2013-09-12T13:00:18-05:00 2012-12-31 CROWE HORWATH LLP 70 West Madison Street Suite 700 Chicago IL 606024903 990 2012-01-01 205276870 LIFEPATH HOSPICE INC LIFE 8138718111 12470 Telecom Drive Temple Terrace FL 33637 DAVID J O'NEIL 2013-09-12 true NICOLE BENCIK P00756195 3128997000 2012 2016-02-24 21:20:13Z X KATHY FERNANDEZ PRESIDENT & CEO 12470 Telecom Parkway Suite 300 Temple Terrace FL 33637 86516343 false X CHAPTERSHEALTH.ORG X 2006 FL LIFEPATH 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. 11 7 961 1083 0 0 0 0 76507397 86504697 0 0 1656 11646 76509053 86516343 0 0 0 0 46957827 50105401 0 0 0 29187423 31556074 76145250 81661475 363803 4854868 13766889 21219024 5981914 7297199 7784975 13921825 X LIFEPATH 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. LIFEPATH HOSPICE, INC. ALSO WORKS TO PROMOTE UNDERSTANDING OF THE NEEDS OF PERSONS WITH LIFE-LIMITING ILLNESSES AND THEIR FAMILIES. true false 68302232 86516343 A. PATIENT CARE- AS A NOT-FOR-PROFIT HOSPICE PROGRAM INITIALLY LICENSED BY THE STATE OF FLORIDA IN 1983 AND CERTIFIED BY THE FEDERAL MEDICARE PROGRAM, LIFEPATH HOSPICE PROVIDES A WIDE RANGE OF PALLIATIVE AND SUPPORTIVE CARE SERVICES TO HELP TERMINALLY ILL PATIENTS, THEIR FAMILIES AND THEIR LOVED ONES. LIFEPATH HOSPICE PROVIDES THESE SERVICES TO THE RESIDENTS OF HILLSBOROUGH COUNTY, FLORIDA. THESE SERVICES ARE PROVIDED BY INTERDISCIPLINARY TEAMS COMPOSED OF QUALIFIED PROFESSIONALS AND TRAINED VOLUNTEERS. LIFEPATH 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 ON SCHEDULE O) 68302232 true false false false false false false false true true false false true false 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 0 961 true false false false false false false false false false false X 11 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 2.00 44.00 X X 0 249670 134813 DAVID O'NEIL 2.00 44.00 X X 0 218842 152531 GENE FOGARTY 2.00 2.00 X X 0 0 0 KATHY L FERNANDEZ 2.00 44.00 X X 0 544726 143000 RONALD S SCHONWETTER 2.00 44.00 X X 0 354417 227560 TRISH MELECH 2.00 0 X X 0 0 0 HERB BELL 2.00 2.00 X 0 0 0 JANET DAVIS 2.00 0 X 0 0 0 KIMBERLY GUY 2.00 0 X 0 0 0 KRISTIN E DIMEO 2.00 2.00 X 0 0 0 VICTOR PRICE LEAVENGOOD 2.00 1.00 X 0 0 0 H DARRELL WHITE 2.00 44.00 X 0 225199 159567 PEGGY M MADILL 2.00 44.00 X 0 186590 66311 CHERYL HAMILTON 40.00 40.00 X 44845 125865 18941 ROXANNE RILEY 40.00 0 X 193380 0 61842 CATHERINE COVINGTON 40.00 0 X 150602 0 7366 GAIL DUDLEY 40.00 0 X 162406 0 6396 KARLA POPE 40.00 0 X 176647 0 21364 MICHELE MARZIANO 40.00 0 X 182598 0 30306 RICHARD WACKSMAN 40.00 0 X 226247 0 16669 GEORGE H WALLACE 2.00 44.00 X 0 235965 5092 1136725 2141274 1051758 18 true true false CHAPTERS HEALTH SYSTEM INC 12470 TELECOM DRIVE SUITE 300 TEMPLE TERRACE FL 33637 SHARED SERVICES 505076 1 0 PATIENT SERVICE REVENUE 624100 86504697 86504697 0 0 0 0 0 0 0 0 86504697 0 0 0 0 0 0 0 0 0 0 0 0 OTHER OPERATING REVENUE 900099 11646 11646 0 0 0 0 0 0 11646 86516343 86516343 0 0 0 0 0 0 306707 306707 0 40991347 35359091 5632256 0 4828300 4805589 22711 3979047 2766028 1213019 0 464902 464902 96187 96187 0 0 0 1616181 468622 1147559 0 111722 12864 98858 4472719 2116149 2356570 962762 4904 957858 0 3442705 2244381 1198324 1207209 1111022 96187 0 160059 99942 60117 200498 200498 14695 14695 1508060 1508060 5737 5737 DRUGS 6585926 6585926 INPATIENT AND RESPITE 4223061 4223061 PATIENT SERVICES 3379802 3379802 CHEMO, RADIATION & THERAPY 1820336 1820336 1283513 1283513 0 0 81661475 68302232 13359243 0 0 1000 1600470 4199860 7008872 0 0 2154641 1780442 541940 374199 0 0 0 0 9024089 12235483 13766889 21219024 5981914 7297199 0 0 0 5981914 7297199 X 7337948 12767359 316262 523701 130765 630765 7784975 13921825 13766889 21219024 X 4854868 1281982 X false true X true false X 0 54890666 79050347 82063611 76507397 86504697 379016718 0 0 0 54890666 79050347 82063611 76507397 86504697 379016718 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 379016718 0 0 0 0 0 0 0 0 0 916 3307 1922 1656 11646 19447 54891582 79053654 82065533 76509053 86516343 379036165 0.99990 0.99990 0.00000 0.00000 X OTHER INCOME, SCHEDULE A, PART III, LINE 12, DESCRIPTION - OTHER INCOME, COLUMN A - 916, COLUMN B - 3307, COLUMN C - 1922, COLUMN D - 1656, COLUMN E - 11646, COLUMN F - 19447;, 162717 515229 677946 130765 31952 0 0 0 0 162717 125634 5131 0 0 0 0 130765 125458 176 0 0 0 0 125634 80360 45098 0 0 0 0 125458 1.00000 0.00000 0.00000 false true true 0 0 0 2154641 1780442 374199 0 374199 BENEFICIAL INTEREST IN NET ASSETS OF CHAPTERS HEALTH SYSTEM 7250872 AMOUNTS DUE FROM RELATED PARTIES 4984611 12235483 0 0 X 87798325 1281982 1281982 86516343 0 0 86516343 81661475 0 0 81661475 0 0 81661475 Intended uses of endowment funds Schedule D, Part V, Line 4 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 LIFEPATH HOSPICE, INC. FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 LPH HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS A NOT-FOR-PROFIT CORPORATION AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND ALSO FROM STATE INCOME TAXES UNDER THE PROVISIONS OF CHAPTER 220.13 OF THE FLORIDA INCOME TAX CODE. THE IRC PROVIDES FOR TAXATION OF UNRELATED BUSINESS INCOME UNDER CERTAIN CIRCUMSTANCES. LPH HAS NO SIGNIFICANT UNRELATED BUSINESS INCOME; HOWEVER, SUCH STATUS IS SUBJECT TO FINAL DETERMINATION UPON EXAMINATION OF THE RELATED INCOME TAX RETURNS BY THE APPROPRIATE TAXING AUTHORITIES. Other revenues in audited financial statements not in form 990 Schedule D, Part XI, Line 2d CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF CHAPTERS HEALTH SYSTEM - 1281982; true true false false false false false false false ANDREW LUTTON 0 248953 0 0 0 717 0 132726 0 2087 0 384483 0 0 CATHERINE COVINGTON 149368 0 0 0 1234 0 0 0 7366 0 157968 0 0 0 CHERYL HAMILTON 44748 95105 0 0 97 30760 0 0 6640 12301 51485 138166 0 0 DAVID O'NEIL 0 216822 0 0 0 2020 0 119953 0 32578 0 371373 0 0 GAIL DUDLEY 140897 0 20000 0 1509 0 0 0 6396 0 168802 0 0 0 GEORGE H WALLACE 0 0 0 0 0 235965 0 0 0 5092 0 241057 0 0 H DARRELL WHITE 0 223136 0 0 0 2063 0 130159 0 29408 0 384766 0 0 KARLA POPE 158921 0 16747 0 979 0 10800 0 10564 0 198011 0 0 0 KATHY L FERNANDEZ 0 399499 0 0 0 145227 0 118500 0 24500 0 687726 0 0 MICHELE MARZIANO 180968 0 0 0 1630 0 18315 0 11991 0 212904 0 0 0 PEGGY M MADILL 0 184884 0 0 0 1706 0 43431 0 22880 0 252901 0 0 RICHARD WACKSMAN 223350 0 0 0 2897 0 12487 0 4182 0 242916 0 0 0 RONALD S SCHONWETTER 0 353313 0 0 0 1104 0 196493 0 31067 0 581977 0 0 ROXANNE RILEY 192432 0 0 0 948 0 48834 0 13008 0 255222 0 0 0 PROCESS OF DETERMINNG COMPENSATION SCHEDULE J, PART I, LINE 3 THE PRESIDENT & CEO OF LIFEPATH HOSPICE, INC. IS PAID BY CHAPTERS HEALTH SYSTEM, INC. (A RELATED ORGANIZATION). CHS USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEYS OR STUDIES, FORMS 990 OF OTHER ORGANIZATIONS, AND APPROVAL BY THE BOARD OR COMMITTEE TO DETERMINE HER COMPENSATION. LIFEPATH HOSPICE, INC. RELIES ON CHS TO ENSURE COMPENSATION IS REASONABLE. Severance or change-of-control payment Schedule J, Part I, Line 4a IN 2012, $235,965 IN SEVERANCE PAYMENTS WERE MADE TO GEORGE WALLACE. Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b CHS (A RELATED ORGANIZATION) HAS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN WHICH SOME OF THE INTERESTED PERSONS PARTICIPATE. DURING 2011, THE FOLLOWING PAYMENTS WERE MADE BY CHS INTO THE SERP PLANS OF THE PARTICIPANTS: KATHY FERNANDEZ - $143,163 RONALD SCHONWETTER - $84,670 H. DARRELL WHITE - $55,555 ANDREW LUTTON - $55,051 DAVID O'NEIL - $47,097 ROXANNE RILEY - $9,860 PEGGY MADILL- $9,513 New program services Form 990, Part III, Line 2 CHAPTERS HEALTH NURSING HOME DIVERSION (HOME DIVERSION): HOME DIVERSION PROVIDES CASE MANAGEMENT SERVICES TO EVALUATE AND COORDINATE VARIOUS SERVICES THAT ARE INDISPENSIBLE TO ELDERLY PERSONS. PROGRAM SERVICES FORM 990, PART III, LINE 4A (CONTINUED FROM PART III) THE STAFF AND VOLUNTEERS OF LIFEPATH 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. LIFEPATH 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. IN ACCORDANCE WITH ITS CHARITY CARE POLICY, LIFEPATH HOSPICE PROVIDED $2,676,000 IN CHARITY CARE DURING THE YEAR ENDED DECEMBER 31, 2012. THIS AMOUNT IS MEASURED BY STANDARD RATES, WHICH ARE NOT BILLED OR COLLECTED BECAUSE THE PATIENT DOES NOT HAVE THE ABILITY TO PAY. THIS AMOUNT DOES NOT INCLUDE ANY CONTRACTUAL ADJUSTMENTS FOR MEDICARE, MEDICAID, OR ANY OTHER THIRD PARTY PAYOR SOURCES. B. HOSPICE IN-PATIENT FACILITIES LIFEPATH HOSPICE OPERATES TWO 24-BED 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 LIFEPATH 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, AND IN BOTH ENGLISH AND SPANISH. 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 LIFEPATH HOSPICE CIRCLE OF LOVE CENTER FOR GRIEVING CHILDREN 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 LIFEPATH HOSPICE CAMP CIRCLE OF LOVE 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. UNIVERSITY OF SOUTH FLORIDA MEDICAL STUDENT PROGRAM IN PARTNERSHIP WITH THE USF COLLEGE OF MEDICINE, LIFEPATH HOSPICE CREATED AND NOW OPERATES A MANDATORY HOSPICE ROTATION FOR ALL THIRD YEAR MEDICAL STUDENTS. IN ADDITION TO CLASSROOM TRAINING, THE STUDENTS GO ON PATIENT VISITS TO SEE FIRSTHAND THE IMPORTANCE OF HOSPICE AND END-OF -LIFE CARE. ADDITIONALLY, LIFEPATH HOSPICE AND USF OFFER AN OPTIONAL HOSPICE ROTATION FOR FOURTH-YEAR STUDENTS AND A PALLIATIVE CARE FELLOWSHIP. E. VOLUNTEER SERVICES LIFEPATH HOSPICE'S 1,083 TRAINED VOLUNTEERS PROVIDED $1,683,211 IN VOLUNTEER HOURS IN 2012. 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, THRIFT STORE VOLUNTEER, AND MANY MORE. F. 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. G. 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 LIFEPATH HOSPICE ARE REQUIRED TO HAVE A MINIMUM OF ONE UNIT OF CPE. H. NATIONAL INSTITUTE FOR JEWISH HOSPICE (NIJH) ACCREDITATION NIJH IS THE RESOURCE CENTER FOR HOSPICE CARE OF JEWISH PATIENTS. LIFEPATH 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. LIFEPATH 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. LIFEPATH 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. I. HOSPICEHELP24 LIFEPATH 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. LIFEPATH 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. J. JOINT COMMISSION ACCREDITATION TO ENSURE THAT PATIENTS AND FAMILIES RECEIVE THE HIGHEST QUALITY OF END-OF-LIFE CARE, LIFEPATH HOSPICE UNDERGOES JOINT COMMISSION ACCREDITATION. JOINT COMMISSION ACCREDITATION IS NOT REQUIRED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES TO OBTAIN LICENSURE. LIFEPATH HOSPICE BELIEVES THAT UNDERGOING THIS VOLUNTARY ACCREDITATION PROCESS EVERY THREE YEARS REINFORCES THE COMPANY MISSION TO PROVIDE OUTSTANDING HOSPICE CARE. K. TRANSITIONS PROGRAM IN 2009, LIFEPATH HOSPICE ESTABLISHED ITS UNFUNDED TRANSITIONS PROGRAM TO PROVIDE SERVICES FOR HILLSBOROUGH COUNTY RESIDENTS WHO ARE NOT YET HOSPICE APPROPRIATE, NO LONGER REQUIRE HOSPICE SERVICES OR DECLINE HOSPICE SERVICES. THE TRANSITIONS PROGRAM PROVIDES CASE MANAGEMENT AND VOLUNTEER SERVICES TO CLIENTS WITH LIFE-LIMITING ILLNESSES BY OFFERING CLIENT/FAMILY SUPPORT, VOLUNTEER VISITS, COMMUNITY SERVICES COORDINATION AND NEEDS ASSESSMENT. Delegate broad authority to a committee Form 990, Part VI, Section A, Line 1a THE EXECUTIVE COMMITTEE, MADE UP OF THE PRESIDENT AND CEO, CFO, 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. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 THE ORGANIZATION HAS A SOLE MEMBER, CHAPTERS HEALTH SYSTEM, INC., THAT BOTH ELECTS THE MEMBERS OF THE GOVERNING BODY OF LIFEPATH HOSPICE, INC. AND ALSO APPROVES CERTAIN SIGNIFICANT DECISIONS MADE BY THE GOVERNING BODY OF LIFEPATH HOSPICE, INC. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a THE ORGANIZATION'S SOLE MEMBER, CHAPTERS HEALTH SYSTEM, INC., NOMINATES AND ELECTS THE ELECTED MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS AND MAY APPOINT REPLACEMENT DIRECTORS AT ANY TIME WHEN A VACANCY OCCURS. Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b 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. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b 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. Conflict of interest policy Form 990, Part VI, Section B, Line 12c 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 LIFE PATH 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. PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, LINE 15A 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 LIFEPATH HOSPICE, INC. IS PAID BY CHAPTERS HEALTH SYSTEM, INC. PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, LINE 15B SEE NARRATIVE FOR PART VI, LINE 15A Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 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. IN ADDITION, THE ORGANIZATION REPORTS ITS FINANCIAL PERFORMANCE EACH YEAR IN ITS ANNUAL REPORT, COPIES OF WHICH ARE AVAILABLE TO THE PUBLIC UPON REQUEST. Other changes in net assets or fund balances Form 990 , Part XI, Line 9 CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF CHAPTERS HEALTH SYSTEM - 1281982; CHAPTERS HEALTH SYSTEM INC 12470 TELECOM DRIVE SUITE 300 TEMPLE TERRACE FL 33637 PARENT FL 501(C)(3) 11 - Type II NA false GOOD SHEPHERD HOSPICE INC 12470 TELECOM DRIVE SUITE 300 TEMPLE TERRACE FL 33637 HOSPICE CARE FL 501(C)(3) 9 CHS false JUDGE ALVA CARVER FOUNDATION INC 12470 TELECOM DRIVE SUITE 300 TEMPLE TERRACE FL 33637 SUPPORT FL 501(C)(3) N/A CHS false CHAPTERS HEALTH SENIOR INDEPENDENCE INC 12470 TELECOM DRIVE SUITE 300 TEMPLE TERRACE FL 33637 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