2022-07-12T10:58:44-05:00 2021-12-31 411431613 BERGANKDV LTD PO BOX 2100 WATERLOO IA 507042100 990 2021-01-01 421154098 IOWA CITY HOSPICE INC IOWA 3193515665 1526 SYCAMORE STREET IOWA CITY IA 52240 KARLA KAMAL CEO 3196884212 2022-07-11 1 KARLA KAMAL 999009999 BRIAN ARONSON CPA P01425251 3192346885 2022-06-29 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z KARLA KAMAL 1526 SYCAMORE STREET IOWA CITY IA 52240 7789107 0 X WWW.IOWACITYHOSPICE.COM X 1980 IA PROVIDE INNOVATIVE CARE FOR PEOPLE WITH SERIOUS ADVANCED ILLNESSES AND END OF LIFE CONDITIONS. 4 4 83 50 0 0 1200117 1938196 6234262 5763934 31064 20973 -4895 -3383 7460548 7719720 0 0 0 0 4262347 4064337 0 0 90876 2531261 2516277 6793608 6580614 666940 1139106 5184182 6148159 1228888 797307 3955294 5350852 X TO PROVIDE COMPASSIONATE CARE FOR ANYONE IN OUR COMMUNITY AFFECTED BY SERIOUS ADVANCED ILLNESS AND END OF LIFE CONDITIONS. 0 0 4649582 5763934 THE ORGANIZATION PROVIDES SERVICES TO THOSE FACING A LIFE LIMITING ILLNESS. IN 2021, 607 NEW PATIENTS WERE SERVED IN OUR SEVEN COUNTY SERVICE AREA (CEDAR, IOWA, JOHNSON, LINN, LOUISA, MUSCATINE AND WASHINGTON COUNTIES) FOR A TOTAL OF 30,199 DAYS OF CARE. IN ADDITION TO OUR PROFESSIONAL STAFF, IOWA CITY HOSPICE VOLUNTEERS PROVIDE SERVICES THAT ARE AS VARIED AS THE PATIENTS, FAMILIES AND COMMUNITIES WE SERVE. PATIENT CARE VOLUNTEERS PROVIDE COMPANIONSHIP AND SUPPORT TO TERMINALLY ILL PATIENTS AND THEIR LOVED ONES. VOLUNTEERS PROVIDE MANY FORMS OF ASSISTANVE, AT ALL LEVELS OF SKILL. OUR 50 PATIENT CARE VOLUNTEERS PROVIDED 731 HOURS OF SUPPORTIVE SERVICES TO THOSE WE SERVED IN 2021. FOLLOWING A PATIENT'S DEATH, IOWA CITY HOSPICE BEREAVEMENT STAFF IS AVAILABLE TO SUPPORT FAMILY MEMBERS AND FRIENDS THROUGHOUT THE GRIEVING PROCESS. OUR SERVICES ARE ALSO AVAILABLE TO ANYONE WHO IS GRIEVING THE LOSS OF A LOVED ONE, REGARDLESS OF WHETHER THE PERSON WAS IN HOSPICE CARE. IOWA CITY HOSPICE OFFERS A VARIETY OF GRIEF SUPPORT SERVICES INCLUDING SUPPORT GROUPS, GRIEF EDUCATION, AND SPECIAL EVENTS. IOWA CITY HOSPICE STAFF MADE 90 HOME VISITS TO SURVIVORS AND 23 PEOPLE ATTENDED SUPPORT GROUPS, BEREAVEMENT LUNCHEONS AND OTHER EVENTS. 4649582 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 1 83 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 1 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KAREN DEGROOT 3196884212 1526 SYCAMORE STREET IOWA CITY IA 52240 KARLA KAMAL CEO 40.00 X X 118690 0 28171 JOSHUA CURPHY ARNP 40.00 X 114065 0 5432 KAREN DEGROOT DIRECTOR OF FINANCE 40.00 X 92763 0 21238 SARA KRIEGER COO 40.00 X X 93362 0 7445 KARA THOMA PSYCHOSOCIAL SERVICES MANAGER 40.00 X X 66703 0 32637 BEN EVANS TREASURER 1.00 X X 0 0 0 RANDY MCDONOUGH SECRETARY 1.00 X X 0 0 0 SUSAN STUTZEL FORMER TREASURER 1.00 X X 0 0 0 DIANA LUNDELL FORMER CHAIR 1.00 X X 0 0 0 DR STEPHEN SCHECKEL FORMER DIRECTOR 0.50 X 0 0 0 LATASHA DELOACH FORMER DIRECTOR 0.50 X 0 0 0 CYNTHIA SCHROCK FORMER DIRECTOR 0.50 X 0 0 0 CATHERINE PUGH FORMER DIRECTOR 0.50 X 0 0 0 BEN RUSSELL FORMER DIRECTOR 0.50 X 0 0 0 485583 0 94923 2 0 0 0 0 126581 1168103 643512 1938196 PATIENT CARE FEES 623990 5763934 5763934 5763934 2849 2849 84128 66004 18124 18124 18124 0 126581 3383 -3383 -3383 7719720 5763934 0 17590 262055 262055 3179647 2092553 1028518 58576 92601 62060 28804 1737 264862 177151 82752 4959 265172 162751 97865 4556 98764 98764 41880 41880 196581 193912 2669 11760 4649 7111 117687 74937 40490 2260 73403 51382 19819 2202 45487 45487 50423 50423 22224 22224 70178 70178 186147 130303 50260 5584 4158 4158 MEDICAL SUPPLIES & DRUG 851762 851762 PATIENT EXPENSES 606946 606946 DUES AND SUBSCRIPTIONS 43478 18689 15361 9428 BAD DEBT 42942 42942 52457 36720 14163 1574 6580614 4649582 1840156 90876 1128997 1001076 761746 983521 585076 35216 32901 1813530 877785 1121815 935745 1914633 2831615 5184182 6148159 524450 446581 244046 460392 350726 1228888 797307 X 2465341 3863214 1489953 1487638 3955294 5350852 5184182 6148159 X 1139106 256452 X 0 1 X 1 0 X 493152 505009 551703 1200117 1176450 3926431 493152 505009 551703 1200117 1176450 3926431 44182 3882249 13967 57458 6821 21634 2849 102729 3920 4060 3745 11725 4040885 29940688 0.96070 0.94720 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: FUNDRAISING INCOME - 2017 AMOUNT: $ 3,920. 2018 AMOUNT: $ 4,060. 2019 AMOUNT: $ 3,745. SCHEDULE A, PART VI, LIST OF UNUSUAL GRANTS: DESCRIPTION: BEQUEST DATE: 06/06/19 AMOUNT: 235760. DESCRIPTION: ERC DATE: 12/31/21 AMOUNT: 761746. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2145317 10175 287999 2443491 1890030 5313 249974 2145317 1578173 6870 304987 1890030 2102063 7895 -81785 450000 1578173 2190680 9160 310348 408125 2102063 0.11000 0.89000 1 0 143130 143130 1009289 487010 522279 661111 390775 270336 935745 BENEFICIAL INTEREST IN ASSETS HELD 2171056 DUE FROM RELATED PARTY 660559 2831615 CAPITAL LEASE OBLIGATIONS 350726 350726 PART V, LINE 4: THE ENDOWMENT FUND REPRESENTS AMOUNTS HELD BY A COMMUNITY FOUNDATION FOR THE ORGANIZATION. THE FUNDS CAN BE USED FOR OPERATING PURPOSES. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION AMENDED ITS BYLAWS TO ADD IOWA CARE COMMUNITY, INC. AS THE SOLE MEMBER, REDUCE THE NUMBER OF DIRECTORS FROM 15 TO 3, AND APPOINT THE CEO AS THE CHAIR OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A IOWA CARE COMMUNITY, INC. IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE CEO EMAILS THE FINAL COPY OF THE FORM 990 TO THE IOWA CARE COMMUNITY, INC. BOARD OF DIRECTORS TO REVIEW AND APPROVE BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS AND EMPLOYEES ARE REQUIRED TO DECLARE ALL CONFLICTS OF INTEREST AT LEAST ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S HUMAN RESOURCE SPECIALIST EVALUATES THE PAY RANGE OF THE CEO ANNUALLY BY USING COMPARATIVE DATA. PAY RANGES FOR THE ORGANIZATION ARE APPROVED CEO BY IOWA CARE COMMUNITY INC.'S BOARD OF DIRECTORS. THIS INFORMATION IS TAKEN INTO ACCOUNT WHEN THE EXECUTIVE DIRECTOR IS EVALUATED ANNUALLY BY THE ENTIRE BOARD OF DIRECTORS. ANY CHANGES TO THE COMPENSATION ARE APPROVED THROUGH THE BUDGETING PROCESS; REVIEWED AND APPROVED BY FIRST THE FINANCE COMMITTEE AND THEN THE BOARD OF DIRECTORS. COMMITTEE WORK HAPPENS THE SECOND HALF OF THE YEAR FOR IMPLEMENTATION IN THE SUBSEQUENT JANUARY. THE APPROVED PAY RATE IS THEN DOCUMENTED AND PLACED IN THE CEO'S PERSONNEL FILE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS AND FORM 990 ARE MADE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF BENEFICIAL INTEREST 256,452. VISTING NURSE ASSOCIATION OF JOHNSON COUNTY 1526 SYCAMORE STREET IOWA CITY IA 52240 420703760 NURSE ASSOCIATION IA 501(C)(3) LINE 7 IOWA CARE COMMUNITY INC 0 IOWA CARE COMMUNITY INC 1526 SYCAMORE STREET IOWA CITY IA 52240 863945811 SUPPORTING ORGANIZATION IA 501(C)(3) LINE 12C, III-FI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 VISITING NURSE ASSOCIATION OF JOHNSON COUNTY R 660563 ACTUAL EXPENSES