Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
HERNANDO PASO HOSPICE INC |
592217929 | 9 | Yes | 232,925 | 0 | |
Total 1
|
232,925 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Line 15a PROCESS FOR DETERMINING COMPENSATION OF TOP MANAGEMENT OFFICIAL | ALL COMPENSATION IS PAID BY HERNANDO PASCO HOSPICE, INC., A RELATED TAX-EXEMPT ORGANIZATION. THE ORGANIZATION ENSURES THAT A REASONABLE AND COMPETITIVE PRESIDENT AND CHIEF EXECUTIVE OFFICER COMPENSATION PACKAGE CONSISTENT WITH MARKET-BASED COMPENSATION PRACTICES IS OFFERED. AN INDEPENDENT COMPENSATION AND BENEFITS COMMITTEE IS APPOINTED BY THE BOARD TO REVIEW THE PERFORMANCE OF THE CHIEF EXECUTIVE OFFICER UPON REPORTING TO THE BOARD AT THE SUBSEQUENT BOARD MEETING, THE BOARD THEN APPROVES THE SALARY AND BENEFITS OF THE CHIEF EXECUTIVE OFFICER. THE DECISIONS OF THE BOARD REGARDING THE COMPENSATION ARRANGEMENT ARE DOCUMENTED WITHIN THE MEETING MINUTES. |
| Form 990, Part VI, Line 15b PROCESS FOR DETERMINING COMPENSATION OF OTHER OFFICERS | ALL COMPENSATION IS PAID BY HERNANDO PASCO HOSPICE, INC., A RELATED TAX-EXEMPT ORGANIZATION. THE ORGANIZATION ENSURES THAT A REASONABLE AND COMPETITIVE cfo's COMPENSATION PACKAGE CONSISTENT WITH MARKET-BASED COMPENSATION PRACTICES IS OFFERED. AN INDEPENDENT COMPENSATION AND BENEFITS COMMITTEE IS APPOINTED BY THE BOARD TO REVIEW THE PERFORMANCE OF THE cfo UPON REPORTING TO THE BOARD AT THE SUBSEQUENT BOARD MEETING, THE BOARD THEN APPROVES THE SALARY AND BENEFITS OF THE cfo. THE DECISIONS OF THE BOARD REGARDING THE COMPENSATION ARRANGEMENT ARE DOCUMENTED WITHIN THE MEETING MINUTES. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | THE BOARD OF TRUSTEES MAY HAVE AN EXECUTIVE COMMITTEE, WHICH SHALL INCLUDE THE CEO OF HERNANDO PASCO HOSPICE, INC. AND SUCH ADDITIONAL TRUSTEES AS THE BOARD OF TRUSTEES, BY RESOLUTION, MAY DESIGNATE FROM ITS MEMBERS. THERE SHALL BE AT LEAST THREE (3) MEMBERS OF THE EXECUTIVE COMMITTEE. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | THE SOLE MEMBER OF THE CORPORATION IS HERNANDO-PASCO HOSPICE, INC. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | THE TOTAL MEMBERSHIP OF THE BOARD OF TRUSTEES SHALL AT ALL TIMES BE REPRESENTED BY THE HOSPICE COMMUNITY OF ENTITIES AS FOLLOWS: (A) CARE SECTOR: THREE TRUSTEES SHALL BE CURRENT MEMBERS IN GOOD STANDING OF THE BOARD OF DIRECTORS OF HERNANDO PASCO HOSPICE, INC. (THE CURRENT OPERATING ENTITY). SUCH TRUSTEES SHALL BE APPOINTED BY THE BOARD OF DIRECTORS OF HERNANDO PASCO HOSPICE, INC. AND SHALL SERVE UNTIL THEY ARE NO LONGER MEMBERS OF SUCH BOARD OR UNTIL THEY ARE REPLACED BY THE BOARD, WHICHEVER OCCURS FIRST. (B) MANAGEMENT SECTOR: TWO TRUSTEES SHALL BE PERSONS EMPLOYED IN A MANAGERIAL POSITION BY HERNANDO PASCO HOSPICE, INC. ONE TRUSTEE SHALL BE THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF HERNANDO PASCO HOSPICE, INC. WHO SHALL SERVE UNTIL HE RESIGNS OR IS TERMINATED FROM OFFICE BY HERNANDO PASCO HOSPICE, INC. ONE TRUSTEE SHALL BE ANY OTHER PERSON EMPLOYED IN A MANAGERIAL POSITION BY HERNANDO PASCO HOSPICE, INC. AND APPOINTED BY THE HPH BOARD OF DIRECTORS. HE/SHE SHALL SERVE UNTIL SHE/HE IS NO LONGER EMPLOYED BY HERNANDO PASCO HOSPICE, INC. OR UNTIL REPLACED BY HPH BOARD OF DIRECTORS, WHICHEVER OCCURS FIRST. (C) AT LARGE SECTOR: ONE TRUSTEE MAY BE APPOINTED ANNUALLY BY THE BOARD OF TRUSTEES OF HPH REAL ESTATE, INC. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | RESTRICTIONS OF AUTHORITY OF THE BOARD OF TRUSTEES: NOT WITHSTANDING ANYTHING IN THE BYLAWS TO THE CONTRARY, UNLESS OTHERWISE APPROVED BY THE AFFIRMATIVE VOTE OF NOT LESS THAN SEVENTY-FIVE PERCENT OF BOTH THE BOARD OF TRUSTEES AND THE BOARD OF DIRECTORS OF HERNANDO PASCO HOSPICE, INC., THE BOARD OF TRUSTEES SHALL NOT HAVE THE AUTHORITY TO DO ANY OF THE FOLLOWING ACTS ON BEHALF OF THE CORPORATION: (A) AMEND, REPEAL OR ALTER, IN WHOLE OR IN PART, ANY PROVISION OF THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS, OR ADOPT NEW ARTICLES OF INCORPORATION OR BYLAWS; (2) REMOVE ANY TRUSTEE FROM OFFICE PRIOR TO THE EXPIRATION OF SUCH TRUSTEE'S TERM; (C) SELL, LEASE OR OTHERWISE DISPOSE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (D) MERGE OR CONSOLIDATE THE CORPORATION WITH OR INTO ANY OTHER CORPORATION, PARTNERSHIP, LIMITED LIABILITY COMPANY OR OTHER ENTITY, OR ENTER INTO ANY PARTNERSHIP, JOINT VENTURE OR ALLIANCE, OR FORM ANY SUBSIDIARY, OR DISSOLVE AND WIND UP THE CORPORATION. (E) CHANGE THE NAME OR PURPOSE OF THE CORPORATION OR CHANGE THE NATURE OF THE BUSINESS OF THE CORPORATION OR DO ANY ACT THAT WOULD MAKE IT IMPOSSIBLE TO CARRY ON THE ORDINARY BUSINESS OF THE CORPORATION OR CHANGE THE PRINCIPAL PLACE OF BUSINESS OF THE CORPORATION; (F) ADMIT ANY PERSON OR ENTITY AS A MEMBER OF THE CORPORATION OR ISSUE, BY SALE, OPTION, WARRANT, FOR PROPERTY, SERVICES OR OTHERWISE, ANY ADDITIONAL VOTING MEMBERSHIP INTERESTS IN THE CORPORATION; (G) ENTER INTO, GIVE OR GRANT ANY MORTGAGES, DEEDS OF TRUSTS, PLEDGES OR OTHER SECURITY INTERESTS, IN ANY REAL PROPERTY OWNED OR ACQUIRED BY THE CORPORATION, OR ANY PORTION THEREOF; (H) FILE FOR BANKRUPTCY, APPOINT A RECEIVER OR TRUSTEE TO MAKE A TRANSFER FOR THE BENEFIT OF CREDITORS; OR (I) ESTABLISH OR MODIFY ANY TAX-RELATED STRATEGY OR POSITION, OR OTHERWISE TAKE ANY ACTION WITH WOULD HAVE A MATERIAL IMPACT ON THE TAX MATTERS RELATING TO THE CORPORATION; INCLUDING ANY DECISION TO CHANGE THE TAX-EXEMPT STATUS OF THE CORPORATION. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | A COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS BEFORE BEING FILED. |
| Form 990, Part VI, Line 12c Conflict of interest policy | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS ALL "INTERESTED PERSONS," WHICH INCLUDES OFFICERS, DIRECTORS, MEMBERS OF ANY COMMITTEE OF THE BOARD, AND MEMBERS OF THE IMMEDIATE FAMILIES OF SUCH INDIVIDUALS. THE DESIGNATED COMPLIANCE OFFICER ROUTINELY REVIEWS THE EXISTING RELATIONSHIPS BETWEEN THE HOSPICE AND ITS "INTERESTED PERSONS", OTHER CARE PROVIDERS, EDUCATIONAL INSTITUTIOS AND PAYERS TO ASSURE THAT ALL RELATIONSHIPS ARE WITHIN THE LAW AND REGULATIONS. IF ANY CONFLICTS OF INTEREST ARE FOUND TO EXIST, THE COMPLIANCE OFFICER IMMEDIATELY REPORTS THE POTENTIAL CONFLICT TO THE CHIEF EXECUTIVE OFFICER. ANY VOTING MEMBER INVOLVED IN A CONFLICT OF INTEREST MUST IMMEDIATELY DISCLOSE IT TO THE CHAIRMAN OF THE BOARD AND IS DISALLOWED FROM VOTING ON ANY MATTERS RELATING TO ANY TRANSACTION WITH AN "INTERESTED PERSON" OR ENTITY. |
| Form 990, Part VI, Line 19 Required documents available to the public | the organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | FORGIVENESS OF DEBT - -8682500; |
| Form 990, Part XII, Line 2b AUDITED FINANCIAL STATEMENTS | FOR THE 2014 TAX YEAR, THE ORGANIZATION DID NOT HAVE AUDITED FINANCIAL STATEMENTS ISSUED. 2014 RETURN REPRESENTS A SHORT YEAR RETURN (OCTOBER 1, 2014-DECEMBER 31, 2014). |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |