2019-05-30T16:28:43-05:00 2018-12-31 421243538 BERGANKDV LTD PO BOX 2100 WATERLOO IA 507042100 990 2018-01-01 421135294 CEDAR VALLEY HOSPICE INC CEDA 3192722002 PO BOX 2880 WATERLOO IA 507042880 MICHAELA VANDERSEE EXECUTIVE DIRECTOR 3192722002 2019-05-15 1 DAVID A RICHTER P00168204 3192346885 2019-05-15 108.178.221.43 2019-05-15 10:16:54 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 8D1AADE1AEEEF148FCD34A6061C7F26534A94228 2018 2019-02-21 02:37:17Z MICHAELA VANDERSEE PO BOX 2880 WATERLOO IA 507042880 12638933 0 X WWW.CVHOSPICE.ORG X 1979 IA PROVIDE HOSPICE AND COUNSELING SERVICES TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES. 16 16 132 400 0 0 1197505 1357056 8065317 8647352 156797 269955 -12847 -14676 9406772 10259687 87921 111605 0 0 5878223 5945582 0 0 190165 4023381 3791974 9989525 9849161 -582753 410526 7010229 6841531 1136196 972693 5874033 5868838 TO ENRICH LIVES WITH KNOWLEDGE, RESPECT, AND COMPASSIONATE CARE. 0 0 7472469 111605 8647352 CEDAR VALLEY HOSPICE IS DEDICATED TO PROVIDING HOSPICE SERVICES TO THOSE WITH A SIX MONTH PROGNOSIS OR LESS, SERVING 911 PATIENTS IN 2018. THE AVERAGE DAILY CENSUS WAS 130 WHICH ALLOWED THE ORGANIZATION TO PROVIDE 47,517 DAYS OF CARE. THE AVERAGE LENGTH OF STAY FOR HOSPICE PATIENTS WAS 53 DAYS. CEDAR VALLEY HOSPICE PROVIDES GRIEF SUPPORT SERVICES TO ANYONE STRUGGLING WITH THE DEATH OF A LOVED ONE, SERVING 2,856 GRIEF CLIENTS IN 2018. GRIEF CLIENTS WERE SERVED THROUGH INDIVIDUAL VISITS, SUPPORT GROUPS, SMALL AND LARGE GROUP SETTINGS (I.E. EMPLOYERS/SCHOOL) AND MAILINGS. CEDAR VALLEY HOSPICE PROVIDES HOME CARE SERVICES TO THOSE WITH A LIFE THREATENING ILLNESS, SERVING 116 CLIENTS IN 2018. 7472469 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 70 0 1 132 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 16 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KRIS GLASER 3192722002 2101 KIMBALL AVENUE SUITE 401 WATERLOO IA 50701 NANCY WEBER PRESIDENT 0.50 X X 0 0 0 MONTE BERG DIRECTOR 0.50 X 0 0 0 SARAH THOMPSON DIRECTOR 0.50 X 0 0 0 KELLY TURNER DIRECTOR 0.50 X 0 0 0 KIM KRIZEK DIRECTOR 0.50 X 0 0 0 DENNIS CLARK DIRECTOR 0.50 X 0 0 0 LISA WALL DIRECTOR 0.50 X 0 0 0 JASON KIRKPATRICK DIRECTOR 0.50 X 0 0 0 JASON WITHAM DIRECTOR 0.50 X 0 0 0 JOHN HOUGEN DIRECTOR 0.50 X 0 0 0 BILL COLWELL DIRECTOR 0.50 X 0 0 0 RENAE BOCKHOLT DIRECTOR 0.50 X 0 0 0 CHRIS KEMP TREASURER 0.50 X X 0 0 0 JUNEVER HEYING SECRETARY 0.50 X X 0 0 0 SCOTT WIENANDS VICE PRESIDENT 0.50 X X 0 0 0 GAIL HUSER DIRECTOR 0.50 X 0 0 0 MICHAELA VANDERSEE EXECUTIVE DIRECTOR 65.00 X 149048 0 28601 KRIS GLASER DIRECTOR OF FINANCE 65.00 X 97597 0 19131 LAURA SKILLEN CLINICAL SERVICES MANAGER 40.00 X 101406 0 16232 348051 0 63964 2 0 1 0 OPTUM HOSPICE PHARMACY SERVICES 4525 EXECUTIVE PARK DR SUITE 100 MONTGOMERY AL 36116 PHARMACIST CONSULTS AND PRESCRIPTIONS 536205 QUALIS MANAGEMENT LLC 58 AZIMUTH COURT ROCKY MOUNT NC 27804 MEDICAL EQUIPMENT MANAGEMENT 283755 COVENANT MEDICAL CLINIC 3421 WEST NINTH STREET WATERLOO IA 50702 INPATIENT AND OUTPATIENT SERVICES 252162 WESTERN HOME COMMUNITIES 5307 CARAWAY LANE CEDAR FALLS IA 50613 NURSING FACILITY - ROOM AND BOARD 190811 BUCHANAN COUNTY HEALTH CENTER 1600 1ST ST E INDEPENDENCE IA 50644 INPATIENT AND OUTPATIENT SERVICES 113672 5 36686 321346 999024 42715 1357056 PATIENT CARE FEES 623990 8647352 8647352 8647352 89667 89667 2533898 2353610 180288 180288 180288 10960 36686 25636 -14676 -14676 10259687 8647352 0 255279 111605 111605 293526 293526 4557173 3431981 1038605 86587 763002 546460 199370 17172 331881 233103 92790 5988 15386 15386 22300 22300 16047 16047 25973 18914 7059 91760 91760 216968 69781 134816 12371 97635 74298 23337 163494 125889 29430 8175 193612 179033 13883 696 95817 35554 60232 31 173320 138773 27037 7510 29194 22479 5255 1460 PATIENT EXPENSES 1572635 1572635 MEDICAL SUPPLIES & DRUG 831277 831277 EQUIPMENT RENTAL & MAIN 72545 72545 CONSORTIUM EXPENSE 6327 6327 167684 74360 43149 50175 9849161 7472469 2186527 190165 386619 526766 48614 111697 233059 573385 1033202 1161931 82031 52990 3568808 2500827 1117302 1067981 4087960 3332107 21442 14674 7010229 6841531 1136196 972693 1136196 972693 X 4920388 4928232 223371 210332 730274 730274 5874033 5868838 7010229 6841531 410526 -415721 0 X 0 1 X 1 0 X 1100429 1287095 965542 1197505 1157056 5707627 1100429 1287095 965542 1197505 1157056 5707627 60368 5647259 189077 105451 110272 103385 89667 597852 16665 11960 11920 12520 10960 64025 6369504 41631285 0.88660 0.86670 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: FUNDRAISING INCOME - 2014 AMOUNT: $ 16,665. 2015 AMOUNT: $ 11,960. 2016 AMOUNT: $ 11,920. 2017 AMOUNT: $ 12,520. 2018 AMOUNT: $ 10,960. SCHEDULE A, LINE 1 BEQUEST OF $207,600 WAS EXCLUDED FROM LINE 1 IN 2016 AS IT WAS LARGE AND UNEXPECTED. BEQUEST OF $200,000 WAS EXCLUDED FROM LINE 1 IN 2018 AS IT WAS LARGE AND UNEXPECTED. 2224411 1139 -85381 2140169 2224411 0 73510 73510 2224411 2235563 19844 27488 54484 2224411 1989532 246031 2870 2870 2235563 1875518 114014 47686 47686 1989532 0.65000 0.35000 1 0 1291732 992105 299627 879461 458984 420477 1397615 1049738 347877 1067981 9802273 -415721 -41693 -457414 10259687 0 10259687 9807468 -41693 -41693 9849161 0 9849161 PART XI, LINE 2D - OTHER ADJUSTMENTS: OTHER FUNDRAISING EXPENSES -25,646. INVESTMENT MANAGEMENT FEES -16,047. PART XII, LINE 2D - OTHER ADJUSTMENTS: OTHER FUNDRAISING EXPENSES -25,646. INVESTMENT MANAGEMENT FEES -16,047. PART V, LINE 4: THE ORGANIZATION'S POLICY IS TO DISTRIBUTE ALL OR A PORTION OF THE ANNUAL NET INVESTMENT EARNINGS TO SUPPORT THE ORGANIZATION'S PROGRAMS WHILE MAINTAINING THE FAIR VALUE OF THE ORIGINAL ENDOWMENT GIFTS. DONOR RESTRICTED ENDOWMENT FUNDS ARE NOT AVAILABLE FOR GENERAL EXPENDITURES. NAUTICAL NIGHTS 47646 36686 10960 15362 10274 47646 36686 10960 15362 10274 25636 -14676 1 EMERGENCY FINANCIAL ASSISTANCE 33 10500 HOUSING SERVICES 33 49386 MEDICAL TRANSPORTATION ASSISTANCE 68 17200 HEALTH INSURANCE PROGRAM 132 34519 SCHEDULE I, PART III: ALL OF THE RECORDS TO ESTABLISH ELIGIBILITY FOR THE GRANT OR ASSISTANCE ARE MAINTAINED IN THE CLIENT'S CASE MANAGEMENT CHART. CHART AUDITS ARE PERFORMED TO ENSURE THAT CLIENTS WHO ARE RECEIVING ASSISTANCE ARE ELIGIBLE TO RECEIVE ASSISTANCE. ALSO TWO OF THE GOVERNMENT AGENCIES THAT GIVE THE ORGANIZATION MONEY TO EXPEND FOR THE BENEFIT OF ITS CLIENTS MONITOR THE ORGANIZATION'S CHARTS AND PAPERWORK FOR COMPLIANCE WITH THE GRANT REQUIREMENTS. THE CASE MANAGER REQUESTING THE ASSISTANCE FILLS OUT A REQUEST FOR THE ASSISTANCE INDICATING WHY/HOW THE CLIENT MEETS ELIGIBILITY. THE SUPERVISOR APPROVES THE ASSISTANCE FOR PAYMENT AND THEN THE ACCOUNTING DEPARTMENT PROCESSES THE CHECK AND MONITORS THE OVERALL USAGE OF THE GRANT. X X X 0 0 0 0 0 0 0 0 0 MICHAELA VANDERSEE EXECUTIVE DIRECTOR 149048 0 0 0 0 0 1613 0 26988 0 177649 0 0 0 X 5986 COST X 9 562 COST X AUCTION ITEMS 140 21622 COST X OTHER 4 12907 COST X EVENT PRIZES 5 1638 COST 0 0 1 0 PART I, COLUMN (B): NUMBER OF CONTRIBUTIONS IS BASED ON THE NUMBER OF ITEMS CONTRIBUTED. FORM 990, PART VI, SECTION B, LINE 11B THE EXECUTIVE DIRECTOR AND DIRECTOR OF FINANCE REVIEW THE FORM 990. ONCE THEY HAVE REVIEWED THE RETURN, IT IS HANDED OUT TO THE BOARD OF DIRECTORS FOR THEIR REVIEW BEFORE BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C THE MONTHLY BOARD MEETING AGENDA INCLUDES AN AGENDA ITEM THAT REQUIRES BOARD MEMBERS TO REVIEW THE APPROVED AGENDA AND DECLARE ANY CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE DETERMINES AND APPROVES THE EXECUTIVE DIRECTOR'S WAGES BASED ON AN ANNUAL REVIEW, REVIEW OF FORM 990 COMPENSATION OF SIMILAR POSITIONS AND INFORMATION OBTAINED FROM INDEPENDENT SALARY SURVEYS. WAGES FOR THE DIRECTOR OF FINANCE AND MEDICAL DIRECTOR ARE DETERMINED BASED ON A REVIEW OF FORM 990 COMPENSATION OF SIMILAR POSITIONS, INFORMATION OBTAINED FROM INDEPENDENT SALARY SURVEYS AND THE COLA ADJUSTMENT. THE EXECUTIVE DIRECTOR AND HUMAN RESOURCE DIRECTOR DETERMINE THE WAGES OF THE DIRECTOR OF FINANCE AND MEDICAL DIRECTOR BASED ON THIS INFORMATION. THE BOARD APPROVES ALL WAGES THROUGH THE BUDGET PROCESS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST.