Form990
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
FAMILY HOSPICE AND PALLIATIVE CARE
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
50 Moffett Street
 
Room/suite
City or town, state or country, and ZIP + 4
Pittsburgh, PA15243
D Employer identification number

25-1529649
E Telephone number

G Gross receipts $ 26,135,613
F Name and address of principal officer:
FRANCO INSANA
50 Moffett Street
Pittsburgh,PA15243
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.FAMILYHOSPICE.COM
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1980
M State of legal domicile: PA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE COMPASSIONATE, QUALITY CARE FOR PEOPLE WITH LIFE-LIMITING ILLNESSES & THEIR FAMILIES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 14
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 335
6 Total number of volunteers (estimate if necessary) ............. 6 495
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 724,263 427,542
9 Program service revenue (Part VIII, line 2g) ......... 21,361,980 25,590,252
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 205 -3,477
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 88,187 33,720
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 22,174,635 26,048,037
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 12,794,545 15,460,179
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet405,130    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 7,667,535 9,249,227
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 20,462,080 24,709,406
19 Revenue less expenses. Subtract line 18 from line 12....... 1,712,555 1,338,631
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 15,122,551 16,621,623
21 Total liabilities (Part X, line 26)............. 4,972,645 5,084,733
22 Net assets or fund balances. Subtract line 21 from line 20..... 10,149,906 11,536,890
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: THE MISSION OF FAMILY HOSPICE AND PALLIATIVE CARE IS TO PROVIDE COMPASSIONATE, QUALITY COMFORT CARE THAT ENHANCES THE LIVES OF PEOPLE WITH LIFE-LIMITING ILLNESSES AND THEIR FAMILIES.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 20,246,335 including grants of $ 0 ) (Revenue $ 24,958,880 )
THE ORGANIZATION PROVIDES HOSPICE CARE AND SUPPORT TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES REGARDLESS OF THEIR ABILITY TO PAY. SERVICES INCLUDE GENERAL ASSISTANCE, EDUCATION, EMOTIONAL AND BEREAVEMENT SERVICES. THE ORGANIZATION PROVIDED CARE TO 3,235 PATIENTS CONSISTING OF 163,240 VISITS BY PHYSICIANS, NURSING, SOCIAL SERVICE, COUNSELING, THERAPY AND BEREAVEMENT STAFF. ALSO, THE ORGANIZATION PROVIDED $150,573 OF UNCOMPENSATED MANDATORY CARE TO 18 PATIENTS. THIS INCLUDED SERVICES PROVIDED BY PHYSICIANS, NURSING, COUNSELING AND BEREAVEMENT, IN ADDITION TO PHARMACEUTICALS, SUPPLIES AND DURABLE MEDICAL EQUIPMENT.
4b (Code:   ) (Expenses $ 518,711 including grants of $ 0 ) (Revenue $ 643,419 )
THE ORGANIZATION PROVIDES PALLIATIVE CARE TO TERMINALLY ILL PATIENTS. SERVICES INCLUDE SYMPTOM AND PAIN MANAGEMENT, GENERAL ASSISTANCE FOR DAILY ACTIVITIES, EDUCATION AND EMOTIONAL SERVICES. THE ORGANIZATION PROVIDED CARE TO 548 PATIENTS CONSISTING OF 8,687 VISITS BY A PHYSICIAN, NURSES, SOCIAL SERVICE STAFF, COUNSELORS, AND THERAPY STAFF. ALSO, THE ORGANIZATION PROVIDED $2,346 OF UNCOMPENSATED MANDATORY CARE TO 1 PATIENT. THIS INCLUDED SERVICES PROVIDED BY PHYSICIANS, NURSING AND COUNSELING.
4c (Code:   ) (Expenses $ 178,108 including grants of $ 0 ) (Revenue $ 0 )
THE ORGANIZATION OFFERS COMPLIMENTARY SERVICES AND PROVIDES THE FOLLOWING PROGRAMS TO BENEFIT THE COMMUNITY: COMPLIMENTARY SERVICES: 551 PATIENTS RECEIVED ART, MASSAGE AND MUSIC THERAPY AS A SUPPLEMENT TO TRADITIONAL HOSPICE AND PALLIATIVE MODELS OF CARE. THESE ADJUNCT SERVICES PROMOTE COMFORT AND CREATE ALTERNATIVE WAYS OF EXPRESSION, AFFIRMING LIFE, PALLIATING SYMPTOMS AND AFFORDING RELAXATION. THE EXPENSE OF COMPLIMENTARY SERVICES WAS $123,832. (CONTINUED IN SCHEDULE O).
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet20,943,154
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III............................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part I........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part II...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III ....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II...
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................
34
 
No
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2...
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
118
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
335
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
14
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
PA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletFranco Insana CFO50 Moffett StreetPittsburghPA15243 (412) 572-8800
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) BOB BUTTER........................................................................
CHAIRPERSON
 5.00
.......................   		X   X       0 0 0
(2) DEBORAH BRODINE........................................................................
VICE CHAIRPERSON
 3.00
.......................   		X   X       0 0 0
(3) FRANCO INSANA........................................................................
INTERIM PRESIDENT AND CEO, AND CFO AND TREASURER
 40.00
.......................   		X   X       112,733 0 26,949
(4) RAFAEL SCIULLO........................................................................
PRESIDENT AND CEO PARTIAL YEAR
 40.00
.......................   		X   X       234,038 0 13,889
(5) SANDRA R TOMLINSON........................................................................
SECRETARY
 2.00
.......................   		X   X       0 0 0
(6) BEVERLY DORMAN........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(7) BRUCE AUSTIN........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(8) DAVID FRIEDLAND MD........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(9) G ALAN YEASTED MD........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(10) JOANNE HAHEY........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(11) JON ALLEGRETTI........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(12) JONATHAN LUSHKO........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(13) KIM WARD BURNS........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(14) LISA TURBEVILLE MARKOWSKI........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(15) PAUL WINKLER........................................................................
IMMEDIATE PAST CHAIRPERSON
 3.00
.......................   		X           0 0 0
(16) ROBERT C JACKSON JR........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(17) MARY BETH SALAMA........................................................................
PHYSICIAN
 40.00
.......................   		        X   186,327 0 6,351
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) THERESA GUALTERI........................................................................
CLINICAL SUPERVISOR
 55.00
.......................   		        X   116,870 0 10,920
























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 649,968 0 58,109
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet4
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
UPMC COMMUNITY PROVIDER SERVICES200 LOTHROP STREETPITTSBURGHPA15213 PHYSICIANS AND NURSE PRACTITIONERS 525,762
UNIVERSITY OF PITTSBURGH PHYSICIANS3550 TERRACE STREETPITTSBURGHPA15261 PHYSICIAN 248,517
CURA HOSPITALITYPO BOX 827276PHILADELPHIAPA19182 DIETARY SERVICES 211,506
ELIZABETH TOWNSHIP AREA EMSPO BOX 539BUENA VISTAPA15018 AMBULANCE 190,506
MBM CONTRACTING4999 OLD CLAIRTON RDPITTSBURGHPA15236 BUILDING IMPROVEMENTS 134,371
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet5
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a 21,033
b Membership dues....1b 0
c Fundraising events....1c 67,019
d Related organizations...1d 0
e Government grants (contributions)1e 0
f All other contributions, gifts, grants, and
similar amounts not included above1f 		339,490
g Noncash contributions included in lines
1a-1f:$ 		0
h Total. Add lines 1a-1f.......MediumBullet 427,542
Program Service Revenue Business Code
2a NET PATIENT REVENUE 623990 25,590,252 25,590,252    
b     0      
c     0      
d     0      
e     0      
f All other program service revenue . 0 0 0 0
g Total. Add lines 2a–2f........MediumBullet 25,590,252
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 18     18
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 6,000  
b Less: rental expenses 9,167  
c Rental income or (loss) -3,167 0
d Net rental income or (loss).......MediumBullet -3,167     -3,167
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 0 0
b Less: cost or other basis and sales expenses 0 3,495
c Gain or (loss) 0 -3,495
d Net gain or (loss)..........MediumBullet -3,495     -3,495
8a Gross income from fundraising events (not including
$ 67,019
of contributions reported on line 1c). See Part IV, line 18 ..
a 68,715
b Less: direct expenses ...b 74,914
c Net income or (loss) from fundraising events..MediumBullet -6,199   -6,199
9a Gross income from gaming activities.
See Part IV, line 19 ...
a 0
b Less: direct expenses ...b 0
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a 0
b Less: cost of goods sold ..b 0
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a FOOD SERVICE 722210 31,039     31,039
b MISCELLANEOUS 900099 12,047 12,047    
c     0      
d All other revenue .... 0 0 0 0
e Total. Add lines 11a–11d ...... MediumBullet 43,086
12 Total revenue. See Instructions......MediumBullet 26,048,037 25,602,299 0 18,196
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 387,609 0 387,609 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 11,949,997 10,314,228 1,375,475 260,294
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 166,214 141,258 20,472 4,484
9 Other employee benefits ....... 2,054,477 1,718,243 300,258 35,976
10 Payroll taxes ........... 901,882 744,682 137,640 19,560
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 48,804 246 48,558 0
c Accounting ........... 50,691 0 50,691 0
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 2,215,563 1,912,221 293,474 9,868
12 Advertising and promotion .... 131,966 42,853 89,101 12
13 Office expenses ....... 737,380 503,964 166,916 66,500
14 Information technology ...... 118,073 936 116,762 375
15 Royalties .. 0      
16 Occupancy ........... 486,292 486,292 0 0
17 Travel ............ 621,519 522,521 94,788 4,210
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 121,323 72,709 47,668 946
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 337,490 110,080 225,977 1,433
23 Insurance .............. 145,212 145,212 0 0
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a PATIENT-RELATED EXPENSES 3,116,643 3,116,643 0 0
b INPATIENT HOSPITAL FEES 790,353 790,353 0 0
c BAD DEBT 302,633 302,633   0
d TRAINING & RECRUITMENT 19,441 12,236 5,733 1,472
e All other expenses 5,844 5,844 0 0
25 Total functional expenses. Add lines 1 through 24e 24,709,406 20,943,154 3,361,122 405,130
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720). 0      
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 4,108,126 1 4,875,791
2 Savings and temporary cash investments ......... 365,867 2 413,541
3 Pledges and grants receivable, net ........... 91,926 3 0
4 Accounts receivable, net ............. 2,262,250 4 2,976,950
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6 0
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges .......... 346,662 9 359,101
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 9,857,508
b Less: accumulated depreciation ..... 10b 1,898,927 7,907,387 10c 7,958,581
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 40,333 15 37,659
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 15,122,551 16 16,621,623
Liabilities 17 Accounts payable and accrued expenses ......... 1,584,901 17 1,758,878
18 Grants payable .................   18  
19 Deferred revenue ................ 6,407 19 3,493
20 Tax-exempt bond liabilities ............. 3,279,278 20 3,112,890
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22 0
23 Secured mortgages and notes payable to unrelated third parties ..   23 171,656
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 102,059 25 37,816
26 Total liabilities. Add lines 17 through 25......... 4,972,645 26 5,084,733
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 9,847,707 27 11,359,268
28 Temporarily restricted net assets ........... 302,199 28 177,622
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 10,149,906 33 11,536,890
34 Total liabilities and net assets/fund balances ........ 15,122,551 34 16,621,623
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
26,048,037
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
24,709,406
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
1,338,631
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
10,149,906
5
Net unrealized gains (losses) on investments ...............
5
48,353
6
Donated services and use of facilities .................
6
0
7
Investment expenses .....................
7
0
8
Prior period adjustments .....................
8
0
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
11,536,890
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID: 12000266
Software Version: v2012.1.0
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
FAMILY HOSPICE AND PALLIATIVE CARE
 
Employer identification number

25-1529649
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
f
g
(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) right arrow (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.") .... 748,994 672,952 705,383 700,287 427,542 3,255,158
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......           0
3 The value of services or facilities furnished by a governmental unit to the organization without charge..           0
4 Total. Add lines 1 through 3 748,994 672,952 705,383 700,287 427,542 3,255,158
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)..           207,684
6 Public support. Subtract line 5 from line 4.           3,047,474
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4.. 748,994 672,952 705,383 700,287 427,542 3,255,158
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... 10,676 5,996 5,323 1,625 6,018 29,638
9 Net income from unrelated business activities, whether or not the business is regularly carried on..           0
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.).. 442,271 119,895 160,949 147,383 111,801 982,299
11 Total support (Add lines 7 through 10).           4,267,095
12
12
102,403,634
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........................................right arrow
Section C. Computation of Public Support Percentage
14
14
71.420 %
15
15
70.390 %
16a
b
17a
b
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 ..................................................... right arrow
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) right arrow (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 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
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 II, LINE 10, DESCRIPTION - GROSS INCOME FROM FUNDRAISING EVENTS, COLUMN A - 103541, COLUMN B - 27197, COLUMN C - 82310, COLUMN D - 89086, COLUMN E - 68715, COLUMN F - 370849; DESCRIPTION - OTHER INCOME, COLUMN A - 338730, COLUMN B - 92698, COLUMN C - 78639, COLUMN D - 58297, COLUMN E - 43086, COLUMN F - 611450;,
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
FAMILY HOSPICE AND PALLIATIVE CARE
 
Employer identification number

25-1529649
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
FAMILY HOSPICE AND PALLIATIVE CARE
  		Employer identification number

25-1529649
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
FAMILY HOSPICE AND PALLIATIVE CARE
  		Employer identification number

25-1529649
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
FAMILY HOSPICE AND PALLIATIVE CARE
  		Employer identification number

25-1529649
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID: 12000266
Software Version: v2012.1.0
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
FAMILY HOSPICE AND PALLIATIVE CARE
 
Employer identification number

25-1529649
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
1,922
j
Total. Add lines 1c through 1i ...............................
1,922
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 THE ORGANIZATION PAYS DUES TO NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION. A PORTION OF THOSE DUES ARE USED FOR LOBBYING.
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
FAMILY HOSPICE AND PALLIATIVE CARE
 
Employer identification number

25-1529649
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   515,000 515,000
b Buildings ................   7,430,207 1,066,125 6,364,082
c Leasehold improvements ............   502,230 87,154 415,076
d Equipment ................   1,410,071 745,648 664,423
e Other .................   0 0 0
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 7,958,581
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
INTEREST RATE SWAP AGREEMENTS 37,816








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 37,816
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 THE ORGANIZATION IS EXEMPT FROM INCOME TAXES ON INCOME FROM RELATED ACTIVITIES UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING STATE TAX LAW. ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR FEDERAL OR STATE INCOME TAXES. U.S. GAAP REQUIRES THAT A TAX POSITION IS RECOGNIZED AS A BENEFIT ONLY IF IT IS "MORE LIKELY THAN NOT" THAT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED IS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE "MORE LIKELY THAN NOT" TEST, NO TAX BENEFIT IS RECORDED. DUE TO ITS TAX-EXEMPT STATUS, THE ORGANIZATION IS NOT GENERALLY SUBJECT TO U.S. FEDERAL INCOME TAX OR STATE INCOME TAX. THE ORGANIZATION'S FORM 990 HAS NOT BEEN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE OR THE STATE OF PENNSYLVANIA FOR THE LAST THREE YEARS. THE ORGANIZATION DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. THE ORGANIZATION RECOGNIZES INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE. THE ORGANIZATION DID NOT HAVE ANY AMOUNTS ACCRUED FOR INTEREST AND PENALTIES AT JUNE 30, 2013 AND 2012.
Schedule D (Form 990) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Form 990-EZ filers are not required to complete this part. right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
FAMILY HOSPICE AND PALLIATIVE CARE
 
Employer identification number

25-1529649
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

GOLF OUTING
(event type) 		(b) Event #2

MEMORIAL WALK
(event type) 		(c) Other events

1
(total number) 		(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 90,014 30,025 15,695 135,734
2 Less: Contributions . . 60,012 7,007 0 67,019
3 Gross income (line 1
minus line 2) . . . 		30,002 23,018 15,695 68,715
VerticalDirectExpenses 4 Cash prizes . . . 1,500 0 0 1,500
5 Noncash prizes . . 13,849 0 0 13,849
6 Rent/facility costs . . 14,653 300 8,013 22,966
7 Food and beverages . 5,307 0 223 5,530
8 Entertainment . . . 0 100 3,500 3,600
9 Other direct expenses . 6,626 13,981 6,862 27,469
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 74,914
11 Net income summary. Combine line 3, column (d), and line 10. .......... right arrow -6,199
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 3
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Identifier Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2012
Additional Data


Software ID: 12000266
Software Version: v2012.1.0
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
FAMILY HOSPICE AND PALLIATIVE CARE
 
Employer identification number

25-1529649
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)RAFAEL SCIULLOPRESIDENT AND CEO PARTIAL YEAR (i)
(ii)		 234,038
0 		0
0 		0
0 		5,686
0 		8,203
0 		247,927
0 		0
0
(2)MARY BETH SALAMAPHYSICIAN (i)
(ii)		 186,218
0 		109
0 		0
0 		5,586
0 		765
0 		192,678
0 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
Tax indemnification and gross-up payments Schedule J, Part I, Line 1a MARY BETH SALAMA AND THERESA GUALTIERI EACH RECEIVED A BONUS PAYMENT WHICH WAS GROSSED-UP.
Non-fixed payments Schedule J, Part I, Line 7 SOME NON-FIXED PAYMENTS WERE PROVIDED TO INTERESTED PERSONS DURING THE YEAR.
Schedule J (Form 990) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
FAMILY HOSPICE AND PALLIATIVE CARE
 
Employer identification number
25-1529649
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A WILKINS AREA INDUSTRIAL DEVELOPMENT AUTHORITY
  		25-1410750   03-20-2009 1,234,326 FINANCING OF BUILDINGS AND STRUCTURES USED FOR TAX-EXEMPT PURPOSES   X   X   X
B WILKINS AREA INDUSTRIAL DEVELOPMENT AUTHORITY
  		25-1410750   03-20-2009 2,895,846 FINANCING OF BUILDINGS AND STRUCTURES USED FOR TAX-EXEMPT PURPOSES   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 554,256 463,027    
2 Amount of bonds legally defeased . . . . . . . . . . . 0 0    
3 Total proceeds of issue . . . . . . . . . . . . . . 1,234,326 2,895,846    
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0 0    
5 Capitalized interest from proceeds . . . . . . . . . . . 0 0    
6 Proceeds in refunding escrows . . . . . . . . . . . . 0 0    
7 Issuance costs from proceeds . . . . . . . . . . . . 20,770 0    
8 Credit enhancement from proceeds . . . . . . . . . . . 0 0    
9 Working capital expenditures from proceeds . . . . . . . . . 0 0    
10 Capital expenditures from proceeds . . . . . . . . . . . 1,213,556 0    
11 Other spent proceeds . . . . . . . . . . . . . . 0 2,895,846    
12 Other unspent proceeds . . . . . . . . . . . . . . 0 0    
13 Year of substantial completion . . . . . . . . . . . . 2009 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X X          
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X        
16 Has the final allocation of proceeds been made? . . . . . . . . X   X          
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X          
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X        
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X        
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .   X   X        
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .   X   X        
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X   X        
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .   X   X        
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.0000% 0.0000%   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.0000% 0.0000%   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0.0000% 0.0000%   %   %
7 Does the bond issue meet the private security or payment test? . . . . .   X   X        
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X   X        
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of. 0.0000% 0.0000%   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X   X        
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X          
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X   X        
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X   X          
b Exception to rebate? . . . . . . . .   X   X        
c No rebate due? . . . . . . . . . .
  X   X        
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . . X   X          
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X   X          
b Name of provider . . . . . . . . . HUNTINGTON NATIONAL BANK
  		HUNTINGTON NATIONAL BANK
  		 
  		 
 
c Term of hedge . . . . . . . . . . 5.0 5.0    
d Was the hedge superintegrated? . . . . . .   X   X        
e Was a hedge terminated? . . . . . . .   X   X        
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X   X        
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . . 0 0    
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .   X   X        
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X   X        
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X          
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X          
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
FAMILY HOSPICE AND PALLIATIVE CARE
 
Employer identification number

25-1529649
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) RX PARTNERS
  		DEBORAH BRODINE, DIRECTOR OF FHPC, IS A DIRECTOR OF RX PARTNERS 920,807 FHPC PURCHASES PATIENT-RELATED SUPPLIES FROM RX PARTNERS.   No
(2) CHARTWELL
  		DEBORAH BRODINE, DIRECTOR OF FHPC, IS A DIRECTOR OF CHARTWELL. 327,423 FHPC PURCHASES PATIENT-RELATED SUPPLIES FROM CHARTWELL.   No
(3) CHARTWELL
  		JOANNE HAHEY, DIRECTOR OF FHPC, IS A DIRECTOR OF CHARTWELL. 327,423 FHPC PURCHASES PATIENT-RELATED SUPPLIES FROM CHARTWELL.   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0




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.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
FAMILY HOSPICE AND PALLIATIVE CARE
 
Employer identification number

25-1529649
Identifier Return Reference Explanation
PROGRAM DESCRIPTION FORM 990, PART III, LINE 4C (CONTINUED FROM PART III) QUALITY OF LIFE: EDUCATION AND INSIGHT INTO THE INVALUABLE IMPACT THE NON-TRADITIONAL INTERVENTIONS CAN OFFER TO PATIENTS AND THEIR LOVED ONES. HIGHLIGHTING THE VALUE OF STORY TELLING AS A GIFT OF LEGACY AND REFLECT ON THE VALUE OF ART, MUSIC AND MASSAGE. THE AUDIENCE IS THE COMMUNITY AT LARGE AND LONG-TERM CARE FACILITIES. THERE WERE 90 PARTICIPANTS. THE COST OF QUALITY OF LIFE SERVICES WAS $65,744. SPIRITUALITY AND END OF LIFE CARE: WEBINAR FOR HEALTH CARE PROFESSIONALS ABOUT END-OF-LIFE CARE. ATTENDED BY 74 PARTICIPANTS. KEEPING THE SPIRITUAL SPARK: ATTENDED BY 16 PARTICIPANTS. GROWING THRU GRIEF: THE "GROWING THRU GRIEF" PROGRAM IS A SIX WEEK EDUCATIONAL PROGRAM THAT IS OPEN TO THE PUBLIC WITH REGISTRATION REQUIRED. 113 ATTENDEES WERE PRESENTED WITH AN ADULT LEARNING MODEL TO EXPLORE THE IMPACT OF THEIR LOSS ON LIFE AND DEVELOP COPING MECHANISMS. REGIONALLY OFFERED AND HOSTED AT CHURCHES, LIBRARIES, COMMUNITY CENTERS. MONTHLY BEREAVEMENT SUPPORT GROUPS: THESE GROUPS ARE OPEN TO THE PUBLIC WITH NO PRE-REGISTRATION REQUIRED. WALK-INS ARE WELCOME. FAMILY HOSPICE AND PALLIATIVE CARE STAFF OR VOLUNTEERS FACILITATE AND EXPLORE THE ISSUES PRESENTED AND OFFERS COPING/ADJUSTMENT CONSIDERATIONS. THE GROUPS ARE DESIGNED TO MEET THE IDENTIFIED NEEDS OF THOSE WHO ARE COPING WITH THE DEATH OF A LOVED ONE. THE GROUPS WERE ATTENDED BY 330 PEOPLE. CAMP HEALING HEARTS: ONE DAY CAMP OUTREACH FOR CHILDREN, AGES 6-12 WHO HAVE EXPERIENCED A LOSS, AND THEIR PARENT OR GUARDIAN. THE CAMP IS OPEN TO THE PUBLIC AND PROVIDED AT SEVERAL LOCATIONS. THERE WERE 76 ATTENDEES. GRIEF AND THE HOLIDAYS: THIS PROGRAM IS OPEN TO THE PUBLIC AT LARGE. ATTENDEES ARE PRESENTED WITH AN UNDERSTANDING OF THE CHALLENGES AND OPPORTUNITIES IN COPING WITH SEASONS THAT REFLECT CELEBRATION HOWEVER NOW ACCENTUATE EMOTIONAL UPHEAVAL RELATED TO THE LOSS OF A LOVED ONE. THE PROGRAM IS HOSTED AT CHURCHES, LIBRARIES, LONG-TERM CARE FACILITIES, FUNERAL HOMES AND SENIOR CENTERS. THERE WERE 159 ATTENDEES. DIFFICULT YET CRITICAL CONVERSATIONS: PRESENTED TO THE COMMUNITY AT LARGE AND HEALTHCARE PROVIDERS. IT IS INTENDED TO HIGHLIGHT THE VITAL IMPORTANCE OF DISCUSSING END OF LIFE ISSUES AND IDENTIFYING ROUTINE AND URGENT TIMES TO HAVE A CONVERSATION. PRESENTED AT SEVERAL LONG-TERM CARE FACILITIES, HOSPITALS, SENIOR CENTERS AND COMMUNITY SERVICE SITES. THERE WERE 49 ATTENDEES DURING THE YEAR. WHEN TO MAKE A REFERRAL - TRADITIONAL VS. PALLIATIVE HOME CARE: OBJECTIVES OF THIS PROGRAM WERE TO DEFINE AND DIFFERENTIATE PALLIATIVE HOME CARE AND HOSPICE SERVICES, DESCRIBE THE BENEFITS AND REQUIREMENTS, AND TO IDENTIFY OPPORTUNITIES TO INTRODUCE APPROPRIATE PROGRAMS TO THEIR BENEFICIARIES. THIS PROGRAM IS PRESENTED TO INSURERS, CASE MANAGERS, AND HEALTH CARE PROFESSIONALS. THERE WERE 21 ATTENDEES. COMPASSIONATE CAREGIVER TRAINING: EDUCATIONAL TUTORIALS WERE OFFERED TO CAREGIVERS OF PATIENTS REFERRED TO FAMILY HOSPICE AND PALLIATIVE CARE'S PALLIATIVE HOME CARE OR HOSPICE PROGRAM. THE PROGRAM INCLUDES NURSE AND PHYSICAL THERAPY INTERACTION INTENDED TO INCREASE CAREGIVER CONFIDENCE, INCREASE PATIENT SAFETY AND ENHANCE QUALITY OF PATIENT EXPERIENCE. HOSPICE AND THE END OF LIFE EXPERIENCE: OPPORTUNITIES IN LONG TERM CARE: TO INCREASE UNDERSTANDING, AWARENESS, ADDED VALUE AND CARE AUGMENTATION WITH A HOSPICE COLLABORATIVE TEAM APPROACH FOR RESIDENTS WITH A LIFE LIMITING ILLNESS. PRESENTED TO 54 PARTICIPANTS INCLUDING PHYSICIANS, NURSES, SOCIAL WORKERS AND SPIRITUAL CARE STAFF AT LONG-TERM CARE FACILITIES. BEREAVEMENT SUPPORT AND EDUCATION: EDUCATION SUPPORT AND DEBRIEFING SESSION RELATED TO GRIEF AND LOSS EXPERIENCED BY STAFF IN THE LONG TERM CARE CONTINUUM (COMMUNITY, STAFF, SURVIVORS). THERE WERE 52 ATTENDEES. MEMORIAL SERVICE: THE MEMORIAL SERVICE AND RECEPTION WAS HELD FOR SURVIVORS OF PATIENTS ON BOTH PALLIATIVE HOME CARE AND HOSPICE PROGRAMS. THE MEMORIAL SERVICE ENGAGES ATTENDEES IN A CELEBRATION AND ENCOURAGES REMEMBERING THEIR LOVED ONES WHO HAVE DIED IN THE PAST 6-12 MONTHS (DEPENDENT ON REGION). THERE WERE 1,100 ATTENDEES. ADVANCE CARE PLANNING: LIVING WILLS, ADVANCE DIRECTIVES, POLST: DEFINES ALL AVENUES RELATED TO ADVANCE CARE PLANNING, DIFFERENTIATING POLST (PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT) AS A PHYSICIAN'S ORDER. AUDIENCE INCLUDES HEALTH CARE PROFESSIONALS IN A VARIETY OF SETTINGS. ATTENDED BY 44 PARTICIPANTS. PAIN AND SYMPTOM MANAGEMENT: IDENTIFY AND DEFINE SPECTRUM OF SYMPTOMS ASSOCIATED WITH END OF LIFE. CLINICAL RECOMMENDATIONS RELATED TO SYMPTOMS ARE IDENTIFIED REFLECTIVE OF ACCEPTABLE AND RECOGNIZED PROTOCOLS. ATTENDED BY 66 HEALTH CARE PROFESSIONALS IN A VARIETY OF SETTINGS. THE DYING PROCESS: REVIEW THE COURSE OF DECLINE IN END OF LIFE CARE FROM MODEL OF CARE THAT INCLUDES BODY MIND AND SPIRIT WITHIN THE SYSTEM THE LIFE. ATTENDED BY 51 HEALTH CARE PROFESSIONALS IN A VARIETY OF SETTINGS. HOSPICE 101: CONVEY THE HISTORY OF THE HOSPICE MOVEMENT, BASIC FUNDAMENTALS OF HOSPICE FROM A REGULATORY AND CARE, TREATMENT AND SERVICES. THERE WERE 78 ATTENDEES. THE ROADS WE'VE TRAVELED: LEGACY & LIFE REVIEW: THE VALUE AND POSITIVE IMPACT OF TELLING OUR STORY AND CREATING A LIFE LEGACY. THIS PROCESS IS ALSO A VALUABLE TOOL AND A CATHARSIS FOR EMOTING FEELINGS RELATIVE ANTICIPATORY GRIEF AND MOURNING. AUDIENCE INCLUDES COMMUNITY AND HEALTHCARE PROFESSIONALS ALL SETTINGS. THERE WERE 28 ATTENDEES. WHEN TO MAKE A HOSPICE REFERRAL: CONVEY THE HISTORY OF THE HOSPICE MOVEMENT, BASIC FUNDAMENTALS OF HOSPICE FROM A REGULATORY AND CARE, TREATMENT AND SERVICES. AUDIENCE INCLUDES ALL HEALTH CARE PROFESSIONALS ALL SETTINGS. THERE WERE 42 ATTENDEES. DON'T LET THE "H" WORD SCARE YOU: DISPEL THE MYTHS OF HOSPICE AND IDENTIFY OPPORTUNITIES TO PROVIDE A MODEL OF CARE. AUDIENCE TO INCLUDE ALL COMMUNITY AND HEALTH CARE STAKEHOLDERS. THERE WERE 18 ATTENDEES. COMFORT MEDICATIONS UTILIZED IN HOSPICE: REVIEW SIGNS AND SYMPTOMS AT END OF LIFE, MANAGEMENT STRATEGIES, BENEFITS AND CHALLENGES, COMMUNICATION TO FAMILY. ATTENDED BY 94 HEALTHCARE PROFESSIONALS, ALL SETTINGS. DISPELLING THE MYTHS ABOUT HOSPICE: CLARIFY AND EDUCATION ABOUT THE COMPONENTS OF HOSPICE, REVIEW THE HISTORY, CONVEY THE LIFE-AFFIRMING NATURE OF THE PLAN OF CARE DRIVEN BY PATIENT AND FAMILY. ATTENDED BY 39 COMMUNITY AND HEALTHCARE STAKEHOLDERS. WOODWELL: AN END OF LIFE COLLABORATIVE: REVIEW THE WOODWELL PROGRAM AS A UNIQUE PARTNERSHIP OF PSC AND FHPC. DESCRIBE THE HOLISTIC COMPREHENSIVE CARE THAT EXPANDS CARE OPTIONS. ATTENDED BY 2 PARTICIPANTS. DEMENTIA CARE AT THE END OF LIFE: THE PRESENTER, A NATIONALLY RECOGNIZED DEMENTIA EXPERT PROVIDED EDUCATION AND INSIGHT RELATIVE TO THE NEEDS, ASSESSMENT AND INTERVENTION OPPORTUNITIES FOR THE PATIENT AND FAMILY AT END OF LIFE. AUDIENCE INCLUDED HEALTHCARE PROVIDERS, PRACTICING IN ALL SETTINGS (2 CONTINUING EDUCATION UNITS). THERE WERE 59 ATTENDEES. PROFESSIONAL BOUNDARIES: IDENTIFY THE COMPLEX, SENSITIVE AND CRITICAL OF RECOGNITION OF THE PROFESSIONAL RELATION, POTENTIAL PROBLEMATIC SITUATIONS, AND IDENTIFY POTENTIAL STRATEGIES TO MANAGE THE BOUNDARIES. ATTENDED BY 14 HEALTHCARE PROVIDERS. HOSPICE AND PHYSICAL THERAPY: MAKING THE MOST OF LIFE: A PROGRAM CREATED AND PRESENTED TO UNDERSTAND THE PURPOSE OF HOSPICE AND PALLIATIVE CARE AND THE MEDICARE ENTITLEMENT, REALIZE THE PHYSICAL THERAPIST'S ROLE IN ASSESSMENT OF CAREGIVER ABILITY AND ENVIRONMENTAL SAFETY IN CONCERT WITH THE PHYSICAL AND FUNCTIONAL ABILITIES OF PATIENTS. PROVIDED FOR 11 HEALTH CARE PROFESSIONALS FROM ALL SETTINGS. COMMUNICATING WITH THE GRIEVING FAMILY: OFFER INSIGHT AND UNDERSTANDING OF THE NATURE OF DEATH AND DYING, GRIEF, LOSS AND MOURNING, AND RECOMMENDED COMMUNICATION CONSIDERATIONS. ATTENDED BY 12 PARTICIPANTS. HOSPICE AND PALLIATIVE CARE AS PART OF THE AGING SERVICES CONTINUUM: IDENTIFY AND PROVIDE CASE STUDIES THAT ENHANCE UNDERSTANDING OF OPPORTUNITIES TO CONSIDER AN ALTERNATIVE PLAN OF CARE REFLECTIVE OF PROGNOSIS, DISEASE TRAJECTORY. ATTENDED BY 30 HEALTH CARE PROVIDERS FROM ALL SETTINGS. MEDICATION MANAGEMENT AND FALLS: HEALTHCARE PROVIDERS REVIEW SAFETY AND CAUTIONARY CONCERNS OF SPECIFIC MEDICATIONS, BOTH BURDENS AND BENEFITS. ATTENDED BY 23 PARTICIPANTS. HOSPICE INPATIENT CARE AND THE USE OF HOSPICE MEDS: REVIEW SIGNS AND SYMPTOMS AT END OF LIFE, MANAGEMENT STRATEGIES, BENEFITS AND CHALLENGES, COMMUNICATION TO FAMILY. AUDIENCE INCLUDED 19 HEALTHCARE PROFESSIONALS FROM ALL SETTINGS. HOSPICE GENERAL INPATIENT LEVEL OF CARE AND GENERAL CRITERIA: PROVIDED TO 36 HEALTHCARE PROFESSIONALS FROM VARIETY OF CARE SETTINGS. PALLIATIVE HOME CARE VS TRADITIONAL HOME CARE: PRESENTATION TO 18 HEALTH CARE PROFESSIONALS IN ALL SETTINGS THAT DEFINED THE DIFFERENCES PROGRAMMATICALLY. DEMENTIA: CAREGIVERS PROGRAM: HEALTH CARE PROFESSIONALS FROM ALL SETTINGS REVIEW THE NON VERBAL SIGNS AND OPPORTUNITIES FOR ASSESSMENT AND INTERVENTION. ATTENDED BY 8 PARTICIPANTS.
PROGRAM DESCRIPTION FORM 990, PART III, LINE 4C (CONTINUED) COPING WITH MULTIPLE LOSSES: EXPLORE THE IMPACT, CHALLENGES AND COPING WITHIN THE CONTEXT OF A HEALTH CARE SETTING AS A PERSON CARES FOR PATIENTS AND RESIDENTS AND SIMULTANEOUSLY EXPERIENCES PERSONAL CHALLENGES. PROVIDED FOR 24 HEALTH CARE PROFESSIONALS FROM ALL SETTINGS. THE GRIEVING FAMILY: EXPLORE WAYS TO SUPPORT PEOPLE GRIEVING. PROVIDED TO 10 COMMUNITY AND HEALTH CARE PROFESSIONALS. MY RESIDENT DIED: INSIGHT AND EXPLORATION OF FEELINGS AND RELATIONSHIPS AFTER THE EVENT OF DEATH. ATTENDED BY 20 PARTICIPANTS. END OF LIFE ETHICAL CONSIDERATION: 18 HEALTH CARE PROVIDERS FROM ALL SETTINGS EXPLORE ETHICAL PRINCIPLES, AREAS OF CONFLICT, OPPORTUNITIES FOR COMMUNICATION AND GOALS OF CARE. FACING THE CHALLENGE COPING WITH COMPLICATED SITUATIONS: 11 HEALTH CARE PROFESSIONALS FROM ALL CARE ENVIRONMENTS REVIEW THE NATURE OF LISTENING, IDENTIFYING CHALLENGING CIRCUMSTANCES, COMPLICATED SITUATIONS AND FACILITATING DIALOGUE. TRANSITIONS - HOW TO TALK TO YOUR DOCTOR: COMMUNITY PRESENTATION IDENTIFYING PREPARATION AND APPROACH TO DISCUSSING HEALTH CARE CONCERNS AND GOALS WITH A PHYSICIAN. ATTENDED BY 30 SENIOR CENTER RESIDENTS. DELIRIUM AND DEPRESSION: DEFINE AND DIFFERENTIATE BOTH DELIRIUM AND DEPRESSION, IDENTIFYING THE CHALLENGES IN ASSESSING AND OFFERING TREATMENT RECOMMENDATIONS. ATTENDED BY 17 PARTICIPANTS. ASK THE NURSE: ATTENDED BY 46 SENIOR CENTER RESIDENTS. NUTRITION: ATTENDED BY 50 SENIOR CENTER RESIDENTS.
Delegate broad authority to a committee Form 990, Part VI, Section A, Line 1a THE EXECUTIVE COMMITTEE, TO THE EXTENT PROVIDED IN THE RESOLUTION OF THE BOARD OF DIRECTORS, SHALL HAVE AND MAY EXERCISE ALL OF THE POWERS AND AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE HOSPICE IN THE INTERVALS BETWEEN MEETINGS OF THE BOARD.
Family/business relationships amongst interested persons Form 990, Part VI, Section A, Line 2 DEBORAH BRODINE AND JOANNE HAHEY - BUSINESS RELATIONSHIP
Significant changes to organizational documents Form 990, Part VI, Section A, Line 4 THE ORGANIZATION'S BOARD OF DIRECTORS AMENDED THE ORGANIZATION'S BYLAWS BY UNANIMOUS CONSENT, TERMINATING THE STATUS OF ST. CLAIR MEMORIAL HOSPITAL AS A CORPORATE MEMBER OF THE ORGANIZATION, EFFECTIVE JANUARY 31, 2013.
Classes of members or stockholders Form 990, Part VI, Section A, Line 6 DIRECTORS OF THE BOARD SHALL BE ELECTED AT REGULARLY SCHEDULED MEETINGS OF THE BOARD. THE SLATE OF POTENTIAL DIRECTORS SHALL BE PREPARED BY THE GOVERNANCE COMMITTEE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE BYLAWS. THE CORPORATE PARTICIPANTS ARE JEFFERSON REGIONAL MEDICAL CENTER ("JRMC"), UPMC HEALTH SYSTEM ("UPMC"), PRESBYTERIAN SENIORCARE ("PRESBYTERIAN") AND GROVE CITY MEDICAL CENTER ("GCMC") AND ANY OTHER ENTITY WHICH THE BOARD MAY FROM TIME TO TIME DESIGNATE. THE BOARD SHALL ELECT AND MAINTAIN A BOARD THAT REFLECTS DIVERSE SKILLS, INFLUENCES AND DEMOGRAPHICS AND MEETS THE FOLLOWING COMPOSITION: -ONE (1) MEMBER FROM THOSE NAMES SUBMITTED BY JRMC; -ONE (1) MEMBER FROM THOSE NAMES SUBMITTED BY UPMC; -ONE (1) MEMBER FROM THOSE NAMES SUBMITTED BY PRESBYTERIAN; -ONE (1) MEMBER FROM THOSE NAMES SUBMITTED BY GCMC; -ONE (1) MEMBER FROM THOSE NAMES PRESENTED BY ANY ENTITY THAT IS A CORPORATE PARTICIPANT TO THE EXTENT NOT SPECIFICALLY ADDRESSED ABOVE; -THE PRESIDENT OF THE HOSPICE, WHO SHALL SERVE AS AN EX-OFFICIO MEMBER WITH VOTE; -THE CHAIRPERSON OF THE BOARD FOR INSTITUTIONAL ADVANCEMENT (THE "BIA") WHO SHALL SERVE AS AN EX-OFFICIO MEMBER WITH VOTE; AND -THE REMAINDER OF THE BOARD SHALL BE COMPRISED OF COMMUNITY MEMBERS AT LARGE.
Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a THE CORPORATE MEMBERS HAVE THE CONTRACTUAL RIGHT TO APPOINT MEMBERS TO THE ORGANIZATION'S BOARD OF DIRECTORS, WHICH MUST BE APPROVED BY THE ORGANIZATION'S ENTIRE BOARD OF DIRECTORS.
Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b THE FINANCE COMMITTEE REVIEWED THE FINAL FORM 990 ON JANUARY 14, 2014 AND RECOMMENDED APPROVAL TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS APPROVED THE FINAL VERSION ON JANUARY 27, 2014.
Conflict of interest policy Form 990, Part VI, Section B, Line 12c FAMILY HOSPICE AND PALLIATIVE CARE REQUIRES ITS INTERESTED PERSONS (WHICH INCLUDES ITS BOARD OF DIRECTORS, BOARD OF OFFICERS, BOARD-DELEGATED COMMITTEE MEMBERS, PRESIDENT, CHIEF EXECUTIVE OFFICER, VICE PRESIDENTS, DIRECTORS, OR ANY OTHER INDIVIDUAL WHO MAY EITHER INFLUENCE OR HAS THE AUTHORITY TO ENTER INTO AGREEMENTS ON BEHALF OF FAMILY HOSPICE AND PALLIATIVE CARE), TO DISCLOSE ANY FINANCIAL INTEREST TO THE BOARD OF DIRECTORS WHENEVER SUCH FINANCIAL INTEREST ARISES. ALSO, SUCH INTERESTED PERSONS MUST, ON AN ANNUAL BASIS, ACKNOWLEDGE RECEIPT OF A COPY OF FAMILY HOSPICE AND PALLIATIVE CARE'S CONFLICT OF INTEREST POLICY AND CONFIRM THE EXISTENCE AND NATURE OF ANY FINANCIAL INTERESTS. AFTER DISCLOSURE OF A FINANCIAL INTEREST, THE BOARD OF DIRECTORS SHALL DETERMINE WHETHER FAMILY HOSPICE AND PALLIATIVE CARE CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE BOARD OF DIRECTORS SHALL DETERMINE BY A MAJORITY VOTE OF ITS DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN FAMILY HOSPICE AND PALLIATIVE CARE'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION THE BOARD OF DIRECTORS SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. IF THE BOARD OF DIRECTORS HAS REASONABLE CAUSE TO BELIEVE THAT A PERSON HAS VIOLATED ITS CONFICT OF INTEREST POLICY BY FAILING TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE BOARD OF DIRECTORS SHALL INFORM THE PERSON OF THE BASIS FOR SUCH BELIEF AND AFFORD SUCH PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF AFTER HEARING THE PERSON'S RESPONSE AND AFTER MAKING SUCH FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE BOARD OF DIRECTORS DETERMINES THAT THE PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE BOARD OF DIRECTORS SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION.
COMPENSATION OF THE TOP MANAGEMENT OFFICIAL FORM 990, PART VI, LINE 15A THE BOARD OF DIRECTORS ESTABLISHES ANNUAL PERFORMANCE GOALS AND OBJECTIVES FOR THE PRESIDENT/CEO. AFTER COMPLETION AND APPROVAL OF ANNUAL AUDITED FINANCIAL STATEMENTS, THE BOARD OF DIRECTORS DETERMINES THE EXTENT OF COMPENSATION ADJUSTMENTS FOR THE PRESIDENT/CEO BASED ON ACHIEVEMENT OF THOSE PREDETERMINED GOALS AND OBJECTIVES. THE BOARD OF DIRECTORS ALSO CONSIDERS THE SCOPE OF THE PRESIDENT/CEO'S RESPONSIBILITIES. THE MINUTES OF ALL RELEVANT BOARD OF DIRECTORS MEETINGS CONTEMPORANEOUSLY DOCUMENT THE DISCUSSION, REVIEW AND APPROVAL PROCESS FOR COMPENSATION OF KEY EMPLOYEES. THIS PROCESS WAS LAST UNDERTAKEN IN 2011.
COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES FORM 990, PART VI, LINE 15B THE PRESIDENT/CEO EVALUATES ANNUAL COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES USING THE SAME PROCESS, BASED ON ANNUAL PERFORMANCE GOALS AND OBJECTIVES, THE KEY EMPLOYEE'S SCOPE OF RESPONSIBILITIES AND MANAGEMENT COMPENSATION PAID BY OTHER COMPARABLE ORGANIZATIONS. THE PROCESS IS DOCUMENTED IN EACH EMPLOYEE'S FILE. THE PROCESS WAS LAST UNDERTAKEN IN 2011.
Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

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Software ID: 12000266
Software Version: v2012.1.0