2016-07-13T09:34:36-05:00 2015-12-31 420714325 RSM US LLP 230 N ELM ST STE 1100 GREENSBORO NC 27401 990 2015-01-01 581343313 HOSPICE & PALLIATIVE CARECENTER HOSP 3367683972 101 HOSPICE LANE WINSTONSALEM NC 27103 LINDA W DARDEN PRESIDENT & CEO 3367683972 2016-07-08 1 ADRIENNE MCKINNEY P00819656 3362724551 2015 2016-09-27 15:27:22Z LINDA W DARDEN 101 HOSPICE LANE WINSTONSALEM NC 27103 27481172 0 X WWW.HOSPICECARECENTER.ORG X 1978 NC HOSPICE & PALLIATIVE CARECENTER PROVIDES IN-HOME AND INPATIENT MEDICAL CARE FOR THE TERMINALLY ILL, TRAINS VOLUNTEERS TO ASSIST WITH FAMILIES OF PATIENTS, AND CONDUCTS EDUCATIONAL GRIEF SEMINARS FOR THE COMMUNITY. IN 2015, HOSPICE & PALLIATIVE CARECENTER CARED FOR 3,327 PATIENTS. 26 26 470 590 0 0 2826979 2584936 24873130 24754783 9159 3868 14391 16346 27723659 27359933 0 0 0 0 17313844 17782348 0 0 693789 10376685 8649293 27690529 26431641 33130 928292 28410220 28812843 2703947 2178278 25706273 26634565 X HOSPICE & PALLIATIVE CARECENTER PROVIDES COMPASSIONATE CARE FOR THOSE INDIVIDUALS LIVING WITH A LIFE-LIMITING ILLNESS AND THEIR FAMILIES, THROUGH QUALITY MEDICAL, EMOTIONAL, SPIRITUAL, AND SOCIAL SUPPORT. 0 0 12769647 16607278 HOSPICE HOMECARE - PROVIDES MEDICAL CARE FOR TERMINALLY ILL PATIENTS, FOCUSING ON IMPROVING QUALITY OF LIFE, PHYSICAL AND EMOTIONAL COMFORT, DIGNITY AND PEACE OF MIND FOR PATIENTS AND THEIR FAMILIES. SKILLED PROFESSIONALS PROVIDE IN-HOME PATIENT SERVICES, INCLUDING NURSING HOMES, ASSISTED LIVING HOMES, GROUP HOMES, REST HOMES, AND RETIREMENT COMMUNITIES, REGARDLESS OF ABILITY TO PAY.IN 2015, HOSPICE & PALLIATIVE CARECENTER PROVIDED 112,568 DAYS OF CARE TO 1,915 PATIENTS IN THIS CAPACITY. 4583209 5072621 KATE B. REYNOLDS (KBR) HOSPICE HOME - 40-BED INPATIENT FACILITY THAT PROVIDES HOSPICE PATIENTS STATE OF THE ART CARE IN A BEAUTIFUL, HOME-LIKE SETTING. HOSPICE PATIENTS RECEIVING CARE AT HOME MAY BE ADMITTED TO THE KBR HOSPICE HOME WHEN NECESSARY MEDICAL CARE IS NOT EASILY MANAGED AT HOME, OR WHEN A CAREGIVER IS IN NEED OF RESPITE.IN 2015, KATE B. REYNOLDS HOSPICE HOME PROVIDED 9,384 DAYS OF CARE TO 1,137 PATIENTS. 2629908 3029384 ROWAN HOSPICE AND PALLIATIVE CARE-HOSPICE AND PALLIATIVE CARECENTER INVESTS IN AND MANAGES ROWAN HOSPICE. REVENUE INCLUDES REIMBURSMENTS FOR OPERATING AND MANAGEMENT EXPENSES. 141128 902 COMMUNITY PARTNERSHIP/COMMUNITY EDUCATION 236192 1775 GRIEF COUNSELING SERVICES 110299 COMPLEMENTARY THERAPIES 45500 PALLIATIVE CARE SERVICES 487619 48177 20470383 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 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 0 0 1 83 0 1 470 1 0 0 0 0 0 1 1 0 0 0 0 X 26 26 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 NC X CAROLYN HINSON 3367683972 101 HOSPICE LANE WINSTONSALEM NC 27103 X MARGARET ANN HOFLER CHAIR 1.00 1.00 X X 0 0 0 TRACEY MARTIN VICE CHAIR 1.00 1.00 X X 0 0 0 MELISSA PHIPPS SECRETARY 1.00 X X 0 0 0 TIM SECHREST TREASURER 1.00 X X 0 0 0 CHARLES HAUSER PAST CHAIR 1.00 X X 0 0 0 STEPHEN POE HOSPICE FOUNDATION, CHAIR 1.00 1.00 X 0 0 0 RICHARD BENNETT AT LARGE 1.00 X 0 0 0 MARY LYLES MD AT LARGE 1.00 X 0 0 0 AARON SINGLETON AT LARGE 1.00 X 0 0 0 CAMILLE BANKS-PAYNE MEMBER 1.00 X 0 0 0 ALLEN CHAMOVITZ MD MEMBER 1.00 X 0 0 0 ROBERT COIL MEMBER 1.00 X 0 0 0 REV R CRAIG FORD MEMBER 1.00 X 0 0 0 THOMAS GROTE MD MEMBER 1.00 X 0 0 0 JENNIFER HOULIHAN MEMBER 1.00 X 0 0 0 PETER JURAN MEMBER 1.00 X 0 0 0 DONNY LAMBETH MEMBER 1.00 X 0 0 0 JEFF LINDSAY MEMBER 1.00 X 0 0 0 STEVE LINEBERGER MEMBER 1.00 X 0 0 0 REV DR SIR WALTER MACK MEMBER 1.00 X 0 0 0 KIMBERLY MOORE MEMBER 1.00 X 0 0 0 REV PRINCE RIVERS MEMBER 1.00 X 0 0 0 HENANDO RAMIREZ-SANTOS MEMBER 1.00 X 0 0 0 ROMAINE SARGENT MEMBER 1.00 X 0 0 0 SARA WALPOLE MEMBER 1.00 X 0 0 0 EDWIN WELCH MEMBER 1.00 X 0 0 0 LINDA W DARDEN CHIEF EXECUTIVE OFFICER 35.00 X 168166 0 23228 DAVE SHELTON CHEIF FINANCIAL OFFICER 40.00 X 104324 0 13053 MICHAEL LALOR CHIEF MEDICAL OFFICER 35.00 X 298426 0 15636 BRENT SHARPE PHARMACIST 40.00 X 156753 0 13444 SUSAN SCOTT PHARMACIST 40.00 X 109990 0 12561 CHRISTINA TUCKER WILLIARD PHARMACIST 40.00 X 110822 0 14207 CHRISTINE BROWN VP BUSINESS DEVELOPMENT 40.00 X 104012 0 12763 1052493 0 104892 8 0 1 0 FORSYTH MEMORIAL HOSPITAL 3333 SILAS CREEK PKWY WINSTONSALEM NC 28275 HOSPITAL 357605 NC BAPTIST HOSPITAL MEDICAL CENTER BLVD WINSTONSALEM NC 27157 HOSPITAL 298963 ALLSCRIPTS 8529 SIX FORKS RD FORUM IV RALEIGH NC 27615 SOFTWARE SERVICES 180124 WFBMC PALLIATIVE CARE MEDICAL CENTER BLVD WINSTONSALEM NC 27157 HOSPITAL 180049 REGENCY CARE OF CLEMMONS LLC PO BOX 249 CLEMMONS NC 27012 NURSING HOME 154472 11 322437 348154 102331 1812014 59215 2584936 PATIENT SERVICE REVENUE 621610 21725399 21725399 MANAGEMENT REVENUE 621610 3029384 3029384 24754783 4035 4035 16606 16773 -167 -167 -167 69650 348154 104466 -34816 -34816 OTHER INCOME 621610 51162 2677 48485 51162 27359933 24757460 0 17537 X 1157385 731839 425546 12997668 10307295 2330200 360173 219655 179029 34597 6029 2281658 1829592 395310 56756 1125982 898276 200388 27318 117260 63113 54147 28880 28880 2969983 2641920 204996 123067 175259 116678 58581 468525 79532 357021 31972 287798 287798 475080 271029 204051 591403 549446 37941 4016 5447 29 5418 645679 339321 306358 99522 99522 PATIENT MEDICAL SUPPLIE 2417629 2417629 EMPLOYEE PROCUREMENT 98143 98143 EQUIPMENT & MAINTENANCE 96346 57402 38944 HOSPITALITY 52773 17157 23327 12289 119566 87774 18204 13588 26431641 20470383 5267469 693789 3995849 3900908 8389877 11188483 3393808 1735730 90349 89905 154415 98284 19326499 7694681 12000535 11631818 102637 106637 282750 61078 28410220 28812843 2503925 2044713 133565 200022 0 2703947 2178278 X 25435886 26389487 270387 245078 25706273 26634565 28410220 28812843 928292 0 X X 0 1 X 1 0 X 2399398 3247773 2193593 2826979 2584936 13252679 2399398 3247773 2193593 2826979 2584936 13252679 1148156 12104523 15922 8601 13331 10187 4035 52076 266696 380219 128851 161663 118135 1055564 14360319 133602792 0.84290 0.82710 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2011 AMOUNT: $ 175,791. 2012 AMOUNT: $ 155,424. 2013 AMOUNT: $ 63,106. 2014 AMOUNT: $ 62,308. 2015 AMOUNT: $ 48,485. SPECIAL EVENTS INCOME - 2011 AMOUNT: $ 90,905. 2012 AMOUNT: $ 224,795. 2013 AMOUNT: $ 65,745. 2014 AMOUNT: $ 99,355. 2015 AMOUNT: $ 69,650. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 756977 756977 12001357 3359260 8642097 4048380 3512297 536083 2519785 823124 1696661 11631818 X 27660380 16195 289670 305865 27354515 5418 5418 27359933 26548677 16195 106259 122454 26426223 5418 5418 26431641 PART X, LINE 2: MANAGEMENT HAS EVALUATED THE HOSPICE'S TAX POSITION AND CONCLUDED THAT HOSPICE HAS TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. WITH FEW EXCEPTIONS, HOSPICE IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE, OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2012. PART XI, LINE 2D - OTHER ADJUSTMENTS: THE HOSPICE FOUNDATION REVENUE 392,001. LESS CONSOLIDATION ELIMINATIONS -102,331. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF INTEREST EXPENSE 5,418. PART XII, LINE 2D - OTHER ADJUSTMENTS: THE HOSPICE FOUNDATION EXPENSES 208,590. LESS CONSOLIDATION ELIMINATIONS -102,331. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF INTEREST EXPENSE 5,418. RACE/FITNESS WALK 210534 155884 54650 3135 1734 37925 GOLF TOURNAMENT 118125 103125 15000 5000 702 9739 23752 8 89145 89145 755 21724 417804 348154 69650 5000 3837 12228 83401 104466 -34816 X X 0 0 0 0 0 0 0 0 0 LINDA W DARDEN CHIEF EXECUTIVE OFFICER 167375 0 101 0 690 0 4375 0 18853 0 191394 0 0 0 MICHAEL LALOR CHIEF MEDICAL OFFICER 236360 0 102 0 61964 0 0 0 15636 0 314062 0 0 0 BRENT SHARPE PHARMACIST 156652 0 101 0 0 0 7971 0 5473 0 170197 0 0 0 LINDA W DARDEN CEO 3029384 SERVICES MANAGER ALSO OF ROWAN HOSPICE AND PALLIATIVE CARE LLC WHICH RECEIVES SERVICES FROM THIS ORGANIZATION. THIS ORGANIZATION HAS A 50% INTEREST IN ROWAN HOSPICE AND PALLIATIVE CARE LLC. THE TOTAL AMOUNT LISTED ABOVE INCLUDES $204,574 IN FEES AND $2,824,810 IN SERVICES. 0 X 720 FMV AT DONATION DATE X 9 16773 FMV AT DONATION DATE X 20 9196 FMV AT DONATION DATE X 4 6532 FMV AT DONATION DATE X FLOWERS 72 18715 FMV AT DONATION DATE X GIFT CARDS 116 4729 FACE VALUE X ROOM RENTAL 1 1500 FMV AT DONATION DATE X RAFFLE TICKETS/ENTERTAINMENT 3 1050 FMV AT DONATION DATE 0 1 0 PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS REFLECTS THE NUMBER OF ITEMS RECEIVED. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 REVIEW PROCESS: WHEN THE FORM IS RECEIVED FROM THE PREPARING ACCOUNTING FIRM, THE ENTIRE FORM IS REVIEWED BY THE PRESIDENT/CEO OF HOSPICE & PALLIATIVE CARECENTER. THIS REVIEW CONSISTS OF CHECKS FOR REASONABLENESS AND DIFFERENCES IN INFORMATION REPORTED TO PREPARING ACCOUNTING FIRM AND FINAL DOCUMENT. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY SIGN A STATEMENT DISCLOSING WHETHER THEY ARE ENGAGED IN ANY ACTIVITIES THAT COULD BE CONSTRUED AS A CONFLICT OF INTEREST TO THE MISSION AND ACTIVITIES OF HOSPICE & PALLIATIVE CARECENTER. FORM 990, PART VI, SECTION B, LINE 15 DETERMINING COMPENSATION FOR THE ORGANIZATION CEO IS DONE BY THE GOVERNING BOARD OF DIRECTORS BY CONSULTING MARKET SURVEYS, PUBLISHED INDUSTRY STANDARDS, AND THE "HOSPICE & HOMECARE SALARY & BENEFITS REPORT". DETERMINING COMPENSATION FOR THE ORGANIZATION'S OTHER KEY EMPLOYEES IS DONE BY THE VP OF HUMAN RESOURCES BY CONSULTING MARKET SURVEYS, PUBLISHED INDUSTRY STANDARDS, AND THE "HOSPICE & HOMECARE SALARY & BENEFITS REPORT". FORM 990, PART VI, SECTION C, LINE 19 HOSPICE & PALLIATIVE CARECENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR ITS FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. DOCUMENTS OPEN TO PUBLIC INSPECTION ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A, COLUMN F THE ORGANIZATION, IN A FULL TRANSPARENCY POSTURE TO REPORTING, IS REPORTING ALL BENEFITS IN FULL IN COLUMN F, PART VII AND IS NOT APPLYING THE $10,000 PER ITEM EXCEPTION FOR CERTAIN BENEFITS. FORM 990, PART VII, LINE 1A, COLUMN B: THE CHAIR AND VICE CHAIR OF HOSPICE & PALLIATIVE CARECENTER JOINTLY SERVE ON THE HOSPICE FOUNDATION AND HOSPICE & PALLIATE CARECENTER'S BOARD OF DIRECTORS. BOTH DIRECTORS DEVOTE APPROXIMATELY ONE HOUR PER WEEK TO EACH OF THE ORGANIZATIONS. THE CHAIR OF THE HOSPICE FOUNDATION JOINTLY SERVES ON THE FOUNDATION'S AND HOSPICE & PALLIATIVE CARECENTER'S BOARD OF DIRECTORS. HE DEVOTES APPROXIMATELY ONE HOUR PER WEEK TO EACH OF THE ORGANIZATIONS. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 2,641,920. MANAGEMENT AND GENERAL EXPENSES 204,996. FUNDRAISING EXPENSES 123,067. TOTAL EXPENSES 2,969,983. FORM 990, PART XII, LINE 2C: FINANCE COMMITTEE THE FINANCE COMMITTEE'S PROCESS OF EVALUATION HAS NOT CHANGED SINCE PRIOR YEAR. THE HOSPICE FOUNDATION 101 HOSPICE LANE WINSTONSALEM NC 27103 561823562 SUPPORT OF HOSPICE & PALLIATIVE CARECENTER NC 501(C)(3) LINE 11A, I HOSPICE & PALLIATIVE CARECENTER 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 THE HOSPICE FOUNDATION C 102331 CASH THE HOSPICE FOUNDATION R 2931805 CASH THE HOSPICE FOUNDATION S 1400 CASH