2019-06-06T08:00:16-05:00 2018-12-31 421243538 BERGANKDV LTD PO BOX 2100 WATERLOO IA 507042100 990 2018-01-01 421154098 IOWA CITY HOSPICE INC IOWA 3193515665 1025 WADE STREET IOWA CITY IA 52240 KARLA KAMAL EXECUTIVE DIRECTOR 3196884212 2019-06-04 1 DAVID A RICHTER P00168204 3192346885 2019-06-04 108.178.221.43 2019-06-04 14:16:34 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 BAAC325D768170348CB03DC56161E8249D320EE2 2018 2019-02-21 02:37:17Z KARLA KAMAL 1025 WADE STREET IOWA CITY IA 52240 6614923 0 X WWW.IOWACITYHOSPICE.COM X 1980 IA PROVIDE INNOVATIVE CARE FOR PEOPLE WITH SERIOUS ADVANCED ILLNESSES AND END OF LIFE CONDITIONS. 11 11 75 100 0 0 489232 505009 5624201 6048396 7060 44897 -894 -625 6119599 6597677 0 0 0 0 3468611 3672782 0 0 115826 2944959 2971088 6413570 6643870 -293971 -46193 4146420 3573021 1524946 1091651 2621474 2481370 X TO PROVIDE COMPASSIONATE CARE FOR ANYONE IN OUR COMMUNITY AFFECTED BY SERIOUS ADVANCED ILLNESS AND END OF LIFE CONDITIONS. 0 0 4873303 6048396 THE ORGANIZATION PROVIDES SERVICES TO THOSE FACING A LIFE LIMITING ILLNESS. IN 2018, 1,694 PATIENTS AND FAMILIES WERE SERVED IN OUR SEVEN COUNTY SERVICE AREA (CEDAR, IOWA, JOHNSON, LINN, LOUISA, MUSCATINE AND WASHINGTON COUNTIES) FOR A TOTAL OF 35,763 DAYS OF CARE. IN ADDITION TO OUR PROFESSIONAL STAFF, IOWA CITY HOSPICE VOLUNTEERS PROVIDE SERVICES THAT ARE AS VARIED AS THE PATIENTS, FAMILIES AND COMMUNITIES WE SERVE. PATIENT CARE VOLUNTEERS PROVIDE COMPANIONSHIP AND SUPPORT TO TERMINALLY ILL PATIENTS AND THEIR LOVED ONES. VOLUNTEERS PROVIDE MANY FORMS OF ASSISTANCE, AT ALL LEVELS OF SKILL. OUR 100 PATIENT CARE VOLUNTEERS PROVIDED 1,409 HOURS OF SUPPORTIVE SERVICES TO THOSE WE SERVED IN 2018. FOLLOWING A PATIENT'S DEATH, IOWA CITY HOSPICE BEREAVEMENT STAFF IS AVAILABLE TO SUPPORT FAMILY MEMBERS AND FRIENDS THROUGHOUT THE GRIEVING PROCESS. OUR SERVICES ARE ALSO AVAILABLE TO ANYONE WHO IS GRIEVING THE LOSS OF A LOVED ONE, REGARDLESS OF WHETHER THE PERSON WAS IN HOSPICE CARE. IOWA CITY HOSPICE OFFERS A VARIETY OF GRIEF SUPPORT SERVICES INCLUDING SUPPORT GROUPS, GRIEF EDUCATION, AND SPECIAL EVENTS. IOWA CITY HOSPICE STAFF MADE 267 HOME VISITS TO SURVIVORS AND 354 PEOPLE ATTENDED SUPPORT GROUPS, BEREAVEMENT LUNCHEONS AND OTHER EVENTS.INCLUDED IN OUR BEREAVEMENT SERVICES ARE SPECIALIZED CARE TO CHILDREN AND YOUTH. MANY CHILDREN AND YOUTH FIND COMFORT AND SECURITY THROUGH GRIEF SUPPORT GROUPS WHERE EVERYONE PARTICIPATING SHARES ONE COMMON ELEMENT: SOMEONE THEY LOVED HAS DIED. IOWA CITY HOSPICE OFFERS THREE UNIQUE GROUPS FOR CHILDREN, YOUTH AND THEIR PARENTS/CAREGIVERS WHO HAVE EXPERIENCED THE LOSS OF A LOVED ONE. IN 2018, 20 CHILDREN, YOUTH AND ADULTS ATTENDED THESE GROUP EVENTS. 4873303 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 5 0 1 75 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KAREN DEGROOT 3196884212 1025 WADE STREET IOWA CITY IA 52240 BEN RUSSELL CHAIR 1.00 X X 0 0 0 SUSAN STUTZEL TREASURER 1.00 X X 0 0 0 RANDY MCDONOUGH SECRETARY 1.00 X X 0 0 0 TODD MEANS PAST CHAIR 1.00 X 0 0 0 BOYD CROSBY DIRECTOR 1.00 X 0 0 0 LEANN TATMAN DIRECTOR 1.00 X 0 0 0 MAHMOODA AHMAD DIRECTOR 1.00 X 0 0 0 DIANA LUNDELL DIRECTOR 1.00 X 0 0 0 BEN EVANS DIRECTOR 1.00 X 0 0 0 DR STEPHEN SCHECKEL DIRECTOR 1.00 X 0 0 0 NOELLE ANDREW DIRECTOR 1.00 X 0 0 0 MELISSA CARRINGTON FORMER SECRETARY 1.00 X X 0 0 0 KARLA KAMAL EXECUTIVE DIRECTOR 40.00 X 102662 0 20138 KAREN DEGROOT DIRECTOR OF FINANCE 40.00 X 38197 0 9857 JENNY HENNINGSEN FORMER DIRECTOR OF FINANCE 40.00 X 36023 0 6967 176882 0 36962 1 0 0 0 0 94168 410841 505009 PATIENT CARE FEES 623990 6048396 6048396 6048396 57458 57458 12561 -12561 -12561 -12561 4060 94168 4685 -625 -625 6597677 6048396 0 44272 219424 219424 2787442 1880089 832731 74622 446877 287811 147532 11534 219039 137644 75930 5465 6308 6308 30314 30314 20114 20114 294218 214445 79773 35259 29858 5401 111269 47031 57216 7022 62682 62682 24405 24405 49037 48880 157 21306 21306 36014 21512 14502 170505 113465 48961 8079 4391 4391 MEDICAL SUPPLIES & DRUG 856738 856738 PATIENT EXPENSES 696685 696685 BAD DEBT 477870 477870 DUES AND SUBSCRIPTIONS 9778 9111 667 64195 28451 32708 3036 6643870 4873303 1654741 115826 3222 7474 1167076 1127064 19468 23032 1890705 893107 1031515 997598 1925139 1417853 4146420 3573021 685100 575841 495456 212263 344390 303547 1524946 1091651 X 1120250 1047598 1501224 1433772 2621474 2481370 4146420 3573021 X -46193 -93911 X 0 1 X 1 0 X 685222 540157 526181 493152 505009 2749721 685222 540157 526181 493152 505009 2749721 2749721 32133 37074 37779 13967 57458 178411 3920 4060 7980 2936112 28894832 0.93650 0.94670 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: FUNDRAISING INCOME - 2014 AMOUNT: $ 0. 2015 AMOUNT: $ 0. 2016 AMOUNT: $ 0. 2017 AMOUNT: $ 3,920. 2018 AMOUNT: $ 4,060. 1469687 51834 1417853 1469687 1469687 1469687 1469687 1219687 250000 1469687 1219687 1219687 1.00000 1 0 143130 143130 973298 415664 557634 752062 463919 288143 22215 13524 8691 997598 BENEFICIAL INTEREST IN ASSETS HELD 1417853 1417853 CAPITAL LEASE OBLIGATION 303547 303547 6496213 -81350 -81350 6577563 20114 20114 6597677 6636317 12561 12561 6623756 20114 20114 6643870 PART V, LINE 4: THE ENDOWMENT FUND REPRESENTS AMOUNTS HELD BY A COMMUNITY FOUNDATION FOR THE ORGANIZATION. THE FUNDS CAN BE USED FOR OPERATING PURPOSES. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF PROPERTY AND EQUIPMENT 12,561. CHANGE IN VALUE OF BENEFICIAL INTEREST -93,911. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF PROPERTY AND EQUIPMENT 12,561. GOLF EVENT 17581 13521 4060 370 WALK EVENT 80647 80647 4315 98228 94168 4060 4685 4685 -625 FORM 990, PART VI, SECTION B, LINE 11B THE EXECUTIVE DIRECTOR EMAILS THE FINAL COPY OF THE FORM 990 TO THE EXECUTIVE COMMITTEE TO REVIEW AND APPROVE BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS AND EMPLOYEES ARE REQUIRED TO DECLARE ALL CONFLICTS OF INTEREST AT LEAST ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S HUMAN RESOURCE SPECIALIST EVALUATES THE PAY RANGE OF THE EXECUTIVE DIRECTOR ANNUALLY BY USING COMPARATIVE DATA. PAY RANGES FOR THE ORGANIZATION ARE APPROVED BY IOWA CITY HOSPICE'S PERSONNEL COMMITTEE. THIS INFORMATION IS TAKEN INTO ACCOUNT WHEN THE EXECUTIVE DIRECTOR IS EVALUATED ANNUALLY BY THE ENTIRE BOARD OF DIRECTORS. ANY CHANGES TO THE COMPENSATION ARE APPROVED THROUGH THE BUDGETING PROCESS; REVIEWED AND APPROVED BY FIRST THE FINANCE COMMITTEE AND THEN THE BOARD OF DIRECTORS. COMMITTEE WORK HAPPENS THE SECOND HALF OF THE YEAR FOR IMPLEMENTATION IN THE SUBSEQUENT JANUARY. THE APPROVED PAY RATE IS THEN DOCUMENTED AND PLACED IN THE EXECUTIVE DIRECTOR'S PERSONNEL FILE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS AND FORM 990 ARE MADE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF BENEFICIAL INTEREST -93,911.