2016-07-13T22:20:40-05:00 2015-09-30 135565207 KPMG LLP 300 N Greene St Suite 400 Greensboro NC 27401 990 2014-10-01 593458145 FLORIDA HEALTH SCIENCES CENTER INC FLOR 8138447000 PO BOX 1289 TAMPA FL 33601 Steve L Short CFO & EVP 8138447000 2016-07-12 Allison H Franklin P00448640 3364337081 2014 2016-09-27 15:27:22Z TAMPA GENERAL HOSPITAL Steve L Short PO BOX 1289 TAMPA FL 33601 1399084060 0 X http://www.tgh.org X 1997 FL Tampa General Hospital is committed to serving all residents of West Central Florida. We provide comprehensive health services,ranging from wellness and primary care to the most complex specialty care and post-acute services. Our care reflects a patient-centered approach, and our services are delivered in an exceptional manner, with benchmark performance in clinical outcomes, care processes, cost-effectiveness, and patient experience. With our unique blend of academic and other health care partners, we play a special role in supporting medical education and research in our region. 15 11 8218 527 739558 218292 6514142 4613286 1075363306 1164551045 45755294 22109121 0 0 1127632742 1191273452 873145 733618 0 0 490538942 528032449 0 0 0 537758616 595863651 1029170703 1124629718 98462039 66643734 1491356417 1540823421 791047462 810149815 700308955 730673606 X Tampa General Hospital is committed to serving all residents of West Central Florida. We provide comprehensive health services,ranging from wellness and primary care to the most complex specialty care and post-acute services. Our care reflects a patient-centered approach, and our services are delivered in an exceptional manner, with benchmark performance in clinical outcomes, care processes, cost-effectiveness, and patient experience. With our unique blend of academic and other health care partners, we play a special role in supporting medical education and research in our region. 0 0 883022509 1109637087 Healthcare Services: Tampa General Hospital, a leading safety net, private not-for-profit hospital, is one of the most comprehensive medical facilities in West Central Florida serving a dozen counties with a population in excess of 4 million. As one of the largest hospitals in Florida, Tampa General is licensed for 1,011 beds, and with over 8,000 employees, is one of the region's largest employers. TGH is the area's only Level 1 Trauma center and one of just four burn centers in Florida. With four medical helicopters, we are able to transport critically injured or ill patients from 23 surrounding counties to receive the advanced care they need. The hospital is home to one of the leading organ transplant centers in the country, having performed more than 6,400 adult solid organ transplants, including the state's first successful heart transplant in 1985. TGH is a state-certified comprehensive stroke center, and its 32-bed Neuroscience Intensive Care Unit is the largest on the west coast of Florida. Other outstanding centers include cardiovascular, orthopedics, high risk and normal obstetrics, urology, ENT, endocrinology, and the Children's Medical Center, which features a nine-bed pediatric intensive care unit and one of just three outpatient pediatric dialysis units in the state. Services for outpatients are provided in a variety of locations. A range of diagnostic and therapeutic outpatient services are provided on the TGH campus. In addition, TGH provides outpatient rehabilitation services in an offsite facility and primary and specialty physician services in various offsite clinics. As the region's leading safety net hospital, Tampa General is committed to providing area residents with excellent and compassionate health care ranging from the simplest to the most complex medical services. TGH provides medical services to those unable to pay through various means, including the Hillsborough County Health Plan and the State Medicaid program. In addition, TGH provides trauma care on a regional basis as well as other services at no charge to eligible patients through its charity care program. Statistics: Total patient days: 295,335, Emergency room visits: 95,485, Deliveries: 5,872, and Surgeries: 30,589. 19108960 9003036 Residents teaching program (the revenues and expenses disclosed in this section include direct graduate medical education only): Tampa General Hospital has been affiliated with the University of South Florida (USF) College of Medicine since the school was created in the early 1970s. Tampa General Hospital is the primary teaching affiliate of the Morsani College of Medicine at the University of South Florida. TGH has approximately 300 residents that rotate through the hospital each year. The Medicare program funds approximately 200 residents, with the remaining slots funded solely by the hospital. These residents are assigned to Tampa General Hospital for specialty training in areas ranging from general internal medicine to neurosurgery. In addition, medical, nursing and physical therapy students all receive part of their training at Tampa General Hospital on an annual basis. University of South Tampa has 120 medical students rotating at Tampa General Hospital during our fiscal year 2015. Faculty of the Morsani College of Medicine at the University of South Florida admit and care for patients at Tampa General Hospital as do community physicians, many of whom also serve as USF adjunct clinical faculty. 2376979 2920354 Clinical Research: As the region's only Level 1 Trauma Center and the primary teaching hospital for the Morsani College of Medicine at the University of South Florida, Tampa General Hospital is uniquely poised to conduct cutting-edge clinical trials advancing the state of medicine every day. The Office of Clinical Research (OCR) is committed to supporting investigators, sponsors, and patients participating in clinical trials. We provide strategic services, education and training, and comprehensive review processes designed to fulfill the potential of clinical investigators and their research staff. TGH is actively engaged in clinical trials with university physicians and private physicians. During fiscal year 2015, the OCR provided oversight for a total of 635 active studies including 178 newly approved studies. In addition to the OCR administrative services, the TGH Center for Outpatient Research Excellence (CORE) provides coordination services that begin before site initiation and continue for the duration of the study. Pre-study services include study placement, coordination of pre-study site visit, regulatory work, laboratory and radiology research pricing, and arrangements for special services. Study coordination services include recruitment, screening, subject enrollment, study visits/procedures, investigational drug services, administration and accountability, packaging and shipping, source documentation, case report form completion, and long term record storage 15885759 733618 42251010 Tampa General Hospital's Other Program Services include cafeteria and vending sales parking garage revenues, pharmacy sales to employees, net assets released from restrictions, and other miscellaneous revenue. 15885759 733618 42251010 920394207 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 785 0 1 8218 1 1 1 1 CJ 0 0 0 0 0 0 X 15 11 0 1 0 0 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X X Steve L Short EVP & CFO 8138447000 1 Tampa General Circle Tampa FL 33606 Blake J Casper Board Member 1.00 X 0 0 0 Charles M Edwards MD Board Member 1.00 X 0 0 0 David A Straz Jr Board Member 1.00 X 0 0 0 Devanand Mangar MD Board Member 1.00 X 0 0 0 Douglas J Dieck Board Member 1.00 X 0 0 0 Erika Wallace Board Member 1.00 X 0 0 0 Gene E Marshall Board Member 1.00 X 0 0 0 John A Brabson Jr Board Member & Chairman 1.00 X X 0 0 0 John B McKibbon III Board Member 1.00 X 0 0 0 John T Sinnott MD Board Member 1.00 X 0 0 0 John T Touchton Jr Board Member 1.00 X 0 0 0 Joseph W Taggart Board Member 1.00 X 0 0 0 Owen Fredrick Dobbins Board Member 1.00 X 0 0 0 Pamela S Muma Board Member 1.00 X 0 0 0 Thomas L Bernasek MD Board Member 1.00 X 20180 0 0 Deana L Nelson EVP & COO 50.00 X 884688 0 44492 James R Burkhart President & CEO 50.00 X 1334806 0 62741 Sally H Houston MD EVP & CMO 50.00 X 741973 0 37708 Steve L Short EVP & CFO 50.00 X 976414 0 45520 Anthony D Escobio VP Patient Financial Svcs 50.00 X 236120 0 26817 Cheryl A Eagan SVP Support Services 50.00 X 365092 0 29055 Chris A Roederer SVP HR 50.00 X 492837 0 31295 David K Robbins VP Professional Services 50.00 X 307614 0 30233 Janet H Davis SVP CNO 50.00 X 431681 0 27705 Judith M Ploszek SVP Finance Adm. 50.00 X 593487 0 27501 Laura Y Haubner MD VP Chief Quality Officer 50.00 X 236123 0 6513 Maja G Gift Administrator Pharmacy Services 50.00 X 189835 0 21194 Mark Anderson SVP Ambulatory Services 50.00 X 374103 0 11467 Mark W Campbell VP Materials Management 50.00 X 241828 0 23951 Michael Gorsage SVP Strategic Services 50.00 X 500981 0 3829 Pamela G Sanders VP Women & Children Svcs 50.00 X 198202 0 18577 Rebecca Zuccarelli SVP Patient Exp.Officer 50.00 X 316559 0 3829 Robin W DeLaVergne SVP Development 50.00 X 436372 0 26989 Scott J Arnold SVP Information Systems 50.00 X 374872 0 33435 Vincent D Perron VP Medical Affairs 50.00 X 320422 0 24908 John P Dunn Director of Public Relations 50.00 X 221339 0 14344 Ronald J Peterson Director of Corporate Comp-Audit 50.00 X 188570 0 27326 Peter T Chang Chief Medical Informatics Officer 50.00 X 150706 0 3015 Debbie A Rinde-Hoffman Internal Medicine Cardio 50.00 X 770372 0 49213 James A Tanner MD SVP TGMG 50.00 X 277743 0 2916 Jana Gardner VP Physician Practice Operations 50.00 X 779753 0 29613 Mark W Weston Internal Medicine Cardio 50.00 X 761468 0 30962 Peter J Berman Internal Medicine Cardio 50.00 X 523520 0 44467 Victor D Bowers Executive Director Transplant Physician 50.00 X 602033 0 31625 Hussein K Osman-Mohamed Transplant Physician 50.00 X 478107 0 29677 Ronald A Hytoff President & CEO 50.00 X 933433 0 34093 Balaji Ramadoss VP & Chief Tech. Officer 50.00 X 279167 0 19033 Elizabeth J Lindsay-Wood SVP Information Technology 50.00 X 228955 0 16502 Jean M Mayer SVP Strategic Services 50.00 X 466594 0 25059 John H Bond Jr VP Surgical Services 50.00 X 324764 0 33056 Julita C Kallenborn VP Acute Care 50.00 X 216907 0 30009 Maureen Ogden VP Cardiovascular Services 50.00 X 271152 0 28687 17048772 0 987356 348 1 1 0 University of South Florida PO Box 917492 Orlando FL 32891 Physicians/Residents 48185626 Lifelink Foundation Inc PO Box 102474 Atlanta GA 30368 Organ Acquisition 12851919 Gulf to Bay Anesthesiology Associates 400 N Ashley Dr Tampa FL 33602 Anesthesiology 4031443 Carlton Fields Jorden Burt PA PO Box 3239 Tampa FL 33601 Legal 3529731 Vology Inc PO Box 116354 Atlanta GA 30368 Information Technology 3425254 145 1435020 3021709 156557 4613286 Patient Service Revenue 622000 1092368691 1092368691 Outpatient Pharmacy Sales-Employe 446110 29500612 29500612 Disproportionate Share Revenue 622000 26271432 26271432 Research, Meaningful Use & Other 621990 15670752 15670752 Commercial Lab 621500 739558 739558 1164551045 16667856 16667856 6872 6872 213245001 207810608 5434393 5434393 5434393 1191273452 1163811487 739558 22109121 X 733618 733618 11807273 2562178 9245095 2907411 2907411 408246034 336121207 72124827 12675975 10153456 2522519 62722459 50240690 12481769 29673297 23768311 5904986 4968986 690810 4278176 5553327 5553327 390605 390605 317611 317611 2261000 2261000 126892210 107033270 19858940 4780903 25275 4755628 295135337 274750538 20384799 28402998 13497096 14905902 16659432 14658671 2000761 2093660 882397 1211263 187082 53966 133116 16496023 14516500 1979523 41911 41911 45836208 30185063 15651145 22403029 22403029 Assessments 14965699 14965699 Dues & Memberships 2327321 657562 1669759 Recruitment Costs 1456682 281843 1174839 Property Taxes & Other 328749 85862 242887 4364878 1809555 2555323 1124629718 920394207 204235511 0 21845 21845 150760813 203584507 841303 736401 121034857 117060965 20553796 22936930 16227701 16574210 918006558 433869598 453897496 484136960 686229999 670185336 9412578 6717840 4832838 4228733 27543191 14639694 1491356417 1540823421 209793009 220524240 1605959 396507365 389556023 324537 184422551 198463593 791047462 810149815 X 691556436 723086035 8752519 7587571 700308955 730673606 1491356417 1540823421 X 66643734 -19685549 -16593534 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 100 0 0 1 317511 0 0 317611 0 Part II-B, Line 1: Tampa General Hospital's lobbying activities focus on communicating the hospital's special status and challenges to elected officials at the County, State, and Federal levels. Given TGH's large share of indigent care in the region, efforts are primarilly focused on maintaining existing funding and seeking additional government support to ensure TGH can continue to deliver quality care to its patients. 910736 2085 912821 902991 7745 910736 850187 52730 74 902991 833825 16455 343 436 850187 812385 31507 397 10464 833825 1.00000 0 1 1 52665127 52665127 459899790 166312278 293587512 348548648 259332625 89216023 56892993 8224695 48668298 484136960 Due From General Estimated Patient Liabilities 25737603 Due From Medicare - Prior Years 30200132 Due From Medicaid - Prior Years 26657138 Accrued Retirement Benefits 23251712 Accrued Supplemental Retirement Benefits 13528899 Accrued Postretirement Benefits 4141720 Accrued Claims Payable - Malpractice 69205629 Accrued Claims Payable - Workers Compensation 1826000 Bond Issue Arbitrage Payable 67847 Captive LT Liability 1828550 Reform Incentive Payment Payable 2018363 198463593 X 1171604165 -19685549 708907 -18976642 1190580807 692645 692645 1191273452 1125288963 659245 659245 1124629718 0 1124629718 Part XI, Line 2d - Other Adjustments: Income from 100% owned for-profit coffee house Part XI, Line 4b - Other Adjustments: Contributions received that were released for PP&E Part XII, Line 2d - Other Adjustments: Expenses from 100% owned for-profit coffee house FIN 48 Footnote The Center 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 Principals (U.S. GAAP) require management to evaluate tax positions taken by the Center and recognize a tax liability (or asset) if the Center 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 by the Center, and has concluded that as of September 30, 2015 and 2014, 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. The Center is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. Management believes it is no longer subject to income tax examinations for years prior to 2012. Central America & the Caribbean 1 2 Program Services Florida Health Sciences Center LTD, which was formed in the Cayman Islands, began operations in June of 2010 and provides professional and general liability insurance to Florida Health Sciences Center, Inc. 323361 1 2 0 0 1 2 323361 0 323361 0 0 1 0 0 0 1 1 X 1 X 1 X 1 1 1 0 1 1 43352377 17268397 26083980 0.02320 192908308 178311695 14596613 0.01300 29972163 11027085 18945078 0.01680 266232848 206607177 59625671 0.05300 3063013 3063013 0.00270 39617560 16214483 23403077 0.02080 3853906 2330625 1523281 0.00140 3164300 2920354 243946 0.00020 950273 950273 0.00080 50649052 21465462 29183590 0.02590 316881900 228072639 88809261 0.07890 1 82789099 228876583 259873461 -30996878 X 1 1 1 1 Florida Health Sciences Center Inc DBA Tampa General Hospital PO Box 1289 Tampa FL 33601 www.tgh.org License # 4044 X X X X X FHSCInc DBA Tampa General Hospital 0 0 1 X X X X X X X X X X 13 1 0 0 1 X www.tgh.org 1 13 1 https://www.tgh.org/community-health-needs-assessment/ 0 0 1 X 200.000000000000 400.000000000000 X X X X X X X 1 1 X X X X 1 X www.tgh.org X X www.tgh.org X X X X X 1 0 X X X X 1 X X 0 0 FHSC, Inc. D/B/A Tampa General Hospital Part V, Section B, Line 3j: In order to provide community input, the Community Health Needs Assessment (CHNA) methodology included both individual interviews and focus groups. Both are qualitative in nature and should be interpreted as reflecting the values and perceptions of those interviewed. This portion of the CHNA process is meant to gather input from persons who represent the broad interest of the community serviced by the hospital facility, as well as individuals providing input who have special knowledge or expertise in public health. It is meant to provide depth and richness to the quantitative data collected. Interview Methodology: Twenty interviews were conducted in-person when possible and via phone when necessary, based on the availability of the interviewee. Interviews required approximately 30 minutes to complete. Interviewers followed the same process for each interview, which included documenting the interviewee's expertise and experience related to the community. Additionally, the following community-focused questions were used as the basis for discussion: Interviewee's name. Interviewee's title. Interviewee's organization. Overview information about the interviewee's organization. What are the top three strengths of the community? What are the top three health concerns of the community? What are the health assets and resources available in the community? What are the health assets or resources that the community lacks? What assets or resources in the community are not being used to their full capacity? What are the barriers to obtaining health services in the community? What is the single most important thing that could be done to improve the health in the community? What changes or trends in the community do you expect over the next five years? What other information can be provided about the community that has not already been discussed? Below is information about the individuals interviewed as part of the CHNA. Interviewee Title/Organization Area(s) Represented Adwale Troutman Executive Director, Public Health Practice and Leadership, Florida Covering Kids and Families Public Health Expert Anne Maynard Program Director, USF Area Health Education Center Public Health Expert Carlos Mercado STD Program Manager, Hillsborough County Health Department Public Health Expert Chloe Cooney Founder, Corporation to Develop Communities of Tampa, Inc. African American Community Representative Donna Peterson Dean, College of Public Health, University of South Florida Public Health Expert Douglas Holt Director, Hillsborough County Health Department Public Health Expert Joyce Thomas Physician, TGH Family Care Center Hospital Staff Leslie Les Miller, Jr. County Commissioner, District 3, Hillsborough County Government Official Margaret Ewen Senior Human Resources Manager, Immunizations/Refugee Public Health Expert Margarita Cancio Physician, Infectious Disease Associates of Tampa Bay Hospital Staff Sally Houston Chief Medical Officer, Tampa General Hospital Hospital Administration Deborah Austin Communication and Community Outreach Director, Central Hillsborough Healthy Start Project, REACHUP, Inc. Medically Underserved Community Organization Representative Luis Lopez Past President, Hispanic Alliance of Tampa Bay; Director, Moffit Cancer Center Hispanic Advisory Board Hispanic Community Representative Amy Petrila Director of Programs and Outreach, Children's Board of Hillsborough County Community Health Organization Representative Maureen Chiodini Associate Vice President of Membership and Programs, Tampa Metropolitan Area YMCA Community Health Organization Representative Maria Russ Supervisor, School Health Services, Hillsborough County Public Schools Public Health Expert Focus Groups. Focus groups were conducted to allow participants to provide information about their experiences in the community and ways in which they think the services and resources provided to the community can be improved. Participants completed a demographic questionnaire and a consent form agreeing to participate in the focus group. The requested information included: * Gender * Age * ZIP Code * Ethnicity * Race * Education Level * Employment Status * Household Income * Health Insurance Status. Focus group participants were notified prior to divulging information that it would be used solely to benefit the public good, and all information would be presented in an anonymous nature. Participants were encouraged to share their ideas, opinions and experiences, including any positive or negative feedback. A focus group session required approximately two hours to complete and followed this agenda: Session Opening - 15 Minutes Introductions. Explanation of the purpose of the focus group. Overview of the rules governing the session. Nominal Group Technique was utilized to identify priority health needs in the community. The Nominal Group Technique process is as follows: Participants are instructed to separately write on a piece of paper their top 3 perceived health concerns within the community. Each participant calls out in order the health concerns round robin style until all options for every person have been exhausted. Participants instruct the facilitator on which like items, if any, they would like to combine. Participants are instructed to separately rank the items most important (3) to least important (1) Each member calls out round robin style their 3's, then 2's and so on until all ranked items have been exhausted and recorded o The facilitator adds up the rankings for each item, ranking the highest to lowest in importance based on the added result, taking the item that has the largest number as highest importance and so on. After this process has been completed, a discussion is facilitated about the results of the process.Examples of these questions include: Was there anything that surprised you? Why do you feel these are the top health concerns? How do you feel these needs could be addressed in the community? Session Conclusion - 15 minutes. Summary of findings. Closing discussion. Distribution of incentives for participation. FHSC, Inc. D/B/A Tampa General Hospital Part V, Section B, Line 5: Same as Line 3 Explanation Above FHSC, Inc. D/B/A Tampa General Hospital Part V, Section B, Line 13b: Family size in combination with household income is used to determine eligibility for either free or discounted care. FHSC, Inc. D/B/A Tampa General Hospital Part V, Section B, Line 18d: TGH engages in standard collection activities such as statements and telephone calls. FHSC, Inc. D/B/A Tampa General Hospital Part V, Section B, Line 22d: Medicaid rate is used in rare instances for those who are not able to afford amounts generally billed by Medicare and commercial insurance. Part V, Section B, Line 16 Financial Assistance Policy Website Availability FHSC,Inc. D/B/A Tampa General Hospital Part V, Section B, line 16a website: www.tgh.org FHSC,Inc. D/B/A Tampa General Hospital Part V, Section B, line 16c website: www.tgh.org 17 Transplant & Specialty Service Center 409 Bayshore Blvd Tampa FL 33606 Transplant & Specialty Services Clinic Cardiology Center 5 Tampa General Circle Tampa FL 33606 Cardiology Clinic Family Care Center Fishhawk 13421 Fishhawk Blvd Lithia FL 33547 Family Care Clinic Family Care Center Healthpark 5802 N 30th Street Tampa FL 33610 Family Care Clinic Family Care Center Kennedy 2501 W Kennedy Blvd Tampa FL 33609 Family Care Clinic Family Care Center Lois 2106 S Lois Ave Tampa FL 33629 Family Care Clinic Family Care Center Sun City 1647 Sun City Center Plaza Sun City Center FL 33573 Family Care Clinic Family Care Center Tampa Palms 16011 Tampa Palms Blvd West Tampa FL 33647 Family Care Clinic Family Care Center Trinity 2433 Country Place Blvd Trinity FL 34655 Family Care Clinic Family Care Center Wesley Chapel 2324 Oak Myrtle Lane Wesley Chapel FL 33544 Family Care Clinic Family Care Center Boyette 11966 Boyette Road Riverview FL 33569 Family Care Clinic Family Care Center Brandon 214 Morrison Road Brandon FL 33511 Family Care Clinic Family Care Center Carrollwood 13860 N Dale Mabry Highway Tampa FL 33618 Family Care Clinic Family Care Center Manhattan 4212 S Manhattan Ave Tampa FL 33611 Family Care Clinic Family Care Center Riverview 10647 Big Bend Road Riverview FL 33579 Family Care Clinic Family Care Center Westchase 10718 Countryway Blvd Tampa FL 33626 Family Care Clinic TGH Community Health Education Center 2106 S Lois Ave Tampa FL 33629 Community Health Education Center Part I, Line 6a: TGH developed a community benefit report for the period ending September 30, 2013 during fiscal year 2013. This report reflected community benefit activities as well as cost. The report was sent to a selected number of stakeholders and made available on the hospital's website. Part I, Line 7: The hospital's cost accounting system was used to calculate the amounts reported in line 7. For the purposes of computing subsidized services, both direct and indirect costs were considered. For research, only direct costs were considered. Part III, Line 4: For receivables associated with services provided to patients who have third party coverage, the Center analyzes contractually due amounts and provides an allowance for doubtful accounts, if necessary. For receivables associated with self pay patients, which includes both patients without insurance and patients with deductible and copayment balances due for which third party coverage exists for part of the bill, the Center records a significant provision for bad debts in the period of service on the basis of its past experience. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The Center records a significant provision for bad debts related to uninsured patients in the period the services are provided. The adequacy of the allowance for bad debts is evaluated regularly, with adjustments to increase or decrease the allowance by adjustments in the provision for bad debts. The calculation of bad debt, at cost, is based on Medicare's cost to charge ratio. Part III, Line 8: The $31 million shortfall reported at Pt. III line 7 should be considered as a community benefit in that much of the shortfall in Medicare payments relates to the costs associated with the TGH liver, heart, kidney, lung and pancreas organ transplant programs, and medical education programs, which are a significant benefit to all patients in these programs and the community as a whole. Medicare revenue and cost are based on the 2015 Medicare cost report excluding revenues and costs associated with subsidized health services and graduate medical education, which are reported separately in Part I lines 7g and 7f. Part III, Line 9b: Each self pay patient is evaluated to determine if covered by Medicaid, Hillsborough County and/or charity assistance. The financial information provided by this evaluation determines into which category a patient resides. Patients who do not qualify for government assistance are then evaluated in accordance with hospital policy for Charity and Discounted Care. Patient balances will either qualify for a total write-off or a discount based on the patient's household income and family size in relation to the Federal Poverty Limitations. TGH's financial assistance and charity care policy, following the guidelines of the Internal Revenue Section 501(r) requirement: Includes eligibility criteria for financial assistance free and discounted (partial charity) care; describes how to apply for financial assistance; describes how TGH will widely publicize the policy within the community served by the hospital; limits the amounts that the hospital will charge for emergency and other medically necessary care provided to individuals eligible for financial assistance to the amount generally billed for medically necessary care. Part VI, Line 2: During fiscal year 2013, Tampa General Hospital (TGH) completed its Community Health Needs Assessment (CHNA) as required by the Patient Protection and Affordable Care Act signed into law in 2010. A CHNA is a report based on epidemiological, qualitative and comparative methods that assesses the health issues in a hospital organization's community and thatcommunity's access to services related to those issues. The CHNA is available to the public on the TGH website (www.tgh.org). As required by the Treasury Department (Treasury) and the Internal Revenue Service (IRS), the TGH CHNA includes the following: * A description community served; * A description of the process and methods used to conduct the CHNA, including: (1) A description of the sources and dates of the data and the other information used in the assessment; and, (2) The analytical methods applied to identify community health needs. * A description of information gaps that impacted TGH's ability to assess the health needs of the community served; * The identification of all organizations with which TGH collaborated, if applicable, including their qualifications; * A description of how TGH took into account input from persons who represented the broad interests of the community served by TGH, including those with special knowledge of or expertise in public health and any individual providing input who was a leader or representative of the community served by TGH; and, * A prioritized description of all of the community health needs identified through the CHNA and a description of the process and criteria used in prioritizing those needs. During FY2014, TGH did not complete any additional assessments of the health care community it serves. Part VI, Line 3: For fiscal year 2015, the costs associated with charity care, unreimbursed Medicaid, and the unreimbursed costs of other means-tested government programs exceeded $59.6 million. These include patients who qualify for free care under Tampa General Hospital's (TGH) charity care policy or are enrolled in programs for low-income or under-insured individuals sponsored by state and local governments. While TGH received reimbursement for some of these patients, the amounts are not sufficient to cover the costs of care provided. Free care is provided to patients who qualify based on an evaluation of their income and assets. Individuals with an income that is less than or equal to 200% of the Federal Poverty Level (FPL) are eligible for charity or free care as are individuals whose income is less than 400% of the FPL but whose hospital charges are greater than 25% of their annual income. Financial counselors work with individuals who seek care and are uninsured. Enrollment assistance is provided to individuals for government programs such as Medicaid, Medicare Disability, Healthcare marketplace, or the Hillsborough County Health Plan as well as determining whether they qualify for charity or discounted care. TGH's financial assistance (charity care and discounted care) policy is available to consumers at TGH.org as well as in the hospital admissions area. The information is written in both English and Spanish. Guidelines, the patient shall be eligible for a discount that is annually calculated using a look back method. Patients eligible for Medicaid or other indigent care programs may be eligible for free or discounted care for non-covered services (including charges for days exceeding any length of stay limit). NON-ELIGIBLE SERVICES AND BALANCES Financial assistance will not apply to the following services or patient responsibilities: * Cosmetic procedures that are not medically necessary * Co-payments and deductible amounts * Balances payable by other insurance (Medicare, Medicaid, automobile insurance, worker's compensation, or liability insurance) * Ventricular Assist Devices * Transplants * Elective procedures for patients residing outside Hillsborough County, Florida DETERMINATION AND SCREENING PROCESS All patients seeking financial assistance are required to complete the TGH Financial Assistance application. Patients will be instructed to complete the forms and return them by mail or in person to a Financial Assistance Specialist. Patients who appear to qualify for government assistance will be offered courtesy assistance with the application process. Unfunded or under-funded patients will be asked to complete a Financial Assistance Application at the time of registration. Financial assistance counseling communication is intended to be clear, concise and considerate of the patient and family members. In addition to income and family information, the patient may be required to provide proof of employment. Some patients may also be asked to provide additional information about their assets, monthly expenses, and any other resources to pay for their care. Determination of eligibility or denial of financial assistance will be communicated to the responsible party within 30 days of receipt of all required documentation. The granting of financial assistance shall be based on an individualized determination of financial need and medical necessity, and shall not take into account age, gender, race, social or immigrant status, sexual orientation or religious affiliation. RELATIONSHIP TO COLLECTIONS AND BILLING POLICY TGH maintains a separate policy outlining its billing and collection procedures. In accordance with its Billing and Collections Policy, TGH will not engage in, nor will it authorize its collection agency to engage in, extraordinary collection actions without verifying that patients have been given the opportunity to apply for financial assistance. COMMUNICATION OF THE AVAILABILITY OF FINANCIAL ASSISTANCE WITHIN THE COMMUNITY Notification about financial assistance available from TGH shall be disseminated by TGH to the community by various means, which may include, but are not limited to, publishing this Policy on the TGH website, placing posters around the hospital, and making brochures available at all patient registration areas. REGULATORY REQUIREMENTS In implementing this Policy, TGH will comply with all other federal, state, and local laws, rules, and regulations that may apply to activities conducted pursuant to this Policy. AVAILABILITY OF FORMS AND POLICY Copies of the Financial Assistance Policy and applications will be made available upon request and without charge by contacting a Financial Assistance Specialist or by submitting a written request to Tampa General Hospital. The hospital's Financial Assistance Specialist is also available to answer any questions about this policy. Part VI, Line 4: Tampa General Hospital's primary service area is Hillsborough County, Florida. As part of the CHNA completed during FY 2013, a complete assessment of the service area's demographics was completed. The CHNA can be found at www.tgh.org. The highlights from the assessment are detailed below. * As of the study date, the primary service area population was 1,314,699 * Slight population growth is expected for individuals aged 18-44 (3.2%). Moderate population growth is expected for individuals aged 0-17 (5.8%) and 45-64 (9.2%). The population of women at childbearing age is expected to grow slightly (2.8%). By 2017, substantial population growth is expected for individuals 65 years and older (21.2%). * The most common race/ethnicity in the service area is white (51.8%), followed by Hispanic (26.5%), black/African American (15.6%), Asian (3.7%), individuals of two races (1.9%) and other (0.5%). * Minority and other race populations are expected to grow faster than the white population. Substantial growth is expected for the Asian (20.6%), Hispanic (17.5%), individuals of two races (15.0%) and black/African American (10.7%) populations. The population of other race individuals is expected to grow moderately (5.3%), while marginal growth is expected for the white population (0.5%). * According to the2011 annual average unemployment rates reported by the U.S. Bureau of Labor Statistics, Hillsborough County's unemployment rate (10.5%) is equal to Florida's. * According to the U.S. Census 2010 American Community Survey (ACS), Hillsborough County has a slightly higher median household income ($47,677) than Florida ($46,077). Poverty thresholds are determined by family size, number of children and age of the head of the household. A family's income before taxes is compared to the annual poverty thresholds. If the income is below the threshold, the family and each individual in it are considered to be in poverty. In 2010, the poverty threshold for a family of four was $22,314. The ACS estimates indicate that 14.2% of Hillsborough County residents and 15.0% of Florida residents are living below poverty level. Children in Hillsborough County are slightly less likely to be living below poverty level (19.9%) compared to all children in Florida (21.3%). * The American Community Survey (ACS) publishes estimates of the highest level of education completed for residents 25 years and older. The ACS 2008-2010 estimates indicate that the percentages of individuals 25 years and older with less than a high school degree in Hillsborough County and in Florida are similar (14.2% and 14.5%, respectively). In Hillsborough County and Florida, approximately 85% of residents have either a high school degree or equivalent or a bachelor's degree. * Fourth and eighth grade math and reading proficiencies are all slightly lower in Hillsborough County compared to Florida and fall between the 25th and 50th percentiles. * Domestic violence and homicide rates are slightly lower in Hillsborough County than in Florida, while the aggravated assault, forced sex offense and robbery rates are substantially lower in Hillsborough County compared to Florida. Part VI, Line 5: Tampa General Hospital's commitment to the health of the community it serves is exemplified by its mission statement. The key elements of TGH's mission include the provision of services ranging from wellness and primary care to the most complex specialty and post-acute services to all of the residents of West Central Florida, a commitment to a patient centered approach and benchmark performance. With our unique blend of academic and other healthcare partners, TGH plays a special role in supporting medical education and research in the region. The Board also authorizes the use of surplus funds through the annual budget process to fund enhancements to services, the physical plant, infrastructure and financial support for training physicians, nurses and other health care providers, health education to the community and support of other not-for-profit organizations in the community with complimentary goals and missions. The 15 member board is composed of independent community leaders as well as members of the TGH medical staff. The board bylaws specify that its membership will include the elected medical chief of staff, a representative of the University of South Florida and the chairman of the TGH Foundation. TGH utilizes its surplus funds for the development of inpatient services and to subsidize outpatient services for underserved members of the community. TGH operates a number of outpatient clinics that provide primary and specialty care for the uninsured and under-insured. Services include adult primary and specialty care, pediatrics, and high risk obstetrics. While many of these patients have some funding either through Medicaid or the Hillsborough County Health Plan, the revenue from these sources is insufficient to cover the costs of providing the services. In fiscal year 2015, TGH's clinics provided 258,470 patient visits. The TGH medical staff is open to any physician that meets the requirements of the medical staff bylaws and rules and regulations. The medical staff is composed of community physicians with private practices and physicians on the faculty of the USF Health Morsani College of Medicine (USFHMCOM). Both the community and USFHMCOM physicians are involved in research and training. Many of the community physicians hold clinical appointments with the USFHMCOM and all staff physicians may participate in research. In FY2015, the TGH Office of Clinical Research supported 635 research studies. These studies received funding from a variety of public agencies and private sponsors, including the Department of Defense and the Children's Oncology Group. Studies were led by both community and university physician principal investigators. This year's research centered on a range of topics, including Phase I studies in the treament of pediatric cancer and conducting of an evidence-based clinical decision support system to predict survival and life expectancy of hospice patients. These research initiatives have immediate benefits to the patients who participate in them as well as long term benefits to the community. TGH is considered a statutory teaching hospital under Florida Law. This designation is only available to hospitals that have made a significant commitment to graduate medical education. In fiscal year 2015, TGH funded approximately 300 GME full time equivalent slots in over 60 specialties. The Medicare program reimburses TGH for a portion of approximately 200 of these GME slots supplemented by minimal reimbursement from the Medicaid and TRICARE programs. Approximately 100 slots are funded almost solely by TGH out of operating funds. In addition to a robust medical education program, TGH is also committed to the training of nurses, pharmacists, and other clinical staff. TGH provides financial support for nursing education at both the University of South Florida and the University of Tampa. Students and residents in a variety of clinical programs (pharmacy, pastoral care, and other programs) rotate through TGH or in some cases are assigned to TGH for their training. Finally, TGH sponsors continuing medical education (CME) for physicians in the community and in outlying areas. In fiscal year 2015, TGH CME sponsorships provided CME education to 989 physicians, none of whom were on the TGH medical staff. The cost of CME sponsorships exceeded $185,000. In all cases, surplus funds are dedicated to the educational mission of TGH. Tampa General's commitment to improving the health status of the community is evident in the vast array of educational programs, screenings and support groups it provides to the community. In fiscal year 2015, TGH provided 353 free programs and screenings to over 15,000 members of the community. Educational programs focused on everything from preventing the flu, to smoking cessation to stress management. Programs were provided in a variety of locations. Programs of interest to seniors were provided at several senior living facilities within the primary service area including Sun City, The Gardens at South Bay, Sun Towers Retirement Center, and the Tampa Baptist Manor. In fiscal year 2015, TGH participated in three programs in collaboration with its community partners. Health & Fit for Life is a program for kids and their parents that focus on making healthy food choices and increasing exercise as a way of maintaining and controlling weight. Health & Fit was designed with More Health, a community based health education program for children in Hillsborough & Pinellas Counties. This program was provided at the University Area Community Development Center. Living Healthy and Matter of Balance are both multi-week programs aimed at individuals with chronic illnesses or balance concerns. These programs were provided in conjunction with the Florida's West Coast Area Agency on Aging. Our commitment to provide our community with free resources to improve their health was demonstrated by two programs, Active Living Every Day and Healthy Living Every Day. Eight weeks each, these programs focus on the importance of being active and eating healthy. In fiscal year 2014, TGH added two programs based on the Community Health Needs Assessment, the National Diabetes Prevention Program (NDPP) and the Breathing Easier With Asthma workshops and support group (Asthma workshop). The NDPP is a 16-week evidence-based program promoted by the Centers for Disease Control (CDC) and was provided by trained TGH staff in several locations within Hillsborough County. The Asthma workshop was provided for the community at the Hillsborough County Children's Board. We provided it at this location because its surrounding neighborhood has a high density of children with asthma. Screenings provided during fiscal year 2015 ranged from blood pressure and diabetes to screenings for memory loss, hearing, peripheral vascular disease and abdominal aortic aneurysms. TGH has a dedicated staff responsible for developing programs as well as identifying high risk areas within the county that might benefit most from screenings and health prevention and promotion programs. In addition to providing educational programs and screenings, TGH also provides financial support to other community not-for-profit organizations. This funding is another way that TGH utilizes its surplus funds to support the community health and well-being. In fiscal year 2015, TGH provided financial support to numerous not-for-profit organizations. This support ranged from donations under $1,000 to commitments in excess of $200,000. Three organizations in particular receive significant support from TGH: More Health Inc., Ronald McDonald Mobile Health Van and Tampa Community Health Center. For more than 20 years, TGH has been the largest single sponsor of More Health, Inc. More Health provides health education in Hillsborough and Pinellas County public and private schools. Innovative, hands on instruction for all grades is a key feature of More Health and more than a million children have benefited from the education provided by More Health. TGH, in conjunction with the USF Health Morsani College of Medicine and the Ronald McDonald Foundation supports a mobile medical van that provides medical and dental services to underserved children in the region. TGH also provides financial support to Tampa Family Health Center (TFHC). TFHC is a federally qualified health center that provides significant amounts of service to underserved populations in Hillsborough County. TGH's donation allows them to expand primary care and other services. In addition TGH supports a variety of other not-for-profits including the American Heart Association, March of Dimes, Ronald McDonald Foundation, the Epilepsy Foundation, and many others. In addition to financial support, many TGH employees volunteer their time and participate in fundraising events like the Heart Walk for the American Heart Association. Part VI, Line 6: Not Applicable. Part VI, Line 7 Florida 1 American Cancer Society 28 Columbia Drive Tampa FL 33606 591835985 501(c)(3) 74000 Support mission to provide temporary lodging and other support for the families of hospitalized children. American Heart Association 11207 Blue Heron Blvd N St Petersburg FL 33716 135613797 501(c)(3) 45000 Support the mission of the AHA via sponsorship of various fundraising events. University of South Florida 4202 E Fowler Ave Tampa FL 33620 593102112 501(c)(3) 8118 TGH & USF together support the Ronald McDonald House pediatric mobile care unit. Gasparilla Distance Classic Association Inc PO Box 1881 Tampa FL 33601 590943559 501(c)(3) 10000 Provide screening and medical services prior to and on the day of the event. Hillsborough Organization for Progress and Equality 5103 N Central Ave Tampa FL 33603 592914463 501(c)(3) 7500 Donation to H.O.P.E. Valspar Championship Copperhead Charities Inc 36750 US Highway 19 North Palm Harbor FL 34684 592319362 501(c)(3) 25000 Support the mission of Copperhead Charities to aid Tampa Bay area charities through professional golf. Junior Achievement of Tampa Bay 13707 N 22nd Street Tampa FL 33613 591098499 501(c)(3) 17500 Support the mission of JA to provide youth programs. Curesearch for Children's Cancer 4600 East-West Highway Bethesda MD 20814 954132414 501(c)(3) 10000 Support the mission to find a cure for children's cancer. Florida Hospital Tampa 3100 E Fletcher Ave Tampa FL 33613 591479658 501(c)(3) 10000 Support the mission of Florida Hospital Tampa. Reveille Summit 2015 Combat Wounded Veterans 26 West Orange Street Tarpon Springs FL 34689 472040547 501(c)(3) 10000 Support wounded war veterans. The Salvation Army 1603 N Florida Ave Tampa FL 33601 237069550 501(c)(3) 10000 Support the mission of the Salvation Army. American Cancer Society 2006 W Kennedy Blvd Tampa FL 33606 131788491 501(c)(3) 6500 Support the mission of the American Cancer Society. Tampa Family Health Center Inc 2103 N Rome Ave Tampa FL 33607 592420282 501(c)(3) 300000 Provide support for hiring additional primary care physicians to serve uninsured individuals. More Health 3821 Henderson Blvd Tampa FL 33629 593397472 501(c)(3) 200000 Support the mission to provide health education to students in Hillsborough County at no charge. 14 Part I, Line 2: Tampa General Hospital monitors the charitable contributions donated throughout the year. We have a select staff whose purpose is to promote health throughout the community with the help of local charities. The staff works closely with the charities to ensure that the funds are directly beneficial to the community. X X 1 1 X X X X X X 1 1 0 0 0 1 0 1 0 Deana L Nelson EVP & COO 492397 0 200599 0 191692 0 39190 0 5302 0 929180 0 0 0 James R Burkhart President & CEO 815688 0 378011 0 141107 0 51828 0 10913 0 1397547 0 0 0 Sally H Houston MD EVP & CMO 436674 0 177018 0 128281 0 27766 0 9942 0 779681 0 0 0 Steve L Short EVP & CFO 513006 0 208256 0 255152 0 31042 0 14478 0 1021934 0 0 0 Anthony D Escobio VP Patient Financial Svcs 173926 0 52514 0 9680 0 11032 0 15785 0 262937 0 0 0 Cheryl A Eagan SVP Support Services 220842 0 81131 0 63119 0 18142 0 10913 0 394147 0 0 0 Chris A Roederer SVP HR 292709 0 101503 0 98625 0 20382 0 10913 0 524132 0 0 0 David K Robbins VP Professional Services 220761 0 65627 0 21226 0 14448 0 15785 0 337847 0 0 0 Janet H Davis SVP CNO 243241 0 86522 0 101918 0 19908 0 7797 0 459386 0 0 0 Judith M Ploszek SVP Finance Adm. 310895 0 109956 0 172636 0 22199 0 5302 0 620988 0 0 0 Laura Y Haubner MD VP Chief Quality Officer 170769 0 61668 0 3686 0 0 0 6513 0 242636 0 0 0 Maja G Gift Administrator Pharmacy Services 162592 0 19443 0 7800 0 12515 0 8679 0 211029 0 0 0 Mark Anderson SVP Ambulatory Services 276713 0 92896 0 4494 0 7426 0 4041 0 385570 0 0 0 Mark W Campbell VP Materials Management 168016 0 49551 0 24261 0 15272 0 8679 0 265779 0 0 0 Michael Gorsage SVP Strategic Services 355320 0 141541 0 4120 0 0 0 3829 0 504810 0 0 0 Pamela G Sanders VP Women & Children Svcs 149383 0 45064 0 3755 0 9898 0 8679 0 216779 0 0 0 Rebecca Zuccarelli SVP Patient Exp.Officer 208297 0 98060 0 10202 0 0 0 3829 0 320388 0 0 0 Robin W DeLaVergne SVP Development 245112 0 86038 0 105222 0 21069 0 5920 0 463361 0 0 0 Scott J Arnold SVP Information Systems 273379 0 97338 0 4155 0 17650 0 15785 0 408307 0 0 0 Vincent D Perron VP Medical Affairs 244881 0 72919 0 2622 0 14966 0 9942 0 345330 0 0 0 John P Dunn Director of Public Relations 193475 0 19449 0 8415 0 8424 0 5920 0 235683 0 0 0 Ronald J Peterson Director of Corporate Comp-Audit 147745 0 19449 0 21376 0 11541 0 15785 0 215896 0 0 0 Peter T Chang Chief Medical Informatics Officer 127963 0 22588 0 155 0 3015 0 0 0 153721 0 0 0 Debbie A Rinde-Hoffman Internal Medicine Cardio 649500 0 0 0 120872 0 34995 0 14218 0 819585 0 0 0 James A Tanner MD SVP TGMG 205932 0 20000 0 51811 0 0 0 2916 0 280659 0 0 0 Jana Gardner VP Physician Practice Operations 180514 0 58553 0 540686 0 13828 0 15785 0 809366 0 0 0 Mark W Weston Internal Medicine Cardio 651316 0 0 0 110152 0 16484 0 14478 0 792430 0 0 0 Peter J Berman Internal Medicine Cardio 515618 0 0 0 7902 0 28942 0 15525 0 567987 0 0 0 Victor D Bowers Executive Director Transplant Physic 540332 0 0 0 61701 0 31625 0 0 0 633658 0 0 0 Hussein K Osman-Mohamed Transplant Physician 371597 0 0 0 106510 0 15346 0 14331 0 507784 0 0 0 Ronald A Hytoff President & CEO 933433 0 0 0 0 0 23440 0 10653 0 967526 0 0 0 Balaji Ramadoss VP & Chief Tech. Officer 204651 0 59502 0 15014 0 13113 0 5920 0 298200 0 0 0 Elizabeth J Lindsay-Wood SVP Information Technology 228955 0 0 0 0 0 4660 0 11842 0 245457 0 0 0 Jean M Mayer SVP Strategic Services 259108 0 91877 0 115609 0 19139 0 5920 0 491653 0 0 0 John H Bond Jr VP Surgical Services 188726 0 57081 0 78957 0 17271 0 15785 0 357820 0 0 0 Julita C Kallenborn VP Acute Care 157549 0 48068 0 11290 0 14224 0 15785 0 246916 0 0 0 Maureen Ogden VP Cardiovascular Services 196806 0 65085 0 9261 0 17774 0 10913 0 299839 0 0 0 Part I, Line 1a Any international travel by an executive is booked with a first class ticket. TGH paid temporary housing expenses and other relocation costs for Mr. James Burkhart, which were treated as taxable compensation to him. Part I, Line 3 Within the framework of applicable law, Tampa General Hospital (TGH) will establish and maintain compensation goals, policies, and programs that enable the hospital to recruit, develop, and retain the most qualified and talented staff. TGH strives to affect a strategic investment in the people who support the hospital's mission. Compensation goals, policies and programs are guided by and reflect our values and principles, which are consistent with the high quality of the hospital's achievement in the furtherance of medical science. Differences in pay will not be based upon such factors as race, religion, gender, sexual orientation, national origin, ancestry, age, marital status, or disability. To ensure that TGH is paying reasonable compensation and not violating the private inurement prohibition, the Compensation Committee of the Board of Directors annually reviews and sets the compensation of officers, the executive group and key employees. The Committee utilizes the outside consulting firm of Towers Watson to provide expert information regarding industry-wide compensation norms. Part I, Lines 4a-b Tampa Genewral Hospital provides the executive staff with a supplemental retirement plan (SERP). Participants of this plan are listed on Statement 4 column c3 (Officers). As these participants become vested, the incremental amount of vested benefits is included on Form W-2; however, distributions are not made until either the participant retires or leaves the organization. The compensation reported in the 2014 W-2s includes the following vested amounts: Cheryl A. Eagan: $43,512; Chris A. Roederer: $84,312; Deana L. Nelson: $134,197; Janet H. Davis: $88,845.00; Jean M. Mayer: $84,443.00; John H. Bond: $53,862.00; Judith M. Ploszek: $141,481; Robin DeLaVergne $79,596; Sally Houston: $126,016; Steve L. Short: $190,408; and Jana Gardner: $537,265. Severance payments were also made in the following amounts: Ronald Hytoff: $757,295; Elizabeth Lindsay-Wood: $69,216; Amy Paratore: $123,492. Part I, Line 6 A portion of bonuses and incentive payments is based on achieving certain financial targets. The remaining bonuses are based on the achievement of certain quality indicators and other non-financial metrics. Part I, Line 7 33.33% of the total bonus and incentive is based on achieving certain targets. The remaining bonus is based on the achievement of certain quality indicators and non-financial metrics. A Hillsborough County Industrial Development Authority 591293512 43233ACT1 2006-09-28 190910329 Hospital Expansion 0 0 0 B Hillsborough County Industrial Development Authority 591293512 43233AEA0 2013-02-28 186480570 Hospital Expansion & Refunding 2003 Bond Issue 0 0 0 C Hillsborough County Industrial Development Authority 591293512 2013-09-19 50889807 Refunding 2003 Bond Issue 0 0 0 A 7795000 202380104 2184896 199158149 870854 166205 2009 0 0 1 1 B 134532845 186485647 1945528 50007274 134532845 2015 1 0 1 1 C 50593688 50889807 296119 50593688 2014 1 0 1 1 A 0 1 0 0 0.00200 0.00000 0.00200 0 0 1 B 0 1 0 0 0.00200 0.00000 0.00200 0 0 1 C 0 1 0 0 0.00200 0.00000 0.00200 0 0 1 A 1 0 0 1 Transamerica Life 2.250000000000 1 0 1 B 1 0 0 0 0 1 C 1 0 0 0 0 1 A 1 B 1 C 1 Gulf to Bay Anesthesiology Associates Dr. Devanand Mangar, a board director of FHSC, is an officer & employee 655321 Anesthesiology services at FMV 0 SunTrust Banks Inc Fred Dobbins, a board director of FHSC, is an employee. 321910 Bank & investment management fees 0 Highlander Properties Inc DBA DeLaVergne & Company Robin DeLaVergne, a SVP of FHSC, is a parent of the 100% owner 18385 Real Estate Commissions, at FMV 0 Florida Orthopedic Institute Dr. Thomas Bernasek, a board director of FHSC, is a shareholder & employee 2269787 Orthopedic services at FMV 0 Caspers Company Blake Casper, a board director of FHSC, is an officer and owner. 184530 Leases space from FHSC at FMV 0 Anita Roederer Chris Roederer, an officer of FHSC, is the spouse. 55173 Salary at FMV 0 Form 990, Part VI, Section A, line 3 Control of hospital cafeteria delegated to Morrison Management Form 990, Part VI, Section A, line 7a USF designates one individual to participate in FHSC's board. In addition, the Chairman of the Board of the Tampa General Hospital Foundation is also a member of the FHSC's board. Form 990, Part VI, Section A, line 7b The Hillsborough County Hospital Authority has the right to approve amendments to FHSC's Articles of Incorporation. Form 990, Part VI, Section B, line 11 The IRS Form 990 is prepared by the Finance Department and sent to Tampa General Hospital's external tax accountants and law firm for review. Following the revisions made at the suggestion of Tampa General Hospital's external tax accountants, if any, the IRS Form 990 is provided to the Chief Financial Officer (CFO) and the President/Chief Executive Officer (CEO) for comment and recommended changes. The Finance Department makes all appropriate revisions. The CFO reviews the Form 990 with the Audit Committee and considers any changes recommended by the Audit Committee. Any agreed-upon changes are incorporated and the draft Form 990, along with the Mission Statement, is distributed to the Board of Directors for review and approval. Upon approval by the Board, the Form 990 is filed with the IRS. Form 990, Part VI, Section B, line 12c 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 and in some cases Corporate Compliance is included 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 B, line 15 Within the framework of applicable law, Tampa General Hospital has established and maintained compensation goals, policies, and programs that enable the hospital to recruit, develop, and retain the most qualified and talented staff. Tampa General Hospital strategically invests in the people who support the hospital's mission. Compensation goals, policies, and programs are guided by and reflect our values and principles, which are consistent with the high quality of the hospital's achievement in the furtherance of medical science. Differences in pay will not be based upon such factors as race, religion, gender, national origin, ancestry, age, marital status, or disability. To ensure that TGH is paying reasonable compensation and not violating the private inurement prohibition, the Compensation Committee of the Board of Directors annually reviews and sets the compensation of officers, the executive group and key employees. The Committee utilizes the outside consulting firm of Towers Watson to provide expert information regarding industry-wide compensation norms. In addition, the hospital utilizes an outisde consulting firm to review the compensation arrangements of employed physicians for compliance with all applicable laws. Form 990, Part VI, Section C, line 19 Florida Health Sciences Center, Inc. d/b/a Tampa General Hospital (TGH) will make the following documents available to the public: (1) Articles of Incorporation and Amendments thereto; (2) Bylaws; (3) Conflict of Interest Policy; (4) Audited Financial Statements; (5) IRS Form 990 and IRS Form 1023; and (6) Community Benefits Report. The preceding documents will be available to the public either through (a) the website at www.tgh.org or (b) upon request made to the TGH Public Relations Office, after payment of reasonable copying fee. Form 990, Part IX, line 11g Residents & Physicians: Program service expenses 46,943,558. Management and general expenses 8,709,741. Fundraising expenses 0. Total expenses 55,653,299. Laboratory: Program service expenses 6,019,612. Management and general expenses 1,116,858. Fundraising expenses 0. Total expenses 7,136,470. Organ Transplant: Program service expenses 15,525,465. Management and general expenses 2,891,457. Fundraising expenses 0. Total expenses 18,416,922. Repair & Maintenance: Program service expenses 10,647,750. Management and general expenses 1,975,546. Fundraising expenses 0. Total expenses 12,623,296. Other: Program service expenses 27,896,885. Management and general expenses 5,165,338. Fundraising expenses 0. Total expenses 33,062,223. Form 990, Part XI, line 9: Pension-related changes other than net periodic pension costs -16,236,535. Equity in 100% owned for-profit coffee house -406,662. Other changes 49,663. FHSC Real Property Holding Company LLC PO Box 1289 Tampa FL 33601 471396315 Real Estate Holding Company FL 0 0 N/A TGH Architecture & Engineering LLC PO Box 1289 Tampa FL 33601 464515477 Architecture FL 0 0 N/A Tampa General Hospital Foundation Inc PO Box 1289 Tampa FL 33601 237354477 Fundraising to support TGH's mission FL 501(c)(3) Line 7 N/A 0 Tampa General Hospital Auxiliary Inc PO Box 1289 Tampa FL 33601 590840712 Support TGH FL 501(c)(3) Line 11c, III-FI N/A 0 Tampa General Medical Group Inc PO Box 1289 Tampa FL 33601 274749421 Physician Specialty Clinics FL 501(c)(3) Line 9 N/A 1 Florida Health Sciences Center LTD Lime Tree Bay Ave PO Box 1051 CJ 980695992 Professional & General Liability Insurance CJ TGH C 69560619 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 Tampa General Hospital Foundation Inc C 1435020 Disbursements from foundation Tampa General Hospital Foundation Inc O 512245 Salaries & Benefits of shared emp Florida Health Sciences Center LTD S 4602746 Claims reimbursed from captive Tampa General Hospital Foundation Inc Q 279359 Disbursements from foundation Tampa General Hospital Foundation Inc N 61800 Fair Market Value