2017-10-25T10:46:10-05:00 2016-12-31 134008324 PRICEWATERHOUSECOOPERS LLP 76 S LAURA STREET SUITE 2100 JACKSONVILLE FL 32202 990 2016-01-01 592490893 NORTH CENTRAL FLORIDA HOSPICE INC NORT 3523728400 SANTAFE HEALTHCAREINC PO BOX 749 GAINESVILLE FL 326270749 RANDALL L STUART ASSISTANT TREASURER 3523378730 2017-10-24 1 MICHAEL J MULDOON P00889797 9043540671 12.8.190.134 2017-10-24 17:22:28 ED P 54BF1586AE195AFAEC0F4B0B882D6F2A8E325AE6 9B8A486F8959EB47C448F2BA708CE67AF1BE41ED 2016 2021-01-29 14:40:06Z HAVEN HOSPICE MICHAEL P GALLAGHER SANTAFE HEALTHCAREINC PO BOX 749 GAINESVILLE FL 326270749 66870292 0 X WWW.HAVENHOSPICE.ORG X 1982 FL HONORING LIFE BY PROVIDING COMFORT, CARE AND COMPASSION TO THOSE WE SERVE. 15 14 755 734 0 0 3482463 4538012 61430163 60540505 1319537 569481 -42894 109730 66189269 65757728 0 0 0 0 33284280 34884097 0 0 457371 34222936 31809453 67507216 66693550 -1317947 -935822 64410582 72001515 17463002 25327883 46947580 46673632 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 39648955 48984975 HAVEN 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'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 3,386 HOSPICE PATIENTS INCLUDING 176,555 DAYS OF SERVICE AND 208,702 VISITS BY NURSES, HOME HEALTH AIDES, SOCIAL WORKERS, CHAPLAINS AND PHYSICIANS TOTALING 185,723 HOURS OF CARE. INCLUDED IN THE EXPENSES IS $421,051 OF UNREIMBURSED CARE. 14614945 11410585 HAVEN OFFERS HOSPICE CARE CENTERS IN GAINESVILLE, PALATKA, CHIEFLAND, LAKE CITY AND ORANGE PARK WHEN THERE IS A NEED FOR SHORT-TERM INPATIENT CARE. IN THESE WELCOMING AND HOME-LIKE SETTINGS, HAVEN 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 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 2,446 PATIENTS IN INPATIENT CARE CENTERS, INCLUDING 18,753 DAYS OF SERVICE AND 100,644 VISITS BY NURSES, HOME HEALTH AIDES, SOCIAL WORKERS, CHAPLAINS AND PHYSICIANS. INCLUDED IN THE EXPENSES IS $216,116 OF UNREIMBURSED CARE. 330152 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 PROVIDES COUNSELLING AND SUPPORT TO AREA BUSINESSES WHOSE STAFF ARE DEALING WITH GRIEF, LOSS, LIFE-LIMITING ILLNESS, OR SERVING AS CAREGIVERS. HAVEN 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 OFFERS SEVERAL COUNSELING AND SUPPORT PROGRAMS AND SERVICES AT COMMUNITY WORKSITES: COPING WITH GRIEF AND LOSS IN THE WORKPLACE; WORKING CAREGIVERS: BALANCING TWO FULL-TIME JOBS; LIFE PLANNING: DOCUMENTS YOU SHOULD NOT LIVE WITHOUT; 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'S STAFF OF PROFESSIONALS AND VOLUNTEERS.HEALING HEARTS GRIEF SUPPORT: HAVEN'S HEALING HEARTS GRIEF SUPPORT PROGRAM OFFERS INDIVIDUAL, FAMILY AND GROUP COUNSELING TO ANYONE COPING WITH LOSS, REGARDLESS OF HOW THE LOSS WAS OCCURRED.COUNSELING AND EDUCATION: HAVEN OFFERS SHORT-TERM INDIVIDUAL, FAMILY AND GROUP BEREAVEMENT COUNSELING WITH SPECIALLY TRAINED HAVEN PROFESSIONALS FOR ANYONE IN THE COMMUNITY WHO HAS EXPERIENCED A LOSS.MEMORIAL SERVICES: HAVEN 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 757 ATTENDING. IN ADDITION, 20,482 SUPPORT MAILERS WERE DISTRIBUTED, 10,241 BEREAVEMENT SUPPORT PHONE CALLS WERE PLACED AND 10,766 INDIVIDUALS WERE PROVIDED EITHER GROUP, INDIVIDUAL, OR FAMILY GRIEF SUPPORT COUNSELING. 20 MEMORIAL SERVICES WERE HELD WITH AN AVERAGE ATTENDANCE OF 75 PARTICIPANTS PER SERVICE. 4 TEEN/KID AND 3 ADULT GRIEF CAMPS WERE HELD FOR 212 PARTICIPANTS. 352555 144945 PALLIATIVE CARE CONSULTATIONS: HAVEN'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'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.MEDICARE CARE CHOICES MODEL (MCCM): THE CENTERS FOR MEDICARE AND MEDICAID SELECTED HAVEN AS ONE OF SEVERAL HOSPICES TO BE INCLUDED IN A TEST MARKET TO INCREASE ACCESS TO HOSPICE SERVICES, IMPROVE QUALITY OF LIFE AND PATIENT AND FAMILY SATISFACTION AND INFORM NEW PAYMENT SYSTEMS FOR THE MEDICARE AND MEDICAID SYSTEM. MCCM PROVIDES MEDICARE BENEFICIARIES WHO QUALIFY FOR COVERAGE UNDER THE MEDICARE HOSPICE BENEFIT AND THE MEDICAID HOSPICE BENEFIT THE OPTION TO ELECT TO RECEIVE HOSPICE SERVICES WHILE CONTINUING TO RECEIVE CURATIVE TREATMENT. 352555 144945 54946607 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 1 357 0 1 755 1 0 0 0 0 0 1 1 0 0 0 0 X 15 14 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X ANNE HOCHSPRUNG CHIEF FINANCIAL OFFICER 3522714679 4200 NW 90TH BLVD GAINESVILLE FL 326065688 X SCOTTIE J BUTLER CHAIRMAN/DIRECTOR 0.10 2.90 X X 0 71123 0 JOE G DUNLAP VICE CHAIRMAN/DIRECTOR 0.10 1.40 X X 0 55010 0 ROBERT L EPLING TREASURER/DIRECTOR 0.10 1.40 X X 0 55663 0 ALBERT E DOTSON PHD SECRETARY/DIRECTOR 0.10 1.40 X X 0 53459 0 RICHARD M ANDERSON MD DIRECTOR 0.10 1.40 X 0 48582 0 JOSEPH W DAVIS DIRECTOR 0.10 1.40 X 0 50564 0 BENJAMIN I DOERR JR DIRECTOR 0.10 2.90 X 0 57405 0 GEORGE E FLETCHER DIRECTOR 0.10 1.40 X 0 51959 0 GLENDA E HOOD DIRECTOR 0.10 1.40 X 0 56509 0 ROBERT C HUDSON DIRECTOR 0.10 1.40 X 0 48909 0 PAMELA J MOONEY PHD DIRECTOR 0.10 1.40 X 0 51805 0 THOMAS A NATIELLO PHD DIRECTOR 0.10 1.40 X 0 55009 0 PAUL R PHILIP DIRECTOR 0.10 1.40 X 0 52959 0 JACKSON N SASSER PHD DIRECTOR 0.10 1.40 X 0 53484 0 JAMES L STRINGFELLOW SR DIRECTOR - THROUGH 2/25/2016 0.10 1.40 X 0 0 0 MICHAEL P GALLAGHER CHIEF EXECUTIVE OFFICER/DIRECTOR 3.00 57.00 X X 0 2987304 43719 RANDALL L STUART ASSISTANT TREASURER 4.00 56.00 X 0 799210 141683 CATHERINE E AYERS ASSISTANT SECRETARY 1.50 58.50 X 0 683536 53998 STEVEN M ZIEGLER ASSISTANT SECRETARY 6.00 56.00 X 0 643202 130811 JAMES L POOLE JR PRESIDENT (INTERIM) 45.00 5.00 X 306599 0 17610 GAYLE MATTSON PRESIDENT 50.00 10.00 X 0 196369 16542 ARTHUR L CLARK JR SVP OPERATIONS & CIO 40.00 0.00 X 242691 0 38138 NEEL G KARNANI MD ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 250433 0 20612 GERALDINE S BICHIER MD ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 203231 0 37273 ELLEN L TALOS MD EXECUTIVE MEDICAL DIRECTOR 40.00 0.00 X 185279 0 11275 PATRICK F WOLOSZYN MD ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 181217 0 37483 STEFANIE B LORD MD EXECUTIVE MEDICAL DIRECTOR 40.00 0.00 X 181183 0 6499 1550633 6072061 555643 20 0 1 0 PARRISH MCCALL CONSTRUCTORS INC PO BOX 142002 GAINESVILLE FL 326142002 CONSTRUCTION SERVICES 5687498 TERRACE OF JACKSONVILLE LLC 10680 OLD ST AUGUSTINE ROAD JACKSONVILLE FL 32257 NURSING HOME SERVICES 1092432 SANTAFE HEALTHCARE INC PO BOX 749 GAINESVILLE FL 326270749 ADMINISTRATIVE SUPPORT SERVICES 899283 PALM GARDEN OF GAINESVILLE LLC 227 SW 62ND BLVD GAINESVILLE FL 32607 NURSING HOME SERVICES 704555 AYERS HEALTH & REHABILITATION CENTER LL 606 NE 7 STREET TRENTON FL 32693 NURSING HOME SERVICES 695538 49 55063 365058 4117891 3133537 4538012 MEDICARE REVENUE 623990 44571729 44571729 MEDICAID REVENUE 623990 12693565 12693565 PATIENT SERVICE REVENUE 623990 3275211 3275211 60540505 583064 583064 726200 10655 738582 11856 -12382 -1201 -13583 -13583 35085 365058 362126 -327041 -327041 ADMINISTRATIVE INCOME 900099 436771 436771 436771 65757728 60540505 0 679211 X 549290 549290 27644032 23074117 4417622 152293 778369 641765 131859 4745 3916001 3047380 852234 16387 1996405 1633406 351687 11312 899283 899283 424509 350414 74095 67475 67475 14217227 13464591 704680 47956 559454 511976 47478 1227330 624748 571828 30754 642090 501212 140878 2042465 1422393 620072 1475577 1087090 378068 10419 70997 16022 54925 50 357942 342704 15238 1655078 1573023 82055 408427 294779 113648 PHARMACY SUPPLIES 2312357 2312357 BAD DEBT 1828240 1827797 443 COMMUNITY SUPPORT 888375 650541 79302 158532 MEDICAL SUPPLIES 598149 597948 201 2134478 972344 1137211 24923 66693550 54946607 11289572 457371 1225997 824188 6115214 3982917 130961 23138 3006612 4751296 417481 337768 54549910 13819145 33730846 40730765 15792981 16588503 2494390 2679477 1496100 2083463 64410582 72001515 7336587 8824918 8490078 14935197 1636337 1567768 17463002 25327883 X 45325214 44229643 1622366 2443989 46947580 46673632 64410582 72001515 X -935822 429726 232148 X X 0 1 X 1 0 X 2775032 3386291 4570471 3482463 4538012 18752269 59236900 57585078 55670400 61430163 60540505 294463046 62011932 60971369 60240871 64912626 65078517 313215315 0 0 0 313215315 504167 578204 767929 606376 583064 3039740 504167 578204 767929 606376 583064 3039740 -189792 130302 -81215 -42894 109730 -73869 62326307 61679875 60927585 65476108 65771311 316181186 0.99060 0.99200 0.00960 0.00910 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: ADMINISTRATIVE INCOME - 2012 AMOUNT: $ 7,188. 2013 AMOUNT: $ 310,563. 2014 AMOUNT: $ 76,847. 2015 AMOUNT: $ 137,798. 2016 AMOUNT: $ 436,771. SPECIAL EVENT INCOME NET - 2012 AMOUNT: $ -196,980. 2013 AMOUNT: $ -180,261. 2014 AMOUNT: $ -158,062. 2015 AMOUNT: $ -180,692. 2016 AMOUNT: $ -327,041. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 86724 86724 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. HAVEN HOSPICE ALSO ENGAGED THE SERVICES OF A REGISTERED LOBBYIST TO MONITOR DEVELOPMENTS AT THE ANNUAL GENERAL SESSION OF THE FLORIDA LEGISLATURE. 2248125 181538 2429663 2249856 -1731 2248125 2099668 150188 2249856 1822987 276681 2099668 1534886 288101 1822987 1.00000 0 0 4522844 4522844 42942173 8638672 34303501 535057 419534 115523 6549836 4760939 1788897 40730765 GIFT ANNUITIES 175464 DUE TO AFFILIATES 137918 CHARITABLE REMAINDER UNITRUST 805000 INTEREST RATE SWAP 300480 CAPITAL LEASE OBLIGATION 148906 1567768 X 64319802 -637167 -637167 64956969 800759 800759 65757728 66006092 -50295 -50295 66056387 637163 637163 66693550 PART V, LINE 4: THE HAVEN HOSPICE ENDOWMENT IS A SEPARATE ACCOUNT OF FUNDS THAT ARE HELD TO PROVIDE CURRENT AND FUTURE INCOME TO HAVEN HOSPICE IN ORDER TO OFFSET THE BURDEN OF UNCOMPENSATED CARE PROVIDED BY HAVEN HOSPICE. THE OBJECTIVE OF THE ENDOWMENT IS TO PROVIDE TIMELY FINANCIAL ASSISTANCE WHEN NEEDED AND LONG-TERM STABILITY TO HAVEN HOSPICE. PART X, LINE 2: ASC 740 FOOTNOTE: DUE TO ITS TAX-EXEMPT STATUS, THE ORGANIZATION IS NOT SUBJECT TO U.S. FEDERAL INCOME TAX OR STATE INCOME TAX. THE ORGANIZATION'S FORM 990 HAS NOT BEEN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE OR THE STATE OF FLORIDA FOR THE LAST THREE YEARS. THE ORGANIZATION DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. THE ORGANIZATION RECOGNIZES INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE. THE ORGANIZATION DID NOT HAVE ANY AMOUNTS ACCRUED FOR INTEREST AND PENALTIES AT DECEMBER 31, 2016 AND DECEMBER 31, 2015. PART XI, LINE 2D - OTHER ADJUSTMENTS: UNREIMBURSED CARE -637,167. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS AND PLEDGES 752,585. LOSS ON ASSET DISPOSAL -1,201. SPECIAL EVENT EXPENSES WERE MOVED FROM EXPENSE TO REVENUE -362,126. MANAGEMENT FEE INCOME 411,501. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES WERE MOVED FROM EXPENSE TO REVENUE 362,126. MANAGEMENT FEE INCOME -411,501. LOSSES ON UNCOLLECTIBLE PLEDGES -920. PART XII, LINE 4B - OTHER ADJUSTMENTS: UNREIMBURSED CARE 637,167. ROUNDING -4. VIVA 163529 158769 4760 3030 51520 42159 1150 31952 EQUUS 70793 64213 6580 4009 32211 26350 10428 13371 5 165821 142076 23745 1305 18016 46341 41335 5995 32954 400143 365058 35085 1305 25055 130072 109844 17573 78277 362126 -327041 0 1 0 0 0 0 0 0 0 MICHAEL P GALLAGHER CHIEF EXECUTIVE OFFICER/DIRECTOR 0 954319 0 1504255 0 528730 0 15900 0 27819 0 3031023 0 0 RANDALL L STUART ASSISTANT TREASURER 0 397774 0 266297 0 135139 0 115901 0 25782 0 940893 0 39716 CATHERINE E AYERS ASSISTANT SECRETARY 0 333839 0 225744 0 123953 0 23850 0 30148 0 737534 0 0 STEVEN M ZIEGLER ASSISTANT SECRETARY 0 334595 0 227147 0 81460 0 98458 0 32353 0 774013 0 66094 JAMES L POOLE JR PRESIDENT (INTERIM) 224115 0 73221 0 9263 0 10270 0 7340 0 324209 0 0 0 GAYLE MATTSON PRESIDENT 0 145530 0 0 0 50839 0 14553 0 1989 0 212911 0 0 ARTHUR L CLARK JR SVP OPERATIONS & CIO 186731 0 49683 0 6277 0 9948 0 28190 0 280829 0 0 0 NEEL G KARNANI MD ASSOCIATE MEDICAL DIRECTOR 247792 0 1741 0 900 0 10133 0 10479 0 271045 0 0 0 GERALDINE S BICHIER MD ASSOCIATE MEDICAL DIRECTOR 200561 0 1770 0 900 0 8583 0 28690 0 240504 0 0 0 ELLEN L TALOS MD EXECUTIVE MEDICAL DIRECTOR 183171 0 1510 0 598 0 7360 0 3915 0 196554 0 0 0 PATRICK F WOLOSZYN MD ASSOCIATE MEDICAL DIRECTOR 178899 0 1418 0 900 0 7748 0 29735 0 218700 0 0 0 STEFANIE B LORD MD EXECUTIVE MEDICAL DIRECTOR 178876 0 1407 0 900 0 5897 0 602 0 187682 0 0 0 PART I, LINE 3 MICHAEL P GALLAGHER IS THE CHIEF EXECUTIVE OFFICER (CEO) OF NORTH CENTRAL FLORIDA HOSPICE, INC. (HAVEN HOSPICE). MR. GALLAGHER IS COMPENSATED BY SANTAFE HEALTHCARE, INC., A RELATED SUPPORTING ORGANIZATION. SANTAFE HEALTHCARE, INC. UTILIZES THE FOLLOWING PROCESS TO ESTABLISH THE CEO'S COMPENSATION AND BENEFITS: THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS ANNUALLY RETAINS AN INDEPENDENT THIRD PARTY COMPENSATION AND BENEFITS CONSULTING FIRM (FIRM) TO CONDUCT A MARKET COMPETITIVENESS REVIEW OF THE CEO'S TOTAL DIRECT COMPENSATION (BASE SALARY, ANNUAL INCENTIVES, AND LONG TERM INCENTIVES) AND BENEFITS. THE COMPETITIVE ANALYSIS INCLUDES COMPARISON TO SIMILAR POSITIONS IN COMPANIES OF SIMILAR SIZE WITHIN THE SAME OR SIMILAR INDUSTRY. THE FIRM MAKES RECOMMENDATIONS, IF ANY, DIRECTLY TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS ESTABLISHES THE FINAL COMPENSATION AND BENEFIT PACKAGE FOR THE CEO TAKING INTO CONSIDERATION THE MARKET COMPETITIVENESS REVIEW AND FINAL RECOMMENDATION OF THE FIRM. THE FIRM PROVIDES AN OPINION LETTER REGARDING THE REASONABLENESS OF THE CEO'S FINAL COMPENSATION AND BENEFITS PACKAGE. THE ACTIONS OF THE BOARD ARE DOCUMENTED IN THE MINUTES OF THE BOARD MEETING. PART I, LINE 4B (RELATES TO PART I, LINE 4A): LISTED PERSONS WHO ARE EMPLOYEES OF HAVEN HOSPICE ARE NOT COVERED BY A SEVERANCE POLICY; SEVERANCE IS HANDLED ON A CASE BY CASE BASIS. CERTAIN LISTED PERSONS, EXCLUDING OUTSIDE DIRECTORS OR EMPLOYEES OF HAVEN HOSPICE, ARE EMPLOYEES OF RELATED ORGANIZATIONS AND ARE COVERED UNDER A SEVERANCE POLICY FOR THEIR RESPECTIVE RELATED ORGANIZATION. THE SEVERANCE POLICY INCLUDES MONTHLY PAYMENTS UP TO A MAXIMUM OF 12 - 36 MONTHS UNDER QUALIFYING CIRCUMSTANCES AND DEPENDING ON POSITION. NO ONE LISTED RECEIVED SEVERANCE OR CHANGE OF CONTROL PAYMENTS DURING 2016. PART I, LINE 4B: LISTED PERSONS PARTICIPATING IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN THE YEAR: MICHAEL P GALLAGHER, RANDALL L STUART, AND GAYLE MATTSON 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 $412,933 FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS IN 2016. MR. STUART VESTED AND RECEIVED $99,418 FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN 2016. CATHERINE E AYERS AND STEVEN M ZIEGLER ARE EMPLOYEES OF AVMED, INC., A RELATED TAX-EXEMPT ORGANIZATION. THEY PARTICIPATE IN TWO NONQUALIFIED DEFERRED COMPENSATION RETIREMENT PLANS SPONSORED BY AVMED, INC. FOR A CERTAIN GROUP OF EXECUTIVES. ONE PLAN RESTORES RETIREMENT BENEFITS EQUIVALENT TO QUALIFIED 401(K) BENEFITS ON INCOME EARNED IN EXCESS OF THE INTERNAL REVENUE SERVICE CODE SECTION 401(A)(17) RECOGNIZABLE PAY LIMITS (A DEFINED CONTRIBUTION RESTORATION PLAN). VESTING IS ACHIEVED AT AGE 55 AND 10 YEARS OF SERVICE OR AT AGE 65 AND 5 YEARS OF SERVICE. THE SECOND SUPPLEMENTAL DEFINED CONTRIBUTION PLAN PROVIDES ADDITIONAL RETIREMENT INCOME BASED ON A PERCENTAGE OF BASE SALARY AND VESTS AT THREE AND FIVE YEARS OF SERVICE. MS. AYERS VESTED AND RECEIVED $99,898 FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS IN 2016. MR. ZIEGLER VESTED AND RECEIVED $72,945 FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN 2016. SCHEDULE J, PART II: CERTAIN SENIOR EXECUTIVES ARE ACCOUNTABLE FOR AND PERFORM SERVICES FOR SANTAFE HEALTHCARE, INC. AND EACH OF ITS AFFILIATES. SANTAFE HEALTHCARE, INC. AND AFFILIATES REPRESENT A DIVERSIFIED FAMILY OF NOT-FOR-PROFIT ORGANIZATIONS WITH $2 BILLION IN GROSS RECEIPTS AND APPROXIMATELY 2,200 EMPLOYEES. THESE SENIOR EXECUTIVES ARE PAID DIRECTLY BY EITHER SANTAFE HEALTHCARE, INC., AVMED, INC. OR NORTH CENTRAL FLORIDA HOSPICE, INC. AND THEIR COMPENSATION AND BENEFITS ARE APPORTIONED AND CHARGED TO THE RESPECTIVE AFFILIATE BASED ON THE ESTIMATED AMOUNT OF TIME SPENT ON EACH AFFILIATE'S ACTIVITIES. FOR 2016, THE FOLLOWING PERCENTAGES OF EACH EXECUTIVE'S COMPENSATION AND BENEFITS (FOR THOSE SENIOR EXECUTIVES PAID BY A RELATED ORGANIZATION) ARE APPORTIONED AND CHARGED TO NORTH CENTRAL FLORIDA HOSPICE, INC. AS FOLLOWS: 5% - MICHAEL P GALLAGHER, CHIEF EXECUTIVE OFFICER 83% - GAYLE MATTSON, PRESIDENT 90% - JAMES L POOLE JR, PRESIDENT (INTERIM) 7% - RANDALL L STUART, ASSISTANT TREASURER 3% - CATHERINE E AYERS, ASSISTANT SECRETARY 10% - STEVEN M ZIEGLER, ASSISTANT SECRETARY A CLAY COUNTY DEVELOPMENT AUTHORITY 596583087 2011-12-21 10000000 CONSTRUCT HOSPICE CARE FACILITY 0 0 0 B ALACHUA COUNTY HEALTH FACILITIES AUTHORITY 592442398 2015-12-15 8600000 HOSPICE CARE FACILITY EXPANSION 0 0 0 A 2096069 10000000 103585 9896415 2012 0 0 1 1 B 8600000 62130 6969136 1568734 2016 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 1 PNC BANK 18.500000000000 0 0 0 0 1 B 0 1 0 0 1 1 BBVA COMPASS 11.500000000000 0 0 0 0 1 A 1 B 1 SCHEDULE K, PARTS I AND II ADDITIONAL INFORMATION REGARDING THE BONDS ISSUE: THE CLAY COUNTY DEVELOPMENT AUTHORITY BONDS WERE ISSUED AS A DRAW-DOWN LOAN FOR THE ACQUISITION OF REAL PROPERTY AND CONSTRUCTION OF A HOSPICE FACILITY. THE FACILITY WAS COMPLETED AND PLACED IN SERVICE DURING 2012, AND THE ENTIRE BALANCE OF THE LOAN WAS DRAWN DOWN. 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. SCHEDULE K, PART II, LINE 17, COLUMN B: ALTHOUGH A FINAL ALLOCATION OF THE ALACHUA COUNTY HEALTH FACILITIES AUTHORITY BOND PROCEEDS WAS NOT COMPLETE AS OF 12/31/2016, THE ORGANIZATION MAINTAINED ADEQUATE BOOKS AND RECORDS TO SUPPORT THE ALLOCATIONS MADE THROUGH 12/31/2016. ONCE THE ALLOCATION OF PROCEEDS IS COMPLETE, THE BOOKS AND RECORDS WILL SUPPORT THE FINAL ALLOCATION. X 2577461 RESALE VALUE X 4 513576 FMV & PLEDGED AMOUNT X 1 42500 SELLING PRICE 0 1 0 PART I, COLUMN (B): LINE 9 - THIS FIGURE REPRESENTS THE NUMBER OF ITEMS RECEIVED. 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 2016 FORM 990 BEGAN WITH PROFESSIONAL DEVELOPMENT OF STAFF (SEVERAL OF WHICH ARE CPAS) WHICH WERE INVOLVED IN THE PREPARATION OF THE 2016 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 2016 FORM 990, PRICEWATERHOUSECOOPERS LLP REVIEWED THE 2016 FORM 990. A COPY OF THE 2016 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 2016 FORM 990 AND ATTACHMENTS WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C HAVEN HOSPICE HAS A PROCEDURE FOR MONITORING AND ENFORCING COMPLIANCE WITH ITS CORPORATE CONFLICT OF INTEREST POLICY (POLICY). EACH COVERED PERSON SHALL RECEIVE A COPY OF THE POLICY FOR REVIEW, SUBMIT AN AFFIRMATION, AND COMPLETE A QUESTIONNAIRE WHICH IS ATTACHED TO THE CODE OF ETHICAL BUSINESS CONDUCT. THE PROCEDURE DETAILS THAT THE CORPORATE SECRETARY HAS RESPONSIBILITY FOR DELIVERY OF THE POLICY TO DIRECTORS AND OFFICERS AND RECEIPT OF THEIR AFFIRMATIONS AND QUESTIONNAIRES. THE HUMAN RESOURCES DEPARTMENT SHALL OBTAIN THE AFFIRMATION AND QUESTIONNAIRE FROM EVERY NEW EMPLOYEE AT ORIENTATION AND FROM ALL EMPLOYEES ANNUALLY. MEMBERS OF CORPORATE ADVISORY BOARDS SUBMIT THE AFFIRMATION AND QUESTIONNAIRE TO THE CHIEF COMPLIANCE OFFICER. ANNUAL CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY INTERNAL STAFF TO ENSURE RECORDS ARE COMPLETE. AS PART OF THE CORPORATE CONTRACT REVIEW PROCESS, CONSIDERATION IS GIVEN TO ANY POTENTIAL CONFLICTS OF INTEREST INVOLVING OPERATIONAL OR FINANCIAL TRANSACTIONS. ALL EMPLOYEES ARE EXPECTED TO DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICT. INITIAL REVIEW OF EMPLOYEE QUESTIONNAIRES WILL BE PERFORMED BY THE HUMAN RESOURCES DEPARTMENT WITH REVIEW OF ANY DISCLOSURES BY THE CHIEF COMPLIANCE OFFICER WHO WILL EVALUATE, MAKE NECESSARY INQUIRIES, AND INVESTIGATE ALTERNATIVES. BOARD MEMBERS SHALL DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICT TO THE CHAIRMAN OF THE SANTAFE HEALTHCARE, INC. BOARD, AND THE CHAIRMAN OR CHIEF COMPLIANCE OFFICER SHALL EVALUATE CONFLICT DISCLOSURES AND, IF APPROPRIATE, INVESTIGATE ALTERNATIVES AND REPORT TO DISINTERESTED BOARD MEMBERS FOR RESOLUTION. THE MINUTES OF THE BOARD OR ANY COMMITTEE MEETING AT WHICH A POTENTIAL OR ACTUAL CONFLICT OF INTEREST IS DISCLOSED OR DISCUSSED SHALL REFLECT THE NAME OF THE INTERESTED PARTY, THE NATURE OF THE CONFLICT, THE DELIBERATIONS AND THE RESOLUTION OF THE CONFLICT. IF IT IS DETERMINED THAT A COVERED PERSON HAS FAILED TO COMPLY WITH THE POLICY, THE CHIEF COMPLIANCE OFFICER OR THE CHAIRMAN SHALL TAKE APPROPRIATE ACTION, WHICH MAY INCLUDE REMOVAL FROM OFFICE OR TERMINATION OF EMPLOYMENT. FORM 990, PART VI, SECTION B, LINE 15 MICHAEL P GALLAGHER IS THE CHIEF EXECUTIVE OFFICER (CEO) OF HAVEN HOSPICE. MR. GALLAGHER IS COMPENSATED BY SANTAFE HEALTHCARE, INC., A RELATED SUPPORTING ORGANIZATION. SANTAFE HEALTHCARE, INC. UTILIZES THE FOLLOWING PROCESS TO ESTABLISH THE CEO'S COMPENSATION AND BENEFITS: THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS ANNUALLY RETAINS AN INDEPENDENT THIRD PARTY COMPENSATION AND BENEFITS CONSULTING FIRM (FIRM) TO CONDUCT A MARKET COMPETITIVENESS REVIEW OF THE CEO'S TOTAL DIRECT COMPENSATION (BASE SALARY, ANNUAL INCENTIVES, AND LONG TERM INCENTIVES) AND BENEFITS. THE COMPETITIVE ANALYSIS INCLUDES COMPARISON TO SIMILAR POSITIONS IN COMPANIES OF SIMILAR SIZE WITHIN THE SAME OR SIMILAR INDUSTRY. THE FIRM MAKES RECOMMENDATIONS, IF ANY, DIRECTLY TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS ESTABLISHES THE FINAL COMPENSATION AND BENEFIT PACKAGE FOR THE CEO TAKING INTO CONSIDERATION THE MARKET COMPETITIVENESS REVIEW AND FINAL RECOMMENDATION OF THE FIRM. THE FIRM PROVIDES AN OPINION LETTER REGARDING THE REASONABLENESS OF THE FINAL COMPENSATION AND BENEFITS PACKAGE. THE ACTIONS OF THE BOARD ARE DOCUMENTED IN THE MINUTES OF THE BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 15B: PROCESS FOR DETERMINING COMPENSATION FOR THE NON-DIRECTOR OFFICERS, PRESIDENT, CHIEF MEDICAL OFFICER, AND DIRECTORS OF HAVEN HOSPICE IS AS FOLLOWS: THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS ANNUALLY RETAINS AN INDEPENDENT THIRD PARTY COMPENSATION AND BENEFITS FIRM (FIRM) TO CONDUCT A MARKET COMPETITIVENESS REVIEW OF THE AFOREMENTIONED OFFICERS' TOTAL DIRECT COMPENSATION (BASE SALARY, ANNUAL INCENTIVES, AND LONG-TERM INCENTIVES) AND BENEFITS. THE COMPETITIVE ANALYSIS INCLUDES COMPARISONS TO SIMILAR POSITIONS IN COMPANIES OF SIMILAR SIZE WITHIN THE SAME OR SIMILAR INDUSTRY. AFTER COMPLETION OF ITS REVIEW, THE FIRM MAKES RECOMMENDATIONS, IF ANY, DIRECTLY TO THE BOARD OF DIRECTORS. THE FIRM PROVIDES AN OPINION LETTER REGARDING THE REASONABLENESS OF TOTAL DIRECT COMPENSATION AND EXECUTIVE BENEFITS. THE ACTIONS OF THE BOARD ARE DOCUMENTED IN THE MINUTES OF THE BOARD MEETINGS. THE SANTAFE HEALTHCARE, INC. BOARD OF DIRECTORS 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. A MARKET COMPETITIVENESS STUDY WAS CONDUCTED IN NOVEMBER 2016 FOR CHANGES MADE EFFECTIVE JANUARY 1, 2017. NO DIRECTOR FEES WERE ALLOCATED TO HAVEN HOSPICE DURING 2016. FORM 990, PART VI, SECTION C, LINE 19 HAVEN HOSPICE'S PROCEDURE FOR MAKING VARIOUS DOCUMENTS AVAILABLE TO THE PUBLIC: HAVEN HOSPICE MAKES ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC ON A CASE BY CASE BASIS IF REQUESTED DIRECTLY FROM THE ORGANIZATION. THE ARTICLES OF INCORPORATION CAN BE ACCESSED DIRECTLY THROUGH THE FLORIDA DEPARTMENT OF STATE, DIVISION OF CORPORATIONS WEBSITE AT WWW.SUNBIZ.ORG. THE CORPORATE BYLAWS, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS CAN BE OBTAINED DIRECTLY FROM THE ORGANIZATION UPON WRITTEN REQUEST. FORM 990, PART VII, SECTION A, LINE 1A: CERTAIN SENIOR EXECUTIVES ARE ACCOUNTABLE FOR AND PERFORM SERVICES FOR SANTAFE HEALTHCARE, INC. AND EACH OF ITS AFFILIATES. SANTAFE HEALTHCARE, INC. AND AFFILIATES REPRESENT A DIVERSIFIED FAMILY OF NOT-FOR-PROFIT ORGANIZATIONS WITH $2 BILLION IN GROSS RECEIPTS AND APPROXIMATELY 2,200 EMPLOYEES. THESE SENIOR EXECUTIVES ARE PAID DIRECTLY BY EITHER SANTAFE HEALTHCARE, INC., AVMED, INC. OR NORTH CENTRAL FLORIDA HOSPICE, INC. AND THEIR COMPENSATION AND BENEFITS ARE APPORTIONED AND CHARGED TO THE RESPECTIVE AFFILIATE BASED ON THE ESTIMATED AMOUNT OF TIME SPENT ON EACH AFFILIATE'S ACTIVITIES. FOR 2016, THE FOLLOWING PERCENTAGES OF EACH EXECUTIVE'S COMPENSATION AND BENEFITS (FOR THOSE SENIOR EXECUTIVES PAID BY A RELATED ORGANIZATION) ARE APPORTIONED AND CHARGED TO NORTH CENTRAL FLORIDA HOSPICE, INC. AS FOLLOWS: 5% - MICHAEL P GALLAGHER, CHIEF EXECUTIVE OFFICER 83% - GAYLE MATTSON, PRESIDENT 90% - JAMES L POOLE JR, PRESIDENT (INTERIM) 7% - RANDALL L STUART, ASSISTANT TREASURER 3% - CATHERINE E AYERS, ASSISTANT SECRETARY 10% - STEVEN M ZIEGLER, ASSISTANT SECRETARY FORM 990, PART IX, LINE 11G MEDICAL : PROGRAM SERVICE EXPENSES 12,435,631. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,435,631. CONTRACT LABOR : PROGRAM SERVICE EXPENSES 828,554. MANAGEMENT AND GENERAL EXPENSES 86,684. FUNDRAISING EXPENSES 47,956. TOTAL EXPENSES 963,194. CONSULTING : PROGRAM SERVICE EXPENSES 77,140. MANAGEMENT AND GENERAL EXPENSES 614,885. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 692,025. SECURITY : PROGRAM SERVICE EXPENSES 6,273. MANAGEMENT AND GENERAL EXPENSES 3,111. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,384. OTHER PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 116,993. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 116,993. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF CHARITABLE REMAINDER UNITRUST (CRUT) 70,379. CHANGE IN NET UNREALIZED GAINS/LOSSES ON CRUT 33,816. NET ASSETS RELEASED FOR OPERATIONS (RECOGNIZED FOR TAX IN PRIOR YEARS) -5,080. CHANGE IN NET UNREALIZED GAINS/LOSSES ON INTEREST RATE SWAP 132,116. GAINS/LOSSES ON UNCOLLECTIBLE PLEDGES 920. ROUNDING -3. 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 101030 430406 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 SANTAFE HEALTHCARE INC 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 M 125846 FAIR MARKET VALUE AVMED INC L 76487 FAIR MARKET VALUE AVMED INC P 73198 ACTUAL INVOICES