2022-09-07T08:20:25-05:00 2021-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2021-01-01 310933339 HOSPICE OF DAYTON INC HOSP 9372564490 324 WILMINGTON AVENUE DAYTON OH 45420 ROBERT MORRIS CFO 9372564490 2022-08-30 1 ROBERT MORRIS 999009999 AMY CIMINELLO P00796388 6148493000 2022-08-30 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z KIM VESEY 324 WILMINGTON AVENUE DAYTON OH 45420 74660154 0 X WWW.HOSPICEOFDATYON.ORG X 1978 OH TO PROVIDE HOSPICE AND PALLIATIVE CARE FOR THE TERMINALLY ILL AND SUPPORT FOR THEIR FAMILIES. 11 11 935 631 0 0 6970410 2277328 72404492 70306657 395543 1849985 150462 186516 79920907 74620486 0 0 0 0 48375034 49428188 0 0 14148 29470481 28844488 77845515 78272676 2075392 -3652190 125883239 116257424 90033708 86773812 35849531 29483612 X THE HOSPICE OF DAYTON, INC. IS COMMITTED TO MAKING QUALITY HOSPICE CARE AVAILABLE AND ACCESSIBLE TO TERMINALLY ILL PERSONS AND THEIR FAMILIES, REGARDLESS OF ABILITY TO PAY, AND IN A MANNER CONSISTENT WITH THE HIGHEST HOSPICE STANDARDS. OUR COMMITMENT TO THE HOSPICE PHILOSOPHY OF CARE INCLUDES A COMPASSIONATE STAFF PLEDGED TO CONTINUOUSLY IMPROVE AND ENHANCE THE CARE WE PROVIDE, RESPECT THE PATIENTS' CHOICES OF CARE, RESPOND TO CHANGING COMMUNITY NEEDS, AND SERVE AS A RESOURCE TO OTHERS FOR IMPROVING THE AVAILABILITY OF QUALITY HOSPICE CARE. 0 0 61473849 0 70420658 COORDINATES A PROGRAM OF HOME, OUTPATIENTS, AND INPATIENT HOSPICE CARE THAT PROVIDES PALLIATIVE CARE, SUPPORTIVE MEDICAL SERVICES, AND OTHER SUPPORT SERVICES TO TERMINALLY ILL PERSONS AND THEIR FAMILIES, REGARDLESS OF ABILITY TO PAY. 61473849 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 935 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X ROBERT MORRIS 9372569507 7575 PARAGON ROAD DAYTON OH 45459 KENT ANDERSON PRESIDENT & CEO - OHI 2.00 58.00 X 0 670685 59948 ANTHONY EVANS PRESIDENT, PURE HEALTHCARE 40.00 0.00 X 395623 0 55402 JOHN AHERN VP OF MEDICAL CARE/MEDICAL DIRECTOR 40.00 0.00 X 314720 0 28557 RANAPREET PATEL TEAM PHYSICIAN 40.00 0.00 X 326876 0 12364 WENDY SCHMITZ TEAM PHYSICIAN 40.00 0.00 X 297408 0 37074 ALI JAFFERY TEAM PHYSICIAN 40.00 0.00 X 280029 0 33379 CALVIN ROBINSON CHIEF FINANCIAL OFFICER - PART YEAR 2.00 38.00 X 0 274825 17965 ANNA RYMER PHYSICIAN MANAGER, PALLIAT 40.00 0.00 X 241675 0 39473 KIM VESEY GENERAL MANAGER/EXECUTIVE 40.00 0.00 X 242146 0 37752 RICHARD GREENO TEAM PHYSICIAN 40.00 0.00 X 213476 0 36374 REBECCA BLEDSOE VP OF PHARMACEUTICAL CARE 40.00 0.00 X 174098 0 38843 YVONNE TURNER VICE PRESIDENT OF CLINICAL 40.00 0.00 X 170299 0 39408 ROBERT MORRIS CHIEF FINANCIAL OFFICER 2.00 38.00 X 0 173853 20339 THOMAS MANN CHAIR 3.00 5.00 X X 0 0 0 PETE HALEY VICE CHAIR 2.00 4.00 X X 0 0 0 TONI SPRINKEL TREASURER 2.00 2.00 X X 0 0 0 PEGGY MARK SECRETARY 2.00 2.00 X X 0 0 0 GARY LEROY MD BOARD MEMBER 2.00 2.00 X 0 0 0 GREG TOMAN BOARD MEMBER 2.00 0.00 X 0 0 0 JON LARRABEE BOARD MEMBER 2.00 0.00 X 0 0 0 LINDSAY JOHNSON BOARD MEMBER 2.00 0.00 X 0 0 0 RATNA PALAKODETI BOARD MEMBER 2.00 0.00 X 0 0 0 LUIS CHANAGA BOARD MEMBER 2.00 0.00 X 0 0 0 LISA HANUAER EMERITUS STATUS 2.00 0.00 X 0 0 0 2656350 1119363 456878 26 0 1 0 0 2190000 87328 2277328 PATIENT SERVICE REVENUE 624100 70306657 70306657 70306657 442052 442052 1447601 0 39668 1447601 -39668 1407933 1407933 CLINICAL EDUCATION SERVICES 900099 114001 114001 CAFETERIA REVENUE 722514 47341 47341 SUBWAY PROPERTY 532000 18516 18516 6658 6658 186516 74620486 70420658 0 1922500 1859207 1859207 36552781 34797284 1755497 1318475 1277419 41056 6981930 6594460 387470 2715795 2662029 53766 134947 529 134418 5048 2250 2798 168080 168080 1124303 1121275 3028 399259 10590 388669 1050801 321193 720299 9309 287141 95355 191786 2108820 1319058 789762 1126907 1042833 84074 314579 139327 170413 4839 711462 115 711347 2787408 2560963 226445 264534 264534 ALLOCATED COSTS 8739910 8739910 MEDICAL SUPPLIES 5410510 5410510 PATIENT SERVICE 1978988 1978988 ROOM & BOARD 1684534 1684534 547257 455137 92120 78272676 61473849 16784679 14148 2585404 740960 10504384 8038130 134656 627692 433741 67884151 27269786 40452336 40614365 20294042 22633180 2284743 524347 49134638 43138045 125883239 116257424 6496252 4952524 16883221 6151999 15320474 15331401 10562187 51333761 49775701 90033708 86773812 X 35849531 29483612 35849531 29483612 125883239 116257424 X -3652190 463027 -3176756 X X 0 1 X 1 1 1 X 1922783 2635729 2124745 6970410 2277328 15930995 60493353 63812725 67628967 72404532 70420658 334760235 62416136 66448454 69753712 79374942 72697986 350691230 0 0 0 350691230 510392 1124728 292624 307158 442052 2676954 510392 1124728 292624 307158 442052 2676954 174187 -126672 3531 150422 72515 273983 63100715 67446510 70049867 79832522 73212553 353642167 0.99170 0.99120 0.00760 0.00800 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 26594337 637541 3364796 1014692 218918 29363064 26320904 3926475 -773676 2717345 162021 26594337 24369051 3878398 1808135 118410 26320904 28829625 -730177 3730397 24369051 24949847 709925 3378753 208900 28829625 0.96220 0.03780 0.00000 0 1 1 1301208 1301208 48243315 19334048 28909267 201178 12038 189140 13292733 7248738 6043995 4845717 674962 4170755 40614365 RELATED PARTY RECEIVABLES 43128872 DEPOSITS 9173 43138045 RELATED PARTY PAYABLES 49775701 49775701 PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY A RELATED PARTY, OHIO'S HOSPICE FOUNDATION, AND ARE INTENTED TO FURTHER SUPPORT HOSPICE OF DAYTON AND ITS ACTIVITIES. 1 0 0 0 0 0 0 1 0 KENT ANDERSON PRESIDENT & CEO - OHI 0 456018 0 214667 0 0 0 32787 0 27161 0 730633 0 0 ANTHONY EVANS PRESIDENT, PURE HEALTHCARE 299760 0 95863 0 0 0 28228 0 27174 0 451025 0 0 0 JOHN AHERN VP OF MEDICAL CARE/MEDICAL DIRECTOR 297058 0 17662 0 0 0 9982 0 18575 0 343277 0 0 0 RANAPREET PATEL TEAM PHYSICIAN 271606 0 55270 0 0 0 12364 0 0 0 339240 0 0 0 WENDY SCHMITZ TEAM PHYSICIAN 283956 0 13452 0 0 0 14500 0 22574 0 334482 0 0 0 ALI JAFFERY TEAM PHYSICIAN 216129 0 63900 0 0 0 10257 0 23122 0 313408 0 0 0 CALVIN ROBINSON CHIEF FINANCIAL OFFICER - PART YEAR 0 194825 0 80000 0 0 0 4946 0 13019 0 292790 0 0 ANNA RYMER PHYSICIAN MANAGER, PALLIAT 234426 0 7249 0 0 0 12499 0 26974 0 281148 0 0 0 KIM VESEY GENERAL MANAGER/EXECUTIVE 222357 0 19789 0 0 0 26226 0 11526 0 279898 0 0 0 RICHARD GREENO TEAM PHYSICIAN 213476 0 0 0 0 0 8952 0 27422 0 249850 0 0 0 REBECCA BLEDSOE VP OF PHARMACEUTICAL CARE 162593 0 11505 0 0 0 12421 0 26422 0 212941 0 0 0 YVONNE TURNER VICE PRESIDENT OF CLINICAL 158267 0 12032 0 0 0 12048 0 27360 0 209707 0 0 0 ROBERT MORRIS CHIEF FINANCIAL OFFICER 0 168228 0 5625 0 0 0 5243 0 15096 0 194192 0 0 PART I, LINE 3 THE EXECUTIVE COMMITTEE OF THE OHI BOARD OF TRUSTEES UTILIZED LOCAL MARKET KNOWLEDGE, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE CEO. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE CEO UNDER GUIDELINES ESTABLISHED BY OHI AND AFFILIATE BOARDS OF TRUSTEES AS PART OF THE BUDGET PROCESS. PART I, LINE 4A CALVIN ROBINSON RECEIVED SEVERENCE PAYMENTS OF $115,885 DURING THE YEAR. PART I, LINE 7 THE BOARD OF DIRECTORS CONDUCTS AN ANNUAL PERFORMANCE REVIEW TO DETERMINE THE COMPENSATION AND BENEFITS OF THE CEO. IN ADDITION TO NORMAL COMPENSATION AND BENEFITS, THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS MAY ALSO AWARD BONUS COMPENSATION TO THE CEO BASED UPON THE ANNUAL PERFORMANCE REVIEW. THE CEO CONDUCTS AN ANNUAL PERFORMANCE REVIEW OF THE OTHER OFFICERS AND EMPLOYEES TO DETERMINE THEIR COMPENSATION AND BENEFITS. IN ADDITION TO NORMAL COMPENSATION AND BENEFITS, THE CEO, WITH THE APPROVAL OF THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, MAY ALSO AWARD BONUS COMPENSATION TO THE OTHER OFFICERS AND EMPLOYEES BASED UPON THEIR ANNUAL PERFORMANCE REVIEW. A COUNTY OF MONTGOMERY OHIO 316000172 2020-04-23 15636807 SEE PART VI 0 0 0 A 15636807 905815 230000 476671 13955864 68457 0 1 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 A 0 1 0 0 1 0 0 0 1 A 1 PART I, LINE A, (F) THE PROCEEDS OF THE SERIES 2020 BONDS WERE USED TO FINANCE THE ACQUISITION, CONSTRUCTION, IMPROVEMENT, RENOVATION AND/OR EQUIPPING OF THE FACILITIES KNOWN AS PURE HEALTHCARE. PART II, LINE 3 THE AMOUNT OF PROCEEDS OF THE ISSUE DIFFERS FROM THE ISSUE PRICE OF THE ISSUE AS A RESULT OF $1,286.19 OF INTEREST EARNINGS ON THE INVESTMENT OF BOND PROCEEDS. PART I AND II THE SERIES 2020 BONDS WERE ISSUED FOR THE BENEFIT OF OHIO'S HOSPICE, INC., THE HOSPICE OF DAYTON, INCORPORATED, PURE HEALTHCARE, LLC, HOSPICE OF MIAMI COUNTY, INC. AND LIFECARE HOSPICE. ONLY A PORTION OF THE PROCEEDS OF THE SERIES 2020 BONDS ARE ALLOCABLE TO PURE HEALTHCARE, LLC, A DISREGARDED ENTITY OF THE HOSPICE OF DAYTON INCORPORATED AND THE AMOUNTS IN PART I AND PART II LINES 1-15 REFLECT SUCH ALLOCATION. THE PORTION OF THE SERIES 2020 BONDS ALLOCABLE TO THE OTHER ENTITIES IS BEING REPORTED ON SCHEDULE K TO EACH OTHER ENTITY'S FORM 990. FORM 990, PART VI, SECTION A, LINE 6 OHIO'S HOSPICE, INC BECAME THE SOLE MEMBER OF HOSPICE OF DAYTON, INC WITH AN AFFILIATION AGREEMENT SIGNED IN JULY 2013. FORM 990, PART VI, SECTION A, LINE 7A OHIO'S HOSPICE INC. HAS THE POWER TO APPOINT THE BOARD OF DIRECTORS. THE BOARD SHALL RECOMMEND INDIVIDUALS TO FILL ANY OPENINGS. OHIO'S HOSPICE HAS THE RIGHT TO ELECT FROM THESE INDIVIDUALS OR OTHER INDIVIDUALS AT ITS DISCRETION. FORM 990, PART VI, SECTION A, LINE 7B OHIO'S HOSPICE INC. RETAINS THE POWER TO AMEND THE ARTICLES OF INCORPORATION, CODE OF REGULATIONS, ETC. OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND REVIEWED BY THE CFO PRIOR TO BEING FILED WITH THE INTERNAL REVENUE SERVICE. THE FORM 990 IS SENT VIA EMAIL TO THE FULL BOARD AND WILL BE REVIEWED IN SESSION BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AT THEIR NEXT MEETING. FORM 990, PART VI, SECTION B, LINE 12C IN THE EVENT ANY DIRECTOR, OFFICER OR EXECUTIVE OF THE ORGANIZATION SHALL HAVE ANY DIRECT OR INDIRECT INTEREST IN OR RELATIONSHIP WITH ANY INDIVIDUAL OR ORGANIZATION THAT PROPOSES TO ENTER INTO ANY TRANSACTION WITH THE ORGANIZATION FOR THE SALE, PURCHASE, LEASE OR RENTAL OF PROPERTY OR TO RENDER OR EMPLOY SERVICES, PERSONAL OR OTHERWISE, SUCH DIRECTOR, OFFICER OR EXECUTIVE SHALL FORTHWITH GIVE THE BOARD OF DIRECTORS, CHAIR OF THE BOARD OR PRESIDENT OF THE ORGANIZATION NOTICE OF SUCH INTEREST OR RELATIONSHIP AND SHALL THEREAFTER NOT BE COUNTED FOR THE PURPOSE OF DETERMINING A QUORUM AND SHALL REFRAIN FROM VOTING OR OTHERWISE ATTEMPTING TO AFFECT ITS DECISION TO PARTICIPATE IN SUCH TRANSACTION. IN THE EVENT THAT A CHALLENGE OR QUESTION IS RAISED WHETHER CONFLICT OR DUALITY OF INTEREST EXISTS, THE BOARD OR CHAIR OF THE BOARD OF THE ORGANIZATION SHALL DETERMINE THAT A DUALITY OF INTEREST EXISTS (BY A 2/3 VOTE OF THE BODY). MINUTES OF APPROPRIATE MEETINGS SHOULD REFLECT THAT SUCH DISCLOSURE WAS MADE, AND THAT SUCH DIRECTOR REMOVED HIMSELF/HERSELF FROM THE ROOM AND DID NOT PARTICIPATE IN THE FINAL DISCUSSION, AND WAS NOT COUNTED FOR THE PURPOSE OF DETERMINING A QUORUM.THE CONFLICT OF INTEREST STATEMENT SHALL BE REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF DIRECTORS, OFFICERS OR EXECUTIVES AND THAT ANY NEW DIRECTORS, OFFICERS OR EXECUTIVES BE ADVISED OF THE POLICY UPON UNDERTAKING THE DUTIES OF SUCH OFFICE. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE OHI BOARD OF TRUSTEES UTILIZED LOCAL MARKET KNOWLEDGE, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE CEO. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE CEO UNDER GUIDELINES ESTABLISHED BY OHI AND AFFILIATE BOARDS OF TRUSTEES AS PART OF THE BUDGET PROCESS. 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 WRITTEN REQUEST. FORM 990, PART XI, LINE 9: LOSS ON IMPAIRMENT OF INVESTMENT -3,176,756. PART XII LINE 2C OHI'S FINANCE COMMITTEE HAS RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT THIS PROCESS IS CONSISTENT WITH PRIOR YEAR. PURE HEALTHCARE LLC 7575 PARAGON ROAD DAYTON OH 45459 TO PROVIDE PALLIATIVE CARE PHYSICIANS & SUPPORT PERSONNEL OH -6553870 24165364 THE HOSPICE OF DAYTON INNOVATIVE CARE SOLUTIONS LLC 33 W FIRST STREET SUITE 600 DAYTON OH 45402 DURABLE MEDICAL EQUIPMENT AND TRANSPORTATION OH -658122 1094958 THE HOSPICE OF DAYTON THE COLLABORATIVE LABORATORY 7575 PARAGON ROAD DAYTON OH 45459 INVEST IN HEALTHCARE INNOVATIONS OH 0 0 THE HOSPICE OF DAYTON OHI HOSPICE INC 7575 PARAGON ROAD DAYTON OH 45459 371495725 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 HOSPICE OF CENTRAL OHIO 2269 CHERRY VALLEY ROAD NEWARK OH 43055 311059756 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 OHIO'S HOSPICE FOUNDATION 7575 PARAGON ROAD DAYTON OH 45459 311769696 TO PROVIDE FINANCIAL SUPPORT TO ITS PARENT, HOSPICE OF DAYTON OH 501(C)(3) LINE 12A, I HOSPICE OF DAYTON INC 1 HOSPICE OF MIAMI COUNTY INC 3230 N COUNTY RD 25A TROY OH 45373 311031277 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 LIFECARE HOSPICE 1900 AKRON ROAD WOOSTER OH 44691 341352875 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 OHIO'S HOSPICE INC 7575 PARAGON ROAD DAYTON OH 45459 463215586 TO PROVIDE MANAGEMENT SERVICES AS A SUPPORTING ORGANIZATION OH 501(C)(3) LINE 12A, I N/A 0 LOVING CARE HOSPICE PO BOX 445 LONDON OH 43140 311370625 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 10 OHIO'S HOSPICE INC 1 HOSPICE OF FAYETTE COUNTY 222 N OAKLAND AVE WASHINGTON COURTHOUSE OH 43160 311243376 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 NATIONAL HOSPICE COOPERATIVE 7575 PARAGON ROAD DAYTON OH 45459 832087147 BUSINESS SUPPORT OH N/A C 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 HOSPICE OF DAYTON FOUNDATION C 2190000 CASH VALUE