2013-02-01T14:48:29-06:00 2012-06-30 593040705 RIVERO GORDIMER & COMPANY PA P O BOX 172359 TAMPA FL 33672 990 2011-07-01 237354477 TAMPA GENERAL HOSPITAL FOUNDATION INC TAMP 8138447250 P O BOX 1289 RM H-149 TAMPA FL 33601 ROBIN DELAVERGNE 8138447250 2013-01-23 1 SAM A LAZZARA P01342929 8138757774 2011 2016-02-25 16:41:14Z ROBIN DELAVERGNE P O BOX 1289 RM H-149 TAMPA FL 33601 24431616 0 X WWW.TGH.ORG X 1974 FL TO SUPPORT AND PROMOTE THE PROGRAM SERVICES OF TAMPA GENERAL HOSPITAL. 32 30 0 150 0 0 1977189 1914380 102058 60904 337199 569840 162052 327323 2578498 2872447 875199 1850604 0 0 164573 143427 0 0 287459 -92030 320662 947742 2314693 1630756 557754 16113633 16579472 3390166 3546398 12723467 13033074 X THE MISSION OF TAMPA GENERAL HOSPITAL FOUNDATION IS TO SUPPORT AND PROMOTE THE PROGRAMS AND SERVICES OF TAMPA GENERAL HOSPITAL. THE STATED MISSIONS OF TAMPA GENERAL HOSPITAL INCLUDE SERVING AS A SAFETY NET HOSPITAL PROVIDING HIGH QUALITY HEALTH SERVICES TO ALL RESIDENTS OF WEST CENTRAL FLORIDA AND AS A TEACHING FACILITY PARTNERING WITH ACADEMIC AND COMMUNITY INSTITUTIONS TO SUPPORT BOTH TEACHING AND RESEARCH. 0 0 621699 583627 60904 PROVIDE OPERATIONAL, EDUCATIONAL AND/OR CAPITAL PURCHASES SUPPORT TO FLORIDA HEALTH SCIENCES CENTER, INC. D/B/A TAMPA GENERAL HOSPITAL. SPECIFIC GRANTS INCLUDE NURSING SCHOLARSHIPS TO ASSIST HOSPITAL EMPLOYEES IN OBTAINING NURSING CREDENTIALS, SMALL CAPITAL EQUIPMENT TO IMPROVE PATIENT SERVICES, HOSPITAL EMPLOYEE EMERGENCY ASSISTANCE, AND SUPPORT OF HOSPITAL COMMUNITY OUTREACH, WHEELCHAIR SPORTS AND REHAB PROGRAMS. 875000 875000 NICU- RENOVATIONS AND EXPANSION OF THE NEONATAL INTENSIVE CARE UNIT. THE FOUNDATION HAS FUNDED OVER 20% OF THE $35 MILLION HOSPITAL PROJECT WHICH INCLUDED AN 82 BED NEONATAL INTENSIVE CARE UNIT EXPANSION. 315000 315000 SURGERY- RENOVATIONS OF OPERATING SUITES WAITING ROOMS. THIS IS A PORTION OF A $15.8 MILLION HOSPITAL PROJECT TO RENOVATE OVER 35,000 SQUARE FEET IN THE SURGICAL, RADIOLOGY AND CARDIOTHORACIC ICU UNITS. THE PROJECT WILL INCREASE THE SURGICAL AREA FROM SIX TO NINE OPERATING ROOMS AND INCREASE WAITING ROOM AREA BY MORE THAN 50%. 76977 76977 CHILDRENS MEDICAL CENTER - PURCHASE AND DISTRIBUTION OF INFANT CAR SEATS TO ALL HOSPITAL NEWBORN PARENTS. 76977 76977 1888676 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 1 1 0 0 0 0 1 0 0 0 0 1 28 0 1 0 0 0 0 0 0 1 1 0 0 X 32 30 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 P O 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 MCIVER BERNER 2.00 X 0 0 0 STEPHEN G BRANTLEY MD 1.00 X 0 0 0 HOLLY TOMLIN 1.00 X 0 0 0 HENRY GONZALEZ III 1.00 X 0 0 0 MARY JANE CAMPBELL 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 ANDREA I GRAMLING 1.00 X 0 0 0 DREW A GRAHAM 1.00 X 0 0 0 RONALD A HYTOFF 1.00 X 0 0 0 JOHN LEONE MD 1.00 X 0 0 0 BARBARA HURST 1.00 X 0 0 0 CLEVELAND A MCINNIS 1.00 X 0 0 0 DEVANAND MANGAR MD 1.00 X 0 0 0 CHARLES N PAIDAS MD 1.00 X 0 0 0 STEVE L SHORT 1.00 X 0 0 0 DAN RIGGS MD 1.00 X 0 0 0 CARIN ZWIEBEL 1.00 X 0 0 0 ROBERT A WALTER 1.00 X 0 0 0 JULIE C WOOLEY 1.00 X 0 0 0 CHARLES B FUNK 1.00 X 0 0 0 PHILLIP E CASEY 1.00 X 0 0 0 T COREY NEIL 1.00 X 0 0 0 CATHERINE LOWRY STRAZ 1.00 X 0 0 0 JEFFRIE VAN LOVEREN 1.00 X 0 0 0 ROBIN DELAVERGNE 50.00 X 0 437109 43034 0 437109 43034 0 0 1 0 0 493537 1420843 115860 1914380 EDUCATIONAL FEES 900099 32941 32941 GROWING FAMILY FIRST 900099 14439 14439 EMPLOYEE WELLNESS CENT 900099 13524 13524 60904 279845 279845 21691176 21401181 289995 289995 289995 458591 493537 157988 300603 300603 MANAGEMENT FEE 900099 26720 26720 26720 2872447 60904 0 897163 1751604 1751604 99000 99000 113050 45352 67698 30377 12186 18191 19600 19600 245577 44007 201570 15461 15461 1952 1952 ALLOWANCE FOR UNCOLLECT 38072 38072 2314693 1888676 138558 287459 1892726 700201 1774747 807719 8412 4607 50849 50603 265 246 8418188 14181210 4019295 885489 16113633 16579472 219925 143557 3170241 3402841 3390166 3546398 X 7991081 8512360 3915512 3675528 816874 845186 12723467 13033074 16113633 16579472 X 557754 -248147 X X 0 1 1 X 0 X 5235133 2280581 2075310 1977189 1914380 13482593 5235133 2280581 2075310 1977189 1914380 13482593 2088782 11393811 862684 365152 261060 202676 279845 1971417 15454010 637396 0.73730 0.76150 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 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 50603 246 246 CERTIFICATES OF DEPOSIT 92000 F MONEY MARKET FUNDS 793489 F 885489 FUNDS HELD FOR THE BENEFIT OF OTHERS 3402841 3402841 2872447 2314693 557754 -248147 -248147 309607 3264863 -248147 482575 157988 392416 2872447 0 2872447 2955256 482575 157988 640563 2314693 0 2314693 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: 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, 2009 REMAIN SUBJECT TO EXAMINATION BY TAXING AUTHORITIES. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT DIRECT EXPENSES 157,988. PART XIII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENTS DIRECT EXPENSES 157,988. GALA 319916 194320 125596 43904 28544 CIRCUS 254613 121560 133053 77656 2 377599 177657 199942 6500 1384 952128 493537 458591 50404 107584 157988 300603 1 FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 35468 EMPLOYEE SERVICES- EQUIPMENT AND EMERGENCY ASSISTANCE FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 46609 RESEARCH DEPARTMENT- CYSTIC FIBROSIS RESEARCH FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 875000 NICU- RENOVATIONS FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 76977 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) 315000 SURGERY - WAITING ROOM RENOVATIONS 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) 21100 REHAB CENTER- EQUIPMENT AND EDUCATION FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL PO BOX 1289 TAMPA FL 33601 593458145 501(C)(3) 303616 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 1 NURSING SCHOLARSHIPS 8 76300 CURRENT SALARY RATES NURSING AWARDS AND EDUCATION 8 22700 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 227992 0 104268 0 104849 0 32070 0 10964 0 480143 0 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 4B: ROBIN DELAVERGNE PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED DEFERRED COMPENSATION PLAN. SHE HAD $85,515 OF NONVESTED BENEFITS ACCRUE DURING THE TAX YEAR ENDING JUNE 30, 2012. 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. COREY NEIL TRUSTEE 14338 MR. NEIL IS THE EXECUTIVE VICE PRESIDENT OF THE FOUNDATION'S PRIMARY BANKING INSTITUTION. "AMOUNT OF TRANSACTION" RELATES TO FEES PAID TO THE FINANCIAL INSTITUTION IN THE NORMAL COURSE OF BUSINESS. 0 X 5 4350 RETAIL PRICING X 3 1645 RETAIL PRICING X GIFTS AND PRIZES 123 77824 RETAIL PRICING X DECORATIONS 3 1209 RETAIL PRICING X TOYS/GAMES 9 6949 RETAIL PRICING X SERVICES 10 22882 RETAIL PRICING X JEWELRY 2 1000 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -248,147. PART XI FINANCIAL STATEMENTS AND REPORTING - LINE 2C THE PROCESS 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 1 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 1850604 BASED ON FOUND. BOARD DECISIONS FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL O 143427 BASED ON SALARY AND BENEFIT CALC. FLORIDA HEALTH SCIENCES CENTER INC DBA TAMPA GENERAL HOSPITAL N 482575 BASED ON SALARY AND BENEFIT CALC.