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 341352875 LIFECARE HOSPICE LIFE 3302644899 1900 AKRON ROAD WOOSTER OH 44691 CALVIN W ROBINSON CFO CFO 3302644899 2019-11-11 1 BERNIE OSTROWSKI P00366367 6148493000 2019-11-11 67.59.56.30 2019-11-11 11:30:01 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F9202394C89F7E1E82AD9F5569A008AA49B9D6B3 2018 2020-03-31 21:24:44Z KURT HOLMES 1900 AKRON ROAD WOOSTER OH 44691 10478050 0 X WWW.LIFECAREHOSPICE.COM X 1980 OH THE MISSION OF HOSPICE IS TO PROVIDE MEDICAL CARE, NURSING CARE, PAIN RELIEF, AND EMOTIONAL AND SPIRITUAL SUPPORT SERVICES TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES. 12 11 156 199 0 0 267733 657582 9534585 9814460 556 62 172031 -3825 9974905 10468279 0 0 0 0 5971812 7389037 0 0 20141 3897911 4601179 9869723 11990216 105182 -1521937 13109262 13970059 7132085 9504819 5977177 4465240 THE MISSION OF HOSPICE IS TO PROVIDE MEDICAL CARE, NURSING CARE, PAIN RELIEF, AND EMOTIONAL AND SPIRITUAL SUPPORT SERVICES TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES. 0 0 9275975 0 9814460 LIFECARE HOSPICE IS COMMITTED TO BEING THE PREMIER PROVIDER DEDICATED TO PRESERVING THE QUALITY OF LIFE BY PROVIDING EXPERT PHYSICAL, EMOTIONAL, AND SPIRITUAL CARE TO PATIENTS AND FAMILIES WITH LIFE-LIMITING ILLNESSES. 9275975 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 52 0 1 156 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X CALVIN W ROBINSON 3302644899 7575 PARAGON ROAD DAYTON OH 45459 SHARON POOLER CHAIR 2.00 0.00 X X 0 0 0 ROSE SOLTZ VICE CHAIR 2.00 0.00 X X 0 0 0 DAVID REYNOLDS SECRETARY 2.00 0.00 X X 0 0 0 JIM GEISER TREASURER 2.00 2.00 X X 0 0 0 JOHN MILLER BOARD MEMBER 2.00 0.00 X 0 0 0 KHANKEO KHOUNBORIN BOARD MEMBER 2.00 0.00 X 0 0 0 MONICA MIYASHITA BOARD MEMBER 2.00 0.00 X 0 0 0 RICHARD GUTTMAN BOARD MEMBER 2.00 0.00 X 0 0 0 ANN BAILEY BOARD MEMBER 2.00 0.00 X 0 0 0 BRYCE CHAFFEE BOARD MEMBER 2.00 0.00 X 0 0 0 TOM CIHA BOARD MEMBER 2.00 0.00 X 0 0 0 KURT HOLMES EXECUTIVE DIRECTOR 40.00 0.00 X X 140514 0 6033 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 DAVID LANCE MEDICAL DIRECTOR 40.00 0.00 X 220101 0 32332 JODI HANNAN TEAM PHYSICIAN 40.00 0.00 X 101728 0 26482 462343 859903 128890 3 0 1 0 SMITHVILLE WESTERN CARE CENTER SPRENGER CORP - JANICE HARRIS 3905 LORAIN OH 44053 HEALTH CARE SERVICES 209852 SYCAMORE RUN 6180 STATE ROUTE 83 MILLERSBURG OH 44654 NURSING AND REHABILITATION SERVICES 175824 WEST VIEW MANOR 1715 MECHANICSBURG ROAD WOOSTER OH 44691 HEALTH CARE SERVICES 166960 SHADY LAWN 15028 OLD LINCOLN WAY E DALTON OH 44618 SKILLED NURSING AND REHABILITATION SERVI 156968 MEDLINE INDUSTRIES INC PO BOX 382075 PITTSBURGH PA 152518075 MEDICAL SUPPLIES 151594 8 75470 582112 335 657582 PATIENT SERVICE FEES 624100 9814460 9814460 9814460 62 62 6021 75470 9771 -3750 -3750 CAFETERIA REVENUE 900099 7660 7660 MISCELLANEOUS REVENUE 900099 -7735 -7735 -75 10468279 9822120 0 -11423 398980 398980 5505954 5068072 422217 15665 163202 153161 10041 919964 829107 88186 2671 400937 345782 55155 4770 4770 -3300 -3300 14051 5739 8312 93955 4875 89080 716596 555988 159138 1470 176097 170 175927 262735 229791 32944 240275 220358 19917 43973 3581 40392 247505 247505 341923 312346 29577 17474 17474 PATIENT SERVICE 1357264 1357264 ALLOCATION COSTS 824219 824219 ROOM & BOARD 148126 148126 DUES & SUBSCRIPTIONS 36308 8421 27887 79208 33194 45679 335 11990216 9275975 2694100 20141 479379 480798 1834045 2711752 15414 21428 11021089 515008 10530424 10506081 250000 250000 0 13109262 13970059 979143 1412255 6070500 5781760 82442 2310804 7132085 9504819 X 5977177 4455240 10000 5977177 4465240 13109262 13970059 X -1521937 10000 X X 0 1 X 1 0 X 375038 380121 541492 85286 657582 2039519 375038 380121 541492 85286 657582 2039519 2039519 26852 22251 41738 30 62 90933 55103 69342 51569 65579 -1714 239879 2370331 47219061 0.86040 0.79540 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1155107 1155107 8559611 268455 8291156 392323 23777 368546 911030 219758 691272 3018 3018 0 10506081 PAYABLE TO RELATED PARTY 2310804 2310804 X X X SPRING GALA 52772 46751 6021 9233 419 CHARM DAYS 28719 28719 119 81491 75470 6021 9233 538 9771 -3750 0 1 0 0 0 0 0 1 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 DAVID LANCE MEDICAL DIRECTOR 207361 0 12740 0 0 0 9995 0 22337 0 252433 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 WERE MADE TO 457(B) DEFERRED COMPENSATION PLANS ON BEHALF OF CALVIN W. ROBINSON. 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 ORGANIZATION. 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 INFORMATION IS AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION, INFORMATION IS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: RESTRICTED CONTRIBUTIONS 10,000. 10 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 0 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 0 HOSPICE OF DAYTON INC 7575 PARAGON ROAD DAYTON OH 45459 310933339 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 0 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 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 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0