2017-11-14T13:21:48-06:00 2016-12-31 390758449 Wipfli LLP 403 East Third Street Sterling IL 61081 990 2016-01-01 363378606 Hospice of the Rock River Valley HOSP 8156253858 2600 N Locust St Ste B Sterling IL 61081 EMILY TAYLOR EXECUTIVE DIRECTOR 8152883673 2017-11-02 1 Jessica Macklin P01613179 8156261277 2017-10-26 199.168.71.34 2017-11-02 16:48:03 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 49E3870F3668247A667EA7A551B803BBC2B6D114 2016 2017-02-10 21:41:12Z Emily Taylor 2600 N Locust St STE B Sterling IL 61081 2109769 0 X www.hospicerockriver.org X 1982 IL HOSPICE OF THE ROCK RIVER VALLEY AFFIRMS LIFE BY PROVIDING EXCEPTIONAL CARE AND SUPPORT TO THOSE TRANSITIONING THROUGH SERIOUS ILLNESS, DEATH AND GRIEF. 11 11 27 35 0 0 382368 554359 1267984 1247806 145870 13090 166077 48827 1962299 1864082 324631 324691 0 0 897685 879810 0 0 4745 320112 310686 1542428 1515187 419871 348895 1528844 2011142 215046 344245 1313798 1666897 X HOSPICE IS THE CONCEPT AND PRACTICE OF COMPASSIONATE HEALTHCARE FOR PATIENTS AND FAMILIES DEALING WITH THE FINAL STAGES OF A LIFE LIMITING ILLNESS. WHEN A CURE IS NO LONGER A VIABLE OPTION, MUCH CAN STILL BE DONE. HOSPICE NEITHER PROLONGS LIFE NOR HASTENS DEATH. INSTEAD, HOSPICE FOCUSES ON QUALITY OF LIFE BY (1)KEEPING THE PATIENT COMFORTABLE IN HIS/HER OWN HOME OR PLACE OF RESIDENCE (2)HELPING THE PATIENT AND FAMILY GAIN A SENSE OF CONTROL AND COMPETENCE (3)PROMOTING THE PATIENT'S AND FAMILY'S DIGNITY, AUTONOMY AND RIGHT TO PRIVACY (4)ENHANCING THE TIME THE PATIENT AND FAMILY SHARE. 0 0 826298 309691 1252229 HOSPICE CARE - To provide fully-licensed hospice care services for terminally ill patients and their families in the Rock River Valley. 3763 5000 VOLUNTEER - Volunteers provide ongoing support and reassurance as well as a broad spectrum of services, including daily household tasks and activities that contribute to the comfort of the patient and family. 5894 10000 BEREAVEMENT - Provide bereavement support to families to help them work through the anxiety, fear, depression, sorrow and anger that are often present at the time of death. 54909 SOCIAL SERVICES - Provide social services to patients and familes to help ensure they are informed of other services available to help them through local agencies. 54909 890864 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 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 1 0 0 27 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 IL X Brenda Van Horn 8156256152 2600 N Locust st Ste B Sterling IL 61081 Linda Olds-Steinert VICE PRESIDENT 2.00 X X 0 0 0 pAT PETTENGER Treasurer 2.00 X X 0 0 0 Donna Adams SECRETARY 2.00 X 0 0 0 KRISTIE GEIL Director 2.00 X 0 0 0 Rick Kerley Director 2.00 X 0 0 0 MARGO JAKOBS DIRECTOR 2.00 X 0 0 0 EMILY TAYLOR EXECUTIVE DIRECTOR 45.00 X X 64997 0 0 JIM EGGELSTON DIRECTOR 2.00 X 0 0 0 Deb Keachall AdvisoRY BOARD MEMBER 2.00 X 0 0 0 Randy Clark president 2.00 X X 0 0 0 Linda Giesen Director 2.00 X 0 0 0 kAYLA bURN DIRECTOR 2.00 X 0 0 0 64997 0 0 0 0 0 0 0 32275 43931 478153 65419 554359 NET Patient Service 624100 1247806 1247806 1247806 11250 11250 232038 230198 1840 1840 1840 65610 32275 15489 50121 50121 OTHER REVENUES AND SUP 900099 -1294 -1294 -1294 1864082 1248352 0 61371 324691 324691 56878 56878 688891 403982 284909 7143 2514 4629 74059 47073 26986 52839 34321 18518 9850 9850 23831 569 23262 67043 21101 45942 5595 5595 10201 68 10133 52451 45124 7327 332 78 254 3456 3456 8220 8220 14225 14225 OTHER EXPENSES 61220 10815 45660 4745 Misc 48454 48454 FEES 5808 528 5280 1515187 890864 619578 4745 735869 922512 81155 79684 217278 346246 4098 9985 485307 65123 274263 420184 216181 232531 1528844 2011142 209445 342110 5601 2135 215046 344245 X 1168994 1366065 144804 300832 1313798 1666897 1528844 2011142 348895 4204 0 X X 0 1 X 1 0 X 303085 185274 550293 382368 562544 1983564 1387490 1244743 1326696 1267984 1247806 6474719 1690575 1430017 1876989 1650352 1810350 8458283 0 0 0 8458283 279 37941 17376 145870 13090 214556 279 37941 17376 145870 13090 214556 42174 42668 40036 166077 40642 331597 2603 2603 1735631 1510626 1934401 1962299 1864082 9007039 0.93910 0.93870 0.02380 0.02370 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 245000 245000 0 15927 14333 1594 39448 34810 4638 184932 15980 168952 420184 X 1883775 4204 4204 1879571 -15489 -15489 1864082 1530676 15489 15489 1515187 0 1515187 Part X, Line 2: Accounting principles generally accepted in the United States of America provides detailed guidance for the financial statement recognition, measurement and disclosure of uncertain tax positions recognized in an enterprise's financial statements. Generally accepted accounting principles require an entity to recognize the financial statement impact of a tax position when it is more likely than not that the position will be sustained upon examination. THERE WERE NO UNCERTAIN TAX POSITIONS NOTED ON THE AUDITED FINANCIAL STATEMENTS. Part XI, Line 4b - Other Adjustments: RECLASS Fundraising Direct Benefit to Donors -15,489. Part XII, Line 2d - Other Adjustments: RECLASS Fundraising Direct Benefit to Donors 15,489. ANNUAL GOLF OUTING 15545 3680 11865 4388 FESTIVAL OF TREES 72223 28595 43628 14526 1 10117 10117 1320 97885 32275 65610 20234 20234 45376 1 ASSISTANCE PROVIDED TO THE PATIENTS INCLUDES MEDICATIONS, ROOM AND BOARD, AN 324691 THE ASSISTANCE PROVIDED IS THE ORGANIZATION PAYS FOR THE PATIENTS' MEDICATIONS, ROOM AND BOARD, AND BRINGS IN MEDICAL EQUIPMENT TO BE USED IN THE PATIENTS' HOMES, AS DESIGNATED IN THE CARE PLAN BASED ON THE PATIENT NEEDS AND ORDERED BY A PHYSICIAN. Part I, Line 2: THE PATIENT MUST MEET THE CRITERIA DESIGNATED BY MEDICARE, TERMINAL DIAGNOSIS AND A LIFE EXPECTANCY OF 6 MONTHS OR LESS. A PHYSICIAN MUST CERTIFY THE PATIENT'S MEDICAL CONDITION AND WRITE THE ORDER TO ADMIT TO HOSPICE CARE. PATIENTS ARE NEVER DENIED ADMISSION UNLESS THEY DO NOT MEET THE CRITERIA OR THE PHYSICIAN DOES NOT CERTIFY THE DIAGNOSIS. THE ORGANIZATION MONITORS THEIR REFERRALS AND ADMISSIONS TO ASSURE EVERY REFERRAL RECEIVES PROMPT ATTENTION. X GOODS RELATED TO FUNDRAISING 68 3680 FAIR MARKET VALUE 0 0 0 Form 990, Part VI, Section B, line 11b ONCE THE 990 IS PREPARED BY AN ACCOUNTING FIRM, THE BOARD CHAIRMAN AND TREASURER REVIEW THE 990 COMPARING IT TO THE AUDITED F/S BEFORE SIGNATURE Form 990, Part VI, Section B, line 12c MEMBERS OF THE BOARD OF DIRECTORS AND HOSPICE STAFF MUST DISCLOSE PERSONAL OR FINANCIAL INTERESTS THAT COULD POTENTIALLY INTERFERE WITH THEIR DUTIES AND RESPONSIBILITIES TO HOSPICE OF THE ROCK RIVER VALLEY. DISCLOSURE FORMS ARE SUBMITTED AT THE TIME OF HIRE OR BOARD APPOINTMENT, ANNUALLY, AND WHENEVER A POTENTIAL CONFLICT ARISES. POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED BY THE BOARD OF DIRECTORS AND/OR BY THE EXECUTIVE DIRECTOR TO DETERMINE APPROPRIATE ACTION. INFORMATION REGARDING THE HOSPICE'S POLICY ON CONFLICTS OF INTEREST IS PROVIDED DURING ORIENTATION OF NEW STAFF, VOLUNTEERS, AND BOARD MEMBERS. FAILURE TO DISCLOSE EXISTING OR POTENTIAL CONFLICTS OF INTEREST IS GROUNDS FOR TERMINATION OF EMPLOYMENT OR BOARD APPOINTMENT. Form 990, Part VI, Section B, line 15a COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS. THE PERSONNEL COMMITTEE OF THE BOARD IS RESPONSIBLE FOR ASSESSING THE PERFORMANCE OF THE EXECUTIVE DIRECTOR AND COMMUNICATING THIS TO THE EXECUTIVE DIRECTOR. A SALARY RECOMMENDATION IS MADE TO THE BOARD AND THEY APPROVE IT. Form 990, Part VI, Section C, line 19 ALL OF THE ORGANIZATIONS FORMS AND GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT HOSPICE OF THE ROCK RIVER VALLEY DURING NORMAL BUSINESS HOURS. FORM 990, PART XI, LINE 2C THERE WAS NO CHANGE IN AUDIT COMMITTEE OVERSIGHT REVIEW FROM THE PRIOR YEAR.