2013-04-01T15:55:09-05:00 2012-12-31 521130974 ALBRIGHT CRUMBACKER MOUL & ITELL CPA'S 1110 PROFESSIONAL COURT SUITE 300 HAGERSTOWN MD 21740 990 2012-01-01 541126227 BLUE RIDGE HOSPICE INC BLUE 5405365210 333 WEST CORK STREET NO 405 WINCHESTER VA 22601 ERNEST J CARNEVALE JR 3017395300 2013-03-21 1 R KERT SHIPWAY P00349171 3017395300 2013-03-20 2012 2016-02-25 16:41:14Z ERNEST J CARNEVALE JR 333 WEST CORK STREET SUITE 405 WINCHESTER VA 22601 16243692 0 X WWW.BLUERIDGEHOSPICE.ORG X 1981 VA BLUE RIDGE HOSPICE'S MISSION IS TO MAKE QUALITY END-OF-LIFE CARE AVAILABLE TO INDIVIDUALS AND THEIR FAMILIES FACING SERIOUS ILLNESS AND TO SUPPORT ANYONE IN OUR COMMUNITY AFFECTED BY DEATH, DYING, AND LOSS. BLUE RIDGE HOSPICE PROVIDES PHYSICAL, EMOTIONAL, SOCIAL, AND SPIRITUAL CARE FOR TERMINALLY ILL PATIENTS AND THEIR FAMILIES IN THE REGIONS OF VIRGINIA CONSISTING OF THE CITY OF WINCHESTER AND COUNTIES OF FREDERICK, CLARKE, WARREN, FAUQUIER, SHENANDOAH, PAGE, RAPPAHANNOCK, AND WESTERN LOUDOUN. BLUE RIDGE HOSPICE PROVIDES AN EMPHASIS ON ENHANCING THE LIVES OF TERMINALLY ILL PERSONS. 18 18 243 906 0 0 2709704 2947657 13483134 12955639 63482 67195 109962 196755 16366282 16167246 0 0 0 0 8705009 8579253 0 0 2265749 7843143 7182501 16548152 15761754 -181870 405492 4946172 5324411 1653195 1506472 3292977 3817939 X SEE SCHEDULE "O" FOR MISSION STATEMENT. 0 0 9620794 12069295 THE ORGANIZATION PROVIDES MEDICAL AND OTHER RELATED SERVICES, SUCH AS NURSING CARE, SOCIAL WORK, CERTIFIED NURSING ASSISTANTS AND VOLUNTEER ASSISTANCE, TO THE TERMINALLY ILL AND THEIR FAMILIES WHO LIVE IN THE COUNTIES OF FREDERICK, CLARKE, WARREN, FAUQUIER, SHENANDOAH, WESTERN LOUDOUN, PAGE, RAPPAHANNOCK AND THE CITY OF WINCHESTER, VA. BLUE RIDGE HOSPICE SERVED OVER 1,109 PATIENTS IN 2012. THESE PATIENTS WERE SERVED REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES. 1341522 726217 BLUE RIDGE HOSPICE INPATIENT CARE CENTER SERVED OVER 200 PATIENTS IN 2012 IN THEIR FACILITY. THE PATIENTS STAY AT THE FACILITY FOR GENERAL INPATIENT LEVEL OF CARE OR FOR ASSISTED LIVING ROOM AND BOARD CARE. THESE PATIENTS WERE SERVED REGARDLESS OF THEIR ABILITY TO PAY FOR THEIR STAY AT THE INPATIENT CARE CENTER. THE CENTER PROVIDES ROOM AND BOARD, NURSING, SOCIAL WORK, CERTIFIED NURSING ASSISTANTS, MUSIC THERAPY, CHAPLAIN, AND VOLUNTEER SERVICES TO ITS PATIENTS. 298529 BLUE RIDGE HOSPICE PROVIDED BEREAVEMENT AND OUTREACH SERVICES, SUCH AS MUSIC THERAPY AND CHAPLAIN SERVICES TO THE POPULATION IN THE ENTIRE SERVICE AREA. BEREAVEMENT SERVICES ARE PROVIDED FREE OF CHARGE TO THE RESIDENTS IN THE BLUE RIDGE HOSPICE SERVICE AREA. MUSIC THERAPY AND CHAPLAIN SERVICES ARE PROVIDED AS AN UNREIMBURSED SERVICE TO HOSPICE PATIENTS. 740833 160127 PALLIATIVE MEDICINE CONSULTANTS STRIVE TO RELIEVE PHYSICAL, EMOTIONAL, AND SPIRITUAL PAIN, WHILE IMPROVING THE QUALITY OF LIFE FOR PATIENTS AND THEIR FAMILIES WHO ARE FACING SERIOUS ILLNESS. PALLIATIVE MEDICINE CONSULTANTS SERVED 482 PATIENTS AND MADE 1,625 VISITS IN 2012 AT THE HOSPITAL AND OUT-PATIENT CLINIC. 740833 160127 12001678 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 33 0 1 243 1 0 0 0 0 0 1 1 1 3 0 0 1 0 0 0 0 0 0 X 18 18 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X X CHERYL RINGER 5405365210 333 WEST CORK STREET SUITE 405 WINCHESTER VA 22601 ROBERT MOWERY CPA 0.00 X X 0 0 0 PAUL DELMERICO 0.00 X X 0 0 0 BETHANNE BERMAN 0.00 X X 0 0 0 NANCY PICKLAP CPA 0.00 X X 0 0 0 KATHY GUSTIN MD 0.00 X X 0 0 0 GEORGE CALEY 0.00 X X 0 0 0 JACKSON W HELM MD 0.00 X X 0 0 0 LYNNE SAYLES 0.00 X X 0 0 0 HELEN ZEBARTH 0.00 X X 0 0 0 CHRISTOPHER CURRAN 0.00 X 0 0 0 WANDA GILBERT 0.00 X 0 0 0 JOHN HARDESTY 0.00 X 0 0 0 MARY ANN KAPLAN 0.00 X 0 0 0 BRENDA MATTHEWS 0.00 X 0 0 0 SALLY MEGEATH 0.00 X 0 0 0 SHERRY THOMAS 0.00 X 0 0 0 JARED TRUBAN 0.00 X 0 0 0 LEONARD YANG MD 0.00 X 0 0 0 ERNEST J CARNEVALE JR 40.00 X X 194308 0 12052 CHERYL RINGER 40.00 X 115497 0 17020 PATRICIA BISHOP 40.00 X 123240 0 6049 RICHARD MILLIGAN 40.00 X 179068 0 17031 JACK WRIGHT 40.00 X 180405 0 12027 PATRICIA GRAY-IRWIN 40.00 X 123971 0 26 ANTHONY CROSEN 40.00 X 108170 0 17056 1024659 0 81261 7 0 1 0 ANTHEM PO BOX 580494 CHARLOTTE NC 282580494 HEATLH INSURANCE PROVIDER 1722054 HOSPISCRIPT LLC PO BOX 933273 ATLANTA GA 311933273 PHARMACY 462297 VALLEY HOME CARE PO BOX 1910 WINCHESTER VA 226048060 DURABLE MEDICAL SUPPLIER 440038 GULF SOUTH PO BOX 841968 DALLAS TX 752841968 MEDICAL SUPPLIES PROVIDER 216288 KEY RISK INSURANCE COMPANY PO BOX 18746 GREENSBORO NC 274198746 WORKERS COMPENSATION INSURANCE 163920 11 2947657 2947657 HOSPICE CARE 623990 12069295 12069295 INPATIENT CARE CENTER 623990 726217 726217 PALLIATIVE CARE 623990 160127 160127 12955639 59385 59385 7810 0 7810 7810 7810 226934 76446 150488 150488 OTHER 900099 46267 46267 46267 16167246 13001906 0 217683 X 327870 327870 7658355 6718600 675305 264450 16231 8338 7571 322 576797 485323 72391 19083 108341 53173 17345 37823 8405 666 6451 1288 423195 259923 81283 81989 174018 137372 23724 12922 384450 360582 20931 2937 3979 246 1982 1751 30216 22722 3747 3747 188936 163316 16586 9034 1301836 1087599 169798 44439 HOSPITAL SERVICES 92484 92484 THRIFT SHOP EXPENSES 1735271 1735271 PATIENT SERVICES - DRUG 618996 618996 EQUIPMENT RENTAL 492112 492112 1620262 1500226 69343 50693 15761754 12001678 1494327 2265749 547021 652551 39974 32391 27526 20819 1328449 1403853 1781 324 98152 104368 2123282 863716 1276231 1259566 1624254 1850539 2784 4946172 5324411 1194861 1037300 458334 469172 1653195 1506472 X 1998623 2525119 1294354 1292820 3292977 3817939 4946172 5324411 405492 129937 -10467 0 X X 0 1 X 1 0 X 1567436 1823183 2325866 2709704 2947657 11373846 1567436 1823183 2325866 2709704 2947657 11373846 11373846 61440 36944 45780 61723 59045 264932 6627 5162 7850 3713 5471 28823 11667601 62557486 0.97480 0.96620 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1134541 60928 60928 1134541 1134541 58219 58219 1134541 1134541 43477 43477 1134541 1134541 35300 35300 1134541 1134541 46948 46948 1134541 1.00000 0 0 93000 93000 229296 27934 201362 682494 149164 533330 975893 577826 398067 142599 108792 33807 1259566 CORPORATE BONDS 177379 F STOCK 71834 F MUTUAL FUNDS 1581450 F OTHER 19876 F 1850539 X 16412598 129937 125882 255819 16156779 10467 10467 16167246 15887636 125882 125882 15761754 0 15761754 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT IS DESIGNATED TO FUND FUTURE GROWTH AND CONSTRUCTION PROJECTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION COMPLIES WITH ASC 740-10 (FORMERLY FIN 48), WHICH ESTABLISHES A THRESHOLD FOR DETERMINING WHEN AN INCOME TAX BENEFIT OF A TAX POSITION CAN BE RECOGNIZED. UNDER ASC 740-10, A TAX POSITION INCLUDES, AMONG OTHER THINGS, (A) A DECISION NOT TO FILE A TAX RETURN (B) AN ALLOCATION OR A SHIFT OF INCOME BETWEEN JURISDICTIONS (C) THE CHARACTERIZATION OF INCOME OR A DECISION TO EXCLUDE REPORTING TAXABLE INCOME IN A TAX RETURN (D) A DECISION TO CLASSIFY A TRANSACTION, ENTITY, OR OTHER POSITION IN A TAX RETURN AS TAX EXEMPT AND (E) AN ENTITY'S STATUS, INCLUDING ITS STATUS AS A TAX-EXEMPT NOT-FOR-PROFIT ENTITY. BASED ON ITS INTERPRETATION OF THE REQUIREMENTS OF ASC 740-10, MANAGEMENT BELIEVES THAT THE ORGANIZATION HAS NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE. ACCORDINGLY, COMPLIANCE WITH THIS STANDARD HAD NO MATERIAL EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. 5K RUN 41835 41835 10333 GALA 125203 125203 40837 4 59896 59896 25276 226934 226934 76446 76446 150488 X 1 1 X X X 0 0 0 0 0 0 0 0 0 ERNEST J CARNEVALE JR 194308 0 0 0 0 0 61 0 11991 0 206360 0 0 0 RICHARD MILLIGAN 179068 0 0 0 0 0 53 0 16978 0 196099 0 0 0 JACK WRIGHT 180405 0 0 0 0 0 36 0 11991 0 192432 0 0 0 LYNNE SAYLES INVESTMENT BANKER/BOARD MEMBER NO DIRECT INVOLVEMENT 0 WANDA GILBERT EMPLOYEE OF VENDOR/LANDLORD/BOARD MEMBER NO DIRECT INVOLVEMENT 0 KATHY GUSTIN EMPLOYEE OF VENDOR/BOARD MEMBER NO DIRECT INVOLVEMENT 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS ARE ENGAGED IN VARIOUS BUSINESS ACTIVITIES THROUGHOUT THE COMMUNITY IN WHICH THEY ENTER INTO VENDOR RELATIONSHIPS. FORM 990, PART VI, SECTION B, LINE 11 BLUE RIDGE HOSPICE SENDS THE FORM 990 TO ALL BOARD MEMBERS VIA EMAIL PRIOR TO THE BOARD MEETING. THE BOARD MEMBERS THEN DISCUSS THE 990 DURING THE FOLLOWING MEETING. ANY BOARD MEMBERS WHO ARE NOT ABLE TO ATTEND THE NEXT MEETING ARE ENCOURAGED TO CALL WITH QUESTIONS OR COMMENTS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY ALL EMPLOYEES AND THE BOARD OF DIRECTORS ARE GIVEN A COPY OF BLUE RIDGE HOSPICE'S WRITTEN CONFLICT OF INTEREST POLICIES AND THEY ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT. EACH CONFLICT OR PERCEIVED CONFLICT ARE REVIEWED TO DETERMINE IF APPROPRIATE CONTROLS ARE IN PLACE TO MAINTAIN ARMS-LENGTH-TRANSACTIONS FOR SUCH RELATIONSHIPS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE ORGANIZATION'S CEO IS DETERMINED ON AN ANNUAL BASIS BY THE BOARD OF DIRECTORS DURING HIS ANNUAL EVALUATION PROCESS. THE BOARD UTILIZES VARIOUS SALARY SERVICES AND RESOURCES TO DETERMINE APPROPRIATE SALARIES FOR POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. ALL OTHER FUNCTIONAL EXPENSES FORM 990, PART IX, LINE 24E NURSING HOME: PROGRAM SERVICE EXPENSES 480,640. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 480,640. BAD DEBT: PROGRAM SERVICE EXPENSES 395,683. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 395,683. SUPPLIES - NURSING AND MEDICAL: PROGRAM SERVICE EXPENSES 219,103. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 219,103. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 99,453. MANAGEMENT AND GENERAL EXPENSES 37,383. FUNDRAISING EXPENSES 31,790. TOTAL EXPENSES 168,626. PATIENT SERVICES - THERAPY: PROGRAM SERVICE EXPENSES 138,252. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 138,252. PATIENT SERVICES - OTHER: PROGRAM SERVICE EXPENSES 58,273. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 58,273. PATIENT SERVICES - TRANSPORTATION: PROGRAM SERVICE EXPENSES 53,674. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,674. DUES AND SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 6,111. MANAGEMENT AND GENERAL EXPENSES 26,851. FUNDRAISING EXPENSES 3,300. TOTAL EXPENSES 36,262. HUMAN RESOURCES: PROGRAM SERVICE EXPENSES 20,161. MANAGEMENT AND GENERAL EXPENSES 3,010. FUNDRAISING EXPENSES 794. TOTAL EXPENSES 23,965. PUBLIC RELATIONS: PROGRAM SERVICE EXPENSES 975. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 13,097. TOTAL EXPENSES 14,072. PATIENT SERVICES - TESTS: PROGRAM SERVICE EXPENSES 10,900. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,900. VOLUNTEER: PROGRAM SERVICE EXPENSES 10,806. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,806. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 6,195. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,195. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,099. FUNDRAISING EXPENSES 1,712. TOTAL EXPENSES 3,811. THE ORGANIZATION HAS NOT CHANGED IT'S OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR.