2013-11-14T10:41:17-06:00 2012-12-31 861065772 DELOITTE TAX LLP 201 E KENNEDY BLVD SUITE 1200 TAMPA FL 33602 990 2012-01-01 592490893 NORTH CENTRAL FLORIDA HOSPICE INC NORT 3523728400 SANTAFE HEALTHCAREINC PO BOX 749 GAINESVILLE FL 326270749 TIMOTHY J BOWEN 3523782121 2013-11-14 1 STEVEN E ROVNER P00648526 8132738300 2012 2016-02-24 21:20:13Z HAVEN HOSPICE MICHAEL P GALLAGHER SANTAFE HEALTHCAREINC PO BOX 749 GAINESVILLE FL 326270749 62745880 0 X WWW.HAVENHOSPICE.ORG X 1982 FL HONORING LIFE BY PROVIDING COMFORT, CARE AND COMPASSION TO THOSE WE SERVE. 13 12 726 851 0 0 2860145 2775032 57146734 59236900 401913 579200 -181250 -189792 60227542 62401340 0 0 0 0 30565379 32288637 0 0 698886 26237592 27526658 56802971 59815295 3424571 2586045 50359060 61063552 11791889 17682366 38567171 43381186 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.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 30044702 47031239 HAVEN HOSPICE PROVIDED SERVICES TO 3,847 HOSPICE PATIENTS INCLUDING 255,247 DAYS OF SERVICE AND 153,771 VISITS BY NURSES, HOME HEALTH AIDES, SOCIAL WORKERS, CHAPLAINS AND PHYSICIANS TOTALING 206,202 HOURS OF CARE. INCLUDED IN THE EXPENSES IS $1,108,731 OF UNREIMBURSED CARE AND PROVISION OF PALLIATIVE MASSAGE THERAPY, VOLUNTEERS AND BEREAVEMENT SERVICES. 8975680 10320505 HAVEN HOSPICE PROVIDED SERVICES TO 1,858 PATIENTS IN INPATIENT CARE CENTERS, INCLUDING 18,698 DAYS OF SERVICE AND 147,746 VISITS BY NURSES, HOME HEALTH AIDES, SOCIAL WORKERS, CHAPLAINS AND PHYSICIANS TOTALING 158,838 HOURS OF CARE. INCLUDED IN THE EXPENSES IS $117,150 OF UNREIMBURSED CARE. 254843 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 20 ON SITE COMMUNITY EDUCATION EVENTS AND 48 OFF SITE COMMUNITY EDUCATION EVENTS. IN ADDITION, 44,080 SUPPORT MAILERS WERE DISTRIBUTED. 19,299 BEREAVEMENT SUPPORT PHONE CALLS WERE PLACED AND 8,271 BEREAVEMENT SUPPORT VISITS WERE MADE TO FAMILIES. 14 MEMORIAL SERVICES WERE HELD WITH AN AVERAGE ATTENDANCE OF 39 PARTICIPANTS PER SERVICE. 63 GRIEF SUPPORT GROUP SESSIONS WERE HELD IN 2012 WITH AN AVERAGE OF 4 PARTICIPANTS AT EACH. 1,139 INDIVIDUAL COUNSELING SESSIONS AND 48 FAMILY COUNSELING SESSIONS WERE CONDUCTED. 3 GRIEF CAMPS WERE HELD WITH AN AVERAGE ATTENDANCE OF 68 CAMP PARTICIPANTS. 7298063 1885156 MISCELLANEOUS PROGRAM SERVICES WHICH INCLUDE $2,144 IN UNREIMBURSED CARE. 7298063 1885156 46573288 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 0 0 1 323 0 1 726 1 0 0 0 0 0 1 1 0 0 0 0 X 13 12 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X TIMOTHY J BOWEN 3523796225 4200 NW 90TH BLVD GAINESVILLE FL 326065688 X D RAY HARRISON JR 1.00 0.00 X X 0 0 0 G THOMAS MALLINI 1.00 0.00 X X 0 0 0 SUZANNE M NORRIS 1.00 0.00 X X 0 0 0 ERIC L GODET 1.00 0.00 X X 0 1000 0 CAROL REED ASH 1.00 0.00 X 0 0 0 GEORGE J CARANASOS MD 1.00 0.00 X 0 0 0 JANET L CHRISTIE 1.00 0.00 X 0 0 0 JAMES W DEFORD MD 1.00 0.00 X 0 0 0 SUSAN D PARRISH 1.00 0.00 X 0 0 0 FRANCES C PEPIS 1.00 0.00 X 0 0 0 NORLENE E ROBERTS 1.00 0.00 X 0 0 0 DALE M WILLIAMS 1.00 0.00 X 0 0 0 MICHAEL P GALLAGHER 5.00 55.00 X X 0 1402446 253819 TIMOTHY J BOWEN 49.90 0.10 X 0 443671 84159 STEVEN M ZIEGLER 6.00 57.00 X 0 316188 105589 GERALDINE S BICHIER MD 40.00 0.00 X 176389 0 30768 DOUGLAS A ROGERS MD 40.00 0.00 X 212770 0 32162 NEEL J KARNANI MD 40.00 0.00 X 190146 0 16625 LINDA ROUEL MD 40.00 0.00 X 208876 0 12482 ELLEN TAOS MD 40.00 0.00 X 162802 0 20911 950983 2163305 556515 15 0 1 0 ELKINS CONSTRUCTORS INC PO BOX 2396 JACKSONVILLE FL 32203 CONSTRUCTION SERVICES 3921879 SANTAFE HEALTHCARE INC P O BOX 749 GAINESVILLE FL 326270749 MANAGEMENT FEES 1642176 HOSPISCRIPT SERVICES LLC 1460 ANN STREET MONTGOMERY AL 36107 PHARMACY SERVICES 1311523 PHOENIX HEALTHCARE PROPERTIES OF MANDARI 10680 OLD ST AUGUSTINE ROAD JACKSONVILLE FL 32257 NURSING HOME SERVICES 823326 CHERNOFF NEWMAN LLC 1411 GERVAIS STREET COLUMBIA SC 29201 ADVERTISING 651819 65 62390 241307 2471335 1718387 2775032 MEDICARE REVENUE 623990 43195366 43195366 MEDICAID REVENUE 623990 14098199 14098199 PATIENT SERVICE REVENUE 623990 1943335 1943335 59236900 504167 504167 156425 4542 77133 8801 79292 -4259 75033 75033 61626 241307 258606 -196980 -196980 ADMINISTRATIVE INCOME 900099 7188 7188 7188 62401340 59236900 0 389408 X 25058717 19164259 5575022 319436 1576299 1067211 484106 24982 3847894 2898802 915683 33409 1805727 1379878 402808 23041 819216 819216 245851 245851 92513 92513 15361627 14638574 674960 48093 768954 748049 6053 14852 1367220 657127 652151 57942 593296 593296 1624152 1118405 505747 1704454 1322991 365622 15841 72692 13688 58076 928 49957 49957 1139938 738439 401499 327179 153820 173359 PHARMACY SUPPLIES 1539228 1539228 MEDICAL SUPPLIES 535031 534678 353 COMMUNITY SUPPORT 515200 303836 60692 150672 FOOD COSTS 130517 130517 639633 113829 516114 9690 59815295 46573288 12543121 698886 74527 660983 6908582 3709252 2456 878703 4998208 3462311 471309 337460 37826528 8703991 23249975 29122537 10544496 19039332 1776447 2051537 2333060 1801437 50359060 61063552 6572865 6122613 3537354 9956332 1681670 1603421 11791889 17682366 X 38244794 41399077 322377 1982109 38567171 43381186 50359060 61063552 X 2586045 538124 1689846 X X 0 1 X 1 0 X 2778953 2198110 2002280 2860145 2775032 12614520 47775904 50582738 54590670 57146734 59236900 269332946 50554857 52780848 56592950 60006879 62011932 281947466 0 0 0 281947466 306721 233421 376917 382400 504167 1803626 306721 233421 376917 382400 504167 1803626 -49004 -82054 -134428 -181250 -189792 -636528 50812574 52932215 56835439 60208029 62326307 283114564 0.99590 0.99190 0.00640 0.00660 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: LIFELINE INCOME - 2008 AMOUNT: $ 14,856. 2009 AMOUNT: $ 3,628. ADMINISTRATIVE INCOME - 2008 AMOUNT: $ 10,956. 2009 AMOUNT: $ 7,892. 2010 AMOUNT: $ 12,271. 2011 AMOUNT: $ 19,291. 2012 AMOUNT: $ 7,188. SPECIAL EVENT INCOME NET - 2008 AMOUNT: $ -74,816. 2009 AMOUNT: $ -93,574. 2010 AMOUNT: $ -146,699. 2011 AMOUNT: $ -200,541. 2012 AMOUNT: $ -196,980. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 66846 66846 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: HAVEN HOSPICE IS A MEMBER OF FLORIDA HOSPICES AND PALLIATIVE CARE, INC. 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. 1534886 288101 1822987 1489469 45417 1534886 1373367 116102 1489469 1249994 123373 1373367 1292160 -42166 1249994 1.00000 0 0 4513102 4513102 27805260 5254064 22551196 588001 311597 276404 4920165 3138330 1781835 29122537 GIFT ANNUITIES 272957 DUE TO AFFILIATES 56960 CAPITAL LEASE OBLIGATION 116513 PLEDGES 105000 CHARITABLE REMAINDER UNITRUST 1045000 CONTRIBUTION PAYABLE 6991 1603421 X 62293943 -30829 -30829 62324772 76568 76568 62401340 59786711 -28584 -28584 59815295 0 59815295 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ASC 740 FOOTNOTE: AS OF DECEMBER 31, 2012 OR 2011, HAVEN HAD NO UNCERTAIN TAX POSITIONS. TAX YEARS 2009 THROUGH 2011 ARE SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. THERE ARE NO INCOME TAX EXAMINATIONS IN PROCESS AS OF THE DATE OF THIS REPORT. PART XI, LINE 2D - OTHER ADJUSTMENTS: UNREIMBURSED CARE -289,435. SPECIAL EVENT EXPENSES 258,606. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS 76,568. PART XII, LINE 2D - OTHER ADJUSTMENTS: UNREIMBURSED CARE -289,435. SPECIAL EVENT EXPENSES 258,606. LOSSES ON UNCOLLECTIBLE PLEDGES 2,245. VIVA 190311 156071 34240 138513 FALL ON THE PRAIRIE 50836 43936 6900 44103 5 55537 36839 18698 45166 296684 236846 59838 227782 227782 -167944 0 1 0 0 0 0 0 0 0 MICHAEL P GALLAGHER 0 826579 0 117242 0 458625 0 229362 0 24457 0 1656265 0 182750 TIMOTHY J BOWEN 0 288733 0 125448 0 29490 0 61944 0 22215 0 527830 0 14030 STEVEN M ZIEGLER 0 307254 0 0 0 8934 0 75899 0 29690 0 421777 0 0 GERALDINE S BICHIER MD 176104 0 0 0 285 0 14496 0 16272 0 207157 0 0 0 DOUGLAS A ROGERS MD 212265 0 0 0 505 0 17298 0 14864 0 244932 0 0 0 NEEL J KARNANI MD 189574 0 0 0 572 0 15113 0 1512 0 206771 0 0 0 LINDA ROUEL MD 208628 0 0 0 248 0 11081 0 1401 0 221358 0 0 0 ELLEN TAOS MD 162715 0 0 0 87 0 8932 0 11979 0 183713 0 0 0 PART I, LINE 3 PART I, LINE 3: MICHAEL P GALLAGHER IS THE CHIEF EXECUTIVE OFFICER (CEO) OF NORTH CENTRAL FLORIDA HOSPICE, INC. (HAVEN). MR. GALLAGHER IS COMPENSATED BY SANTAFE HEALTHCARE, INC. (SANTAFE), A RELATED SUPPORTING ORGANIZATION. SANTAFE UTILIZES THE FOLLOWING PROCESS TO ESTABLISH THE CEO'S COMPENSATION AND BENEFITS: ANNUALLY, THE SANTAFE BOARD OF DIRECTORS RETAINS AN INDEPENDENT THIRD PARTY COMPENSATION AND BENEFITS CONSULTING 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 INDEPENDENT CONSULTING 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 INDEPENDENT CONSULTING FIRM. THE INDEPENDENT CONSULTING 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 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 MONTHS UNDER QUALIFYING CIRCUMSTANCES. NO ONE LISTED RECEIVED SEVERANCE OR CHANGE OF CONTROL PAYMENTS DURING 2012. PART I, LINE 4B: LISTED PERSONS PARTICIPATING IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN THE YEAR: MICHAEL P GALLAGHER AND TIMOTHY J BOWEN ARE EMPLOYEES OF SANTAFE HEALTHCARE, INC. (SANTAFE) A RELATED SUPPORTING ORGANIZATION. MR. GALLAGHER AND MR. BOWEN PARTICIPATE IN TWO NONQUALIFIED DEFERRED COMPENSATION RETIREMENT PLANS SPONSORED BY SANTAFE 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 RECEIVED $364,445 FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS IN 2012. MR. BOWEN RECEIVED $15,241 FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN 2012. STEVEN M ZIEGLER IS AN EMPLOYEE OF AVMED, INC. (AVMED) A RELATED TAX-EXEMPT ORGANIZATION. HE PARTICIPATES IN TWO NONQUALIFIED DEFERRED COMPENSATION RETIREMENT PLANS SPONSORED BY AVMED 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. SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART II: CERTAIN SENIOR EXECUTIVES ARE ACCOUNTABLE FOR AND PERFORM SERVICES FOR SANTAFE HEALTHCARE, INC. AND EACH OF ITS AFFILIATES. SANTAFE HEALTHCARE 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 2012, THE FOLLOWING PERCENTAGES OF EACH EXECUTIVE'S COMPENSATION AND BENEFITS (FOR THOSE SENIOR EXECUTIVES PAID BY A RELATED ORGANIZATION) IS APPORTIONED AND CHARGED TO HAVEN HOSPICE AS FOLLOWS: 8% - MICHAEL P GALLAGHER, CHIEF EXECUTIVE OFFICER 100% - TIMOTHY J BOWEN, PRESIDENT 10% - STEVEN M ZIEGLER, DIRECTOR A CLAY COUNTY DEVELOPMENT AUTHORITY 596583087 2011-12-21 10000000 CONSTRUCT HOSPICE CARE FACILITY 0 0 0 A 43668 10000000 103585 9896415 2012 0 0 0 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 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 INTO SERVICE DURING 2012. AT THE END OF THE REPORTING YEAR, THE ENTIRE BALANCE OF THE LOAN HAD BEEN DRAWN DOWN. X 1673638 RESALE VALUE 0 1 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF NORTH CENTRAL FLORIDA HOSPICE, INC., AS STATED IN ARTICLE IV OF ITS BYLAWS IS SANTAFE HEALTHCARE, INC. SANTAFE HEALTHCARE, INC. IS A FLORIDA NOT-FOR-PROFIT CORPORATION AND THE 509(A)(3) SUPPORTING ORGANIZATION OF NORTH CENTRAL FLORIDA HOSPICE, INC. FORM 990, PART VI, SECTION A, LINE 7A SANTAFE HEALTHCARE, INC., A 509(A)(3) SUPPORTING ORGANIZATION TO NORTH CENTRAL FLORIDA HOSPICE, INC., 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 NORTH CENTRAL FLORIDA HOSPICE, INC. 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 2012 FORM 990 BEGAN WITH PROFESSIONAL DEVELOPMENT OF STAFF (SEVERAL OF WHICH ARE CPAS) WHICH WERE INVOLVED IN THE PREPARATION OF THE 2012 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 DELOITTE TAX LLP, REGARDING THE FORM 990 AND THEIR INVOLVEMENT IN REVIEWING THE RETURN. FOLLOWING MANAGEMENT'S PREPARATION OF THE 2012 FORM 990, DELOITTE TAX LLP REVIEWED THE 2012 FORM 990. A COPY OF THE 2012 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 2012 FORM 990 AND ATTACHMENTS WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C HAVEN HOSPICE'S CONFLICT OF INTEREST POLICY (THE POLICY) COVERS BOARD MEMBERS, OFFICERS, ALL EMPLOYEES AND VOLUNTEERS. THE HUMAN RESOURCES DEPARTMENT IS RESPONSIBLE FOR PROVIDING EACH EMPLOYEE WITH A COPY OF THE POLICY AND OBTAINING THE EMPLOYEE'S ACKNOWLEDGMENT STATEMENT AND SIGNATURE AT THE TIME OF HIRE AND ANNUALLY THEREAFTER. THE VOLUNTEER SERVICES DEPARTMENT IS RESPONSIBLE FOR PROVIDING EACH VOLUNTEER WITH A COPY OF THE POLICY AND OBTAINING THE VOLUNTEER'S ACKNOWLEDGMENT STATEMENT AND SIGNATURE DURING ORIENTATION. ON AN ANNUAL BASIS, ALL BOARD MEMBERS MUST ACKNOWLEDGE AND SIGN A COPY OF THE POLICY. EMPLOYEES, VOLUNTEERS AND BOARD MEMBERS WILL REPORT SUSPECT CONDUCT OR ACTIVITY OF A KNOWN VIOLATION OF THE POLICY, INCLUDING THOSE AFFECTING A PROPOSED OR ONGOING OPERATIONAL OR FINANCIAL TRANSACTION, TO HAVEN HOSPICE'S DIRECTOR OF CORPORATE COMPLIANCE AS SOON AS POSSIBLE OR PRACTICAL. WILLFUL VIOLATIONS OF THE POLICY WILL RESULT IN DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION. THE PRESIDENT OF HAVEN HOSPICE AND THE CHIEF EXECUTIVE OFFICER OF SANTAFE HEALTHCARE, INC. (THE SUPPORTING ORGANIZATION FOR HAVEN HOSPICE) ARE VESTED WITH ULTIMATE AUTHORITY AND RESPONSIBILITY TO DETERMINE THE APPLICABILITY OF THE POLICY TO ANY SET OF FACTS THAT MAY ARISE, AND TO DETERMINE ANY STEPS THAT SHOULD BE TAKEN TO CORRECT A SITUATION DEEMED NOT IN THE BEST INTEREST OF HAVEN HOSPICE, INCLUDING, IF DEEMED APPROPRIATE, DISCIPLINARY ACTION. FORM 990, PART VI, SECTION B, LINE 15 MICHAEL P GALLAGHER IS THE CHIEF EXECUTIVE OFFICER (CEO) OF NORTH CENTRAL FLORIDA HOSPICE, INC. (HAVEN). MR. GALLAGHER IS COMPENSATED BY SANTAFE HEALTHCARE, INC. (SANTAFE), A RELATED SUPPORTING ORGANIZATION. SANTAFE UTILIZES THE FOLLOWING PROCESS TO ESTABLISH THE CEO'S COMPENSATION AND BENEFITS: THE SANTAFE BOARD OF DIRECTORS ANNUALLY RETAINS AN INDEPENDENT THIRD PARTY COMPENSATION AND BENEFITS CONSULTING 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 INDEPENDENT CONSULTING 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 INDEPENDENT CONSULTING FIRM. THE INDEPENDENT CONSULTING 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. FORM 990, PART VI, SECTION B, LINE 15B: PROCESS FOR DETERMINING COMPENSATION FOR THE ASSISTANT SECRETARY AND PRESIDENT OF HAVEN HOSPICE IS AS FOLLOWS: THE SANTAFE HEALTHCARE, INC. (SANTAFE) 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 INDEPENDENT CONSULTING FIRM MAKES RECOMMENDATIONS, IF ANY, DIRECTLY TO THE SANTAFE 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 COMPENSATION FOR THE HAVEN HOSPICE MEDICAL DIRECTOR IS DETERMINED BY A MARKET COMPETITIVENESS STUDY CONDUCTED BY AN INDEPENDENT THIRD PARTY CONSULTANT. THE COMPETITIVENESS ANALYSIS INCLUDES COMPARISONS TO SIMILAR POSITIONS IN COMPANIES OF SIMILAR SIZE WITHIN THE HOSPICE INDUSTRY. THE ANALYSIS ALSO INCLUDES FORM 990 DATA COMPARISON FOR HOSPICES WITHIN A SIMILAR REVENUE SIZE AND/OR MARKET LOCATION. THE MOST RECENT COMPENSATION REVIEW WAS COMPLETED IN 2011. 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 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 2012, THE FOLLOWING PERCENTAGES OF EACH EXECUTIVE'S COMPENSATION AND BENEFITS (FOR THOSE SENIOR EXECUTIVES PAID BY A RELATED ORGANIZATION) IS APPORTIONED AND CHARGED TO HAVEN HOSPICE AS FOLLOWS: 8% - MICHAEL P GALLAGHER, CHIEF EXECUTIVE OFFICER 100% - TIMOTHY J BOWEN, PRESIDENT 10% - STEVEN M ZIEGLER, DIRECTOR OTHER FEES FORM 990, PART IX, LINE 11G MEDICAL FEES: PROGRAM SERVICE EXPENSES 13,633,629. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,633,629. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 823,595. MANAGEMENT AND GENERAL EXPENSES 68,359. FUNDRAISING EXPENSES 36,386. TOTAL EXPENSES 928,340. CONSULTING: PROGRAM SERVICE EXPENSES 66,726. MANAGEMENT AND GENERAL EXPENSES 603,707. FUNDRAISING EXPENSES 11,707. TOTAL EXPENSES 682,140. SECURITY: PROGRAM SERVICE EXPENSES 15,611. MANAGEMENT AND GENERAL EXPENSES 2,894. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,505. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 99,013. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 99,013. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF RESTRICTED PLEDGES 851,308. NET ASSETS RELEASED FROM RESTRICTION USED FOR SERVICES -3,373. CHANGE IN VALUE OF DONOR RESTRICTED CONTRIBUTIONS 932,995. CHANGE IN FAIR VALUE OF CHARITABLE REMAINDER UNITRUST -104,634. CHANGE IN NET UNREALIZED GAINS/LOSSES ON CRUT INVESTMENT 92,363. LOSSES ON UNCOLLECTIBLE PLEDGES -2,245. NET ASSETS RELEASED FROM RESTRICTION USED FOR PROPERTY AND EQUIPMENT -76,568. AUDIT COMMITTEE OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT: 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. HAVEN MEDICAL GROUP LLC P O BOX 749 GAINESVILLE FL 326270749 592490893 CONDUCT A MEDICAL PRACTICE SPECIALIZING IN PALLIATIVE CARE FL 4736 0 NORTH CENTRAL FLORIDA HOSPICE INC SANTAFE HEALTHCARE INC PO BOX 749 GAINESVILLE FL 326270749 592317607 MANAGEMENT AND FINANCIAL SUPPORT FOR NOT-FOR-PROFIT AFFILIATES FL 501(C)(3) 11B TYPE II N/A 0 AVMED INC PO BOX 749 GAINESVILLE FL 326270749 592742907 HEALTH CARE FL 501(C)(4) N/A N/A 0 NORTH FLORIDA RETIREMENT VILLAGE INC PO BOX 749 GAINESVILLE FL 326270749 591912330 RETIREMENT COMMUNITY FL 501(C)(3) 9 N/A 0 SANTAFE SENIOR LIVING INC PO BOX 749 GAINESVILLE FL 326270749 203700526 MANAGEMENT AND FINANCIAL SUPPORT FOR NOT-FOR-PROFIT AFFILIATES FL 501(C)(3) 11A TYPE I N/A 0 BVG ACQUISITION INC PO BOX 749 GAINESVILLE FL 326270749 203701186 RETIREMENT COMMUNITY FL 501(C)(3) 9 N/A 0 EAST RIDGE RETIREMENT VILLAGE INC PO BOX 749 GAINESVILLE FL 326270749 590903331 RETIREMENT COMMUNITY FL 501(C)(3) 9 N/A 0 BONITA SPRINGS RETIREMENT VILLAGE INC PO BOX 749 GAINESVILLE FL 326270749 262386152 RETIREMENT COMMUNITY FL 501(C)(3) 9 N/A 0 SANTAFE SENIOR LIVING FOUNDATION INC PO BOX 749 GAINESVILLE FL 326270749 264464727 CHARITABLE & EDUCATIONAL PURPOSES FL 501(C)(3) 7 N/A 0 SF HOLDING CORPINC & SUBSIDIARY PO BOX 749 GAINESVILLE FL 326270749 592903901 HOLDING COMPANY FL N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 AVMED INC M 2392981 FAIR MARKET VALUE AVMED INC L 137255 FAIR MARKET VALUE