2015-06-18T13:00:18-05:00 2014-12-31 421243538 BERGAN PAULSEN & COMPANY PC PO BOX 2100 WATERLOO IA 507042100 990 2014-01-01 421135294 CEDAR VALLEY HOSPICE INC CEDA 3192722002 PO BOX 2880 WATERLOO IA 507042880 MARVIN FAGERLIND EXECUTIVE DIRECTOR 3192722002 2015-05-26 1 DAVID A RICHTER P00168204 3192346885 2014 2016-02-25 16:41:14Z MARVIN FAGERLIND PO BOX 2880 WATERLOO IA 507042880 16031825 0 X www.cvhospice.org X 1979 IA PROVIDE HOSPICE AND COUNSELING SERVICES TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES. 15 15 144 400 0 0 1682703 1100429 8484501 8321721 344292 976846 -20205 -5447 10491291 10393549 61819 31593 0 0 6333132 6026410 0 0 205931 4273809 4448717 10668760 10506720 -177469 -113171 10557131 9664480 1318702 1106533 9238429 8557947 CEDAR VALLEY HOSPICE PROVIDES THE LEADERSHIP AND SETS THE STANDARD FOR EXCELLENCE IN DELIVERING COMPREHENSIVE PALLIATIVE AND END OF LIFE CARE TO PATIENTS AND SERVICES TO THOSE THAT GRIEVE. 0 0 8242867 31593 8321721 CEDAR VALLEY HOSPICE IS DEDICATED TO PROVIDING HOSPICE SERVICES TO THOSE WITH A SIX MONTH PROGNOSIS OR LESS, SERVING 947 PATIENTS IN 2014. THE AVERAGE DAILY CENSUS WAS 134 WHICH ALLOWED THE ORGANIZATION TO PROVIDE 48,991 DAYS OF CARE. THE AVERAGE LENGTH OF STAY FOR HOSPICE PATIENTS WAS 54 DAYS. CEDAR VALLEY HOSPICE PROVIDES GRIEF SUPPORT SERVICES TO ANYONE STRUGGLING WITH THE DEATH OF A LOVED ONE, SERVING 4,290 GRIEF CLIENTS IN 2014. GRIEF CLIENTS WERE SERVED THROUGH INDIVIDUAL VISITS, SUPPORT GROUPS, SMALL AND LARGE GROUP SETTINGS (I.E. EMPLOYERS/SCHOOL) AND MAILINGS. CEDAR VALLEY HOSPICE PROVIDES HOME CARE SERVICES TO THOSE WITH A LIFE THREATENING ILLNESS, SERVING 44 CLIENTS IN 2014. 8242867 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 55 0 1 144 1 0 0 0 0 0 1 1 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X MICHAELA VANDERSEE 3192722002 2101 KIMBALL AVENUE SUITE 401 WATERLOO IA 50701 SUE MORKEL SECRETARY 0.50 X X 0 0 0 SHELLI PINT DIRECTOR 0.50 X 0 0 0 GENE SANDELL TREASURER 0.50 X X 0 0 0 CHRIS SCHILDROTH VICE PRESIDENT 0.50 X X 0 0 0 GIA SHANNON PRESIDENT 0.80 X X 0 0 0 RENAE BOCKHOLT DIRECTOR 0.50 X 0 0 0 JUNEVER HEYING DIRECTOR 0.50 X 0 0 0 SCOTT WIENANDS DIRECTOR 0.50 X 0 0 0 BILL COLWELL DIRECTOR 0.50 X 0 0 0 JOHN HOUGEN DIRECTOR 0.50 X 0 0 0 DOREEN MINGO DIRECTOR 0.50 X 0 0 0 MIKE WALDEN DIRECTOR 0.50 X 0 0 0 NANCY WEBER DIRECTOR 0.50 X 0 0 0 JASON WITHAM DIRECTOR 0.50 X 0 0 0 GAIL HUSER DIRECTOR 0.50 X 0 0 0 MARVIN FAGERLIND EXECUTIVE DIRECTOR 65.00 X 119698 0 19092 MICHAELA VANDERSEE FINANCE DIRECTOR 65.00 X 87002 0 35711 MICHAEL DETERS MEDICAL DIRECTOR 30.00 X 139043 0 18699 345743 0 73502 2 0 1 0 HOSPISCRIPT SERVICES LLC 4525 EXECUTIVE PARK DR SUITE 100 MONTGOMERY AL 36116 PHARMACIST CONSULTS AND PRESCRIPTIONS 640002 COVENANT MEDICAL CLINIC 3421 WEST NINTH STREET WATERLOO IA 50702 INPATIENT AND OUTPATIENT SERVICES 408544 CERNER 2800 ROCKCREEK PARKWAY NORTH KANSAS CITY MO 64117 PROFESSIONAL SERVICES AND SOFTWARE 198322 WAVERLY HEALTH CENTER 312 9TH ST SW WAVERLY IA 50677 INPATIENT AND OUTPATIENT SERVICES 134150 MARTIN HEALTH CENTER 420 EAST 11TH STREET CEDAR FALLS IA 50613 MEDICAID ROOM AND BOARD PASS THROUGH 112967 7 60361 152840 887228 53896 1100429 PATIENT CARE FEES 623990 8321721 8321721 8321721 265399 265399 6327611 5616164 711447 711447 711447 16665 60361 22112 -5447 -5447 10393549 8321721 0 971399 31593 31593 420227 167428 252799 4412540 3399573 923410 89557 34855 26148 7942 765 804933 631403 160527 13003 353855 262600 85031 6224 2072 2072 18000 18000 21498 21498 65833 43019 22814 101057 101057 263094 92723 159774 10597 104672 21707 81460 1505 145159 111772 26129 7258 280052 253718 25282 1052 45400 23726 21625 49 148540 114376 26737 7427 38616 29734 6951 1931 PATIENT EXPENSES 1831546 1831546 MEDICAL SUPPLIES & DRUG 1133114 1133114 EQUIPMENT RENTAL & MAIN 59449 59449 CONSORTIUM EXPENSE 29851 29851 160764 38836 55365 66563 10506720 8242867 2057922 205931 311299 812582 455129 583847 655180 279087 1580210 1125295 98076 79934 3235959 2196576 1100815 1039383 6336513 5675323 19909 69029 10557131 9664480 1318702 1106533 1318702 1106533 X 7773722 7108346 736183 720777 728524 728824 9238429 8557947 10557131 9664480 -113171 -567311 0 X 0 1 X 1 0 X 936024 1125441 1085004 1195203 1100429 5442101 936024 1125441 1085004 1195203 1100429 5442101 240610 5201491 164926 188290 199804 246211 189077 988308 6430409 43990261 0.80890 0.81360 X SCHEDULE A, LINE 1 BEQUEST IN THE AMOUNT OF $237,500 AND PLEDGE IN THE AMOUNT OF $250,000 WERE EXCLUDED FROM LINE 1 IN 2013 AS THEY WERE LARGE AND UNEXPECTED. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1875518 114014 47686 47686 1989532 1840277 35241 78171 78171 1875518 1725337 114940 47436 47436 1840277 1608914 116423 11860 11860 1725337 1415943 158598 55344 20971 1608914 0.63000 0.37000 1 0 1693210 1011938 681272 359033 350256 8777 1183716 834382 349334 1039383 9880667 -567311 17211 180456 -369644 10250311 143238 143238 10393549 10546043 17211 22112 39323 10506720 0 10506720 Part XI, Line 2d - Other Adjustments: NET ASSETS RELEASED FROM RESTRICTIONS 158,344. SPECIAL EVENTS EXPENSE 22,112. Part XI, Line 4b - Other Adjustments: TEMPORARILY RESTRICTED NET ASSET CONTRIBUTIONS 142,938. PERMANENTLY RESTRICTED NET ASSET CONTRIBUTIONS 300. Part XII, Line 2d - Other Adjustments: SPECIAL EVENTS EXPENSE 22,112. PART V, LINE 4: THE ORGANIZATION'S POLICY IS TO DISTRIBUTE ALL OR A PORTION OF THE ANNUAL NET INVESTMENT EARNINGS TO SUPPORT THE ORGANIZATION'S PROGRAMS WHICH ARE NOT SELF-SUFFICIENT WHILE MAINTAINING THE FAIR VALUE OF THE ORIGINAL ENDOWMENT GIFTS. NAUTICAL NIGHTS 64901 54181 10720 12883 7184 GOLF OUTING 12125 6180 5945 2045 77026 60361 16665 12883 9229 22112 -5447 1 ORAL HEALTH CARE 50 748 EMERGENCY FINANCIAL ASSISTANCE 32 3599 HOUSING SERVICES 15 20995 MEDICAL TRANSPORTATION ASSISTANCE 41 4940 HEALTH INSURANCE PROGRAM 1 443 MENTAL HEALTH SERVICES 4 868 SCHEDULE I, PART III: ALL OF THE RECORDS TO ESTABLISH ELIGIBILITY FOR THE GRANT OR ASSISTANCE ARE MAINTAINED IN THE CLIENT'S CASE MANAGEMENT CHART. CHART AUDITS ARE PERFORMED TO ENSURE THAT CLIENTS WHO ARE RECEIVING ASSISTANCE ARE ELIGIBLE TO RECEIVE ASSISTANCE. ALSO TWO OF THE GOVERNMENT AGENCIES THAT GIVE THE ORGANIZATION MONEY TO EXPEND FOR THE BENEFIT OF ITS CLIENTS MONITOR THE ORGANIZATION'S CHARTS AND PAPERWORK FOR COMPLIANCE WITH THE GRANT REQUIREMENTS. THE CASE MANAGER REQUESTING THE ASSISTANCE FILLS OUT A REQUEST FOR THE ASSISTANCE INDICATING WHY/HOW THE CLIENT MEETS ELIGIBILITY. THE SUPERVISOR APPROVES THE ASSISTANCE FOR PAYMENT AND THEN THE ACCOUNTING DEPARTMENT PROCESSES THE CHECK AND MONITORS THE OVERALL USAGE OF THE GRANT. 0 0 0 0 0 0 0 0 0 MICHAEL DETERS MEDICAL DIRECTOR 139043 0 0 0 0 0 1411 0 17288 0 157742 0 0 0 X 153 COST X 9451 COST X 18 2175 COST X AUCTION ITEMS 126 29967 COST X EVENT PRIZES 113 9550 COST X OTHER 10 2600 COST 0 0 1 0 Part I, Column (b): NUMBER OF CONTRIBUTORS IS BASED ON THE NUMBER OF ITEMS CONTRIBUTED. Form 990, Part VI, Section B, line 11 THE EXECUTIVE DIRECTOR AND FINANCE DIRECTOR REVIEW THE FORM 990. ONCE THEY HAVE REVIEWED THE RETURN, IT IS HANDED OUT TO THE BOARD OF DIRECTORS FOR THEIR REVIEW BEFORE BEING FILED. Form 990, Part VI, Section B, line 12c THE MONTHLY BOARD MEETING AGENDA INCLUDES AN AGENDA ITEM THAT REQUIRES BOARD MEMBERS TO REVIEW THE APPROVED AGENDA AND DECLARE ANY CONFLICTS OF INTEREST. Form 990, Part VI, Section B, line 15 THE EXECUTIVE COMMITTEE DETERMINES AND APPROVES THE EXECUTIVE DIRECTOR'S WAGES BASED ON AN ANNUAL REVIEW, REVIEW OF FORM 990 COMPENSATION OF SIMILAR POSITIONS AND INFORMATION OBTAINED FROM INDEPENDENT SALARY SURVEYS. THE DIRECTOR OF FINANCE'S AND MEDICAL DIRECOR'S WAGES ARE DETERMINED BASED ON A REVIEW OF FORM 990 COMPENSATION OF SIMILAR POSITIONS, INFORMATION OBTAINED FROM INDEPENDENT SALARY SURVEYS AND THE COLA ADJUSTMENT. THE EXECUTIVE DIRECTOR AND HUMAN RESOURCE DIRECTOR DETERMINE THE DIRECTOR OF FINANCE'S AND MEDICAL DIRECTOR'S WAGES BASED ON THIS INFORMATION. BOARD APPROVES ALL WAGES THROUGH THE BUDGET PROCESS. Form 990, Part VI, Section C, line 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST.