2025-08-15T13:59:34-05:00 2024-09-30 135565207 KPMG LLP 500 WEST 5TH ST SUITE 800 WINSTONSALEM NC 27101 990 2023-10-01 863038188 ACADEMIC MEDICAL GROUP INC ACAD 8778295500 1 TAMPA GENERAL CIR TAMPA FL 33606 MARK RUNYON TREASURER & DIRECTOR 8778295500 2025-08-15 1 0 WHITNEY B HEBRON P01226647 3362753394 2023 2025-03-06 01:10:19Z CHARLES LOCKWOOD MD 1 TAMPA GENERAL CIR TAMPA FL 33606 0 0 X N/A X 2020 FL SEE SCHEDULE O 10 6 2066 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9024215 132468924 0 0 0 -9024215 -132468924 0 0 0 0 44227018 22284321 44369574 22426877 -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 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 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 14 0 2066 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 & 1.00 0.00 X X 0 0 0 JOHN COURIS SECRETARY & DIRECTOR 1.00 49.00 X X 0 2614354 44844 MARGARET DUGGAN MD DIRECTOR 1.00 49.00 X 0 1107948 44844 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 1348397 35757 ADAM SMITH DIRECTOR 1.00 49.00 X 0 1003788 33057 STEVE OMLI DIRECTOR 1.00 0.00 X 0 0 0 HARRY VAN LOVEREN MD DIRECTOR 1.00 0.00 X 0 0 0 RHEA LAW DIRECTOR 1.00 0.00 X 0 0 0 MARK MOSELEY PRESIDENT USFTGP 50.00 0.00 X 579438 0 35809 MATTHEW CANTONIS SVP COO USFTGP 50.00 0.00 X 355448 0 28436 RACHEL SULLIVAN AGENCY DIR OF FINANCE 50.00 0.00 X 241722 0 28410 KIMBERLY CLIFFORD SR DIR CLINICAL OPERATIONS 50.00 0.00 X 207223 0 0 LILYVETTE NUNEZ SR DIR PRIMARY CARE OPS 50.00 0.00 X 167607 25627 24976 JOSEPH KIRKNER CLINICAL MANAGER 50.00 0.00 X 156657 0 20403 1708095 6100114 296536 88 0 1 0 UNIVERSITY MEDICAL SERVICE ASSOCIATION I PO BOX 917492 ORLANDO FL 328917492 MEDICAL SERVICES 3154609 EXECUTIVE CONSULTING GROUP LLC PO BOX 74008176 CHICAGO IL 60674 PROFESSIONAL SERVICES 288692 THE ADVISORY BOARD COMPANY 655 NEW YORK AVE NW WASHINGTON DC 20001 PROFESSIONAL SERVICES 250757 SCRUBS AND BEYOND LLC 12969 MANCHESTER ROAD LOUISIANA MO 63131 MEDICAL EQUIPMENT 227814 BDO USA LLP PO BOX 642743 PITTSBURGH PA 15264 PROFESSIONAL SERVICES 167082 6 0 0 0 0 X 99529201 66362546 33166655 2527106 2021685 505421 23262627 18610102 4652525 7149990 1046333 6103657 57682 57682 1085 1085 14700 14700 1252360 1252360 MEDICAL PROFESSIONAL CO 51451221 0 51451221 PURCHASED SERVICES 10684682 967586 9717096 MEDICAL AND OTHER SUPPL 433358 120627 312731 REIMBURSED EXPENSES -196979173 -89195621 -107783552 615161 66742 548419 0 0 0 0 2592888 -763912 15451778 22813488 110222 234745 26072130 0 44227018 22284321 44369574 22426877 44369574 22426877 X -142556 -142556 -142556 -142556 44227018 22284321 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 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, 2024 AND 2023, 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 1292365 0 1321989 0 0 0 16500 0 28344 0 2659198 0 0 MARK RUNYON TREASURER & DIRECTOR 0 684214 0 664183 0 0 0 14929 0 20828 0 1384154 0 0 MARGARET DUGGAN MD DIRECTOR 0 605117 0 502831 0 0 0 16500 0 28344 0 1152792 0 0 ADAM SMITH DIRECTOR 0 468234 0 484850 0 50704 0 7317 0 25740 0 1036845 0 0 MARK MOSELEY PRESIDENT USFTGP 447113 0 122964 0 9361 0 0 0 35809 0 615247 0 0 0 MATTHEW CANTONIS SVP COO USFTGP 271729 0 61235 0 22484 0 3856 0 24580 0 383884 0 0 0 RACHEL SULLIVAN AGENCY DIR OF FINANCE 229129 0 10000 0 2593 0 9778 0 18632 0 270132 0 0 0 LILYVETTE NUNEZ SR DIR PRIMARY CARE OPS 135258 25627 25765 0 6584 0 3454 0 21522 0 192583 25627 0 0 KIMBERLY CLIFFORD SR DIR CLINICAL OPERATIONS 175045 0 25820 0 6358 0 0 0 0 0 207223 0 0 0 JOSEPH KIRKNER CLINICAL MANAGER 141758 0 10295 0 4604 0 4580 0 15823 0 177060 0 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 SHALL CONSIST OF TEN (10) DIRECTORS, WHICH ARE DIVIDED INTO TWO (2) CLASSES: A USF HSSO CLASS AND A TGH CLASS. THE USF HSSO CLASS SHALL INCLUDE THE USF HSSO CHAIR, EX OFFICIO, WITH FULL VOTING RIGHTS, AND FOUR (4) DIRECTORS APPOINTED BY THE USF HSSO CHAIR. TWO (2) OF THE DIRECTORS APPOINTED BY THE USF HSSO CHAIR SHALL BE SENIOR MANAGEMENT PERSONNEL OF A USF-CONTROLLED ENTITY, ONE (1) SHALL BE A PHYSICIAN WHO PROVIDES SUBSTANTIAL CLINICAL SERVICES, AND ONE (1) SHALL BE AN INDIVIDUAL THAT THE USF HSSO CHAIR APPOINTS AT HIS OR HER OWN DISCRETION. THE TGH CLASS SHALL INCLUDE THE TGH CEO, EX OFFICIO, WITH FULL VOTING RIGHTS, AND FOUR (4) DIRECTORS APPOINTED BY THE TGH CEO. TWO (2) OF THE DIRECTORS APPOINTED BY THE TGH CEO SHALL BE SENIOR MANAGEMENT PERSONNEL OF A TGH-CONTROLLED ENTITY, ONE (1) SHALL BE A PHYSICIAN WHO PROVIDES SUBSTANTIAL CLINICAL SERVICES, AND ONE (1) SHALL BE AN INDIVIDUAL THAT THE TGH CEO APPOINTS AT HIS OR HER OWN DISCRETION. 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 ANY ANNUAL OR LONG-TERM CAPITAL OR OPERATIONAL BUDGET FOR THE CORPORATION, OR ANY CHANGES EXCEEDING TEN PERCENT (10%) OF THE TOTAL ANNUAL BUDGET; (B) INCUR ANY EXPENSE, WHICH IS NOT PROVIDED FOR IN AN ANNUAL OR LONG-TERM CAPITAL OR OPERATIONAL BUDGET APPROVED BY THE MEMBER, IF THE AMOUNT INVOLVED EXCEEDS TWO HUNDRED AND FIFTY THOUSAND DOLLARS ($250,000); (C) INCUR OR GUARANTEE ANY LONG-TERM DEBT; (D) APPROVE CLINICAL STRATEGIC PLANS AND CLINICAL PROGRAM PRIORITIES FOR THE USF PROVIDERS; AND (E) APPROVE CLINICAL OPERATING BUDGETS FOR THE USF PROVIDERS FUNDED THROUGH THE GLOBAL PROFESSIONAL SERVICES AGREEMENT. FORM 990, PART VI, SECTION B, LINE 11B THE DRAFT FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. 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 0. MANAGEMENT AND GENERAL EXPENSES 1,252,360. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,252,360. 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