2018-08-02T08:11:53-05:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 901 N GLEBE ROAD SUITE 200 ARLINGTON VA 22203 990 2017-01-01 521114719 MONTGOMERY HOSPICE INC MONT 3019214400 1355 PICCARD DRIVE NO 100 ROCKVILLE MD 20850 ANN MITCHELL PRESIDENT & CHIEF EXECUTIVE OFFICER 3019214400 2018-08-01 1 IVY BECKHAM P01316131 5712279500 2017 2022-09-23 18:48:47Z ANN MITCHELL 1355 PICCARD DRIVE NO 100 ROCKVILLE MD 20850 33324275 0 X WWW.MONTGOMERYHOSPICE.ORG X 1979 MD TO GENTLE THE JOURNEY THROUGH SERIOUS ILLNESS AND LOSS WITH SKILL AND COMPASSION. 22 21 360 325 0 0 1312176 1994435 24503528 26680377 389867 606404 -55073 11810 26150498 29293026 0 0 0 0 19812513 22595983 0 0 576463 5653881 5991782 25466394 28587765 684104 705261 25647701 27513655 3001811 3381236 22645890 24132419 X TO GENTLE THE JOURNEY THROUGH SERIOUS ILLNESS AND LOSS WITH SKILL AND COMPASSION. TO BRING COMFORT BY PROVIDING COMPASSIONATE, PROFESSIONAL CARE TO COMMUNITY RESIDENTS WHO ARE FACING SERIOUS ILLNESS AND LOSS. TO PROVIDE DIGNITY FOR THE DYING AND UNCONDITIONAL COMPASSION, THROUGH DEDICATION AND COLLABORATION. 0 0 25833293 26680377 THE ORGANIZATION PROVIDES SPECIALIZED MEDICAL AND PSYCHOSOCIAL END-OF-LIFE CARE TO MONTGOMERY COUNTY, MARYLAND RESIDENTS WHO ARE LIVING WITH A LIFE LIMITING ILLNESS. PATIENTS (AND THEIR FAMILIES) ARE CARED FOR IN HOMES, EXTENDED CARE FACILITIES AND AT CASEY HOUSE, OUR ACUTE CARE FACILITY. OUR TEAMS OF DOCTORS, NURSE PRACTITIONERS, NURSES, SPIRITUAL COUNSELORS, SOCIAL WORKERS, CERTIFIED NURSING ASSISTANTS, COMPLEMENTARY THERAPISTS, BEREAVEMENT COUNSELORS AND VOLUNTEERS WORK TOGETHER TO PROVIDE COMFORT CARE CUSTOMIZED FOR EACH PATIENT. IN 2017, MONTGOMERY HOSPICE SERVED 2,312 PATIENTS AND THEIR FAMILIES. AMONG THE TOTAL PATIENTS SERVED, 25 WERE CHILDREN AND 54 WERE EITHER UNINSURED OR UNDERINSURED. CASEY HOUSE, IS THE ONLY ALL-HOSPICE ACUTE FACILITY IN MONTGOMERY COUNTY; 491 PATIENTS WITH SERIOUS PAIN OR OTHER SYMPTOMS RECEIVED INTENSIVE NURSING AND MEDICAL CARE AND ATTENTION AT CASEY HOUSE IN 2017. MONTGOMERY HOSPICE ALSO SUPPORTED MORE THAN 4,220 GRIEVING HOSPICE FAMILY MEMBERS AND 1,470 COMMUNITY MEMBERS, AND PROVIDED END-OF-LIFE CARE EDUCATION TO ALMOST 2,900 HEALTHCARE PROFESSIONALS AND 2,800 COMMUNITY MEMBERS. 25833293 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 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 0 1 0 0 0 1 13 0 360 1 0 0 0 0 0 0 0 0 0 0 X 22 21 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 MD X MONICA ESCALANTE CHIEF FINANCIAL O 3019214400 1355 PICCARD DRIVE SUITE 100 ROCKVILLE MD 20850 PAUL E ALPUCHE JR ESQ CHAIRMAN 1.00 X X 0 0 0 LYA MALL KARM MD VICE CHAIRMAN 1.00 X X 0 0 0 STERLING KING JR DR PH IMMEDIATE PAST CHAIRMAN 1.00 X X 0 0 0 DEBORA S MCGREGOR TREASURER 1.00 X X 0 0 0 ELMA M LEVY SECRETARY 1.00 X X 0 0 0 BRADLEY H COLTON DIRECTOR 1.00 X 0 0 0 CESAR E PALACIOS DIRECTOR 1.00 X 0 0 0 CYNTHIA A MESMER DIRECTOR 1.00 X 0 0 0 DELEGATE BONNIE L CULLISON DIRECTOR 1.00 X 0 0 0 DIANE K KUWAMURA ESQ DIRECTOR 1.00 X 0 0 0 GERMAN PARAUD DIRECTOR 1.00 X 0 0 0 JANET S GOLDMAN DIRECTOR 1.00 X 0 0 0 JEAN OBERSTAR DIRECTOR 1.00 X 0 0 0 JO ANNE ZUJEWSKI MD DIRECTOR 1.00 X 0 0 0 MICHAEL ZHUANG DIRECTOR 1.00 X 0 0 0 RONALD J RUBIN DIRECTOR 1.00 X 0 0 0 SENATOR BRIAN J FELDMAN DIRECTOR 1.00 X 0 0 0 SHERIFF DARREN M POPKIN DIRECTOR 1.00 X 0 0 0 STEVEN V ROBERTS DIRECTOR 1.00 X 0 0 0 SURESH K GUPTA MD DIRECTOR 1.00 X 0 0 0 SUSAN L GLOVER DIRECTOR 1.00 X 0 0 0 BARRY R MEIL DIRECTOR (UNTIL 06/2017) 1.00 X 0 0 0 DONGMEI WANG MD DIRECTOR (UNTIL 06/2017) 1.00 X 0 0 0 KATHY TORRENCE DIRECTOR (UNTIL 06/2017) 1.00 X 0 0 0 MICHAEL G BANKS ESQ DIRECTOR (UNTIL 06/2017) 1.00 X 0 0 0 TAREK ELGAWHARY PHD DIRECTOR (UNTIL 11/2017) 1.00 X 0 0 0 ANN MITCHELL PRESIDENT & CHIEF EXECUTIVE OFFICER 40.00 X X 251524 0 18962 MONICA ESCALANTE CFO/VP COM EDUC/OUTREACH 45.00 X 200916 0 22831 GEOFFREY COLEMAN MD CHIEF MEDICAL OFFICER 41.00 X 223566 0 51505 MILLICENT WHYTE-HIGGINS SR. VP OF NURSING SERVICES 45.00 X 170303 0 13265 MARK GOLDMAN TEAM PHYSICIAN 34.00 X 162505 0 0 JANET CAUFFIEL VP OF HUMAN RESOURCES 41.00 X 149058 0 6315 MARLENE BRADFORD VP OF PHYLANTHROPY 42.00 X 123427 0 13126 LISA MORRIS VP OF SW AND VOLUNTEER SERVICE 44.00 X 119943 0 28699 HELEN WELLS PRIMARY NURSE 47.00 X 118623 0 19325 1519865 0 174028 21 0 1 0 HOSPICE PHARMACY SOLUTIONS PO BOX 161134 ATLANTA GA 30321 PHARMACY 969669 JOERNS HEALTHCARE 2430 WHITEHALL PARK DRIVE SUITE 10 CHARLOTTE NC 28273 DURABLE MEDICAL EQUIPMENT 936449 MEDLINE INDUSTRIES INC PO BOX 382075 PITTSBURGH PA 15251 MEDICAL SUPPLIES 494269 CORAM INC PO BOX 809160 CHICAGO IL 60680 INFUSION 183644 PROCURA HEALTHCARE SOFTWARE 1827 WALDEN OFFICE SQUARE 104 SCHAUMBURG IL 60173 EMR SYSTEM 115266 6 49594 1944841 5717 1994435 PATIENT SERVICE REVENUE 624100 26680377 26680377 26680377 497953 497953 4139700 4031249 108451 108451 108451 11810 11810 11810 29293026 26680377 0 618214 952872 847611 86512 18749 18036910 16165138 1527487 344285 464635 394580 60109 9946 1837809 1529914 261498 46397 1303757 1162003 114917 26837 46754 46754 42349 42349 29010 29010 58199 58199 1716603 1643491 72912 200 98577 98577 454579 32763 367596 54220 213684 6534 191737 15413 625222 270414 354808 360645 356475 2854 1316 68920 45780 2855 20285 47208 47208 164887 139274 25613 98456 36513 61943 PHARMACY PURCHASES 975738 975738 MEDICAL SUPPLIES 564928 564928 EQUIPMENT LEASE/PURCHAS 330938 1608 329330 DUES & PUBLICATION 61983 10649 46133 5201 33102 1551303 -1551815 33614 28587765 25833293 2178009 576463 2946864 2004185 7024775 7703697 49316 30368 2933323 3705687 330237 424907 5202463 2307026 2857631 2895437 9505555 10749374 25647701 27513655 2939325 3335010 62486 46226 3001811 3381236 X 17491598 18551492 791914 989644 4362378 4591283 22645890 24132419 25647701 27513655 705261 781268 0 X 0 1 X 1 0 X 794435 2301665 1870904 1354491 1994435 8315930 21088768 20898450 22349027 24465613 26680377 115482235 21883203 23200115 24219931 25820104 28674812 123798165 0 111171 111171 111171 111171 123686994 3480 335335 361494 503953 497953 1702215 3480 335335 361494 503953 497953 1702215 34827 9794 17477 2683 11810 76591 21921510 23545244 24598902 26326740 29184575 125576971 0.98490 0.98920 0.01360 0.01010 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2013 AMOUNT: $ 32,205. 2014 AMOUNT: $ 357. 2015 AMOUNT: $ 15,772. 2016 AMOUNT: $ 42. 2017 AMOUNT: $ 9,908. MEALS - NON-PATIENT - 2013 AMOUNT: $ 2,622. 2014 AMOUNT: $ 1,518. 2015 AMOUNT: $ 1,705. 2016 AMOUNT: $ 2,641. 2017 AMOUNT: $ 1,902. GAIN ON LEASE TERMINATION - 2014 AMOUNT: $ 7,919. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 29010 0 0 29010 0 PART II-B, LINE 1: MONTGOMERY HOSPICE (MH) AND OTHER NONPROFIT HOSPICE IN MONTGOMERY COUNTY PAID OUTSIDE CONTRACTOR TO TALK TO LEGISLATORS AND CMS BECAUSE THEY ARE NOT PAID AT DC METROPOLITAN RATE. 6733391 1810 819624 189966 7364859 6562932 800 347615 177956 6733391 6733056 590 -8524 162190 6562932 4220799 2458595 190966 137304 6733056 3877148 71994 396770 125113 4220799 0.31330 0.62340 0.06330 0 0 1082200 1082200 2506838 1186235 1320603 264187 61178 203009 594962 594962 0 754276 464651 289625 2895437 X 30030459 781268 14364 795632 29234827 58199 58199 29293026 28543930 14364 14364 28529566 58199 58199 28587765 PART V, LINE 4: THE ENDOWMENT FUNDS RESULTED FROM DONOR-RESTRICTED FUNDS FOR SUPPORT OF SEVERAL HOSPICE PROGRAM ACTIVITIES. CONTRIBUTIONS FROM MAJOR DONORS WERE RESTRICTED TO THE OPERATIONS, MAINTENANCE AND PATIENT CARE AT THE HOSPICE'S INPATIENT ACUTE CARE FACILITY. DONORS HAVE ALSO CONTRIBUTED TO THE FUNDING OF NURSING SERVICES PROVIDED AT THE INPATIENT HOSPICE. THE HOSPICE IN-HOME SERVICES ARE BEING SUPPORTED TO PROVIDE MEDICAL CARE SERVICES BY PHYSICIANS, NURSES, SOCIAL WORKERS AND HOSPICE AIDES. THE ENDOWMENTS ALSO SUPPORT CHARITY CARE AND THE UNCOMPENSATED SERVICES PROVIDED TO PATIENTS AND THEIR FAMILIES THROUGH BEREAVEMENT AND PASTORAL CARE SUPPORT. PART X, LINE 2: THE HOSPICE IS A TAX-EXEMPT ENTITY AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). PALLIATIVE MEDICINE IS A LIMITED LIABILITY COMPANY WHOSE OPERATING RESULTS FLOW THROUGH TO THE HOSPICE, WHICH IS ITS SOLE CORPORATE MEMBER. NEITHER OF THESE ENTITIES ARE CLASSIFIED AS A PRIVATE FOUNDATION AS DEFINED BY THE INTERNAL REVENUE SERVICE. THE IRC PROVIDES FOR TAXATION OF UNRELATED BUSINESS INCOME UNDER CERTAIN CIRCUMSTANCES. THE HOSPICE AND ITS AFFILIATED ENTITIES HAVE NO SIGNIFICANT UNRELATED BUSINESS INCOME; HOWEVER, SUCH STATUS IS SUBJECT TO FINAL DETERMINATION UPON EXAMINATION OF THE RELATED INCOME TAX RETURNS BY THE APPROPRIATE TAXING AUTHORITIES. X X X 0 0 0 0 0 0 0 0 0 ANN MITCHELL PRESIDENT & CHIEF EXECUTIVE OFFICER 227774 0 23750 0 0 0 7197 0 11765 0 270486 0 0 0 MONICA ESCALANTE CFO/VP COM EDUC/OUTREACH 193416 0 7500 0 0 0 5995 0 16836 0 223747 0 0 0 GEOFFREY COLEMAN MD CHIEF MEDICAL OFFICER 223566 0 0 0 0 0 6597 0 44908 0 275071 0 0 0 MILLICENT WHYTE-HIGGINS SR. VP OF NURSING SERVICES 170303 0 0 0 0 0 5104 0 8161 0 183568 0 0 0 MARK GOLDMAN TEAM PHYSICIAN 162505 0 0 0 0 0 0 0 0 0 162505 0 0 0 JANET CAUFFIEL VP OF HUMAN RESOURCES 149058 0 0 0 0 0 4589 0 1726 0 155373 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE BOARD CHAIRPERSON, BOARD VICE CHAIRPERSON, BOARD SECRETARY, BOARD TREASURER, IMMEDIATE PAST CHAIRPERSON, AND THE PRESIDENT/CHIEF EXECUTIVE OFFICER (CEO), AND SUCH OTHER BOARD MEMBERS AS THE BOARD MAY DEEM APPROPRIATE. IT SHALL HAVE AUTHORITY TO CONDUCT ESSENTIAL HOSPICE BUSINESS BETWEEN BOARD MEETINGS, WHEN DELAY IN ACTION WOULD BE DETRIMENTAL TO THE HOSPICE, EXCEPT AS TO THE MATTERS LISTED BELOW AS WELL AS ANY OTHERS IMPOSED BY THE BOARD: 1. AMENDING THE ARTICLES OF INCORPORATION OR THE BYLAWS; 2. APPROVING A PLAN OF MERGER OR CONSOLIDATION; 3. FILLING VACANCIES ON THE HOSPICE BOARD OR REMOVING DIRECTORS OR OFFICERS FROM OFFICE; 4. APPOINTING OR REMOVING MEMBERS OF THE EXECUTIVE COMMITTEE; 5. APPOINTING OR REMOVING ANY OFFICER, THE MEDICAL DIRECTOR OR THE PRESIDENT/CEO, WITHOUT THE APPROVAL OF A MAJORITY OF THE BOARD; 6. APPROVING SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY OR ASSETS OF THE HOSPICE; OR 7. APPROVING VOLUNTARY DISSOLUTION OF THE HOSPICE OR REVOCATION OF VOLUNTARY DISSOLUTION PROCEEDINGS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE PRESIDENT AND MEMBERS OF THE FINANCE COMMITTEE BEFORE FILING. THE CHAIRMAN GIVES A SUMMARY REPORT TO THE BOARD. BOARD MEMBERS CAN REQUEST A COPY OF THE FORM 990 RETURN. FORM 990, PART VI, SECTION B, LINE 12C ALL INDIVIDUALS, UPON APPOINTMENT TO THE BOARD OF DIRECTORS, ANY BOARD DESIGNATED COMMITTEE, OR MONTGOMERY HOSPICE STAFF OR VOLUNTEER POSITION, SHALL BE REQUIRED TO EXAMINE AND SIGN AN INDIVIDUAL STATEMENT REGARDING CONFLICT OF INTEREST. IN THE EVENT A CONFLICT OF INTEREST OR POTENTIAL CONFLICT ARISES, THE CONFLICT OF INTEREST STATEMENT MUST PROMPTLY BE UPDATED AND BROUGHT TO THE ATTENTION OF THE PRESIDENT/CEO AND/OR CHAIRMAN OF THE BOARD. IF THE MATTER CONCERNS A STAFF MEMBER OR VOLUNTEER, THE CHANGE SHOULD BE PRESENTED TO THE INDIVIDUAL'S SUPERVISOR. THE INDIVIDUAL BOARD MEMBERS, WHO HAVE A CONFLICT OF INTEREST WITH THEIR CURRENT BUSINESS RELATIONSHIP AND THE HOSPICE, WILL WITHDRAW THEMSELVES FROM BOARD DISCUSSIONS AND VOTING. FORM 990, PART VI, SECTION B, LINE 15A REVIEW FOR PRESIDENT/CEO IS CONDUCTED ANNUALLY BY CERTAIN MEMBERS OF THE EXECUTIVE COMMITTEE. MEMBERS MAY INTERVIEW PRESIDENT/CEO'S COLLEAGUES CONCERNING THEIR INTERACTION AND RELATIONSHIP WITH PRESIDENT/CEO. OTHER ANALYSIS INCLUDES A WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE EXECUTIVE COMMITTEE. KEY EMPLOYEES ARE GIVEN ANNUAL PERFORMANCE REVIEWS BY THEIR IMMEDIATE SUPERVISOR INCLUDING THE PRESIDENT/CEO. THE PERFORMANCE SUMMARY IS REVIEWED AND DISCUSSED WITH THE PRESIDENT/CEO. AN ANALYSIS OF COMPARABLE STAFF POSITIONS AND SIMILAR HOSPICE ORGANIZATIONS IS DONE BY HR DEPARTMENT. DATA FROM BENCHMARK REPORTS PROVIDED BY NHPCO ARE ALSO USED IN THIS ANALYSIS. THE MOST RECENT YEAR IN WHICH THE COMPENSATION PROCESS WAS REVIEWED WAS 2017. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE ALSO SUMMARIZED ON THE ORGANIZATION'S WEBSITE. PALLIATIVE MEDICINE CONSULTANTS OF GREATER WASHINGTON LLC 1355 PICCARD DR SUITE 100O ROCKVILLE MD 20850 522343635 TO OFFER A CONTINUUM OF CARE FOR PATIENTS WITH ADVANCED ILLNESS MD 0 10844 MONTGOMERY HOSPICE INC