2013-05-15T07:37:48-05:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2012-01-01 561452373 HOSPICE OF CLEVELAND COUNTY INC HOSP 7044874677 951 WENDOVER HEIGHTS DRIVE SHELBY NC 281503565 MYRA MCGINNIS 7044874677 2013-05-09 1 GREGORY W JOHNS P00535091 7049985200 2012 2016-02-24 21:20:13Z HOSPICE CLEVELAND COUNTY MYRA MCGINNIS 951 WENDOVER HEIGHTS DRIVE SHELBY NC 281503565 10711915 0 X WWW.HOSPICECARES.CC X 1984 NC HOSPICE OF CLEVELAND COUNTY PROVIDES CARE AND SUPPORT TO PATIENTS WITH A LIFE-LIMITING ILLNESS. 17 17 181 231 -698 0 398738 251474 10725372 10375761 43107 44486 37060 24208 11204277 10695929 0 0 0 0 5886211 5663466 0 0 0 4315243 4019580 10201454 9683046 1002823 1012883 17590193 18602734 1252838 1260267 16337355 17342467 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 5026146 7039794 HOSPICE CLEVELAND COUNTY PROVIDES COMPREHENSIVE END OF LIFE HEALTHCARE FOR TERMINALLY ILL PATIENTS AND THEIR FAMILIES DURING THE FINAL STAGES OF ILLNESS. DURING 2012, HOSPICE CLEVELAND COUNTY PROVIDED 43,010 DAYS OF HOMECARE INCLUDING 10,799 DAYS OF NURSING HOME AND HOSPITAL INPATIENT CARE. HOSPICE CLEVELAND COUNTY SERVED 571 HOMECARE PATIENTS IN 2012. HOSPICE CLEVELAND COUNTY'S INTERDISCIPLINARY TEAMS CONSISTING OF PHYSICIANS, NURSES, HOSPICE AIDES, SOCIAL WORKERS, AND OTHER SUPPORTIVE PERSONNEL PROVIDED OVER 34,101 VISITS DURING 2012. 2590196 3065998 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 2012, HOSPICE CLEVELAND COUNTY PROVIDED 8,012 DAYS OF CARE IN THESE FACILITIES. HOSPICE CLEVELAND COUNTY SERVED 389 PATIENTS IN THE HOSPICE HOUSES IN 2012. 723300 269969 PALLIATIVE CARE CLEVELAND COUNTY PROVIDES A PROGRAM OF PAIN CONTROL, SYMPTOM MANAGEMENT AND ASSISTANCE WITH DIFFICULT DECISION MAKING. DURING 2012, PALLIATIVE CARE CLEVELAND COUNTY SERVED 923 PATIENTS. 8339642 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 0 0 0 0 0 1 0 0 0 1 30 0 181 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 1.00 X X 0 0 0 ANDREA LESLIE-FITE 1.00 X 0 0 0 JENNIE LAMBERT 1.00 X X 0 0 0 EARL LUTZ 1.00 X X 0 0 0 STEVE PADGETT 1.00 X 0 0 0 JT SCRUGGS 1.00 X X 0 0 0 EDDIE HOLBROOK 1.00 X 0 0 0 KEN MILLER 1.00 X 0 0 0 PETE MOORE 1.00 X 0 0 0 DR MIKE RIBADENEYRA 1.00 X 0 0 0 RIT VARRIALE 1.00 X 0 0 0 DOUG SATTERFIELD 1.00 X X 0 0 0 BECKY BROWN 1.00 X 0 0 0 BRENDA LOVELACE 1.00 X 0 0 0 ROBBY REYNOLDS 1.00 X 0 0 0 PAMELA ENLOE 1.00 X 0 0 0 GREG MCINNIS 1.00 X 0 0 0 WILLIAM THOMPSON 1.00 X 0 0 0 JOSEPH TYSINGER 1.00 X 0 0 0 MYRA MCGINNIS 42.00 X 0 131435 41796 DR JAMES POTTS 48.60 X 175791 0 35510 DR SANGYA PATEL 42.80 X 209524 0 42324 385315 131435 119630 2 0 1 0 MORRISON CONSTRUCTION COMPANY INC PO BOX 1488 SHELBY NC 28151 CONSTRUCTION 309806 CLEVELAND COUNTY HEALTHCARE SYSTEM 201 E GROVER STREET SHELBY NC 28150 MANAGEMENT SERVICES 279382 2 104054 147420 251474 PATIENT REVENUE 621610 10375761 10375761 10375761 46773 46773 2287 -2287 -2287 -2287 49832 13699 36133 36133 -11925 -698 -11227 -11925 10695929 10375761 -698 69392 131435 131435 4578794 4121059 457735 109879 96135 13744 503623 440628 62995 339735 297240 42495 39319 39319 325881 71922 253959 31343 31343 118865 56383 62482 104897 26759 78138 247214 127844 119370 161391 156566 4825 22950 14559 8391 574947 574947 41894 41894 PURCHASED SERVICES 1235310 1235310 SUPPLIES 746643 746643 BAD DEBT EXPENSES 211438 211438 PROFESSIONAL FEES 26962 26962 130526 103904 26622 9683046 8339642 1343404 0 5613953 5356273 3003410 3033161 529981 424625 1017195 1015670 5667 6009 71189 63653 10323284 3109067 7340834 7214217 1477587 7964 11539 17590193 18602734 880957 880162 371881 380105 1252838 1260267 X 15609833 16712095 529981 424625 197541 205747 16337355 17342467 17590193 18602734 X 1012883 -25481 17710 X 0 1 X 1 0 X 1180647 923415 791778 398738 251474 3546052 1180647 923415 791778 398738 251474 3546052 324554 3221498 187882 85611 40682 43107 46773 404055 -70 -395 -2295 -698 -3458 10608 13028 -6019 3049 -2728 17938 3964587 49826527 0.81260 0.77260 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 463 463 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE ORGANIZATION BELONGS TO THE NATIONAL HOSPICE & PALLIATIVE CARE ORGANIZATION WHICH DETERMINED THAT 8.43% OF ITS PROVIDER DUES WERE USED FOR SPECIFIC LOBBYING PURPOSES. 238989 9968 22422 9968 261411 238989 238989 0.21000 0.79000 0 0 295737 295737 7729303 2011118 5718185 1625911 847939 777972 672333 250010 422323 7214217 ESTIMATED THIRD PARTY LIABILITY 380105 380105 X 10685961 0 10685961 9968 9968 10695929 9683046 0 9683046 0 9683046 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: PERMANENT ENDOWMENT FUND ($205,747) PLUS BOARD-DESIGNATED QUASI-ENDOWMENT FOREVER FUND ($55,665). DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION ADOPTED 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, 2012. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION FOR FOREVER FUND 9,968. VARIOUS 49832 49832 1250 5464 350 6635 49832 49832 1250 5464 350 6635 13699 36133 X 1 1 X X X 0 0 0 0 0 0 0 0 0 MYRA MCGINNIS 0 107901 0 15699 0 7835 0 0 0 41796 0 173231 0 0 DR JAMES POTTS 175241 0 550 0 0 0 0 0 35510 0 211301 0 0 0 DR SANGYA PATEL 208974 0 550 0 0 0 0 0 42324 0 251848 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. 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 CLEVELAND COUNTY HEATHCARE SYSTEM COMPLIANCE DIRECTOR. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION OF THE PRESIDENT/CEO AND SENIOR LEADERSHIP WAS LAST REVIEWED IN 2012. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: RESTRICTED PLEDGES RECEIVED 3,000. CHANGE IN DISCOUNT FOR PLEDGES RECEIVED 11,937. ALLOWANCE FOR UNCOLLECTIBLE PLEDGES -5,433. ENDOWMENT FUND 8,206. CLEVELAND REGIONAL MEDICAL CENTER 201 E GROVER ST SHELBY NC 28150 560654386 GOVERNMENTAL HOSPITAL NC 501(C)(3) 170(B)(1)(A)(III) 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 279382 CLEVELAND REGIONAL MEDICAL CENTER P 59359