2015-10-12T12:10:14-05:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 4250 N FAIRFAX DRIVE SUITE 1020 ARLINGTON VA 22203 990 2014-01-01 521114719 MONTGOMERY HOSPICE INC MONT 3019214400 1355 PICCARD DRIVE NO 100 ROCKVILLE MD 20850 ANN MITCHELL PRESIDENT & CEO 3019214400 2015-10-06 1 KAREN GRIES P00078514 5712279500 2014 2016-02-25 16:41:14Z ANN MITCHELL 1355 PICCARD DRIVE NO 100 ROCKVILLE MD 20850 26403578 0 X WWW.MONTGOMERYHOSPICE.ORG X 1979 MD TO GENTLE THE JOURNEY THROUGH SERIOUS ILLNESS AND LOSS WITH SKILL AND COMPASSION. 19 18 277 300 0 0 794435 2301665 21088768 20898450 3480 473524 34827 -8276 21921510 23665363 0 0 0 0 16033794 16995624 0 0 489251 5343957 5709750 21377751 22705374 543759 959989 10389949 22507302 2439282 2187887 7950667 20319415 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 20326523 0 20898450 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 2014, MONTGOMERY HOSPICE SERVED 2,100 PATIENTS AND THEIR FAMILIES. AMONG THE TOTAL PATIENTS SERVED, 22 WERE CHILDREN AND MORE THAN 100 WERE EITHER UNINSURED OR UNDERINSURED. OUR INPATIENT UNIT, CASEY HOUSE, IS THE ONLY ALL-HOSPICE ACUTE FACILITY IN MONTGOMERY COUNTY. IN 2014, 513 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 6,400 INDIVIDUALS AND 3,000 YOUNG ADULTS, AND END-OF-LIFE CARE EDUCATION TO MORE THAN 2,500 CLINICIANS AND PEOPLE IN THE LAY COMMUNITY. 20326523 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 0 0 0 0 0 1 1 1 0 0 1 16 0 277 1 0 0 0 0 0 0 0 0 0 0 X 19 18 0 0 1 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 35.00 11.00 X X 208493 0 16355 STERLING KING JR DR PH CHAIRMAN 1.00 0.00 X X 0 0 0 BERYL L FEINBERG IMMEDIATE PAST CHAIRMAN 1.00 0.00 X X 0 0 0 PAUL E ALPUCHE JR ESQ VICE CHAIRMAN 1.00 0.00 X X 0 0 0 LYA MALL KARM MD SECRETARY 1.00 0.00 X X 0 0 0 DEBORA S MCGREGOR TREASURER 1.00 0.00 X X 0 0 0 MICHAEL G BANKS ESQ DIRECTOR 1.00 0.00 X 0 0 0 BRIAN A CARPENTER MD DIRECTOR 1.00 0.00 X 0 0 0 SENATOR BRIAN J FELDMAN DIRECTOR 1.00 0.00 X 0 0 0 SAFIA S KADIR ESQ DIRECTOR 1.00 0.00 X 0 0 0 JASON A KIRSCH DIRECTOR 1.00 0.00 X 0 0 0 ADRIENNE C KOHN DIRECTOR 1.00 0.00 X 0 0 0 ELMA M LEVY DIRECTOR 1.00 0.00 X 0 0 0 HON PAUL A MCGUCKIAN DIRECTOR 1.00 0.00 X 0 0 0 BARRY R MEIL DIRECTOR 1.00 1.00 X 0 0 0 GERMAN PARAUD DIRECTOR 1.00 0.00 X 0 0 0 DARREN M POPKIN DIRECTOR 1.00 0.00 X 0 0 0 LILY QI DIRECTOR 1.00 0.00 X 0 0 0 JOSE A QUIROS MD DIRECTOR 1.00 0.00 X 0 0 0 STEVEN V ROBERTS DIRECTOR 1.00 0.00 X 0 0 0 RONALD J RUBIN DIRECTOR 1.00 0.00 X 0 0 0 WILLIAM M SCHLOSSENBERG DIRECTOR 1.00 0.00 X 0 0 0 KATHY TORRENCE DIRECTOR 1.00 0.00 X 0 0 0 RANDALL P WAGNER MD DIRECTOR 1.00 0.00 X 0 0 0 DONGMEI WANG MD DIRECTOR 1.00 0.00 X 0 0 0 RONALD M WOLFSHEIMER DIRECTOR 1.00 0.00 X 0 0 0 MONICA ESCALANTE CFO/VP COM EDUC/OUTREACH 45.00 0.00 X 155281 0 5677 GEOFFREY COLEMAN MD MEDICAL DIRECTOR 48.00 0.00 X 177705 0 33618 GRACE HUFFMAN ASSOCIATE MEDICAL DIRECTOR 42.00 0.00 X 143100 0 1909 MILLICENT WHYTE-HIGGINS SR. VP OF NURSING SERVICES 48.00 0.00 X 137239 0 9880 JANET CAUFFIEL VP OF HUMAN RESOURCES 42.00 0.00 X 135867 0 4798 GERRY VENT VP OF PHILANTHROPY 42.00 0.00 X 114062 0 10459 PATRICIA VITACCO DIRECTOR OF QAPI 42.00 0.00 X 109653 0 13119 1181400 0 95815 17 0 1 0 DELTA CARE RX PO BOX 23410 STUBENVILLE OH 43553 PHARMACY 1015320 MEDLINE INDUSTRIES INC ONE MEDLINE PLACE MUNDELEIN IL 60060 MEDICAL SUPPLIES 446820 GLOBAL MEDICAL LLC 8332 BRISTOL COURT 100 JESSUP MD 20794 DURABLE MEDICAL EQUIPMENT 358538 RECOVERCARE 1920 STANLEY GAULT PARKWAY 100 LOUISVILLE KY 40223 DURABLE MEDICAL EQUIPMENT 267172 LERCH EARLY & BREWER 3 BETHESDA METRO CENTER 460 BETHESDA MD 20814 LEGAL SERVICES 158642 7 45010 34967 2221688 2301665 PATIENT SERVICE REVENUE 624100 20898450 20898450 20898450 335335 335335 2858334 2720145 138189 138189 138189 0 45010 18070 -18070 -18070 GAIN ON LEASE TERMINATION 900099 7919 7919 MISCELLANEOUS REVENUE 900099 1875 1875 9794 23665363 20898450 0 465248 594399 202858 335557 55984 13935961 12638527 998077 299357 234581 204937 11632 18012 1176509 1075941 88106 12462 1054174 933018 93941 27215 150987 150987 97536 97536 49558 49558 593959 584844 5615 3500 21270 12425 2671 6174 612754 43375 558221 11158 282870 57014 212017 13839 493985 197121 296864 317244 313306 3291 647 36582 12788 12582 11212 7187 7187 344425 96443 247982 208746 69028 139718 MEDICAL EQUIPMENT, SUPP 2105888 2105888 LAUNDRY AND LINEN SUPPL 51849 51849 GIVING CAMPAIGN 28376 28376 O/H ALLOCATION 0 1714321 -1714321 306534 12840 292379 1315 22705374 20326523 1889600 489251 600 700 2764840 4965396 2659280 2726827 287003 317114 4387253 1789533 2722856 2597720 0 11884186 6000 15359 1949370 0 10389949 22507302 2209949 2081429 38714 106458 190619 0 2439282 2187887 X 7950667 14972352 0 1000138 0 4346925 7950667 20319415 10389949 22507302 X 959989 -76345 11485104 X X 0 1 X 1 0 X 317078 1143592 791825 794435 2301665 5348595 17038437 20961488 22144610 21088768 20898450 102131753 17355515 22105080 22936435 21883203 23200115 107480348 0 0 0 107480348 1945 5025 6975 3480 335335 352760 1945 5025 6975 3480 335335 352760 1856 2437 9166 34827 9794 58080 17359316 22112542 22952576 21921510 23545244 107891188 0.99620 0.99920 0.00330 0.00020 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 4220799 2458595 190966 137304 6733056 3877148 71994 396770 125113 4220799 3695745 36095 268010 122702 3877148 3147870 326203 326792 105120 3695745 1216353 1931517 3147870 0.28780 0.64560 0.06660 0 0 672721 672721 2506838 997429 1509409 1207694 792104 415590 2597720 X 23607088 -76345 18070 -58275 23665363 0 23665363 22723444 18070 18070 22705374 0 22705374 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 IS 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. THE TAX RETURNS FOR THE FISCAL YEARS ENDED 2011 THROUGH 2013 ARE OPEN TO EXAMINATION BY FEDERAL AND STATE AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 18,070. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 18,070. TREE OF LIGHT 45010 45010 10414 499 300 6857 45010 45010 10414 499 300 6857 18070 -18070 X X 0 0 0 0 0 0 0 0 0 ANN MITCHELL PRESIDENT & CEO 198643 0 9850 0 0 0 4924 0 11431 0 224848 0 0 0 MONICA ESCALANTE CFO/VP COM EDUC/OUTREACH 155281 0 0 0 0 0 3783 0 1894 0 160958 0 0 0 GEOFFREY COLEMAN MD MEDICAL DIRECTOR 177705 0 0 0 0 0 4680 0 28938 0 211323 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, FOUNDATION BOARD 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 FOUNDATION, OR REVOCATION OF VOLUNTARY DISSOLUTION PROCEEDINGS. FORM 990, PART VI, SECTION A, LINE 4 THE HOSPICE AMENDED ITS GOVERNING DOCUMENTS TO REMOVE ALL REFERENCES AND ARTICLES THAT PERTAINED TO THE MONTGOMERY HOSPICE FOUNDATION, WHICH DISSOLVED AND MERGED INTO THE HOSPICE ON JULY 1, 2014. THE HOSPICE ALSO AMENDED ITS BYLAWS FOR THE FOLLOWING: 1. ADDED THE FINANCE AND AUDIT COMMITTEE PURPOSE, COMPOSITION AND RESPONSIBILITIES. 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 THE COMPENSATION REVIEW FOR THE PRESIDENT/CEO IS CONDUCTED ANNUALLY BY EXECUTIVE COMMITTEE MEMBERS. THE MEMBERS MAY INTERVIEW THE PRESIDENT/CEO'S COLLEAGUES CONCERNING THEIR INTERACTION AND RELATIONSHIP WITH PRESIDENT/CEO. OTHER ANALYSIS INCLUDE A WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE EXECUTIVE COMMITTEE. THE MOST RECENT YEAR IN WHICH THE COMPENSATION PROCESS WAS REVIEWED WAS 2014. 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 THE HUMAN RESOURCES DEPARTMENT. DATA FROM BENCHMARK REPORTS PROVIDED BY NHPCO AND MVI ARE ALSO USED FOR THIS ANALYSIS. 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. FORM 990, PART XI, LINE 9: TRANSFER FROM MONTGOMERY HOSPICE FOUNDATION, INC. 11,469,376. NET ASSETS OF DISREGARDED ENTITY 15,728. FORM 990, PART XII, LINE 2C: THE HOSPICE AMENDED ITS BYLAWS TO PROVIDE FOR THE FINANCE AND AUDIT COMMITTEE: THE PURPOSE OF THE COMMITTEE IS TO ENSURE AND OVERSEE AN INDEPENDENT AUDIT IS CONDUCTED ANNUALLY; ENSURE ACCURATE TRACKING, MONITORING AND ACCOUNTABILITY FOR FUNDS AND ENSURE ADEQUATE FINANCIAL CONTROLS. THE COMMITTEE RECOMMENDS THE APPROVAL OF THE AUDIT TO THE FULL BOARD. 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