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NORTH CENTRAL FLORIDA HOSPICE INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
NORTH CENTRAL FLORIDA HOSPICE INC (EIN 59-2490893)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-10-13
IRS object ID
201112869349301411
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-10-13T16:04:08-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1201 E KENNEDY BLVD SUITE 1200AddressLine1
CityTAMPACity
StateFLState
ZIP Code33602ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN592490893EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1NORTH CENTRAL FLORIDA HOSPICE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNORTNameControl
Phone3523728400Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1SANTAFE HEALTHCAREINC PO BOX 749AddressLine1
CityGAINESVILLECity
StateFLState
ZIP Code326270749ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRANDALL L STUARTName
TitleSR VICE PRESIDENT AND CFOTitle
Phone3523378730Phone
Date Signed2011-10-11DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSTEVEN E ROVNERName
Phone8132738300Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeXAddressChange

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1HAVEN HOSPICEBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonMICHAEL P GALLAGHERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1SANTAFE HEALTHCAREINC PO BOX 749AddressLine1
CityGAINESVILLECity
StateFLState
ZIP Code326270749ZIPCode
FieldValueIRS element (for citing)
Gross Receipts61974218GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.HAVENHOSPICE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1982YearFormation
State Legal DomicileFLStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE COMPASSIONATE CARE TO PEOPLE & THEIR COMMUNITIES AFFECTED BY LIFE-LIMITING ILLNESS.THE MISSION OF NORTH CENTRAL FLORIDA HOSPICE, INC. IS TO SERVE PEOPLE AND THEIR COMMUNITIES AFFECTED BY LIFE-LIMITING ILLNESS AND LOSS BY PROVIDING COMPREHENSIVE, COMPASSIONATE CARE, WHILE RESPECTING EACH PERSON'S NEEDS, BELIEFS AND WISHES. SEE PART III, LINE 1 FOR MORE INFORMATION.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees681TotalNbrEmployees
Total Nbr Volunteers1135TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2198110ContributionsGrantsPriorYear
Contributions Grants Current Year2002280ContributionsGrantsCurrentYear
Program Service Revenue Prior Year50582738ProgramServiceRevenuePriorYear
Program Service Revenue CY54590670ProgramServiceRevenueCY
Investment Income Prior Year276381InvestmentIncomePriorYear
Investment Income Current Year495546InvestmentIncomeCurrentYear
Other Revenue Prior Year-82054OtherRevenuePriorYear
Other Revenue Current Year-134428OtherRevenueCurrentYear
Total Revenue Prior Year52975175TotalRevenuePriorYear
Total Revenue Current Year56954068TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year27739652SalariesEtcPriorYear
Salaries Etc Current Year28947467SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year621999TotalFundrsngExpCurrentYear
Other Expense Prior Year24500622OtherExpensePriorYear
Other Expenses Current Year26342151OtherExpensesCurrentYear
Total Expenses Prior Year52240274TotalExpensesPriorYear
Total Expenses Current Year55289618TotalExpensesCurrentYear
Revenues Less Expenses Prior Year734901RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1664450RevenuesLessExpensesCY
Total Assets BOY38608995TotalAssetsBOY
Total Assets EOY41057742TotalAssetsEOY
Total Liabilities BOY5651698TotalLiabilitiesBOY
Total Liabilities EOY6098728TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY32957297NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY34959014NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE MISSION OF NORTH CENTRAL FLORIDA HOSPICE, INC. (HAVEN HOSPICE) IS TO SERVE PEOPLE AND THEIR COMMUNITIES AFFECTED BY LIFE-LIMITING ILLNESS AND LOSS BY PROVIDING COMPREHENSIVE, COMPASSIONATE CARE, WHILE RESPECTING EACH PERSON'S NEEDS, BELIEFS AND WISHES. 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 PARTICIPATED IN A DEMONSTRATION GRANT (UNFUNDED) THROUGH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES TO IMPROVE DELIVERY OF HOSPICE CARE IN RURAL AREAS. 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense27397705Expense
Revenue42974362Revenue
DescriptionHAVEN HOSPICE PROVIDED SERVICES TO 3,370 HOSPICE PATIENTS INCLUDING 242,616 DAYS OF SERVICE AND 124,984 VISITS BY NURSES, HOME HEALTH AIDES, SOCIAL WORKERS, CHAPLAINS AND PHYSICIANS TOTALING 236,402 HOURS OF CARE. INCLUDED IN THE EXPENSES IS $223,289 OF UNREIMBURSED CARE AND PROVISION OF PALLIATIVE MASSAGE THERAPY, VOLUNTEERS AND BEREAVEMENT SERVICES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense8176019Expense
Revenue9689843Revenue
DescriptionHAVEN HOSPICE PROVIDED SERVICES TO 1,273 PATIENTS IN INPATIENT CARE CENTERS, INCLUDING 18,874 DAYS OF SERVICE AND 125,443 VISITS BY NURSES, HOME HEALTH AIDES, SOCIAL WORKERS, CHAPLAINS AND PHYSICIANS TOTALING 181,499 HOURS OF CARE. INCLUDED IN THE EXPENSES IS $386,681 OF UNREIMBURSED CARE.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense88637Expense
DescriptionHAVEN HOSPICE PROVIDED BEREAVEMENT SERVICES TO THE COMMUNITIES IN WHICH WE SERVE AND TO FAMILY MEMBERS OF PATIENTS WHO HAVE DIED IN OUR CARE. 14 MEMORIAL SERVICES WERE HELD WITH AN AVERAGE ATTENDANCE OF 79 PARTICIPANTS PER SERVICE. 117 GRIEF SUPPORT GROUP SESSIONS WERE HELD IN 2010 WITH AN AVERAGE OF 4 PARTICIPANTS AT EACH AND 465 INDIVIDUAL COUNSELING SESSIONS WERE CONDUCTED. SIX CHILDREN'S GRIEF CAMPS WERE HELD WITH AN AVERAGE ATTENDANCE OF 20 CHILDREN.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense6959682Expense
Revenue1926465Revenue
DescriptionMISCELLANEOUS PROGRAM SERVICESDescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp6959682TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev1926465TotalOfOtherProgramServiceRev
Total Program Service Expense42622043TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096310NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees681NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PATRICIA C LAW VICE PRESIDENTCHIEF FINANCIAL OFFICERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3523796241TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14200 NW 90TH BLVDAddressLine1
CityGAINESVILLECity
StateFLState
ZIP Code326065688ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
JAMES L POOLE
CHAIRMAN/DIRECTOR1.00XX000
D RAY HARRISON JR
VICE CHAIRMAN/DIRECTOR1.00XX000
ERIC L GODET
SECRETARY/DIRECTOR1.00XX020000
MICHAEL P GALLAGHER
CHIEF EXECUTIVE OFFICER/DIRECTOR4.00XX02382570245651
GEORGE J CARANASOS MD
DIRECTOR1.00X000
JANET L CHRISTIE
DIRECTOR1.00X000
JAMES W DEFORD MD
DIRECTOR1.00X000
G THOMAS MALLINI
TREASURER/DIRECTOR1.00XX000
SUZANNE M NORRIS
DIRECTOR1.00X000
SUSAN D PARRISH
DIRECTOR1.00X000
NORLENE E ROBERTS
DIRECTOR1.00X000
DALE M WILLIAMS
DIRECTOR1.00X000
CAROL REED ASH
DIRECTOR1.00X000
FRANCIS C PEPIS
DIRECTOR1.00X000
STEPHEN J DEMONTMOLLIN
ASSISTANT SECRETARY2.00X057472363105
TIMOTHY J BOWEN
PRESIDENT50.00X034785875804
NEEL KARNANI MD
MEDICAL DIRECTOR40.00191061016315X
MICHELE BOATWRIGHT MD
ASSOCIATE MEDICAL DIRECTOR40.00183501038744X
CASSANDRA DONOVAN RN
VICE PRESIDENT OPERATIONS40.00144384023586X
ANDREA FINDLATER MD
ASSOCIATE MEDICAL DIRECTOR40.00173635040014X
GERALDINE BICHIER MD
ASSOCIATE MEDICAL DIRECTOR40.00163906031785X
PATRICIA C LAW
VICE PRESIDENT/CFO40.00144138018593X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1000625TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3307151TotalReportableCompFrmRltdOrgs
Total Other Compensation553597TotalOtherCompensation
Number Individuals GT100 K17NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
AVMED INC
P O BOX 749GAINESVILLEFL326270749HEALTH INSURANCE3102500
SANTAFE HEALTHCARE INC
P O BOX 749GAINESVILLEFL326270749MANAGEMENT FEES887380
GAINESVILLE REHABILITATION AND NURSING C
1000 SW 16TH AVENUEGAINESVILLEFL32601MEDICAL795911
HEALTH SERVICES OF PALATKAINC
110 KAY LARKIN DRIVEPALATKAFL32177MEDICAL696864
BLUE CROSS BLUE SHIELD OF FLORIDA
PO BOX 660299DALLASTX752660299HEALTH INSURANCE683801
FieldValueIRS element (for citing)
Number Of Contractors GT100 K48NumberOfContractorsGT100K
Federated Campaigns84921FederatedCampaigns
Fundraising Events191315FundraisingEvents
All Other Contributions1726044AllOtherContributions
Noncash Contributions1040851NoncashContributions
Total Contributions2002280TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICARE REVENUE6239903886249538862495
MEDICAID REVENUE6239901350053013500530
PATIENT SERVICE REVENU62399022276452227645
FieldValueIRS element (for citing)
Total Program Service Revenue54590670TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column376917TotalRevenueColumn
Exclusion$376,917ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities4944000Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities4809780Securities
Other15591Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities134220Securities
Other-15591Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column118629TotalRevenueColumn
Exclusion$118,629ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events48080GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events191315CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses194779FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-146699TotalRevenueColumn
Exclusion-$146,699ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionADMINISTRATIVE INCOMEDescription
Business Code900099BusinessCode
Total Revenue Column12271TotalRevenueColumn
Exclusion$12,271ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue12271TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column56954068TotalRevenueColumn
Related Or Exempt Function Income54590670RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$361,118ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total216469Total
Program Services216469ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total21951989Total
Program Services16450560ProgramServices
Management And General5244837ManagementAndGeneral
Fundraising256592Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1718267Total
Program Services931672ProgramServices
Management And General774177ManagementAndGeneral
Fundraising12418Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3554725Total
Program Services2519530ProgramServices
Management And General998513ManagementAndGeneral
Fundraising36682Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1506017Total
Program Services1140935ProgramServices
Management And General350119ManagementAndGeneral
Fundraising14963Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total716278Total
Management And General716278ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total195250Total
Management And General195250ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total89640Total
Management And General89640ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total14679223Total
Program Services14081528ProgramServices
Management And General552555ManagementAndGeneral
Fundraising45140Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total787639Total
Program Services778157ProgramServices
Management And General988ManagementAndGeneral
Fundraising8494Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1361294Total
Program Services650730ProgramServices
Management And General657609ManagementAndGeneral
Fundraising52955Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total526504Total
Program Services2101ProgramServices
Management And General524403ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1311661Total
Program Services933255ProgramServices
Management And General378406ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total1473110Total
Program Services1149608ProgramServices
Management And General313004ManagementAndGeneral
Fundraising10498Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total71343Total
Program Services22530ProgramServices
Management And General48664ManagementAndGeneral
Fundraising149Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total94Total
Management And General94ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1226299Total
Program Services693438ProgramServices
Management And General532861ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total318936Total
Program Services141317ProgramServices
Management And General177619ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
PHARMACY SUPPLIES13326261332626
COMMUNITY SUPPORT84324862102961341160878
MEDICAL SUPPLIES404996404996
BAD DEBT37771036579662711287
FOOD COSTS106397106397

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total519903Total
Program Services79369ProgramServices
Management And General428591ManagementAndGeneral
Fundraising11943Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total55289618Total
Program Services42622043ProgramServices
Management And General12045576ManagementAndGeneral
Fundraising621999Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY46125BOY
EOY64866EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3281042BOY
EOY315094EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY98801BOY
EOY35044EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4499989BOY
EOY7202075EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY519658BOY
EOY516923EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis26897673LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec7522015LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY19553766BOY
EOY19375658EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY8746732BOY
EOY11729221EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY1584197BOY
EOY1708486EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY278685BOY
EOY110375EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY38608995BOY
EOY41057742EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5392229BOY
EOY5644208EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY4000BOY
EOY2000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY255469BOY
EOY452520EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5651698BOY
EOY6098728EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY32914293BOY
EOY34947909EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY43004BOY
EOY11105EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY32957297BOY
EOY34959014EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY38608995BOY
EOY41057742EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1664450ReconcilationRevenueExpenses
Reconcilation Other Changes337267ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1772746CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1130815CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2778953CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2198110CurrentTaxYearMinus1Year
Current Tax Year2002280CurrentTaxYear
Total9882904Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years39609568CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years44081014CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years47775904CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year50582738CurrentTaxYearMinus1Year
Current Tax Year54590670CurrentTaxYear
Total236639894Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years41382314CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years45211829CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years50554857CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year52780848CurrentTaxYearMinus1Year
Current Tax Year56592950CurrentTaxYear
Total246522798Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509246522798PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years483957CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years472182CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years306721CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year233421CurrentTaxYearMinus1Year
Current Tax Year376917CurrentTaxYear
Total1873198Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years483957CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years472182CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years306721CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year233421CurrentTaxYearMinus1Year
Current Tax Year376917CurrentTaxYear
Total1873198Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years821948CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years838709CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years-49004CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year-82054CurrentTaxYearMinus1Year
Current Tax Year-134428CurrentTaxYear
Total1395171Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years42688219CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years46522720CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years50812574CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year52932215CurrentTaxYearMinus1Year
Current Tax Year56835439CurrentTaxYear
Total249791167Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98690PublicSupportPercentage509
Prior Year Support Percentage0.98230PriorYearSupportPercentage
Investment Income Percentage0.00750InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00800PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME IN 2010: ADMINISTRATIVE INCOME: $12,271 SPECIAL EVENT INCOME, NET: $-146,699GeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$30,525OtherActivitiesAmount
Total Lobbying Expenditures IIB30525TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationHAVEN 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.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1373367BeginningOfYearBalance
Investment Earnings Or Losses116102InvestmentEarningsOrLosses
End Of Year Balance1489469EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1249994BeginningOfYearBalance
Investment Earnings Or Losses123373InvestmentEarningsOrLosses
End Of Year Balance1373367EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1292160BeginningOfYearBalance
Investment Earnings Or Losses-42166InvestmentEarningsOrLosses
End Of Year Balance1249994EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance1.00000BoardDesignatedEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1866351OtherCostOrOtherBasis
Book Value1866351BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis19882687OtherCostOrOtherBasis
Depreciation4102809Depreciation
Book Value15779878BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis280479OtherCostOrOtherBasis
Depreciation123198Depreciation
Book Value157281BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4868156OtherCostOrOtherBasis
Depreciation3296008Depreciation
Book Value1572148BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings19375658TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
GIFT ANNUITIES$152,506
DUE TO AFFILIATES$82,132
CAPITAL LEASE OBLIGATION$217,882
FieldValueIRS element (for citing)
Total Of Amounts452520TotalOfAmounts
Total Revenue56954068TotalRevenue
Total Expenses55289618TotalExpenses
Excess Or Deficit For Year1664450ExcessOrDeficitForYear
Net Unrealized GL On Investments359577NetUnrealizedGLOnInvestments
Other-$22,310OtherAmount
Total Adjustments337267TotalAdjustments
Excess Or Deficit Per FS2001717ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt56538878TotRevenueEtcAuditedFinclStmt
Other Revenues-415190OtherRevenues
Revenue Not Rptd F990-415190RevenueNotRptdF990
Revenue Subtotal56954068RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99056954068TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt54874428TotExpensesEtcAuditedFinclStmt
Other Expenses Included-415190OtherExpensesIncluded
Expenses Not Rptd F990-415190ExpensesNotRptdF990
Expenses Subtotal55289618ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99055289618TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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:FIN 48 FOOTNOTE: HAVEN HAD NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2010. TAX YEARS 2007 THROUGH 2010 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 8 - OTHER ADJUSTMENTS:CHANGE IN VALUE OF RESTRICTED PLEDGES -18,396. NET ASSETS RELEASED FROM RESTRICTION USED FOR SERVICES -3,914.
PART XII, LINE 2D - OTHER ADJUSTMENTS:UNREIMBURSED CARE -609,971. SPECIAL EVENT EXPENSES 194,781.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:UNREIMBURSED CARE -609,971. SPECIAL EVENT EXPENSES 194,781.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1VIVANameOfEvent1
Gross Receipts Event1143328GrossReceiptsEvent1
Charitable Contributions Event1114558CharitableContributionsEvent1
Gross Revenue Event128770GrossRevenueEvent1
Other Direct Expenses Event1120840OtherDirectExpensesEvent1
Name Of Event2FALL AT FARMNameOfEvent2
Gross Receipts Event252472GrossReceiptsEvent2
Charitable Contributions Event245252CharitableContributionsEvent2
Gross Revenue Event27220GrossRevenueEvent2
Other Direct Expenses Event236524OtherDirectExpensesEvent2
Total Number Of Other Events3TotalNumberOfOtherEvents
Gross Receipts Other Events43595GrossReceiptsOtherEvents
Charitable Contrib Other Events31505CharitableContribOtherEvents
Gross Revenue Other Events12090GrossRevenueOtherEvents
Other Direct Expenses Other Events37415OtherDirectExpensesOtherEvents
Gross Receipts Total239395GrossReceiptsTotal
Charitable Contributions Total191315CharitableContributionsTotal
Gross Revenue Total Events48080GrossRevenueTotalEvents
Other Direct Expenses Total Events194779OtherDirectExpensesTotalEvents
Direct Expense Summary Events194779DirectExpenseSummaryEvents
Net Income Summary-146699NetIncomeSummary

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MICHAEL P GALLAGHER
0801182069700108843870223059022592026282210132300
STEPHEN J DEMONTMOLLIN
030099401592910114438047125015980063782800
TIMOTHY J BOWEN
02703210488930286440560600197440423662012488
NEEL KARNANI MD
189035017270299014803015120207376000
MICHELE BOATWRIGHT MD
182850054101100156840230600222245000
CASSANDRA DONOVAN RN
131626011440013180120430115430167970000
ANDREA FINDLATER MD
1718520541012420141190258950213649000
GERALDINE BICHIER MD
163239050701600133400184450195691000
PATRICIA C LAW
1242430192760619011361072320162731000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
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 EMPLOYEES OF RELATED ORGANIZATIONS AND ARE COVERED BY A SEVERANCE POLICY FOR THEIR RESPECTIVE ORGANIZATION. THE SEVERANCE POLICY INCLUDES MONTHLY PAYMENTS UP TO A MAXIMUM OF 12 MONTHS UNDER QUALIFYING CIRCUMSTANCES. 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 VESTED AND RECEIVED PAYMENTS FROM A FROZEN NONQUALIFIED DEFINED BENEFIT RESTORATION PLAN IN 2010. MR. GALLAGHER ALSO VESTED AND RECEIVED PAYMENTS FROM THE NONQUALIFIED DEFINED CONTRIBUTION RESTORATION AND THE SUPPLEMENTAL RETIREMENT PLANS IN 2010. THE TOTAL AMOUNT OF THESE PAYMENTS WAS $831,870. MR. BOWEN VESTED AND RECEIVED $15,468 FROM THE SUPPLEMENTAL RETIREMENT PLAN IN 2010. STEPHEN J. DEMONTMOLLIN WAS 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 (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. MR. DEMONTMOLLIN RECEIVED $101,761 FROM THE DEFINED CONTRIBUTION RESTORATION AND SUPPLEMENTAL RETIREMENT INCOME PLANS IN 2010.
PART IIIPART I, LINE 3: MICHAEL P. GALLAGHER IS THE CHIEF EXECUTIVE OFFICER (CEO) OF NORTH CENTRAL FLORIDA HOSPICE, INC. 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 EXTERNAL 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 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 CONSULTING FIRM. THE 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.SUPPLEMENTAL INFORMATION

Schedule M IRS990ScheduleM

Clothing And Household Goods ClothingAndHouseholdGoods

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F990995916NoncashContribsRptdF990
Method Of Determining RevenuesRESALE VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts1ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 6THE 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 7ASANTAFE 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 7BTHE 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 11THE ORGANIZATION'S PROCESS FOR ENSURING THE ACCURATE PREPARATION, REVIEW AND APPROVAL OF THE 2010 FORM 990 BEGAN WITH PROFESSIONAL DEVELOPMENT OF STAFF (SEVERAL OF WHICH ARE CPAS) WHICH WERE INVOLVED IN THE PREPARATION OF THE 2010 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 2010 FORM 990, DELOITTE TAX LLP PERFORMED A DETAILED REVIEW OF THE 2010 FORM 990. A COPY OF THE 2010 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 2010 FORM 990 AND ATTACHMENTS WITH THE IRS.
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 12C
LINE 15A: MICHAEL P. GALLAGHER IS THE CHIEF EXECUTIVE OFFICER (CEO) OF HAVEN HOSPICE. 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 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 CONSULTING FIRM. THE CONSULTING 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 ASSISTANT SECRETARY AND PRESIDENT OF HAVEN HOSPICE IS AS FOLLOWS: THE 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 OF 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 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 COMPENSATION 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 2008.FORM 990, PART VI, SECTION B, LINE 15
UPDATED ARTICLES OF INCORPORATION FOR HAVEN HOSPICE ARE AVAILABLE ON THE STATE OF FLORIDA, SECRETARY OF STATE WEBSITE WWW.SUNBIZ.ORG.FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL, MICHAEL P. GALLAGHER, IS EMPLOYED BY SANTAFE HEALTHCARE, INC. (SANTAFE), THE PRINCIPAL SUPPORTING ORGANIZATION FOR NORTH CENTRAL FLORIDA HOSPICE, INC. (D/B/A HAVEN HOSPICE). MR. GALLAGHER'S COMPENSATION IS PAID DIRECTLY BY SANTAFE. SANTAFE CHARGES HAVEN HOSPICE A MANAGEMENT FEE FOR SERVICES PROVIDED BY MR. GALLAGHER. ONE OF THE ORGANIZATION'S OFFICERS, STEPHEN J. DEMONTMOLLIN, IS EMPLOYED BY AVMED, INC. (AVMED), A RELATED TAX-EXEMPT ORGANIZATION. MR. DEMONTMOLLIN'S COMPENSATION IS PAID DIRECTLY BY AVMED. NONE OF MR. DEMONTMOLLIN'S COMPENSATION WAS CHARGED TO HAVEN HOSPICE. ONE OF THE ORGANIZATION'S OFFICERS, TIMOTHY J. BOWEN, IS EMPLOYED BY SANTAFE, THE PRINCIPAL SUPPORTING ORGANIZATION FOR HAVEN HOSPICE. MR. BOWEN'S COMPENSATION IS PAID DIRECTLY BY SANTAFE. SANTAFE CHARGES HAVEN HOSPICE A MANAGEMENT FEE FOR SERVICES PROVIDED BY MR. BOWEN.FORM 990, PART VII, SECTION A, LINE 1A:
AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS:MICHAEL P GALLAGHER DEVOTED AN AVERAGE OF 56 HOURS PER WEEK TO RELATED ORGANIZATIONS. STEPHEN J DEMONTMOLLIN DEVOTED AN AVERAGE OF 58 HOURS PER WEEK TO RELATED ORGANIZATIONS.FORM 990, PART VII, SECTION A, COLUMN B:
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 359,577. CHANGE IN VALUE OF RESTRICTED PLEDGES -18,396. NET ASSETS RELEASED FROM RESTRICTION USED FOR SERVICES -3,914. TOTAL TO FORM 990, PART XI, LINE 5: 337,267.FORM 990, PART XI, LINE 5:
AUDIT COMMITTEE OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT: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.FORM 990, PART XII, LINE 2C:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
SANTAFE HEALTHCARE INC
PO BOX 749GAINESVILLEFL326270749592317607MANAGEMENT AND FINANCIAL SUPPORT FOR NOT-FOR-PROFIT AFFILIATESFL501(C)(3)11B TYPE IIN/A0
AVMED INC
PO BOX 749GAINESVILLEFL326270749592742907HEALTH CAREFL501(C)(4)N/AN/A0
NORTH FLORIDA RETIREMENT VILLAGE INC
PO BOX 749GAINESVILLEFL326270749591912330RETIREMENT COMMUNITYFL501(C)(3)9N/A0
SANTAFE SENIOR LIVING INC
PO BOX 749GAINESVILLEFL326270749203700526MANAGEMENT AND FINANCIAL SUPPORT FOR NOT-FOR-PROFIT AFFILIATESFL501(C)(3)11A TYPE IN/A0
BVG ACQUISITION INC
PO BOX 749GAINESVILLEFL326270749203701186RETIREMENT COMMUNITYFL501(C)(3)9N/A0
EAST RIDGE RETIREMENT VILLAGE INC
PO BOX 749GAINESVILLEFL326270749590903331RETIREMENT COMMUNITYFL501(C)(3)9N/A0
BONITA SPRINGS RETIREMENT VILLAGE INC
PO BOX 749GAINESVILLEFL326270749262386152RETIREMENT COMMUNITYFL501(C)(3)9N/A0
SANTAFE SENIOR LIVING FOUNDATION INC
PO BOX 749GAINESVILLEFL326270749264464727CHARITABLE & EDUCATIONAL PURPOSESFL501(C)(3)7N/A0

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1SF HOLDING CORPINC & SUBSIDIARYBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 749AddressLine1
CityGAINESVILLECity
StateFLState
ZIP Code326270749ZIPCode
FieldValueIRS element (for citing)
EIN592903901EIN
Primary ActivityHOLDING COMPANYPrimaryActivity
Legal Domicile StateFLLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
AVMED INC
L2408433FAIR MARKET VALUE
AVMED INC
K204296FAIR MARKET VALUE