2014-05-13T07:55:17-05:00 2013-06-30 160929175 DOPKINS & COMPANY LLP 200 INTERNATIONAL DR BUFFALO NY 142215794 990 2012-07-01 222524016 NIAGARA HOSPICE INC NIAG 7164394417 4675 SUNSET DRIVE LOCKPORT NY 14094 ANDREA SAMMARCO 7164394417 2014-05-02 1 KAREN COSTA P01448677 7166348800 2012 2015-11-30 17:44:51Z JOHN LOMEO 4675 SUNSET DRIVE LOCKPORT NY 14094 12789393 0 X WWW.NIAGARAHOSPICE.ORG X 1982 NY TO PROVIDE SPECIALIZED SERVICES TO PERSONS WITH A LIFE LIMITING ILLNESS AND THEIR FAMILIES. 15 15 207 120 0 0 262042 245617 11453340 12373254 28569 29695 25538 38065 11769489 12686631 0 0 0 0 5755091 6524925 0 0 89329 6412952 6176925 12168043 12701850 -398554 -15219 10553759 10540513 3268205 3159118 7285554 7381395 X TO PROVIDE SPECIALIZED SERVICES TO PERSONS WITH A LIFE LIMITING ILLNESS AND THEIR FAMILIES. 0 0 7658295 10021592 PATIENT REVENUE FOR NIAGARA HOSPICE (NH)IS EARNED BASED ON PATIENTS SERVICES PROVIDED AND THEN REIMBURSED BY INSURANCES. THERE ARE A FEW TYPES OF PATIENT SERVICE FEES, WHICH ARE EXPLAINED BELOW. PATIENTS RECEIVE VARIOUS TYPES OF SERVICES, IN WHICH THE LARGEST REVENUE TYPES INCLUDE HOMECARE ROUTINE, NURSING HOME REIMBURSEMENT AND IN-PATIENT GENERAL. HOMECARE ROUTINE CONSISTS OF THE BASIC IN-HOME VISISTS TO THE PATIENTS OWN HOME AT LEAST ONCE A WEEK TO DO VARIOUS CARE-TAKING SERVICES (IE. BATHS, LAUNDRY, VISITING). THE NURSING HOME REIMBURSEMENT REVENUE IS FROM THE HOSPICE PATIENTS THAT ARE IN NURSING HOMES, IN WHICH THE NURSING HOMES BILL NIAGARA HOSPICE AND NH, IN TURN, BILLS THE INSURANCES FOR REIMBURSEMENT. INPATIENT GENERAL CONSISTS OF PATIENTS IN THE VARIOUS HOSPITALS, IN WHICH THE HOSPITALS BILL NH AND NH SEEKS REIMBURSEMENT FROM THE INSURANCES. THE CONTINUOUS CARE PROGRAM PROVIDES "EXTENDED CARE" VERSUS THE REGULAR HOME HEALTH AIDES. THIS EXTENDED CARE IS BILLED AT A HIGHER RATE DUE TO THE INCREASED AMOUNT OF TIME THE LPNS. THIS SERVICE REQUIRES AT LEAST 12 HOURS OF TIME WITH A REGISTERED NURSE. 3381505 2351657 ALTHOUGH HOSPICE CARE WILL ALWAYS BE PRIMARILY PROVIDED IN A PATIENT'S OR CAREGIVER'S HOME, THERE ARE SOME INDIVIDUALS WHO DO NOT HAVE A HOME ENVIRONMENT APPROPRIATE FOR HOSPICE CARE, OR LACK THE FAMILY OR FRIENDS NECESSARY TO PROVIDE 24/7 CARE IN A HOME ENVIRONMENT. ADDITIONALLY, SOME HOSPICE PATIENTS NEED AROUND-THE-CLOCK MEDICAL ATTENTION DURING MEDICATION ADJUSTMENTS OR FOR SYMPTOM MANAGEMENT. IN RESPONSE TO THESE NEEDS, NIAGARA HOSPICE HOUSE WAS BUILT.NIAGARA HOSPICE HOUSE IS NIAGARA COUNTY'S ONLY RESIDENTIAL HOSPICE HOUSE, PROVIDING SERVICES TO PATIENTS AND THEIR FAMILIES WHO ARE NOT ABLE TO RECEIVE HOME HOSPICE CARE. THE RESIDENTIAL WING CONSISTS OF EIGHT SUITES SPECIFICALLY DESIGNED FOR LONGER STAYS WHEN THE HOME CAREGIVING STRUCTURE IS COMPROMISED. THE IN-PATIENT WING HAS TEN SUITES DESIGNED FOR PATIENTS NEEDING SHORT-TERM MEDICAL MONITORING AND SYMPTOM MANAGEMENT.EACH SUITE IS DESIGNED WITH PATIENT AND FAMILY IN MIND WITH A SITTING AREA AND EASY-CHAIR SLEEPER. EACH FAMILY ALSO HAS ACCESS TO GATHERING ROOMS, FIREPLACES, A CHAPEL, KITCHEN AND THE HOSPICE MEMORIAL GARDENS. 11039800 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 30 0 1 207 1 0 0 0 0 0 1 1 0 0 0 0 X 15 15 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X CARLO FIGLIOMENI 7164394417 4675 SUNSET DRIVE LOCKPORT NY 14094 X PATRICIA EVANS 0.50 X 0 0 0 SHARON JEAN HEWNER PHD 0.50 X 0 0 0 LINDA FLESSEL RN 0.50 X 0 0 0 FRANK DEMART 0.50 X 0 0 0 NICHOLAS GRANCHELLI 0.50 X 0 0 0 PAUL BEATTY JR 0.50 X 0 0 0 EUGENE NENNI 0.50 X 0 0 0 MARY BRENNAN-TAYLOR 0.50 X 0 0 0 JOHN J M REARDON 0.50 X 0 0 0 REV LOU PEREZ 0.50 X 0 0 0 JANICE P LITZ LCSW-R 0.50 X 0 0 0 DAN MANDAVILLE 0.50 X 0 0 0 STEVEN M SINCLAIR 0.50 X 0 0 0 JAMES M SHAW DDS 0.50 X 0 0 0 ANDREA SAMMARCO ESQ 0.50 X 0 0 0 CARLO FIGLIOMENI 16.00 X 0 0 0 JOHN LOMEO 20.70 X 0 0 0 SARINA BAX DEBIASO 40.00 X 133308 0 8355 133308 0 8355 1 0 0 0 THE HOSPICE AND PALLIATIVE CARE GROUP I 4675 SUNSET DRIVE LOCKPORT NY 14094 MANAGMENT FEE 926412 HOSPI-SCRIPT SERVICES PO BOX 933273 ATLANTA GA 31193 PHARMACY 285562 2 14196 57089 174332 245617 HOME CARE 623990 10021597 10021597 HOSPICE HOUSE 623990 2351657 2351657 12373254 29695 29695 27000 0 27000 27000 27000 114439 57089 102762 11677 11677 MISC. REVENUE-RELATED-990 561000 -5 -5 MISCELLANEOUS 561000 -607 -607 -612 12686631 12373249 0 67765 5077901 4821514 256387 159035 150218 8817 884555 842264 42291 403434 382596 20838 926412 926412 28860 28860 18459 18459 973339 965000 8339 143667 105470 27032 11165 479125 383656 34758 60711 60410 58992 1418 178321 166808 11513 272254 270847 1407 12472 -1 12473 415012 339998 59333 15681 57418 55102 2316 NURSING HOME EXPENSE 1528776 1528776 MEDICAL EQUIPMENT 743104 743104 REPAIRS AND MAINTENANCE 148320 148320 REPAIRS AND MAINTENANCE 37864 37864 153112 77136 74204 1772 12701850 11039800 1572721 89329 1100 1100 1471811 1117336 54247 22156 1516946 1873646 1419 119 161293 174284 9529124 3524288 6200262 6004836 986590 1126166 15000 15000 145091 205870 10553759 10540513 1107153 1175693 63826 83725 2020592 1833277 76634 66423 3268205 3159118 X 7240969 7336810 44585 44585 7285554 7381395 10553759 10540513 -15219 111060 0 X X 0 1 X 1 0 X 1012875 524503 98544 257915 188528 2082365 11527767 11784296 11987944 11453340 12373254 59126601 12540642 12308799 12086488 11711255 12561782 61208966 0 0 0 61208966 68947 131523 58793 57369 56695 373327 68947 131523 58793 57369 56695 373327 2697 -612 2085 12609589 12440322 12147978 11768624 12617865 61584378 0.99390 0.99290 0.00610 0.00700 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 57023 57023 21914 34585 524 57023 17953 3961 21914 16243 1710 17953 20175 -3932 16243 0 0 160248 160248 7038502 1619029 5419473 2330374 1905259 425115 6004836 DUE TO PALLIATIVE HOME CARE OF NIAGARA, INC. D/B/A LIBERTY HOME CARE 66423 66423 X 12874088 111060 30819 45578 187457 12686631 0 12686631 12778248 30819 45578 76397 12701851 0 12701851 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE AGENCY IS AN ORGANIZATION EXEMPT FROM TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN FOR INCOME TAX PURPOSES WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS ONLY TO THE EXTENT THAT AN UNCERTAIN TAX POSITION (IF ANY) IS ATTRIBUTABLE TO THE AGENCY. MANAGEMENT HAS EVALUTATED THESE TAX POSITIONS AND AS A RESULT NOTHING HAS BEEN RECORDED. THE TAX RETURNS FOR THE TAX YEARS ENDED JUNE 30TH, 2009 - 2012 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE FOR U.S. FEDERAL TAX PURPOSES AND ALSO BY NEW YORK STATE FOR STATE TAX PURPOSES. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING REVENUE OFFSET 45,578. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSE OFFSET 45,578. GM RAFFLE 65262 39736 25526 16170 MIGHTY NIAGARA 106266 17353 88913 251 2043 1143 700 82455 171528 57089 114439 251 2043 1143 700 98625 102762 11677 FORM 990, PART VI, SECTION A, LINE 3 THE HOSPICE AND PALLIATIVE CARE GROUP, INC. (AN AFFILIATED 501 (C) (3) ORGANIZATION - AFFILIATED THROUGH COMMON BOARD MEMBERS) (EIN 56-2298553) PERFORMS SOME MANAGEMENT, FUNDRAISING AND ADMINISTRATIVE SERVICES FOR NIAGARA HOSPICE, INC. THE HOSPICE AND PALLIATIVE CARE GROUP, INC. CHARGES NIAGARA HOSPICE, INC. A MANAGEMENT FEE FOR THESE SERVICES. NIAGARA HOSPICE, INC.'S BOARD OF DIRECTORS HAS OVERSIGHT OVER THESE ACTIVITIES. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PRESENTED IN DRAFT FORM TO THE MEMBERS OF THE GOVERNING BODY OF NIAGARA HOSPICE, INC. AFTER IT HAS BEEN REVIEWED BY AGENCY FISCAL PERSONNEL. EACH MEMBER OF THE BOARD HAS THE OPPORTUNITY TO REVIEW THE RETURN AND SUGGEST ANY CHANGES PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C NIAGARA HOSPICE, INC. IS COMMITTED TO IDENTIFY AND DISCLOSE ALL INDIVIDUALS THAT MAY HAVE A POTENTIAL TO INFLUENCE OR DIRECT DECISIONS TO HIS/HER OWN GAIN. ALL BOARD MEMBERS AND EMPLOYEES PARTICIPATING IN THE ACTIVITIES AND/OR OPERATIONS OF THE NIAGARA HOSPICE, INC. MUST SIGN A CONFLICT OF INTEREST FORM, AND DISCLOSE ANY DIRECT OR INDIRECT RELATIONSHIP, INVESTMENT OR INTEREST WHICH MAY REQUIRE HIS/HER EXCLUSION FROM PARTICIPATING IN CERTAIN DECISION - MAKING PROCESSES. IN ADDITION, EACH MEMBER OF THE BOARD OF DIRECTORS MUST COMPLETE A DISCLOSURE OF POTENTIAL CONFLICT OF INTEREST FORM. NO EMPLOYEE OF NIAGARA HOSPICE, INC. MAY HAVE EMPLOYMENT, CONSULTING OR OTHER BUSINESS RELATIONSHIP WITH A COMPETITOR, PATIENT/FAMILY, SUPPLIER, OR INVEST IN ANY COMPETITOR OR SUPPLIER (EXCEPT FOR MODERATE HOLDINGS OF PUBLICLY TRADED SECURITIES) UNLESS WRITTEN PERMISSION IS GRANTED BY THE CEO AND COO IN ADVANCE. OUTSIDE EMPLOYMENT MAY CONSTITUTE A CONFLICT OF INTEREST IF IT PLACES AN EMPLOYEE IN THE POSITION OF APPEARING TO REPRESENT THE AGENCY, INVOLVES SERVICES SIMILAR TO THOSE THE AGENCY PROVIDES OR LESSENS THE EFFICIENCY, ALERTNESS OR PRODUCTIVITY NORMALLY EXPECTED OF EMPLOYEES ON THEIR JOBS. OUTSIDE EMPLOYMENT MAY ALSO CONSTITUTE A CONFLICT OF INTEREST IF EMPLOYEES PERFORM SERVICES EITHER FOR INDIVIDUALS OR ENTITIES THAT MAKE REFERRALS. ALL OUTSIDE EMPLOYMENT THAT IS IN QUESTION MUST BE DISCLOSED TO THE AGENCY AND BE EVALUATED BY THE CCO. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE IS CHARGED BY THE BOARD OF DIRECTORS WITH THE RESPONSIBILITY TO DETERMINE THE COMPENSATION OF THE CHIEF EXECUTIVE & CHIEF OPERATING OFFICER. THE PURPOSE OF THIS COMMITTEE IS TO: APPROVE THE ANNUAL PERFORMANCE STANDARDS OF THE EXECUTIVE DIRECTOR. DETERMINE APPROPRIATE PERFORMANCE MEASURES AND ESTABLISH CRITERIA FOR ANY INCENTIVE BASED COMPENSATION. CONDUCT THE ANNUAL PERFORMANCE APPRAISAL. DETERMINE THE TOTAL COMPENSATION PACKAGE. ANNUALLY REVIEW, AND APPROVE ANY CHANGE TO, THE TOTAL COMPENSATION OF THE CHIEF EXECUTIVE & CHIEF OPERATING OFFICER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FORM 1023 AND FORM 990 AVAILIABLE TO THE PUBLIC UPON REQUEST OVER THE PHONE, IN WRITING, IN PERSON, AND VIA E-MAIL. THE 990 IS ALSO AVAILABLE THROUGH THE GUIDESTAR AND NY AGS WEBSITES. THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTERST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A: THE HOSPICE AND PALLIATIVE CARE GROUP, INC. (THE GROUP) PERFORMS SOME MANAGEMENT, FUNDRAISING AND ADMINISTRATIVE SERVICES FOR NIAGARA HOSPICE, INC. THE GROUP CHARGES NIAGARA HOSPICE, INC. A MANAGEMENT FEE FOR THESE SERVICES WHICH INCLUDES THE PAYROLL RELATED EXPENSES OF THE CHIEF EXECUTIVE OFFICER AND CHIEF OPERATING OFFICER. THESE INDIVIDUALS MEET THE DEFINITION OF OFFICERS OF NIAGARA HOSPICE, INC. ACCORDING TO THE IRS 990 INSTRUCTIONS. HOWEVER, NIAGARA HOSPICE, INC.'S AND THE GROUP'S RELATIONSHIP DOES NOT MEET THE DEFINITION OF RELATED PARTIES PER THE IRS 990 INSTRUCTIONS AND THEREFORE THEIR WAGE INFORMATION HAS NOT BEEN REPORTED ON PART VII, SECTION A NOR ON SCHEDULE J. DONATED SERVICES FORM 990; SCHEDULE D; PAGE 4; PART XII LINE 2B AND PART XIII LINE 2A NIAGARA HOSPICE, INC. RECEIVED VOLUNTEER SERVICES IN THE AMOUNT OF $30,819. THEY RECEIVED AN ADDITIONAL APPROXIMATE 9,400 HOURS FROM VOLUNTEERS WHO ASSISTED WITH PATIENT SERVICES AND FUNDRAISING, THE VALUE OF WHICH CANNOT BE DETERMINED. FORM 990, PART IV, LINE 34: NIAGARA HOSPICE, INC. DOES NOT HAVE ANY RELATED PARTIES THAT MEET THE DEFINITION PER THE 990 INSTRUCTIONS. FOR FINANCIAL STATEMENT PURPOSES, NIAGARA HOSPICE, INC. IS CONSIDERED RELATED TO THE FOLLOWING ENTITIES: PALLIATIVE HOME CARE OF NIAGARA, INC. (16-1611701), NIAGARA HOSPICE ALLIANCE, INC.(26-1101852) AND HOSPICE AND PALLIATIVE CARE GROUP, INC. D/B/A THE HOMECARE PARTNERS (56-2298553). WHILE NONE OF THESE ORGANIZATIONS ARE COMPLETELY CONTROLLED BY ANY OTHER OF THE ORGANIZATIONS, THE ORGANIZATIONS DO HAVE COMMON BOARD MEMBERS AND MANAGEMENT.