Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
THE VILLAGES TRI-COUNTY MEDICAL CENTER INC
Employer identification number
59-3527036
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
THE VILLAGES TRI-COUNTY MEDICAL CENTER INC
Employer identification number
59-3527036
Identifier
Return Reference
Explanation
DECISIONS SUBJECT TO MEMBER APPROVAL
FORM 990, PART VI, SECTION A, LINES 6, 7A, AND 7B
CENTRAL FLORIDA HEALTH ALLIANCE ("CFHA") IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH, CFHA APPOINTS THE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY AND CERTAIN DECISIONS OF THE ORGANIZATION, AS DEFINED IN THE ORGANIZATION'S BYLAWS, ARE SUBJECT TO CFHA APPROVAL.
PROCESS USED TO REVIEW 990
FORM 990, PART VI, SECTION B, LINE 11
DURING APRIL 2012, MANAGEMENT DISTRIBUTED A DRAFT OF THE 2010 FORM 990 TO FINANCE COMMITTEE FOR ITS REVIEW. THE FINANCE COMMITTEE MEMBERS HAD AN OPPORTUNITY TO PROVIDE COMMENTS AND ASK QUESTIONS WITH RESPECT TO THE DRAFT. BASED ON FEEDBACK PROVIDED FROM THE COMMITTEE MEMBERS, MANAGEMENT UPDATED THE DRAFT FORM 990. UPON FINALIZATION OF THE RETURN, MANAGEMENT PROVIDED A FINALIZED COPY OF THE RETURN TO THE BOARD OF DIRECTORS PRIOR TO FILING.
MONITORING AND ENFORCING CONFLICT OF INTEREST POLICY
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION HAS ESTABLISHED A CONFLICT OF INTEREST POLICY WHICH HAS BEEN REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. THE ORGANIZATION'S POLICY REQUIRES CERTAIN INDIVIDUALS TO DISCLOSE PARTICIPATION IN ACTIVITIES OR CIRCUMSTANCES THAT MAY PRESENT A CONFLICT OF INTEREST ON AN ANNUAL BASIS OR IF AT ANY TIME SUCH INDIVIDUAL BECOMES AWARE OF CIRCUMSTANCES THAT MAY PRESENT A CONFLICT OF INTEREST. THESE DISCLOSURES ARE REVIEWED BY THE BOARD. INDIVIDUALS COVERED BY THE CONFLICT OF INTEREST POLICY MUST ABSTAIN FROM DELIBERATIONS AND VOTING WITH RESPECT TO TRANSACTIONS WHEREIN A CONFLICT IS DEEMED TO EXIST.
PROCESS FOR DETERMINING COMPENSATION
FORM 990, PART VI, SECTION B, LINE 15B
THE BOARD OF THE ORGANIZATION APPOINTS THE COMPENSATION COMMITTEE. THE INDIVIDUALS SERVING ON THE COMPENSATION COMMITTEE ALSO SERVE ON THE EXECUTIVE COMMITTEE OF THE ORGANIZATION. THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE COMPENSATION FOR THE PRESIDENT AND CEO AS WELL AS THE VICE PRESIDENTS AND SENIOR VICE PRESIDENTS. THE COMPENSATION COMMITTEE HAS A COMPENSATION CHARTER AND PHILOSOPHY. THE ORGANIZATION UTILIZES COMPARABLE COMPENSATION INFORMATION FROM COMMUNITY HOSPITAL CORPORATION AS ITS THIRD PARTY NEUTRAL SOURCE TO PREPARE AND GATHER MARKET INFORMATION FOR REVIEW BY THE COMPENSATION COMMITTEE. DETAILED MINUTES ARE KEPT OF ALL ACTIONS.
INVESTMENT IN JOINT VENTURE
FORM 990, PART VI, SECTION B, LINE 16B
BEFORE PARTICIPATING IN A JOINT VENTURE, THE ORGANIZATION WILL ENSURE THAT THE JOINT VENTURE FURTHERS THE ORGANIZATION'S EXEMPT PURPOSES AND WILL NEGOTIATE AT ARM'S LENGTH CONTRACTUAL AND OTHER TERMS OF PARTICIPATION THAT SAFEGUARD THE ORGANIZATION'S EXEMPTION FROM FEDERAL INCOME TAX. SUCH TERMS SHALL BE IN WRITING IN THE OPERATING AGREEMENT OF THE JOINT VENTURE. THE ORGANIZATION PARTICIPATES IN JOINT VENTURES THAT ARE BENEFICIAL TO THE HEALTH CARE OF THE COMMUNITY.
MAKING DOCUMENTS AVAILABLE TO THE PUBLIC
FORM 990, PART VI, SECTION C, LINE 19
GENERALLY, THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS OR ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. HOWEVER, THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE PUBLICLY AVAILABLE THROUGH FLORIDA'S SECRETARY OF STATE WEBSITE WWW.SUNBIZ.COM.
PREPARING SCHEDULE K
SCHEDULE K, PART I, LINE 1, COLUMNS E AND G AND LINE 1
PLEASE NOTE THAT THE SCHEDULE K IS COMPLETED IN A MANNER THAT IS CONSISTENT WITH THE FORM 8038 FILED FOR THE 2008BC BOND ISSUE ALTHOUGH A PORTION OF THE 2008BC BOND WAS REFUNDED BY THE 2009A BOND ISSUE LISTED.
BOND DESCRIPTION
SCHEDULE K, PART I, COLUMN F, LINES A AND B
DESCRIPTION LINE A: VILLAGES 2008BC ISSUE WAS USED TO REFUND THE SERIES 2006 ISSUE JANUARY 25, 2006 DESCRIPTION LINE B: VILLAGES 2009A ISSUE WAS USED TO REFUND A PORTION OF THE 2008BC ISSUE
OTHER CHANGES IN NET ASSETS OR FUND BALANCES
FORM 990, PART XI, LINE 5
OTHER CHANGES IN NET ASSETS: CHANGE IN FMV OF INTEREST RATE: 626,665 NET ASSET TRANSFER TO LEESBURG REGIONAL: 428,131 TOTAL: 1,054,796
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DAVID L SUSTARSIC MD TITLE:CHAIRMAN HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:ROBERT Q WILLIAMS ESQUIRE TITLE:VICE CHAIRMAN HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:W THOMAS BROOKS TITLE:SECRETARY HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:GREGORY R LEWIS TITLE:TREASURER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JOHN D BRANDEBURG TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:SHIVAKUMAR S HANUBAL MD TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:TIMOTHY H SENNETT TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:TIMOTHY I SULLIVAN TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:TERRY R UPTON TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DON V HAHNFELDT TITLE:Board Member HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:ROGER W. SHERMAN MD TITLE:Board Member HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:EVAN RICHARDS TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JANET BOLIVAR TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DIANE SPENCER TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JOHN A COWIN MD TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:GEORGE E KAINZ MD TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:LEE HUNTLEY TITLE:PRESIDENT/CEO HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:TIMOTHY HAWKINS TITLE:TVHS CEO HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:PHYLLIS BAUM TITLE:LRMC CEO HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DALE E HOCKING TITLE:SENIOR VP/CFO HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DANIEL CARLSON TITLE:SENIOR VP MEDICAL AFFAIRS HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:NANCY VESTER TITLE:VP INFO & TECH HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DARLENE STONE TITLE:SENIOR VP HUMAN RESOURCES HOURS:50