a plan of merger or consolidation of Winter Haven Hospital with another Corporation. 4. Organize or acquire, or authorize or approve the organization or acquisition of any subsidiary or affiliate of the Corporation. Form 990, Part VI, Section B, line 11 The Executive Director of Accounting and CFO of Winter Haven Hospital 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 Winter Haven Hospital 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 losses on investments: -2,932,754. Change in Value of Swap Liability -2,213,896. Transfer to Mid-Florida Medical Services Foundation, Inc. -286,253. Income from Investments in Partnerships -5,919. Total to Form 990, Part XI, Line 5: -5,438,822. Mid-Florida Medical Services Inc 200 Ave F NE Winter Haven FL 33881 592486580 Support Organization FL 501(c)(3) 509(a)(3) - Type 1 N/A 0 Mid-Florida Medical Services Foundation Inc 200 Ave F NE Winter Haven FL 33881 030406130 Fundraising FL 501(c)(3) 509(a)(3) - Type 1 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 Mid-Florida Medical Services Foundation Inc Q 286252 Cost Mid-Florida Medical Services Foundation Inc C 2056202 Cost Mid-Florida Medical Services Foundation Inc L 464681 Cost mid-Florida Medical Services Foundation Inc P 1959379 Cost