2014-03-05T09:05:52-06:00 2013-06-30 593040705 RIVERO GORDIMER & COMPANY PA P O BOX 172359 TAMPA FL 33672 990 2012-07-01 237354477 TAMPA GENERAL HOSPITAL FOUNDATION INC TAMP 8138447250 PO BOX 1289 RM H-149 TAMPA FL 33601 ROBIN DELAVERGNE 8138447250 2014-03-04 1 SAM A LAZZARA P01342929 8138757774 2012 2015-11-30 17:44:51Z ROBIN DELAVERGNE PO BOX 1289 RM H-149 TAMPA FL 33601 11107765 0 X WWW.TGH.ORG X 1974 FL TO SUPPORT AND PROMOTE THE PROGRAM SERVICES OF TAMPA GENERAL HOSPITAL. 35 33 0 150 0 0 1914380 2567364 60904 54413 569840 554254 327323 168183 2872447 3344214 1850604 1378033 0 0 143427 301964 0 0 391810 320662 130622 2314693 1810619 557754 1533595 16579472 18873927 3546398 3688902 13033074 15185025 X THE MISSION OF THE FOUNDATION IS TO SUPPORT AND PROMOTE THE PROGRAMS AND SERVICES OF TAMPA GENERAL HOSPITAL (TGH). AS A 501(C)(3) CHARITABLE ORGANIZATION, TGH IS COMMITTED TO SERVING ALL RESIDENTS OF WEST CENTRAL FLORIDA. TGH PROVIDES COMPREHENSIVE HEALTH SERVICES, RANGING FROM WELLNESS AND PRIMARY CARE TO THE MOST COMPLEX SPECIALTY CARE AND POST-ACUTE SERVICES. WITH TGH'S UNIQUE BLEND OF ACADEMIC AND OTHER HEALTHCARE PARTNERS, TGH PLAYS A SPECIAL ROLE IN SUPPORTING MEDICAL EDUCATION AND RESEARCH IN THE WEST CENTRAL FLORIDA REGION. 0 0 544436 669838 54413 PROVIDE OPERATIONAL, EDUCATIONAL AND/OR CAPITAL PURCHASES SUPPORT TO FLORIDA HEALTH SCIENCES CENTER, INC. D/B/A TAMPA GENERAL HOSPITAL. SPECIFIC GRANTS INCLUDE PURCHASE AND DISTRIBUTION OF INFANT CAR SEATS TO HOSPITAL NEWBORN PARENTS, CYSTIC FIBROSIS RESEARCH, SMALL CAPITAL EQUIPMENT TO IMPROVE PATIENT SERVICES, HOSPITAL EMPLOYEE EMERGENCY ASSISTANCE, AND SUPPORT OF HOSPITAL COMMUNITY OUTREACH, WHEELCHAIR SPORTS AND REHAB PROGRAMS. 400000 400000 SUPPORT THE CONSTRUCTION OF THE SUN CITY PRIMARY CARE FACILITY - IN AN EFFORT TO PROVIDE RESIDENTS OF TAMPA BAY GREATER ACCESS TO A VARIETY OF COMMUNITY-BASED HEALTHCARE SERVICES, TGH IS EXPANDING THE NUMBER OF PRIMARY CARE FACILITIES IN THE REGION. THE FOUNDATION HAS FUNDED APPROXIMATELY 50% OF THE $800,000 TOTAL COST OF PROVIDING A PRIMARY CARE FACILITY TO SUN CITY. 220000 220000 NEONATAL INTENSIVE CARE UNIT RENOVATION AND EXPANSION - THE FOUNDATION HAS FUNDED OVER 20% OF THE $35 MILLION HOSPITAL PROJECT, WHICH INCLUDED EXPANSION TO AN 82-BED NEONATAL INTENSIVE CARE UNIT. 88195 88195 NURSING SCHOLARSHIP PROGRAM - FOR THE PAST TEN YEARS THE FOUNDATION HAS PROVIDED SCHOLARSHIP FUNDING FOR SELECTED TAMPA GENERAL HOSPITAL EMPLOYEES WHO CONTINUE WORKING WHILE ATTENDING NURSING SCHOOL. 88195 88195 1252631 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 57 0 1 0 0 0 0 0 0 1 1 0 0 X 35 33 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X ROBIN DELAVERGNE 8138447250 PO BOX 1289 ROOM H-149 TAMPA FL 336011289 RICHARD L KOUWE 2.00 X X 0 0 0 PAMELA S MUMA 1.00 X X 0 0 0 J ERIC TAYLOR 1.00 X X 0 0 0 DOUGLAS J DIECK 2.00 X X 0 0 0 MICHAEL S MURRAY 2.00 X X 0 0 0 STEPHEN G BRANTLEY MD 1.00 X 0 0 0 DREW A GRAHAM 1.00 X 0 0 0 MCIVER S GRIM 1.00 X 0 0 0 HOLLY TOMLIN 1.00 X 0 0 0 MARY JANE CAMPBELL 1.00 X 0 0 0 PHILLIP E CASEY 1.00 X 0 0 0 BLAKE J CASPER 1.00 X 0 0 0 GREGORY J CELESTAN 1.00 X 0 0 0 RICHARD DOBKIN 1.00 X 0 0 0 ANTHONY M EVERETT 1.00 X 0 0 0 CHARLES B FUNK 1.00 X 0 0 0 JACK AMOR 1.00 X 0 0 0 ANDREA I GRAMLING 1.00 X 0 0 0 BARBARA HURST 1.00 X 0 0 0 JAMES BURKHART 1.00 X 0 0 0 JOHN LEONE MD 1.00 X 0 0 0 R KYLE BAILEY 1.00 X 0 0 0 THOMAS BERNASEK MD 1.00 X 0 0 0 T COREY NEIL 1.00 X 0 0 0 CHARLES N PAIDAS MD 1.00 X 0 0 0 DAN RIGGS MD 1.00 X 0 0 0 DEANA NELSON 1.00 X 0 0 0 CATHERINE LOWRY STRAZ 1.00 X 0 0 0 JEFFRIE VAN LOVEREN 1.00 X 0 0 0 ROBERT A WALTER 1.00 X 0 0 0 JULIE C WOOLEY 1.00 X 0 0 0 CARIN ZWIEBEL 1.00 X 0 0 0 MARION ALBANESE 1.00 X 0 0 0 TOD LEIWEKE 1.00 X 0 0 0 JOSEPH METERCHICK 1.00 X 0 0 0 ROBIN DELAVERGNE 50.00 X 0 418516 30651 0 418516 30651 0 0 1 0 0 664766 1902598 139982 2567364 EDUCATIONAL FEES 900099 28614 28614 GROWING FAMILY FIRST 900099 14554 14554 EMPLOYEE WELLNESS CENTER 900099 11245 11245 54413 462050 462050 7620854 7528650 92204 92204 92204 379600 664766 234901 144699 144699 MANAGEMENT FEE 900099 23484 23484 23484 3344214 54413 0 722437 1245507 1245507 132526 132526 237223 55285 181938 64741 15855 48886 20500 20500 187926 26940 160986 14277 14277 20500 20500 3897 3897 DONOR RECOGNITION 8924 8924 ALLOWANCE FOR UNCOLLECT -125402 -125402 1810619 1252631 166178 391810 1585690 1383338 807719 338030 4607 7557 50849 50622 246 227 14181210 17144775 16579472 18873927 143557 150471 3402841 3538431 3546398 3688902 X 8512360 9412653 3675528 4903822 845186 868550 13033074 15185025 16579472 18873927 1533595 618356 0 X X 0 1 X 1 0 X 2280581 2075310 1977189 1914380 2567364 10814824 2280581 2075310 1977189 1914380 2567364 10814824 711165 10103659 365152 261060 202676 279845 462050 1570783 12385607 601817 0.81580 0.73730 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 845186 23290 74 868550 816874 38455 341 10484 845186 808259 8632 397 414 816874 766418 42339 1025 1523 808259 746527 19870 3335 3314 766418 1.00000 0 0 50849 50622 227 227 FUNDS HELD FOR THE BENEFIT OF OTHERS 3538431 3538431 X 4722995 618356 525524 234901 1378781 3344214 0 3344214 2571044 525524 234901 760425 1810619 0 1810619 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS SUPPORT THE MISSION OF TAMPA GENERAL HOSPITAL, INCLUDING RESEARCH, EDUCATION, AND HEALTHCARE DELIVERY. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE FOUNDATION HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986. INCOME EARNED IN FURTHERANCE OF THE ORGANIZATION'S TAX-EXEMPT PURPOSE IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. THE FOUNDATION IS NOT AWARE OF ANY TAX POSITIONS IT HAS TAKEN THAT ARE SUBJECT TO A SIGNIFICANT DEGREE OF UNCERTAINTY. TAX YEARS AFTER JUNE 30, 2010 REMAIN SUBJECT TO EXAMINATION BY TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT DIRECT EXPENSES 234,901. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENTS DIRECT EXPENSES 234,901. GALA 390935 269386 121549 110544 CIRCUS 297218 174555 122663 79826 3 356213 220825 135388 44531 1044366 664766 379600 234901 234901 144699 1 FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 44357 EMPLOYEE SERVICES - EMERGENCY ASSISTANCE FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 54690 RESEARCH DEPARTMENT - CYSTIC FIBROSIS RESEARCH FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 220000 NICU - RENOVATIONS FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 69971 CHILDREN'S MEDICAL CENTER - INFANT CAR SEATS FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 24276 EMPLOYEE WELLNESS CENTER - EQUIPMENT AND EDUCATION FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 400000 AMBULATORY CARE - SUN CITY PRIMARY CARE FACILITY FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 30000 MORE HEALTH - CONTRIBUTION OF OPERATING SUPPORT FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 33944 REHAB CENTER - EQUIPMENT AND EDUCATION FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 299094 VARIOUS - EQUIPMENT AND EDUCATION FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 23558 WHEELCHAIR SPORTS - EQUIPMENT AND EDUCATION FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 45617 CHILDRENS MEDICAL CENTER - MISC EQUIPMENT 1 NURSING SCHOLARSHIPS 7 88195 CURRENT SALARY RATES NURSING AWARDS AND EDUCATION 49 44331 CURRENT SALARY RATES PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FOUNDATION EXECUTIVE COMMITTEE ESTABLISHES A RESTRICTED FUND AFTER A CAREFUL REVIEW OF THE FUND'S SPECIFIC PURPOSE AND ANTICIPATED APPROVED EXPENDITURES. EACH RESTRICTED FUND IS ASSIGNED TO A TAMPA GENERAL HOSPITAL (TGH) VICE PRESIDENT WHO THEN DESIGNATES A FUND OFFICER. THE FUND OFFICER MUST BE EMPLOYED BY TGH AS A MEDICAL STAFF MEMBER, VICE PRESIDENT, DEPARTMENT MANAGER OR DIRECTOR. THE FUND OFFICER AND VICE PRESIDENT ARE DIRECTLY AND SOLELY RESPONSIBLE FOR MEETING THE REQUIREMENTS OF THE FUND PURPOSE. DISBURSEMENTS FROM THE FUND MAY ONLY BE MADE WHEN A PROPERLY COMPLETED CHECK REQUEST FORM WITH SUPPORTING DOCUMENTATION HAS BEEN SUBMITTED BY THE FUND OFFICER, APPROVED BY THE ASSIGNED VICE PRESIDENT AND REVIEWED BY THE FOUNDATION EXECUTIVE DIRECTOR TO ENSURE THAT THE REQUEST MEETS THE ORIGINALLY ESTABLISHED FUND CRITERIA. ALL LEVELS OF APPROVAL MUST BE OBTAINED BEFORE A CHECK IS PRODUCED. THE EXECUTIVE DIRECTOR AND BOARD TREASURER OR ASSISTANT TREASURER PERFORM A FINAL REVIEW OF THE DOCUMENTATION PRIOR TO SIGNING PRINTED CHECKS. X X X X X X 0 1 0 0 0 0 0 0 0 ROBIN DELAVERGNE 0 248948 0 58769 0 110799 0 22651 0 8000 0 449167 0 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 4B: ROBIN DELAVERGNE PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED DEFERRED COMPENSATION PLAN. SHE HAD $107,417 OF NONVESTED BENEFITS ACCRUE DURING THE TAX YEAR ENDING JUNE 30, 2013. THIS AMOUNT IS INCLUDED IN PART II, COLUMN B(III). PART II, LINE 1(II), COLUMN E: ROBIN DELAVERGNE'S COMPENSATION IS NOT PAID BY THE TAMPA GENERAL HOSPITAL FOUNDATION, INC. HER COMPENSATION IS PAID BY A RELATED ORGANIZATION, FLORIDA HEALTH SCIENCES CENTER, INC. D/B/A TAMPA GENERAL HOSPITAL. X 5 1001 RETAIL PRICING X 643 RETAIL PRICING X 670 RETAIL PRICING X 9 7520 RETAIL PRICING X 7 1746 RETAIL PRICING X 1 750 RETAIL PRICING X FLORAL ARRANGEMENTS 1 300 RETAIL PRICING X TICKETS TO EVENTS 27 23476 RETAIL PRICING X TRAVEL/TRIPS 18 36728 RETAIL PRICING X MISCELLANEOUS 103 67148 RETAIL PRICING 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS REVIEWED BY THE FINANCE COMMITTEE. ONCE SATISFIED WITH THE RETURN, IT WAS PRESENTED TO THE BOARD OF TRUSTEES AT A BOARD MEETING FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C EACH FOUNDATION TRUSTEE, OFFICER, KEY EMPLOYEE AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS IS REQUIRED TO SIGN AN "ANNUAL DISCLOSURE STATEMENT (CONFLICT OF INTEREST AND IRS MATTERS)." ON THE FORM THE PERSON AFFIRMS THAT HE/SHE HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; HAS READ AND UNDERSTANDS THE POLICY; HAS AGREED TO COMPLY WITH THE POLICY; AND UNDERSTANDS THAT THE FOUNDATION IS A CHARITABLE, TAX EXEMPT ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. ADDITIONALLY, HE/SHE DISCLOSES ALL KNOWN POTENTIAL OR ACTUAL CONFLICTS. UPON COMPLETION, THE ANNUAL DISCLOSURE STATEMENT IS PROVIDED TO THE FOUNDATION'S EXECUTIVE DIRECTOR, WITH A COPY TO LEGAL COUNSEL. TO ENSURE THAT THE FOUNDATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX, PERIODIC REVIEWS ARE CONDUCTED AT LEAST ANNUALLY AND ON A CHANGE OF CIRCUMSTANCE. THE MINUTES OR OTHER RECORDS OF THE BOARD AND ALL COMMITTEES WITH BOARD DELEGATED POWERS CONTAIN THE NAMES OF ANY PERSONS WHO ABSTAIN FROM VOTING DUE TO A REAL OR POTENTIAL CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 TAMPA GENERAL HOSPITAL FOUNDATION, INC. HAS ADOPTED THE FOLLOWING PROCEDURES FROM TAMPA GENERAL HOSPITAL ("TGH") AND DEPENDS ON TGH TO PROVIDE THE ANALYSIS DESCRIBED. 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 EFFECT 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, 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. FORM 990, PART VI, SECTION C, LINE 19 TAMPA GENERAL HOSPITAL FOUNDATION, INC. 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; AND (5) IRS FORM 990. THE FOREGOING DOCUMENTS WILL BE AVAILABLE TO THE PUBLIC UPON REQUEST AND AFTER PAYMENT OF REASONABLE COPYING FEES. FORM 990, PART XII, LINE 2C, FINANCIAL STATEMENTS AND REPORTING: THE PROCESS FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. FL HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL 1 TAMPA GENERAL CIRCLE TAMPA FL 33606 593458145 1004 BED PRIVATE, NOT-FOR-PROFIT HOSPITAL FL 501(C)(3) 3 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL B 1378033 BASED ON FOUND. BOARD DECISIONS FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL P 301964 BASED ON SALARY AND BENEFIT CALC. FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL O 475804 BASED ON SALARY AND BENEFIT CALC. FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL N 49720 BASED ON FAIR RENTAL VALUE