2014-10-24T13:58:38-05:00 2013-12-31 310800053 CLARK SCHAEFER HACKETT & CO 10100 INNOVATION DR SUITE 400 DAYTON OH 45342 990 2013-01-01 310933339 HOSPICE OF DAYTON INC HOSP 9372564490 324 WILMINGTON AVE DAYTON OH 45420 JERRY DURST CFO 9372564490 2014-07-18 1 KEVIN T DAVIS CPA P00039883 9372260070 2014-07-18 2013 2015-11-30 17:44:51Z KENT ANDERSON 324 WILMINGTON AVE DAYTON OH 45420 61506277 0 X HTTP://WWW.HOSPICEOFDAYTON.ORG X 1978 OH TO PROVIDE HOSPICE CARE FOR TERMINALLY ILL INDIVIDUALS 13 12 795 793 0 0 2779667 3113810 50835808 48612501 853190 1426691 132674 56163 54601339 53209165 0 0 0 0 38799595 38312892 0 0 166114 17665737 17136201 56465332 55449093 -1863993 -2239928 75086944 78009251 17101044 17240764 57985900 60768487 X THE HOSPICE OF DAYTON, INC. IS COMMITTED TO MAKING QUALITY HOSPICE CARE AVAILABLE AND ACCESSIBLE TO TERMINALLY ILL PERSONS AND THEIR FAMILIES, REGARDLESS OF ABILITY TO PAY, AND IN A MANNER CONSISTENT WITH THE HIGHEST HOSPICE STANDARDS. OUR COMMITMENT TO THE HOSPICE PHILOSOPHY OF CARE INCLUDES A COMPASSIONATE STAFF PLEDGED TO CONTINUOUSLY IMPROVE AND ENHANCE THE CARE WE PROVIDE, RESPECT THE PATIENTS' CHOICES OF CARE, RESPOND TO CHANGING COMMUNITY NEEDS, AND SERVE AS A RESOURCE TO OTHERS FOR IMPROVING THE AVAILABILITY OF QUALITY HOSPICE CARE. 0 0 46907870 48626364 COORDINATES A PROGRAM OF HOME, OUTPATIENT, AND INPATIENT HOSPICE CARE THAT PROVIDES PALLIATIVE CARE, SUPPORTIVE MEDICAL SERVICES, AND OTHER SUPPORT SERVICES TO TERMINALLY ILL PERSONS AND THEIR FAMILIES, REGARDLESS OF ABILITY TO PAY. 46907870 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 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 1 1 0 0 0 1 254 0 795 1 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X JERRY DURST 9372564490 324 WILMINGTON AVE DAYTON OH 454201891 KENT ANDERSON PRESIDENT/CEO 40.00 X X 330734 0 78438 PAMELA MORRIS BOARD MEMBER 2.00 X 0 0 0 LISA HANAUER BOARD MEMBER - SECRETARY 2.00 X X 0 0 0 CLAIRE RODEHAVER BOARD MEMBER 2.00 X 0 0 0 TONI SPRINKEL BOARD MEMBER - TREASURER 2.00 X X 0 0 0 LOIS SUTHERLAND BOARD MEMBER 2.00 X 0 0 0 GREG TOMAN BOARD MEMBER - CHAIR 2.00 X X 0 0 0 LARRY ZUMSTEIN BOARD MEMBER 2.00 X 0 0 0 THOMAS MANN BOARD MEMBER - VICE CHAIR 2.00 X X 0 0 0 PAULA MACILWAINE BOARD MEMBER 2.00 X 0 0 0 RATNA PALAKODETI MD BOARD MEMBER 2.00 X 0 0 0 LINDSAY M JOHNSON ESQ BOARD MEMBER 2.00 X 0 0 0 BURHAN YANES MD BOARD MEMBER 2.00 X 0 0 0 JERRY DURST CFO 40.00 X 180260 0 44076 BRENDA HUMFLEET MKTG DIRECTOR/ HODF PRES. 2.00 X 204780 0 31463 JULES SHERMAN CHIEF MEDICAL OFFICER 40.00 X 258857 0 23174 RUTH THOMSON VP OF MEDICAL SERVICES 40.00 X 343278 0 45817 WENDY SCHMITZ ASSOC. MEDICAL DIRECTOR 40.00 X 230128 0 27804 CHIRAG PATEL PHYSICIAN 40.00 X 263438 0 28317 RANAPREET PATEL PHYSICIAN 40.00 X 230242 0 5752 CLEANNE CASS PHYSICIAN 40.00 X 241258 0 14495 2282975 0 299336 19 0 1 0 THERAPY SUPPORT INC 2803 N OAK GROVE AVE SPRINGFIELD MO 658034976 THERAPY 2234583 EXCELLERX PO BOX 510818 PHILADELPHIA PA 19175 PHARMACEUTICAL 2177122 KETTERING MEDICAL CENTER PO BOX 713086 COLUMBUS OH 432713086 HOSPITAL 712839 MIAMI VALLEY HOSPITAL PO BOX 713073 COLUMBUS OH 432713073 HOSPITAL 316263 DEDICATED NURSING ASSOCIATES 3875 FRANKLINTOWNE COURTS SUITE 24 MURRYSVILLE PA 15668 CONTRACT NURSING 304507 5 3113810 3113810 PATIENT SERVICE 624100 48397191 48397191 CAFETERIA 624100 215310 215310 48612501 415889 415889 42300 0 42300 42300 42300 9307914 8297112 1010802 1010802 1010802 MISCELLANEOUS INCOME 900099 13863 13863 13863 53209165 48626364 0 1468991 1151782 282031 633508 236243 29823781 27087206 2315609 420966 434764 339972 88709 6083 4406328 3999273 374029 33026 2496237 2022536 427402 46299 147541 147541 1349547 47058 264785 1037704 573644 207999 365645 98774 36855 61919 590843 126346 453759 10738 117211 117211 261281 261281 1845708 1291995 387599 166114 252059 252059 MEDICATIONS & SUPPLIES 3099934 3099934 EQUIPMENT RENTAL AND MA 2877914 2068099 809815 CONTRACTED SERVICES 1792640 889372 903268 GENERAL INPATIENT EXPEN 1326608 1326608 2802497 3965375 628181 -1791059 55449093 46907870 8375109 166114 92530 918 2709225 24881 6677250 6347914 119180 94180 35866695 13695033 22393211 22171662 16423122 18939778 26672426 30429918 75086944 78009251 16510480 16444427 590564 796337 17101044 17240764 X 56210656 59045090 665244 613397 1110000 1110000 57985900 60768487 75086944 78009251 X -2239928 1195437 3827078 X X 0 1 X 1 0 X 1444606 1177836 2151665 2779667 3113810 10667584 1444606 1177836 2151665 2779667 3113810 10667584 10667584 460081 1728571 1596590 868690 1426691 6080623 62753 20249 356439 90024 13863 543328 17291535 230679180 0.61690 0.81420 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 25177232 50000 3959453 29186685 22867326 2309906 25177232 22828457 38869 22867326 14407503 6273655 2324795 177496 22828457 7500120 6015800 1396370 504787 14407503 0.96200 0.03800 0.00000 0 1 0 956114 956114 29702355 10647855 19054500 5095332 2971614 2123718 112894 75564 37330 22171662 BENEFICIAL INTEREST IN SUBSIDIARY FOUNDATION 27792613 DUE FROM RELATED ENTITY (HOSPICE OF DAYTON FDTN. 31-1769696) 2637305 30429918 RETIREMENT PLAN LIABILITY 796337 796337 X 62867593 1195437 8610532 9805969 53061624 147541 147541 53209165 60085006 4783454 4783454 55301552 147541 147541 55449093 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD FAIL TO BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. AS DISCUSSED ABOVE, THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES AND MANAGEMENT BELIEVES THE ORGANIZATION HAS NOT ENGAGED IN ANY ACTIVITIES THAT WOULD DISQUALIFY IT FROM TAX-EXEMPT STATUS OR INCUR A TAX OBLIGATION FOR THE YEARS ENDED DECEMBER 31, 2013 AND 2012. THE ORGANIZATION BELIEVES THEIR ESTIMATES ARE APPROPRIATE BASED ON CURRENT FACTS AND CIRCUMSTANCES. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE ORGANIZATION BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS ENDED PRIOR TO DECEMBER 31, 2010. THE ORGANIZATIONS POLICY WITH REGARD TO INTEREST AND PENALTY, IF INCURRED, IS TO RECOGNIZE INTEREST THROUGH INTEREST EXPENSE AND PENALTIES THROUGH OTHER EXPENSE. PART XI, LINE 2D - OTHER ADJUSTMENTS: ELIMINATION OF NET REVENUE ACTIVITY OF SUBSIDIARY FOUNDATION 8,610,532. PART XII, LINE 2D - OTHER ADJUSTMENTS: ELIMINATION OF NET EXPENSE ACTIVITY OF SUBSIDIARY FOUNDATION 4,783,454. PART V, LINE 4: ENDOWMENT FUNDS ARE MAINTAINED BY A RELATED ORGANIZATION, HOSPICE OF DAYTON FOUNDATION (31-1769696). ENDOWMENT FUNDS ARE MAINTAINED BY THE FOUNDATION TO SUPPORT THE HOSPICE OF DAYTON, INC., THE FOUNDATION'S PARENT ORGANIZATION. IT IS THE FOUNDATION'S OBJECTIVE TO UTILIZE CURRENT FUNDRAISING TO SUPPORT PROGRAMS OF THE HOSPICE OF DAYTON, INC., TO GROW AND PROVIDE RESERVES FOR UNFORESEEN CIRCUMSTANCES, OR TO FUND SIGNIFICANT NEW INITIATIVES. THE BENEFICIAL INTEREST IN SUBSIDIARY FOUNDATION REPORTED ON SCHEDULE D, PART IX INCLUDES THE ENDOWMENT ASSETS SHOWN ON SCHEDULE D, PART V. X X 0 1 0 0 0 0 0 0 0 KENT ANDERSON PRESIDENT/CEO 302486 0 28248 0 0 0 56496 0 21942 0 409172 0 0 0 JERRY DURST CFO 164510 0 15750 0 0 0 22134 0 21942 0 224336 0 0 0 BRENDA HUMFLEET MKTG DIRECTOR/ HODF PRES. 185715 0 19065 0 0 0 22743 0 8720 0 236243 0 0 0 JULES SHERMAN CHIEF MEDICAL OFFICER 258857 0 0 0 0 0 6375 0 16799 0 282031 0 0 0 RUTH THOMSON VP OF MEDICAL SERVICES 313928 0 29350 0 0 0 23875 0 21942 0 389095 0 0 0 WENDY SCHMITZ ASSOC. MEDICAL DIRECTOR 230128 0 0 0 0 0 5862 0 21942 0 257932 0 0 0 CHIRAG PATEL PHYSICIAN 263438 0 0 0 0 0 6375 0 21942 0 291755 0 0 0 RANAPREET PATEL PHYSICIAN 230242 0 0 0 0 0 5752 0 0 0 235994 0 0 0 CLEANNE CASS PHYSICIAN 241258 0 0 0 0 0 5970 0 8525 0 255753 0 0 0 PART I, LINE 3 THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES UTILIZES LOCAL MARKET KNOWLEDGE, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE PRESIDENT/CEO. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE PRESIDENT/CEO UNDER GUIDELINES ESTABLISHED BY THE BOARD OF TRUSTEES AS PART OF THE BUDGET PROCESS. FORM 990, SCHEDULE J, PART I, ITEM 4B: CONTRIBUTIONS OF $17,500 EACH WERE MADE TO 457(B) DEFERRED COMPENSATION PLANS ON BEHALF OF K. ANDERSON, B. HUMFLEET, J. DURST, AND R. THOMSON. THE ORGANIZATION ALSO ACCRUED $38,996 UNDER AN UNFUNDED SUPPLEMENTAL RETIREMENT PLAN ON BEHALF OF K. ANDERSON. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF TRUSTEES IS PROVIDED A COPY OF FORM 990 TO REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES ANNUALLY REPORTS ON ANY ACTIVITY THAT COULD GIVE RISE TO POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 A & B THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES UTILIZES LOCAL MARKET KNOWLEDGE, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE PRESIDENT/CEO. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE PRESIDENT/CEO UNDER GUIDELINES ESTABLISHED BY THE BOARD OF TRUSTEES AS PART OF THE BUDGET PROCESS. FORM 990, PART VI, SECTION C, LINE 19 HOSPICE OF DAYTON, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON RECEIPT OF A WRITTEN REQUEST FOR SUCH INFORMATION. FORM 990, PART XI, LINE 9: CHANGE IN NET ASSETS OF BENEFICIAL INTEREST IN RELATED ENTITY (31-1769696) 3,827,078. FORM 990, PART XI, LINE 2C: THE BOARD OF TRUSTEES HAS CHARGED THE FINANCE COMMITTEE WITH OVERSIGHT OF THE INDEPENDENT AUDIT. THIS PROCESS IS CONSISTENT WITH THE PRIOR YEAR. FORM 990, PART IX, LINE 24F: ALL COMPENSATION OF EMPLOYEES OF HOSPICE OF DAYTON FOUNDATION (31-1769696) IS PAID BY HOSPICE OF DAYTON, INC. AND IS ALLOCATED TO THE FOUNDATION, CONSISTING OF $634,246.00 OF SALARIES, $62,072.00 OF EMPLOYEE BENEFITS AND $46,299.00 OF PAYROLL TAXES. IN ADDITION, $1,038,725.00 OF FOUNDATION ACTIVITIES AND $10,738.00 OF FOUNDATION OCCUPANCY COSTS WERE PAID BY THE HOSPICE OF DAYTON, INC. AND ALLOCATED TO THE FOUNDATION. ALL ALLOCATIONS ARE BASED ON ACTUAL COSTS OF FOUNDATION OPERATIONS. THE TOTAL AMOUNT ALLOCATED TO THE FOUNDATION IS $1,792,080.00. 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