2017-11-14T07:52:44-06:00 2016-12-31 310800053 CLARK SCHAEFER HACKETT & CO 10100 Innovation Drive Dayton OH 45342 990 2016-01-01 310933339 HOSPICE OF DAYTON INC HOSP 9372564490 324 WILMINGTON AVE DAYTON OH 45420 CALVIN ROBINSON CFO 9372564490 2017-11-09 1 Herbert L Lemaster CPA P00039882 9372260070 2017-11-09 24.142.191.122 2017-11-09 13:25:59 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 FF1ADF7F950BE2AA8621E5D4B8A2222E21169A02 2016 2021-01-29 14:40:06Z KENT ANDERSON 324 WILMINGTON AVE DAYTON OH 45420 60964328 0 X HTTP://WWW.HOSPICEOFDAYTON.ORG X 1978 OH TO PROVIDE HOSPICE AND PALLATIVE CARE FOR THE TERMINALLY ILL AND SUPPORT FOR THEIR FAMILIES. 11 10 475 823 0 0 3497069 1604867 44673103 50416875 1192475 671382 146770 47412 49509417 52740536 0 0 0 0 36670176 28115623 0 0 123323 15294410 28213871 51964586 56329494 -2455169 -3588958 77930571 78656391 21047361 21643725 56883210 57012666 X THE HOSPICE OF DAYTON, INC. IS COMMITTED TO MAKING QUALITY HOSPICE CARE AVAILABLE AND ACCESSIBLE TO TERMINALLY ILL PERSONS AND THEIR FAMILIES, REGARDLESS OF ABILITY TO PAY, AND IN A MANNER CONSISTENT WITH THE HIGHEST HOSPICE STANDARDS. OUR COMMITMENT TO THE HOSPICE PHILOSOPHY OF CARE INCLUDES A COMPASSIONATE STAFF PLEDGED TO CONTINUOUSLY IMPROVE AND ENHANCE THE CARE WE PROVIDE, RESPECT THE PATIENTS' CHOICES OF CARE, RESPOND TO CHANGING COMMUNITY NEEDS, AND SERVE AS A RESOURCE TO OTHERS FOR IMPROVING THE AVAILABILITY OF QUALITY HOSPICE CARE. 0 0 39944627 50416875 COORDINATES A PROGRAM OF HOME, OUTPATIENT, AND INPATIENT HOSPICE CARE THAT PROVIDES PALLIATIVE CARE, SUPPORTIVE MEDICAL SERVICES, AND OTHER SUPPORT SERVICES TO TERMINALLY ILL PERSONS AND THEIR FAMILIES, REGARDLESS OF ABILITY TO PAY. 39944627 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 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 1 0 0 0 1 126 0 475 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X CALVIN ROBINSON 9372564490 324 WILMINGTON AVE Dayton OH 454201891 GREG TOMAN CPAABV BOARD MEMBER - PAST CHAIR 2.00 X X 0 0 0 THOMAS MANN BOARD MEMBER - CHAIR 2.00 X X 0 0 0 LISA HANAUER BOARD MEMBER - VICE CHAIR 2.00 X X 0 0 0 PETE HALEY BOARD MEMBER - SECRETARY (MAR-DEC) 2.00 X X 0 0 0 TONI SPRINKEL BOARD MEMBER - TREASURER 2.00 X X 0 0 0 BURHAN YANES MD BOARD MEMBER 2.00 X 0 0 0 LINDSAY M JOHNSON ESQ BOARD MEMBER 2.00 X 0 0 0 RATNA PALAKODETI MD BOARD MEMBER 2.00 X 0 0 0 SYLVAIN TREPANIER DNP RN CENP BOARD MEMBER 2.00 X 0 0 0 GARY LEROY MD BOARD MEMBER 2.00 X 0 0 0 KENT ANDERSON CEO - OHI 8.00 32.00 X X 0 357456 72598 CALVIN ROBINSON CFO - OHI 8.00 32.00 X 0 181131 46428 JERRY DURST CHIEF ADMINISTRATIVE OFFICER 8.00 32.00 X 0 204763 42281 RUTH M THOMSON CMO 8.00 32.00 X 0 378633 43982 AMY M WAGNER COO 8.00 32.00 X 0 191318 37558 MARY E MURPHY PRESIDENT - HOD 40.00 40.00 X 0 217675 31076 LORI IGEL PRESIDENT - HODF 0.00 40.00 X 0 113373 17455 JULES SHERMAN SENIOR MEDICAL DIRECTOR 40.00 0.00 X 153890 0 4471 RANAPREET PATEL CLINICAL MEDICAL DIRECTOR 40.00 0.00 X 241233 0 6025 TIMOTHY MACLEAN CLINICAL MEDICAL DIRECTOR 40.00 0.00 X 229268 0 7577 CLEANNE CASS MED DIR. COMMUNITY CARE & ED 40.00 0.00 X 266884 0 6539 WENDY SCHMITZ MED DIR. IMPATIENT CARE 40.00 0.00 X 241690 0 25312 CHIRAG PATEL MED DIR. INNOVATIVE CARE SOLUTIONS 40.00 0.00 X 287214 0 25982 1420179 1644349 367284 6 0 1 0 THERAPY SUPPORT INC 2803 N OAK GROVE AVE SPRINGFIELD MO 658034976 THERAPY 1590836 MEDLINE INDUSTRIES INC DEPT CH 14400 PALATINE IL 600554400 PHARMACEUTICAL 334111 OWENS & MINOR DISTRIBUTION INC 1605 WORLDWIDE BLVD HEBRON KY 41048 MEDICAL SUPPLIES 276318 COOLIDGE WALL 33 WEST FIRST ST SUITE 600 DAYTON OH 454021289 CONTRACT SERVICES 255798 DEDICATED NURSING ASSOCIATES INC 3875 FRANKLINTOWNE COURTS SUITE 240 MURRYSVILLE PA 15668 CONTRACT NURSING 249518 5 1604867 1604867 patient service 624100 50185915 50185915 CAFETERIA 624100 230960 230960 50416875 437193 437193 8456981 1000 8223792 0 233189 1000 234189 234189 MISCELLANEOUS INCOME 900099 47412 47412 47412 52740536 50416875 0 718794 158361 158361 26010829 24692037 690989 627803 18658 18658 436588 250767 185821 1491187 1491187 143762 143762 758999 696 17526 740777 300655 263932 36723 197305 10126 187179 1169828 997201 34704 137923 224034 40922 183112 1374415 977040 274052 123323 141423 141423 ALLOCATION OF OVERHEAD 13643861 13643861 MEDICATIONS & SUPPLIES 3094967 3094967 EQUIP. RENTAL & MAINT. 1825306 1807278 18028 CONTRACTED SERVICES 797734 416135 381599 4541582 5743978 322765 -1525161 56329494 39944627 16261544 123323 918 491 212393 15395 7043918 9030928 284195 338462 39890000 17987763 22295471 21902237 18006073 18924041 30087603 28444837 77930571 78656391 20039102 20468075 1008259 1175650 21047361 21643725 X 54561426 52378841 1211784 3523825 1110000 1110000 56883210 57012666 77930571 78656391 X -3588958 146840 3571574 X X 0 1 X 1 0 X 2779667 3113810 2431175 3497069 1604818 13426539 2779667 3113810 2431175 3497069 1604818 13426539 13426539 512582 415889 395310 437166 437193 2198140 15624679 241505204 0.85930 0.84720 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 28773188 30000 1146659 5000000 24949847 28776265 25000 -4436 23641 28773188 29186685 1556223 1966643 28776265 25177232 50000 3959453 29186685 22867326 2309906 25177232 0.95550 0.04450 0.00000 0 1 1 956114 956114 30812793 13661697 17151096 6766 194 6572 6140034 4133491 2006543 1974293 192381 1781912 21902237 BENEFICIAL INTEREST IN SUBSIDIARY FOUNDATION 28444837 28444837 RETIREMENT PLAN LIABILITY 1175650 1175650 X 59330869 146840 6587255 6734095 52596774 143762 143762 52740536 59201413 3015681 3015681 56185732 143762 143762 56329494 Part X, Line 2: Accounting principles generally accepted in the United States of America require management to evaluate tax positions taken by the Organization and recognize a tax liability if the Organization has taken an uncertain position that more likely than not would fail to be sustained upon examination by the Internal Revenue Service. As discussed above, the Organization is exempt from federal income taxes and management believes the Organization has not engaged in any activities that would disqualify it from tax-exempt status or incur a tax obligation for the year ended December 31, 2016. The Organization believes their estimates are appropriate based on current facts and circumstances. The Organization is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. Part XI, Line 2d - Other Adjustments: elimination of net revenue activity of subsidiary foundation 6,587,255. Part XII, Line 2d - Other Adjustments: elimination of net expense activity of subsidiary foundation 3,015,681. Part v, Line 4: Endowment funds are maintained by a related organization, Hospice of Dayton Foundation (31-1769696). Endowment funds are maintained by the foundation to support the Hospice of Dayton, Inc., the foundation's parent organization. It is the foundation's objective to utilize current fundraising to support programs of The Hospice of Dayton, Inc., to grow and provide reserves for unforeseen circumstances, or to fund significant new initiatives. The beneficial interest in subsidiary foundation reported on schedule D, Part IX includes the endowment assets shown on schedule d, part v. 0 1 0 0 0 0 0 0 0 KENT ANDERSON CEO - OHI 0 357456 0 0 0 0 0 58000 0 14598 0 430054 0 0 CALVIN ROBINSON CFO - OHI 0 181131 0 0 0 0 0 26406 0 20022 0 227559 0 0 JERRY DURST CHIEF ADMINISTRATIVE OFFICER 0 204763 0 0 0 0 0 23117 0 19164 0 247044 0 0 RUTH M THOMSON CMO 0 378633 0 0 0 0 0 24625 0 19357 0 422615 0 0 AMY M WAGNER COO 0 191318 0 0 0 0 0 22733 0 14825 0 228876 0 0 MARY E MURPHY PRESIDENT - HOD 0 217675 0 0 0 0 0 23476 0 7600 0 248751 0 0 JULES SHERMAN SENIOR MEDICAL DIRECTOR 153890 0 0 0 0 0 3996 0 475 0 158361 0 0 0 RANAPREET PATEL CLINICAL MEDICAL DIRECTOR 241233 0 0 0 0 0 6025 0 0 0 247258 0 0 0 TIMOTHY MACLEAN CLINICAL MEDICAL DIRECTOR 229268 0 0 0 0 0 341 0 7236 0 236845 0 0 0 CLEANNE CASS MED DIR. COMMUNITY CARE & ED 266884 0 0 0 0 0 6539 0 0 0 273423 0 0 0 WENDY SCHMITZ MED DIR. IMPATIENT CARE 241690 0 0 0 0 0 6148 0 19164 0 267002 0 0 0 CHIRAG PATEL MED DIR. INNOVATIVE CARE SOLUTIONS 287214 0 0 0 0 0 6625 0 19357 0 313196 0 0 0 Part I, Line 4b CONTRIBUTIONS AND/OR ACCRUALS OF $18,000 EACH WERE MADE TO 457(B) DEFERRED COMPENSATION PLANS ON BEHALF OF K. ANDERSON, J. DURST, R. THOMSON, C. ROBINSON, AND A. WAGNER. THE ORGANIZATION ALSO ACCRUED $40,000 UNDER AN UNFUNDED SUPPLEMENTAL RETIREMENT PLAN ON BEHALF OF K. ANDERSON. PART I, LINE 3: THE EXECUTIVE COMMITTEE OF THE OHI 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 OHI AND AFFILIATE BOARDS OF TRUSTEES AS PART OF THE BUDGET PROCESS. Form 990, Part VI, Section A, line 6 OHIO'S HOSPICE, INC. IS THE SOLE MEMBER OF THE HOSPICE OF DAYTON THROUGH AN AFFILIATION AGREEMENT. Form 990, Part VI, Section B, line 11b THE CFO REVIEWS THE FORM 990 AND PROVIDES A COPY OF THE FORM 990 TO THE BOARD FOR REVIEW PRIOR TO FILING. Form 990, Part VI, Section B, line 12c THE BOARD OF TRUSTEES ANNUALLY REPORTS ON ANY ACTIVITY THAT COULD GIVE RISE TO POTENTIAL CONFLICTS OF INTEREST. Form 990, Part VI, Section B, line 15 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 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. Form 990, Part XI, line 9: change in net assets of beneficial interest in related entity (31-1769696) 3,571,574. FORM 990, PART XI, 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 THE PRIOR YEAR. INNOVATIVE CARE SOLUTIONS LLC 324 WILMINGTON AVENUE DAYTON OH 45420 TO PROVIDE PALLIATIVE CARE PHYSICIANS & SUPPORT PERSONNEL OH THE HOSPICE OF DAYTON HOSPICE OF DAYTON FOUNDATION 324 WILMINGTON AVENUE DAYTON OH 45420 311769696 TO PROVIDE FINANCIAL SUPPORT TO ITS PARENT, HOSPICE OF DAYTON OH 501(c)(3) Line 12a, I HOSPICE OF DAYTON INC 1 OHIO'S HOSPICE INC 324 WILMINGTON AVENUE DAYTON OH 45420 463215586 TO PROVIDE MANAGEMENT SERVICES AS A SUPPORTING ORGANIZATION OH 501(c)(3) Line 12a, I N/A 0 HOSPICE OF MIAMI COUNTY 550 SUMMIT AVENUE TROY OH 45373 311031277 TO PROVIDE HOSPICE CARE OH 501(c)(3) Line 7 OHIO'S HOSPICE INC 0 COMMUNITY CARE HOSPICE INC P O BOX 123 WILMINGTON OH 45177 371495725 TO PROVIDE HOSPICE CARE OH 501(c)(3) Line 7 OHIO'S HOSPICE INC 0 HOSPICE OF CENTRAL OHIO LTD 2269 CHERRY VALLEY ROAD NEWARK OH 43055 311059756 TO PROVIDE HOSPICE CARE OH 501(c)(3) Line 7 OHIO'S HOSPICE INC 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 HOSPICE OF DAYTON FOUNDATION (31-1769696) C 1604867 cash value HOSPICE OF DAYTON FOUNDATION (31-1769696) M 740777 cash value HOSPICE OF DAYTON FOUNDATION (31-1769696) N 137923 cash value HOSPICE OF DAYTON FOUNDATION (31-1769696) O 646461 cash value OHIO'S HOSPICE (46-3215586) M 13643861 CASH VALUE