2015-07-14T13:08:23-07:00 2014-09-30 135565207 KPMG LLP 300 North Greene Street Suite 400 Greensboro NC 27401 990 2013-10-01 593458145 FLORIDA HEALTH SCIENCES CENTER INC FLOR 8138447000 PO BOX 1289 TAMPA FL 33601 Steve L Short CFO and Executive Vice President 8138444601 2015-07-14 1 Allison Franklin P00448640 3364337081 2015-07-14 2013 2016-03-07 17:11:31Z TAMPA GENERAL HOSPITAL Steve L Short CFO Attn Corporate Accounting P O Box 1289 Tampa FL 33601 1457733374 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. 14 9 8218 350 929510 368346 6022441 6514142 1010430381 1075363306 25688257 45755294 -6595029 0 1035546050 1127632742 1029444 873145 0 0 482254874 490538942 0 0 0 503438848 537758616 986723166 1029170703 48822884 98462039 1372968721 1491356417 761007306 791047462 611961415 700308955 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 784899586 1024135138 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 1,018 beds, and with over 6,500 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 6,000 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: 279,625, Emergency room visits: 90,949, Deliveries: 5,281, and Surgeries: 29,450. 20520220 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 2014. 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. 2238075 2209073 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 2014, the OCR provided oversight for a total of 578 active studies including 218 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. 35053083 2784943 39086549 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. 35053083 2784943 39086549 842710964 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 1 684 0 1 8218 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 14 9 0 0 0 0 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 FL X Steve L Short EVP and CFO 8138447000 1 Tampa General Cir Tampa FL 33606 John A Brabson Jr Board Member 1 0 X 0 0 0 Owen Fredrick Dobbins Board Member 1 0 X 0 0 0 Devanand Mangar MD Board Member 1 0 X 0 0 0 John B McKibbon III Board Member 1 0 X 0 0 0 Eugene H McNichols Board Member 1 0 X 0 0 0 Pamela S Muma Board Member 1 0 X 0 0 0 Shelton E Quarles Board Member 1 0 X 0 0 0 Dana L Shires MD Board Member 1 0 X 0 0 0 John T Sinnott MD Board Member 1 0 X 0 0 0 David A Straz Jr Board Member & Chairman 1 0 X X 0 0 0 Joseph W Taggart Board Member 1 0 X 0 0 0 John T Touchton Jr Board Member 1 0 X 0 0 0 Erika Wallace Board Member 1 0 X 0 0 0 Bruce Zwiebel MD Board Member 4.00 0 X 61667 0 0 Michael Gorsage Senior Vice President of Strategic Svcs and Business Development 50 0 X 0 0 0 Laura Haubner MD Vice President Chief Quality Officer 50 0 X 0 0 0 James Tanner MD Senior Vice President TGMG 50 0 X 0 0 0 Rebecca Zucarelli Senior Vice President Patient Experience Officers 50 0 X 0 0 0 Mark Anderson Sr Vice President of Ambulatory Services 50 0 X 0 0 0 James R Burkhart President - CEO 50 0 X 1032108 0 6685 Janet H Davis Senior Vice President, CNO 50 0 X 517502 0 39143 Robin W DeLaVergne Senior Vice President Development 50 0 X 392844 0 30397 Cheryl A Eagan Senior Vice President Support Services 50 0 X 393370 0 33654 Anthony D Escobio Vice President Patient Financial Services 50 0 X 296829 0 36675 Sally H Houston Senior Vice President, CMO 50 0 X 670810 0 51355 Jean M Mayer Senior Vice President Strategic Services 50 0 X 463581 0 41111 Deana L Nelson Executive Vice President, COO 50 0 X 967971 0 70175 John H Bond Jr Vice President Surgical Services 50 0 X 326494 0 38564 Mark W Campbell Vice President Materials Management 50 0 X 285472 0 32194 Scott J Arnold Senior Vice President Information Systems 50 0 X 316103 0 32757 Maureen Ogden Vice President Cardiovascular Services 50 0 X 372705 0 26726 Judith M Ploszek Senior Vice President Finance Administration 50 0 X 569768 0 45201 Chris A Roederer Senior Vice President Human Resources 50 0 X 451674 0 37464 Steve L Short Executive Vice President, CFO 50 0 X 870656 0 79127 Jana Gardner Vice President Physician Practice Operations 50 0 X 232376 0 37334 Vincent D Perron Vice President Medical Affairs 50 0 X 297825 0 26693 Pamela G Sanders Vice President Women and Children Svcs 50 0 X 165034 0 24578 Julita C Kallenborn Vice President Acute Care 50 0 X 194532 0 32712 David K Robbins Vice President Professional Svcs 50 0 X 341571 0 41242 Balaji Ramadoss Vice President Chief Technology Officer 50 0 X 221229 0 21944 Maja G Gift Director of Pharmacy 50 X 200087 0 26533 Mark W Weston Internal Medicine Cardiology 50 0 X 765401 0 56813 Debbie A Rinde-Hoffman Internal Medicine Cardiology 50 0 X 758366 0 56634 Peter J Berman Internal Medicine Cardiology 50 0 X 527258 0 54936 Ting C Huang Transplant Physician Surgery 50 0 X 432690 0 39369 Guy W Neff MD Transplant Physician 50 0 X 503067 0 35307 Richard L Paula Chief Medical Informatics Officer 50 0 X 306162 0 31558 Amy J Paratore Vice President Emergency Services 50 0 X 216536 0 18850 Elizabeth J Lindsay-Wood Senior Vice President Information Technology 50 0 X 406294 0 27920 Ronald A Hytoff President, CEO 50 0 X 3843375 0 27912 17401357 0 1161563 355 1 1 0 LIFELINK FOUNDATION INC PO BOX 102474 ATLANTA GA 30368 ORGAN ACQUISITION 14916687 GULF TO BAY ANESTHESIOLOGY ASSOCIATE 400 N ASHLEY DRIVE TAMPA FL 33602 PHYSICIANS 4478252 CARLTON FIELDS PA PO BOX 3239 TAMPA FL 33601 LEGAL SERVICES 3270671 GP MICROSOFT LICENSING 1950 N STEMMONS FAIRWAY SUITE 5010 DALLAS TX 75207 SOFTWARE LICENSING 3244640 UNIVERSITY MED SERVICE ASSOC PO BOX 917492 ORLANDO FL 32891 PHYSICIAN DIRECTORSHIP 3025485 137 0 0 0 2671408 3671239 171495 0 6514142 Patient Service Revenue 622000 1009494444 1009494444 0 0 Disproportionate Share Revenue 622000 23643730 23643730 0 0 Outpatient Pharmacy Sales-Employees 446110 23082325 23082325 0 0 Research, Meaningful Use and Other 621990 18213297 18213297 0 0 Commercial Lab 621500 929510 0 929510 0 0 0 0 0 1075363306 17206147 0 0 17206147 8877 0 0 8877 0 0 0 0 0 0 358640902 0 330100632 0 28540270 0 28540270 0 0 28540270 0 0 0 0 0 0 1127632742 1074433796 929510 45755294 X 873145 873145 9329538 2025179 7304359 4823283 4823283 372989008 307539213 65449795 12705827 10484228 2221599 63229845 54009658 9220187 27461441 22556975 4904466 5701084 1231864 4469220 3605544 1500 3604044 338676 338676 371864 371864 2182467 2182467 110043179 96065670 13977509 4065725 17376 4048349 270751898 249931729 20820169 31251751 11459572 19792179 15478536 13621112 1857424 1572531 579546 992985 181227 96424 84803 16336401 14376033 1960368 46712 46712 43148593 28592019 14556574 13932052 13932052 Assessments 13949209 13949209 0 0 Dues and Memberships 1958358 478017 1480341 0 Property Taxes and Other Taxes 135324 32705 102619 0 Recruitment Costs 1431698 231591 1200107 0 1275787 254283 1021504 0 1029170703 842710964 186459739 0 21645 21845 125131782 150760813 566765 841303 140200302 121034857 20167792 20553796 6178463 16227701 842736456 388838960 449020218 453897496 610935246 686229999 7261894 9412578 5436943 4832838 8047671 27543191 1372968721 1491356417 175938189 209793009 41194 398755102 396507365 2235310 324537 184037511 184422551 761007306 791047462 X 602195811 691556436 9765604 8752519 0 0 611961415 700308955 1372968721 1491356417 X 98462039 -4901801 0 0 0 -5212698 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 100 0 0 1 371864 0 0 371964 0 Schedule C, 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 primarily focused on maintaining existing funding and seeking additional government support to ensure TGH can continue to deliver quality care to its patients. 902991 7745 0 0 0 0 910736 850187 52730 74 0 0 0 902991 833825 16455 343 0 436 0 850187 812385 31507 397 0 10464 0 833825 797412 15675 821 0 1523 0 812385 0 1 0 0 1 1 0 46639635 46639635 0 435882131 147259101 288623030 0 0 0 0 0 320819921 233819519 87000402 0 39394769 7760340 31634429 453897496 DUE FROM(TO)GENERAL ESTIMATED PATIENT LIABILITIES 29747603 DUE FROM (TO) MEDICARE PRIOR YEARS 39659901 DUE TO MEDICAID PRIOR YEARS 20869017 ACCRUED RETIREMENT BENEFITS 4972224 ACCRUED SUPPLEMENTAL RETIREMENT BENEFITS 16393100 ACCRUED POSTRETIREMENT BENEFITS 4210430 ACCRUED CLAIMS PAYABLE MALPRACTICE 63763659 ACCRUED CLAIMS PAYABLE WORKERS COMPENSATION 2216000 2006 BOND ISSUE ARBITRAGE PAYABLE 73820 CAPTIVE LT LIABILITY 1889545 REFORM INCENTIVE PAYMENT 627252 184422551 X 1120645566 -4901800 0 0 0 -4901800 1125547366 0 2085376 2085376 1127632742 1029170703 0 0 0 0 0 1029170703 0 0 0 1029170703 Schedule D, Part V, Line 4 Permanently restricted funds were available for hospital construction projects, equipment, and educational initiatives. Schedule D, Part X, Line 2 Schedule D, Part X, Line 2 - TGH has been recognized by the Internal Revenue Service as a tax exempt organization described in Section 501(c)(3) of the Internal Revenue Code. Accordingly, income earned in the furtherance of TGH's tax-exempt purpose is exempt from federal and state income taxes. TGH applies Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) Topic 740 for 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. Schedule D, Part XI, Line 4b The sum of $2,085,376 represents contributions received that were released for property, plant, and equipment and which are not recognized as income in the financial statements. Central America and the Caribbean 1 2 Program Services Florida Health Sciences Center, Ltd., which was formed in Cayman Islands, began operations on June 1, 2010. It provides professional and general liability insurance to Florida Health Sciences Center, Inc. 342301 1 2 342301 0 0 1 0 0 0 Schedule F, Part I, Line 3 Florida Sciences Center Limited, which was formed in the Cayman Islands, began operations in June 10, 2010 and provides professional and general liability insurance to Florida Health Sciences Center, Inc. 1 1 X 1 X 1 X 1 1 1 0 1 1 51326584 13868461 37458123 0.037 171253450 154005240 17248210 0.017 29564109 10669835 18894274 0.019 0 0 252144143 178543536 73600607 0.073 2749013 2749013 0.003 38916999 15892558 23024441 0.023 8983911 5239009 3744902 0.001 2815889 2209273 606616 0.001 1027981 1027981 0.001 0 0 54493793 23340840 31152953 0.029 0 0 306637936 201884376 104753560 0.102 1 10473642 0 237377621 241807134 -4429513 X 1 1 1 1 Florida Health Sciences Center Inc dba Tampa General Hospital PO Box 1289 Tampa FL 33601 www.tgh.org 4044 X X X X X Florida Health Sciences Center Inc dba Tampa General Hospital 1 1 X X X X X X X X X 13 1 0 1 X www.tgh.org X X X X 1 0 1 1 200 1 400 1 X X X X X X 1 1 X X X X 1 X 0 1 X X X 0 0 Schedule H, Part V, Section B, Line 1-Florida Health Sciences Center Inc 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. Schedule H, Part V, Section B, Line 3-Florida Health Sciences Center Inc Same as Line 1 Explanation Above Schedule H, Part V, Section B, Line 12-Florida Health Sciences Center Inc Family size in combination with household income is used to determine eligibility for either free or discounted care. Schedule H, Part V, Section B, Line 16-Florida Health Sciences Center Inc TGH engages in standard collection activities such as statements and telephone calls. Schedule H, Part V, Section B, Line 20-Florida Health Sciences Center Inc Medicaid rate is used in rare instances for those who are not able to afford amounts generally billed by Medicare and commercial insurance. 11 Transplant Abdominal Clinic 409 Bayshore Blvd Tampa FL 33606 Transplant clinic. Family Care Center Brandon 214 Morrison Rd Brandon FL 33511 Family care clinic. Family Care Center Lois 2106 South Lois Avenue Tampa FL 33629 Family care clinic Family Care Center Carrollwood 13860 North Dale Mabry Highway Tampa FL 33618 Family care clinic Family Care Center Riverview 10647 Big Bend Road Suite 212 Riverview FL 33579 Family care clinic Family Care Sun City 1647 Sun City Center Plaza Sun City Center FL 33573 Primary care clinic Family Care Center Westchase 10718 Countryway Blvd Tampa FL 33626 Primary care clinic Family Care Center Tampa Palms 16011 Tampa Palms Blvd W Tampa FL 33647 Primary Care clinic Family Care Center Boyette 11966 Boyette Rd Riverview FL 33569 Primary care clinic Family Care Center Manhattan 4212 S Manhattan Ave Tampa FL 33611 Family care clinic TGH Community Health Education 2106 S Lois Ave Tampa FL 33629 Community health education center Schedule H, Part I, Line 6a TGH developed a community benefit report for the period ending September 30, 2013 during fiscal year 2014. 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. Schedule H, 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. Schedule H, Part III, Section A, 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. Schedule H, Part III, Section B, Line 8 The $4.2 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 2014 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. Schedule H, Part III, Section C, 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. Schedule H, 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 that community'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 of the 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. Schedule H, Part VI, Line 3 For fiscal year 2014, the costs associated with charity care, unreimbursed Medicaid, and the unreimbursed costs of other means-tested government programs exceeded $73.6 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. Schedule H, 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 the 2011 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. Schedule H, 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 16 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 2014, TGH's clinics provided 198,103 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 FY2014, the TGH Office of Clinical Research supported 578 research studies at a net cost of $2.2 million. 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 2014, TGH funded approximately 300 GME full time equivalent slots in over 50 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 2014, TGH CME sponsorships provided CME education to 975 physicians, none of whom were on the TGH medical staff. The cost of CME sponsorships exceeded $151,000. 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 2014, TGH provided 412 free programs and screenings to 15,099 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 2014, 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 2014 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 2014, TGH provided financial support to numerous not-for-profit organizations. This support ranged from donations under $1,000 to commitments in excess of $250,000. 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. Schedule H, Part VI, Line 6 Not applicable. Schedule H, Part VI, Line 7 Florida 1 Tampa Family Health Center Inc 2103 N Rome Ave Tampa FL 33607 592420282 501(c)(3) 300000 0 Amount paid. Support for hiring additional primary care physicians to serve uninsured patients. More Health 3821 Henderson Blvd Tampa FL 33629 593397472 501(c)(3) 238715 0 Amount Paid NA Support mission to provide health education to students in Hillsborough County at no charge. Ronald McDonald House 28 Columbia Drive Tampa FL 33606 591835985 501(c)(3) 74000 0 Amount Paid NA Support mission to provide temporary lodging and other support for the families of hospitalized children. University of South Florida 4202 E Fowler Ave Tampa FL 33620 593102112 501(c)(3) 60000 0 Amount Paid 0 Tampa General Hospital and University of South Florida together support the Ronald McDonald House pediatric care mobile unit. The unit provides medical services to children. American Heart Association 11207 Blue Heron Blvd N Suite P St Petersburg FL 33716 135613797 501(c)(3) 50000 0 Amount paid NA Support the mission of the American Heart Association via sponsorship of various fundraising events. University of Tampa 401 W Kennedy Blvd Tampa FL 33606 590624459 501(c)(3) 54778 0 Amount Paid NA Support education of healthcare professionals by funding a portion of an instructor's salary. University of South Florida 4202 E Fowler Ave Tampa FL 33620 593102112 501(c)(3) 33002 0 Amount paid 0 Support education of healthcare professionals by funding a portion of instructor's salary. March of Dimes 405 North Reo Street Suite 160 Tampa FL 33609 131846366 501(c)(3) 26500 0 Amount Paid NA Support of the mission of the March of Dimes via sponsorships of various March of Dimes fundraising events. Gasparilla Distance Classic Association Inc PO Box 1881 Tampa FL 33601 590943559 501(c)(3) 20150 0 Amount Paid NA Provide free screening and medical services prior to and on the day of the event. Hillsborough Organization for Progress and Equality Inc 5103 N Central Ave Tampa FL 33603 592914463 501(c)3 7500 0 Amount Paid NA Donation to H.O.P.E. WEDU 1300 North Boulevard Tampa FL 33607 590840626 501(c)3 8500 0 Amount Paid NA Sponsorship of programing for preventing substance abuse in children and adolescents 11 0 Schedule I, 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 John H Bond Jr Vice President Surgical Services 182571 0 55417 0 88506 0 23440 0 15124 0 365058 0 0 0 Mark W Campbell Vice President Materials Management 162825 0 48107 0 74540 0 20348 0 11846 0 317666 0 0 0 Janet H Davis Senior Vice President, CNO 234901 0 84000 0 198601 0 30938 0 8205 0 556645 0 0 0 Robin W DeLaVergne Senior Vice President Development 238317 0 83530 0 70997 0 24288 0 6109 0 423241 0 0 0 Cheryl A Eagan Senior Vice President Support Services 215692 0 79150 0 98528 0 22995 0 10659 0 427024 0 0 0 Anthony D Escobio Vice President Patient Financial Services 170113 0 50983 0 75733 0 21564 0 15110 0 333503 0 0 0 Sally H Houston Senior Vice President, CMO 405262 0 150747 0 114801 0 41092 0 10263 0 722165 0 0 0 Ronald A Hytoff President, CEO 933912 0 1376 0 2908087 0 17260 0 10652 0 3871287 0 0 0 Elizabeth J Lindsay-Wood Senior Vice President Information Technology 292960 0 0 0 113334 0 12690 0 15230 0 434214 0 0 0 Jean M Mayer Senior Vice President Strategic Services 252350 0 90073 0 121158 0 33118 0 7993 0 504692 0 0 0 Deana L Nelson Executive Vice President, COO 477276 0 194751 0 295944 0 64124 0 6050 0 1038145 0 0 0 Maureen Ogden Vice President Cardiovascular Services 196684 0 91181 0 84840 0 16091 0 10635 0 399431 0 0 0 Amy J Paratore Vice President Emergency Services 158512 0 0 0 58024 0 3752 0 15098 0 235386 0 0 0 Richard L Paula Chief Medical Informatics Officer 231345 0 70298 0 4519 0 17214 0 14344 0 337720 0 0 0 Judith M Ploszek Senior Vice President Finance Administration 305115 0 106750 0 157903 0 39317 0 5885 0 614970 0 0 0 Scott J Arnold Senior Vice President Information Systems 243290 0 71984 0 829 0 17601 0 15156 0 348860 0 0 Peter J Berman Internal Medicine Cardiology 517001 0 544 0 9713 0 39644 0 15292 0 582194 0 0 0 James R Burkhart President - CEO 631432 0 368112 0 32564 0 0 0 6685 0 1038793 0 0 0 Jana Gardner Vice President Physician Practice Operations 173667 0 53046 0 5663 0 22219 0 15115 0 269710 0 0 0 Maja G Gift Director of Pharmacy 165403 0 17163 0 17521 0 17936 0 8597 0 226620 0 0 0 Ting C Huang Transplant Physician Surgery 431199 0 544 0 946 0 24009 0 15360 0 472058 0 0 0 Guy W Neff MD Transplant Physician 399430 0 408 0 103229 0 19971 0 15336 0 538374 0 0 0 Vincent D Perron Vice President Medical Affairs 231960 0 63269 0 2596 0 16595 0 10098 0 324518 0 0 0 Balaji Ramadoss Vice President Chief Technology Officer 194697 0 20885 0 5647 0 15874 0 6069 0 243172 0 0 0 Debbie A Rinde-Hoffman Internal Medicine Cardiology 650801 0 544 0 107021 0 42042 0 14592 0 815000 0 0 0 David K Robbins Vice President Professional Svcs 207849 0 61250 0 72472 0 26097 0 15145 0 382813 0 0 0 Chris A Roederer Senior Vice President Human Resources 266230 0 93717 0 91727 0 26763 0 10701 0 489138 0 0 0 Pamela G Sanders Vice President Women and Children Svcs 136001 0 26402 0 2631 0 16008 0 8569 0 189611 0 0 0 Steve L Short Executive Vice President, CFO 474858 0 194751 0 201048 0 64535 0 14592 0 949784 0 0 0 Mark W Weston Internal Medicine Cardiology 652393 0 544 0 112464 0 42221 0 14592 0 822214 0 0 0 Julita C Kallenborn Vice President Acute Care 149934 0 34372 0 10226 0 18192 0 14521 0 227245 0 0 0 Mark Anderson Sr Vice President of Ambulatory Services 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Michael Gorsage Senior Vice President of Strategic Svcs and Business Development 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Laura Haubner MD Vice President Chief Quality Officer 0 0 0 0 0 0 0 0 0 0 0 0 0 James Tanner MD Senior Vice President TGMG 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rebecca Zucarelli Senior Vice President Patient Experience Officers 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Schedule J, Part I, Line 1a Any international travel by an executive is booked with a first class ticket. TGH paid temporary housing expenses during relocation period for Mr. James R Burkhart. Schedule J, Part I, Line 3 Within the framework of applicable law, Tampa General Hospital will establish and maintain compensation goals, policies, and programs that enable the hospital to recruit, develop, and retain the most qualified and talented staff. Tampa General Hospital 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. Schedule J, Part I, Line 4 Schedule J, Part 1, Line 4 -Tampa General 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. Schedule J, Part I, Line 6 A portion of the bonuses and incentive is based achieving certain financial targets. The remaining bonuses are based on the achievement of certain quality indicators and other non-financial metrics. Schedule J, Part I, Line 7 33.33% of the total bonus and incentive is based on achieving certain financial targets. The remaining bonus is based on the achievement of certain quality indicators and other 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 and Refunding 2003 Bond Issue 0 0 0 C Hillsborough County Industrial Development Authority (PNC) 591293512 2013-09-19 50889807 Refunding 2003 Bond Issue 0 0 0 A 5590000 0 202380091 0 0 0 2184896 0 0 199158149 870854 166192 2009 0 0 1 1 B 0 134532845 186485298 0 0 0 1945528 0 0 33096528 134532845 16910397 2015 1 0 0 1 C 0 50593688 50889807 0 0 0 296119 0 0 0 50593688 0 2014 1 0 1 1 A 0 1 0 0 0.002 0 0.002 0 0 1 B 0 1 0 0 0.002 0 0.002 0 0 1 C 0 1 0 0 0.002 0 0.002 0 0 1 A 1 0 0 1 Transamerica Life 2.25 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 Associate Dr. Devanand Mangar, a board member, is president and employee of Florida Gulf to Bay Anesthesiology 3123100 Gulf to Bay Anesthesiology provides anesthesiology services which are paid at fair market value. 0 Lifelink Foundation Inc Dr. Dana L Shires (board member at FHSC) is co-founder and current Chairman of the Lifelink Foundati 14916687 Lifelink Foundation provides organ procurement services for FHSC at fair market value 0 Radiology Associates of Tampa PA Dr. Bruce Zwiebel is a board member of FHSC and shareholder of Radiology Associates 553070 Radiology Associates provides radiology services to FHSC at fair market value. 0 Suntrust Mr. Dobbins, a board member of FHSC is an employee of Suntrust Bank. 371367 Suntrust Bank performs custodial functions for FHSC 0 Marriott Business Services Tampa Marriott Tampa Marriott Westshore and Courtyard by Marriott Mr. John McKibbon has an ownership interest in the Courtyard by Marriott in downtown Tampa 96681 Payment at market value for various hospital events. $92,547 of the total paid was paid to Marriott Business Services 0 Schedule L, Part IV Gulf to Bay Anesthesiologists is a physician group practice, of which Dr. Devanand Mangar (board director and former Chief of Staff at FHSC) is President and an employee. FHSC engages Gulf to Bay Anesthesiologists for the provision of anesthesiology services, which are paid at fair market value. Suntrust Bank is a national bank, of which Fred Dobbins (board director of FHSC) is an employee. FHSC has commercial bank accounts with Suntrust Bank that are maintained in the ordinary course of business. Lifelink Foundation is an organ procurement organization, of which Dr. Dana Shires (board director at FHSC) is co-founder, former CEO and current Chairman of the Foundation. FHSC utilizes Marriott for various functions and pays for services provided at fair market price. Mr. John McKibbon, a board member, has ownership interest in the Tampa downtown Marriott Hotel. Radiology Associates of Tampa is a physician group practice, of which Dr. Bruce Zweibel (board director and Chief of Staff at FHSC) is a shareholder and employee. FHSC engages Radiology Associates for the provision of radiology services, which are paid at fair market value. Form 990, Part III, Line 4d Tampa General Hospital's Other Program Services includes cafeteria and vending sales, parking garage revenues, pharmacy sales to employees, net assets released from restrictions, and other miscellaneous revenue. 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 11b 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 This amount includes payments for residents, organ transplant fees, medical equipment repair and maintenance contracts and various professional fees. Form 990, Part XI, Line 9 This amount includes $5,292,413 in pension-related changes other than net periodic pension costs and other changes in net assets of ($79,715). FHSC Real Property Holding Company LLC P O 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 Organized to design future properties 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 P O Box 1289 Tampa FL 33601 590810712 Support Tampa General Hospital FL 501(c)(3) Line 11c - Type III N/A 0 Tampa General Medical Group Inc P O Box 1289 Tampa FL 33601 274749421 Physician Specialty Offices FL 501(c)(3) Line 9 (509)(a)(2) N/A 0 Florida Health Sciences Center LTD 23 Lime Tree Bay Avenue PO Box 1051 Marsh Management Grand Cayman CJ KY1-1102 980695992 Professional liability & general liability CJ Florida Health Sciences Center Inc C 75437268 1 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 2534007 Based on disbursements from Tampa General Hospital Foundation Inc. Tampa General Hospital Foundation Inc o 511418 Based on salaries and benefits of shared employees. Florida Health Sciences Center LTD s 3659145 Claims reimbursed from captive. Tampa General Hospital Auxiliary Inc s 137401 Funds received from the TGH Auxiliary for hospital activities.