2011-05-13T14:25:30-05:00 2010-06-30 ERNST & YOUNG US LLP 75 BEATTIE PLACE SUITE 800 GREENVILLE SC 29601 990 2009-07-01 593238634 H LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL INC HLEE 8137454673 12902 MAGNOLIA DRIVE TAMPA FL 33612 Janene Culumber 8137451329 2011-05-13 8642425740 2009 2016-02-24 21:20:13Z JANENE CULUMBER 12902 MAGNOLIA DRIVE TAMPA FL 33612 553517171 0 X WWW.MOFFITT.ORG X 1994 FL TO CONTRIBUTE TO THE PREVENTION AND CURE OF CANCER. 14 10 2581 400 0 0 4692682 7551785 452127642 514831626 2395753 3009349 2176044 3050462 461392121 528443222 99847 141450 0 178975259 189234730 0 0 245904589 270869961 424979695 460246141 36412426 68197081 305218442 325027437 35246528 44109244 269971914 280918193 THE PRIMARY PURPOSE OF THE H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL, INC. IS TO CONTRIBUTE TO THE PREVENTION AND CURE OF CANCER. 0 0 391237103 141450 515571444 H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE HOSPITAL, INC. (THE "HOSPITAL") HAS MADE A LASTING COMMITMENT TO THE PREVENTION AND CURE OF CANCER, WORKING TIRELESSLY IN THE AREAS OF PATIENT CARE, RESEARCH AND EDUCATION TO ADVANCE ONE STEP FURTHER IN FIGHTING THIS DISEASE.LOCATED ON THE CAMPUS OF THE UNIVERSITY OF SOUTH FLORIDA IN TAMPA, FL, THE HOSPITAL HAS ONE MISSION "TO CONTRIBUTE TO THE PREVENTION AND CURE OF CANCER." MOFFITT IS A LEADING NATIONAL CANCER INSTITUTE (NCI) COMPREHENSIVE CANCER CENTER - ONE OF ONLY 40 IN THE NATION TO HOLD THIS DISTINCTION. ADDITIONALLY, TO SERVE OUR LEGISLATIVE MANDATE TO BE A STATEWIDE RESOURCE FOR CANCER RESEARCH AND TREATMENT, THE HOSPITAL HAS CREATED A NETWORK OF STRATEGIC PARTNERS COMPOSED OF 17 AFFILIATE HOSPITALS (14 WITHIN THE STATE OF FLORIDA) AND PRACTICE AFFILIATIONS REPRESENTED BY MORE THAN 400 ONCOLOGISTS.REIMBURSEMENT FOR SERVICES IS CRITICAL TO THE OPERATION OF THE HOSPITAL; HOWEVER, KNOWING THAT ALL PATIENTS DO NOT HAVE THE ABILITY TO PAY, THE HOSPITAL RECOGNIZES ITS RESPONSIBILITY TO PROVIDE CANCER SERVICES AND EDUCATION TO THOSE NEEDING OUR SPECIALIZED RESEARCH CAPABILITIES. PATIENTS WHO MEET MOFFITT'S MEDICAL AND SURGICAL PROTOCOLS AND DO NOT HAVE THE ABILITY TO PAY WILL BE TREATED, IF SUCH PROTOCOLS ARE NOT AVAILIABLE IN THEIR COMMUNITY.IT IS THIS COMMITTMENT THAT HAS CONSISTENTLY GUIDED THE HOSPITAL TO:(1) PROVIDE CARE FOR PATIENTS COVERED BY GOVERNMENTAL PROGRAMS BELOW COST(2) PROVIDE FREE CHARITY CARE FOR THOSE WHO CANNOT PAY(3) PROVIDE ONCOLOGY SPECIALIZATION TO THE STATE OF FLORIDA THROUGH INVOLVEMENT IN INVESTIGATIONAL PROTOCOLS, EDUCATION OF FUTURE PHYSICIANS AND CONTINUING PROFESSIONAL EDUCATION FOR PHYSICIANS AND OTHER ALLIED HEALTH CARE PROFESSIONALS(4) TAKE A LEADERSHIP ROLE IN CANCER PREVENTION AND SCREENING ACTIVITIES THAT INVOLVE NOT ONLY THE LOCAL COMMUNITY BUT ALSO THE STATE OF FLORIDATHE HOSPITAL IS A CRITICAL RESOURCE FOR THE STATE OF FLORIDA, WHICH RANKS SECOND IN THE NATION IN BOTH CANCER INCIDENCE AND MORTALITY. THE MOFFITT ORGANIZATION HAS MORE THAN 4,200 EMPLOYEES AND SUPPORTS A MEDICAL STAFF OF 340. IT IS LICENSED FOR 206 BEDS AND INCLUDES A FREESTANDING CLINIC, A MAJOR RESEARCH INSTITUTE CONSISTING OF 625 SCIENTIFIC MEMBERS AND THEIR SUPPORT STAFF AND A FREESTANDING LIFETIME CANCER SCREENING AND PREVENTION CENTER PROVIDING A WIDE ARRAY OF OUTREACH AND EDUCATIONAL ACTIVITIES FOR THE GENERAL PUBLIC AND SELECT UNDERSERVED POPULATIONS.IN FISCAL YEAR 2010, THE HOSPITAL RECORDED 320,558 OUTPATIENT VISITS AND 8,616 INPATIENT ADMISSIONS. 391237103 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 1 181 0 2581 1 0 0 0 0 0 0 0 0 0 14 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X JANENE CULUMBER 8137451329 12902 MAGNOLIA DRIVE TAMPA FL 33612 BETH A HOUGHTON 1.00 X X 0 0 0 THE HONORABLE MARK A PIZZO 1.00 X X 0 0 0 THE HONORABLE H LEE MOFFITT 1.00 X X 0 0 0 W MICHAEL ALBERTS 40.00 X X 0 372270 44337 KAREN A ARNOLD 1.00 X 0 0 0 JOSEPH CABALLERO 1.00 X 0 0 0 MUNYA CHIURA PHD 1.00 X 0 0 0 JULIE DJEU 1.00 X 0 289246 25602 HARVEY M GREENBERG MD 1.00 X 0 0 0 DWAYNE HAWKINS 1.00 X 0 0 0 RONALD A HURST 1.00 X 0 0 0 STEPHEN K KLASKO MD 1.00 X 0 0 0 THE HONORABLE GWEN MILLER 1.00 X 0 0 0 MARY ANNE REILLY 1.00 X 0 0 0 WILLIAM S DALTON 40.00 X 0 1032396 40756 LOUIS D DE LA PARTE 40.00 X 0 385088 39756 JOHN A KOLOSKY 40.00 X 0 667836 47071 ALAN F LIST 40.00 X 0 522633 43375 NICOLAS C PORTER 40.00 X 0 487527 54177 BRAULIO VICENTE 40.00 X 135056 142875 42453 JANENE CULUMBER 40.00 X 0 289872 32816 BRENDA S GORDON 40.00 X 203909 0 19555 KELLY HALL 40.00 X 29650 148967 10003 DEAN R HEAD 40.00 X 63725 92485 19169 MARK F HULSE 40.00 X 0 197311 5136 MARY E REARDON 40.00 X 243019 0 2558 YVETTE LYONS TREMONTI 40.00 X 0 249143 29459 W J WILSON 40.00 X 234346 0 24634 SCOTT D ELDREDGE 40.00 X 166654 0 17020 PHILIP E JOHNSON 40.00 X 201367 0 21627 VLADIMIR FEYGELMAN 40.00 X 216598 0 29518 KENNETH M FORSTER 40.00 X 268408 0 38849 BRIAN K NORIEGA 40.00 X 206568 0 29636 SIRIPORN SARANGKASIRI 40.00 X 210477 0 18809 STUART G WASSERMAN 40.00 X 216389 0 23440 THOMAS A SELLERS 40.00 X 0 463530 49455 2396166 5341179 709211 185 1 1 0 ERNST & YOUNG US LLP 200 PLAZA DRIVE SECAUCUS NJ 07094 AUDIT AND TAX SERVICES 268410 CUMMINS POWER SOUTH LLC 5125 HWY 85 ATLANTA GA 30349 CONSTRUCTION SERVICES 245135 AULT INTL MEDICAL MGMT LLC 8425 PULSAR PL STE 270 COLUMBUS OH 43240 BENEFITS MANAGEMENT SERVICES 233540 TAMPA BAY RAYS BASEBALL LTD ONE TROPICANA DRIVE ST PETERSBURG FL 33705 SPONSORSHIP 163521 RARNA LLC 20110 NATURES HIKE WAY TAMPA FL 33647 CONSULTING SERVICES 157680 9 4366116 3185669 2455240 7551785 NET PATIENT SERVICE RE 900099 497521422 497521422 OUTPATIENT PHARMACY 900099 14410807 14410807 CONFERENCE PLANNING 611710 755711 755711 REIMBURSEMENTS 541900 621287 621287 BMT LODGING PROGRAM 721000 501564 501564 1020835 565343 455492 514831626 2444289 2444289 547886 547886 25022028 69095 24972172 101777 49856 -32682 17174 17174 CAFETERIA 722210 2035377 2035377 SERIES 2002A-2002B 523000 633292 633292 INT FROM INS CO 524114 126253 126253 255540 14132 241408 3050462 528443222 515571444 0 5319993 141450 141450 1726031 1380825 345206 148829396 118784652 30044744 8479315 6767746 1711569 18928873 15214809 3714064 11271115 8996015 2275100 90172 90172 196418 196418 677192 677192 80982 80982 10278592 9111059 1167533 1959990 1959990 157873799 153806608 4067191 5509185 5509185 14191276 9825663 4365613 357627 253481 104146 602683 602683 7201618 7196856 4762 26508501 18353782 8154719 1210618 1210618 PURCHASED SERVICES 25471092 20714811 4756281 BAD DEBT EXPENSE 7802815 7802815 HCCB ASSESSMENT 5500022 5500022 CATERING/FOOD SERVICE 1527854 1509683 18171 MINOR EQUIPMENT 1362921 506044 856877 2466604 1597491 869113 460246141 391237103 69009038 0 11725 12625 1021169 1157383 55809503 57914955 6956936 8433711 7032605 7113030 468631242 238290613 228070045 230340629 6316459 20055104 305218442 325027437 35246528 41148192 0 2961052 35246528 44109244 X 267653914 278802193 2318000 2116000 269971914 280918193 305218442 325027437 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 1 80491 0 0 1 809889 0 1 9116 899496 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: THE H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE, INC. AND ITS THREE NON-PROFIT SUBSIDIARY CORPORATIONS ("CORPORATION") WERE CREATED TO GOVERN AND OPERATE THE H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE ("INSTITUTE") PURSUANT TO SECTION 1004.43, FLORIDA STATUTES. AMONG OTHER THINGS, SECTION 1004.43, FLORIDA STATUTES PROVIDES: (1) THAT THE CORPORATION SHALL ENTER INTO AN AGREEMENT WITH THE STATE BOARD OF EDUCATION FOR THE UTILIZATION OF FACILITIES ON THE CAMPUS OF THE UNIVERSITY OF SOUTH FLORIDA; (2) THAT THE CORPORATION SUBMIT ANNUAL POST AUDITS OF ITS FINANCIAL ACCOUNTS TO THE AUDITOR GENERAL OF THE STATE OF FLORIDA AND THE BOARD OF GOVERNORS FOR THEIR REVIEW; AND (3) THAT THE CORPORATION'S CEO REPORT TO THE BOARD OF GOVERNORS OR ITS DESIGNEE AND PROVIDE COPIES OF THE INSTITUTE'S ANNUAL REPORT TO THE GOVERNOR OF THE STATE OF FLORIDA, THE CABINET, THE PRESIDENT OF THE SENATE, THE SPEAKER OF THE HOUSE AND THE CHAIR OF THE BOARD OF GOVERNORS. ALTHOUGH THE CORPORATION IS A PRIVATE ENTITY, IT IS NONETHELESS SUBJECT TO THE STATE OF FLORIDA'S PUBLIC RECORDS AND THE PUBLIC MEETINGS LAWS. THE CORPORATION ALSO RELIES ON ANNUAL APPROPRIATIONS BY THE LEGISLATURE OF THE STATE OF FLORIDA AND GRANTS FROM VARIOUS LOCAL, STATE AND FEDERAL AGENCIES FOR OPERATION AND MAINTENANCE OF ITS FACILITIES AND FOR SPECIFIC RESAERCH AND CLINICAL PROGRAMS. FOR THESE REASONS, THE CORPORATION FROM TIME TO TIME ENGAGES LOBBYISTS AND OTHER CONSULTANTS: (1) TO ASSIST IT IN COMPLYING WITH ITS REPORTING REQUIREMENTS TO THE STATE OF FLORIDA UNDER SECTION 1004.43, FLORIDA STATUTES; (2) TO MONITOR LEGISLATIVE AND EXECUTIVE BRANCH ACTION AT LOCAL, STATE AND FEDERAL LEVELS OF GOVERNMENT WHICH IMPACT ITS OPERATION AND THE FULFILLMENT OF ITS MISSION; AND (3) TO INFLUENCE LEGISLATION IN FURTHERANCE OF ITS MISSION IN THE AREAS OF CANCER RESEARCH AND TREATMENT, THE TEACHING AND TRAINING OF HEALTH CARE PROFESSIONALS AND COMMUNITY EDUCATION AND OUTREACH ACTIVITIES. THE CORPORATION DOES NOT ENGAGE IN ANY ACTIVITIES TO SUPPORT OR OPPOSE ANY CANDIDATE FOR PUBLIC OFFICE. OTHER ACTIVITIES, LINE 1i: THE OTHER ACTIVITIES AMOUNT LISTED ON LINE 1i IS COMPRISED OF EXPENSES RELATED TO ORGANIZING VOLUNTEERS TO VISIT LEGISLATORS. 212493448 55333261 157160187 3405873 2806609 599264 244556116 180150743 64405373 8175805 8175805 230340629 INVESTMENT IN PREMIER 75000 LONG-TERM DEPOSITS 119574 INTEREST IN NET ASSETS OF FOUNDATION 2116000 ESTIMATED THIRD-PARTY SETTLEMENTS 17744530 20055104 HCCB ASSESSMENT 2780974 LEASE INCENT OBLIG 180078 2961052 Part X: Description of Uncertain Tax Positions Under FIN 48: The Cancer Center recognizes uncertain tax positions when it is more likely than not (i.e., greater than 50% likelihood of receiving benefit) and records these benefits at the amount most likely to be realized assuming a review by tax authorities having all relevant information and applying current conventions. The Cancer Center has no significant unrecognized tax benefits and does not believe that there will be any material changes in the Cancer Center's unrecognized tax position over the next 12 months. 1 1 1 X 1 X 1 1 1 0 1 1 3924 20252643 0 20252643 0.04470 2266 32937568 10966345 21971223 0.04850 220 1875918 721439 1154479 0.00250 6410 55066129 11687784 43378345 0.09570 16 3831 80121 16459 63662 0.00010 5 1553 492663 411522 81141 0.00010 0 0 0 0 0 0 0.00000 21 5384 572784 427981 144803 0.00020 21 11794 55638913 12115765 43523148 0.09590 1 2210545 108977000 122243000 -13266000 X 1 1 H LEE MOFFITT CANCER CENTER & RESEARCH

12902 MAGNOLIA DRIVE TAMPA FL 33612

X Part I, Line 3c: CHARITY ADJUSTMENTS ARE PROVIDED BY THE CANCER CENTER AS FOLLOWS:A. PATIENTS WHO HAVE FAMILY INCOME AND ASSETS AT OR BELOW 200% FO THE FEDERAL POVERTY GUIDELINE FOR THE PATIENT'S FAMILY SIZE SHALL BE ENTITLED TO CHARITY ADJUSTMENTS OF 100% ON QUALIFYING BALANCES.B. PATIENTS, WHO HAVE FAMILY INCOME AND ASSETS BETWEEN 201%-300% OF THE FEDERAL POVERTY GUIDELINE FOR THE PATIENT'S FAMILY SIZE, SHALL BE ENTITLED TO CHARITY ADJUSTMENTS OF 70% ON QUALIFYING BALANCES.C. PATIENTS, WHO HAVE FAMILY INCOME AND ASSETS BETWEEN 301%-400% OF THE FEDERAL POVERTY GUIDELINE FOR THE PATIENT'S FAMILY SIZE, SHALL BE ENTITLED TO CHARITY ADJUSTMENTS OF 60% ON QUALIFYING BALANCES.PART I, LINE 4: CHARITY CARE IS PROVIDED TO THOSE CLASSIFIED AS MEDICALLY INDIGENT IF A PATIENT'S MEDICAL BILLS/CHARGES EXCEED 25% OF PATIENT'S AND FAMILY'S GROSS ANNUAL INCOME AND ASSETS. OUTSTANDING MEDICAL BALANCES FROM FACILITIES OTHER THAN THE CANCER CENTER CAN AND WILL BE USED IN THIS DETERMINATION. MEDICALLY INDIGENT PATIENTS SHALL BE ENTITLED TO CHARITY ADJUSTMENTS OF 100% ON QUALIFYING BALANCES. PART I, LINE 5A & 5B: THE ANNUAL BUDGETED AMOUNT FOR CHARITY CARE IS AN ESTIMATE USED FOR FINANCIAL BUDGETING PURPOSES AND DOES NOT LIMIT THE CANCER CENTER FROM PROVIDING CARE TO QUALIFYING PATIENTS. Part I, Line 6a: OUR ANNUAL COMMUNITY BENEFIT REPORT WAS MAILED TO SEVERAL COMMUNITY ORGANIZATIONS WITH WHOM WE ARE ASSOCIATED. THE REPORT IS ALSO MADE AVAILABLE TO THE PUBLIC UPON REQUEST. Part I, Line 7: COST METHODOLOGY FOR CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS IS THE COST-TO-CHARGE RATIO USED FOR THE CHARITY CARE AND MEANS TESTED PROGRAMS AND DIRECT COST METHOD FOR THE OTHER BENEFITS/PROGRAMS. Part I, Line 7f: OUR TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN A FOR HOSPITAL $460,246,141. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS $7,802,815. AFTER BAD DEBT WAS DEDUCTED FROM THE TOTAL EXPENSES THE AMOUNT OF TOTAL EXPENSES USED TO CALCULATE THE PERCENT IN LINE 7, COLUMN F WAS $452,443,326. Part III, Line 4: ADDITIONS TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS ARE MADE BY MEANS OF THE PROVISION FOR BAD DEBTS. ACCOUNTS ARE WRITTEN OFF WHEN DEEMED TO BE UNCOLLECTIBLE AND ARE DEDUCTED FROM THE PATIENT'S ACCOUNTS RECEIVABLE BALANCE.THE AMOUNT OF THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN FEDERAL AND STATE GOVERNMENT HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS. ONE TOOL USED IN MANAGEMENT'S ASSESSMENT IS A DETAILED REVIEW OF HISTORICAL COLLECTIONS AND WRITE-OFFS AT THE CANCER CENTER THAT REPRESENT A MAJORITY OF THE CANCER CENTER'S REVENUES AND ACCOUNTS RECEIVABLE. THE RESULTS OF THE DETAILED REVIEW OF HISTORICAL COLLECTIONS AND WRITE-OFFS EXPERIENCE, ADJUSTED FOR CHANGES IN TRENDS AND CONDITIONS, ARE USED TO EVALUATE THE ALLOWANCE AMOUNT FOR THE CURRENT PERIOD.PART III, LINE 2: THE RATIO OF PATIENT COST TO CHARGES IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS REPORTED ON LINE 2. DISCOUNTS ARE NOT NETTED AGAINST BAD DEBT EXPENSE BUT RATHER ARE CONSIDERED AJUSTMENTS TO REVENUE.PART III, LINE 3: AN AMOUNT OF BAD DEBT SHOULD BE INCLUDED IN COMMUNITY BENEFIT; HOWEVER, AT THIS TIME A THOROUGH ASSESSMENT/ANALYSIS HAS NOT BEEN MADE TO DETERMINE THE AMOUNT THAT SHOULD BE CONSIDERED CHARITY CARE. Part III, Line 8: THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS IS THE STEP DOWN METHOD WHICH DISALLOWS CERTAIN COSTS TO BE CONSIDERED AS COSTS RELATED TO PATIENT CARE. MEDICARE SHORTFALLS WHICH ARE COSTS INCURRED BY THE HOSPITAL TO PROVIDE QUALITY CARE AND TREATMENT OF ITS PATIENTS SHOULD BE TREATED AS COMMUNITY BENEFIT. TO NOT INCUR THESE COST WOULD POTENTIALLY LIMIT OR EVEN COMPROMISE THE QUALITY OF SERVICE PROVIDED. Part III, Line 9b: PATIENTS ARE SCREENED DURING THE ADMISSIONS PROCESS (PRIOR TO THE COLLECTION PROCESS)TO ASSESS THE NEED FOR FINANCIAL ASSISTANCE. HOWEVER, IF AT ANY POINT IN THE COLLECTION PROCESS IT IS DETERMINED THAT THE PATIENT MAY BE UNABLE TO MEET ITS OBLIGATION, THE PATIENT WILL BE SENT AN APPLICATION FOR FINANCIAL ASSISTANCE OR CHARITY ADJUSTMENT. BASED ON PATIENT'S ELIGIBILITY THE QUALIFYING AMOUNT WILL NO LONGER BE BILLED. Part V: CERTAIN COMMUNITY BENEFIT PROGRAMS AND MEDICAL RESEARCH ARE IN COLLABORATION WITH OR CONDUCTED BY OTHER RELATED ENTITIES. SINCE MOFFITT'S RELATED ENTITIES, SUCH AS ITS RESEARCH FACILITY, ARE SEPARATE LEGAL ENTITIES AND ARE NOT LICENSED AS HOSPITALS, EXPENSES INCURRED RELATED TO COMMUNITY BENEFIT ARE NOT INCLUDED IN SCHEDULE H PART I. EXPENSES INCURRED BY RELATED ENTITIES ARE SHOWN IN THE SUPPLEMENTAL SECTION OF SCHEDULE H PART VI LINE 7. Part VI, Line 2: IN RESPONSE TO AN URGENT NEED TO CREATE SOLUTIONS FOR THE DEVELOPMENT OF EFFECTIVE CANCER INTERVENTIONS AND EFFECTIVE PENETRATION WITHIN THE COMMUNITY, THE CANCER CENTER IN COLLABORATION WITH LOCAL COMMUNITY-BASED HEALTH CENTERS, SOCIAL SERVICES AGENCIES, FAITH-BASED GROUPS, ADULT EDUCATION AND LITERACY GROUPS, AND LOCAL MEDIA FORMED A NETWORK. THIS NETWORK AIMS TO ADDRESS CRITICAL ACCESS, PREVENTION AND CANCER CONTROL ISSUES THAT IMPACT MEDICALLY UNDERSERVED, LOW-LITERACY AND LOW-INCOME POPULATIONS IN THE COMMUNITY. Part VI, Line 3: DURING THE PATIENT ADMISSION/REGISTRATION PROCESS, PATIENTS WILL MEET WITH A HOSPITAL PATIENT SERVICE REPRESENTATIVE WHO OBTAINS DEMOGRAPHIC AND FINANCIAL, I.E. INSURANCE, INFORMATION. WHEN THE PATIENT SERVICE REPRESENTATIVE DETERMINES A PATIENT HAS NO INSURANCE COVERAGE AND WILL NOT LIKELY BE ABLE TO PAY FOR ANTICIPATED SERVICES, THE PATIENT SERVICE REPRESENTATIVE WILL DETERMINE THE PATIENT'S ELIGIBLITY FOR RELEVANT STATE, COUNTY, AND FEDERAL PROGRAMS. IF THE PATIENT DOES NOT QUALIFY FOR ELIGIBLE FUNDING THE PATIENT SERVICE REPRESENTATIVE WILL WORK WITH THE PATIENT TO COMPLETE A FINANCIAL STATEMENT FOR DETERMINATION OF CHARITY CARE OR PARTIAL CARE ELIGIBILITY. Part VI, Line 4: THE HOSPITAL IS THE ONLY FLORIDA BASED NCI DESIGNATED CANCER CENTER, PRIMARILY SERVICING FIVE COUNTIES WITH A BROAD RANGE OF COMMUNITIES. WITHIN A 15 MILE RADIUS, MINORITIES, MAINLY COMPRISING OF AFRICAN-AMERICAN AND HISPANICS, MAKE UP 30-40% OF THE POPULATION WITH MEDIAN HOUSEHOLD INCOME RANGING FROM $30k TO $39k AND UNEMPLOYMENT AS OF THE BEGINNING OF 2011 AT 12.5%, SLIGHTLY ABOVE THE FLORIDA UNEMPLOYMENT RATE. Part VI, Line 6: THE HOSPITAL IS INTERNATIONALLY RECONGIZED FOR ITS FOCUS ON TOTAL CANCER CARE AND TRANSLATIONAL RESEARCH AND HAS GROWN TO BE THE THIRD-LARGEST CANCER CENTER IN THE U.S. BASED ON OUTPATIENT VISITS. IT HAS CREATED ALLIANCES WITH 14 STATEWIDE HEALTH CARE SYSTEMS TO FURTHER IMPROVE THE DELIVERY OF CANCER CARE AND ACCESS TO CLINICAL TRIALS. Part VI, Line 7: AFFILIATES OF THE HOSPITAL DEDICATED TO SERVING INDIVIDUALS WHO ARE IN NEED OF FINANCIAL ASSISTANCE, HELPING TO DEVELOP AND FUND COMMUNITY PROGRAMS AND PERFORM TRANSLATIONAL RESEARCH TO BENEFIT THE COMMUNITY, INCLUDE MOFFITT FOUNDATION, MOFFITT MEDICAL GROUP, AND MOFFITT RESEARCH. MOFFITT FOUNDATION SOLICITS FUNDS TO SUPPORT THE WORK OF THE CANCER CENTER. DONATIONS MAINTAINED BY THE FOUNDATION MAY BE USED FOR A SPECIFIC PROGRAM OR MAY BE USED TO FURTHER THE OVERALL NEEDS OF THE COMMUNITY. MOFFITT MEDICAL GROUP EMPLOYS PHYSICIANS THAT STAFF THE HOSPITAL AND PROVIDE CLINICAL RESEARCH TO THE CANCER CENTER HEALTH CARE SYSTEM. THESE PHYSICIANS PROVIDE MEDICAL SERVICES TO THOSE PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. IN ADDITON, PHYSICIANS PARTICIPATE IN COMMUNITY RELATED PROGRAMS PROVIDING EDUCATION AND TRAINING. MOFFITT'S CANCER RESEARCH FACILITY PERFORMS STUDIES AND INVESTIGATIONS TO GENERATE GENERALIZABLE KNOWLEDGE AVAILABLE TO THE PUBLIC. THE RESEARCH FACILITY IS ALSO THE PARENT COMPANY OF THE CANCER CENTER HEALTH CARE SYSTEM THAT PLANS, DEVELOPS, AND IMPLEMENTS COMMUNITY BENEFIT PROGRAMS TO ADDRESS COMMUNITY NEEDS SEPARATELY FROM, AS WELL AS IN COLLABORATION WITH, THE HOSPITAL.COMMUNITY BENEFIT EXPENSES PERFORMED BY OUR AFFILIATED ENTITIES:SUBSIDIZED HEALTH SERVICES NET COMMUNITY BENEFIT EXPENSE WAS $35,914PERCENT OF TOTAL AFFILIATE EXPENSE: <.01%PERCENT OF COMBINED EXPENSE: <.01%RESEARCH NET COMMUNITY BENEFIT EXPENSE WAS $36,104,701PERCENT OF TOTAL AFFILIATE EXPENSE: 28.93%PERCENT OF COMBINED EXPENSE: 6.25%THE AFFILIATES'S SUBSIDIZED HEALTH SERVICES RELATES TO OUR CANCER SCREENING MOBILE UNIT WHERE PHYSICIAN'S, MID-LEVEL PRACTITIONERS, NURSES AND OTHER STAFF MEMBERS PROVIDE SUPPORT TRAVELING TO VENUES AROUND FLORIDA TO OFFER FREE SCREENINGS AND CANCER EDUCATION. SINCE 1995 THE MOLE PATROL HAS SCREENED THOUSANDS OF FLORIDIANS, IDENTIFYING HUNDREDS OF SUSPICIOUS SKIN LESIONS THAT HAVE RESULTED IN THE DIAGNOSIS OF MELANOMA, BASAL AND SQUAMOUS CELL CANCERS, DESPITE OPERATING AT A FINANCIAL LOSS. 1 AMERICAN CANCER SOCIETY 8095 NW 12TH ST 200 DORAL FL 33126 590657320 501(C)(3) 18000 SPONSORSHIP HILLSBOROUGH COUNTY MEDICAL ASSOC FDN INC 606 SOUTH BLVD TAMPA FL 33606 593470072 501(C)(3) 5300 SPONSORSHIP TAMPA GENERAL HOSPITAL FOUNDATION INC PO BOX 1289 RM H-149 TAMPA FL 33601 237354477 501(C)(3) 10000 SPONSORSHIP THE V FOUNDATION 106 TOWERVIEW COURT CARY NC 27513 133705951 501(C)(3) 25000 SPONSORSHIP JULIE WEINTRAUB'S HANDS ACROSS THE BAY 3800 ULMERTON RD CLEARWATER FL 33762 271983612 501(C)(3) 7500 SPONSORSHIP 5 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: SPONSORSHIPS ARE APPROVED THROUGH THE CHECK REQUEST PROCESS. BECAUSE OF THE NATURE OF THE GRANTS, THE GRANT USE IS NOT MONITORED SINCE THEY ARE GIVEN TO THE ORGANIZATION FOR A SPECIFIC PURPOSE OR EVENT. X X 0 1 X X X X X 0 0 0 0 0 0 0 0 0 W MICHAEL ALBERTS 0 318833 0 0 0 53437 0 25603 0 25289 0 423162 0 0 JULIE DJEU 0 269041 0 711 0 19494 0 25602 0 1547 0 316395 0 0 WILLIAM S DALTON 0 894794 0 0 0 137602 0 25603 0 23102 0 1081101 0 0 LOUIS D DE LA PARTE 0 383304 0 0 0 1784 0 25603 0 16522 0 427213 0 0 JOHN A KOLOSKY 0 518538 0 0 0 149298 0 25603 0 27641 0 721080 0 0 ALAN F LIST 0 493050 0 10072 0 19511 0 25602 0 25436 0 573671 0 0 NICOLAS C PORTER 0 425486 0 0 0 62041 0 25603 0 32492 0 545622 0 0 BRAULIO VICENTE 131905 135614 0 0 3151 7261 7906 11694 12037 14049 154999 168618 0 0 JANENE CULUMBER 0 273308 0 0 0 16564 0 19600 0 17584 0 327056 0 0 BRENDA S GORDON 193655 0 0 0 10254 0 15986 0 11984 0 231879 0 0 0 KELLY HALL 3747 13299 0 0 25903 135668 0 1276 535 9934 30185 160177 0 0 DEAN R HEAD 62894 91351 831 1134 0 0 5153 7496 3957 5397 72835 105378 0 0 MARK F HULSE 0 134073 0 37120 0 26118 0 1327 0 5716 0 204354 0 0 MARY E REARDON 215067 0 0 0 27952 0 18538 0 15977 0 277534 0 0 0 YVETTE LYONS TREMONTI 0 230149 0 0 0 18994 0 19549 0 18588 0 287280 0 0 W J WILSON 224904 0 0 0 9442 0 18114 0 11046 0 263506 0 0 0 SCOTT D ELDREDGE 164543 0 0 0 2111 0 10564 0 9967 0 187185 0 0 0 PHILIP E JOHNSON 188289 0 0 0 13078 0 12549 0 11524 0 225440 0 0 0 VLADIMIR FEYGELMAN 215806 0 0 0 792 0 22789 0 8662 0 248049 0 0 0 KENNETH M FORSTER 251317 0 0 0 17091 0 25603 0 16984 0 310995 0 0 0 BRIAN K NORIEGA 205580 0 0 0 988 0 13231 0 19983 0 239782 0 0 0 SIRIPORN SARANGKASIRI 209489 0 0 0 988 0 13231 0 7554 0 231262 0 0 0 STUART G WASSERMAN 210922 0 0 0 5467 0 13941 0 11323 0 241653 0 0 0 THOMAS A SELLERS 0 424448 0 0 0 39082 0 25602 0 31866 0 520998 0 0 Part I, Line 1b PAYMENTS MADE FOR PERSONAL SERVICES AND PAYMENT WHICH ARE GROSSED UP ARE APPROVED BY THE JOINT EXECUTIVE COMPENSATION AND BENEFITS COMMITTEE (JEC&BC). PAYMENTS ARE A FIXED AMOUNT BASED ON JOB CLASSIFICATION AND IS DOCUMENTED IN MINUTES OF THE COMMITTEE AND REPORTED BACK TO THE BOARD. STORR OFFICE EQUIPMENT SEE SCHEDULE O EXPLANATION 754231 OFFICE EQUIPMENT 0 X EQUIPMENT 16 2455240 PURCHASE PRICE 0 0 0 0 Method for Determining Number of Contributors: Part I, Column (b): THE NUMBER OF CONTRIBUTORS REPORTED REFLECTS THE NUMBER OF ITEMS CONTRIBUTED. Form 990, Part VI, Section B, line 11 PRIOR TO PROVIDING FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, TO THE HOSPITAL BOARD OF DIRECTORS FOR REVIEW, THE CHIEF FINANCIAL OFFICER REVIEWS THE RETURN. SUGGESTED COMMENTS OR CHANGES ARE DISCUSSED AND ANY NECESSARY CORRECTIONS ARE MADE. PRIOR TO ELECTRONICALLY FILING FORM 990, MOFFITT HOSPITAL PROVIDES A COPY OF THE RETURN TO THE GOVERNING BODY, GIVING EACH BOARD MEMBER TIME TO REVIEW THE RETURN. BOARD MEMBERS HAVE THE OPPORTUNITY TO ASK QUESTIONS RELATED TO THE INFORMATION PROVIDED ON THE RETURN. Form 990, Part VI, Section B, line 12c ON AN ANNUAL BASIS A PRESENTATION IS MADE TO HOSPITAL BOARD MEMBERS TO REVIEW THE CONFLICT OF INTEREST POLICY AND PROCEDURES FOR DISCLOSING ANY POTENTIAL CONFLICTS. EACH DIRECTOR, OFFICER, COMMITTEE MEMBER, AND KEY EMPLOYEE SHALL COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM ATTACHED TO THE POLICY. ANY DIRECTOR, OFFICER, COMMITTEE MEMBER, OR KEY EMPLOYEE WHO REASONABLY BELIEVES THAT HE OR SHE MAY HAVE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST MUST DISCLOSE THE EXISTENCE OF AND THE MATERIAL FACTS OF THE NATURE OF HIS/HER INTEREST ON THE FORM. THE FORM IS SUBMITTED TO THE CORPORATE COMPLIANCE OFFICE, WHICH REVIEWS THE FORMS, GATHERS ADDITIONAL RELEVANT INFORMATION WHERE NECESSARY, AND PREPARES A SUMMARY OF THE DISCLOSURES TO BE REVIEWED BY THE CONFLICT OF INTERST WORK GROUP. IF A DIRECTOR OR COMMITTEE MEMBER DISCLOSES THAT HE/SHE HAS A POTENTIAL CONFLICT OF INTEREST AT A BOARD OR COMMITTEE MEETING, SUCH DIRECTOR OR COMMITTEE MEMBER MUST DISCLOSE THE NATURE OF THE INTEREST AND ANY RELATED INFORMATION AND RESPOND TO QUESTIONS AS MAY BE REQUIRED BY THE REMAINING MEMBERS. BASED ON THE INFORMATION DISCLOSED, THE REMAINING BOARD MEMBERS WILL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. IF A CONFLICT EXISTS THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER AN ALTERNATIVE TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT IS EQUALLY ADVANTAGEOUS. IF AN ALTERNATIVE TRANSACTION IS NOT EQUALLY ADVANTAGEOUS THE DIRECTOR OR COMMITTEE MEMBER WHO IS THE SUBJECT OF THE CONFLICT SHALL NOT VOTE ON, NOR USE HIS/HER PERSONAL INFLUENCE ON, NOR PARTICIPATE IN DISCUSSIONS OR DELIBERATIONS WITH RESPECT TO THE TRANSACTION. Form 990, Part VI, Section B, line 15a MOFFITT'S BOARD OF DIRECTORS HAS AN ESTABLISHED SUB-COMMITTEE, THE JOINT EXECUTIVE COMPENSATION & BENEFITS COMMITTEE (JEC&BC) THAT IS MADE UP ENTIRELY OF INDEPENDENT, OUTSIDE DIRECTORS. THIS COMMITTEE IS CHARGED WITH THE OVERSIGHT OF THE PERFORMANCE AND COMPENSATION OF MOFFITT EXECUTIVES AND DISQUALIFIED PERSONS. THESE POSITIONS INCLUDE THE CEO, EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, VICE PRESIDENTS AND DEPARTMENT CHAIRPERSONS. TO ACCOMPLISH ITS MISSION, THE COMMITTEE CAN AS NEEDED AND DOES AT ITS DISCRETION, ENGAGE OUTSIDE INDEPENDENT, OUTSIDE ADVISORS INCLUDING, BUT NOT LIMITED TO ATTORNEYS AND COMPENSATION CONSULTANTS. ON AN ANNUAL BASIS THE JEC&BC ENGAGES A NATIONALLY KNOWN, THIRD PARTY CONSULTING FIRM TO PROVIDE A DETAILED STUDY OF THE CASH COMPENSATION FOR EACH EXECUTIVE, DISQUALIFIED PERSON AND INDIVIDUAL IN KEY POSITIONS. THE CONSULTANT USES A VARIETY OF PUBLISHED SURVEYS COMPILED BY INDEPENDENT FIRMS TO PROVIDE THE SOURCE DATA FOR THE STUDY. USING FUNCTIONALLY COMPARABLE POSITIONS IN OTHER SIMILARLY SIZED, NOT-FOR-PROFIT AND FOR-PROFIT HEALTHCARE, ACADEMIC AND RESEARCH ORGANIZATIONS, THE CONSULTING FIRM PRODUCES A STUDY THAT COMPARES EACH DESIGNATED MOFFITT POSITION TO ITS APPROPRIATE MARKET EQUIVALENT. THE RESULTING DATA IS PROVIDED TO THE DIRECTOR OF COMPENSATION, WHO IS NOT INCLUDED IN THE EXECUTIVE OR DISQUALIFIED PERSON CATEGORIES, FOR USE IN THE FORMULATION OF RECOMMENDATIONS FOR COMPENSATION CHANGES TO MAINTAIN MARKET COMPETITIVENESS OR TO REWARD PERFORMANCE. THESE RECOMMENDATIONS ALONG WITH THE CONSULTANT'S COMPARABILITY DATA ARE PRESENTED TO THE JEC&BC FOR IT TO CONFIRM ITS REASONABLENESS, MAKE MODIFICATIONS AS IT DEEMS NECESSARY AND PROVIDE FINAL APPROVAL. EVERY THIRD YEAR THE INDEPENDENT CONSULTANT ANALYZES THE TOTAL EXECUTIVE COMPENSATION PROGRAM, USING THE SAME METHODOLOGY AS DESCRIBED ABOVE, THAT INCLUDEDS THE VALUE OF ALL BENEFITS AND PREREQUISITES (CASH AND NON-CASH) PROVIDED AS COMPENSATION TO THE EXECUTIVES AND DISQUALIFIED PERSONS. THE PURPOSE OF THE ANALYSIS IS TO PROVIDE AN OPINION ON THE REASONABLENESS OF EACH OF THE INDIVIDUAL COMPENSATION COMPONENTS AND THE AGGREGATE COMPENSATION TOTAL. THIS MORE COMPREHENSIVE ANALYSIS IS PROVIDED TO THE JEC&BC FOR THEIR USE IN THE ANNUAL REVIEW PROCESS. MINUTES ARE KEPT AT EACH OF THESE ANNUAL MEETINGS DETAILING THE RECOMMENDATIONS PRESENTED AND THE DECISIONS MADE BY THE COMMITTEE. THESE MINUTES ARE PUBLISHED TO THE COMMITTEE AT THE NEXT MEETING AND REPORTED BACK TO THE FULL BOARD. Form 990, Part VI, Section C, line 19 MOFFITT HOSPITAL MAKES AVAILABLE TO THE PUBLIC THROUGH THIRD PARTY VENDORS' WEBSITES, ITS FORM 990 AND AUDITED FINANCIAL STATEMENTS. FORM 990 IS MADE AVAILABLE ON GUIDESTAR WHILE THE AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE ON DACBOND. ALL ORGANIZING AND GOVERNING DOCUMENTS SUCH AS FORM 1023, CONFLICTS OF INTEREST POLICY, AND BYLAWS AS WELL AS FORM 990 AND AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. Form 990, Part VII, Section A, Line 1a: EMPLOYEES WHO ARE LISTED ON HOSPITAL 2009 FORM 990 ARE EMPLOYEES WHOSE 2009 W-2'S WERE ISSUED BY MOFFITT INSTITUTE. AFTER SIGNIFICANT ANALYSIS A DETERMINATION WAS MADE THAT TO REPORT EMPLOYEES BY ENTITY RATHER THAN BY THE ORGANIATION WHICH ISSUED THE W-2'S IS A MORE CONSERVATIVE APPROACH SINCE KEY EMPLOYEES HAVE THE POTENTIAL OF BEING EXCLUDED DUE TO THE FACT THAT THESE EMPLOYEES ARE NOT KEY EMPLOYEES OF THE ENTITY THAT ISSUED THE W-2'S. PROCEDURES TO REPORT COMPENSATION OF THESE EMPLOYEES ON FORM 990 PART VII AND ON SCHEDULE J ARE IN ACCORDANCE WITH IRS INSTRUCTIONS FOR EACH RESPECTIVE SECTION. IN ADDITION, SEVERAL OFFICERS LISTED IN PART VII SECTION A ARE ALSO OFFICERS OF A RELATED ORGANIZATION AND THEIR HOURS ARE TRACKED AND SALARIES PAID BY A RELATED ORGANIZATION. THESE HOURS AND SALARIES ARE NOT SPECIFICALLY ALLOCATED BETWEEN THE ORGANIZATIONS FOR THESE OFFICERS SINCE THEIR DUTIES AND RESPONSIBILITIES IMPACT THE ORGANIZATION(S) AS A WHOLE. PART IV LINE 28C AND SCHEDULE L PART IV: HOSPITAL TRANSACTS BUSINESS WITH STORR OFFICE EQUIPMENT, AN ENTITY OF WHICH A CURRENT BOARD MEMBER, KAREN ARNOLD, IS A KEY EMPLOYEE. FORM 990, Part I Line 4 and Part VI Section A Line 1B: DURING THE FISCAL YEAR ENDING JUNE 30, 2010 H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE, INC., A RELATED ENTITY AND PARENT ORGANIZATION, BECAME AWARE THAT A BOARD MEMBER WHO IS ALSO A MEMBER OF THE HOSPITAL BOARD, PERIODICALLY USED A PORTION OF SPACE RENTED BY THE RESEARCH ENTITY. THE CANCER CENTER BECAME AWARE OF THE USE WHEN MR. MOFFITT COMPLETED A CONFLICT OF INTEREST QUESTIONNAIRE. THE RELATED ENTITY CONFIRMED THAT RENT INADVERTENTLY WAS NOT CHARGED TO MR. MOFFITT. MR. MOFFITT AND THE RELATED ENTITY CORRECTED THE EXCESS BENEFIT TRANSACTION IN ACCORDANCE WITH CODE SECTION 4958 AND 4962 WITHIN 30 DAYS. H LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE INC 12902 MAGNOLIA DRIVE TAMPA FL 33612 592451713 RESEARCH FL 501(c)(3) 509(a)(1) N/A H LEE MOFFITT CC&RI FOUNDATION INC 12902 MAGNOLIA DRIVE TAMPA FL 33612 593238636 FUNDRAISING FL 501(c)(3) 509(a)(2) N/A H LEE MOFFITT CC&RI LIFETIME CANCER SCREENING CENTER INC 12902 MAGNOLIA DRIVE TAMPA FL 33612 593238640 PRACTICE MANAGEMENT FL 501(c)(3) 509(a)(2) N/A MOFFITT TECHNOLOGIES CORPORATION 12902 MAGNOLIA DRIVE TAMPA FL 33612 300332914 TECHNOLOGY MANAGEMENT FL N/A C MOFFITT GENETICS CORPORATION 12902 MAGNOLIA DRIVE TAMPA FL 33612 208486180 DATABASE MANAGEMENT FL N/A C 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 MOFFITT GENETICS CORPORATION E 5132241