2020-11-12T16:18:55-06:00 2019-12-31 450250958 EIDE BAILLY LLP 2950 E HARMONY RD STE 290 FORT COLLINS CO 805283429 990 2019-01-01 840816047 PIKES PEAK HOSPICE AND PALLIATIVE CARE CARE INC PIKE 7196333400 8289 E LOWRY BLVD DENVER CO 80230 PAUL TOSETTI CHIEF FINANCIAL OFFICER 7196333400 2020-11-12 1 KYLE FRITCH CPA P01313374 9702238825 2020-11-12 71.205.71.115 2020-11-12 14:38:33 MS P 95ED5CAB5FB8D2750519DCD6613D81AA6EC75CA8 BBD53E55469E4B987BF8E8344891013371E39694 2019 2021-01-29 14:40:06Z X GLORIA A BROOKS 8289 E LOWRY BLVD DENVER CO 80230 15008555 0 X WWW.PIKESPEAKHOSPICE.ORG X 1981 CO PROVIDE COMPASSIONATE AND EXPERT END-OF-LIFE CARE TO PATIENTS AND THEIR FAMILIES, PARTNER WITH THOSE WHO SHARE OUR VISION, AND LEAD CHANGE IN THE COMMUNITY TO ENSURE COMFORT FOR ALL WHO FACE SERIOUS ILLNESS. 9 8 183 230 0 0 1497553 987701 12683532 14018733 737 2121 0 0 14181822 15008555 0 0 0 0 9559511 9203868 0 0 2774 4413530 4785269 13973041 13989137 208781 1019418 8917381 9833526 1444452 1341179 7472929 8492347 THE MISSION OF PIKES PEAK HOSPICE & PALLIATIVE CARE IS TO PROVIDE COMPASSIONATE AND EXPERT END-OF-LIFE CARE TO PATIENTS AND THEIR FAMILIES, PARTNER WITH THOSE WHO SHARE OUR VISION, AND LEAD CHANGE IN THE COMMUNITY TO ENSURE COMFORT FOR ALL WHO FACE SERIOUS ILLNESS. 0 0 10756300 14018733 PROVIDES INDIVIDUALIZED CONTINUUM OF CARE TO THOSE EXPERIENCING THEIR END OF LIFE JOURNEY AND THEIR LOVED ONES. SERVICES ARE PROVIDED WHEREVER THE PATIENT CALLS 'HOME': IN A RESIDENTIAL HOME, LONG TERM CARE FACILITIES, AND OUR LICENSED HOSPICE INPATIENT FACILITY. WE SERVE EL PASO AND TELLER COUNTIES AND SURROUNDING COMMUNITIES. PIKES PEAK HOSPICE AND PALLIATIVE CARE PROVIDES ADVANCED ILLNESS MANAGEMENT FOR INDIVIDUALS LIVING WITH SERIOUS ILLNESS. WE PROVIDE PAIN AND SYMPTOM MANAGEMENT THROUGH COLLABORATION WITH THE PATIENT'S PRIMARY CARE PHYSICIAN THROUGH OUR NURSE PRACTITIONERS, NURSES AND SOCIAL WORK SERVICES. IN 2019, WE SERVED 1,450 UNDUPLICATED HOSPICE PATIENTS AND 788 PALLIATIVE CARE PATIENTS INCLUDING ADULTS AND CHILDREN. 10756300 1 1 0 1 0 0 0 1 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 50 0 1 183 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 1 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CO X PAUL TOSETTI 3033212828 8289 E LOWRY BLVD DENVER CO 80230 BRIAN WAGNER CHAIR FROM 1219 VICE-CHAIR (THRU 11/19)/BOARD LN 1.00 0.00 X X 0 0 0 SCOTT DAVIS CHAIR (THRU 8/19) 1.00 0.00 X X 0 0 0 DOUG FLINN IMMEDIATE PAST CHAIR 1.00 0.00 X X 0 0 0 MIKE HELWEGE SECRETARY 1.00 0.00 X X 0 0 0 COLIN PERRY TREASURER 1.00 0.00 X X 0 0 0 JEFF ROSACKER DIRECTOR/MEMBER AT LARGE 1.00 0.00 X X 0 0 0 STEVE HOCHSTETTER DIRECTOR 1.00 0.00 X 0 0 0 SR MARY COLLEEN SCHWARZ DIRECTOR 1.00 0.00 X 0 0 0 NATHAN NEWBROUGH DIRECTOR 1.00 1.00 X 0 0 0 TIM J BOWEN DIRECTOR/CHIEF EXECUTIVE OFFICER 1.00 43.00 X X 0 681913 113297 CHERYL HAMILTON FRIED INTERIM PRESIDENT (FROM 10/19) 40.00 1.00 X 47681 0 109 GLORIA BROOKS PRESIDENT (THRU 9/19) 40.00 1.00 X 160396 0 39200 RONALD FERET CHIEF FINANCIAL OFFICER 1.00 43.00 X 0 254663 44291 ANGELA POPPE-RIES MEDICAL DIRECTOR 40.00 0.00 X 268852 0 8949 JOAN SELMAN EXECUTIVE DIRECTOR PIKES PEAK HOSPICE FOUNDATION 40.00 1.00 X 134300 0 12481 MICHAEL OLDFATHER DIRECTOR OF BUSINESS DEVELOPMENT 40.00 0.00 X 115004 0 0 CLARISA HERNANDEZ-KOOGLE NURSE PRACTITIONER 40.00 0.00 X 101364 0 16553 827597 936576 234880 5 0 1 0 CARE SYNERGY 8289 E LOWRY BLVD DENVER CO 80230 MANAGEMENT SERVICES 616544 ONEPOINT PATIENT CARE PO BOX 25587 TEMPE AZ 85282 PHARMACY 532175 STATESERV MEDICAL 1201 S ALMA SCHOOL ROAD MESA AZ 85210 DME & OXYGEN 439981 MAXIMUM HEALTHCARE SERVICES 13877 COLLECTIONS CENTER DR CHICAGO IL 60693 CONTRACT LABOR 153417 CORE MEDICAL GROUP 655 S WILLOW STREET STE 128 MANCHESTER NH 03103 STAFFING AND RECRUTING SERVICES 137382 5 987701 987701 PATIENT SERVICE REVENUE 621610 14018733 14018733 14018733 2121 2121 15008555 14018733 0 2121 636048 611310 24738 7241082 5957562 1283520 67770 67770 709577 698898 10679 549391 468652 80739 616544 616544 94305 94305 278 278 337823 337823 185425 45796 139629 70596 9098 61498 42403 2268 40135 705555 367115 338440 29794 10860 18934 10458 2893 7565 1073 1073 470049 155002 315047 DIRECT PATIENT EXPENSES 1825457 1825457 DUES & SUBSCRIPTIONS 80987 8468 72519 PROFESSIONAL & RISK MAN 71659 22947 48712 RECRUITING 61558 13805 47753 181305 150576 27955 2774 13989137 10756300 3230063 2774 1886671 2154396 1748305 2190898 58464 69644 8370582 3833044 4956503 4537538 267438 881050 8917381 9833526 902847 1191872 541605 149307 1444452 1341179 X 7472929 8492347 7472929 8492347 8917381 9833526 1019418 0 X 0 1 X 1 0 X 583758 768132 945989 1497553 987701 4783133 16119689 4086256 15183311 12683532 14018733 62091521 16703447 4854388 16129300 14181085 15006434 66874654 583758 691858 945989 1497553 987701 4706859 0 583758 691858 945989 1497553 987701 4706859 62167795 6328 1462 3445 936 2121 14292 6328 1462 3445 936 2121 14292 16709775 4855850 16132745 14182021 15008555 66888946 0.92940 0.93540 0.00020 0.00020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 278 278 0 PART II-B, LINE 1: LOBBYING ACTIVITIES INCLUDED AS PART OF DUES TO NHPCO $278, AS DISCLOSED ON THE ANNUAL MEMBERSHIP RENEWAL FORM. IN 2019, 3.81% OF OUR TOTAL DUES OF $7,288 WERE ALLOCATED TO LOBBYING. 22150 X 0 3379893 9277 676815 129873 3936112 3571156 12512 -75697 128078 3379893 3147820 121560 426941 125165 3571156 2993626 123966 54209 23981 3147820 2376851 495864 216834 95923 2993626 0.68500 0.31500 0 1 1 448131 448131 3951867 989745 2962122 1160069 935587 224482 2562259 1790274 771985 248256 117438 130818 4537538 DUE FROM PIKES PEAK FOUNDATION 844205 DUE FROM CARE SYNERGY 36845 881050 DEFERRED LEASE INCENTIVES 149307 149307 X 14965471 -43084 -43084 15008555 0 15008555 13946053 0 13946053 43084 43084 13989137 PART III, LINE 4: ARTWORK IS MAINTAINED FOR AN AESTHETIC ENVIRONMENT PART V, LINE 4: ENDOWMENT FUNDS CONSISTS OF A SINGLE POOLED FUND ESTABLISHED BY DONORS TO PROVIDE ANNUAL FUNDING FOR FUTURE OPERATIONS. PART X, LINE 2: PIKES PEAK HOSPICE AND PALLIATIVE CARE, INC. IS ORGANIZED AS COLORADO NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3), QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTIONS 170(B)(1)(A)(VIII), AND HAS BEEN DETERMINED NOT TO BE PRIVATE FOUNDATION UNDER SECTIONS 509(A)(2), RESPECTIVELY. THE ORGANIZATION IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE ORGANIZAITON IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSES. WE HAVE DETERMINED THAT THE ORGANIZATION IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990-T) WITH THE IRS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD BEDBT EXPENSE NETTED REVENUES ON FINANCIALS -43,084. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED REVENUES ON FINANCIALS 43,084. X X X X X X 0 1 0 0 0 0 0 1 0 TIM J BOWEN DIRECTOR/CHIEF EXECUTIVE OFFICER 0 519108 0 134392 0 28413 0 88084 0 25988 0 795985 0 0 GLORIA BROOKS PRESIDENT (THRU 9/19) 128114 0 28963 0 3319 0 21773 0 17426 0 199595 0 0 0 RONALD FERET CHIEF FINANCIAL OFFICER 0 222753 0 30494 0 1416 0 44291 0 516 0 299470 0 0 ANGELA POPPE-RIES MEDICAL DIRECTOR 266508 0 0 0 2344 0 8949 0 557 0 278358 0 0 0 PART I, LINE 3 FOR COMPENSATION PAID TO OFFICERS FROM A RELATED TAX-EXEMPT ENTITY, THE ORGANIZATION RELIED ON THE RELATED ORGANIZATION THAT USED ONE OR MORE OF THESE METHODS TO ESTABLISH THE COMPENSATION OF THOSE OFFICERS. PART I, LINE 4B CARE SYNERGY, A RELATED TAX-EXEMPT ORGANIZATION, ESTABLISHED A SECTION 457(F) NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR THE EXCLUSIVE BENEFIT OF CERTAIN EXECUTIVES. FUNDS ARE SUBJECT TO RISK OF FORFEITURE BY PLAN PARTICIPANTS AND ARE AVAILABLE TO THE CREDITORS OF CARE SYNERGY. IN ACCORDANCE WITH THE BOARD OF DIRECTORS' INTENT, CARE SYNERGY WILL FUND INDIVIDUAL PARTICIPANT ACCOUNTS THROUGH INVESTMENT OPTIONS DIRECTED BY THE PARTICIPANTS. THE DEFERRED COMPENSATION PLAN IS PARTIALLY FUNDED, AND CARE SYNERGY REPORTS THE DEFERRALS AND RELATED FUNDING IN ACCRUED EXPENSES AND INVESTMENTS, RESPECTIVELY, IN THE BALANCE SHEET. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE 457(F) NON-QUALIFIED DEFERRED COMPENSATION PLAN IN 2019, FOR WHICH THE EXPENSE WAS INCURRED BY THE SPONSORING ORGANIZATIONS, BUT THE FUNDS HAVE NOT VESTED OR BEEN PAID OUT TO THESE INDIVIDUALS. THE AMOUNTS LISTED BELOW ARE INCLUDED ON SCHEDULE J, PART II, COLUMN (C): TIM BOWEN (CARE SYNERGY CEO): $75,584 RON FERET (CARE SYNERGY CFO): $35,381 GLORIA BROOKS (PIKES PEAK HOSPICE & PALLIATIVE CARE PRESIDENT): $15,097 PART I, LINE 7 THE ORGANIZATION AND THE COMPENSATION COMMITTEE OF CARE SYNERGY, A RELATED TAX-EXEMPT ORGANIZATION, ANNUALLY REVIEWS THE PERFORMANCES OF THE EXECUTIVE STAFF AND OTHER STAFF TO DETERMINE IF ADDITIONAL COMPENSATION IN THE FORM OF BONUSES WILL BE PAID. THE DETERMINATION OF BONUSES IS BASED ON ACHIEVEMENT OF CERTAIN METRICS INCLUDED IN OVERALL STRATEGIC OBJECTIVES INCLUDING FINANCIAL PERFORMANCE, PATIENT CENSUS GROWTH, AND QUALITY RATINGS. INCENTIVE COMPENSATION IS ALSO PAID FOR VARIOUS FORMS OF VARIABLE PAY INCLUDING BUT NOT LIMITED TO ON CALL PAY AND SHIFT DIFFERENTIALS. DURING CALENDAR YEAR ENDED DECEMBER 31, 2019, THE ORGANIZATION AND/OR CARE SYNERGY AWARDED THE DIRECTOR/CEO, CHIEF FINANCIAL OFFICER, PRESIDENT, EXECUTIVE DIRECTOR - PIKES PEAK HOSPICE FOUNDATION, INTERIM PRESIDENT, NURSE PRACTITIONER, AND DIRECTOR OF BUSINESS DEVELOPMENT A BONUS AND/OR OTHER VARIABLE COMPENSATION BASED ON REVIEW OF THEIR PERFORMANCES AND SERVICES TO THE ORGANIZATION. SCHEDULE J, PART II: THE COMPENSATION PAID TO THE DIRECTOR/CEO AND CFO IS PAID FOR BY CARE SYNERGY, A RELATED TAX-EXEMPT ORGANIZATION. CARE SYNERGY'S COMPENSATION COMMITTEE ENGAGES AN INDEPENDENT THIRD-PARTY COMPENSATION AND BENEFITS CONSULTANT TO CONDUCT A MARKET ANALYSIS, WHICH INCLUDES COMPARISONS OF SIMILARLY SIZED HOSPICES AND OTHER HEALTHCARE ORGANIZATIONS, TO DETERMINE COMPENSATION AMOUNTS FOR THESE INDIVIDUALS. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRPERSON, THE VICE CHAIRPERSON, TREASURER, SECRETARY, THE IMMEDIATE PAST CHAIRPERSON, ONE MEMBER ELECTED BY A MAJORITY OF THE HOSPICE BOARD (THE "MEMBER-AT-LARGE), AND THE CHIEF EXECUTIVE OFFICER WITH EACH MEMBER HAVING THE RIGHT TO VOTE ON ALL MATTERS. THE OFFICERS OF THE HOSPICE BOARD OR THE CHIEF EXECUTIVE OFFICER SHALL PRESENT TO THE EXECUTIVE COMMITTEE FOR REVIEW, AT ITS REGULARLY SCHEDULED MEETING IMMEDIATELY PRIOR TO THE HOSPICE BOARD MEETING AT WHICH ACTION IS SOUGHT, ALL ITEMS REQUIRING THE ACTION OF THE HOSPICE BOARD. THE EXECUTIVE COMMITTEE SHALL THEREAFTER MAKE ITS RECOMMENDATION TO THE HOSPICE BOARD ON EACH ITEM FOR WHICH HOSPICE ACTION IS SOUGHT. THE EXECUTIVE COMMITTEE SHALL SET THE AGENDA FOR EACH HOSPICE BOARD MEETING. AT THE DISCRETION OF THE CHAIRPERSON, THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF THE HOSPICE BOARD ON ALL MATTERS REQUIRING A DECISION OF THE HOSPICE BOARD AND ARISING BETWEEN HOSPICE BOARD MEETINGS. THE EXECUTIVE COMMITTEE SHALL REPORT AND SUCH ACTIONS TO THE HOSPICE BOARD AT THE NEXT REGULARLY SCHEDULED OR SPECIAL MEETING OF THE HOSPICE BOARD AND SHALL FOREGO DECISIONS ON THOSE MATTERS WHICH CAN BE DELAYED UNTIL THE NEXT REGULARLY SCHEDULED OR SPECIAL MEETING OF THE HOSPICE BOARD, OR UNTIL WRITTEN CONSENT OF THE HOSPICE BOARD CAN BE OBTAINED. FORM 990, PART VI, SECTION A, LINE 2 THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER ARE OFFICERS OF AND EMPLOYED BY CARE SYNERGY, A RELATED EXEMPT ORGANIZATION. THESE INDIVIDUALS ARE ALSO OFFICERS OF THE HOSPICE OF METRO DENVER, HALCYON HOSPICE, COLORADO VISITING NURSE ASSOCIATION, AND PATHWAYS HOSPICE. THEREFORE, BUSINESS RELATIONSHIPS EXIST BETWEEN THESE INDIVIDUALS. FORM 990, PART VI, SECTION A, LINE 3 CARE SYNERGY, A RELATED EXEMPT ORGANIZATION, PERFORMED EXECUTIVE MANAGEMENT SERVICES INCLUDING FINANCE AND ACCOUNTING, PAYROLL, INFORMATION TECHNOLOGY, HUMAN RESOURCES, QUALITY MANAGEMENT, COMPLIANCE, HIGH LEVEL RISK MANAGEMENT, AND GROUP CONTRACTING SERVICES. SEE FORM 990, PART VII FOR COMPENSATION PAID BY THE RELATED MANAGEMENT COMPANY. FORM 990, PART VI, SECTION A, LINE 6 PIKES PEAK HOSPICE AND PALLIATIVE CARE'S SOLE MEMBER IS CARE SYNERGY, A COLORADO NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER, CARE SYNERGY HAS THE POWER TO ELECT AND REMOVE DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CONTROLLER AND CFO AND IS THEN PROVIDED TO THE BOARD OF DIRECTORS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL EDUCATION IS PROVIDED TO THE BOARD MEMBERS, OFFICERS, AND STAFF. ALL CONFLICTS ARE ADDRESSED BY OFFICERS AND CONTRACT LEGAL COUNSEL AS NEEDED. BOARD MEMBERS ARE REQUIRED TO SIGN AN ANNUAL CONFLICT OF INTEREST STATEMENT. BOARD MEMBERS WHO HAVE A CONFLICT WITH RESPECT TO A MATTER BEFORE THE BOARD ARE DIRECTED TO DISCLOSE THE CONFLICT AND ABSTAIN FROM VOTING ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS FOR CARE SYNERGY, A RELATED TAX-EXEMPT ORGANIZATION, FUNCTIONS AS THE COMPENSATION COMMITTEE. THEY ENGAGE AN INDEPENDENT THIRD-PARTY COMPENSATION AND BENEFITS CONSULTANT TO CONDUCT A MARKET ANALYSIS OF COMPENSATION AND BENEFITS FOR ALL TOP MANAGEMENT AND TOP FINANCIAL OFFICIALS OF THE ORGANIZATION. THE ANALYSIS INCLUDES COMPARISONS OF SIMILARLY SIZED HOSPICE AND OTHER HEALTHCARE ORGANIZATIONS. THE CONSULTING FIRM ALSO EVALUATES THE REASONABLENESS OF EXECUTIVE COMPENSATION FROM AN INTERMEDIATE SANCTIONS PERSPECTIVE. ANY COMPENSATION OR BENEFIT CHANGES FOR TOP MANAGEMENT AND FINANCIAL OFFICIALS ARE APPROVED BY THE EXECUTIVE COMMITTEE OF THE CARE SYNERGY BOARD OF DIRECTORS AND DOCUMENTED IN THE COMMITTEE MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE ON-SITE AND UPON REQUEST. PIKES PEAK HOSPICE FOUNDATION 2550 TENDERFOOT HILL STREET COLORADO SPRINGS CO 80906 841453050 SUPPORT OF PIKES PEAK HOSPICE & PALLIATIVE CARE CO 501(C)(3) LINE 12A, I PIKES PEAK HOSPICE AND PALLIATIVE CARE 1 COMFORT BRIDGE (DBA CARE SYNERGY) 8289 E LOWRY BLVD DENVER CO 80230 471820366 ADMINISTRATIVE SUPPORT SERVICES TO RELATED ORGANIZATIONS CO 501(C)(3) LINE 12B, II N/A 0 PATHWAYS HOSPICE 8289 E LOWRY BLVD DENVER CO 80230 840782874 HOSPICE AND PALLIATIVE CARE SERVICES CO 501(C)(3) LINE 10 COMFORT BRIDGE DBA CARE SYNERGY 0 HOSPICE OF METRO DENVER INC DBA THE DENVER HOSPICE AND OPTIO HEALTH SERVIC 8289 E LOWRY BLVD DENVER CO 80230 840743121 HOSPICE AND PALLIATIVE CARE SERVICES CO 501(C)(3) LINE 10 COMFORT BRIDGE DBA CARE SYNERGY 0 HALCYON HOSPICE 8289 E LOWRY BLVD DENVER CO 80230 471820492 HOSPICE AND PALLIATIVE CARE SERVICES CO 501(C)(3) LINE 10 COMFORT BRIDGE DBA CARE SYNERGY 0 COLORADO VISITING NURSES ASSOCIATION 8289 E LOWRY BLVD DENVER CO 80230 841043351 HOSPICE AND PALLIATIVE CARE SERVICES CO 501(C)(3) LINE 10 COMFORT BRIDGE DBA CARE SYNERGY 0 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 PIKES PEAK HOSPICE FOUNDATION D 844205 COST PIKES PEAK HOSPICE FOUNDATION C 987701 COST