STRATEGY STUDIO / PUBLIC DATA EXPLORER

WINTER HAVEN HOSPITAL FOUNDATION INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
WINTER HAVEN HOSPITAL FOUNDATION INC (EIN 03-0406130)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-06
IRS object ID
201242199349300449
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-06T12:37:36-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PERSHING YOAKLEY & ASSOCIATES PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12963 GULF TO BAY BLVD STE 267AddressLine1
CityCLEARWATERCity
StateFLState
ZIP Code337594255ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN030406130EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mid-Florida Medical Services Foundation IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMID-NameControl
Phone8632931121Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 Ave F NEAddressLine1
CityWinter HavenCity
StateFLState
ZIP Code33881ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJoel ThomasName
TitleExecutive DirectorTitle
Phone8632931121Phone
Date Signed2012-08-06DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTerry HaefnerName
Phone7274427110Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1Winter Haven Hospital FoundationBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonJoel ThomasNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1200 Ave F NEAddressLine1
CityWinter HavenCity
StateFLState
ZIP Code33881ZIPCode
FieldValueIRS element (for citing)
Gross Receipts4693592GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.mfms.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2002YearFormation
State Legal DomicileFLStateLegalDomicile
Activity Or Mission DescriptionMid-Florida Medical Services Foundation raises philanthropic funds to support Winter Haven Hospital's healthcare mission.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers200TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year844165ContributionsGrantsPriorYear
Contributions Grants Current Year2989616ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year254343InvestmentIncomePriorYear
Investment Income Current Year436482InvestmentIncomeCurrentYear
Other Revenue Prior Year-87795OtherRevenuePriorYear
Other Revenue Current Year14159OtherRevenueCurrentYear
Total Revenue Prior Year1010713TotalRevenuePriorYear
Total Revenue Current Year3440257TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year196565GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2163061GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year-2450SalariesEtcPriorYear
Salaries Etc Current Year12099SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year77481TotalFundrsngExpCurrentYear
Other Expense Prior Year404626OtherExpensePriorYear
Other Expenses Current Year552505OtherExpensesCurrentYear
Total Expenses Prior Year598741TotalExpensesPriorYear
Total Expenses Current Year2727665TotalExpensesCurrentYear
Revenues Less Expenses Prior Year411972RevenuesLessExpensesPriorYear
Revenues Less Expenses CY712592RevenuesLessExpensesCY
Total Assets BOY12631801TotalAssetsBOY
Total Assets EOY13462472TotalAssetsEOY
Total Liabilities BOY81848TotalLiabilitiesBOY
Total Liabilities EOY186022TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY12549953NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY13276450NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionMid-Florida Medical Services Foundation raises philanthropic funds to support Winter Haven Hospital, Inc's healthcare mission.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense2508322Expense
Grants2052288Grants
DescriptionMid-Florida Medical Services Foundation, Inc. (The "Foundation"), is a not-for-profit charitable organization whose primary purpose is to raise philanthropic funds to support Winter Haven Hospital, Inc.'s healthcare mission. The Foundation is currently administering a major gifts campaign designed to acquire funding for a number of hospital initiatives including:1. Support and upgrades for various hospital departments, including the Cassidy Cancer Center, Stroke Center, Bostick Heart Center and the Center for Urology.2. Expanding the number of physicians serving the community where shortages exists based on population need.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Grants52336Grants
DescriptionThe Foundation provides scholarships to employees of Winter Haven Hospital that are awarded based on the needs of the organization. In order to receive a scholarship applicants must have been employed by the hospital for two years, receive positive reference from their manager, attend an accredited school, and meet performance standards on their annual performance evaluation.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Grants37500Grants
DescriptionThe Foundation provides support for community organizations including the local nursing school to ensure continued excellence in the supply of nursing professionals and the American Cancer Society.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Grants20937Grants
Revenue134575Revenue
DescriptionThe Foundation also provided other scholarships or members of the community.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Grnt20937TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev134575TotalOfOtherProgramServiceRev
Total Program Service Expense2508322TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art1DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Joel ThomasBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8632931121TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1200 Avenue F NEAddressLine1
CityWinter HavenCity
StateFLState
ZIP Code33881ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
Don Ingram
Immediate Past Chairman2.00X000
Charles W McPherson
Member2.00X000
Brian K Swain
Member2.00X000
William G Burns
Secretary/Treasurer2.00X000X
Eric Adamson
Chairman2.00X000X
Mike Compton
Member2.00X000
Steve Cassidy
Member2.00X000
Dorothy Griffin
Member2.00X000
Alan Gustafson
Member2.00X000
Steve Saterbo
Member2.00X000
Bud Strang
2nd Vice Chair2.00X000X
Richard Straughn
Member2.00X000
Lynn Oakley
1st Vice Chair2.00X000X
Cindy Henry
Member2.00X000
Bet Tucker
Member2.00X000
Lance Anastasio
President & CEO2.00048634028804X
David MacDougall
Vice President/CFO2.00025210939684X
John Parman
CP/Corporate Counsel2.00014659322912X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs885042TotalReportableCompFrmRltdOrgs
Total Other Compensation91400TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events582019FundraisingEvents
All Other Contributions2407597AllOtherContributions
Noncash Contributions22998NoncashContributions
Total Contributions2989616TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column235162TotalRevenueColumn
Exclusion$235,162ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1311264Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1109944Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities201320Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column201320TotalRevenueColumn
Exclusion$201,320ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events22975GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events582019CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses143391FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-120416TotalRevenueColumn
Exclusion-$120,416ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Nursing Research561000118690118690
Health Fairs5610001588515885
FieldValueIRS element (for citing)
Total Other Revenue134575TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column3440257TotalRevenueColumn
Related Or Exempt Function Income134575RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$316,066ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total2104725Total
Program Services2104725ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total58336Total
Program Services58336ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2511Total
Management And General1155ManagementAndGeneral
Fundraising1356Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total157Total
Management And General72ManagementAndGeneral
Fundraising85Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total9431Total
Management And General4338ManagementAndGeneral
Fundraising5093Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total131385Total
Management And General60438ManagementAndGeneral
Fundraising70947Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total20900Total
Management And General20900ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total33530Total
Management And General33530ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total4498Total
Management And General4498ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total7948Total
Management And General7948ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1204Total
Management And General1204ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Nursing Research132983132983
Consulting127278127278
Bad Debt8500085000
Miscellaneous51315131
Bank Charges26482648

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2727665Total
Program Services2508322ProgramServices
Management And General141862ManagementAndGeneral
Fundraising77481Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY278628BOY
EOY447026EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY493184BOY
EOY266901EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY2700000BOY
EOY2700000EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY35664BOY
EOY28583EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis3006780LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4623LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3003360BOY
EOY3002157EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY5821964BOY
EOY6733890EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY299001BOY
EOY283915EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12631801BOY
EOY13462472EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY71430BOY
EOY78550EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY10418BOY
EOY107472EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY81848BOY
EOY186022EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY10845535BOY
EOY11444085EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY738019BOY
EOY865966EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY966399BOY
EOY966399EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12549953BOY
EOY13276450EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12631801BOY
EOY13462472EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses712592ReconcilationRevenueExpenses
Reconcilation Other Changes13905ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1Winter Haven Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
EIN590724462EIN
Type Of Organization3TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Amount$2,396,549Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts2396549SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance8780241BeginningOfYearBalance
Contributions3015639Contributions
Investment Earnings Or Losses72400InvestmentEarningsOrLosses
Grants Or Scholarships58336GrantsOrScholarships
Other Expenditures2041736OtherExpenditures
Administrative Expenses332571AdministrativeExpenses
End Of Year Balance9435637EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance4110450BeginningOfYearBalance
Contributions128251Contributions
Investment Earnings Or Losses374157InvestmentEarningsOrLosses
Grants Or Scholarships13524GrantsOrScholarships
End Of Year Balance4599334EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance3324387BeginningOfYearBalance
Contributions592125Contributions
Investment Earnings Or Losses245307InvestmentEarningsOrLosses
Grants Or Scholarships51369GrantsOrScholarships
End Of Year Balance4110450EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.80580BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.09180PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.10240TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis3000019OtherCostOrOtherBasis
Book Value3000019BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis6761OtherCostOrOtherBasis
Depreciation4623Depreciation
Book Value2138BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3002157TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDue to Winter Haven HospitalDescription
Amount$107,472Amount
FieldValueIRS element (for citing)
Total Of Amounts107472TotalOfAmounts
Total Revenue3440257TotalRevenue
Total Expenses2727665TotalExpenses
Excess Or Deficit For Year712592ExcessOrDeficitForYear
Net Unrealized GL On Investments-272350NetUnrealizedGLOnInvestments
Other$286,255OtherAmount
Total Adjustments13905TotalAdjustments
Excess Or Deficit Per FS726497ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt3072184TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-259610NetUnrealizedGainsInvestments
Other Revenues132288OtherRevenues
Revenue Not Rptd F990-127322RevenueNotRptdF990
Revenue Subtotal3199506RevenueSubtotal
Other Revenues Not Included240751OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt240751RevenueNotRptdOnFinStmt
Total Revenue Per Form9903440257TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2759890TotExpensesEtcAuditedFinclStmt
Other Expenses Included32225OtherExpensesIncluded
Expenses Not Rptd F99032225ExpensesNotRptdF990
Expenses Subtotal2727665ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9902727665TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Intended Use of Endowment Funds:Part V, Line 4:The endowment funds are used for both capital improvements and scholarships. The Foundation has determined that the Endowments were not properly valued as of September 30, 2010. Accordingly, there was a one-time valuation adjustment of $4,180,907 made from the fiscal year 2009 ending balance to the fiscal year 2010 beginning balance.
Description of Uncertain Tax Positions Under FIN 48:Part X:The Foundation received tax-exempt status under Section 501(c)(3) of the Internal Revenue Code (the Code) on May 20, 2004. The Code provides for taxation of unrelated business income under certain circumstances. The Foundation has no unrelated business income.
Part XI, Line 8 - Other Adjustments:Transfer from Winter Haven Hospital 286,255.
Part XII, Line 2d - Other Adjustments: Satisfaction of Donor Restrictions 100,063 Revenues Netted with Expenses 32,225 Total 132,288 Part XII, Line 4b - Other Adjustments: Contributions Included in Net Assets 213,556 Investment Income 6,350 Special Event Revenue 20,845 Total 240,751 Part XIII, Line 2d - Other Adjustments: Expenses Netted with Revenues 32,225

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GalaNameOfEvent1
Gross Receipts Event1547679GrossReceiptsEvent1
Charitable Contributions Event1538304CharitableContributionsEvent1
Gross Revenue Event19375GrossRevenueEvent1
Rent Facility Costs Event1931RentFacilityCostsEvent1
Food And Beverage Event112222FoodAndBeverageEvent1
Entertainment Event122500EntertainmentEvent1
Other Direct Expenses Event168191OtherDirectExpensesEvent1
Name Of Event2Mountain Lake Golf TournamentNameOfEvent2
Gross Receipts Event246500GrossReceiptsEvent2
Charitable Contributions Event232900CharitableContributionsEvent2
Gross Revenue Event213600GrossRevenueEvent2
Non Cash Prizes Event24492NonCashPrizesEvent2
Food And Beverage Event24029FoodAndBeverageEvent2
Other Direct Expenses Event223705OtherDirectExpensesEvent2
Total Number Of Other Events1TotalNumberOfOtherEvents
Gross Receipts Other Events10815GrossReceiptsOtherEvents
Charitable Contrib Other Events10815CharitableContribOtherEvents
Cash Prizes Other Events4000CashPrizesOtherEvents
Other Direct Expenses Other Events3321OtherDirectExpensesOtherEvents
Gross Receipts Total604994GrossReceiptsTotal
Charitable Contributions Total582019CharitableContributionsTotal
Gross Revenue Total Events22975GrossRevenueTotalEvents
Cash Prizes Total Events4000CashPrizesTotalEvents
Non Cash Prizes Total Events4492NonCashPrizesTotalEvents
Rent Facility Costs Total Events931RentFacilityCostsTotalEvents
Food And Beverage Total Events16251FoodAndBeverageTotalEvents
Entertainment Total Events22500EntertainmentTotalEvents
Other Direct Expenses Total Events95217OtherDirectExpensesTotalEvents
Direct Expense Summary Events143391DirectExpenseSummaryEvents
Net Income Summary-120416NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Winter Haven Hospital
200 Ave F NEWinter HavenFL33881590724462501(c)(3)2052288To provide general support to Winter Haven Hospital.
Polk State College Foundation
999 Ave H NEWinter HavenFL33881591819213501(c)(3)37500Endowed chair
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantScholarshipsTypeOfGrant
Number Of Recipients27NumberOfRecipients
Amount Of Cash Grant58336AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: Mid-Florida Medical Services Foundation provides support to Winter Haven Hospital as part of its exempt purpose. These grants were used to purchase specialized equipment for the Winter Haven Hospital Stroke Center and also to support various other areas of the hospital. Mid-Florida Medical Services Foundation also provides scholarships to employees of Winter Haven Hospital that are awarded based on the needs of the organization. In order to receive a scholarship applicants must have been employed by the hospital for two years, receive positive reference from their manager, attend an accredited school, and meet performance standards on their annual performance evaluation. Mid-Florida Medical Services Foundation also provided other scholarships to members of the community.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Lance Anastasio
046585000020490017129011675051514400
David MacDougall
02482530003856017145022539029179300
John Parman
01438490002744011591011321016950500

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePart I, Line 1aReturnReference
ExplanationLance 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. The full amount of $543 was included in taxable wages.Explanation

Schedule M IRS990ScheduleM

Works Of Art WorksOfArt

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions2NumberOfContributions
Noncash Contribs Rptd F9904000NoncashContribsRptdF990
Method Of Determining RevenuesExpert OpinionMethodOfDeterminingRevenues

Clothing And Household Goods ClothingAndHouseholdGoods

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F9901354NoncashContribsRptdF990
Method Of Determining RevenuesFair Market ValueMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionVarious Gala Auction ItemsDescription
Number Of Contributions29NumberOfContributions
Noncash Contribs Rptd F99017644NoncashContribsRptdF990
Method Of Determining RevenuesFair Market ValueMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 6The sole member of Mid-Florida Medical Services Foundation, Inc. is Winter Haven Hospital, Inc.
Form 990, Part VI, Section A, line 7aThe Trustees of the Corporation shall be elected by the Officers of the Winter Haven Hospital, Inc., the sole member, at its annual meeting each year for staggered three (3) year terms. No Trustee shall serve more than two consecutive three year terms; however, a former Trustee shall again become eligible for Board membership following a lapse of one year after expiration of his last term of office.
Form 990, Part VI, Section A, line 7bAny changes to the Bylaws or Articles of Incorporation of Mid-Florida Medical Services Foundation, Inc. must be approved by the Officers of the Board of Directors of Winter Haven Hospital, Inc. Furthermore the Board of Trustees of Winter Haven Hospital, Inc. have the authority to approve the annual operating budget of the Foundation.
Form 990, Part VI, Section B, line 11The Director of Accounting and CFO of Mid-Florida Medical Services Foundation intially reviewed Form 990. After their review was completed, the final Form 990 was then presented and made available to all Board Members including all voting members of the governing body.
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 12c
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 B, line 15
The finanical statements of Mid-Florida Medical Services Foundation, Inc. are made availabe to the public upon request. The organization's governing documents and conflict of interest policy are not made available to the public.Form 990, Part VI, Section C, line 19
Changes in Net Assets or Fund Balances:Net unrealized losses on investments: -272,350. Transfer from Winter Haven Hospital 286,255. Total to Form 990, Part XI, Line 5: 13,905.Form 990, Part XI, line 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Mid-Florida Medical Services Inc
200 Ave F NEWinter HavenFL33881592486580Support OrganizationFL501(c)(3)11A - Type 1N/A0
Winter Haven Hospital Inc
200 Ave F NEWinter HavenFL33881590724462Medical ServicesFL501(c)(3)30Mid-Florida Medical Services Inc
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg