HOSPICE ALLIANCE INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
HOSPICE ALLIANCE INC (EIN 39-1403883)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-08-29
IRS object ID
201332419349300753
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-29T15:19:12-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ANDREA & ORENDORFF LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line16300 76TH ST STE 200AddressLine1
CityKENOSHACity
StateWIState
ZIP Code531424018ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN391403883EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOSPICE ALLIANCE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHOSPNameControl
Phone2626524400Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line110220 PRAIRIE RIDGE BLVDAddressLine1
CityPLEASANT PRAIRIECity
StateWIState
ZIP Code53158ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHAEL LANGENDORFName
TitlePRESIDENTTitle
Phone2626524400Phone
Date Signed2013-08-08DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameALLISON WRIGHTName
Phone2626577716Phone
Date Prepared2013-08-09DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMICHAEL LANGENDORFNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line110220 PRAIRIE RIDGE BLVDAddressLine1
CityPLEASANT PRAIRIECity
StateWIState
ZIP Code53158ZIPCode
FieldValueIRS element (for citing)
Gross Receipts11158900GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.HOSPICEALLIANCE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1981YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionHOSPICE ALLIANCE HAS SERVED OVER 8,000 TERMINALLY ILL PATIENTS AND THEIR FAMILIES SINCE 1981; SERVICING KENOSHA, EASTERN WALWORTH, AND RACINE COUNTIES. HOSPICE ALLIANCE REMAINS COMMITTED TO CARING FOR THE TERMINALLY ILL AND EMPOWERING THOSE WHO SUPPORT THEM. INCORPORATED IN 1981 IN KENOSHA, WISCONSIN, HOSPICE ALLIANCE, INC. WAS ESTABLISHED BY A GROUP OF COMMUNITY CITIZENS THAT WERE CONCERNED WITH THE LACK OF END OF LIFE CARE AVAILBLE TO TERMINALLY ILL PERSONS AND THEIR FAMILIES. THESE COMMUNITY CITIZENS BELIEVED THAT IF TERMINALLY ILL PEOPLE WERE GIVEN A CHOICE AS TO WHERE THEY WOULD LIKE TO BE, IT WOULD BE IN THEIR HOME SURROUNDED BY THE PEOPLE AND THINGS THEY LOVE. HOSPICE ALLIANCE, INC. LIVES THIS MISSION DAILY THROUGH COMMITMENT, COMPASSION, AND CHOICES. HOSPICE ALLIANCE, INC. PROVIDES CARE IN THE FOLLOWING SETTINGS: 1. IN THE PATIENT'S HOME, SURROUNDED BY THE PEOPLE AND THINGS THEY LOVE. THIS CHOICE ALLOWS FAMILY AND FRIENDS TO SUPPORT THEIR LOVED ONE IN COMFORT AND PRIVACY. 2. INActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees142TotalNbrEmployees
Total Nbr Volunteers191TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year316895ContributionsGrantsPriorYear
Contributions Grants Current Year257093ContributionsGrantsCurrentYear
Program Service Revenue Prior Year9429592ProgramServiceRevenuePriorYear
Program Service Revenue CY10818487ProgramServiceRevenueCY
Investment Income Prior Year3276InvestmentIncomePriorYear
Investment Income Current Year1501InvestmentIncomeCurrentYear
Other Revenue Prior Year89762OtherRevenuePriorYear
Other Revenue Current Year81819OtherRevenueCurrentYear
Total Revenue Prior Year9839525TotalRevenuePriorYear
Total Revenue Current Year11158900TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year500000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2000000GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year5080232SalariesEtcPriorYear
Salaries Etc Current Year5384759SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3810596OtherExpensePriorYear
Other Expenses Current Year3892165OtherExpensesCurrentYear
Total Expenses Prior Year9390828TotalExpensesPriorYear
Total Expenses Current Year11276924TotalExpensesCurrentYear
Revenues Less Expenses Prior Year448697RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-118024RevenuesLessExpensesCY
Total Assets BOY3494421TotalAssetsBOY
Total Assets EOY3558732TotalAssetsEOY
Total Liabilities BOY761446TotalLiabilitiesBOY
Total Liabilities EOY943781TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2732975NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2614951NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionHOSPICE ALLIANCE HAS SERVED OVER 8,000 TERMINALLY ILL PATIENTS AND THEIR FAMILIES SINCE 1981; SERVICING KENOSHA, EASTERN WALWORTH, AND RACINE COUNTIES. HOSPICE ALLIANCE REMAINS COMMITTED TO CARING FOR THE TERMINALLY ILL AND EMPOWERING THOSE WHO SUPPORT THEM. INCORPORATED IN 1981 IN KENOSHA, WISCONSIN, HOSPICE ALLIANCE, INC. WAS ESTABLISHED BY A GROUP OF COMMUNITY CITIZENS THAT WERE CONCERNED WITH THE LACK OF END OF LIFE CARE AVAILBLE TO TERMINALLY ILL PERSONS AND THEIR FAMILIES. THESE COMMUNITY CITIZENS BELIEVED THAT IF TERMINALLY ILL PEOPLE WERE GIVEN A CHOICE AS TO WHERE THEY WOULD LIKE TO BE, IT WOULD BE IN THEIR HOME SURROUNDED BY THE PEOPLE AND THINGS THEY LOVE. HOSPICE ALLIANCE, INC. LIVES THIS MISSION DAILY THROUGH COMMITMENT, COMPASSION, AND CHOICES. HOSPICE ALLIANCE, INC. PROVIDES CARE IN THE FOLLOWING SETTINGS: 1. IN THE PATIENT'S HOME, SURROUNDED BY THE PEOPLE AND THINGS THEY LOVE. THIS CHOICE ALLOWS FAMILY AND FRIENDS TO SUPPORT THEIR LOVED ONE IN COMFORT AND PRIVACY. 2. INMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense9796320Expense
Grants2000000Grants
Revenue11158900Revenue
DescriptionHOSPICE ALLIANCE PROVIDED 63,991 DAYS OF SERVICE WHICH INCLUDES, 2,117 DAYS OF RESIDENTIAL HOSPICE CARE IN OUR HOSPICE HOUSE AND 4,537 DAYS OF HOME HEALTH CARE IN 2012.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense63210Expense
DescriptionBEREAVEMENT SERVICES - HOSPICE ALLIANCE BEREAVEMENT SERVICES ARE AVAILABLE FOR 13 MONTHS FOLLOWING THE DEATH OF A LOVED ONE. COUNSELORS COMMUNICATE REGULARLY WITH FAMILY MEMBERS, FACILITATE SUPPORT GROUPS AND COORDINATE THE SOCIAL GROUP GATHERINGS. THE BEREAVEMENT DEPARTMENT ALSO HOLDS SEMI-ANNUAL MEMORIAL SERVICES AND PLANS THE ANNUAL GRIEF TELECONFERENCE. MOST IMPORTANTLY, BEREAVEMENT SERVICES ARE AVAILABLE TO ALL IN THE COMMUNITY, NOT JUST THOSE WHO HAVE LOST A LOVED ONE WHILE IN HOSPICE CARE.Description
FieldValueIRS element (for citing)
Total Program Service Expense9859530TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationtrueBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109647NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees142NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonLAWRENCE HAASNamePerson
Telephone Number2626524400TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line110220 PRAIRIE RIDGE BLVDAddressLine1
CityPLEASANT PRAIRIECity
StateWIState
ZIP Code53158ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
CONNIE MATTER
EXEC DIRECTO45.00XX11123700
RITA HAGEN RN MSN
EXEC DIRECTR45.00XX3646400
JOSHUA BLOOM MD
MEDICAL DIR20.00X3275000
RICHARD REGNER
PAST PRESIDE0.50X000
ESTHER LETVEN
PAST PRESIDE0.50XX000
ROBERT BICHLER
MEMBER0.50X000
CHUCK DUFORD
VICE PRESIDE1.00XX000
DANIEL HEYDEN CPA
SEC / TREAS1.00XX000
MICHAEL LANGENDORF
PRESIDENT1.00XX000
SCOTT MCARTHEY
MEMBER0.50X000
MARY ANN CARDINALI RN
MEMBER0.50X000
KATHLEEN NUZZO
MEMBER0.50X000
GENE OLSON
MEMBER0.50X000
JERRY BAIN
MEMBER0.50X000
NANCY PIASECKI
MEMBER0.50X000
PAMELA THOMEY
MEMBER0.50X000
MICHAEL HAUBRICH
MEMBER0.50X000
DAVID KNIGHT MD
MEMBER0.50X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org180451TotalReportableCompFromOrg
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Related Organizations188997RelatedOrganizations
Government Grants18096GovernmentGrants
All Other Contributions50000AllOtherContributions
Noncash Contributions188997NoncashContributions
Total Contributions257093TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE1029921110299211
HOSPICE HOUSE REVENUE519276519276
FieldValueIRS element (for citing)
Total Program Service Revenue10818487TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1501TotalRevenueColumn
Related Or Exempt Function Income1501RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ADMINISTRATION FEES-FDN6430164301
OTHER REVENUE95809580
SUPPORT & SUPPLIES-FDN79387938
FieldValueIRS element (for citing)
Total Other Revenue81819TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11158900TotalRevenueColumn
Related Or Exempt Function Income10901807RelatedOrExemptFunctionIncome

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total2000000Total
Program Services2000000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total180451Total
Program Services32750ProgramServices
Management And General147701ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4257681Total
Program Services3695130ProgramServices
Management And General562551ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total624455Total
Program Services552588ProgramServices
Management And General71867ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total322172Total
Program Services270614ProgramServices
Management And General51558ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total18373Total
Management And General18373ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total11330Total
Management And General11330ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total74466Total
Program Services65710ProgramServices
Management And General8756ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total52467Total
Program Services6396ProgramServices
Management And General46071ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total150825Total
Program Services133936ProgramServices
Management And General16889ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total46085Total
Management And General46085ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total387400Total
Program Services115689ProgramServices
Management And General271711ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total276193Total
Program Services231982ProgramServices
Management And General44211ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total42630Total
Management And General42630ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total51500Total
Management And General51500ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PATIENT MEDICAL EXPENSES26461612646161
MEDICAL SUPPLIES8525785257
REPAIRS/MAINTENANCE1822518225
DUES/SUBSCRIPTIONS1677716777

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total14476Total
Program Services6540ProgramServices
Management And General7936ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total11276924Total
Program Services9859530ProgramServices
Management And General1417394ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2112965BOY
EOY1965330EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY55166BOY
EOY55360EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1092271BOY
EOY1276683EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY23001BOY
EOY21812EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY71298BOY
EOY82567EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis835234LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec678254LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY139720BOY
EOY156980EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY3494421BOY
EOY3558732EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY401983BOY
EOY526441EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY359463BOY
EOY417340EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY761446BOY
EOY943781EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2732975BOY
EOY2614951EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2732975BOY
EOY2614951EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3494421BOY
EOY3558732EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-118024ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years199897CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years204307CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years204304CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year316895CurrentTaxYearMinus1Year
Current Tax Year257093CurrentTaxYear
Total1182496Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7782226CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8804959CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9652971CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9522630CurrentTaxYearMinus1Year
Current Tax Year10901807CurrentTaxYear
Total46664593Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7982123CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9009266CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9857275CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9839525CurrentTaxYearMinus1Year
Current Tax Year11158900CurrentTaxYear
Total47847089Total
FieldValueIRS element (for citing)
Public Support Total50947847089PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years24467CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6856CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4799CurrentTaxYearMinus2Years
Total36122Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years24467CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6856CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4799CurrentTaxYearMinus2Years
Total36122Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8006590CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9016122CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9862074CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9839525CurrentTaxYearMinus1Year
Current Tax Year11158900CurrentTaxYear
Total47883211Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99920PublicSupportPercentage509
Prior Year Support Percentage0.99870PriorYearSupportPercentage
Investment Income Percentage0.00000InvestmentIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$559OtherActivitiesAmount
Total Lobbying Expenditures IIB559TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
SCHEDULE C, PART I-A, LINE 1HOSPICE ALLIANCE, INC. IS NOT DIRECTLY INVOLVED WITH ANY LOBBYING OR POLICITCAL CAMPAIGN ACTIVITES. THE ORGANIZATION PAYS ANNUAL DUES TO PROFESSIONAL ASSOCIATIONS THAT USE A PORTION OF THOSE MEMBERSHIP DUES FOR LOBBYING ACTIVITES.
SCHEDULE C, PART II-B, LINE 1THE NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION (NHPCO) IS AN ORGANIZATION THAT LEADS AND MOBILIZES SOCIAL CHANGE FOR IMPROVED CARE AT THE END OF LIFE. HOSPICE ALLIANCE, INC. IS A MEMBER OF THE NHPCO. NHPCO SAYS THAT 8.1% OF DUES ARE FOR LOBBYING PURPOSES, WHICH EQUATES TO 504 FOR THE YEAR. THE STATE ORGANIZATION, CALLED HOPE, DOES NOT USE MEMBERSHIP DUES FOR LOBBYING PURPOSES. THE NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE (NAHC)IS A PROFESSIONAL ASSOCIATION REPRESENTING THE INTERESTS OF AMERICANS WHO NEED HOME HEALTH CARE AND THE CAREGIVERS THAT PROVIDE THEM WITH IN-HOME HEALTH AND SUPPORTIVE SERVICES. NAHC SAYS THAT 55 OF HOSPICE ALLIANCE'S MEMBERSHIP DUES ARE FOR LOBBYING PURPOSES.

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis32960OtherCostOrOtherBasis
Book Value32960BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis802274OtherCostOrOtherBasis
Depreciation678254Depreciation
Book Value124020BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings156980TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
ACCRUED PAYROLL$225,549
ACCRUED VACATION$159,621
DEFERRED REVENUE$32,170
FieldValueIRS element (for citing)
Total Of Amounts417340TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt11158900TotRevenueEtcAuditedFinclStmt
Revenue Subtotal11158900RevenueSubtotal
Total Revenue Per Form99011158900TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt11276924TotExpensesEtcAuditedFinclStmt
Expenses Subtotal11276924ExpensesSubtotal
Total Expenses Per Form99011276924TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierLIABILITY UNDER FIN 48 FOOTNOTEIdentifier
Return ReferenceSCHEDULE D, PAGE 3, PART XReturnReference
ExplanationHOSPICE QUALIFIES AS A TAX-EXEMPT NON-PROFIT ORGANIZATION UNDER SECTION 501(C)3 OF THE INTERNAL REVENUE CODE AND SIMILAR STATUES OF WISCONSIN LAW. HOSPICE IS SUBJECT TO FEDERAL INCOME TAX ONLY ON NET UNRELATED BUSINESS INCOME UNDER THE PROVISIONS OF SECTION 501(C)3 OF THE INTERNAL REVENUE CODE. HOSPICE CURRENTLY HAS NO OBLIGATION FOR UNRELATED BUSINESS INCOME TAX. ACCORDINGLY, NO PROVISIONS FOR FEDERAL OR STATE INCOME TAXES ARE REQUIRED.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1HOSPICE ALLIANCE FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line110220 PRAIRIE RIDGE BLVDAddressLine1
CityPLEASANT PRAIRIECity
StateWIState
ZIP Code53158ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient391822945EINOfRecipient
IRC Section501C3IRCSection
Amount Of Cash Grant2000000AmountOfCashGrant
Method Of ValuationBOOKMethodOfValuation
Purpose Of GrantFOR OPS FUTURE USEPurposeOfGrant

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonJOSHUA BLOOM MDNamePerson
FieldValueIRS element (for citing)
RelationshipMEDICAL DIRECTORelationship
Description Of TransactionPAID MED DIRECTORDescriptionOfTransaction
Sharing Of RevenuesfalseSharingOfRevenues

Schedule M IRS990ScheduleM

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionIN-KIND RENTDescription
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990188997NoncashContribsRptdF990
Method Of Determining RevenuesMARKET VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990 - ORGANIZATION'S MISSIONHOSPICE ALLIANCE HAS SERVED OVER 8,000 TERMINALLY ILL PATIENTS AND THEIR FAMILIES SINCE 1981; SERVICING KENOSHA, EASTERN WALWORTH, AND RACINE COUNTIES. HOSPICE ALLIANCE REMAINS COMMITTED TO CARING FOR THE TERMINALLY ILL AND EMPOWERING THOSE WHO SUPPORT THEM. INCORPORATED IN 1981 IN KENOSHA, WISCONSIN, HOSPICE ALLIANCE, INC. WAS ESTABLISHED BY A GROUP OF COMMUNITY CITIZENS THAT WERE CONCERNED WITH THE LACK OF END OF LIFE CARE AVAILBLE TO TERMINALLY ILL PERSONS AND THEIR FAMILIES. THESE COMMUNITY CITIZENS BELIEVED THAT IF TERMINALLY ILL PEOPLE WERE GIVEN A CHOICE AS TO WHERE THEY WOULD LIKE TO BE, IT WOULD BE IN THEIR HOME SURROUNDED BY THE PEOPLE AND THINGS THEY LOVE. HOSPICE ALLIANCE, INC. LIVES THIS MISSION DAILY THROUGH COMMITMENT, COMPASSION, AND CHOICES. HOSPICE ALLIANCE, INC. PROVIDES CARE IN THE FOLLOWING SETTINGS: 1. IN THE PATIENT'S HOME, SURROUNDED BY THE PEOPLE AND THINGS THEY LOVE. THIS CHOICE ALLOWS FAMILY AND FRIENDS TO SUPPORT THEIR LOVED ONE IN COMFORT AND PRIVACY. 2. IN LONG TERM CARE AND ASSISTED LIVING FACTILITES, SUCH AS NURSING HOMES, SENIOR APARTMENTS AND GROUP HOMES. HOSPICE ALLIANCE PROFESSIONALS COMPLEMENT THE CARE ALREADY PROVIDED BY STAFF IN THESE SETTINGS. 3. THE HOSPICE ALLIANCE HOSPICE HOUSE OFFERS AN OPTION FOR THOSE WHO, FOR WHATEVER REASON, CANNOT REMAIN IN THEIR OWN HOME. THE HOUSE OPERATES AT A SIGNIFICANT LOSS DUE TO HOSPICE'S MISSION. 4. PRE-HOSPICE PALLIATIVE CARE MAY BE THE CHOICE FOR SOMEONE WHO IS NOT READY FOR THE HOSPICE PROGRAM. 5. BEREAVEMENT SERVICES AND GRIEF SUPPORT GROUPS ARE AVAILABLE WHEN THE TIME IS APPROPRIATE
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITSFORM 990, PAGE 1, PART I, LINE 6HOSPICE ALLIANCE VOLUNTEERS ARE A VITAL PART OF THE HOSPICE TEAM. WHILE ENHANCING THE LIVES OF PATIENTS AND THEIR FAMILIES, VOLUNTEERS GAIN SATISFACTION AND ENRICHMENT IN THEIR OWN LIVES. THERE ARE MANY WAYS VOLUNTEERS HELP, INCLUDING: COMPANIONSHIP, RESPITE CARE, RUNNING ERRANDS, NURSING HOME VISITS, MAILINGS, OFFICE HELP, COMPUTER WORK, EXPOS AND HEALTH FAIRS, FUNDRAISING, GARDENING, PREPARING MEALS AND BAKING. ALL VOLUNTEERS TAKE PART IN AN EIGHT SESSION TRAINING CLASS WHICH COVERS AN INTRODUCTION TO HOSPICE SERVICES, COMMUNICATION, DISEASE PROCESS, AND THE ROLE OF HOSPICE ALLIANCE TEAM MEMBERS. IN 2012, VOLUNTEERS COMMITTED 11,171 HOURS OF THEIR TIME.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BTHE 990 WAS REVIEWED IN DETAIL BY THE FINANCE DIRECTOR AND THEN FURTHER REVIEWED BY THE ORGANIZATION'S FINANCE COMMITTEE AND THEN APPROVED BY THE FULL BOARD OF DIRECTORS. ALL FINANCIAL INFORMATION IN THIS RETURN IS BASED OFF OF THE AUDITED FINANCIAL STATEMENTS.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CFULL DISCLOSURE, BY NOTICE IN WRITING, SHALL BE MADE BY THE INTERESTED PARTIES TO THE FULL BOARD OF DIRECTORS IN ALL CONFLICTS OF INTEREST. THIS IS DONE ON AN ANNUAL BASIS WITH BOARD MEMBERS, STAFF, AND VOLUNTEERS. IF THERE IS A POTENTIAL CONFLICT OF INTEREST, THE POLICY STATES PROCEDURES ON HOW TO HANDLE DIFFERENT SITUATIONS.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ATHE EXECUTIVE DIRECTOR'S SALARY IS DETERMINED BY THE BOARD. ALL OTHER STAFF SALARIES ARE DETERMINED USING THE NATIONAL ASSOCIATION FOR HOMECARE AND HOSPICE'S HOSPICE SALARY & BENEFIT REPORT AS WELL AS STATE AND NATIONAL GOVERNMENT WAGE DATA.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19THE ORGANIZATION WILL FURNISH AUDITED FINANCIAL STATEMENTS UPON REQUEST.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1HOSPICE ALLIANCE FOUNDATION INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line110220 PRAIRIE RIDGE BLVDAddressLine1
CityPLEASANT PRAIRIECity
StateWIState
ZIP Code53158ZIPCode
FieldValueIRS element (for citing)
EIN391822945EIN
Primary ActivitiesFUNDRAISERPrimaryActivities
Legal Domicile StateWILegalDomicileState
Exempt Code Section501C3ExemptCodeSection
Public Charity Status11APublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
HOSPICE ALLIANCE FDN INC
B2000000CASH CONTRIBUTION
HOSPICE ALLIANCE FDN INC
C188997INKIND CONTRIB OF RENT
HOSPICE ALLIANCE FDN INC
J99996COST OF ANNUAL RENT
HOSPICE ALLIANCE FDN INC
M72240COST OF SERVICES

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