IOWA CITY HOSPICE INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: IOWA CITY HOSPICE INC (EIN 42-1154098)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-07-09
IRS object ID: 201331909349300443
Schema version: 2012v2.1
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule G
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-07-09T14:13:33-05:00	Timestamp
Tax Period End Date	2012-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	WINKEL PARKER & FOSTER CPA PC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	1301 19TH AVE NW	AddressLine1
City	CLINTON	City
State	IA	State
ZIP Code	52732	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	421154098	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	IOWA CITY HOSPICE INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	IOWA	NameControl
Phone	3193515665	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1025 WADE STREET	AddressLine1
City	IOWA CITY	City
State	IA	State
ZIP Code	52240	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	MARGRET ELLIOTT	Name
Title	EXECUTIVE DIRECTOR	Title
Phone	3193515665	Phone
Date Signed	2013-06-28	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	PATRICK W PARKER CPA	Name
Phone	5632423440	Phone
Date Prepared	2013-07-01	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	MARGRET ELLIOTT	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	1025 WADE STREET	AddressLine1
City	IOWA CITY	City
State	IA	State
ZIP Code	52240	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	7109892	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.IOWACITYHOSPICE.COM	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1980	YearFormation
State Legal Domicile	IA	StateLegalDomicile
Activity Or Mission Description	TO BE THE LEADERS IN PROVIDING EXCEPTIONAL PATIENT-CENTERED, END-OF-LIFE CARE AND GRIEF SUPPORT TO ANYONE AFFECTED BY A TERMINAL ILLNESS.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	13	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	13	NbrIndependentVotingMembers
Total Nbr Employees	81	TotalNbrEmployees
Total Nbr Volunteers	200	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	548653	ContributionsGrantsPriorYear
Contributions Grants Current Year	661362	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	6509182	ProgramServiceRevenuePriorYear
Program Service Revenue CY	6408809	ProgramServiceRevenueCY
Investment Income Prior Year	29705	InvestmentIncomePriorYear
Investment Income Current Year	39721	InvestmentIncomeCurrentYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	7087540	TotalRevenuePriorYear
Total Revenue Current Year	7109892	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	3189506	SalariesEtcPriorYear
Salaries Etc Current Year	3313414	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	149415	TotalFundrsngExpCurrentYear
Other Expense Prior Year	3280321	OtherExpensePriorYear
Other Expenses Current Year	3506012	OtherExpensesCurrentYear
Total Expenses Prior Year	6469827	TotalExpensesPriorYear
Total Expenses Current Year	6819426	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	617713	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	290466	RevenuesLessExpensesCY
Total Assets BOY	4119267	TotalAssetsBOY
Total Assets EOY	4361298	TotalAssetsEOY
Total Liabilities BOY	1171160	TotalLiabilitiesBOY
Total Liabilities EOY	1009648	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	2948107	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	3351650	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	TO BE THE LEADERS IN PROVIDING EXCEPTIONAL PATIENT-CENTERED, END-OF-LIFE CARE AND GRIEF SUPPORT TO ANYONE AFFECTED BY A TERMINAL ILLNESS.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	5536577	Expense
Revenue	6408809	Revenue
Description	THE ORGANIZATION PROVIDES SERVICES TO THOSE FACING A LIFE LIMITING ILLNESS. IN 2012, 638 PATIENTS AND FAMILIES WERE SERVED IN OUR SEVEN COUNTY SERVICE AREA (CEDAR, IOWA, JOHNSON, LINN, LOUISA, MUSCATINE AND WASHINGTON COUNTIES) FOR A TOTAL OF 37,132 DAYS OF CARE. IN ADDITION TO OUR PROFESSIONAL STAFF, IOWA CITY HOSPICE VOLUNTEERS PROVIDE SERVICES THAT ARE AS VARIED AS THE PATIENTS, FAMILIES AND COMMUNITIES WE SERVE. PATIENT CARE VOLUNTEERS PROVIDE COMPANIONSHIP AND SUPPORT TO TERMINALLY ILL PATIENTS AND THEIR LOVED ONES. VOLUNTEERS PROVIDE MANY FORMS OF ASSISTANCE, AT ALL LEVELS OF SKILL. OUR 200 PATIENT CARE VOLUNTEERS PROVIDED 10,000 HOURS OF SUPPORTIVE SERVICES TO THOSE WE SERVED IN 2012. FOLLOWING A PATIENT'S DEATH, IOWA CITY HOSPICE BEREAVEMENT STAFF IS AVAILABLE TO SUPPORT FAMILY MEMBERS AND FRIENDS THROUGHOUT THE GRIEVING PROCESS. OUR SERVICES ARE ALSO AVAILABLE TO ANYONE WHO IS GRIEVING THE LOSS OF A LOVED ONE, REGARDLESS OF WHETHER THE PERSON WAS IN HOSPICE CARE. IOWA CITY HOSPICE OFFERS A VARIETY OF GRIEF SUPPORT SERVICES INCLUDING SUPPORT GROUPS, GRIEF EDUCATION, AND SPECIAL EVENTS. IOWA CITY HOSPICE STAFF MADE 155 HOME VISITS TO SURVIVORS; MADE 872 PHONE CONNECTIONS; AND, HAD 369 ATTENDEES AT OUR SUPPORT GROUPS, BEREAVEMENT LUNCHEONS AND MEMORIAL SERVICES. INCLUDED IN OUR BEREAVEMENT SERVICES ARE SPECIALIZED CARE TO CHILDREN AND YOUTH. MANY CHILDREN AND YOUTH FIND COMFORT AND SECURITY THROUGH GRIEF- SUPPORT GROUPS WHERE EVERYONE PARTICIPATING SHARES ONE COMMON ELEMENT: SOMEONE THEY LOVE HAS DIED. IOWA CITY HOSPICE OFFERS THREE UNIQUE GROUPS FOR CHILDREN, YOUTH AND THEIR PARENTS/CAREGIVERS WHO HAVE EXPERIENCED THE LOSS OF A LOVED ONE. OVER THE 10 MONTH PERIOD THESE GROUPS MET IN 2012, 85 CHILDREN, YOUTH AND ADULTS ATTENDED.	Description
Total Program Service Expense	5536577	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	true	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	true	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	true	ReportFin48Footnote
Independent Audit Financial Stmt	true	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	true	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	false	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	3	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	81	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Form8899 Filed	false	Form8899Filed
Form1098 C Filed	false	Form1098CFiled
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	13	NbrVotingGoverningBodyMembers
Number Independent Voting Members	13	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	MARGRET ELLIOTT	NamePerson
Telephone Number	3196884212	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1025 WADE STREET	AddressLine1
City	IOWA CITY	City
State	IA	State
ZIP Code	52240	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer
MARY ADAMEK
DIRECTOR	1.00	X	0	0	0
TARA CLARK
DIRECTOR	1.00	X	0	0	0
DEAN CARRINGTON
DIRECTOR	1.00	X	0	0	0
ALLISON LAW
DIRECTOR	1.00	X	0	0	0
ELIZABETH COULTER
SECRETARY	1.00	X	0	0	0	X
BRAD LANGGUTH
DIRECTOR	1.00	X	0	0	0
ELI WYNES
DIRECTOR	1.00	X	0	0	0
LORI LEGGINS
CHAIR-ELECT	1.00	X	0	0	0	X
CINDY PENNEY
CHAIR	1.00	X	0	0	0	X
STEVE ROE
PAST-CHAIR	1.00	X	0	0	0	X
DOUG RUPPERT
DIRECTOR	1.00	X	0	0	0
BRUCE VANHOUWELING
DIRECTOR	1.00	X	0	0	0
MIKE MESSIER
TREASURER	1.00	X	0	0	0	X
MAGGIE ELLIOT
EXECUTIVE DI	40.00		87501	0	10409	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	87501	TotalReportableCompFromOrg
Total Other Compensation	10409	TotalOtherCompensation
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
Fundraising Events	279829	FundraisingEvents
All Other Contributions	381533	AllOtherContributions
Total Contributions	661362	TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICARE/MEDICAID PAYMENTS	5951380	5951380
PRIVATE INSURANCE	457429	457429

Field	Value	IRS element (for citing)
Total Program Service Revenue	6408809	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	39721	TotalRevenueColumn
Exclusion	$39,721	ExclusionAmount

Field	Value	IRS element (for citing)
Cntrbtns Rprtd Fundraising Events	279829	CntrbtnsRprtdFundraisingEvents

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	7109892	TotalRevenueColumn
Related Or Exempt Function Income	6408809	RelatedOrExemptFunctionIncome
Exclusion	$39,721	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	97910	Total
Program Services	14686	ProgramServices
Management And General	78328	ManagementAndGeneral
Fundraising	4896	Fundraising

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	2660933	Total
Program Services	1975955	ProgramServices
Management And General	628148	ManagementAndGeneral
Fundraising	56830	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	328606	Total
Program Services	245697	ProgramServices
Management And General	76033	ManagementAndGeneral
Fundraising	6876	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	225965	Total
Program Services	163534	ProgramServices
Management And General	57399	ManagementAndGeneral
Fundraising	5032	Fundraising

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	10950	Total
Management And General	10950	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	37387	Total
Program Services	37387	ProgramServices

Advertising Advertising

Field	Value	IRS element (for citing)
Total	108230	Total
Program Services	53336	ProgramServices
Management And General	54894	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	202404	Total
Program Services	68928	ProgramServices
Management And General	133476	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	18532	Total
Management And General	18532	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	151648	Total
Program Services	143024	ProgramServices
Management And General	8624	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	36691	Total
Program Services	36691	ProgramServices

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	175212	Total
Program Services	145912	ProgramServices
Management And General	29300	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices
MEDICAL SUPPLIES	852160	852160
NURSING HOME FEES	695474	695474
HOSPITAL INPATIENT	508891	508891
MEDICATIONS	431431	431431

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	277002	Total
Program Services	163471	ProgramServices
Management And General	37750	ManagementAndGeneral
Fundraising	75781	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	6819426	Total
Program Services	5536577	ProgramServices
Management And General	1133434	ManagementAndGeneral
Fundraising	149415	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	1410	BOY
EOY	1711	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	1284818	BOY
EOY	1236129	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	619747	BOY
EOY	687489	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	5184	BOY
EOY	14340	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	1845801	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	880434	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	1119079	BOY
EOY	965367	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	1089029	BOY
EOY	1456262	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	4119267	BOY
EOY	4361298	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	434706	BOY
EOY	374074	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	736454	BOY
EOY	635574	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	1171160	BOY
EOY	1009648	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	2925438	BOY
EOY	3339374	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	22669	BOY
EOY	12276	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	2948107	BOY
EOY	3351650	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	4119267	BOY
EOY	4361298	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	290466	ReconcilationRevenueExpenses
Reconcilation Other Changes	113077	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org170b1 Avi	X	PubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	900918	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	624865	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	607518	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	548653	CurrentTaxYearMinus1Year
Current Tax Year	661362	CurrentTaxYear
Total	3343316	Total

Total170 Total170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	900918	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	624865	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	607518	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	548653	CurrentTaxYearMinus1Year
Current Tax Year	661362	CurrentTaxYear
Total	3343316	Total

Field	Value	IRS element (for citing)
Public Support Total170	3343316	PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	28704	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	25090	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	24591	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	29705	CurrentTaxYearMinus1Year
Current Tax Year	39721	CurrentTaxYear
Total	147811	Total

Field	Value	IRS element (for citing)
Total Support	3491127	TotalSupport
Gross Receipts From Admissions Etc	6408809	GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage170	0.95770	PublicSupportPertcentage170
Public Support Pertcent Prior Year	0.96290	PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170	X	ThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	1089029	BeginningOfYearBalance
Contributions	244364	Contributions
Investment Earnings Or Losses	140828	InvestmentEarningsOrLosses
Administrative Expenses	17959	AdministrativeExpenses
End Of Year Balance	1456262	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	718262	BeginningOfYearBalance
Contributions	368748	Contributions
Investment Earnings Or Losses	14848	InvestmentEarningsOrLosses
Administrative Expenses	12829	AdministrativeExpenses
End Of Year Balance	1089029	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	632184	BeginningOfYearBalance
Contributions	13860	Contributions
Investment Earnings Or Losses	81806	InvestmentEarningsOrLosses
Administrative Expenses	9588	AdministrativeExpenses
End Of Year Balance	718262	EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	522800	BeginningOfYearBalance
Contributions	620	Contributions
Investment Earnings Or Losses	117575	InvestmentEarningsOrLosses
Administrative Expenses	8811	AdministrativeExpenses
End Of Year Balance	632184	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	1.00000	BoardDesignatedEOYBalance
Endowments Held By Unrelated Orgs	true	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	false	EndowmentsHeldByRelatedOrgs

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	140000	OtherCostOrOtherBasis
Book Value	140000	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	500401	OtherCostOrOtherBasis
Depreciation	211354	Depreciation
Book Value	289047	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1205400	OtherCostOrOtherBasis
Depreciation	669080	Depreciation
Book Value	536320	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	965367	TotalOfBookValueLandBuildings

Other Assets OtherAssets

Field	Value	IRS element (for citing)
Description	BENEFICIAL INTEREST IN ENDOWMENT	Description
Book Value	1456262	BookValue

Field	Value	IRS element (for citing)
Total Book Value Other Assets	1456262	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescription	AmountAmount
LEASE PAYABLE	$483,834
ACCRUED PTO	$135,358
ACCRUED WAGES	$16,382

Field	Value	IRS element (for citing)
Total Of Amounts	635574	TotalOfAmounts
Footnote In Part XIII	X	FootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt	7222969	TotRevenueEtcAuditedFinclStmt
Other Revenues	113077	OtherRevenues
Revenue Not Rptd F990	113077	RevenueNotRptdF990
Revenue Subtotal	7109892	RevenueSubtotal
Total Revenue Per Form990	7109892	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	6819426	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	6819426	ExpensesSubtotal
Total Expenses Per Form990	6819426	TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
INTENDED USES FOR ENDOWMENT FUNDS	SCHEDULE D, PAGE 2, PART V, LINE 4	THE ENDOWMENT FUND WAS ESTABLISHED TO SERVE AS THE REPOSITORY OF GIFTS SPECIFICALLY DESIGNATED TO SUCH FUND. THE FUND IS MAINTAINED IN PERPETUITY. ANNUALLY THE BOARD OF DIRECTORS DETERMINE WHAT PORTION OF THE NET APPRECIATION OF THE ENDOWMENT FUND WILL BE MADE AVAILABLE TO THE ORGANIZATION FOR OPERATIONAL PURPOSES.
LIABILITY UNDER FIN 48 FOOTNOTE	SCHEDULE D, PAGE 3, PART X	THE ORGANIZATION ADOPTED THE FASB'S REQUIREMENTS FOR ACCOUNTING FOR UNCERTAIN TAX POSITIONS ON JANUARY 1, 2009. THE ORGANIZATION DETERMINED THAT IT WAS NOT REQUIRED TO RECORD A LIABILITY RELATED TO CERTAIN TAX POSITIONS AS A RESULT OF IMPLEMENTING THE NEW REQUIREMENTS.
REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER	SCHEDULE D, PAGE 4, PART XI, LINE 2D	CHANGE IN BENEFICIAL INTEREST IN ASSETS HELD BY COMM FOUND 113,077

Schedule G IRS990ScheduleG

Events Information EventsInformation

Field	Value	IRS element (for citing)
Name Of Event1	990PTVIII1C	NameOfEvent1
Gross Receipts Event1	279829	GrossReceiptsEvent1
Charitable Contributions Event1	279829	CharitableContributionsEvent1
Gross Receipts Total	279829	GrossReceiptsTotal
Charitable Contributions Total	279829	CharitableContributionsTotal

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
FIRST ACCOMPLISHMENT DESCRIPTION	FORM 990, PAGE 2, PART III, LINE 4A	FOLLOWING A PATIENT'S DEATH, IOWA CITY HOSPICE BEREAVEMENT STAFF IS AVAILABLE TO SUPPORT FAMILY MEMBERS AND FRIENDS THROUGHOUT THE GRIEVING PROCESS. OUR SERVICES ARE ALSO AVAILABLE TO ANYONE WHO IS GRIEVING THE LOSS OF A LOVED ONE, REGARDLESS OF WHETHER THE PERSON WAS IN HOSPICE CARE. IOWA CITY HOSPICE OFFERS A VARIETY OF GRIEF SUPPORT SERVICES INCLUDING SUPPORT GROUPS, GRIEF EDUCATION, AND SPECIAL EVENTS. IOWA CITY HOSPICE STAFF MADE 155 HOME VISITS TO SURVIVORS; MADE 872 PHONE CONNECTIONS; AND, HAD 369 ATTENDEES AT OUR SUPPORT GROUPS, BEREAVEMENT LUNCHEONS AND MEMORIAL SERVICES. INCLUDED IN OUR BEREAVEMENT SERVICES ARE SPECIALIZED CARE TO CHILDREN AND YOUTH. MANY CHILDREN AND YOUTH FIND COMFORT AND SECURITY THROUGH GRIEF- SUPPORT GROUPS WHERE EVERYONE PARTICIPATING SHARES ONE COMMON ELEMENT: SOMEONE THEY LOVE HAS DIED. IOWA CITY HOSPICE OFFERS THREE UNIQUE GROUPS FOR CHILDREN, YOUTH AND THEIR PARENTS/CAREGIVERS WHO HAVE EXPERIENCED THE LOSS OF A LOVED ONE. OVER THE 10 MONTH PERIOD THESE GROUPS MET IN 2012, 85 CHILDREN, YOUTH AND ADULTS ATTENDED.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	THE EXECUTIVE DIRECTOR EMAILS THE FINAL COPY OF THE FORM 990 TO THE EXECUTIVE COMMITTEE TO REVIEW BEFORE IT IS FILED.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	ALL BOARD MEMBERS AND EMPLOYEES ARE REQUIRED TO DECLARE ALL CONFLICTS AT LEAST ANNUALLY.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	THE ORGANIZATION'S HUMAN RESOURCE SPECIALIST EVALUATES THE PAY RANGE OF THE EXECUTIVE DIRECTOR ANNUALLY USING COMPARATIVE DATA. PAY RANGES FOR THE ORGANIZATION ARE APPROVED BY IOWA CITY HOSPICE'S PERSONNEL COMMITTEE. THIS INFORMATION IS TAKEN INTO ACCOUNT WHEN THE EXECUTIVE DIRECTOR IS EVALUATED ANNUALLY BY THE ENTIRE BOARD OF DIRECTORS. ANY CHANGES TO THE COMPENSATION ARE APPROVED THROUGH THE BUDGETING PROCESS; REVIEWED AND APPROVED BY FIRST THE FINANCE COMMITTEE AND THEN THE IOWA CITY HOSPICE BOARD OF DIRECTORS. COMMITTEE WORK HAPPENS THE SECOND HALF OF THE YEAR FOR IMPLEMENTATION IN THE SUBSEQUENT JANUARY.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	THERE ARE NO OTHER OFFICERS OR BOARD MEMBERS THAT ARE COMPENSATED.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	IOWA CITY HOSPICE MAKES THEIR GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND FORM 990 AVAILABLE TO THE PUBLIC THROUGH REQUEST DURING NORMAL OPERATING HOURS.
RECONCILIATION OF CHANGES - OTHER	FORM 990, PART XI, LINE 9	CHANGE IN BENEFICIAL INTEREST IN ASSETS HELD BY COMM FOUND 113,077

IOWA CITY HOSPICE INC: Form 990, tax year 2012

Return header ReturnHeader

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Preparer Firm US Address PreparerFirmUSAddress

Filer Filer

Name Name

US Address USAddress

Officer Officer

Preparer Preparer

Form 990 IRS990

Address Principal Officer US AddressPrincipalOfficerUS

The Books Are In Care Of TheBooksAreInCareOf

Address US AddressUS

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

Program Service Revenue ProgramServiceRevenue (2 entries)

Investment Income InvestmentIncome

Total Revenue TotalRevenue

Comp Current Officers Directors CompCurrentOfficersDirectors

Other Salaries And Wages OtherSalariesAndWages

Other Employee Benefits OtherEmployeeBenefits

Payroll Taxes PayrollTaxes

Fees For Services Accounting FeesForServicesAccounting

Fees For Services Other FeesForServicesOther

Advertising Advertising

Office Expenses OfficeExpenses

Occupancy Occupancy

Travel Travel

Interest Interest

Depreciation Depletion DepreciationDepletion

Other Expenses OtherExpenses (4 entries)

All Other Expenses AllOtherExpenses

Total Functional Expenses TotalFunctionalExpenses

Cash Non Interest Bearing CashNonInterestBearing

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Pledges And Grants Receivable PledgesAndGrantsReceivable

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Other Assets Total OtherAssetsTotal

Total Assets TotalAssets

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Other Liabilities OtherLiabilities

Total Liabilities TotalLiabilities

Unrestricted Net Assets UnrestrictedNetAssets

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Schedule A IRS990ScheduleA

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

Total170 Total170

Gross Investment Income170 GrossInvestmentIncome170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Contributor Name Business ContributorNameBusiness

Contributor Address US ContributorAddressUS

Schedule D IRS990ScheduleD

Current Year CurrentYear

Current Year Minus1 Year CurrentYearMinus1Year

Current Year Minus2 Years CurrentYearMinus2Years

Current Year Minus3 Years CurrentYearMinus3Years

Land Land

Buildings Buildings

Equipment Equipment

Other Assets OtherAssets

Other Liabilities OtherLiabilities (3 entries)

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

Schedule G IRS990ScheduleG

Events Information EventsInformation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Comments