2012-06-20T12:55:52-04:00 2011-12-31 COHEN RUTHERFORD KNIGHT PC 6903 ROCKLEDGE DRIVE SUITE 500 BETHESDA MD 208171800 990 2011-01-01 541920770 Capital Hospice % DAVID A SCHWIND CAPI 7035382065 2900 Telestar Court Falls Church VA 22042 David Schwind 2012-06-06 3018281008 2011 2016-02-24 21:20:13Z CAPITAL CARING MALENE DAVIS 2900 TELESTAR COURT FALLS CHURCH VA 22042 80493451 false X www.capitalcaring.org X 1998 VA THE MISSION OF CAPITAL HOSPICE IS TO IMPROVE CARE FOR THOSE FACING LIFE-LIMITING ILLNESSES THROUGH DIRECT SUPPORT OF PATIENTS AND THEIR FAMILIES, PUBLIC EDUCATION AND PUBLIC ADVOCACY. 13 12 777 888 32973 21192 7174636 7130256 63454199 69455835 1090407 955501 959912 922810 72679154 78464402 29454 28402 0 0 39202816 43208919 87800 45173 2020596 26727011 28631732 66047081 71914226 6632073 6550176 56658442 62980420 15419674 16738901 41238768 46241519 THE MISSION OF CAPITAL HOSPICE IS TO IMPROVE CARE FOR THOSE FACING LIFE-LIMITING ILLNESSES THROUGH DIRECT SUPPORT OF PATIENTS AND THEIR FAMILIES, PUBLIC EDUCATION AND PUBLIC ADVOCACY. false false 52767701 28402 Capital Hospice provides expert medical, emotional, spiritual and practical care and support to patients with serious, progressive illness and their families 24 hours a day, seven days a week to patients wherever they live by qualified physicians, nurses, nurses' aides, social workers, non-denominational chaplains and other professionals. It is the objective of Capital Hospice to provide care to anyone medically eligible, regardless of the patient's ability to pay. Capital Hospice provided services to 5,781 patients during 2011 and had 374,833 patient days of care. Capital Hospice had costs related to services and supplies under its charity care policy of approximately $2,368,000 in 2011. In addition, Capital Hospice provided uncompensated care, where reimbursement for services is less than the actual cost of care provided, of approximately $2,838,000. 3384490 Halquist Memorial Inpatient Center provides care for our hospice patients that need constant monitoring and whose pain and symptoms can't be adequately managed at home. It is the objective of the Halquist Memorial Inpatient Center to make our patients as symptom free and comfortable as possible. Halquist Memorial Inpatient Center provided care to 808 patients and had 4,699 patient days of care in 2011. 5273462 Capital Palliative Care Consultants provides physician services to our hospice patients, and to non-hospice eligible patients who are in need of symptom management. It is the objective of Capital Palliative Care Consultants to provide physician services to all patients in need of symptom management, regardless of the patient's ability to pay. Capital Palliative Care Consultants provided 13,881 patient visits during 2011. 61425653 true true false true false false false false true true true true false true false true false false false false false false true true false true true true false true true false false false false false false false false true false true false false false true false false false false false true 111 0 true 777 true true true false false false false true true false false false false X 13 12 false false false false false false false true true false false true true true true true true true true false DC MD VA X X DAVID A SCHWIND 7035311108 2900 TELESTAR COURT Falls Church VA 22042 X ROBIN PORTMAN 2.0 X 0 0 0 HEATHER GOLD 1.0 X 0 0 0 PAUL MANCA 1.0 X 0 0 0 MALENE DAVIS 40.0 X X 533909 0 28725 LAURA INNISS 1.0 X 0 0 0 SANDRA MABRY 1.0 X 0 0 0 SCOTT ROYAL 1.0 X 0 0 0 FRANK GOMES 1.0 X 0 0 0 RANDY SEGAL 1.0 X 0 0 0 CHRISTINE CANDIO 1.0 X 0 0 0 L REUVEN PASTERNAK 1.0 X 0 0 0 ERIC SWANK 1.0 X 0 0 0 MARK WEBER 1.0 X 0 0 0 BOB STIFEL 1.0 X 0 0 0 LEN ADLER 1.0 X 0 0 0 TOM KOUTSOUMPAS 1.0 X 0 0 0 DAVID SCHWIND 40.0 X 209139 0 22361 JAMES CAMERON MUIR 40.0 X 255293 0 15436 LINDA MAURANO 40.0 X 207994 0 4571 MATTHEW KESTENBAUM 40.0 X 173540 0 3876 JAMES SHEAR 40.0 X 173287 0 402 DONA LESKUSKI 40.0 X 162182 0 2645 RICHARD WEINBERG 40.0 X 174484 0 8950 ELLEN RICHARDSON 40.0 X 161675 0 3687 2051503 0 90653 57 false true false WILBEA MEDICAL EQUIPMENT PO BOX 3449 HARKER HEIGHTS TX 76548 RENT MED EQUIP 2119148 CORAM HEALTHCARE OF GREATER DC PO BOX 74775 CHICAGO IL 606944775 INTRAVENOUS THERAPY 761417 AMN HEALTHCARE 2735 COLLECTION CIRCLE DRIVE CHICAGO IL 60693 NURSING HOME SERVICE 664435 CARROLL MANOR NURSING HOME 1150 VARUM STREET NE WASHINGTON DC 20017 NURSING HOME SERVICE 673770 WOODBINE REHAB HEALTHCARE 2729 KING STREET ALEXANDRIA VA 22302 NURSING HOME SERVICE 649104 29 912093 10000 6208163 27735 7130256 PATIENT SERVICES 69455835 69455835 69455835 526654 526654 0 0 814512 814512 814512 814512 1967134 1538287 428847 428847 428847 180500 912093 490762 -310262 -310262 0 0 CAFETERIA REVENUE 11773 11773 MISCELLANEOUS 541700 406787 373814 32973 418560 78464402 69841422 32973 1459751 28402 28402 0 0 0 1394382 0 1394382 0 0 35478126 31838926 2869657 769543 571496 505208 54263 12025 3128070 2765246 297008 65816 2636845 2330997 250367 55481 0 0 0 0 0 0 0 0 75706 0 75706 0 2296 0 2296 0 45173 45173 105209 0 105209 0 100127 100127 0 0 490827 136098 351664 3065 1689936 714238 723101 252597 1723449 1070038 589830 63581 0 0 0 0 2343895 1950718 254958 138219 1082098 966940 103902 11256 0 0 0 0 177095 174805 2197 93 536240 14739 402967 118534 0 1336041 1261932 47128 26981 268890 97648 171242 0 CONTRACT SERVICES 10706125 9515919 746400 443806 MEDICAL SUPPLIES 6629582 6629477 66 39 BAD DEBT 1183490 1183490 0 0 OTHER 176113 140705 21021 14387 4613 4613 71914226 61425653 8467977 2020596 0 0 17454290 18603305 1458927 1749962 6395335 7388189 0 0 0 0 0 0 17716 18216 675978 815782 22124491 8934599 13507679 13189892 8756009 9564560 6504756 7792280 1400000 3400000 0 0 487752 458234 56658442 62980420 6876191 7650953 0 0 0 0 7065000 6905000 0 0 0 0 0 0 0 0 1478483 2182948 15419674 16738901 X 29236012 31453807 8298538 11084392 3704218 3703320 41238768 46241519 56658442 62980420 X 6550176 -1547425 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 1308 false true 988 2296 Other lobbying activities Schedule C, Part II-B, Line 1i National Hospice & Palliative Care Organizations (NHPCO) dues percent for lobbying. NHPCO arranged a day for visiting congress in which our President participated to make them aware of the need to rescind the cut in Medicare Hospice payment. 22037437 2989222 174302 203368 105209 24892384 18711870 1940464 1649411 166791 97517 22037437 14774229 1886968 2175178 31515 92990 18711870 654205 17330573 -2982657 113731 114161 14774229 0.45000 0.17000 0.38000 false false 1906678 1906678 11624045 2885361 8738684 602708 582478 20230 7379115 5454579 1924536 611944 12180 599764 13189892 US GOVERNMENT SECURITIES 2072096 F CD'S AND MONEY MARKET FUNDS 3643741 F CORPORATE DEBT SECURITIES 1645743 F CASH AND CASH EQUIVALENTS 430700 F FOREIGN BONDS 0 F 7792280 CD'S AND MONEY MARKET FUNDS 3400000 F 3400000 0 CHARITABLE GIFT ANNUITIES 240581 CAPITAL LEASE OBLIGATION 199367 INTEREST RATE SWAP 1743000 2182948 78464402 71914226 6550176 -690525 -856900 -1547425 5002751 78159429 -690525 490762 -199763 78359192 105209 1 105210 78464402 72589696 780679 780679 71809017 105209 105209 71914226 Reconciliation of Revenue Part XII Line 2d & 4b Special events expense $490,762 ROUNDING 1 Reconciliation of Expenses Part XIII, Lines 2d and 4b Amortization of unused space $291,018 Special events expense $489,662 Rounding $ (1) -------- Total $780,679 Endowment Funds Schedule D, Part V, Line 4 Capital Hospice intends to invest their endowment funds until they reach five million dollars at which time with the Board of Trustees approval eighty percent of any earnings would be used for ongoing operations and twenty percent would be added to the fund. Temporarily restricted funds will be used as the donor intended. Our largest temporarily restricted fund is for the construction of a Hospice inpatient unit in Loudoun County Virginia. The Board Restricted Funds are to be used for any emergency or new service that the Board approves. RECONCILIATION OF CHANGE TO NET ASSETS UNREALIZED LOSS INTEREST RATE SWAP $(858,000) NON-CASH PRIZES SPECIAL EVENTS 1,100 TOTAL ---------- $(856,900) X X X X X true KATE M HILLAS 2026 Labrador Lane Vienna VA 22182 PLANNED GIVING false 2822984 45173 2777811 2822984 45173 2777811 gala dinner 689500 617800 71700 92248 9181 165729 daffodil ball 164826 148901 15925 24653 6125 31372 4 238267 145392 92875 1100 12000 52490 2500 93364 1092593 912093 180500 1100 12000 169391 17806 290465 490762 -310262 2900 Telestar Court Falls Church VA 220423018 true true true X true X true true true false false 2366878 2366878 0.03340 8229506 8590818 -361312 0.00510 10596384 8590818 2005566 0.02830 60290 60290 0.00090 593592 12390 581202 0.00820 5014858 3099384 1915474 0.02710 273075 8018 265057 0.00370 26367 26367 0.00040 5968182 3119792 2848390 0.04030 16564566 11710610 4853956 0.06860 true 1133715 54363801 52346299 2017502 X true true 1 1 Capital Hospice HALQUIST MEMORIAL IN CTR

4715 N 15TH ST ARLINTON VA 222052640

X HOSPICE INPATIENT CENTER Capital Hospice HALQUIST MEMORIAL IN CTR 1 true true 200. true 300. true X X X X X X X true true X X X X true false false X X false false 13 Capital Hospice

2900 Telestar Court Falls Church VA 220421206

hospice office Capital Hospice

209 Gibson St Suite 202 Leesburg VA 201762122

Hospice office Capital Hospice

10530 Linden Lake Plaza Suite 200 Manassas VA 201096434

Hospice office Capital Hospice

5568 General Washington Dr Suite A2 Alexandria VA 223122465

Hospice office Capital Hospice

4401 Connecticut Avenue Suite 700 Washington DC 200082322

Hospice office Capital Hospice

9200 Basil Court Suite 200 Largo MD 207745337

Hospice office Capital Hospice

950 North Glebe Road Suite 500 Arlington VA 222034183

Hospice office CPCC - Alexandria Clinic

4660 Kenmore Ave Ste 1018 Alexandria VA 22304

palliative care clinic HALQUIST MEMORIAL INPATIENT CENTER

4715 NORTH 15TH STREET ARLINGTON VA 22205

PALLIATIVE CARE CLINIC PROSPERITY CLINIC

8503 ARLINGTON BLVD STE 400 FAIRFAX VA 22031

PALLIATIVE CARE CLINIC LEESBURG CLINIC

44035 RIVERSIDE PARKWAY STE 300 LEESBURG VA 20176

PALLIATIVE CARE CLINIC WHC CANCER INSTITUTE

110 IRVING ST NW WASHINGTON DC 20010

PALLIATIVE CARE CLINIC TRANSPLANT CLINIC

3300 GALLOWS RD FALLS CHURCH VA 22042

PALLIATIVE CARE CLINIC Part I, Line 3c IN ADDITION TO USING THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY UNDER THE FINANCIAL ASSISTANCE POLICY, THE ORGANIZATION WILL, ON A CASE BY CASE DETERMINATION, ASSESS A PATIENT'S LIQUID ASSETS. THE PATIENT'S LIQUID ASSETS WILL BE ASSESSED IF THE PATIENT HAS HIGH MEDICAL DEBT OUTSTANDING. Part I, line 5 IT IS THE ORGANIZATION'S POLICY TO PROVIDE FINANCIAL ASSISTANCE TO ANY INDIVIDUAL THAT QUALIFIES UNDER THE ORGANIZATION'S ASSISTANCE POLICY, REGARDLESS OF THE AMOUNT OF CHARITY CARE PROVIDED BY THE ORGANIZATION DURING THE YEAR. Part I, Line 7G CAPITAL HOSPICE PROVIDES A 15 BED INPATIENT UNIT FOR TREATMENT OF HOSPICE PATIENTS THAT NEED CONSTANT MONITORING BUT WHOSE PAIN AND SYMPTOMS CANNOT BE ADEQUATELY TREATED AT HOME. CAPITAL HOSPICE ALSO PROVIDES CONTINUOUS CARE SERVICES FOR HOSPICE PATIENTS THAT NEED MONITORING, BUT WHO CAN REMAIN AT HOME. BOTH PROGRAMS HELP TO MEET AN IDENTIFIED COMMUNITY NEED AND DO NOT RECEIVE SUFFICIENT REVENUE TO COVER COSTS. PART I, LINE 7, Column F THE BAD DEBT EXPENSE IS $1,183,490, WHICH WAS REMOVED FROM TOTAL EXPENSES TO DETERMINE THE PERCENTAGES OF TOTAL EXPENSES. PART I, LINE 7 A COST TO CHARGE RATIO WAS USED TO DETERMINE THE COST ASSOCIATED WITH THE PROVISION OF CARE TO FINANCIAL ASSISTANCE AND MEDICAID PATIENTS. WE DETERMINED AN OVERHEAD RATE BASED ON OUR MEDICARE COST REPORT TO DETERMINE INDIRECT COSTS FOR OUR HEALTH IMPROVEMENT, EDUCATION AND HEALTH SERVICES BENEFITS. Part III, Section A, Line 4 We do not have a bad debt footnote in our financial statements. We used a ratio of cost to charges for the amount reported on line 2. We do not include any of the bad debt as a community benefit. Part III, Section B, Line 8 We used the ratio of Medicare charges to Medicare allowable costs to determine the amount on line 6. Part III, Section C, Line 9b THE ORGANIZATION PROVIDES FINANCIAL ASSISTANCE TO ALL PATIENTS THAT QUALIFY UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. ALTHOUGH THE ORGANIZATION'S DEBT COLLECTION POLICY DOES NOT HAVE A SPECIFIC PROVISION FOR PATIENTS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE BECAUSE THE ORGANIZATION DOES NOT MAKE ANY ATTEMPT TO COLLECT FROM SUCH PATIENTS, IF WE BECOME AWARE THAT A PATIENT THAT WAS NOT INITIALLY IDENTIFIED AS QUALIFYING FOR FINANCIAL ASSISTANCE DOES IN FACT QUALIFY FOR FINANCIAL ASSISTANCE, THEN THE PATIENT RECEIVES FINANCIAL ASSISTANCE AND ALL COLLECTION EFFORTS (IF COMMENCED) ARE STOPPED IMMEDIATELY. Part V, Line 11 THE HOSPITAL FACILITY DETERMINES THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE ELIGIBLE INDIVIDUALS (THAT DO NOT QUALIFY FOR FREE CARE) FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE THROUGH THE USE OF A SLIDING FEE SCHEDULE FOR FINANCIAL ASSISTANCE PATIENTS. THE SLIDING SCALE BEGINS AT A LEVEL BELOW THE MEDICARE RATES FOR SUCH CARE FOR PATIENTS THAT HAVE FAMILY ANNUAL INCOME OF 300% OF THE FEDERAL POVERTY GUIDELINES AND GOES DOWN TO 25% OF FULL CHARGES (APPROXIMATELY 35-40% OF MEDICARE RATES) FOR PATIENTS THAT HAVE FAMILY ANNUAL INCOME OF 225% OF THE FEDERAL POVERTY GUIDELINES. IN ADDITION, THE HOSPITAL FACILITY PROVIDES A 20% DISCOUNT TO ALL UNINSURED PATIENTS THAT HAVE FAMILY ANNUAL INCOME UP TO 400% OF THE FEDERAL POVERTY GUIDELINES AND DO NOT QUALIFY UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY. IF THE UNINSURED PATIENT IS DEEMED TO BE MEDICALLY INDIGENT, THEN THE HOSPITAL FACILITY WILL PROVIDE A GREATER DISCOUNT. Part V, Line 15 THE HOSPITAL FACILITY MAKES REASONABLE EFFORTS TO DETERMINE A PATIENT'S ELIGIBILITY UNDER THE FINANCIAL ASSISTANCE POLICY BEFORE TURNING OVER THE UNPAID ACCOUNT TO A COLLECTION AGENCY FOR ATTEMPTED RECOVERY (NO OTHER 3RD PARTY COLLECTION ACTIVITY OR EXTRAORDINARY COLLECTION ACTIONS ARE UNDERTAKEN BY THE ORGANIZATION). THE HOSPITAL FACILITY VISITIS EACH PATIENT BEFORE THE PATIENT IS ADMITTED TO THE FACILITY. AS PART OF THAT VISIT ANY INSURANCE COVERAGE OR ELIGIBILITY FOR MEDICAID IS DISCUSSED. IF IT IS APPARENT THAT INSURANCE COVERAGE OR MEDICAID COVERAGE IS NOT AVAILABLE, OR IS LIMITED, THEN THE FACILITY ENCOURAGES THE PATIENT TO APPLY FOR ITS FINANCIAL ASSISTANCE POLICY. IF THE PATIENT DOES NOT APPLY FOR FINANCIAL ASSISTANCE AT THAT TIME, THE FACILITY CONTINUES TO NOTIFY THE PATIENT OF THE EXISTENCE OF ITS FINANCIAL ASSISTANCE POLICY UPON ADMISSION TO THE FACILITY AND WITH EACH BILL THAT IS SENT TO THE PATIENT. ADDITIONALLY, THE EXISTENCE OF THE FINANCIAL ASSISTANCE POLICY WAS POSTED ON THE HOSPITAL FACILITY'S WEBSITE AND IS MADE AVAILABLE UPON REQUEST. Part V, Line 18 THE HOSPITAL FACILITY SOLELY PROVIDES HOSPICE AND PALLIATIVE CARE. AS A RESULT, THE HOSPITAL FACILITY DOES NOT PROVIDE ANY EMERGENCY CARE SERVICES. Part V, Line 19 THE HOSPITAL FACILITY DETERMINES THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE ELIGIBLE INDIVIDUALS (THAT DO NOT QUALIFY FOR FREE CARE) FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE THROUGH THE USE OF A SLIDING FEE SCHEDULE FOR FINANCIAL ASSISTANCE PATIENTS. THE SLIDING SCALE BEGINS AT A LEVEL BELOW THE MEDICARE RATES FOR SUCH CARE FOR PATIENTS THAT HAVE FAMILY ANNUAL INCOME OF 300% OF THE FEDERAL POVERTY GUIDELINES AND GOES DOWN TO 25% OF FULL CHARGES (APPROXIMATELY 35-40% OF MEDICARE RATES) FOR PATIENTS THAT HAVE FAMILY ANNUAL INCOME OF 225% OF THE FEDERAL POVERTY GUIDELINES. Part VI, Line 2 Needs Assessment MARKET ANALYSIS IS AN INTERGRAL PART OF CAPITAL HOSPICE'S STRATEGIC PLANNING PROCESS. EMPIRICAL DATA IS COLLECTED BY: *REFERRAL CENTER STAFF (WHICH FACILITATES ADMISSION INTO OUR PROGRAM); *ACCESS STAFF, WHO INTERACT DIRECTLY WITH THE HOSPITALS, CLINICS, NURSING HOMES, ASSISTED LIVING FACILITIES AND PHYSICIAN PRACTICES THAT SERVE AS THE MAIN SOURCE OF REFERRALS INTO OUR CARE; *OUTREACH STAFF, WHO INTERACT DIRECTLY WITH MUNICIPAL AGENCIES, FAITH COMMUNITIES AND COMMUNITY ORGANZIATIONS; *EDUCATION STAFF, WHO INTERACT WITH LOCAL UNIVERSITIES, AND *PUBLIC RELATIONS STAFF ARE PRESENT AT COMMUNITY HEALTH FAIRS AND OTHER PUBLIC EVENTS. *ADDITIONALLY, CAPITAL HOSPICE MONITORS AND ANALYZES GOVERNMENT-PROVIDED STATISTICS TO COMPARE THE NUMBER OF DEATHS SERVED BY HOSPICE TO THE TOTAL NUMBER OF DEATHS IN OUR SERVICE AREA TO REVEAL WHERE SERVICES ARE UNDER-UTILIZED. Part VI, Line 3 Patient education of eligibility for assistance ALL PATIENTS RECEIVE AN ADMISSION VISIT BEFORE BEING ADMITTED INTO OUR HOSPICE CARE. AS PART OF THAT VISIT ANY INSURANCE COVERAGE IS VERIFIED. IF THE PATIENT HAS NO, OR LIMITED INSURANCE COVERAGE, THEN WE INQUIRE AS TO THEIR ABILITY TO BE COVERED BY MEDICAID. IF IT IS APPARENT THAT NO MEDICAID COVERAGE IS AVAILABLE THEN THE PATIENT IS ENCOURAGED TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION FORM. BASED ON THE INFORMATION OBTAINED FROM THE FINANCIAL ASSISTANCE FORM THEN FINANCIAL ASSISTANCE IS GRANTED. IF THE PATIENT DOES NOT APPLY FOR FINANCIAL ASSISTANCE AT THE TIME OF THE ADMISSION VISIT, THE FACILITY CONTINUES TO NOTIFY THE PATIENT OF THE EXISTENCE OF ITS FINANCIAL ASSISTANCE POLICY UPON ADMISSION TO THE FACILITY AND WITH EACH BILL THAT IS SENT TO THE PATIENT. ADDITIONALLY, THE EXISTENCE OF THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL FACILITY'S WEBSITE AND IS MADE AVAILABLE UPON REQUEST. Part VI, Line 4 Community Information CAPITAL HOSPICE SERVES AN ETHNIC, RACIAL, RELIGIOUS AND CULTURALLY DIVERSE REGION THAT ENCOMPASSES MUCH OF TWO STATES (VIRGINIA AND MARYLAND) AND THE DISTRICT OF COLUMBIA. COMMUNITIES SPAN THE SPECTRUM FROM URBAN/INNER CITY (DC) TO SUBURBAN (PRINCE GEORGE'S COUNTY, MD., FAIRFAX COUNTY, VA) TO RURAL (FAUQUIER COUNTY AND PARTS OF LOUDOUN COUNTY, VA). THE SOCIO-ECONOMIC COMPOSITION OF THE COMMUNITIES WE SERVE IS EQUALLY DIVERSE, RANGING FROM THE INDIGENT HOMELESS TO THE LOW-MODERATE INCOME TO ONE OF THE MOST AFFLUENT COUNTIES IN THE UNITED STATES. OUR SERVICE AREA ALSO IS HOME TO A VERY LARGE INTERNATIONAL COMMUNITY WITH A MULTITUDE OF LANGUAGES, TRADITIONS AND VALUES. Part VI, Line 5 Promotion of community health Regardless of the venue or circumstance, Capital Hospice staff and volunteers make clear that lack of insurance or resources to pay for our services is not a barrier to receiving care. That also is clearly stated in our literature and our website. (Approximately two million in charity care has been provided in each of the past two years.) Additionally, Capital Hospice provides grief and loss services (seminars, workshops, support groups) throughout our service area, offered at no charge; this includes an annual summer weekend camp for grieving children, teens and adults. Attending/referring physicians from the community are encouraged to participate in or follow their patients' care. Physicians seeking board certification in the medical sub-specialty of Palliative Medicine can apply for the physician fellowship program Capital Hospice offers jointly with the National Institutes of Health Clinical Center. Hospice partners with area hospitals, nursing homes and physician practices to provide facility clinics for Palliative Care consultations requested by community physicians. Community advisory boards are utilized to develop strategies to increase awareness of Capital Hospice services within their respective communities. Caminando Juntos is an outreach program dedicated to raising awareness of the availability of Capital Hospice services within the Latino community. Capital Hospice staff regularly conduct teaching/training sessions to improve care provided jointly with nursing homes, hospitals and assisted living facilities. These are offered at our partners' facilities for no charge. Capital Hospice regularly offers Palliative Care Grand Rounds and Josefino Magno Palliative Care Conference Series as instructional sessions for community physicians and other professional health care providers; participates in and offers "viewing sites" to the community for the annual Hospice Foundation of America educational teleconference. More than A majority of Capital Hospice's governing body is comprised of independent persons who reside in the organization's primary service area. Capital Hospice has an open medical staff policy, pursuant to which all qualified physicians may become members of the medical staff. Any surplus funds earned by Capital Hospice are used to improve patient care and provide further community benefit. Part VI, Line 6 Affiliated Health care system CAPITAL HOSPICE IS NOT PART OF AN AFFILIATED GROUP. false FOUNDATION FOR HOSPICES IN SUB SAHARAN 1731 KING ST SUITE 300 ALEXANDRIA VA 22314 15117 ARLINGTON FREE HEALTH CLINIC 2921 11TH STREET SOUTH ARLINGTON VA 22204 6000 X X X X X X false true false false false true false false false DAVID SCHWIND 205106 0 0 0 4033 0 3996 0 18365 0 231500 0 MALENE DAVIS 307588 0 219650 0 6671 0 21729 0 6996 0 562634 0 JAMES CAMERON MUIR 252526 0 1087 0 1680 0 4494 0 10942 0 270729 0 LINDA MAURANO 205910 0 0 0 2084 0 4169 0 402 0 212565 0 MATTHEW KESTENBAUM 170300 0 1500 0 1740 0 3474 0 402 0 177416 0 JAMES SHEAR 166385 0 4990 0 1912 0 0 0 402 0 173689 0 DONA LESKUSKI 151653 0 10425 0 104 0 0 0 2645 0 164827 0 RICHARD WEINBERG 166566 0 7622 0 296 0 3399 0 5551 0 183434 0 ELLEN RICHARDSON 159272 0 2130 0 273 0 3285 0 402 0 165362 0 compensation based on net earnings If the organization reaches its budgeted amount of net income from operations for the year then all employees are eligible for a bonus, which is based upon certain key metrics that are unrelated to net income. SCHEDULE J, PART I, LINE 4B nonqualified deferred compensation IN 2011, THE ORGANIZATION TERMINATED THE NONQUALIFIED DEFERRED COMPENSATION PLAN PARTICIPATED IN BY THE ORGANIZATION'S CEO. PURSUANT TO THE PLAN TERMINATION, ALL OF THE AMOUNTS THAT HAD PREVIOUSLY BEEN CONTRIBUTED BY THE ORGANIZATION INTO THE DEFERRED COMPENSATION PLAN WERE DISTRIBUTED TO THE CEO. ALL OF THE PLAN CONTRIBUTIONS HAD BEEN REPORTED PRIOR TO 2011 AS TAXABLE WAGE INCOME ON THE CEO'S FORMS W-2. fairfax county economic development authority 911910090 30382yaa8 2009-01-29 7200000 purchase and renovation of a facil false false false 295000 0 7200000 0 0 0 225106 0 0 6974894 0 0 2009 false false true true false false false false 0.00000 0.00000 0.00000 true false true true bb&t 10. false false false 0 false false Susan Muir wife of JamesCameron Muir 15436 interior decorating services false X 12 27735 Sale of securities false false true Sale of Non-Cash Contributions Schedule M, Part I, Question 32b The firm Robinson & Lukens was used to sell any stock gifts. DESCRIPTION OF REVIEW PROCESS PART VI, LINE 10 The 990 for Capital Hospice is reviewed by the Controller and the Executive Vice President/Chief Financial Officer, who will sign the return when it is finalized. Next the 990 is sent to all the members of the Board of Trustees including the President of Capital Hospice for their review and to solicit any comments or questions. After it has been reviewed by the Board it will be finalized, signed and filed. CONFLICTS MONITORING AND ENFORCEMENT PART VI, LINE 12 ALL BOARD MEMBERS, OFFICERS AND KEY MANAGERS ARE REQUIRED TO REPORT ANY REAL OR POTENTIAL OR PERCEIVED CONFLICT OF INTEREST INVOLVING THEM OR ANOTHER PERSON BY PROMPTLY FILING A WRITTEN DISCLOSURE STATEMENT WITH THE PRESIDENT OR CHAIR OF THE BOARD OF TRUSTEES. THE PRESIDENT WILL REVIEW ALL SUCH STATEMENTS AND THE ANNUAL DISCLOSURE STATEMENTS AND DISCUSS WITH THE CHAIR OF THE BOARD ANY POTENTIAL CONFLICTS OF INTEREST. IF THE PRESIDENT AND THE CHAIR OF THE BOARD DETERMINE THAT A POTENTIAL CONFLICT EXISTS, THEN THE BOARD SHALL INFORM THE PERSON OF THE BASIS FOR SUCH BELIEF AND ALLOW THE PERSON TO EXPLAIN AND DISCLOSE. [FOR ANY TRANSACTION/ARRANGEMENT DISCUSSED DURING A BOARD MEETING FOR WHICH A CONFLICT OF INTEREST IS DEEMED TO EXIST, THE AFFECTED BOARD MEMBER SHALL NOT BE COUNTED IN DETERMINING THE QUOROM FOR THE MEETING BUT SHALL BE PERMITTED TO BRIEFLY STATE HIS POSITION ON THE MATTER AND ANSWER PERTINENT QUESTIONS OF OTHER BOARD MEMBERS BEFORE VACATING THE GOVERNING BOARD. THE BOARD MEMBER SHALL LEAVE THE GOVERNING BOARD AND A MAJORITY OF THE REMAINING BOARD MEMBERS SHALL DETERMINE WHETHER TO UNDERTAKE SUCH TRANSACTION/ARRANGEMENT.] IF THE BOARD DECIDES THAT A PERSON HAS FAILED TO DISCLOSE, THE BOARD SHALL TAKE CORRECTIVE ACTION. CEO, Officers and Key Employees process for determining compensation Part VI, Section B, Line 15 The independent Compensation Committee of Capital Caring has engaged Towers Watson, an independent consulting group, experienced in this work, to conduct a survey to gather comparable, valid market data of executive compensation from both tax-exempt and for-profit employers, of similar size and comparable scope for the CEO and other key personnel. The report was reviewed and approved by the independent Compensation Committee after thorough discussion of the data, it sources and the findings. Capital Caring, as subject to Intermediate Sanctions under Internal Revenue Code (IRC) Section 4958, considers that the Intermediate Sanctions market benchmarking methodology for disqualified individuals, conducted by Towers Watson, has provided a valid and robust means of determining market based compensation competitiveness. Capital Caring has appointed an independent Compensation Committee to review and approve (with contemporaneous substantiation of the deliberation and decision) the compensation for other officers and key employees of Capital Caring. The review is done in conjunction with independent market review and findings presented from Towers Watson. DOCUMENT AVAILABILITY PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. net asset reconciliation part xi, line 5 unrealized LOSS on investments $(690,525) unrealized loss on interest rate swap (825,000) NON-CASH PRIZES SPECIAL EVENTS 1,100 -------- total $(1,547,425) HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBIN PORTMAN TITLE:CHAIR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HEATHER GOLD TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PAUL MANCA TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MALENE DAVIS TITLE:PRESIDENT HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LAURA INNISS TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SANDRA MABRY TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SCOTT ROYAL TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:FRANK GOMES TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RANDY SEGAL TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHRISTINE CANDIO TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:L REUVEN PASTERNAK TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ERIC SWANK TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARK WEBER TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BOB STIFEL TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LEN ADLER TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TOM KOUTSOUMPAS TITLE:BOARD MEMBER HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID SCHWIND TITLE:EXECUTIVE VP CFO HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES CAMERON MUIR TITLE:EVP MEDICAL SERVICES HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LINDA MAURANO TITLE:EVP CLINICAL SERVICES HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MATTHEW KESTENBAUM TITLE:chief of medical staff HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES SHEAR TITLE:ASSOCIATE MEDICAL DIRECTOR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DONA LESKUSKI TITLE:ASSOCIATE MEDICAL DIRECTOR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD WEINBERG TITLE:ASSOCIATE MEDICAL DIRECTOR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELLEN RICHARDSON TITLE:ASSOCIATE MEDICAL DIRECTOR HOURS: Capital Palliative Care Consultants 2900 Telestar Ct Falls Church VA 22042 522361003 Palliative MD 1694462 664339 Capital Hosp Capital Palliative Care Consultants Q