2019-11-04T14:18:07-06:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2018-01-01 930738493 WILLAMETTE VALLEY HOSPICE WILL 5035883600 1015 3RD STREET NW SALEM OR 97304 IRIA NISHIMURA EXECUTIVE DIRECTOR 5035883600 2019-10-30 1 KURT BENNION CPA P01469618 4252506100 2019-10-30 67.137.57.251 2019-10-30 16:16:22 PD P 809E54FA8C64BBE3CBB7CEA9C7808FE856DB1227 0A137849BC389FB7B51D6FC2D6742665ACC5CBED 2018 2020-01-14 16:20:31Z IRIA NISHIMURA 1015 3RD STREET NW SALEM OR 97304 13190475 0 X WWW.WVH.ORG X 1978 OR COMPREHENSIVE CARE FOR THE TERMINALLY ILL. 15 15 135 187 0 0 1006334 466800 10267041 10259559 455420 182286 52974 89450 11781769 10998095 1634 1913 0 0 9180048 9026291 0 0 44781 3628379 3402429 12810061 12430633 -1028292 -1432538 10506395 8986378 1235668 1581064 9270727 7405314 X TO CHANGE THE END OF LIFE EXPERIENCE FOR TERMINALLY ILL PERSONS AND THEIR FAMILIES, TO PROVIDE BEREAVEMENT SUPPORT FOR THE CAREGIVERS AND FAMILIES OF OUR PATIENTS AND MEMBERS OF THE COMMUNITY, AND TO EDUCATE THE COMMUNITY ABOUT END OF LIFE PHILOSOPHY AND PROGRAMS. 0 0 7847588 1913 10259559 WILLAMETTE VALLEY HOSPICE PROVIDES COMPASSIONATE HOSPICE CARE TO TERMINALLY ILL PATIENTS AND THEIR CAREGIVERS. SERVICES INCLUDE IN-HOME NURSING VISITS, PAIN AND SYMPTOM MANAGEMENT, PERSONAL CARE ASSISTANCE, SOCIAL SERVICE ASSISTANCE, RESPITE, SPIRITUAL COUNSELING, MASSAGE, MUSIC AND PET THERAPY, AND BEREAVEMENTS SUPPORT FOR CAREGIVERS AND THE COMMUNITY. WVH RECEIVES FUNDING FROM MEDICARE AND OTHER INSURANCE PLANS. HOWEVER, THIS DOES NOT COVER VOLUNTEER SERVICES, BEREAVEMENT SERVICES, AND ADDITIONAL THERAPIES SUCH AS MUSIC AND MASSAGE. SERVICES ARE ALSO PROVIDED REGARDLESS OF A PATIENT'S ABILITY TO PAY. WVH PROVIDES A UNIQUE SERVICE AS IT IS THE ONLY FREE-STANDING NONPROFIT HOSPICE CARE ORGANIZATION WITHIN A 35-MILE RADIUS OF SALEM. WVH WORKS AS A PARTNER WITH OTHER HEALTHCARE COMMUNITIES, RESIDENTIAL CARE FACILITIES, ADULT FOSTER HOMES, AND ASSISTED LIVING CENTERS, PROVIDING SUPPORT AND EDUCATION ABOUT END OF LIFE CARE. DURING 2018, WVH PROVIDED COMPREHENSIVE HOSPICE CARE TO 1,164 TERMINALLY ILL PATIENTS AND THEIR FAMILIES, INCLUDING NURSING CARE AND MEDICAL AND PSYCHOSOCIAL ASSISTANCE. 10,860 VOLUNTEER HOURS WERE UTILIZED IN PERFORMING THE SERVICES OF THE ORGANIZATION. WVH PROVIDED ADULT FOSTER CARE TO 63 HOSPICE PATIENTS WHO COULD NO LONGER RESIDE IN THEIR OWN HOME. WVH PROVIDED PALLIATIVE CARE TO 128 PATIENTS AND FAMILIES. WVH PROVIDED UNCOMPENSATED SERVICES TO 39 TRANSITION CLIENTS AND 1,421 BEREAVED INDIVIDUALS THROUGH ONEONONE COUNSELING AND GROUP THERAPIES. 7847588 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 36 0 135 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 OR X X TERRY DETHROW 5035883600 1015 3RD STREET NW SALEM OR 97304 CAROLYN VAN OTTEN PRESIDENT 0.50 X X 0 0 0 MANUEL PALACIO VICE PRESIDENT & DIRECTOR 0.50 X X 0 0 0 REV JOHN MOODY DIRECTOR & VICE PRESIDENT 0.50 X X 0 0 0 HOLLY COLLIER SECRETARY 0.50 X X 0 0 0 BETTY O'BRIEN DRIECTOR & TREASURER 0.50 X X 0 0 0 NAOMI HORMANN PAST PRESIDENT 0.50 X X 0 0 0 ANDREW BONE DIRECTOR 0.50 X 0 0 0 DAVID BOOTH DIRECTOR 0.50 X 0 0 0 JINX BRANDT DIRECTOR 0.50 X 0 0 0 CHAD CAMPBELL DIRECTOR 0.50 X 0 0 0 MYCHAL CHERRY DIRECTOR 0.50 X 0 0 0 SCOTT GALLANT DIRECTOR 0.50 X 0 0 0 WAYNE KINKADE DIRECTOR 0.50 X 0 0 0 SHERRIE LESINGER DIRECTOR 0.50 X 0 0 0 GAIL STECK DIRECTOR 0.50 X 0 0 0 IRIA NISHIMURA EXECUTIVE DIRECTOR 40.00 X 158885 0 8824 LINDA HAYS ASSOCIATE DIRECTOR COMMUNITY 40.00 X 122020 0 8828 BARB FARMER ASSOC DIRECTOR OF CLINICAL SERVICES 40.00 X 142008 0 8824 DEANNE BOWER HOSPICE PHYSICIAN 30.00 X 211262 0 1263 JEANINE BROTTON REGISTERED NURSE 40.00 X 142574 0 8916 JENNIFER MCKENZIE REGISTERED NURSE 40.00 X 115617 0 8810 892366 0 45465 13 0 1 0 MAXIM STAFFING 10220 SW GREENBURG ROAD 400 PORTLAND OR 97223 NURSING SERVICES 176523 ACCOUNTEMPS PO BOX 743295 LOS ANGELES CA 90074 FINANCE & ADMINISTRATIVE STAFF 122823 2 15291 451509 466800 PATIENT SERVICES 621610 9790050 9790050 ADULT FOSTER HOME 621610 469509 469509 10259559 98517 98517 2273645 2189876 83769 83769 83769 0 15291 2504 -2504 -2504 MISCELLANEOUS INCOME 900099 91954 91954 91954 10998095 10259559 0 271736 1913 1913 167709 167709 7259716 4967427 2283527 8762 1037671 657910 376770 2991 561195 358095 202828 272 33871 33871 77134 77134 29236 29236 752265 279545 472720 247644 691 214197 32756 307009 2314 304695 117392 1910 115482 256507 242633 13874 19830 19830 9333 9333 168481 23409 145072 72076 90 71986 PATIENT COSTS 1311651 1311651 12430633 7847588 4538264 44781 1534269 653440 184856 493696 1298126 1698511 11040 7200 165658 123917 5468895 2972649 2571698 2496246 4709736 3484542 31012 28826 10506395 8986378 1235668 1094030 487034 1235668 1581064 X 9085870 7201948 184857 203366 9270727 7405314 10506395 8986378 -1432538 -432875 0 X X 0 1 X 1 0 X 288703 320369 279099 1006334 466800 2361305 14205720 13335897 13503495 10267041 10259559 61571712 14494423 13656266 13782594 11273375 10726359 63933017 0 0 0 63933017 177940 179111 164745 110843 98517 731156 177940 179111 164745 110843 98517 731156 31878 61141 56853 55399 91954 297225 14704241 13896518 14004192 11439617 10916830 64961398 0.98420 0.98480 0.01130 0.01170 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME FUNDRAISING EVENT REVENUES 0 0 0 0 0 0 0 0 1 1247 1247 0 PART II-B, LINE 1: WILLAMETTE VALLEY HOSPICE PAYS MEMBERSHIP DUES TO THE OREGON PALLIATIVE AND HOSPICE ASSOCIATION AND THE OREGON ASSOCIATION OF HEALTHCARE WORKERS. A PORTION OF THE MEMBERSHIP DUES ARE USED BY THOSE ASSOCIATIONS TO LOBBY ON BEHALF OF THEIR MEMBERS. 596790 425000 -132693 5613 883484 263964 318176 16733 2083 596790 202813 50853 16028 1559 4171 263964 96476 107794 3061 3320 1198 202813 29962 66819 1237 1281 261 96476 1.00000 0.00000 0.00000 1 0 416150 416150 3341242 1331858 2009384 1711503 1640791 70712 2496246 X 10837537 -432875 40237 393057 419 10837118 29236 131741 160977 10998095 12441634 40237 40237 12401397 29236 29236 12430633 PART V, LINE 4: BOARD-DESIGNATED ENDOWMENTS PROVIDE FOR UNFUNDED HOSPICE CARE FOR THE COMMUNITY AND PROVIDE FOR UNCOMPENSATED CARE. PART X, LINE 2: THE HOSPICE IS TAX EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION. THE INTERNAL REVENUE SERVICE DOES NOT CLASSIFY THE HOSPICE AS A PRIVATE FOUNDATION. MANAGEMENT HAS EVALUATED TAX POSITIONS TAKEN AND HAS DETERMINED THAT ANY UNCERTAINTY IN THESE POSITIONS WOULD NOT HAVE A MATERIAL EFFECT ON THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 43,951. REALIZED AND UNREALIZED INVESTMENT LOSSES 349,106. PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST AND DIVIDENDS 69,281. RESTRICTED CONTRIBUTIONS AND BEQUESTS 62,460. WALK N WAG 15291 15291 297 22 2185 15291 15291 297 22 2185 2504 -2504 X X X X 0 0 0 0 0 0 0 0 0 IRIA NISHIMURA EXECUTIVE DIRECTOR 158885 0 0 0 0 0 0 0 8824 0 167709 0 0 0 BARB FARMER ASSOC DIRECTOR OF CLINICAL SERVICES 142008 0 0 0 0 0 0 0 8824 0 150832 0 0 0 DEANNE BOWER HOSPICE PHYSICIAN 172672 0 38590 0 0 0 0 0 1263 0 212525 0 0 0 JEANINE BROTTON REGISTERED NURSE 142574 0 0 0 0 0 0 0 8916 0 151490 0 0 0 IRIA NISHIMURA OFFICER RELOCATION ASSISTANCE X 12000 7200 0 1 1 7200 FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE BOARD. THE EXCUTIVE COMMITTEE HAS THE POWER OF THE BOARD TO AUTHORIZE EXPENDITURES AND AMENDMENTS TO BUDGETS, SET POLICIES, AND AUTHORIZE PROGRAMS OR ACTIVITIES. THE EXECUTIVE COMMITTE MAKES REASONABLE EFFORTS TO COMMUNICATE WITH THE FULL BOARD IN ADVANCE REGARDING THE ISSUES AND DECISIONS THAT WILL BE CONSIDERED OR VOTED ON AT EXECUTIVE COMMITTEE MEETINGS. THE EXECUTIVE COMMITTEE IS RESPONSIBLE FOR FINANCIAL OVERSIGHT OF THE ORGANIZATION'S INCOME AND EXPENSES. THE COMMITTEE IS RESPONSIBLE FOR OVERSEEING THE ORGANIZATION'S FINANCIAL TRANSACTIONS AND THE IMPLEMENTATION OF THE ORGANIZATION'S FINANCIAL POLICIES. THE COMMITTEE REVIEWS ON A MONTHLY BASIS, OR OVERSEE A MONTHLY REVIEW OF, THE ORGANIZATION'S EXPENDITURES, FINANCIAL TRANSACTIONS, BANK STATEMENTS, RETURNED CHECKS, AND CREDIT CARD STATEMENTS. THE COMMITTEE ALSO MAKES THE NECESSARY ARRANGEMENTS FOR AND OVERSEES THE ORGANIZATION'S ANNUAL AUDIT OR ANNUAL FINANCIAL REVIEW. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S BYLAWS WERE AMENDED IN JUNE 2018 TO MODIFY THE RESPONSIBILITIES OF THE EXECUTIVE COMMITTEE, TO CREATE THE FINANCE COMMITTEE, AND TO INCREASE THE NUMBER OF CONSECUTIVE TERMS THAT A BOARD MEMBER MAY SERVE. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE FINANCE MANAGER, THE EXECUTIVE DIRECTOR AND THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL BOARD MEMBERS AND EMPLOYEES. ALL BOARD MEMBERS, VOLUNTEERS AND STAFF SIGN A CONFLICT OF INTEREST STATEMENT UPON JOINING THE ORGANIZATION. BOARD MEMBERS AND EXECUTIVE STAFF ANNUALLY PROVIDE WRITTEN DISCLOSURE OF ALL PROFESSIONAL AND PERSONAL RELATIONSHIPS OR INTERESTS, DIRECT OR INDIRECT, THAT MIGHT PRESENT A CONFLICT OF INTEREST. IF A MATTER ARISES IN WHICH A BOARD MEMBER HAS AN ACTUAL OR POTENTIAL CONFLICT, THAT CONFLICT IS IMMEDIATELY DISCLOSED TO THE BOARD. IF THE MATTER INVOLVES A VOTE, THE CONFLICTED INDIVIDUAL ABSTAINS FROM VOTING. IF A MATTER ARISES IN WHICH A VOLUNTEER OR EMPLOYEE HAS AN ACTUAL OR POTENTIAL CONFLICT, THE CONFLICT IS IMMEDIATELY DISCLOSED TO THE EXECUTIVE DIRECTOR WHO INVESTIGATES IT. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AND IS SUMMARIZED IN AN EMPLOYMENT CONTRACT. ALL OTHER EMPLOYEES' COMPENSATION IS REVIEWED AND APPROVED BY THE EXECUTIVE DIRECTOR. COMPARABLE COMPENSATION WAS DETERMINED BY USING MARKET RESEARCH WITH ASSISTANCE FROM A COMPENSATION CONSULTING FIRM. MARKET SURVEYS ARE DONE ON ALL EMPLOYEES EACH YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: DURING 2018, OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT WAS MOVED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, WHICH CONSISTS OF THE OFFICERS OF THE BOARD.