2015-09-28T09:38:22-05:00 2014-12-31 134008324 PRICEWATERHOUSECOOPERS LLP 76 S LAURA STREET SUITE 2100 JACKSONVILLE FL 32202 990 2014-01-01 592490893 NORTH CENTRAL FLORIDA HOSPICE INC NORT 3523728400 SANTAFE HEALTHCAREINC PO BOX 749 GAINESVILLE FL 326270749 RANDALL L STUART ASSISTANT TREASURER 3523378730 2015-09-25 1 MICHAEL J MULDOON P00889797 9043540671 2014 2016-04-25 22:37:26Z HAVEN HOSPICE MICHAEL P GALLAGHER SANTAFE HEALTHCAREINC PO BOX 749 GAINESVILLE FL 326270749 64721543 0 X WWW.HAVENHOSPICE.ORG X 1982 FL HONORING LIFE BY PROVIDING COMFORT, CARE AND COMPASSION TO THOSE WE SERVE. 17 16 727 717 0 0 5096349 4570471 57585078 55670400 667897 808258 130302 -81215 63479626 60967914 0 0 0 0 32176682 30939112 0 0 589918 27182907 27154100 59359589 58093212 4120037 2874702 66205247 67516285 20146122 18053444 46059125 49462841 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 24546508 40030061 HAVEN HOSPICE PROVIDED SERVICES TO 4,409 HOSPICE PATIENTS INCLUDING 249,024 DAYS OF SERVICE AND 178,554 VISITS BY NURSES, HOME HEALTH AIDES, SOCIAL WORKERS, CHAPLAINS AND PHYSICIANS TOTALING 199,079 HOURS OF CARE. INCLUDED IN THE EXPENSES IS $119,255 OF UNREIMBURSED CARE. 10875313 12680143 HAVEN HOSPICE PROVIDED SERVICES TO 2,673 PATIENTS IN INPATIENT CARE CENTERS, INCLUDING 23,652 DAYS OF SERVICE AND 103,024 VISITS BY NURSES, HOME HEALTH AIDES, SOCIAL WORKERS, CHAPLAINS AND PHYSICIANS. INCLUDED IN THE EXPENSES IS $188,032 OF UNREIMBURSED CARE. 208380 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 7,719 ATTENDING. IN ADDITION, 16,266 SUPPORT MAILERS WERE DISTRIBUTED, 6,193 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 WITH AN ATTENDANCE OF 36 CHILDREN AND 14 ADULTS. 9007006 2960196 MISCELLANEOUS PROGRAM SERVICES 9007006 2960196 44637207 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 1 341 0 1 727 1 0 0 0 0 0 1 1 0 0 0 0 X 17 16 0 0 1 0 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X ALAN FEHLNER 3522714679 4200 NW 90TH BLVD GAINESVILLE FL 326065688 X SCOTTIE J BUTLER CHAIRMAN/DIRECTOR 0.20 2.80 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 57624 0 ALBERT E DOTSON PHD SECRETARY/DIRECTOR 0.10 1.40 X X 0 51390 0 RICHARD M ANDERSON MD DIRECTOR 0.10 1.40 X 0 53132 0 JOSEPH W DAVIS DIRECTOR 0.10 1.40 X 0 55420 0 BEN I DOERR JR DIRECTOR 0.20 2.80 X 0 58059 0 GEORGE E FLETCHER DIRECTOR 0.10 1.40 X 0 53112 0 HUGH J FLOYD DIRECTOR 0.10 1.40 X 0 53920 0 GLENDA E HOOD DIRECTOR 0.10 1.40 X 0 56816 0 ROBERT C HUDSON DIRECTOR 0.10 1.40 X 0 52459 0 GORDON L JOHNSON DIRECTOR - THROUGH 12/10/2014 0.10 1.40 X 0 55663 0 PAMELA J MOONEY PHD DIRECTOR 0.10 1.40 X 0 49236 0 THOMAS A NATIELLO PHD DIRECTOR 0.10 1.40 X 0 54113 0 PAUL R PHILIP DIRECTOR 0.10 1.40 X 0 55420 0 JACKSON N SASSER PHD DIRECTOR 0.10 1.40 X 0 56316 0 JAMES L STRINGFELLOW SR DIRECTOR 0.10 1.40 X 0 54267 0 MICHAEL P GALLAGHER CHIEF EXECUTIVE OFFICER/DIRECTOR 3.00 57.00 X X 0 2790372 280950 RANDALL L STUART ASSISTANT TREASURER 3.00 57.00 X 0 768166 154160 CATHERINE E AYERS ASSISTANT SECRETARY 4.00 56.00 X 0 890578 68183 STEVEN M ZIEGLER ASSISTANT SECRETARY 6.00 57.00 X 0 606113 140971 TIMOTHY J BOWEN PRESIDENT 50.00 0.10 X 0 569190 92617 FERNANDO PETRY DO CHIEF MEDICAL OFFICER 40.00 0.00 X 290516 0 31571 NEEL G KARNANI MD ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 227709 0 23343 DOUGLAS A ROGERS DO ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 221510 0 43415 SHARON P SAUCIER CHIEF OPERATING OFFICER 40.00 0.00 X 213110 0 28330 JOHN L SIMONS DO ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 189736 0 25402 1142581 6570766 888942 20 0 1 0 SANTAFE HEALTHCARE INC PO BOX 749 GAINESVILLE FL 326270749 MANAGEMENT FEES 1113533 PARRISH MCCALL CONSTRUCTORS INC PO BOX 142002 GAINESVILLE FL 326142002 CONSTRUCTION SERVICES 743455 TERRACE OF JACKSONVILLE LLC 10680 OLD ST AUGUSTINE ROAD JACKSONVILLE FL 32257 NURSING HOME SERVICES 563541 PHOENIX HEALTHCARE PROPERTIES OF MANDARI 10680 OLD ST AUGUSTINE ROAD JACKSONVILLE FM 32257 NURSING HOME SERVICES 519500 SV-JUPITER PROPERTIES INC 833 KINGSLEY AVE ORANGE PARK FL 320734701 NURSING HOME SERVICES 470283 45 69822 240455 4260194 2746246 4570471 MEDICARE REVENUE 623990 41718059 41718059 MEDICAID REVENUE 623990 10927284 10927284 PATIENT SERVICE REVENUE 623990 3025057 3025057 55670400 767929 767929 3571115 3523741 7045 47374 -7045 40329 40329 64781 240455 222843 -158062 -158062 ADMINISTRATIVE INCOME 900099 76847 76847 76847 60967914 55670400 0 727043 X 24693009 18768810 5688997 235202 1265792 987698 272625 5469 3264311 2329599 893141 41571 1716000 1329717 365896 20387 1113533 1113533 173085 173085 63154 63154 13515513 12670091 804989 40433 656749 656749 1265446 596457 616583 52406 652200 652200 1794913 1224520 570393 1328362 932377 381858 14127 51163 12347 38274 542 349400 349400 1427284 1025350 401934 406957 175581 231376 PHARMACY SUPPLIES 1887791 1887791 BAD DEBT 711570 703085 8485 COMMUNITY SUPPORT 606103 319219 122703 164181 MEDICAL SUPPLIES 498064 495157 2907 652813 173259 463954 15600 58093212 44637207 12866087 589918 199011 308444 7705477 5239205 51627 174281 2680067 4865668 323053 370951 42604002 11052309 31461872 31551693 19672534 20631361 2328658 2481768 1782948 1892914 66205247 67516285 8486335 7202443 9475983 8951965 2183804 1899036 20146122 18053444 X 45674754 47824433 384371 1638408 46059125 49462841 66205247 67516285 X 2874702 718504 -189490 X X 0 1 X 1 0 X 2002280 2860145 2775032 3386291 4570471 15594219 54590670 57146734 59236900 57585078 55670400 284229782 56592950 60006879 62011932 60971369 60240871 299824001 0 0 0 299824001 376917 382400 504167 578204 767929 2609617 376917 382400 504167 578204 767929 2609617 -134428 -181250 -189792 130302 -81215 -456383 56835439 60208029 62326307 61679875 60927585 301977235 0.99290 0.99450 0.00860 0.00710 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: LIFELINE INCOME - ADMINISTRATIVE INCOME - 2010 AMOUNT: $ 12,271. 2011 AMOUNT: $ 19,291. 2012 AMOUNT: $ 7,188. 2013 AMOUNT: $ 310,563. 2014 AMOUNT: $ 76,847. SPECIAL EVENT INCOME NET - 2010 AMOUNT: $ -146,699. 2011 AMOUNT: $ -200,541. 2012 AMOUNT: $ -196,980. 2013 AMOUNT: $ -180,261. 2014 AMOUNT: $ -158,062. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 42104 42104 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. 2099668 150188 2249856 1822987 276681 2099668 1534886 288101 1822987 1489469 45417 1534886 1373367 116102 1489469 1.00000 0 0 4513102 4513102 32025522 6829116 25196406 610741 255952 354789 5454637 3967241 1487396 31551693 GIFT ANNUITIES 244050 DUE TO AFFILIATES 183766 CAPITAL LEASE OBLIGATION 31776 CHARITABLE REMAINDER UNITRUST 1032248 CONTRIBUTION PAYABLE 2178 INTEREST RATE SWAP 405018 1899036 X 59622087 -84444 -84444 59706531 1261383 1261383 60967914 58005845 -87367 -87367 58093212 0 58093212 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, 2014 AND DECEMBER 31, 2013. PART XI, LINE 2D - OTHER ADJUSTMENTS: UNREIMBURSED CARE -307,287. SPECIAL EVENT EXPENSES 222,843. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS 1,261,383. PART XII, LINE 2D - OTHER ADJUSTMENTS: UNREIMBURSED CARE -307,287. SPECIAL EVENT EXPENSES 222,843. LOSSES ON UNCOLLECTIBLE PLEDGES -2,923. VIVA 164595 124115 40480 0 6979 58365 42810 8950 7152 FALL ON THE RANGE 66585 57165 9420 0 21060 5758 11642 1128 3519 4 74056 59175 14881 0 7662 20474 18153 1840 7351 305236 240455 64781 35701 84597 72605 11918 18022 222843 -158062 0 1 0 0 0 0 0 0 0 MICHAEL P GALLAGHER CHIEF EXECUTIVE OFFICER/DIRECTOR 0 925247 0 1326646 0 538479 0 254966 0 25984 0 3071322 0 207121 RANDALL L STUART ASSISTANT TREASURER 0 384984 0 237560 0 145622 0 131130 0 23030 0 922326 0 0 CATHERINE E AYERS ASSISTANT SECRETARY 0 320919 0 203097 0 366562 0 35900 0 32283 0 958761 0 0 STEVEN M ZIEGLER ASSISTANT SECRETARY 0 325228 0 202887 0 77998 0 110220 0 30751 0 747084 0 61592 TIMOTHY J BOWEN PRESIDENT 0 305724 0 209689 0 53777 0 69731 0 22886 0 661807 0 29022 FERNANDO PETRY DO CHIEF MEDICAL OFFICER 220316 0 69877 0 323 0 8906 0 22665 0 322087 0 0 0 NEEL G KARNANI MD ASSOCIATE MEDICAL DIRECTOR 226202 0 0 0 1507 0 15898 0 7445 0 251052 0 0 0 DOUGLAS A ROGERS DO ASSOCIATE MEDICAL DIRECTOR 219769 0 0 0 1741 0 16259 0 27156 0 264925 0 0 0 SHARON P SAUCIER CHIEF OPERATING OFFICER 155901 0 56000 0 1209 0 15282 0 13048 0 241440 0 0 0 JOHN L SIMONS DO ASSOCIATE MEDICAL DIRECTOR 188270 0 0 0 1466 0 10798 0 14604 0 215138 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, LINE 4B (RELATES TO PART I, LINE 4A): LISTED PERSONS WHO ARE EMPLOYEES OF HAVEN HOSPICE ARE NOT COVERED BY A SEVERANCE POLICY. CERTAIN LISTED PERSONS EXCLUDING OUTSIDE DIRECTORS OR EMPLOYEES OF HAVEN HOSPICE ARE EMPLOYESS 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 DEPENDING ON POSITION. NO ONE LISTED RECEIVED SEVERANCE OR CHANGE OF CONTROL PAYMENTS DURING 2014. 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 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 $437,059 FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS IN 2014. MR. STUART VESTED AND RECEIVED $109,740 FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN 2014. MR. BOWEN VESTED AND RECEIVED $38,042 FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN 2014. 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 $339,470 FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS IN 2014. MR. ZIEGLER VESTED AND RECEIVED $66,343 FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN 2014. 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 2,000 EMPLOYEES. THESE SENIOR EXECUTIVES ARE PAID DIRECTLY BY EITHER SANTAFE HEALTHCARE, INC. OR AVMED, 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 2014, THE FOLLOWING PERCENTAGES OF EACH EXECUTIVE'S COMPENSATION AND BENEFITS (FOR THOSE SENIOR EXECUTIVES PAID BY A RELATED ORGANIZATION) ARE APPORTIONED AND CHARGED TO HAVEN HOSPICE AS FOLLOWS: 5% - MICHAEL P GALLAGHER, CHIEF EXECUTIVE OFFICER 100% - TIMOTHY J BOWEN, PRESIDENT 5% - RANDALL L STUART, ASSISTANT TREASURER 6% - 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 A 1048035 10000000 103585 9896415 2012 0 0 1 1 A 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 A 1 SCHEDULE K, PARTS I AND II ADDITIONAL INFORMATION REGARDING THE BOND ISSUE: THE 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. X 2089351 RESALE VALUE X 13 656895 FMV & PLEDGED AMOUNT 0 0 1 0 PART I, COLUMN (B): LINE 9 - THIS FIGURE REPRESENTS THE NUMBER OF ITEMS RECEIVED. FORM 990, PART VI, SECTION A, LINE 4 IN 2014, THE ARTICLES OF INCORPORATION AND BYLAWS WERE CHANGED FOR THE PURPOSES OF (I) STANDARDIZING THE GOVERNANCE PROVISIONS FOR ALL OF THE AFFILIATES OF SANTAFE HEALTHCARE, INC., WHICH INCLUDES HAVEN HOSPICE; (II) ADOPTING A UNIFIED BOARD STRUCTURE IN WHICH THE MEMBERS OF THE BOARD OF DIRECTORS OF SANTAFE HEALTHCARE, INC. ALSO SERVE AS THE BOARD OF DIRECTORS FOR ALL OF THE AFFILIATES OF SANTAFE HEALTHCARE, INC., INCLUDING HAVEN HOSPICE; AND (III) ADOPTING A UNIFIED BOARD COMMITTEE STRUCTURE IN WHICH THE BOARD COMMITTEES FOR SANTAFE HEALTH CARE, INC. SERVE AS THE BOARD COMMITTEES FOR ALL OF THE AFFILIATES, INCLUDING HAVEN HOSPICE. FORM 990, PART VI, SECTION A, LINE 7A SANTAFE HEALTHCARE, INC., A 509(A)(3) SUPPORTING ORGANIZATION TO HAVEN HOSPICE, HAS RESERVED POWERS AS DELINEATED IN THE ARTICLES OF INCORPORATION AND BYLAWS THAT PERMITS IT TO ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY OF HAVEN HOSPICE. FORM 990, PART VI, SECTION A, LINE 7B THE RESERVED POWERS OF SANTAFE HEALTHCARE, INC., AS DELINEATED IN THE ARTICLES OF INCORPORATION AND BYLAWS, PERMIT IT TO APPROVE OR RATIFY THE GOVERNING BODY'S DECISIONS RELATED TO BOARD MEMBER ELECTIONS OR REMOVALS, THE DECISION TO DISSOLVE THE ORGANIZATION AND OTHER MATTERS THAT MAY COME BEFORE THE 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 2014 FORM 990 BEGAN WITH PROFESSIONAL DEVELOPMENT OF STAFF (SEVERAL OF WHICH ARE CPAS) WHICH WERE INVOLVED IN THE PREPARATION OF THE 2014 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 2014 FORM 990, PRICEWATERHOUSECOOPERS LLP REVIEWED THE 2014 FORM 990. A COPY OF THE 2014 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 2014 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 BOARD OF DIRECTORS BASED ON THE MARKET COMPETITIVENESS STUDY. A MARKET COMPETITIVENESS STUDY WAS CONDUCTED IN NOVEMBER 2012 FOR CHANGES MADE EFFECTIVE JANUARY 1, 2013. NO DIRECTOR FEES WERE ALLOCATED TO HAVEN HOSPICE DURING 2014. FORM 990, PART VI, SECTION C, LINE 19 UPDATED ARTICLES OF INCORPORATION FOR HAVEN HOSPICE ARE AVAILABLE ON THE STATE OF FLORIDA, SECRETARY OF STATE WEBSITE WWW.SUNBIZ.ORG. 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 2,000 EMPLOYEES. THESE SENIOR EXECUTIVES ARE PAID DIRECTLY BY EITHER SANTAFE HEALTHCARE, INC. OR AVMED, 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 2014, THE FOLLOWING PERCENTAGES OF EACH EXECUTIVE'S COMPENSATION AND BENEFITS (FOR THOSE SENIOR EXECUTIVES PAID BY A RELATED ORGANIZATION) ARE APPORTIONED AND CHARGED TO HAVEN HOSPICE AS FOLLOWS: 5% - MICHAEL P GALLAGHER, CHIEF EXECUTIVE OFFICER 100% - TIMOTHY J BOWEN, PRESIDENT 5% - RANDALL L STUART, ASSISTANT TREASURER 6% - CATHERINE E AYERS, ASSISTANT SECRETARY 10% - STEVEN M ZIEGLER, ASSISTANT SECRETARY FORM 990, PART IX, LINE 11G MEDICAL : PROGRAM SERVICE EXPENSES 11,408,539. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,408,539. CONTRACT LABOR : PROGRAM SERVICE EXPENSES 1,053,554. MANAGEMENT AND GENERAL EXPENSES 193,372. FUNDRAISING EXPENSES 40,433. TOTAL EXPENSES 1,287,359. CONSULTING : PROGRAM SERVICE EXPENSES 77,137. MANAGEMENT AND GENERAL EXPENSES 608,351. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 685,488. SECURITY : PROGRAM SERVICE EXPENSES 5,831. MANAGEMENT AND GENERAL EXPENSES 3,266. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,097. OTHER PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 125,030. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 125,030. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF RESTRICTED PLEDGES 11,205. NET ASSETS RELEASED FROM RESTRICTION USED FOR SERVICES -745. CHANGE IN VALUE OF DONOR RESTRICTED CONTRIBUTIONS 1,245,452. CHANGE IN FAIR VALUE OF CHARITABLE REMAINDER UNITRUST -1,250. CHANGE IN NET UNREALIZED GAINS/LOSSES ON CRUT INVESTMENT -125. LOSSES ON UNCOLLECTIBLE PLEDGES 2,923. CHANGE IN NET UNREALIZED GAINS/LOSSES ON INTEREST RATE SWAP -185,567. RESTRICTED ASSETS REPORTED IN CURRENT YEAR INCOME -1,261,383. 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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