2018-11-15T09:21:58-06:00 2017-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2017-01-01 310933339 HOSPICE OF DAYTON INC HOSP 9372564490 7575 PARAGON ROAD DAYTON OH 45459 CALVIN W ROBINSON CFO 9372564490 2018-11-14 1 BERNIE OSTROWSKI P00366367 6148493000 2018-11-14 67.59.56.33 2018-11-14 14:14:26 ES P 71FC02686D5490A881FD7503DE3ADB1FBAB90BB1 F51046F0BD5714FDBFEEE435C204D6AFFC186FF5 2017 2019-02-21 02:37:17Z X KENT ANDERSON 7575 PARAGON ROAD DAYTON OH 45459 63100715 0 X WWW.HOSPICEOFDATYON.ORG X 1978 OH TO PROVIDE HOSPICE AND PALLIATIVE CARE FOR THE TERMINALLY ILL AND SUPPORT FOR THEIR FAMILIES. 12 10 751 650 0 0 1604867 1922783 50416875 60284424 671382 308245 47412 383116 52740536 62898568 0 0 0 0 28115623 36183841 0 0 0 28213871 25695703 56329494 61879544 -3588958 1019024 78656391 50649081 21643725 22394308 57012666 28254773 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 51292165 0 60592669 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. 51292165 1 1 0 0 0 0 0 0 0 1 1 0 0 0 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 1 256 0 1 751 1 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X CALVIN W ROBINSON 9372564490 7575 PARAGON ROAD DAYTON OH 45459 MARY MURPHY PRESIDENT & CEO - HOD 40.00 0.00 X X 0 249014 40724 KENT ANDERSON PRESIDENT & CEO - OHI 8.00 32.00 X X 0 422470 38876 THOMAS MANN CHAIR 3.00 0.00 X X 0 0 0 LISA HANUAER VICE CHAIR 2.00 0.00 X X 0 0 0 TONI SPRINKEL TRESAURER 2.00 0.00 X X 0 0 0 PETE HALEY SECRETARY 2.00 0.00 X X 0 0 0 LINDSAY JOHNSON BOARD MEMBER 2.00 0.00 X 0 0 0 JON LARRABEE BOARD MEMBER 2.00 0.00 X 0 0 0 GARY LEROY MD 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 GREG TOMAN BOARD MEMBER 2.00 0.00 X 0 0 0 CALVIN ROBINSON CHIEF FINANCIAL OFFICER - OHI 8.00 32.00 X 0 235558 42976 AMY WAGNER CHIEF OPERATING OFFICER - OHI 8.00 32.00 X 0 242117 44509 ED RUFF CHIEF INFORMATION OFFCIER - OHI 8.00 32.00 X 0 180913 48580 JERRY DURST CHIEF ADMINISTRATIVE OFFICER - OHI 8.00 32.00 X 0 229326 38209 CHIRAG PATEL PRESIDENT, ICS & REGIONAL CHIEF MED OFFICER 40.00 0.00 X 306093 0 35336 RUTH THOMSON CHIEF MEDICAL OFFICER - HOD 40.00 0.00 X 0 473208 48233 KIM VESEY CHIEF MISSION OFFICER - HOD 40.00 0.00 X 0 170309 33518 REBECCA BLEDSOE DIRECTOR OF PHARAMACY - HOD 40.00 0.00 X 153540 0 7752 WENDY SCHMITZ VICE PRESIDENT OF MEDICAL CARE 40.00 0.00 X 289668 0 34481 CLEANNE CASS MEDICAL DIR OF COMMUNITY CARE AND EDUCATION 40.00 0.00 X 284084 0 12931 RANAPREET PATEL MEDICAL DIRECTOR COMMUNITY CARE 40.00 0.00 X 306093 0 35336 TIMOTHY MACLEAN MEDICAL DIRECTOR HOSPICE HOUSE/ INPATIENT 40.00 0.00 X 221054 0 14570 AMY MESTEMAKER MEDICAL DIRECTOR COMMUNITY CARE 40.00 0.00 X 208731 0 31565 1769263 2202915 507596 6 0 1 0 SPRINGFIELD REGIONAL MEDICAL CENTER PO BOX 636374 CINCINNATI OH 452636374 MEDICAL SERVICES 628594 AMERICAN UNITED LIFE INS CO PO BOX 368 ONE AMERICAN SQUARE INDIANAPOLIS IN 462060368 INSURANCE SERVICES 507500 ARCADIA HEALTH CARE DAYTON 3884 INDIAN RIPPLE RD BEAVERCREEK OH 454403448 MEDICAL PERSONNEL 434293 TRILOGY HEALTHCARE MONTGOMERY LLC 600 WEST NATIONAL ROAD ENGLEWOOD OH 45322 MEDICAL SERVICES 425098 BROOKSIDE GROUP LLC 4279 ROSWELL RD SUITE 208-290 ATLANTA GA 30342 COMMUNICATION CONSULTANT 392290 26 1922783 1922783 PATIENT SERVICE 624100 60284424 60284424 60284424 510392 510392 202147 -202147 -202147 -202147 TRANSPORTATION INCOME 900099 152800 152800 CAFETERIA REVENUE 900099 107376 107376 CATERING REVENUE 101553 101553 101553 21387 21387 383116 62898568 60493353 0 482432 502721 502721 29014539 27777009 1237530 1031208 982294 48914 3530647 3510496 20151 2104726 2104726 40305 7443 32862 27244 7683 19561 152754 152754 1662448 1272232 390216 222236 100392 121844 564981 347317 217664 443663 281615 162048 1152989 1073939 79050 1261261 1016957 244304 102 102 360219 360219 1743584 5032 1738552 7590 7590 ALLOCATION COSTS 8297372 2609996 5687376 MEDICAL SUPPLIES 5723433 5723433 PATIENT SERVICE 2090986 2090866 120 BAD DEBT EXPENSE 1260581 1260581 683955 464679 219276 61879544 51292165 10587379 0 491 450 15395 9030928 7884277 338462 196885 40883911 19512116 21902237 21371795 18924041 19954281 28444837 1241393 78656391 50649081 20468075 5679839 1175650 16714469 21643725 22394308 X 52378841 28254773 3523825 0 1110000 0 57012666 28254773 78656391 50649081 X 1019024 1145862 -30922779 X X 0 1 X 1 0 X 3113810 2431175 3497069 1604818 1922783 12569655 3113810 2431175 3497069 1604818 1922783 12569655 12569655 458189 424160 437166 437193 510392 2267100 47412 174187 221599 15058354 250776806 0.83470 0.85930 X 24949847 709925 3378753 208900 28829625 28773188 30000 1146659 5000000 24949847 28776265 25000 -4436 23641 28773188 29186685 1556223 1966643 28776265 25177232 50000 3959453 29186685 0.95550 0.04450 0.00000 0 1 1 1226624 1226624 30383494 14622894 15760600 6766 604 6162 7145905 4635232 2510673 2121122 253386 1867736 21371795 RETIREMENT PLAN LIABILITY 1231372 PAYABLE TO RELATED PARTY 5146799 LINE OF CREDIT 1336298 LONG TERM DEBT 9000000 16714469 X 1 1 0 0 0 0 0 1 0 MARY MURPHY PRESIDENT & CEO - HOD 0 218864 0 30150 0 0 0 28231 0 12493 0 289738 0 0 KENT ANDERSON PRESIDENT & CEO - OHI 0 359470 0 63000 0 0 0 18000 0 20876 0 461346 0 0 CALVIN ROBINSON CHIEF FINANCIAL OFFICER - OHI 0 208558 0 27000 0 0 0 26849 0 16127 0 278534 0 0 AMY WAGNER CHIEF OPERATING OFFICER - OHI 0 211967 0 30150 0 0 0 25664 0 18845 0 286626 0 0 ED RUFF CHIEF INFORMATION OFFCIER - OHI 0 160663 0 20250 0 0 0 26080 0 22500 0 229493 0 0 JERRY DURST CHIEF ADMINISTRATIVE OFFICER - OHI 0 205701 0 23625 0 0 0 18334 0 19875 0 267535 0 0 CHIRAG PATEL PRESIDENT, ICS & REGIONAL CHIEF MED 284968 0 21125 0 0 0 11407 0 23929 0 341429 0 0 0 RUTH THOMSON CHIEF MEDICAL OFFICER - HOD 0 416358 0 56850 0 0 0 24153 0 24080 0 521441 0 0 KIM VESEY CHIEF MISSION OFFICER - HOD 0 150059 0 20250 0 0 0 23423 0 10095 0 203827 0 0 REBECCA BLEDSOE DIRECTOR OF PHARAMACY - HOD 143624 0 9916 0 0 0 7752 0 0 0 161292 0 0 0 WENDY SCHMITZ VICE PRESIDENT OF MEDICAL CARE 270256 0 19412 0 0 0 14557 0 19924 0 324149 0 0 0 CLEANNE CASS MEDICAL DIR OF COMMUNITY CARE AND E 263896 0 20188 0 0 0 12931 0 0 0 297015 0 0 0 RANAPREET PATEL MEDICAL DIRECTOR COMMUNITY CARE 284968 0 21125 0 0 0 11407 0 23929 0 341429 0 0 0 TIMOTHY MACLEAN MEDICAL DIRECTOR HOSPICE HOUSE/ INPA 219054 0 2000 0 0 0 4118 0 10452 0 235624 0 0 0 AMY MESTEMAKER MEDICAL DIRECTOR COMMUNITY CARE 208731 0 0 0 0 0 10185 0 21380 0 240296 0 0 0 PART I, LINE 3 THE EXECUTIVE COMMITTE 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 TRUSTESS AS PART OF THE BUDGET PROCESS PART I, LINES 4A-B PART I, LINE 4A JERRY DURST LISTED ON FORM 990, PART VII RECEIVED A SEVERANCE PAYMENT DURING THE 2017 CALENDAR YEAR. THE SEVERANCE PAYMENT, IN THE AMOUNT OF $6,731, IS REPORTED ON SCHEDULE J, PART II, COLUMN B(III). PART I, LINE 4B CONTRIBUTIONS AND/OR ACCRUALS OF $18,000 EACH WERE MADE TO 457(B) DEFERRED COMPENSATION PLANS ON BEHALF OF KENT ANDERSON, CALVIN ROBINSON, AMY WAGNER, ED RUFF, MARY MURPHY, AND KIM VESEY. CONTRIBUTIONS OF $9,000 WERE MADE TO 457(B) DEFERRED COMPENSATION PLANS ON BEHALF OF RUTH THOMSON AND JERRY DURST. CONTRIBUTIONS OF $5,000 WERE MADE TO 457(B) DEFERRED COMPENSATION PLANS ON BEHALF OF HEATHER BOLTON AND JEFFREY LYCAN. 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 XI, LINE 9: REMOVAL OF BENEFICIARY INTEREST IN FOUNDATION TO FOLLOW FINANCIAL STATEMENT TREATMENT -30,922,779. 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. 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