2018-10-01T15:05:28-05:00 2017-12-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2017-01-01 454485835 EMMANUEL HOSPICE EMMA 6167190919 2161 LEONARD ST NW GRAND RAPIDS MI 49504 SARA LOWE EXECUTIVE DIRECTOR 6167190919 2018-09-25 1 CAROL LALONDE CPA P00181637 2695674500 2018-09-25 2017 2022-09-23 18:48:47Z DR LAURENCE BURNS 2161 LEONARD ST NW GRAND RAPIDS MI 49504 4880828 0 X WWW.EMMANUELHOSPICE.ORG X 2012 MI TO PROVIDE END OF LIFE HOSPICE CARE AND RELATED SERVICES TO INDIVIDUALS IN THE COMMUNITY WHO HAVE A TERMINAL CONDITION. 12 12 41 29 0 0 72205 106187 4138099 4770913 0 0 -4168 -7989 4206136 4869111 0 0 0 0 1793239 2223658 14832 810 72850 1958801 2157629 3766872 4382097 439264 487014 1163442 1830439 438364 729474 725078 1100965 THE MISSION OF EMMANUEL HOSPICE, AN INTERFAITH PARTNERSHIP, IS TO PROVIDE EXEMPLARY SPIRITUAL AND PHYSICAL CARE CREATING A PEACEFUL EXPERIENCE FOR THE DYING AND THEIR LOVED ONES. 0 0 2886501 4770913 HOSPICE AND BEREAVEMENT CARE 2886501 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 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 1 0 0 0 1 0 0 41 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 MI X CRAIG VANDENBOS 6169541799 4450 CASCADE ROAD GRAND RAPIDS MI 49546 LAURENCE BURNS CHAIR 5.00 0.00 X X 0 0 0 JANE TOOT VICE CHAIR 3.00 0.00 X X 0 0 0 RICK WALKER TREASURER 3.00 0.00 X X 0 0 0 SISTER GABRIELA HILKE DIRECTOR, CHAPLAIN 30.00 0.00 X 0 0 0 THOMAS WESHOLSKI DIRECTOR 1.00 0.00 X 0 0 0 DONNA HINTON DIRECTOR 1.00 0.00 X 0 0 0 COREY KOPERSKI DIRECTOR 1.00 0.00 X 0 0 0 MARY THERESA HEGARTY DIRECTOR 1.00 0.00 X 0 0 0 JAMES BRADY DIRECTOR 1.00 0.00 X 0 0 0 ROBERT HERR DIRECTOR 1.00 0.00 X 0 0 0 JUDY BAKER DIRECTOR 1.00 0.00 X 0 0 0 KATHLEEN HOLT DIRECTOR 1.00 0.00 X 0 0 0 SARA LOWE EXECUTIVE DIRECTOR 50.00 0.00 X 113006 0 13361 113006 0 13361 1 0 0 0 0 25015 81172 106187 MEDICARE/MEDICAID 623000 4630847 4630847 INSURANCE CLAIM 623000 140066 140066 4770913 3150 25015 11717 -8567 -8567 MISCELLANEOUS 900099 578 578 578 4869111 4770913 0 -7989 127061 120708 6353 1769371 1106106 620299 42966 14935 8975 5535 425 312291 208989 92114 11188 225278 225278 12998 12998 17450 17450 810 810 1944 1944 34577 1706 32341 530 75119 75119 16296 16296 65774 65774 12000 12000 98549 92637 5564 348 83 83 25210 25210 7109 7109 NURSING HOME ROOM & BOA 849515 849515 EQUIPMENT/SUPPLIES 232380 217827 12877 1676 PHARMACY 186678 186678 SEQUESTRATION 55861 55861 240808 158207 74047 8554 4382097 2886501 1422746 72850 529636 612279 562793 1129341 10296 12309 172885 96375 60717 76510 1163442 1830439 438364 658806 0 70668 438364 729474 X 0 0 0 0 725078 1100965 725078 1100965 1163442 1830439 X 487014 -111127 X X 1 X 0 1 0 X 56060 51811 72205 106187 286263 55396 2450182 2722345 4138099 4770913 14136935 55396 2506242 2774156 4210304 4877100 14423198 9969 15421 25390 0 9969 15421 25390 14397808 14212 23 78 3531 3728 21572 69608 2506265 2774234 4213835 4880828 14444770 0.99670 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2013 AMOUNT: $ 14,212. 2014 AMOUNT: $ 23. 2015 AMOUNT: $ 78. 2016 AMOUNT: $ 331. 2017 AMOUNT: $ 578. FUNDRAISING - 2016 AMOUNT: $ 3,200. 2017 AMOUNT: $ 3,150. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 133611 74750 58861 39274 21625 17649 76510 DUE TO AFFILIATE 70668 70668 ANNUAL CELEBRATION 28165 25015 3150 1000 8530 400 1787 28165 25015 3150 1000 8530 400 1787 11717 -8567 FORM 990, PART VI, SECTION A, LINE 6 THE STOCKHOLDERS ARE ST ANN'S - 54%, PORTER HILLS - 18%, CLARK RETIREMENT COMMUNITY - 18%, AND SUNSET MANOR - 10%. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS ARE AUTHORIZED TO APPOINT INDIVIDUALS TO AND REMOVE INDIVIDUALS FROM THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B CHANGES IN PURPOSE, MERGERS, INCURRENCE OF LONG TERM DEBT, SALE OF ASSETS GREATER THAN $5,000, HIRING OF EXECUTIVE DIRECTOR REQUIRE UNANIMOUS STOCKHOLDER VOTE. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY. FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE COMMITTEE PLANS TO REVIEW THE RETURN BEFORE FILING THE 990. THE ENTIRE BOARD RECEIVES A COPY OF THE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, THE CONFLICT OF INTEREST POLICY IS SIGNED BY EACH BOARD MEMBER. IF A CONFLICT DOES ARISE, THE SITUATION IS REVIEWED WITH THE MEMBER AND THE BOARD CHAIR. IF A MATTER IS UNDER CONSIDERATION BY THE BOARD IN WHICH THERE IS A POSSIBLE CONFLICT OF INTEREST, THE BOARD MEMBER SHALL NOT VOTE OR USE THEIR PERSONAL INFLUENCE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15A ON AN ANNUAL BASIS THE EXECUTIVE DIRECTOR'S SALARY IS APPROVED BY THE BOARD AFTER REVIEWING COMPARATIVE DATA. THE DELIBERATION AND APPROVAL OF THE COMPENSATION IS DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER TO AFFILIATES -111,127. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS SINCE PRIOR YEAR. ST ANN'S HOME INC 2161 LEONARD ST NW GRAND RAPIDS MI 49504 381872660 NURSING HOME MI 501(C)(3) LINE 10 N/A 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0