2014-07-11T10:13:58-05:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 101 NORTH TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2013-01-01 561452373 HOSPICE OF CLEVELAND COUNTY INC HOSP 7044874677 951 WENDOVER HEIGHTS DRIVE SHELBY NC 281503565 MYRA MCGINNIS PRESIDENT/CEO 7044874677 2014-07-11 1 JOHN NORMAN P01506766 7049985200 2013 2015-11-30 17:44:51Z X HOSPICE CLEVELAND COUNTY MYRA MCGINNIS 951 WENDOVER HEIGHTS DRIVE SHELBY NC 281503565 11628992 0 X WWW.HOSPICECARES.CC X 1984 NC HOSPICE OF CLEVELAND COUNTY PROVIDES CARE AND SUPPORT TO PATIENTS WITH A LIFE-LIMITING ILLNESS. 17 17 178 201 254 0 251474 318197 10375761 11053929 44486 112782 24208 38265 10695929 11523173 0 0 0 0 5663466 6006592 0 0 0 4019580 4497731 9683046 10504323 1012883 1018850 18602734 20035431 1260267 1379405 17342467 18656026 HOSPICE CLEVELAND COUNTY EXISTS TO PROVIDE HIGH QUALITY SKILLED COMPASSIONATE CARE AND SUPPORT FOR INDIVIDUALS WITH A LIFE-LIMITING ILLNESS, THEIR FAMILIES, AND THE COMMUNITY, REGARDLESS OF THEIR ABILITY TO PAY. 0 0 5689004 7695752 HOSPICE CLEVELAND COUNTY PROVIDES COMPREHENSIVE END OF LIFE HEALTHCARE FOR TERMINALLY ILL PATIENTS AND THEIR FAMILIES DURING THE FINAL STAGES OF ILLNESS. DURING 2013, HOSPICE CLEVELAND COUNTY PROVIDED 47,215 DAYS OF HOMECARE INCLUDING 10,342 DAYS OF NURSING HOME AND HOSPITAL INPATIENT CARE. HOSPICE CLEVELAND COUNTY SERVED 643 HOMECARE PATIENTS IN 2013. HOSPICE CLEVELAND COUNTY'S INTERDISCIPLINARY TEAMS CONSISTING OF PHYSICIANS, NURSES, HOSPICE AIDES, SOCIAL WORKERS, AND OTHER SUPPORTIVE PERSONNEL PROVIDED OVER 33,776 VISITS DURING 2013. 2624821 3095549 HOSPICE CLEVELAND COUNTY OWNS AND OPERATES TWO HOSPICE HOUSES THAT PROVIDE HOSPICE INPATIENT AND RESIDENTIAL CARE FOR TERMINALLY ILL PATIENTS DURING THE FINAL STAGES OF ILLNESS. THE WENDOVER HOSPICE HOUSE HAS 16 BEDS AND THE KINGS MOUNTAIN HOSPICE HOUSE HAS 8 BEDS. DURING 2013, HOSPICE CLEVELAND COUNTY PROVIDED 7,931 DAYS OF CARE IN THESE FACILITIES. HOSPICE CLEVELAND COUNTY SERVED 419 PATIENTS IN THE HOSPICE HOUSES IN 2013. 680457 262628 PALLIATIVE CARE CLEVELAND COUNTY PROVIDES A PROGRAM OF PAIN CONTROL, SYMPTOM MANAGEMENT AND ASSISTANCE WITH DIFFICULT DECISION MAKING. DURING 2013, PALLIATIVE CARE CLEVELAND COUNTY SERVED 889 PATIENTS. 8994282 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 37 0 178 1 0 0 0 0 0 0 0 0 0 0 X 17 17 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X PAM BENFIELD 7044874677 951 WENDOVER HEIGHTS DRIVE SHELBY NC 28150 KATHY WILSON BOARD MEMBER 1.00 X X 0 0 0 ANDREA LESLIE-FITE BOARD MEMBER 1.00 X 0 0 0 JENNIE LAMBERT BOARD MEMBER 1.00 X X 0 0 0 STEVE PADGETT BOARD MEMBER 1.00 X 0 0 0 EDDIE HOLBROOK BOARD MEMBER 1.00 X 0 0 0 PETE MOORE BOARD MEMBER 1.00 X 0 0 0 DR MIKE RIBADENEYRA BOARD MEMBER 1.00 X 0 0 0 RIT VARRIALE BOARD MEMBER 1.00 X 0 0 0 BECKY BROWN BOARD MEMBER 1.00 X X 0 0 0 BRENDA LOVELACE BOARD MEMBER 1.00 X 0 0 0 ROBBY REYNOLDS BOARD MEMBER 1.00 X X 0 0 0 PAMELA ENLOE BOARD MEMBER 1.00 X 0 0 0 GREG MCINNIS BOARD MEMBER 1.00 X 0 0 0 WILLIAM THOMPSON BOARD MEMBER 1.00 X 0 0 0 JOSEPH TYSINGER BOARD MEMBER 1.00 X 0 0 0 FORREST THOMPSON BOARD MEMBER 1.00 X 0 0 0 CARYL AUSTELL BOARD MEMBER 1.00 X 0 0 0 MYRA MCGINNIS PRESIDENT/CEO 48.80 X 0 132745 38098 DR JAMES POTTS HOSPICE MEDICAL DIRECTOR 50.70 X 184279 0 36856 DR SANGYA PATEL PALLIATIVE CARE MEDICAL DIRECTOR 47.30 X 214202 0 42840 DR REBECCA LOVE HOSPICE PHYSICIAN - VP OF PALLIATIVE CARE 53.30 X 139864 0 27973 538345 132745 145767 3 0 1 0 CLEVELAND COUNTY HEALTHCARE SYSTEM 201 E GROVER STREET SHELBY NC 28150 MANAGEMENT AND OTHER LABOR SERVICES 290604 1 59804 258393 318197 PATIENT REVENUE 621610 11053929 11053929 11053929 112022 112022 94286 93526 760 760 760 50304 12293 38011 38011 HOSPICE ITEMS SALES 900099 254 254 254 11523173 11053929 254 150793 132745 132745 4893552 4259944 633608 109605 95521 14084 514962 448675 66287 355728 310017 45711 33860 33860 254439 124034 130405 27413 27413 125886 57928 67958 133231 25756 107475 275920 147309 128611 183097 178689 4408 52736 22608 30128 581903 581903 44087 44087 PURCHASED SERVICES 1581969 1581969 SUPPLIES 818969 818969 BAD DEBT EXPENSES 251485 251485 MISC EXPENSES 47272 47272 85464 62062 23402 10504323 8994282 1510041 0 5356273 5820682 3033161 3330228 424625 247498 1015670 970797 6009 28882 63653 70990 10357978 3624871 7214217 6733107 1477587 2823859 11539 9388 18602734 20035431 880162 970111 380105 409294 1260267 1379405 X 16712095 18176412 424625 253872 205747 225742 17342467 18656026 18602734 20035431 X 1018850 279778 -21658 36589 X X 0 1 X 1 0 X 923415 791778 398738 251474 318197 2683602 923415 791778 398738 251474 318197 2683602 371273 2312329 85611 40682 43107 46773 112022 328195 -70 -395 -2295 -698 254 -3204 13028 -6019 3049 -2728 7330 3015923 52324213 0.76670 0.81260 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 282 282 0 PART II-B, LINE 1: THE ORGANIZATION BELONGS TO THE NATIONAL HOSPICE & PALLIATIVE CARE ORGANIZATION WHICH DETERMINED THAT A PORTION OF ITS PROVIDER DUES WERE USED FOR SPECIFIC LOBBYING PURPOSES. 261411 9804 39410 9804 300821 238989 9968 22422 9968 261411 238989 238989 0.25000 0.75000 0 0 295737 295737 7731353 2385942 5345411 1658555 943122 715433 672333 295807 376526 6733107 ESTIMATED THIRD PARTY LIABILITY 409294 409294 X 11491711 -21658 -21658 11513369 9804 9804 11523173 10504323 0 10504323 0 10504323 PART V, LINE 4: PERMANENT ENDOWMENT FUND ($225,742) PLUS BOARD-DESIGNATED QUASI-ENDOWMENT FOREVER FUND ($75,079). PART X, LINE 2: THE ORGANIZATION FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE IMPLEMENTATION OF THIS STANDARD HAD NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2013. PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT FEES -21,658. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION FOR FOREVER FUND 9,804. CORKS & TAPS 30761 30761 4398 2038 CHICKEN DINNER 12194 12194 2916 1281 42955 42955 4398 2916 3319 10633 32322 X 1 1 X X 0 0 0 0 0 0 0 0 0 MYRA MCGINNIS PRESIDENT/CEO 0 109839 0 14934 0 7972 0 0 0 38098 0 170843 0 0 DR JAMES POTTS HOSPICE MEDICAL DIRECTOR 183618 0 661 0 0 0 0 0 36856 0 221135 0 0 0 DR SANGYA PATEL PALLIATIVE CARE MEDICAL DIRECTOR 213526 0 676 0 0 0 0 0 42840 0 257042 0 0 0 DR REBECCA LOVE HOSPICE PHYSICIAN - VP OF PALLIATIVE 139203 0 661 0 0 0 0 0 27973 0 167837 0 0 0 PART I, LINE 1A HOSPICE OF CLEVELAND COUNTY, INC. PAYS A PORTION OF MONTHLY DUES FOR EMPLOYEES WHO CHOOSE TO JOIN THE LOCAL YMCA PROGRAM. THIS IS REPORTED AS TAXABLE FRINGE IN THE EMPLOYEES PAYROLL EARNINGS AND TAXED APPROPRIATELY. X 6205 SALES VALUE - FMV X 88025 SALES VALUE - FMV X 1 14500 APPRAISAL 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 HOSPICE OF CLEVELAND COUNTY, INC. HAS AN AGREEMENT WITH CLEVELAND REGIONAL MEDICAL CENTER TO PROVIDE MANAGEMENT SERVICES FOR DAY-TO-DAY OPERATIONS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S PRESIDENT/CEO WILL REVIEW AND APPROVE FORM 990 AND WILL PRESENT IT TO THE FINANCE COMMITTEE BEFORE IT IS FILED. THE FINANCE COMMITTEE WILL THEN PRESENT THE PREPARED FORM 990 TO THE BOARD OF DIRECTORS FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MAINTAINS A CONFLICT OF INTEREST POLICY THAT COVERS ALL EMPLOYEES AND BOARD MEMBERS. EACH YEAR THE CONFLICT OF INTEREST POLICY IS REVIEWED AT ONE OF THE MONTHLY STAFF MEETINGS WITH ALL EMPLOYEES. SENIOR LEADERSHIP AND ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE, SIGN AND DATE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM. ALL DISCLOSURES BY BOARD MEMBERS ARE REVIEWED AND APPROVED BY THE BOARD CHAIRMAN. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION OF THE PRESIDENT/CEO AND SENIOR LEADERSHIP WAS LAST REVIEWED IN 2013. FORM 990, PART VI, SECTION C, LINE 19 REQUESTS FOR REVIEW OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS MUST BE SUBMITTED TO HOSPICE OF CLEVELAND COUNTY, INC. IN WRITING AND MUST INCLUDE THE NAME, ADDRESS, AND TELEPHONE NUMBER OF THE INDIVIDUAL OR ENTITY MAKING THE REQUEST. ALL REQUESTS ARE SUBMITTED TO THE PRESIDENT/CEO FOR APPROVAL. UPON APPROVAL, THE DOCUMENTS ARE MADE AVAILABLE WITHIN TWO WEEKS OF RECEIPT OF THE WRITTEN REQUEST. THE DOCUMENTS ARE AVAILABLE FOR REVIEW AT THE HOSPICE OF CLEVELAND COUNTY, INC. ADMINISTRATIVE OFFICE BUILDING. FORM 990, PART XI, LINE 9: RESTRICTED PLEDGES RECEIVED 3,698. ENDOWMENT FUND - PERMANENTLY RESTRICTED 19,995. CHANGE IN DISCOUNT FOR PLEDGES RECEIVED 6,522. OTHER RESTRICTED CONTRIBUTIONS RECEIVED 6,407. NET ASSETS RELEASED FROM RESTRICTIONS FOR RESPITE CARE PROGRAM -33. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. AMENDED RETURN SUBSEQUENT TO FILING, THE ORGANIZATION DETERMINED THAT IT HAD FAILED TO REPORT A NONCASH CONTRIBUTION OF REAL ESTATE ON THE RETURN. THE ADDITION OF THAT NONCASH CONTRIBUTION IS REFLECTED ON PART VIII, LINE 1, SCHEDULE B AND SCHEDULE M. CLEVELAND REGIONAL MEDICAL CENTER 201 E GROVER ST SHELBY NC 28150 560654386 GOVERNMENTAL HOSPITAL NC 115 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 CLEVELAND REGIONAL MEDICAL CENTER O 290604 CLEVELAND REGIONAL MEDICAL CENTER P 50895