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
2012
Open to Public Inspection
Name of the organization
HOSPICE OF PALM BEACH COUNTY INC
Employer identification number
59-1825937
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
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—2011.
If the organization did not check a 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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
5,170,083
4,866,837
4,891,198
4,311,172
3,226,635
22,465,925
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......
82,712,530
83,731,836
85,743,372
87,644,487
88,444,643
428,276,868
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
1,169,442
1,272,271
0
46,721
0
2,488,434
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
89,052,055
89,870,944
90,634,570
92,002,380
91,671,278
453,231,227
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
0
0
0
0
0
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.
0
0
0
0
0
0
c
Add lines 7a and 7b..
0
0
0
0
0
0
8
Public support (Subtract line 7c from line 6.)
453,231,227
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
89,052,055
89,870,944
90,634,570
92,002,380
91,671,278
453,231,227
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
40,618
2,553
734
16
0
43,921
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
40,618
2,553
734
16
0
43,921
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
80,258
58,297
95,044
140,384
9,996
383,979
13
Total support. (Add lines 9, 10c, 11, and 12.)..
89,172,931
89,931,794
90,730,348
92,142,780
91,681,274
453,659,127
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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
99.900 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
99.960 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
0.020 %
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
OTHER INCOME, SCHEDULE A, PART III, LINE 12, DESCRIPTION - OTHER INCOME, COLUMN A - 80258, COLUMN B - 58297, COLUMN C - 95044, COLUMN D - 140384, COLUMN E - 9996, COLUMN F - 383979;,
Schedule A (Form 990 or 990-EZ) 2012
Additional Data
Software ID:
12000266
Software Version:
v2012.1.0
-
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
2012
Open to Public Inspection
Name of the organization
HOSPICE OF PALM BEACH COUNTY INC
Employer identification number
59-1825937
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990, PART III, LINE 1
(CONTINUED FROM PART III) HPBC PROVIDES A COORDINATED, COMPREHENSIVE PROGRAM INCLUDING PHYSICAL, PSYCHOSOCIAL, SPIRITUAL, MUSIC, AND BEREAVEMENT SUPPORT TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES IN PALM BEACH COUNTY, FLORIDA.
Delegation of management duties
Form 990, Part VI, Section A, Line 3
THE ORGANIZATION HAS DELEGATED CERTAIN MANAGEMENT FUNCTIONS TO TRUSTBRIDGE, INC., A RELATED TAX-EXEMPT ORGANIZATION.
Classes of members or stockholders
Form 990, Part VI, Section A, Line 6
THE SOLE MEMBER OF HOSPICE OF PALM BEACH COUNTY, INC. SHALL BE TRUSTBRIDGE, INC. (SOLE MEMBER), A RELATED TAX-EXEMPT ORGANIZATION.
Members or stockholders electing members of governing body
Form 990, Part VI, Section A, Line 7a
AT THE ANNUAL MEETING, THE SOLE MEMBER SHALL ELECT MEMBERS OF THE BOARD OF DIRECTORS AND TRANSACT SUCH OTHER BUSINESS AS MAY PROPERLY BE BROUGHT BEFORE THE MEETING. THE DIRECTORS SHALL BE ELECTED TO SERVE A THREE (3) YEAR TERM, OR UNTIL SUCH DIRECTOR SUMBITS HIS OR HER WRITTEN RESIGNATION TO THE CHAIRPERSON OF THE CORPORATION. ANY DIRECTOR MAY BE REMOVED, WITH OR WITHOUT CAUSE, BY THE SOLE MEMBER AT THE MEETING OF THE SOLE MEMBER, OR BY THE AFFIRMATIVE VOTE OF TWO-THIRDS (2/3) OF THE DIRECTORS THEN IN OFFICE. THE SOLE MEMBER SHALL NOT HAVE ANY FORM OF EQUITY OR OWNERSHIP INTEREST IN THE ORGANIZATION OR ANY RIGHT, TITLE OR INTEREST IN ITS ASSETS AT ANY TIME DURING THE COURSE OF ITS ACTIVE OPERATION. ALL RIGHTS OF THE PERSON OR ENTITY DESIGNATED AS SOLE MEMBER SHALL CEASE ON THE TERMINATION OF THE SOLE MEMBERSHIP. ONLY THE SOLE MEMBER SHALL BE ENTITLED TO SHARE IN THE DISTRIBUTION OF CORPORATE ASSETS UPON ANY DISSOLUTION OF THE ORGANIZATION.
Decisions requiring approval by members or stockholders
Form 990, Part VI, Section A, Line 7b
THE SOLE MEMBER HAS THE RIGHT TO APPROVE DECISIONS OF THE BOARD.
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11b
THE RETURN IS REVIEWED BY THE AUDIT COMMITTEE AND THE INDEPENDENT PAID TAX PREPARER WILL MAKE A PRESENTATION TO THE AUDIT COMMITTEE REGARDING THE FORM 990. A COPY OF THE FINAL FORM 990 IS SENT TO ALL BOARD MEMBERS PRIOR TO FILING THE RETURN WITH THE IRS.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
THE ORGANIZATION SENDS OUT THE CONFLICT OF INTEREST QUESTIONNAIRES TO BOARD MEMBERS AND OFFICERS ANNUALLY. THE RESPONSES TO THE QUESTIONNAIRES ARE MONITORED AND COLLECTED BY THE CFO. SHOULD A CONFLICT EXIST THE PERSON WITH THE CONFLICT WILL ABSTAIN FROM VOTING ON THE ISSUE IN QUESTION.
PROCESS FOR DETERMINING COMPENSATION OF TOP MANAGEMENT OFFICIAL
FORM 990, PART VI, LINE 15A
THE PRESIDENT & CEO IS PAID BY TRUSTBRIDGE, INC., A RELATED TAX-EXEMPT ORGANIZATION. TRUSTBRIDGE HEALTH, INC. USES A COMPENSATION COMMITTEE, COMPARABILITY DATA, AN INDEPENDENT COMPENSATION CONSULTANT, AND APPROVAL BY THE BOARD, TO DETERMINE THE COMPENSATION. THIS REVIEW LAST TOOK PLACE IN FEBRUARY 2013 AND IS DOCUMENTED IN THE BOARD AND COMMITTEE MINUTES.
PROCESS FOR DETERMINING COMPENSATION OF OTHER OFFICERS
FORM 990, PART VI, LINE 15B
THE CCO IS PAID BY THE ORGANIZATION. ALL OTHER OFFICERS ARE PAID BY TRUSTBRIDGE, INC., A RELATED TAX-EXEMPT ORGANIZATION. BOTH ORGANIZATIONS USE COMPARABILITY DATA AND AN INDEPENDENT COMPENSATION CONSULTANT TO DETERMINE THE COMPENSATION AND THEN THE COMPENSATION COMMITTEE'S RECOMMENDATION IS APPROVED BY THE BOARD OF DIRECTORS. THIS REVIEW LAST TOOK PLACE IN FEBRUARY 2013 AND IS DOCUMENTED IN THE BOARD AND COMMITTEE MINUTES.
Governing documents, conflict of interest policy and financial statements available to the public
Form 990, Part VI, Section C, Line 19
FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME.
COMPENSATION PAID TO INTERESTED PERSONS
FORM 990, PART VII, SECTION A
DAVID FIELDING COMPENSATION REPORTED FOR MR. FIELDING IS FOR CALENDAR YEAR 2012. HE SERVES AS CEO FOR SPECTRUM HEALTH, INC., HOSPICE OF PALM BEACH COUNTY, HOSPICE OF BROWARD COUNTY, SOUTH FLORIDA PALLIATIVE MEDICINE, INC. AND THE MEDICAL STORE, INC. HIS TIME IS SHARED BY ALL ENTITIES. OTHER COMPENSATION FOR CY 2012 IS FOR HIS EMPLOYEE HEALTH AND RETIREMENT BENEFITS WHICH ARE UNDER THE SAME PLANS PROVIDED TO ALL EMPLOYEES. FRED WATSON COMPENSATION REPORTED FOR MR. WATSON IS FOR CALENDAR YEAR 2012. HE SERVES AS CAO FOR SPECTRUM HEALTH, INC., HOSPICE OF PALM BEACH COUNTY, HOSPICE OF BROWARD COUNTY, SOUTH FLORIDA PALLIATIVE MEDICINE SPECIALISTS AND THE MEDICAL STORE, INC. HIS TIME IS SHARED EQUALLY BY ALL ENTITIES. OTHER COMPENSATION FOR CY 2012 IS FOR HIS EMPLOYEE HEALTH AND RETIREMENT BENEFITS WHICH ARE UNDER THE SAME PLANS PROVIDED TO ALL EMPLOYEES. RICHARD CALCOTE COMPENSATION REPORTED FOR MR. CALCOTE IS FOR CALENDAR YEAR 2012. HE SERVES AS THE CFO FOR SPECTRUM HEALTH, INC., HOSPICE OF PALM BEACH COUNTY FOUNDATION, INC., HOSPICE OF PALM BEACH COUNTY, HOSPICE OF BROWARD COUNTY, SOUTH FLORIDA PALLIATIVE MEDICINE SPECIALISTS AND THE MEDICAL STORE. HIS TIME IS SHARED EQUALLY BY ALL ENTITIES. OTHER COMPENSATION FOR CY 2012 IS FOR HIS EMPLOYEE HEALTH AND RETIREMENT BENEFITS WHICH ARE UNDER THE SAME PLANS PROVIDED TO ALL EMPLOYEES. JACQUELINE LOPEZ-DEVINE COMPENSATION REPORTED FOR MS. LOPEZ-DEVINE IS FOR CALENDAR YEAR 2012. SHE SERVES AS CCO FOR HOSPICE OF PALM BEACH COUNTY, AND HOSPICE OF BROWARD COUNTY. HER TIME IS SHARED EQUALLY BY BOTH ENTITIES. OTHER COMPENSATION FOR CY 2012 IS FOR HER EMPLOYEE HEALTH AND RETIREMENT BENEFITS WHICH ARE UNDER THE SAME PLANS PROVIDED TO ALL EMPLOYEES. DR. FAUSTINO GONZALEZ, M.D. COMPENSATION REPORTED FOR DR. GONZALEZ IS FOR CALENDAR YEAR 2012. HE OVERSEES MEDICAL AFFAIRS FOR SPECTRUM HEALTH, INC., HOSPICE OF PALM BEACH COUNTY, HOSPICE OF BROWARD COUNTY AND SOUTH FLORIDA PALLIATIVE MEDICINE SPECIALISTS INC. HIS TIME IS SHARED EQUALLY BY ALL ENTITIES. A PORTION OF HIS COMPENSATION IS FROM HIS PHYSICIAN FEES FOR SERVICE. OTHER COMPENSATION FOR CY 2012 IS FOR HIS EMPLOYEE HEALTH AND RETIREMENT BENEFITS WHICH ARE UNDER THE SAME PLANS PROVIDED TO ALL EMPLOYEES. RANDY PRANGE COMPENSATION REPORTED FOR MR. PRANGE IS FOR A PARTIAL CALENDAR YEAR 2012. HE SERVES AS COO FOR SPECTRUM HEALTH, INC., HOSPICE OF PALM BEACH COUNTY, HOSPICE OF BROWARD COUNTY, SOUTH FLORIDA PALLIATIVE MEDICINE SPECIALISTS AND THE MEDICAL STORE, INC. HIS TIME IS SHARED EQUALLY BY ALL ENTITIES. OTHER COMPENSATION FOR CY 2012 IS FOR HIS EMPLOYEE HEALTH AND RETIREMENT BENEFITS WHICH ARE UNDER THE SAME PLANS PROVIDED TO ALL EMPLOYEES. BARBARA IVANKO COMPENSATION REPORTED FOR MS. IVANKO IS FOR CALENDAR YEAR 2012. SHE SERVED FOR A PARTIAL YEAR AS THE COO FOR SPECTRUM HEALTH, INC., HOSPICE OF PALM BEACH COUNTY FOUNDATION, INC., HOSPICE OF PALM BEACH COUNTY, HOSPICE OF BROWARD COUNTY, SOUTH FLORIDA PALLIATIVE MEDICINE SPECIALISTS AND THE MEDICAL STORE. HER TIME WAS SHARED EQUALLY BY ALL ENTITIES. OTHER COMPENSATION FOR CY 2012 INCLUDES A SEVERANCE PAYMENT AND HER EMPLOYEE HEALTH AND RETIREMENT BENEFITS WHICH ARE UNDER THE SAME PLANS PROVIDED TO ALL EMPLOYEES. DR. GAIL COONEY, M.D. COMPENSATION REPORTED FOR DR. COONEY IS FOR CALENDAR YEAR 2012. SHE SERVES AS VP ACCESS SERVICES, AND ALSO PROVIDES MEDICAL SERVICES TO TRUSTBRIDGE, INC., HOSPICE OF PALM BEACH COUNTY, HOSPICE OF BROWARD COUNTY AND SOUTH FLORIDA PALLIATIVE MEDICINE, INC. HER TIME IS SHARED EQUALLY BY ALL ENTITIES. IN CY 2012, A PORTION OF HER FEES WERE FROM PHYSICIAN FEES FOR SERVICE. OTHER COMPENSATION FOR CY 2012 IS FOR HER EMPLOYEE HEALTH AND RETIREMENT BENEFITS WHICH ARE UNDER THE SAME PLANS PROVIDED TO ALL EMPLOYEES. AMY CANNIZZO-BRENNAN COMPENSATION REPORTED FOR MS. CANNIZZO-BRENNAN IS FOR CALENDAR YEAR 2012. SHE SERVES AS THE VP QUALITY & EDUCATION FOR TRUSTBRIDGE, INC., HOSPICE OF PALM BEACH COUNTY FOUNDATION, INC., HOSPICE OF PALM BEACH COUNTY, HOSPICE OF BROWARD COUNTY, SOUTH FLORIDA PALLIATIVE MEDICINE SPECIALISTS AND THE MEDICAL STORE. HER TIME IS SHARED EQUALLY BY ALL ENTITIES. OTHER COMPENSATION FOR CY 2012 IS FOR HER EMPLOYEE HEALTH AND RETIREMENT BENEFITS WHICH ARE UNDER THE SAME PLANS PROVIDED TO ALL EMPLOYEES.
Other changes in net assets or fund balances
Form 990 , Part XI, Line 9
CHANGE IN INTEREST IN NET ASSETS OF HFPBC - 1474638;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.