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 311769696 HOSPICE OF DAYTON FOUNDATION 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 14:11:18 ES P 71FC02686D5490A881FD7503DE3ADB1FBAB90BB1 F51046F0BD5714FDBFEEE435C204D6AFFC186FF5 2017 2018-06-14 16:35:46Z LORI IGEL 324 WILMINGTON AVE DAYTON OH 45420 7458752 0 X WWW.HOSPICEOFDAYTON.ORG X 2001 OH TO PROVIDE FINANCIAL SUPPORT TO ITS PARENT ORGANIZATION, THE HOSPICE OF DAYTON, INC. (31-0933339) 15 12 19 22 0 0 5195475 4246307 0 0 1060653 2679163 125057 431925 6381185 7357395 1604867 1922783 0 0 0 687688 0 0 1045694 1525161 747901 3130028 3358372 3251157 3999023 30924051 35401701 1272 57875 30922779 35343826 X HOSPICE OF DAYTON FOUNDATION IS A SUPPORTIVE FOUNDATION OF THE HOSPICE OF DAYTON, INC. IT PROVIDES COUNSEL AND ASSISTANCE TO THE HOSPICE OF DAYTON INC., BY HELPING TO IDENTIFY AND ACCESS INDIVIDUAL AND CORPORATE FINANCIAL SUPPORT WITHIN THE HOSPICE OF DAYTON'S SERVICE AREA, PROVIDING A COMMUNITY PERSPECTIVE ON KEY ISSUES RELEVANT TO PALLIATIVE AND HOSPICE CARE, AIDING IN THE DEVELOPMENT OF A COMPREHENSIVE COMMUNITY OUTREACH EDUCATIONAL PROGRAM, HELPING TO SHAPE KEY MESSAGES ON HOSPICE AND PALLIATIVE CARE, HELPING FORMULATE STRATEGIES TO INCREASE NON-EARNED REVENUE, AND MAKING FUNDING/GRANTING DECISIONS RELATIVE TO THE HOSPICE OF DAYTON, INC. 0 0 1930383 1922783 190629 SUPPORT OF THE HOSPICE OF DAYTON, INC. (EIN 31-0933339) GRANTS PAID SUPPORT INDIGENT CARE, PATHWAYS OF HOPE, COMPLIMENTARY CARE, PALLIATIVE CARE, AS WELL AS THE OVERALL COMMUNITY BASED MODEL OF CARE. 1930383 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 19 0 0 0 0 0 0 1 1 0 0 0 0 X 15 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X CALVIN ROBINSON 9372564490 7575 PARAGON ROAD DAYTON OH 45459 KENT ANDERSON PRESIDENT & CEO - OHI 8.00 32.00 X X 0 422470 38876 CHIP MUES CHAIR 3.00 0.00 X X 0 0 0 JANICE CULVER VICE CHAIR 2.00 0.00 X X 0 0 0 CALVIN ROBINSON TREASURER 8.00 32.00 X X 0 235558 42976 LORI IGEL SECRETARY, EXECUTIVE DIRECTOR OF FOUNDATION 40.00 0.00 X X 0 129056 26931 LYNDA HOFFMAN BOARD MEMBER 2.00 0.00 X 0 0 0 FRANZ HOGE BOARD MEMBER 2.00 0.00 X 0 0 0 TONY LOMBARDO BOARD MEMBER 2.00 0.00 X 0 0 0 JOHN SWEENEY BOARD MEMBER 2.00 0.00 X 0 0 0 JERRY TATAR BOARD MEMBER 2.00 0.00 X 0 0 0 RICHARD WICK BOARD MEMBER 2.00 0.00 X 0 0 0 JANE WINCH BOARD MEMBER 2.00 0.00 X 0 0 0 MARY MURPHY BOARD MEMBER 0.00 40.00 X 0 249014 40724 THOMAS MANN BOARD MEMBER 2.00 0.00 X 0 0 0 GREG TOMAN BOARD MEMBER 2.00 0.00 X 0 0 0 AMY WAGNER CHIEF OPERATING OFFICER - OHI 8.00 32.00 X 0 242117 44509 JERRY DURST CHIEF ADMINISTRATIVE OFFICER - OHI 8.00 32.00 X 0 229326 38209 0 1507541 232225 0 0 1 0 0 7520 4238787 4246307 2679163 2679163 342653 7520 101357 241296 241296 190629 0 190629 190629 7357395 190629 0 2920459 1922783 1922783 539665 539665 17936 17936 88685 88685 41402 41402 1051 1051 7564 7564 209566 209566 28723 28723 200170 22225 177945 104301 11 104290 18104 18104 114322 114322 18240 1670 16570 7600 7600 DONATED SERVICES 25886 25886 EQUIPMENT RENTAL 6045 6045 DUES & SUBSCRIPTIONS 5671 5671 EMPLOYEE EXPENSE 614 614 44 44 3358372 1930383 382295 1045694 2500 399112 75394 3373825 2042437 0 8032 61607 8233 43271 53374 24949847 28829625 2479214 4069121 30924051 35401701 1272 57875 1272 57875 X 26288954 31786525 3523825 2447301 1110000 1110000 30922779 35343826 30924051 35401701 X 3999023 1407886 26906 -1012768 X X 0 1 X 1 0 X X 1 THE HOSPICE OF DAYTON INC 310933339 7 1 1922783 0 1 1922783 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 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 0 38000 8233 29767 23607 23607 53374 DUE FROM RELATED ENTITIES 4069121 4069121 PART V, LINE 4 ENDOWMENT FUNDS ARE MAINTAINED TO PROVIDE FINANCIAL SUPPORT TO THE FOUNDATION'S PARENT ORGANIZATION, THE HOPSICE OF DAYTON, INC. (31-0933339) IT IS THE FOUNDATION'S OBJECTICE TO UTILIZE CURRENT FUNDRAISING TO SUPPORT THE HOSPICE OF DAYTON, INC'S PROGRAMS, TO GROW AND PROVIDE RESERVES FOR UNFORESEEN CIRCUMSTANCES OR TO FUND SIGNIFICANT NEW INITIATIVES. GOLF CLASSIC 101730 2600 99130 4480 16224 507 670 1195 STEINS, STEMS, SAVORIES, & SWEETS 104043 810 103233 6390 10985 5862 892 5449 4 144400 4110 140290 22127 40 5133 21403 350173 7520 342653 10870 49336 6409 6695 28047 101357 241296 0 THE HOSPICE OF DAYTON INC 324 WILMINGTON AVENUE DAYTON OH 45420 310933339 501(C)(3) 1922783 TO FACILITATE THE HOSPICE OF DAYTON, INC PURPOSE TO PROVIDE HOSPICE CARE TO THE TERMINALLY ILL 1 1 1 0 0 0 0 0 0 0 KENT ANDERSON PRESIDENT & CEO - OHI 0 359470 0 63000 0 0 0 18000 0 20876 0 461346 0 0 CALVIN ROBINSON TREASURER 0 208558 0 27000 0 0 0 26849 0 16127 0 278534 0 0 LORI IGEL SECRETARY, EXECUTIVE DIRECTOR OF FOU 0 117243 0 11813 0 0 0 6194 0 20737 0 155987 0 0 MARY MURPHY BOARD MEMBER 0 218864 0 30150 0 0 0 28231 0 12493 0 289738 0 0 AMY WAGNER CHIEF OPERATING OFFICER - OHI 0 211967 0 30150 0 0 0 25664 0 18845 0 286626 0 0 JERRY DURST CHIEF ADMINISTRATIVE OFFICER - OHI 0 205701 0 23625 0 0 0 18334 0 19875 0 267535 0 0 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, AND MARY MURPHY. CONTRIBUTIONS OF $9,000 WERE MADE TO 457(B) DEFERRED COMPENSATION PLANS ON BEHALF OF JERRY DURST. 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. 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 15A 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 HOSPICE OF DAYTON FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND ITS FINANCIAL STATEMENTS (INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF ITS PARENT, THE HOSPICE OF DAYTON, INC.) AVAILABLE TO THE PUBLIC UPON RECEIPT OF A WRITTEN REQUEST. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTION -2,139,551. RESTRICTED CONTRIBUTIONS 1,126,783. 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. COMMUNITY CARE HOSPICE INC PO BOX 123 WILMINGTON OH 45177 371495725 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 0 FOUNDATION FOR HOSPICE OF CENTRAL OHIO 2269 CHERRY VALLEY ROAD NEWARK OH 43055 550855205 TO PROVIDE FINANCIAL SUPPORT TO ITS PARENT, HOSPICE OF CENTRAL OHIO OH 501(C)(3) LINE 12A, I HOSPICE OF CENTRAL OHIO 0 HOSPICE OF CENTRAL OHIO 2269 CHERRY VALLEY ROAD NEWARK OH 43055 311059756 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 0 HOSPICE OF DAYTON INC 7575 PARAGON ROAD DAYTON OH 45459 310933339 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 0 HOSPICE OF MIAMI COUNTY INC 550 SUMMIT AVENUE TROY OH 45373 311031277 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 0 LIFECARE HOSPICE 1900 AKRON ROAD WOOSTER OH 44691 341352875 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 0 OHIO'S HOSPICE INC 7575 PARAGON ROAD DAYTON OH 45459 463215586 TO PROVIDE MANAGEMENT SERVICES AS A SUPPORTING ORGANIZATION OH 501(C)(3) LINE 12A, I N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0 HOSPICE OF DAYTON INC B 1922783 CASH VALUE HOSPICE OF DAYTON INC P 1250000 CASH VALUE