2017-05-12T12:38:41-05:00 2016-06-30 346565596 ERNST & YOUNG US LLP 201 NORTH FRANKLIN STREET SUITE 2400 TAMPA FL 33602 990 2015-07-01 593238634 H LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL INC HLEE 8137454673 12902 MAGNOLIA DRIVE TAMPA FL 33612 Yvette Tremonti EVP/CFO 8137457862 2017-05-12 1 MELANIE A MCPEAK P01346034 8132254800 2015 2021-01-29 14:40:06Z JOHN A KOLOSKY 12902 MAGNOLIA DRIVE TAMPA FL 33612 817642958 0 X WWW.MOFFITT.ORG X 1994 FL TO CONTRIBUTE TO THE PREVENTION AND CURE OF CANCER. 16 15 3539 632 0 0 7224360 10663909 754476547 804486683 -9709 -47718 3265748 2359775 764956946 817462649 12583712 3000 0 0 260232114 281506279 0 0 0 378615602 418618359 651431428 700127638 113525518 117335011 141481633 162071983 55082488 51185320 86399145 110886663 X THE PRIMARY PURPOSE OF THE H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL, INC. IS TO CONTRIBUTE TO THE PREVENTION AND CURE OF CANCER. 0 0 601462571 3000 804486683 H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE HOSPITAL, INC. (THE "HOSPITAL") IS LOCATED ON THE CAMPUS OF THE UNIVERSITY OF SOUTH FLORIDA IN TAMPA, FL. SINCE OPENING IN 1986, THE HOSPITAL HAS BEEN GUIDED BY ONE MISSION, "TO CONTRIBUTE TO THE PREVENTION AND CURE OF CANCER." MOFFITT IS A LEADING NATIONAL CANCER INSTITUTE (NCI) COMPREHENSIVE CANCER CENTER - ONE OF ONLY 45 IN THE NATION TO HOLD THIS DISTINCTION. MOFFITT IS THE TOP-RANKED CANCER HOSPITAL IN FLORIDA, THE NUMBER 6 CANCER HOSPITAL IN THE NATION, AND HAS BEEN LISTED IN U.S. NEWS & WORLD REPORT AS ONE OF THE "BEST HOSPITALS" FOR CANCER CARE SINCE 1999. WITH MORE THAN 5,200 EMPLOYEES BETWEEN THE HOSPITAL AND RELATED ORGANIZATIONS, MOFFITT HAS AN ECONOMIC IMPACT ON FLORIDA OF NEARLY $2.1 BILLION. RESEARCH IS CRITICAL TO MOFFITT'S MISSION. MUCH OF OUR CLINICAL TRIALS AND STUDIES ARE DONE THROUGH COLLABORATION BETWEEN MOFFITT RESEARCHERS AND PHYSICIANS WHO FOCUS ON COMPREHENSIVE CANCER TREATMENT. THE CLINICAL TRIALS AND STUDIES EXPLORE NEW MEDICAL DISCOVERIES OR NEW WAYS TO USE EXISTING TREATMENTS TO IMPROVE PATIENT CARE. EVERY PARTICIPANT HELPS TAKE US ONE STEP CLOSER TO THAT NEXT BIG BREAKTHROUGH IN CANCER TREATMENT.REIMBURSEMENT IS ALSO CRITICAL TO THE HOSPITAL'S OPERATIONS; HOWEVER, MOFFITT RECOGNIZES ITS RESPONSIBILITY TO PROVIDE SERVICES AND EDUCATION TO THOSE NEEDING SPECIALIZED RESEARCH CAPABILITIES. PATIENTS WHO MEET MOFFITT'S MEDICAL AND SURGICAL PROTOCOLS AND DO NOT HAVE THE ABILITY TO PAY WILL BE TREATED, IF SUCH PROTOCOLS ARE NOT AVAILABLE IN THEIR COMMUNITY.IT IS THIS COMMITMENT THAT GUIDES THE HOSPITAL TO:(1) PROVIDE CARE FOR PATIENTS COVERED BY GOVERNMENTAL PROGRAMS BELOW COST(2) PROVIDE FREE CHARITY CARE FOR THOSE WHO CANNOT PAY(3) PROVIDE ONCOLOGY SPECIALIZATION TO THE STATE OF FLORIDA THROUGH INVOLVEMENT IN INVESTIGATIONAL PROTOCOLS, EDUCATION OF FUTURE PHYSICIANS AND CONTINUING PROFESSIONAL EDUCATION FOR PHYSICIANS AND OTHER ALLIED HEALTH CARE PROFESSIONALS(4) TAKE A LEADERSHIP ROLE IN CANCER PREVENTION AND SCREENING ACTIVITIES THE HOSPITAL IS A CRITICAL RESOURCE FOR THE STATE OF FLORIDA, WHICH RANKS SECOND IN THE NATION IN BOTH CANCER INCIDENCE AND MORTALITY. MOFFITT IS LICENSED FOR 206 BEDS AND DEVOTES MORE THAN 2 MILLION SQUARE FEET TO RESEARCH AND PATIENT CARE. ADDITIONALLY, MOFFITT PROVIDES A WIDE ARRAY OF OUTREACH AND EDUCATIONAL ACTIVITIES FOR THE GENERAL PUBLIC AND SELECT UNDERSERVED POPULATIONS. IN FISCAL YEAR 2016, THE HOSPITAL RECORDED 351,421 OUTPATIENT VISITS AND 9,384 INPATIENT ADMISSIONS 601462571 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 1 119 0 1 3539 1 0 0 0 0 0 0 0 0 0 0 X 16 15 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X YVETTE M LYONS TREMONTI 8137457862 12902 MAGNOLIA DRIVE TAMPA FL 33612 BETH A HOUGHTON DIRECTOR, CHAIR 1.00 1.00 X X 0 0 0 THE HONORABLE MARK A PIZZO DIRECTOR, VICE CHAIR 1.00 1.00 X X 0 0 0 THE HONORABLE H LEE MOFFITT DIRECTOR, SECRETARY/TREAS 1.00 4.00 X X 0 0 0 W MICHAEL ALBERTS DIRECTOR, MEDICAL DIRECTOR MCKINLEY 51.00 0.00 X 466417 0 44179 MICHAEL BICE DIRECTOR 1.00 0.00 X 0 0 0 JOSEPH CABALLERO DIRECTOR 1.00 1.00 X 0 0 0 ROLAND DANIELS DIRECTOR 1.00 0.00 X 0 0 0 VALERIE GODDARD DIRECTOR 1.00 0.00 X 0 0 0 JACQUELINE LEWIS DIRECTOR 1.00 0.00 X 0 0 0 JO MANION DIRECTOR 1.00 0.00 X 0 0 0 JENNIFER MOFFITT DIRECTOR 1.00 1.00 X 0 0 0 ORLANDO NIEVES DIRECTOR 1.00 0.00 X 0 0 0 KEVIN PLUMMER DIRECTOR 1.00 0.00 X 0 0 0 NICOLAS PORTER DIRECTOR 1.00 0.00 X 0 0 0 MARY ANNE REILLY DIRECTOR 1.00 0.00 X 0 0 0 HAL WALKER DIRECTOR 1.00 0.00 X 0 0 0 JOHN A KOLOSKY HOSPITAL PRESIDENT 25.00 30.00 X 0 942465 94556 LOUIS D DE LA PARTE EVP-GEN COUNSEL, ASST SEC 20.00 35.00 X 0 610363 50636 G DOUGLAS LETSON EVP-PHYS IN CHIEF 22.00 33.00 X 833151 0 49115 YVETTE LYONS TREMONTI EVP-CFO & ASST TREASURER 20.00 35.00 X 0 653701 51585 BRAULIO VICENTE SVP-HOSP OPERATIONS 35.00 20.00 X 458385 0 48625 JANE FUSILERO VP-PATIENT CARE SVS/CNO 55.00 0.00 X 419550 0 37944 ROBERT KEENAN VP-QUAL & MED AFFAIRS/CMO 55.00 0.00 X 525506 0 11553 CYNTHIA TERRANO VP-PAYER STRATEGIES 35.00 20.00 X 341041 0 3529 JOANNA WEISS VP REV CYCLE MGMT 35.00 20.00 X 0 281754 45355 GENE WETZSTEIN CHIEF PHARMACY OFFICER 50.00 0.00 X 229103 0 36178 VLADIMIR FEYGELMAN ASSOC MBR PHYSICIST 50.00 0.00 X 231284 0 39255 EDUARDO G MOROS SR MBR PHYSICIST 50.00 0.00 X 363544 0 49310 AMARJIT S SAINI COORD BRACHYTHERAPY PHYSIC 50.00 0.00 X 244484 0 12971 SIRIPORN SARANGKASIRI CLINICAL PHYSICIST II 50.00 0.00 X 225081 0 24410 STUART G WASSERMAN DIR CLINICAL PHYSICS 50.00 0.00 X 302319 0 41023 JULIE DJEU FORMER DIRECTOR, ACD RSCH EDUC 0.00 50.00 X 0 414922 64611 JANENE CULUMBER FORMER SVP-CFO&ASST TREAS 0.00 0.00 X 0 130196 0 WILLIAM S DALTON FORMER PRES/CEO 0.00 55.00 X 0 1097768 53801 ALAN F LIST FORMER EVP-PHYS IN CHIEF 0.00 55.00 X 0 2904711 76128 SCOTT D ELDREDGE FORMER KEY EMP, DEPT ADMIN 50.00 0.00 X 198245 0 26053 4838110 7035880 860817 195 1 1 0 LEIDOS HEALTH LLC PO BOX 223866 PITTSBURGH PA 15251 PROFESSIONAL SERVICES 2425715 LAB CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 1184285 HARMONY HEALTHCARE 2909 W BAY TO BAY BLVD STE 500 TAMPA FL 33629 PROFESSIONAL SERVICES 978090 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 30384 PROFESSIONAL SERVICES 484993 THIRD EYE TELERADIOLOGY LLC 11725 RED OAK VALLEY LN AUSTIN TX 78732 RADIOLOGY SERVICES 356800 16 3448983 237595 6977331 1073042 10663909 NET PATIENT SERV REV 900099 784387328 784387328 SPECIALTY PHARMACY 900099 18290717 18290717 OUTPATIENT PHARMACY 900099 800000 800000 EDUCATION CONFERENCES 611710 447345 447345 AFFILIATE SERVICES 900099 143414 143414 417879 417879 804486683 132591 180309 -47718 -47718 -47718 CAFETERIA 722210 1581332 1581332 REBATES 900099 331370 331370 INT FROM INS CO 524114 301514 301514 145559 145559 2359775 817462649 804486683 0 2312057 X 3000 3000 3691410 3471703 219707 284831 222924 61907 218871732 170467562 48404170 10947714 8668520 2279194 32146246 28422177 3724069 15564346 12263734 3300612 1982965 1982965 299510 299510 439816 439816 19750206 13098503 6651703 5833936 29519 5804417 49432213 32344322 17087891 5594027 5594027 15936185 3833212 12102973 785226 369646 415580 506149 506149 9108972 9108972 30591471 13133185 17458286 1184396 1184396 MEDICAL SUPPLIES 219082456 219079626 2830 ALLOC OF INTERCO EXP 0 55886901 -55886901 PURCHASED SERVICES 35417708 21940882 13476826 HCCB ASSESSMENT 8663756 8663756 14009367 9057250 4952117 700127638 601462571 98665067 0 7525 4175 2592814 2859855 81102636 90615228 10963297 11975543 1063242 1210898 195448959 148644291 38553027 46804668 7199092 8601616 141481633 162071983 25375908 22792320 167354 97525 29539226 28295475 55082488 51185320 X 82974466 107062975 3424679 3823688 86399145 110886663 141481633 162071983 X 117335011 -92847493 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 1 26324 1 99316 0 1 549963 1 23550 1 16977 716130 0 Part II-B, Line 1: THE H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE, INC. AND ITS THREE NON-PROFIT SUBSIDIARY CORPORATIONS ("CORPORATION") WERE CREATED TO GOVERN AND OPERATE THE H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE ("INSTITUTE") PURSUANT TO SECTION 1004.43, FLORIDA STATUTES. AMONG OTHER THINGS, SECTION 1004.43 FLORIDA STATUTES PROVIDES: (1) THAT THE CORPORATION SHALL ENTER INTO AN AGREEMENT WITH THE STATE BOARD OF EDUCATION FOR THE UTILIZATION OF FACILITIES ON THE CAMPUS OF THE UNIVERSITY OF SOUTH FLORIDA; (2) THAT THE CORPORATION SUBMIT ANNUAL POST AUDITS OF ITS FINANCIAL ACCOUNTS TO THE AUDITOR GENERAL OF THE STATE OF FLORIDA AND THE BOARD OF GOVERNORS FOR THEIR REVIEW; AND (3) THAT THE CORPORATION'S CEO REPORT TO THE BOARD OF GOVERNORS OR ITS DESIGNEE AND PROVIDE COPIES OF THE INSTITUTE'S ANNUAL REPORT TO THE GOVERNOR OF THE STATE OF FLORIDA, THE CABINET, THE PRESIDENT OF THE SENATE, THE SPEAKER OF THE HOUSE AND THE CHAIR OF THE BOARD OF GOVERNORS. ALTHOUGH THE CORPORATION IS A PRIVATE ENTITY, IT IS NONETHELESS SUBJECT TO THE STATE OF FLORIDA'S PUBLIC RECORDS AND THE PUBLIC MEETINGS LAWS. THE CORPORATION ALSO RELIES ON ANNUAL APPROPRIATIONS BY THE LEGISLATURE OF THE STATE OF FLORIDA AND GRANTS FROM VARIOUS LOCAL, STATE AND FEDERAL AGENCIES FOR OPERATION AND MAINTENANCE OF ITS FACILITIES AND FOR SPECIFIC RESEARCH AND CLINICAL PROGRAMS. FOR THESE REASONS, THE CORPORATION FROM TIME TO TIME ENGAGES LOBBYISTS AND OTHER CONSULTANTS: (1) TO ASSIST IT IN COMPLYING WITH ITS REPORTING REQUIREMENTS TO THE STATE OF FLORIDA UNDER SECTION 1004.43, FLORIDA STATUTES; (2) TO MONITOR LEGISLATIVE AND EXECUTIVE BRANCH ACTION AT LOCAL, STATE AND FEDERAL LEVELS OF GOVERNMENT WHICH IMPACT ITS OPERATION AND THE FULFILLMENT OF ITS MISSION; AND (3) TO INFLUENCE LEGISLATION IN FURTHERANCE OF ITS MISSION IN THE AREAS OF CANCER RESEARCH AND TREATMENT, THE TEACHING AND TRAINING OF HEALTH CARE PROFESSIONALS AND COMMUNITY EDUCATION AND OUTREACH ACTIVITIES. THE CORPORATION DOES NOT ENGAGE IN ANY ACTIVITIES TO SUPPORT OR OPPOSE ANY CANDIDATE FOR PUBLIC OFFICE. PART II-B, LINE 1i, OTHER ACTIVITIES THE OTHER ACTIVITIES AMOUNT LISTED ON LINE 1i IS COMPRISED OF EXPENSES RELATED TO ORCHESTRATING CONTACT BETWEEN GRASSROOTS SUPPORTERS AND ELECTED OFFICIALS TO PROMOTE THE INSTITUTION'S LEGISLATIVE INITIATIVES. 281110 281110 0 192230601 148363181 43867420 2937248 2937248 46804668 INVESTMENT IN PREMIER 4681746 INTEREST IN NET ASSETS OF FOUNDATION 3823688 RECEIVABLE - OTHER 96182 8601616 HCCB ASSESSMENT 10955018 ESTIMATED THIRD-PARTY SETTLEMENTS 17340457 28295475 X Part X, Line 2: THE CANCER CENTER RECOGNIZES UNCERTAIN TAX POSITIONS WHEN IT IS MORE LIKELY THAN NOT (I.E., GREATER THAN 50% LIKELIHOOD OF RECEIVING BENEFIT) AND RECORDS THESE BENEFITS AT THE AMOUNT MOST LIKELY TO BE REALIZED ASSUMING A REVIEW BY TAX AUTHORITIES HAVING ALL RELEVANT INFORMATION AND APPLYING CURRENT CONVENTIONS. THE CANCER CENTER HAS NO SIGNIFICANT UNRECOGNIZED TAX BENEFITS AND DOES NOT BELIEVE THAT THERE WILL BE ANY MATERIAL CHANGES IN THE CANCER CENTER'S UNRECOGNIZED TAX POSITION OVER THE NEXT 12 MONTHS. 1 1 X 1 X 1 X 1 1 1 0 1 1 16967395 16967395 0.02440 20026757 10323297 9703460 0.01400 36994152 10323297 26670855 0.03840 801560 801560 0.00110 2478275 2478275 0.00360 27233 27233 0.00000 3307068 3307068 0.00470 40301220 10323297 29977923 0.04310 2912 2912 0.00000 4131 4131 0.00000 1220 1220 0.00000 8263 8263 1 1613258 193108665 207595135 -14486470 X 1 1 1 1 H LEE MOFFITT CANCER CENTER & RESEARCH 12902 MAGNOLIA DRIVE TAMPA FL 33612 www.moffitt.org 4334 X H LEE MOFFITT CANCER CENTER & RESEARCH 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X SEE PART V, LINE 10a X 1 15 1 WWW.MOFFITT.ORG/PUBLICATIONS/COMMUNITY-BENEFIT 0 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X 1 X 0 X 0 X X X X 0 0 H LEE MOFFITT CANCER CENTER & RESEARCH Part V, Section B, Line 5: INDIVIDUALS, INCLUDING ORGANIZATIONAL LEADERS FROM MULTIPLE SECTORS, COMMUNITY STAKEHOLDERS, AND RESIDENTS, PARTICIPATED IN FOCUS GROUPS AND INTERVIEWS TO GAUGE THEIR PERCEPTIONS OF THE COMMUNITY, THEIR HEALTH CONCERNS, AND WHAT PROGRAMMING, SERVICES, OR INITIATIVES ARE MOST NEEDED TO ADDRESS THESE CONCERNS. ADDITIONALLY, AN ADVISORY COMMITTEE COMPRISED OF BOTH INTERNAL MOFFITT STAFF AND COMMUNITY LEADERS PROVIDED FEEDBACK AND GUIDANCE THROUGHOUT THE ASSESSMENT PROCESS.THE FOLLOWING INDIVIDUALS WERE INTERVIEWED AS PART OF THIS HEALTH ASSESSMENT, EITHER BY PHONE ON IN PERSON. THEY CONTRIBUTED IMMEASURABLE VALUE IN THE FORMATION OF THIS REPORT, PROVIDING PROFESSIONAL KNOWLEDGE, EXPERT INFORMATION, AND INFORMED PUBLIC POLICY DIRECTION BY PARTICIPATING IN THE ASSESSMENT PROCESS AS KEY INFORMANTS. WE WOULD LIKE TO ACKNOWLEDGE EACH OF THESE INDIVIDUALS AND THANK THEM FOR THEIR GENEROUS TIME AND CONTRIBUTIONS TO THIS ASSESSMENT.CHRISTINE ABARCA, FLORIDA DEPT. OF HEALTH PASCO COUNTY; KIM AMTMANN-BUETTNER, PATIENT & FAMILY ADVISORY PROGRAM, MOFFITT CANCER CENTER; DEBORAH AUSTIN, PHD, DIRECTOR OF COMMUNITY ENGAGEMENT, REACHUP, INC.; PASTOR DAN CAMPBELL, DIRECTOR OF DEVELOPMENT FOR PASCO COUNTY METROPOLITAN MINISTRIES; ERMELINDA CENTENO, DIRECTOR OF ENABLING SERVICES, CENTRAL FLORIDA HEALTH CARE, INC.; KRISTIN CHESNUTT, HEALTH SYSTEMS MANAGER, AMERICAN CANCER SOCIETY, FLORIDA DIVISION; VENESSA RIVERA COL N, MANAGER OF MOFFITT PROGRAM FOR OUTREACH WELLNESS EDUCATION & RESOURCES, MOFFITT CANCER CENTER; ERNEST CONEY, CEO, CDC OF TAMPA; KATHY DAIN, EXECUTIVE DIRECTOR, BETH-EL FARMWORKER MINISTRY; LOLITA DASH-PITTS, EXECUTIVE DIRECTOR, FRONT PORCH CDA, INC.; MARTINE DORVIL, DIRECTOR OF PROGRAMS, UNIVERSITY AREA COMMUNITY DEVELOPMENT CORPORATION; KATHERINE EAGAN, CEO, HILLSBOROUGH AREA REGIONAL TRANSIT (HART); SUSAN EASTER, DIRECTOR OF HEALTH CENTER, ST. PETERSBURG FREE CLINIC; MARIA NIEVES EDMONDS, CHAIRPERSON, HISPANIC LEADERSHIP COUNCIL; SHEILA FERRALL, SENIOR DIR., NURSING PRACTICE, EDUC. & CLINIC EFFICIENCY, MOFFITT CANCER CENTER; KHALIAH FLEMING, COMMUNITY HEALTH EDUCATOR, MOFFITT CANCER CENTER; MIGUEL FUENTES, REDLANDS CHRISTIAN MIGRANT ASSOCIATION (RCMA); GEORGE GARCIA, BRANCH EXECUTIVE, HIGHPOINT BRANCH, YMCA OF THE SUNCOAST; LYNDA GOWING, REGIONAL COORDINATOR, FLORIDA DEPT. OF HEALTH PASCO COUNTY; LUCY GUERRA, MD, ASSOCIATE PROFESSOR OF MEDICINE, UNIVERSITY OF SOUTH FLORIDA SCHOOL OF MEDICINE; ERIC HAAS, MD, SENIOR MEDICAL DIRECTOR FOR MEDICARE ADVANTAGE, FLORIDA BLUE; CARRIE HEPBURN, EXECUTIVE DIRECTOR, TAMPA BAY HEALTHCARE COLLABORATIVE; SHERRY HOBACK, CHIEF CLINICAL SERVICES OFFICER, TAMPA FAMILY HEALTH CENTERS; DOUGLAS HOLT, MD, DIRECTOR, FLORIDA DEPT. OF HEALTH HILLSBOROUGH COUNTY; JOY JACKSON, MD, DIRECTOR, FLORIDA DEPT. OF HEALTH POLK COUNTY; DENESE METEYE JAMES, COMMUNITY VOLUNTEER; CYNTHIA JOHNSON, ED.D, EDFP, SENIOR MANAGER BUSINESS ASSISTANCE, PINELLAS COUNTY ECONOMIC DEVELOPMENT; CHERI WRIGHT-JONES, REGIONAL VICE PRESIDENT, ALLEGHANY FRANCISCAN MINISTRIES; ROBERT KEENAN, MD, CHIEF MEDICAL OFFICER, VP QUALITY, MOFFITT CANCER CENTER; JACK KOLOSKY, CHIEF OPERATING OFFICER, MOFFITT CANCER CENTER; GINA KRAVITZ, EXECUTIVE DIRECTOR, SUSAN G KOMEN SUNCOAST; VALARIE LEE, PUBLIC HEALTH SERVICES MANAGER, FLORIDA DEPT. OF HEALTH PINELLAS COUNTY; DOUGLAS LETSON, MD, EXECUTIVE VICE PRESIDENT, PHYSICIAN-IN-CHIEF, MOFFITT CANCER CENTER; KARENNE LEVY, DIRECTOR OF PATIENT EXPERIENCE (FORMERLY), MOFFITT CANCER CENTER; NATASHA MARTIN, HUMAN SERVICES MANAGER, PASCO COUNTY HUMAN SERVICES; CHRISTINA MATHIS, CEO, GULFCOAST NORTH AREA HEALTH EDUCATION CENTER; MICHELE MCCOY, SEMINOLE INDIAN TRIBE; KATE MCDONALD, HEALTH SERVICES COORDINATOR, LAKE WALES CARE CENTER; SETH MCKEEL, SOUTHERN STRATEGY GROUP, FORMER REPRESENTATIVE OF POLK COUNTY DISTRICT 40; KYLE MOBLEY, SENIOR MANAGER FOR HOSPITAL SYSTEMS, AMERICAN CANCER SOCIETY, FLORIDA DIVISION; MIKE NAPIER, ADMINISTRATOR, FLORIDA DEPT. OF HEALTH PASCO COUNTY; SHALEWA NOEL-THOMAS, PHD, MANAGER, SOCIAL SERVICES DEPT. (FORMERLY), HILLSBOROUGH COUNTY BOARD OF COMMISSIONERS; DONNA PETERSEN, PHD, DEAN, USF COLLEGE OF PUBLIC HEALTH; MARIA PINZ N, EXECUTIVE DIRECTOR, HISPANIC SERVICES COUNCIL; CHERYL POLLOCK, DIRECTOR, BUSINESS DEVELOPMENT & COMMUNITY SERVICES, PREMIER COMMUNITY HEALTHCARE GROUP; LARRY POWELL, PRESIDENT, ANGELS CARE CENTER OF ELOISE; SISTER SARA PROCTOR, PROGRAM COORDINATOR, CATHOLIC MOBILE MEDICAL SERVICES; FRANK RIDDICK, CHAIRMAN, TAMPA CITY COUNCIL; CLARA REYNOLDS, PRESIDENT/CEO, CRISIS CENTER OF TAMPA BAY; ASHLEY RIVERA, CHIEF EXECUTIVE OFFICER, WE CARE OF POLK COUNTY; MARGARITA ROMO, EXECUTIVE DIRECTOR, FARMWORKERS SELF-HELP, INC.; JOLENE ROWE, SOCIAL WORK SUPERVISOR, MOFFITT CANCER CENTER; LEISA STANLEY, PHD, ASSOCIATE EXECUTIVE DIRECTOR, HEALTHY START COALITION OF HILLSBOROUGH COUNTY, INC.; DONNA THOMAS, ASSISTANT DIRECTOR, GOOD SAMARITAN HEALTH CLINIC OF PASCO; JOSSETTE TOULME, TREASURER, HAITIAN ASSOCIATION FOUNDATION OF TAMPA BAY, INC.; MARY LYNN ULREY, CEO, DRUG ABUSE COMP. COORDINATING OFFICE (DACCO); BRIAN WINFIELD, CHIEF FINANCIAL OFFICER (FORMERLY), EQUALITY FLORIDA INSTITUTE, INC.; AND CARRIE ZEISSE, CHIEF OPERATING OFFICER, UNITED WAY SUNCOAST H LEE MOFFITT CANCER CENTER & RESEARCH Part V, Section B, Line 6b: IN OCTOBER 2015, MOFFITT COLLABORATED WITH THE FLORIDA DEPARTMENT OF HEALTH, HILLSBOROUGH COUNTY, TO COMPLETE THE CHNA AND LATER ESTABLISH HEALTHY HILLSBOROUGH. HEALTHY HILLSBOROUGH IS A COMMITTEE OF LOCAL HOSPITALS, THE COUNTY HEALTH DEPARTMENT, AND FEDERALLY QUALIFIED HEALTH CENTERS. THE PURPOSE OF HEALTHY HILLSBOROUGH WAS TO MEET THE FEDERAL CHNA REQUIREMENTS FOR ALL ENTITIES AND TO WORK COLLABORATIVELY IN THE PROCESS. THE ORGANIZATIONS INVOLVED ARE:FLORIDA DEPARTMENT OF HEALTH HILLSBOROUGH COUNTYFLORIDA HOSPITAL CARROLLWOODFLORIDA HOSPITAL TAMPASOUTH FLORIDA BAPTIST HOSPITALST. JOSEPH'S HOSPITALSUNCOAST COMMUNITY HEALTH CENTERSTAMPA FAMILY HEALTH CENTERSTAMPA GENERAL HOSPITAL H LEE MOFFITT CANCER CENTER & RESEARCH Part V, Section B, Line 11: BASED ON THE RESULTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, LEGACY CONSULTING GROUP IDENTIFIED TWELVE SIGNIFICANT HEALTH NEEDS WITHIN THE COMMUNITY. THESE TWELVE NEEDS CAN BE GROUPED INTO FOUR BASIC CATEGORIES: -ACCESS TO CARE (TRANSPORTATION FOR DISADVANTAGED, AVAILABILITY OF PRIMARY CARE PHYSICIANS, HEALTH CARE NAVIGATION); -SCREENING AND PREVENTION, GENERAL (LUNG CANCER, BREAST CANCER, PROSTATE CANCER, COLORECTAL CANCER, SMOKING CESSATION);-CANCER EDUCATION AND AWARENESS; AND -OBESITY (ACCESS TO HEALTHY FOODS, DIET/NUTRITION, EXERCISE).IN ORDER TO EVALUATE AND PRIORITIZE THESE NEEDS, A MEETING OF THE MOFFITT CANCER CENTER COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE WAS HELD ON MARCH 24, 2016, AT THE MOFFITT BUSINESS CENTER IN TAMPA. TEN COMMITTEE MEMBERS ATTENDED IN PERSON AND THREE PARTICIPATED BY PHONE. THE PRIORITIZING CRITERIA WERE BASED ON ALIGNMENT TO MOFFITT'S MISSION, THE ABILITY AND FEASIBILITY TO ADDRESS A PARTICULAR HEALTH NEED, AND THE RESULTING IMPACT AND BENEFIT TO THE COMMUNITY. THE STEERING COMMITTEE DECIDED THAT MOFFITT WOULD NOT ADDRESS "AVAILABILITY OF PRIMARY CARE PHYSICIANS AND "OBESITY" SINCE THESE ISSUES EITHER DO NOT ALIGN WITH MOFFITT'S MISSION AND VISION OR THAT OTHER ENTITIES WERE BETTER EQUIPPED TO ADDRESS THEM. IN ADDITION, "GENERAL CANCER EDUCATION AND AWARENESS" CONTINUES TO BE A CORNERSTONE OF MOFFITT'S STRATEGIC PLAN. IT HAS INCORPORATED SEVERAL EDUCATION AND AWARENESS PROGRAMS IN THE IMPLEMENTATION WHICH FOLLOWS. H LEE MOFFITT CANCER CENTER & RESEARCH Part V, Section B, Line 13b: PATIENTS WHO ARE MEDICALLY NEEDY MAY STILL APPLY FOR FINANCIAL ASSISTANCE, BUT WILL PRESUMPTIVELY QUALIFY FOR FINANCIAL ASSISTANCE IF THEY CANNOT MEET THEIR SHARE OF COST AS DETERMINED BY THE FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES. THE LEVEL OF ASSISTANCE WILL BE DETERMINED BY WHICH INCOME LEVEL THE PATIENT'S SHARE OF COST FALLS ON THE FEDERAL POVERTY GUIDELINES. H LEE MOFFITT CANCER CENTER & RESEARCH Part V, Section B, Line 15e: METHOD BY WHICH PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE:A. PATIENTS THAT REQUEST FINANCIAL ASSISTANCE OR WHO HAVE BEEN IDENTIFIED AS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE WILL BE REFERRED TO THE CENTER'S FINANCIAL COUNSELORS.B. PATIENTS MAY CONTACT THE MOFFITT CANCER CENTER BUSINESS OFFICE AT 12902 MAGNOLIA DRIVE, MCB-BO, TAMPA, FLORIDA 33612, OR CALL 1-800-456-3434 EXT. 8422 OR THE DIRECT NUMBER AT 813-745-8422 FOR INFORMATION AND ASSISTANCE REGARDING THE FINANCIAL ASSISTANCE APPLICATION.C. PATIENTS WILL BE INFORMED OF THE PROCESS AND PROCEDURES INVOLVED FOR A FINANCIAL ASSISTANCE APPLICATION EITHER BEFORE RECEIVING SERVICES OR DURING THE BILLING AND COLLECTION PROCESS.D. THE PATIENT AND/OR THE PATIENT'S FAMILY WILL BE ADVISED OF ALL DOCUMENTATION REQUIRED TO MAKE A DETERMINATION AS TO ELIGIBILITY FOR FINANCIAL ASSISTANCE.E. A FINANCIAL COUNSELOR WILL INTERVIEW THE PATIENT OR THE PATIENT'S RELATIVES WHO ARE LEGALLY RESPONSIBLE FOR THE PATIENT'S SUPPORT IN COMPLIANCE WITH HIPAA GUIDELINES. DURING THE INTERVIEW, THE FINANCIAL COUNSELOR WILL GATHER INFORMATION ABOUT THE PATIENT'S CIRCUMSTANCES AND ABILITY TO PAY AND, IF REQUESTED, MAY ASSIST THE PATIENT OR PATIENT'S FAMILY IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION. ANY PATIENT WHO IS FINANCIALLY SUPPORTED BY ANOTHER PERSON, AS DEEMED BY THE CENTER, MUST ALSO PROVIDE INCOME, ASSETS, TAX RECORDS OR OTHER DOCUMENTS TO DETERMINE PATIENT ELIGIBILITY.F. A PATIENT AND/OR A PATIENT'S FAMILY MAY ALSO MEET WITH THE CENTER'S PHARMACY REPRESENTATIVE TO APPLY FOR AVAILABLE ASSISTANCE PROGRAMS FOR PHARMACEUTICAL CARE.G. A REQUEST FOR FINANCIAL ASSISTANCE AND A DETERMINATION OF ELIGIBILITY FOR FINANCIAL ASSISTANCE SHOULD OCCUR PRIOR TO RENDERING NON-EMERGENT MEDICALLY NECESSARY SERVICES. HOWEVER, THE DETERMINATION MAY BE DONE AT ANY POINT IN THE COLLECTION PROCESS.H. IF THE MARITAL STATUS OF A MINOR CANNOT BE DETERMINED, OR WHERE THERE IS NOT SUFFICIENT DOCUMENTATION TO CONFIRM A MINOR'S EMANCIPATION, ELIGIBILITY OF FINANCIAL ASSISTANCE WILL BE BASED ON THE INCOME AND ASSETS OF THE PARENT/PARENTS OR LEGAL GUARDIAN OF THE MINOR. DOCUMENTATION PROVIDED FOR THE FINANCIAL ASSISTANCE APPLICATION MUST BE CONSISTENT WITH ALL OTHER DOCUMENTATION PRESENTED FOR REVIEW. H LEE MOFFITT CANCER CENTER & RESEARCH Part V, Section B, Line 16i: REFERENCE TO THE POLICY IS ADDED TO THE BILLING INVOICE STATING THAT A MOFFITT REPRESENTATIVE CAN HELP EVALUATE ELIGIBILITY FOR FINANCIAL ASSISTANCE IF THE PATIENT IS UNABLE TO PAY. HOSPITAL'S BILLING AND COLLECTIONS AREA OF ITS WEBSITE ALSO STATES THAT IF A PATIENT IS UNDERINSURED OR UNABLE TO PAY, A PATIENT ACCOUNT REPRESENTATIVE OR A SOCIAL WORKER WILL HELP IDENTIFY ASSISTANCE PROGRAMS THAT OFFER HELP IN MEETING FINANCIAL OBLIGATIONS. H LEE MOFFITT CANCER CENTER & RESEARCH Part V, Section B, Line 20e: MOFFITT HOSPITAL DID NOT INITIATE ANY OF THE ACTIONS DESCRIBED IN SCHEDULE H, PART V, SECTION B, LINE 17. HOWEVER, IF THE HOSPITAL HAD UNDERTAKEN ANY OF THE LISTED ACTIONS, IT WOULD HAVE FIRST NOTIFIED PATIENTS OF ITS FINANCIAL ASSISTANCE POLICY ON ADMISSION, PRIOR TO DISCHARGE, AND IN COMMUNICATIONS WITH THE PATIENTS REGARDING THEIR BILLS. MOFFITT HOSPITAL DOCUMENTS ITS DETERMINATION OF WHETHER PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER ITS FINANCIAL ASSISTANCE POLICY. H LEE MOFFITT CANCER CENTER & RESEARCH Part V, Section B, Line 21d: THE CANCER CENTER IS A SPECIALTY HOSPITAL AND THEREFORE, DOES NOT PROVIDE EMERGENCY MEDICAL TREATMENT WITHIN THE MEANING OF SECTION 1867 OF THE SOCIAL SECURITY ACT (42 USC 1395DD). IF, HOWEVER, AN INDIVIDUAL SEEKING SUCH CARE ENTERS THE CANCER CENTER'S FACILITY, THE CANCER CENTER WITHOUT DISCRIMINATION WILL STABILIZE THE PATIENT AND ASSIST THE PATIENT AND/OR THE PATIENT'S FAMILY IN OBTAINING TRANSPORTATION FOR THE PATIENT TO A LOCAL HOSPITAL EQUIPPED FOR EMERGENCY MEDICAL CARE. H LEE MOFFITT CANCER CENTER & RESEARCH Part V, Section B, Line 22d: THE CENTER'S CURRENT AMOUNT GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE IS THIRTY-FIVE PERCENT (35%). THE CENTER DETERMINES THE AGB ANNUALLY BY USING THE LOOK-BACK METHOD, AS DESCRIBED AT 26 CFR S. 1.501(R)-5(B)(3). SPECIFICALLY, THE CENTER DIVIDES THE SUM OF THE AMOUNTS OF ALL OF ITS CLAIMS FOR MEDICALLY NECESSARY CARE THAT HAVE BEEN ALLOWED BY HEALTH INSURERS, INCLUDING MEDICARE, MEDICAID, AND ALL PRIVATE HEALTH INSURERS, DURING A PRIOR 12-MONTH PERIOD BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. PART V, LINE 16a-c: WWW.MOFFITT.ORG/PATIENT-FAMILY/INSURANCE-FINANCIAL-INFORMATION/FINANCIAL-ASSISTANCE Part I, Line 3c: CHARITY ADJUSTMENTS ARE PROVIDED BY THE CANCER CENTER AS FOLLOWS:A. PATIENTS WHO HAVE FAMILY INCOME AND ASSETS AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES FOR THE PATIENT'S FAMILY SIZE SHALL BE ENTITLED TO 100% FINANCIAL ASSISTANCE ON QUALIFYING BALANCES.B. PATIENTS WHO HAVE FAMILY INCOME AND ASSETS BETWEEN 201%-400% OF THE FEDERAL POVERTY GUIDELINE FOR THE PATIENT'S FAMILY SIZE SHALL BE CLASSIFIED AS "SELF PAY TIER 1" STATUS AND ARE ENTITLED TO FINANCIAL ASSISTANCE OF 65% ON QUALIFYING BALANCES.C. PATIENTS WHO ARE MEDICALLY NEEDY MAY STILL APPLY FOR FINANCIAL ASSISTANCE, BUT WILL PRESUMPTIVELY QUALIFY FOR FINANCIAL ASSISTANCE IF THEY CANNOT MEET THEIR SHARE OF COST AS DETERMINED BY THE FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES. THE LEVEL OF ASSISTANCE WILL BE DETERMINED BY WHICH INCOME LEVEL THE PATIENT'S SHARE OF COST FALLS ON THE FEDERAL POVERTY GUIDELINES. Part I, Line 7: METHODOLOGY USED TO CALCULATE CHARITY CARE, MEDICAID, AND OTHER MEANS-TESTED EXPENSES IS COST TO CHARGE RATIO, USING PATIENT EXPENSES TO GROSS CHARGES, WHILE THE DIRECT COST METHOD IS USED TO DETERMINE OTHER COMMUNITY BENEFITS/PROGRAMS EXPENSES. Part I, Ln 7 Col(f): OUR TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN A FOR HOSPITAL IS $700,127,638. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS $5,305,063. AFTER BAD DEBT WAS DEDUCTED FROM THE TOTAL EXPENSES THE AMOUNT OF TOTAL EXPENSES USED TO CALCULATE THE PERCENT IN LINE 7, COLUMN F WAS $694,822,575. Part III, Line 2: THE METHODOLOGY USED TO CALCULATE BAD DEBT EXPENSE WAS CALCULATING THE COST TO CHARGE RATIO, USING PATIENT EXPENSES TO GROSS CHARGES, AND APPLYING IT TO THE BAD DEBT PROVISION IN PART III, LINE 4. Part III, Line 4: ADDITIONS TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS ARE MADE BY MEANS OF THE PROVISION FOR BAD DEBTS. ACCOUNTS ARE WRITTEN OFF WHEN DEEMED TO BE UNCOLLECTIBLE AND ARE DEDUCTED FROM THE PATIENT'S ACCOUNTS RECEIVABLE BALANCE.THE AMOUNT OF THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENT HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS. ONE TOOL USED IN MANAGEMENT'S ASSESSMENT IS A DETAILED REVIEW OF HISTORICAL COLLECTIONS AND WRITE-OFFS AT THE CANCER CENTER THAT REPRESENT A MAJORITY OF THE CANCER CENTER'S REVENUES AND ACCOUNTS RECEIVABLE. THE RESULTS OF THE DETAILED REVIEW OF HISTORICAL COLLECTIONS AND WRITE-OFFS EXPERIENCE, ADJUSTED FOR CHANGES IN TRENDS AND CONDITIONS, ARE USED TO EVALUATE THE ALLOWANCE AMOUNT FOR THE CURRENT PERIOD. Part III, Line 8: THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS IS THE STEP DOWN METHOD WHICH DISALLOWS CERTAIN COSTS TO BE CONSIDERED AS COSTS RELATED TO PATIENT CARE. MEDICARE SHORTFALLS WHICH ARE COSTS INCURRED BY THE HOSPITAL TO PROVIDE QUALITY CARE AND TREATMENT OF ITS PATIENTS SHOULD BE TREATED AS COMMUNITY BENEFIT. TO NOT INCUR THESE COST WOULD POTENTIALLY LIMIT OR EVEN COMPROMISE THE QUALITY OF SERVICE PROVIDED TO THE ELDERLY OR DISABLED. Part III, Line 9b: PATIENTS ARE SCREENED DURING THE ADMISSIONS PROCESS TO ASSESS THE NEED FOR FINANCIAL ASSISTANCE. HOWEVER, IF AT ANY POINT IN THE COLLECTION PROCESS IT IS DETERMINED THAT THE PATIENT MAY BE UNABLE TO MEET ITS OBLIGATION, THE PATIENT WILL BE SENT AN APPLICATION FOR FINANCIAL ASSISTANCE OR CHARITY ADJUSTMENT. IF PATIENT DOES NOT EXPRESS THE INABILITY TO PAY PRIOR TO BILLING, AN INVOICE IS SENT TO THE PATIENT WHICH INCLUDES CONTACT INFORMATION FOR A PATIENT SERVICE REPRESENTATIVE IF THE PATIENT NEEDS FINANCIAL ASSISTANCE. A HOSPITAL REPRESENTATIVE WILL MAKE EVERY EFFORT TO WORK WITH THE PATIENT TO DETERMINE WHETHER FINANCIAL ASSISTANCE IS NEEDED. IF THE PATIENT DOES NOT STATE THE NEED OR DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE THEREAFTER, AND PAYMENTS ARE NOT MADE AS AGREED, THE HOSPITAL REPRESENTATIVE MAY OFFER REASONABLE PAYMENT PLANS TO HELP PATIENTS MEET THEIR FINANCIAL OBLIGATIONS. Part VI, Line 2: THE H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE (MOFFITT) IS A NATIONALLY RECOGNIZED COMPREHENSIVE CANCER CENTER WHOSE MISSION IS "TO CONTRIBUTE TO THE PREVENTION AND CURE OF CANCER." LOCATED IN TAMPA, FLORIDA, MOFFITT PRIMARILY SERVES A FOUR COUNTY CATCHMENT AREA (HILLSBOROUGH, PASCO, PINELLAS, AND POLK) AND AN ELEVEN COUNTY SECONDARY AREA (CHARLOTTE, CITRUS, DESOTO, HARDEE, HERNANDO, HIGHLANDS, LAKE, LEE, MANATEE, SARASOTA, AND SUMTER).ITS COMMUNITY BENEFIT MISSION IS TO PROVIDE PATIENT-CENTERED AND CULTURALLY COMPETENT OUTREACH, EDUCATION, TRAINING, AND RESOURCES THROUGHOUT THE GREATER TAMPA BAY COMMUNITY AND THE STATE OF FLORIDA TO SUPPORT PATIENTS, FAMILIES AND CLINICIANS IN ADVANCING CANCER PREVENTION, EARLY DETECTION, CLINICAL CARE, AND RESEARCH SPECIFICALLY FOR THOSE AT-RISK POPULATIONS DISPROPORTIONATELY IMPACTED BY THE DISEASE.IN 2015 MOFFITT CONTRACTED WITH LEGACY CONSULTING GROUP, A HEALTHCARE CONSULTING ORGANIZATION WITH A LOCAL OFFICE TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN AN EFFORT TO ASSIST IN TARGETING ITS STRATEGIC GOALS, SPECIFICALLY:DEMONSTRATE AND PROMOTE SUPERIOR PERFORMANCE EMBODYING HIGH-QUALITY, COST EFFECTIVE CARE;DEVELOP A NETWORK THAT BROADENS MOFFITT'S REACH, PROVIDES ACCESS TO ITS EXPERTISE AND DELIVERS SUPERIOR VALUE;DEMONSTRATE STRONG FINANCIAL STEWARDSHIP THAT EMBODIES A FRESH REVIEW, REPRIORITIZATION AND REENGINEERING OF MOFFITT'S HISTORICAL BUSINESS MODELS;ENHANCE AND STRENGTHEN MOFFITT'S PROVISION OF PRECISION MEDICINE; AND, MAXIMIZE MOFFITT'S AWARENESS AND REPUTATION IN THE STATE AND NATION, REFLECTING ITS SUPERIOR VALUE AND PIONEERING STRENGTHS.THE CHNA DEFINES HEALTH IN THE BROADEST SENSE AND RECOGNIZES NUMEROUS FACTORS AT MULTIPLE LEVELS, FROM LIFESTYLE BEHAVIORS (E.G., DIET AND EXERCISE) TO CLINICAL CARE (E.G., ACCESS TO MEDICAL SERVICES) TO SOCIAL AND ECONOMIC FACTORS (E.G., EMPLOYMENT OPPORTUNITIES) TO THE PHYSICAL ENVIRONMENT (E.G., AIR QUALITY), ALL HAVE AN IMPACT ON THE COMMUNITY'S HEALTH. EXISTING SOCIAL, ECONOMIC, AND HEALTH DATA WERE DRAWN FROM SUCH SOURCES AS U.S. CENSUS BUREAU, FLORIDA DEPARTMENT OF HEALTH, NIELSEN/CLARITAS, AND THE CDC. Part VI, Line 3: PUBLICATION OF THE POLICY:A. THE CENTER WILL MAKE THIS POLICY, THE FINANCIAL ASSISTANCE APPLICATION, AND THE PLAIN LANGUAGE SUMMARY OF THIS POLICY WIDELY AVAILABLE ON ITS WEBSITE. INDIVIDUALS WITH ACCESS TO THE INTERNET CAN ACCESS, DOWNLOAD, VIEW, AND PRINT A HARD COPY OF THIS POLICY, THE FINANCIAL ASSISTANCE APPLICATION, AND THE PLAIN LANGUAGE SUMMARY OF THIS POLICY FROM THE WEBSITE:I. WITHOUT REQUIRING SPECIAL COMPUTER HARDWARE OR SOFTWARE (OTHER THAN SOFTWARE THAT IS READILY AVAILABLE TO MEMBERS OF THE PUBLIC WITHOUT PAYMENT OF ANY FEE);II. WITHOUT PAYING A FEE TO THE CENTER; ANDIII. WITHOUT CREATING AN ACCOUNT OR BEING OTHERWISE REQUIRED TO PROVIDE PERSONALLY IDENTIFIABLE INFORMATION.B. THE CENTER WILL PROVIDE ANY INDIVIDUALS WHO ASK HOW TO ACCESS A COPY OF THIS POLICY, THE FINANCIAL ASSISTANCE APPLICATION, AND THE PLAIN LANGUAGE SUMMARY OF THIS POLICY ONLINE WITH THE DIRECT WEBSITE ADDRESS, OR URL, OF THE WEB PAGE WHERE THIS POLICY, THE FINANCIAL ASSISTANCE APPLICATION, AND THE PLAIN LANGUAGE SUMMARY OF THIS POLICY ARE POSTED.C. THE CENTER WILL MAKE PAPER COPIES OF THIS POLICY, THE FINANCIAL ASSISTANCE APPLICATION, AND THE PLAIN LANGUAGE SUMMARY OF THIS POLICY AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH BY MAIL AND IN PUBLIC LOCATIONS AT THE CENTER, INCLUDING ANY ADMISSIONS AREAS.D. THE CENTER WILL NOTIFY AND INFORM PATIENTS WHO RECEIVE CARE AT THE CENTER ABOUT THIS POLICY BY:I. OFFERING A PAPER COPY OF THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY AS PART OF THE INTAKE OR DISCHARGE PROCESS; ANDII. INCLUDING A CONSPICUOUS WRITTEN NOTICE ON BILLING STATEMENTS THAT NOTIFIES AND INFORMS RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THIS POLICY AND INCLUDES THE TELEPHONE NUMBER OF THE CENTER OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THIS POLICY AND THE FINANCIAL ASSISTANCE APPLICATION PROCESS ALONG WITH THE DIRECT WEBSITE ADDRESS (OR URL) WHERE COPIES OF THIS POLICY, THE FINANCIAL ASSISTANCE APPLICATION, AND THE PLAIN LANGUAGE SUMMARY OF THIS POLICY MAY BE OBTAINED.E. AT ANY TIME DURING THE PATIENT'S TREATMENT THE PATIENT MAY REQUEST A COPY OF THIS POLICY, THE FINANCIAL ASSISTANCE APPLICATION, OR THE PLAIN LANGUAGE SUMMARY OF THIS POLICY.F. IF A MEMBER OF THE WORKFORCE BECOMES AWARE OF THE PATIENT'S NEED FOR FINANCIAL ASSISTANCE DURING THE ADMISSION PROCESS, THE PSS WILL PROVIDE THE PATIENT WITH THE NECESSARY INFORMATION NEEDED TO APPLY FOR FINANCIAL ASSISTANCE.G. THE CENTER WILL ALSO TRANSLATE THIS POLICY, THE FINANCIAL ASSISTANCE APPLICATION, AND THE PLAIN LANGUAGE SUMMARY OF THIS POLICY INTO THE PRIMARY LANGUAGES SPOKEN BY ALL SIGNIFICANT POPULATIONS SERVED BY THE CENTER. Part VI, Line 4: DEMOGRAPHICS OF MOFFITT'S SERVICE AREA:BASED ON AN ASSESSMENT OF MOFFITT'S PATIENT ORIGIN AND DISCUSSIONS WITH KEY MOFFITT STAKEHOLDERS, MOFFITT'S PRIMARY SERVICE AREA ("COMMUNITY SERVED") HAS BEEN DEFINED AS ALL RESIDENTS OF HILLSBOROUGH, PASCO, PINELLAS, AND POLK COUNTIES IN WEST CENTRAL FLORIDA. THIS AREA IS HOME TO 3.4 MILLION PEOPLE WITH AN ANTICIPATED GROWTH OF 5.5% BY 2020. IN ADDITION, A SECONDARY SERVICE AREA COMPRISING RESIDENTS OF CHARLOTTE, CITRUS, DESOTO, HARDEE, HERNANDO, HIGHLANDS, LAKE, LEE, MANATEE, SARASOTA, AND SUMTER COUNTIES HAS ALSO BEEN DEFINED FOR MOFFITT'S RESEARCH INITIATIVES.THE CURRENT (2015) POPULATION OF THE PRIMARY SERVICE AREA STANDS AT 3,375,615. HILLSBOROUGH COUNTY ACCOUNTS FOR THE LARGEST SHARE (39%) OF THIS TOTAL. PRIMARY SERVICE AREA POPULATION IS EXPECTED TO GROW TO 3,559,672 BY 2020, A GROWTH OF 5.5% OR 184,057 PEOPLE. THE SECONDARY SERVICE AREA'S CURRENT POPULATION IS 2,498,932 AND IS EXPECTED TO GROW BY 5.8% TO 2,654,040 BY 2020. HEAVIEST GROWTH IN THE PRIMARY SERVICE AREA IS EXPECTED TO BE AMONG THOSE AT LEAST 65 YEARS OF AGE. GROWTH IN THIS GROUP IS EXPECTED TO BE 17.1% BETWEEN 2015 AND 2020, REPRESENTING 58.7% OF TOTAL GROWTH IN THE FOUR COUNTY AREA.THE PRIMARY SERVICE AREA COMPRISES 63.6% WHITE RESIDENTS, 12.5% BLACK RESIDENTS, AND 18.5% HISPANICS. BY COMPARISON, THE SECONDARY SERVICE AREA HAS A SOMEWHAT LARGER WHITE POPULATION (74.8%), A SMALLER BLACK POPULATION (7.4%), AND A SMALLER HISPANIC POPULATION (14.3%) THAN IN THE PRIMARY SERVICE AREA.THE VAST MAJORITY OF PRIMARY SERVICE AREA RESIDENTS (87.5%) ARE NATIVE BORN. THE COMPARABLE FIGURE FOR FLORIDA IS 80.4%. ONE IN FIVE (20.0%) SPEAK A LANGUAGE OTHER THAN ENGLISH AT HOME, PRIMARILY SPANISH. ABOUT 7.4% OF PRIMARY SERVICE AREA RESIDENTS REPORT THAT THEY DO NOT SPEAK ENGLISH VERY WELL, SOMEWHAT LESS THAN FOR FLORIDA OVERALL (11.7%). RESIDENTS OF HILLSBOROUGH COUNTY ARE SOMEWHAT BETTER OFF FINANCIALLY THAN ARE RESIDENTS OF THE STATE OVERALL. THE MEDIAN HOUSEHOLD INCOME IN THE COUNTY IS ESTIMATED TO BE $50,122, ABOUT 6% HIGHER THAN THE STATE'S MEDIAN HOUSEHOLD INCOME OF $47,212. SOME 79.3% OF THE COUNTY'S HOUSEHOLDS RECEIVED EARNINGS DURING THE PERIOD 2010-2014 COMPARED TO 72.4% OF THE STATE. IN ADDITION, A SMALLER PERCENTAGE OF THE COUNTY'S HOUSEHOLDS REPORTED RECEIVING SOCIAL SECURITY BENEFITS THAN IS THE CASE FOR THE STATE OVERALL. HOWEVER, A LARGER PERCENTAGE OF THE COUNTY'S RESIDENTS (3.3%) RECEIVED CASH ASSISTANCE THAN DID THE STATE'S RESIDENTS (2.2%) AND A HIGHER PERCENTAGE (15.7%) RECEIVED FOOD STAMP BENEFITS THAN IS THE CASE FOR THE STATE OVERALL (14.3%). THE PRIMARY SERVICE AREA'S HOUSEHOLD INCOME DISTRIBUTION IS VIRTUALLY IDENTICAL TO THAT FOR FLORIDA. WHILE POLK COUNTY HAS THE HIGHEST LEVEL OF HOUSEHOLDS WITH INCOMES UNDER $25,000 (27.1%), HILLSBOROUGH COUNTY HAS THE HIGHEST LEVEL OF HOUSEHOLDS WITH INCOMES OF AT LEAST $100,000 (20.9%). Part VI, Line 5: IN 2013, MOFFITT'S LAST CHNA DETERMINED FIVE PRIORITIES TO ADDRESS. BELOW IS A SUMMARY OF THOSE PRIORITIES AND HOW EACH PRIORITY AREA HAS BEEN ADDRESSED SINCE THE LAST CHNA.CULTURAL COMPETENCE: EFFORTS TO ADDRESS CULTURAL COMPETENCE FOCUSED ON PROVIDING INTERNAL AND EXTERNAL CULTURAL AND LINGUISTIC COMPETENCE (CLC) INITIATIVES. THE LANGUAGE SERVICES TEAM AVERAGED MORE THAN 7,000 INTERPRETING ENCOUNTERS AND MORE THAN 450 TRANSLATION PROJECTS EACH YEAR. ALSO, LANGUAGE SERVICES EDUCATION WAS PROVIDED TO CLINICAL TEAMS TO IMPROVE EFFICACY IN COMMUNICATING WITH PATIENTS, FAMILIES, AND WITH MEDICAL INTERPRETERS.A CLC STEERING COMMITTEE WAS CREATED TO IMPROVE PATIENT EXPERIENCE, CLC EDUCATION, DATA COLLECTION, AND LANGUAGE AND COMMUNICATION SERVICES. AN EXTERNAL ADVISORY COMMITTEE OF NATIONAL EXPERTS ALSO HELPED GUIDE MOFFITT ON IMPLEMENTING CLC INITIATIVES. ADDITIONALLY, AN ONLINE CLC TRAINING WAS PILOTED FOR CLINICAL FACULTY IN 2014 AND IMPLEMENTED ORGANIZATION WIDE IN 2016.PREVENTION, SCREENING, EDUCATION & OUTREACH: THE MOFFITT PROGRAM FOR OUTREACH, WELLNESS, EDUCATION AND RESOURCES (M-POWER) AVERAGES NEARLY 170 HEALTH EDUCATION WORKSHOPS ON CANCER PREVENTION AND SCREENING AND REACHES OVER 5,000 INDIVIDUALS EACH YEAR. M-POWER: HEALTH INITIATIVES - COMMUNITY HEALTH WORKER TRAINING: THIS PROGRAM EDUCATES INDIVIDUALS BY TRAINING THEM ON THE PRINCIPLES OF BEING A CHW. THE PROGRAM'S GOAL IS TO INCREASE KNOWLEDGE AND AWARENESS, EMPOWER INDIVIDUALS TO BECOME PROACTIVE ABOUT THEIR HEALTH, AND TO ENCOURAGE COMMUNITY ADVOCACY IN THE AFRICAN AMERICAN, HISPANIC/LATINO AND HAITIAN COMMUNITIES. CHW TRAININGS UTILIZE EDUCATIONAL KITS CREATED BY THE M-POWER TEAM. THE TOOLKIT IS A LOW-LITERACY AND CULTURALLY APPROPRIATE TOOL THAT COVERS BREAST, CERVICAL, AND PROSTATE CANCERS. THE TOOLKITS ARE AVAILABLE IN ENGLISH, SPANISH AND HAITIAN CREOLE. CHW TRAINING PARTICIPANTS LEARN ABOUT ADULT LITERACY, ADULT EDUCATION, EDUCATION DELIVERY METHODS, ROLE-PLAYING, SCREENING RECOMMENDATIONS, AND HEALTH DISPARITIES. THE M-POWER TEAM HAS TRAINED NEARLY 300 INDIVIDUALS THROUGHOUT THE STATE OF FLORIDA, INCLUDING GAINESVILLE, JACKSONVILLE, MIAMI, TAMPA, ST. PETERSBURG, TALLAHASSEE, ARCADIA, AND ORLANDO.M-POWER: HEALTH INITIATIVES - EMPOWERMENT PROJECT:THIS PROGRAM FOCUSES ON THE DELIVERY OF MEN'S HEALTH EDUCATION TO UNDERSERVED MEN IN THE TAMPA BAY AREA ON CANCER PREVENTION AND HEALTHY LIFESTYLES. THIS PROGRAM IS TAUGHT IN A 5 WEEK SERIES FOCUSING ON CANCER PREVENTION TOPICS AFFECTING MEN SUCH AS HEALTHY LIFESTYLES, COLORECTAL, PROSTATE, LUNG AND SKIN CANCERS IN CHURCHES, HALFWAY HOUSES, HOMELESS SHELTERS, COMMUNITY CENTERS AND SCHOOLS. ITS FOCUS IS TO EMPOWER MEN TO HAVE THE TOOLS NECESSARY TO MAKE HEALTHY CHOICES.M-POWER: HEALTH INITIATIVES - MOFFITT HEALTHY KIDZ PROGRAM: THIS 5-WEEK HEALTHY LIFESTYLES PROGRAM FOCUSED ON CHILDREN IS A PARTNERSHIP FORGED BETWEEN HILLSBOROUGH COUNTY PUBLIC LIBRARY COOPERATIVE, HEAD START, LOCAL SCHOOLS AND LED BY MOFFITT. MOFFITT HEALTH KIDZ PROMOTES HEALTHY LIFESTYLES AND LITERACY BY PROVIDING CANCER AWARENESS EDUCATION AND WELLNESS TIPS IN A FUN, FAMILY-FRIENDLY ENVIRONMENT. CHILDREN LEARN ABOUT THE DANGERS OF SMOKING, PROTECTION FROM THE SUN, FITNESS, AND NUTRITION THROUGH CREATIVE GAMES, HANDHELD LEARNING MODELS, AND CRAFTS WHILE INFUSING ACTIVE LEARNING METHODS TO AROUSE CURIOSITY, MAKING HEALTHY CHOICES EASY TO UNDERSTAND AND EMPOWERING CHILDREN TO TEACH THEIR FAMILIES TO ADOPT THEM.M-POWER: HEALTH INITIATIVES - THE WITNESS PROJECT: THE WITNESS PROJECT OF TAMPA BAY: THIS NATIONAL FAITH-BASED PROGRAM PLACES EMPHASIS ON THE EARLY DETECTION OF BREAST AND CERVICAL CANCER IN THE AFRICAN AMERICAN COMMUNITY THROUGH EDUCATION IN CHURCHES. THIS PROGRAM UTILIZES SURVIVORS (CALLED WITNESS PROJECT ROLE MODELS) WHO "WITNESS OR TESTIFY ABOUT THEIR TRIUMPH OVER BREAST OR CERVICAL CANCER. ADDITIONALLY, LAY HEALTH ADVISORS (LHAS), PROVIDE INFORMATION TO PROGRAM PARTICIPANTS ON BREAST AND CERVICAL CANCER, HPV, HEALTHY LIFESTYLES, SCREENINGS AND SERVICES. PROGRAMS ARE CONDUCTED IN LOCAL CHURCHES, COMMUNITY CENTERS AND SOCIAL SERVICE ORGANIZATIONS. CURRENTLY, THERE OVER 20 WOMEN TRAINED TO SERVE AS EITHER WITNESS ROLE MODELS OR LAY HEALTH ADVISORS. IN 2010, THE WITNESS PROJECT STARTED SURVIVORS APPLYING FAITH AND ENCOURAGEMENT (S.A.F.E.), A SUPPORT GROUP FOCUSED ON PROVIDING SURVIVORS WITH SUPPORT THROUGHOUT THEIR CANCER JOURNEY.M-POWER: HEALTH INITIATIVES - YO ME CUIDO: YO ME CUIDO IS A BREAST HEALTH EDUCATION PROGRAM THAT FOCUSES ON THE IMPORTANCE OF EARLY DETECTION IN LATINAS. LATINAS ARE MORE LIKELY TO BE DIAGNOSED AT MORE ADVANCED STAGES OF BREAST CANCER WHERE FEWER TREATMENT OPTIONS ARE AVAILABLE. THE HEALTH EDUCATION WORKSHOPS ARE DELIVERED IN ENGLISH AND SPANISH AND FOCUS ON BREAST CANCER STATISTICS, MAMMOGRAPHY SCREENING RECOMMENDATIONS, AND RISK REDUCTION THROUGH HEALTHY LIFESTYLES.M-POWER: SUPPORT SERVICES: MAMMOGRAPHY VOUCHERS: THIS PROGRAM NOW UTILIZES A VOUCHER SYSTEM THROUGH WHICH WOMEN SCHEDULE APPOINTMENTS WITH THE LIFETIME CANCER SCREENING AND PREVENTION CENTER TO RECEIVE SCREENING SERVICES. THE QUALIFICATIONS FOR THE VOUCHER ARE BASED ON SEVERAL FACTORS INCLUDING INCOME (E.G., THOSE EARNING LESS THAN 200% OF THE US FEDERAL POVERTY GUIDELINES). ADDITIONALLY, M-POWER ORGANIZES QUARTERLY "COMMUNITY DAYS" WHERE TRANSPORTATION TO LIFETIME IS PROVIDED SO THAT WOMEN IN NEED ARE ABLE TO RECEIVE MAMMOGRAPHY-RELATED SCREENINGS.MOLE PATROL ORGANIZES OVER 15 SKIN CANCER SCREENING AND EDUCATION EVENTS IN THE COMMUNITY AND REACHES OVER 1,000 INDIVIDUALS EACH YEAR.MOFFITT'S LUNG AND THORACIC TUMOR EDUCATION (LATTE) PROGRAM CONDUCTS OVER 20 COMMUNITY OUTREACH AND ADVOCACY EVENTS ON LUNG CANCER EACH YEAR.HEALTH DISPARITIES: RESEARCH AND EDUCATIONAL EFFORTS HAVE BEEN IMPLEMENTED TO ADDRESS CANCER HEALTH DISPARITIES. SPECIFICALLY, HEALTH EDUCATION HAS BEEN DELIVERED TO COMMUNITY HEALTH WORKERS ACROSS FLORIDA VIA WEBINARS TO HELP REACH SPECIFIC POPULATIONS WITH RISING CANCER RATES. MOFFITT HOSTS THE MEN'S HEALTH FORUM TO PROVIDE HEALTH SCREENINGS FOR MEN WHO ARE MEDICALLY UNDERSERVED, REACHING OVER 500 MEN EACH YEAR.THE POPULATION SCIENCES RESEARCH PROGRAM FOCUSES ITS RESEARCH STRATEGIES TO ADDRESS AND REDUCE CANCER HEALTH DISPARITIES. THE CLINICAL TRIALS TASK FORCE DEVELOPED STRATEGIES TO INCREASE MINORITY ACCRUAL IN CLINICAL TRIALS. THE PHYSICIANS RELATIONS TEAM PARTNERS WITH PHYSICIANS SERVING IN MINORITY CATCHMENT AREAS AND EDUCATES THEM ON HEALTH DISPARITIES.ACCESS: NO COST MAMMOGRAMS AND PROSTATE CANCER SCREENINGS HAVE BEEN OFFERED TO AN AVERAGE OF OVER 600 WOMEN AND 200 MEN WHO ARE UNINSURED EACH YEAR TO ALLEVIATE FINANCIAL BARRIERS FOR ACCESSING CARE. ALSO, PATIENT AND FAMILY SERVICES OFFERS CAB VOUCHERS, ROUND TRIP TICKETS, GIFT CARDS, AND HOUSING SERVICES, EXPENDING OVER $450,000, TO HELP PROVIDE SUPPORT TO HUNDREDS OF PATIENTS AND THEIR FAMILIES IN NEED EVERY YEAR.AS A TEACHING HOSPITAL MEDICAL RESIDENTS AND FELLOWS, AS WELL AS MEDICAL STUDENTS FROM THE USF COLLEGE OF MEDICINE AND OTHER SITES RECEIVE MEDICAL EDUCATION AND TRAINING THROUGH MOFFITT CANCER CENTER'S GRADUATE MEDICAL EDUCATION (GME) PROGRAM. TRAINEES LEARN PHYSICAL EXAMINATION SKILLS, ASSIST CANCER RESEARCHERS, STUDY STRATEGIES FOR PREVENTING CANCER AND COMPLETE ELECTIVES IN MANY ASPECTS OF ONCOLOGY, INCLUDING CANCER SCREENING.CANCER ANSWERS IS A TOLL FREE NATIONWIDE CANCER INFORMATION SERVICE STAFFED BY REGISTERED NURSES WHO PROVIDE ANSWERS TO CANCER RELATED QUESTIONS CONCERNING DIAGNOSIS, TREATMENT, NEW DISCOVERIES, DRUG THERAPIES, THE AVAILABILITY OF RESEARCH STUDIES AND CLINICAL TRIALS. Part VI, Line 6: TO FURTHER THE MISSION OF CONTRIBUTING TO THE PREVENTION AND CURE OF CANCER, MOFFITT CANCER CENTER COLLABORATES WITH RESPECTED ACADEMIC, HOSPITAL SYSTEMS, REGIONAL CARE CENTERS AND PHYSICIANS GROUPS KNOWN AS THE MOFFITT ONCOLOGY NETWORK.WHOLLY COMMITTED TO MOFFITT'S MODEL OF PATIENT-CENTERED, INTEGRATED CANCER CARE, THE MOFFITT ONCOLOGY NETWORK IS HELPING MOFFITT DEVELOP A PREMIER CANCER CARE DELIVERY SYSTEM, FOCUSED SOLELY ON PROVIDING PATIENTS THE BEST PERSONALIZED CANCER CARE. THE MOFFITT ONCOLOGY NETWORK IMPLEMENTS MOFFITT'S CLINICAL CARE MODEL, INCLUDING MULTIDISCIPLINARY CANCER CARE, PEER REVIEW, CLINICAL PATHWAYS AND QUALITY ASSURANCE.THE COMMUNITY HEALTH NEEDS ASSESSMENT DETERMINED OPPORTUNITIES THAT CAN BE ADDRESSED BY THE CANCER CENTER AS A WHOLE. THE CANCER CENTER'S NON-HOSPITAL FACILITIES DEDICATED TO SERVING INDIVIDUALS WHO ARE IN NEED OF FINANCIAL ASSISTANCE, HELPING TO DEVELOP AND FUND COMMUNITY PROGRAMS AND PERFORM TRANSLATIONAL RESEARCH TO BENEFIT THE COMMUNITY, INCLUDE MOFFITT FOUNDATION, MOFFITT MEDICAL GROUP, AND MOFFITT RESEARCH. MOFFITT FOUNDATION SOLICITS FUNDS TO SUPPORT THE WORK OF THE CANCER CENTER. DONATIONS MAINTAINED BY THE FOUNDATION MAY BE USED FOR A SPECIFIC PROGRAM OR MAY BE USED TO FURTHER THE OVERALL NEEDS OF THE COMMUNITY. MOFFITT MEDICAL GROUP EMPLOYS PHYSICIANS THAT STAFF THE HOSPITAL AND PROVIDE CLINICAL RESEARCH TO THE CANCER CENTER HEALTH CARE SYSTEM. THESE PHYSICIANS PROVIDE MEDICAL SERVICES TO THOSE PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. IN ADDITION, PHYSICIANS PARTICIPATE IN COMMUNITY RELATED PROGRAMS PROVIDING EDUCATION AND TRAINING. MOFFITT'S CANCER RESEARCH FACILITY PERFORMS STUDIES AND INVESTIGATIONS TO GENERATE GENERALIZABLE KNOWLEDGE AVAILABLE TO THE PUBLIC. THE RESEARCH FACILITY IS ALSO THE PARENT COMPANY OF THE CANCER CENTER HEALTH CARE SYSTEM THAT PLANS, DEVELOPS, AND IMPLEMENTS COMMUNITY BENEFIT PROGRAMS TO ADDRESS COMMUNITY NEEDS SEPARATELY FROM, AS WELL AS IN COLLABORATION WITH, THE HOSPITAL. COMMUNITY BENEFIT EXPENSES PERFORMED BY RELATED ENTITIES:MOFFITT MEDICAL GROUPFINANCIAL ASSISTANCE AT COST WAS $1,670,092PERCENT OF TOTAL MMG ENTITY EXPENSE: 1.29%PERCENT OF COMBINED EXPENSE: .19%MOFFITT MEDICAL GROUPHEALTH PROFESSIONS EDUCATION WAS $7,148,619PERCENT OF TOTAL MMG ENTITY EXPENSE: 5.50%PERCENT OF COMBINED EXPENSE: .73%MOFFITT MEDICAL GROUP'S BAD DEBT EXPENSE AT COST: $721,348MOFFITT RESEARCHRESEARCH NET COMMUNITY BENEFIT EXPENSE WAS $32,714,327PERCENT OF TOTAL AFFILIATE EXPENSE: 20.71%PERCENT OF COMBINED EXPENSE: 3.33% 1 1 0 0 0 1 1 0 0 W MICHAEL ALBERTS DIRECTOR, MEDICAL DIRECTOR MCKINLEY 313784 0 113425 0 39208 0 26856 0 22934 0 516207 0 0 0 JOHN A KOLOSKY HOSPITAL PRESIDENT 0 600516 0 257315 0 84634 0 75454 0 21083 0 1039002 0 0 LOUIS D DE LA PARTE EVP-GEN COUNSEL, ASST SEC 0 405550 0 174254 0 30559 0 32202 0 27042 0 669607 0 0 G DOUGLAS LETSON EVP-PHYS IN CHIEF 543509 0 234075 0 55567 0 26443 0 24402 0 883996 0 0 0 YVETTE LYONS TREMONTI EVP-CFO & ASST TREASURER 0 435554 0 186073 0 32074 0 35568 0 22672 0 711941 0 0 BRAULIO VICENTE SVP-HOSP OPERATIONS 316861 0 115605 0 25919 0 19950 0 31221 0 509556 0 0 0 JANE FUSILERO VP-PATIENT CARE SVS/CNO 306106 0 108909 0 4535 0 22911 0 23372 0 465833 0 0 0 ROBERT KEENAN VP-QUAL & MED AFFAIRS/CMO 440511 0 79650 0 5345 0 0 0 12875 0 538381 0 0 0 CYNTHIA TERRANO VP-PAYER STRATEGIES 172965 0 148076 0 20000 0 1360 0 0 0 342401 0 0 0 JOANNA WEISS VP REV CYCLE MGMT 0 217870 0 63036 0 848 0 16950 0 30157 0 328861 0 0 GENE WETZSTEIN CHIEF PHARMACY OFFICER 188485 0 32524 0 8094 0 10786 0 27072 0 266961 0 0 0 VLADIMIR FEYGELMAN ASSOC MBR PHYSICIST 229562 0 500 0 1222 0 24366 0 16054 0 271704 0 0 0 EDUARDO G MOROS SR MBR PHYSICIST 357936 0 500 0 5108 0 26443 0 25302 0 415289 0 0 0 AMARJIT S SAINI COORD BRACHYTHERAPY PHYSIC 243984 0 500 0 0 0 12674 0 297 0 257455 0 0 0 SIRIPORN SARANGKASIRI CLINICAL PHYSICIST II 218848 0 500 0 5733 0 14640 0 10867 0 250588 0 0 0 STUART G WASSERMAN DIR CLINICAL PHYSICS 254123 0 39886 0 8310 0 10786 0 27072 0 340177 0 0 0 JULIE DJEU FORMER DIRECTOR, ACD RSCH EDUC 0 298339 0 107567 0 9016 0 49578 0 16155 0 480655 0 0 JANENE CULUMBER FORMER SVP-CFO&ASST TREAS 0 0 0 0 0 130196 0 0 0 0 0 130196 0 0 WILLIAM S DALTON FORMER PRES/CEO 0 643507 0 408438 0 45823 0 37518 0 26203 0 1161489 0 0 ALAN F LIST FORMER EVP-PHYS IN CHIEF 0 780687 0 1949803 0 174221 0 45755 0 37617 0 2988083 0 0 SCOTT D ELDREDGE FORMER KEY EMP, DEPT ADMIN 169905 0 24057 0 4283 0 16260 0 13367 0 227872 0 0 0 Part I, Line 3 HOSPITAL'S PRESIDENT IS PAID BY A RELATED ORGANIZATION WHICH ESTABLISHES COMPENSATION BY RELYING ON AN INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEYS OR STUDIES, AN EXECUTIVE COMPENSATION COMMITTEE, AND THE APPROVAL BY THE BOARD OR THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD. Part I, Lines 4a-b IN GENERAL, HOSPITAL OFFERS SEVERANCE PAYMENTS TO TEAM MEMBERS IF THE TEAM MEMBER IS IN A POSITION THAT HAS BEEN ELIMINATED OR REALIGNED. JANENE J. CULUMBER, A FORMER OFFICER, LEFT MOFFITT INSTITUTE, A RELATED ORGANIZATION, ON MAY 25, 2014 AND CONTINUED TO RECEIVED SEVERANCE PAYMENTS OF $130,195.61 ELIGIBILITY TO PARTICIPATE IN/CONTRIBUTE TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN IS BASED ON JOB POSITION, YEAR'S OF SERVICE AND ANNUAL SALARY THRESHOLD WHICH ASSISTS IN DETERMINING THE TIER FOR WHICH THE TEAM MEMBER IS CLASSIFIED. THE COMPANY'S MATCHING CONTRIBUTION VARIES BETWEEN TIERS. THE FOLLOWING INDIVIDUALS PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN AND AMOUNTS LISTED ARE INCLUDED IN THEIR TOTAL COMPENSATION LISTED IN SCH J, PART II, COLUMN B, RESPECTIVELY: WILLIAM M. ALBERTS-$15,087 YVETTE M. LYONS TREMONTI-$29,772 JOHN A. KOLOSKY-$53,507 BRAULIO VICENTE-$10,980 LOUIS D. DE LA PARTE-$28,036 G. DOUGLAS LETSON-$44,113 WILLIAM S. DALTON-$0 ALAN F. LIST-$81,565 W. J. WILSON-$0 JULIE Y. DJEU-$0 JANE FUSILERO-$0 Part I, Line 6 IN GENERAL, INCENTIVE COMPENSATION IS BASED ON MOFFITT'S ACHIEVEMENT AGAINST SPECIFIC ORGANIZATIONAL GOALS RELATED TO NET OPERATING INCOME AND ON DIVISION OR INDIVIDUAL GOALS. NET OPERATING INCOME MUST MEET OR EXCEED A CERTAIN THRESHOLD IN ORDER TO TRIGGER A PAYOUT FOR THE ORGANIZATIONAL GOAL COMPONENTS. CAITLAN CORDERO SEE PART V 22503 SEE PART V;ListTotal 0.00 0 NICHOLAS ELDREDGE SEE PART V 25296 SEE PART V 0 SCHEDULE L, PART IV (LINE 1): INTERESTED PERSON: CAITLAN CORDERORELATIONSHIP: FAMILY MEMBER OF BRAULIO VICENTE, OFFICERTRANSACTION: COMPENSATION AS AN EMPLOYEE OF THE ORGANIZATION SCHEDULE L, PART IV (LINE 2): INTERESTED PERSON: NICHOLAS ELDREDGERELATIONSHIP: FAMILY MEMBER OF SCOTT ELDREDGE, FORMER KEY EMPLOYEETRANSACTION: COMPENSATION AS AN EMPLOYEE OF THE ORGANIZATION X EQUIPMENT 3 1073042 PURCHASE PRICE 0 0 0 0 Part I, Column (b): THE NUMBER ON LINE 25(B) REPRESENTS THE NUMBER OF ITEMS CONTRIBUTED, NOT THE NUMBER OF CONTRIBUTIONS. Form 990, Part VI, Section A, line 2 THE HONORABLE H. LEE MOFFITT AND JENNIFER MOFFITT THAT SERVE ON THE HOSPITAL BOARD ARE FATHER AND DAUGHTER. THE FOLLOWING DIRECTORS AND OFFICERS, THAT JOINTLY SERVE ON THE HOSPITAL AND A FOR-PROFIT RELATED ENTITY, QUALIFY AS HAVING A BUSINESS RELATIONSHIP. HOSPITAL & MOFFITT GENETICS CORPORATION: H. LEE MOFFITT - DIRECTOR JOHN A. KOLOSKY - OFFICER LOUIS D. DE LA PARTE - OFFICER YVETTE LYONS TREMONTI - OFFICER HOSPITAL & MOFFITT TECHNOLOGIES CORPORATION: JOHN A. KOLOSKY - OFFICER LOUIS D. DE LA PARTE - OFFICER YVETTE LYONS TREMONTI - OFFICER Form 990, Part VI, Section A, line 6 H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE, INC. IS THE SOLE MEMBER OF THE HOSPITAL. Form 990, Part VI, Section A, line 7a AS THE SOLE MEMBER OF THE HOSPITAL, H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE, INC. SHALL HAVE THE POWER TO APPROVE, DISAPPROVE OR REMOVE ANY MEMBER OF THE BOARD OF DIRECTORS OR OFFICER OF THE HOSPITAL. Form 990, Part VI, Section A, line 7b H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE, INC. AS THE SOLE MEMBER OF THE CORPORATION SHALL ALSO HAVE THE FOLLOWING POWERS: A. APPROVE, DISAPPROVE OR RECOMMEND THE ADOPTION, CHANGE, AMENDMENT OR REPEAL OF THE ARTICLES OF INCORPORATION OF THE CORPORATION; B. APPROVE, DISAPPROVE OR RECOMMEND THE ADOPTION, CHANGE, AMENDMENT OR REPEAL OF THE BYLAWS OF THE CORPORATION; C. APPROVE, DISAPPROVE OR RECOMMEND THE SELECTION OF A QUALIFIED AUDIT FIRM AND THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; D. APPROVE OR DISAPPROVE THE TRANSFER, SALE, LEASE OR DISPOSITION OF ANY ASSET OF THE CORPORATION IN EXCESS OF TWO HUNDRED THOUSAND DOLLARS ($200,000.00); E. APPROVE OR DISAPPROVE THE CONFERRING OF ANY LIEN OR SECURITY INTEREST IN ASSETS OF THE CORPORATION IN EXCESS OF ONE MILLION DOLLARS ($1,000,000.00), WHETHER SAME SHALL BE IN CONNECTION WITH EITHER PUBLIC OR PRIVATE FINANCING, OR OTHERWISE; F. APPROVE OR DISAPPROVE ALL DONATIONS OR CHARITABLE CONTRIBUTIONS BY THE CORPORATION IN EXCESS OF TWENTY THOUSAND DOLLARS ($20,000.00) PER CONTRIBUTION OR ANNUAL CONTRIBUTION EXCEEDING FIFTY THOUSAND DOLLARS ($50,000.00) IN THE AGGREGATE; G. APPROVE, DISAPPROVE OR RECOMMEND THE ADOPTION OF THE CORPORATION'S MISSION AND PHILOSOPHY STATEMENT; AND H. APPROVE OR DISAPPROVE CAPITAL EXPENDITURES BY THE CORPORATION IN EXCESS OF FIVE HUNDRED THOUSAND DOLLARS ($500,000.00) PER EXPENDITURE OR FIVE HUNDRED THOUSAND DOLLARS ($500,000.00) IN THE AGGREGATE ANNUALLY. I. APPROVE, DISAPPROVE OR REMOVE ANY MEMBER OF THE BOARD OR OFFICER OF THE CORPORATION. Form 990, Part VI, Section B, line 11 LINE 11B, PRIOR TO PROVIDING FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, TO THE HOSPITAL BOARD OF DIRECTORS FOR REVIEW, THE CHIEF FINANCIAL OFFICER REVIEWS THE RETURN. SUGGESTED COMMENTS OR CHANGES ARE DISCUSSED AND ANY NECESSARY CORRECTIONS ARE MADE. PRIOR TO ELECTRONICALLY FILING FORM 990, MOFFITT HOSPITAL PROVIDES A COPY OF THE RETURN TO THE GOVERNING BODY, GIVING EACH BOARD MEMBER TIME TO REVIEW THE RETURN. BOARD MEMBERS HAVE THE OPPORTUNITY TO ASK QUESTIONS RELATED TO THE INFORMATION PROVIDED ON THE RETURN. Form 990, Part VI, Section B, line 12c ON AN ANNUAL BASIS A PRESENTATION IS MADE TO HOSPITAL BOARD MEMBERS TO REVIEW THE CONFLICT OF INTEREST POLICY AND PROCEDURES FOR DISCLOSING ANY POTENTIAL CONFLICTS. EACH DIRECTOR, OFFICER, COMMITTEE MEMBER, AND KEY EMPLOYEE SHALL COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM ATTACHED TO THE POLICY. ANY DIRECTOR, OFFICER, COMMITTEE MEMBER, OR KEY EMPLOYEE WHO REASONABLY BELIEVES THAT HE OR SHE MAY HAVE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST MUST DISCLOSE THE EXISTENCE OF AND THE MATERIAL FACTS OF THE NATURE OF HIS/HER INTEREST ON THE FORM. THE FORM IS SUBMITTED TO THE CORPORATE COMPLIANCE OFFICE, WHICH REVIEWS THE FORMS, GATHERS ADDITIONAL RELEVANT INFORMATION WHERE NECESSARY, AND PREPARES A SUMMARY OF THE DISCLOSURES TO BE REVIEWED BY THE CONFLICT OF INTEREST WORK GROUP. IF A DIRECTOR OR COMMITTEE MEMBER DISCLOSES THAT HE/SHE HAS A POTENTIAL CONFLICT OF INTEREST AT A BOARD OR COMMITTEE MEETING, SUCH DIRECTOR OR COMMITTEE MEMBER MUST DISCLOSE THE NATURE OF THE INTEREST AND ANY RELATED INFORMATION AND RESPOND TO QUESTIONS AS MAY BE REQUIRED BY THE REMAINING MEMBERS. BASED ON THE INFORMATION DISCLOSED, THE REMAINING BOARD MEMBERS WILL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. IF A CONFLICT EXISTS THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER AN ALTERNATIVE TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT IS EQUALLY ADVANTAGEOUS. IF AN ALTERNATIVE TRANSACTION IS NOT EQUALLY ADVANTAGEOUS THE DIRECTOR OR COMMITTEE MEMBER WHO IS THE SUBJECT OF THE CONFLICT SHALL NOT VOTE ON, NOR USE HIS/HER PERSONAL INFLUENCE ON, NOR PARTICIPATE IN DISCUSSIONS OR DELIBERATIONS WITH RESPECT TO THE TRANSACTION. Form 990, Part VI, Section B, line 15 LINE 15A & 15B, THE BOARD OF DIRECTORS OF H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE, INC. ("MOFFITT"), A RELATED ENTITY, HAS AN ESTABLISHED SUB-COMMITTEE, THE JOINT EXECUTIVE COMPENSATION & BENEFITS COMMITTEE (JEC&BC) THAT IS MADE UP ENTIRELY OF INDEPENDENT, OUTSIDE DIRECTORS. THIS COMMITTEE IS CHARGED WITH THE OVERSIGHT OF THE PERFORMANCE AND COMPENSATION OF MOFFITT AND ITS SUBSIDIARIES' EXECUTIVES AND DISQUALIFIED PERSONS. THESE POSITIONS INCLUDE THE CEO, EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, VICE PRESIDENTS AND DEPARTMENT CHAIRPERSONS. TO ACCOMPLISH ITS MISSION, THE COMMITTEE CAN AS NEEDED AND DOES AT ITS DISCRETION, ENGAGE OUTSIDE INDEPENDENT, OUTSIDE ADVISORS INCLUDING, BUT NOT LIMITED TO ATTORNEYS AND COMPENSATION CONSULTANTS. ON AN ANNUAL BASIS THE JEC&BC ENGAGES A NATIONALLY KNOWN, THIRD PARTY CONSULTING FIRM TO PROVIDE A DETAILED STUDY OF THE CASH COMPENSATION FOR EACH EXECUTIVE, DISQUALIFIED PERSON AND INDIVIDUAL IN KEY POSITIONS. THE CONSULTANT USES A VARIETY OF PUBLISHED SURVEYS COMPILED BY INDEPENDENT FIRMS TO PROVIDE THE SOURCE DATA FOR THE STUDY. USING FUNCTIONALLY COMPARABLE POSITIONS IN OTHER SIMILARLY SIZED, NOT-FOR-PROFIT AND FOR-PROFIT HEALTHCARE, ACADEMIC AND RESEARCH ORGANIZATIONS, THE CONSULTING FIRM PRODUCES A STUDY THAT COMPARES EACH DESIGNATED POSITION TO ITS APPROPRIATE MARKET EQUIVALENT. THE RESULTING DATA IS PROVIDED TO THE DIRECTOR OF COMPENSATION, WHO IS NOT INCLUDED IN THE EXECUTIVE OR DISQUALIFIED PERSON CATEGORIES, FOR USE IN THE FORMULATION OF RECOMMENDATIONS FOR COMPENSATION CHANGES TO MAINTAIN MARKET COMPETITIVENESS OR TO REWARD PERFORMANCE. THESE RECOMMENDATIONS ALONG WITH THE CONSULTANT'S COMPARABILITY DATA ARE PRESENTED TO THE JEC&BC FOR IT TO CONFIRM ITS REASONABLENESS, MAKE MODIFICATIONS AS IT DEEMS NECESSARY AND PROVIDE FINAL APPROVAL. EVERY THIRD YEAR THE INDEPENDENT CONSULTANT ANALYZES THE TOTAL EXECUTIVE COMPENSATION PROGRAM, USING THE SAME METHODOLOGY AS DESCRIBED ABOVE, THAT INCLUDES THE VALUE OF ALL BENEFITS AND PREREQUISITES (CASH AND NON-CASH) PROVIDED AS COMPENSATION TO THE EXECUTIVES AND DISQUALIFIED PERSONS. THE PURPOSE OF THE ANALYSIS IS TO PROVIDE AN OPINION ON THE REASONABLENESS OF EACH OF THE INDIVIDUAL COMPENSATION COMPONENTS AND THE AGGREGATE COMPENSATION TOTAL. THIS MORE COMPREHENSIVE ANALYSIS IS PROVIDED TO THE JEC&BC FOR THEIR USE IN THE ANNUAL REVIEW PROCESS. MINUTES ARE KEPT AT EACH OF THESE ANNUAL MEETINGS DETAILING THE RECOMMENDATIONS PRESENTED AND THE DECISIONS MADE BY THE COMMITTEE. THESE MINUTES ARE PUBLISHED TO THE COMMITTEE AT THE NEXT MEETING AND REPORTED BACK TO THE FULL BOARD. Form 990, Part VI, Section C, line 19 MOFFITT HOSPITAL MAKES AVAILABLE TO THE PUBLIC THROUGH THIRD PARTY VENDORS' WEBSITES, ITS FORM 990 AND AUDITED FINANCIAL STATEMENTS. FORM 990 IS MADE AVAILABLE ON GUIDESTAR WHILE THE AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE ON DACBOND. ALL ORGANIZING AND GOVERNING DOCUMENTS SUCH AS FORM 1023, CONFLICTS OF INTEREST POLICY, AND BYLAWS AS WELL AS FORM 990 AND AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. Form 990, Part IX, Column (D): THERE ARE NO FUNDRAISING EXPENSES BECAUSE THE CONTRIBUTIONS ARE FROM RELATED AND NON-RELATED ORGANIZATIONS. H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE FOUNDATION, INC. HANDLES ALL FUNDRAISING ACTIVITIES FOR H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE, INC. AND ITS SUBSIDIARIES. Form 990, Part XI, line 9: TRANSFER TO TAX EXEMPT AFFILIATES -94897791. INTEREST IN NET ASSETS OF FOUNDATION 399009. NET ASSETS RELEASED FROM RESTRICTION 1651289. H LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE INC 12902 MAGNOLIA DRIVE TAMPA FL 33612 592451713 PARENT-RESEARCH FL 501(c)(3) Line 7 N/A 0 H LEE MOFFITT CANCER CTR & RESEARCH INSTITUTE FOUNDATION INC 12902 MAGNOLIA DRIVE TAMPA FL 33612 593238636 FUNDRAISING FL 501(c)(3) Line 7 H LEE MOFFITT CANCER CTR & RES INST INC 0 H LEE MOFFITT CC&RI LIFETIME CANCER SCREENING CENTER INC 12902 MAGNOLIA DRIVE TAMPA FL 33612 593238640 PRACTICE MANAGEMENT FL 501(c)(3) Line 9 H LEE MOFFITT CANCER CTR & RES INST INC 0 MOFFITT TECHNOLOGIES CORPORATION 12902 MAGNOLIA DRIVE TAMPA FL 33612 300332914 TECHNOLOGY MANAGEMENT FL N/A C 0 MOFFITT GENETICS CORPORATION 10902 N MCKINLEY DRIVE TAMPA FL 33612 208486180 DATABASE MANAGEMENT FL N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0