2021-11-09T13:23:23-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2020-01-01 561452373 HOSPICE OF CLEVELAND COUNTY INC HOSP 7044874677 951 WENDOVER HEIGHTS DRIVE SHELBY NC 281503565 PETER A BRUNNICK PRESIDENT/CEO 7043750100 2021-11-05 1 PETER BRUNNICK 999009999 JOHN NORMAN P01506766 7049985200 2021-11-05 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z HOSPICE CLEVELAND COUNTY PETER A BRUNNICK PO BOX 470408 CHARLOTTE NC 28247 27825719 0 X WWW.HOSPICECARES.CC X 1984 NC HOSPICE OF CLEVELAND COUNTY PROVIDES CARE AND SUPPORT TO PATIENTS WITH A LIFE-LIMITING ILLNESS. X 20 20 168 88 0 0 689043 469374 11874715 12325800 650327 1073366 27432 504651 13241517 14373191 0 22448342 0 0 6806390 7539391 0 0 9837 5016269 5656171 11822659 35643904 1418858 -21270713 29314481 12797729 1482386 1974122 27832095 10823607 HOSPICE CLEVELAND COUNTY EXISTS TO PROVIDE HIGH QUALITY SKILLED COMPASSIONATE CARE AND SUPPORT FOR INDIVIDUALS WITH A LIFE-LIMITING ILLNESS, THEIR FAMILIES, AND THE COMMUNITY, REGARDLESS OF THEIR ABILITY TO PAY. 0 0 30106055 22448342 9558646 HOSPICE CLEVELAND COUNTY PROVIDES COMPREHENSIVE END OF LIFE HEALTHCARE FOR TERMINALLY ILL PATIENTS AND THEIR FAMILIES DURING THE FINAL STAGES OF ILLNESS. DURING 2020, HOSPICE CLEVELAND COUNTY PROVIDED 47,488 DAYS OF HOMECARE INCLUDING 11,178 DAYS OF NURSING HOME AND HOSPITAL INPATIENT CARE. HOSPICE CLEVELAND COUNTY SERVED 825 HOMECARE PATIENTS IN 2020. HOSPICE CLEVELAND COUNTY'S INTERDISCIPLINARY TEAMS CONSISTING OF PHYSICIANS, NURSES, HOSPICES AIDES, SOCIAL WORKERS, AND OTHER SUPPORTIVE PERSONNEL PROVIDED OVER 21,516 VISITS DURING 2020. 2932088 2563026 HOSPICE CLEVELAND COUNTY OWNS AND OPERATES TWO HOSPICE HOUSES THAT PROVIDE HOSPICE INPATIENT AND RESIDENTIAL CARE FOR TERMINALLY ILL PATIENTS DURING THE FINAL STAGES OF ILLNESS. THE WENDOVER HOSPICE HOUSE HAS 16 BEDS AND THE TESTA FAMILY HOSPICE HOUSE HAS 8 BEDS. DURING 2020, HOSPICE CLEVELAND COUNTY PROVIDED 6,352 DAYS OF CARE IN THESE FACILITIES. HOSPICE CLEVELAND COUNTY SERVED 399 PATIENTS IN THE HOSPICE HOUSES IN 2020. 639306 204128 PALLIATIVE CARE CLEVELAND PROVIDES A PROGRAM OF PAIN CONTROL, SYMPTOM MANAGEMENT AND ASSISTANCE WITH DIFFICULT DECISION MAKING. DURING 2020, PALLIATIVE CARE CLEVELAND COUNTY SERVED 651 PATIENTS. 33677449 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 1 44 0 168 1 0 0 0 0 0 0 0 0 0 0 0 0 X 20 20 0 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X PETER A BRUNNICK 7043750100 PO BOX 470408 CHARLOTTE NC 28247 PETE MOORE CHAIRPERSON 1.00 X X 0 0 0 JENNIE LAMBERT VICE CHAIRPERSON 1.00 X X 0 0 0 GREG GRIER SECRETARY 1.00 X X 0 0 0 LARRY DOOLEY TREASURER 1.00 X X 0 0 0 JT SCRUGGS DIRECTOR 1.00 X 0 0 0 CHARLES WEBBER DIRECTOR 1.00 X 0 0 0 KYLE ALDINGER DIRECTOR 1.00 X 0 0 0 KEVIN BENNETT DIRECTOR 1.00 X 0 0 0 DONNA BERINGER DIRECTOR 1.00 X 0 0 0 JASON GLASS DIRECTOR 1.00 X 0 0 0 JONATHAN RHODES DIRECTOR 1.00 X 0 0 0 KATIE BORDERS DIRECTOR 1.00 X 0 0 0 SCOTT FRANKLIN DIRECTOR 1.00 X 0 0 0 ANDREA LESLIE-FITE DIRECTOR 1.00 X 0 0 0 JOSEPH TYSINGER DIRECTOR 1.00 X 0 0 0 JANE B NEESE PHD RN CHAIRPERSON 0.00 1.00 X X 0 0 0 LAURA ENGEL CHAIR ELECT 0.00 1.00 X X 0 0 0 JOHN A MORRICE SECRETARY 0.00 1.00 X X 0 0 0 MICHAEL A MCNAMARA TREASURER 0.00 1.00 X X 0 0 0 GEORGE MACBAIN IV VICE CHAIRPERSON 0.00 1.00 X X 0 0 0 JEFFREY G GORE VICE CHAIRPERSON 0.00 1.00 X X 0 0 0 GREGORY R KILPATRICK VICE CHAIRPERSON 0.00 1.00 X X 0 0 0 LARRY BREHMER DIRECTOR 0.00 1.00 X 0 0 0 HEATHER CARSON DIRECTOR 0.00 1.00 X 0 0 0 PATRICK FLETCHER DIRECTOR 0.00 1.00 X 0 0 0 COLLIE LEHN DIRECTOR 0.00 1.00 X 0 0 0 BRYAN R MIDURA DIRECTOR 0.00 1.00 X 0 0 0 ZVONIMIR MILAS DIRECTOR 0.00 1.00 X 0 0 0 DAVID H JONES DIRECTOR 0.00 1.00 X 0 0 0 MEREDITH PINSON DIRECTOR 0.00 1.00 X 0 0 0 KENNETH W POE DIRECTOR 0.00 1.00 X 0 0 0 ALAN R THALINGER MD DIRECTOR 0.00 1.00 X 0 0 0 CHRISTOPHER G ULLRICH MD DIRECTOR 0.00 1.00 X 0 0 0 MYRA MCGINNIS PRESIDENT 40.00 X 200853 0 18172 PETER BRUNNICK PRESIDENT & CEO 1.00 40.00 X 0 573312 18444 TODD FONTENOT CHIEF FINANCIAL OFFICER 1.00 40.00 X 0 242444 29952 MICHAEL BOLEWITZ CHIEF OPERATING OFFICER 1.00 40.00 X 0 321224 0 ROBERT SMITH MD MEDICAL DIRECTOR 1.00 40.00 X 0 311424 1083 JESSICA FOX DO HMDC CHIEF MEDICAL OFFICER 1.00 40.00 X 0 260591 18579 PETE DAVIES CHIEF INFORMATION OFFICER 1.00 40.00 X 0 170276 39453 JASON BEAM VP OF ADMIN SERVICES 40.00 X 104907 0 14215 PATRICIA MCMURRY VP OF ACCESS 40.00 X 106538 0 14265 ERIC PARKER NURSE PRACTITIONER 40.00 X 104992 0 14185 517290 1879271 168348 4 0 1 0 0 67410 19309 382655 166256 469374 GROSS PATIENT REVENUE 621610 12325800 12325800 12325800 345950 345950 14450 0 14450 14450 14450 14175075 13447659 727416 727416 727416 0 19309 4869 -4869 -4869 PROVIDER RELIEF FUNDS 900099 494577 494577 MISCELLANEOUS 900099 493 493 495070 14373191 12325800 0 1578017 22448342 22448342 200853 200853 6041729 5110447 923205 8077 149042 122065 26768 209 745356 607704 136664 988 402411 329575 72273 563 50844 50844 45997 45997 379621 379621 22389 22389 131216 58656 72560 110015 6959 103056 199442 84538 114904 116497 113747 2750 21937 11518 10419 425271 274543 150728 38207 12084 26123 PURCHASED SERVICES 2627350 2627350 SUPPLIES 888416 868942 19474 BAD DEBT EXPENSES 295077 295077 THRIFT STORE EXPENSES 252063 252063 51829 51829 35643904 33677449 1956618 9837 3760 4952 11660122 4422682 14833 12048 1141310 1376321 27858 24011 72838 59342 7283188 1188031 5316931 6095157 11011599 65230 803216 29314481 12797729 1100464 1469541 120628 381922 383953 1482386 1974122 X 27577829 10031052 254266 792555 27832095 10823607 29314481 12797729 X -21270713 -54055 4316280 X X 0 0 0 X 345339 517499 552491 697286 469374 2581989 345339 517499 552491 697286 469374 2581989 2581989 272029 246245 589801 665906 360400 2134381 349 12943 2994 1831 495070 513187 5229557 58879683 0.49370 0.54690 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1323 1323 0 PART II-B, LINE 1: THE ORGANIZATION BELONGS TO THE NATIONAL HOSPICE & PALLIATIVE CARE ORGANIZATION AND THE ASSOCIATION FOR HOME AND HOSPICE CARE OF NORTH CAROLINA. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS WAS USED FOR SPECIFIC LOBBYING PURPOSES. 317000 317000 4988470 12597 4975873 178000 1675 176325 1799718 1173759 625959 6095157 LEASE RECEIVABLES 774150 OTHER ASSETS 29066 803216 ESTIMATED THIRD PARTY LIABILITY 383953 383953 X 12668026 0 12668026 1705165 1705165 14373191 12648422 0 12648422 22995482 22995482 35643904 PART X, LINE 2: THE ORGANIZATION FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE IMPLEMENTATION OF THIS STANDARD HAD NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2020. PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER RESTRICTED CONTRIBUTIONS RECEIVED 5,032. BAD DEBT EXP 295,077. INTEREST INCOME 1,073,366. CONTRIBUTIONS, OTHER REVENUE 139,080. THRIFT STORE REVENUE 177,667. MISCELLANEOUS REVENUE 493. THRIFT STORE RENTAL 14,450. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXP 295,077. CONTRIBUTIONS PROVIDED TO OTHERS 19,675,745. CONTRIBUTION OF PROPERTY AND EQUIPMENT TO OTHERS 2,772,597. THRIFT STORE EXPENSES 252,063. HEARTS FOR HOSPICE 10543 10543 1688 LIGHTING THE WAY LUMINARY 6793 6793 2131 17336 17336 3819 3819 -3819 1 HOSPICE CLEVELAND COUNTY FOUNDATION 212 S WASHINGTON ST SHELBY NC 28150 850575028 501(C)(3) 19675745 2772597 FMV OF ASSETS AND REVALUATION OF PPE CASH, INVESTMENTS, AND FIXED ASSETS SEE PART IV 1 PART I, LINE 2: GENERALLY, THE ORGANIZATION ONLY PROVIDES GRANTS TO ORGANIZATIONS THAT SUPPORT SIMILAR ACTIVITIES AS THOSE CARRIED OUT BY THE ORGANIZATION. PART II - HOSPICE CLEVELAND COUNTY FOUNDATION THE MISSION OF THE FOUNDATION IS TO STRIVE TO MAINTAIN THE SUCCESS OF THE HOSPICE TRADITION IN CLEVELAND COUNTY BY SUPPORTING EFFORTS TO HELP PEOPLE LEAD HEALTHY, PRODUCTIVE LIVES AND EXPERIENCE PEACEFUL, DIGNIFIED DEATHS. WE SEEK TO ENSURE THAT ALL PEOPLE ESPECIALLY THOSE WITH THE FEWEST RESOURCES, HAVE ACCESS TO THE OPPORTUNITIES THEY NEED TO SUCCEED IN SCHOOL AND IN LIFE. 1 X X X X 0 0 0 0 0 0 0 0 0 PETER BRUNNICK PRESIDENT & CEO 0 490020 0 81684 0 1608 0 0 0 18444 0 591756 0 0 MICHAEL BOLEWITZ CHIEF OPERATING OFFICER 0 277886 0 42000 0 1338 0 0 0 0 0 321224 0 0 ROBERT SMITH MD MEDICAL DIRECTOR 0 294972 0 15000 0 1452 0 0 0 1083 0 312507 0 0 JESSICA FOX DO HMDC CHIEF MEDICAL OFFICER 0 232866 0 27500 0 225 0 0 0 18579 0 279170 0 0 TODD FONTENOT CHIEF FINANCIAL OFFICER 0 203466 0 38000 0 978 0 0 0 29952 0 272396 0 0 MYRA MCGINNIS PRESIDENT 171629 0 27640 0 1584 0 6063 0 12109 0 219025 0 0 0 PETE DAVIES CHIEF INFORMATION OFFICER 0 154508 0 15000 0 768 0 0 0 39453 0 209729 0 0 X 7376 SALES VALUE - FMV X 158880 SALES VALUE - FMV 0 0 0 CASH AND INVESTMENTS 2020-11-17 19675745 FMV AT TIME OF TRANSFER 850575028 HOSPICE CLEVELAND COUNTY FOUNDATION 212 S WASHINGTON ST SHELBY NC 28150 501(C)(3) PROPERTY AND EQUIPMENT 2020-11-17 2772597 REVALUATION AT TIME OF TRANSFER 850575028 HOSPICE CLEVELAND COUNTY FOUNDATION 212 S WASHINGTON ST SHELBY NC 28150 501(C)(3) 1 0 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: BOARD MEMBERS PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: ALL OF THE FORMER HOSPICE CLEVELAND COUNTY BOARD MEMBERS, WITH THE EXCEPTION OF ONE PERSON, BECAME BOARD MEMBERS OF THE HOSPICE OF CLEVELAND COUNTY FOUNDATION. FORM 990, PART VI, SECTION A, LINE 4 DURING THE YEAR ENDED DECEMBER 31, 2020, HOSPICE CLEVELAND COUNTY (HCC) ENTERED INTO AN AFFILIATION AGREEMENT WITH HOSPICE AND PALLIATIVE CARE CHARLOTTE REGION (HPCCR), A NORTH CAROLINA NOT-FOR-PROFIT NONSTOCK CORPORATION, TO FURTHER THE ORGANIZATIONS CHARITABLE PURPOSES TO PROVIDE A PROGRAM FOR HOSPICE, PALLIATIVE, AND SUPPORTING CARE FOR TERMINALLY ILL PATIENTS AND THEIR FAMILIES IN AND AROUND CLEVELAND COUNTY. NORTH CAROLINA. EFFECTIVE NOVEMBER 18. 2020, HPCCR BECAME HCC'S SOLE MEMBER. AS SOLE MEMBER OF HCC, HPCCR HAS THOSE RIGHTS AND POWERS PRESCRIBED BY LAW AND RIGHTS AND POWERS PROVIDED IN THE AMENDED AND RESTATED ARTICLES OF INCORPORATION AND THE AMENDED AND RESTATED BYLAWS OF HCC. THE FOLLOWING SIGNIFICANT CHANGES WERE MADE TO HCC'S ARTICLES OF INCORPORATION: -- ARTICLES OF INCORPORATION NAME HPCCR AS THE SOLE MEMBER OF HCC AND GIVES HPCCR THE RIGHT TO APPOINT HCC'S BOARD OF DIRECTORS. -- HPCCR BOARD IS AUTHORIZED TO EXERCISE ALL POWERS OVER HCC THAT WOULD OTHERWISE BE EXERCISED BY HCC'S BOARD OF DIRECTORS. THE FOLLOWING SIGIFICANT CHANGES WERE MADE TO HCC'S BYLAWS: -- ARTICLE III PURPOSE: PROVIDES SPECIFIC LANGUAGE REGARDING THE PURPOSE OF HCC -- ARTICLE IV: NAMES HPCCR AS THE SOLE MEMBER OF THE CORPORATION, WITH RIGHTS AS RESERVED IN HCC S ARTICLES AND BYLAWS -- ARTICLE V MEMBERSHIP MEETINGS: MEETINGS, INCLUDING ANNUAL MEETING, OCCUR IN ACCORDANCE WITH BYLAWS OF THE MEMBER -- FORM 990, PART VI, SECTION A, LINE 6 HOSPICE & PALLIATIVE CARE CHARLOTTE REGION IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A AS SOLE MEMBER OF THE ORGANIZATION, HOSPICE & PALLIATIVE CARE CHARLOTTE REGION HAS THE POWER TO SELECT ALL BOARD MEMBERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER OF THE ORGANIZATION, HOSPICE & PALLIATIVE CARE CHARLOTTE REGION RESERVES THE RIGHT TO APPROVE CERTAIN DECISIONS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION 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 DIRECTORS' EXECUTIVE COMMITTEE, WHEN A BOARD MEMBER IS INVOLVED, OR BY THE CEO, PRESIDENT, AND 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 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 KEY PERSONNEL OF THE ORGANIZATION, INCLUDING THE PRESIDENT/CEO, ARE SUBJECT TO THE COMPENSATION, CLASSIFICATION, AND ALL OTHER PERSONEL POLICIES OF THE ORGANIZATION'S SOLE MEMBER, HOSPICE & PALLIATIVE CARE CHARLOTTE REGION. 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 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AS REQUESTED. FORM 990, PART XI, LINE 9: CHANGE IN DISCOUNT FOR PLEDGES RECEIVABLE 215. CHANGE IN ENDOWMENT HELD BY OTHERS -14,090. TRANSFER OF SPENDABLE PORTION OF ENDOWMENT TO FOREVER FUND -10,028. NET ASSETS RELEASED FROM RESTRICTIONS FOR RESPITE CARE -4,863. GAIN/LOSS ON BENEFICIAL INTEREST -108,992. RESTRICTED LEASE CONTRIBUTION RECEIVED 811,418. NET ASSETS RELEASED FROM RESTRICTION FOR LEASE CONTRIBUTION -37,269. REVALUATION OF PROPERTY AND EQUIPMENT 3,889,015. CONTRIBUTION OF ENDOWMENT HELD BY THIRD PARTY PROVIDED TO OTHERS -209,126. FORM 990, PART XII, LINE 2C DURING THE YEAR, THE ORGANIZATION DID NOT CHANGE ITS PROCESS FOR OVERSEEING THE ANNUAL AUDIT OR THE PROCESS FOR SELECTING AN INDEPENDENT ACCOUNTANT TO PERFORM THE ANNUAL AUDIT. HOSPICE & PALLIATIVE CARE CHARLOTTE REGION PO BOX 470408 CHARLOTTE NC 28247 561219017 HEALTHCARE NC 501(C)(3) LINE 7 0 HOSPICE OF LAURENS COUNTY 1304 SPRINGDALE DR CLINTON SC 29325 570843527 HEALTHCARE SC 501(C)(3) LINE 7 HOSPICE & PALLIATIVE CARE CHARLOTTE REGION 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1