2012-11-14T10:42:02-06:00 2011-12-31 861065772 DELOITTE TAX LLP 201 E KENNEDY BLVD SUITE 1200 TAMPA FL 33602 990 2011-01-01 592490893 NORTH CENTRAL FLORIDA HOSPICE INC NORT 3523728400 SANTAFE HEALTHCAREINC PO BOX 749 GAINESVILLE FL 326270749 RANDALL L STUART 3523378730 2012-11-14 1 STEVEN E ROVNER P00648526 8132738300 2011 2016-02-24 21:20:13Z HAVEN HOSPICE MICHAEL P GALLAGHER SANTAFE HEALTHCAREINC PO BOX 749 GAINESVILLE FL 326270749 62172209 0 X WWW.HAVENHOSPICE.ORG X 1982 FL HONORING LIFE BY PROVIDING COMFORT, CARE AND COMPASSION TO THOSE WE SERVE. 13 12 720 651 0 0 2002280 2860145 54590670 57146734 495546 401913 -134428 -181250 56954068 60227542 0 0 0 0 28947467 30565379 0 0 665023 26342151 26237592 55289618 56802971 1664450 3424571 41057742 50359060 6098728 11791889 34959014 38567171 X THE MISSION OF NORTH CENTRAL FLORIDA HOSPICE, INC. (HAVEN HOSPICE) IS TO HONOR LIFE BY PROVIDING COMFORT, CARE AND COMPASSION TO THOSE WE SERVE.HAVEN HOSPICE HELPS PATIENTS BE AS COMFORTABLE AS POSSIBLE AND PROVIDE THEIR CAREGIVERS WITH NEEDED RESOURCES AND ASSISTANCE. HAVEN HOSPICE PROVIDES THE MOST CURRENT THERAPIES AND METHODS TO MAXIMIZE COMFORT AND CARE TO PATIENTS INCLUDING ACCESS TO PROFESSIONAL STAFF AROUND THE CLOCK. HAVEN HOSPICE PROVIDES CLINICAL EDUCATION ABOUT END-OF-LIFE AND PALLIATIVE CARE, GRIEF SUPPORT TO CHILDREN AND FAMILIES AND BEREAVEMENT PROGRAMS FOR BOTH GROUPS AND INDIVIDUALS IN ITS SERVICE AREA. 0 0 28115054 45120926 HAVEN HOSPICE PROVIDED SERVICES TO 3,170 HOSPICE PATIENTS INCLUDING 254,979 DAYS OF SERVICE AND 142,734 VISITS BY NURSES, HOME HEALTH AIDES, SOCIAL WORKERS, CHAPLAINS AND PHYSICIANS TOTALING 188,240 HOURS OF CARE. INCLUDED IN THE EXPENSES IS $1,141,977 OF UNREIMBURSED CARE AND PROVISION OF PALLIATIVE MASSAGE THERAPY, VOLUNTEERS AND BEREAVEMENT SERVICES. 7780331 9854680 HAVEN HOSPICE PROVIDED SERVICES TO 1,686 PATIENTS IN INPATIENT CARE CENTERS, INCLUDING 17,940 DAYS OF SERVICE AND 143,157 VISITS BY NURSES, HOME HEALTH AIDES, SOCIAL WORKERS, CHAPLAINS AND PHYSICIANS TOTALING 150,230 HOURS OF CARE. INCLUDED IN THE EXPENSES IS $140,517 OF UNREIMBURSED CARE. 196933 0 HAVEN HOSPICE PROVIDED BEREAVEMENT SERVICES TO THE COMMUNITIES IN WHICH IT SERVES AND TO FAMILY MEMBERS OF PATIENTS WHO HAVE DIED IN ITS CARE. THE BEREAVEMENT DEPARTMENT CONDUCTED 23 ON SITE COMMUNITY EDUCATION EVENTS AND 43 OFF SITE COMMUNITY EDUCATION EVENTS. IN ADDITION, 40,080 SUPPORT MAILERS WERE DISTRIBUTED. 10,688 BEREAVEMENT SUPPORT PHONE CALLS WERE PLACED AND 8,016 BEREAVEMENT SUPPORT VISITS WERE MADE TO FAMILIES. 16 MEMORIAL SERVICES WERE HELD WITH AN AVERAGE ATTENDANCE OF 32 PARTICIPANTS PER SERVICE. 41 GRIEF SUPPORT GROUP SESSIONS WERE HELD IN 2011 WITH AN AVERAGE OF 4 PARTICIPANTS AT EACH. 504 INDIVIDUAL COUNSELING SESSIONS AND 85 FAMILY COUNSELING SESSIONS WERE CONDUCTED. SEVEN GRIEF CAMPS WERE HELD WITH AN AVERAGE ATTENDANCE OF 10 CAMP PARTICIPANTS. 7415368 2171128 MISCELLANEOUS PROGRAM SERVICES WHICH INCLUDE $4,830 IN UNREIMBURSED CARE. 7415368 2171128 43507686 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 1 326 0 1 720 1 0 0 0 0 0 1 1 0 0 0 0 X 13 12 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X PATRICIA C LAW VICE PRESIDENTCHIEF FINANCIAL OFFICER 3523796241 4200 NW 90TH BLVD GAINESVILLE FL 326065688 X D RAY HARRISON JR 1.00 X X 0 0 0 G THOMAS MALLINI 1.00 X X 0 0 0 SUZANNE M NORRIS 1.00 X X 0 0 0 ERIC L GODET 1.00 X X 0 1000 0 MICHAEL P GALLAGHER 5.00 X X 0 2101549 252885 CAROL REED ASH 1.00 X 0 0 0 GEORGE J CARANASOS MD 1.00 X 0 0 0 JANET L CHRISTIE 1.00 X 0 0 0 JAMES W DEFORD MD 1.00 X 0 0 0 SUSAN D PARRISH 1.00 X 0 0 0 FRANCES C PEPIS 1.00 X 0 0 0 NORLENE E ROBERTS 1.00 X 0 0 0 DALE M WILLIAMS 1.00 X 0 0 0 JAMES L POOLE 1.00 X X 0 0 0 TIMOTHY J BOWEN 50.00 X 0 395459 78096 STEVEN M ZIEGLER 6.00 X 0 261721 76912 DOUGLAS A ROGERS MD 40.00 X 252295 0 0 STEPHEN A ROTHSTEIN MD 40.00 X 250564 0 0 NEEL J KARNANI MD 40.00 X 196025 0 0 MICHELLE L BOATWRIGHT MD 40.00 X 193747 0 0 GERALDINE S BICHIER MD 40.00 X 166220 0 0 STEPHEN J DEMONTMOLLIN 0.00 X 0 480468 23983 1058851 3240197 431876 15 1 1 0 AVMED INC P O BOX 749 GAINESVILLE FL 326270749 HEALTH INSURANCE 2787420 HOSPISCRIPT SERVICES INC 1460 ANN STREET MONTGOMERY AL 36107 PHARMACY SERVICES 1345026 SANTAFE HEALTHCARE INC P O BOX 749 GAINESVILLE FL 326270749 MANAGEMENT FEES 940595 BLUE CROSS BLUE SHIELD OF FLORIDA PO BOX 660299 DALLAS TX 752660299 HEALTH INSURANCE 815034 CHERNOFF NEWMAN LLC 1411 GERVAIS STREET COLUMBIA SC 29201 ADVERTISING 730895 50 93493 231682 2534970 1392046 2860145 MEDICARE REVENUE 623990 42279605 42279605 MEDICAID REVENUE 623990 12489614 12489614 PATIENT SERVICE REVENU 623990 2377515 2377515 57146734 382400 382400 1700000 1670395 10092 29605 -10092 19513 19513 63639 231682 264180 -200541 -200541 ADMINISTRATIVE INCOME 900099 19291 19291 19291 60227542 57146734 0 220663 23646315 17986982 5349298 310035 1528030 890234 618758 19038 3726610 2654590 1034107 37913 1664424 1259481 383935 21008 763569 763569 210891 210891 80750 80750 14359834 13662504 660453 36877 656403 646077 6457 3869 1331816 597112 682681 52023 484320 8750 475570 1670159 1035196 634963 1700418 1269920 415364 15134 63167 15618 47549 1139025 680043 458982 318601 133626 184975 PHARMACY SUPPLIES 1368924 1368924 COMMUNITY SUPPORT 822199 419641 243533 159025 MEDICAL SUPPLIES 475066 475066 BAD DEBT 222480 222015 465 569970 181907 377962 10101 56802971 43507686 12630262 665023 64866 74527 315094 6908582 35044 2456 7202075 4998208 516923 471309 30947307 7697332 19375658 23249975 11729221 10544496 1708486 1776447 110375 2333060 41057742 50359060 5644208 6572865 2000 0 3537354 452520 1681670 6098728 11791889 X 34947909 38244794 11105 322377 34959014 38567171 41057742 50359060 X 3424571 183586 X X 0 1 1 X 0 X 1130815 2778953 2198110 2002280 2860145 10970303 44081014 47775904 50582738 54590670 57146734 254177060 45211829 50554857 52780848 56592950 60006879 265147363 0 0 0 265147363 472182 306721 233421 376917 382400 1771641 472182 306721 233421 376917 382400 1771641 838709 -49004 -82054 -134428 -181250 391973 46522720 50812574 52932215 56835439 60208029 267310977 0.99190 0.98690 0.00660 0.00750 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME IN 2011: ADMINISTRATIVE INCOME $ 19,291 SPECIAL EVENT INCOME, NET $-200,541 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 30968 30968 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: HAVEN HOSPICE IS A MEMBER OF FLORIDA HOSPICES AND PALLIATIVE CARE, INC. AND THE NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION AND PARTICIPATES IN LOBBYING AND STRATEGY DISCUSSIONS. HAVEN HOSPICE HAS ENGAGED THE SERVICES OF A REGISTERED LOBBYIST TO MONITOR DEVELOPMENTS AT THE ANNUAL GENERAL SESSION OF THE FLORIDA LEGISLATURE. 1489469 45417 1534886 1373367 116102 1489469 1249994 123373 1373367 1292160 -42166 1249994 1.00000 0 0 4513102 4513102 22010193 4650279 17359914 400460 202558 197902 4023552 2844495 1179057 23249975 GIFT ANNUITIES 219393 DUE TO AFFILIATES 138369 CAPITAL LEASE OBLIGATION 172012 PLEDGES 140000 CHARITABLE REMAINDER UNITRUST 1006000 CONTRIBUTION PAYABLE 5896 1681670 60227542 56802971 3424571 129766 53820 183586 3608157 59804747 -143082 -143082 59947829 279713 279713 60227542 56661344 -141627 -141627 56802971 0 56802971 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE HAVEN HOSPICE ENDOWMENT IS A SEPARATE ACCOUNT OF FUNDS THAT ARE HELD TO PROVIDE CURRENT AND FUTURE INCOME TO HAVEN HOSPICE IN ORDER TO OFFSET THE BURDEN OF UNCOMPENSATED CARE PROVIDED BY HAVEN HOSPICE. THE OBJECTIVE OF THE ENDOWMENT IS TO PROVIDE TIMELY FINANCIAL ASSISTANCE WHEN NEEDED AND LONG-TERM STABILITY TO HAVEN HOSPICE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: FIN 48 FOOTNOTE: AS OF DECEMBER 31, 2011 OR 2010, HAVEN HAD NO UNCERTAIN TAX POSITIONS. TAX YEARS 2008 THROUGH 2011 ARE SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. THERE ARE NO INCOME TAX EXAMINATIONS IN PROCESS AS OF THE DATE OF THIS REPORT. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUE OF RESTRICTED PLEDGES -7,261. NET ASSETS RELEASED FROM RESTRICTION USED FOR SERVICES -10,284. CHANGE IN VALUE OF DONOR RESTRICTED CONTRIBUTIONS 69,860. CHANGE IN FAIR VALUE OF CHARITABLE REMAINDER UNITRUST 6,846. CHANGE IN NET UNREALIZED GAINS/LOSSES ON CRUT INVESTMENT -3,886. LOSSES ON UNCOLLECTIBLE PLEDGES -1,455. TOTAL TO SCHEDULE D, PART XI, LINE 8: 53,820. PART XII, LINE 2D - OTHER ADJUSTMENTS: UNREIMBURSED CARE -407,262. SPECIAL EVENT EXPENSES 264,180. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION REVENUE OF RESTRICTED CHARITABLE REMAINDER UNITRUST 279,713. PART XIII, LINE 2D - OTHER ADJUSTMENTS: UNREIMBURSED CARE -407,262. SPECIAL EVENT EXPENSES 264,180. LOSSES ON UNCOLLECTIBLE PLEDGES 1,455. VIVA 183506 148625 34881 123282 FALL AT THE LODGE 54683 46433 8250 44330 5 53512 35072 18440 79893 291701 230130 61571 247505 247505 -185934 1 1 0 0 0 0 0 0 0 MICHAEL P GALLAGHER 0 825126 0 795972 0 480451 0 229162 0 23723 0 2354434 0 174240 TIMOTHY J BOWEN 0 280332 0 84178 0 30949 0 57238 0 20858 0 473555 0 12581 STEVEN M ZIEGLER 0 252730 0 0 0 8991 0 59043 0 17869 0 338633 0 0 DOUGLAS A ROGERS MD 251805 0 0 0 490 0 17060 0 20447 0 289802 0 0 0 STEPHEN A ROTHSTEIN MD 213834 0 18480 0 18250 0 3616 0 12093 0 266273 0 0 0 NEEL J KARNANI MD 195462 0 0 0 563 0 15637 0 684 0 212346 0 0 0 MICHELLE L BOATWRIGHT MD 183709 0 0 0 10038 0 8238 0 21555 0 223540 0 0 0 GERALDINE S BICHIER MD 165964 0 0 0 256 0 13833 0 18587 0 198640 0 0 0 STEPHEN J DEMONTMOLLIN 0 25426 0 0 0 455042 0 23676 0 307 0 504451 0 0 PART I, LINE 3 PART I, LINE 3: MICHAEL P. GALLAGHER IS THE CHIEF EXECUTIVE OFFICER (CEO) OF NORTH CENTRAL FLORIDA HOSPICE, INC. MR. GALLAGHER IS COMPENSATED BY SANTAFE HEALTHCARE, INC. (SANTAFE), A RELATED SUPPORTING ORGANIZATION. SANTAFE UTILIZES THE FOLLOWING PROCESS TO ESTABLISH THE CEO'S COMPENSATION AND BENEFITS: ANNUALLY, THE SANTAFE BOARD OF DIRECTORS RETAINS AN INDEPENDENT COMPENSATION AND BENEFITS CONSULTING FIRM TO CONDUCT A MARKET COMPETITIVENESS REVIEW OF THE CEO'S TOTAL DIRECT COMPENSATION (BASE SALARY, ANNUAL INCENTIVES, AND LONG TERM INCENTIVES) AND BENEFITS. THE COMPETITIVE ANALYSIS INCLUDES COMPARISON TO SIMILAR POSITIONS IN COMPANIES OF SIMILAR SIZE WITHIN THE SAME OR SIMILAR INDUSTRY. THE INDEPENDENT CONSULTING FIRM MAKES RECOMMENDATIONS, IF ANY, DIRECTLY TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS ESTABLISHES THE FINAL COMPENSATION AND BENEFIT PACKAGE FOR THE CEO TAKING INTO CONSIDERATION THE MARKET COMPETITIVENESS REVIEW AND FINAL RECOMMENDATION OF THE INDEPENDENT CONSULTING FIRM. THE INDEPENDENT CONSULTING FIRM PROVIDES AN OPINION LETTER REGARDING THE REASONABLENESS OF THE CEO'S FINAL COMPENSATION AND BENEFITS PACKAGE. THE ACTIONS OF THE BOARD ARE DOCUMENTED IN THE MINUTES OF THE BOARD MEETING. PART I, LINES 4A-B (RELATES TO PART I, LINE 4A): LISTED PERSONS, WHO ARE EMPLOYEES OF HAVEN HOSPICE, ARE NOT COVERED BY A SEVERANCE POLICY. CERTAIN LISTED PERSONS EXCLUDING OUTSIDE DIRECTORS OR EMPLOYEES OF HAVEN HOSPICE, ARE EMPLOYEES OF RELATED ORGANIZATIONS AND ARE COVERED BY A SEVERANCE POLICY FOR THEIR RESPECTIVE ORGANIZATION. THE SEVERANCE POLICY INCLUDES MONTHLY PAYMENTS UP TO A MAXIMUM OF 12 MONTHS UNDER QUALIFYING CIRCUMSTANCES. LISTED PERSONS RECEIVING A SEVERANCE PAYMENT OR CHANGE OF CONTROL PAYMENT IN THE YEAR: STEPHEN DEMONTMOLLIN RECEIVED $370,540 IN COMPENSATION PAYMENTS FROM AVMED, INC., A RELATED TAX-EXEMPT ORGANIZATION, DUE TO HIS RESIGNATION AND RETIREMENT FROM EMPLOYMENT IN ACCORDANCE WITH BOARD-APPROVED RESIGNATION AND RETIREMENT AGREEMENTS. PART I, LINE 4B: LISTED PERSONS PARTICIPATING IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN THE YEAR: MICHAEL P. GALLAGHER AND TIMOTHY J. BOWEN ARE EMPLOYEES OF SANTAFE HEALTHCARE, INC. (SANTAFE), A RELATED SUPPORTING ORGANIZATION. MR. GALLAGHER AND MR. BOWEN PARTICIPATE IN TWO NONQUALIFIED DEFERRED COMPENSATION RETIREMENT PLANS SPONSORED BY SANTAFE FOR A CERTAIN GROUP OF EXECUTIVES. ONE PLAN RESTORES RETIREMENT BENEFITS EQUIVALENT TO QUALIFIED 401(K) BENEFITS ON INCOME EARNED IN EXCESS OF THE INTERNAL REVENUE SERVICE CODE SECTION 401(A)(17) RECOGNIZABLE PAY LIMITS (A DEFINED CONTRIBUTION RESTORATION PLAN)VESTING FOR THIS PLAN IS ACHIEVED AT AGE 55 AND 10 YEARS OF SERVICE OR AT AGE 65 AND 5 YEARS OF SERVICE. THE SECOND SUPPLEMENTAL DEFINED CONTRIBUTION PLAN PROVIDES ADDITIONAL RETIREMENT INCOME BASED ON A PERCENTAGE OF BASE SALARY AND VESTS AT THREE AND FIVE YEARS OF SERVICE. MR. GALLAGHER RECEIVED PAYMENTS FROM THE NONQUALIFIED DEFINED CONTRIBUTION RESTORATION AND THE SUPPLEMENTAL RETIREMENT PLANS IN 2011. THE TOTAL AMOUNT OF THESE PAYMENTS WAS $373,453. MR. BOWEN VESTED AND RECEIVED $17,688 FROM THE SUPPLEMENTAL RETIREMENT PLAN IN 2011 . STEVEN M. ZIEGLER IS AN EMPLOYEE OF AVMED, INC. (AVMED), A RELATED TAX-EXEMPT ORGANIZATION. HE PARTICIPATES IN TWO NONQUALIFIED DEFERRED COMPENSATION RETIREMENT PLANS SPONSORED BY AVMED FOR A CERTAIN GROUP OF EXECUTIVES. ONE PLAN RESTORES RETIREMENT BENEFITS EQUIVALENT TO QUALIFIED 401(K) BENEFITS ON INCOME EARNED IN EXCESS OF THE INTERNAL REVENUE SERVICE CODE SECTION 401(A)(17) RECOGNIZABLE PAY LIMITS (DEFINED CONTRIBUTION RESTORATION PLAN). VESTING IS ACHIEVED AT AGE 55 AND 10 YEARS OF SERVICE OR AT AGE 65 AND 5 YEARS OF SERVICE. THE SECOND SUPPLEMENTAL DEFINED CONTRIBUTION PLAN PROVIDES ADDITIONAL RETIREMENT INCOME BASED ON A PERCENTAGE OF BASE SALARY AND VESTS AT THREE AND FIVE YEARS OF SERVICE. MR. DEMONTMOLLIN RECEIVED $35,992 FROM THE DEFINED CONTRIBUTION RESTORATION AND SUPPLEMENTAL RETIREMENT INCOME PLANS IN 2011 . SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART II: CERTAIN SENIOR EXECUTIVES ARE ACCOUNTABLE FOR AND PERFORM SERVICES FOR SANTAFE HEALTHCARE, INC. AND EACH OF ITS AFFILIATES. SANTAFE HEALTHCARE AND AFFILIATES REPRESENT A DIVERSIFIED FAMILY OF NOT-FOR-PROFIT ORGANIZATIONS WITH $2 BILLION IN REVENUE AND APPROXIMATELY 2,000 EMPLOYEES. THESE SENIOR EXECUTIVES ARE PAID DIRECTLY BY EITHER SANTAFE HEALTHCARE, INC. OR AVMED, INC. AND THEIR COMPENSATION AND BENEFITS ARE APPORTIONED AND CHARGED TO THE RESPECTIVE AFFILIATE BASED ON THE ESTIMATED AMOUNT OF TIME SPENT ON EACH AFFILIATE'S ACTIVITIES. FOR 2011, THE FOLLOWING PERCENTAGES OF EACH EXECUTIVE'S COMPENSATION AND BENEFITS (FOR THOSE SENIOR EXECUTIVES PAID BY A RELATED ORGANIZATION) IS APPORTIONED AND CHARGED TO HAVEN HOSPICE, AS FOLLOWS: << 8% - MICHAEL P. GALLAGHER, CHIEF EXECUTIVE OFFICER << 100% - TIMOTHY J. BOWEN, PRESIDENT << 10% - STEVEN M. ZIEGLER, ASSISTANT SECRETARY CLAY COUNTY DEVELOPMENT AUTHORITY 596583087 2011-12-21 10000000 CONSTRUCT HOSPICE CARE FACILITY 0 0 0 10000000 103585 3433768 6462647 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 SCHEDULE K, PARTS I AND II ADDITIONAL INFORMATION REGARDING THE BOND ISSUE: THE BONDS WERE ISSUED AS A DRAW-DOWN LOAN. THE ISSUE PRICE AND PROCEEDS AMOUNTS SHOWN ON PARTS I AND II ARE THE MAXIMUM AMOUNT OF THE LOAN. AS OF THE END OF THE REPORTING YEAR, LESS THAN THE ENTIRE BALANCE OF THE LOAN HAD BEEN DRAWN DOWN. SCHEDULE K, PART II, LINE 17 EXPLANATION FOR FINAL ALLOCATION OF THE PROCEEDS: ALTHOUGH A FINAL ALLOCATION OF THE PROCEEDS WAS NOT COMPLETE AS OF 12/31/2011, THE ORGANIZATION MAINTAINED ADEQUATE BOOKS AND RECORDS TO SUPPORT THE ALLOCATIONS MADE THROUGH 12/31/2011. ONCE THE ALLOCATION OF PROCEEDS IS COMPLETE, THE BOOKS AND RECORDS WILL SUPPORT THE FINAL ALLOCATION. X 1348807 RESALE VALUE 0 1 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF NORTH CENTRAL FLORIDA HOSPICE, INC., AS STATED IN ARTICLE IV OF ITS BYLAWS IS SANTAFE HEALTHCARE, INC. SANTAFE HEALTHCARE, INC. IS A FLORIDA NOT-FOR-PROFIT CORPORATION AND THE 509(A)(3) SUPPORTING ORGANIZATION OF NORTH CENTRAL FLORIDA HOSPICE, INC. FORM 990, PART VI, SECTION A, LINE 7A SANTAFE HEALTHCARE, INC., A 509(A)(3) SUPPORTING ORGANIZATION TO NORTH CENTRAL FLORIDA HOSPICE, INC., HAS RESERVED POWERS AS DELINEATED IN THE ARTICLES OF INCORPORATION AND BYLAWS THAT PERMITS IT TO ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY OF NORTH CENTRAL FLORIDA HOSPICE, INC. FORM 990, PART VI, SECTION A, LINE 7B THE RESERVED POWERS OF SANTAFE HEALTHCARE, INC., AS DELINEATED IN THE ARTICLES OF INCORPORATION AND BYLAWS, PERMIT IT TO APPROVE OR RATIFY THE GOVERNING BODY'S DECISIONS RELATED TO BOARD MEMBER ELECTIONS OR REMOVALS, THE DECISION TO DISSOLVE THE ORGANIZATION AND OTHER MATTERS THAT MAY COME BEFORE THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S PROCESS FOR ENSURING THE ACCURATE PREPARATION, REVIEW AND APPROVAL OF THE 2011 FORM 990 BEGAN WITH PROFESSIONAL DEVELOPMENT OF STAFF (SEVERAL OF WHICH ARE CPAS) WHICH WERE INVOLVED IN THE PREPARATION OF THE 2011 FORM 990. IN ADDITION TO STAFF DEVELOPMENT, WHICH INCLUDED ATTENDING TAX SEMINARS AND CLASSES, MANAGEMENT ALSO CONSULTED WITH INDEPENDENT ACCOUNTING FIRMS AND TAX LEGAL COUNSEL REGARDING THE IRS FORM 990 CODE AND FILING REQUIREMENTS. THE ORGANIZATION ALSO PREVIOUSLY EDUCATED ITS MANAGEMENT TEAM, OFFICERS AND DIRECTORS, WITH THE ASSISTANCE OF DELOITTE TAX LLP, REGARDING THE FORM 990 AND THEIR INVOLVEMENT IN REVIEWING THE RETURN. FOLLOWING MANAGEMENT'S PREPARATION OF THE 2011 FORM 990, DELOITTE TAX LLP REVIEWED THE 2011 FORM 990. A COPY OF THE 2011 FORM 990 AND ATTACHMENTS WERE PROVIDED TO THE ORGANIZATION'S CURRENT BOARD OF DIRECTORS FOR THEIR REVIEW AND COMMENT. EXECUTIVE MANAGEMENT ADDRESSED ANY QUESTIONS RAISED BY THE BOARD MEMBERS PRIOR TO FILING THE 2011 FORM 990 AND ATTACHMENTS WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C HAVEN HOSPICE'S CONFLICT OF INTEREST POLICY (THE POLICY) COVERS BOARD MEMBERS, OFFICERS, ALL EMPLOYEES AND VOLUNTEERS. THE HUMAN RESOURCES DEPARTMENT IS RESPONSIBLE FOR PROVIDING EACH EMPLOYEE WITH A COPY OF THE POLICY AND OBTAINING THE EMPLOYEE'S ACKNOWLEDGMENT STATEMENT AND SIGNATURE AT THE TIME OF HIRE AND ANNUALLY THEREAFTER. THE VOLUNTEER SERVICES DEPARTMENT IS RESPONSIBLE FOR PROVIDING EACH VOLUNTEER WITH A COPY OF THE POLICY AND OBTAINING THE VOLUNTEER'S ACKNOWLEDGMENT STATEMENT AND SIGNATURE DURING ORIENTATION. ON AN ANNUAL BASIS, ALL BOARD MEMBERS MUST ACKNOWLEDGE AND SIGN A COPY OF THE POLICY. EMPLOYEES, VOLUNTEERS AND BOARD MEMBERS WILL REPORT SUSPECT CONDUCT OR ACTIVITY OF A KNOWN VIOLATION OF THE POLICY, INCLUDING THOSE AFFECTING A PROPOSED OR ONGOING OPERATIONAL OR FINANCIAL TRANSACTION, TO HAVEN HOSPICE'S DIRECTOR OF CORPORATE COMPLIANCE AS SOON AS POSSIBLE OR PRACTICAL. WILLFUL VIOLATIONS OF THE POLICY WILL RESULT IN DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION. THE PRESIDENT OF HAVEN HOSPICE AND THE CHIEF EXECUTIVE OFFICER OF SANTAFE HEALTHCARE, INC. (THE SUPPORTING ORGANIZATION FOR HAVEN HOSPICE) ARE VESTED WITH ULTIMATE AUTHORITY AND RESPONSIBILITY TO DETERMINE THE APPLICABILITY OF THE POLICY TO ANY SET OF FACTS THAT MAY ARISE, AND TO DETERMINE ANY STEPS THAT SHOULD BE TAKEN TO CORRECT A SITUATION DEEMED NOT IN THE BEST INTEREST OF HAVEN HOSPICE, INCLUDING, IF DEEMED APPROPRIATE, DISCIPLINARY ACTION. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A: MICHAEL P. GALLAGHER IS THE CHIEF EXECUTIVE OFFICER (CEO) OF HAVEN HOSPICE. MR. GALLAGHER IS COMPENSATED BY SANTAFE HEALTHCARE, INC. (SANTAFE), A RELATED SUPPORTING ORGANIZATION. SANTAFE UTILIZES THE FOLLOWING PROCESS TO ESTABLISH THE CEO'S COMPENSATION AND BENEFITS: THE SANTAFE BOARD OF DIRECTORS ANNUALLY RETAINS AN INDEPENDENT THIRD PARTY COMPENSATION AND BENEFITS CONSULTING FIRM TO CONDUCT A MARKET COMPETITIVENESS REVIEW OF THE CEO'S TOTAL DIRECT COMPENSATION (BASE SALARY, ANNUAL INCENTIVES, AND LONG TERM INCENTIVES) AND BENEFITS. THE COMPETITIVE ANALYSIS INCLUDES COMPARISON TO SIMILAR POSITIONS IN COMPANIES OF SIMILAR SIZE WITHIN THE SAME OR SIMILAR INDUSTRY. THE INDEPENDENT CONSULTING FIRM MAKES RECOMMENDATIONS, IF ANY, DIRECTLY TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS ESTABLISHES THE FINAL COMPENSATION AND BENEFIT PACKAGE FOR THE CEO TAKING INTO CONSIDERATION THE MARKET COMPETITIVENESS REVIEW AND FINAL RECOMMENDATION OF THE INDEPENDENT CONSULTING FIRM. THE INDEPENDENT CONSULTING FIRM PROVIDES AN OPINION LETTER REGARDING THE REASONABLENESS OF THE FINAL COMPENSATION AND BENEFITS PACKAGE. THE ACTIONS OF THE BOARD ARE DOCUMENTED IN THE MINUTES OF THE BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 15B: PROCESS FOR DETERMINING COMPENSATION FOR THE ASSISTANT SECRETARY AND PRESIDENT OF HAVEN HOSPICE IS AS FOLLOWS: THE SANTAFE BOARD OF DIRECTORS ANNUALLY RETAINS AN INDEPENDENT THIRD PARTY COMPENSATION AND BENEFITS FIRM (FIRM) TO CONDUCT A MARKET COMPETITIVENESS REVIEW OF THE AFOREMENTIONED OFFICERS OF TOTAL DIRECT COMPENSATION (BASE SALARY, ANNUAL INCENTIVES, AND LONG-TERM INCENTIVES) AND BENEFITS. THE COMPETITIVE ANALYSIS INCLUDES COMPARISONS TO SIMILAR POSITIONS IN COMPANIES OF SIMILAR SIZE WITHIN THE SAME OR SIMILAR INDUSTRY. AFTER COMPLETION OF ITS REVIEW, THE INDEPENDENT CONSULTING FIRM MAKES RECOMMENDATIONS, IF ANY, DIRECTLY TO THE SANTAFE BOARD OF DIRECTORS. THE INDEPENDENT CONSULTING FIRM PROVIDES AN OPINION LETTER REGARDING THE REASONABLENESS OF TOTAL DIRECT COMPENSATION AND EXECUTIVE BENEFITS. THE ACTIONS OF THE BOARD ARE DOCUMENTED IN THE MINUTES OF THE BOARD MEETINGS. THE COMPENSATION FOR THE HAVEN HOSPICE MEDICAL DIRECTOR IS DETERMINED BY A MARKET COMPETITIVENESS STUDY CONDUCTED BY AN INDEPENDENT THIRD PARTY COMPENSATION CONSULTANT. THE COMPETITIVENESS ANALYSIS INCLUDES COMPARISONS TO SIMILAR POSITIONS IN COMPANIES OF SIMILAR SIZE WITHIN THE HOSPICE INDUSTRY. THE ANALYSIS ALSO INCLUDES FORM 990 DATA COMPARISON FOR HOSPICES WITHIN A SIMILAR REVENUE SIZE AND/OR MARKET LOCATION. THE MOST RECENT COMPENSATION REVIEW WAS COMPLETED IN 2011. FORM 990, PART VI, SECTION C, LINE 19 UPDATED ARTICLES OF INCORPORATION FOR HAVEN HOSPICE ARE AVAILABLE ON THE STATE OF FLORIDA, SECRETARY OF STATE WEBSITE WWW.SUNBIZ.ORG. FORM 990, PART VII, SECTION A, LINE 1A: CERTAIN SENIOR EXECUTIVES ARE ACCOUNTABLE FOR AND PERFORM SERVICES FOR SANTAFE HEALTHCARE, INC. AND EACH OF ITS AFFILIATES. SANTAFE HEALTHCARE AND AFFILIATES REPRESENT A DIVERSIFIED FAMILY OF NOT-FOR-PROFIT ORGANIZATIONS WITH $2 BILLION IN REVENUE AND APPROXIMATELY 2,000 EMPLOYEES. THESE SENIOR EXECUTIVES ARE PAID DIRECTLY BY EITHER SANTAFE HEALTHCARE, INC. OR AVMED, INC. AND THEIR COMPENSATION AND BENEFITS ARE APPORTIONED AND CHARGED TO THE RESPECTIVE AFFILIATE BASED ON THE ESTIMATED AMOUNT OF TIME SPENT ON EACH AFFILIATE'S ACTIVITIES. FOR 2011, THE FOLLOWING PERCENTAGES OF EACH EXECUTIVE'S COMPENSATION AND BENEFITS (FOR THOSE SENIOR EXECUTIVES PAID BY A RELATED ORGANIZATION) IS APPORTIONED AND CHARGED TO HAVEN HOSPICE, AS FOLLOWS: << 8% - MICHAEL P. GALLAGHER, CHIEF EXECUTIVE OFFICER << 100% - TIMOTHY J. BOWEN, PRESIDENT << 10% - STEVEN M. ZIEGLER, ASSISTANT SECRETARY AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, COLUMN B: MICHAEL P GALLAGHER DEVOTED AN AVERAGE OF 55 HOURS PER WEEK TO RELATED ORGANIZATIONS. STEVEN M ZIEGLER DEVOTED AN AVERAGE OF 57 HOURS PER WEEK TO RELATED ORGANIZATIONS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 129,766. CHANGE IN VALUE OF RESTRICTED PLEDGES -7,261. NET ASSETS RELEASED FROM RESTRICTION USED FOR SERVICES -10,284. CHANGE IN VALUE OF DONOR RESTRICTED CONTRIBUTIONS 69,860. CHANGE IN FAIR VALUE OF CHARITABLE REMAINDER UNITRUST 6,846. CHANGE IN NET UNREALIZED GAINS/LOSSES ON CRUT INVESTMENT -3,886. LOSSES ON UNCOLLECTIBLE PLEDGES -1,455. TOTAL TO FORM 990, PART XI, LINE 5: 183,586. AUDIT COMMITTEE OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT: FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE FROM THE PRIOR YEAR TO THE PROCESS RELATED TO AUDIT OVERSIGHT AND SELECTION OF THE INDEPENDENT ACCOUNTANT FOR THE ORGANIZATION. HAVEN MEDICAL GROUP LLC P O BOX 749 GAINESVILLE FL 326270749 592490893 CONDUCT A MEDICAL PRACTICE SPECIALIZING IN PALLIATIVE CARE FL 0 0 NORTH CENTRAL FLORIDA HOSPICE INC SANTAFE HEALTHCARE INC PO BOX 749 GAINESVILLE FL 326270749 592317607 MANAGEMENT AND FINANCIAL SUPPORT FOR NOT-FOR-PROFIT AFFILIATES FL 501(C)(3) 11B TYPE II N/A 0 AVMED INC PO BOX 749 GAINESVILLE FL 326270749 592742907 HEALTH CARE FL 501(C)(4) N/A N/A 0 NORTH FLORIDA RETIREMENT VILLAGE INC PO BOX 749 GAINESVILLE FL 326270749 591912330 RETIREMENT COMMUNITY FL 501(C)(3) 9 N/A 0 SANTAFE SENIOR LIVING INC PO BOX 749 GAINESVILLE FL 326270749 203700526 MANAGEMENT AND FINANCIAL SUPPORT FOR NOT-FOR-PROFIT AFFILIATES FL 501(C)(3) 11A TYPE I N/A 0 BVG ACQUISITION INC PO BOX 749 GAINESVILLE FL 326270749 203701186 RETIREMENT COMMUNITY FL 501(C)(3) 9 N/A 0 EAST RIDGE RETIREMENT VILLAGE INC PO BOX 749 GAINESVILLE FL 326270749 590903331 RETIREMENT COMMUNITY FL 501(C)(3) 9 N/A 0 BONITA SPRINGS RETIREMENT VILLAGE INC PO BOX 749 GAINESVILLE FL 326270749 262386152 RETIREMENT COMMUNITY FL 501(C)(3) 9 N/A 0 SANTAFE SENIOR LIVING FOUNDATION INC PO BOX 749 GAINESVILLE FL 326270749 264464727 CHARITABLE & EDUCATIONAL PURPOSES FL 501(C)(3) 7 N/A 0 SF HOLDING CORPINC & SUBSIDIARY PO BOX 749 GAINESVILLE FL 326270749 592903901 HOLDING COMPANY FL N/A C 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 AVMED INC L 2343538 FAIR MARKET VALUE AVMED INC K 105085 FAIR MARKET VALUE