2024-08-15T14:53:24-05:00 2023-09-30 135565207 KPMG LLP 500 W 5TH ST SUITE 800 WINSTONSALEM NC 27101 990 2022-10-01 863038188 ACADEMIC MEDICAL GROUP INC ACAD 8778295500 1 TAMPA GENERAL CIR TAMPA FL 33606 MARK RUNYON TREASURER & DIRECTOR 8778295500 2024-08-15 1 0 WHITNEY B HEBRON P01226647 3362753394 2024-07-29 2022 2024-08-08 14:25:15Z CHARLES LOCKWOOD MD 1 TAMPA GENERAL CIR TAMPA FL 33606 0 0 X N/A X 2020 FL SEE SCHEDULE O 10 6 1915 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9024215 0 0 0 242556 -9024215 242556 0 -242556 0 23230435 44227018 23372991 44369574 -142556 -142556 X AMG WAS FORMED FOR THE PURPOSE OF COLLABORATION BETWEEN THE TAX-EXEMPT ENTITIES, FHSC AND USF, AND THEIR RESPECTIVE AFFILIATES. THAT PURPOSE INCLUDES COORDINATION OF THE INTEGRATED CLINICAL SERVICES OF PHYSICIANS AND ADVANCED PRACTICE PROVIDERS EMPLOYED BY USF AND TAMPA GENERAL MEDICAL GROUP, INC. ("TGMG"), AN AFFILIATE OF FHSC, AND THEIR RESPECTIVE AFFILIATES, IN ORDER TO EXPAND THE AVAILABILITY AND IMPROVE THE QUALITY OF PROFESSIONAL MEDICAL SERVICES IN WEST CENTRAL FLORIDA AND TO PROMOTE PUBLIC HEALTH, CONSISTENT WITH THE CHARITABLE, EDUCATIONAL, SCIENTIFIC, AND MEDICAL PURPOSES OF THE ORGANIZATIONS. AMG WILL PROVIDE SUPPORT SERVICES INCLUDING MANAGEMENT, OPERATIONAL, ADMINISTRATIVE, AND PRACTICE INFRASTRUCTURE SERVICES FOR TGMG, USF, AND ANY OF THEIR AFFILIATED ENTITIES IN FURTHERANCE OF FHSC AND USF'S SHARED MISSIONS. IN EXCHANGE FOR AMG'S SUPPORT SERVICES, TGMG AND USF WILL EACH PAY A FAIR MARKET VALUE FEE FOR THE SERVICES THEY RECEIVE FROM AMG. 0 1 -812656 1. FACILITATE THE EXPANSION OF AVAILABILITY AND IMPROVEMENT OF THE QUALITY OF PROFESSIONAL MEDICAL SERVICES IN WEST CENTRAL FLORIDA2. PROMOTE PUBLIC HEALTH, CONSISTENT WITH THE CHARITABLE, EDUCATIONAL, SCIENTIFIC AND MEDICAL PURPOSES OF FHSC AND USF. N/A N/A -812656 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 16 0 1915 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 6 0 0 0 0 1 1 1 1 1 0 0 1 1 0 1 1 1 0 0 0 FL X LIJAH LOKENAUTH 8138447000 1 TAMPA GENERAL CIR TAMPA FL 33606 CHARLES LOCKWOOD MD CHAIRMAN/CHIEF EXECUTIVE & DIRECTOR 1.00 0.00 X X 0 0 0 JOHN COURIS SECRETARY & DIRECTOR 1.00 49.00 X X 0 2113230 41496 STACEY BRANDT DIRECTOR 1.00 0.00 X 0 762222 41496 RAJENDRA BALIGA MD DIRECTOR 1.00 0.00 X 0 0 0 JUDETTE LOUIS MD DIRECTOR 1.00 0.00 X 0 0 0 MARK RUNYON TREASURER & DIRECTOR 1.00 49.00 X X 0 911936 35040 ADAM SMITH DIRECTOR 1.00 49.00 X 0 687361 40888 RICH SOBIERAY DIRECTOR 1.00 0.00 X 0 0 0 MARK MOSELEY MD DIRECTOR 1.00 0.00 X 0 0 0 STEVE CURRALL PHD DIRECTOR 1.00 0.00 X 0 0 0 0 4474749 158920 3 0 1 0 UNIVERSITY MEDICAL SERVICE ASSOCIATION I PO BOX 917492 ORLANDO FL 328917492 MEDICAL SERVICES 3033278 BDO USA LLP PO BOX 642743 PITTSBURGH PA 15264 PROFESSIONAL SERVICES 158779 2 0 0 0 0 X 39617 39617 2648820 2121705 527115 6335778 5074958 1260820 119732 16643 103089 899865 539062 360803 680 348 332 66576 52061 14515 7868 1370 6498 EMPLOYEE LEASING AGREEM 2158645 715591 1443054 PURCH SVCS - MGMT AGREE 1141918 378546 763372 DUES AND MEMBERSHIPS 237311 47453 189858 REIMBURSED EXPENSES -13702567 -9815177 -3887390 45757 15167 30590 0 -812656 812656 0 2313708 2592888 13021654 15451778 110222 110222 7784851 26072130 23230435 44227018 23372991 44369574 23372991 44369574 X -142556 -142556 -142556 -142556 23230435 44227018 0 0 X 0 1 X 1 0 X X 2 FLORIDA HEALTH SCIENCES CENTER INC 593458145 3 1 0 0 UNIVERSITY OF SOUTH FLORIDA 592684166 2 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 DUE FROM AFFILIATES 26072130 26072130 X PART X, LINE 2: AMG APPLIES FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAX POSITIONS AND PROVIDES GUIDANCE WHEN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS AND HOW THE VALUE OF THESE POSITIONS ARE DETERMINED. U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (U.S. GAAP) REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF IT HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINABLE UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2023 AND 2022, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. 0 0 0 0 0 0 0 1 0 JOHN COURIS SECRETARY & DIRECTOR 0 1231255 0 881975 0 0 0 15250 0 26246 0 2154726 0 0 MARK RUNYON TREASURER & DIRECTOR 0 650924 0 261012 0 0 0 13006 0 22034 0 946976 0 0 STACEY BRANDT DIRECTOR 0 500136 0 261306 0 780 0 15250 0 26246 0 803718 0 0 ADAM SMITH DIRECTOR 0 395005 0 243498 0 48858 0 15250 0 25638 0 728249 0 0 PART I, LINE 7 NON-FIXED PAYMENTS PROVIDED BONUS AND INCENTIVE COMPENSATION IS BASED ON ACHIEVEMENT OF CERTAIN TARGETS, QUALITY INDICATORS, AND NON-FINANCIAL METRICS. FORM 990, PART I, LINE 1 COLLABORATION BETWEEN THE FLORIDA HEALTH SCIENCES CENTER AND UNIVERSITY OF SOUTH FLORIDA AND THEIR RESPECTIVE AFFILIATES. FORM 990, PART III, LINE 3 THE CORPORATION WAS FORMED TO PROVIDE CERTAIN SERVICES TO ASSIST THE PHYSICIANS EMPLOYED BY THE UNIVERSITY OF SOUTH FLORIDA BOARD OF TRUSTEES ("USF") AND TAMPA GENERAL MEDICAL GROUP, INC. ("TGMG"). THE CORPORATION'S BOARD OF DIRECTORS ARE COMPOSED OF REPRESENTATIVES OF UNIVERSITY OF SOUTH FLORIDA (USF) HEALTH SERVICES SUPPORT ORGANIZATION, INC. ("USF HSSO"), AN AFFILIATE OF USF, AND FLORIDA HEALTH SCIENCE CENTER, INC. D/B/A TAMPA GENERAL HOSPITAL ("FHSC"), AN AFFILIATE OF TGMG. THE OFFICERS FOR TGMG AND UNIVERSITY MEDICAL SERVICE ASSOCIATION, INC. ("UMSA"), A CONTROLLED AFFILIATE OF USF, WILL BE INVOLVED IN THE MANAGEMENT OF THE CORPORATION INDIRECTLY THROUGH THE CORPORATION'S PRESIDENT. THE OFFICERS OF TGMG AND UMSA WILL COLLABORATE WITH THE CORPORATION'S LEADERSHIP AND MAY HAVE AN INDIRECT INFLUENCE ON THE CORPORATION'S MANAGEMENT DECISIONS. THE GOVERNING BOARD OF THE CORPORATION CONSISTS OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF FHSC ("PRESIDENT") AND THE CHAIR OF USF HSSO, A CONTROLLED AFFILIATE OF USF ("CHAIR"). THE PRESIDENT AND CHAIR EACH APPOINT FOUR (4) ADDITIONAL DIRECTORS TO SERVE ON THE GOVERNING BOARD OF THE CORPORATION. THE NUMBER OF MEMBERS OF THE GOVERNING BOARD APPOINTED BY A TGH OR USF REPRESENTATIVE SHALL ALWAYS BE EQUAL. THE GOVERNING BOARD'S AUTHORITY INCLUDES (I) OVERSEEING THE FINANCIAL PERFORMANCE AND ESTABLISHING FINANCIAL METRICS AND TARGETS RELATING TO THE CORPORATION, (II) ESTABLISHING OVERHEAD FUNDING POLICIES FOR THE CORPORATION, (III) OVERSEEING THE OPERATING AND EXPENSE STRUCTURE OF THE CORPORATION, AND (IV) OVERSEEING INFRASTRUCTURE AND REVENUE CYCLE SERVICES PROVIDED BY THE CORPORATION IN SUPPORT OF ITS OPERATIONS. THE CORPORATION WILL PROVIDE SUPPORT SERVICES IN FURTHERANCE OF THE SUPPORTED ORGANIZATIONS' SHARED MISSIONS AND EXEMPT PURPOSES. THE CORPORATION WILL PROVIDE INTEGRAL SERVICES TO BOTH SUPPORTED ORGANIZATIONS, WHICH INCLUDE MANAGEMENT, ADMINISTRATIVE, ORGANIZATIONAL, AND PRACTICE INFRASTRUCTURE SERVICES. BUT FOR THE CORPORATION PROVIDING SUCH SERVICES, FHSC AND USF WOULD EACH HAVE TO PERFORM THE SERVICES THEMSELVES. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE MEMBER IS FLORIDA HEALTH SCIENCES CENTER INC (FHSC), A 501(C)(3) ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF AMG HAS TEN (10) DIRECTORS DIVIDED INTO THREE (3) CLASSES. CLASS 1 - SMT DIRECTORS: THREE DIRECTORS APPOINTED BY FLORIDA HEALTH SCIENCES CENTER INC (FHSC), COMPRISED OF MEMBERS OF THE SENIOR MANAGEMENT TEAM OF FHSC. CLASS 2 - COMMUNITY DIRECTORS: THREE DIRECTORS APPOINTED BY FHSC TO REPRESENT FHSC AND THE COMMUNITY. ONE OF THESE THREE DIRECTORS WILL ALSO BE A DIRECTOR OF FHSC. CLASS 3 - PHYSICIAN DIRECTORS: THREE DIRECTORS ELECTED BY THE PHYSICIANS OF TGMG. THE SMT AND COMMUNITY DIRECTORS SHALL BE APPOINTED BY FHSC AFTER RECEIVING THE RECOMMENDATIONS OF THE NOMINATING COMMITTEE. THE PHYSICIAN DIRECTORS SHALL BE ELECTED BY THE PHYSICIANS AFTER RECEIVING THE RECOMMENDATIONS OF THE NOMINATING COMMITTEE. ONLY PERSONS APPROVED BY THE NOMINATING COMMITTEE ARE ELIGIBLE TO SERVE AS DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUBJECT TO APPROVAL OF MEMBERS PER THE BYLAWS OF AMG. FLORIDA HEALTH SCIENCES CENTER INC (FHSC) IS THE SOLE MEMBER OF THE CORPORATION. AS SUCH, FHSC IS ENTITLED TO ALL RIGHTS AND POWERS OF A MEMBER UNDER THE LAWS OF THE STATE OF FLORIDA, AND THE ARTICLES OF INCORPORATION AND BYLAWS OF AMG. UNDER THE BYLAWS, CERTAIN POWERS ARE EXPRESSLY RESERVED TO FHSC: (A) ADOPT, AMEND, MODIFY OR RESTATE THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION, IN WHOLE OR IN PART; (B) APPROVE ANY AMENDMENT TO THE CORPORATION'S CHARITY OR DISCOUNTED CARE POLICIES; (C) INCUR ANY DEBT; (D) APPROVE THE CORPORATION ENTERING INTO ANY NEW SERVICE LINES; (E) APPOINT AND REMOVE THE COMMUNITY DIRECTORS AND SMT DIRECTORS, WITH OR WITHOUT CAUSE; (F) APPROVE THE ESTABLISHMENT OR DISSOLUTION OF ORGANIZATIONAL RELATIONSHIPS, INCLUDING SUBSIDIARY CORPORATIONS, PARTNERSHIPS, JOINT VENTURES, MERGERS AND CONSOLIDATIONS; (G) APPROVE THE MERGER, CONSOLIDATION, DISSOLUTION OR OTHER FUNDAMENTAL CORPORATE REORGANIZATION OF THE CORPORATION; AND (H) APPROVE THE ANNUAL CAPITAL AND OPERATING BUDGETS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE DRAFT FORM 990 WAS REVIEWED AT THE REGULARLY SCHEDULED BOARD OF DIRECTOR MEETING IN JULY 2024. UPON APPROVAL BY THE BOARD, THE FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C AMG ADHERES TO THE CONFLICT OF INTEREST POLICY OF ITS SOLE MEMBER ENFORCEMENT OF CONFLICTS POLICY THE MONITORING AND ENFORCING OF THE CONFLICT OF INTEREST POLICY IS A JOINT EFFORT BETWEEN CORPORATE COMPLIANCE AND HUMAN RESOURCES. ALL NEW HIRES ARE REQUIRED TO REVIEW, COMPLETE, AND SIGN THE CONFLICT OF INTEREST (COI) STATEMENT. THE LEADERSHIP GROUP AND ALL BOARD MEMBERS ARE REQUIRED TO REVIEW, COMPLETE, AND SIGN THE COI ANNUALLY. IN ADDITION, EXISTING EMPLOYEES ARE REQUIRED AS PART OF THEIR ANNUAL PERFORMANCE EVALUATION TO REVIEW, COMPLETE, AND SIGN THE COI. ALL THE COIS ARE REVIEWED BY HUMAN RESOURCES. IF THERE IS A COI DISCLOSED ON THE FORM, ADDITIONAL INFORMATION IS REQUESTED FROM THE EMPLOYEE. IN SOME CASES, THE CORPORATE COMPLIANCE DEPARTMENT IS INVOLVED WHERE ADDITIONAL INPUT OR GUIDANCE IS NEEDED BY HUMAN RESOURCES. EMPLOYEES ARE ALSO ADVISED TO DISCLOSE COIS THAT MAY ARISE DURING THE COURSE OF THE YEAR. EMPLOYEES AND OTHER TGH HEALTHCARE PARTNERS CAN SIMILARLY REPORT COIS TO CORPORATE COMPLIANCE USING THE COMPLIANCE LINE, EMAIL, PHONE, ETC. PERIODICALLY, IN NEWSLETTERS ISSUED BY CORPORATE COMPLIANCE, REFERENCE IS MADE TO COI. IT IS THE RESPONSIBILITY OF CORPORATE COMPLIANCE TO INITIATE INVESTIGATIONS OF ALLEGATIONS OF COIS. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 539,062. MANAGEMENT AND GENERAL EXPENSES 360,803. TOTAL EXPENSES 899,865. 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