2019-11-13T07:24:56-06:00 2018-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2018-01-01 310933339 HOSPICE OF DAYTON INC HOSP 9372564490 324 WILMINGTON AVENUE DAYTON OH 45420 CALVIN W ROBINSON CFO 9372564490 2019-11-11 1 BERNIE OSTROWSKI P00366367 6148493000 2019-11-11 67.59.56.30 2019-11-11 12:06:56 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F9202394C89F7E1E82AD9F5569A008AA49B9D6B3 2018 2020-03-31 21:24:44Z KENT ANDERSON 324 WILMINGTON AVENUE DAYTON OH 45420 67446510 0 X WWW.HOSPICEOFDATYON.ORG X 1978 OH TO PROVIDE HOSPICE AND PALLIATIVE CARE FOR THE TERMINALLY ILL AND SUPPORT FOR THEIR FAMILIES. 11 10 810 833 0 0 1922783 2635729 60284424 63557825 308245 1124728 383116 128228 62898568 67446510 0 0 0 0 36183841 41729485 0 0 45247 25695703 23692487 61879544 65421972 1019024 2024538 50649081 77137379 22394308 48828587 28254773 28308792 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 53591868 0 63812725 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. 53591868 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 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 297 0 1 810 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X CALVIN W ROBINSON 9372564490 7575 PARAGON ROAD DAYTON OH 45459 THOMAS MANN CHAIR 3.00 4.00 X X 0 0 0 LISA HANUAER VICE CHAIR 2.00 2.00 X X 0 0 0 TONI SPRINKEL TREASURER 2.00 2.00 X X 0 0 0 PETE HALEY 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 PEGGY MARK BOARD MEMBER 2.00 0.00 X 0 0 0 RATNA PALAKODETI BOARD MEMBER 2.00 0.00 X 0 0 0 MARY MURPHY PRESIDENT - HOD 38.00 2.00 X X 0 254070 41897 KENT ANDERSON PRESIDENT & CEO - OHI 2.00 38.00 X 0 615829 20727 CALVIN W ROBINSON CHIEF FINANCIAL OFFICER - OHI 2.00 38.00 X 0 244074 43316 CHIRAG PATEL PRESIDENT, ICS & REGIONAL CHIEF MED OFFICER 40.00 0.00 X 380108 0 35644 JACQUELINE MATTHEWS VICE PRESIDENT OF PALLIATIVE & SUPPORT CARE 40.00 0.00 X 176415 0 32081 REBECCA BLEDSOE DIRECTOR OF PHARAMACY - HOD 40.00 0.00 X 153206 0 4832 WENDY SCHMITZ VP OF MEDICAL CARE/MEDICAL DIRECTOR 40.00 0.00 X 331525 0 33683 CLEANNE CASS MEDICAL DIR OF COMMUNITY CARE AND EDUCATION 40.00 0.00 X 284883 0 13263 JOHN AHERN MEDICAL DIRECTOR COMMUNITY CARE 40.00 0.00 X 231964 0 33782 TIMOTHY MACLEAN MEDICAL DIRECTOR HOSPICE HOUSE / INPATIENT 40.00 0.00 X 218568 0 18002 RANAPREET PATEL MEDICAL DIRECTOR HOSPICE HOUSE / INPATIENT 40.00 0.00 X 228774 0 11417 ANNA RYMER MEDICAL DIRECTOR PALLIATIVE CARE 40.00 0.00 X 240909 0 36368 2246352 1113973 325012 14 0 1 0 VANCREST LTD 1600 PARK AVENUE EATON OH 45320 MEDICAL SERVICES 794591 MEDLINE INDUSTRIES INC PO BOX 382075 PITTSBURGH PA 152518075 MEDICAL SUPPLIES 730497 BROOKHAVEN NURSING CENTER 1 COUNTRY LANE BROOKVILLE OH 45309 MEDICAL SERVICES 628129 SPRINGFIELD REG MED CENTER PO BOX 636374 CINCINNATI OH 452636374 MEDICAL SERVICES 552502 COOLIDGE WALL 33 WEST FIRST STREET SUITE 60 DAYTON OH 454021289 LEGAL SERVICES 516568 42 2635729 2635729 PATIENT SERVICE 624100 63557825 63557825 63557825 1124728 1124728 CATERING REVENUE 900099 122998 122998 CAFETERIA REVENUE 900099 105149 105149 SUBWAY PROPERTY 900099 26753 26753 -126672 -126672 128228 67446510 63812725 0 998056 2465424 2465424 30631818 30285134 345802 882 1013948 1012105 1843 5303345 4963375 339812 158 2314950 2127204 187679 67 53960 11776 42184 300 300 1475026 1065106 409608 312 579741 37290 541873 578 1026883 602361 389609 34913 738700 354448 384017 235 1190603 1070518 120085 1300909 1246833 53731 345 267904 150579 109568 7757 553986 553986 1845957 1629875 216082 97250 97250 MEDICAL SUPPLIES 5903832 5902413 1419 0 ALLOCATION COSTS 5325293 0 5325293 0 PATIENT SERVICE 2011061 2011054 7 0 ROOM & BOARD 728435 728435 592647 393362 199285 65421972 53591868 11784857 45247 450 -1255232 7884277 7042472 196885 361230 52202526 21358071 21371795 30844455 19954281 15669622 661966 1241393 23812866 50649081 77137379 5679839 6146104 16714469 42682483 22394308 48828587 X 28254773 28308792 28254773 28308792 50649081 77137379 2024538 -1970519 0 X X 0 1 X 1 0 X 2431175 3497069 1604818 1922783 2635729 12091574 2431175 3497069 1604818 1922783 2635729 12091574 12091574 424160 437166 437193 510392 1124728 2933639 47412 174187 -126672 94927 15120140 265963167 0.79970 0.83470 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 28829625 -730177 3730397 24369051 24949847 709925 3378753 208900 28829625 28773188 30000 1146659 5000000 24949847 28776265 25000 -4436 23641 28773188 29186685 1556223 1966643 28776265 0.96150 0.03850 0.00000 0 1 1 1301208 1301208 30303142 15529672 14773470 7286 698 6588 7877108 5458608 2418500 12713782 369093 12344689 30844455 INTERCOMPANY RECEIVABLES 23812866 23812866 RETIREMENT PLAN LIABILITY 808860 PAYABLE TO RELATED PARTY 30476882 LINE OF CREDIT 11396741 42682483 0 1 0 0 0 0 0 1 0 MARY MURPHY PRESIDENT - HOD 0 223920 0 30150 0 0 0 19678 0 22219 0 295967 0 0 KENT ANDERSON PRESIDENT & CEO - OHI 0 399329 0 216500 0 0 0 0 0 20727 0 636556 0 0 CALVIN W ROBINSON CHIEF FINANCIAL OFFICER - OHI 0 214074 0 30000 0 0 0 19227 0 24089 0 287390 0 0 CHIRAG PATEL PRESIDENT, ICS & REGIONAL CHIEF MED 345791 0 34317 0 0 0 11562 0 24082 0 415752 0 0 0 JACQUELINE MATTHEWS VICE PRESIDENT OF PALLIATIVE & SUPPO 158290 0 18125 0 0 0 11353 0 20728 0 208496 0 0 0 REBECCA BLEDSOE DIRECTOR OF PHARAMACY - HOD 140514 0 12692 0 0 0 2212 0 2620 0 158038 0 0 0 WENDY SCHMITZ VP OF MEDICAL CARE/MEDICAL DIRECTOR 302817 0 28708 0 0 0 13750 0 19933 0 365208 0 0 0 CLEANNE CASS MEDICAL DIR OF COMMUNITY CARE AND ED 259265 0 25618 0 0 0 13259 0 4 0 298146 0 0 0 JOHN AHERN MEDICAL DIRECTOR COMMUNITY CARE 231964 0 0 0 0 0 9338 0 24444 0 265746 0 0 0 TIMOTHY MACLEAN MEDICAL DIRECTOR HOSPICE HOUSE / INP 218568 0 0 0 0 0 6492 0 11510 0 236570 0 0 0 RANAPREET PATEL MEDICAL DIRECTOR HOSPICE HOUSE / INP 228774 0 0 0 0 0 11406 0 11 0 240191 0 0 0 ANNA RYMER MEDICAL DIRECTOR PALLIATIVE CARE 219659 0 21250 0 0 0 12440 0 23928 0 277277 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 4B CONTRIBUTIONS AND/OR ACCRUALS OF $9,000 EACH WERE MADE TO 457(B) DEFERRED COMPENSATION PLANS ON BEHALF OF CALVIN W. ROBINSON, AMY WAGNER, ED RUFF, AND MARY MURPHY. CONTRIBUTIONS OF $2,500 WERE MADE TO 457(B) DEFERRED COMPENSATION PLANS ON BEHALF OF JACQUELINE MATTHEWS. 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. FORM 990, PART VI, SECTION A, LINE 6 OHIO'S HOSPICE, INC IS THE SOLE MEMBER OF THE HOSPICE OF DAYTON THROUGH AN AFFILIATION AGREEMENT. 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 BOARD OF TRUSTEES UTILIZES 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 THE BOARD OF TRUSTEES AS PART OF THE BUDGET PROCESS. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. 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. FORM 990, 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. INNOVATIVE CARE SOLUTIONS LLC 7575 PARAGON ROAD DAYTON OH 45459 TO PROVIDE PALLIATIVE CARE PHYSICIANS & SUPPORT PERSONNEL OH 4466295 10301186 THE HOSPICE OF DAYTON COMMUNITY CARE HOSPICE INC PO BOX 123 WILMINGTON OH 45177 371495725 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 0 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 0 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 550 SUMMIT AVENUE TROY OH 45373 311031277 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 0 LIFECARE HOSPICE 1900 AKRON ROAD WOOSTER OH 44691 341352875 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 0 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 0 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 0 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0