2020-10-27T14:01:23-05:00 2019-12-31 134008324 PRICEWATERHOUSECOOPERS LLP 76 S LAURA STREET SUITE 2100 JACKSONVILLE FL 32202 990 2019-01-01 592490893 NORTH CENTRAL FLORIDA HOSPICE INC NORT 3523728400 SANTAFE HEALTHCAREINC PO BOX 749 GAINESVILLE FL 326270749 RANDALL L STUART ASSISTANT TREASURER 3523378730 2020-10-27 1 MICHAEL J MULDOON P00889797 9043540671 12.8.190.134 2020-10-27 13:22:37 ED P C0B6FCE7C92735BAA889312035EEB5B663ECBE10 C0B6FCE7C92735BAA889312035EEB5B663ECBE10 2019 2021-01-29 14:40:06Z HAVEN HOSPICE LAWRENCE G SCHREIBER SANTAFE HEALTHCAREINC PO BOX 749 GAINESVILLE FL 326270749 43117202 0 X WWW.BEYOURHAVEN.ORG X 1982 FL HONORING LIFE BY PROVIDING COMFORT, CARE AND COMPASSION TO THOSE WE SERVE. 11 10 628 619 0 0 3582393 4172614 50754030 37312819 1181456 345245 590878 1207015 56108757 43037693 0 0 0 0 29422508 27180795 0 0 483712 26003000 15912694 55425508 43093489 683249 -55796 57406134 56906320 14612672 13125821 42793462 43780499 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 PROVIDES 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 17896556 27107856 HAVEN HOSPICE OFFERS COMPASSIONATE HOSPICE CARE AND SUPPORT TO INDIVIDUALS WITH LIFE-LIMITING ILLNESS AND THEIR FAMILIES, WHICH ADDRESS THE PHYSICAL, PSYCHOSOCIAL, EMOTIONAL AND SPIRITUAL NEEDS ASSOCIATED WITH ADVANCED ILLNESS WHILE RESPECTING EACH INDIVIDUAL'S GOALS, BELIEFS AND WISHES. HAVEN HOSPICE'S TEAM OF MEDICAL PROVIDERS AND STAFF EXPERTLY MANAGE PAIN AND SYMPTOMS AT HOME OR IN A VARIETY OF SETTINGS INCLUDING HOSPITALS, NURSING HOMES OR ASSISTED LIVING FACILITIES. HAVEN HOSPICE PROVIDED SERVICES TO 2,747 HOSPICE PATIENTS INCLUDING 185,284 DAYS OF SERVICE. EXPENSES INCLUDE $697,232 OF UNREIMBURSED CARE. 8910541 9522948 HAVEN HOSPICE OFFERS HOSPICE CARE CENTERS IN GAINESVILLE, PALATKA, LAKE CITY AND ORANGE PARK WHEN THERE IS A NEED FOR SHORT-TERM INPATIENT CARE. IN THESE WELCOMING AND HOME-LIKE SETTINGS, HAVEN HOSPICE PHYSICIANS, ADVANCED REGISTERED NURSE PRACTITIONERS AND OTHER CLINICIANS PROVIDE AROUND-THE-CLOCK CARE TO PATIENTS NEEDING INTENSE PAIN AND SYMPTOM MANAGEMENT AS WELL AS PROVIDE EDUCATION AND SUPPORT TO FAMILY AND LOVED ONES. FAMILY MEMBERS ARE WELCOME 24 HOURS A DAY AND ARE ENCOURAGED TO STAY. HAVEN HOSPICE ALSO WELCOMES VISITS FROM CHILDREN AND FAMILY PETS. THE CARE CENTERS OFFER OVERNIGHT RESPITE CARE TO PROVIDE A BREAK TO PRIMARY CAREGIVERS FOR UP TO FIVE DAYS. EACH CARE CENTER OFFERS THE LOCAL COMMUNITY A PLACE TO HOLD MEETINGS AND EDUCATIONAL EVENTS.HAVEN HOSPICE PROVIDED SERVICES TO 2,246 PATIENTS IN INPATIENT CARE CENTERS, FOR A TOTAL OF 14,980 DAYS OF SERVICE. EXPENSES INCLUDE $649,498 OF UNREIMBURSED CARE. 192265 0 HAVEN HOSPICE PROVIDES BEREAVEMENT SERVICES TO FAMILY MEMBERS OF PATIENTS WHO HAVE DIED IN OUR CARE AND TO THE COMMUNITIES IN WHICH WE SERVE. WORKPLACE COUNSELING AND SUPPORT: HAVEN HOSPICE PROVIDES COUNSELING AND SUPPORT TO AREA BUSINESSES WHOSE STAFF ARE DEALING WITH GRIEF, LOSS, LIFE-LIMITING ILLNESS, OR SERVING AS CAREGIVERS. HAVEN HOSPICE IS A RESOURCE FOR COUNSELING SERVICES AND EDUCATIONAL PROGRAMS. HELPING EMPLOYEES WITH FAMILY CONCERNS HAS PROVEN TO LOWER UNSCHEDULED ABSENCES, REDUCE THE NUMBER OF BENEFIT CLAIMS AND INCREASE PRODUCTIVITY. HAVEN HOSPICE OFFERS SEVERAL COUNSELING AND SUPPORT PROGRAMS AND SERVICES AT COMMUNITY WORKSITES AS FOLLOWS: COPING WITH GRIEF AND LOSS IN THE WORKPLACE; WORKING CAREGIVERS: BALANCING TWO FULL-TIME JOBS; LIFE PLANNING: DOCUMENTS YOU SHOULDN'T LIVE WITHOUT; AND PREVENTING COMPASSION FATIGUE IN THE CAREGIVING PROFESSION.CAMP SAFE HAVEN: CAMP SAFE HAVEN PROVIDES CHILDREN, TEENS AND FAMILIES WITH FUN AND THERAPEUTIC ACTIVITIES TO HELP THEM WORK THROUGH THEIR FEELINGS OF GRIEF. THE CAMP IS SUPPORTED BY HAVEN HOSPICE'S STAFF OF PROFESSIONALS AND VOLUNTEERS.HEALING HEARTS GRIEF SUPPORT: HAVEN HOSPICE'S HEALING HEARTS GRIEF SUPPORT PROGRAM OFFERS INDIVIDUAL, FAMILY AND GROUP COUNSELING TO ANYONE COPING WITH LOSS, REGARDLESS OF HOW THE LOSS OCCURRED.COUNSELING AND EDUCATION: HAVEN HOSPICE OFFERS SHORT-TERM INDIVIDUAL, FAMILY AND GROUP BEREAVEMENT COUNSELING WITH SPECIALLY TRAINED HAVEN HOSPICE PROFESSIONALS FOR ANYONE IN THE COMMUNITY WHO HAS EXPERIENCED A LOSS.MEMORIAL SERVICES: HAVEN HOSPICE HOSTS LOVE AND REMEMBRANCE (MEMORIAL) SERVICES IN SPRING AND FALL TO HONOR THE LIVES OF FAMILY, FRIENDS AND LOVED ONES.THE BEREAVEMENT DEPARTMENT CONDUCTED COMMUNITY EDUCATION EVENTS WITH 73 INDIVIDUALS ATTENDING. EIGHT SESSIONS ON COPING WITH GRIEF DURING THE HOLIDAYS WERE HOSTED IN THE COMMUNITY WITH 74 INDIVIDUALS ATTENDING. IN ADDITION, 4,481 SUPPORT MAILERS WERE DISTRIBUTED, 3,735 BEREAVEMENT SUPPORT PHONE CALLS WERE PLACED AND 202 INDIVIDUALS WERE PROVIDED EITHER GROUP, INDIVIDUAL, OR FAMILY GRIEF SUPPORT COUNSELING. 34 MEMORIAL SERVICES WERE HELD WITH AN AVERAGE ATTENDANCE OF 75 PARTICIPANTS PER SERVICE. 2 TEEN/KID GRIEF CAMPS WERE HELD FOR 60 PARTICIPANTS. 2977735 682015 PALLIATIVE CARE CONSULTATIONS: HAVEN HOSPICE'S PALLIATIVE CARE CONSULTATIONS ARE PROVIDED BY A TEAM OF PHYSICIANS AND NURSE PRACTITIONERS. THE PROGRAM INCLUDES A PALLIATIVE CARE MEDICAL EXAMINATION TO ADDRESS PAIN AND SYMPTOMS AS WELL AS DISCUSSIONS WITH INDIVIDUALS AND THEIR HEALTHCARE PROVIDERS ABOUT TREATMENT GOALS, OPTIONS AND RECOMMENDATIONS.TRANSITIONS: HAVEN HOSPICE'S TRANSITIONS PROGRAM OFFERS EMOTIONALLY SUPPORTIVE PHONE CALLS, VOLUNTEER COMPANIONS AND REFERRALS TO COMMUNITY SERVICES FOR INDIVIDUALS AND FAMILIES WHO ARE DEALING WITH ADVANCED ILLNESS AND WHO ARE NEEDING ADDITIONAL SUPPORT.ADVANCE CARE PLANNING (ACP): THE MISSION OF ADVANCE CARE PLANNING IS TO HAVE AS MANY PEOPLE OVER THE AGE OF 18 AND ESPECIALLY THOSE WITH ADVANCED ILLNESS EXPERIENCE AN ADVANCE CARE PLANNING SESSION. THE GOAL IS TO HAVE THE CONVERSATION WITH LOVED ONES AND/OR A HEALTH CARE SURROGATE SO THAT THE INDIVIDUAL'S CURRENT AND FUTURE HEALTHCARE GOALS, WISHES AND VALUES ARE DOCUMENTED AND SHARED. IN ORDER TO HONOR WISHES, OTHERS HAVE TO BE INFORMED. 2977735 682015 29977097 1 1 0 1 0 0 0 0 0 1 1 0 1 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 1 342 0 1 628 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 11 10 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X RANDALL L STUART ASST TREASURER 3523378730 4300 NW 89TH BLVD GAINESVILLE FL 326065688 X MICHAEL P GALLAGHER CEO/DIRECTOR (THROUGH 3/1/2019) 3.00 57.00 X X 0 2733988 27664 RANDALL L STUART ASSISTANT TREASURER 3.00 57.00 X 0 919470 141343 LAWRENCE G SCHREIBER CHIEF EXECUTIVE OFFICER/DIRECTOR 3.00 57.00 X X 0 675832 171408 STEVEN M ZIEGLER ASSISTANT SECRETARY 3.00 57.00 X 0 689964 154569 GAYLE MATTSON PRESIDENT (THROUGH 5/31/2019) 54.00 6.00 X 0 385031 10439 TIFFANY T MASSEY MD ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 317531 0 9403 GERALDINE S BICHIER MD ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 238066 0 51790 CATHERINE E AYERS FORMER ASSISTANT SECRETARY 2.00 38.00 X 0 235694 9463 KATHERINE L FERNANDEZ INTERIM PRESIDENT 54.00 6.00 X 240000 0 0 CHRISTOPHER RUSSELL VP OF OPERATIONS 50.00 0.00 X 60514 97525 29042 DEBORAH M GREEN VP/CHIEF FINANCIAL OFFICER 50.00 0.00 X 104881 60551 17425 CHARLES L SUGGS III MD ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 175773 0 4537 JACQUELINE S HART DIRECTOR OF CLINICAL PRACTICE 40.00 0.00 X 139620 0 20420 PATRICK F WOLOSZYN MD ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 149174 0 7610 GLENDA E HOOD CHAIR/DIRECTOR 0.10 2.90 X X 0 91374 0 JACKSON N SASSER PHD VICE CHAIR/DIRECTOR 0.10 1.40 X X 0 63624 0 ROBERT L EPLING TREASURER/DIRECTOR 0.10 1.40 X X 0 61224 0 ALBERT E DOTSON PHD SECRETARY/DIRECTOR 0.10 1.40 X X 0 60897 0 BENJAMIN I DOERR JR DIRECTOR 0.10 1.40 X 0 60031 0 PAUL R PHILIP DIRECTOR 0.10 1.40 X 0 58631 0 JOSEPH W DAVIS DIRECTOR 0.10 1.40 X 0 57631 0 THOMAS A NATIELLO PHD DIRECTOR 0.10 1.40 X 0 56731 0 PAMELA J MOONEY PHD DIRECTOR 0.10 1.40 X 0 55504 0 GEORGE E FLETCHER DIRECTOR 0.10 1.40 X 0 54904 0 SCOTTIE J BUTLER DIRECTOR (THROUGH 11/13/2019) 0.10 1.40 X 0 41669 0 1425559 6460275 655113 16 1 1 0 SANTAFE MANAGEMENT SERVICES LLC PO BOX 749 GAINESVILLE FL 326270749 MANAGEMENT SERVICES 1827863 RIVERWOOD NH LLC 808 S COLLEY ROAD STARKE FL 32091 NURSING HOME SERVICES 631263 SOLARIS HEALTHCARE LAKE CITY LLC 560 SW MCFARLANE AVENUE LAKE CITY FL 32025 NURSING HOME SERVICES 628633 HEALTH FACILITIES INC 7280 SW SR 26 TRENTON FL 32693 NURSING HOME SERVICES 597398 TERRACE OF JACKSONVILLE LLC 10680 OLD ST AUGUSTINE ROAD JACKSONVILLE FL 32257 NURSING HOME SERVICES 551116 38 54689 80743 4037182 2989249 4172614 MEDICARE REVENUE 623990 24308267 24308267 MEDICAID REVENUE 623990 11527578 11527578 NET PATIENT SERVICE REVENUES 623990 1476974 1476974 37312819 331675 331675 40968 2500 29898 0 11070 2500 13570 13570 19500 80743 49611 -30111 -30111 ADMINISTRATIVE INCOME 900099 1237126 1237126 1237126 43037693 37312819 0 1552260 417268 59717 357551 21558468 17153654 4357982 46832 996507 834500 159665 2342 2641355 1977062 651736 12557 1567197 1238657 324826 3714 2014037 756667 1006170 251200 183610 183610 70017 70017 2743320 1350461 1329552 63307 51290 50247 1043 1156547 433473 695744 27330 658667 13517 645150 1631916 827742 804174 1153387 947808 199706 5873 26640 6067 20573 225651 202285 23366 1799501 913245 886256 413283 106464 306819 COMMUNITY SUPPORT 1436002 1354898 32826 48278 PHARMACY SUPPLIES 1146887 1146887 MEDICAL SUPPLIES 409444 405138 4306 DUES AND SUBSCRIPTIONS 252844 78232 174612 539651 120376 398039 21236 43093489 29977097 12632680 483712 2958121 2310628 2568533 440339 4475 55049 1797911 2642633 333501 465163 54946148 17385305 38524389 37560843 6605229 7598128 2731380 3189769 1882595 2643768 57406134 56906320 6412186 5000653 6880827 6551128 1319659 1574040 14612672 13125821 X 42443096 43349909 350366 430590 42793462 43780499 57406134 56906320 X -55796 1232886 -190053 X X 0 1 X 1 0 X 3482463 4538012 3845699 3582393 4172614 19621181 61430163 60540505 53737892 50754030 37312819 263775409 64912626 65078517 57583591 54336423 41485433 283396590 0 0 0 283396590 606376 583064 571466 354098 331675 2446679 606376 583064 571466 354098 331675 2446679 -42894 109730 191268 590878 1206815 2055797 65476108 65771311 58346325 55281399 43023923 287899066 0.98440 0.98810 0.00850 0.00940 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: ADMINISTRATIVE INCOME - 2015 AMOUNT: $ 137,798. 2016 AMOUNT: $ 436,771. 2017 AMOUNT: $ 366,745. 2018 AMOUNT: $ 739,613. 2019 AMOUNT: $ 1,237,126. SPECIAL EVENT INCOME NET - 2015 AMOUNT: $ -180,692. 2016 AMOUNT: $ -327,041. 2017 AMOUNT: $ -175,477. 2018 AMOUNT: $ -148,735. 2019 AMOUNT: $ -30,311. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1289 1289 0 PART II-B, LINE 1: HAVEN HOSPICE IS A MEMBER OF THE FLORIDA HOSPICE AND PALLIATIVE CARE, INC., ALLIANCE FOR CARE, AND THE NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION. MEMBERSHIP DUES TO THE ASSOCIATIONS INCLUDE A SMALL PERCENTAGE FOR LOBBYING EFFORTS. 2519832 655946 3175778 2769117 -249285 2519832 2429663 339454 2769117 2248125 181538 2429663 2249856 -1731 2248125 1.00000 0 0 5645194 5645194 40892968 10477274 30415694 1043700 739633 304067 7364286 6168398 1195888 37560843 BOARD DESIGNATED ENDOWMENT 3175778 F GIFT ANNUITIES 13991 F 3189769 CHARITABLE REMAINDER UNITRUST 787000 DUE TO AFFILIATES 234945 CAPITAL LEASE OBLIGATION 221707 INTEREST RATE SWAP 188848 GIFT ANNUITIES 141540 1574040 X 41378941 -1346721 -1346721 42725662 312031 312031 43037693 41485462 -261306 -261306 41746768 1346721 1346721 43093489 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: HAVEN IS EXEMPT FROM INCOME TAXES ON INCOME FROM RELATED ACTIVITIES UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING STATE TAX LAW. ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR FEDERAL OR STATE INCOME TAXES. U.S. GAAP REQUIRES THAT A TAX POSITION IS RECOGNIZED AS A BENEFIT ONLY IF IT IS "MORE LIKELY THAN NOT" THAT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED IS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY TO BE REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE "MORE LIKELY THAN NOT" TEST, NO TAX BENEFIT IS RECORDED. HAVEN'S FORM 990 HAS NOT BEEN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE OR THE STATE OF FLORIDA FOR THE LAST THREE YEARS. HAVEN DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. HAVEN RECOGNIZES INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE. HAVEN DID NOT HAVE ANY AMOUNTS ACCRUED FOR INTEREST AND PENALTIES AT DECEMBER 31, 2019 AND DECEMBER 31, 2018. PART XI, LINE 2D - OTHER ADJUSTMENTS: UNREIMBURSED CARE -1,346,721. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS AND PLEDGES 50,725. SPECIAL EVENT EXPENSES WERE MOVED FROM EXPENSE TO REVENUE -49,611. MANAGEMENT FEE INCOME 310,917. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES WERE MOVED FROM EXPENSE TO REVENUE 49,611. MANAGEMENT FEE INCOME -310,917. PART XII, LINE 4B - OTHER ADJUSTMENTS: UNREIMBURSED CARE 1,346,721. VIVA 100243 80743 19500 0 100 11221 20020 7871 10399 100243 80743 19500 100 11221 20020 7871 10399 49611 -30111 0 1 0 0 0 0 0 0 0 MICHAEL P GALLAGHER CEO/DIRECTOR (THROUGH 3/1/2019) 0 249096 0 2051247 0 433645 0 16800 0 10864 0 2761652 0 0 RANDALL L STUART ASSISTANT TREASURER 0 482682 0 262698 0 174090 0 116077 0 25266 0 1060813 0 85241 LAWRENCE G SCHREIBER CHIEF EXECUTIVE OFFICER/DIRECTOR 0 642682 0 0 0 33150 0 153462 0 17946 0 847240 0 0 STEVEN M ZIEGLER ASSISTANT SECRETARY 0 382640 0 216862 0 90462 0 120218 0 34351 0 844533 0 71294 GAYLE MATTSON PRESIDENT (THROUGH 5/31/2019) 0 187688 0 158248 0 39095 0 10199 0 240 0 395470 0 0 TIFFANY T MASSEY MD ASSOCIATE MEDICAL DIRECTOR 316828 0 505 0 198 0 7130 0 2273 0 326934 0 0 0 GERALDINE S BICHIER MD ASSOCIATE MEDICAL DIRECTOR 226026 0 1110 0 10930 0 14925 0 36865 0 289856 0 0 0 CATHERINE E AYERS FORMER ASSISTANT SECRETARY 0 85537 0 144035 0 6122 0 9183 0 280 0 245157 0 0 KATHERINE L FERNANDEZ INTERIM PRESIDENT 240000 0 0 0 0 0 0 0 0 0 240000 0 0 0 CHRISTOPHER RUSSELL VP OF OPERATIONS 44873 92819 15059 0 582 4706 1424 10923 7051 9644 68989 118092 0 0 DEBORAH M GREEN VP/CHIEF FINANCIAL OFFICER 91047 57954 12600 0 1234 2597 3738 9012 3558 1117 112177 70680 0 0 CHARLES L SUGGS III MD ASSOCIATE MEDICAL DIRECTOR 173131 0 900 0 1742 0 3024 0 1513 0 180310 0 0 0 JACQUELINE S HART DIRECTOR OF CLINICAL PRACTICE 120156 0 15595 0 3869 0 9744 0 10676 0 160040 0 0 0 PATRICK F WOLOSZYN MD ASSOCIATE MEDICAL DIRECTOR 148481 0 693 0 0 0 7610 0 0 0 156784 0 0 0 PART I, LINE 3 LAWRENCE G SCHREIBER AND MICHAEL P GALLAGHER (THROUGH 3/1/2019) ARE THE CHIEF EXECUTIVE OFFICERS (CEO) OF NORTH CENTRAL FLORIDA HOSPICE, INC. (HAVEN HOSPICE). MR. SCHREIBER AND MR. GALLAGHER ARE 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; SEVERANCE IS HANDLED ON A CASE BY CASE BASIS. EMPLOYEES OF RELATED ORGANIZATIONS ARE COVERED UNDER A SEVERANCE POLICY WHICH INCLUDES MONTHLY PAYMENTS UP TO A MAXIMUM OF 12 - 36 MONTHS UNDER QUALIFYING CIRCUMSTANCES AND DEPENDING ON POSITION. NO ONE LISTED RECEIVED SEVERANCE OR CHANGE OF CONTROL PAYMENTS DURING 2019. PART I, LINE 4B: LISTED PERSONS PARTICIPATING IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN THE YEAR: LAWRENCE G SCHREIBER, MICHAEL P GALLAGHER (THROUGH 3/1/2019), RANDALL L STUART, STEVEN M ZIEGLER AND GAYLE MATTSON (THROUGH 5/31/2019) ARE EMPLOYEES OF SANTAFE HEALTHCARE, INC., A RELATED SUPPORTING ORGANIZATION. THEY 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 $217,522 FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS IN 2019. MR. STUART VESTED AND RECEIVED $124,495 FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS IN 2019. MR. ZIEGLER VESTED AND RECEIVED $74,857 FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN 2019. CATHERINE E AYERS, A FORMER OFFICER, VESTED AND RECEIVED $6,122 FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN 2019. 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 OVER $2 BILLION IN GROSS RECEIPTS AND MORE THAN 1,900 EMPLOYEES. THESE SENIOR EXECUTIVES ARE PAID DIRECTLY BY SANTAFE HEALTHCARE, INC. AND THEIR COMPENSATION AND BENEFITS ARE APPORTIONED AND CHARGED TO THE RESPECTIVE AFFILIATES BASED ON THE ESTIMATED AMOUNT OF TIME SPENT ON EACH AFFILIATE'S ACTIVITIES. FOR 2019, EXECUTIVE COMPENSATION AND BENEFITS WERE APPORTIONED AND CHARGED TO HAVEN HOSPICE AS FOLLOWS: 5% - LAWRENCE G SCHREIBER, CHIEF EXECUTIVE OFFICER 5% - MICHAEL P GALLAGHER, CHIEF EXECUTIVE OFFICER (THROUGH 3/1/2019) 5% - RANDALL L STUART, ASSISTANT TREASURER 5% - CATHERINE E AYERS, FORMER ASSISTANT SECRETARY 5% - STEVEN M ZIEGLER, ASSISTANT SECRETARY 100% - GAYLE MATTSON, PRESIDENT (THROUGH 5/31/2019) 100% - DEBORAH M GREEN, CHIEF FINANCIAL OFFICER 100% - CHRISTOPHER RUSSELL, VP OF OPERATIONS A ALACHUA COUNTY HEALTH FACILITIES AUTHORITY 592442398 2015-12-15 8600000 HOSPICE CARE FACILITY EXPANSION 0 0 0 A 1779873 8600000 62130 8268871 268999 2016 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 BBVA COMPASS 11.500000000000 0 0 0 0 1 A 1 SCHEDULE K, PARTS I AND II ADDITIONAL INFORMATION REGARDING THE BONDS ISSUE: THE ALACHUA COUNTY HEALTH FACILITIES AUTHORITY BONDS WERE ISSUED AS A DRAW-DOWN LOAN FOR EXPANSION OF THE E.T. YORK CARE CENTER. THE ISSUE PRICE AND PROCEEDS AMOUNTS SHOWN ON PARTS I AND II ARE THE MAXIMUM AMOUNT OF THE LOAN. AS OF THE END OF THE REPORTING YEAR, LESS THAN THE ENTIRE BALANCE OF THE LOAN HAD BEEN DRAWN DOWN. X 2978839 RESALE VALUE X 2 10410 FAIR MARKET VALUE 0 1 0 FORM 990, PART VI, SECTION A, LINE 7A HAVEN HOSPICE'S ARTICLES OF INCORPORATION AND BYLAWS STATE THAT THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS SHALL CONSTITUTE THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS CONSTITUTES THE ORGANIZATION'S BOARD OF DIRECTORS, WHICH MAKES ALL GOVERNANCE DECISIONS OF THE ORGANIZATION. THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS HAS THE POWER AND AUTHORITY TO ESTABLISH COMMITTEES, TO ELECT AND REMOVE OFFICERS, TO APPROVE AMENDMENTS OF THE ORGANIZATION'S GOVERNING DOCUMENTS, AND TO MODIFY, AMEND, RESCIND, OR REPEAL ANY ACTION TAKEN BY THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S PROCESS FOR ENSURING THE ACCURATE PREPARATION, REVIEW AND APPROVAL OF THE 2019 FORM 990 BEGAN WITH PROFESSIONAL DEVELOPMENT OF STAFF (SEVERAL OF WHICH ARE CPAS) WHICH WERE INVOLVED IN THE PREPARATION OF THE 2019 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 2019 FORM 990, PRICEWATERHOUSECOOPERS LLP REVIEWED THE 2019 FORM 990. A COPY OF THE 2019 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 2019 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 COMPLIANCE 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 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 COMPLIANCE DEPARTMENT WITH REVIEW OF ANY DISCLOSURES BY THE 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 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 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 LAWRENCE G SCHREIBER AND MICHAEL P GALLAGHER (THROUGH 3/1/2019) ARE THE CHIEF EXECUTIVE OFFICERS (CEO) OF HAVEN HOSPICE. MR. SCHREIBER AND MR. GALLAGHER ARE 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 ANNUALLY RETAINS AN INDEPENDENT THIRD PARTY CONSULTANT TO CONDUCT A MARKET COMPETITIVENESS REVIEW OF THE BOARD OF DIRECTORS' (INCLUDING OFFICER POSITIONS) COMPENSATION. THE COMPETITIVENESS ANALYSIS INCLUDES COMPARISONS TO BOTH NOT-FOR-PROFIT AND PUBLIC COMPANY (EXCLUDING EQUITY COMPONENT) DATA FOR COMPANIES WITHIN THE SAME OR SIMILAR INDUSTRY. ANY COMPENSATION CHANGES ARE APPROVED BY THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS BASED ON THE MARKET COMPETITIVENESS STUDY. NO DIRECTOR FEES WERE ALLOCATED TO HAVEN HOSPICE DURING 2019. FORM 990, PART VI, SECTION C, LINE 19 HAVEN HOSPICE'S PROCEDURE FOR MAKING VARIOUS DOCUMENTS AVAILABLE TO THE PUBLIC IS AS FOLLOWS: THE ARTICLES OF INCORPORATION CAN BE ACCESSED DIRECTLY THROUGH THE FLORIDA DEPARTMENT OF STATE, DIVISION OF CORPORATIONS WEBSITE AT WWW.SUNBIZ.ORG. THE CONFLICT OF INTEREST POLICY CAN BE OBTAINED DIRECTLY FROM THE ORGANIZATION UPON WRITTEN REQUEST. HAVEN HOSPICE DID NOT OTHERWISE MAKE ITS GOVERNING DOCUMENTS, INCLUDING BYLAWS, AVAILABLE TO THE PUBLIC. IN ADDITION, DURING THE TAX YEAR, HAVEN HOSPICE DID NOT MAKE ITS AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. 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 OVER $2 BILLION IN GROSS RECEIPTS AND MORE THAN 1,900 EMPLOYEES. THESE SENIOR EXECUTIVES ARE PAID DIRECTLY BY SANTAFE HEALTHCARE, INC. AND THEIR COMPENSATION AND BENEFITS ARE APPORTIONED AND CHARGED TO THE RESPECTIVE AFFILIATES BASED ON THE ESTIMATED AMOUNT OF TIME SPENT ON EACH AFFILIATE'S ACTIVITIES. FOR 2019, EXECUTIVE COMPENSATION AND BENEFITS WERE APPORTIONED AND CHARGED TO HAVEN HOSPICE AS FOLLOWS: 5% - LAWRENCE G SCHREIBER, CHIEF EXECUTIVE OFFICER 5% - MICHAEL P GALLAGHER, CHIEF EXECUTIVE OFFICER (THROUGH 3/1/2019) 5% - RANDALL L STUART, ASSISTANT TREASURER 5% - CATHERINE E AYERS, FORMER ASSISTANT SECRETARY 5% - STEVEN M ZIEGLER, ASSISTANT SECRETARY 100% - GAYLE MATTSON, PRESIDENT (THROUGH 5/31/2019) 100% - DEBORAH M GREEN, CHIEF FINANCIAL OFFICER 100% - CHRISTOPHER RUSSELL, VP OF OPERATIONS FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF DONOR RESTRICTED CONTRIBUTIONS -5,803. CHANGE IN FAIR VALUE OF CHARITABLE REMAINDER UNITRUST (CRUT) -123,419. CHANGE IN NET UNREALIZED GAINS/LOSSES ON CRUT 182,801. NET ASSETS RELEASED FOR OPERATIONS (RECOGNIZED FOR TAX IN PRIOR YEARS) -24,080. CHANGE IN NET UNREALIZED GAINS/LOSSES ON INTEREST RATE SWAP -219,552. FORM 990, PART XII, LINE 2C: AUDIT OVERSIGHT PROCESS: THE COMPANY'S AUDIT COMMITTEE HAS NOT CHANGED ITS PROCESS FOR SELECTION OF THE INDEPENDENT ACCOUNTANT OR ITS PROCESS FOR MANAGING THE AUDIT. HAVEN MEDICAL GROUP LLC P O BOX 749 GAINESVILLE FL 326270749 592490893 CONDUCT A MEDICAL PRACTICE SPECIALIZING IN PALLIATIVE CARE FL 112058 40751 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) 12B TYPE II N/A 0 AVMED INC PO BOX 749 GAINESVILLE FL 326270749 592742907 HEALTH CARE FL 501(C)(4) N/A SANTAFE HEALTHCARE INC 0 NORTH FLORIDA RETIREMENT VILLAGE INC PO BOX 749 GAINESVILLE FL 326270749 591912330 RETIREMENT COMMUNITY FL 501(C)(3) 10 SANTAFE HEALTHCARE INC 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) 12B TYPE II SANTAFE HEALTHCARE INC 0 BVG ACQUISITION INC PO BOX 749 GAINESVILLE FL 326270749 203701186 RETIREMENT COMMUNITY FL 501(C)(3) 10 SANTAFE HEALTHCARE INC 0 EAST RIDGE RETIREMENT VILLAGE INC PO BOX 749 GAINESVILLE FL 326270749 590903331 RETIREMENT COMMUNITY FL 501(C)(3) 10 SANTAFE HEALTHCARE INC 0 BONITA SPRINGS RETIREMENT VILLAGE INC PO BOX 749 GAINESVILLE FL 326270749 262386152 RETIREMENT COMMUNITY FL 501(C)(3) 10 SANTAFE HEALTHCARE INC 0 SANTAFE SENIOR LIVING FOUNDATION INC PO BOX 749 GAINESVILLE FL 326270749 264464727 CHARITABLE & EDUCATIONAL PURPOSES FL 501(C)(3) 7 SANTAFE HEALTHCARE INC 0 HOSPICE OF THE FLORIDA KEYS INC PO BOX 749 GAINESVILLE FL 326270749 592386289 HOSPICE CARE & HOME HEALTH CARE FL 501(C)(3) 7 SANTAFE HEALTHCARE INC 0 SF HOLDING CORPINC PO BOX 749 GAINESVILLE FL 326270749 592903901 HOLDING COMPANY FL N/A C 0 AVMED ADMINISTRATORS INC PO BOX 749 GAINESVILLE FL 326270749 842931956 THIRD PARTY ADMINISTRATIVE SERVICES FL N/A C 0 CHARITABLE REMAINDER UNITRUST CHARITABLE REMAINDER UNITRUST FL N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 AVMED INC L 69265 FAIR MARKET VALUE OF SERVICES AVMED INC M 3061577 FAIR MARKET VALUE OF SERVICES