2016-11-15T07:15:22-06:00 2015-12-31 310800053 CLARK SCHAEFER HACKETT & CO 10100 INNOVATION DR SUITE 400 DAYTON OH 45342 990 2015-01-01 311769696 HOSPICE OF DAYTON FOUNDATION HOSP 9372564490 324 WILMINGTON AVE DAYTON OH 45420 JERRY DURST CFO 9372564490 2016-11-14 1 STEPHANIE R PYLES CPA P00613386 9372260070 2016-11-14 2015 2017-02-10 21:41:12Z LORI IGEL 324 WILMINGTON AVE DAYTON OH 45420 15037193 0 X HTTP://WWW.HOSPICEOFDAYTON.ORG X 2001 OH TO PROVIDE FINANCIAL SUPPORT TO ITS PARENT ORGANIZATION, THE HOSPICE OF DAYTON, INC. (31-0933339) 14 12 0 0 0 0 3062247 3075029 0 0 2332163 1789835 64505 204934 5458915 5069798 2430095 3488691 0 0 0 0 0 0 1110791 1413891 1439282 3843986 4927973 1614929 141825 30052388 30025661 1191333 2674456 28861055 27351205 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 THE NON-EARNED REVENUE; AND MAKING FUNDING/GRANTING DECISIONS RELATIVE TO THE HOSPICE OF DAYTON, INC. 0 0 3488691 3488691 SUPPORT OF THE HOSPICE OF DAYTON, INC. (EIN. 31-0933339). GRANTS PAID SUPPORT PATHWAYS OF HOPE, COMPLIMENTARY CARE, PALLIATIVE CARE, AS WELL AS THE OVERALL COMMUNITY BASED MODEL OF CARE. 3488691 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 14 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 OH X JERRY DURST 9372564490 324 WILMINGTON AVE DAYTON OH 454201891 JERRY TATAR TRUSTEE - CHAIR 2.00 X X 0 0 0 ROBERT MUES TRUSTEE - VICE CHAIR 2.00 X X 0 0 0 DAVID FREIMUTH TRUSTEE 2.00 X 0 0 0 FRANZ HOGE TRUSTEE 2.00 X 0 0 0 JANE WINCH TRUSTEE 2.00 X 0 0 0 JANICE L CULVER CPA TRUSTEE 2.00 X 0 0 0 MERVYN ALPHONSO TRUSTEE 2.00 X 0 0 0 PETER HALEY TRUSTEE 2.00 X 0 0 0 RICHARD WICK TRUSTEE 2.00 X 0 0 0 ROBERT A YECK TRUSTEE 2.00 X 0 0 0 HOWARD MICHAELS TRUSTEE (JAN - AUG) 2.00 X 0 0 0 GREG TOMAN TRUSTEE - BVOP 2.00 X 0 0 0 THOMAS MANN TRUSTEE - BVOP 2.00 X 0 0 0 KENT ANDERSON TRUSTEE - BVOP (PRES. OF HOD) 2.00 48.00 X 0 366989 73485 BRENDA HUMFLEET PRESIDENT (JAN - MAY) 40.00 2.00 X X 0 154504 2800 LORI IGEL EXECUTIVE DIRECTOR (BEG. IN JUNE) 40.00 2.00 X X 0 105351 9726 JERRY DURST TREASURER (CFO OF HOD) 2.00 48.00 X 0 159681 43290 0 786525 129301 0 0 1 0 0 95000 190666 2789363 256529 3075029 765404 765404 10897189 9872758 1024431 1024431 1024431 280508 190666 94637 185871 185871 19063 0 19063 19063 5069798 19063 0 1975706 3488691 3488691 2518 2518 142596 142596 10392 1669 8723 32884 32884 106646 106646 24673 1825 22848 ALLOCATED SALARIES, BEN 620259 620259 PRINTING AND PUBLICATIO 187985 80 187905 POSTAGE AND MAILINGS 102700 102700 OTHER EVENT EXPENSE 56352 330 56022 152277 72827 79450 4927973 3488691 328491 1110791 2500 2500 38440 36599 1235183 1211784 28776265 28773188 0 1590 30052388 30025661 58 1191275 2674456 1191333 2674456 X 26515872 25029421 1235183 1211784 1110000 1110000 28861055 27351205 30052388 30025661 141825 -1651675 0 X X 0 1 X 1 0 X X 1 THE HOSPICE OF DAYTON INC 310933339 7 1 3488691 0 1 3488691 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 28776265 25000 -4436 23641 28773188 29186685 1556223 1966643 28776265 25177232 50000 3959453 29186685 22867326 2309906 25177232 22828457 38869 22867326 0.96140 0.03860 0.00000 0 0 0 DUE TO RELATED ENTITY (THE HOSPICE OF DAYTON, INC. 31-0933339) 2674456 2674456 X 3395084 -1651675 24920 94637 -1532118 4927202 142596 142596 5069798 4904934 24920 94637 119557 4785377 142596 142596 4927973 PART V, LINE 4: ENDOWMENT FUNDS ARE MAINTAINED TO PROVIDE FINACIAL SUPPORT TO THE FOUNDATION'S PARENT ORGANIZATION, THE HOSPICE OF DAYTON, INC. (31-0933339). IT IS THE FOUNDATION'S OBJECTIVE 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. 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, 2015. 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: DIRECT FUNDRAISING EXPENSE 94,637. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT FUNDRAISING EXPENSE 94,637. GOLF CLASSIC 137643 30720 106923 3360 18383 1742 STEINS, STEMS AND SAVORIES 104575 6560 98015 680 2200 3151 21806 4 228956 153386 75570 100 18943 2550 21722 471174 190666 280508 100 4040 21143 21534 2550 45270 94637 185871 1 THE HOSPICE OF DAYTON INC 324 WILMINGTON AVE DAYTON OH 45420 310933339 501(C)(3) 3488691 TO FACILIATE THE HOSPICE OF DAYTON, INC. PURPOSE TO PROVIDE HOSPICE CARE TO THE TERMINALLY ILL. 1 0 FORM 990, SCHEDULE F, PART I, QUESTION 2 FORM 990, SCHEDULE F, PART I, QUESTION 2; GRANTS ARE ONLY PROVIDED TO THE HOSPICE OF DAYTON, INC. TO SUPPORT PROGRAMS IDENTIFIED AND APPROVED BY THE FOUNDATION'S BOARD OF TRUSTEES. 1 1 0 0 0 0 0 0 0 KENT ANDERSON TRUSTEE - BVOP (PRES. OF HOD) 0 366989 0 0 0 0 0 58000 0 15485 0 440474 0 0 BRENDA HUMFLEET PRESIDENT (JAN - MAY) 0 125906 0 28598 0 0 0 0 0 2800 0 157304 0 0 JERRY DURST TREASURER (CFO OF HOD) 0 159681 0 0 0 0 0 22969 0 20321 0 202971 0 0 PART I, LINES 4A-B CONTRIBUTIONS OF $18,000 EACH WERE MADE TO 457(B) DEFERRED COMPENSATION PLANS ON BEHALF OF K. ANDERSON, J. DURST, AND R. THOMSON. THE ORGANIZATION ALSO ACCRUED $40,000 UNDER AN UNFUNDED SUPPLEMENTAL RETIREMENT PLAN ON BEHALF OF K. ANDERSON. B. HUMFLEET RECEIVED A SEVERANCE BONUS OF $28,598. X 239289 FAIR MARKET VALUE X 2 PLOTS IN THE GARDEN OF RESURRECTION 1 10865 FAIR MARKET VALUE X 2 PLOTS IN THE GARDEN OF RESURRECTION 1 6375 FAIR MARKET VALUE 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE OF THE HOSPICE OF DAYTON, INC. TRUSTEES AND THE BOARD MEMBERS OF HOSPICE OF DAYTON FOUNDATION ARE PROVIDED THE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPICE OF DAYTON, INC. MAINTAINS A CONFLICT OF INTEREST POLICY. 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 15A THE PRESIDENT/CEO OF THE HOSPICE OF DAYTON, INC. UTILIZES LOCAL MARKET KNOWLEDGE, DATA FROM SIMILAR HOSPICE AND MEDICAL FACILITIES, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE PRESIDENT OF THE HOSPICE OF DAYTON FOUNDATION. 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 FOR SUCH INFORMATION. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES HAS CHARGED THE FINANCE COMMITTEE OF THE HOSPICE OF DAYTON, INC. WITH OVERSIGHT OF THE INDEPENDENT AUDIT. THIS PROCESS IS CONSISTENT WITH THE PRIOR YEAR. FORM 990, PART IX, LINE 24A: ALL COMPENSATION OF EMPLOYEES OF HOSPICE OF DAYTON FOUNDATION (31-1769696) IS PAID BY HOSPICE OF DAYTON, INC. AND IS ALLOCATED TO THE FOUNDATION, CONSISTING OF $580,035 OF SALARIES, $34,959 OF EMPLOYEE BENEFITS AND $5,265 OF PAYROLL TAXES. THE HOSPICE OF DAYTON INC 324 WILMINGTON AVENUE DAYTON OH 45420 310933339 TO PROVIDE HOSPICE CARE OH 501(C)(3) 170(B)(1)(A)(VI) N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 THE HOSPICE OF DAYTON INC (31-0933339) B 3488691 CASH VALUE THE HOSPICE OF DAYTON INC (31-0933339) L 712377 CASH VALUE THE HOSPICE OF DAYTON INC (31-0933339) N 106646 CASH VALUE THE HOSPICE OF DAYTON INC (31-0933339) O 620259 CASH VALUE