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WINTER HAVEN HOSPITAL FOUNDATION INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
WINTER HAVEN HOSPITAL FOUNDATION INC (EIN 03-0406130)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-08-03
IRS object ID
201122159349300327
Schema version
2009v1.7
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)
Timestamp2011-08-03T15:25:42-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

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 Date2009-10-01TaxPeriodBeginDate

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 Signed2011-08-03DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTerry HaefnerName
Phone7274427110Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
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 Receipts2804018GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
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 Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers200TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1068978ContributionsGrantsPriorYear
Contributions Grants Current Year844165ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year337088InvestmentIncomePriorYear
Investment Income Current Year254343InvestmentIncomeCurrentYear
Other Revenue Prior Year-94625OtherRevenuePriorYear
Other Revenue Current Year-87795OtherRevenueCurrentYear
Total Revenue Prior Year1311441TotalRevenuePriorYear
Total Revenue Current Year1010713TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year175105GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY196565GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year33913SalariesEtcPriorYear
Salaries Etc Current Year-2450SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year138603TotalFundrsngExpCurrentYear
Other Expense Prior Year514090OtherExpensePriorYear
Other Expenses Current Year404626OtherExpensesCurrentYear
Total Expenses Prior Year723108TotalExpensesPriorYear
Total Expenses Current Year598741TotalExpensesCurrentYear
Revenues Less Expenses Prior Year588333RevenuesLessExpensesPriorYear
Revenues Less Expenses CY411972RevenuesLessExpensesCY
Total Assets BOY11620299TotalAssetsBOY
Total Assets EOY12631801TotalAssetsEOY
Total Liabilities BOY70500TotalLiabilitiesBOY
Total Liabilities EOY81848TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY11549799NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY12549953NetAssetsOrFundBalancesEOY
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
Expense360879Expense
Grants50344Grants
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 capital 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 and Stroke Center.2. Expanding the number of physicians serving the community where shortages exist based on population need.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Grants75535Grants
DescriptionMid-Florida Medical Services 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

Activity3 Activity3

FieldValueIRS element (for citing)
Grants57486Grants
DescriptionMid-Florida Medical Services 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 must meet performance standards on their annual performance evaluation.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Grants13200Grants
Revenue45837Revenue
DescriptionMid-Florida Medical Services Foundation also provided other scholarships to members of the community.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Grnt13200TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev45837TotalOfOtherProgramServiceRev
Total Program Service Expense360879TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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
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
Nbr Voting Governing Body Members16NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
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
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployee
Don Ingram
Member2.00X000
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
Joanne Ferguson-Morgan
Member2.00X000
Cindy Henry
Member2.00X000
Bet Tucker
Member2.00X000
Lance Anastasio
President & CEO2.00034017424861X
David MacDougall
Vice President/CFO2.00023247735298X
Joel L Thomas
VP/DMPR40.00012621028048X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs698861TotalReportableCompFrmRltdOrgs
Total Other Compensation88207TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events600621FundraisingEvents
All Other Contributions243544AllOtherContributions
Noncash Contributions176471NoncashContributions
Total Contributions844165TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column221551TotalRevenueColumn
Exclusion$221,551ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1666415Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1633623Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities32792Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column32792TotalRevenueColumn
Exclusion$32,792ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events26050GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events600621CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses159682FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-133632TotalRevenueColumn
Exclusion-$133,632ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Nursing Research5610003531135311
Health Fairs5610001052610526
FieldValueIRS element (for citing)
Total Other Revenue45837TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1010713TotalRevenueColumn
Related Or Exempt Function Income45837RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$120,711ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total125879Total
Program Services125879ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total70686Total
Program Services70686ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2677Total
Management And General669ManagementAndGeneral
Fundraising2008Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total-14853Total
Management And General-3713ManagementAndGeneral
Fundraising-11140Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total9726Total
Management And General2432ManagementAndGeneral
Fundraising7294Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total136236Total
Management And General34059ManagementAndGeneral
Fundraising102177Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total20200Total
Management And General20200ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total26309Total
Management And General26309ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1248Total
Management And General1248ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total7568Total
Management And General7568ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total459Total
Management And General459ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1204Total
Management And General1204ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesFundraisingFundraisingManagement And GeneralManagementAndGeneral
Consulting9087890878
Nursing Research7343673436
Property Taxes3826438264
Bank Charges28112811
Polk County Amateur Cha15001500

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total4513Total
Management And General4513ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total598741Total
Program Services360879ProgramServices
Management And General99259ManagementAndGeneral
Fundraising138603Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY127874BOY
EOY278628EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY596683BOY
EOY493184EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY2700000BOY
EOY2700000EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY24942BOY
EOY35664EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis3006780LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3420LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3004565BOY
EOY3003360EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY4830186BOY
EOY5821964EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY336049BOY
EOY299001EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11620299BOY
EOY12631801EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY70500BOY
EOY71430EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY10418EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY70500BOY
EOY81848EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY7393748BOY
EOY10845535EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3189652BOY
EOY738019EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY966399BOY
EOY966399EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11549799BOY
EOY12549953EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11620299BOY
EOY12631801EOY
FieldValueIRS element (for citing)
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$290,193Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts290193SumOfAmounts

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 Balance4110450BeginningOfYearBalance
Contributions128251Contributions
Investment Earnings Or Losses374157InvestmentEarningsOrLosses
Grants Or Scholarships13524GrantsOrScholarships
End Of Year Balance4599334EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

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 Balance0.74260BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.21010PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.04720TermEndowmentEOYBalance
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
Depreciation3420Depreciation
Book Value3341BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3003360TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDue to Winter Haven HospitalDescription
Amount$10,418Amount
FieldValueIRS element (for citing)
Total Of Amounts10418TotalOfAmounts
Total Revenue1010713TotalRevenue
Total Expenses598741TotalExpenses
Excess Or Deficit For Year411972ExcessOrDeficitForYear
Net Unrealized GL On Investments328949NetUnrealizedGLOnInvestments
Other$259,233OtherAmount
Total Adjustments588182TotalAdjustments
Excess Or Deficit Per FS1000154ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt3821850TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments302972NetUnrealizedGainsInvestments
Other Revenues2603977OtherRevenues
Revenue Not Rptd F9902906949RevenueNotRptdF990
Revenue Subtotal914901RevenueSubtotal
Other Revenues Not Included95812OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt95812RevenueNotRptdOnFinStmt
Total Revenue Per Form9901010713TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt629296TotExpensesEtcAuditedFinclStmt
Other Expenses Included30555OtherExpensesIncluded
Expenses Not Rptd F99030555ExpensesNotRptdF990
Expenses Subtotal598741ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990598741TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part V, Line 4:Description of Intended Use of Endowment Funds:The endowment funds are used for both capital improvements and scholarships.
Part X:Description of Uncertain Tax Positions Under FIN 48: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 259,234 Part XII, Line 2d - Other Adjustments: Satisfaction of Donor Restrictions 2,573,422 Revenues Netted with Expenses 30,555 Total 2,603,977 Part XII, Line 4b - Other Adjustments: Contributions Included in Net Assets 23,468 Investment Income 11,184 Special Event Revenue 61,160 Total 95,812 Part XIII, Line 2d - Other Adjustments: Expenses Netted with Revenues 30,555

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GalaNameOfEvent1
Gross Receipts Event1466320GrossReceiptsEvent1
Charitable Contributions Event1458370CharitableContributionsEvent1
Gross Revenue Event17950GrossRevenueEvent1
Rent Facility Costs Event1800RentFacilityCostsEvent1
Other Direct Expenses Event169353OtherDirectExpensesEvent1
Name Of Event2100 Holes of GolfNameOfEvent2
Gross Receipts Event299733GrossReceiptsEvent2
Charitable Contributions Event297633CharitableContributionsEvent2
Gross Revenue Event22100GrossRevenueEvent2
Rent Facility Costs Event23000RentFacilityCostsEvent2
Other Direct Expenses Event249692OtherDirectExpensesEvent2
Total Number Of Other Events2TotalNumberOfOtherEvents
Gross Receipts Other Events60618GrossReceiptsOtherEvents
Charitable Contrib Other Events44618CharitableContribOtherEvents
Gross Revenue Other Events16000GrossRevenueOtherEvents
Cash Prizes Other Events4000CashPrizesOtherEvents
Non Cash Prizes Other Events3360NonCashPrizesOtherEvents
Other Direct Expenses Other Events29477OtherDirectExpensesOtherEvents
Gross Receipts Total626671GrossReceiptsTotal
Charitable Contributions Total600621CharitableContributionsTotal
Gross Revenue Total Events26050GrossRevenueTotalEvents
Cash Prizes Total Events4000CashPrizesTotalEvents
Non Cash Prizes Total Events3360NonCashPrizesTotalEvents
Rent Facility Costs Total Events3800RentFacilityCostsTotalEvents
Other Direct Expenses Total Events148522OtherDirectExpensesTotalEvents
Direct Expense Summary Events159682DirectExpenseSummaryEvents
Net Income Summary-133632NetIncomeSummary

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)50344To provide general support to Winter Haven Hospital.
Polk State College Foundation
999 Ave H NEWinter HavenFL33881591819213501(c)(3)75000Endowed 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 Recipients39NumberOfRecipients
Amount Of Cash Grant70686AmountOfCashGrant

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 must 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
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
03218480001832601519209669036503500
David MacDougall
02271910005286016160019138026777500
Joel L Thomas
0120690000552009168018880015425800

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 $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.Explanation

Schedule M IRS990ScheduleM

Works Of Art WorksOfArt

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F9903200NoncashContribsRptdF990
Method Of Determining RevenuesExpert OpinionMethodOfDeterminingRevenues

Securities Publicly Traded SecuritiesPubliclyTraded

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions3NumberOfContributions
Noncash Contribs Rptd F9908469NoncashContribsRptdF990
Method Of Determining RevenuesFair Market ValueMethodOfDeterminingRevenues

Food Inventory FoodInventory

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F9905000NoncashContribsRptdF990
Method Of Determining RevenuesFair Market ValueMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable (4 entries)

Non Cash CheckboxNonCashCheckboxDescriptionDescriptionNumber Of ContributionsNumberOfContributionsNoncash Contribs Rptd F990NoncashContribsRptdF990Method Of Determining RevenuesMethodOfDeterminingRevenues
XAdvertising7157500Fair Market Value
XService1500Fair Market Value
XGift Card21000Fair Market Value
XGenerator Use1803Fair Market Value
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanation
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. Board of Trustees 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.
Form 990, Part VI, Section B, line 12cThe 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 15The 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 19The 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.

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 NADirectControllingEntityNABusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Mid-Florida Medical Services Inc
200 Ave F NEWinter HavenFL33881592486580Support OrganizationFL501(c)(3)11A - Type 1N/A
Winter Haven Hospital Inc
200 Ave F NEWinter HavenFL33881590724462Medical ServicesFL501(c)(3)3Mid-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 Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg