Consolidated Financial Statements and Report of Independent Certified Public Accountants

Transcription

1 Consolidated Financial Statements and Report of Independent Certified Public Accountants H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries June 30, 2017 and 2016

2 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries Table of contents Report of Independent Certified Public Accountants 1-2 Consolidated financial statements: Consolidated balance sheets 3 Consolidated statements of operations and changes in net assets 4-5 Consolidated statements of cash flows 6 Notes to consolidated financial statements 7-26 Supplementary information: Consolidating balance sheet Consolidating statement of operations 30

3 REPORT OF INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS The Board of Directors H. Lee Moffitt Cancer Center & Research Institute, Inc. Grant Thornton LLP 101 E Kennedy Boulevard, Suite 3850 Tampa, FL T F GrantThornton.com linkd.in/grantthorntonus twitter.com/grantthorntonus Report on the financial statements We have audited the accompanying consolidated financial statements of H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries (the Cancer Center), which comprise the consolidated balance sheet as of June 30, 2017, and the related consolidated statements of operations and changes in net assets and cash flows for the year then ended and the related notes to the consolidated financial statements. Management s responsibility for the financial statements Management is responsible for the preparation and fair presentation of these consolidated financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of consolidated financial statements that are free of material misstatement, whether due to fraud or error. Auditor s responsibility Our responsibility is to express an opinion on these consolidated financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards issued by the Comptroller General of the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the consolidated financial statements are free of material misstatement. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the consolidated financial statements. The procedures selected depend on the auditor s judgment, including the assessment of the risks of material misstatement of the consolidated financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity s preparation and fair presentation of the consolidated financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity s internal control. Accordingly, we express no such opinion. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements. Grant Thornton LLP U.S. member firm of Grant Thornton International Ltd

4 We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion. Opinion In our opinion, the consolidated financial statements referred to above present fairly, in all material respects, the consolidated financial position of the H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries as of June 30, 2017 and the results of their operations, changes in their net assets and their cash flows for the year then ended in accordance with accounting principles generally accepted in the United States of America. Other matters Supplementary information Our audit was conducted for the purpose of forming an opinion on the consolidated financial statements as a whole. The consolidating balance sheet and consolidating statement of operations are presented for purposes of additional analysis and are not a required part of the consolidated financial statements. Such information is the responsibility of management and was derived from and relates directly to the underlying accounting and other records used to prepare the consolidated financial statements. The information has been subjected to the auditing procedures applied in the audit of the consolidated financial statements and certain additional procedures, including comparing and reconciling such information directly to the underlying accounting and other records used to prepare the consolidated financial statements or to the consolidated financial statements themselves, and other additional procedures in accordance with auditing standards generally accepted in the United States. In our opinion, the information is fairly stated, in all material respects, in relation to the consolidated financial statements as a whole. Other auditors The consolidated financial statements of H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries as of and for the year ended June 30, 2016 were audited by other auditors. Those auditors expressed an unmodified opinion on those 2016 financial statements in their report dated September 28, Other Reporting Required by Government Auditing Standards In accordance with Government Auditing Standards, we also have issued our report dated September 25, 2017 on our consideration of the Cancer Center s internal control over financial reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts, and grant agreements and other matters. The purpose of that report is solely to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on the effectiveness of the Cancer Center s internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards in considering the Cancer Center s internal control over financial reporting and compliance. Tampa, Florida September 25, 2017 Grant Thornton LLP U.S. member firm of Grant Thornton International Ltd

5 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 3 Consolidated balance sheets June 30, Assets Current assets: Cash and cash equivalents $ 201,030,321 $ 179,235,229 Current portion of assets limited as to use 19,669,978 14,492,114 Accounts receivable, less allowances for uncollectibles (2017 $10,902,000; 2016 $11,198,000) 107,457,812 96,091,533 Current portion of pledges receivable 4,663,779 3,196,338 Inventories 13,154,729 11,975,543 Grant receivables 19,862,126 16,326,395 Prepaid and other current assets 32,462,133 21,947,637 Total current assets 398,300, ,264,789 Assets limited as to use, net of current portion 308,973, ,758,172 Pledges receivable, less discounts and allowances for uncollectible pledges, net of current portion 5,714,603 5,459,785 Property, plant, and equipment: Land 18,106,905 9,306,184 Building and land improvements 467,777, ,192,682 Equipment 462,510, ,367, ,394, ,866,443 Less accumulated depreciation (540,050,024) (515,310,177) 408,344, ,556,266 Construction-in-progress 27,819,576 15,373, ,164, ,930,182 Other assets 22,689,532 5,548,058 Total assets $ 1,171,842,779 $ 1,029,960,986 Liabilities and net assets Current liabilities: Accounts payable and accrued expenses $ 84,511,912 $ 58,779,734 Accrued employee compensation 62,723,039 57,195,748 Accrued interest 5,360,835 5,372,508 Current portion of deferred revenue 16,646,381 - Estimated third-party settlements 15,683,821 17,340,457 Current portion of long-term debt 11,170,000 9,180,000 Total current liabilities 196,095, ,868,447 Other liabilities 33,914,663 49,153,198 Long-term debt, net of current portion 313,772, ,482,929 Total liabilities 543,783, ,504,574 Net assets: Unrestricted 530,271, ,638,535 Temporarily restricted 84,244,495 73,345,240 Permanently restricted 13,543,380 13,472,637 Total net assets 628,059, ,456,412 Total liabilities and net assets $ 1,171,842,779 $ 1,029,960,986 The accompanying notes are an integral part of these consolidated financial statements.

6 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 4 Consolidated statements of operations and changes in net assets For the years ended June 30, Unrestricted revenues and other support: Net patient service revenues $ 969,489,075 $ 859,965,383 Provision for patient service bad debts (9,250,412) (7,677,154) Net patient service revenues, less provision for bad debts 960,238, ,288,229 Other revenues, less provision for grant and other bad debts (2017 $823,000; 2016 $374,000) 136,485, ,765,041 Net assets released from restrictions and used for operating expenses 36,114,342 39,155,749 Total unrestricted revenues and other support 1,132,838,855 1,011,209,019 Expenses: Salaries, wages, and benefits 541,787, ,247,601 Faculty fees 10,133,621 10,206,580 Purchased services 107,923,088 98,039,906 Supplies 310,954, ,065,035 Other operating expenses 74,866,793 71,145,380 Depreciation and amortization 43,122,286 40,965,852 Interest 9,551,617 10,024,631 Total expenses 1,098,339, ,694,985 Income from operations 34,499,660 18,514,034 Nonoperating gains, net 16,412,223 16,135 Excess of revenues and gains over expenses and losses before tax 50,911,883 18,530,169 Income tax benefit 6,140,659 - Excess of revenues and gains over expenses and losses 57,052,542 18,530,169 Other changes: Net assets released from restrictions and used to purchase property, plant, and equipment 85,412 45,845 Net assets released from restrictions and used for payment of long-term debt 7,721,968 8,104,310 Change in net unrealized losses on investments - (249,920) Grants received for reimbursement of property, plant, and equipment 212, ,211 Restricted investment income (642,121) (639,673) Other 1,203,289 (43,479) Increase in unrestricted net assets 65,633,363 25,981,463 The accompanying notes are an integral part of these consolidated financial statements.

7 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 5 Consolidated statements of operations and changes in net assets (continued) For the years ended June 30, Temporarily restricted net assets: Contributions and memorials $ 16,624,481 $ 8,361,125 Grants and contracts with purpose restrictions 22,041,694 25,368,864 Investment income 642, ,673 Net assets released from purpose restrictions and used to purchase property, plant, and equipment (85,412) (45,845) Net assets released from purpose restrictions and used for payment of long-term debt (7,721,968) (8,104,310) Net assets released from purpose restrictions and used for payment of operating expenses (30,734,004) (35,439,331) Net assets released from purpose restrictions and used for payment of interest (3,606,225) (2,890,007) Net assets released from time restrictions and used for payment of operating expenses (1,774,113) (826,411) Proceeds from the Cigarette Tax Trust Fund 15,524,028 15,524,028 Interest earnings on proceeds from the Cigarette Tax Trust Fund 1, Loss on uncollectible temporarily restricted pledges (12,804) (22,500) Other - (29,630) Increase in temporarily restricted net assets 10,899,255 2,535,974 Permanently restricted net assets: Contributions and memorials 70,743 54,623 Other - (100,000) Increase (decrease) in permanently restricted net assets 70,743 (45,377) Increase in net assets 76,603,361 28,298,366 Net assets at beginning of year 551,456, ,158,046 Net assets at end of year $ 628,059,773 $ 551,456,412 The accompanying notes are an integral part of these consolidated financial statements.

8 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 6 Consolidated statements of cash flows For the years ended June 30, Operating activities and nonoperating gains: Increase in net assets $ 76,603,361 $ 28,298,366 Adjustments to reconcile increase in net assets to net cash provided by operating activities and nonoperating gains: Loss on sale of property, plant, and equipment 1,151, ,502 Restricted contributions and restricted investment income (32,862,830) (24,579,767) Contribution of unrestricted and restricted securities (253,722) (1,488) Grants and contracts with purpose restrictions (22,041,694) (25,368,864) Deferred income tax benefit (7,244,248) - Grants received for reimbursement of property, plant, and equipment purchases (167,909) (234,211) Change in net unrealized (gains) losses on investments (15,255,237) (1,519,683) Depreciation and amortization 43,122,286 40,965,852 Amortization of bond premium, discount and issuance costs (1,953,210) (2,646,328) Loss on early extinguishment of debt 3,141,075 - Provision for bad debts 10,073,364 8,051,588 Changes in operating assets and liabilities: Accounts receivable (20,616,691) (16,139,396) Inventories (1,179,186) (1,012,246) Grant receivables (4,358,683) (2,151,180) Prepaid and other assets (18,815,983) (4,309,371) Pledges receivable (1,722,259) 509,626 Accounts payable and accrued expenses 24,628,589 (7,407,799) Accrued employee compensation 5,527,291 7,553,346 Accrued interest (11,673) (127,000) Estimated third-party settlements (1,656,636) (1,858,180) Income tax payable 1,103,589 - Other liabilities 1,407,846 25,471,676 Net cash provided by operating activities and nonoperating gains 38,618,726 23,673,443 Investing activities: Purchases of property, plant, and equipment (72,507,930) (57,060,992) Change in assets limited as to use (31,158,108) 41,447,140 Net cash used in investing activities (103,666,038) (15,613,852) Financing activities: Payments on long-term debt (119,483,755) (8,850,000) Restricted contributions and restricted investment income 32,862,830 24,579,767 Grants and contracts with purpose restrictions 22,041,694 25,368,864 Contribution of securities with purpose restrictions 274,149 60,274 Proceeds from issuance of long-term debt 152,575,316 - Payments for debt financing costs (1,595,739) - Grants received for reimbursement of property, plant, and equipment purchases 167, ,211 Net cash provided by financing activities 86,842,404 41,393,116 Increase in cash and cash equivalents 21,795,092 49,452,707 Cash and cash equivalents at beginning of year 179,235, ,782,522 Cash and cash equivalents at end of year $ 201,030,321 $ 179,235,229 The accompanying notes are an integral part of these consolidated financial statements.

9 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 7 Notes to consolidated financial statements Note 1 Organization H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries (the Cancer Center), located in Tampa, Florida, was created by the Florida Legislature and incorporated on April 17, 1984, as a not-for-profit corporation, and is currently licensed to operate 206 general acute care beds. The Cancer Center s activities relate primarily to research in the areas of basic science, cancer prevention and control, translational science, pre-clinical and clinical investigations, and providing management and certain other support services as the sole corporate member and parent for the following subsidiary corporations: H. Lee Moffitt Cancer Center & Research Institute Hospital, Inc. (the Hospital) The Hospital provides medical and hospital care, medical education, and training and clinical (patient-related) research in maintaining health and preventing, detecting, and treating cancer. H. Lee Moffitt Cancer Center & Research Institute Lifetime Cancer Screening Center, Inc. (the Screening Center) The Screening Center is doing business as the Moffitt Medical Group (MMG), and operates as part of the Cancer Center s health care system by employing and managing physicians and other medical professionals who staff the Hospital and provide clinical research services to the Cancer Center. H. Lee Moffitt Cancer Center & Research Institute Foundation, Inc. (the Foundation) The Foundation is the principal fund-raising organization for the Cancer Center and its subsidiaries. Moffitt Technologies Corporation (MTC) MTC is a for-profit subsidiary of the Cancer Center that conducts technology management and commercialization activities for the Cancer Center, including intellectual property developed by the Cancer Center. In addition, the Cancer Center is the controlling shareholder of the following subsidiary corporation: Moffitt Genetics Corporation (M2Gen) is a for-profit subsidiary of the Cancer Center. M2Gen supports advancement of the Cancer Center s personalized medicine initiatives. The consolidated financial statements include the accounts of the Cancer Center, the Hospital, MMG, the Foundation, MTC, and M2Gen (collectively, the Cancer Center). All intercompany transactions and accounts have been eliminated in consolidation. Mission Statement The mission of the Cancer Center is to contribute to the prevention and cure of cancer. The Cancer Center is a leader in focused, innovative cancer research, a major regional oncology referral center, and an environment conducive for training future scientific and clinical leaders in oncology. The Cancer Center has been designated as a National Cancer Institute Comprehensive Cancer Center.

10 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 8 Note 2 Summary of Significant Accounting Policies Nonoperating Gains and Losses The Cancer Center s revenues and other support include amounts generated from direct patient care, unrestricted appropriations from the State of Florida (the State), federal and nonfederal grants and contracts, and sundry revenues related to the operations of the Cancer Center s facilities. Activities that result in gains or losses unrelated to the Cancer Center s operations are considered to be nonoperating. Nonoperating gains and losses primarily include investment income, dividends and realized and unrealized gains (losses) on unrestricted investments, and gains and losses on disposals of assets. Use of Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities at the date of the financial statements. Estimates also affect the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Statements of Cash Flows For the purposes of the consolidated statements of cash flows, the Cancer Center considers all highly liquid investments with a maturity of three months or less when purchased, except those classified as assets limited as to use, to be cash equivalents. Estimated Third-Party Settlements The Cancer Center is reimbursed on a cost basis for Medicare inpatient and outpatient services subject to certain limitations. The Cancer Center is reimbursed at a tentative rate with final settlement determined after submission of annual cost reports by the Cancer Center and audits by the Medicare fiscal intermediary. For services provided to Medicaid beneficiaries, the Cancer Center is reimbursed on a cost basis for outpatient services, subject to certain limitations, and reimbursed based on All Payor Related Diagnostic Related Groups for inpatient services. Regulations require annual retroactive cost reimbursement settlements for these amounts based upon annual cost reports. These retroactive cost settlements are estimated and recorded in the consolidated financial statements. The Cancer Center has reviewed its Medicaid outpatient rate, and believes it has received a higher rate in prior fiscal years than to which it is entitled. The Cancer Center contacted Florida s Agency for Health Care Administration to discuss the issue, but no resolution of the matter has occurred. Therefore, the Cancer Center has accrued a liability for the years ended June 30, 2017 and 2016, of approximately $8,861,000 and $8,489,000, respectively, for the estimated overpayments received by the Cancer Center. These amounts are recorded in estimated settlements due to third-parties in the accompanying consolidated balance sheets. Laws and regulations governing the Medicare and Medicaid programs are extremely complex and subject to interpretation. As a result, there is at least a reasonable possibility that recorded estimates will change by a material amount in the near term. Net Patient Service Revenues, Patient Accounts Receivable, and the Allowance for Uncollectibles Net patient service revenues are reported at the estimated net realizable amounts from patients, third-party payors, and others for services rendered, and include estimated retroactive revenue adjustments due to future audits, reviews, and investigations. Retroactive adjustments are considered in the recognition of revenue on an estimated basis in the period the related services are rendered, and such amounts are adjusted in future periods as adjustments become known or as years are no longer subject to such audits, reviews, and investigation. Net patient service revenue increased by approximately $4,132,000 and $5,188,000 for the years ended June 30, 2017 and 2016, respectively, for adjustments to prior-year estimated third-party settlements.

11 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 9 Net patient revenues are recorded during the period the health care services are provided based upon the estimated amounts due from the patients and third-party payors. Third-party payors include federal and state agencies (under Medicare, Medicaid, and other programs), managed care health plans, and other private contractual agreements. Estimates of contractual adjustments under managed care health plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). The Cancer Center also records a provision for doubtful accounts related to uninsured accounts to record the net self-pay accounts receivable at the estimated collectible amounts. Net patient service revenues from third-party payors and others for the years ended June 30, 2017 and 2016, are summarized in the following table: Years ended June 30, Managed care 69.6% 68.5% Medicare Medicaid Other/commercial/self-pay Revenues before provision for patient service bad debts Provision for patient service bad debts (1.0) (0.9) Net patient service revenues less provision for bad debts 100.0% 100.0% The Cancer Center provides for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to the estimated net realizable value. 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 accounts receivable balance. These allowances are based upon management s assessment of historical and expected net collections, business and economic conditions, trends in federal and state government health care 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 represents 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. For all payor types, when the Cancer Center can no longer reasonably expect collectability of an account based on the aging of the balance due, the Cancer Center reserves all amounts due. The Cancer Center s reserve percentage for patients with third-party accounts receivable as of June 30, 2017 and 2016 was 13.0%. In addition, the Cancer Center s third-party write-offs for the years ended June 30, 2017 and 2016 were $69,772,000 and $70,663,000, respectively. These changes were primarily a result of policy and noncovered charges. The Cancer Center has not changed its charity care or uninsured discount policies during the years ended June 30, 2017 or The Cancer Center s allowance for doubtful accounts percentages for self-pay/commercial accounts receivable as of June 30, 2017 and 2016, were 36.2% and 38.9%, respectively. In addition, the Cancer Center s selfpay/commercial write-offs for the years ended June 30, 2017 and 2016 were $16,418,000 and $16,609,000, respectively. The allowance percentage decreased compared to prior year as a result of aging improvements and positive trends in the collection of self-pay/commercial patients during the year ended June 30, Excess of Revenues and Gains Over Expenses and Losses The consolidated statements of operations and changes in net assets include the excess of revenues and gains over expenses and losses. Changes in unrestricted net assets that are excluded from the excess of revenues and gains over expenses and losses, include the change in unrealized gains and losses on other-than-trading securities, contributions of long-lived assets (including assets acquired using contributions, which by donor restriction, were to be used for the purposes of acquiring such assets), and contributions restricted for the payment of long-term debt.

12 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 10 Inventories Inventories consist principally of medical and surgical supplies and pharmaceuticals, and are valued at the lower of cost (first-in, first-out method) or market. Risk Management and Self-Insurance The Cancer Center is exposed to various risks from torts, thefts, damage to and destruction of assets, business interruption, errors and omissions, employee injuries and illnesses, and natural disasters. Commercial insurance coverage is purchased for claims arising from such matters. The Cancer Center is insured for medical malpractice claims as described in Note 14. The Cancer Center is self-insured for amounts up to specified levels for health, medical, and workers compensation claims for its employees. The estimated liability for such self-insurance arrangements is the total estimated amounts to be paid for all known claims or incidents, and an estimate for incurred but not reported claims. Fair Value of Certain Financial Instruments The carrying amounts reported in the consolidated balance sheets for financial instruments classified as current assets and current liabilities approximate fair value because of the short-term maturity of these instruments. Fair Value Measurements Fair value is determined using assumptions that market participants would use to determine the price of an asset or liability as opposed to measurements determined based upon information specific to the entity holding those assets and liabilities. To determine those market participant assumptions, the Financial Accounting Standard Board (FASB) established a hierarchy of inputs that the entity must consider, including both independent market data inputs and the entities assumptions about the market s participant assumptions. In accordance with ASU , investments that are valued using net asset value (NAV) as a practical expedient are excluded from this three-tier hierarchy. For all other investments measured at fair value, the hierarchy prioritizes the inputs used to measure fair value. The hierarchy is summarized as follows: Level 1 Unadjusted quoted prices in active markets for identical assets and liabilities as of the reporting date. Level 2 Directly or indirectly observable inputs, other than quoted prices included in Level 1. Level 2 inputs may include, among others, interest rates and yield curves observable at commonly quoted intervals, volatilities, credit risks, and other inputs that are derived principally from or corroborated by observable market data by correlation or other means as of the reporting date. Level 3 Unobservable inputs used when there is little, if any, market activity for the asset or liability at the measurement date. These inputs represent the entity s own assumptions about the assumptions that market participants would use to price the asset or liability developed using the best information available. The Cancer Center s Level 1 assets include investments in equity and U.S. Government agency securities, and are valued at the quoted market prices. The Cancer Center s Level 2 assets include investments in fixed income securities and are valued based upon directly or indirectly observable inputs. Transfers between levels in the hierarchy are recognized at the end of the reporting period. The Cancer Center s long-term debt is valued based on quoted market prices for the same or similar issues for debt of the same remaining maturities (Level 2). The estimated fair value of the Cancer Center s long-term debt at June 30, 2017 and 2016 is approximately $330,348,111 and $302,498,000, respectively.

13 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 11 The following table summarizes the Cancer Center s significant financial assets measured at fair value as of June 30, 2017 and 2016: Fair Value Measurements at Reporting Date Using Level 1 Level 2 Level 3 June 30, 2017 Total Inputs Inputs Inputs Assets: Cash and cash equivalents $ 201,030,321 $ 201,030,321 $ - $ - Assets limited as to use: Equity securities 135,738, ,738, Cash and cash equivalents 120,530, ,530, Fixed income securities 42,881,870-42,881,870 - U.S. Government obligations 11,061,327 11,061, Total assets $ 511,242,077 $ 468,360,207 $ 42,881,870 $ - Fair Value Measurements at Reporting Date Using Level 1 Level 2 Level 3 June 30, 2016 Total Inputs Inputs Inputs Assets: Cash and cash equivalents $ 179,235,229 $ 179,235,229 $ - $ - Assets limited as to use: - Equity securities 116,960, ,960, Cash and cash equivalents 91,776,130 91,776, Fixed income securities 39,444,086-39,444,086 - U.S. Government obligations 14,734,604 14,734, Total assets $ 442,150,319 $ 402,706,233 $ 39,444,086 $ - The following table represents a reconciliation of financial instruments at fair value to the accompanying consolidated balance sheets as follows: June 30, Cash, investments and assets limited as to use at fair value $ 511,242,077 $ 442,150,319 Alternative investments 18,431,448 19,335,196 Total $ 529,673,525 $ 461,485,515 Alternative Investments The Cancer Center s investment policy provides for a diversified investment portfolio which considers risk, return, preservation and appreciation of capital as well as the Cancer Center s short-term and long-term liquidity needs. This policy allows participation in alternative investment funds (hedge and real estate funds). The hedge funds principal investment objective is to achieve consistent, positive returns, while attempting to reduce risk and volatility. The real estate fund s objective is to outperform the NFI-ODCE Index over a full market cycle with a lower level of risk. Alternative investments often have liquidity restrictions under which the Cancer Center s capital may be divested only at specified times. The hedge funds are in the process of closing and are conducting compulsory redemptions for all fund investors with the first occurring in June Effective June 30, 2016, the fund will not charge management or performance fees. Liquidity restrictions may apply to all or portions of a particular invested amount. The real estate fund has quarterly liquidity subject to available cash flow. There were no unfunded commitments for these investments as of June 30, 2017 and Realized and unrealized gains and losses from these alternative investments are included in the nonoperating gains, net section of the consolidated statements of operations.

14 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 12 Alternative investments accounted for at fair value based on NAV totaled $18,431,448 and $19,335,196 as of June 30, 2017 and 2016, respectively, and were classified as investments and assets limited as to use in the accompanying consolidated balance sheets. Assets Limited as to Use Assets limited as to use represent funds internally designated for program development and capital expenditures, funds externally designated by donors and under the terms of bond indentures, and funds from the State of Florida Cigarette Tax Trust Fund (Cigarette Tax). The Board of Directors (the Board) retains control over internally designated funds and may, at its discretion, use the funds for other purposes. Amounts required to meet current liabilities have been reclassified to current assets in the consolidated balance sheets and totaled at June 30, 2017 and Investments and Investment Income Investments in debt and equity securities with readily determinable fair values are recorded at fair value in the consolidated balance sheets. Investments without readily determinable fair values (collectively alternative investments ) are accounted for based on net asset value (NAV), a practical expedient, of each alternative investment. Financial information used by the Cancer Center to evaluate its alternative investments is provided by the investment manager and may include fair value valuations (quoted market prices and values determined through other means) of the underlying securities and other financial instruments held by the investee, and estimates that require varying degrees of judgment. The financial statements of the investee companies are audited annually by independent auditors, although the timing for reporting the results of such audits does not always coincide with the Cancer Center s financial statement reporting period. Funds held by the bond trustee under indenture and from the Cigarette Tax are invested in cash and cash equivalents and are designated as other-than-trading investments. Investment securities are designated as trading investments. Investment income is reported net of management fees, and includes interest and dividend income, as well as realized gains and losses on such investments. Investment income is reported as an increase in unrestricted net assets in the period earned unless such earnings are subject to donor-imposed restrictions. Investment income restricted by donor stipulations is reported as an increase in temporarily or permanently restricted net assets in the period earned. Property, Plant, and Equipment Property, plant, and equipment are recorded at historical cost or fair market value, if donated, at the date of donation. Depreciation expense is computed using the straight-line method over the estimated useful lives of the related assets. Interest cost incurred during the period of construction of capital assets is capitalized as a component of the cost of constructing those assets. Expenditures that materially increase values, change capacity, or extend useful lives are capitalized. The Cancer Center has under construction, or is planning construction projects, with remaining estimated costs to complete of approximately $71,467,000 as of June 30, 2017, to be primarily funded by the bond proceeds described in Note 6.

15 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 13 Contributed Resources The Cancer Center reports gifts of cash and other assets as restricted contributions if they are received with donor stipulations that limit the use of the donated assets. When a donor restriction expires, temporarily restricted net assets are reclassified to unrestricted net assets and reported in the consolidated statements of operations and changes in net assets as net assets released from restrictions. Unconditional promises to give with payments to be received in future periods are reported as temporarily restricted contributions in the period the pledge is made. If there are no donor restrictions on the pledge, the temporarily restricted net assets are reclassified to unrestricted net assets in the period the payment is received. Conditional promises to give are recognized when the conditions on which they depend have been met. State Appropriations The Cancer Center receives an annual appropriation from the State, which is recorded as other revenues in the accompanying consolidated statements of operations and changes in net assets for the year ended June 30, For the year ended June 30, 2017, a portion of the appropriation was redirected to be used as state matching funds for the Cancer Center s participation in the Low Income Pool, and received by the Cancer Center as enhanced Medicaid funding. Beginning January 1, 1999, and continuing for 10 years thereafter, the Cancer Center received an approximate aggregate minimum of $100,000,000 from the Cigarette Tax. Additionally, beginning July 1, 2002 and continuing through June 30, 2014, an additional amount was received from the Cigarette Tax aggregating $64,000,000 as a result of extensions and increases from the State in 2002, 2009, and During the year ended June 30, 2014, the State enacted legislation increasing the appropriation from 2.75% to 4.04%, for the period July 1, 2014 through June 30, 2033 to approximately $297,000,000. During the year ended June 30, 2017, the State amended the appropriation to extend the act through June 30, 2053 for an additional amount of approximately $310,000,000. From January 1, 1999, and continuing through June 30, 2013, the Cigarette Tax funds were to be used for the purposes of constructing, furnishing, and equipping a cancer center research facility (research tower) at the university adjacent to the Cancer Center, as well as for the repayment of the debt incurred for the research tower. As of July 1, 2013, the Cigarette Tax funds are to be used for the purposes of constructing, furnishing, equipping, financing, operating, and maintaining cancer research and clinical and related facilities and other properties owned or leased by the Cancer Center, as well as for the repayment of the debt incurred for the Series 2012A bonds with additional bonds issued for the Series 2016A. No receivable is recorded as of June 30, 2017 or 2016 in the accompanying consolidated balance sheets for the proceeds from the Cigarette Tax related to the period July 1, 2017 to June 30, 2053, as the amounts are subject to future legislative support from the State. For each of the years ended June 30, 2017 and 2016, the Cancer Center received approximately $15,524,000 from the Cigarette Tax proceeds and applicable earnings. These amounts are recorded as both other operating revenue and increases in temporarily restricted net assets for the years ended June 30, 2017 and Deferred Financing Costs Deferred financing costs are included as a reduction of long-term debt, and are deferred and amortized over the remaining lives of the financing. Bond Premium and Discount Bonds payable are included in long-term debt, net of related original issue premium and discount. Such premiums and discounts are being amortized over the life of the bonds using the effective interest method.

16 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 14 Income Taxes The Cancer Center, the Hospital, the Moffitt Medical Group, and the Foundation have been recognized by the Internal Revenue Service as tax-exempt organizations as described in Section 501(c)(3) of the Internal Revenue Code of 1986, and are exempt from federal and state taxes on related income pursuant to the Internal Revenue Code and Chapter of the Florida Statutes, respectively. MTC and M2Gen are corporations subject to income tax. With respect to its for-profit entities, as well as any unrelated business income generated by the tax-exempt entities, the Cancer Center records income taxes using the asset and liability method under which deferred tax assets and liabilities are recognized for expected future tax consequences of temporary differences between financial accounting and tax bases of assets and liabilities and are measured using the currently enacted tax rate and laws applicable in the period that the deferred tax asset or liability is expected to be realized or settled. A valuation allowance is provided when it is more likely than not that some portion or all of a deferred tax asset will not be realized. At June 30, 2016, the Cancer Center maintained a full valuation allowance against its deferred tax asset. During the year ended June 30, 2017, the Cancer Center determined that it is more likely than not that the portion of its deferred tax asset arising from the operations of M2Gen will be realized. Accordingly, the Cancer Center reversed the approximately $7,700,000 valuation allowance related to M2Gen. For the year ended June 30, 2017, the Cancer Center recognized a net income tax benefit of approximately $6,100,000. At June 30, 2017, the Cancer Center has a deferred income tax asset of approximately $7,200,000, which primarily relates to the temporary difference of recognizing revenue on advance payments received by M2Gen. The deferred tax asset is included as a component of other assets in the accompanying consolidated balance sheets. The Cancer Center recognizes a tax position after determining that a relevant tax authority would more likely than not (greater than 50% likelihood) sustain the position following an audit 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. Community Benefit Since its inception and in accordance with its mission, the Cancer Center has been dedicated to improving community health and to collaborating with other community members to provide comprehensive care through an array of health programs and education, health services, and medical research for the uninsured and underinsured. Community benefit projects and services provided by the Cancer Center are identified through health assessments and strategic and/or clinical priorities. Community benefit categories include community benefit services, traditional charity care, and unpaid charges for government programs. The community benefit services include health care programs for the underserved in the community, including services such as health screenings, preventive care, and health education programs. The Cancer Center provides care to patients who meet criteria under established charity care policies without charge or at amounts less than its established rates. The Cancer Center does not pursue collection of amounts determined to qualify as charity care, and they are not reported as revenue. Charity care is reported based upon criteria established by the Cancer Center and the State of Florida Agency for Health Care Administration. The estimated costs of providing the charity care were approximately $24,501,000 and $18,637,000 for the years ended June 30, 2017 and 2016, respectively. The Cancer Center also provides services to indigent patients who meet criteria established by Medicaid and other governmental programs at amounts that are less than its established rates. The Cancer Center maintains records to identify and monitor the level of subsidized government indigent care it provides. The estimated costs of providing these services were $18,867,000 and $21,221,000 for the years ended June 30, 2017 and 2016, respectively. The estimated costs (based on selected operating expenses, which include salaries, wages and benefits, supplies, and other operating expenses) were based on a calculation that multiplied the percentage of the selected operating expenses identified above to gross charges by the gross charity care or indigent care amount.

17 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 15 In addition to the charity and indigent care services noted above, an assessment of 1.0% to 1.5% of certain operating revenues is paid by the Cancer Center to help fund the Florida Medicaid and indigent care program. These assessments were approximately $9,625,000 and $8,664,000 for the years ended June 30, 2017 and 2016, respectively. Multiple-Element Arrangements, Licensing Revenues, and Milestone Payments The Cancer Center enters into multiple-element revenue arrangements, which may include any combination of services, licensing, and/or access to data. When evaluating agreements with multiple element deliverables, the Cancer Center considers whether the deliverables under the arrangement represent separate units of accounting. This evaluation requires subjective determinations and requires management to make judgments about the individual deliverables and whether such deliverables are separable from the other aspects of the contractual relationship. In determining the units of accounting, management evaluates certain criteria, including whether the deliverables have standalone value, based on the consideration of the relevant facts and circumstances for each arrangement. The consideration received is allocated among the separate units of accounting using the relative selling price method, and the applicable revenue recognition criteria are applied to each of the separate units. Revenue recognized as a single unit of accounting during the period of ongoing involvement is deferred and amortized on a straight-line basis over the period of ongoing involvement. With regard to licensing revenues, the Cancer Center s licensing agreements have terms that include upfront payments upon contract signing and additional payments if and when certain milestones in the product s development or commercialization are reached. Milestone payments are recognized as other operating revenue upon the achievement of specified milestones if (i) the milestone is substantive in nature and the achievement of the milestone was not reasonably assured at the inception of the agreement; and (ii) the fees are non-refundable. Any milestone payments received prior to satisfying these revenue recognition criteria are recorded as deferred revenue. Royalty revenue is recognized when earned. Recently Issued Accounting Pronouncements In May 2014, the FASB issued ASU No , Revenue from Contracts with Customers (Topic 606) guidance that further clarifies the accounting for revenue and related revenue transactions, such as the provision for doubtful accounts. The standard was amended in March 2016 by ASU , Revenue from Contracts with Customers (Topic 606), Principal versus Agent Considerations (Reporting Revenue Gross versus Net) related to identifying performance obligations. In April 2016, ASU No , Revenue from Contracts with Customers (Topic 606), Identifying Performance Obligations and Licensing was issued to further clarify the principal versus agent guidance. The standard was amended further in May 2016 with issuance of ASU No , Revenue from Contracts with Customers (Topic 606), Narrow-Scope Improvements and Practical Expedients which clarifies revenue recognition guidance on transition, collectability, noncash consideration and the presentation of sales and other similar taxes. The standard is effective for fiscal years beginning after December 15, 2017, and interim periods within those years. Management is currently evaluating the effect of adopting the new standard on the Cancer Center s financial statements. In April 2015, the FASB issued ASU No , Interest Imputation of Interest (Subtopic ), Simplifying the Presentation of Debt Issuance Costs, that requires debt issuance costs related to a recognized debt liability to be presented in the balance sheet as a direct deduction from the liability rather than as an asset to make the presentation consistent with debt discounts and premiums. The Cancer Center adopted the provision of this standard during 2017 and retrospectively applied the provision. The resulting balance sheet adjustment to decrease other assets and long-term debt was approximately $1,912,000 and $1,502,000 at June 30, 2017 and 2016, respectively.

18 H. Lee Moffitt Cancer Center & Research Institute, Inc. and Subsidiaries 16 In February 2016, the FASB issued ASU No , Leases which requires lessees to recognize on the balance sheet the assets and liabilities for the rights and obligations created by leases with lease terms of more than 12 months. The recognition, measurement, and presentation of expenses and cash flows arising from a lease by a lessee will continue to primarily depend on its classification as a finance or operating lease. However, unlike current U.S. GAAP, which requires only capital leases to be recognized on the balance sheet, ASU will require both types of leases to be recognized on the balance sheet. ASU also requires disclosures about the amount, timing, and uncertainty of cash flows arising from leases. These disclosures include qualitative and quantitative requirements, providing additional information about the amounts recorded in the financial statements. The standard is effective for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years. Management is currently evaluating the effect of adopting the new standard on the Cancer Center s financial statements. In August 2016, the FASB issued ASU , Presentation of Financial Statements of Not-for-Profit Entities (Topic 958), which changes certain financial statement requirements for not-for-profit (NFP) entities within the scope of Accounting Standards Codification (ASC) 958. NFP s will no longer be required to distinguish between resources with temporary and permanent restrictions on the face of their financial statements, which will now result in presenting only two classes of net assets. The guidance also includes changes how entities report certain expenses and provide information about their available resources and liquidity. The guidance is effective for fiscal years beginning after December 15, 2017, and interim periods within fiscal years beginning December 15, 2018 with early adoption permitted. Management is currently evaluating the effect of adopting the new standard on the Cancer Center s financial statements. Note 3 Subsequent Events The Cancer Center has evaluated subsequent events for the year ended June 30, 2017 through September 25, 2017, the date the consolidated financial statements were issued. On August 18, 2017, the Cancer Center s for-profit subsidiary, M2Gen, sold preferred stock representing 24.9% outstanding interest in M2Gen to an unrelated party to accelerate the discovery of innovative cancer therapies and improve care for patients nationwide. This funding will expand the efforts of the Oncology Research Information Exchange Network (ORIEN) and will lead to M2Gen s ability to provide clinical decision support tools at the point of care based on the learning from the hundreds of thousand patient partners in Total Cancer Care. Note 4 Assets Limited as to Use The composition of assets limited as to use, stated at fair value, is set forth in the following table: June 30, Cash and cash equivalents: Money market funds $ 120,530,284 $ 91,776,130 Fixed income securities: Corporate debt securities 26,856,007 19,555,573 Mortgage-backed securities 11,311,649 15,223,486 Asset-backed securities 4,714,214 4,665,027 Equity securities 135,738, ,960,270 U.S. Government obligations 11,061,327 14,734,604 Alternative investments 18,431,448 19,335, ,643, ,250,286 Less current portion (19,669,978) (14,492,114) $ 308,973,226 $ 267,758,172