2021-11-15T08:27:36-06:00 2020-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2020-01-01 310933339 HOSPICE OF DAYTON INC HOSP 9372564490 324 WILMINGTON AVENUE DAYTON OH 45420 ROBERT MORRIS CFO 9372564490 2021-11-11 1 ROBERT MORRIS 999009999 AMY CIMINELLO P00796388 6148493000 2021-11-08 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z KIM VESEY 324 WILMINGTON AVENUE DAYTON OH 45420 79923000 0 X WWW.HOSPICEOFDATYON.ORG X 1978 OH TO PROVIDE HOSPICE AND PALLIATIVE CARE FOR THE TERMINALLY ILL AND SUPPORT FOR THEIR FAMILIES. 10 10 877 697 0 0 2124745 6970410 67505990 72404492 1231840 395543 126508 150462 70989083 79920907 0 0 0 0 43364064 48375034 0 0 49016 24188630 29470481 67552694 77845515 3436389 2075392 102782333 125883239 70469069 90033708 32313264 35849531 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 60117296 0 72404532 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. 60117296 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 1 261 0 1 877 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 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 1076506 55353 ANTHONY EVANS PRESIDENT, PURE HEALTHCARE 40.00 0.00 X 390360 0 55225 WENDY SCHMITZ VP OF MEDICAL CARE/MEDICAL DIRECTOR 40.00 0.00 X 351285 0 41305 CALVIN ROBINSON CHIEF FINANCIAL OFFICER - OHI 2.00 38.00 X 0 312879 57985 ANNA RYMER PHYSICIAN MANAGER, PALLIATIVE 40.00 0.00 X 301521 0 40270 KIM VESEY GENERAL MANAGER/EXECUTIVE VP 40.00 0.00 X 281106 0 39979 JOHN AHERN PHYSICIAN MANAGER, CLINICAL TEAM LIAISON 40.00 0.00 X 286900 0 31055 MARY MURPHY PRESIDENT OF HOSPICE OF DAYTON 0.00 0.00 X 288420 0 10178 RANAPREET PATEL TEAM PHYSICIAN 40.00 0.00 X 278764 0 12340 CLEANNE CASS DIRECTOR COMMUNITY SERV. & PHYSICIAN EDU. 40.00 0.00 X 236144 0 13467 RICHARD GREENO TEAM PHYSICIAN 40.00 0.00 X 211606 0 37000 YVONNE TURNER VICE PRESIDENT OF CLINICAL CARE 40.00 0.00 X 201300 0 41334 REBECCA BLEDSOE VP OF PHARMACEUTICAL CARE & MISSION 40.00 0.00 X 208180 0 29876 JACQUELINE MATTHEWS VP PALLIATIVE & SUPPORTIVE CARE 40.00 0.00 X 195616 0 34255 TONYA PERRY VP OF CARE MANAGEMENT & COMMUNITY PROGRAMS 40.00 0.00 X 212019 0 11245 PRIYAMVADA MURALI TEAM PHYSICIAN 40.00 0.00 X 211122 0 6422 ALI JAFFERY TEAM PHYSICIAN 40.00 0.00 X 176383 0 19255 AMY KEMPER VP OF FINANCE & ANALYTICS 40.00 0.00 X 168358 0 20608 THOMAS MANN CHAIR 3.00 4.00 X X 0 0 0 PETE HALEY VICE CHAIR 2.00 0.00 X X 0 0 0 TONI SPRINKEL TREASURER 2.00 2.00 X X 0 0 0 PEGGY MARK SECRETARY 2.00 0.00 X X 0 0 0 GARY LEROY MD BOARD MEMBER 2.00 2.00 X 0 0 0 GREG TOMAN BOARD MEMBER 2.00 5.00 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 3999084 1389385 557152 30 1 1 0 MEDLINE INDUSTRIES INC PO BOX 382075 PITTSBURGH PA 152518075 MEDICAL SUPPLIES 1236366 SPRINGFIELD REG MED CENTER PO BOX 636374 CINCINNATI OH 452636374 MEDICAL SERVICES 861609 VANCREST LTD 1600 PARK AVENUE EATON OH 45320 MEDICAL SERVICES 576910 ST LEONARD 8100 CLYO ROAD CENTERVILLE OH 45458 MEDICAL SERVICES 515794 PAUL J STRIEBEL & ASSOCIATES INC 10027 PUTTERVIEW WAY CENTERVILLE OH 45458 ARCHITECTURE SERVICES 510053 39 2528203 4442207 6970410 PATIENT SERVICE REVENUE 624100 72404492 72404492 72404492 307158 307158 90478 0 2093 90478 -2093 88385 88385 CAFETERIA REVENUE 900099 54176 54176 SUBWAY PROPERTY 900099 18719 18719 CATERING REVENUE 900099 2088 2088 75479 40 75439 150462 79920907 72404532 0 545965 2849616 2849616 35491094 34473674 1017420 1516303 1314019 202284 5773094 5263305 509750 39 2744927 2441699 303228 157909 2662 155247 3100 3100 128441 128441 1164754 566115 598639 397042 3041 394001 1532562 894128 626350 12084 819103 52650 733968 32485 2048733 1528152 520581 1167925 1121176 46749 205333 128031 76602 700 679231 679231 2337693 2139406 198287 289545 210660 75177 3708 ALLOCATED COSTS 8182959 8182959 MEDICAL SUPPLIES 5930483 5924268 6215 ROOM & BOARD 2042528 2042528 PATIENT SERVICE 1615329 1615329 767811 396453 371358 77845515 60117296 17679203 49016 -231657 2585404 8742873 10504384 1507073 627692 64982469 24530133 39887929 40452336 11015687 20294042 768966 2284743 41091462 49134638 102782333 125883239 10732558 6496252 0 16883221 0 15320474 59736511 51333761 70469069 90033708 X 32313264 35849531 32313264 35849531 102782333 125883239 2075392 1460875 0 X X 0 1 X 1 1 0 X 1604818 1922783 2635729 2124745 6970410 15258485 50416875 60493353 63812725 67628967 72404532 314756452 52021693 62416136 66448454 69753712 79374942 330014937 0 0 0 330014937 437193 510392 1124728 292624 307158 2672095 437193 510392 1124728 292624 307158 2672095 47412 174187 -126672 3531 150422 248880 52506298 63100715 67446510 70049867 79832522 332935912 0.99120 0.99040 0.00800 0.00930 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 26320904 3926475 -773676 2717345 162021 26594337 24369051 3878398 1808135 118410 26320904 28829625 -730177 3730397 24369051 24949847 709925 3378753 208900 28829625 28773188 30000 1146659 5000000 24949847 0.95826 0.04174 0.00000 0 1 1 1301208 1301208 48113262 17855422 30257840 201178 5101 196077 10887518 6094523 4792995 4479303 575087 3904216 40452336 INTERCOMPANY RECEIVABLES 49134638 49134638 PAYABLE TO RELATED PARTY 40461870 BANK NOTE PAYABLE 10871891 51333761 PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY A RELATED PARTY, HOSPICE OF DAYTON 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 903741 0 172765 0 0 0 28095 0 27259 0 1131860 0 0 ANTHONY EVANS PRESIDENT, PURE HEALTHCARE 301945 0 88415 0 0 0 28153 0 27072 0 445585 0 0 0 WENDY SCHMITZ VP OF MEDICAL CARE/MEDICAL DIRECTOR 286306 0 64979 0 0 0 18745 0 22560 0 392590 0 0 0 CALVIN ROBINSON CHIEF FINANCIAL OFFICER - OHI 0 245899 0 66980 0 0 0 30665 0 27320 0 370864 0 0 ANNA RYMER PHYSICIAN MANAGER, PALLIATIVE 283451 0 18070 0 0 0 14250 0 26020 0 341791 0 0 0 KIM VESEY GENERAL MANAGER/EXECUTIVE VP 215941 0 65165 0 0 0 29021 0 10957 0 321084 0 0 0 JOHN AHERN PHYSICIAN MANAGER, CLINICAL TEAM LIA 272149 0 14751 0 0 0 9882 0 21173 0 317955 0 0 0 MARY MURPHY PRESIDENT OF HOSPICE OF DAYTON 0 0 0 0 288420 0 10178 0 0 0 298598 0 0 0 RANAPREET PATEL TEAM PHYSICIAN 260111 0 18653 0 0 0 12340 0 0 0 291104 0 0 0 CLEANNE CASS DIRECTOR COMMUNITY SERV. & PHYSICIAN 196160 0 39984 0 0 0 11800 0 1666 0 249610 0 0 0 RICHARD GREENO TEAM PHYSICIAN 208956 0 2650 0 0 0 8928 0 28072 0 248606 0 0 0 YVONNE TURNER VICE PRESIDENT OF CLINICAL CARE 164275 0 37025 0 0 0 15275 0 26059 0 242634 0 0 0 REBECCA BLEDSOE VP OF PHARMACEUTICAL CARE & MISSION 174515 0 33665 0 0 0 4503 0 25372 0 238055 0 0 0 JACQUELINE MATTHEWS VP PALLIATIVE & SUPPORTIVE CARE 178042 0 17574 0 0 0 11203 0 23052 0 229871 0 0 0 TONYA PERRY VP OF CARE MANAGEMENT & COMMUNITY PR 189567 0 22452 0 0 0 11245 0 0 0 223264 0 0 0 PRIYAMVADA MURALI TEAM PHYSICIAN 208472 0 2650 0 0 0 6328 0 94 0 217544 0 0 0 ALI JAFFERY TEAM PHYSICIAN 168733 0 7650 0 0 0 3343 0 15913 0 195639 0 0 0 AMY KEMPER VP OF FINANCE & ANALYTICS 138781 0 29577 0 0 0 9758 0 10850 0 188966 0 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 MARY MURPHY RECEIVED SEVERENCE PAYMENTS OF $288,420 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 15637935 SEE PART VI 0 0 0 A 15637935 183300 230000 476671 818263 11862546 2064742 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 $1,206.30 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 HOSPICE OF DAYTON 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. 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. FORM 990, PART XII, LINE 3B: THE REQUIRED SINGLE AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 HAS NOT BEEN COMPLETED YET FOR THE CALENDAR YEAR-END 12/31/20, BUT PLANS TO BE COMPLETED BY THE EXTENDED DUE DATE AS ESTABLISHED IN THE RELEVANT OMB GUIDANCE. PURE HEALTHCARE LLC 7575 PARAGON ROAD DAYTON OH 45459 TO PROVIDE PALLIATIVE CARE PHYSICIANS & SUPPORT PERSONNEL OH 4036500 20578013 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 FOUNDATION FOR HOSPICE OF CENTRAL OHIO 2269 CHERRY VALLEY ROAD NEWARK OH 43055 550855205 TO PROVIDE FINANCIAL SUPPORT TO ITS PARENT, HOSPICE OF CENTRAL OHIO OH 501(C)(3) LINE 12A, I HOSPICE OF CENTRAL OHIO 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 HOSPICE OF DAYTON 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 2528203 CASH VALUE