2019-08-12T14:57:23-05:00 2018-12-31 560574444 CHERRY BEKAERT LLP 1111 METROPOLITAN AVE STE 900 CHARLOTTE NC 28204 990 2018-01-01 561219017 HOSPICE & PALLIATIVE CARE CHARLOTTE REGION HOSP 7043750100 PO BOX 470408 CHARLOTTE NC 28247 PETER A BRUNNICK PRESIDENT & CEO 7043750100 2019-08-09 1 AMANDA ADAMS P00748038 7043771678 38.142.98.34 2019-08-09 15:05:41 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 18694F53AD11E15FFCEA276DE93F63B2E746D691 2018 2019-02-21 02:37:17Z PETER A BRUNNICK PO BOX 470408 CHARLOTTE NC 28247 65953684 0 X HPCCR.ORG X 1978 NC OPERATING SINCE 1978, HOSPICE & PALLIATIVE CARE CHARLOTTE REGION ("HPCCR") PROVIDES EXPERT END OF LIFE CARE, INCLUDING HOSPICE, PALLIATIVE MEDICINE, GRIEF SUPPORT, AND COMMUNITY EDUCATION. HPCCR IS COMMITTED TO OFFERING QUALITY OF LIFE TO PATIENTS AND FAMILIES IN OUR COMMUNITY WHO ARE COPING WITH TERMINAL ILLNESS. 17 17 650 434 0 0 2503255 2653217 51291877 54007827 624045 2705683 353952 69700 54773129 59436427 0 0 0 0 34875137 34527225 0 0 634757 18541562 20878410 53416699 55405635 1356430 4030792 50932536 50733601 9088907 5982511 41843629 44751090 X OUR MISSION IS TO RELIEVE SUFFERING AND IMPROVE THE QUALITY AND DIGNITY OF LIFE THROUGH COMPASSIONATE HOSPICE CARE AT THE END OF LIFE, PALLIATIVE CARE FOR THOSE WITH ADVANCED ILLNESS, AND THROUGH COMMUNITY EDUCATION. 0 0 47530043 53056826 ADULT HOSPICE CARE SERVICES - HOSPICE CARE IS PROVIDED TO PATIENTS WHO ARE FACING ILLNESSES THAT NO LONGER RESPOND TO CURE-ORIENTED TREATMENT AND WHO HAVE A LIFE EXPECTANCY OF SIX MONTHS OR LESS. CARE IS PROVIDED IN ANY SETTING, INCLUDING THE PATIENT'S PRIVATE RESIDENCE, NURSING FACILITY, HOSPITAL, OR OUR OWN LEVINE & DICKSON HOSPICE HOUSES. AS A NOT-FOR-PROFIT ORGANIZATION, HOSPICE & PALLIATIVE CARE CHARLOTTE REGION PROVIDES SERVICES WITHOUT REGARD TO A PATIENT'S INSURANCE STATUS OR ABILITY TO PAY. THESE SERVICES INCLUDE NURSING CARE, PHYSICIAN VISITS, SOCIAL WORK, AND CHAPLAIN SERVICES. IN ADDITION, ANCILLARY SERVICES AND BEREAVEMENT SUPPORT ARE PROVIDED AFTER THE PATIENT'S DEATH. THE PRIMARY FOCUS OF HOSPICE & PALLIATIVE CARE CHARLOTTE REGION'S CARE IS TO IMPROVE THE QUALITY AND DIGNITY OF LIFE FOR THOSE WHO ARE FACING A LIFE THREATENING ILLNESS. 1669426 512542 PALLIATIVE MEDICINE CONSULTATION SERVICES - PALLIATIVE MEDICINE CONSULTATION SERVICES ENABLE PATIENTS WHO MAY NOT YET BE ELIGIBLE FOR COMPREHENSIVE HOSPICE SERVICES TO HAVE ACCESS TO PALLIATIVE MEDICINE CONSULTATIONS. HOSPICE & PALLIATIVE CARE CHARLOTTE REGION'S PRACTITIONERS OFFER EXPERTISE IN SYMPTOM MANAGEMENT AND OPTIONS FOR COUNSELING FOR THOSE WITH SERIOUS AND PROGRESSIVE ILLNESSES AND CONDITIONS - THESE SERVICES ARE OFFERED IN VARIOUS LOCATIONS INCLUDING HOSPITALS, NURSING HOMES, CLINICS, AND IN PATIENTS' PRIVATE RESIDENCES IN AN EFFORT TO ENHANCE QUALITY OF LIFE AND MAXIMIZE THE LIKELIHOOD OF GOOD RESPONSE TO DISEASE-SPECIFIC AND RESTORATIVE THERAPIES FOR CHRONICALLY ILL AND MEDICALLY FRAGILE PATIENTS.IN 2018, HOSPICE & PALLIATIVE CARE CHARLOTTE REGION'S PALLIATIVE MEDICINE CONSULTATION SERVICES SERVED 2.057 PATIENTS. ALTHOUGH INADEQUATELY REIMBURSED, HPCCR HAS DEVELOPED THESE SERVICES IN FULFILLMENT OF ITS MISSION OF RELIEF OF SUFFERING AND IMPROVING QUALITY AND DIGNITY OF LIFE. THE COST IN 2018 FOR THESE UNREIMBURSED SERVICES WAS $1,156,884. 377926 438459 PEDIATRIC CARE (KIDS PATH) - KIDS PATH IS A UNIQUE PROGRAM FOR CHILDREN, RANGING FROM INFANTS TO EIGHTEEN YEARS OF AGE, AND THEIR FAMILIES FACING THE CHALLENGES OF COPING WITH A SERIOUS PROGRESSIVE CONDITION. OUR PEDIATRIC TEAM OFFERS PHYSICAL, EMOTIONAL, AND SPIRITUAL CARE WITH A GOAL OF ENHANCING THE QUALITY OF LIFE FOR TERMINALLY ILL CHILDREN AND TEENS, AND THOSE WHO SHARE THEIR LIVES. HOSPICE & PALLIATIVE CARE CHARLOTTE REGION'S PEDIATRIC SERVICES ALSO INCLUDE GRIEF SERVICES FOR CHILDREN AND THEIR FAMILIES THROUGH CHAMELEON'S JOURNEY OVERNIGHT AND DAY CAMPS AND IN-SCHOOL GRIEF PROGRAMS. HOSPICE & PALLIATIVE CARE CHARLOTTE REGION HAS THE HONOR OF TOUCHING THE LIVES OF HUNDREDS OF GRIEVING YOUTH AND THEIR PARENT-GUARDIANS. 49577395 1 1 0 0 0 0 0 0 1 1 1 1 0 1 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 226 0 1 650 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC SC X PETER A BRUNNICK 7043750100 PO BOX 470408 CHARLOTTE NC 28247 JANE B NEESE CHAIR 1.00 1.00 X X 0 0 0 JEFFREY G GORE VICE CHAIR AT LARGE 1.00 1.00 X X 0 0 0 LAURA ENGEL SECRETARY 1.00 1.00 X X 0 0 0 GEORGE MACBAIN IV TREASURER 1.00 1.00 X X 0 0 0 MICHAEL A MCNAMARA PAST CHAIR 1.00 1.00 X 0 0 0 LARRY BREHMER DIRECTOR 1.00 1.00 X 0 0 0 KEVIN DAVIS DIRECTOR 1.00 1.00 X 0 0 0 GREGORY R KILPATRICK DIRECTOR 1.00 1.00 X 0 0 0 DAVID LAMOTHE DIRECTOR 1.00 1.00 X 0 0 0 COLLIE LEHN DIRECTOR 1.00 1.00 X 0 0 0 BRYAN R MIDURA DIRECTOR 1.00 1.00 X 0 0 0 ZIVONIMIR MILAS DIRECTOR 1.00 1.00 X 0 0 0 JOHN A MORRICE DIRECTOR 1.00 1.00 X 0 0 0 KENNETH W POE DIRECTOR 1.00 1.00 X 0 0 0 ALAN R THALINGER DIRECTOR 1.00 1.00 X 0 0 0 CHRISTOPHER G ULLRICH DIRECTOR 1.00 1.00 X 0 0 0 WILLIAM B WEBB DIRECTOR 1.00 1.00 X 0 0 0 PETER BRUNNICK PRESIDENT & CEO 40.00 1.00 X 510976 0 15869 TODD FONTENOT CHIEF FINANCIAL OFFICER 40.00 1.00 X 58065 0 6293 MICHAEL BOLEWITZ CHIEF OPERATING OFFICER 40.00 1.00 X 245401 0 500 ROBERT SMITH CHIEF MEDICAL OFFICER 40.00 X 286066 0 0 DEIDRA GATLIN PHYSICIAN 40.00 X 200166 0 35267 WILLIAM WILLIAMS PHYSICIAN 40.00 X 175502 0 0 JANET CROOK PHYSICIAN 40.00 X 156884 0 0 JOSHI MRINALINI PHYSICIAN 40.00 X 155215 0 0 CYNTHIA TILLEY VP OF HR 40.00 X 153596 0 12071 1941871 0 70000 13 0 1 0 PAYCOM 7501 W MEMORIAL RD OKLAHOMA CITY OK 73142 PAYROLL PROCESSING 103765 1 17725 338134 2297358 353991 2653217 PATIENT SERVICE REVENUE, NET 623000 54007827 54007827 54007827 270942 270942 3500 0 3500 3500 3500 5504778 3330800 5471755 929082 33023 2401718 2434741 2434741 171598 338134 116420 55178 55178 11022 11022 11022 59436427 54007827 0 2775383 1123173 286067 837106 27512157 25084566 2103997 323594 316329 274851 32736 8742 3597060 3191989 366111 38960 1978506 1760478 184794 33234 88237 88237 1084463 631542 392144 60777 68253 68114 139 844061 650006 135547 58508 568674 301837 237698 29139 1061055 888451 158263 14341 798169 751934 42393 3842 110976 46438 59176 5362 984097 750093 227490 6514 144288 90094 53480 714 NURSING HOME RM/BOARD 6758216 6758216 MEDICINE 2690767 2690767 DURABLE MEDICAL EQUIP 2058978 2058978 MEDICAL SUPPLIES 1060131 1060131 2558045 2300957 206197 50891 55405635 49577395 5193483 634757 2869295 3630825 359955 426823 766872 665992 5691989 5677491 14809 0 734053 881884 29246971 8364322 22100719 20882649 11463076 11121338 4453809 4289224 7500 7500 249846 249846 2220613 2900029 50932536 50733601 3589915 4118617 2009592 1863894 3489400 0 9088907 5982511 X 41201205 44150249 348967 307384 293457 293457 41843629 44751090 50932536 50733601 4030792 -1123331 0 X 0 1 X 1 0 X 2362937 1938041 3581252 2503255 2653217 13038702 2362937 1938041 3581252 2503255 2653217 13038702 1767115 11271587 264182 263576 211336 204879 274442 1218415 117458 167991 148565 55178 489192 16875 16294 45983 350116 11022 440290 15186599 257514802 0.74220 0.76090 X 0 1 X 427804 -29175 18860 379769 391402 56586 20184 427804 391922 19929 20449 391402 425518 600 -14496 19700 391922 424416 100 18291 17289 425518 0.00000 0.77270 0.22730 0 0 378334 6131622 6509956 15871698 3702045 12169653 998579 277173 721406 3596162 2858183 737979 2270576 1526921 743655 20882649 POOLED FUNDS - FFTC 4289224 F 4289224 DUE FROM AFFILIATE 2873829 SPLIT-INTEREST AGREEMENT 26200 2900029 X PART IV, LINE 2B: HPCCR PROVIDES CERTAIN EMPLOYEES THE OPPORTUNITY TO DEFER CURRENT COMPENSATION UNDER A 457(B) PLAN AND HOLDS THE DEFERRED AMOUNTS, PLUS ANY EARNINGS, FOR THEIR BENEFIT. DEFERRALS ARE ELECTIVE, AND PARTICIPANTS ARE REQUIRED TO COMMENCE BENEFIT PAYMENTS NO EARLIER THAN 61 DAYS FOLLOWING SEPARATION FROM SERVICE OR NO LATER THAN AGE 70.5. HPCCR'S POLICY IS TO RECOGNIZE THE FAIR VALUE OF INVESTMENTS HELD BY THE PLAN AND AN OFFSETTING LIABILITY UNTIL BENEFITS ARE DISTRIBUTED, AT WHICH TIME THE ASSET AND LIABILITY ARE REMOVED FROM HPCCR'S BOOKS. PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT CONSISTS OF FOUR INDIVIDUAL DONOR-RESTRICTED FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. THE ORGANIZATION HAS A POLICY OF APPROPRIATING FOR DISTRIBUTION (TO FUND CURRENT PROGRAMS) EACH YEAR 4.5% OF THE ENDOWMENT FUNDS' AVERAGE FAIR VALUE USING THE PRIOR THREE YEARS' VALUE AT THE CALENDAR YEAR-END PRECEDING THE FISCAL YEAR IN WHICH THE DISTRIBUTION IS PLANNED. PART X, LINE 2: HPCCR AND HOLC ARE ORGANIZED UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AS NONPROFIT, TAX-EXEMPT ORGANIZATIONS. MANAGEMENT BELIEVES THAT HPCCR AND HOLC CONTINUE TO SATISFY THE REQUIREMENTS OF THE TAX-EXEMPT ORGANIZATION AND IS NOT SUBJECT TO TAX. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN REFLECTED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT HAS EVALUATED THE EFFECT OF FASB GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES IN AN ENTITY'S CONSOLIDATED FINANCIAL STATEMENTS BY PRESCRIBING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE ORGANIZATION'S POLICY IS TO RECORD A LIABILITY FOR ANY TAX POSITION TAKEN THAT IS BENEFICIAL TO THE ORGANIZATION, INCLUDING ANY RELATED INTEREST AND PENALTIES, WHEN IT IS MORE LIKELY THAN NOT THE POSITION TAKEN BY MANAGEMENT WITH RESPECT TO A TRANSACTION OR CLASS OF TRANSACTIONS WILL BE OVERTURNED BY A TAXING AUTHORITY UPON EXAMINATION. LKN REGATTA & PARTY 212812 163156 49656 17982 12552 CORKS & KARATS 120924 76881 44043 24716 2000 17449 5 145743 98097 47646 41721 479479 338134 141345 42698 2000 71722 116420 24925 X X X X 0 0 0 0 0 0 0 1 0 PETER BRUNNICK PRESIDENT & CEO 384965 0 122392 0 3619 0 0 0 15869 0 526845 0 0 0 MICHAEL BOLEWITZ CHIEF OPERATING OFFICER 207500 0 35568 0 2333 0 0 0 500 0 245901 0 0 0 ROBERT SMITH CHIEF MEDICAL OFFICER 258600 0 24557 0 2909 0 0 0 0 0 286066 0 0 0 DEIDRA GATLIN PHYSICIAN 195181 0 4985 0 0 0 0 0 35267 0 235433 0 0 0 WILLIAM WILLIAMS PHYSICIAN 170457 0 5045 0 0 0 0 0 0 0 175502 0 0 0 JANET CROOK PHYSICIAN 151904 0 4980 0 0 0 0 0 0 0 156884 0 0 0 JOSHI MRINALINI PHYSICIAN 155090 0 125 0 0 0 0 0 0 0 155215 0 0 0 CYNTHIA TILLEY VP OF HR 144000 0 8000 0 1596 0 0 0 12071 0 165667 0 0 0 PART I, LINE 7 BONUS PAYMENTS ARE BASED ON THE EVALUATION OF THE YEAR'S ACCOMPLISHMENTS AND DEGREE OF COMPLETION OF A COMMONLY AGREED UPON SET OF GOALS. THE EVALUATION OF THE PRESIDENT & CEO'S PERFORMANCE AND DETERMINATION OF BONUS PAYMENT IS MADE BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE EVALUATION OF OTHER EXECUTIVES' PERFORMANCE AND DETERMINATION OF BONUS PAYMENT IS MADE BY THE PRESIDENT & CEO AND VP OF HR. X 2 2250 FMV X 2 8363 FMV X 1 216900 FMV X SUPPLIES 181 66174 FMV X AUCTION ITEMS 287 60304 FMV 0 0 1 0 FORM 990, PART VI, SECTION B, LINE 11B BEFORE SUBMITTING THE FORM 990 TO THE IRS, HOSPICE & PALLIATIVE CARE CHARLOTTE REGION EMAILS THE FINAL COPY OF THE FORM 990, INCLUDING ALL REQUIRED SCHEDULES, TO ALL VOTING MEMBERS OF THE GOVERNING BODY. THE FINANCE COMMITTEE MAKES A FULL REVIEW OF THE PREPARED RETURN. ANY COMMENTS OR QUESTIONS REGARDING THE RETURN ARE DISCUSSED AT THE NEXT SCHEDULED MEETING OF THE FULL BOARD. THE BOARD CHAIR, OR DESIGNEE, IS RESPONSIBLE FOR FACILITATING THE REVIEW. FORM 990, PART VI, SECTION B, LINE 12C WHEN A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED, THE CONFLICT WILL BE RESOLVED BY EITHER THE BOARD OF DIRECTOR'S EXECUTIVE COMMITTEE, WHEN A BOARD MEMBER IS INVOLVED, OR BY THE CEO AND THE VICE PRESIDENT OF HUMAN RESOURCES WHEN THE CONFLICT INVOLVES AN EMPLOYEE. IN EACH CASE, A MEETING WILL BE CALLED WITH THE INDIVIDUAL WITH THE POTENTIAL CONFLICT AND THE PARTIES WILL REACH A MUTUALLY AGREED UPON RESOLUTION. IF A CONFLICT OF INTEREST CANNOT BE RESOLVED TO THE SATISFACTION OF BOTH PARTIES, OR IF THERE IS A FAILURE TO COMPLY WITH THE CONFLICT OF INTEREST POLICY, THEN ACTIONS NECESSARY TO ELIMINATE THE CONFLICT OF INTEREST WILL BE TAKEN, UP TO AND INCLUDING THE RESIGNATION OF EITHER THE BOARD MEMBER OR EMPLOYEE. NO BOARD MEMBER OR COMMITTEE MEMBER WILL BE PERMITTED TO BE PRESENT FOR DISCUSSION OF OR BE PERMITTED TO VOTE ON ANY SPECIFIC ISSUE IN WHICH HE OR SHE HAS A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE REVIEW OF THE CEO AND OTHER EXECUTIVES ARE CONDUCTED ANNUALLY BY THE VP OF HR AND REVIEWED WITH THE CEO. REVIEW INCLUDES ANALYSIS OF SALARY DATA FROM FORM 990S OF COMPARABLE HOSPICE ORGANIZATIONS NATIONALLY AS WELL AS LOCAL LARGE NOT-FOR-PROFIT ENTITIES. DATA IS AGED TO CURRENT DATE. THE CEO SALARY COMPARISON INFORMATION IS SHARED BY VP OF HR TO THE EXECUTIVE COMMITTEE ANNUALLY AT THE TIME OF THE CEO'S PERFORMANCE EVALUATION. OTHER TOP SALARY REVIEWS ARE HANDLED ANNUALLY OR AS THE NEED ARISES BY THE CEO AND VP OF HR. THE DATA RELIED UPON AND THE COMPENSATION DECISION IS DOCUMENTED IN THE MINUTES TO THE EXECUTIVE COMMITTEE MEETING. FORM 990, PART VI, SECTION C, LINE 19 HOSPICE & PALLIATIVE CARE CHARLOTTE REGION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON A REQUEST BASIS. HOSPICE OF LAURENS COUNTY PO BOX 178 CLINTON SC 29645 570843527 HOSPICE CARE SC 501(C)(3) LINE 7 HOSPICE AND PALLIATIVE CARE CARE CHARLOTTE REGION 1 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 0 1 1 1 HOSPICE OF LAURENS COUNTY D 2873829 BOOK