2011-08-03T15:25:42-05:00 2010-09-30 PERSHING YOAKLEY & ASSOCIATES PC 2963 GULF TO BAY BLVD STE 267 CLEARWATER FL 337594255 990 2009-10-01 030406130 Mid-Florida Medical Services Foundation Inc MID- 8632931121 200 Ave F NE Winter Haven FL 33881 Joel Thomas 8632931121 2011-08-03 1 Terry Haefner 7274427110 2009 2016-02-24 21:20:13Z Winter Haven Hospital Foundation Joel Thomas 200 Ave F NE Winter Haven FL 33881 2804018 0 X www.mfms.com X 2002 FL Mid-Florida Medical Services Foundation raises philanthropic funds to support Winter Haven Hospital's healthcare mission. 16 16 0 200 0 0 1068978 844165 0 337088 254343 -94625 -87795 1311441 1010713 175105 196565 0 33913 -2450 0 138603 514090 404626 723108 598741 588333 411972 11620299 12631801 70500 81848 11549799 12549953 Mid-Florida Medical Services Foundation raises philanthropic funds to support Winter Haven Hospital, Inc's healthcare mission. 0 0 360879 50344 Mid-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. 75535 Mid-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. 57486 Mid-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. 13200 45837 Mid-Florida Medical Services Foundation also provided other scholarships to members of the community. 13200 45837 360879 1 1 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 16 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Joel Thomas 8632931121 200 Avenue F NE Winter Haven FL 33881 X Don Ingram 2.00 X 0 0 0 Charles W McPherson 2.00 X 0 0 0 Brian K Swain 2.00 X 0 0 0 William G Burns 2.00 X X 0 0 0 Eric Adamson 2.00 X X 0 0 0 Mike Compton 2.00 X 0 0 0 Steve Cassidy 2.00 X 0 0 0 Dorothy Griffin 2.00 X 0 0 0 Alan Gustafson 2.00 X 0 0 0 Steve Saterbo 2.00 X 0 0 0 Bud Strang 2.00 X X 0 0 0 Richard Straughn 2.00 X 0 0 0 Lynn Oakley 2.00 X X 0 0 0 Joanne Ferguson-Morgan 2.00 X 0 0 0 Cindy Henry 2.00 X 0 0 0 Bet Tucker 2.00 X 0 0 0 Lance Anastasio 2.00 X 0 340174 24861 David MacDougall 2.00 X 0 232477 35298 Joel L Thomas 40.00 X 0 126210 28048 0 698861 88207 0 0 1 0 0 600621 243544 176471 844165 221551 221551 1666415 1633623 32792 32792 32792 26050 600621 159682 -133632 -133632 Nursing Research 561000 35311 35311 Health Fairs 561000 10526 10526 45837 1010713 45837 0 120711 125879 125879 70686 70686 2677 669 2008 -14853 -3713 -11140 9726 2432 7294 136236 34059 102177 20200 20200 26309 26309 1248 1248 7568 7568 459 459 1204 1204 Consulting 90878 90878 Nursing Research 73436 73436 Property Taxes 38264 38264 Bank Charges 2811 2811 Polk County Amateur Cha 1500 1500 4513 4513 598741 360879 99259 138603 127874 278628 596683 493184 2700000 2700000 24942 35664 3006780 3420 3004565 3003360 4830186 5821964 336049 299001 11620299 12631801 70500 71430 0 10418 70500 81848 X 7393748 10845535 3189652 738019 966399 966399 11549799 12549953 11620299 12631801 X 0 1 1 X 0 X X X 0 0 0 Winter Haven Hospital Inc 590724462 3 1 290193 1 290193 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4110450 128251 374157 13524 4599334 3324387 592125 245307 51369 4110450 0.74260 0.21010 0.04720 0 0 3000019 3000019 6761 3420 3341 3003360 Due to Winter Haven Hospital 10418 10418 1010713 598741 411972 328949 259233 588182 1000154 3821850 302972 2603977 2906949 914901 95812 95812 1010713 629296 30555 30555 598741 0 598741 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 Gala 466320 458370 7950 800 69353 100 Holes of Golf 99733 97633 2100 3000 49692 2 60618 44618 16000 4000 3360 29477 626671 600621 26050 4000 3360 3800 148522 159682 -133632 1 Winter Haven Hospital 200 Ave F NE Winter Haven FL 33881 590724462 501(c)(3) 50344 To provide general support to Winter Haven Hospital. Polk State College Foundation 999 Ave H NE Winter Haven FL 33881 591819213 501(c)(3) 75000 Endowed chair 2 Scholarships 39 70686 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule 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. X 1 1 X X X 0 0 0 0 0 0 0 0 0 Lance Anastasio 0 321848 0 0 0 18326 0 15192 0 9669 0 365035 0 0 David MacDougall 0 227191 0 0 0 5286 0 16160 0 19138 0 267775 0 0 Joel L Thomas 0 120690 0 0 0 5520 0 9168 0 18880 0 154258 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. X 1 3200 Expert Opinion X 3 8469 Fair Market Value X 1 5000 Fair Market Value X Advertising 7 157500 Fair Market Value X Service 1 500 Fair Market Value X Gift Card 2 1000 Fair Market Value X Generator Use 1 803 Fair Market Value 0 0 0 Form 990, Part VI, Section A, line 6 The sole member of Mid-Florida Medical Services Foundation, Inc. is Winter Haven Hospital, Inc. Form 990, Part VI, Section A, line 7a The 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 7b Any 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 11 The 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 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 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. Mid-Florida Medical Services Inc 200 Ave F NE Winter Haven FL 33881 592486580 Support Organization FL 501(c)(3) 11A - Type 1 N/A Winter Haven Hospital Inc 200 Ave F NE Winter Haven FL 33881 590724462 Medical Services FL 501(c)(3) 3 Mid-Florida Medical Services Inc 0 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 1 0