Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
BayCare Home Care Inc
Employer identification number
59-3582520
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Although the organization is exempt as a hospital, it is not required to be licensed as a hospital under the state law; therefore, Schedule H is not filed for the organization.
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
BayCare Home Care Inc
Employer identification number
59-3582520
Identifier
Return Reference
Explanation
Part VI
Part VI, Line 2 - Description of Family and Business Relationship Stephen Mason and Tommy Inzina are both board members of the organization, as well as board members of a taxable entity, which is an affiliate of the filing organization. Part VI, Line 4 - Significant Changes to Organizing Documents The Articles of Incorporation were restated to add Community Health Corporation as a member of the organization as well as to change the composition of the board. Part VI, Line 6 - Description of Classes of Members or Stockholders The members of the corporation shall be BayCare Health System, Inc and Community Health Corporation (CHC). Part VI, Line 7a - Description of Classes of Persons and the Nature of Their Rights The Board of Directors of the Corporation shall consist of Directors appointed by the Members. BayCare shall appoint five Members of the board of Directors and CHC shall appoint one Member of the Board of Directors. Each Director shall serve a term of one year and may serve as many terms as approved by the Member which made the appointment. A vacancy occuring among the Directors may only be filled by appointment by the Member that appointed the Director whose resignation, removal, death or disability reated the vacancy. Part VI, Line 7b - Descr Classes of Persons, Decisions Requiring Appr & Type of Voting Rights Reservation of Powers in the Member. 1. Loan. Any loans shall be authorized by a resolution of the Board of Directors; however, any loan not included in the Corporation's annual budget in excess of $25,000 shall be approved by the Member before the loan is contracted on behalf of the Corporation. 2. Budgets. The Board of Directors shall prepare or have prepared the annual budgets of the Corporation. The annual budgets shall be approved by the Member before the same shall become effective. 3. Asset Transfers. No transfer or pledge of the Corporation's assets not in the ordinary course of business shall be made unless approved by the Member prior to the transfer or pledge. 4. Approval and Removal of Directors and Officers. The Member shall approve all Directors and Officers and may remove any Director or Officer. 5. Contracts. The Board may authorize any officer to enter into a contract or execute any instrument in the name of and on behalf of the Corporation; however, no contract in excess of $25,000 not contained in an approved budget and not in the ordinary course of business may be entered into except with the prior approval of the Member. Part VI, Line 11b - Describe the Process used by Management &/or Governing Body to Review 990 The Form 990 is prepared by the organization and reviewed by the CFO, as well as the organization's paid preparer. A final copy of the Form 990 was reviewed by a subcommittee of the Board of Directors prior to filing with the IRS. Prior to filing with the IRS, a final copy of the Form 990 will be made available to the entire Board. Part VI, Line 12c - Description of Process to Monitor Transactions for Conflicts of Interest BayCare Home Care, Inc. has two separate conflict of interest procedures; one that relates to Board members and another that relates to non-board member employees. Both groups are required on an annual basis to complete, sign and file an annual disclosure statement detailing existing or potential conflicts of interests. For Board members, the review of conflicts or potential conflicts occurs at the Board or committee level. After disclosure of the Board Member's or Committee Member's actual or potential conflict, the following procedures for addressing the conflict of interest will be adhered to by each Board and all Committees with Board delegated powers, without exception: 1. The interested Director or Committee member shall leave the Board or Committee meeting while the conflict of interest issue is discussed. 2. The remaining Board or Committee Members shall decide if a conflict of interest exists. 3. If a conflict of interest is deemed to exist: a. The Chairperson of the Board or Committee shall, if appropriate, appoint a disinterested individual or committee to investigate the proposed transaction or arrangement. b. The Board or Committee shall determine whether the BayCare entity can obtain a more advantageous transaction or arrangement with reasonable efforts from an individual or entity that would not give rise to a conflict of interest. c. If a more advantageous transaction or arrangement is not reasonably available, the Board or Committee shall determine whether the transaction or arrangement is in the BayCare entity's best interest, and whether the transaction is fair and reasonable to BayCare. An interested Director or Committee Member shall not vote, participate in, influence or attempt to influence any determination or proceedings. The Director or Committee Member may, however, respond to questions posed by the Board or Committee regarding the contract or transaction. Any such contract or transaction must be authorized by a vote of at least two-thirds (2/3) of the Directors or Committee Members entitled to vote at a meeting at which a quorum was present. Any interested Director or Committee Member may not be counted in determining the existence of a quorum. For employees, the review of conflicts of interest or potential conflicts goes to the Conflict of Interest Determination Committee. This committee consists of BayCare Chief Compliance Officer, the Corporate Responsibility Officers, and the BayCare Vice President of Team Resources. This committee shall determine if an actual conflict exists and any action required to address the conflict of interest situation.
Part VI
Part VI, Line 15a & 15b - Process used for compensation review and approval The filing organization does not directly compensate some of its top management employees; rather compensation is paid by a related organization that also follows the compensation policy of the Compensation Committee. The independent Compensation Committee is appointed by the Board of Directors. The Compensation Committee's purpose is to provide oversight for the organization's executive compensation program, review and approve compensation and benefits for all "disqualified persons" subject to the Intermediate Sanctions regulations issued under Section 4958 of the Internal Revenue Code (including the Chief Executive Officer, Chief Administrative Officer & CFO, other system and entity executives, and other disqualified persons as defined in the Intermediate Sanctions regulations (i.e., voting members of the governing body, family members, former officers)), and establish the compensation philosophy for all other executives. This committee engages nationally recognized compensation consultants to assist them in review of executive compensation. The compensation consultants provide a review of each vice president and above in the system to determine if that employee's compensation is reasonable when compared against market standards. The data reviewed comes from compensation studies that include comparable compensation for similarly qualified persons in functionally comparable positions at similarly situated organizations. The organization keeps contemporaneous minutes of the compensation committees meetings and decisions. External consultants review compensation every other year with the last review occurring in 2011, but the compensation committee regularly monitors compensation and all other procedures are followed annually. Part VI, Line 16b - Procedure to Evaluate Joint Venture Arrangements The organization has a joint venture committee of subject matter experts who review potential arrangements with taxable joint ventures. Included in its review are a review for compliance with relevant tax laws and a review of whether the joint venture furthers the organization's exempt purpose. Part VI, Line 19 - Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public BayCare Home Care, Inc. does not make its governing documents, conflict of interest policy or financial statements available to the public.
Part VII, Compensation
Form 990, Part VII, Section A, Column B - Estimated hours worked by officers, directors, trustees, key employees, and highest compensated employees at related entities: Denton Crockett - BayCare Health System, Inc. - 45 Denton Crockett - Morton Plant Mease Health Services, Inc. - 1 Denton Crockett - St. Joseph's Enterprises, Inc. - 1 Glenn Waters - BayCare Alliant Hospital, Inc. - 1 Glenn Waters - Morton Plant Hospital Association, Inc. - 1 Glenn Waters - Morton Plant Mease Health Care, Inc. - 45 Glenn Waters - Morton Plant Mease Primary Care, Inc. - 1 Glenn Waters - Trustees of Mease Hospital, Inc. - 1 Stephen Mason - BayCare Health System, Inc. - 45 Stephen Mason - Morton Plant Hospital Association, Inc. - 1 Stephen Mason - Morton Plant Mease Health Care, Inc. - 1 Stephen Mason - Morton Plant Mease Primary Care, Inc. - 1 Stephen Mason - St. Anthony's Hospital, Inc. - 1 Stephen Mason - Trustees of Mease Hospital, Inc. - 1 Tommy Inzina - BayCare Alliant Hospital, Inc. - 1 Tommy Inzina - BayCare Health System, Inc. - 45 Thomas Ribble - Morton Plant Mease Health Services, Inc - 1 Thomas Ribble - St. Joseph's Enterprises, Inc - 1
Part XI, LINE 5
Capital distribution ($55,001,932) Contributed capital $677,210 Total ($54,324,722)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.