2019-11-01T12:49:38-05:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 901 N GLEBE ROAD SUITE 200 ARLINGTON VA 22203 990 2018-01-01 521114719 MONTGOMERY HOSPICE INC MONT 3019214400 1355 PICCARD DRIVE NO 100 ROCKVILLE MD 20850 ANN MITCHELL PRESIDENT & CHIEF EXECUTIVE OFFICER 3019214400 2019-11-01 1 AMY CHAPMAN P00843460 5712279500 67.137.57.251 2019-11-01 13:29:38 ED P 0514B758026FFB4303D1E4DFF3C58ED2768E19CE 1938324BD4D887D076751857843371B82258E98C 2018 2020-03-31 21:24:44Z ANN MITCHELL 1355 PICCARD DRIVE NO 100 ROCKVILLE MD 20850 37739946 0 X WWW.MONTGOMERYHOSPICE.ORG X 1979 MD TO GENTLE THE JOURNEY THROUGH SERIOUS ILLNESS AND LOSS WITH SKILL AND COMPASSION. 22 21 370 369 0 0 1994435 4814109 26680377 27321360 606404 1004722 11810 112668 29293026 33252859 0 0 0 0 22595983 23008714 0 0 585419 5991782 5910717 28587765 28919431 705261 4333428 27513655 30036201 3381236 3237621 24132419 26798580 X TO GENTLE THE JOURNEY THROUGH SERIOUS ILLNESS AND LOSS WITH SKILL AND COMPASSION. TO BRING COMFORT BY PROVIDING COMPASSIONATE, PROFESSIONAL CARE TO COMMUNITY RESIDENTS WHO ARE FACING SERIOUS ILLNESS AND LOSS. TO PROVIDE DIGNITY FOR THE DYING AND UNCONDITIONAL COMPASSION, THROUGH DEDICATION AND COLLABORATION. 0 0 26004050 0 27321360 THE ORGANIZATION PROVIDES SPECIALIZED MEDICAL AND PSYCHOSOCIAL END-OF-LIFE CARE TO MONTGOMERY COUNTY, MARYLAND RESIDENTS WHO ARE LIVING WITH A LIFE LIMITING ILLNESS. PATIENTS (AND THEIR FAMILIES) ARE CARED FOR IN HOMES, EXTENDED CARE FACILITIES AND AT CASEY HOUSE, OUR ACUTE CARE FACILITY. OUR TEAMS OF DOCTORS, NURSE PRACTITIONERS, NURSES, SPIRITUAL COUNSELORS, SOCIAL WORKERS, CERTIFIED NURSING ASSISTANTS, COMPLEMENTARY THERAPISTS, BEREAVEMENT COUNSELORS AND VOLUNTEERS WORK TOGETHER TO PROVIDE COMFORT CARE CUSTOMIZED FOR EACH PATIENT. IN 2018, MONTGOMERY HOSPICE SERVED 2,304 PATIENTS AND THEIR FAMILIES. AMONG THE TOTAL PATIENTS SERVED, 29 WERE CHILDREN AND 80 WERE EITHER UNINSURED OR UNDERINSURED. CASEY HOUSE, IS THE ONLY ALL-HOSPICE ACUTE FACILITY IN MONTGOMERY COUNTY. 26004050 1 1 0 1 0 0 0 0 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 1 0 1 0 0 0 1 9 0 370 1 0 0 0 0 0 0 0 0 0 0 0 0 X 22 21 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 MD X MONICA ESCALANTE CHIEF FINANCIAL O 3019214400 1355 PICCARD DRIVE SUITE 100 ROCKVILLE MD 20850 LYA M KARM MD CHAIRMAN 1.00 X X 0 0 0 ELMA M LEVY VICE CHAIRMAN 1.00 X X 0 0 0 PAUL E ALPUCHE JR ESQ IMMEDIATE PAST CHAIRMAN 1.00 X X 0 0 0 MICHAEL ZHUANG TREASURER 1.00 X X 0 0 0 DIANE K KUWAMURA ESQ SECRETARY 1.00 X X 0 0 0 REV JAMES E BONEY DIRECTOR (SINCE 06/2018) 1.00 X 0 0 0 BRADLEY H COLTON DIRECTOR 1.00 X 0 0 0 DELEGATE BONNIE L CULLISON DIRECTOR 1.00 X 0 0 0 SENATOR BRIAN J FELDMAN DIRECTOR 1.00 X 0 0 0 SUSAN L GLOVER DIRECTOR 1.00 X 0 0 0 JANET S GOLDMAN DIRECTOR 1.00 X 0 0 0 SURESH K GUPTA MD DIRECTOR 1.00 X 0 0 0 MIMI HASSANEIN DIRECTOR (SINCE 06/2018) 1.00 X 0 0 0 DEBORAH PARHAM HOPSON PHD DIRECTOR (SINCE 06/2018) 1.00 X 0 0 0 CYNTHIA A MESMER DIRECTOR 1.00 X 0 0 0 JEAN OBERSTAR DIRECTOR 1.00 X 0 0 0 CECILIA M OTERO DIRECTOR (SINCE 06/2018) 1.00 X 0 0 0 CESAR E PALACIOS DIRECTOR 1.00 X 0 0 0 GERMAN PARAUD DIRECTOR 1.00 X 0 0 0 RONALD J RUBIN DIRECTOR 1.00 X 0 0 0 JO ANNE ZUJEWSKI MD DIRECTOR 1.00 X 0 0 0 DEBORA S MCGREGOR TREASURER (UNTIL 05/2018) 1.00 X 0 0 0 STERLING KING JR DR PH IMMEDIATE PAST CHAIRMAN (UNTIL 05/2018) 1.00 X 0 0 0 SHERIFF DARREN M POPKIN DIRECTOR (UNTIL 05/2018) 1.00 X 0 0 0 STEVEN V ROBERTS DIRECTOR (UNTIL 05/2018) 1.00 X 0 0 0 ANN MITCHELL PRESIDENT & CEO 40.00 X X 267994 0 24776 MONICA ESCALANTE CFO/CCO 40.00 X 210208 0 19775 GEOFFREY COLEMAN MD CHIEF MEDICAL OFFICER 40.00 X 248863 0 61937 ANN LICHTENSTEIN ASSOCIATE MEDICAL DIRECTOR 40.00 X 186516 0 16908 MARK GOLDMAN TEAM PHYSICIAN 32.00 X 155242 0 0 JANET CAUFFIEL VP OF HUMAN RESOURCE 40.00 X 151836 0 10750 JENNIFER PLUDE SR VP OF NURSING SERVICES 40.00 X 133688 0 5363 MARLENE BRADFORD VP OF PHILANTHROPY 40.00 X 131803 0 16082 KATHLEEN MCCABE TEAM PHYSICIAN 28.00 X 131722 0 0 1617872 0 155591 24 0 1 0 HOSPICE PHARMACY SOLUTIONS PO BOX 161134 ATLANTA GA 30321 PHARMACY 1187723 JOERNS HEALTHCARE 2430 WHITEHALL PARK DR 100 CHARLOTTE NC 28273 DURABLE MEDICAL EQUIPMENT 1028367 PROCURA HEALTHCARE SOFTWARE 1827 WALDEN OFFICE SQUARE 104 SCHAUMBURG IL 60173 EMR SYSTEM 162341 CORAM INC PO BOX 809160 CHICAGO IL 60680 INFUSION 140556 4 49881 4764228 5458 4814109 PATIENT SERVICE REVENUE 624100 27321360 27321360 27321360 588192 588192 4903617 4487087 416530 416530 416530 112668 112668 112668 33252859 27321360 0 1117390 1036977 924642 94980 17355 18414137 16523321 1581662 309154 373869 317003 49091 7775 1850437 1574107 249428 26902 1333294 1189839 119288 24167 41632 41632 48921 48921 7814 7814 66520 66520 1593292 1505910 87382 97632 97632 378225 33694 336397 8134 205769 191068 14701 601315 247582 353733 385796 382358 2876 562 176782 25646 4743 146393 27107 27107 170997 152565 18432 89729 34492 55237 MEDICAL SUPPLIES 1161738 1161738 PHARMACY PURCHASES 554543 554543 EQUIPMENT LEASE/PURCHAS 159936 820 159116 DUES & PUBLICATION 70451 14748 52458 3245 72518 1263410 -1217923 27031 28919431 26004050 2329962 585419 2004185 2505285 7703697 9851294 30368 15179 3705687 3148411 424907 380794 5119221 2003324 2895437 3115897 10749374 11017468 0 1873 27513655 30036201 3335010 2745486 46226 492135 3381236 3237621 X 18551492 20115170 989644 1329519 4591283 5353891 24132419 26798580 27513655 30036201 4333428 -1667267 0 X 0 1 X 1 0 X 2301665 1870904 1354491 1994435 4814109 12335604 20898450 22349027 24465613 26680377 27321360 121714827 23200115 24219931 25820104 28674812 32135469 134050431 0 0 0 134050431 335335 361494 503953 497953 588192 2286927 335335 361494 503953 497953 588192 2286927 9794 17477 2683 11810 112668 154432 23545244 24598902 26326740 29184575 32836329 136491790 0.98210 0.98490 0.01680 0.01360 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2014 AMOUNT: $ 357. 2015 AMOUNT: $ 15,772. 2016 AMOUNT: $ 42. 2017 AMOUNT: $ 9,908. 2018 AMOUNT: $ 112,668. MEALS - NON-PATIENT - 2014 AMOUNT: $ 1,518. 2015 AMOUNT: $ 1,705. 2016 AMOUNT: $ 2,641. 2017 AMOUNT: $ 1,902. GAIN ON LEASE TERMINATION - 2014 AMOUNT: $ 7,919. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 1 7814 0 0 7814 0 PART II-B, LINE 1: MONTGOMERY HOSPICE (MH) AND ANOTHER NONPROFIT HOSPICE IN MONTGOMERY COUNTY, MD PAID AN OUTSIDE CONTRACTOR TO DISCUSS REIMBURSEMENT RATES WITH LEGISLATORS AND THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. 7364859 1100030 -558627 191820 7714442 6733391 1810 819624 189966 7364859 6562932 800 347615 177956 6733391 6733056 590 -8524 162190 6562932 4220799 2458595 190966 137304 6733056 0.27860 0.72140 0.00000 0 0 1082200 1082200 2570992 1244400 1326592 264187 86311 177876 311629 311629 0 890213 360984 529229 3115897 CAPITAL LEASE OBLIGATION 143618 ACCRUED RENT PAYABLE 348517 492135 X 31533872 -1667267 14800 -1652467 33186339 66520 66520 33252859 28867711 14800 14800 28852911 66520 66520 28919431 PART V, LINE 4: THE ENDOWMENT FUNDS RESULTED FROM DONOR-RESTRICTED FUNDS FOR SUPPORT OF SEVERAL HOSPICE PROGRAM ACTIVITIES. CONTRIBUTIONS FROM MAJOR DONORS WERE RESTRICTED TO THE OPERATIONS, MAINTENANCE AND PATIENT CARE AT THE HOSPICE'S INPATIENT ACUTE CARE FACILITY. DONORS HAVE ALSO CONTRIBUTED TO THE FUNDING OF NURSING SERVICES PROVIDED AT THE INPATIENT HOSPICE. THE HOSPICE IN-HOME SERVICES ARE BEING SUPPORTED TO PROVIDE MEDICAL CARE SERVICES BY PHYSICIANS, NURSES, SOCIAL WORKERS AND HOSPICE AIDES. THE ENDOWMENTS ALSO SUPPORT CHARITY CARE AND THE UNCOMPENSATED SERVICES PROVIDED TO PATIENTS AND THEIR FAMILIES THROUGH BEREAVEMENT AND PASTORAL CARE SUPPORT. PART X, LINE 2: THE IRC PROVIDES FOR TAXATION OF UNRELATED BUSINESS INCOME UNDER CERTAIN CIRCUMSTANCES. THE HOSPICE AND ITS AFFILIATED ENTITIES HAVE NO SIGNIFICANT UNRELATED BUSINESS INCOME; HOWEVER, SUCH STATUS IS SUBJECT TO FINAL DETERMINATION UPON EXAMINATION OF THE RELATED INCOME TAX RETURNS BY THE APPROPRIATE TAXING AUTHORITIES. X X X 0 0 0 0 0 0 0 0 0 ANN MITCHELL PRESIDENT & CEO 239244 0 28750 0 0 0 12962 0 11814 0 292770 0 0 0 MONICA ESCALANTE CFO/CCO 209708 0 500 0 0 0 10508 0 9267 0 229983 0 0 0 GEOFFREY COLEMAN MD CHIEF MEDICAL OFFICER 248363 0 500 0 0 0 12146 0 49791 0 310800 0 0 0 ANN LICHTENSTEIN ASSOCIATE MEDICAL DIRECTOR 186016 0 500 0 0 0 0 0 16908 0 203424 0 0 0 MARK GOLDMAN TEAM PHYSICIAN 154742 0 500 0 0 0 0 0 0 0 155242 0 0 0 JANET CAUFFIEL VP OF HUMAN RESOURCE 151336 0 500 0 0 0 7727 0 3023 0 162586 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE BOARD CHAIRPERSON, BOARD VICE CHAIRPERSON, BOARD SECRETARY, BOARD TREASURER, IMMEDIATE PAST CHAIRPERSON, AND THE PRESIDENT/CHIEF EXECUTIVE OFFICER (CEO), AND SUCH OTHER BOARD MEMBERS AS THE BOARD MAY DEEM APPROPRIATE. IT SHALL HAVE AUTHORITY TO CONDUCT ESSENTIAL HOSPICE BUSINESS BETWEEN BOARD MEETINGS, WHEN DELAY IN ACTION WOULD BE DETRIMENTAL TO THE HOSPICE, EXCEPT AS TO THE MATTERS LISTED BELOW AS WELL AS ANY OTHERS IMPOSED BY THE BOARD: 1. AMENDING THE ARTICLES OF INCORPORATION OR THE BYLAWS; 2. APPROVING A PLAN OF MERGER OR CONSOLIDATION; 3. FILLING VACANCIES ON THE HOSPICE BOARD OR REMOVING DIRECTORS OR OFFICERS FROM OFFICE; 4. APPOINTING OR REMOVING MEMBERS OF THE EXECUTIVE COMMITTEE; 5. APPOINTING OR REMOVING ANY OFFICER, THE MEDICAL DIRECTOR OR THE PRESIDENT/CEO, WITHOUT THE APPROVAL OF A MAJORITY OF THE BOARD; 6. APPROVING SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY OR ASSETS OF THE HOSPICE; OR 7. APPROVING VOLUNTARY DISSOLUTION OF THE HOSPICE OR REVOCATION OF VOLUNTARY DISSOLUTION PROCEEDINGS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE PRESIDENT AND MEMBERS OF THE FINANCE COMMITTEE BEFORE FILING. THE CHAIRMAN GIVES A SUMMARY REPORT TO THE BOARD. BOARD MEMBERS CAN REQUEST A COPY OF THE FORM 990 RETURN. FORM 990, PART VI, SECTION B, LINE 12C ALL INDIVIDUALS, UPON APPOINTMENT TO THE BOARD OF DIRECTORS, ANY BOARD DESIGNATED COMMITTEE, OR MONTGOMERY HOSPICE STAFF OR VOLUNTEER POSITION, SHALL BE REQUIRED TO EXAMINE AND SIGN AN INDIVIDUAL STATEMENT REGARDING CONFLICT OF INTEREST. IN THE EVENT A CONFLICT OF INTEREST OR POTENTIAL CONFLICT ARISES, THE CONFLICT OF INTEREST STATEMENT MUST PROMPTLY BE UPDATED AND BROUGHT TO THE ATTENTION OF THE PRESIDENT/CEO AND/OR CHAIRMAN OF THE BOARD. IF THE MATTER CONCERNS A STAFF MEMBER OR VOLUNTEER, THE CHANGE SHOULD BE PRESENTED TO THE INDIVIDUAL'S SUPERVISOR. THE INDIVIDUAL BOARD MEMBERS, WHO HAVE A CONFLICT OF INTEREST WITH THEIR CURRENT BUSINESS RELATIONSHIP AND THE HOSPICE, WILL WITHDRAW THEMSELVES FROM BOARD DISCUSSIONS AND VOTING. FORM 990, PART VI, SECTION B, LINE 15A REVIEW FOR PRESIDENT/CEO IS CONDUCTED ANNUALLY BY CERTAIN MEMBERS OF THE EXECUTIVE COMMITTEE. MEMBERS MAY INTERVIEW PRESIDENT/CEO'S COLLEAGUES CONCERNING THEIR INTERACTION AND RELATIONSHIP WITH PRESIDENT/CEO. OTHER ANALYSIS INCLUDES A WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE EXECUTIVE COMMITTEE. KEY EMPLOYEES ARE GIVEN ANNUAL PERFORMANCE REVIEWS BY THEIR IMMEDIATE SUPERVISOR INCLUDING THE PRESIDENT/CEO. THE PERFORMANCE SUMMARY IS REVIEWED AND DISCUSSED WITH THE PRESIDENT/CEO. AN ANALYSIS OF COMPARABLE STAFF POSITIONS AND SIMILAR HOSPICE ORGANIZATIONS IS DONE BY HR DEPARTMENT. DATA FROM BENCHMARK REPORTS PROVIDED BY NHPCO ARE ALSO USED IN THIS ANALYSIS. THE MOST RECENT YEAR IN WHICH THE COMPENSATION PROCESS WAS REVIEWED WAS 2018. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE ALSO SUMMARIZED ON THE ORGANIZATION'S WEBSITE. PALLIATIVE MEDICINE CONSULTANTS OF GREATER WASHINGTON LLC 1355 PICCARD DR SUITE 100O ROCKVILLE MD 20850 522343635 TO OFFER A CONTINUUM OF CARE FOR PATIENTS WITH ADVANCED ILLNESS MD 0 10452 MONTGOMERY HOSPICE INC