Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
FLORIDA HEALTH SCIENCES CENTER INC |
593458145 | 3 | Yes | 0 | 0 | |
| (B)
UNIVERSITY OF SOUTH FLORIDA |
592684166 | 2 | Yes | 0 | 0 | |
|
Total 2
|
0 | 0 | ||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf .... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2023 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, LINE 1 | COLLABORATION BETWEEN THE FLORIDA HEALTH SCIENCES CENTER AND UNIVERSITY OF SOUTH FLORIDA AND THEIR RESPECTIVE AFFILIATES. |
| FORM 990, PART III, LINE 3 | THE CORPORATION WAS FORMED TO PROVIDE CERTAIN SERVICES TO ASSIST THE PHYSICIANS EMPLOYED BY THE UNIVERSITY OF SOUTH FLORIDA BOARD OF TRUSTEES ("USF") AND TAMPA GENERAL MEDICAL GROUP, INC. ("TGMG"). THE CORPORATION'S BOARD OF DIRECTORS ARE COMPOSED OF REPRESENTATIVES OF UNIVERSITY OF SOUTH FLORIDA (USF) HEALTH SERVICES SUPPORT ORGANIZATION, INC. ("USF HSSO"), AN AFFILIATE OF USF, AND FLORIDA HEALTH SCIENCE CENTER, INC. D/B/A TAMPA GENERAL HOSPITAL ("FHSC"), AN AFFILIATE OF TGMG. THE OFFICERS FOR TGMG AND UNIVERSITY MEDICAL SERVICE ASSOCIATION, INC. ("UMSA"), A CONTROLLED AFFILIATE OF USF, WILL BE INVOLVED IN THE MANAGEMENT OF THE CORPORATION INDIRECTLY THROUGH THE CORPORATION'S PRESIDENT. THE OFFICERS OF TGMG AND UMSA WILL COLLABORATE WITH THE CORPORATION'S LEADERSHIP AND MAY HAVE AN INDIRECT INFLUENCE ON THE CORPORATION'S MANAGEMENT DECISIONS. THE GOVERNING BOARD OF THE CORPORATION CONSISTS OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF FHSC ("PRESIDENT") AND THE CHAIR OF USF HSSO, A CONTROLLED AFFILIATE OF USF ("CHAIR"). THE PRESIDENT AND CHAIR EACH APPOINT FOUR (4) ADDITIONAL DIRECTORS TO SERVE ON THE GOVERNING BOARD OF THE CORPORATION. THE NUMBER OF MEMBERS OF THE GOVERNING BOARD APPOINTED BY A TGH OR USF REPRESENTATIVE SHALL ALWAYS BE EQUAL. THE GOVERNING BOARD'S AUTHORITY INCLUDES (I) OVERSEEING THE FINANCIAL PERFORMANCE AND ESTABLISHING FINANCIAL METRICS AND TARGETS RELATING TO THE CORPORATION, (II) ESTABLISHING OVERHEAD FUNDING POLICIES FOR THE CORPORATION, (III) OVERSEEING THE OPERATING AND EXPENSE STRUCTURE OF THE CORPORATION, AND (IV) OVERSEEING INFRASTRUCTURE AND REVENUE CYCLE SERVICES PROVIDED BY THE CORPORATION IN SUPPORT OF ITS OPERATIONS. THE CORPORATION WILL PROVIDE SUPPORT SERVICES IN FURTHERANCE OF THE SUPPORTED ORGANIZATIONS' SHARED MISSIONS AND EXEMPT PURPOSES. THE CORPORATION WILL PROVIDE INTEGRAL SERVICES TO BOTH SUPPORTED ORGANIZATIONS, WHICH INCLUDE MANAGEMENT, ADMINISTRATIVE, ORGANIZATIONAL, AND PRACTICE INFRASTRUCTURE SERVICES. BUT FOR THE CORPORATION PROVIDING SUCH SERVICES, FHSC AND USF WOULD EACH HAVE TO PERFORM THE SERVICES THEMSELVES. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION'S SOLE MEMBER IS FLORIDA HEALTH SCIENCES CENTER INC (FHSC), A 501(C)(3) ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD SHALL CONSIST OF TEN (10) DIRECTORS, WHICH ARE DIVIDED INTO TWO (2) CLASSES: A USF HSSO CLASS AND A TGH CLASS. THE USF HSSO CLASS SHALL INCLUDE THE USF HSSO CHAIR, EX OFFICIO, WITH FULL VOTING RIGHTS, AND FOUR (4) DIRECTORS APPOINTED BY THE USF HSSO CHAIR. TWO (2) OF THE DIRECTORS APPOINTED BY THE USF HSSO CHAIR SHALL BE SENIOR MANAGEMENT PERSONNEL OF A USF-CONTROLLED ENTITY, ONE (1) SHALL BE A PHYSICIAN WHO PROVIDES SUBSTANTIAL CLINICAL SERVICES, AND ONE (1) SHALL BE AN INDIVIDUAL THAT THE USF HSSO CHAIR APPOINTS AT HIS OR HER OWN DISCRETION. THE TGH CLASS SHALL INCLUDE THE TGH CEO, EX OFFICIO, WITH FULL VOTING RIGHTS, AND FOUR (4) DIRECTORS APPOINTED BY THE TGH CEO. TWO (2) OF THE DIRECTORS APPOINTED BY THE TGH CEO SHALL BE SENIOR MANAGEMENT PERSONNEL OF A TGH-CONTROLLED ENTITY, ONE (1) SHALL BE A PHYSICIAN WHO PROVIDES SUBSTANTIAL CLINICAL SERVICES, AND ONE (1) SHALL BE AN INDIVIDUAL THAT THE TGH CEO APPOINTS AT HIS OR HER OWN DISCRETION. |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS SUBJECT TO APPROVAL OF MEMBERS PER THE BYLAWS OF AMG. FLORIDA HEALTH SCIENCES CENTER INC (FHSC) IS THE SOLE MEMBER OF THE CORPORATION. AS SUCH, FHSC IS ENTITLED TO ALL RIGHTS AND POWERS OF A MEMBER UNDER THE LAWS OF THE STATE OF FLORIDA, AND THE ARTICLES OF INCORPORATION AND BYLAWS OF AMG. UNDER THE BYLAWS, CERTAIN POWERS ARE EXPRESSLY RESERVED TO FHSC: (A) ADOPT ANY ANNUAL OR LONG-TERM CAPITAL OR OPERATIONAL BUDGET FOR THE CORPORATION, OR ANY CHANGES EXCEEDING TEN PERCENT (10%) OF THE TOTAL ANNUAL BUDGET; (B) INCUR ANY EXPENSE, WHICH IS NOT PROVIDED FOR IN AN ANNUAL OR LONG-TERM CAPITAL OR OPERATIONAL BUDGET APPROVED BY THE MEMBER, IF THE AMOUNT INVOLVED EXCEEDS TWO HUNDRED AND FIFTY THOUSAND DOLLARS ($250,000); (C) INCUR OR GUARANTEE ANY LONG-TERM DEBT; (D) APPROVE CLINICAL STRATEGIC PLANS AND CLINICAL PROGRAM PRIORITIES FOR THE USF PROVIDERS; AND (E) APPROVE CLINICAL OPERATING BUDGETS FOR THE USF PROVIDERS FUNDED THROUGH THE GLOBAL PROFESSIONAL SERVICES AGREEMENT. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE DRAFT FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. UPON APPROVAL BY THE BOARD, THE FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | AMG ADHERES TO THE CONFLICT OF INTEREST POLICY OF ITS SOLE MEMBER ENFORCEMENT OF CONFLICTS POLICY 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. IN SOME CASES, THE CORPORATE COMPLIANCE DEPARTMENT IS INVOLVED WHERE ADDITIONAL INPUT OR GUIDANCE IS NEEDED BY HUMAN RESOURCES. EMPLOYEES ARE ALSO ADVISED TO DISCLOSE COIS THAT MAY ARISE DURING THE COURSE OF THE YEAR. EMPLOYEES AND OTHER TGH HEALTHCARE PARTNERS CAN SIMILARLY REPORT COIS TO CORPORATE COMPLIANCE USING THE COMPLIANCE LINE, EMAIL, PHONE, ETC. PERIODICALLY, IN NEWSLETTERS ISSUED BY CORPORATE COMPLIANCE, REFERENCE IS MADE TO COI. IT IS THE RESPONSIBILITY OF CORPORATE COMPLIANCE TO INITIATE INVESTIGATIONS OF ALLEGATIONS OF COIS. |
| FORM 990, PART VI, SECTION C, LINE 19 | NO DOCUMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,252,360. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,252,360. |
| Software ID: | |
| Software Version: |