GOOD SHEPHERD HOSPICE INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SHEPHERD HOSPICE INC (EIN 20-5276923)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-08-07
- IRS object ID
- 201212209349301306
- Schema version
- 2011v1.2
- 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) |
|---|---|---|
| Timestamp | 2012-08-07T17:00:15-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE HORWATH LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 70 West Madison Street | AddressLine1 |
| Address Line2 | Suite 700 | AddressLine2 |
| City | Chicago | City |
| State | IL | State |
| ZIP Code | 606024903 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 205276923 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SHEPHERD HOSPICE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GOOD | NameControl |
| Phone | 8138718100 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12973 telecom parkway | AddressLine1 |
| City | temple terrace | City |
| State | FL | State |
| ZIP Code | 33637 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID J O'NEIL | Name |
| Title | CFO | Title |
| Date Signed | 2012-07-31 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| PTIN | P00756195 | PTIN |
| Phone | 3128997000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Name Of Principal Officer Business NameOfPrincipalOfficerBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KATHY FERNANDEZ PRESIDENT & CEO | BusinessNameLine1 |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12973 Telecom Parkway | AddressLine1 |
| City | Temple Terrace | City |
| State | FL | State |
| ZIP Code | 33637 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 40779912 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | CHAPTERSHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2006 | YearFormation |
| State Legal Domicile | FL | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 492 | TotalNbrEmployees |
| Total Nbr Volunteers | 580 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 49394311 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 40778927 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 402 | OtherRevenuePriorYear |
| Other Revenue Current Year | 985 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 49394713 | TotalRevenuePriorYear |
| Total Revenue Current Year | 40779912 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 27153393 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 26171532 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 21639602 | OtherExpensePriorYear |
| Other Expenses Current Year | 15700943 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 48792995 | TotalExpensesPriorYear |
| Total Expenses Current Year | 41872475 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 601718 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1092563 | RevenuesLessExpensesCY |
| Total Assets BOY | 8298417 | TotalAssetsBOY |
| Total Assets EOY | 7972978 | TotalAssetsEOY |
| Total Liabilities BOY | 4653517 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4655972 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3644900 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3317006 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 35675324 | Expense |
| Grants | 0 | Grants |
| Revenue | 40779912 | Revenue |
| Description | 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. 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. 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. (CONTINUED IN SCHEDULE O) | Description |
| Total Program Service Expense | 35675324 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 492 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | true | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | FL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | David J O'Neil | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8138718111 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12973 Telecom Parkway Suite 100 | AddressLine1 |
| City | Temple Terrace | City |
| State | FL | State |
| ZIP Code | 33637 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| ANDREW LUTTON | ||||||||
| CHIEF OPERATING OFFICER | 2.00 | X | X | 0 | 263441 | 84023 | ||
| DAVID O'NEIL | ||||||||
| CHIEF FINANCIAL OFFICER | 2.00 | X | X | 0 | 225499 | 48988 | ||
| GEORGE H WALLACE | ||||||||
| EVP-FINANCE & OPERATIONS - PARTIAL YEAR | 2.00 | X | X | 0 | 325694 | 18666 | ||
| KATHY L FERNANDEZ | ||||||||
| CHAIR | 2.00 | X | X | 0 | 716660 | 24684 | ||
| PHIL WEGMAN | ||||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | ||
| REX YENTES | ||||||||
| VICE CHAIR | 2.00 | X | X | 0 | 0 | 0 | ||
| RONALD S SCHONWETTER | ||||||||
| CHIEF MED OFFICER | 2.00 | X | X | 0 | 457440 | 139856 | ||
| BRIAN HINTON | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| JACK BARNHART | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| JAMES T JOINER | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| JANE HANCOCK | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| PHILLIP WALKER | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| STANLEY L PIOTROWSKI | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| H DARRELL WHITE | ||||||||
| CHIEF LEGAL OFFICER | 2.00 | X | 0 | 279623 | 67689 | |||
| WILLIAM C BREDBENNER | ||||||||
| EXECUTIVE DIRECTOR | 40.00 | 180034 | 0 | 9518 | X | |||
| ALANNA KAPLAN | ||||||||
| PHYSICIAN | 40.00 | 156380 | 0 | 8089 | X | |||
| JOSEPH BEHAL | ||||||||
| PHYSICIAN | 40.00 | 160234 | 0 | 19307 | X | |||
| REBECCA MCINTRYE | ||||||||
| CHIEF CLINICAL OFFICER | 40.00 | 106687 | 0 | 3350 | X | |||
| STEWART STEIN | ||||||||
| MEDICAL DIRECTOR | 40.00 | 223408 | 0 | 9342 | X | |||
| SUSAN MOFFITT | ||||||||
| NURSE PRACTITIONER | 40.00 | 103538 | 0 | 25503 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 930281 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2268357 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 459015 | TotalOtherCompensation |
| Number Individuals GT100 K | 12 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHAPTERS HEALTH SYSTEM INC | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12973 N TELECOM PARKWAY SUITE 100 | AddressLine1 |
| City | TEMPLE TERRACE | City |
| State | FL | State |
| ZIP Code | 33637 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | SHARED SERVICES | DescriptionOfServices |
| Compensation | 242312 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Total Contributions | 0 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENUE | Description |
| Business Code | 624100 | BusinessCode |
| Total Revenue Column | 40778927 | TotalRevenueColumn |
| Related Or Exempt Function Income | 40778927 | RelatedOrExemptFunctionIncome |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 40778927 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER OPERATING REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 985 | TotalRevenueColumn |
| Related Or Exempt Function Income | 985 | RelatedOrExemptFunctionIncome |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 985 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 40779912 | TotalRevenueColumn |
| Related Or Exempt Function Income | 40779912 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 189552 | Total |
| Program Services | 189552 | ProgramServices |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21249188 | Total |
| Program Services | 18564582 | ProgramServices |
| Management And General | 2684606 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2686330 | Total |
| Program Services | 2672696 | ProgramServices |
| Management And General | 13634 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2046462 | Total |
| Program Services | 1445958 | ProgramServices |
| Management And General | 600504 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76225 | Total |
| Management And General | 76225 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59493 | Total |
| Management And General | 59493 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1198425 | Total |
| Program Services | 609696 | ProgramServices |
| Management And General | 588729 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98183 | Total |
| Program Services | 33733 | ProgramServices |
| Management And General | 64450 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2134734 | Total |
| Program Services | 1135753 | ProgramServices |
| Management And General | 998981 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 401382 | Total |
| Program Services | 5384 | ProgramServices |
| Management And General | 395998 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2391827 | Total |
| Program Services | 1834703 | ProgramServices |
| Management And General | 557124 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 894231 | Total |
| Program Services | 851471 | ProgramServices |
| Management And General | 42760 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71671 | Total |
| Program Services | 32629 | ProgramServices |
| Management And General | 39042 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 114906 | Total |
| Program Services | 114906 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5577 | Total |
| Management And General | 5577 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 738124 | Total |
| Program Services | 738124 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42543 | Total |
| Program Services | 42543 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| DRUGS | 2904489 | 2834461 | 70028 |
| INPATIENT AND RESPITE | 1707836 | 1707836 | |
| PATIENT SERVICES | 1231096 | 1231096 | |
| CHEMO, RADIATION & THERAPY | 919338 | 919338 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 710863 | Total |
| Program Services | 710863 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41872475 | Total |
| Program Services | 35675324 | ProgramServices |
| Management And General | 6197151 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Joint Costs TotalJointCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1000 | BOY |
| EOY | 1000 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3341669 | BOY |
| EOY | 2295146 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1277790 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1000429 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 320945 | BOY |
| EOY | 277361 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4634803 | BOY |
| EOY | 5399471 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8298417 | BOY |
| EOY | 7972978 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2946052 | BOY |
| EOY | 3012978 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1707465 | BOY |
| EOY | 1642994 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4653517 | BOY |
| EOY | 4655972 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3367181 | BOY |
| EOY | 3017041 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 277719 | BOY |
| EOY | 268013 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 31952 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3644900 | BOY |
| EOY | 3317006 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8298417 | BOY |
| EOY | 7972978 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1092563 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 764669 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 111082 | CurrentTaxYearMinus2Years |
| Total | 111082 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 27704428 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 45993604 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 49394311 | CurrentTaxYearMinus1Year |
| Current Tax Year | 40778927 | CurrentTaxYear |
| Total | 163871270 | Total |
Gross Receipts From Non UBI GrossReceiptsFromNonUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 27704428 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 46104686 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 49394311 | CurrentTaxYearMinus1Year |
| Current Tax Year | 40778927 | CurrentTaxYear |
| Total | 163982352 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 163982352 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Post1975 UBTI Post1975UBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Net Income From Other UBI NetIncomeFromOtherUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 340 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 905 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 402 | CurrentTaxYearMinus1Year |
| Current Tax Year | 985 | CurrentTaxYear |
| Total | 2632 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 27704768 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 46105591 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 49394713 | CurrentTaxYearMinus1Year |
| Current Tax Year | 40779912 | CurrentTaxYear |
| Total | 163984984 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | X | First5Years509 |
| General Explanation | OTHER INCOME, SCHEDULE A, PART III, LINE 12, DESCRIPTION - OTHER INCOME, COLUMN A - , COLUMN B - 340, COLUMN C - 905, COLUMN D - 402, COLUMN E - 985, COLUMN F - 2632;, | GeneralExplanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 130765 | BeginningOfYearBalance |
| Contributions | 31952 | Contributions |
| Investment Earnings Or Losses | 0 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 162717 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 125634 | BeginningOfYearBalance |
| Contributions | 5131 | Contributions |
| Investment Earnings Or Losses | 0 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 130765 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 125458 | BeginningOfYearBalance |
| Contributions | 176 | Contributions |
| Investment Earnings Or Losses | 0 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 125634 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 80360 | BeginningOfYearBalance |
| Contributions | 45098 | Contributions |
| Investment Earnings Or Losses | 0 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 125458 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 1.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | true | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | true | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 0 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 0 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 0 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1277790 | OtherCostOrOtherBasis |
| Depreciation | 1000429 | Depreciation |
| Book Value | 277361 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 277361 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | BENEFICIAL INTEREST IN NET ASSETS OF CHAPTERS HEALTH SYSTEM | Description |
| Book Value | 5399471 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 5399471 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | AMOUNTS DUE TO RELATED PARTIES | Description |
| Amount | $1,642,994 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1642994 | TotalOfAmounts |
| Total Revenue | 40779912 | TotalRevenue |
| Total Expenses | 41872475 | TotalExpenses |
| Excess Or Deficit For Year | -1092563 | ExcessOrDeficitForYear |
| Other | $764,669 | OtherAmount |
| Total Adjustments | 764669 | TotalAdjustments |
| Excess Or Deficit Per FS | -327894 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 41544581 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 764669 | OtherRevenues |
| Revenue Not Rptd F990 | 764669 | RevenueNotRptdF990 |
| Revenue Subtotal | 40779912 | RevenueSubtotal |
| Other Revenues Not Included | 0 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 40779912 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 41872475 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 0 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 41872475 | ExpensesSubtotal |
| Other Expenses Not Included | 0 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 41872475 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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 GOOD SHEPHERD HOSPICE, INC. |
| FIN 48 (ASC 740) footnote | Schedule D, Part X, Line 2 | GSH 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. GSH 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| H DARRELL WHITE | |||||||||||||
| 0 | 217481 | 0 | 61043 | 0 | 1099 | 0 | 37048 | 0 | 30641 | 0 | 347312 | 0 | 61043 |
| KATHY L FERNANDEZ | |||||||||||||
| 0 | 378913 | 0 | 153826 | 0 | 183921 | 0 | 0 | 0 | 24684 | 0 | 741344 | 0 | 153826 |
| WILLIAM C BREDBENNER | |||||||||||||
| 159953 | 0 | 19593 | 0 | 488 | 0 | 5406 | 0 | 4112 | 0 | 189552 | 0 | 19593 | 0 |
| RONALD S SCHONWETTER | |||||||||||||
| 0 | 344522 | 0 | 111814 | 0 | 1104 | 0 | 108825 | 0 | 31031 | 0 | 597296 | 0 | 111814 |
| ANDREW LUTTON | |||||||||||||
| 0 | 221198 | 0 | 41546 | 0 | 697 | 0 | 59778 | 0 | 24245 | 0 | 347464 | 0 | 41546 |
| STEWART STEIN | |||||||||||||
| 211408 | 0 | 10000 | 0 | 2000 | 0 | 0 | 0 | 9342 | 0 | 232750 | 0 | 0 | 0 |
| JOSEPH BEHAL | |||||||||||||
| 158077 | 0 | 346 | 0 | 1811 | 0 | 0 | 0 | 19307 | 0 | 179541 | 0 | 0 | 0 |
| ALANNA KAPLAN | |||||||||||||
| 155278 | 0 | 0 | 0 | 1102 | 0 | 0 | 0 | 8089 | 0 | 164469 | 0 | 0 | 0 |
| DAVID O'NEIL | |||||||||||||
| 0 | 172513 | 0 | 51304 | 0 | 1682 | 0 | 16758 | 0 | 32230 | 0 | 274487 | 0 | 51304 |
| GEORGE H WALLACE | |||||||||||||
| 0 | 163227 | 0 | 63896 | 0 | 98571 | 0 | 0 | 0 | 18666 | 0 | 344360 | 0 | 63896 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROCESS OF DETERMINING COMPENSATION | SCHEDULE J, PART I, LINE 3 | 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. |
| Severance or change-of-control payment | Schedule J, Part I, Line 4a | IN 2011, SEVERANCE PAYMENTS WERE MADE TO THE FOLLOWING: GEORGE WALLAGE - $95,403 |
| 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 - $181,857 RONALD SCHONWETTER - $108,825 H. DARRELL WHITE - $37,048 ANDREW LUTTON - $59,778 DAVID O'NEIL - $16,758 WILLIAM BREDBENNER - $5,406 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (13 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROGRAM SERVICES | FORM 990, PART III, LINE 4A | (CONTINUED FROM PART III) 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. IN ACCORDANCE WITH ITS CHARITY CARE POLICY, GOOD SHEPHERD HOSPICE PROVIDED $1,200,000 IN CHARITY CARE DURING THE YEAR ENDED DECEMBER 31, 2011. 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 - GOOD SHEPHERD HOSPICE OPERATES TWO 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 - GOOD SHEPHERD HOSPICE'S 580 TRAINED VOLUNTEERS PROVIDED $656,265 IN VOLUNTEER HOURS IN 2011. 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. |
| 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 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. |
| Significant changes to organizational documents | Form 990, Part VI, Section A, Line 4 | THE ARTICLES OF INCORPORATION WERE AMENDED BECAUSE THE ORGANIZATION'S SOLE MEMBER CHANGED ITS NAME FROM HPC HEALTHCARE, INC. TO CHAPTERS HEALTH SYSTEM, INC. |
| 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 GOOD SHEPHERD HOSPICE, INC. AND ALSO APPROVES CERTAIN SIGNIFICANT DECISIONS MADE BY THE GOVERNING BODY OF GOOD SHEPHERD 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 MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS AND MAY APPOINT REPLACEMENT DIRECTORS WHEN 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, CHAPERS 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 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. |
| Process used to establish compensation of top management official | Form 990, Part VI, Section B, 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 GOOD SHEPHERD HOSPICE, INC. IS PAID BY CHAPTERS HEALTH SYSTEM, INC. |
| Process used to establish compensation of other officers/key employees | Form 990, Part VI, Section B, 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. 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. |
| HOURS DEVOTED TO RELATED ORGANIZATIONS | FORM 990, PART VII, SECTION A | GEORGE H. WALLACE, H. DARRELL WHITE, KATHY L. FERNANDEZ, RONALD S. SCHONWETTER, ANDREW LUTTON AND DAVID O'NEIL DEVOTE APPROXIMATELY 40 HOURS A WEEK TO CHAPTERS HEALTH SYSTEM, INC., APPROXIMATELY 2 HOURS A WEEK TO LIFEPATH HOSPICE, INC., 1 HOUR A WEEK TO JUDGE ALVA CARVER FOUNDATION, AND 2 HOURS A WEEK TO CHAPTERS HEALTH SENIOR INDEPENDENCE, INC. BRIAN HINTON, JAMES T. JOINER, REX YENTES AND STANLEY L. PIOTROWSKI DEVOTE APPROXIMATELY 2 HOURS A WEEK TO CHAPTERS HEALTH SYSTEM, INC. |
| Other changes in net assets or fund balances | Form 990, Part XI, Line 5 | CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF CHAPTERS HEALTH SYSTEM - 764669; |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| CHAPTERS HEALTH SYSTEM INC | ||||||||||
| 12973 TELECOM PARKWAY STE 100 | TEMPLE TERRACE | FL | 33637 | 592264957 | PARENT | FL | 501(C)(3) | Type II | NA | false |
| LIFEPATH HOSPICE INC | ||||||||||
| 12973 TELECOM PARKWAY STE 100 | TEMPLE TERRACE | FL | 33637 | 205276870 | HOSPICE CARE | FL | 501(C)(3) | N/A | CHS | false |
| JUDGE ALVA CARVER FOUNDATION INC | ||||||||||
| 12973 TELECOM PARKWAY STE 100 | TEMPLE TERRACE | FL | 33637 | 200187631 | SUPPORT | FL | 501(C)(3) | N/A | CHS | false |
| CHAPTERS HEALTH SENIOR INDEPENDENCE INC | ||||||||||
| 12973 TELECOM PARKWAY STE 100 | TEMPLE TERRACE | FL | 33637 | 275158323 | LONG-TERM CARE | FL | 501(C)(3) | 9 | CHS | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
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