2023-11-01T08:32:11-05:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 901 N GLEBE ROAD SUITE 200 ARLINGTON VA 22203 990 2022-01-01 521114719 MONTGOMERY HOSPICE INC MONT 3019214400 1355 PICCARD DRIVE 100 ROCKVILLE MD 20850 ANN MITCHELL PRESIDENT & CHIEF EXECUTIVE OFFICER 3019214400 2023-10-30 1 ANN MITCHELL 999009999 0 ROBERT WILLIAMS P01345960 5712279500 2023-10-30 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z ANN MITCHELL 1355 PICCARD DRIVE 100 ROCKVILLE MD 20850 41629996 0 X WWW.MONTGOMERYHOSPICE.ORG X 1979 MD TO GENTLE THE JOURNEY THROUGH SERIOUS ILLNESS AND LOSS WITH SKILL AND COMPASSION. 17 16 321 280 0 0 12720722 8161442 20415350 21567440 1629869 347097 81010 66354 34846951 30142333 0 0 0 0 22168709 22225389 0 0 400501 6089989 7428500 28258698 29653889 6588253 488444 47002540 43787259 3811397 4203455 43191143 39583804 X TO GENTLE THE JOURNEY THROUGH SERIOUS ILLNESS AND LOSS WITH SKILL AND COMPASSION. TO BRING COMFORT BY PROVIDING COMPASSIONATE, PROFESSIONAL CARE TO COMMUNITY RESIDENTS WHO ARE FACING SERIOUS ILLNESS AND LOSS. TO PROVIDE DIGNITY FOR THE DYING AND UNCONDITIONAL COMPASSION, THROUGH DEDICATION AND COLLABORATION. 0 0 27115879 21567440 HOSPICE CARE: THE ORGANIZATION PROVIDES SPECIALIZED MEDICAL AND PSYCHOSOCIAL END-OF-LIFE CARE TO MONTGOMERY AND PRINCE GEORGE'S COUNTY, MARYLAND RESIDENTS OF ALL AGES WHO ARE LIVING WITH A LIFE LIMITING ILLNESS. PATIENTS (AND THEIR FAMILIES) ARE CARED FOR IN HOMES, EXTENDED CARE FACILITIES AND AT CASEY HOUSE, ITS INPATIENT HOSPICE FACILITY. TEAMS OF DOCTORS, NURSE PRACTITIONERS, NURSES, SPIRITUAL COUNSELORS, SOCIAL WORKERS, CERTIFIED NURSING ASSISTANTS, COMPLEMENTARY THERAPISTS, BEREAVEMENT COUNSELORS AND VOLUNTEERS WORK TOGETHER TO PROVIDE COMFORT CARE CUSTOMIZED FOR EACH PATIENT. MONTGOMERY HOSPICE INC. PROVIDES CONSULTATIVE PALLIATIVE CARE (PALLIATIVE MEDICINE CONSULTUNTS) PROVIDED BY DOCTORS, NURSE PRACTITIONORS, SOCIAL WORKERS AND SPRITUAL COUNSELORS. 27115879 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 20 0 1 321 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 16 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 MD X ABEBAW WUBIYE CONTROLLER 3019214400 1355 PICCARD DRIVE SUITE 100 ROCKVILLE MD 20850 ANN MITCHELL PRESIDENT & CEO 40.00 X X 304502 0 12808 DAVID SCHRIER CHIEF MEDICAL OFFICER 40.00 X 259765 0 21912 ANN LICHTENSTEIN ASSOCIATE MEDICAL OFFICER 40.00 X 227771 0 15080 GUY-EDGARD DOLTAIRE NURSE 40.00 X 209506 0 21820 MARLENE BRADFORD VP PHILANTHROPY 40.00 X 195948 0 10729 LISSA BERROA GARCIA PHYSICIAN 32.00 X 188204 0 8787 JENNIFER PLUDE CHEIF CLINICAL OFFICER 40.00 X 187257 0 3645 CORDELIA SANNOH NURSE 40.00 X 155520 0 10272 CORNELIA STRONGE VP OF QUALITY & COMPLIANCE 40.00 X 143901 0 17527 ABEBAW WUBIYE DIRECTOR OF FINANCE 40.00 X 100981 0 14007 DIANE K KUWAMURA ESQ CHAIRMAN 1.00 X X 0 0 0 DAWN E DOEBLER VICE CHAIRMAN 1.00 X X 0 0 0 REV JAMES E BONEY SECRETARY 1.00 X X 0 0 0 JUSTIN G REAVES TREASURER 1.00 X X 0 0 0 ELMA M LEVY IMMEDIATE PAST CHAIR 1.00 X X 0 0 0 BRADLEY H COLTON DIRECTOR (UNTIL 6/22) 1.00 X 0 0 0 SUSAN L GLOVER DIRECTOR (UNTIL 6/22) 1.00 X 0 0 0 SURESH K GUPTA MD DIRECTOR (UNTIL 6/22) 1.00 X 0 0 0 MIMI HASSANEIN DIRECTOR 1.00 X 0 0 0 DEBORAH PARHAM HOPSON PHD DIRECTOR 1.00 X 0 0 0 SHADY JADALI DIRECTOR 1.00 X 0 0 0 LYA M KARM MD DIRECTOR (UNTIL 6/22) 1.00 X X 0 0 0 NURNEY K MASON DIRECTOR 1.00 X 0 0 0 CYNTHIA A MESMER DIRECTOR (UNTIL 6/22) 1.00 X 0 0 0 FRANCISCO NUGENT DIRECTOR 1.00 X 0 0 0 CECILIA M OTERO DIRECTOR 1.00 X 0 0 0 CHRISTOPHER N PALMER DIRECTOR 1.00 X 0 0 0 MICHELLE Q PROFIT ESQ DIRECTOR 1.00 X 0 0 0 DEVANG SHAH DIRECTOR 1.00 X 0 0 0 SHOBHANA SHARMA DIRECTOR 1.00 X 0 0 0 JO ANNE ZUJEWSKI MD DIRECTOR 1.00 X 0 0 0 1973355 0 136587 48 0 1 0 KAISER PERMANETE 2101 E JEFFERSON ST BOX 6611 ROCKVILLE MD 20849 EMPLOYEE HEALTHCARE 1803415 MAXIM HEALTHCARE STAFFING 12558 COLLECTIONS CENTER DR CHICAGO IL 60693 STAFFING AGENCY 913098 JOERNS HEALTHCARE 2430 WHITEHALL PARK DR 100 CHARLOTTE NC 28273 MEDICAL SUPPLIES 612053 MEDLINE INDUSTRIES PO BOX 382075 PITTSBURGH PA 15251 MEDICAL SUPPLIES 568473 HOSPICE PHARMACY SOLUTIONS 2201 N CENTRAL EXPRESSWAY 250 RICHARDSON TX 75080 PHARMACY 424768 18 634806 7526636 466395 8161442 PATIENT SERVICE REVENUE 624100 21567440 21567440 21567440 779708 779708 11055052 11487663 -432611 -432611 -432611 MISC REVENUE 900099 66354 66354 66354 30142333 21567440 0 413451 1157993 867670 68437 221886 17744819 16223510 1398481 122828 176744 159344 17388 12 1812467 1632983 176075 3409 1333366 1198724 132761 1881 125045 111290 11254 2501 85641 76220 7708 1713 119770 119770 53767 53767 38963 38963 374444 341174 27221 6049 1055627 942516 92545 20566 546945 511408 29076 6461 13718 12209 1235 274 224342 218889 4462 991 126420 115756 8725 1939 PHARMACY & MEDICAL EQUI 2130002 2130002 COMMUNICATIONS 304707 293652 8575 2480 STAFF TRAINING & TRANSP 273262 272922 278 62 DUES & PUBLICATIONS 74869 68549 5171 1149 1880978 1846331 28347 6300 29653889 27115879 2137509 400501 3176532 672447 5326807 6322084 3421614 289248 5778217 4448229 134517 271916 5727737 2585846 3239823 3141891 25572810 27486922 352220 1154522 47002540 43787259 2892338 2743655 634806 1390400 284253 69400 3811397 4203455 X 33865515 31512149 9325628 8071655 43191143 39583804 47002540 43787259 X 488444 -4040783 -55000 X 0 1 X 1 0 X 4814109 3702218 12879860 12651515 8161442 42209144 27321360 24983462 23777662 20346018 21567440 117995942 32135469 28685680 36657522 32997533 29728882 160205086 11101498 1313232 3850000 16264730 0 11101498 1313232 3850000 16264730 143940356 588192 635334 713272 693684 779708 3410190 588192 635334 713272 693684 779708 3410190 112668 39472 112579 81010 66354 412083 32836329 29360486 37483373 33772227 30574944 164027359 0.87750 0.90220 0.02080 0.01920 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 25083774 2000000 -2532452 652292 23899030 18113610 5398000 2201406 629242 25083774 8805557 8100000 1647153 439100 18113610 7714442 100000 1195330 204215 8805557 7364859 1100030 -558627 191820 7714442 0.66390 0.33610 0 0 1082200 1082200 3304147 1664262 1639885 264187 186842 77345 123070 106430 16640 954133 628312 325821 3141891 CAPITAL LEASE OBLIGATION 69400 69400 X 25981780 -4040783 -4040783 30022563 119770 119770 30142333 29534119 0 29534119 119770 119770 29653889 PART V, LINE 4: THE ENDOWMENT FUNDS RESULTED FROM DONOR-RESTRICTED FUNDS FOR SUPPORT OF SEVERAL HOSPICE PROGRAM ACTIVITIES. CONTRIBUTIONS FROM MAJOR DONORS WERE RESTRICTED TO THE OPERATIONS, MAINTENANCE AND PATIENT CARE AT THE HOSPICE'S INPATIENT ACUTE CARE FACILITY. DONORS HAVE ALSO CONTRIBUTED TO THE FUNDING OF NURSING SERVICES PROVIDED AT THE INPATIENT HOSPICE. THE HOSPICE IN-HOME SERVICES ARE BEING SUPPORTED TO PROVIDE MEDICAL CARE SERVICES BY PHYSICIANS, NURSES, SOCIAL WORKERS AND HOSPICE AIDES. THE ENDOWMENTS ALSO SUPPORT CHARITY CARE AND THE UNCOMPENSATED SERVICES PROVIDED TO PATIENTS AND THEIR FAMILIES THROUGH BEREAVEMENT AND PASTORAL CARE SUPPORT. PART X, LINE 2: THE HOSPICE IS A TAX-EXEMPT ENTITY AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). THE IRC PROVIDES FOR TAXATION OF UNRELATED BUSINESS INCOME UNDER CERTAIN CIRCUMSTANCES. THE HOSPICE AND ITS SUBSIDIARY HAVE NO SIGNIFICANT UNRELATED BUSINESS INCOME; HOWEVER, SUCH STATUS IS SUBJECT TO FINAL DETERMINATION UPON EXAMINATION OF THE RELATED INCOME TAX RETURNS BY THE APPROPRIATE TAXING AUTHORITIES. X X X X X 0 0 0 0 0 0 0 0 0 ANN MITCHELL PRESIDENT & CEO 285384 0 19118 0 0 0 2962 0 9846 0 317310 0 0 0 DAVID SCHRIER CHIEF MEDICAL OFFICER 259765 0 0 0 0 0 0 0 21912 0 281677 0 0 0 ANN LICHTENSTEIN ASSOCIATE MEDICAL OFFICER 227771 0 0 0 0 0 2600 0 12480 0 242851 0 0 0 GUY-EDGARD DOLTAIRE NURSE 209506 0 0 0 0 0 1873 0 19947 0 231326 0 0 0 MARLENE BRADFORD VP PHILANTHROPY 185948 0 10000 0 0 0 1942 0 8787 0 206677 0 0 0 LISSA BERROA GARCIA PHYSICIAN 188204 0 0 0 0 0 0 0 8787 0 196991 0 0 0 JENNIFER PLUDE CHEIF CLINICAL OFFICER 187257 0 0 0 0 0 2073 0 1572 0 190902 0 0 0 CORDELIA SANNOH NURSE 155520 0 0 0 0 0 1604 0 8668 0 165792 0 0 0 CORNELIA STRONGE VP OF QUALITY & COMPLIANCE 137901 0 6000 0 0 0 1440 0 16087 0 161428 0 0 0 X 2 466395 PUBLISHED MARKET VALUE 0 0 0 PART I, COLUMN (B): TWO STOCK CONTRIBUTIONS WERE DONATED TO THE ORGANIZATION. ONE FROM JOSEPHINE ROSS SHEPARD TRUST IN THE AMOUNT OF $454,140 AND ONE FROM LOUISE GOODING IN THE AMOUNT OF $12,255. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE BOARD CHAIRPERSON, BOARD VICE CHAIRPERSON, BOARD SECRETARY, BOARD TREASURER, IMMEDIATE PAST CHAIRPERSON, AND THE PRESIDENT/CHIEF EXECUTIVE OFFICER (CEO), AND SUCH OTHER BOARD MEMBERS AS THE BOARD MAY DEEM APPROPRIATE. IT SHALL HAVE AUTHORITY TO CONDUCT ESSENTIAL HOSPICE BUSINESS BETWEEN BOARD MEETINGS, WHEN DELAY IN ACTION WOULD BE DETRIMENTAL TO THE HOSPICE, EXCEPT AS TO THE MATTERS LISTED BELOW AS WELL AS ANY OTHERS IMPOSED BY THE BOARD: 1. AMENDING THE ARTICLES OF INCORPORATION OR THE BYLAWS; 2. APPROVING A PLAN OF MERGER OR CONSOLIDATION; 3. FILLING VACANCIES ON THE HOSPICE BOARD OR REMOVING DIRECTORS OR OFFICERS FROM OFFICE; 4. APPOINTING OR REMOVING MEMBERS OF THE EXECUTIVE COMMITTEE; 5. APPOINTING OR REMOVING ANY OFFICER, THE MEDICAL DIRECTOR OR THE PRESIDENT/CEO, WITHOUT THE APPROVAL OF A MAJORITY OF THE BOARD; 6. APPROVING SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY OR ASSETS OF THE HOSPICE; OR 7. APPROVING VOLUNTARY DISSOLUTION OF THE HOSPICE OR REVOCATION OF VOLUNTARY DISSOLUTION PROCEEDINGS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE PRESIDENT AND MEMBERS OF THE FINANCE COMMITTEE BEFORE FILING. THE CHAIRPERSON GIVES A SUMMARY REPORT TO THE BOARD. BOARD MEMBERS CAN REQUEST A COPY OF THE FORM 990 RETURN. THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. FORM 990, PART VI, SECTION B, LINE 12C ALL INDIVIDUALS, UPON APPOINTMENT TO THE BOARD OF DIRECTORS, ANY BOARD DESIGNATED COMMITTEE, OR MONTGOMERY HOSPICE SENIOR STAFF SHALL BE REQUIRED TO EXAMINE AND SIGN AN INDIVIDUAL STATEMENT REGARDING CONFLICT OF INTEREST. IN THE EVENT A CONFLICT OF INTEREST OR POTENTIAL CONFLICT ARISES, THE CONFLICT OF INTEREST STATEMENT MUST PROMPTLY BE UPDATED AND BROUGHT TO THE ATTENTION OF THE PRESIDENT/CEO AND/OR CHAIRPERSON OF THE BOARD. IF THE MATTER CONCERNS A STAFF MEMBER, THE CHANGE SHOULD BE PRESENTED TO THE INDIVIDUAL'S SUPERVISOR. THE INDIVIDUAL BOARD MEMBERS, WHO HAVE A CONFLICT OF INTEREST WITH THEIR CURRENT BUSINESS RELATIONSHIP AND THE HOSPICE, WILL WITHDRAW THEMSELVES FROM BOARD DISCUSSIONS AND VOTING. FORM 990, PART VI, SECTION B, LINE 15A REVIEW FOR PRESIDENT/CEO IS CONDUCTED ANNUALLY BY CERTAIN MEMBERS OF THE EXECUTIVE COMMITTEE. MEMBERS MAY INTERVIEW PRESIDENT/CEO'S COLLEAGUES CONCERNING THEIR INTERACTION AND RELATIONSHIP WITH PRESIDENT/CEO. OTHER ANALYSIS INCLUDES A WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE EXECUTIVE COMMITTEE. KEY EMPLOYEES ARE GIVEN ANNUAL PERFORMANCE REVIEWS BY THEIR IMMEDIATE SUPERVISOR INCLUDING THE PRESIDENT/CEO. THE PERFORMANCE SUMMARY IS REVIEWED AND DISCUSSED WITH THE PRESIDENT/CEO. AN ANALYSIS OF COMPARABLE STAFF POSITIONS AND SIMILAR HOSPICE ORGANIZATIONS IS DONE BY HR DEPARTMENT. DATA FROM BENCHMARK REPORTS PROVIDED BY NHPCO ARE ALSO USED IN THIS ANALYSIS. THE MOST RECENT YEAR IN WHICH THE COMPENSATION PROCESS WAS REVIEWED WAS 2021. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE ALSO SUMMARIZED ON THE ORGANIZATION'S WEBSITE IN A WRITTEN ANNUAL REPORT. FORM 990, PART XI, LINE 9: LEASE STANDARD IMPLEMENTATION -55,000. PALLIATIVE MEDICINE CONSULTANTS OF GREATER WASHINGTON LLC 1355 PICCARD DR SUITE 100 ROCKVILLE MD 20850 522343635 TO OFFER A CONTINUUM OF CARE FOR PATIENTS WITH ADVANCED ILLNESS MD 287437 142157 MONTGOMERY HOSPICE INC