2016-11-15T07:16:15-06:00 2015-12-31 310800053 CLARK SCHAEFER HACKETT & CO 10100 INNOVATION DR SUITE 400 DAYTON OH 45342 990 2015-01-01 310933339 HOSPICE OF DAYTON INC 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 KENT ANDERSON 324 WILMINGTON AVE DAYTON OH 45420 58225822 0 X HTTP://WWW.HOSPICEOFDAYTON.ORG X 1978 OH TO PROVIDE HOSPICE CARE FOR TERMINALLY ILL INDIVIDUALS 11 10 731 694 0 0 2431175 3497069 46392914 44673103 1424624 1192475 57477 146770 50306190 49509417 0 0 0 0 34674694 36670176 0 0 188209 15063752 15294410 49738446 51964586 567744 -2455169 79337749 77930571 17300239 21047361 62037510 56883210 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 44433878 44818673 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. 44433878 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 1 249 0 731 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X JERRY DURST 9372564490 324 WILMINGTON AVE DAYTON OH 454201891 GREG TOMAN CPAABV BOARD MEMBER - CHAIR 2.00 X X 0 0 0 THOMAS MANN BOARD MEMBER - VICE CHAIR 2.00 X X 0 0 0 LISA HANAUER BOARD MEMBER - SECRETARY 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 JON LARRABEE BOARD MEMBER 2.00 X 0 0 0 LINDSAY M JOHNSON ESQ BOARD MEMBER 2.00 X 0 0 0 LOIS SUTHERLAND 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 KENT ANDERSON PRESIDENT/CEO 40.00 10.00 X X 366989 0 73485 JERRY DURST CFO 40.00 10.00 X 159681 0 43290 BRENDA HUMFLEET MKTG DIRECTOR/HODF PRES. (JAN - MAY) 2.00 40.00 X 154504 0 2800 LORI IGEL HODF EXEC. DIR. (JUN - DEC) 2.00 40.00 X 105351 0 9726 JULES SHERMAN CHIEF MEDICAL OFFICER 40.00 0.00 X 158710 0 19322 RUTH THOMSON MEDICAL DIRECTOR 40.00 0.00 X 402621 0 44946 CHIRAG PATEL PHYSICIAN 40.00 0.00 X 297729 0 27145 CLEANNE CASS PHYSICIAN 40.00 0.00 X 277154 0 6625 WENDY SCHMITZ ADMINISTRATIVE MEDICAL DIRECTOR 40.00 0.00 X 226770 0 26098 RANAPREET PATEL PHYSICIAN 40.00 0.00 X 238851 0 5965 2388360 0 259402 26 0 1 0 THERAPY SUPPORT INC 2803 N OAK GROVE AVE SPRINGFIELD MO 658034976 THERAPY 1873950 OMNICELL INC 590 E MIDDLEFIELD RD MOUNTAIN VIEW CA 940434008 CONTRACT SERVICES 491559 DEDICATED NURSING ASSOCIATES INC 3875 FRANKLINTOWNE COURTS SUITE 240 MURRYSVILLE PA 15668 CONTRACT SERVICES 428073 COOLIDGE WALL 33 WEST FIRST ST SUITE 600 DAYTON OH 454021289 LEGAL 327965 PAUL J STRIEBEL & ASSOCIATES INC 10027 PUTTERVIEW WAY CENTERVILLE OH 45458 ARCHITECTURAL SERVICES 323763 18 3497069 3497069 PATIENT SERVICE 624100 44485486 44485486 CAFETERIA 624100 187617 187617 44673103 435966 435966 1200 0 1200 1200 1200 9472914 8716405 756509 756509 756509 MISCELLANEOUS INCOME 900099 145570 145570 145570 49509417 44818673 0 1193675 1093858 178032 643445 272381 29280505 26247668 2703315 329522 429518 324323 96203 8992 3430214 3112213 304560 13441 2436081 2387628 43188 5265 824187 1480 118708 703999 488528 337923 150558 47 368909 2964 365945 957348 850702 106646 358176 171050 186669 457 1773650 1259292 354729 159629 246589 246589 MEDICATIONS & SUPPLIES 2848448 2848448 0 0 EQUIP. RENTAL & MAINT. 1958239 1909917 48322 0 CONTRACTED SERVICES 1888003 938173 949830 0 GENERAL INPATIENT EXP. 880353 880353 0 0 2701980 2983712 1130438 -1412170 51964586 44433878 7342499 188209 918 918 81032 212393 8030946 7043918 199477 284195 39619407 17323936 21082189 22295471 19004408 18006073 30938779 30087603 79337749 77930571 16345846 20039102 954393 1008259 17300239 21047361 X 59692327 54561426 1235183 1211784 1110000 1110000 62037510 56883210 79337749 77930571 X -2455169 -1189281 -1509850 X X 0 1 X 1 0 X 2151665 2779667 3113810 2431175 3497069 13973386 2151665 2779667 3113810 2431175 3497069 13973386 13973386 759667 512582 415889 395310 437166 2520614 16494000 238829400 0.84720 0.78550 X 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 1 1 956114 956114 30584442 12769467 17814975 6296125 4446225 1849900 1782726 108244 1674482 22295471 BENEFICIAL INTEREST IN SUBSIDIARY FOUNDATION 27351205 DUE FROM RELATED ENTITY (HOSPICE OF DAYTON FDTN. 31-1769696) 2674456 DUE FROM RELATED ENTITY (HOSPICE OF MIAMI COUNTY 31-1031277) 61942 30087603 RETIREMENT PLAN LIABILITY 1008259 1008259 X 51715220 -1189281 3395084 2205803 49509417 0 49509417 56869520 4904934 4904934 51964586 0 51964586 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: ELIMINATION OF NET REVENUE ACTIVITY OF SUBSIDIARY FOUNDATION 3,395,084. PART XII, LINE 2D - OTHER ADJUSTMENTS: ELIMINATION OF NET EXPENSE ACTIVITY OF SUBSIDIARY FOUNDATION 4,904,934. 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. X X 1 1 0 0 0 0 0 0 0 KENT ANDERSON PRESIDENT/CEO 366989 0 0 0 0 0 58000 0 15485 0 440474 0 0 0 JERRY DURST CFO 159681 0 0 0 0 0 22969 0 20321 0 202971 0 0 0 BRENDA HUMFLEET MKTG DIRECTOR/HODF PRES. (JAN - MAY) 125906 0 28598 0 0 0 0 0 2800 0 157304 0 0 0 JULES SHERMAN CHIEF MEDICAL OFFICER 158710 0 0 0 0 0 3968 0 15354 0 178032 0 0 0 RUTH THOMSON MEDICAL DIRECTOR 402621 0 0 0 0 0 24625 0 20321 0 447567 0 0 0 CHIRAG PATEL PHYSICIAN 272873 0 24856 0 0 0 6625 0 20520 0 324874 0 0 0 CLEANNE CASS PHYSICIAN 252308 0 24846 0 0 0 6625 0 0 0 283779 0 0 0 WENDY SCHMITZ ADMINISTRATIVE MEDICAL DIRECTOR 226770 0 0 0 0 0 5777 0 20321 0 252868 0 0 0 RANAPREET PATEL PHYSICIAN 238851 0 0 0 0 0 5965 0 0 0 244816 0 0 0 PART I, LINE 3 THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES UTILIZES LOCAL MARKET KNOWLEDGE, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE PRESIDENT/CEO. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE PRESIDENT/CEO UNDER GUIDELINES ESTABLISHED BY THE BOARD OF TRUSTEES AS PART OF THE BUDGET PROCESS. 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. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF TRUSTEES IS PROVIDED A COPY OF FORM 990 TO 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 LINES A & B: THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES UTILIZES LOCAL MARKET KNOWLEDGE, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE PRESIDENT/CEO. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE PRESIDENT/CEO UNDER GUIDELINES ESTABLISHED BY THE BOARD OF TRUSTEES AS PART OF THE BUDGET PROCESS. FORM 990, PART VI, SECTION C, LINE 19 HOSPICE OF DAYTON, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON RECEIPT OF A WRITTEN REQUEST FOR SUCH INFORMATION. FORM 990, PART XI, LINE 9: CHANGE IN NET ASSETS OF BENEFICIAL INTEREST IN RELATED ENTITY (31-1769696) -1,509,850. FORM 990, PART XI, LINE 2C: THE BOARD OF TRUSTEES HAS CHARGED THE FINANCE COMMITTEE WITH OVERSIGHT OF THE INDEPENDENT AUDIT. THIS PROCESS IS CONSISTENT WITH THE PRIOR YEAR. FORM 990, PART IX, LINE 24F: 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. IN ADDITION, $712,377 OF FOUNDATION ACTIVITIES AND $106,646 OF FOUNDATION OCCUPANCY COSTS WERE PAID BY THE HOSPICE OF DAYTON, INC. AND ALLOCATED TO THE FOUNDATION. ALL ALLOCATIONS ARE BASED ON ACTUAL COSTS OF FOUNDATION OPERATIONS. THE TOTAL AMOUNT ALLOCATED TO THE FOUNDATION IS $1,439,282. INNOVATIVE CARE SOLUTIONS LLC 324 WILMINGTON AVENUE DAYTON OH 45420 TO PROVIDE PALLIATIVE CARE PHYSICIANS & SUPPORT PERSONNEL OH -362243 588689 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 11A, 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 11A, 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 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 3488691 CASH VALUE HOSPICE OF DAYTON FOUNDATION (31-1769696) M 712377 CASH VALUE HOSPICE OF DAYTON FOUNDATION (31-1769696) N 106646 CASH VALUE HOSPICE OF DAYTON FOUNDATION (31-1769696) O 620259 CASH VALUE OHIO'S HOSPICE (46-3215586) M 18003579 CASH VALUE