2011-08-03T15:25:18-05:00 2010-09-30 PERSHING YOAKLEY & ASSOCIATES PC 2963 GULF TO BAY BLVD STE 267 CLEARWATER FL 337594255 990 2009-10-01 592486580 Mid-Florida Medical Services Inc MID- 8632971899 200 Ave F NE Winter Haven FL 33881 Lance W Anastasio 8632971899 2011-08-03 1 Terry Haefner 7274427110 2009 2016-02-24 21:20:13Z Lance W Anastasio 200 Ave F NE Winter Haven FL 33881 3688871 0 X www.mfms.com X 1983 FL To provide strategic direction to the Hospital by identifying health trends and community needs. 8 8 7 8 0 0 0 3100486 3688871 0 0 3100486 3688871 68750 75000 0 1895962 2350603 0 0 2133686 2256798 4098398 4682401 -997912 -993530 122719573 122841123 14524487 13370718 108195086 109470405 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 4632040 75000 3688871 Mid-Florida Medical Services, Inc., ("Mid-Florida"), is a not-for-profit corporation located in Polk County, Florida. Mid-Florida serves as the holding company for Winter Haven Hospital, Inc., ("The Hospital"). Mid-Florida's purpose is to provide strategic direction to the Hospital by identifying health trends and community needs that the Hospital may be able to meet. The all volunteer governing board of Mid-Florida is comprised of the Executive Committee of the Hospital board and several additional at-large board members experienced in healthcare.Mid-Florida Medical Services, Inc. is the holding company for Physician Service Entities in various specialties.Additionally, it serves as the holding company for the Winter Haven Hospital Foundation, which provides philanthropic support to Winter Haven Hospital. The Foundation funds support state-of-the art medical care, cutting-edge technology and equipment, top quality education, and the best and brightest personnel. 4632040 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 7 1 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Lance Anastasio 8632931121 200 Avenue F NE Winter Haven FL 33881 Tommy Oakley 2.00 X X 0 0 0 William G Burns 2.00 X 0 0 0 Mark Bostick 2.00 X X 0 0 0 Todd Dantzler 2.00 X 0 0 0 Brian K Swain 2.00 X X 0 0 0 Charles W McPherson 2.00 X X 0 0 0 Don Ingram 2.00 X X 0 0 0 Richard Straughn 2.00 X X 0 0 0 Lance Anastasio 40.00 X 340174 0 24861 Dave MacDougall 40.00 X 232477 0 35298 David Libby 40.00 X 158643 0 20967 Mary Jo Schreiber 40.00 X 167308 0 12186 John Parman 40.00 X 113977 0 19136 Donald Gale 40.00 X 117886 0 16437 Andrea Kaye Hixon 40.00 X 165541 0 9378 1296006 0 138263 7 0 1 0 0 Medical Services 621990 1703951 1703951 Administrative Salary 561000 1657534 1657534 Lease Income 531120 225000 225000 Net Income From Subsid 532000 102386 102386 3688871 3688871 3688871 0 0 75000 75000 1580975 1580975 629775 629775 32792 32792 8162 8162 98899 98899 6700 6700 9138 9138 9749 9749 28982 28982 Professional Fees 1915926 1912539 3387 Bad Debts 256190 256190 Bank Fees 17596 17596 Contract Labor 8726 8726 Miscellaneous 3791 3791 4682401 4632040 50361 0 17651 17467 227185 242767 1328790 1096598 2082719 1355779 755922 726940 116690288 116792674 3699737 3964677 122719573 122841123 42531 272077 14481956 13098641 14524487 13370718 X 104039035 107765987 3189652 738019 966399 966399 108195086 109470405 122719573 122841123 X 0 1 1 X 0 X X X 0 0 0 Winter Haven Hospital Inc 590724462 3 1 4632040 1 4632040 229417 229417 1159280 661757 497523 109741 109741 0 584281 584281 0 726940 Investment in Winter Haven Hospital 104242721 F Investment in Mid-Florida Medical Services Fnd 12549953 F 116792674 Deferred Compensation 457(b) Plan Liability 3964289 Accrued Pension Liability 6776303 Due to Affiliates 2358049 13098641 3688871 4682401 -993530 2268849 2268849 1275319 3688871 0 3688871 0 3688871 4682401 0 4682401 0 4682401 Part X: Description of Uncertain Tax Positions Under FIN 48: Mid-Florida Medical Services (MFMS) adopted FASB-issued guidance for accounting for uncertainty in income taxes. MFMS files a Form 990 (Return of Organization Exempt from Income Tax) annually. When the return is filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the following: the tax-exempt status of each entity, the continued tax-exempt status of bonds, and various positions relative to potential sources of unrelated business taxable income. Tax Positions are not offset or aggregated with other positons. 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. Upon the adoption of the FASB-issued guidance and as of September 30, 2010 and 2009, there were no unrecognized tax benefits identified and recorded as a liability. Part XI, Line 8 - Other Adjustments Additional Pension Liability 2,268,849 1 Florida Clinical Practice Association PO Box 100205 Gainesville FL 326100205 561680273 501(c)(3) 75000 To support clinical oncology research. 1 Other Information: Part IV: Mid-Florida Medical Services provided support to Florida Clinical Practice Assocation for oncology research. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 Lance Anastasio 321848 0 0 0 18326 0 15192 0 9669 0 365035 0 0 0 Dave MacDougall 227191 0 0 0 5286 0 16160 0 19138 0 267775 0 0 0 David Libby 150558 0 0 0 8085 0 11341 0 9626 0 179610 0 0 0 Mary Jo Schreiber 160000 0 0 0 7308 0 12186 0 0 0 179494 0 0 0 Andrea Kaye Hixon 164967 0 0 0 574 0 8991 0 387 0 174919 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 $5,177. This membership was used to entertain and hold meetings with business associates, board members and employee relations. The full amount of $5,177 was included in taxable wages. Polk County Industrial Development Authority 591292108 noneAvail 2009-03-26 20000000 Capital Expenditures 0 0 Polk County Industrial Development Authority 591292108 NoneAvail 2010-05-13 26100000 Capital Expenditures 0 0 Polk County Industrial Development Authority 591292108 7311B2AA5 2010-05-13 26100000 Capital Expenditures 0 0 Polk County Industrial Development Authority 591292108 73112BAB3 2010-05-13 14600000 Capital Expenditures 0 0 20000000 1755517 205775 18244483 1 0 0 0 26100000 1687628 170868 24241571 1 0 0 0 26100000 1583265 264989 24251829 1 0 0 0 14600000 151509 144700 14303798 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 NA 0 NA 0 0 0 1 1 Morgan Stanley 24.500000000000 0 NA 0 0 0 1 1 Morgan Stanley/Goldman 24.500000000000 0 NA 0 0 0 1 1 Goldman Sachs 30.250000000000 0 NA 0 0 Form 990, Part VI, Section B, line 11 The Director of Accounting and CFO of Mid-Florida Medical Services, Inc. intially reviewed Form 990. After their review was completed, the final Form 990 was then presented and made available to all Board Members including all voting members of the governing body. Form 990, Part VI, Section B, line 12c The Chairman of the Board of Directors inquires at least annually if there are any conflicts of interest. In addition all officers, directors, trustees and key employees are required to sign a conflict of interest statement annually. Form 990, Part VI, Section B, line 15 The Executive Compensation Committee of the Board of Directors sets compensation for the President and Vice Presidents of the hospital. The Executive Compensation Committee consists of four Board members, all of whom are independent. The Executive Compensation Committee has used the consulting firm of Sullivan and Cotter to advise them about executive compensation and to provide them with comparability data. Minutes of the Executive Compensation Committee meetings are kept and retained at the Hospital. Form 990, Part VI, Section C, line 19 The financial statements of Mid-Florida Medical Services, Inc. are made availabe to the public upon request. The organization's governing documents and conflict of interest policy are not made available to the public. Mid-Florida Critical Care Physician Services LLC 200 Ave F NE Winter Haven FL 33881 421765832 Medical Services FL 261360 18867 Mid-Florida OBGYN Hospitalist Physician Services LLC 200 Ave F NE Winter Haven FL 33881 421765830 Medical Services FL 1324907 215886 Mid-Florida Oncology Physician Services LLC 200 Ave F NE Winter Haven FL 33881 611558556 Medical Services FL 117685 8803 Mid-Florida Urology Physician Services LLC 200 Ave F NE Winter Haven FL 33881 611558558 Medical Services FL 0 0 Mid-Florida Physician Services LLC 200 Ave F NE Winter Haven FL 33881 611558557 Medical Services FL 0 0 Mid-Florida Medical Services Foundation Inc 200 Ave F NE Winter Haven FL 33881 030406130 Fundraising FL 501(c)(3) 11A - Type 1 Winter Haven Hospital Inc 200 Ave F NE Winter Haven FL 33881 590724462 Medical Services FL 501(c)(3) 3 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 Winter Haven Hospital I 225000 Winter Haven Hospital A 225000 Winter Haven Hospital N 1657534