The Community Hospice Inc.

“The sole member of the community hospice, inc. Is st. Peter's health care services. See line 7 for additional information.”

“St. Peter's health partners is related to the community hospice through a direct chain of sole memberships. St. Peter's health partners has the right to appoint all persons to the board of directors of the community hospice, inc.”

“St. Peter's health partners must approve certain decisions of the governing body, including the strategic plan, annual capital plan, and annual operating budget. St. Peter's health partners must also approve significant changes such as a merger, dissolution, sale of assets in excess of certain limits, and modifications to governing documents.”

“The community hospice, inc.'s form 990 was reviewed by management. Management review took place before the form 990 was filed with the internal revenue service. The board receives a copy of the return in its final form before it is filed with the internal revenue service.”

“The community hospice, inc. Has adopted trinity health's governance policy no. 1, which sets forth the organization's conflict of interest policy and processes. It applies to all "interested persons" of the community hospice, inc., which includes directors, principal officers, key employees, and members of committees with board-delegated powers. Interested persons are expected to discharge their duties in a manner the person reasonably believes to be in the best interests of the community hospice, inc. And to avoid situations involving a conflict of interest. On an annual basis, interested persons are required to complete a conflict of interest disclosure statement and to affirm their receipt of the conflict of interest policy, compliance with its requirements, and agree to notify the organization of changes impacting their annual disclosure in accordance with the policy. The annual disclosures are provided to internal legal counsel and the integrity and compliance officer, from which legal counsel prepares a report for the board chair and ceo. A summary of potential conflicts is reviewed with the board of directors of the community hospice, inc. (or a delegated committee of the board) on a yearly basis. Interested persons are required to make full disclosure to the community hospice, inc. Of any financial or business interests that might result in or have the appearance of a conflict of interest. The board of directors of the community hospice, inc. (or a delegated committee of the board) is responsible for the review of transactions to determine whether an actual conflict of interest exists. In the event of an actual conflict, the board (or a delegated committee of the board) will either avoid the conflict or appropriately scrutinize the transaction to ensure it is in the best interests of the community hospice, inc. Interested persons are required to recuse themselves from discussion and voting on matters involving a conflict of interest. The policy further addresses the proper documentation of the proceedings and potential disciplinary and corrective action for violations of the policy. The policy is available to the public upon request.”

“Question 15a is answered "no" because the compensation for the community hospice, inc.'s system ceo is established and paid by trinity health, a related organization. In establishing system ceo compensation, trinity health follows a process and policy that is intended to mirror the irc section 4958 guidelines for obtaining a "rebuttable presumption of reasonableness" with regard to compensation and benefits. As part of that process, the compensation and benefits of the system ceo of the community hospice, inc. Are reviewed at least annually by the trinity health board or the trinity health human resources and compensation committee (hrcc) of the board, authorized to act on behalf of the board with respect to certain compensation matters. As part of its review process, the hrcc retains an independent firm experienced in compensation and benefit matters for not-for-profit healthcare organizations to advise it in the determinations it makes on the reasonableness of proposed compensation and benefits arrangements. For the compensation of other officers and key employees, the community hospice, inc. Has a process for determining compensation which includes the following: compensation is reviewed by an independent compensation consultant who reviews the salaries to ensure they are within market and market competitive. This is done on an annual basis, reviewed by either the organization's or a related organization's compensation committee and communicated to the other officers and key employees.”

“The community hospice, inc. Is a subsidiary organization in the trinity health system. Trinity health makes certain of its key documents available to the public on its website, www.trinity-health.org, in the "about us" section. In this section, the consolidated audited financial statements are publicly available. The community hospice, inc.'s governing documents and conflict of interest policy are available upon request.”

“Medical specialist fees: program service expenses 9,750. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,750. Consulting services: program service expenses 56,041. Management and general expenses 4,702. Fundraising expenses 0. Total expenses 60,743. Billing & collection services: program service expenses 988. Management and general expenses 83. Fundraising expenses 0. Total expenses 1,071. Reference lab: program service expenses 73,250. Management and general expenses 0. Fundraising expenses 0. Total expenses 73,250. Other purchased services: program service expenses 9,521,772. Management and general expenses 798,959. Fundraising expenses 0. Total expenses 10,320,731.”

“Equity transfers to/from affiliates -445,952.”

“The community hospice, inc.'s financial statements were included in the fy15 consolidated financial statements of trinity health, which were audited by an independent public accounting firm.”