2014-11-13T20:15:33-06:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 4250 N FAIRFAX DRIVE SUITE 1020 ARLINGTON VA 22203 990 2013-01-01 521114719 MONTGOMERY HOSPICE INC MONT 3019214400 1355 PICCARD DRIVE NO 100 ROCKVILLE MD 20850 ANN MITCHELL PRESIDENT & CEO 3019214400 2014-11-06 1 KAREN GRIES P00078514 5712279500 2013 2015-11-30 17:44:51Z ANN MITCHELL 1355 PICCARD DRIVE NO 100 ROCKVILLE MD 20850 21921510 0 X WWW.MONTGOMERYHOSPICE.ORG X 1979 MD TO GENTLE THE JOURNEY THROUGH SERIOUS ILLNESS AND LOSS WITH SKILL AND COMPASSION. 21 20 290 332 0 0 791825 794435 22144610 21088768 6975 3480 9166 34827 22952576 21921510 700000 0 0 0 16230484 16033794 0 0 0 5495284 5343957 22425768 21377751 526808 543759 9796799 10389949 2389891 2439282 7406908 7950667 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 18219934 21088768 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 PAID PROFESSIONALS AND VOLUNTEERS. IN 2013, MONTGOMERY HOSPICE SERVED 2,150 PATIENTS AND THEIR FAMILIES. OUR INPATIENT HOSPICE, CASEY HOUSE, IS THE ONLY SUCH HEALTHCARE FACILITY IN MONTGOMERY COUNTY. IN 2013, 550 PATIENTS RECEIVED INTENSIVE NURSING AND MEDICAL CARE AND ATTENTION AT CASEY HOUSE. MONTGOMERY HOSPICE ALSO PROVIDED BEREAVEMENT SERVICES TO 9,600 INDIVIDUALS, AND END-OF-LIFE CARE EDUCATION TO MORE THAN 9,300 CLINICIANS AND PEOPLE IN THE LAY COMMUNITY. 18219934 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 13 0 290 1 0 0 0 0 0 0 0 0 0 0 X 21 20 0 0 0 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 PAUL E ALPUCHE JR SECRETARY 1.00 X X 0 0 0 ADRIENNE C KOHN DIRECTOR 1.00 X 0 0 0 JASON A KIRSCH DIRECTOR 1.00 X 0 0 0 ANN MITCHELL PRESIDENT 35.00 11.00 X X 194035 0 16669 PAUL S NICHOLSON IMMEDIATE PAST CHAIRMAN 1.00 X X 0 0 0 MICHAEL G BANKS ESQ DIRECTOR 1.00 X 0 0 0 RICHARD A BINDER MD DIRECTOR 1.00 X 0 0 0 BRIAN A CARPENTER MD DIRECTOR 1.00 X 0 0 0 LYA MALL KARM MD DIRECTOR 1.00 X 0 0 0 DEBORA S MCGREGOR DIRECTOR 1.00 X 0 0 0 BERYL L FEINBERG CHAIRMAN 1.00 X X 0 0 0 MARK K LI MD DIRECTOR 1.00 X 0 0 0 BARRY R MEIL DIRECTOR 1.00 1.00 X 0 0 0 SHEILA E BOLAND DIRECTOR 1.00 X 0 0 0 STERLING KING JR DRP VICE CHAIRMAN 1.00 X X 0 0 0 JOSE A QUIROS MD DIRECTOR 1.00 X 0 0 0 STEVEN V ROBERTS DIRECTOR 1.00 X 0 0 0 CATHERINE S LEGGETT DIRECTOR 1.00 X 0 0 0 HON PAUL A MCGUCKIAN DIRECTOR 1.00 X 0 0 0 WILLIAM M SCHLOSSENBERG DIRECTOR 1.00 X 0 0 0 HONG QI DIRECTOR 1.00 X 0 0 0 RONALD M WOLFSHEIMER TREASURER 1.00 X X 0 0 0 DARREN M POPKIN DIRECTOR 1.00 X 0 0 0 SAFIA S KADIR ESQ DIRECTOR 1.00 X 0 0 0 GARMAN PARAUD DIRECTOR 1.00 X 0 0 0 RANDALL P WAGNER MD DIRECTOR 1.00 X 0 0 0 MONICA ESCALANTE CFO/VP COMMUNITY EDUCATION 45.00 X 150741 0 5499 GEOFFREY COLEMAN MEDICAL DIRECTOR 48.00 X 170617 0 32732 CATHERINE DEGUZMAN NURSE 55.00 X 133652 0 4866 JANET CAUFFIEL VP HUMAN RESOURCES 42.00 X 133220 0 4801 MILLICENT WHYTE-HIGGINSMILLICENT WH SR. VP OF NURSING SERVICES 45.00 X 115411 0 6924 TERRIE RADA VISIT NURSE (NIGHTS AND WEEKENDS) 49.00 X 108492 0 9037 PATRICIA VITACCO DIRECTOR OF QAPI 42.00 X 107548 0 12867 1113716 0 93395 11 0 1 0 GLOBAL MEDICAL 8332 BRISTOL COURT -SUITE 108 JESSUP MD 20794 DURABLE MED EQUIP 603189 DELTA CARE RX PO BOX 23410 STEUBENVILLE OH 43553 PHARMACY 564995 PRO CARE PBM 12767 PROFESSIONAL PARKWAY GAINESVILLE GA 30507 PHARMACY 510868 MEDLINE INDUSTRIES ONE MEDLINE PLACE MUNDELEIN IL 60060 MEDICAL SUPPLIES 336277 LERCH EARLY & BREWER 3 BETHESDA METRO CENTER SUITE 460 BETHESDA MD 20814 LEGAL SERVICES 164164 7 794435 794435 PATIENT SERVICE REVENUE 624100 21088768 21088768 21088768 3480 3480 MISCELLANEOUS REVENUE 624100 34827 34827 34827 21921510 21088768 0 38307 582085 194094 387991 13188617 12333688 854929 1287385 1204442 82943 975707 886971 88736 76292 76292 71747 71747 582668 571740 10928 14654 13594 1060 536353 82511 453842 161480 8235 153245 625861 195410 430451 377570 373542 4028 56805 42962 13843 5750 5750 400104 92729 307375 243669 80356 163313 MEDICAL EQUIPMENT, SUPP 2020730 2020730 MISCELLANEOUS EXPENSE 116251 64907 51344 LAUNDRY AND LINEN SUPPL 54023 54023 21377751 18219934 3157817 0 600 600 2468795 2764840 3237645 2659280 246607 287003 5936106 3213250 2911308 2722856 6000 6000 925844 1949370 9796799 10389949 2056537 2209949 69664 38714 263690 190619 2389891 2439282 X 7406908 7950667 7406908 7950667 9796799 10389949 543759 0 X X 0 1 X 1 0 X 368239 317078 1143592 791825 794435 3415169 13140770 17038437 20961488 22144610 21088768 94374073 13509009 17355515 22105080 22936435 21883203 97789242 0 0 0 97789242 1772 1945 5025 6975 3480 19197 1772 1945 5025 6975 3480 19197 9163 1856 2437 9166 34827 57449 13519944 17359316 22112542 22952576 21921510 97865888 0.99920 0.99950 0.00020 0.00020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3877148 71994 396770 125113 4220799 3695745 36095 268010 122702 3877148 3147870 326203 326792 105120 3695745 1216353 1931517 3147870 1049576 166777 1216353 0.10410 0.79400 0.10190 0 1 1 650709 650709 2503638 934727 1568911 744871 631228 113643 1214883 1037038 177845 822005 610257 211748 2722856 INVESTMENT IN PALLIATIVE MEDICINE CONSULTANTS OF GREATER WASHINGTON, LLC -15728 INTERCOMPANY INVESTMENT TRANSFER 500000 DUE FROM MONTGOMERY HOSPICE FOUNDATION, INC. 1433649 DUE FROM PALLIATIVE MEDICINE CONSULTANTS OF GREATER WASHINGTON, LLC 31449 1949370 DEFERRED RENT PAYABLE - LEASE 190619 190619 PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY MONTGOMERY HOSPICE FOUNDATION AND 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. X X 0 0 0 0 0 0 0 0 0 ANN MITCHELL PRESIDENT 194035 0 0 0 0 0 5275 0 11394 0 210704 0 0 0 MONICA ESCALANTE CFO/VP COMMUNITY EDUCATION 150741 0 0 0 0 0 3451 0 2048 0 156240 0 0 0 GEOFFREY COLEMAN MEDICAL DIRECTOR 170617 0 0 0 0 0 4588 0 28144 0 203349 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 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 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 REVIEW FOR PRESIDENT (CEO) IS CONDUCTED ANNUALLY BY EXECUTIVE COMMITTEE MEMBERS. MEMBERS MAY INTERVIEW PRESIDENT'S COLLEAGUES CONCERNING THEIR INTERACTION AND RELATIONSHIP WITH PRESIDENT. OTHER ANALYSIS INCLUDE WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE EXECUTIVE COMMITTEE. 2013 WAS THE MOST RECENT YEAR IN WHICH THE COMPENSATION PROCESS WAS REVIEWED. KEY EMPLOYEES ARE GIVEN ANNUAL PERFORMANCE REVIEWS BY THEIR IMMEDIATE SUPERVISOR INCLUDING CEO. THE PERFORMANCE SUMMARY IS REVIEWED AND DISCUSSED WITH THE CEO. AN ANALYSIS OF COMPARABLE STAFF POSITIONS AND SIMILAR HOSPICE ORGANIZATIONS IS DONE BY HR DEPARTMENT. DATA FROM BENCHMARK REPORTS PROVIDED BY NHPCO AND MVI ARE ALSO USED IN THIS ANALYSIS. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AND ALSO SUMMARIZED ON THE ORGANIZATION'S WEBSITE. FORM 990, PART XII, LINE 2C: NEITHER THE OVERSIGHT NOR SELECTION PROCESS FOR THE FINANCE COMMITTEE HAS CHANGED FROM THE PRIOR YEAR. PALLIATIVE MEDICINE CONSULTANTS OF GREATER WASHINGTON LLC 1355 PICCARD DR SUITE 100O ROCKVILLE MD 20850 522343635 TO OFFER A CONTINUUM OF CARE FOR PATIENTS WITH ADVANCED ILLNESS MD 24000 15720 MONTGOMERY HOSPICE INC MONTGOMERY HOSPICE FOUNDATION INC 1355 PICCARD DRIVE 100 ROCKVILLE MD 20850 521664426 CHARITABLE FOUNDATION FOR THE BENEFIT OF THE HOSPICE MD 501(C)(3) LINE 11B, II N/A 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 MONTGOMERY HOSPICE FOUNDATION INC C 794435 CASH VALUE MONTGOMERY HOSPICE FOUNDATION INC E 871291 CASH VALUE MONTGOMERY HOSPICE FOUNDATION INC N 90000 CASH VALUE