2016-07-29T13:53:11-05:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 4250 N FAIRFAX DRIVE SUITE 1020 ARLINGTON VA 22203 990 2015-01-01 521114719 MONTGOMERY HOSPICE INC MONT 3019214400 1355 PICCARD DRIVE NO 100 ROCKVILLE MD 20850 ANN MITCHELL PRESIDENT & CEO 3019214400 2016-07-27 1 YUNG-HEE GALLINARO P00035293 5712279500 2015 2016-12-15 16:53:06Z ANN MITCHELL 1355 PICCARD DRIVE NO 100 ROCKVILLE MD 20850 39865701 0 X WWW.MONTGOMERYHOSPICE.ORG X 1979 MD TO GENTLE THE JOURNEY THROUGH SERIOUS ILLNESS AND LOSS WITH SKILL AND COMPASSION. 22 21 287 300 0 0 2301665 1870904 20898450 22248199 473524 994036 -8276 17876 23665363 25131015 0 0 0 0 16995624 17587788 0 0 511789 5709750 5210607 22705374 22798395 959989 2332620 22507302 23943011 2187887 2223267 20319415 21719744 X TO GENTLE THE JOURNEY THROUGH SERIOUS ILLNESS AND LOSS WITH SKILL AND COMPASSION. TO BRING COMFORT BY PROVIDING COMPASSIONATE, PROFESSIONAL CARE TO COMMUNITY RESIDENTS WHO ARE FACING SERIOUS ILLNESS AND LOSS. TO PROVIDE DIGNITY FOR THE DYING AND UNCONDITIONAL COMPASSION, THROUGH DEDICATION AND COLLABORATION. 0 0 20579878 22248199 HOSPICE AND BEREAVEMENT SERVICES: THE ORGANIZATION PROVIDES SPECIALIZED MEDICAL AND PSYCHOSOCIAL END-OF-LIFE CARE TO MONTGOMERY COUNTY, MARYLAND RESIDENTS LIVING WITH A LIFE LIMITING ILLNESS, AS WELL AS, THEIR FAMILIES, WITH AN INTERDISCIPLINARY TEAM OF TRAINED PROFESSIONALS (AND VOLUNTEERS). IN ADDITION TO CONVENTIONAL MEDICAL CARE, MONTGOMERY HOSPICE USES HOLISTIC THERAPIES AND SERVICES FOR COMFORT AND SYMPTOM RELIEF, CUSTOMIZED FOR EACH PATIENT. IN 2015, MONTGOMERY HOSPICE SERVED 2,300 PATIENTS AND THEIR FAMILIES. AMONG THE TOTAL PATIENTS SERVED, 15 WERE CHILDREN AND 59 WERE EITHER UNINSURED OR UNDERINSURED. OUR INPATIENT UNIT, CASEY HOUSE, IS THE ONLY ALL-HOSPICE ACUTE FACILITY IN MONTGOMERY COUNTY. IN 2015, 575 PATIENTS WITH SERIOUS PAIN OR OTHER SYMPTOMS RECEIVED INTENSIVE NURSING AND MEDICAL CARE AND ATTENTION AT CASEY HOUSE. MONTGOMERY HOSPICE ALSO PROVIDED BEREAVEMENT SERVICES TO ALMOST 5,900 INDIVIDUALS AND 3,300 YOUNG ADULTS, AND END-OF-LIFE CARE EDUCATION TO MORE THAN 2,900 CLINICIANS AND PEOPLE IN THE LAY COMMUNITY. 20579878 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 1 12 0 287 1 0 0 0 0 0 1 1 0 0 0 0 X 22 21 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 MD X MONICA ESCALANTE CFO 3019214400 1355 PICCARD DRIVE ROCKVILLE MD 20850 ANN MITCHELL PRESIDENT & CEO 46.00 X X 217272 0 14779 STERLING KING JR DR PH CHAIRMAN 1.00 X X 0 0 0 BERYL L FEINBERG IMMEDIATE PAST CHAIRMAN 1.00 X X 0 0 0 PAUL E ALPUCHE JR ESQ VICE CHAIRMAN 1.00 X X 0 0 0 LYA MALL KARM MD SECRETARY 1.00 X X 0 0 0 DEBORA S MCGREGOR TREASURER 1.00 X X 0 0 0 MICHAEL G BANKS ESQ DIRECTOR 1.00 X 0 0 0 BRIAN A CARPENTER MD DIRECTOR 1.00 X 0 0 0 SENATOR BRIAN J FELDMAN DIRECTOR 1.00 X 0 0 0 SAFIA S KADIR ESQ DIRECTOR 1.00 X 0 0 0 ELMA M LEVY DIRECTOR 1.00 X 0 0 0 BARRY R MEIL DIRECTOR 1.00 X 0 0 0 GERMAN PARAUD DIRECTOR 1.00 X 0 0 0 DARREN M POPKIN DIRECTOR 1.00 X 0 0 0 STEVEN V ROBERTS DIRECTOR 1.00 X 0 0 0 RONALD J RUBIN DIRECTOR 1.00 X 0 0 0 KATHY TORRENCE DIRECTOR 1.00 X 0 0 0 RANDALL P WAGNER MD DIRECTOR 1.00 X 0 0 0 DONGMEI WANG MD DIRECTOR 1.00 X 0 0 0 DELEGATE BONNIE L CULLISON DIRECTOR 1.00 X 0 0 0 AMY E DIAS ESQ DIRECTOR 1.00 X 0 0 0 CESAR E PALACIOS DIRECTOR 1.00 X 0 0 0 MONICA ESCALANTE CFO/VP COM EDUC/OUTREACH 45.00 X 177754 0 4103 GEOFFREY COLEMAN MD MEDICAL DIRECTOR 44.00 X 200588 0 29156 GRACE HUFFMAN ASSOCIATE MEDICAL DIRECTOR 43.00 X 199035 0 2000 MILLICENT WHYTE-HIGGINS SR. VP OF NURSING SERVICES 51.00 X 156299 0 9909 JANET CAUFFIEL VP OF HUMAN RESOURCES 42.00 X 148370 0 4829 GERRY VENT VP OF PHILANTHROPY 42.00 X 120054 0 12585 PATRICIA VITACCO DIRECTOR OF QAPI 42.00 X 116871 0 11499 1336243 0 88860 22 0 1 0 HOSPICE PHARMACY SOLUTIONS PO BOX 93689 SOUTHLAKE TX 76092 PHARMACY 554349 DELTA CARE RX PO BOX 23410 STUBENVILLE OH 43553 PHARMACY 461715 MEDLINE INDUSTRIES INC BOX 382075 PITTSBURGH PA 15251 MEDICAL SUPPLIES 410617 RECOVERCARE 1920 STANLEY GAULT PARKWAY 100 LOUISVILLE KY 40223 DURABLE MEDICAL EQUIPMENT 337231 VERIZON WIRELESS PO BOX 25505 LEHIGH VALLEY PA 18002 TELEPHONE/INTERNET SVC 196062 10 66804 276166 37790 1490144 458078 1870904 PATIENT SERVICE REVENUE 624100 22248199 22248199 22248199 361494 361494 15266799 14634257 632542 632542 632542 100828 276166 100429 399 399 17477 17477 17477 25131015 22248199 0 1011912 656840 231787 366585 58468 14299016 13001462 987572 309982 340542 323800 6737 10005 1284252 1117424 133685 33143 1007138 894067 85838 27233 10715 10715 31106 31106 47316 47316 1267503 1257334 8020 2149 64792 62242 2550 346555 38601 300354 7600 210259 24282 171731 14246 607591 248124 359467 310170 305515 3775 880 85717 28649 12857 44211 13124 13124 298115 123404 174711 158376 49378 108998 PHARMACY PURCHASES 931941 931941 MEDICAL SUPPLIES 441976 441976 EQUIPMENT LEASE/PURCHAS 311738 2430 309308 DUES & PUBLICATION 57939 10235 46394 1310 15674 1487227 -1471565 12 22798395 20579878 1706728 511789 700 700 4965396 4947032 41061 2726827 3082727 317114 324909 4990590 2050348 2597720 2940242 11884186 12606340 15359 22507302 23943011 2081429 2175041 106458 48226 2187887 2223267 X 14972352 16397678 1000138 1015283 4346925 4306783 20319415 21719744 22507302 23943011 2332620 -932291 0 X 0 1 X 1 0 X 1143592 791825 794435 2301665 1870904 6902421 20961488 22144610 21088768 20898450 22349027 107442343 22105080 22936435 21883203 23200115 24219931 114344764 0 0 0 114344764 5025 6975 3480 335335 361494 712309 5025 6975 3480 335335 361494 712309 2437 9166 34827 9794 17477 73701 22112542 22952576 21921510 23545244 24598902 115130774 0.99320 0.99620 0.00620 0.00330 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME MEALS - NON-PATIENT GAIN ON LEASE TERMINATION RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6733056 61131 -8524 162190 6623473 4220799 2458595 190966 137304 6733056 3877148 71994 396770 125113 4220799 3695745 36095 268010 122702 3877148 3147870 326203 326792 105120 3695745 0.29180 0.65020 0.05800 0 0 1082200 1082200 2506838 1060364 1446474 208956 14247 194709 594962 539919 55043 597634 435818 161816 2940242 X 24288819 -932291 36982 100429 -794880 25083699 47316 47316 25131015 22888490 36982 100429 137411 22751079 47316 47316 22798395 PART V, LINE 4: THE ENDOWMENT FUNDS RESULTED FROM DONOR-RESTRICTED FUNDS FOR SUPPORT OF SEVERAL HOSPICE PROGRAM ACTIVITIES. CONTRIBUTIONS FROM MAJOR DONORS WERE RESTRICTED TO THE OPERATIONS, MAINTENANCE AND PATIENT CARE AT THE HOSPICE'S INPATIENT ACUTE CARE FACILITY. DONORS HAVE ALSO CONTRIBUTED TO THE FUNDING OF NURSING SERVICES PROVIDED AT THE INPATIENT HOSPICE. THE HOSPICE IN-HOME SERVICES ARE BEING SUPPORTED TO PROVIDE MEDICAL CARE SERVICES BY PHYSICIANS, NURSES, SOCIAL WORKERS AND HOSPICE AIDES. THE ENDOWMENTS ALSO SUPPORT CHARITY CARE AND THE UNCOMPENSATED SERVICES PROVIDED TO PATIENTS AND THEIR FAMILIES THROUGH BEREAVEMENT AND PASTORAL CARE SUPPORT. PART X, LINE 2: THE HOSPICE IS A TAX-EXEMPT ENTITY AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). PALLIATIVE MEDICINE IS A LIMITED LIABILITY COMPANY WHOSE OPERATING RESULTS FLOW THROUGH TO THE HOSPICE, WHICH IS ITS SOLE CORPORATE MEMBER. NEITHER OF THESE ENTITIES ARE CLASSIFIED AS A PRIVATE FOUNDATION AS DEFINED BY THE INTERNAL REVENUE SERVICE. THE IRC PROVIDES FOR TAXATION OF UNRELATED BUSINESS INCOME UNDER CERTAIN CIRCUMSTANCES. THE HOSPICE AND ITS AFFILIATED ENTITIES HAVE NO SIGNIFICANT UNRELATED BUSINESS INCOME; HOWEVER, SUCH STATUS IS SUBJECT TO FINAL DETERMINATION UPON EXAMINATION OF THE RELATED INCOME TAX RETURNS BY THE APPROPRIATE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 100,429. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 100,429. CHEF NIGHT 179664 111621 68043 19600 3396 2015 GALA 148335 115550 32785 8390 36655 7750 13687 1 48995 48995 4124 600 300 5927 376994 276166 100828 12514 56855 8050 23010 100429 399 X X 0 0 0 0 0 0 0 0 0 ANN MITCHELL PRESIDENT & CEO 217272 0 0 0 0 0 4228 0 10551 0 232051 0 0 0 MONICA ESCALANTE CFO/VP COM EDUC/OUTREACH 177754 0 0 0 0 0 3118 0 985 0 181857 0 0 0 GEOFFREY COLEMAN MD MEDICAL DIRECTOR 200588 0 0 0 0 0 3843 0 25313 0 229744 0 0 0 GRACE HUFFMAN ASSOCIATE MEDICAL DIRECTOR 199035 0 0 0 0 0 0 0 2000 0 201035 0 0 0 MILLICENT WHYTE-HIGGINS SR. VP OF NURSING SERVICES 156299 0 0 0 0 0 2746 0 7163 0 166208 0 0 0 JANET CAUFFIEL VP OF HUMAN RESOURCES 143370 0 5000 0 0 0 2719 0 2110 0 153199 0 0 0 X 747 100918 FMV X 1 357160 FMV 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE BOARD CHAIRPERSON, BOARD VICE CHAIRPERSON, BOARD SECRETARY, BOARD TREASURER, IMMEDIATE PAST CHAIRPERSON, AND THE PRESIDENT/CEO, AND SUCH OTHER BOARD MEMBERS AS THE BOARD MAY DEEM APPROPRIATE. IT SHALL HAVE AUTHORITY TO CONDUCT ESSENTIAL HOSPICE BUSINESS BETWEEN BOARD MEETINGS, WHEN DELAY IN ACTION WOULD BE DETRIMENTAL TO THE HOSPICE, EXCEPT AS TO THE MATTERS LISTED BELOW AS WELL AS ANY OTHERS IMPOSED BY THE BOARD: 1. AMENDING THE ARTICLES OF INCORPORATION OR THE BYLAWS; 2. APPROVING A PLAN OF MERGER OR CONSOLIDATION; 3. FILLING VACANCIES ON THE HOSPICE BOARD OR THE FOUNDATION BOARD OR REMOVING DIRECTORS OR OFFICERS OF EACH BOARD FROM OFFICE; 4. APPOINTING OR REMOVING MEMBERS OF THE EXECUTIVE COMMITTEE; 5. APPOINTING OR REMOVING ANY OFFICER, THE MEDICAL DIRECTOR OR THE PRESIDENT/CEO, WITHOUT THE APPROVAL OF A MAJORITY OF THE BOARD; 6. APPROVING SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY OR ASSETS OF THE HOSPICE; OR 7. APPROVING VOLUNTARY DISSOLUTION OF THE HOSPICE OR REVOCATION OF VOLUNTARY DISSOLUTION PROCEEDINGS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE PRESIDENT AND MEMBERS OF THE FINANCE COMMITTEE BEFORE FILING. THE CHAIRMAN GIVES A SUMMARY REPORT TO THE BOARD. BOARD MEMBERS CAN REQUEST A COPY OF THE FORM 990 RETURN. FORM 990, PART VI, SECTION B, LINE 12C ALL INDIVIDUALS, UPON APPOINTMENT TO THE BOARD OF DIRECTORS, ANY BOARD DESIGNATED COMMITTEE, OR MONTGOMERY HOSPICE STAFF OR VOLUNTEER POSITION, SHALL BE REQUIRED TO EXAMINE AND SIGN AN INDIVIDUAL STATEMENT REGARDING CONFLICT OF INTEREST. IN THE EVENT A CONFLICT OF INTEREST OR POTENTIAL CONFLICT ARISES, THE CONFLICT OF INTEREST STATEMENT MUST PROMPTLY BE UPDATED AND BROUGHT TO THE ATTENTION OF THE PRESIDENT/CEO AND/OR CHAIRMAN OF THE BOARD. IF THE MATTER CONCERNS A STAFF MEMBER OR VOLUNTEER, THE CHANGE SHOULD BE PRESENTED TO THE INDIVIDUAL'S SUPERVISOR. THE INDIVIDUAL BOARD MEMBERS, WHO HAVE A CONFLICT OF INTEREST WITH THEIR CURRENT BUSINESS RELATIONSHIP AND THE HOSPICE, WILL WITHDRAW THEMSELVES FROM BOARD DISCUSSIONS AND VOTING. FORM 990, PART VI, SECTION B, LINE 15A REVIEW FOR PRESIDENT/CEO IS CONDUCTED ANNUALLY BY CERTAIN MEMBERS OF THE EXECUTIVE COMMITTEE. MEMBERS MAY INTERVIEW PRESIDENT/CEO'S COLLEAGUES CONCERNING THEIR INTERACTION AND RELATIONSHIP WITH PRESIDENT/CEO. OTHER ANALYSIS INCLUDES A WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE EXECUTIVE COMMITTEE. KEY EMPLOYEES ARE GIVEN ANNUAL PERFORMANCE REVIEWS BY THEIR IMMEDIATE SUPERVISOR INCLUDING THE PRESIDENT/CEO. THE PERFORMANCE SUMMARY IS REVIEWED AND DISCUSSED WITH THE PRESIDENT/CEO. AN ANALYSIS OF COMPARABLE STAFF POSITIONS AND SIMILAR HOSPICE ORGANIZATIONS IS DONE BY HR DEPARTMENT. DATA FROM BENCHMARK REPORTS PROVIDED BY NHPCO AND MVI ARE ALSO USED IN THIS ANALYSIS. THE MOST RECENT YEAR IN WHICH THE COMPENSATION PROCESS WAS REVIEWED WAS 2015. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE ALSO SUMMARIZED ON THE ORGANIZATION'S WEBSITE. PALLIATIVE MEDICINE CONSULTANTS OF GREATER WASHINGTON LLC 1355 PICCARD DR SUITE 100O ROCKVILLE MD 20850 522343635 TO OFFER A CONTINUUM OF CARE FOR PATIENTS WITH ADVANCED ILLNESS MD 0 12732 MONTGOMERY HOSPICE INC