2022-10-21T12:22:42-05:00 2021-12-31 560574444 CHERRY BEKAERT LLP 1111 METROPOLITAN AVE STE 900 CHARLOTTE NC 28204 990 2021-01-01 561219017 HOSPICE & PALLIATIVE CARE CHARLOTTE REGION HOSP 7043750100 PO BOX 470408 CHARLOTTE NC 28247 PETER A BRUNNICK PRESIDENT & CEO 7043750100 2022-10-19 1 PETER BRUNNICK 999009999 AMANDA ADAMS P00748038 7043771678 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z PETER A BRUNNICK PO BOX 470408 CHARLOTTE NC 28247 75055311 0 X HPCCR.ORG X 1978 NC OPERATING SINCE 1978, HOSPICE & PALLIATIVE CARE CHARLOTTE REGION ("HPCCR") PROVIDES EXPERT END OF LIFE CARE, INCLUDING HOSPICE, PALLIATIVE MEDICINE, GRIEF SUPPORT, AND COMMUNITY EDUCATION. HPCCR IS COMMITTED TO OFFERING QUALITY OF LIFE TO PATIENTS AND FAMILIES IN OUR COMMUNITY WHO ARE COPING WITH TERMINAL ILLNESS. 18 18 639 291 0 0 3339164 2002713 66942845 70653659 827997 1044885 33390 -1626 71143396 73699631 0 0 0 0 40588392 40705252 0 0 628392 25706127 27924460 66294519 68629712 4848877 5069919 72726417 75544529 14145800 10315911 58580617 65228618 X OUR MISSION IS TO RELIEVE SUFFERING AND IMPROVE THE QUALITY AND DIGNITY OF LIFE THROUGH COMPASSIONATE HOSPICE CARE AT THE END OF LIFE, PALLIATIVE CARE FOR THOSE WITH ADVANCED ILLNESS, AND THROUGH COMMUNITY EDUCATION. 0 0 60369192 69603922 ADULT HOSPICE CARE SERVICES - HOSPICE CARE IS PROVIDED TO PATIENTS WHO ARE FACING ILLNESSES THAT NO LONGER RESPOND TO CURE-ORIENTED TREATMENT AND WHO HAVE A LIFE EXPECTANCY OF SIX MONTHS OR LESS. CARE IS PROVIDED IN ANY SETTING, INCLUDING THE PATIENT'S PRIVATE RESIDENCE, NURSING FACILITY, HOSPITAL, OR OUR OWN LEVINE & DICKSON HOSPICE HOUSES. AS A NOT-FOR-PROFIT ORGANIZATION, HOSPICE & PALLIATIVE CARE CHARLOTTE REGION PROVIDES SERVICES WITHOUT REGARD TO A PATIENT'S INSURANCE STATUS OR ABILITY TO PAY. THESE SERVICES INCLUDE NURSING CARE, PHYSICIAN VISITS, SOCIAL WORK, AND CHAPLAIN SERVICES. IN ADDITION, ANCILLARY SERVICES AND BEREAVEMENT SUPPORT ARE PROVIDED AFTER THE PATIENT'S DEATH. THE PRIMARY FOCUS OF HOSPICE & PALLIATIVE CARE CHARLOTTE REGION'S CARE IS TO IMPROVE THE QUALITY AND DIGNITY OF LIFE FOR THOSE WHO ARE FACING A LIFE THREATENING ILLNESS. 1899507 764864 PALLIATIVE MEDICINE CONSULTATION SERVICES - PALLIATIVE MEDICINE CONSULTATION SERVICES ENABLE PATIENTS WHO MAY NOT YET BE ELIGIBLE FOR COMPREHENSIVE HOSPICE SERVICES TO HAVE ACCESS TO PALLIATIVE MEDICINE CONSULTATIONS. HOSPICE & PALLIATIVE CARE CHARLOTTE REGION'S PRACTITIONERS OFFER EXPERTISE IN SYMPTOM MANAGEMENT AND OPTIONS FOR COUNSELING FOR THOSE WITH SERIOUS AND PROGRESSIVE ILLNESSES AND CONDITIONS - THESE SERVICES ARE OFFERED IN VARIOUS LOCATIONS INCLUDING HOSPITALS, NURSING HOMES, CLINICS, AND IN PATIENTS' PRIVATE RESIDENCES IN AN EFFORT TO ENHANCE QUALITY OF LIFE AND MAXIMIZE THE LIKELIHOOD OF GOOD RESPONSE TO DISEASE-SPECIFIC AND RESTORATIVE THERAPIES FOR CHRONICALLY ILL AND MEDICALLY FRAGILE PATIENTS.ALTHOUGH INADEQUATELY REIMBURSED, HPCCR HAS DEVELOPED THESE SERVICES IN FULFILLMENT OF ITS MISSION OF RELIEF OF SUFFERING AND IMPROVING QUALITY AND DIGNITY OF LIFE. 341751 284873 PEDIATRIC CARE (KIDS PATH) - KIDS PATH IS A UNIQUE PROGRAM FOR CHILDREN, RANGING FROM INFANTS TO EIGHTEEN YEARS OF AGE, AND THEIR FAMILIES FACING THE CHALLENGES OF COPING WITH A SERIOUS PROGRESSIVE CONDITION. OUR PEDIATRIC TEAM OFFERS PHYSICAL, EMOTIONAL, AND SPIRITUAL CARE WITH A GOAL OF ENHANCING THE QUALITY OF LIFE FOR TERMINALLY ILL CHILDREN AND TEENS, AND THOSE WHO SHARE THEIR LIVES. HOSPICE & PALLIATIVE CARE CHARLOTTE REGION'S PEDIATRIC SERVICES ALSO INCLUDE GRIEF SERVICES FOR CHILDREN AND THEIR FAMILIES THROUGH CHAMELEON'S JOURNEY OVERNIGHT AND DAY CAMPS AND IN-SCHOOL GRIEF PROGRAMS. HOSPICE & PALLIATIVE CARE CHARLOTTE REGION HAS THE HONOR OF TOUCHING THE LIVES OF HUNDREDS OF GRIEVING YOUTH AND THEIR PARENT-GUARDIANS. 62610450 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 193 0 1 639 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 X 18 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC SC X PETER A BRUNNICK 7043750100 PO BOX 470408 CHARLOTTE NC 28247 LAURA ENGEL CHAIR 1.00 2.00 X X 0 0 0 JANE B NEESE PHD RN PAST BOARD CHAIR 1.00 2.00 X X 0 0 0 JOHN A MORRICE SECRETARY 1.00 2.00 X X 0 0 0 MICHAEL A MCNAMARA TREASURER 1.00 2.00 X X 0 0 0 GEORGE MACBAIN IV VICE CHAIR 1.00 2.00 X X 0 0 0 JEFFREY G GORE VICE CHAIR 1.00 2.00 X X 0 0 0 GREGORY R KILPATRICK VICE CHAIR 1.00 2.00 X X 0 0 0 LARRY BREHMER DIRECTOR 1.00 2.00 X 0 0 0 HEATHER G CARSON DIRECTOR 1.00 2.00 X 0 0 0 PATRICK FLETCHER DIRECTOR 1.00 2.00 X 0 0 0 COLLIE LEHN DIRECTOR 1.00 2.00 X 0 0 0 BRYAN R MIDURA DIRECTOR 1.00 2.00 X 0 0 0 GREGORY GRIER DIRECTOR 1.00 2.00 X 0 0 0 DAVID H JONES DIRECTOR 1.00 2.00 X 0 0 0 MEREDITH PINSON DIRECTOR 1.00 2.00 X 0 0 0 KENNETH W POE DIRECTOR 1.00 2.00 X 0 0 0 ALAN R THALINGER MD DIRECTOR 1.00 2.00 X 0 0 0 JOSEPH TYSINGER DIRECTOR 1.00 2.00 X 0 0 0 PETER BRUNNICK PRESIDENT & CEO 40.00 2.00 X 621964 0 13980 TODD FONTENOT CHIEF FINANCIAL OFFICER 40.00 2.00 X 314232 0 24565 PETE DAVIES CIO 40.00 2.00 X 185302 0 23489 JESSICA FOX CHIEF MEDICAL OFFICER 40.00 2.00 X 327246 0 13179 MICHAEL BOLEWITZ CHIEF OPERATING OFFICER 40.00 2.00 X 346714 0 0 ROBERT SMITH MEDICAL OFFICER 40.00 2.00 X 303618 0 0 CHARLENE KNIGHT PHYSICIAN 40.00 0.00 X 222010 0 14728 STEPHANIE CONNOLLY VP BUSINESS DEVELOPMENT 40.00 0.00 X 182892 0 10337 RONAK JASWANT SHAH PHYSICIAN 40.00 0.00 X 228909 0 10888 CYNTHIA TILLEY VP HUMAN RESOURCES 40.00 0.00 X 190925 0 27315 MRINALINI JOSHI MEDICAL DIRECTOR 40.00 0.00 X 173666 0 0 3097478 0 138481 45 0 1 0 MCGUIREWOODS LLP 201 N TRYON STREET 3000 CHARLOTTE NC 28202 LEGAL SERVICES 161527 PAYCOM 7501 W MEMORIAL ROAD OKLAHOMA CITY OK 73142 PAYROLL PROCESSING 145463 2 327083 284134 1391496 40499 2002713 PATIENT SERVICE REVENUE, NET 623000 70653659 70653659 70653659 472372 472372 3500 0 3500 3500 3500 1314607 560908 1091500 211502 223107 349406 572513 572513 45352 327083 52678 -7326 -7326 2200 2200 2200 73699631 70653659 0 1043259 2174290 644044 1530246 31382814 29548588 1451973 382253 317256 279845 31416 5995 4863733 4432645 391261 39827 1967159 1758269 185597 23293 91832 91832 958682 220815 714340 23527 61681 61681 975597 827372 111731 36494 1106169 949465 138674 18030 1026826 901123 118392 7311 919880 877052 40716 2112 10626 10626 1439233 1113772 285981 39480 176968 118570 51685 6713 PATIENT ANCILLARY EXPEN 19841985 19841985 BAD DEBT 751068 751068 EVENT EXPENSES 26920 7034 1136 18750 536993 328177 184209 24607 68629712 62610450 5390870 628392 2839606 8586235 8682823 3410373 489827 202520 8722806 7404562 526582 486427 34095389 11729486 23982017 22365903 20641986 26061686 2630134 490472 249846 249846 3960790 6286505 72726417 75544529 6743885 6038936 2103956 0 2305876 3010741 1632936 45306 1359147 1220928 14145800 10315911 X 57857918 64457873 722699 770745 58580617 65228618 72726417 75544529 5069919 1578082 0 X 0 1 X 1 0 X 2503255 2653217 2685871 3339164 2002713 13184220 2503255 2653217 2685871 3339164 2002713 13184220 1674240 11509980 204879 274442 481528 510524 475872 1947245 55178 12685 12561 80424 350116 11022 13939 14829 2200 392106 15603995 304861371 0.73760 0.72660 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2017 AMOUNT: $ 350,116. 2018 AMOUNT: $ 11,022. 2019 AMOUNT: $ 13,939. 2020 AMOUNT: $ 14,829. 2021 AMOUNT: $ 2,200. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 453017 55627 18171 490473 430077 41226 18286 453017 379769 68260 17952 430077 427804 -29175 18860 379769 391402 56586 20184 427804 0.00000 1.00000 0.00000 0 0 6453455 6453455 20352640 6308880 14043760 4523106 4191846 331260 2766188 1228760 1537428 22365903 DUE FROM AFFILIATE 6244037 SPLIT-INTEREST AGREEMENT 42468 6286505 LONG-TERM LEASE INCENTIVE OBLIGATION 1220928 1220928 X PART IV, LINE 2B: HPCCR PROVIDES CERTAIN EMPLOYEES THE OPPORTUNITY TO DEFER CURRENT COMPENSATION UNDER A 457(B) PLAN AND HOLDS THE DEFERRED AMOUNTS, PLUS ANY EARNINGS, FOR THEIR BENEFIT. DEFERRALS ARE ELECTIVE, AND PARTICIPANTS ARE REQUIRED TO COMMENCE BENEFIT PAYMENTS NO EARLIER THAN 61 DAYS FOLLOWING SEPARATION FROM SERVICE OR NO LATER THAN AGE 70.5. HPCCR'S POLICY IS TO RECOGNIZE THE FAIR VALUE OF INVESTMENTS HELD BY THE PLAN AND AN OFFSETTING LIABILITY UNTIL BENEFITS ARE DISTRIBUTED, AT WHICH TIME THE ASSET AND LIABILITY ARE REMOVED FROM HPCCR'S BOOKS. PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT CONSISTS OF FOUR INDIVIDUAL DONOR-RESTRICTED FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. THE ORGANIZATION HAS A POLICY OF APPROPRIATING FOR DISTRIBUTION (TO FUND CURRENT PROGRAMS) EACH YEAR 4.5% OF THE ENDOWMENT FUNDS' AVERAGE FAIR VALUE USING THE PRIOR THREE YEARS' VALUE AT THE CALENDAR YEAR-END PRECEDING THE FISCAL YEAR IN WHICH THE DISTRIBUTION IS PLANNED. THE PERCENTAGE REPORTED FOR PERMANENT ENDOWMENTS INCLUDES AMOUNTS THAT MUST BE MAINTAINED IN PERPETUITY AS WELL AS ACCUMULATED EARNINGS ON SUCH AMOUNTS THAT HAVE NOT YET BEEN APPROPRIATED FOR EXPENDITURE. PART X, LINE 2: MANAGEMENT HAS EVALUATED THE EFFECT OF FASB GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES IN AN ENTITY'S CONSOLIDATED FINANCIAL STATEMENTS BY PRESCRIBING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE ORGANIZATION'S POLICY IS TO RECORD A LIABILITY FOR ANY TAX POSITION TAKEN THAT IS BENEFICIAL TO THE ORGANIZATION, INCLUDING ANY RELATED INTEREST AND PENALTIES, WHEN IT IS MORE LIKELY THAN NOT THE POSITION TAKEN BY MANAGEMENT WITH RESPECT TO A TRANSACTION OR CLASS OF TRANSACTIONS WILL BE OVERTURNED BY A TAXING AUTHORITY UPON EXAMINATION. LKN REGATTA & PARTY 180315 180133 182 20112 SOUP ON SUNDAY 56020 45060 10960 10399 5 77470 43260 34210 22167 313805 268453 45352 52678 52678 -7326 X X X X 0 0 0 0 0 0 0 1 0 PETER BRUNNICK PRESIDENT & CEO 532954 0 87402 0 1608 0 0 0 13980 0 635944 0 0 0 MICHAEL BOLEWITZ CHIEF OPERATING OFFICER 303250 0 42000 0 1464 0 0 0 0 0 346714 0 0 0 JESSICA FOX CHIEF MEDICAL OFFICER 297820 0 28200 0 1226 0 0 0 13179 0 340425 0 0 0 TODD FONTENOT CHIEF FINANCIAL OFFICER 271590 0 41250 0 1392 0 0 0 24565 0 338797 0 0 0 ROBERT SMITH MEDICAL OFFICER 301481 0 1000 0 1137 0 0 0 0 0 303618 0 0 0 RONAK JASWANT SHAH PHYSICIAN 227909 0 1000 0 0 0 0 0 10888 0 239797 0 0 0 CHARLENE KNIGHT PHYSICIAN 221510 0 500 0 0 0 0 0 14728 0 236738 0 0 0 CYNTHIA TILLEY VP HUMAN RESOURCES 172567 0 17500 0 858 0 0 0 27315 0 218240 0 0 0 PETE DAVIES CIO 167981 0 16500 0 821 0 0 0 23489 0 208791 0 0 0 STEPHANIE CONNOLLY VP BUSINESS DEVELOPMENT 154200 0 28000 0 692 0 0 0 10337 0 193229 0 0 0 MRINALINI JOSHI MEDICAL DIRECTOR 172666 0 1000 0 0 0 0 0 0 0 173666 0 0 0 PART I, LINE 7 BONUS PAYMENTS ARE BASED ON THE EVALUATION OF THE YEAR'S ACCOMPLISHMENTS AND DEGREE OF COMPLETION OF A COMMONLY AGREED UPON SET OF GOALS. THE EVALUATION OF THE PRESIDENT & CEO'S PERFORMANCE AND DETERMINATION OF BONUS PAYMENT IS MADE BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE EVALUATION OF OTHER EXECUTIVES' PERFORMANCE AND DETERMINATION OF BONUS PAYMENT IS MADE BY THE PRESIDENT & CEO AND VP OF HR. X 4 7575 FMV X 3 10684 FMV X SUPPLIES 37 14157 FMV X AUCTION ITEMS 22 8083 FMV 0 1 0 FORM 990, PART VI, SECTION B, LINE 11B BEFORE SUBMITTING THE FORM 990 TO THE IRS, HOSPICE & PALLIATIVE CARE CHARLOTTE REGION EMAILS THE FINAL COPY OF THE FORM 990, INCLUDING ALL REQUIRED SCHEDULES, TO ALL VOTING MEMBERS OF THE GOVERNING BODY. THE FINANCE COMMITTEE MAKES A FULL REVIEW OF THE PREPARED RETURN. ANY COMMENTS OR QUESTIONS REGARDING THE RETURN ARE DISCUSSED AT THE NEXT SCHEDULED MEETING OF THE FULL BOARD. THE BOARD CHAIR, OR DESIGNEE, IS RESPONSIBLE FOR FACILITATING THE REVIEW. FORM 990, PART VI, SECTION B, LINE 12C WHEN A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED, THE CONFLICT WILL BE RESOLVED BY EITHER THE BOARD OF DIRECTOR'S EXECUTIVE COMMITTEE, WHEN A BOARD MEMBER IS INVOLVED, OR BY THE CEO AND THE VICE PRESIDENT OF HUMAN RESOURCES WHEN THE CONFLICT INVOLVES AN EMPLOYEE. IN EACH CASE, A MEETING WILL BE CALLED WITH THE INDIVIDUAL WITH THE POTENTIAL CONFLICT AND THE PARTIES WILL REACH A MUTUALLY AGREED UPON RESOLUTION. IF A CONFLICT OF INTEREST CANNOT BE RESOLVED TO THE SATISFACTION OF BOTH PARTIES, OR IF THERE IS A FAILURE TO COMPLY WITH THE CONFLICT OF INTEREST POLICY, THEN ACTIONS NECESSARY TO ELIMINATE THE CONFLICT OF INTEREST WILL BE TAKEN, UP TO AND INCLUDING THE RESIGNATION OF EITHER THE BOARD MEMBER OR EMPLOYEE. NO BOARD MEMBER OR COMMITTEE MEMBER WILL BE PERMITTED TO BE PRESENT FOR DISCUSSION OF OR BE PERMITTED TO VOTE ON ANY SPECIFIC ISSUE IN WHICH HE OR SHE HAS A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE REVIEW OF THE CEO AND OTHER EXECUTIVES ARE CONDUCTED ANNUALLY BY THE VP OF HR AND REVIEWED WITH THE CEO. REVIEW INCLUDES ANALYSIS OF SALARY DATA FROM FORM 990S OF COMPARABLE HOSPICE ORGANIZATIONS NATIONALLY AS WELL AS LOCAL LARGE NOT-FOR-PROFIT ENTITIES. DATA IS AGED TO CURRENT DATE. THE CEO SALARY COMPARISON INFORMATION IS SHARED BY VP OF HR TO THE EXECUTIVE COMMITTEE ANNUALLY AT THE TIME OF THE CEO'S PERFORMANCE EVALUATION. OTHER TOP SALARY REVIEWS ARE HANDLED ANNUALLY OR AS THE NEED ARISES BY THE CEO AND VP OF HR. THE DATA RELIED UPON AND THE COMPENSATION DECISION IS DOCUMENTED IN THE MINUTES TO THE EXECUTIVE COMMITTEE MEETING. FORM 990, PART VI, SECTION C, LINE 19 HOSPICE & PALLIATIVE CARE CHARLOTTE REGION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON A REQUEST BASIS. CAROLINAS HOSPICE & PALLIATIVE CARE LLC 7845 LITTLE AVENUE CHARLOTTE NC 28226 DORMANT NC 0 0 HOSPICE & PALLIATIVE CARE CHARLOTTE REGION CAROLINAS HOSPICE LLC 7845 LITTLE AVENUE CHARLOTTE NC 28226 DORMANT NC 0 0 HOSPICE & PALLIATIVE CARE CHARLOTTE REGION HOSPICE & PALLIATIVE CARE GASTON COUNTY LLC 7845 LITTLE AVENUE CHARLOTTE NC 28226 DORMANT NC 0 0 HOSPICE & PALLIATIVE CARE CHARLOTTE REGION HOSPICE & PALLIATIVE CARE UNION COUNTY LLC 7845 LITTLE AVENUE CHARLOTTE NC 28226 DORMANT NC 0 0 HOSPICE & PALLIATIVE CARE CHARLOTTE REGION PALLIATIVE MEDICINE CONSULTANTS LLC 7845 LITTLE AVENUE CHARLOTTE NC 28226 DORMANT NC 0 0 HOSPICE & PALLIATIVE CARE CHARLOTTE REGION HOSPICE OF LAURENS COUNTY PO BOX 470408 CHARLOTTE NC 28247 570843527 HOSPICE CARE SC 501(C)(3) LINE 7 HOSPICE AND PALLIATIVE CARE CARE CHARLOTTE REGION 1 HOSPICE OF CLEVELAND COUNTY 951 WENDOVER HEIGHTS DRIVE SHELBY NC 28150 561452373 HOSPICE CARE NC 501(C)(3) LINE 7 HOSPICE AND PALLIATIVE CARE CARE CHARLOTTE REGION 1 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 0 1 1 1 HOSPICE OF LAURENS COUNTY D 5186215 BOOK HOSPICE OF CLEVELAND COUNTY D 1057822 BOOK