2014-08-14T09:32:19-05:00 2013-12-31 421243538 BERGAN PAULSEN & COMPANY PC PO BOX 2100 WATERLOO IA 507042100 990 2013-01-01 421135294 CEDAR VALLEY HOSPICE INC CEDA 3192722002 PO Box 2880 WATERLOO IA 507042880 MARVIN FAGERLIND EXECUTIVE DIRECTOR 3192722002 2014-08-14 1 DAVID A RICHTER P00168204 3192346885 2013 2015-11-30 17:44:51Z MARVIN FAGERLIND PO Box 2880 WATERLOO IA 507042880 11888346 0 X www.cvhospice.org X 1979 IA PROVIDE HOSPICE AND COUNSELING SERVICES TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES. 15 15 155 400 0 0 1085004 1682703 8946423 8484501 214552 344292 -4493 -20205 10241486 10491291 104196 61819 0 0 6163311 6333132 23134 0 186267 4596365 4273809 10887006 10668760 -645520 -177469 10365349 10557131 1317355 1318702 9047994 9238429 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 8269394 61819 8484501 CEDAR VALLEY HOSPICE IS DEDICATED TO PROVIDING HOSPICE SERVICES TO THOSE WITH A SIX MONTH PROGNOSIS OR LESS, SERVING 936 PATIENTS IN 2013. THE AVERAGE DAILY CENSUS WAS 138.92 WHICH ALLOWED US TO PROVIDE 50,705.80 DAYS OF CARE. THE AVERAGE LENGTH OF STAY FOR OUR HOSPICE PATIENTS WAS 61.2 DAYS. CEDAR VALLEY HOSPICE PROVIDES GRIEF SUPPORT SERVICES TO ANYONE STRUGGLING WITH THE DEATH OF A LOVED ONE, SERVING 3,771 GRIEF CLIENTS IN 2013. 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 55 CLIENTS IN 2013. 8269394 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 41 0 1 155 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 0.20 X X 0 0 0 SHELLI PINT DIRECTOR 0.20 X 0 0 0 GENE SANDELL DIRECTOR 0.20 X 0 0 0 CHRIS SCHILDROTH VICE PRESIDENT 0.20 X X 0 0 0 GIA SHANNON PRESIDENT 0.20 X X 0 0 0 RENAE BOCKHOLT DIRECTOR 0.20 X 0 0 0 PAM DOWIE DIRECTOR 0.20 X 0 0 0 JUNEVER HEYING DIRECTOR 0.20 X 0 0 0 JOAN HEADINGTON DIRECTOR 0.20 X 0 0 0 CHRIS HYERS DIRECTOR 0.20 X 0 0 0 KRIS IREY DIRECTOR 0.20 X 0 0 0 ED LARSON DIRECTOR 0.20 X 0 0 0 SCOTT WIENANDS DIRECTOR 0.20 X 0 0 0 TRACY MUDD DIRECTOR 0.20 X 0 0 0 MICHAEL RUFFCOM TREASURER 0.20 X X 0 0 0 JAMES O'CONNER DIRECTOR 0.20 X 0 0 0 MARVIN FAGERLIND EXECUTIVE DIRECTOR 65.00 X 123753 0 17059 MICHAELA VANDERSEE FINANCE DIRECTOR 65.00 X 82230 0 36517 MICHAEL DETERS MEDICAL DIRECTOR 30.00 X 148809 0 26595 354792 0 80171 2 0 0 0 HOSPISCRIPT SERVICES LLC 4525 EXECUTIVE PARK DR SUITE 100 MONTGOMERY AL 36116 PHARMACIST CONSULTS AND PRESCRIPTIONS 541076 COVENANT MEDICAL CLINIC 3421 WEST NINTH STREET WATERLOO IA 50702 INPATIENT AND OUTPATIENT SERVICES 203832 CERNER 2800 ROCKCREEK PARKWAY NORTH KANSAS CITY MO 64117 PROFESSIONAL SERVICES AND SOFTWARE 159680 WAVERLY HEALTH CENTER 312 9TH ST SW WAVERLY IA 50677 INPATIENT AND OUTPATIENT SERVICES 147275 MARTIN HEALTH CENTER 420 EAST 11TH STREET CEDAR FALLS IA 50613 MEDICAID ROOM AND BOARD PASS THROUGH 135397 5 80746 163415 1438542 39841 1682703 PATIENT CARE FEES 623990 8484501 8484501 8484501 246211 246211 1469383 1371302 98081 98081 98081 5548 80746 25753 -20205 -20205 10491291 8484501 0 324087 61819 61819 412418 157851 254567 4752234 3729853 938948 83433 114744 83479 28737 2528 681771 511784 160183 9804 371965 283443 82515 6007 78707 78707 18500 18500 28418 28418 48480 19015 29465 117011 270 116741 283968 104003 169267 10698 79253 77958 1295 148202 115323 25731 7148 281604 257899 22729 976 105081 73843 31115 123 152501 117426 27450 7625 46354 34485 9289 2580 PATIENT EXPENSES 1734651 1734651 MEDICAL SUPPLIES & DRUG 931102 931102 EQUIPMENT RENTAL & MAIN 89769 89769 CONSORTIUM EXPENSE 23605 23605 106603 29543 23010 54050 10668760 8269394 2213099 186267 882754 311299 295482 455129 60620 655180 1408388 1580210 99827 98076 3148851 2048036 1249023 1100815 6354872 6336513 14383 19909 10365349 10557131 1317355 1318702 1317355 1318702 X 8261786 7773722 58534 736183 727674 728524 9047994 9238429 10365349 10557131 -177469 367904 0 X 0 1 X 1 0 X 996711 936024 1125441 1085004 1195203 5338383 996711 936024 1125441 1085004 1195203 5338383 224585 5113798 147483 164926 188290 199804 246211 946714 6285097 44845838 0.81360 0.81750 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 AS THEY WERE LARGE AND UNEXPECTED. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1840277 35241 78171 78171 1875518 1725337 114940 47436 47436 1840277 1608914 116423 11860 11860 1725337 1415943 158598 55344 20971 1608914 1234758 98391 82794 1415943 0.61000 0.39000 1 0 1634479 945190 689289 359033 345693 13340 1155339 757153 398186 1100815 X 10223830 367904 17381 36616 421901 9801929 689362 689362 10491291 10711894 17381 25753 43134 10668760 0 10668760 Part X, Line 2: INCOME TAX RETURNS ARE SUBJECT TO UNCERTAIN TAX POSITIONS THAT MIGHT NOT BE SUSTAINED UPON EXAMINATION BY TAXING AUTHORITIES. MANAGEMENT ANNUALLY MAKES AN APPROPRIATE EVALUATION OF ANY UNCERTAIN TAX POSITIONS THAT MAY EXIST WITHIN THE ORGANIZATION'S TAX RETURN. AS OF DECEMBER 31, 2013, MANAGEMENT BELIEVES THAT THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS THAT ARE REQUIRED TO BE RECORDED OR DISCLOSED. WITH FEW EXCEPTIONS, THE ORGANIZATION IS NO LONGER SUBJECT TO TAX EXAMINATIONS FOR YEARS BEFORE 2010. Part XI, Line 2d - Other Adjustments: NET ASSETS RELEASED FROM RESTRICTIONS 10,863. SPECIAL EVENTS EXENSE 25,753. Part XI, Line 4b - Other Adjustments: TEMPORARILY RESTRICTED NET ASSET CONTRIBUTIONS 688,512. PERMANENTLY RESTRICTED NET ASSET CONTRIBUTIONS 850. Part XII, Line 2d - Other Adjustments: SPECIAL EVENTS EXPENSE 25,753. 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 74714 74566 148 12508 10297 GOLF OUTING 11580 6180 5400 2948 86294 80746 5548 12508 13245 25753 -20205 1 ORAL HEALTH CARE 3 1154 EMERGENCY FINANCIAL ASSISTANCE 35 5173 HOUSING SERVICES 11 10988 MEDICAL TRANSPORTATION ASSISTANCE 33 5885 HEALTH INSURANCE PROGRAM 14 35285 MENTAL HEALTH SERVICES 6 3334 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. X 62 COST X 10407 COST X 7 668 COST X AUCTION ITEMS 110 15947 COST X EVENT PRIZES 147 7516 COST X OTHER 17 5241 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.