ROCK RIVER HOSPICE & HOME: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- ROCK RIVER HOSPICE & HOME (EIN 36-3378606)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2023-02-02
- IRS object ID
- 202330339349301713
- Schema version
- 2021v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-02-02T16:20:18-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 273238017 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LUCAS GROUP CPAS ADVISORS LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1617 TEMPLE LANE | AddressLine1Txt |
| City | ROCKFORD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61112 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363378606 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSPICE OF THE ROCK RIVER VALLEY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HOSP | BusinessNameControlTxt |
| Phone | 8156253858 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2706 AVENUE E | AddressLine1Txt |
| City | STERLING | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61081 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | EMILY TAYLOR | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 8156253858 | PhoneNum |
| Signature | 2023-02-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | EMILY | PersonFirstNm |
| Person Last | TAYLOR | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARK OLSON | PreparerPersonNm |
| PTIN | P00998832 | PTIN |
| Phone | 8159649955 | PhoneNum |
| Preparation | 2023-02-01 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-03-07 01:45:13Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROCK RIVER HOSPICE AND HOME | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | EMILY TAYLOR | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2706 AVENUE E | AddressLine1Txt |
| City | STERLING | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61081 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,993,629 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HOSPICEROCKRIVER.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1982 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | HOSPICE OF THE ROCK RIVER VALLEY AFFIRMS LIFE BY PROVIDING EXCEPTIONAL CARE AND SUPPORT TO THOSE TRANSITIONING THROUGH SERIOUS ILLNESS, DEATH, AND GRIEF. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 45 | TotalEmployeeCnt |
| Total Volunteers | 16 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $743,453 | PYContributionsGrantsAmt |
| CY Contributions Grants | $350,734 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,618,793 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,493,037 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,194 | PYInvestmentIncomeAmt |
| CY Investment Income | $11,712 | CYInvestmentIncomeAmt |
| PY Other Revenue | $64,083 | PYOtherRevenueAmt |
| CY Other Revenue | $100,624 | CYOtherRevenueAmt |
| PY Total Revenue | $2,431,523 | PYTotalRevenueAmt |
| CY Total Revenue | $1,956,107 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $318,656 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $310,015 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,373,857 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,321,643 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $31,668 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $525,493 | PYOtherExpensesAmt |
| CY Other Expenses | $622,037 | CYOtherExpensesAmt |
| PY Total Expenses | $2,218,006 | PYTotalExpensesAmt |
| CY Total Expenses | $2,253,695 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $213,517 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$297,588 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,126,933 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,910,915 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,172,061 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,074,784 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,954,872 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,836,131 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | HOSPICE IS THE CONCEPT AND PRACTICE OF COMPASSIONATE HEALTHCARE FOR PATIENTS AND FAMILIES DEALING WITH THE FINAL STAGES OF A LIFE LIMITING ILLNESS. WHEN A CURE IS NO LONGER A VIABLE OPTION, MUCH CAN STILL BE DONE. HOSPICE NEITHER PROLONGS LIFE NOR HASTENS DEATH. INSTEAD, HOSPICE FOCUSES ON QUALITY OF LIFE BY (1) KEEPING THE PATIENT COMFORTABLE IN HIS/HER OWN HOME OR PLACE OF RESIDENCE; (2) HELPING THE PATIENT AND FAMILY GAIN A SENSE OF CONTROL AND COMPETENCE; (3) PROMOTING THE PATIENT'S AND FAMILY'S DIGNITY, AUTONOMY, AND RIGHT TO PRIVACY; AND (4) ENHANCING THE TIME THE PATIENT AND FAMILY SHARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,608,779 | ExpenseAmt |
| Grant | $310,015 | GrantAmt |
| Revenue | $1,493,037 | RevenueAmt |
| Desc | HOSPICE CARE - TO PROVIDE FULLY-LICENSED HOSPICE CARE SERVICES FOR TERMINALLY ILL PATIENTS AND THEIR FAMILIES IN THE ROCK RIVER VALLEY. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $395 | ExpenseAmt |
| Desc | VOLUNTEER - VOLUNTEERS PROVIDE ONGOING SUPPORT AND REASSURANCE AS WELL AS A BROAD SPECTRUM OF SERVICES, INCLUDING DAILY HOUSEHOLD TASKS AND ACTIVITIES THAT CONTRIBUTE TO THE COMFORT OF THE PATIENT AND FAMILY. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $61,200 | ExpenseAmt |
| Desc | BEREAVEMENT - PROVIDE BEREAVEMENT SUPPORT TO FAMILIES TO HELP THEM WORK THROUGH THE ANXIETY, FEAR, DEPRESSION, SORROW AND ANGER THAT ARE OFTEN PRESENT AT THE TIME OF DEATH. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $71,942 | ExpenseAmt |
| Desc | SOCIAL SERVICES - PROVIDE SOCIAL SERVICES TO PATIENTS AND FAMILIES TO HELP ENSURE THEY ARE INFORMED OF OTHER SERVICES AVAILABLE TO HELP THEM THROUGH LOCAL AGENCIES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $71,942 | TotalOtherProgSrvcExpenseAmt |
| Total Program Service Expenses | $1,742,316 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 45 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JODIE LARSON | PersonNm |
| Phone | 8156253858 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2706 AVENUE E | AddressLine1Txt |
| City | STERLING | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61081 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|
| EMILY TAYLOR | ||||||
| EXECUTIVE DI | 45.00 | Yes (X) | $66,268 | $0 | $17,062 | |
| DIANE BAKER | ||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |
| JERRY BERANEK | ||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |
| KARLA BURN | ||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |
| MATT COLE | ||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |
| JIM EGGLESTON | ||||||
| VICE PRESIDE | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| PAM FLUCK | ||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |
| KRISTIE GEIL | ||||||
| PAST PRESIDE | 2.00 | $0 | $0 | $0 | Yes (X) | |
| DAVID OSBORN | ||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |
| PAT PETTENGER | ||||||
| TREASURER | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| CINDY WADSWORTH | ||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |
| NATHAN WELLS | ||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $66,268 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $17,062 | TotalOtherCompensationAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Government Grants | $33,085 | GovernmentGrantsAmt |
| All Other Contributions | $317,649 | AllOtherContributionsAmt |
| Noncash Contributions | $9,455 | NoncashContributionsAmt |
| Total Contributions | $350,734 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PROGRAM SERVICE REVENUE | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $1,493,037 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,493,037 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,493,037 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,712 | TotalRevenueColumnAmt |
| Exclusion | $11,712 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $138,146 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $37,522 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $100,624 | TotalRevenueColumnAmt |
| Exclusion | $100,624 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,956,107 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,493,037 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $112,336 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $310,015 | TotalAmt |
| Program Services | $310,015 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,268 | TotalAmt |
| Management And General | $66,268 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,004,670 | TotalAmt |
| Program Services | $918,231 | ProgramServicesAmt |
| Management And General | $86,439 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $250,705 | TotalAmt |
| Program Services | $214,956 | ProgramServicesAmt |
| Management And General | $35,749 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150 | TotalAmt |
| Management And General | $150 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,800 | TotalAmt |
| Management And General | $14,800 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,632 | TotalAmt |
| Program Services | $49,879 | ProgramServicesAmt |
| Management And General | $35,753 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,248 | TotalAmt |
| Management And General | $15,248 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,740 | TotalAmt |
| Program Services | $6,462 | ProgramServicesAmt |
| Management And General | $3,823 | ManagementAndGeneralAmt |
| Fundraising | $9,455 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,679 | TotalAmt |
| Program Services | $54,094 | ProgramServicesAmt |
| Management And General | $34,585 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,194 | TotalAmt |
| Management And General | $24,194 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,799 | TotalAmt |
| Management And General | $127,799 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $163,821 | TotalAmt |
| Program Services | $140,463 | ProgramServicesAmt |
| Management And General | $23,358 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,529 | TotalAmt |
| Program Services | $11,303 | ProgramServicesAmt |
| Management And General | $7,226 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | FundraisingFundraisingAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|---|
| COMMUNICATIONS | $31,179 | $27,962 | $3,217 | |
| PATIENT ROOM AND BOARD | $18,996 | $18,996 | ||
| MISCELLANEOUS | $13,270 | $8,951 | $4,319 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,253,695 | TotalAmt |
| Program Services | $1,742,316 | ProgramServicesAmt |
| Management And General | $479,711 | ManagementAndGeneralAmt |
| Fundraising | $31,668 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $439,957 | BOYAmt |
| EOY | $193,588 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,240 | BOYAmt |
| EOY | $175,044 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $946 | BOYAmt |
| EOY | $946 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,087,930 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $734,644 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,517,110 | BOYAmt |
| EOY | $3,353,286 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,680 | BOYAmt |
| EOY | $188,051 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,126,933 | BOYAmt |
| EOY | $3,910,915 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,308 | BOYAmt |
| EOY | $72,856 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,082,932 | BOYAmt |
| EOY | $1,998,468 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,821 | BOYAmt |
| EOY | $3,460 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,172,061 | BOYAmt |
| EOY | $2,074,784 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,931,743 | BOYAmt |
| EOY | $1,817,874 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,129 | BOYAmt |
| EOY | $18,257 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,954,872 | BOYAmt |
| EOY | $1,836,131 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,126,933 | BOYAmt |
| EOY | $3,910,915 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$297,588 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $20,753 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $158,094 | PriorPeriodAdjustmentsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $736,864 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $405,147 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $414,790 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $743,453 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $350,734 | CurrentTaxYearAmt |
| Total | $2,650,988 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,587,424 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,537,250 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,337,519 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,618,793 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,493,037 | CurrentTaxYearAmt |
| Total | $7,574,023 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,324,288 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,942,397 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,752,309 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,362,246 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,843,771 | CurrentTaxYearAmt |
| Total | $10,225,011 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $150,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $25,685 | CurrentTaxYearMinus1YearAmt |
| Total | $175,685 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $150,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $25,685 | CurrentTaxYearMinus1YearAmt |
| Total | $175,685 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $10,049,326 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $11,868 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,644 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $34,531 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,194 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,712 | CurrentTaxYearAmt |
| Total | $76,949 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $11,868 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,644 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $34,531 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,194 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,712 | CurrentTaxYearAmt |
| Total | $76,949 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $40,374 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $44,651 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $42,951 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $61,149 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $99,624 | CurrentTaxYearAmt |
| Total | $288,749 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $620 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus1 Year | $2,934 | CurrentTaxYearMinus1YearAmt |
| Total | $3,554 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,377,150 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,000,692 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,829,791 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,431,523 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,955,107 | CurrentTaxYearAmt |
| Total | $10,594,263 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.94860 | PublicSupportCY509Pct |
| Public Support PY509 | 0.95360 | PublicSupportPY509Pct |
| Investment Income CY | 0.01000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.01000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART III, LINE 12 | FormAndLineReferenceDesc |
| Explanation | 3,554 | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $245,000 | OtherCostOrOtherBasisAmt |
| Book Value | $245,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,292,550 | OtherCostOrOtherBasisAmt |
| Depreciation | $357,214 | DepreciationAmt |
| Book Value | $2,935,336 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $550,380 | OtherCostOrOtherBasisAmt |
| Depreciation | $377,430 | DepreciationAmt |
| Book Value | $172,950 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,353,286 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $1,976,860 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $20,753 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $20,753 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,956,107 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $1,956,107 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,253,695 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $2,253,695 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $2,253,695 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS ORGANIZED AS A NON-PROFIT CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION PAYS NO INCOME TAX ON ITS REALTED FUNCTION INCOME AS LONG AS IT STAYS WITHIN THE GUIDELINES OF SECTION 501(C)(3). THE ORGANIZATION IS SUBJECT TO INCOME TAX ON ITS "NON- RELATED" FUNCTION INCOME. FOR THE YEAR ENDING DECEMBER 31, 2021, THE ORGANIZATOIN DID NOT HAVE ANY "NON-RELATED" FUNCTION INCOME. ACCORDINGLY, THE ORGANIZATION HAD NO TAXABLE INCOME FOR THE YEAR. FORMS 990 FILED BY THE ORGANIZATION ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN. FORMS 990 FILED BY THE ORGANIZATION ARE NO LONGER SUBJECT TO EXAMINATION FOR TAX YEARS BEFORE DECEMBER 31, 2018. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA PROVIDE DETAILED GUIDANCE FOR THE FINANCIAL STATEMENT RECOGNITION, MEASUREMENT, AND DISCLOSURE OF UNCERATIN TAX POSITIONS RECOGNIZED IN AN ENTERPRISE'S FINANCIAL STATEMENTS. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE AN ENTITY TO RECOGNIZE THE FINANCIAL STATEMENT IMPACT OF A TAX POSITION WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | FESTIVAL OF TRE | Event1Nm |
| Gross Receipts Event1 | $108,319 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $108,319 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $23,936 | OtherDirectExpensesEvent1Amt |
| Event2 | GOLF OUTING | Event2Nm |
| Gross Receipts Event2 | $22,005 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $22,005 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $6,926 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $7,822 | GrossReceiptsOtherEventsAmt |
| Gross Revenue Other Events | $7,822 | GrossRevenueOtherEventsAmt |
| Oth Direct Expnss Other Events | $6,660 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $138,146 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $138,146 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $37,522 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $37,522 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $100,624 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | MEDS, EQUIP, ROOM & BOARD | GrantTypeTxt |
| Cash Grant | $310,015 | CashGrantAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE I, PAGE 1, PART I, LINE 2 | THE PATIENT MUST MEET THE CRITERIA DESIGNATED BY MEDICARE AND HAVE A TERMINAL DIAGNOSIS AND A LIFE EXPECTANCY OF 6 MONTHS OR LESS. A PHYSICIAN MUST CERTIFY THE PATIENT'S MEDICAL CONDITION AND WRITE THE ORDER TO ADMIT TO HOSPICE CARE. PATIENTS ARE NEVER DENIED ADMISSION UNLESS THEY DO NOT MEET THE CRITERIA OR THE PHYSICIAN DOES NOT CERTIFY THE DIAGNOSIS. THE ORGANIZATION MONITORS THEIR REFERRALS AND ADMISSIONS TO ASSURE EVERY REFERRAL RECEIVES PROMPT ATTENTION. |
| SCHEDULE I, PAGE 4, PART IV | THE ORGANIZATION PAYS FOR THE PATIENTS' MEDICATIONS, ROOM AND BOARD, AND BRINGS IN MEDICAL EQUIPMENT TO BE USED IN TEH PATIENTS' HOMES, AS DESIGNATED IN THE CARE PLAN BASED ON THE PATIENTS' NEEDS AND ORDERED BY A PHYSICIAN. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | HOSPICE IS THE CONCEPT AND PRACTICE OF COMPASSIONATE HEALTHCARE FOR PATIENTS AND FAMILIES DEALING WITH THE FINAL STAGES OF A LIFE LIMITING ILLNESS. WHEN A CURE IS NO LONGER A VIABLE OPTION, MUCH CAN STILL BE DONE. HOSPICE NEITHER PROLONGS LIFE NOR HASTENS DEATH. INSTEAD, HOSPICE FOCUSES ON QUALITY OF LIFE BY (1) KEEPING THE PATIENT COMFORTABLE IN HIS/HER OWN HOME OR PLACE OF RESIDENCE; (2) HELPING THE PATIENT AND FAMILY GAIN A SENSE OF CONTROL AND COMPETENCE; (3) PROMOTING THE PATIENT'S AND FAMILY'S DIGNITY, AUTONOMY, AND RIGHT TO PRIVACY; AND (4) ENHANCING THE TIME THE PATIENT AND FAMILY SHARE. |
| FORM 990, PAGE 2, PART III, LINE 4D | SOCIAL SERVICES - PROVIDE SOCIAL SERVICES TO PATIENTS AND FAMILIES TO HELP ENSURE THEY ARE INFORMED OF OTHER SERVICES AVAILABLE TO HELP THEM THROUGH LOCAL AGENCIES. |
| FORM 990, PAGE 6, PART VI, LINE 11B | ONCE THE 990 IS PREPARED BY AN ACCOUNTING FIRM, THE BOARD CHAIRMAN AND TREASURER REVIEW THE 990 COMPARING IT TO THE AUDITED F/S BEFORE SIGNATURE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | MEMBERS OF THE BOARD OF DIRECTORS AND HOSPICE STAFF MUST DISCLOSE PERSONAL OR FINANCIAL INTERESTS THAT COULD POTENTIALLY INTERFERE WITH THEIR DUTIES AND RESPONSIBILITIES TO HOSPICE OF THE ROCK RIVER VALLEY. DISCLOSURE FORMS ARE SUBMITTED AT THE TIME OF HIRE OR BOARD APPOINTMENT, ANNUALLY, AND WHENEVER A POTENTIAL CONFLICT ARISES. POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED BY THE BOARD OF DIRECTORS AND/OR BY THE EXECUTIVE DIRECTOR TO DETERMINE APPROPRIATE ACTION. INFORMATION REGARDING THE HOSPICE'S POLICY ON CONFLICTS OF INTEREST IS PROVIDED DURING ORIENTATION OF NEW STAFF, VOLUNTEERS, AND BOARD MEMBERS. FAILURE TO DISCLOSE EXISTING OR POTENTIAL CONFLICTS OF INTEREST IS GROUNDS FOR TERMINATION OF EMPLYOMENT OR BOARD APPOINTMENT. |
| FORM 990, PAGE 6, PART VI, LINE 15A | COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS. THE PERSONNEL COMMITTEE OF THE BOARD IS RESPONSIBLE FOR ASSESSING THE PERFORMANCE OF THE EXECUTIVE DIRECTOR AND COMMUNICATING THIS TO THE EXECUTIVE DIRECTOR. A SALARY RECOMMENDATION IS MADE TO THE BOARD AND THEY APPROVE IT. |
| FORM 990, PAGE 6, PART VI, LINE 19 | ALL OF THE ORGANIZATION'S FORMS AND GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT HOSPICE OF THE ROCK RIVER VALLEY DURING NORMAL BUSINESS HOURS. |
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