2016-05-04T08:36:06-05:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2015-01-01 561452373 HOSPICE OF CLEVELAND COUNTY INC HOSP 7044874677 951 WENDOVER HEIGHTS DRIVE SHELBY NC 281503565 MYRA MCGINNIS PRESIDENT/CEO 7044874677 2016-05-02 1 JOHN NORMAN P01506766 7049985200 2016-04-25 2015 2016-09-27 15:27:22Z HOSPICE CLEVELAND COUNTY MYRA MCGINNIS 951 WENDOVER HEIGHTS DRIVE SHELBY NC 281503565 12432116 0 X WWW.HOSPICECARES.CC X 1984 NC HOSPICE OF CLEVELAND COUNTY PROVIDES CARE AND SUPPORT TO PATIENTS WITH A LIFE-LIMITING ILLNESS. 17 17 199 192 0 0 824110 313180 12021797 11737751 254067 218963 37775 30569 13137749 12300463 0 0 0 0 6348570 6695979 0 0 0 4389462 4368995 10738032 11064974 2399717 1235489 22503042 23167346 1371697 1255160 21131345 21912186 HOSPICE CLEVELAND COUNTY EXISTS TO PROVIDE HIGH QUALITY SKILLED COMPASSIONATE CARE AND SUPPORT FOR INDIVIDUALS WITH A LIFE-LIMITING ILLNESS, THEIR FAMILIES, AND THE COMMUNITY, REGARDLESS OF THEIR ABILITY TO PAY. 0 0 5994517 8576207 HOSPICE CLEVELAND COUNTY PROVIDES COMPREHENSIVE END OF LIFE HEALTHCARE FOR TERMINALLY ILL PATIENTS AND THEIR FAMILIES DURING THE FINAL STAGES OF ILLNESS. DURING 2015, HOSPICE CLEVELAND COUNTY PROVIDED 53,489 DAYS OF HOMECARE INCLUDING 10,648 DAYS OF NURSING HOME AND HOSPITAL INPATIENT CARE. HOSPICE CLEVELAND COUNTY SERVED 774 HOMECARE PATIENTS IN 2015. HOSPICE CLEVELAND COUNTY'S INTERDISCIPLINARY TEAMS CONSISTING OF PHYSICIANS, NURSES, HOSPICES AIDES, SOCIAL WORKERS, AND OTHER SUPPORTIVE PERSONNEL PROVIDED OVER 33,331 VISITS DURING 2015. 3070711 3023609 HOSPICE CLEVELAND COUNTY OWNS AND OPERATES TWO HOSPICE HOUSES THAT PROVIDE HOSPICE INPATIENT AND RESIDENTIAL CARE FOR TERMINALLY ILL PATIENTS DURING THE FINAL STAGES OF ILLNESS. THE WENDOVER HOSPICE HOUSE HAS 16 BEDS AND THE TESTA FAMILY HOSPICE HOUSE HAS 8 BEDS. DURING 2015, HOSPICE CLEVELAND COUNTY PROVIDED 7,716 DAYS OF CARE IN THESE FACILITIES. HOSPICE CLEVELAND COUNTY SERVED 410 PATIENTS IN THE HOSPICE HOUSES IN 2015. 514680 137935 PALLIATIVE CARE CLEVELAND PROVIDES A PROGRAM OF PAIN CONTROL, SYMPTOM MANAGEMENT AND ASSISTANCE WITH DIFFICULT DECISION MAKING. DURING 2015, PALLIATIVE CARE CLEVELAND COUNTY SERVED 532 PATIENTS. 9579908 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 33 0 1 199 1 0 0 0 0 0 0 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X PAM BENFIELD 7044874677 951 WENDOVER HEIGHTS DRIVE SHELBY NC 28150 CARYL AUSTELL BOARD MEMBER 1.00 X 0 0 0 BECKY BROWN BOARD MEMBER 1.00 X X 0 0 0 JENNIE LAMBERT BOARD MEMBER 1.00 X 0 0 0 ANDREA LESLIE-FITE BOARD MEMBER 1.00 X X 0 0 0 STEVE PADGETT BOARD MEMBER 1.00 X X 0 0 0 FORREST THOMPSON BOARD MEMBER 1.00 X 0 0 0 ALEX BELL BOARD MEMBER 1.00 X 0 0 0 REX GIBBS BOARD MEMBER 1.00 X 0 0 0 BRENDA LOVELACE BOARD MEMBER 1.00 X 0 0 0 PETE MOORE BOARD MEMBER 1.00 X 0 0 0 ROBBY REYNOLDS BOARD MEMBER 1.00 X X 0 0 0 MIKE RIBADENEYRA BOARD MEMBER 1.00 X 0 0 0 PAMELA ENLOE BOARD MEMBER 1.00 X 0 0 0 GREG GRIER BOARD MEMBER 1.00 X 0 0 0 JT SCRUGGS BOARD MEMBER 1.00 X 0 0 0 CHARLES WEBBER BOARD MEMBER 1.00 X 0 0 0 JOSEPH TYSINGER BOARD MEMBER 1.00 X 0 0 0 MYRA MCGINNIS PRESIDENT/CEO 48.20 X 149087 0 13191 JASON BEAM VICE PRESIDENT OF ADMINISTRATIVE SERVICES 46.80 X 98709 0 10587 LEE ANN LONG VICE PRESIDENT OF CLINICAL SERVICES 46.40 X 106553 0 7674 DR REBECCA LOVE VICE PRESIDENT OF PALLIATIVE CARE 60.00 X 178081 0 12004 DR JAMES POTTS HOSPICE MEDICAL DIRECTOR 57.30 X 199631 0 6737 732061 0 50193 4 0 1 0 0 85388 227792 313180 PATIENT REVENUE 621610 11737751 11737751 11737751 217005 217005 126841 124883 1958 1958 1958 37062 6770 30292 30292 HOSPICE ITEMS - NET 900099 277 277 277 12300463 11737751 0 249532 354349 354349 5257382 4665523 591859 133795 112292 21503 546733 503161 43572 403720 338835 64885 36203 36203 103383 94919 8464 30402 30402 134142 64031 70111 117731 22757 94974 267417 154264 113153 174718 166548 8170 36749 20983 15766 540958 540958 42222 42222 PURCHASED SERVICES 1477126 1477126 SUPPLIES 965962 965962 BAD DEBT EXPENSES 319046 319046 PROFESSIONAL FEES 41611 41611 81325 61490 19835 11064974 9579908 1485066 0 5474576 5875100 3434692 3512131 548643 145501 1080346 986689 16272 16817 99145 102010 10523955 4655320 6338382 5868635 5483447 6648568 27539 11895 22503042 23167346 950216 813066 421481 442094 1371697 1255160 X 20341316 21544621 558292 204306 231737 163259 21131345 21912186 22503042 23167346 X 1235489 -405034 -45355 -4259 X X 0 1 X 1 0 X 398738 251474 318197 824110 313180 2105699 398738 251474 318197 824110 313180 2105699 325068 1780631 43107 46773 112022 259024 217005 677931 -2295 -698 254 -74 -2813 3049 -2728 277 598 2781415 56006360 0.64020 0.63600 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 408 408 0 PART II-B, LINE 1: THE ORGANIZATION BELONGS TO THE NATIONAL HOSPICE & PALLIATIVE CARE ORGANIZATION WHO HAS ESTIMATED THAT 5.44% OF ITS PROVIDER DUES WERE USED FOR SPECIFIC LOBBYING PURPOSES. MEMBERSHIP DUES IN 2015 WERE $7500.50 WHICH EQUATES TO $408 THAT WOULD BE ATTRIBUTABLE TO LOBBYING ACTIVITIES. 398923 35730 -11474 10730 412449 300821 87961 19660 9519 398923 261411 9804 39410 9804 300821 238989 9968 22422 9968 261411 238989 238989 0.47710 0.39580 0.12710 0 0 295737 295737 7750239 3101875 4648364 711081 372124 338957 1766898 1181321 585577 5868635 ESTIMATED THIRD PARTY LIABILITY 442094 442094 X 12243105 -45355 -45355 12288460 12003 12003 12300463 11064974 0 11064974 0 11064974 PART V, LINE 4: TO SUPPORT OPERATIONS AS NEEDED. PART X, LINE 2: THE ORGANIZATION FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE IMPLEMENTATION OF THIS STANDARD HAD NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2015. PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT FEES -45,355. PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER RESTRICTED CONTRIBUTIONS RECEIVED 1,273. CONTRIBUTION TO FOREVER FUND 10,730. CHICKEN DINNER 23508 23508 4062 425 HEARTS FOR HOSPICE 7485 7485 1988 1 30993 30993 4062 2413 6475 24518 X 1 1 X X X X 0 0 0 0 0 0 0 0 0 MYRA MCGINNIS PRESIDENT/CEO 140014 0 7861 0 1212 0 4350 0 8841 0 162278 0 0 0 DR REBECCA LOVE VICE PRESIDENT OF PALLIATIVE CARE 177381 0 700 0 0 0 5356 0 6648 0 190085 0 0 0 DR JAMES POTTS HOSPICE MEDICAL DIRECTOR 198931 0 700 0 0 0 5989 0 748 0 206368 0 0 0 PART I, LINE 1A HOSPICE OF CLEVELAND COUNTY, INC. PAYS A PORTION OF MONTHLY DUES FOR EMPLOYEES WHO CHOOSE TO JOIN THE LOCAL YMCA PROGRAM. THIS IS REPORTED AS TAXABLE FRINGE IN THE EMPLOYEES PAYROLL EARNINGS AND TAXED APPROPRIATELY. X 7294 SALES VALUE - FMV X 119544 SALES VALUE - FMV 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S PRESIDENT/CEO WILL REVIEW AND APPROVE FORM 990 AND WILL PRESENT IT TO THE FINANCE COMMITTEE BEFORE IT IS FILED. THE FINANCE COMMITTEE WILL THEN PRESENT THE PREPARED FORM 990 TO THE BOARD OF DIRECTORS FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MAINTAINS A CONFLICT OF INTEREST POLICY THAT COVERS ALL EMPLOYEES AND BOARD MEMBERS. EACH YEAR THE CONFLICT OF INTEREST POLICY IS REVIEWED BY EMPLOYEES THROUGH AN ON-LINE EDUCATION MODULE CALLED HCC CORPORATE COMPLIANCE. SENIOR LEADERSHIP AND ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE, SIGN, AND DATE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM. ALL DISCLOSURES BY BOARD MEMBERS ARE REVIEWED AND APPROVED BY THE BOARD CHAIRPERSON. FORM 990, PART VI, SECTION B, LINE 15 THE PERSONNEL COMMITTEE AND BOARD MEET AND EVALUATE THE PRESIDENT/CEO PERFORMANCE FOR THE YEAR USING THE HCC ANNUAL PERFORMANCE EVALUATION FORM. THEY THEN PRESENT THEIR RECOMMENDATIONS FOR ANY INCREASE IN COMPENSATION TO THE BOARD OF DIRECTORS FOR A VOTE. THE PRESIDENT/CEO DOES A REVIEW OF SALARY SURVEYS TO ESTABLISH SALARY RANGE GUIDELINES FOR ALL POSITIONS. THESE SALARY RANGES ARE THEN APPROVED BY THE PERSONNEL COMMITTEE. AN ANNUAL PERFORMANCE REVIEW IS COMPLETED FOR EACH EMPLOYEE AND ANY ADJUSTMENT TO COMPENSATION IS DETERMINED AT THAT TIME. FORM 990, PART VI, SECTION C, LINE 19 REQUESTS FOR REVIEW OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS MUST BE SUBMITTED TO HOSPICE OF CLEVELAND COUNTY, INC. IN WRITING AND MUST INCLUDE THE NAME, ADDRESS, AND TELEPHONE NUMBER OF THE INDIVIDUAL OR ENTITY MAKING THE REQUEST. ALL REQUESTS ARE SUBMITTED TO THE PRESIDENT/CEO FOR REVIEW. THE DOCUMENTS ARE MADE AVAILABLE WITHIN TWO WEEKS OF RECEIPT OF THE WRITTEN REQUEST. THE DOCUMENTS ARE AVAILABLE FOR REVIEW AT THE HOSPICE OF CLEVELAND COUNTY. INC. ADMINISTRATIVE OFFICE BUILDING. FORM 990, PART XI, LINE 9: CHANGE IN DISCOUNT FOR PLEDGES RECEIVABLE 44,114. CHANGE IN ENDOWMENT HELD BY OTHERS -5,335. CHANGE IN ALLOWANCE FOR UNCOLLECTIBLE PLEDGES -27,778. TRANSFER OF SPENDABLE PORTION OF ENDOWMENT TO FOREVER FUND -10,730. NET ASSETS RELEASED FROM RESTRICTIONS FOR RESPITE CARE -4,530. FORM 990, PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR.