2016-09-26T16:08:07-05:00 2015-12-31 134008324 PRICEWATERHOUSECOOPERS LLP 76 S LAURA STREET SUITE 2100 JACKSONVILLE FL 32202 990 2015-01-01 592490893 NORTH CENTRAL FLORIDA HOSPICE INC NORT 3523728400 SANTAFE HEALTHCAREINC PO BOX 749 GAINESVILLE FL 326270749 RANDALL L STUART ASSISTANT TREASURER 3523378730 2016-09-26 1 MICHAEL J MULDOON P00889797 9043540671 2015 2017-02-10 21:41:12Z HAVEN HOSPICE MICHAEL P GALLAGHER SANTAFE HEALTHCAREINC PO BOX 749 GAINESVILLE FL 326270749 73006377 0 X WWW.HAVENHOSPICE.ORG X 1982 FL HONORING LIFE BY PROVIDING COMFORT, CARE AND COMPASSION TO THOSE WE SERVE. 16 15 755 798 0 0 4570471 3482463 55670400 61430163 808258 1319537 -81215 -42894 60967914 66189269 0 0 0 0 30939112 33284280 0 0 499490 27154100 34222936 58093212 67507216 2874702 -1317947 67516285 64410582 18053444 17463002 49462841 46947580 X THE MISSION OF NORTH CENTRAL FLORIDA HOSPICE, INC. (HAVEN HOSPICE) IS TO HONOR LIFE BY PROVIDING COMFORT, CARE AND COMPASSION TO THOSE WE SERVE.NORTH CENTRAL FLORIDA HOSPICE, INC. (HAVEN HOSPICE) HELPS PATIENTS BE AS COMFORTABLE AS POSSIBLE AND PROVIDE THEIR CAREGIVERS WITH NEEDED RESOURCES AND ASSISTANCE. HAVEN HOSPICE PROVIDES THE MOST CURRENT THERAPIES AND METHODS TO MAXIMIZE COMFORT AND CARE TO PATIENTS INCLUDING ACCESS TO PROFESSIONAL STAFF AROUND THE CLOCK. HAVEN HOSPICE PROVIDES CLINICAL EDUCATION ABOUT END-OF-LIFE AND PALLIATIVE CARE, GRIEF SUPPORT TO CHILDREN AND FAMILIES AND BEREAVEMENT PROGRAMS FOR BOTH GROUPS AND INDIVIDUALS IN ITS SERVICE AREA. 0 0 30122833 46117758 HAVEN HOSPICE PROVIDED SERVICES TO 3,389 HOSPICE PATIENTS INCLUDING 259,131 DAYS OF SERVICE AND 201,756 VISITS BY NURSES, HOME HEALTH AIDES, SOCIAL WORKERS, CHAPLAINS AND PHYSICIANS TOTALING 220,414 HOURS OF CARE. INCLUDED IN THE EXPENSES IS $119,510 OF UNREIMBURSED CARE. 13079725 12440359 HAVEN HOSPICE PROVIDED SERVICES TO 2,599 PATIENTS IN INPATIENT CARE CENTERS, INCLUDING 21,644 DAYS OF SERVICE AND 109,213 VISITS BY NURSES, HOME HEALTH AIDES, SOCIAL WORKERS, CHAPLAINS AND PHYSICIANS. INCLUDED IN THE EXPENSES IS $39,571 OF UNREIMBURSED CARE. 215459 0 HAVEN HOSPICE PROVIDED BEREAVEMENT SERVICES TO THE COMMUNITIES IN WHICH IT SERVES AND TO FAMILY MEMBERS OF PATIENTS WHO HAVE DIED IN ITS CARE. THE BEREAVEMENT DEPARTMENT CONDUCTED COMMUNITY EDUCATION EVENTS WITH 6,445 ATTENDING. IN ADDITION, 17,578 SUPPORT MAILERS WERE DISTRIBUTED, 6,716 BEREAVEMENT SUPPORT PHONE CALLS WERE PLACED AND 2,871 INDIVIDUALS WERE PROVIDED EITHER GROUP, INDIVIDUAL, OR FAMILY GRIEF SUPPORT COUNSELING. 16 MEMORIAL SERVICES WERE HELD WITH AN AVERAGE ATTENDANCE OF 39 PARTICIPANTS PER SERVICE. 5 GRIEF CAMPS WERE HELD FOR 166 PARTICIPANTS. 9544498 2872046 MISCELLANEOUS PROGRAM SERVICES. 9544498 2872046 52962515 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 1 363 0 1 755 1 0 0 0 0 0 1 1 0 0 0 0 X 16 15 0 0 0 0 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X RANDALL L STUART ASST TREASURER 3523378730 4200 NW 90TH BLVD GAINESVILLE FL 326065688 X SCOTTIE J BUTLER CHAIRMAN/DIRECTOR 0.10 2.90 X X 0 72757 0 JOE G DUNLAP VICE CHAIRMAN/DIRECTOR 0.10 1.40 X X 0 56643 0 ROBERT L EPLING TREASURER/DIRECTOR 0.10 1.40 X X 0 55991 0 ALBERT E DOTSON PHD SECRETARY/DIRECTOR 0.10 1.40 X X 0 54440 0 RICHARD M ANDERSON MD DIRECTOR 0.10 1.40 X 0 52612 0 JOSEPH W DAVIS DIRECTOR 0.10 1.40 X 0 53440 0 BENJAMIN I DOERR JR DIRECTOR 0.10 2.90 X 0 57731 0 GEORGE E FLETCHER DIRECTOR 0.10 1.40 X 0 53593 0 HUGH J FLOYD DIRECTOR - THROUGH 11/4/2015 0.10 1.40 X 0 39705 0 GLENDA E HOOD DIRECTOR 0.10 1.40 X 0 56316 0 ROBERT C HUDSON DIRECTOR 0.10 1.40 X 0 52132 0 PAMELA J MOONEY PHD DIRECTOR 0.10 1.40 X 0 52631 0 THOMAS A NATIELLO PHD DIRECTOR 0.10 1.40 X 0 55990 0 PAUL R PHILIP DIRECTOR 0.10 1.40 X 0 54440 0 JACKSON N SASSER PHD DIRECTOR 0.10 1.40 X 0 56317 0 JAMES L STRINGFELLOW SR DIRECTOR 0.10 1.40 X 0 49563 0 MICHAEL P GALLAGHER CHIEF EXECUTIVE OFFICER/DIRECTOR 2.50 57.50 X X 0 2806271 46890 RANDALL L STUART ASSISTANT TREASURER 3.00 57.00 X 0 596841 134709 CATHERINE E AYERS ASSISTANT SECRETARY 14.00 46.00 X 0 540788 60570 STEVEN M ZIEGLER ASSISTANT SECRETARY 6.00 57.00 X 0 487411 126177 TIMOTHY BOWEN PRESIDENT (THROUGH 2/20/2015) 50.00 0.10 X 0 110144 22216 JAMES L POOLE PRESIDENT (INTERIM) 45.00 5.10 X 355456 0 17613 ARTHUR L CLARKE JR SVP OPERATIONS & CIO 40.00 0.00 X 320307 0 39115 CAROLYN L WEBBER HUMAN RESOURCES DIRECTOR 40.00 0.00 X 257667 0 20210 NEEL G KARNANI MD REGIONAL MEDICAL DIRECTOR 40.00 0.00 X 243455 0 22652 GERALDINE S BICHIER ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 211523 0 36472 PATRICK F WOLOSZYN ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 209126 0 32121 CATHERINE MITCHELL VP HAVEN CFO 40.00 0.00 X 200140 0 7337 1797674 5415756 566082 18 0 1 0 SANTAFE HEALTHCARE INC PO BOX 749 GAINESVILLE FL 326270749 MANAGEMENT FEES 1480658 PARRISH MCCALL CONSTRUCTORS INC PO BOX 142002 GAINESVILLE FL 326142002 CONSTRUCTION SERVICES 1222969 TERRACE OF JACKSONVILLE LLC 10680 OLD ST AUGUSTINE ROAD JACKSONVILLE FL 32257 NURSING HOME SERVICES 1209378 GRAY CONSTRUCTION SERVICES INC 222 WEST WADE STREET TRENTON FL 32693 CONSTRUCTION SERVICES 859357 SV-JUPITER PROPERTIES LLC 833 KINGSLEY AVE ORANGE PARK FL 320734701 NURSING HOME SERVICES 581804 48 68897 242970 3170596 2460539 3482463 MEDICARE REVENUE 623990 45219181 45219181 MEDICAID REVENUE 623990 12329476 12329476 PATIENT SERVICE REVENUE 623990 3881506 3881506 61430163 606376 606376 7201070 89992 6496245 81656 704825 8336 713161 713161 58515 242970 239207 -180692 -180692 ADMINISTRATIVE INCOME 900099 137798 137798 137798 66189269 61430163 0 1276643 X 26819114 20761103 5883632 174379 1231340 940368 285700 5272 3339337 2346903 972948 19486 1894489 1467446 414230 12813 611593 611593 238095 115 237980 79320 79320 14758707 13929618 782125 46964 617273 566632 50641 1254852 598350 618347 38155 736348 1057 735291 1881709 1329521 552188 1421332 997211 413990 10131 124500 5860 118640 331253 331253 1448913 1062819 386094 468006 198060 269946 BAD DEBT 5163862 5162543 1319 PHARMACY SUPPLIES 2190897 2190897 MEDICAL SUPPLIES 670680 668309 2371 COMMUNITY SUPPORT 464900 176226 109880 178794 1760696 228224 1518976 13496 67507216 52962515 14045211 499490 308444 1225997 5239205 6115214 174281 130961 4865668 3006612 370951 417481 46161735 12430889 31551693 33730846 20631361 15792981 2481768 2494390 1892914 1496100 67516285 64410582 7202443 7336587 8951965 8490078 1899036 1636337 18053444 17463002 X 47824433 45325214 1638408 1622366 49462841 46947580 67516285 64410582 X -1317947 -1114293 -83021 X X 0 1 X 1 0 X 2860145 2775032 3386291 4570471 3482463 17074402 57146734 59236900 57585078 55670400 61430163 291069275 60006879 62011932 60971369 60240871 64912626 308143677 0 0 0 308143677 382400 504167 578204 767929 606376 2839076 382400 504167 578204 767929 606376 2839076 -181250 -189792 130302 -81215 -42894 -364849 60208029 62326307 61679875 60927585 65476108 310617904 0.99200 0.99290 0.00910 0.00860 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: LIFELINE INCOME - ADMINISTRATIVE INCOME - 2011 AMOUNT: $ 19,291. 2012 AMOUNT: $ 7,188. 2013 AMOUNT: $ 310,563. 2014 AMOUNT: $ 76,847. 2015 AMOUNT: $ 137,798. SPECIAL EVENT INCOME NET - 2011 AMOUNT: $ -200,541. 2012 AMOUNT: $ -196,980. 2013 AMOUNT: $ -180,261. 2014 AMOUNT: $ -158,062. 2015 AMOUNT: $ -180,692. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 41671 41671 0 PART II-B, LINE 1: HAVEN HOSPICE IS A MEMBER OF FLORIDA HOSPICE AND PALLIATIVE CARE, INC., ALLIANCE FOR CARE, AND THE NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION AND PARTICIPATES IN LOBBYING AND STRATEGY DISCUSSIONS. HAVEN HOSPICE HAS ENGAGED THE SERVICES OF A REGISTERED LOBBYIST TO MONITOR DEVELOPMENTS AT THE ANNUAL GENERAL SESSION OF THE FLORIDA LEGISLATURE. 2249856 -1731 2248125 2099668 150188 2249856 1822987 276681 2099668 1534886 288101 1822987 1489469 45417 1534886 1.00000 0 0 4522844 4522844 35221895 7695490 27526405 535057 343128 191929 5881939 4392271 1489668 33730846 GIFT ANNUITIES 185801 DUE TO AFFILIATES 74753 CHARITABLE REMAINDER UNITRUST 942000 CONTRIBUTION PAYABLE 1187 INTEREST RATE SWAP 432596 1636337 X 66193544 80126 80126 66113418 75851 75851 66189269 67587285 239707 239707 67347578 159638 159638 67507216 PART V, LINE 4: THE HAVEN HOSPICE ENDOWMENT IS A SEPARATE ACCOUNT OF FUNDS THAT ARE HELD TO PROVIDE CURRENT AND FUTURE INCOME TO HAVEN HOSPICE IN ORDER TO OFFSET THE BURDEN OF UNCOMPENSATED CARE PROVIDED BY HAVEN HOSPICE. THE OBJECTIVE OF THE ENDOWMENT IS TO PROVIDE TIMELY FINANCIAL ASSISTANCE WHEN NEEDED AND LONG-TERM STABILITY TO HAVEN HOSPICE. PART X, LINE 2: ASC 740 FOOTNOTE: DUE TO ITS TAX-EXEMPT STATUS, THE ORGANIZATION IS NOT SUBJECT TO U.S. FEDERAL INCOME TAX OR STATE INCOME TAX. THE ORGANIZATION'S FORM 990 HAS NOT BEEN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE OR THE STATE OF FLORIDA FOR THE LAST THREE YEARS. THE ORGANIZATION DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. THE ORGANIZATION RECOGNIZES INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE. THE ORGANIZATION DID NOT HAVE ANY AMOUNTS ACCRUED FOR INTEREST AND PENALTIES AT DECEMBER 31, 2015 AND DECEMBER 31, 2014. PART XI, LINE 2D - OTHER ADJUSTMENTS: UNREIMBURSED CARE -159,081. SPECIAL EVENT EXPENSES WERE MOVED FROM EXPENSE TO REVENUE 239,707. SPECIAL EVENT EXPENSES (ST AUGUSTINE 5K) WERE MOVED FROM REVENUE TO EXPENSE -500. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS, PLEDGES, AND LAND 75,851. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES WERE MOVED FROM EXPENSE TO REVENUE 239,707. PART XII, LINE 4B - OTHER ADJUSTMENTS: UNREIMBURSED CARE 159,081. SPECIAL EVENT EXPENSES (ST AUGUSTINE 5K) WERE MOVED FROM REVENUE TO EXPENSE 500. LOSSES ON UNCOLLECTIBLE PLEDGES 57. VIVA 139675 110475 29200 1400 34054 46427 7869 14228 FALL ON THE FARM 53837 46847 6990 6435 15029 15858 600 3582 4 107973 85648 22325 2025 8695 33473 19077 4134 26321 301485 242970 58515 2025 16530 82556 81362 12603 44131 239207 -180692 1 1 0 0 0 0 0 0 0 MICHAEL P GALLAGHER CHIEF EXECUTIVE OFFICER/DIRECTOR 0 928355 0 660599 0 1217317 0 18400 0 28490 0 2853161 0 627113 RANDALL L STUART ASSISTANT TREASURER 0 386665 0 93324 0 116852 0 108243 0 26466 0 731550 0 0 CATHERINE E AYERS ASSISTANT SECRETARY 0 324095 0 79901 0 136792 0 30100 0 30470 0 601358 0 0 STEVEN M ZIEGLER ASSISTANT SECRETARY 0 325353 0 80762 0 81296 0 92687 0 33490 0 613588 0 62554 JAMES L POOLE PRESIDENT (INTERIM) 228918 0 116281 0 10257 0 8938 0 8675 0 373069 0 0 0 ARTHUR L CLARKE JR SVP OPERATIONS & CIO 182215 0 138075 0 17 0 10373 0 28742 0 359422 0 0 0 CAROLYN L WEBBER HUMAN RESOURCES DIRECTOR 122841 0 134035 0 791 0 10452 0 9758 0 277877 0 0 0 NEEL G KARNANI MD REGIONAL MEDICAL DIRECTOR 242174 0 300 0 981 0 9530 0 13122 0 266107 0 0 0 GERALDINE S BICHIER ASSOCIATE MEDICAL DIRECTOR 210265 0 300 0 958 0 8292 0 28180 0 247995 0 0 0 PATRICK F WOLOSZYN ASSOCIATE MEDICAL DIRECTOR 207931 0 225 0 970 0 4425 0 27696 0 241247 0 0 0 CATHERINE MITCHELL VP HAVEN CFO 102698 0 34650 0 62792 0 1810 0 5527 0 207477 0 0 0 PART I, LINE 3 MICHAEL P GALLAGHER IS THE CHIEF EXECUTIVE OFFICER (CEO) OF NORTH CENTRAL FLORIDA HOSPICE, INC. (HAVEN HOSPICE). MR. GALLAGHER IS COMPENSATED BY SANTAFE HEALTHCARE, INC., A RELATED SUPPORTING ORGANIZATION. SANTAFE HEALTHCARE, INC. UTILIZES THE FOLLOWING PROCESS TO ESTABLISH THE CEO'S COMPENSATION AND BENEFITS: THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS ANNUALLY RETAINS AN INDEPENDENT THIRD PARTY COMPENSATION AND BENEFITS CONSULTING FIRM (FIRM) TO CONDUCT A MARKET COMPETITIVENESS REVIEW OF THE CEO'S TOTAL DIRECT COMPENSATION (BASE SALARY, ANNUAL INCENTIVES, AND LONG TERM INCENTIVES) AND BENEFITS. THE COMPETITIVE ANALYSIS INCLUDES COMPARISON TO SIMILAR POSITIONS IN COMPANIES OF SIMILAR SIZE WITHIN THE SAME OR SIMILAR INDUSTRY. THE FIRM MAKES RECOMMENDATIONS, IF ANY, DIRECTLY TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS ESTABLISHES THE FINAL COMPENSATION AND BENEFIT PACKAGE FOR THE CEO TAKING INTO CONSIDERATION THE MARKET COMPETITIVENESS REVIEW AND FINAL RECOMMENDATION OF THE FIRM. THE FIRM PROVIDES AN OPINION LETTER REGARDING THE REASONABLENESS OF THE CEO'S FINAL COMPENSATION AND BENEFITS PACKAGE. THE ACTIONS OF THE BOARD ARE DOCUMENTED IN THE MINUTES OF THE BOARD MEETING. PART I, LINES 4A-B (RELATES TO PART I, LINE 4A): LISTED PERSONS WHO ARE EMPLOYEES OF HAVEN HOSPICE ARE NOT COVERED BY A SEVERANCE POLICY; SEVERANCE IS HANDLED ON A CASE BY CASE BASIS. CERTAIN LISTED PERSONS, EXCLUDING OUTSIDE DIRECTORS OR EMPLOYEES OF HAVEN HOSPICE, ARE EMPLOYEES OF RELATED ORGANIZATIONS AND ARE COVERED UNDER A SEVERANCE POLICY FOR THEIR RESPECTIVE RELATED ORGANIZATION. THE SEVERANCE POLICY INCLUDES MONTHLY PAYMENTS UP TO A MAXIMUM OF 12 - 36 MONTHS UNDER QUALIFYING CIRCUMSTANCES AND DEPENDING ON POSITION. LISTED PERSONS ACTUALLY RECEIVING A SEVERANCE PAYMENT OR CHANGE OF CONTROL PAYMENT IN THE YEAR: CATHERINE MITCHELL RECEIVED $60,024 IN COMPENSATION PAYMENTS DUE TO A SEVERANCE AGREEMENT. PART I, LINE 4B: LISTED PERSONS PARTICIPATING IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN THE YEAR: MICHAEL P GALLAGHER, RANDALL L STUART, AND TIMOTHY J BOWEN (THROUGH 02/20/2015) ARE EMPLOYEES OF SANTAFE HEALTHCARE, INC., A RELATED SUPPORTING ORGANIZATION. MR. GALLAGHER, MR. STUART, AND MR. BOWEN PARTICIPATE IN TWO NONQUALIFIED DEFERRED COMPENSATION RETIREMENT PLANS SPONSORED BY SANTAFE HEALTHCARE, INC. FOR A CERTAIN GROUP OF EXECUTIVES. ONE PLAN RESTORES RETIREMENT BENEFITS EQUIVALENT TO QUALIFIED 401(K) BENEFITS ON INCOME EARNED IN EXCESS OF THE INTERNAL REVENUE SERVICE CODE SECTION 401(A)(17) RECOGNIZABLE PAY LIMITS (A DEFINED CONTRIBUTION RESTORATION PLAN). VESTING FOR THIS PLAN IS ACHIEVED AT AGE 55 AND 10 YEARS OF SERVICE OR AT AGE 65 AND 5 YEARS OF SERVICE. THE SECOND SUPPLEMENTAL DEFINED CONTRIBUTION PLAN PROVIDES ADDITIONAL RETIREMENT INCOME BASED ON A PERCENTAGE OF BASE SALARY AND VESTS AT THREE AND FIVE YEARS OF SERVICE. MR. GALLAGHER VESTED AND RECEIVED $1,081,328 FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS IN 2015. MR. STUART VESTED AND RECEIVED $92,722 FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN 2015. CATHERINE E AYERS AND STEVEN M ZIEGLER ARE EMPLOYEES OF AVMED, INC., A RELATED TAX-EXEMPT ORGANIZATION. THEY PARTICIPATE IN TWO NONQUALIFIED DEFERRED COMPENSATION RETIREMENT PLANS SPONSORED BY AVMED, INC. FOR A CERTAIN GROUP OF EXECUTIVES. ONE PLAN RESTORES RETIREMENT BENEFITS EQUIVALENT TO QUALIFIED 401(K) BENEFITS ON INCOME EARNED IN EXCESS OF THE INTERNAL REVENUE SERVICE CODE SECTION 401(A)(17) RECOGNIZABLE PAY LIMITS (A DEFINED CONTRIBUTION RESTORATION PLAN). VESTING IS ACHIEVED AT AGE 55 AND 10 YEARS OF SERVICE OR AT AGE 65 AND 5 YEARS OF SERVICE. THE SECOND SUPPLEMENTAL DEFINED CONTRIBUTION PLAN PROVIDES ADDITIONAL RETIREMENT INCOME BASED ON A PERCENTAGE OF BASE SALARY AND VESTS AT THREE AND FIVE YEARS OF SERVICE. MS. AYERS VESTED AND RECEIVED $108,699 FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS IN 2015. MR. ZIEGLER VESTED AND RECEIVED $69,233 FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN 2015. SCHEDULE J, PART II: CERTAIN SENIOR EXECUTIVES ARE ACCOUNTABLE FOR AND PERFORM SERVICES FOR SANTAFE HEALTHCARE, INC. AND EACH OF ITS AFFILIATES. SANTAFE HEALTHCARE, INC. AND AFFILIATES REPRESENT A DIVERSIFIED FAMILY OF NOT-FOR-PROFIT ORGANIZATIONS WITH $2 BILLION IN GROSS RECEIPTS AND APPROXIMATELY 2,200 EMPLOYEES. THESE SENIOR EXECUTIVES ARE PAID DIRECTLY BY EITHER SANTAFE HEALTHCARE, INC., AVMED, INC. OR NORTH CENTRAL FLORIDA HOSPICE, INC. AND THEIR COMPENSATION AND BENEFITS ARE APPORTIONED AND CHARGED TO THE RESPECTIVE AFFILIATE BASED ON THE ESTIMATED AMOUNT OF TIME SPENT ON EACH AFFILIATE'S ACTIVITIES. FOR 2015, THE FOLLOWING PERCENTAGES OF EACH EXECUTIVE'S COMPENSATION AND BENEFITS (FOR THOSE SENIOR EXECUTIVES PAID BY A RELATED ORGANIZATION) ARE APPORTIONED AND CHARGED TO NORTH CENTRAL FLORIDA HOSPICE, INC. AS FOLLOWS: 4% - MICHAEL P GALLAGHER, CHIEF EXECUTIVE OFFICER 100% - TIMOTHY J BOWEN, PRESIDENT (OUTGOING) 90% - JAMES L POOLE, PRESIDENT (INTERIM) 5% - RANDALL L STUART, ASSISTANT TREASURER 22% - CATHERINE E AYERS, ASSISTANT SECRETARY 10% - STEVEN M ZIEGLER, ASSISTANT SECRETARY A CLAY COUNTY DEVELOPMENT AUTHORITY 596583087 2011-12-21 10000000 CONSTRUCT HOSPICE CARE FACILITY 0 0 0 B ALACHUA COUNTY HEALTH FACILITIES AUTHORITY 592442398 2015-12-15 8600000 HOSPICE CARE FACILITY EXPANSION 0 0 0 A 1572052 10000000 103585 9896415 2012 0 0 1 1 B 8600000 62130 8537870 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 1 PNC BANK 18.500000000000 0 0 0 0 1 B 0 1 0 0 1 1 BBVA COMPASS 11.500000000000 0 0 0 0 1 A 1 B 1 SCHEDULE K, PARTS I AND II ADDITIONAL INFORMATION REGARDING THE BONDS ISSUE: THE CLAY COUNTY DEVELOPMENT AUTHORITY BONDS WERE ISSUED AS A DRAW-DOWN LOAN FOR THE ACQUISITION OF REAL PROPERTY AND CONSTRUCTION OF A HOSPICE FACILITY. THE FACILITY WAS COMPLETED AND PLACED IN SERVICE DURING 2012, AND THE ENTIRE BALANCE OF THE LOAN WAS DRAWN DOWN. THE ALACHUA COUNTY HEALTH FACILITIES AUTHORITY BONDS WERE ISSUED AS A DRAW-DOWN LOAN FOR EXPANSION OF THE E.T. YORK CARE CENTER. THE ISSUE PRICE AND PROCEEDS AMOUNTS SHOWN ON PARTS I AND II ARE THE MAXIMUM AMOUNT OF THE LOAN. AS OF THE END OF THE REPORTING YEAR, LESS THAN THE ENTIRE BALANCE OF THE LOAN HAD BEEN DRAWN DOWN. SCHEDULE K, PART II, LINE 17, COLUMN B: ALTHOUGH A FINAL ALLOCATION OF THE ALACHUA COUNTY HEALTH FACILITIES AUTHORITY BOND PROCEEDS WAS NOT COMPLETE AS OF 12/31/2015, THE ORGANIZATION MAINTAINED ADEQUATE BOOKS AND RECORDS TO SUPPORT THE ALLOCATIONS MADE THROUGH 12/31/2015. ONCE THE ALLOCATION OF PROCEEDS IS COMPLETE, THE BOOKS AND RECORDS WILL SUPPORT THE FINAL ALLOCATION. X 2423830 RESALE VALUE X 6 26967 FMV & PLEDGED AMOUNT X 1 9742 RECORDED BOOK VALUE 0 1 0 PART I, COLUMN (B): LINE 9 - THIS FIGURE REPRESENTS THE NUMBER OF ITEMS RECEIVED. FORM 990, PART VI, SECTION A, LINE 7A HAVEN HOSPICE'S ARTICLES OF INCORPORATION AND BYLAWS STATE THAT THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS SHALL CONSTITUTE THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS CONSTITUTES THE ORGANIZATION'S BOARD OF DIRECTORS, WHICH MAKES ALL GOVERNANCE DECISIONS OF THE ORGANIZATION. THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS HAS THE POWER AND AUTHORITY TO ESTABLISH COMMITTEES, TO ELECT AND REMOVE OFFICERS, TO APPROVE AMENDMENTS OF THE ORGANIZATION'S GOVERNING DOCUMENTS, AND TO MODIFY, AMEND, RESCIND, OR REPEAL ANY ACTION TAKEN BY THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S PROCESS FOR ENSURING THE ACCURATE PREPARATION, REVIEW AND APPROVAL OF THE 2015 FORM 990 BEGAN WITH PROFESSIONAL DEVELOPMENT OF STAFF (SEVERAL OF WHICH ARE CPAS) WHICH WERE INVOLVED IN THE PREPARATION OF THE 2015 FORM 990. IN ADDITION TO STAFF DEVELOPMENT, WHICH INCLUDED ATTENDING TAX SEMINARS AND CLASSES, MANAGEMENT ALSO CONSULTED WITH INDEPENDENT ACCOUNTING FIRMS AND TAX LEGAL COUNSEL REGARDING THE IRS FORM 990 CODE AND FILING REQUIREMENTS. THE ORGANIZATION ALSO PREVIOUSLY EDUCATED ITS MANAGEMENT TEAM, OFFICERS AND DIRECTORS, WITH THE ASSISTANCE OF PRICEWATERHOUSECOOPERS LLP, REGARDING THE FORM 990 AND THEIR INVOLVEMENT IN REVIEWING THE RETURN. FOLLOWING MANAGEMENT'S PREPARATION OF THE 2015 FORM 990, PRICEWATERHOUSECOOPERS LLP REVIEWED THE 2015 FORM 990. A COPY OF THE 2015 FORM 990 AND ATTACHMENTS WERE PROVIDED TO THE ORGANIZATION'S CURRENT BOARD OF DIRECTORS FOR THEIR REVIEW AND COMMENT. EXECUTIVE MANAGEMENT ADDRESSED ANY QUESTIONS RAISED BY THE BOARD MEMBERS PRIOR TO FILING THE 2015 FORM 990 AND ATTACHMENTS WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C HAVEN HOSPICE HAS A PROCEDURE FOR MONITORING AND ENFORCING COMPLIANCE WITH ITS CORPORATE CONFLICT OF INTEREST POLICY (POLICY). EACH COVERED PERSON SHALL RECEIVE A COPY OF THE POLICY FOR REVIEW, SUBMIT AN AFFIRMATION, AND COMPLETE A QUESTIONNAIRE WHICH IS ATTACHED TO THE CODE OF ETHICAL BUSINESS CONDUCT. THE PROCEDURE DETAILS THAT THE CORPORATE SECRETARY HAS RESPONSIBILITY FOR DELIVERY OF THE POLICY TO DIRECTORS AND OFFICERS AND RECEIPT OF THEIR AFFIRMATIONS AND QUESTIONNAIRES. THE HUMAN RESOURCES DEPARTMENT SHALL OBTAIN THE AFFIRMATION AND QUESTIONNAIRE FROM EVERY NEW EMPLOYEE AT ORIENTATION AND FROM ALL EMPLOYEES ANNUALLY. MEMBERS OF CORPORATE ADVISORY BOARDS SUBMIT THE AFFIRMATION AND QUESTIONNAIRE TO THE CHIEF COMPLIANCE OFFICER. ANNUAL CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY INTERNAL STAFF TO ENSURE RECORDS ARE COMPLETE. AS PART OF THE CORPORATE CONTRACT REVIEW PROCESS, CONSIDERATION IS GIVEN TO ANY POTENTIAL CONFLICTS OF INTEREST INVOLVING OPERATIONAL OR FINANCIAL TRANSACTIONS. ALL EMPLOYEES ARE EXPECTED TO DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICT. INITIAL REVIEW OF EMPLOYEE QUESTIONNAIRES WILL BE PERFORMED BY THE HUMAN RESOURCES DEPARTMENT WITH REVIEW OF ANY DISCLOSURES BY THE CHIEF COMPLIANCE OFFICER WHO WILL EVALUATE, MAKE NECESSARY INQUIRIES, AND INVESTIGATE ALTERNATIVES. BOARD MEMBERS SHALL DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICT TO THE CHAIRMAN OF THE SANTAFE HEALTHCARE, INC. BOARD, AND THE CHAIRMAN OR CHIEF COMPLIANCE OFFICER SHALL EVALUATE CONFLICT DISCLOSURES AND, IF APPROPRIATE, INVESTIGATE ALTERNATIVES AND REPORT TO DISINTERESTED BOARD MEMBERS FOR RESOLUTION. THE MINUTES OF THE BOARD OR ANY COMMITTEE MEETING AT WHICH A POTENTIAL OR ACTUAL CONFLICT OF INTEREST IS DISCLOSED OR DISCUSSED SHALL REFLECT THE NAME OF THE INTERESTED PARTY, THE NATURE OF THE CONFLICT, THE DELIBERATIONS AND THE RESOLUTION OF THE CONFLICT. IF IT IS DETERMINED THAT A COVERED PERSON HAS FAILED TO COMPLY WITH THE POLICY, THE CHIEF COMPLIANCE OFFICER OR THE CHAIRMAN SHALL TAKE APPROPRIATE ACTION, WHICH MAY INCLUDE REMOVAL FROM OFFICE OR TERMINATION OF EMPLOYMENT. FORM 990, PART VI, SECTION B, LINE 15 MICHAEL P GALLAGHER IS THE CHIEF EXECUTIVE OFFICER (CEO) OF HAVEN HOSPICE. MR. GALLAGHER IS COMPENSATED BY SANTAFE HEALTHCARE, INC., A RELATED SUPPORTING ORGANIZATION. SANTAFE HEALTHCARE, INC. UTILIZES THE FOLLOWING PROCESS TO ESTABLISH THE CEO'S COMPENSATION AND BENEFITS: THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS ANNUALLY RETAINS AN INDEPENDENT THIRD PARTY COMPENSATION AND BENEFITS CONSULTING FIRM (FIRM) TO CONDUCT A MARKET COMPETITIVENESS REVIEW OF THE CEO'S TOTAL DIRECT COMPENSATION (BASE SALARY, ANNUAL INCENTIVES, AND LONG TERM INCENTIVES) AND BENEFITS. THE COMPETITIVE ANALYSIS INCLUDES COMPARISON TO SIMILAR POSITIONS IN COMPANIES OF SIMILAR SIZE WITHIN THE SAME OR SIMILAR INDUSTRY. THE FIRM MAKES RECOMMENDATIONS, IF ANY, DIRECTLY TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS ESTABLISHES THE FINAL COMPENSATION AND BENEFIT PACKAGE FOR THE CEO TAKING INTO CONSIDERATION THE MARKET COMPETITIVENESS REVIEW AND FINAL RECOMMENDATION OF THE FIRM. THE FIRM PROVIDES AN OPINION LETTER REGARDING THE REASONABLENESS OF THE FINAL COMPENSATION AND BENEFITS PACKAGE. THE ACTIONS OF THE BOARD ARE DOCUMENTED IN THE MINUTES OF THE BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 15B: PROCESS FOR DETERMINING COMPENSATION FOR THE NON-DIRECTOR OFFICERS, PRESIDENT, CHIEF MEDICAL OFFICER, AND DIRECTORS OF HAVEN HOSPICE IS AS FOLLOWS: THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS ANNUALLY RETAINS AN INDEPENDENT THIRD PARTY COMPENSATION AND BENEFITS FIRM (FIRM) TO CONDUCT A MARKET COMPETITIVENESS REVIEW OF THE AFOREMENTIONED OFFICERS' TOTAL DIRECT COMPENSATION (BASE SALARY, ANNUAL INCENTIVES, AND LONG-TERM INCENTIVES) AND BENEFITS. THE COMPETITIVE ANALYSIS INCLUDES COMPARISONS TO SIMILAR POSITIONS IN COMPANIES OF SIMILAR SIZE WITHIN THE SAME OR SIMILAR INDUSTRY. AFTER COMPLETION OF ITS REVIEW, THE FIRM MAKES RECOMMENDATIONS, IF ANY, DIRECTLY TO THE BOARD OF DIRECTORS. THE FIRM PROVIDES AN OPINION LETTER REGARDING THE REASONABLENESS OF TOTAL DIRECT COMPENSATION AND EXECUTIVE BENEFITS. THE ACTIONS OF THE BOARD ARE DOCUMENTED IN THE MINUTES OF THE BOARD MEETINGS. THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS RETAINS AN INDEPENDENT THIRD PARTY CONSULTANT TO CONDUCT A MARKET COMPETITIVENESS REVIEW OF THE BOARD OF DIRECTORS' (INCLUDING OFFICER POSITIONS) COMPENSATION EVERY TWO TO THREE YEARS. THE COMPETITIVENESS ANALYSIS INCLUDES COMPARISONS TO BOTH NOT-FOR-PROFIT AND PUBLIC COMPANY (EXCLUDING EQUITY COMPONENT) DATA FOR COMPANIES WITHIN THE SAME OR SIMILAR INDUSTRY. ANY COMPENSATION CHANGES ARE APPROVED BY THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS BASED ON THE MARKET COMPETITIVENESS STUDY. A MARKET COMPETITIVENESS STUDY WAS CONDUCTED IN NOVEMBER 2014 FOR CHANGES MADE EFFECTIVE JANUARY 1, 2015. NO DIRECTOR FEES WERE ALLOCATED TO HAVEN HOSPICE DURING 2015. FORM 990, PART VI, SECTION C, LINE 19 HAVEN HOSPICE'S PROCEDURE FOR MAKING VARIOUS DOCUMENTS AVAILABLE TO THE PUBLIC: HAVEN HOSPICE MAKES ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC ON A CASE BY CASE BASIS IF REQUESTED DIRECTLY FROM THE ORGANIZATION. THE ARTICLES OF INCORPORATION CAN BE ACCESSED DIRECTLY THROUGH THE FLORIDA DEPARTMENT OF STATE, DIVISION OF CORPORATIONS WEBSITE AT WWW.SUNBIZ.ORG. THE CORPORATE BYLAWS, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS CAN BE OBTAINED DIRECTLY FROM THE ORGANIZATION UPON WRITTEN REQUEST. FORM 990, PART VII, SECTION A, LINE 1A: CERTAIN SENIOR EXECUTIVES ARE ACCOUNTABLE FOR AND PERFORM SERVICES FOR SANTAFE HEALTHCARE, INC. AND EACH OF ITS AFFILIATES. SANTAFE HEALTHCARE, INC. AND AFFILIATES REPRESENT A DIVERSIFIED FAMILY OF NOT-FOR-PROFIT ORGANIZATIONS WITH $2 BILLION IN GROSS RECEIPTS AND APPROXIMATELY 2,200 EMPLOYEES. THESE SENIOR EXECUTIVES ARE PAID DIRECTLY BY EITHER SANTAFE HEALTHCARE, INC., AVMED, INC. OR NORTH CENTRAL FLORIDA HOSPICE, INC. AND THEIR COMPENSATION AND BENEFITS ARE APPORTIONED AND CHARGED TO THE RESPECTIVE AFFILIATE BASED ON THE ESTIMATED AMOUNT OF TIME SPENT ON EACH AFFILIATE'S ACTIVITIES. FOR 2015, THE FOLLOWING PERCENTAGES OF EACH EXECUTIVE'S COMPENSATION AND BENEFITS (FOR THOSE SENIOR EXECUTIVES PAID BY A RELATED ORGANIZATION) ARE APPORTIONED AND CHARGED TO NORTH CENTRAL FLORIDA HOSPICE, INC. AS FOLLOWS: 4% - MICHAEL P GALLAGHER, CHIEF EXECUTIVE OFFICER 100% - TIMOTHY J BOWEN, PRESIDENT (OUTGOING) 90% - JAMES L POOLE, PRESIDENT (INTERIM) 5% - RANDALL L STUART, ASSISTANT TREASURER 22% - CATHERINE E AYERS, ASSISTANT SECRETARY 10% - STEVEN M ZIEGLER, ASSISTANT SECRETARY FORM 990, PART IX, LINE 11G MEDICAL : PROGRAM SERVICE EXPENSES 11,873,912. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,873,912. CONTRACT LABOR : PROGRAM SERVICE EXPENSES 1,832,082. MANAGEMENT AND GENERAL EXPENSES 237,842. FUNDRAISING EXPENSES 46,964. TOTAL EXPENSES 2,116,888. CONSULTING : PROGRAM SERVICE EXPENSES 87,961. MANAGEMENT AND GENERAL EXPENSES 539,321. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 627,282. SECURITY : PROGRAM SERVICE EXPENSES 3,616. MANAGEMENT AND GENERAL EXPENSES 3,681. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,297. OTHER PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 132,047. MANAGEMENT AND GENERAL EXPENSES 1,281. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 133,328. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF CHARITABLE REMAINDER UNITRUST (CRUT) 913. CHANGE IN NET UNREALIZED GAINS/LOSSES ON CRUT -49,707. NET ASSETS RELEASED FOR OPERATIONS (RECOGNIZED FOR TAX IN PRIOR YEARS) -6,706. CHANGE IN NET UNREALIZED GAINS/LOSSES ON INTEREST RATE SWAP -27,578. LOSSES ON UNCOLLECTIBLE PLEDGES 57. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE FROM THE PRIOR YEAR TO THE PROCESS RELATED TO AUDIT OVERSIGHT AND SELECTION OF THE INDEPENDENT ACCOUNTANT FOR THE ORGANIZATION. 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