2014-07-09T14:15:37-07:00 2013-09-30 990 2012-10-01 593458145 FLORIDA HEALTH SCIENCES CENTER INC FLOR 8138447000 PO BOX 1289 TAMPA FL 33601 Steve L Short 8138447000 2014-06-27 2012 2015-11-30 17:44:51Z TAMPA GENERAL HOSPITAL Jim Burkhart PO BOX 1289 TAMPA FL 33601 1313533354 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 7839 340 748119 210815 4941867 6022441 979746553 1010430381 19811789 25688257 190732 -6595029 1004690941 1035546050 861333 1029444 0 0 480497524 482254874 0 0 0 495429065 503438848 976787922 986723166 27903019 48822884 1246358549 1372968721 783826302 761007306 462532247 611961415 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 760854573 968930661 Hospital Patient 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 6,000 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 five 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: 278,998, Emergency room visits: 87,632, Deliveries: 5,209, and Surgeries: 28,844. 22069672 9596628 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 the Tampa General Hospital on an annual basis. University of South Tampa has 120 medical students rotating at Tampa General Hospital during our Fiscal Year 2013. 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. 1818049 0 2039668 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 2013, the OCR provided oversight for a total of 518 active studies including 156 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. 26675356 2154009 29863424 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. 26675356 2154009 29863424 811417650 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 0 1 1 1 0 0 1 538 0 1 7839 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 15 11 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 Brabson 1 0 X 0 0 0 Phillip S Dingle 1 0 X 0 0 0 Owen Fredrick Dobbins 1 0 X 0 0 0 Richard L Kouwe 1 0 X X 0 0 0 Devanand Mangar MD 1 X 12722 0 0 John McKibbon III 1 0 X 0 0 0 Eugene H McNichols 1 0 X 0 0 0 Shelton E Quarles 1 0 X 0 0 0 Dana L Shires MD 1 0 X 0 0 0 John T Sinnott MD 1 0 X 0 0 0 David A Straz Jr 1 0 X 0 0 0 Joseph W Taggart 1 0 X 0 0 0 John T Touchton Jr 1 0 X 0 0 0 Erika Wallace 1 0 X 0 0 0 Bruce Zwiebel 4 0 X 28500 0 0 Pamela S Muma 1 0 X 0 0 0 Jim Burkhart 50 0 X 0 0 0 Janet H Davis 50 0 X 405374 0 35399 Robin W DeLaVergne 0 50 X 418515 0 30651 Cheryl A Eagan 50 0 X 324325 0 31160 Anthony D Escobio 50 0 X 225963 0 34100 Sally H Houston 50 0 X 741818 0 37987 Jean M Mayer 50 0 X 432298 0 38639 Deana L Nelson 50 0 X 882992 0 64857 John H Bond Jr 50 0 X 359087 0 36051 Mark W Campbell 50 0 X 233145 0 29442 Scott J Arnold 50 0 X 271045 0 29874 Maureen Ogden 50 0 X 329721 0 35488 Richard L Paula 50 0 X 283665 0 30184 Judith M Ploszek 50 0 X 503488 0 41335 Chris A Roederer 50 0 X 488369 0 29624 Steve L Short 50 0 X 842138 0 73377 Jana Gardner 50 0 X 233675 0 34234 Vincent D Perron 50 0 X 235652 0 22868 Pamela G Sanders 50 0 X 113655 0 18986 Julita C Kallenborn 50 0 X 157315 0 29518 David K Robbins 50 0 X 254913 0 32909 Balaji Ramadoss 50 0 X 186212 0 15547 Maja G Gift 50 0 X 200067 0 26673 Mark W Weston 50 0 X 766051 0 87034 Debbie A Rinde-Hoffman 50 0 X 756847 0 86868 Victor D Bowers 50 0 X 566836 0 53833 Peter J Berman 50 0 X 525469 0 52788 Ting C Huang 50 0 X 433664 0 32786 Amy J Paratore 50 0 X 292672 0 32893 Kathi K Katz 50 0 X 199780 0 6695 Veronica B Martin 50 0 X 253578 0 22801 Elizabeth J Lindsay-Wood 50 0 X 1643957 0 35716 Ronald A Hytoff 50 0 X 1641677 0 133173 Thomas L Bernasek MD 2 0 X 52027 0 0 15297212 0 1303490 325 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 1563218 4358999 100224 0 6022441 Patient Service Revenue 622000 954890039 954890039 0 0 Dispropoprtionate Share Revenue 622000 23637250 23637250 0 0 Outpatient Pharmacy Sales-Employees and Patients 446110 11733852 11733852 0 0 Research, Meaningful Use and Other 621990 19421121 19421121 0 0 Commercial Lab 621500 748119 0 748119 0 0 0 0 0 1010430381 14626452 0 0 14626452 937764 0 0 937764 0 0 0 0 0 0 288111345 0 277987304 0 10124041 0 10124041 0 0 10124041 0 0 0 0 0 0 0 Loss on extinguishment of debt 900099 -6792087 0 0 -6792087 197058 0 0 197058 -6595029 1035546050 1009682262 748119 19093228 X 1029444 1029444 0 9939230 2172212 7767018 6740027 441357 6298670 349677749 289596655 60081094 33753665 27002932 6750733 55575479 44460383 11115096 26568724 21254979 5313745 4618639 778170 3840469 4295320 630 4294690 289449 0 289449 413686 413686 0 1445808 0 1445808 104907711 91175587 13732124 3830338 23176 3807162 251022601 234096161 16926440 21873529 10591188 11282341 0 0 0 14995620 13196146 1799474 1190390 471843 718547 157773 65757 92016 18829853 16570272 2259581 26838 0 26838 42700334 28792976 13907358 15007071 15007071 0 Assessments 13316357 13316357 0 Dues and Memberships 1711375 309757 1401618 Property Taxes and Other Taxes 239656 239350 306 Recruitment Costs 1025025 190105 834920 1541475 221456 1320019 986723166 811417650 175305516 0 21395 21645 121686297 125131782 575491 566765 137215612 140200302 20615322 20167792 4506692 6178463 795316190 346295972 459277846 449020218 473781719 610935246 5570104 7261894 6041047 5436943 17067024 8047671 1246358549 1372968721 175364770 175938189 227277 41194 364720726 398755102 7904993 2235310 235608536 184037511 783826302 761007306 X 450654759 602195811 11877488 9765604 0 0 462532247 611961415 1246358549 1372968721 X 48822884 22233095 0 0 0 78373189 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 100 0 0 1 413686 0 0 413786 0 SchC_P2B_S00_L01 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. 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 762812 34373 3539 0 3312 0 797412 0 1 0 0 1 1 0 46639634 46639634 0 417846446 129316061 288530385 0 0 0 0 0 292583877 209613739 82970138 0 38246233 7366172 30880061 449020218 0 Accrued Claims Payable Malpractice 76609348 Accrued Retirement Benefits 2397624 Accrued Supplemental Retirement Benefits 14993877 Accrued Postretirement Benefits 3513221 Accrued Workers Compensation 2372000 Due to Third Party Payor/Reform Incentive 84071946 2006 Bond Issue Arbitrage Payable 79495 184037511 X 1055386821 22233096 0 0 0 22233096 1033153725 0 2392325 2392325 1035546050 986723166 0 0 0 0 0 986723166 0 0 0 986723166 SchD_P05_S00_L04 Schedule D, Part V, Line 4 Permanently restricted funds were available for hospital construction projects, equipment, and educational initiatives. SchD_P10_S00_L02 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. SchD_P11_S00_L04b Schedule D, Part XI, Line 4b The sum of $2,392,325 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 Professional Liability 365964 1 2 365964 0 0 1 0 0 0 SchF_P01_S00_L03 Schedule F, Part I, Line 3 Florida Health Sciences Center Ltd., which was formed in Cayman Islands began operations June 1, 2010, 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 60660172 14040622 46619550 0.047 174598936 154066827 20532109 0.021 26940469 9585623 17354846 0.018 0 0 262199577 177693072 84506505 0.086 2497217 2497217 0.002 40554811 16386318 24168493 0.024 5025619 1171399 3854220 0.004 2428917 2039668 389249 0.001 948776 948776 0.001 0 0 51455340 19597385 31857955 0.032 0 0 313654917 197290457 116364460 0.118 1 14058869 0 228725364 236836617 -8111253 X 1 1 1 1 Florida Health Sciences Center Inc dba Tampa General Hospital

PO Box 1289 Tampa FL 33601

www.tgh.org 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 X 13 1 0 1 X 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 X 1 X X X X X X 1 X X X 0 0 6 TGH Community Health Education

740 S Village Circle Tampa FL 33606

Community health education center. 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 SchH_P01_S00_L06a Schedule H, Part I, Line 6a TGH completed a Community Benefit report and this information is available at www.tgh.org. SchH_P01_S00_L07 Schedule H, Part I, Line 7 The hospital's cost accounting system was used to calculate the amounts reported in line 7. For the purpose of computing subsidized services, both direct and indirect costs were considered. For research, only direct costs were considered. SchH_P03_S0A_L02 Schedule H, Part III, Section A, Line 2 Bad debt results when a patient, who has been determined to have the financial capacity to pay for healthcare services, is unwilling to settle the claim or provide substantiating documentation for any charity and/or discount program. The hospital records a provision for bad debts in the period the services are provided. As accounts age, increasing percentages of bad debt allowances are applied based on ageing category to reflect estimated uncollectable amounts. This method is consistently applied based on established risk parameters. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Receivables are reported net of an allowance for bad debt and contractual adjustment estimates. Although the aggregate amount of receivables may include balances due from patients and third party payers, amounts due from third-party payers for retroactive adjustments of items, such as final settlements or appeals, are reported separately in the financial statements. 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. As expected payments are determined to be uncollectible, they are written off against the allowance for bad debts. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The $8.0 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 2013 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. SchH_P03_S0C_L09b 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 the basis for calculating discount amounts to patients eligible for financial assistance under this policy; describes the method by which patients may 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. SchH_P05_S0B_L01 Schedule H, Part V, Section B, Line 1 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 o Introductions o Explanation of the purpose of the focus group o 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: o Participants are instructed to separately write on a piece of paper their top 3 perceived health concerns within the community o Each participant calls out in order the health concerns round robin style until all options for every person have been exhausted o Participants instruct the facilitator on which like items, if any, they would like to combine o Participants are instructed to separately rank the items most important (3) to least important (1) o 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: o Was there anything that surprised you? o Why do you feel these are the top health concerns? o How do you feel these needs could be addressed in the community? * Session Conclusion - 15 minutes o Summary of findings o Closing discussion o Distribution of incentives for participation SchH_P05_S0B_L03 Schedule H, Part V, Section B, Line 3 This CHNA was conducted following the requirements outlined by the Treasury and the IRS, which included obtaining necessary information from the following sources: Input from persons who represented the broad interests of the community served by TGH, which included those with special knowledge of or expertise in public health; Identifying federal, tribal, regional, state, or local health or other departments or agencies, with current data or other information relevant to the health needs of the community served by TGH, leaders, representatives, or members of medically underserved, low-income, and minority populations with chronic disease needs in the community served by TGH; and, Consultation or input from other persons located in and or serving TGH's community, such as: Healthcare community advocates; Nonprofit organizations; Academic experts; Local government officials; Community based organizations, including organizations focused on one or more health issues; Healthcare providers, including community health centers and other providers focusing on medically underserved populations, low income persons, minority groups, or those with chronic disease needs. For a list of persons that the hospital consulted reference Schedule H, Part V, Section B Line 1. SchH_P05_S0B_L12 Schedule H, Part V, Section B, Line 12 Family size in combination with household income is used to determine eligibility for either charity or discounted care. SchH_P05_S0B_L16 Schedule H, Part V, Section B, Line 16 TGH engages in standard collection activities such as statements and telephone calls. As of July 1, 2013, Tampa General no longer reports unpaid debts to the credit bureau or engages in extraordinary collection efforts. SchH_P05_S0B_L17 Schedule H, Part V, Section B, Line 17 TGH engages in standard collection activities such as statements and telephone calls. As of July 1, 2013, Tampa General no longer reports unpaid debts to the credit bureau or engages in extraordinary collection efforts. SchH_P05_S0B_L20 Schedule H, Part V, Section B, Line 20 Medicaid rate is used in rare instances for those that are not able to afford amounts generally billed by Medicare and commercial insurance. SchH_P05_S0B_L22 Schedule H, Part V, Section B, Line 22 We assess total charges to international patients coming for highly specialized elective care. SchH_P06_S00_L02 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 (tgh.org) and is included as an attachment to this filing. 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 FY2013, TGH did not complete any additional assessments of the health care community it serves. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 For Fiscal Year 2013, the costs associated with charity care, unreimbursed Medicaid, and the unreimbursed costs of other means-tested government programs care exceeded $84.5 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. Assistance is provided to enroll eligible individuals in government programs such as Medicaid, Medicare Disability 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, a copy of which is attached. 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. SchH_P06_S00_L04 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 and is attached to this filing. The highlights from the assessment are detailed below. * The primary service area population is currently 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. SchH_P06_S00_L05 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 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 2013, TGH's clinics provided 175,400 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 FY2013, the TGH Office of Clinical Research supported 518 research studies at a net cost of $1.8 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 2013, TGH funded approximately 300 GME full time equivalent slots in over 50 specialties. The Medicare program funds a portion of approximately 200 of these GME slots, with the remaining slots funded solely by TGH out of hospital 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 2013, TGH CME sponsorships provided CME education to 983 physicians, none of whom were on the TGH medical staff. The cost of CME sponsorships exceeded $70,500. 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 2013, TGH provided 403 free programs and screenings to 7,503 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. For example, programs of particular interest to seniors were provided at several senior living facilities within the primary service area including Sun City, University Village, Bayshore Presbyterian and Tampa Baptist Manor. In fiscal year 2013, 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 the addition of two new 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. Screenings provided during fiscal year 2013 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 2013, 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 Community Health Center (TCHC). TCHC 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, Wheels of Success, the Epilepsy Foundation, Joshua House, the Spring 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. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 Not Applicable SchH_P06_S00_L07 Schedule H, Part VI, Line 7 Florida SchH_P06_S00_L08 Schedule H, Part VI, Line 8 Not Applicable 1 Tampa Family Health Center Inc 2103 N Rome Ave Tampa FL 33607 592420282 501(c)3 300000 Provides support for hiring additional primary care physicians to serve uninsured patients. More Health Inc 3821 Henderson Blvd Tampa FL 33629 593397472 501(c)3 288271 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 79000 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 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 Support the mission of the American Heart Association via sponsorship of various American Heart Association fundraising events. University of Tampa 401 W Kennedy Blvd Tampa FL 33606 590624459 501(c)3 47667 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 Support education of healthcare professionals by funding a portion of an instructor's salary. March of Dimes 131846366 501(c)3 25000 Support the mission of the March of Dimes via sponsorship of various March of Dimes fundraising events. Gasparilla Distance Classic Association Inc PO Box 1881 Tampa FL 33601 590943559 501(c)3 19530 Provide free screening and medical services prior to and on the day of the event. Friends of the Riverwalk 101 E Kennedy Blvd Suite 2000 Tampa FL 33602 203146250 501(c)3 8500 Support community development of outdoor spaces. Hillsborough Organization for Progress and Equality Inc 5103 N Central Ave Tampa FL 33603 592914463 501(c)3 7500 Donation to H.O.P.E. WEDU 1300 North Boulevard Tampa FL 336075646 590840626 501(c)3 7500 Sponsorship of programming for preventing substance abuse in children and adolescents. 12 0 SchI_P01_S00_L02 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 199547 0 38028 0 121512 0 21320 0 14730 0 395137 0 0 0 Mark W Campbell 169381 0 32718 0 31046 0 14737 0 14706 0 262588 0 0 0 Janet H Davis 228949 0 63728 0 112696 0 27598 0 7801 0 440772 0 0 Robin W DeLaVergne 248948 0 58769 0 110799 0 22651 0 8000 0 449167 0 0 0 Cheryl A Eagan 219346 0 55687 0 49292 0 20891 0 10269 0 355485 0 0 0 Anthony D Escobio 170928 0 33818 0 21218 0 19389 0 14711 0 260064 0 0 0 Sally H Houston 390117 0 96038 0 255663 0 28132 0 9856 0 779806 0 0 0 Ronald A Hytoff 1009013 0 307847 0 324817 0 120031 0 13142 0 1774850 0 0 0 Elizabeth J Lindsay-Wood 333138 0 73859 0 1236960 0 20876 0 14840 0 1679673 0 0 0 Veronica B Martin 193115 0 59464 0 1000 0 14571 0 8230 0 276380 0 0 0 Jean M Mayer 266180 0 63373 0 102745 0 30939 0 7701 0 470938 0 0 Deana L Nelson 518273 0 137021 0 227698 0 59198 0 5659 0 947849 0 0 Maureen Ogden 191269 0 68261 0 70191 0 25247 0 10241 0 365209 0 0 0 Amy J Paratore 163951 0 53511 0 75210 0 18185 0 14708 0 325565 0 0 0 Richard L Paula 233397 0 49459 0 809 0 16231 0 13953 0 313849 0 0 0 Judith M Ploszek 314899 0 73055 0 115534 0 35849 0 5487 0 544824 0 0 0 David K Robbins 213438 0 40016 0 1458 0 18167 0 14742 0 287821 0 0 0 Chris A Roederer 289409 0 65937 0 133023 0 19314 0 10309 0 517992 0 0 0 Steve L Short 516363 0 137021 0 188754 0 59198 0 14180 0 915516 0 0 0 Maja G Gift 179107 0 19448 0 1512 0 18467 0 8206 0 226740 0 0 0 Peter J Berman 520023 0 544 0 4902 0 38586 0 14202 0 578257 0 0 0 Victor D Bowers 560030 0 1904 0 4902 0 53353 0 480 0 620669 0 0 0 Debbie A Rinde-Hoffman 753681 0 544 0 2622 0 72666 0 14202 0 843715 0 0 0 Mark W Weston 759655 0 544 0 5852 0 72832 0 14202 0 853085 0 0 0 Ting C Huang 432136 0 544 0 984 0 32786 0 0 0 466450 0 0 0 Balaji Ramadoss 173783 0 12174 0 255 0 9908 0 5639 0 201759 0 0 0 Julita C Kallenborn 139802 0 17104 0 408 0 14832 0 14685 0 186831 0 0 0 Jana Gardner 198115 0 33861 0 1699 0 19523 0 14712 0 267910 0 0 0 Scott J Arnold 218182 0 52209 0 654 0 15112 0 14762 0 300919 0 0 0 Vincent D Perron 221288 0 12038 0 2326 0 13173 0 9695 0 258520 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a TGH pays membership dues for the University Club of Tampa for Mr. Ronald Hytoff. These membership dues were not treated as taxable compensation to the recipient. Any international travel by an executive is booked with a first class ticket. SchJ_P01_S00_L03 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 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. SchJ_P01_S00_L04 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 2012 W-2s includes the following vested amounts: Amy J. Paratore: $74,448; Anthony D. Escobio: $20,735: Cheryl A. Eagan: $40,216; Chris A. Roederer: $130,401; David K. Robbins: $141,000; Deana L. Nelson: $225,203; Elizabeth Lindsay-Wood: $1,234,122; Janet H. Davis: $109,977; Jean M. Mayer: $95,221; John H. Bond: $116,614; Judith M. Ploszek: $112,725; Mark W. Campbell: $30,722; Maureen Ogden: $68,418; Robin DeLaVergne: $107,417; Ronald A. Hytoff: $298,909; Sally Houston: $253,648; and Steve L. Short: $186,259. SchJ_P01_S00_L06 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. SchJ_P01_S00_L07 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 591293512 2013-09-19 50889807 Refunding 2003 Bond Issue 0 0 0 A 4550000 0 202380091 0 0 0 2184896 0 0 199158149 870854 166192 2009 0 0 1 1 B 0 0 186480570 0 0 134532845 1945528 0 0 19672822 0 30329375 2015 1 0 0 1 C 0 0 50889807 0 50593688 161750 0 0 0 0 134369 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 0 0 0 1 0 0 0 0 1 C 0 0 1 1 0 0 0 0 1 A 1 B 1 C 1 SchK_P01_S00_L00e Schedule K, Part I, Column e Differences between "Issue Price" (column e) and "Total Proceeds of Issue" (line 3) are the result of investment earnings. SchK_P04_S00_L02c Schedule K, Part IV, Line 2c 100% of these funds were utilized to defease other outstanding issues; therefore, no arbitrage calculation is required. DeLaVergne & Company Business owned by son of Robin DeLaVergne (Senior Vice President of FHSC). 51840 Real Estate Commission 0 Florida Orthopedic Institute Dr. Bernasek, a former board member 1896243 Florida Orthopedic Institute provides orthopedic services. 0 Suntrust Mr. Dobbins, a board member 309589 Suntrust performs a custodial function. 0 Lifelink Foundation Inc Dr Dana L Shires, board member 14916687 Lifelink Foundation Inc provides organs for transplant 0 Gulf to Bay Anesthesiology Associate Dr Devanand Mangar, a board member and former chief of staff 4478252 Gulf to Bay Anesthesiology provides anesthesiology 0 Radiology Associates of Tampa PA Bruce Zwiebel, a board member and chief of staff 1320481 Radiology Associates of Tampa PA provides radiology physician group 0 SchL_P04_S00_L00 Schedule L, Part IV Schedule L, Part IV - DeLaVergne & Company is a real estate brokerage firm owned by the son of Robin DeLaVergne (Senior Vice President of FHSC). FHSC engages DeLaVergne & Company for commercial real estate services, which are paid at fair market value. Florida Orthopedic is an orthopedic care center, of which Dr. Thomas Bernasek (former board director and Chief of Staff at FHSC) is a shareholder and employee. FHSC engages Florida Orthopedic Institute for orthopedic 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 purchases organs for transplantation at fair market value from the Lifelink Foundation. 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. 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. F990_P06_S0A_L07a 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 FHSC's board. F990_P06_S0A_L07b 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. F990_P06_S0B_L11b 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 tax accountants for review. Following the revisions made at the suggestion of Tampa General Hospital's tax accountants, 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. F990_P06_S0B_L12c 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. F990_P06_S0B_L15 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. F990_P06_S0C_L19 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. F990_P09_S00_L11g Form 990, Part IX, Line 11g The amount in other expenses includes $20,015,282 in payments to residents, $30,705,146 in payments to physicians, $18,286,483 for organ transplant fees, $11,822,590 in medical equipment repairs and maintenance contracts , and the remaining balance is made up of other various professional fees. F990_P11_S00_L09 Form 990, Part XI, Line 9 This amount includes $78,600,330 in pension-related changes associated with a plan amendment and increases in plan assets and other net changes in net assets of $(227,141). 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 c/o Marsh Management Svcs 23 Lime Tree Bay Av Bd 4 Fl 2 Georgetown Grand Cayman CJ KY1-1102 980695992 Professional liability & general liability coverage to TGH on a claims made basis. CJ Florida Health Scences Center Inc C 75437268 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 Tampa General Hospital Foundation Inc c 1398292 Donated amounts based on hospital needs. Tampa General Hospital Foundation Inc n 472534 Based on benefit and salary of shared employees. Florida Health Sciences Center LTD s 6167525 Based on cost of services. Extension filed and approved by the Internal Revenue Service.