2018-10-01T16:40:09-05:00 2017-12-31 411431613 BERGANKDV LTD PO BOX 2100 WATERLOO IA 507042100 990 2017-01-01 421154098 IOWA CITY HOSPICE INC IOWA 3193515665 1025 WADE STREET IOWA CITY IA 52240 KARLA KAMAL EXECUTIVE DIRECTOR 3196884212 2018-09-27 1 DAVID A RICHTER P00168204 3192346885 2018-09-26 2017 2022-09-23 18:48:47Z KARLA KAMAL 1025 WADE STREET IOWA CITY IA 52240 6131320 0 X WWW.IOWACITYHOSPICE.COM X 1980 IA PROVIDE INNOVATIVE CARE FOR PEOPLE WITH SERIOUS ADVANCED ILLNESSES AND END OF LIFE CONDITIONS. 12 12 71 90 0 0 526181 489232 5012761 5624201 37779 7060 2090 -894 5578811 6119599 0 0 0 0 3554396 3468611 0 0 113799 3423372 2944959 6977768 6413570 -1398957 -293971 4273670 4146420 1521870 1524946 2751800 2621474 X TO PROVIDE COMPASSIONATE CARE FOR ANYONE IN OUR COMMUNITY AFFECTED BY SERIOUS ADVANCED ILLNESS AND END OF LIFE CONDITIONS. 0 0 4884984 5624201 THE ORGANIZATION PROVIDES SERVICES TO THOSE FACING A LIFE LIMITING ILLNESS. IN 2017, 633 PATIENTS AND FAMILIES WERE SERVED IN OUR SEVEN COUNTY SERVICE AREA (CEDAR, IOWA, JOHNSON, LINN, LOUISA, MUSCATINE AND WASHINGTON COUNTIES) FOR A TOTAL OF 31,991 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 ASSISTANVE, AT ALL LEVELS OF SKILL. OUR 90 PATIENT CARE VOLUNTEERS PROVIDED 4,026 HOURS OF SUPPORTIVE SERVICES TO THOSE WE SERVED IN 2017. 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 163 HOME VISITS TO SURVIVORS AND 392 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 2017, 15 CHILDREN, YOUTH AND ADULTS ATTENDED THESE GROUP EVENTS. 4884984 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 4 0 1 71 1 0 0 0 0 0 0 0 0 0 0 X 12 12 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KARLA KAMAL 3196884212 1025 WADE STREET IOWA CITY IA 52240 TODD MEANS CHAIR 1.00 X X 0 0 0 DEAN CARRINGTON TREASURER 1.00 X X 0 0 0 MELISSA CARRINGTON SECRETARY 1.00 X X 0 0 0 JOSHUA BREWSTER PAST CHAIR 1.00 X 0 0 0 BOYD CROSBY DIRECTOR 1.00 X 0 0 0 ELI WYNES 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 TERESA WEINER DIRECTOR 1.00 X 0 0 0 BEN RUSSELL 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 KARLA KAMAL EXECUTIVE DIRECTOR 40.00 X 90748 0 5966 JENNY HENNINGSEN DIRECTOR OF FINANCE 40.00 X 30986 0 6233 121734 0 12199 0 0 0 0 0 88491 400741 489232 PATIENT CARE FEES 623990 5624201 5624201 5624201 13967 13967 6907 -6907 -6907 -6907 3920 88491 4814 -894 -894 6119599 5624201 0 6166 128519 128519 2763819 1904145 780969 78705 352115 252011 90522 9582 224158 160431 57627 6100 3496 3496 59649 59649 34835 34835 254428 213707 40721 21044 16574 4470 109056 50725 54145 4186 66565 66565 19176 19176 68853 68647 206 15513 15513 49942 26200 23742 205000 138789 60246 5965 2906 2906 MEDICAL SUPPLIES & DRUG 886524 886524 PATIENT EXPENSES 779129 779129 BAD DEBT 319656 319656 DUES AND SUBSCRIPTIONS 12417 2852 9565 36770 15604 16375 4791 6413570 4884984 1414786 113799 4600 3222 867803 1167076 25068 19468 1853130 821615 1185519 1031515 2190680 1925139 4273670 4146420 731506 685100 0 344665 495456 445699 344390 1521870 1524946 X 2735202 1120250 16598 1501224 2751800 2621474 4273670 4146420 X -293971 -146418 310063 X 0 1 X 1 0 X 557494 685222 540157 526181 493152 2802206 557494 685222 540157 526181 493152 2802206 2802206 36663 32133 37074 37779 13967 157616 2959822 28753120 0.94670 0.94190 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1469687 1469687 1469687 1469687 1219687 250000 1469687 1219687 1219687 1219687 1219687 1.00000 1 0 140000 140000 1001565 371950 629615 689350 443546 245804 22215 6119 16096 1031515 BENEFICIAL INTEREST IN ASSETS HELD 1925139 1925139 CAPITAL LEASE OBLIGATION 344390 344390 6406548 321784 321784 6084764 34835 34835 6119599 6390456 11721 11721 6378735 34835 34835 6413570 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: SPECIAL EVENTS EXPENSE 4,814. LOSS ON SALE OF ASSETS 6,907. CHANGE IN VALUE OF BENEFICIAL INTEREST 310,063. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSE 4,814. LOSS ON SALE OF ASSETS 6,907. GOLF EVENT 17159 13239 3920 778 WALK EVENT 75252 75252 4036 92411 88491 3920 4814 4814 -894 FORM 990, PART VI, SECTION A, LINE 2 MELISSA CARRINGTON IS THE DAUGHTER-IN-LAW OF DEAN CARRINGTON. 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 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 INFOMRATION 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 310,063.