2017-11-10T16:08:40-06:00 2016-12-31 ERNST & YOUNG US LLP 201 N FRANKLIN ST STE 2400 TAMPA FL 33602 990 2016-01-01 581377711 John Knox Village of Tampa Bay Inc % JANICE POLO EVP & CFO JOHN 8136322401 4100 East Fletcher Avenue Tampa FL 33613 CARL TREMONTI CFO 8138704025 2017-11-09 true Melanie A McPeak P01346034 8132254800 73.184.231.48 65095320173145000020 2017-11-10 P 090DF3880695D33BA5F0896781DD7F1FFA4BF94E A9F34ED436352FF4B1AA576E9CC518543F23A016 2016 2017-02-10 21:41:12Z Glenn Waters 2985 Drew Street clearwater FL 33759 28920208 false X http://www.stjosephsjohnknox.org/ X 1979 FL JOHN KNOX VILLAGE of tampa bay, inc. WILL improve the health OF ALL WE SERVE THROUGH COMMUNITY-OWNED HEALTH CARE services that set THE STANDARD FOR HIGH-QUALITY, COMPASSIONATE CARE. 6 2 513 159 0 11140 8318 29167428 28823944 58426 87946 0 0 29236994 28920208 0 0 0 0 16316247 16938078 0 0 0 15946981 15384118 32263228 32322196 -3026234 -3401988 30754625 29187234 30505400 32329936 249225 -3142702 X JOHN KNOX VILLAGE OF TAMPA BAY, INC. WILL IMPROVE THE HEALTH OF ALL WE SERVE THROUGH COMMUNITY-OWNED HEALTH CARE SERVICES THAT SET THE STANDARD FOR HIGH-QUALITY, COMPASSIONATE CARE. false false 29649497 0 28823944 See Schedule O 29649497 true false false true false false false false false false true false false false true false true true false false false false false false false false false false false true false false false false false false false false false false false false false true true false false false true 59 0 true 513 true false false false false false false false false false false X 6 2 true false false false true true true true true false false true true true true true true true false false X JANICE POLO EVP CFO 7278208021 2985 DREW STREET Clearwater FL 33759 X PATRICIA DONNELLY TTEE/VP, PATIENT SVCS/CNO-EAST 1.0 45.0 X 0 498774 42044 KIMBERLY GUY TTEE/PRES SJH/SVP MARKER LDER 1.0 45.0 X X 0 597170 39703 LORRAINE LUTTON TRUSTEE/PRES ST JOSEPH'S HOSP 1.0 45.0 X 0 543628 86270 MADELYN MOSELEY TRUSTEE/EXEC DIR HOME CARE 1.0 45.0 X 0 219916 20642 DOLORES O'BRIEN TRUSTEE 1.0 0.0 X 0 0 0 RON SHUCK TRUSTEE 1.0 0.0 X 0 0 0 CARL TREMONTI TTEE/SECR/TREA/VP,CFO BYCR HOS 1.0 45.0 X X 0 619350 24420 GLENN WATERS EVP, COO BAYCARE HEALTH SYSTEM 1.0 45.0 X 0 1341759 88360 LISA LYONS DIRECTOR JOHN KNOX VILLAGE 45.0 0.0 X 176786 0 32056 ELLEN KOBERLEIN CONTROLLER JOHN KNOX VILLAGE 45.0 0.0 X 119158 0 23499 MICHAEL JAMES FACILITIES DIRECTOR 45.0 0.0 X 109541 0 17633 SANDY ROSS SENIOR LIVING COUNSELOR LEAD 45.0 0.0 X 109926 0 21518 DONNA WASHBURN DIRECTOR NURSING SERVICES 45.0 0.0 X 127074 0 22102 CATHY YODER FORMER TRUSTEE/OFFICER 0.0 45.0 X 0 406417 47051 642485 4227014 465298 5 true true false Sodexo Inc Affiliates 9801 Washington Blvd GAITHERSBURG MD 20878 Management Svcs 736234 Quality Care Rehab Inc 8477 Suncoast Blvd HOMOSASSA FL 34446 Rehab services 1807417 FMR Management Services PO Box 3693 PLANT CITY FL 335633693 Laundry services 351092 Securitas Security Services USA In 3450 Buschwood Park Dr STE 340 TAMPA FL 33618 Professional svcs 253741 Siemens Industry Inc 1000 Deefield Pkwy BUFFALO GROVE IL 60089 Equipment maintenanc 176790 5 8318 8318 SKILLED NURSING 621990 7692725 7692725 MEDICARE/MEDICAID PAYMENTS 621990 9356331 9356331 RENTAL INCOME 621990 11596815 11596815 DIETARY REVENUE 621990 168033 168033 OTHER 621990 10040 10040 28823944 87946 87946 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28920208 28823944 87946 0 0 0 0 208842 208842 0 12972280 12972280 395500 395500 2449854 2449854 911602 911602 0 20534 20534 195 195 2400 2400 0 0 2772295 2771250 1045 122866 122866 1260555 393526 867029 96375 96086 289 0 1441546 1441546 54831 3906 50925 0 0 557770 557770 0 2386341 2385917 424 1363851 1173043 190808 MISCELLANEOUS SUPPLIES 1910595 1910595 MANAGEMENT FEES 1332607 1332607 MEDICAL SUPPLIES 1228006 1228005 1 BAD DEBT 406478 406478 426873 426873 32322196 29649497 2672699 0 51947 9598 0 0 0 0 2045160 1798759 0 0 0 0 77508 377266 51961 42542 55670 32932 72536966 54508823 19669103 18028143 8691527 8800584 0 0 0 0 0 0 111749 97410 30754625 29187234 1478534 1630144 0 0 7686893 8243382 0 0 0 0 0 0 0 0 0 0 21339973 22456410 30505400 32329936 X -437207 -3866790 686432 724088 0 0 249225 -3142702 30754625 29187234 -3401988 10061 X false true X true false X 13842 3270 2830 11140 8318 39400 29437722 30467297 31012915 29167428 28823944 148909306 0 0 0 29451564 30470567 31015745 29178568 28832262 148948706 0 0 0 148948706 702839 636629 49567 58426 87946 1535407 0 702839 636629 49567 58426 87946 1535407 0 27749 27749 30154403 31134945 31065312 29236994 28920208 150511862 0.98961 0.98560 0.01020 0.01422 X false true false false false false true 2400 false false 2400 false Schedule C, Part II - B, Line 1b & 1g, Supplemental Information BayCare employees were compensated for lobbying activities. 3100000 3100000 59103111 44867014 14236097 10260588 9641809 618779 73267 73267 18028143 0 DEPOSITS 619328 ENDOWMENT DEPOSITS 59754 EST THIRD PARTY SETTLEMENTS 867069 DUE TO AFFILIATES 20910259 22456410 28513730 28513730 406478 406478 28920208 31915720 31915720 406476 406476 32322196 SCHED D, PART XI, LINE 4B BAD DEBT EXPENSE $406,478 ROUNDING $ (2) Total $406,476 SCHED D, PART XII, LINE 4B BAD DEBT EXPENSE $406,478 ROUNDING $ (1) TOTAL $406,477 true true false false false false false false false PATRICIA DONNELLY TTEE/VP, PATIENT SVCS/CNO-EAST 0 304018 0 94965 0 99791 0 20793 0 21251 0 540818 0 17053 KIMBERLY GUY TTEE/PRES SJH/SVP MARKER LDER 0 387360 0 102302 0 107508 0 13250 0 26453 0 636873 0 24285 LORRAINE LUTTON TRUSTEE/PRES ST JOSEPH'S HOSP 0 323909 0 113907 0 105812 0 58914 0 27356 0 629898 0 0 MADELYN MOSELEY TRUSTEE/EXEC DIR HOME CARE 0 195847 0 22913 0 1156 0 11203 0 9439 0 240558 0 0 CARL TREMONTI TTEE/SECR/TREA/VP,CFO BYCR HOS 0 380105 0 115677 0 123568 0 13250 0 11170 0 643770 0 18141 GLENN WATERS EVP, COO BAYCARE HEALTH SYSTEM 0 855648 0 324235 0 161876 0 57114 0 31246 0 1430119 0 0 LISA LYONS DIRECTOR JOHN KNOX VILLAGE 156423 0 18230 0 2133 0 8806 0 23250 0 208842 0 0 0 CATHY YODER FORMER TRUSTEE/OFFICER 0 228201 0 82545 0 95671 0 30383 0 16668 0 453468 0 0 Part I, line 3 The filing organization does not use any of the options listed in Schedule J, Part I, Line 3 to establish the compensation of the CEO/Executive Director. However, the related organization, BayCare Health System Inc, uses Compensation committee, Independent compensation consultant, Written employment contract, Compensation survey or study and Approval by the board or compensation committee as a means to establish the CEO's compensation of the filing organization. PART I, LINE 4a Cathy Yoder received a severance payment in the amount of $26,704 during 2016. Part I, Line 4b Patricia Donnelly - Participated in a supplemental nonqualified deferred compensation plan. She had $86,568 in benefits vest in 2016. This amount is included in Part II (B)(iii) Other compensation. The plan made cash distribution of $36,315 in 2016. Kimberly Guy - Participated in a supplemental nonqualified deferred compensation plan. She had $99,643 in benefits vest in 2016. This amount is included in Part II (B)(iii) Other compensation. The plan made cash distribution of $41,800 in 2016. Carl Tremonti - Participated in a supplemental nonqualified deferred compensation plan. He had $97,566 in benefits vest in 2016. This amount is included in Part II (B)(iii) Other compensation. The plan made cash distribution of $40,928 in 2016. Lorraine Lutton - Participated in a supplemental nonqualified deferred compensation plan. She had $62,826 in benefits vest in 2016. This amount is included in Part II (B)(iii) Other compensation. The plan made cash distribution of $26,356 in 2016. Glenn Waters - Participated in a supplemental nonqualified deferred compensation plan. He had $142,556 in benefits vest in 2016. This amount is included in Part II (B)(iii) Other Compensation. He had $40,877 of nonvested benefits accrue during 2016. This amount is included in Part II (C) Retirement and other deferred compensation. The plan made cash distribution of $59,802 in 2016. Form 990, Part III - Program Service Accomplishments John Knox Village of Tampa Bay, Inc. serves the elderly population through a continuum of care including independent living with home health assistance, assisted living and skilled nursing care. This includes a secured level of care of Alzheimer's patients in the assisted and skilled levels. All services and amenities to improve the quality of daily living are provided. These services include health care, housing, home health, dietary, security, maintenance, social services, activities and related services to over 473 residents/patients. Medicaid patients are served in our skilled care facility and assisted living through the diversion plan as well as assistance from veteran's aid and attendance program. We educate the community regarding senior living services as well as current elder population programs. Form 990, Part VI, Line 1b John Knox Village of Tampa Bay, Inc. is controlled by St. Joseph's Health Care Center, Inc., a 501(c)(3) tax-exempt organization. A majority of the voting members of the board of St. Joseph's Health Care Center, Inc., are independent. Form 990, Part VI, Line 2 Carl Tremonti and Glenn Waters are officers of the filing organization as well as board members of a taxable entity affiliated with the filing organization. Form 990, Part VI, Line 6 The sole member of John Knox Village of Tampa Bay, Inc. is St. Joseph's Health Care Center, Inc. Form 990, Part VI, Line 7a Designation and Election of Directors: (a) The President of the Corporation shall serve as a permanent Director. (b) All Directors shall be elected by the Member. Form 990, Part VI, Line 7b The taxpayer is a Participant, as defined in the Second Restated Joint Operating Agreement dated as of May 23, 2006, as amended (the "JOA"). Under the JOA, BayCare health System, Inc. is responsible for the operations of the Participants. The JOA Participants include the taxpayer and other hospitals and non-hospital organizations. Notice of the JOA was previously provided to the Internal Revenue Service by letter dated July 1, 1997. The Member shall reserve to itself in its capacity as the Corporate Member of the Corporation the following two categories of actions: Class I Member Reserved Rights and Class II Member Reserved Rights. A. Class I Member Reserved Rights. 1. Addition, deletion or reconfiguration of services of the Corporation. 2. Establishment of overall capital and operating budgets and strategic plans applicable to the Corporation, including the use of the funds of the Corporation. 3. Exclusive authority to enter into managed care contracts on behalf of the Corporation. 4. Approval of contracts on behalf of the Corporation (but the Class I Member may establish policies from time to time providing that only specific types of contracts or contracts involving obligations in excess of specified levels need to be approved by the Class I Member). 5. Authority to establish fees and charges on behalf of the Corporation. 6. Determination of whether the Corporation should join any networks or alternative or integrated delivery systems. 7. Establishment of employment and other policies applicable to all personnel employed by the Corporation. 8. Approval of the philosophy, mission statement and purposes of the Corporation. 9. Approval of changes in the Articles of Incorporation or in the Bylaws of the Corporation. 10. Approval of the merger, consolidation, dissolution, sale or other transfer of substantially all assets of the Corporation, or other change in corporate form, causing a fundamental reorganization of the Corporation. 11. Approval of the incurrence of indebtedness by the Corporation above certain limits established by the Class I Member. 12. Approval of the establishment of additional affiliates or subsidiaries of the Corporation. 13. Adoption of strategic plans or major changes in programs or services of the Corporation. 14. Approval of the purchase, sale, transfer, or other encumbrance of assets of the Corporation above specified levels established by the Class I Member. B. Class II Member Reserved Rights. 1. Approval of the philosophy, mission statement and purposes of the Corporation. 2. Approval of the merger, consolidation, dissolution, sale or other transfer of substantially all assets of the Corporation, or other change in corporate form, causing a fundamental reorganization of the Corporation. 3. Approval of any sale, long term lease, mortgage, encumbrance or disposition of property of the Corporation constituting an 'alienation' under principles of canon law. 4. Approval of matters relating to the implementation of and compliance with the Ethical and Religious Directives. 5. Approval of substantive changes in the Articles of Incorporation of the Corporation and these Bylaws (provided that prior notice of any change in the Articles of Incorporation of the Corporation or these Bylaws shall be provided to Trinity Health and, if such change, as a result of Trinity Health being a Catholic entity, must be approved by Trinity Health, such change, regardless of whether it is substantive as a matter of civil law, shall be subject to the approval of Trinity Health). 6. With regard to any assets of the Corporation no longer required in the operations of the Corporation, approval of any sale or other disposition of any assets not in the ordinary course which have a value in excess of $3 million, and with regard to all other assets of the Corporation used in the operations of the Corporation, approval of any sale or other disposition of such assets not in the ordinary course (but the foregoing is not intended to limit any transfer of the location of the assets from the Corporation to another entity in connection with a duly authorized reconfiguration of services). 7. The determination of the distribution of assets upon dissolution or liquidation of the Corporation. Form 990, Part VI, Line 11b The Form 990 is prepared by the organization and reviewed by the CFO, as well as the organization's paid preparer. Prior to filing with the IRS, a final copy of the Form 990 was provided to the entire Board. Form 990, Part VI, Line 12c John Knox Village of Tampa Bay, Inc. has two separate conflict of interest procedures; one that relates to Board members and another that relates to non-board member employees. Both groups are required on an annual basis to complete, sign and file an annual disclosure statement detailing existing or potential conflicts of interests. For Board members, the review of conflicts or potential conflicts occurs at the Board or committee level. After disclosure of the Board Member's or Committee Member's actual or potential conflict, the following procedures for addressing the conflict of interest will be adhered to by each Board and all Committees with Board delegated powers, without exception: 1. The interested Director or Committee member shall leave the Board or Committee meeting while the conflict of interest issue is discussed. 2. The remaining Board or Committee Members shall decide if a conflict of interest exists. 3. If a conflict of interest is deemed to exist: a. The Chairperson of the Board or Committee shall, if appropriate, appoint a disinterested individual or committee to investigate the proposed transaction or arrangement. b. The Board or Committee shall determine whether the BayCare entity can obtain a more advantageous transaction or arrangement with reasonable efforts from an individual or entity that would not give rise to a conflict of interest. c. If a more advantageous transaction or arrangement is not reasonably available, the Board or Committee shall determine whether the transaction or arrangement is in the BayCare entity's best interest, and whether the transaction is fair and reasonable to BayCare. An interested Director or Committee Member shall not vote, participate in, influence or attempt to influence any determination or proceedings. The Director or Committee Member may, however, respond to questions posed by the Board or Committee regarding the contract or transaction. Any such contract or transaction must be authorized by a vote of at least two-thirds (2/3) of the Directors or Committee Members entitled to vote at a meeting at which a quorum was present. Any interested Director or Committee Member may not be counted in determining the existence of a quorum. For employees, the review of conflicts of interest or potential conflicts goes to the Conflict of Interest Determination Committee. This committee consists of BayCare Chief Compliance Officer, the Corporate Responsibility Officers, and the BayCare Vice President of Team Resources. This committee shall determine if an actual conflict exists and any action required to address the conflict of interest situation. Form 990, Part VI, Lines 15a & 15b The filing organization does not directly compensate some of its top management employees; rather compensation is paid by a related organization that also follows the compensation policy of the Compensation Committee. The independent Compensation Committee is appointed by the Board of Directors. The Compensation Committee's purpose is to provide oversight for the organization's executive compensation program, review and approve compensation and benefits for all "disqualified persons" subject to the Intermediate Sanctions regulations issued under Section 4958 of the Internal Revenue Code (including the Chief Executive Officer, Chief Operating Officer & Chief Financial Officer, other system and entity executives, and other disqualified persons as defined in the Intermediate Sanctions regulations (i.e., voting members of the governing body, family members, former officers)), and establish the compensation philosophy for all other executives. This committee engages nationally recognized compensation consultants to assist them in review of executive compensation. The compensation consultants provide a review of each vice president and above in the system to determine if that employee's compensation is reasonable when compared against market standards. The data reviewed comes from compensation studies that include comparable compensation for similarly qualified persons in functionally comparable positions at similarly situated organizations. The organization keeps contemporaneous minutes of the compensation committees meetings and decisions. External consultants review compensation every other year the last review occurring in 2015, but the compensation committee regularly monitors compensation and all other procedures are followed annually. Form 990, Part VI, Line 19 John Knox Village of Tampa Bay's governing documents are available to the public via Sunbiz.org. St Joseph's Hospital of Tampa Found Inc 3001 W Dr Martin Luther King Jr Bl Tampa FL 33607 591100828 Fundraising FL 501(C)(3) 12c SJHCC true SOUTH FLORIDA BAPTIST HOSPITAL 301 N ALEXANDER STREET PLANT CITY FL 33563 590594631 MEDICAL SRVCS FL 501(C)(3) 3 na false Franciscan Properties Inc 3001 W Dr Martin Luther King Jr Bl Tampa FL 33607 592822519 Supports SJH FL 501(C)(3) 12b SJHCC true St Anthony's Professional Building & Se 1200 7th Avenue North St Petersburg FL 33705 592018848 Real Estate FL 501(C)(3) 10 SJHCC true St Joseph's Enterprises Inc 3001 W Dr Martin Luther King Jr Bl Tampa FL 33607 592822516 Health invest FL 501(C)(3) 12b SJHCC true BayCare Health System Inc 2985 Drew St Clearwater FL 33759 592796965 Support srvcs FL 501(C)(3) 12a na false St Joseph's Health Care Center Inc 3001 W Dr Martin Luther King Jr B Tampa FL 33607 592593686 Support srvcs FL 501(C)(3) 12b na false St Joseph's Hospital Inc 3001 W Dr Martin Luther King Jr B Tampa FL 33607 590774199 Health Srvcs FL 501(C)(3) 3 na false St Joseph's Community Care Inc 3001 W Dr Martin Luther King Jr Tampa FL 33607 593152608 Medical asst FL 501(C)(3) 10 SJHCC true Carillon Surg Cntr 900 Carillon St Pet FL 33716 261116740 HEALTH SRVC FL SAPOB N/A 0 0 false 0 false St Ant Phy Surg Cntr 705 16th St N St Pet FL 33705 010861245 HEALTH SRVC FL SAPOB N/A 0 0 false 0 false Healthpoint Management Services Inc 4902 Eisenhower Blvd Suite 300 Tampa FL 33634 650645457 Billing/mgmt FL SJHCC C corp 0 0 0.00000 true Healthpoint Medical Group Inc 4902 Eisenhower Blvd Suite 300 Tampa FL 33634 593244268 Physicians group FL SJHCC C corp 0 0 0.00000 true false false false false false false false false false false false false true false true false false true true