2014-11-06T14:00:49-06:00 2013-12-31 CROWE HORWATH LLP 70 WEST MADISON STREET SUITE 700 CHICAGO IL 606024903 990 2013-01-01 205276923 GOOD SHEPHERD HOSPICE INC GOOD 8138718100 12470 telecom drive temple terrace FL 33637 DAVID J O'NEIL CHIEF FINANCIAL OFFICER 2014-10-29 true NICOLE BENCIK P00756195 3128997000 2013 2015-11-30 17:44:51Z KATHY FERNANDEZ PRESIDENT & CEO 12470 Telecom drive Temple Terrace FL 33637 35198204 false X CHAPTERSHEALTH.ORG X 2006 FL PROVIDES HOSPICE AND PALLIATIVE CARE SERVICES THAT RELIEVE THE SUFFERING OF PERSONS RESIDING IN ITS COMMUNITIES AFFECTED BY LIFE-LIMITING ILLNESSES AND END-OF-LIFE ISSUES SO ALL MAY LIVE AS FULLY AS POSSIBLE. 10 7 478 459 0 0 0 111082 39512866 35070537 0 0 730 16585 39513596 35198204 0 0 0 0 25221256 23638525 0 0 0 15386424 14248552 40607680 37887077 -1094084 -2688873 9681035 8705988 6668059 7567857 3012976 1138131 X 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. THE ORGANIZATION ALSO WORKS TO PROMOTE UNDERSTANDING OF THE NEEDS OF PERSONS WITH SERIOUS OR LIFE-LIMITING ILLNESSES AS WELL AS THE NEEDS OF THEIR FAMILIES. false false 32382392 35087122 A. PATIENT CARE - AS A NOT-FOR-PROFIT HOSPICE PROGRAM INITIALLY LICENSED BY THE STATE OF FLORIDA IN 1984 AND 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 PROVIDES THESE SERVICES TO THE RESIDENTS OF POLK, HIGHLANDS, AND HARDEE COUNTIES, FLORIDA. IN 2013, GOOD SHEPHERD HOSPICE SERVED 3,731 PATIENTS IN ITS COMMUNITIES. 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) 32382392 true true false false false false false false true true false false true true true true true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false false true 0 0 478 true false false false false false false false false false false X 10 7 false false false false true true true true true false false true true true true true true false false false FL X David J O'Neil 8138718111 12470 Telecom drive Suite 300 Temple Terrace FL 33637 ANDREW LUTTON CHIEF OPERATING OFFICER - PARTIAL YEAR 2.00 44.00 X X 0 354371 7282 DAVID O'NEIL CHIEF FINANCIAL OFFICER 2.00 44.00 X X 0 300911 114495 KATHY L FERNANDEZ PRESIDENT & CEO 2.00 44.00 X X 0 678666 52470 PHIL WEGMAN SECRETARY 2.00 0 X X 0 0 0 REX YENTES VICE CHAIR 2.00 2.00 X X 0 0 0 RONALD S SCHONWETTER CHIEF MED OFFICER 2.00 44.00 X X 0 715562 165314 BRIAN HINTON BOARD MEMBER 2.00 2.00 X 0 0 0 JACK BARNHART BOARD MEMBER 2.00 0 X 0 0 0 JAMES JOINER BOARD MEMBER 2.00 2.00 X 0 0 0 JANE HANCOCK BOARD MEMBER 2.00 0 X 0 0 0 PHILIP WALKER BOARD MEMBER 2.00 0 X 0 0 0 STANLEY L PIOTROWSKI BOARD MEMBER 2.00 0 X 0 0 0 H DARRELL WHITE CHIEF LEGAL OFFICER 2.00 44.00 X 0 299054 122990 PEGGY M MADILL Chief Compliance and Clinical Officer 2.00 44.00 X 0 246177 86437 DONALD EVANS Executive Director 40.00 0 X 172475 0 39695 ALANNA KAPLAN PHYSICIAN 40.00 0 X 171114 0 28143 CHERI MCCUE Physician 40.00 0 X 180077 0 25569 JOSE FERNANDEZ-SEMIDEY PHYSICIAN 40.00 0 X 184323 0 52027 JOSEPH BEHAL PHYSICIAN 40.00 0 X 196938 0 34445 REBECCA MCINTRYE CHIEF CLINICAL OFFICER 40.00 0 X 114247 0 4558 1019174 2594741 733425 14 false true false CHAPTERS HEALTH SYSTEM INC 12470 TELECOM DRIVE SUITE 300 TEMPLE TERRACE FL 33637 SHARED SERVICES 221871 1 111082 111082 PATIENT SERVICE REVENUE 624100 35070537 35070537 0 0 0 0 0 0 0 0 35070537 0 0 0 0 0 0 0 0 0 0 0 0 OTHER OPERATING REVENUE 900099 16585 16585 0 0 0 0 0 0 16585 35198204 35087122 0 0 0 0 0 0 212170 212170 0 19242192 16618782 2623410 0 2349049 2341681 7368 1835114 1254212 580902 0 81610 81610 40805 40805 0 0 0 741516 539759 201757 0 41875 13538 28337 2043584 1130576 913008 437518 437518 0 2330642 1800746 529896 826816 789978 36838 0 64510 41274 23236 71555 71555 0 897643 897643 0 DRUGS 2867807 2867807 PATIENT SERVICES 1343018 1343018 INPATIENT AND RESPITE 1219419 1219419 CHEMO, RADIATION & THERAPY 409313 409313 830921 830921 0 0 37887077 32382392 5504685 0 0 1000 1000 2725714 988869 0 0 0 0 1444105 1171543 204792 272562 0 0 0 0 560000 440000 6189529 7003557 9681035 8705988 3577893 3139650 0 0 3090166 4428207 6668059 7567857 X 2517965 454411 447830 636539 47181 47181 3012976 1138131 9681035 8705988 X -2688873 814028 X false true X true false X 111082 111082 222164 45993604 49394311 40778927 39512866 35070537 210750245 0 0 0 46104686 49394311 40778927 39512866 35181619 210972409 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 210972409 0 0 0 0 0 0 0 0 0 905 402 985 730 16585 19607 46105591 49394713 40779912 39513596 35198204 210992016 0.99990 1.00000 0.00000 0.00000 X Schedule A, Part III, Line 12, Other Income DESCRIPTION - OTHER INCOME, COLUMN A - 905, COLUMN B - 402, COLUMN C - 985, COLUMN D - 730, COLUMN E - 16585, COLUMN F - 19607; RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 677946 100 19748 697794 162717 515229 677946 130765 31952 0 0 0 0 162717 125634 5131 0 0 0 0 130765 125458 176 0 0 0 0 125634 0.02800 0.97200 0.00000 false true true 0 0 0 1444105 1171543 272562 0 272562 BENEFICIAL INTEREST IN NET ASSETS OF CHAPTERS HEALTH SYSTEM 7003557 7003557 0 AMOUNTS DUE TO RELATED PARTIES 4428207 4428207 X 36012232 814028 814028 35198204 0 0 35198204 37887077 0 0 37887077 0 0 37887077 Schedule D, Part V, Line 4, Intended uses of endowment funds THE BUILDING ENDOWMENT FUND PROVIDES FUNDS FOR THE NECESSARY MAINTENANCE AND FACILITY UP-KEEP 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. THE 2010, 2011, AND 2012 TAX RETURNS ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. Schedule D, Part XI, Line 2d, Other revenues in audited financial statements not in form 990 CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF CHAPTERS HEALTH SYSTEM - 814028; true true false false false false false false false KATHY L FERNANDEZ PRESIDENT & CEO 0 414502 0 110000 0 154164 0 28350 0 24120 0 731136 0 110000 RONALD S SCHONWETTER CHIEF MED OFFICER 0 363995 0 103323 0 248244 0 134322 0 30992 0 880876 0 349661 ANDREW LUTTON CHIEF OPERATING OFFICER - PARTIAL YEAR 0 211836 0 70256 0 72279 0 5624 0 1658 0 361653 0 70256 DAVID O'NEIL CHIEF FINANCIAL OFFICER 0 231964 0 66023 0 2924 0 81735 0 32760 0 415406 0 66023 H DARRELL WHITE CHIEF LEGAL OFFICER 0 229461 0 67688 0 1905 0 93196 0 29794 0 422044 0 67688 PEGGY M MADILL CHIEF COMPLIANCE AND CLINICAL OFFICER 0 214845 0 29508 0 1824 0 63224 0 23213 0 332614 0 29508 DONALD EVANS EXECUTIVE DIRECTOR 170378 0 0 0 2097 0 14303 0 25392 0 212170 0 0 0 JOSE FERNANDEZ-SEMIDEY PHYSICIAN 172719 0 10122 0 1482 0 25078 0 26949 0 236350 0 10122 0 JOSEPH BEHAL PHYSICIAN 183464 0 11141 0 2333 0 15776 0 18669 0 231383 0 11141 0 ALANNA KAPLAN PHYSICIAN 160017 0 9749 0 1348 0 18475 0 9668 0 199257 0 9749 0 CHERI MCCUE PHYSICIAN 172676 0 5768 0 1633 0 16592 0 8977 0 205646 0 0 0 SCHEDULE J, PART I, LINE 3, PROCESS OF DETERMINING COMPENSATION THE PRESIDENT & CEO IS PAID BY CHAPTERS HEALTH SYSTEM, INC. (A RELATED ORGANIZATION). CHAPTERS HEALTH SYSTEM USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, FORMS 990 OF OTHER ORGANIZATIONS, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO DETERMINE HER COMPENSATION. GOOD SHEPHERD HOSPICE, INC. RELIES ON CHAPTERS HEALTH SYSTEM TO ENSURE COMPENSATION IS REASONABLE. Schedule J, Part I, Line 4a, Severance or change-of-control payment DURING 2013, THE FOLLOWING SEVERANCE PAYMENTS WERE MADE BY CHS TO THE LISTED PARTICIPANTS: ANDREW LUTTON - $71,781 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 2013, THE FOLLOWING PAYMENTS WERE MADE BY CHS INTO THE SERP PLANS OF THE PARTICIPANTS: KATHY FERNANDEZ - $152,259 RONALD SCHONWETTER - $112,118 HUBERT WHITE - 76,511 DAVID O'NEIL - $64,613 PEGGY MADILL- $56,536 DONALD EVANS - 12,503 IN ADDITION, THE FOLLOWING SERP BENEFITS BECAME VESTED DURING 2013: RONALD SCHONWETTER - $246,339 FORM 990, PART III, LINE 4A, PROGRAM SERVICES (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. DURING THE YEAR ENDED DECEMBER 31, 2013 THE COST OF CHARITY CARE PROVIDED WAS APPROXIMATELY $1,032,000. 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. VOLUNTEER SERVICES - THE COMPANY HAS 459 TRAINED VOLUNTEERS WHOSE DONATED TIME IS VALUED AT $621,682. 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, Sec A, 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, Sec A, 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, Sec A, 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, Sec A, 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, Sec B, 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, Sec B, 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 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. FORM 990, PART VI, LINE 15B, PROCESS FOR DETERMINING COMPENSATION SEE NARRATIVE FOR PART VI, LINE 15A Form 990, Part VI, Sec C, 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 - 814028; CHAPTERS HEALTH SYSTEM INC 12470 TELECOM DRIVE STE 300 TEMPLE TERRACE FL 33637 592264957 PARENT FL 501(C)(3) 11 - 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) N/A CHS false CHAPTERS HEALTH SENIOR INDEPENDENCE INC 12470 TELECOM DRIVE STE 300 TEMPLE TERRACE FL 33637 275158323 LONG-TERM CARE FL 501(C)(3) 9 CHS false false false false false false false false false false false true false true false true true false false false