2023-11-15T10:05:54-06:00 2022-12-31 113266576 GRASSI & CO CPA'S PC 750 THIRD AVENUE 28TH FLOOR NEW YORK NY 10017 990 2022-01-01 843787656 CAPITAL CARING ADVANCED ILLNESS SERVICES INC CAPI 7035382065 3180 FAIRVIEW PARK DRIVE FALLS CHURCH VA 22042 JOSEPH MURRAY CFO 7035382065 2023-11-14 1 JOSEPH MURRAY 999009999 0 JAIME RAPPS P01462990 2126616166 2023-11-14 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z JOSEPH MURRAY 3180 FAIRVIEW PARK DRIVE FALLS CHURCH VA 22042 783740 0 X WWW.CAPITALCARING.ORG X 2019 VA THE MISSION OF CAPITAL CARING ADVANCED ILLNESS SERVICES, INC. IS TO PROVIDE TO PATIENTS, THEIR FAMILIES AND CAREGIVERS WITH COMPREHENSIVE, HIGH-QUALITY ADVANCED ILLNESS CARE, OVER TIME, AND ACROSS DIFFERENT SETTINGS OF CARE. ADVANCED ILLNESS CARE INCLUDES PALLATIVE AND PRIMARY CARE SERVICES, AS WELL AS MENTAL AND BEHAVIORAL HEALTH AND SOCIAL DETERMINANTS OF HEALTH SERVICES AND SUPPORTS. 10 9 17 9 0 0 32790 65802 653110 353825 0 0 0 364113 685900 783740 0 0 0 0 1187613 1394725 0 0 0 144804 119018 1332417 1513743 -646517 -730003 118634 206241 1746671 2564281 -1628037 -2358040 X THE MISSION OF CAPITAL CARING ADVANCED ILLNESS SERVICES, INC. IS TO PROVIDE HOME BASED PRIMARY CARE FOR THOSE FACING SERIOUD ILLNESS OR DISABILITY THROUGH DIRECT SUPPORT OF PATIENTS AND THEIR FAMILIES. 0 0 823623 254266 CAPITAL CARING ADVANCED ILLNESS SERVICES, INC. (CCAIS) PROVIDES PRIMARY CARE AT HOME SERVICES (PCH). UNDER PCH, CCAIS SERVES ELDERS, AGED 65 AND OLDER, WHO ARE HOMELIMITEDOR OTHERWISE BENEFIT FROM RECEIVING MOST OF THEIR CARE IN THE HOME DUE TO AN ADVANCED ILLNESS ORDISABILITY. THESE SERVICES HAVE BEEN IMPORTANT DURING THE COVID19 PANDEMIC AND PUBLIC HEALTH EMERGENCY. CCAIS PROVIDES SOCIAL WORK SUPPORT TO PATIENTS AND THEIR FAMILIES TO FIND RESOURCES, ASSIST WITH LIFE TRANSITIONS, AND PROVIDE COUNSELING AND CAREGIVER SUPPORT. CCAIS OFFERS 24/7 ONCALL MEDICAL STAFF BY PHONE WHO PROVIDE AFTERHOURS ADVICE TO PATIENTS AND FAMILIES. THE GOAL OF CCAIS IS TO PROVIDE PEACE OF MIND FOR PATIENTS AND FAMILIES AND ALLOW PATIENTS TO SAFELY AGE IN PLACE, REGARDLESS OF THE PATIENT'S ABILITY TO PAY. (CONTINUED ON SCHEDULE O)FOR THE YEAR ENDING DECEMBER 31, 2022, CCAIS SERVED 521 PATIENTS AND PERFORMED 3617 VISITS. 144681 99559 CAPITAL CARING ADVANCED ILLNESS SERVICES, INC. (CCAIS) PROVIDES MEDICAL DIRECTOR SUPPORT AT ASSISTED LIVING FACILITIES IN THE AREA TO PROVIDE CARE FOR THEIR RESIDENTS. FOR THE YEAR ENDED DECEMBER 31, 2022, CCAIS PROVIDED 817 HOURS OF MEDICAL DIRECTOR SERVICES TO THESE FACILITIES. 968304 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 17 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 DC MD VA X THE ORGANIZATION 7035316231 3180 FAIRVIEW PARK DRIVE SUITE 500 FALLS CHRUCH VA 22042 LYNN MENTO CEO 1.00 3.00 X X 0 0 0 REV DR TYRONE PITTS VICE CHAIR 1.00 3.00 X X 0 0 0 ANGELA WEBB INTERIM TREASURER 1.00 3.00 X X 0 0 0 TOM KOUTSOUMPAS PRESIDENT AND CEO 5.00 35.00 X X 0 496429 13544 JOHN ADAMS BOARD MEMBER 1.00 3.00 X 0 0 0 CLIFFORD BARNES BOARD MEMBER 1.00 3.00 X 0 0 0 JEANINE ENGLISH BOARD MEMBER 1.00 3.00 X 0 0 0 TOM NELSON BOARD MEMBER 1.00 3.00 X 0 0 0 BILL NOVELLI BOARD MEMBER 1.00 3.00 X 0 0 0 DIANE TY BOARD MEMBER 1.00 3.00 X 0 0 0 DR HEIDI YOUNG CHEIF MEDICAL OFFICER 35.00 5.00 X 290522 0 1363 290522 496429 14907 1 0 1 0 0 65802 65802 PATIENT SERVICE REVENU 621610 353825 353825 353825 OTHER OPERATING REVENU 900099 204363 204363 AIP PCC NON OPERATING 900099 159750 159750 364113 783740 353825 0 364113 290522 177218 113304 905088 639655 265433 1100 752 348 121286 82866 38420 76729 52423 24306 7156 7156 80802 80802 14105 6730 7375 1685 1685 BANK CHARGES 8295 8295 MEDICAL SUPPLIES 6975 6975 1513743 968304 545439 0 27293 78901 182665 12440 23576 118634 206241 949 4338 1745722 2559943 1746671 2564281 X -1628037 -2393025 34985 -1628037 -2358040 118634 206241 -730003 0 X X 0 1 X 1 0 X 153812 32790 65802 252404 239581 653110 458629 1351320 393393 685900 524431 1603724 0 0 0 1603724 364113 364113 393393 685900 888544 1967837 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2022 AMOUNT: $ 364,113. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 RECEIVABLE FROM RELATED PARTIES - CAPITAL PALATIVE CARE CONSULTANTS 12440 RECEIVABLE FROM RELATED PARTIES - CAPITAL CARING HOSPICE 10500 RECEIVABLE FROM RELATED PARTIES - CAPITAL CARING STAY AT HOME 636 23576 PAYABLE FROM RELATED PARTIES - CAPITAL HOSPICE 2559943 2559943 X PART X, LINE 2: THE CONSOLIDATED GROUP HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE CONSOLIDATED GROUP IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE CONSOLIDATED GROUP BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS PRIOR TO 2019. 0 1 0 0 0 0 0 1 0 TOM KOUTSOUMPAS PRESIDENT AND CEO 0 496429 0 0 0 0 0 11548 0 1996 0 509973 0 0 DR HEIDI YOUNG CHEIF MEDICAL OFFICER 290522 0 0 0 0 0 692 0 671 0 291885 0 0 0 PART I, LINE 4B DURING THE 2022 CALENDAR YEAR, THE COMPANY MAINTAINED A NON QUALIFIED 457(B) DEFERRED COMPENSATION PLAN FOR THE FOLLOWING EMPLOYEE: JOHN T. KOUTSOUMPAS DURING 2022, THE COMPANY MADE CONTRIBUTIONS TO THE PLAN TOTALING $10,400. IN 2022, THERE WERE NO DISBURSEMENTS FROM THE PLAN. PART I, LINE 5 COMPENSATION OF THE ORGANIZATION'S PRESIDENT AND CEO IS PAID BY CAPITAL HOSPICE, A RELATED TAX-EXEMPT ORGANIZATION. CAPITAL HOSPICE USES THE FOLLOWING METHODS TO DETERMINE THE PRESIDENT AND CEO'S COMPENSATION: COMPENSATION COMMITTEE-INDEPENDENT COMPENSATION CONSULTANT-FORM 990 OF OTHER ORGANIZATIONS-COMPENSATION SURVEY OR STUDY-APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 7 IF THE ORGANIZATION REACHES ITS BUDGETED AMOUNT OF NET INCOME FROM OPERATIONS FOR THE YEAR THEN EMPLOYEES ARE ELIGIBLE FOR A BONUS, WHICH IS BASED UPON KEY METRICS THAT ARE UNRELATED TO NET INCOME. FORM 990, PART VI, SECTION A, LINE 1A THERE SHALL BE AN EXECUTIVE COMMITTEE COMPOSED OF MEMBERS ELECTED FROM AMONG THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL HAVE POWERS AND DUTIES AS DELEGATED BY THE BOARD OF DIRECTORS AND CONSISTENT WITH THESE BY LAWS AND THE ACT. FORM 990, PART VI, SECTION A, LINE 6 CAPITAL CARING HEALTH, A VIRGINIA NOT FOR PROFIT CORPORATION ("MEMBER"), IS THE SOLE MEMBER OF THE CORPORATION. THE SOLE MEMBER SHALL HAVE AND EXERCISE CERTAIN RIGHTS AND CERTAIN POWERS RELATED TO THE CORPORATION SET FORTH IN THE CORPORATION'S BYLAWS. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE CORPORATION, CAPITAL CARING HEALTH, SHALL HAVE THE RIGHT TO APPOINT THE DIRECTORS OF THE CORPORATION FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER, THROUGH ITS CHAIR OR CEO, OR THROUGH ANY OTHER OFFICER OF THE MEMBER WHO IS AUTHORIZED BY THE BOARD OF DIRECTORS OF THE MEMBER (THE "MEMBER BOARD"), SHALL EXERCISE ALL AUTHORITY AT MEETINGS OF THE CORPORATION AS MEMBERS ARE AUTHORIZED TO EXERCISE. FORM 990, PART VI, SECTION B, LINE 11B THE 990 FOR CAPITAL CARING ADVANCED ILLNESS SERVICES IS REVIEWED BY THE CONTROLLER AND CHIEF FINANCIAL OFFICER. NEXT, THE 990 IS SENT TO ALL OF THE MEMBERS OF THE BOARD OF TRUSTEES INCLUDING THE PRESIDENT OF CAPITAL HOSPICE FOR THEIR REVIEW AND TO SOLICIT ANY COMMENTS OR QUESTIONS. THE FINANCE AUDIT INVESTMENT COMMITTEE (FAIC) OF THE BOARD MEETS TO REVIEW AND DISCUSS THE FORM 990 IN DETAIL. THIS MEETING IS OPEN TO ALL BOARD MEMBERS INCLUDING THE COMPENSATION AND OTHER COMMITTEE CHAIRS. AFTER THE FORM 990 HAS BEEN REVIEWED BY THE BOARD AND ANY COMMENTS OR QUESTIONS FROM BOARD MEMBERS HAVE BEEN RESPONDED TO, THE FORM 990 WILL BE FINALIZED, SIGNED BY THE PRESIDENT/CEO AND SUBSEQUENTLY FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMEBERS, OFFICERS AND KEY MANAGERS ARE REQUIRED TO REPORT ANY REAL OR POTENTIAL OR PERCEIVED CONFLICT OF INTEREST INVOLVING THEM OR ANOTHER PERSON BY PROMPTLY FILING A WRITTEN DISCLOSURE STATEMENT WITH THE PRESIDENT OR CHAIR OF THE BOARD OF TRUSTEES. THE PRESIDENT WILL REVIEW ALL SUCH STATEMENTS AND THE ANNUAL DISCLOSURE STATEMENTS AND DISCUSS WITH THE CHAIR OF THE BOARD ANY POTENTIAL CONFLICTS OF INTEREST. IF THE PRESIDENT AND THE CAHIR OF THE BOARD DETERMINE THAT A POTENTIAL CONFLICT EXISTS, THEN THE BOARD SHALL INFORM THE PERSON OF THE BASIS FOR SUCH BELIEF AND ALLOW THE PERSON TO EXPLAIN AND DISCLOSE . FOR ANY TRANSACTION/ARRANGEMENT DISCUSWSED DURING A BOARD MEETING FOR WHICH A CONFLICT OF INTEREST IS DEEMED TO EXIST, THE AFFECTED BOARD MEMBER SHALL NOT BE COUNTED IN DETERMINING THE QUOROM FOR THE MEETING BUT SHALL BE PERMITTED TO BRIEFLY STATE THEIR POSITION ON THE MATTER AND ANSWER PERTINENT QUESTIONS OF OTHER BOARD MEMBERS BEFORE VACATING THE GOVERNING BOARD. THE BAORD MEMBER SHALL LEAVE THE GOVERNING BAORD AND A MAJORITY OF THE REMAINING BOARD MEMBERS SHALL DETERMINE WHETHER TO UNDERTAKE SUCH TRANSACTION/ARRANGEMENT. IF THE BOARD DECIDES THAT A PERSON HAS FAILED TO DISCLOSE A CONFLICT OF INTEREST. THE BOAD SHALL TAKE CORRECTIVE ACTION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CAPITAL HOSPICE 3180 FAIRVIEW PARK DRIVE SUITE 500 FALLS CHURCH VA 220421206 541920770 DIRECT SUPPORT OF PATIENTS AND THEIR FAMILIES, PUBLIC EDUCATION AND ADVOCACY VA 501(C)(3) 10 CAPITAL CARING HEALTH 0 CAPITAL CARING HEALTH 3180 FAIRVIEW PARK DRIVE SUITE 500 FALLS CHURCH VA 220421206 843773372 MEDICAL SUPPORT SERVICES VA 501(C)(3) TYPE III-FI N/A 0 CAPITAL CARING STAY AT HOME SERVICES INC 3180 FAIRVIEW PARK DRIVE SUITE 500 FALLS CHURCH VA 220421206 843797085 AT HOME MEDICAL SERVICES VA 501(C)(3) 7 CAPITAL CARING HEALTH 0 ADVANCED ILLNESS PARTNERS LLC 3180 FAIRVIEW PARK DR FALLS CHURCH VA 22042 853613085 MEDICARE DIRECT CONTRACT MEDICAL SERVICES DE CAPITAL CARING ADVANCED ILLNESS SERVICES INC RELATED 419627 206241 0 1 0.14290 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 1