2018-11-08T15:00:58-06:00 2017-12-31 350921680 CROWE LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2017-01-01 205276923 Good Shepherd Hospice Inc GOOD 8138718100 12470 telecom drive Suite 300 temple terrace FL 33637 David J O'Neil chief financial officer 2018-11-08 true NICOLE BENCIK P00756195 3128997000 2017 2018-06-14 16:35:46Z ANDREW MOLOSKY President & CEO 12470 Telecom drive Temple Terrace FL 33637 35618767 false X chaptershealth.org X 2006 FL Provides hospice and palliative care services that relieve the suffering of persons residing in its communities affected by life-limiting illnesses and end-of-life issues so all may live as fully as possible. 8 7 400 383 0 0 109085 113582 32277601 35492647 0 0 14401 12538 32401087 35618767 0 0 0 0 20847167 22123504 0 0 0 12895603 15024038 33742770 37147542 -1341683 -1528775 12868246 14879372 10425750 12850943 2442496 2028429 Good Shepherd Hospice, Inc. provides hospice and palliative care services that relieve the suffering of persons residing in its communities affected by life-limiting illnesses and end-of-life issues so all may live as fully and comfortably as possible. false false 31261233 0 35505185 A. PATIENT CARE - AS A NOT-FOR-PROFIT HOSPICE PROGRAM CERTIFIED BY THE FEDERAL MEDICARE PROGRAM, GOOD SHEPHERD HOSPICE PROVIDES A WIDE RANGE OF PALLIATIVE AND SUPPORTIVE CARE SERVICES TO HELP TERMINALLY ILL PATIENTS, THEIR FAMILIES AND THEIR LOVED ONES. Good Shepherd Hospice is a Medicare-certified agency that provides end-of-life care in Polk, Highlands and Hardee counties in Florida. In 2017, Good Shepherd Hospice served 3,795 patients in its communities. Good Shepherd Hospice maintains 53% market share in Polk Highlands and Hardee counties in 2017. These SERVICES ARE PROVIDED BY INTERDISCIPLINARY TEAMS COMPOSED OF QUALIFIED PROFESSIONALS AND TRAINED VOLUNTEERS. GOOD SHEPHERD HOSPICE ALSO HAS DEVELOPED AN EXTENSIVE NETWORK OF PARTNERSHIPS WITH HOSPITALS, ASSISTED LIVING FACILITIES AND NURSING HOMES TO IDENTIFY PATIENTS WHO WOULD BENEFIT FROM THE SERVICES AVAILABLE. (CONTINUED IN SCHEDULE O) 31261233 true true false false false false false false false true false false false true true true true true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 400 true false false false false false false true false false false X 8 7 false false false false true true true true true false false true true true true true true false false false FL X David J O'Neil 8138718111 12470 Telecom drive Suite 300 Temple Terrace FL 33637 Kathy L Fernandez president/ceo 2.0 48.0 X X 0 811441 255883 Philip D Wegman VICE CHAIR 2.0 2.0 X X 0 0 0 Martha Santiago secretary 2.0 0 X X 0 0 0 Thomas Conger board member 2.0 2.0 X 0 0 0 Michelle Heston Board Member 2.0 0 X 0 0 0 Brian Hinton Board Member (PARTIAL YEAR) 2.0 2.0 X 0 0 0 Willie Hogan Board Member 2.0 0 X 0 0 0 James Joiner Board Member (PARTIAL YEAR) 2.0 2.0 X 0 0 0 Phillip Walker Board Member (PARTIAL YEAR) 2.0 2.0 X 0 0 0 CLIFFORD RHOADES board member 2.0 2.0 X 0 0 0 ANNE FURR BOARD MEMBER 2.0 0 X 0 0 0 Donald D Evans Chief Integration and Business Development Officer 2.0 48.0 X 0 321930 106057 Audra Farish Chief Human Resources officer 2.0 48.0 X 0 290709 108952 David J O'Neil Chief Financial Officer 2.0 48.0 X 0 477921 213893 Sharon P Saucier Chief Compliance & Clinical Officer 2.0 48.0 X 0 309469 65373 Ronald S Schonwetter MD Chief Medical Officer 2.0 48.0 X 0 552028 242194 Sheryl J Sypek Chief Information Officer 2.0 46.0 X 0 305378 151221 Hubert Darrell White Jr Chief Legal Officer 2.0 48.0 X 0 395104 268409 Cheryl Fried CHIEF OPERATING OFFICER 2.0 48.0 X 0 177393 105451 Andrew Molosky INCOMING PRESIDENT/CEO (PARTIAL YEAR - STARTING 12/2017) 2.0 48.0 X 0 120077 0 Sara A Bohn Staff Physician (partial year) 40.0 0 X 156388 0 17649 Mary Grindel RN, MHA 40.0 0 X 129794 0 30445 Michele L Marziano staff physician 20.0 20.0 X 22600 160298 18024 NATALIA WETTERER MEDICAL DOCTOR 40.0 0 X 151598 0 17799 Andrea Miller medical director 40.0 0 X 148184 0 5339 608564 3921748 1606689 11 false true false CHAPTERS HEALTH SYSTEM INC 12470 TELECOM DRIVE SUITE 300 TEMPLE TERRACE FL 33637 SHARED SERVICES 203091 1 113582 113582 Patient Service Revenue 624100 35250695 35250695 Corporate allocation 900099 241952 241952 0 0 0 0 35492647 0 0 0 0 DIETARY SERVICES 900099 12168 12168 OTHER INCOME 900099 370 370 0 0 0 0 12538 35618767 35505185 0 0 0 0 17771896 15308304 2463592 2603982 2597208 6774 1747626 1161083 586543 162019 162019 55888 55888 646630 500418 146212 0 53253 752 52501 2580526 1967451 613075 614769 614769 2393592 2030602 362990 697018 672743 24275 103450 79740 23710 20323 20323 757431 80000 677431 Drugs 1980159 1980159 PATIENT SERVICES 1486643 1486643 INPATIENT AND RESPITE 1287979 1287979 Chemo, Radiation & Therapy 134911 134911 2049447 1973240 76207 0 37147542 31261233 5886309 0 1000 1000 2642966 3623567 0 0 0 0 0 0 0 0 0 80000 0 10144280 11254805 12868246 14879372 3242929 3784864 0 7182821 9066079 10425750 12850943 X 1748406 936112 589675 974741 104415 117576 2442496 2028429 12868246 14879372 X -1528775 1114708 X false true X true false X 111082 111082 127121 109085 113582 571952 35070537 29566558 33257755 32277601 35492647 165665098 0 0 0 35181619 29677640 33384876 32386686 35606229 166237050 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 166237050 0 0 0 0 0 0 0 0 0 0 0 0 0 16585 18084 0 14401 12538 61608 35198204 29695724 33384876 32401087 35618767 166298658 0.9996 0.9997 0 0.0 X Schedule A, Part III, Line 12 Other Income DESCRIPTION - OTHER INCOME, COLUMN A - 16585.0, COLUMN B - 18084.0, COLUMN C - 0.0, COLUMN D - 14401.0, COLUMN E - 12538.0, COLUMN F - 61608.0; 952006 14046 966052 938429 13577 0 952006 750493 181026 6910 938429 697796 15741 36956 750493 677948 100 19748 697796 0.0658 0.9342 0.0 false true true Beneficial Interest in net assets of Chapters Health System 11248069 due from THE third party 6736 11254805 Amounts Due to Related Parties 9066079 9066079 X 36491523 1114708 1114708 35376815 241952 241952 35618767 36905590 0 0 36905590 241952 241952 37147542 Schedule D, Part V, Line 4 Intended uses of endowment funds The Building Endowment fund provides funds for the necessary maintenance and facility upkeep of all Chapters Health System (CHS) facilities; the Children's Endowment fund provides funds for specific equipment and staffing to meet the needs of pediatric patients, grieving children and families; The Medical Student endowment provides funds to the Medical Student Program that educates future physicians on the importance of end-of-life care. These endowments are held by CHS and the programs and facilities of CHS support Good Shepherd Hospice, Inc. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote GSH is a noNprofit organization as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Internal Revenue Code. GSH's income tax returns are subject to review and examination by federal, state and local authorities. GSH is not aware of any activities that would jeopardize its tax-exempt status. GSH is subject to tax on unrelated business income for management fees received but is not aware of any activities that are subject to excise or other taxes. Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990 CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF CHS - 1114708 Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements CORPORATE ALLOCATION REDUCTION OF EXPENSES - 241952 Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements CORPORATE ALLOCATION REDUCTION OF EXPENSES - 241952 false true false false false false false false false Kathy L Fernandez president/ceo 0 581448 0 68884 0 161109 0 226580 0 29303 0 1067324 0 68884 Donald D Evans Chief Integration and Business Development Officer 0 235122 0 33663 0 53145 0 102166 0 3891 0 427987 0 33664 Audra Farish Chief Human Resources officer 0 247745 0 35032 0 7932 0 106950 0 2002 0 399661 0 35032 David J O'Neil Chief Financial Officer 0 406561 0 58458 0 12902 0 179230 0 34663 0 691814 0 58458 Sharon P Saucier Chief Compliance & Clinical Officer 0 299624 0 0 0 9845 0 50849 0 14524 0 374842 0 0 Ronald S Schonwetter MD Chief Medical Officer 0 472015 0 68523 0 11490 0 207512 0 34682 0 794222 0 68523 Sheryl J Sypek Chief Information Officer 0 256448 0 39928 0 9002 0 117414 0 33807 0 456599 0 39928 Hubert Darrell White Jr Chief Legal Officer 0 337050 0 48934 0 9120 0 243405 0 25004 0 663513 0 48934 Cheryl Fried CHIEF OPERATING OFFICER 0 171964 0 0 0 5429 0 99530 0 5921 0 282844 0 0 Sara A Bohn Staff Physician (partial year) 147468 0 8068 0 852 0 0 0 17649 0 174037 0 8068 0 Mary Grindel RN, MHA 121802 0 7037 0 955 0 7548 0 22897 0 160239 0 7037 0 Michele L Marziano staff physician 22553 138008 0 21912 47 378 665 5337 470 11552 23735 177187 0 21912 NATALIA WETTERER MEDICAL DOCTOR 136307 0 10000 0 5291 0 3686 0 14113 0 169397 0 10000 0 Andrea Miller medical director 142090 0 5000 0 1094 0 0 0 5339 0 153523 0 5000 0 Schedule J, Part I, Line 3 PROCESS OF DETERMINING COMPENSATION THE PRESIDENT & CEO IS PAID BY CHAPTERS HEALTH SYSTEM, INC. (A RELATED ORGANIZATION). CHAPTERS HEALTH SYSTEM USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, FORMS 990 OF OTHER ORGANIZATIONS, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO DETERMINE HER COMPENSATION. GOOD SHEPHERD HOSPICE, INC. RELIES ON CHAPTERS HEALTH SYSTEM TO ENSURE COMPENSATION IS REASONABLE. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan CHS (a related organization) has a supplemental executive retirement plan (SERP) in which some of the interested persons participate. During 2017, the following payments were made by CHS into the SERP plans of the participants: KATHY FERNANDEZ - $141,584 Ronald Schonwetter - $76,591 H. DARRELL WHITE - $149,502 DAVID O'NEIL - $66,211 AUDRA FARISH - $39,157 DONALD EVANS - $37,474 SHARON SAUCIER - $41,760 SHERYL SYPEK - $44,629 Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS (continued from Part III) THE STAFF AND VOLUNTEERS OF GOOD SHEPHERD HOSPICE ADDRESS THE PHYSICAL, EMOTIONAL, SOCIAL AND SPIRITUAL NEEDS OF HOSPICE PATIENTS AND THEIR FAMILIES BY OFFERING MEDICAL SERVICES, NURSING SERVICES, SOCIAL WORK SERVICES, PASTORAL CARE SERVICES, COUNSELING SERVICES AND BEREAVEMENT SERVICES. THESE HOSPICE SERVICES ARE AVAILABLE 24-HOURS-A-DAY, SEVEN-DAYS-A-WEEK, AND ARE TAILORED TO ADDRESS SPECIFIC PATIENT AND FAMILY NEEDS OR PREFERENCES AT ANY TIME DURING THE LENGTH OF CARE. IN ADDITION, THE ORGANIZATION PROVIDES PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, DIETARY COUNSELING, HOME HEALTH AIDE SERVICES, HOMEMAKER SERVICES AND INFUSION THERAPY AS NEEDED. GOOD SHEPHERD HOSPICE PROVIDES PATIENTS WITH ALL PRESCRIBED MEDICATIONS, MEDICAL SUPPLIES AND DURABLE MEDICAL EQUIPMENT, SUCH AS HOSPITAL BEDS, WALKERS AND OXYGEN EQUIPMENT RELATED TO THE HOSPICE DIAGNOSIS. THESE SERVICES AND EQUIPMENT ARE PROVIDED REGARDLESS OF RACE, COLOR, CREED, AGE, GENDER, SEXUAL ORIENTATION, RELIGION, NATIONAL ORIGIN, DISEASE DIAGNOSIS OR ABILITY TO PAY. Good Shepherd Hospice provided $674,000 in charity care in 2017. B. HOSPICE IN-PATIENT FACILITIES - GOOD SHEPHERD HOSPICE OPERATES THREE HOSPICE HOUSES WHICH CAN ADMIT PATIENTS 24 HOURS PER DAY, SEVEN DAYS PER WEEK. THIS ALLOWS HOSPICE PATIENTS TO AVOID HOSPITAL EMERGENCY ROOMS AND THE POTENTIAL FOR UNWANTED OR UNNEEDED TESTS AND PROCEDURES. AT TIMES, PATIENTS REQUIRE A HIGHER LEVEL OF CARE THAN WHAT CAN BE PROVIDED AT HOME. THE HOSPICE HOUSES OFFER A "HOME AWAY FROM HOME;" THE FOCUS IS ON SPECIALIZED CARE IN A WARM HOME-LIKE ENVIRONMENT. FAMILY MEMBERS AND LOVED ONES CAN VISIT AND STAY WITH THEIR LOVED ONES IN A SERENE SETTING, AS OFTEN, AND FOR AS LONG AS THEY LIKE. THE HOSPICE HOUSE TEAMS ARE COMPOSED OF PHYSICIANS, NURSES, SOCIAL WORKERS, CHAPLAINS, NURSING ASSISTANTS, PHARMACISTS, DIETICIANS, THERAPISTS, AND TRAINED VOLUNTEERS. C. GRIEF COUNSELING - GOOD SHEPHERD HOSPICE OFFERS GRIEF COUNSELING AND BEREAVEMENT SERVICES TO THE COMMUNITY IN A VARIETY OF FORMATS. FACILITATED GROUP COUNSELING SESSIONS ALLOW GRIEVING INDIVIDUALS TO EXPRESS THEIR GRIEF WHILE RECEIVING SUPPORT FROM OTHERS IN SIMILAR SITUATIONS. THESE SESSIONS ARE OFFERED IN A VARIETY OF DAYS, TIMES, AND LOCATIONS. GRIEVING CHILDREN HAVE SPECIAL NEEDS; THEY ARE OFTEN TOO YOUNG TO UNDERSTAND OR EXPRESS THE PAIN THEY FEEL WITH THE LOSS OF A LOVED ONE. THE GOOD SHEPHERD HOSPICE BETHANY CENTER IS A SAFE PLACE WHERE GRIEVING CHILDREN CAN VISIT AND PARTICIPATE IN A NUMBER OF AGE-APPROPRIATE HANDS-ON ACTIVITIES THAT HELP THEM LEARN TO EXPRESS THEIR GRIEF. EACH YEAR, THE GOOD SHEPHERD HOSPICE CAMP BRAVE HEART GIVES YOUNGSTERS WHO HAVE LOST A LOVED ONE THE OPPORTUNITY TO MEET OTHER CHILDREN IN SIMILAR CIRCUMSTANCES, AND ENJOY THE GREAT OUTDOORS WHILE PARTICIPATING IN INDIVIDUAL AND GROUP ACTIVITIES DESIGNED TO BE OUTLETS FOR THEIR EMOTIONS. ALL OF THESE SERVICES ARE AVAILABLE TO EVERYONE IN THE COMMUNITY, NOT JUST THOSE WHOSE LOVED ONE DIED IN HOSPICE. D. The company has 383 trained volunteers whose donated time is valued at $603,360. VOLUNTEERS UNDERGO A VIGOROUS TRAINING PROGRAM AND SCREENING PROCESS BEFORE MEETING WITH PATIENTS AND FAMILY MEMBERS. VOLUNTEERS SERVE IN A NUMBER OF ROLES, INCLUDING PATIENT COMPANION, CAREGIVER COMPANION, CAREGIVER RESPITE, OFFICE VOLUNTEER, SPECIAL EVENTS VOLUNTEER AND MANY MORE. E. CAREGIVER PROGRAM - THIS PROGRAM PROVIDES ASSISTANCE IN THE HOME BASED ON THE PATIENT AND FAMILY NEEDS, ON A SLIDING-FEE SCALE BASIS. THIS ENABLES PATIENTS TO STAY IN THEIR HOME AND IS AN INTERIM SUPPORT WHEN A PRIVATE CAREGIVER IS TO BE HIRED OR THE PATIENT IS WAITING FOR NURSING HOME PLACEMENT. F. CLINICAL PASTORAL EDUCATION (CPE) - ACCREDITED BY THE ASSOCIATION FOR CLINICAL PASTORAL EDUCATION, INC. (ACPE) TO OFFER PROGRAMS AT THE LEVEL I AND LEVEL II. THE ASSOCIATION FOR CLINICAL PASTORAL EDUCATION, INC. IS RECOGNIZED BY THE U.S. DEPARTMENT OF EDUCATION AS AN ACCREDITING AGENCY. CLINICAL PASTORAL EDUCATION IS INTERFAITH PROFESSIONAL EDUCATION FOR MINISTRY TO PERSONS WITH SPIRITUAL AND EMOTIONAL NEEDS. ALL CHAPLAINS EMPLOYED BY GOOD SHEPHERD ARE REQUIRED TO HAVE A MINIMUM OF ONE UNIT OF CPE. G. NATIONAL INSTITUTE FOR JEWISH HOSPICE (NIJH) ACCREDITATION - NIJH IS THE RESOURCE CENTER FOR HOSPICE CARE OF JEWISH PATIENTS. GOOD SHEPHERD HOSPICE PARTICIPATES IN ORDER TO EDUCATE STAFF, PHYSICIANS, NURSES, SOCIAL WORKERS, VOLUNTEERS, AND CHAPLAINS INVOLVED IN THE TREATMENT AND CARE OF TERMINALLY ILL JEWISH PATIENTS. GOOD SHEPHERD HOSPICE STAFF RECEIVES ANNUAL EDUCATION ON THE SPIRITUAL NEEDS OF JEWISH PATIENTS AND FAMILIES. HUMANE PALLIATIVE STRATEGIES THAT ARE TAILORED TO THE NEEDS OF JEWISH PATIENTS THAT TAKE INTO ACCOUNT THE CELEBRATION OF THE JEWISH HIGH HOLY DAYS AND OTHER NEEDS AND WISHES HAVE BEEN DEVELOPED. GOOD SHEPHERD HOSPICE STAFF RECEIVES EDUCATION ON JEWISH MEDICAL ETHICS, ADVANCE DIRECTIVES, LIVING WILLS, TREATMENT OF BODY AFTER DEATH, GLOSSARY OF JEWISH TERMS AND HOLY DAYS AND OBSERVANCE. H. HOSPICEHELP24 - GOOD SHEPHERD HOSPICE'S SPECIALIZED TRIAGE PROGRAM PROVIDES PATIENTS AND FAMILIES WITH DIRECT ACCESS TO HOSPICE PROFESSIONALS, INSTEAD OF HAVING THEM GO THROUGH AN ANSWERING SERVICE, LIKE MANY HOSPICES USE. GOOD SHEPHERD HOSPICE'S DEDICATED STAFF WORKS TO COORDINATE AND MEET THE NEEDS OF PATIENTS AND FAMILIES INCLUDING ACCESS TO ALL DISCIPLINES. PATIENT INFORMATION IS ACCESSIBLE BY COMPUTER TO ASSIST HOSPICE STAFF IN CARING FOR THE PATIENT AND FAMILY. I. JOINT COMMISSION ACCREDITATION - TO ENSURE THAT PATIENTS AND FAMILIES RECEIVE THE HIGHEST QUALITY OF END-OF-LIFE CARE, GOOD SHEPHERD HOSPICE UNDERGOES JOINT COMMISSION ACCREDITATION. JOINT COMMISSION ACCREDITATION IS NOT REQUIRED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES TO OBTAIN LICENSURE. GOOD SHEPHERD HOSPICE BELIEVES THAT UNDERGOING THIS VOLUNTARY ACCREDITATION PROCESS EVERY THREE YEARS REINFORCES THE COMPANY MISSION TO PROVIDE OUTSTANDING HOSPICE CARE Form 990, Part VI, Line 15a PROCESS FOR DETERMINING COMPENSATION The organization engaged an independent compensation consultant to assist in establishing a Compensation Charter that details the organization's procedures for setting compensation of the President/CEO and all other officers and key employees of the organization. The Compensation Charter established the Compensation Committee, the independent body responsible for establishing the compensation of the President/CEO. The Compensation Committee relies on a recent compensation study performed by an independent compensation consultant, which is done on an annual basis, that provides compensation data for similarly qualified persons in comparable organizations to support its decision-making process and reports its activities to the Board of Directors at the next regularly scheduled meeting. The Compensation Committee adequately documents its compensation determinations in the meeting minutes on a timely basis. this process took place during 2017. The president/CEO of Good Shepherd Hospice, Inc. is paid by Chapters Health System, Inc. The form 990 instructions indicate when the CEO is not paid by the filing organization, the question should be answered "no". Form 990, Part VI, Line 15b PROCESS FOR DETERMINING COMPENSATION the compensation of all other officers and key employees is determined by the president/ceo. the president/ceo uses COMPARABILITY DATA AND AN INDEPENDENT COMPENSATION CONSULTANT TO DETERMINE THE COMPENSATION. THE DECISIONS ARE DOCUMENTED IN EACH EMPLOYEE'S file. this process took place in 2017. Form 990, Part VI, Line 1a Delegate broad authority to a committee The Executive committee, made up of The President and CEO, CFO and Chief Medical Officer, the Vice Chairperson of the Board and the Secretary, shall carry out the work of the Board of Directors between meetings and make recommendations to the Board of Directors for its action. The Executive Committee shall have all the authority of the Board of Directors except as may be limited by Florida Law and subject to the approval of the Sole Member. Form 990, Part VI, Line 6 Classes of members or stockholders he organization has a Sole Member, Chapters Health System, Inc. that both elects the members of the governing body of Good Shepherd Hospice, Inc. and also approves certain significant decisions made by the governing body of Good Shepherd Hospice, Inc. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body he organization's Sole Member, Chapters Health System, Inc., nominates and elects the members of the organization's Board of Directors and may appoint replacement directors when vacancy occurs. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Without the written approval of the organization's Sole Member, Chapters Health System, Inc., the organization's governing body is not permitted to: (1) Sell, lease, or dispose of assets, merge, combine or reorganize with any other entity, convert the organization's corporate structure to another form or enter into any management services agreement; (2) enter into any loan facility, borrow any funds or pledge or hypothecate any or all of its assets as security for any borrowing; (3) change the character or nature of the organization's business to something other than the operation of a hospice; (4) remove or appoint the President and CEO of the organization; (5) execute any deed, mortgage, note or bond; (6) adopt or amend the annual operating and/or capital budgets proposed by the President and CEO and the management of the organization; (7) make any contribution or distribution of assets or property to any person; (8) dissolve, liquidate or otherwise cause the organization to cease to exist as a Florida Not-for-Profit Corporation which is exempt from taxation under Section 501(c)(3) of the Internal Revenue Code; (9) forM, DISSOLVE, LIQUIDATE, SELL, MERGE OR OTHERWISE TRANSFER OWNERSHIP OR CONTROL OF any subsidiary corporation; or (10) acquire, enjoy, utilize, and dispose of patents, copyrights, and trademarks and any licenses and other rights or interests thereunder or therein. Form 990, Part VI, Line 11b Review of form 990 by governing body The organization retains an independent tax advisor to assist management in the preparation and review of its IRS Form 990. Prior to filing the return, management and the independent tax advisor review the return and all required schedules with the Compensation Committee of the Board of Directors. The Compensation Committee is composed of independent directors of the Company. Upon completion of its review, the Compensation Committee recommends to the Executive Committee of the Board of Directors that management be authorized to sign and file the return. Under the Company's by laws the Executive Committee has the authority to take this action on behalf of the Board of Directors. A complete copy of the Form 990 is provided to the full board prior to filing with the IRS and the Executive Committee reports its activities to the Board of Directors on a quarterly basis Form 990, Part VI, Line 12c Conflict of interest policy Annually, each officer, director and key employee signs an acknowledgement and disclosure form attesting that they have read the Conflict of Interest Policy and agreeing to comply fully with its terms and conditions during their services with Chapters Health System, Inc. (CHS) and Affiliates. They further agree that if, at any time subsequent to the submission of the disclosure form, they become aware of any actual or potential conflict of interest or the information previously submitted becomes inaccurate or incomplete, they will promptly notify the CHS Board of Directors, the President and CEO of Chapters Health System, Inc. and the Good Shepherd Hospice board of directors. DETERMINATION OF AND REMEDIES FOR CONFLICTS OF INTEREST 1. Disclosure. In connection with any actual or possible conflict of interest, an interested person must disclose the existence of his or her financial interest and must be given the opportunity to disclose all material facts to the Directors (and members of committees) considering the proposed transaction or arrangement. The disclosure shall be made as soon as practicable following the realization by the interested person that an actual or possible conflict of interest exists. Ordinarily, disclosures by interested persons should be to the Chairperson of the Board. When an actual or possible conflict of interest becomes apparent in the course of a Board meeting (or committee meeting), the interested person shall immediately disclose his or her financial interest and related material facts to the presiding Director or officer at such meeting. 2. Determining Whether a Conflict of Interest Exists. After disclosure of the financial interest and all material facts, and after any discussion with the interested person, the interested person shall leave the Board (or committee) meeting while the determination of a conflict of interest is discussed and voted upon. The remaining Board (or committee) members shall decide if a conflict of interest exists. 3. Procedures for Addressing the Conflict of Interest. (a) An interested person who has a conflict of interest may make a presentation at the Board (or committee) meeting, but after such presentation, he or she shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that result in the conflict of interest. The interested person who has a conflict of interest will not be counted as present for determining a majority with respect to the vote on the transaction or arrangement that results in the conflict of interest. (b) The Chairperson of the Board (or committee) shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. (c) After exercising due diligence, the Board (or Committee) shall determine whether CHS and Affiliates can obtain a more advantageous transaction or arrangement with reasonable efforts from a person or business entity that would not give rise to a conflict of interest. (d)If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the Board (or committee) shall determine by a majority vote of the disinterested Directors (or committee members) whether the transaction or arrangement is in the best interest of CHS and Affiliates and for its own benefit and whether the transaction is fair and reasonable to CHS and Affiliates and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination. Violations of the Conflicts of Interest Policy (a) If the Board (or committee) has reasonable cause to believe that an interested person has failed to disclose actual or possible conflicts of interest, it shall inform the interested person of the basis for such belief and afford the interested person an opportunity to explain the alleged failure to disclose. (b) If, after hearing the response of the interested person and making such further investigation as may be warranted under the circumstances, the Board (or committee) determines that the interested person has in fact failed to disclose an actual or possible conflict of interest, it shall take such action as it determines to be appropriate, including corrective and disciplinary action. RECORD OF PROCEEDINGS The minutes of the Board (and each committee) shall contain: 1. The name of each person who disclosed or otherwise was found to have a financial interest in connection with an actual or possible conflict of interest, the nature of the financial interest, any action taken to determine whether a conflict of interest was present, and the Board's (or committee's) decision as to whether a conflict of interest in fact existed. 2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement, the content of the discussion, including any alternatives to the proposed transaction or arrangement, and a record of any votes taken in connection therewith. PERIODIC REVIEWS To ensure that CHS and Affiliates operate in a manner consistent with their charitable purposes and that it does not engage in activities that could jeopardize their status as organizations exempt from federal income tax, periodic reviews shall be conducted. CHS and Affiliates may, but need not, use an outside advisor to conduct a periodic review. The periodic review shall include, at a minimum, the following subjects: 1. Whether compensation arrangements and benefits are reasonable and are the results of arm's-length bargaining. 2. Whether agreements to provide health care and agreements with other health care providers, employees and third party payers further the charitable purposes of CHS and Affiliates and do not result in private inurement or impermissible private benefit. Form 990, Part VI, Line 19 Required documents available to the public The organization's articles of incorporation are filed with and viewable by the public at the official website of the Florida Department of State, Division of Corporations. The organization's Bylaws and conflict of interest policy are not made available to the public. Unaudited financial statements of the organization are filed and viewable by the public at the official website of the State of Florida, Division of Consumer Services. The organization is required to file its audited consolidated financial statements and other financial information with its annual Medicare cost report. This information is subject to a public records request. In addition, the organization reports its financial performance each year in its Annual Report, copies of which are available to the public upon request. Form 990, Part XI, Line 9 Other changes in net assets or fund balances CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF CHAPTERS HEALTH SYSTEM - 1114708; CHAPTERS HEALTH SYSTEM INC 12470 TELECOM DRIVE STE 300 TEMPLE TERRACE FL 33637 592264957 PARENT FL 501(c)(3) Type II NA false LIFEPATH HOSPICE INC 12470 TELECOM DRIVE STE 300 TEMPLE TERRACE FL 33637 205276870 HOSPICE CARE FL 501(c)(3) 10 CHS false JUDGE ALVA CARVER FOUNDATION INC 12470 TELECOM DRIVE STE 300 TEMPLE TERRACE FL 33637 200187631 SUPPORT FL 501(c)(3) PF CHS false CHAPTERS HEALTH HOME CONNECT INC 12470 TELECOM DRIVE STE 300 TEMPLE TERRACE FL 33637 275158323 LONG-TERM CARE FL 501(c)(3) 10 CHS false HOSPICE FOUNDATION INC 12470 TELECOM DRIVE suite 300 TEMPLE TERRACE FL 33637 593467282 foundation FL 501(c)(3) 7 CHS false HERNANDO PASCO HOSPICE INC 12470 TELECOM DRIVE suite 300 TEMPLE TERRACE FL 33637 592217929 hospice care FL 501(c)(3) 10 CHS false false false false true false false false false false false true false true true true true false true false