Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
Trustees of Mease Hospital Inc
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
601 Main Street
Suite
Room/suite
City or town, state or country, and ZIP + 4
Dunedin, FL34698
D Employer identification number

59-0855412
E Telephone number

G Gross receipts $ 362,124,625
F Name and address of principal officer:
Glenn Waters
601 Main Street
Dunedin,FL34698
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.measehospitals.com
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1938
M State of legal domicile: FL
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: Trustees of Mease Hospital, Inc. will improve the health of all we serve through community-owned health care services that set the standard for high-quality, compassionate care.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 24
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 19
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 2,598
6 Total number of volunteers (estimate if necessary) ............. 6 767
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 18,187
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 11,958
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 2,486,532 1,553,837
9 Program service revenue (Part VIII, line 2g) ......... 361,143,068 346,663,105
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -102,871 286,039
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 4,772,225 13,490,289
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 368,298,954 361,993,270
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 184,622 202,825
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 125,228,933 124,794,608
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 190,833,546 193,434,698
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 316,247,101 318,432,131
19 Revenue less expenses. Subtract line 18 from line 12....... 52,051,853 43,561,139
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 446,527,449 474,236,120
21 Total liabilities (Part X, line 26)............. 36,093,542 21,658,438
22 Net assets or fund balances. Subtract line 21 from line 20..... 410,433,907 452,577,682
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: Trustees of Mease Hospital, Inc. will improve the health of all we serve through community-owned health care services that set the standard for high-quality, compassionate care.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 267,273,878 including grants of $ 202,825 ) (Revenue $ 355,735,702 )
Trustees of Mease Hospital, Inc. (TOM) is a full-service 443-bed community hospital. During 2012, TOM provided inpatient care to 21,428 patients, treated 77,301 patients in the emergency department, and delivered 2,075 babies. Through efforts of the medical assistance program and the hospital's charity care program TOM saw a net community benefit expense of $26.0 million. The hospital also provided other community services totaling more than $1.5 million. Some of the programs included Faith Community Nursing, Health Fairs, and Support groups. Refer to Schedule H for additional information.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet267,273,878
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III
Click to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment
...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II
.......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV
..................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I
...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
312
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
2,598
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
24
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
19
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletCarl Tremonti300 PINELLAS STClearwaterFL33756 (727) 462-7176
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) GLENN WATERS........................................................................
TRUSTEE AND PRESIDENT
1.0
.......................48.0
X   X       0 1,066,245 193,461
(2) MAHESH AMIN........................................................................
TRUSTEE AND CHAIRMAN
1.0
.......................3.0
X   X            
(3) ED ARMSTRONG........................................................................
TRUSTEE
1.0
.......................3.0
X                
(4) ALAN BOMSTEIN........................................................................
TRUSTEE
1.0
.......................3.0
X                
(5) JAMES CANTONIS........................................................................
TRUSTEE
1.0
.......................3.0
X                
(6) V RAYMOND FERRERA........................................................................
Trustee and VICE CHAIRMAN
1.0
.......................4.0
X   X            
(7) WILLIAM HORNE........................................................................
TRUSTEE AND SECRETARY
1.0
.......................2.0
X   X            
(8) JIM HUGUET........................................................................
TRUSTEE
1.0
.......................2.0
X                
(9) LONNIE KLEIN........................................................................
TRUSTEE
1.0
.......................2.0
X                
(10) ODALYS LARA........................................................................
TRUSTEE
1.0
.......................2.0
X                
(11) ROBERT MCGIVNEY........................................................................
TRUSTEE AND TREASURER
1.0
.......................3.0
X   X            
(12) LARRY MORGAN........................................................................
TRUSTEE
1.0
.......................3.0
X                
(13) THOMAS NASH........................................................................
TRUSTEE
1.0
.......................2.0
X                
(14) STEPHEN MASON........................................................................
TRUSTEE
1.0
.......................50.0
X           0 4,003,358 49,908
(15) MARC BOWMAN........................................................................
TRUSTEE
1.0
.......................2.0
X                
(16) DEWEY MITCHELL........................................................................
TRUSTEE
1.0
.......................2.0
X                
(17) NANCY RIDENOUR........................................................................
TRUSTEE
1.0
.......................2.0
X                
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) STEPHANIE VANZANDT........................................................................
TRUSTEE
1.0
.......................2.0
X                
(19) THOMAS WHIDDON........................................................................
TRUSTEE
1.0
.......................3.0
X                
(20) GAY LANCASTER........................................................................
TRUSTEE
1.0
.......................2.0
X                
(21) CHRISTOS PITARYS........................................................................
TRUSTEE
1.0
.......................2.0
X                
(22) TED SMALL........................................................................
TRUSTEE
1.0
.......................2.0
X                
(23) MICHAEL WANGER........................................................................
TRUSTEE
1.0
.......................47.0
X           0 538,856 36,825
(24) DEBBIE WHITE........................................................................
TRUSTEE
1.0
.......................2.0
X                
(25) CARL TREMONTI........................................................................
CFO - MPM
1.0
.......................49.0
    X       0 394,465 42,657
(26) CELIA LARIMORE........................................................................
DIR SURGICAL SERVICES - MEASE
45.0
.......................  
      X     187,617 0 31,510
(27) GERALD MASSEY........................................................................
DIRECTOR, OPERATIONS - MEASE
45.0
.......................  
      X     170,718 0 14,020
(28) ROBIN LAPHAM........................................................................
DIR. PATIENT SERVICES - MCH
45.0
.......................  
      X     169,797 0 23,145
(29) LOUIS GALDIERI........................................................................
COO, MEASE HOSPITALS
1.0
.......................45.0
      X     0 391,647 51,984
(30) MOHSEN HABIB........................................................................
MANAGER PHARMACY
45.0
.......................  
        X   161,119 0 28,614
(31) KELLY CULLEN........................................................................
DIR PATIENT SVCS, MDH/ER
45.0
.......................  
        X   182,850 0 19,146
(32) GERMAIN SIESS........................................................................
MANAGER PHARMACY
45.0
.......................  
        X   138,983 0 18,319
(33) NICOLE HANNA........................................................................
CLINICAL PHARMACIST
45.0
.......................  
        X   139,732 0 23,091
(34) MAIKEL BOLOS........................................................................
CLINICAL PHARMACIST
45.0
.......................  
        X   145,497 0 12,837
(35) PETER BLUMENCRANZ........................................................................
FORMER DIRECTOR
 
.......................45.0
          X 0 725,614 36,628
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,296,313 7,120,185 582,145
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet50
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
WEHR CONSTRUCTORS INC, 4425 N LOIS AVTAMPAFL33614 construction srvs 2,239,959
BAY LINEN INC, 11525 47TH ST NORTHCLEARWATERFL33762 LAUNDRY SERVICES 2,012,230
PERKINS WILL, 15057 Collections Center DrCHICAGOIL60693 construction svcs 1,296,727
SIEMENS MEDICAL SOLUTIONS USA, PO BOX 120001 Dept 0733DALLASTX75312 IT Consulting 1,258,037
GRAHAM FLORIDA II MEDICAL BLDGS, 505 FIFTH AVE STE 200DES MOINESIA503092449 architectural svcs 939,638
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet31
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 1,537,507
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above
1f
16,330
g Noncash contributions included in lines
1a-1f:$
 
h Total. Add lines 1a-1f.......MediumBullet 1,553,837
 Program Service Revenue Business Code
2a HOSPITAL PATIENT CARE 621999 187,870,369 187,870,369    
b MEDICARE/MEDICAID NET REVENUE 621999 158,597,021 158,597,021    
c RENTAL INCOME FROM AFFILIATES 532000 195,715 195,715    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 346,663,105
 Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 36,595   18,187 18,408
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 2,715,559  
b Less: rental expenses    
c Rental income or (loss) 2,715,559 0
d Net rental income or (loss).......MediumBullet 2,715,559     2,715,559
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   380,799
b Less: cost or other basis and sales expenses   131,355
c Gain or (loss)   249,444
d Net gain or (loss)..........MediumBullet 249,444     249,444
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CAFETERIA 722310 1,702,133     1,702,133
b MISCELLANEOUS 621999 955,351 955,351    
c HITECH ELECTRONIC MEDICAL RECORD INCENTIVE 621999 8,117,246 8,117,246    
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 10,774,730
12 Total revenue. See Instructions......MediumBullet 361,993,270 355,735,702 18,187 4,685,544
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 202,825 202,825
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 599,806 412,068 187,738  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 106,323,280 106,289,587 33,693  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 3,552,607 3,551,481 1,126  
9 Other employee benefits ....... 6,712,102 6,709,975 2,127  
10 Payroll taxes ........... 7,606,813 7,595,235 11,578  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 126   126  
c Accounting ........... 0      
d Lobbying ........... 10,098 10,098    
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 7,477,109 6,751,768 725,341  
12 Advertising and promotion .... 401,566 401,341 225  
13 Office expenses ....... 5,390,106 3,039,999 2,350,107  
14 Information technology ...... 228,787 226,105 2,682  
15 Royalties .. 0      
16 Occupancy ........... 7,305,559 7,247,311 58,248  
17 Travel ............ 107,175 3,368 103,807  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 5,821,859 5,815,048 6,811  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 20,761,738 20,754,418 7,320  
23 Insurance .............. 1,695,350 424,619 1,270,731  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 51,047,916 51,047,916    
b MANAGEMENT FEES 45,653,732   45,653,732  
c BAD DEBT EXPENSE 19,863,789 19,863,789    
d IMPAIRMENT LOSS 14,120,453 14,120,453    
e All other expenses 13,549,335 12,806,474 742,861  
25 Total functional expenses. Add lines 1 through 24e 318,432,131 267,273,878 51,158,253 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 6,629 1 456,248
2 Savings and temporary cash investments ......... 0 2 0
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 38,162,798 4 37,685,422
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 4,260,412 7 3,040,823
8 Inventories for sale or use .............. 5,981,732 8 6,062,502
9 Prepaid expenses and deferred charges .......... 1,125,669 9 1,290,697
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 340,762,178
b Less: accumulated depreciation ..... 10b 182,585,462 175,361,027 10c 158,176,716
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 345,863 13 312,168
14 Intangible assets ............... 6,783,581 14 6,050,221
15 Other assets. See Part IV, line 11 ........... 214,499,738 15 261,161,323
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 446,527,449 16 474,236,120
Liabilities 17 Accounts payable and accrued expenses ......... 14,997,748 17 14,019,667
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 2,363,659 19 1,166,945
20 Tax-exempt bond liabilities ............. 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 5,069,082 23 4,623,095
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 13,663,053 25 1,848,731
26 Total liabilities. Add lines 17 through 25......... 36,093,542 26 21,658,438
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 410,433,907 27 452,577,682
28 Temporarily restricted net assets ........... 0 28 0
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 410,433,907 33 452,577,682
34 Total liabilities and net assets/fund balances ........ 446,527,449 34 474,236,120
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
361,993,270
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
318,432,131
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
43,561,139
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
410,433,907
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-1,417,364
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
452,577,682
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Trustees of Mease Hospital Inc
 
Employer identification number

59-0855412
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
f
g
(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 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 monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
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........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
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 ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
Trustees of Mease Hospital Inc
 
Employer identification number

59-0855412
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
Trustees of Mease Hospital Inc
 
Employer identification number

59-0855412
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
Trustees of Mease Hospital Inc
 
Employer identification number

59-0855412
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
Trustees of Mease Hospital Inc
 
Employer identification number

59-0855412
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  

Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Trustees of Mease Hospital Inc
 
Employer identification number

59-0855412
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in)
(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e))
         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))
         
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
 
c
Media advertisements? ....................................
 
 
 
d
Mailings to members, legislators, or the public? .........................
 
 
 
e
Publications, or published or broadcast statements? .......................
 
 
 
f
Grants to other organizations for lobbying purposes? .......................
 
 
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
 
 
i
Other activities? ..........................
Yes
 
10,098
j
Total. Add lines 1c through 1i ...............................
10,098
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
SCHEDULE C PART II-B, LINE 1I   DUES WERE PAID TO THE FLORIDA HOSPITAL ASSOCIATION. THIS ASSOCIATION USES A PORTION OF ITS DUES FOR LOBBYING ACTIVITIES.
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Trustees of Mease Hospital Inc
 
Employer identification number

59-0855412
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........
         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   11,967,167 11,967,167
b Buildings ................   176,640,150 73,380,618 103,259,532
c Leasehold improvements ............   75,223 9,403 65,820
d Equipment ................   135,107,087 109,195,441 25,911,646
e Other .................   16,972,551   16,972,551
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 158,176,716
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)
(b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) DUE FROM AFFILIATES 261,161,323








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 261,161,323
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
EST 3RD PARTY SETTLEMENTS 1,565,563
ASSET RETIREMENT OBLIGATION LT 108,620
ASSET RETIREMENT OBLIGATION ST 164,500
DEPOSITS 10,048





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,848,731
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 360,356,622
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 120,144
e Add lines 2a through 2d ..................... 2e 120,144
3 Subtract line 2e from line 1..................... 3 360,236,478
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b 1,756,792
c Add lines 4a and 4b....................... 4c 1,756,792
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 361,993,270
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1 318,212,846
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3 318,212,846
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b 219,285
c Add lines 4a and 4b....................... 4c 219,285
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 318,432,131
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Sch D Supplemental Information   Schedule D, Part XI, Line 2d Unrealized gain on swaps $120,144 Schedule D, Part XI, Line 4b Change in net assets of foundation $1,537,507 Revenues netted against expenses $219,287 Rounding ($2) Total $1,756,792 Schedule D, Part XII, Line 4b Revenues netted against expenses $219,287 Rounding ($2) Total $219,285
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Trustees of Mease Hospital Inc
 
Employer identification number

59-0855412
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
 
No
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) ..
2 11,428 11,751,599   11,751,599 3.940 %
b Medicaid (from Worksheet 3,
column a) ....
2 21,082 33,584,957 20,835,877 12,749,080 4.270 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) .
2 56 94,405 20,121 74,284 0.020 %
d Total Financial Assistance
and Means-Tested
Government Programs .
6 32,566 45,430,961 20,855,998 24,574,963 8.230 %
Other Benefits
7 9,662 183,168   183,168 0.060 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) ..
2 7 1,188,552   1,188,552 0.400 %
g Subsidized health services
(from Worksheet 6) ..
           
h Research (from Worksheet 7) 2   40,777   40,777 0.010 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8)
8 12 39,144   39,144 0.010 %
j Total. Other Benefits .. 19 9,681 1,451,641   1,451,641 0.480 %
k Total. Add lines 7d and 7j . 25 42,247 46,882,602 20,855,998 26,026,604 8.710 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
19,863,789
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
9,394,843
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
82,018,212
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
86,579,849
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-4,561,637
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?2
Name, address, and primary website address
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Mease Countryside Hospital
3231 McMullen Booth Rd
Clearwater,FL33761
www.mpmhealth.com
X X         X     A
2 Mease Dunedin Hospital
601 Main Street
Dunedin,FL34698
www.mpmhealth.com
X X         X     A
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
A - Trustees of Mease Hospital Inc
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1    
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20  
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3    
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4    
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5    
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7    
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a    
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 250.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?2
Name and address Type of Facility (describe)
1 TRINITY IMMEDIATE CARE CENTER
1306 SEVEN SPRINGS BLVD
TRINITY,FL34655
IMMEDIATE CARE
2 WALSINGHAM IMMEDIATE CARE CENTER
13670 WALSINGHAM ROAD
LARGO,FL33774
IMMEDIATE CARE
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
Part I Line 3c   Patients who are uninsured or underinsured and cannot pay for hospital services are eligible for charity consideration. These patients are screened by designated team members in our Financial Assistance Department. The Agency for Health Care Administration (AHCA) defines charity eligibility at 200 percent of the federal poverty guidelines, unless the total hospital bill is more than 25 percent of the patient's annual income. Medicaid recipients who have exceeded their coverage limits are also considered for charity care. Trustees of Mease Hospital, Inc goes above and beyond the AHCA requirements by providing additional "hardship" charity for patients who are at 250 percent of the federal poverty guidelines. In addition, an uninsured discount of 40% is automatically given to any patient who does not have insurance coverage or benefits. There is no income or asset test required for the uninsured discount. Patients receive an additional 10% discount if the account is paid within 30 days.
Part I Line 6a   N/A - The Community Benefit Report is available to the public.
Part I Line 7   Financial assistance and means-tested government programs costs (lines A through D) are determined using our cost accounting system, which captures all inpatients and outpatients, including emergency room patients. The system also captures all patient pay types - private insurance, Medicare, Medicaid, uninsured and self pay. The costs have been offset by any payments received from Medicaid or any other uncompensated care program. Other benefits at cost (lines E through J, as well as amounts reported in Part II) were compiled by the community health department using the Catholic Health Association guide for planning and reporting community benefits.
Part I Line 7 Column f   Bad Debt expense of $19,863,789 was included on form 990, Part IX, Line 25, Column (a), but subtracted for purposes of calculating the percentage in this column.
Part III Line 2,3, & 4   The organization's financial statements do not include a footnote directly on bad debt expense. Bad debt expense is reported as total bad debt for the facility. The amount of bad debt expense attributable to patients eligible for financial assistance is calculated as a charge ratio, derived from data sampling. The resulting charge ratio is then applied to total bad debt accounts of the organization, which calculates the bad debt attributable to finance assistance. The state of Florida requires the patient to provide certain documentation in order to qualify for financial assistance. In cases where the patient has not responded to hospital requests or billing statement alerts, those accounts are processed as bad debt, if unpaid.
Part III Line 8   Cost reports were used to report Medicare allowable costs. Medicare defines allowable costs as those appropriate and helpful in developing and maintaining the operation of patient care facilities and activities. It specifically excludes certain costs that are not directly related to patient care. The hospital incurs additional expense related to the provision of care to Medicare patients that Medicare has deemed non-allowable. This additional expense includes costs of physician services (emergency on-call fees, hospitalist program, recruitment, etc.), advertising costs, cafeteria costs for meals sold to visitors, etc. The hospital attempts to collect coinsurance and deductibles from Medicare beneficiaries. To the extent collection efforts are unsuccessful, Medicare reimburses the hospital at 70% of unpaid amounts. The following table reconciles the surplus or shortfall from Line 7 to the actual surplus or shortfall. The additional costs were allocated to Medicare based upon Medicare's percentage of total allowable costs. The unpaid coinsurance/deductibles were estimated using historical collection results. Any shortfall amounts have not been treated as community benefit. Line 7 Surplus or (Shortfall) ($4,561,637) Additional non-allowable costs and unpaid/non-reimbursed coinsurance/deductibles ($10,649,767) Total Surplus or (Shortfall) ($15,211,404)
Part III Line 9b   Patients who are unable to pay are encouraged by BayCare Health System representatives, via personal interviews, signage, on patient billing statements, brochures or Customer Service phone calls, to submit financial information to the Financial Assistance Department to determine eligibility for programs, such as County, Medicaid, Disability, Victims of Crime, Charity, etc. For those patients who provide all the necessary documentation and qualify for charity according to the Financial Assistance policy, (defined in Part I, line 3c), patients' account balance would be written off completely to charity and not billed to the patients.
Part V Section B Line 11   An uninsured discount of 40% is given to any patient who does not have insurance coverage or benefits. There is no income or asset test required for the uninsured discount. Patients receive an additional 10% discount if the account is paid within 30 days.
Part V Section B Line 14   Contact information related to financial assistance is posted in the emergency room waiting area, admissions office, and printed on all patient billing.
Part V Section B Line 16   Lien action related to collections is limited to patients involving auto liability insurance.
Part V Section B Line 20d   Patients who are uninsured or underinsured and cannot pay for hospital services are eligible for charity consideration. These patients are screened by designated team members in our Financial Assistance Department. The Agency for Health Care Administration (AHCA) defines charity eligibility at 200 percent of the federal poverty guidelines, unless the total hospital bill is more than 25 percent of the patient's annual income. Medicaid recipients who have exceeded their coverage limits are also considered for charity care. Trustees of Mease Hospital, Inc goes above and beyond the AHCA requirements by providing additional "hardship" charity for patients who are at 250 percent of the federal poverty guidelines. Once a patient is identified as eligible for financial assistance his/her account balance is written off 100% to charity write-offs and are no longer billed for services provided.
Part VI - Line 2 Needs Assessment   Trustees of Mease Hospital, Inc is committed to meeting the needs of the community it serves. Our quality philosophy is modeled around understanding our customers' needs in the communities it serves. Trustees of Mease Hospital, Inc addresses community health status assessments by accessing existing third party databases profiling health status information for geographies it serves. The assessments provide a profile of health status indicators in comparison to state averages and, if available, national benchmarks. In addition, Trustees of Mease Hospital, Inc conducts physician community need studies that outline physician deficits by specialty for the geographic area served. Studies are also conducted to identify gaps in geographic access to services such as primary care, outpatient services and inpatient services. All of the above processes occur on an ongoing basis to assist Trustees of Mease Hospital, Inc in developing initiatives and programs/services to address identified health care needs in the communities it serves.
Part VI - Line 3 Patient Education of Eligibility for Assistance   Trustees of Mease Hospital, Inc Financial Assistance team members are dedicated to assisting patients in obtaining assistance through federal, state and local government programs or through the Trustees of Mease Hospital, Inc financial assistance policy. Signage and brochures are available, as well as team members whose full responsibility is to assist patients in the emergency room and on inpatient units. The Financial Assistance team interviews patients for all available programs, assists the patients in completing applications to government agencies and for hospital charity care, advises patients regarding available community resources for health care, reviews and approves patient requests for charity care, and provides education and support to the patient throughout the assistance process. In addition to the aforementioned comprehensive process, Trustees of Mease Hospital, Inc also informs and educates patients who may be billed for patient care, but may be eligible for charity or other programs, via patient billing statements and customer service representative calls. The goal in using these various means is to effectively communicate with the entire patient population so they are informed and educated about their eligibility for assistance.
Part VI - Line 4 Community Information   Mease Hospitals are in a suburban setting serving parts of Hillsborough, Pasco and Pinellas counties. The average income is lower than both the state and national averages. The population served is predominantly Caucasian and high-school or higher educated. Hispanics are the second largest ethnic group representing 11% of the population and 13% of households are at poverty level. Mease Hospitals are part of BayCare Health System that serves west central Florida. The area served by Mease Hospitals has 8 hospitals with 5 being Not-For-Profit. There are 4 federally designated medically underserved areas in Mease Hospitals' service area. With the over 65 population expected to grow 11% in the next five years, the health care needs of our service area are expanding and changing. The population served by Mease Hospitals is expected to grow 2.7% in the next 5 years. This expected growth is lower than the expected growth rate for the United States. However, the population Age 55+ is expected to grow 10% in the next 5 years. The community experiences higher incidence rates compared to the state of Florida in the following areas: adults with asthma, HIV cases, AIDs cases, adults with high blood cholesterol, melanoma, asthma hospitalization, adult smokers, domestic violence, fully immunized kindergarteners and sexually transmitted diseases. Based on Florida inpatient discharge data for the period of 10/01/11-09/30/12, the payor mix for the geographic area consists of 54.9% Medicare/Medicare HMO, 13.6% Medicaid/Medicaid HMO, 20.8% Commercial Insurance, 7.5% Self-pay, and 3.2% Other.
Part VI - Line 5 Promotion of Community Health   Mease Countryside and Mease Dunedin Hospitals Residents of the small city of Dunedin encouraged Dr. Jack Mease to build a hospital with the community's help in 1937. Today Mease Dunedin is a 143-bed hospital celebrating more than 75 years of meeting the needs of the community it serves. Mease Countryside Hospital originally began as a satellite clinic to Mease Dunedin Hospital. The needs of the community grew along with a housing boom and in 1985 Mease Countryside Hospital opened. Today, Mease Countryside Hospital is a 300-bed facility. Mease Countryside Hospital has been nationally recognized by Truven in a study identifying the 100 top U.S. hospitals based on their overall organizational performance. This marks the ninth time Mease Countryside has been recognized among the 100 Top Hospitals. Mease Countryside also was among 16 hospitals in the nation to receive an Everest Award from Truven, which recognizes hospitals that have achieved both the highest current performance and the fastest long-term improvement over five years. The Truven Health 100 Top Hospitals study evaluates performance in 10 areas: mortality; medical complications; patient safety; average patient stay; expenses; profitability; patient satisfaction; adherence to clinical standards of care; core measures score; and post-discharge mortality and readmission rates for acute myocardial infarction (heart attack), heart failure, and pneumonia. 2012 Overview Mease Dunedin Hospital Construction of New Operative Suites In June, the hospital opened its new surgical center featuring three integrated technology operating suites, better suited to accommodate today's surgical equipment. Averaging approximately 600-square-feet, the new operating suites are more than double the size of previous operating rooms. 75th Anniversary On April 18, 1937, Mease Dunedin opened as a 19-bed hospital with a staff of three physicians and two nurses. In 2012, Mease Dunedin celebrated its 75th year of improving the health of the community. Celebrations included team member events and a proclamation by the City of Dunedin. Weight Loss Surgery Program Mease Dunedin Hospital is the center for the Surgical Bariatric Program within Morton Plant Mease. It is the only hospital in the BayCare Health System that currently performs all three surgical weight loss procedures; Gastric Band, Sleeve Gastrectomy, and Gastric Bypass. The goal is to become a Bariatric Center of Excellence. Mease Countryside Hospital In January, the new Mease Countryside Wound Care Center at East Lake Outpatient Center opened, offering patients needing care for chronic wounds another location option in the north Pinellas and Trinity areas. Work started on a new Central Utility Plant (CUP), the first phase of the hospital's master facility plan. The new CUP building is scheduled for completion in 2014. Commitment to Children's Care Mease Countryside Hospital continued its commitment to strengthen and advance children's care in north Pinellas and south Pasco counties through its partnership with St. Joseph's Children's Hospital. Called St. Joseph's Children's at Morton Plant Mease, the goal of the partnership is to bring more access to innovative and high-tech care in a family-centered setting to the community. A child life specialist works with children and their parents to bring a sense of normalcy to the experience of hospitalization. Through Children's Advocacy, Mease Countryside Hospital is committed to providing leadership, experience and expertise as a community and state resource to advocate for the health and wellbeing of children and their families. Educational classes and community activities include home safety assessments and education on prevention of falls, airway obstruction, drowning, fire/burn and poisoning; asthma assessments and education; child passenger safety education; bicycle and pedestrian safety education and Florida KidCare insurance outreach. The St. Joseph's Children's Specialty Center on the Mease Countryside campus provides the north Pinellas and south Pasco communities with more access to physical, occupational, speech, and sensory therapy programs and educational programs, as well as pediatric physician specialty services for neurology, gastroenterology, endocrinology and cardiology and convenient, on-site pediatric laboratory services and a community education room for parent information and education. As part of its goal of meeting its patients and visitors needs, Mease Countryside welcomed the opening of the Baby & Me Boutique. The Boutique was made possible by the hospital's Volunteer Resources, in partnership with Morton Plant Mease Foundation. It specializes in providing a welcoming, personal shopping experience for new moms and their families and friends. Community Screenings Morton Plant Mease screened community members on such diseases and conditions as high blood pressure, prostate cancer, skin cancer and cardiovascular disease. The health screenings were conducted at many venues, such as recreation centers, senior expos and hospital-sponsored events. In addition, Morton Plant Mease gave free athletic physicals to 275 Pinellas County high school students. Our comprehensive physicals included checks of height, weight, blood pressure, vision and lungs, a musculoskeletal exam and cardiovascular screenings. Physicians and other health care practitioners from Morton Plant Mease conducted free skin cancer screenings in support of the 17th Annual Melanoma Monday, a nationwide campaign to raise awareness and encourage early detection of skin cancers. Support Groups Mease Dunedin and Mease Countryside hospitals provide free community support groups on a wide variety of topics ranging from Alzheimer's to women's cancers. In 2012, active support groups included Grief Support Group, Alzheimer's Support Group, Breastfeeding Support Groups, Diabetes Support Groups, Support Groups for Bariatric Surgery Patients, Cancer Patients' Hope and Support Group, Men's Cancer Discussion Group and Women's Cancer Support Group. In addition, Morton Plant Mease provides free meeting room space on its campuses for such community organizations as Al-Anon, Boy Scouts of America, Clearwater Women's Open, Crohns and Colitis Support Group, Eating Disorders Support Group, Girl Scouts of America, Hepatitis/Liver Disease Support Group, Junior League of Clearwater-Dunedin, Keep it Simple, and the Suncoast Epilepsy Association. Community Organization Support Morton Plant Mease believes in providing financial support to not-for-profit organizations whose missions are to improve the health and well-being of our community. In 2012, we donated $39,750 to 11 organizations, including the following: American Cancer Society Clearwater Free Clinic Upper Pinellas Association for Retarded Citizens Youth and Family Alternatives, Inc. Community Lectures In 2012, Mease Countryside and Mease Dunedin held lectures on a variety of topics including asthma, breast cancer, cervical cancer, diabetes, hearing health, sleep disorders, youth sports safety, skin cancer, women's health and wellness, heart health, back pain and spinal health, joint health and vascular disease. Faith Community Nursing Faith Community Nursing offers a unique partnership between two healing groups - Morton Plant Mease Health Care and faith communities in Pinellas, Pasco, Hernando and Citrus counties. This nursing specialty takes a "whole person" approach to health care, promoting wellness of body, mind and spirit within the context of the values, beliefs and practices of a faith community. Our faith community nurses work to improve congregational health by encouraging preventative care and referring parishioners to appropriate health resources. Members of faith communities learn ways to take control of their own well-being and better manage their family's health. In 2012, 88 Registered Nurses in 45 various faith communities had one to one contact with 14,000 individuals in and around their faith communities and conducted more than 2,500 screenings. Morton Plant Mease Faith Community Nurses referred 1,974 people to seek further evaluation for health concerns and donated 12,539 hours of care as unpaid professionals. Primary Care Recognizing that access to primary care physicians is central to the health and wellness of the community, Morton Plant Mease has developed a group of approximately 38 physician offices with 110 board-certified or board-eligible physicians specializing in family medicine, internal medicine, pediatrics, geriatrics and gastroenterology. Patients are encouraged to select a personal long-term care physician for preventive, acute and chronic problems. Morton Plant Mease Primary Care physician offices are nationally recognized as Level 3 Patient-Centered Medical Homes from the Physician Practice Connections-Patient-Centered Medical Home (PPC-PCMH) and the National Committee for Quality Assurance (NCQA). Level 3 is the highest attainable level of recognit
Part VI - Line 5 Promotion of Community Health Continued   Through the its Team Member Loyalty Task Force, Morton Plant Mease helped those serving overseas with A Support the Troops Drive was also held to gather toiletries, snacks and other items for overseas troops.
Part VI - Line 6 Affiliated Health Care System   Trustees of Mease Hospital, Inc is part of BayCare Health System, a leading, community-based health system in the Tampa Bay area with 20,100 employees, 10 not-for-profit hospitals, 14 outpatient centers, and a complete range of services, such as imaging, laboratory, behavioral health, and home care. BayCare hospitals include Mease Countryside, Mease Dunedin, Morton Plant, Morton Plant North Bay, St. Anthony's, South Florida Baptist, St. Joseph's, St. Joseph's Women's, St. Joseph's Children's, and St. Joseph's Hospital-North. St. Joseph's hospitals operate as one entity and file one Form 990. BayCare was founded in 1997 when the area's top not-for-profit hospitals came together, united by a common mission to improve the health of their communities and continue caring for all patients regardless of their ability to pay. In 2012, BayCare provided $188.6 million in community benefits, which includes $86.2 million in traditional charity care, $91.5 million in Medicaid and other means-tested programs, and $10.9 million in unbilled community services. All of these are measured in unreimbursed cost. BayCare's financial stability and centralization of shared services in finance, information technology and human resources strengthens each hospital's ability to allocate resources to meet the needs of their communities. BayCare's hospitals are located in three geographic regions, each with its own Board of local leadership focused on its community's specific needs. BayCare also meets the needs of the community by being one of the largest employers in the Tampa Bay region, spending $1.2 billion on payroll and benefits for 20,100 employees. In 2012, BayCare added 500 new employees during a tough economy when unemployment rates in other areas remained high. To meet the health care needs of the community, BayCare provides expert medical care through a network with more than 200 access points connecting patients to a complete range of preventive, diagnostic and treatment services for any health care need. BayCare's network includes primary care and specialist physicians, urgent/immediate care centers, imaging, wellness centers, and 21 laboratory locations providing general, specialized and molecular testing. In addition, BayCare's home care division is one of the largest in Florida, providing 622,000 home health visits in 2012, helping patients leave the hospital sooner and recover at home where they are more comfortable. Recognizing the community's need for mental health services, BayCare also continues to be the largest, not-for-profit provider of behavioral health services in west central Florida. BayCare Behavioral Health offers inpatient, outpatient, in-home treatment, support group and case management services. BayCare's designated Baker Act-receiving facilities in Hillsborough, Pinellas, and Pasco counties provide inpatient crisis stabilization and partial hospitalization programs as part of the continuum of mental health care. BayCare also operates the only private, freestanding Baker Act-receiving hospitals in Hillsborough and Pasco counties. In 2012, BayCare began the process of assisting each hospital with a Community Health Needs Assessment (CHNA) as required by the Patient Protection and Affordable Care Act. As part of the process, BayCare conducted primary research with community stakeholders and focus groups, and secondary research to analyze the area's health status indicators, morbidity, mortality prevalence rates, socio-economic factors, behavioral risk factors, community needs scores, and prevention quality indicators. BayCare will use this information to develop reports for each hospital, implementation plans to address identified community needs, and specific measures to monitor progress. BayCare also continued developing its clinically integrated network, known as BayCare Physician Partners. This is a new model of care designed to improve the clinical coordination between employed physicians, independent physicians and health system resources. The goal of BayCare Physician Partners is to improve the overall health and patient experience of populations served by the network. More than 1,100 physicians joined BayCare Physician Partners in 2012. The network also approved 17 clinical performance measures for all of its member physicians and attained contractual agreements with three major health plans, affecting about 50,000 patient lives in the area. In addition to the strong growth of physician membership in 2012, BayCare Physician Partners continued developing the administrative and technology infrastructure needed to deliver the network's improved care coordination and overall population health in 2013. To meet the health care needs of a growing but medically underserved area in southern Hillsborough, BayCare has started construction on St. Joseph's Hospital South, a 352,000-square-foot, 90-bed, acute-care community hospital. The $237-million facility, which includes an 86,000-square-foot medical office building, is scheduled to open in 2015. In 2012, BayCare also successfully completed its seven-year implementation of a system-wide, electronic medical record at its 10 hospitals. With the completion of the project, all ancillary, nursing and physician staff members now document clinical information electronically, providing the entire care team with a more complete and more accurate care record, available in real time. BayCare hosted its largest annual Quality Sharing Day event in 2012, with more than 600 employees taking part in a full day of learning about best practices from Six Sigma and performance improvement projects throughout the health system. The event featured 13 teams presenting summaries of successful process improvements and 80 storyboard exhibits on projects recognized for quality contributions. Since BayCare began its Six Sigma program in 2004, thousands of employees have participated in performance improvement projects that have helped drive process efficiency and cost savings throughout the organization. To help educate future nurses and health care professionals, BayCare collaborates with Hillsborough Community College, University of Tampa, St. Petersburg College, Pasco Hernando Community College, and the Pinellas Technical Education Center. In 2012, BayCare also supported more than 90 community organizations and charities, big and small, through event sponsorships as part of the health system's commitment to the community. These organizations include the American Heart Association, Susan G. Komen for the Cure, American Cancer Society, the Tampa Bay Partnership: ONE BAY Healthy Communities, and local economic development councils and chambers of commerce.
Part VI - Line 7 State Filing   N/A: Trustees of Mease Hospital, Inc does not file CBR.
Part VI - Line 8 Facility Reporting Group   All answers provided in Part VI pertain to Facility Group A which includes Mease Countryside Hospital and Mease Dunedin Hospital.
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Trustees of Mease Hospital Inc
 
Employer identification number
59-0855412
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC Code section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) Suncoast Community Health Centers Inc
13110 Elk Mountain Dr
Riverview,FL33579
59-1741303 501(c)(3) 202,825       Donation






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients
(c)Amount of
cash grant
(d)Amount of
non-cash assistance
(e)Method of valuation (book,
FMV, appraisal, other)
(f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
Description of Organization's Procedures for Monitoring the Use of Grants Form 990, Schedule I, Part I, Line 2 Trustees of Mease Hospital is committed to assisting non-profit organizations whose focus is to improve the health and wellness of the communities we serve. Trustees of Mease Hospital's senior management team reviews each cash donation request to determine whether the organization is one we want to donate to, based on the organization's mission, non-profit status, and usage of funds. Once approved, we require proper documentation from the organization of its non-profit status, and as needed, follow-up with the organization to ensure the activity occured.
Schedule I (Form 990) 2012


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Trustees of Mease Hospital Inc
 
Employer identification number

59-0855412
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)CELIA LARIMOREDIR SURGICAL SERVICES - MEASE (i)
(ii)
166,664
0
20,010
0
943
0
21,154
0
10,356
0
219,127
0
0
0
(2)GERALD MASSEYDIRECTOR, OPERATIONS - MEASE (i)
(ii)
149,135
0
20,515
0
1,068
0
7,952
0
6,068
0
184,738
0
0
0
(3)ROBIN LAPHAMDIR. PATIENT SERVICES - MCH (i)
(ii)
149,987
0
19,273
0
537
0
8,215
0
14,930
0
192,942
0
0
0
(4)MOHSEN HABIBMANAGER PHARMACY (i)
(ii)
140,754
0
10,919
0
9,446
0
7,884
0
20,730
0
189,733
0
0
0
(5)KELLY CULLENDIR PATIENT SVCS, MDH/ER (i)
(ii)
154,080
0
21,109
0
7,661
0
8,394
0
10,752
0
201,996
0
0
0
(6)GERMAIN SIESSMANAGER PHARMACY (i)
(ii)
124,227
0
8,622
0
6,134
0
6,675
0
11,644
0
157,302
0
0
0
(7)NICOLE HANNACLINICAL PHARMACIST (i)
(ii)
138,292
0
1,075
0
365
0
7,076
0
16,015
0
162,823
0
0
0
(8)LOUIS GALDIERICOO, MEASE HOSPITALS (i)
(ii)
0
262,618
0
88,437
0
40,592
0
36,617
0
15,367
0
443,631
0
0
(9)CARL TREMONTICFO - MPM (i)
(ii)
0
254,694
0
87,048
0
52,723
0
30,752
0
11,905
0
437,122
0
0
(10)GLENN WATERSTRUSTEE AND PRESIDENT (i)
(ii)
0
714,965
0
336,760
0
14,520
0
163,320
0
30,141
0
1,259,706
0
0
(11)PETER BLUMENCRANZFORMER DIRECTOR (i)
(ii)
0
592,465
0
120,484
0
12,665
0
19,495
0
17,133
0
762,242
0
0
(12)STEPHEN MASONTRUSTEE (i)
(ii)
0
1,091,361
0
662,350
0
2,249,647
0
24,790
0
25,118
0
4,053,266
0
583,588
(13)MICHAEL WANGERTRUSTEE (i)
(ii)
0
219,165
0
317,051
0
2,640
0
12,500
0
24,325
0
575,681
0
0
(14)MAIKEL BOLOSCLINICAL PHARMACIST (i)
(ii)
138,154
0
7,223
0
120
0
6,954
0
5,883
0
158,334
0
0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
Supplemental Compensation Information   The filing organization does not use any of the options listed in Schedule J, Line 3 to establish the compensation of the CEO/Executive Director. However, the related organization, BayCare Health System Inc, uses Compensation committee, Independent compensation consultant, Written employment contract, Compensation survey or study and Approval by the board or compensation committee as a means to establish the CEO's compensation of the filing organization. Part I, Line 4b Louis Galdieri - Participated in a supplemental nonqualified deferred compensation plan. He had $31,699 in benefits vest in 2012. This amount is included in Part II (B)(iii) Other compensation. He had $23,552 of nonvested benefits accrue during 2012 and his earnings on the plan in 2012 were $11,062. These amounts are included in Part II (C) Retirement and other deferred compensation. The plan made cash distribution of $11,554 in 2012. Stephen Mason - Participated in a supplemental nonqualified deferred compensation plan. He became 100% vested in his benefits in 2012. He had $2,212,111 in benefits vest in 2012. This amount is included in Part II (B)(iii) Other compensation. The plan made cash distribution of $806,314 in 2012. Carl Tremonti - Participated in a supplemental nonqualified deferred compensation plan. He had $33,747 in benefits vest in 2012. This amount is included in Part II (B)(iii) Other compensation. He had $18,473 of nonvested benefits accrue during 2012 and his earnings on the plan in 2012 were $9,459. These amounts are included in Part II (C) Retirement and other deferred compensation. The plan made cash distribution of $12,301 in 2012. Glenn Waters - Participated in a supplemental nonqualified deferred compensation plan. He had $0 in benefits vest in 2012. He had $145,547 of nonvested benefits accrue during 2012 and his earnings on the plan in 2012 were $14,809. These amounts are included in Part II (C) Retirement and other deferred compensation.
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Trustees of Mease Hospital Inc
 
Employer identification number

59-0855412
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) MFP Inc DBA Financial Credit Serv See Part V 415,626 Collection Services   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Relationship between interested person and the organization   Stephen Mason and Glenn Waters are trustees and/or officers of the filing organization as well as board members of MFP, Inc.
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  




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.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Trustees of Mease Hospital Inc
 
Employer identification number

59-0855412
Identifier Return Reference Explanation
Part VI   Part VI, Line 2 - Description of Family or Business Relationship Glenn Waters, Carl Tremonti and Stephen Mason are Board members of the Organization, as well as Board members of a taxable entity, which is an affiliate of the filing Organization. Part VI, Line 6 - Description of Classes of Members or Stockholders The sole member of Trustees of Mease Hospital, Inc. is Morton Plant Mease Health Care, Inc. Part VI, Line 7a - Description of Classes of Persons and the Nature of Their Rights The Board shall consist of no more than twenty-six (26) members (each, a "Trustee"), all of whom shall be appointed by the Member such that at all times the Board is comprised of all of the members of the Board of Directors of the Member. Part VI, Line 7b - Descr Classes of Persons, Decisions Requiring Appr & Type of Voting Rights The taxpayer is a Participant, as defined in the Second Restated Joint Operating Agreement dated as of May 23, 2006, as amended (the "JOA"). Under the JOA, BayCare health System, Inc. is responsible for the operations of the Participants. The JOA Participants include the taxpayer and other hospitals and non-hospital organizations. Notice of the JOA was previously provided to the Internal Revenue Service by letter dated July 1, 1997. The Member reserves to itself the following two categories of actions: Class I Member Reserved Rights and Class II Member Reserved Rights. A. Class I Member Reserved Rights. 1. Addition, deletion or reconfiguration of services of the Corporation. 2. Establishment of overall capital and operating budgets and strategic plans applicable to the Corporation, including the use of the funds of the Corporation. 3. Exclusive authority to enter into managed care contracts on behalf of the Corporation and its subsidiaries and affiliates. 4. Approval of contracts on behalf of the Corporation (but the Class I Member may establish policies from time to time providing that only specific types of contracts or contracts involving obligations in excess of specified levels need to be approved by the Class I Member). 5. Authority to establish fees and charges on behalf of the Corporation. 6. Determination of whether the Corporation should join any networks or alternative or integrated delivery systems. 7. Establishment of employment and other policies applicable to all personnel employed by the Corporation. 8. Approval of the philosophy, mission statement and purposes of the Corporation. 9. Approval of changes in the Articles of Incorporation or in the Bylaws of the Corporation. 10. Approval of the merger, consolidation, dissolution, sale or other transfer of substantially all assets of the Corporation, or other change in corporate form, causing a fundamental reorganization of the Corporation. 11. Approval of the incurrence of indebtedness by the Corporation above certain limits established by the Class I Member. 12. Approval of the establishment of additional affiliates or subsidiaries of the Corporation. 13. Adoption of strategic plans or major changes in programs or services of the Corporation. 14. Approval of the purchase, sale, transfer, or other encumbrance of assets of the Corporation above specified levels established by the Class I Member. B. Class II Member Reserved Rights. 1. Approval of the philosophy, mission statement and purposes of the Corporation. 2. Approval of the merger, consolidation, dissolution, sale or other transfer of substantially all assets of the Corporation, or other change in corporate form, causing a fundamental reorganization of the Corporation. 3. With regard to any assets of the Corporation no longer required in the operations of the Corporation, approval of any sale or other disposition of any assets not in the ordinary course which have a value in excess of $3 million, and with regard to all other assets of the Corporation used in the operations of the Corporation, approval of any sale or other disposition of such assets not in the ordinary course (but the foregoing is not intended to limit any transfer of the location of the assets from the Corporation to another entity in connection with a duly authorized reconfiguration of services). 4. Approval of the closure of a hospital facility of the Corporation. 5. Change in the name of a hospital facility of the Corporation. 6. Approval of substantive changes in the Bylaws of the Articles of Incorporation of the Corporation. Part VI, Line 11b - Describe the Process used by Management &/or Governing Body to Review 990 The Form 990 is prepared by the organization and reviewed by the CFO, as well as the organization's paid preparer. Prior to filing with the IRS, a final copy of the Form 990 will be made available to the entire Board via a web portal. Part VI, Line 12c - Description of Process to Monitor Transactions for Conflicts of Interest Trustees of Mease Hospital, Inc. has two separate conflict of interest procedures; one that relates to Board members and another that relates to non-board member employees. Both groups are required on an annual basis to complete, sign and file an annual disclosure statement detailing existing or potential conflicts of interests. For Board members, the review of conflicts or potential conflicts occurs at the Board or committee level. After disclosure of the Board Member's or Committee Member's actual or potential conflict, the following procedures for addressing the conflict of interest will be adhered to by each Board and all Committees with Board delegated powers, without exception: 1. The interested Director or Committee member shall leave the Board or Committee meeting while the conflict of interest issue is discussed. 2. The remaining Board or Committee Members shall decide if a conflict of interest exists. 3. If a conflict of interest is deemed to exist: a. The Chairperson of the Board or Committee shall, if appropriate, appoint a disinterested individual or committee to investigate the proposed transaction or arrangement. b. The Board or Committee shall determine whether the BayCare entity can obtain a more advantageous transaction or arrangement with reasonable efforts from an individual or entity that would not give rise to a conflict of interest. c. If a more advantageous transaction or arrangement is not reasonably available, the Board or Committee shall determine whether the transaction or arrangement is in the BayCare entity's best interest, and whether the transaction is fair and reasonable to BayCare. An interested Director or Committee Member shall not vote, participate in, influence or attempt to influence any determination or proceedings. The Director or Committee Member may, however, respond to questions posed by the Board or Committee regarding the contract or transaction. Any such contract or transaction must be authorized by a vote of at least two-thirds (2/3) of the Directors or Committee Members entitled to vote at a meeting at which a quorum was present. Any interested Director or Committee Member may not be counted in determining the existence of a quorum. For employees, the review of conflicts of interest or potential conflicts goes to the Conflict of Interest Determination Committee. This committee consists of BayCare Chief Compliance Officer, the Corporate Responsibility Officers, and the BayCare Vice President of Team Resources. This committee shall determine if an actual conflict exists and any action required to address the conflict of interest situation.
Part VI   Part VI, Lines 15a & 15b - Process used for Compensation Review and Approval The filing organization does not directly compensate some of its top management employees; rather compensation is paid by a related organization that also follows the compensation policy of the Compensation Committee. The independent Compensation Committee is appointed by the Board of Directors. The Compensation Committee's purpose is to provide oversight for the organization's executive compensation program, review and approve compensation and benefits for all "disqualified persons" subject to the Intermediate Sanctions regulations issued under Section 4958 of the Internal Revenue Code (including the Chief Executive Officer, Chief Operating Officer & CFO, other system and entity executives, and other disqualified persons as defined in the Intermediate Sanctions regulations (i.e., voting members of the governing body, family members, former officers)), and establish the compensation philosophy for all other executives. This committee engages nationally recognized compensation consultants to assist them in review of executive compensation. The compensation consultants provide a review of each vice president and above in the system to determine if that employee's compensation is reasonable when compared against market standards. The data reviewed comes from compensation studies that include comparable compensation for similarly qualified persons in functionally comparable positions at similarly situated organizations. The organization keeps contemporaneous minutes of the compensation committees meetings and decisions. External consultants review compensation every other year with the last review occurring in 2011 but the compensation committee regularly monitors compensation and all other procedures are followed annually. Part VI, Question 19 - How and If the Governing Documents, Conflict of Interest Policy and Financial Statements are Made Available to the Public Trustees of Mease Hospital Inc. publishes its financial statements with the Agency for Health Care Administration. Governing documents and policies are not available for public inspection.
Part XI Line 9   Form 990, Part XI, Line 9 Other changes in net assets: Unrealized gains on swaps $120,144 Change in net assets of foundation ($1,537,507) Rounding ($1) Total ($1,417,364)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
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SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Trustees of Mease Hospital Inc
 
Employer identification number

59-0855412
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity











Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1) BayCare Health System Inc

16255 Bay Vista Drive

Clearwater,FL33760
59-2796965
Support srvcs FL 501(C)(3) 11A na
 
 
No
(2) Morton Plant Hospital Association Inc

300 Pinellas Street

Clearwater,FL33756
59-0624462
Health srvcs FL 501(C)(3) 3 MPMHC
 
Yes
 
(3) Morton Plant Mease Health Care Found Inc

1200 Druid Road South

Clearwater,FL33756
59-1751535
Fundraising FL 501(C)(3) 11A TOMMPH
 
Yes
 
(4) Morton Plant Mease Health Care Inc

300 Pinellas Street

Clearwater,FL33756
59-2374556
Support srvcs FL 501(C)(3) 11B na
 
 
No
(5) Morton Plant Mease Health Services Inc

8452 118th Ave N

Largo,FL33773
59-2600684
Health srvcs FL 501(C)(3) 9 MPMHC
 
Yes
 
(6) Morton Plant Mease Primary Care Inc

300 S Park Place Blvd Ste 170

Clearwater,FL33759
59-3140335
Health srvcs FL 501(C)(3) 9 MPMHC
 
Yes
 


For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


Yes No Yes No
(1) Trinity Surgery Center LLC

2102 Trinity Oaks Blvd
New Port Richey,FL34655
02-0656933
Health srvcs FL na
 
n/a                












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Global Health Care Inc

8452 118th Avenue North
Largo,FL33773
59-1853449
Health srvcs FL na
 
C corp       Yes  
(2) Medspecialists Inc

16255 Bay Vista Drive
Clearwater,FL33760
68-0587533
Health srvcs FL na
 
C corp       Yes  
(3) MFP Inc

628 Bypass Road
Clearwater,FL33764
59-2374569
Collection sr FL na
 
C corp       Yes  
(4) Morton Plant Health Ventures Inc

8452 118th Avenue North
Largo,FL33773
59-2728600
Health srvcs FL na
 
C corp       Yes  






Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
Yes
 
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
Yes
 
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) Morton Plant Mease Primary Care Inc

a(iv) 253,666 FMV
(2) Morton Plant Mease Health Care Foundation

c 1,537,507 FMV
(3) Morton Plant Hospital Association Inc

g 434,408 FMV
(4) Morton Plant Hospital Association Inc

k 101,459 FMV
(5) Morton Plant Mease Health Services Inc

k 84,799 FMV
(6) Morton Plant Hospital Association Inc

o 1,374,658 FMV
(7) Morton Plant Mease Health Services Inc

o 81,294 FMV
(8) Morton Plant Hospital Association Inc

s 543,293 FMV
(9) Morton Plant Mease Health Services Inc

s 248,912 FMV
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


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Software Version: