DEKALB COUNTY HOSPICE INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- DEKALB COUNTY HOSPICE INC (EIN 36-3164329)
- Tax period
- 2012-05-01 to 2013-04-30
- Filed
- 2013-12-12
- IRS object ID
- 201343469349300434
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-12-12T15:09:18-06:00 | Timestamp |
| Tax Period End Date | 2013-04-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 114 E EVERETT | AddressLine1 |
| City | DIXON | City |
| State | IL | State |
| ZIP Code | 61021 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-05-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363164329 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB COUNTY HOSPICE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DEKA | NameControl |
| Phone | 8157563000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE KISH HOSPITAL DRIVE | AddressLine1 |
| City | DEKALB | City |
| State | IL | State |
| ZIP Code | 601159204 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LOREN FOELSKE | Name |
| Title | VICE PRESIDENT - FINANCE, KHS | Title |
| Phone | 8157561521 | Phone |
| Date Signed | 2013-12-10 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KELLY JACKSON HARDY | Name |
| PTIN | P00747242 | PTIN |
| Phone | 8152842285 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | X | AddressChange |
| Name Of Principal Officer Person | KEVIN P POORTEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE KISH HOSPITAL DRIVE | AddressLine1 |
| City | DEKALB | City |
| State | IL | State |
| ZIP Code | 601159204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1988343 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.DEKALBCOUNTYHOSPICE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1981 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HOSPICE SERVICES TO TERMINALLY ILL INDIVIDUALS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 29 | TotalNbrEmployees |
| Total Nbr Volunteers | 300 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 201302 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 365483 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 1739366 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 1609413 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 5554 | InvestmentIncomePriorYear |
| Investment Income Current Year | 3451 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 6406 | OtherRevenuePriorYear |
| Other Revenue Current Year | 6876 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1952628 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1985223 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1416047 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1462028 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 3500 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 670850 | OtherExpensePriorYear |
| Other Expenses Current Year | 624656 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2086897 | TotalExpensesPriorYear |
| Total Expenses Current Year | 2086684 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -134269 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -101461 | RevenuesLessExpensesCY |
| Total Assets BOY | 970141 | TotalAssetsBOY |
| Total Assets EOY | 863177 | TotalAssetsEOY |
| Total Liabilities BOY | 676097 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 658464 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 294044 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 204713 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | OUR MISSION IS TO ASSIST PEOPLE TO LIVE WITH DIGNITY AND HOPE IN WAYS THAT BEST MEET THEIR NEEDS WHILE COPING WITH END-OF-LIFE ISSUES AND TO SUPPORT GRIEVING FAMILY AND COMMUNITY MEMBERS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 2036434 | Expense |
| Grants | 0 | Grants |
| Revenue | 1609413 | Revenue |
| Description | ORGANIZATION PROVIDED HOSPICE SERVICES TO THE COMMUNITY. OVER 300 VOLUNTEERS PROVIDED 4,856 HOURS OF SUPPORTIVE SERVICES TO PATIENTS/FAMILIES, FUNDRAISING EFFORTS, OFFICE SUPPORT, BEREAVEMENT SERVICES, AND EQUIPMENT AND SUPPLY DELIVERY. THE TRANSITIONS PROGRAM PROVIDED EMOTIONAL SUPPORT AND CASE MANAGEMENT TO 33 TERMINALLY ILL INDIVIDUALS WITH A PROGNOSIS OF 1 YEAR OR LESS, AT NO COST TO THE CLIENT. VOLUNTEERS ARE A KEY COMPONENT TO THIS PROGRAM. OFFERED AT NO COST TO ATTENDEES, POWERFUL TOOLS FOR CAREGIVERS CLASSES ARE OFFERED 2 TIMES DURING THE YEAR, WITH 6 SESSIONS IN EACH CLASS TO PROVIDE EDUCATION AND SUPPORT TO CAREGIVERS LIVING IN THE COMMUNITY AT LARGE.MAILED AN AVERAGE OF 4,766 BEREAVEMENT CARE NEWSLETTERS 5 TIMES A YEAR. MAILED AN AVERAGE OF 290 SUPPORT MAILINGS MONTHLY TO THE NEWLY BEREAVED. MAILED 553 BOOKLETS OUT AT THE HOLIDAYS TO FAMILIES FACING FIRST HOLIDAY SEASON AFTER DEATH. 195 HOURS OF COMMUNITY CONTACT WAS PROVIDED IN THE FORM OF BEREAVEMENT GROUPS, BEREAVED PARENT CANDLE LIGHT SERVICE, MEMORIAL TEDDY BEAR WORKSHOPS, 1:1 GRIEF SUPPORT WITH COMMUNITY MEMBERS, AND CHURCH, CIVIC GROUP, NURSING HOME EDUCATION AND SUPPORT. 35 HOURS SPENT PROVIDING COMMUNITY EDUCATION ABOUT THE PROGRAM, SERVICES, AND GENERAL GRIEF. | Description |
| Total Program Service Expense | 2036434 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 5 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 29 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LOREN FOELSKE - VP FINANCE KHS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8157561521 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE KISH HOSPITAL DRIVE | AddressLine1 |
| City | DEKALB | City |
| State | IL | State |
| ZIP Code | 60115 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated | OfficerOfficer |
|---|---|---|---|---|---|---|---|
| JANICE FRITSCH | |||||||
| DIRECTOR - THRU MAY 2012 | 1.00 | X | 0 | 0 | 0 | ||
| KURT SCHWEITZER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| KEVIN POORTEN | |||||||
| PRESIDENT & CEO KISH. HEAL | 1.00 | X | 0 | 966472 | 220153 | 54.00 | X |
| DR MICHAEL THORNTON | |||||||
| MEDICAL DIR. KISH. MED. AS | 1.00 | X | 33375 | 0 | 0 | ||
| MARVIN BARNES | |||||||
| CHAIR | 1.00 | X | 0 | 0 | 0 | X | |
| STACI HOSTE | |||||||
| VICE CHAIR | 1.00 | X | 0 | 0 | 0 | X | |
| KAREN MASON | |||||||
| SECRETARY/TREAS | 1.00 | X | 0 | 0 | 0 | X | |
| JUDY BERGESON | |||||||
| DIRECTOR - THRU MAY 2012 | 1.00 | X | 0 | 0 | 0 | ||
| MARK HILDE | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| ELISA RUBECK | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| RUTH WALKER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DENISE CURRAN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DR CATHY RUETTEN | |||||||
| DIRECTOR, ASSOCIATE MEDICAL DIRECTOR | 1.00 | X | 4275 | 0 | 0 | ||
| KAREN HAGEN | |||||||
| EXECUTIVE DIRECTOR | 40.00 | 92399 | 0 | 20168 | X | ||
| LOREN FOELSKE | |||||||
| VICE PRES. & CFO OF KISH H | 2.00 | 0 | 284734 | 117504 | 45.00 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 130049 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1251206 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 357825 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| KISHHEALTH SYSTEM | |||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | MANAGEMENT SERVICES | 103822 |
| HOSPICE PHARMACIA | |||||
| BOX 510818 | PHILADELPHIA | PA | 19175 | MEDICAL SERVICES | 101901 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Federated Campaigns | 12743 | FederatedCampaigns |
| Related Organizations | 170840 | RelatedOrganizations |
| Government Grants | 7617 | GovernmentGrants |
| All Other Contributions | 174283 | AllOtherContributions |
| Noncash Contributions | 2306 | NoncashContributions |
| Total Contributions | 365483 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE RE | Description |
| Business Code | 621610 | BusinessCode |
| Total Revenue Column | 1609413 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1609413 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 1609413 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3451 | TotalRevenueColumn |
| Exclusion | $3,451 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 9996 | GrossIncomeGaming |
| Gaming Direct Expenses | 3120 | GamingDirectExpenses |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6876 | TotalRevenueColumn |
| Exclusion | $6,876 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1985223 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1609413 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $10,327 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 154805 | Total |
| Program Services | 154805 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 930725 | Total |
| Program Services | 930725 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44864 | Total |
| Program Services | 44864 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 248334 | Total |
| Program Services | 248334 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 83300 | Total |
| Program Services | 83300 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 90713 | Total |
| Program Services | 90713 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 179 | Total |
| Management And General | 179 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2850 | Total |
| Management And General | 2850 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78 | Total |
| Program Services | 78 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 134169 | Total |
| Program Services | 90448 | ProgramServices |
| Management And General | 43721 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15421 | Total |
| Program Services | 15421 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 239624 | Total |
| Program Services | 236124 | ProgramServices |
| Fundraising | 3500 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59605 | Total |
| Program Services | 59605 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49117 | Total |
| Program Services | 49117 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22522 | Total |
| Program Services | 22522 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4980 | Total |
| Program Services | 4980 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| MISCELLANEOUS EXPENSE | 2487 | 2487 |
| EMPLOYEE RECOGNITION AN | 1583 | 1583 |
| FLOWERS AND CONDOLENCES | 790 | 790 |
| DUES AND LICENSES | 538 | 538 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2086684 | Total |
| Program Services | 2036434 | ProgramServices |
| Management And General | 46750 | ManagementAndGeneral |
| Fundraising | 3500 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75 | BOY |
| EOY | 75 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 488456 | BOY |
| EOY | 230390 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 257618 | BOY |
| EOY | 411986 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7439 | BOY |
| EOY | 2475 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 260803 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 58103 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 202700 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 216553 | BOY |
| EOY | 15551 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 970141 | BOY |
| EOY | 863177 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 264372 | BOY |
| EOY | 343766 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 411725 | BOY |
| EOY | 314698 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 676097 | BOY |
| EOY | 658464 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 169720 | BOY |
| EOY | 195730 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 124324 | BOY |
| EOY | 8983 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 294044 | BOY |
| EOY | 204713 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 970141 | BOY |
| EOY | 863177 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -101461 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 12130 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | 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 | 203848 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 343029 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 225030 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 201302 | CurrentTaxYearMinus1Year |
| Current Tax Year | 365483 | CurrentTaxYear |
| Total | 1338692 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 203848 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 343029 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 225030 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 201302 | CurrentTaxYearMinus1Year |
| Current Tax Year | 365483 | CurrentTaxYear |
| Total | 1338692 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 285005 | AmountsSubstContributorsTotal |
| Public Support Total170 | 1053687 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3372 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 3270 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 2138 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 5554 | CurrentTaxYearMinus1Year |
| Current Tax Year | 3451 | CurrentTaxYear |
| Total | 17785 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3120 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 6691 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3348 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 10230 | CurrentTaxYearMinus1Year |
| Current Tax Year | 9996 | CurrentTaxYear |
| Total | 33385 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 1389862 | TotalSupport |
| Gross Receipts From Admissions Etc | 7986885 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.75810 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.83780 | 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
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 260803 | OtherCostOrOtherBasis |
| Depreciation | 58103 | Depreciation |
| Book Value | 202700 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 202700 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO RELATED ENTITIES | Description |
| Amount | $314,698 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 314698 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 1817503 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 3120 | OtherRevenues |
| Revenue Not Rptd F990 | 3120 | RevenueNotRptdF990 |
| Revenue Subtotal | 1814383 | RevenueSubtotal |
| Other Revenues Not Included | 170840 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 170840 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 1985223 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 2089804 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 3120 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 3120 | ExpensesNotRptdF990 |
| Expenses Subtotal | 2086684 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 2086684 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | THE SYSTEM, KCH, VWCH, KHF, KPG, DCH, CFHP (CCC), CFHM, AND KHC ARE TAX-EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HPI IS A TAXABLE ORGANIZATION AND FILES A CORPORATE INCOME TAX RETURN, WHICH INCLUDES OPT, IRCC, AND HVL. THE SYSTEM FILES VARIOUS FORM 990'S (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THESE RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). UBIT IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50 PERCENT LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE ACCOMPANYING STATEMENTS OF FINANCIAL POSITION ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. AT APRIL 30, 2013 AND 2012, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENTS EXPENSES 3,120. | |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | CONTRIBUTIONS FROM AFFILIATE POSTED THROUGH EQUITY ON FINANCIAL STATEMENTS 170,840. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENTS EXPENSES 3,120. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KEVIN POORTEN | ||||||||||||||
| PRESIDENT & CEO KISH. HEAL | 0 | 548333 | 0 | 168139 | 0 | 250000 | 0 | 196100 | 0 | 24053 | 0 | 1186625 | 0 | 0 |
| LOREN FOELSKE | ||||||||||||||
| VICE PRES. & CFO OF KISH H | 0 | 256230 | 0 | 28504 | 0 | 0 | 0 | 94286 | 0 | 23218 | 0 | 402238 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 3 | THE ORGANIZATION RELIED ON A RELATED ORGANIZATION, KISHHEALTH SYSTEM, THAT USED ONE OR MORE METHODS DESCRIBED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. |
| PART I, LINE 4B | THE ORGANIZATION'S EXECUTIVES PARTICIPATE IN A NONQUALIFIED DEFERRED COMPENSATION PLAN. CONTRIBUTIONS FOR CALENDAR YEAR 2012 RELATED TO OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF DEKALB COUNTY HOSPICE WERE $200,200. THIS CONTRIBUTION REFLECTS AMOUNTS DUE FOR BOTH THE FISCAL YEARS ENDING APRIL 30, 2011 AND APRIL 30, 2012, WITH 50% OF THE CONTRIBUTION BEING ALLOCATED TO EACH YEAR. THE ORGANIZATION'S CEO PARTICIPATES IN AN ADDITIONAL NONQUALIFIED DEFERRED COMPENSATION PLAN. CONTRIBUTIONS FOR CALENDAR YEAR 2012 WERE $60,000. DURING FY13, THE CEO TOOK A DISTRIBUTION FROM THE DEFERRED COMPENSATION PLAN IN THE AMOUNT OF $250,000. THIS DISTRIBUTION IS INCLUDED AS W-2 WAGES, HOWEVER THE ACCRUAL OF THE DEFERRED COMPENSATION PAYMENTS HAS ALSO BEEN INCLUDED AS "OTHER COMPENSATION" ON PRIOR YEAR FORM 990S. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE BOARD SHALL HAVE TWO (2) STANDING COMMITTEES OF THE BOARD ("BOARD COMMITTEES") AND SUCH OTHER STANDING AND SPECIAL BOARD COMMITTEES AS THE BOARD DEEMS NECESSARY. THE STANDING BOARD COMMITTEES SHALL BE: (I) AN EXECUTIVE COMMITTEE AND (II) A BUSINESS AFFAIRS COMMITTEE. AT A BOARD COMMITTEE MEETING, A QUORUM SHALL BE A MAJORITY OF THE NUMBER OF MEMBERS OF THE BOARD COMMITTEE AND A MAJORITY OF BOARD COMMITTEE MEMBERS PRESENT AND VOTING AT A MEETING AT WHICH A QUORUM IS PRESENT SHALL BE NECESSARY FOR BOARD COMMITTEE ACTION UNLESS OTHERWISE SPECIFIED BY THESE BYLAWS OR THE BOARD. EACH BOARD COMMITTEE SHALL HAVE THE POWERS NECESSARY TO ACCOMPLISH THE PURPOSE OF THE BOARD COMMITTEE, BUT NO BOARD COMMITTEE SHALL HAVE THE POWER TO TAKE FINAL ACTION ON BEHALF OF THE BOARD ON ANY MATTER, EXCEPT THOSE SPECIFICALLY AUTHORIZED BY THESE BYLAWS OR BY RESOLUTION OF THE BOARD AND NOT OTHERWISE PROHIBITED BY THE NFP CORPORATION ACT. THE DESIGNATION AND APPOINTMENT OF ANY COMMITTEE AND DELEGATION OF AUTHORITY THERETO SHALL NOT OPERATE TO RELIEVE THE BOARD OR ANY INDIVIDUAL DIRECTOR OF ANY RESPONSIBILITY IMPOSED UPON IT OR HIM/HER BY LAW. EACH BOARD COMMITTEE SHALL HAVE TWO (2) OR MORE DIRECTORS AND A MAJORITY OF EACH BOARD COMMITTEE'S MEMBERSHIP SHALL BE DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 2 | KEVIN POORTEN AND LOREN FOELSKE ARE BOTH EMPLOYEES OF KISHEALTH SYSTEM, THE PARENT ORGANIZATION OF DEKALB COUNTY HOSPICE. MR. POORTEN IS PRESIDENT AND CEO OF KISHHEALTH SYSTEM AND SERVES AS AN EX-OFFICIO DIRECTOR FOR ALL ORGANIZATIONS RELATED TO KISHHEALTH SYSTEM. MR. FOELSKE SERVES AS THE VICE-PRESIDENT - FINANCE OF KISHHEALTH SYSTEM, AND IS THE TOP FINANCIAL OFFICIAL FOR ALL ORGANIZATIONS IN THE SYSTEM. | |
| FORM 990, PART VI, SECTION A, LINE 6 | KISHHEALTH SYSTEM IS THE SOLE MEMBER OF DEKALB COUNTY HOSPICE. | |
| FORM 990, PART VI, SECTION A, LINE 7A | AS THE SOLE MEMBER AND PARENT ORGANIZATION OF DEKALB COUNTY HOSPICE, KISHHEALTH SYSTEM HAS THE RIGHT TO ELECT CERTAIN MEMBERS OF THE HOSPICE GOVERNING BOARD. PER THE HOSPICE'S BYLAWS, THE VOTING TRUSTEES ARE ELECTED BY THE KHS BOARD AT EACH ANNUAL MEETING. | |
| FORM 990, PART VI, SECTION A, LINE 7B | KISHHEALTH SYSTEM (KHS) SERVES AS THE SOLE MEMBER AND PARENT ORGANIZATION OF DEKALB COUNTY HOSPICE. THE BYLAWS OF THE HOSPICE STATE THAT THE HOSPICE BOARD MAY TAKE NO ACTION PERTAINING TO THE FOLLOWING WITHOUT APPROVAL OF THE KHS BOARD: A. APPROVING THE ANNUAL OPERATING AND CAPITAL BUDGETS FOR THE HOSPICE; B. ELECTING THE MEMBERS OF THE HOSPICE'S BOARD; C. APPROVING THE STRATEGIC PLAN FOR THE HOSPICE; D. APPROVING THE DISPOSITION OF ANY ASSETS OF THE HOSPICE OTHER THAN IN THE ORDINARY COURSE OF BUSINESS OF THE HOSPICE; E. APPROVING ANY CHANGE IN MEMBERSHIP OF THE HOSPICE; F. APPROVING, EVALUATING AND/OR REMOVING THE PRESIDENT AND CEO AND REVIEWING AND APPROVING THE EMPLOYMENT CONTRACT OF THE PRESIDENT AND CEO AND ESTABLISHING COMPENSATION FOR SUCH OFFICE; G. APPROVING THE ADOPTION OF AND AMENDMENTS TO THE ORGANIZATIONAL DOCUMENTS, INCLUDING THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE HOSPICE; H. APPROVING THE ADOPTION OF A PLAN OF MERGER OR ADOPTING A PLAN OF CONSOLIDATION WITH ANOTHER CORPORATION; I. EXERCISING ALL RIGHTS THAT THE HOSPICE HAS AS A SHAREHOLDER OR MEMBER OF A SUBSIDIARY ENTITY; J. AUTHORIZING THE SALE, LEASE, EXCHANGE, OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE HOSPICE; K. AUTHORIZING THE VOLUNTARY DISSOLUTION OF THE HOSPICE OR REVOKING PROCEEDINGS THEREOF; L. ADOPTING A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF THE HOSPICE; M. APPROVING ANY AFFILIATIONS OF THE HOSPICE; N. SELECTING OF THE MEDICAL DIRECTOR OF THE HOSPICE; O. REQUIRING MINUTES OF MEETINGS, FINANCIAL RECORDS AND SUCH OTHER INFORMATION AS MAY BE NECESSARY TO PROPERTY EVALUATE THE PERFORMANCE OF THE HOSPICE; P. TRANSFERRING MONEY OR PROPERTY AMONG THE HOSPICE, KHS AND ONE OR MORE SUBSIDIARY CORPORATION; AND Q. INITIATING ACTION TO REMOVE OR REINSTATE A DIRECTOR IN ACCORDANCE WITH SECTION 4.14. SUBJECT TO THE AUTHORITY OF THE BOARD AS SET FORTH IN THIS ARTICLE IV, THE KHS BOARD MAY INITIATE AND APPROVE ANY OF THE FOREGOING ON BEHALF OF THE HOSPICE. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A DRAFT COPY OF FORM 990 IS PROVIDED TO THE GOVERNING BODY (BOARD OF DIRECTORS) AND THE GOVERANCE COMMITTEE FOR REVIEW BY THE RETURN PREPARER PRIOR TO FILING. THE ORGANIZATION'S CEO, CFO, AND OTHER MEMBERS OF THE ACCOUNTING DEPARTMENT ARE ALSO PROVIDED A COPY OF THE RETURN FOR THEIR REVIEW. THE CHAIR OF THE AUDIT COMMITTEE AND THE AUDIT COMMITTEE MEMBERS ARE ALSO PROVIDED DRAFT COPIES AND REVIEW. IF CHANGES ARE NECESSARY, THEY ARE REPORTED TO THE RETURN PREPARER AND INCORPORATED INTO THE FINAL RETURN. | |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICTS OF INTEREST ARE INVESTIGATED BY APPOINTED MEMBERS OF THE GOVERANCE COMMITTEE ON AN ONGOING BASIS. IF IT IS DETERMINED THAT AN INDIVIDUAL FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM THE INDIVIDUAL OF SUCH A BELIEF AND AFFORD HIM AN OPPORTUNITY TO EXPLAIN. AFTER SAID EXPLANATION, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION AS DEEMED NECESSARY. THE CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD ANNUALLY AND UPDATED AS NEEDED. | |
| DEKALB COUNTY HOSPICE IS NOT DIRECTLY INVOLVED IN DETERMINING THE COMPENSATION OF THE CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT, AS THE INDIVIDUALS ARE EMPLOYED THROUGH KISHHEALTH SYSTEM. KISHHEALTH SYSTEM DOES COMPLY WITH THE REQUIREMENTS NOTED ABOVE. THROUGH THE OVERSIGHT OF THE BOARD OF DIRECTORS EXECUTIVE COMPENSATION COMMITTEE, THE KISHHEALTH SYSTEM EXECUTIVE TOTAL COMPENSATION PROGRAM WILL BE COMPETITIVELY POSITIONED IN THE MARKET PLACE OF RELEVANT ORGANIZATIONS AND FALL WITHIN THE SAFE HARBOR GUIDELINES ESTABLISHED BY THE INTERMEDIATE SANCTIONS RULES. THE EXECUTIVE COMPENSATION COMMITTEE IS MADE UP OF THREE MEMBERS OF THE BOARD OF DIRECTORS WHO MEET THE BOARD APPROVED DEFINITION OF "INDEPENDENT DIRECTORS". ANNUALLY THE EXECUTIVE COMPENSATION COMMITTEE CONTRACTS WITH SULLIVAN, COTTER AND ASSOCIATES, AN INDEPENDENT HUMAN RESOURCES CONSULTING FIRM TO PROVIDE THE COMMITTEE ANALYSIS AND COMPARABILITY DATA. USING THE SUPPLIED DATA THE COMPENSATION COMMITTEE APPROVES EACH EXECUTIVE'S TOTAL CASH COMPENSATION AND PROVIDES CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. TOTAL CASH COMPENSATION IS DEFINED AS THE SUM OF BASE SALARIES PLUS INCENTIVE AWARDS. BASED ON THE COMPARABILITY DATA AND THE PERFORMANCE OF EACH EXECUTIVE IN MEETING GOALS AND STRATEGIC OBJECTIVES, THE EXECUTIVE COMPENSATION COMMITTEE APPROVES INCREASES AND INCENTIVE AWARDS FOR EACH EXECUTIVE WITHIN THE GUIDELINES ESTABLISHED. THE EXECUTIVE COMPENSATION COMMITTEE REPORTS ON ALL COMPENSATION MATTERS TO THE FULL BOARD OF DIRECTORS. | ||
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST IN WRITING TO ADMINISTRATION. | |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN NET ASSETS OF KISHHEALTH FOUNDATION 173. OTHER 11,957. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XI, LINE 2C | NO CHANGES IN THIS PROCESS WERE MADE DURING THE TAX YEAR. THE ORGANIZATION MAINTAINS AN INDEPENDENT AUDIT COMMITTEE WHICH IS RESPONSIBLE FOR OVERSIGHT OF THE AUDITED FINANCIAL STATEMENTS. THIS COMMITTEE IS ALSO RESPONSIBLE FOR THE SELECTION OF THE INDEPENDENT AUDITOR. MEMBERS OF THE AUDIT COMMITTEE ARE ALSO MEMBERS OF THE KISHHEALTH SYSTEM BOARD OF DIRECTORS. KISHEALTH SYSTEM IS THE PARENT CORPORATION OF DEKALB COUNTY HOSPICE, INC. | RESPONSIBILITY FOR OVERSIGHT OF FINANCIAL STATEMENTS |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| KISHHEALTH SYSTEM | |||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 363649080 | PARENT CORPORATION OF 501(C)(3) HEALTH SYSTEM | IL | 501(C)(3) | 11B | N/A | 0 | |
| KISHHEALTH FOUNDATION | |||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 363649077 | SUPPORT OF CHARITABLE HEALTH ORGANIZATIONS | IL | 501(C)(3) | 7 | 0 | KISHHEALTH SYSTEM | |
| KISHWAUKEE COMMUNITY HOSPITAL | |||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 237087041 | HEALTHCARE SERVICES, PRIMARILY ACUTE CARE | IL | 501(C)(3) | 3 | 0 | KISHHEALTH SYSTEM | |
| VALLEY WEST COMMUNITY HOSPITAL | |||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 364244337 | HEALTHCARE SERVICES, PRIMARILY ACUTE CARE | IL | 501(C)(3) | 3 | 0 | KISHHEALTH SYSTEM | |
| COMMUNITY CARES CLINIC | |||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 800424001 | HEALTHCARE SERVICES, PRIMARILY ACUTE CARE | IL | 501(C)(3) | 3 | 0 | KISHHEALTH SYSTEM | |
| KISHWAUKEE PHYSICIANS GROUP INC | |||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 651293967 | HEALTHCARE SERVICES, PRIMARILY FAMILY PRACTICE | IL | 501(C)(3) | 3 | 0 | KISHHEALTH SYSTEM | |
| CENTER FOR FAMILY HEALTH - MALTA | |||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 800869393 | HEALTHCARE SERVICES, PRIMARILY ACUTE CARE | IL | 501(C)(3) | 3 | 0 | KISHHEALTH SYSTEM | |
| KISHHEALTH SYSTEM HOME CARE | |||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 371703513 | HEALTHCARE SERVICES, HOME CARE | IL | 501(C)(3) | 3 | 0 | KISHHEALTH SYSTEM | |
Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| HEALTH VENTURES LLC | |||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 753255958 | RENTAL REAL ESTATE PROVIDED TO HEALTHCARE RELATED BUSINESSES | IL | N/A |
| KISHWAUKEE AREA PHO | |||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 364205273 | MEDICARE SERVICES | IL | N/A |
| ILLINOIS REGIONAL CANCER CENTER | |||||||
| 10 HEALTH SERVICES DRIVE | DEKALB | IL | 60115 | 363847273 | CANCER TREATMENT SERVICES | IL | N/A |
| MIDLAND SURGICAL CENTER LLC | |||||||
| 3085 WOLF COURT | DEKALB | IL | 60115 | 352194610 | SURGICAL SERVICES | IL | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEALTH PROGRESS INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE KISH HOSPITAL DRIVE | AddressLine1 |
| City | DEKALB | City |
| State | IL | State |
| ZIP Code | 60115 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363824138 | EIN |
| Primary Activity | INVESTMENT IN HEALTHCARE RELATED SMALL BUSINESSES | PrimaryActivity |
| Legal Domicile State | IL | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Comments