GOOD SHEPHERD HOSPICE INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SHEPHERD HOSPICE INC (EIN 20-5276923)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-07
- IRS object ID
- 201613129349300926
- Schema version
- 2015v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-07T10:00:42-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE HORWATH LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 West Wacker Drive | AddressLine1Txt |
| Address Line2 | Suite 2600 | AddressLine2Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606061224 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 205276923 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Shepherd Hospice Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 8138718100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12470 telecom drive Suite 300 | AddressLine1Txt |
| City | temple terrace | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33637 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | David J O'Neil | PersonNm |
| Person Title | chief financial officer | PersonTitleTxt |
| Signature | 2016-10-18 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | NICOLE BENCIK | PreparerPersonNm |
| PTIN | P00756195 | PTIN |
| Phone | 3128997000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kathy Fernandez President & CEO | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12470 telecom drive | AddressLine1Txt |
| City | temple terrace | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33637 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $33,384,876 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | chaptershealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2006 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 411 | TotalEmployeeCnt |
| Total Volunteers | 449 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $111,082 | PYContributionsGrantsAmt |
| CY Contributions Grants | $127,121 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $29,566,558 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $33,257,755 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $18,084 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $29,695,724 | PYTotalRevenueAmt |
| CY Total Revenue | $33,384,876 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $19,368,999 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,636,142 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,050,711 | PYOtherExpensesAmt |
| CY Other Expenses | $12,508,506 | CYOtherExpensesAmt |
| PY Total Expenses | $30,419,710 | PYTotalExpensesAmt |
| CY Total Expenses | $33,144,648 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$723,986 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $240,228 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,540,114 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,955,103 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,761,663 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,118,726 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,778,451 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,836,377 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $26,749,478 | ExpenseAmt |
| Revenue | $33,257,755 | RevenueAmt |
| Desc | 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 2015, Good Shepherd Hospice served 3,678 patients in its communities. Good Shepherd Hospice maintains 60% market share in Polk Highlands and Hardee counties in 2015. 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) | Desc |
| Total Program Service Expenses | $26,749,478 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 411 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (true) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | FL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | David J O'Neil | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8138718111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12470 Telecom drive Suite 300 | AddressLine1Txt |
| City | Temple Terrace | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33637 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Kathy Fernandez | |||||||||
| president/ceo | 2.0 | 48.0 | Yes (X) | Yes (X) | $0 | $726,495 | $150,106 | ||
| James Joiner | |||||||||
| Vice Chair | 2.0 | 2.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Phillip Walker | |||||||||
| Secretary | 2.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Brian Hinton | |||||||||
| Board Member | 2.0 | 2.0 | Yes (X) | $0 | $0 | $0 | |||
| Jane Hancock | |||||||||
| Board Member | 2.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Michelle Heston | |||||||||
| Board Member | 2.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Willie Hogan | |||||||||
| Board Member | 2.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Martha Santiago | |||||||||
| Board Member | 2.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Philip Wegman | |||||||||
| board member | 2.0 | 2.0 | Yes (X) | $0 | $0 | $0 | |||
| H Darrell White | |||||||||
| Chief Legal Officer | 2.0 | 46.0 | Yes (X) | $0 | $288,543 | $221,145 | |||
| Peggy Bertels | |||||||||
| Chief Operating Officer (partial year) | 2.0 | 46.0 | Yes (X) | $0 | $217,831 | $83,515 | |||
| David O'Neil | |||||||||
| Chief Financial Officer | 2.0 | 46.0 | Yes (X) | $0 | $339,601 | $193,978 | |||
| Sharon Saucier | |||||||||
| Chief Compliance & Clinical Officer (partial year) | 2.0 | 46.0 | Yes (X) | $0 | $150,882 | $5,686 | |||
| Ronald Schonwetter | |||||||||
| Chief Medical Officer | 2.0 | 46.0 | Yes (X) | $0 | $428,226 | $286,330 | |||
| PEGGY MADILL | |||||||||
| CHIEF OPERATING OFFICER | 2.0 | 44.0 | Yes (X) | $0 | $133,388 | $13,260 | |||
| Audra Farish | |||||||||
| Chief Human Resources officer | 2.0 | 44.0 | Yes (X) | $0 | $211,603 | $68,719 | |||
| Donald Evans | |||||||||
| Chief integration and business development officer | 2.0 | 44.0 | Yes (X) | $0 | $164,393 | $71,850 | |||
| Kim Walker | |||||||||
| Executive Director (partial year) | 2.0 | 40.0 | $22,170 | $187,138 | $20,178 | Yes (X) | |||
| Kendra Hall | |||||||||
| Medical Director (Partial Year) | 40.0 | 0 | $118,676 | $0 | $8,444 | Yes (X) | |||
| Rebecca McIntyre | |||||||||
| Clinical Administrator & Interim Executive Director | 40.0 | 2.0 | $100,751 | $30,380 | $11,402 | Yes (X) | |||
| Robert Weissinger | |||||||||
| Medical Director (Partial Year) | 2.0 | 0 | $120,420 | $0 | $6,224 | Yes (X) | |||
| JOSE Fernandez-SEMIDEY | |||||||||
| staff physician | 40.0 | 0 | $203,095 | $0 | $53,755 | Yes (X) | |||
| JOSEPH BEHAL | |||||||||
| staff physician | 40.0 | 0 | $119,821 | $0 | $17,447 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $684,933 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,878,480 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,212,039 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHAPTERS HEALTH SYSTEM INC | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12470 TELECOM DRIVE SUITE 300 | AddressLine1Txt |
| City | TEMPLE TERRACE | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33637 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | SHARED SERVICES | ServicesDesc |
| Compensation | $196,266 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $127,121 | FederatedCampaignsAmt |
| Total Contributions | $127,121 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Patient Service Revenue | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $33,257,755 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $33,257,755 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $33,257,755 | TotalProgramServiceRevenueAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,384,876 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $33,257,755 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,170 | TotalAmt |
| Program Services | $22,170 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,633,608 | TotalAmt |
| Program Services | $14,066,008 | ProgramServicesAmt |
| Management And General | $2,567,600 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,314,528 | TotalAmt |
| Program Services | $2,306,584 | ProgramServicesAmt |
| Management And General | $7,944 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,665,836 | TotalAmt |
| Program Services | $1,026,686 | ProgramServicesAmt |
| Management And General | $639,150 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $197,367 | TotalAmt |
| Management And General | $197,367 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,328 | TotalAmt |
| Management And General | $51,328 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $726,473 | TotalAmt |
| Program Services | $450,893 | ProgramServicesAmt |
| Management And General | $275,580 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,951 | TotalAmt |
| Program Services | $7,287 | ProgramServicesAmt |
| Management And General | $25,664 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,993,256 | TotalAmt |
| Program Services | $1,343,107 | ProgramServicesAmt |
| Management And General | $650,149 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $511,443 | TotalAmt |
| Management And General | $511,443 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,426,648 | TotalAmt |
| Program Services | $1,894,430 | ProgramServicesAmt |
| Management And General | $532,218 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $687,161 | TotalAmt |
| Program Services | $654,776 | ProgramServicesAmt |
| Management And General | $32,385 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,381 | TotalAmt |
| Program Services | $28,550 | ProgramServicesAmt |
| Management And General | $23,831 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,717 | TotalAmt |
| Management And General | $50,717 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,444 | TotalAmt |
| Management And General | $2,444 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $840,689 | TotalAmt |
| Program Services | $162,433 | ProgramServicesAmt |
| Management And General | $678,256 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Drugs | $1,977,798 | $1,977,798 |
| PATIENT SERVICES | $1,097,741 | $1,097,741 |
| INPATIENT AND RESPITE | $998,085 | $998,085 |
| Chemo, Radiation & Therapy | $143,129 | $143,129 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $718,895 | TotalAmt |
| Program Services | $569,801 | ProgramServicesAmt |
| Management And General | $149,094 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,144,648 | TotalAmt |
| Program Services | $26,749,478 | ProgramServicesAmt |
| Management And General | $6,395,170 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,000 | BOYAmt |
| EOY | $1,000 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,678,746 | BOYAmt |
| EOY | $3,568,543 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $0 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $0 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $172,505 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $320,000 | BOYAmt |
| EOY | $200,000 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,367,863 | BOYAmt |
| EOY | $9,185,560 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,540,114 | BOYAmt |
| EOY | $12,955,103 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,889,210 | BOYAmt |
| EOY | $3,098,714 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,872,453 | BOYAmt |
| EOY | $7,020,012 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,761,663 | BOYAmt |
| EOY | $10,118,726 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,084,872 | BOYAmt |
| EOY | $2,092,700 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $630,656 | BOYAmt |
| EOY | $651,971 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,923 | BOYAmt |
| EOY | $91,706 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,778,451 | BOYAmt |
| EOY | $2,836,377 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,540,114 | BOYAmt |
| EOY | $12,955,103 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $240,228 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $817,698 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $111,082 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $111,082 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $127,121 | CurrentTaxYearAmt |
| Total | $349,285 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $40,778,927 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $39,512,866 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $35,070,537 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $29,566,558 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $33,257,755 | CurrentTaxYearAmt |
| Total | $178,186,643 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $40,778,927 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $39,512,866 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $35,181,619 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $29,677,640 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $33,384,876 | CurrentTaxYearAmt |
| Total | $178,535,928 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $178,535,928 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Post1975 UBTI Post1975UBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $985 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $730 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $16,585 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $18,084 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $36,384 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $40,779,912 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $39,513,596 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $35,198,204 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $29,695,724 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $33,384,876 | CurrentTaxYearAmt |
| Total | $178,572,312 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.9998 | PublicSupportCY509Pct |
| Public Support PY509 | 0.9998 | PublicSupportPY509Pct |
| Investment Income CY | 0 | InvestmentIncomeCYPct |
| Investment Income PY | 0.0 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part III, Line 12 Other Income | FormAndLineReferenceDesc |
| Explanation | DESCRIPTION - OTHER INCOME, COLUMN A - 985.0, COLUMN B - 730.0, COLUMN C - 16585.0, COLUMN D - 18084.0, COLUMN E - 0.0, COLUMN F - 36384.0; | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $750,493 | BeginningYearBalanceAmt |
| Contributions | $181,026 | ContributionsAmt |
| Investment Earnings Or Losses | $6,910 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $938,429 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $697,796 | BeginningYearBalanceAmt |
| Contributions | $15,741 | ContributionsAmt |
| Investment Earnings Or Losses | $36,956 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $750,493 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $677,948 | BeginningYearBalanceAmt |
| Contributions | $100 | ContributionsAmt |
| Investment Earnings Or Losses | $19,748 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $697,796 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $162,717 | BeginningYearBalanceAmt |
| Contributions | $515,231 | ContributionsAmt |
| Investment Earnings Or Losses | $0 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $677,948 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $130,765 | BeginningYearBalanceAmt |
| Contributions | $31,952 | ContributionsAmt |
| Investment Earnings Or Losses | $0 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $162,717 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.0678 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.9322 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.0 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Beneficial Interest in net assets of Chapters Health System | Desc |
| Book Value | $9,185,560 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $9,185,560 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Amounts Due to Related Parties | Desc |
| Amt | $7,020,012 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $7,020,012 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $33,917,827 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $817,698 | OtherRevenueAmt |
| Revenue Not Reported | $817,698 | RevenueNotReportedAmt |
| Revenue Subtotal | $33,100,129 | RevenueSubtotalAmt |
| Other Revenues Not Included | $284,747 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $284,747 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $33,384,876 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $32,859,901 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $0 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $32,859,901 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $284,747 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $284,747 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $33,144,648 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 not-for-profit 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 CHAPTERS HEALTH SYSTEM - 817698 |
| Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements | patient revenue recorded in expenses - 284747 |
| Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements | patient revenue recorded in expenses - 284747 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kathy Fernandez | ||||||||||||||
| president/ceo | $0 | $444,427 | $0 | $48,205 | $0 | $233,863 | $0 | $124,329 | $0 | $25,777 | $0 | $876,601 | $0 | $48,205 |
| H Darrell White | ||||||||||||||
| Chief Legal Officer | $0 | $265,797 | $0 | $20,212 | $0 | $2,534 | $0 | $199,375 | $0 | $21,770 | $0 | $509,688 | $0 | $20,212 |
| Peggy Bertels | ||||||||||||||
| Chief Operating Officer (partial year) | $0 | $209,428 | $0 | $0 | $0 | $8,403 | $0 | $71,550 | $0 | $11,965 | $0 | $301,346 | $0 | $0 |
| David O'Neil | ||||||||||||||
| Chief Financial Officer | $0 | $306,533 | $0 | $21,254 | $0 | $11,814 | $0 | $162,938 | $0 | $31,040 | $0 | $533,579 | $0 | $21,254 |
| Sharon Saucier | ||||||||||||||
| Chief Compliance & Clinical Officer (partial year) | $0 | $140,956 | $0 | $5,000 | $0 | $4,926 | $0 | $0 | $0 | $5,686 | $0 | $156,568 | $0 | $0 |
| Ronald Schonwetter | ||||||||||||||
| Chief Medical Officer | $0 | $386,295 | $0 | $30,933 | $0 | $10,998 | $0 | $254,925 | $0 | $31,405 | $0 | $714,556 | $0 | $30,526 |
| Audra Farish | ||||||||||||||
| Chief Human Resources officer | $0 | $199,999 | $0 | $0 | $0 | $11,604 | $0 | $67,000 | $0 | $1,719 | $0 | $280,322 | $0 | $0 |
| Donald Evans | ||||||||||||||
| Chief integration and business development officer | $0 | $158,739 | $0 | $1,173 | $0 | $4,481 | $0 | $43,530 | $0 | $28,320 | $0 | $236,243 | $0 | $1,173 |
| Kim Walker | ||||||||||||||
| Executive Director (partial year) | $22,170 | $167,681 | $0 | $1,850 | $0 | $17,607 | $665 | $3,144 | $0 | $16,369 | $22,835 | $206,651 | $0 | $1,850 |
| JOSE Fernandez-SEMIDEY | ||||||||||||||
| staff physician | $195,297 | $0 | $6,636 | $0 | $1,162 | $0 | $26,639 | $0 | $27,116 | $0 | $256,850 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 4a Severance or change-of-control payment | During 2015, the following severance payment was made: Kim Walker - $15,837 |
| 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 2015, the following payments were made by CHS into the SERP plans of the participants: Kathy Fernandez - $217,480 Ronald Schonwetter - $139,158 H. Darrell White - $119,128 David O'Neil - $68,767 Audra Farish - $14,000 Sharon Jones - $11,554 Donald Evans - $11,877 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a | (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 $535,000 in charity care in 2015. 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 449 trained volunteers whose donated time is valued at $660,657. 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 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 CEO AND ALL OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. 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. The 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 | SEE NARRATIVE FOR PART VI, LINE 15A |
| 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 at 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 4 Significant changes to organizational documents | IN MAY OF 2015, THE BYLAWS WERE AMENDED TO reflect adjustments to the number, composition, qualifications, authority, and duties of the organization's officers. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | The 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 | The 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 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 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 - 817698; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 9 | 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 | 9 | CHS | false |
| HOSPICE FOUNDATION INC | ||||||||||
| 12470 TELECOM DRIVE suite 300 | TEMPLE TERRACE | FL | 33637 | 593467282 | foundation | FL | 501(c)(3 | Type II | CHS | false |
| HERNANDO PASCO HOSPICE INC | ||||||||||
| 12470 TELECOM DRIVE suite 300 | TEMPLE TERRACE | FL | 33637 | 592217929 | hospice care | FL | 501(c)(3 | 9 | CHS | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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