OUR HOSPICE OF SOUTH CENTRAL INDIANA INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
OUR HOSPICE OF SOUTH CENTRAL INDIANA INC (EIN 35-1479425)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-07-02
IRS object ID
201201849349300445
Schema version
2011v1.2
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)
Timestamp2012-07-02T14:45:35-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN351178661EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BLUE & CO LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1106 COMMUNITY DRAddressLine1
CitySEYMOURCity
StateINState
ZIP Code47274ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN351479425EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF SOUTH CENTRAL INDIANA INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHOSPNameControl
Phone8123148000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12626 E 17TH STREETAddressLine1
CityCOLUMBUSCity
StateINState
ZIP Code47201ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSANDRA CARMICHAELName
TitlePRESIDENTTitle
Phone8123148000Phone
Date Signed2012-06-25DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKANDY L WISCHMEIER CPAName
PTINP00118327PTIN
Phone8125228416Phone
Date Prepared2012-06-11DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSANDRA CARMICHAELNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12626 E 17TH STREETAddressLine1
CityCOLUMBUSCity
StateINState
ZIP Code47201ZIPCode
FieldValueIRS element (for citing)
Gross Receipts10587472GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.HOSPICEOFSOUTHCENTRALINDIANA.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1980YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionHOSPICE OF SOUTH CENTRAL INDIANA, INC. (HSCI) IS AN INDEPENDENT, NOT-FOR-PROFIT ORGANIZATION PROVIDING SERVICES TO THE TERMINALLY ILL IN A 15-COUNTY SERVICE AREA. SINCE ITS INCEPTION 31 YEARS AGO, HOSPICE HAS EXPANDED TO MEET THE NEEDS FOR END-OF-LIFE CARE IN SOUTHERN INDIANA.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees159TotalNbrEmployees
Total Nbr Volunteers228TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year496162ContributionsGrantsPriorYear
Contributions Grants Current Year435840ContributionsGrantsCurrentYear
Program Service Revenue Prior Year10107114ProgramServiceRevenuePriorYear
Program Service Revenue CY9862917ProgramServiceRevenueCY
Investment Income Prior Year10345InvestmentIncomePriorYear
Investment Income Current Year3424InvestmentIncomeCurrentYear
Other Revenue Prior Year186801OtherRevenuePriorYear
Other Revenue Current Year142897OtherRevenueCurrentYear
Total Revenue Prior Year10800422TotalRevenuePriorYear
Total Revenue Current Year10445078TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7975631SalariesEtcPriorYear
Salaries Etc Current Year7367696SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year241115TotalFundrsngExpCurrentYear
Other Expense Prior Year3004907OtherExpensePriorYear
Other Expenses Current Year2735651OtherExpensesCurrentYear
Total Expenses Prior Year10980538TotalExpensesPriorYear
Total Expenses Current Year10103347TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-180116RevenuesLessExpensesPriorYear
Revenues Less Expenses CY341731RevenuesLessExpensesCY
Total Assets BOY8862871TotalAssetsBOY
Total Assets EOY8946911TotalAssetsEOY
Total Liabilities BOY1512415TotalLiabilitiesBOY
Total Liabilities EOY1254724TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7350456NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7692187NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionHOSPICE OF SOUTH CENTRAL INDIANA, INC. (HSCI) IS AN INDEPENDENT, NOT-FOR-PROFIT ORGANIZATION PROVIDING SERVICES TO THE TERMINALLY ILL IN A 15-COUNTY SERVICE AREA. SINCE ITS INCEPTION 31 YEARS AGO, HOSPICE HAS EXPANDED TO MEET THE NEEDS FOR END-OF-LIFE CARE IN SOUTHERN INDIANA.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense8966177Expense
Revenue9879118Revenue
DescriptionHOSPICE OF SOUTH CENTRAL INDIANA, INC. (HSCI) IS AN INDEPENDENT, NOT-FOR-PROFIT ORGANIZATION PROVIDING SERVICES TO THE TERMINALLY ILL IN A 15-COUNTY SERVICE AREA. SINCE ITS INCEPTION 32 YEARS AGO, HOSPICE HAS EXPANDED TO MEET THE NEEDS FOR END-OF-LIFE CARE IN SOUTHERN INDIANA, AND CURRENTLY HAS THREE OFFICE LOCATIONS, AS WELL AS A 14-BED INPATIENT FACILITY, LOCATED IN COLUMBUS, INDIANA. HOSPICE EXISTS TO PROVIDE CARE AND SUPPORT TO INDIVIDUALS AND THEIR FAMILIES IN THE LAST PHASES OF AN INCURABLE DISEASE SO THAT THEY MAY LIVE AS FULLY AND COMFORTABLY AS POSSIBLE. BEREAVEMENT SERVICES ARE PROVIDED TO FAMILY MEMBERS AND/OR SIGNIFICANT OTHERS FOR 13 MONTHS FOLLOWING A DEATH. AN INTERDISCIPLINARY TEAM CARES FOR THE PHYSICAL, PSYCHOSOCIAL, SPIRITUAL AND EMOTIONAL NEEDS OF THOSE WHO CHOOSE HSCI, WHETHER IT IS A MATTER OF DAYS, WEEKS, OR MONTHS. SERVICES ARE PROVIDED IN A VARIETY OF SETTINGS, INCLUDING THE PATIENT'S HOME, A LONG-TERM CARE FACILITY, AN ASSISTED LIVING FACILITY OR THE HOSPICE INPATIENT FACILITY. A TEAM OF HIGHLY SKILLED PROFESSIONALS AND VOLUNTEERS ARE AVAILABLE 24-HOURS A DAY, 7 DAYS A WEEK.HSCI IS LICENSED BY THE STATE OF INDIANA AND CERTIFIED BY THE FEDERAL GOVERNMENT. MEDICARE, MEDICAID AND PRIVATE INSURANCE COVER MOST SERVICES. ADDITIONAL FUNDS ARE RAISED THROUGH MEMORIALS, PRIVATE DONATIONS, FUND-RAISING ACTIVITIES, GRANTS AND THE UNITED WAY. TO ENSURE THAT CARE CAN BE PROVIDED REGARDLESS OF ABILITY TO PAY, HSCI IS A COMMUNITY RESOURCE FOR END-OF-LIFE CARE. HOSPICE PROFESSIONALS AND VOLUNTEERS ARE AVAILABLE TO PARTICIPATE IN EDUCATIONAL OFFERINGS IN A VARIETY OF SETTINGS, INCLUDING CHURCHES, SCHOOLS, CIVIC ORGANIZATIONS, AND OTHER HEALTH CARE PROVIDERS. IN 2011, OVER 682 PEOPLE WERE REACHED THROUGH PRESENTATIONS IN THE COMMUNITIES WE SERVE.IN 2011, 1,062 PATIENTS AND FAMILIES RECEIVED 60,637 DAYS OF CARE. ADDITIONALLY, BEREAVEMENT SERVICES WERE PROVIDED TO 2,736 INDIVIDUALS. APPROXIMATELY 9% OF HSCI'S ANNUAL BUDGET IS RAISED EACH YEAR TO PROVIDE THE SPECIALIZED CARE NEEDED BY THE TERMINALLY ILL AND THEIR FAMILIES. YOU ARE WELCOME TO VISIT OUR WEBSITE AT WWW.HOSPICEOFSOUTHCENTRALINDIANA.ORG FOR ADDITIONAL INFORMATION AND TO VIEW PHOTOS OF THE INPATIENT FACILITY.Description
Total Program Service Expense8966177TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming1Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109610NumberFormsTransmittedWith1096
Number W2 G Included1NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees159NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonSANDRA CARMICHAELNamePerson
Telephone Number8123148000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12626 E 17TH STREETAddressLine1
CityCOLUMBUSCity
StateINState
ZIP Code47201ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
JEFF WASHBURN
BOARD PRESIDENT1.00XX000
TOM DOWD
PRESIDENT - ELECT1.00XX000
MARLENE WEATHERWAX
SECRETARY/TREASURER1.00XX000
REV DENNIS AUD
BOARD MEMBER1.00X000
JAMES BICKEL
BOARD MEMBER1.00X000
DAVID FINKEL
BOARD MEMBER1.00X000
SLADE CROWDER MD
BOARD MEMBER1.00X000
RICHARD A KRAMER
BOARD MEMBER1.00X000
JANE DAVEE
BOARD MEMBER1.00X000
PAT MYERS
BOARD MEMBER1.00X000
HUTCH SCHUMAKER PAST PRESIDENT
BOARD MEMBER1.00X000
JOE SHEEHY MD
BOARD MEMBER1.00X000
KAREN SHAW RN
BOARD MEMBER1.00X000
SUZANNE WELLS
BOARD MEMBER1.00X000
DAVID M THOMPSON
BOARD MEMBER1.00X000
SANDRA CARMICHAEL
PRESIDENT40.00X154346018134
ROY GOODE MD
MEDICAL DIRECTOR24.00139315024670X
FieldValueIRS element (for citing)
Total Reportable Comp From Org293661TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation42804TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Federated Campaigns66612FederatedCampaigns
Government Grants46850GovernmentGrants
All Other Contributions322378AllOtherContributions
Total Contributions435840TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE RE62410098465169846516
BAD DEBT RECOVERIES6241001640116401
FieldValueIRS element (for citing)
Total Program Service Revenue9862917TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3424TotalRevenueColumn
Exclusion$3,424ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events231460GrossIncomeFundraisingEvents
Fundraising Direct Expenses131394FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column100066TotalRevenueColumn
Exclusion$100,066ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming37630GrossIncomeGaming
Gaming Direct Expenses11000GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column26630TotalRevenueColumn
Exclusion$26,630ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER INCOMEDescription
Business Code900099BusinessCode
Total Revenue Column16201TotalRevenueColumn
Related Or Exempt Function Income16201RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue16201TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column10445078TotalRevenueColumn
Related Or Exempt Function Income9879118RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$130,120ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total172480Total
Program Services151783ProgramServices
Management And General15523ManagementAndGeneral
Fundraising5174Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5454233Total
Program Services4799725ProgramServices
Management And General490881ManagementAndGeneral
Fundraising163627Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total279996Total
Program Services246396ProgramServices
Management And General25200ManagementAndGeneral
Fundraising8400Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1023818Total
Program Services900959ProgramServices
Management And General92144ManagementAndGeneral
Fundraising30715Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total437169Total
Program Services384709ProgramServices
Management And General39345ManagementAndGeneral
Fundraising13115Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total54288Total
Management And General54288ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total22356Total
Program Services20791ProgramServices
Management And General1565ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total166437Total
Program Services131745ProgramServices
Management And General26869ManagementAndGeneral
Fundraising7823Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total55320Total
Program Services48681ProgramServices
Management And General4979ManagementAndGeneral
Fundraising1660Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total141215Total
Program Services103087ProgramServices
Management And General29655ManagementAndGeneral
Fundraising8473Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total173269Total
Program Services171764ProgramServices
Fundraising1505Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total246023Total
Program Services189438ProgramServices
Management And General56585ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total76281Total
Program Services69416ProgramServices
Management And General6865ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
PATIENT SERVICE EXPENSE15213691521369
REPAIRS AND MAINTENANCE24027319462145652
MISCELLANEOUS20763182711869623
DUES SUBSCRIPTIONS BOOK17431134224009

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total626Total
Management And General626ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total10103347Total
Program Services8966177ProgramServices
Management And General896055ManagementAndGeneral
Fundraising241115Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1794309BOY
EOY2129845EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1279980BOY
EOY1269485EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY5207BOY
EOY4988EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY79364BOY
EOY69780EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis7998615LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2574017LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5660082BOY
EOY5424598EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY43929BOY
EOY48215EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8862871BOY
EOY8946911EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1512415BOY
EOY1254724EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1512415BOY
EOY1254724EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY7337795BOY
EOY7686525EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY12661BOY
EOY5662EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7350456BOY
EOY7692187EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8862871BOY
EOY8946911EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses341731ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years617831CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years473380CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years580971CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year496162CurrentTaxYearMinus1Year
Current Tax Year435840CurrentTaxYear
Total2604184Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years617831CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years473380CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years580971CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year496162CurrentTaxYearMinus1Year
Current Tax Year435840CurrentTaxYear
Total2604184Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total169029AmountsSubstContributorsTotal
Public Support Total1702435155PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years82270CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years55848CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years26678CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10345CurrentTaxYearMinus1Year
Current Tax Year3424CurrentTaxYear
Total178565Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3856CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12535CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9941CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2877CurrentTaxYearMinus1Year
Current Tax Year16201CurrentTaxYear
Total45410Total
FieldValueIRS element (for citing)
Total Support2828159TotalSupport
Gross Receipts From Admissions Etc49634930GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.86100PublicSupportPertcentage170
Public Support Pertcent Prior Year0.84750PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

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 D IRS990ScheduleD

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis7998615OtherCostOrOtherBasis
Depreciation2574017Depreciation
Book Value5424598BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5424598TotalOfBookValueLandBuildings
Total Revenue10445078TotalRevenue
Total Expenses10103347TotalExpenses
Excess Or Deficit For Year341731ExcessOrDeficitForYear
Excess Or Deficit Per FS341731ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt10655610TotRevenueEtcAuditedFinclStmt
Donated Srvc And Use Of Facilities84539DonatedSrvcAndUseOfFacilities
Other Revenues142394OtherRevenues
Revenue Not Rptd F990226933RevenueNotRptdF990
Revenue Subtotal10428677RevenueSubtotal
Other Revenues Not Included16401OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt16401RevenueNotRptdOnFinStmt
Total Revenue Per Form99010445078TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt10313879TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities84539DonatedServicesUseOfFacilities
Other Expenses Included125993OtherExpensesIncluded
Expenses Not Rptd F990210532ExpensesNotRptdF990
Expenses Subtotal10103347ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99010103347TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY HOSPICE AND RECOGNIZE A TAX LIABILITY IF HOSPICE HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY HOSPICE, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2011 AND 2010, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. HOSPICE IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS.
PART XII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENTS EXPENSE 142,394.
PART XII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT RECOVERIES 16,401.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENTS EXPENSES 142,394. BAD DEBT RECOVERIES -16,401.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1CONCERTNameOfEvent1
Gross Receipts Event1119777GrossReceiptsEvent1
Gross Revenue Event1119777GrossRevenueEvent1
Cash Prizes Event111950CashPrizesEvent1
Other Direct Expenses Event189156OtherDirectExpensesEvent1
Name Of Event2JENNINGS GALANameOfEvent2
Gross Receipts Event235483GrossReceiptsEvent2
Gross Revenue Event235483GrossRevenueEvent2
Other Direct Expenses Event26922OtherDirectExpensesEvent2
Gross Receipts Other Events76200GrossReceiptsOtherEvents
Gross Revenue Other Events76200GrossRevenueOtherEvents
Cash Prizes Other Events500CashPrizesOtherEvents
Other Direct Expenses Other Events22866OtherDirectExpensesOtherEvents
Gross Receipts Total231460GrossReceiptsTotal
Gross Revenue Total Events231460GrossRevenueTotalEvents
Cash Prizes Total Events12450CashPrizesTotalEvents
Other Direct Expenses Total Events118944OtherDirectExpensesTotalEvents
Direct Expense Summary Events131394DirectExpenseSummaryEvents
Net Income Summary100066NetIncomeSummary

Gaming Information GamingInformation

FieldValueIRS element (for citing)
Gross Revenue Other Gaming37630GrossRevenueOtherGaming
Cash Prizes Other Gaming11000CashPrizesOtherGaming
Volunteer Labor Other Gaming0VolunteerLaborOtherGaming
Gross Revenue Total Gaming37630GrossRevenueTotalGaming
Cash Prizes Total Gaming11000CashPrizesTotalGaming
Direct Expense Summary Gaming11000DirectExpenseSummaryGaming
Net Gaming Income Summary26630NetGamingIncomeSummary
FieldValueIRS element (for citing)
States Where Gaming ConductedINStatesWhereGamingConducted
Licensed1Licensed
License Suspended Etc0LicenseSuspendedEtc
Gaming With Nonmembers0GamingWithNonmembers
Member Of Other Entity0MemberOfOtherEntity
Percentage Of Gaming Othr Facility1.00000PercentageOfGamingOthrFacility
Name Of Gaming Rec Keeper PersonPHIL BUSHNameOfGamingRecKeeperPerson

Address Of Gaming Rec Keeper US AddressOfGamingRecKeeperUS

FieldValueIRS element (for citing)
Address Line12626 E 17TH STREETAddressLine1
CityCOLUMBUSCity
StateINState
ZIP Code47201ZIPCode
FieldValueIRS element (for citing)
Contract With3rd Party For Gam Rev0ContractWith3rdPartyForGamRev
Gaming Manager Name PersonSANDRA CARMICHAELGamingManagerNamePerson
Gaming Manager Services ProvidedOVERALL RESPONSIBILITY FOR THE OPERATION AND CONDUCT OF THE GAMING EVENTGamingManagerServicesProvided
Gaming Manager Is EmployeeXGamingManagerIsEmployee
Charitable Distrib Required0CharitableDistribRequired

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
SANDRA CARMICHAEL
1543460000000181340172480000
ROY GOODE MD
1393150000000246700163985000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11THE EXECUTIVE COMMITTEE OF THE BOARD DELEGATED AUTHORITY TO THE FINANCE COMMITTEE OF THE BOARD TO APPROVE THE FORM 990. THE FINANCE COMMITTEE OF THE BOARD WILL REVIEW THE ENTIRE FORM 990. ONCE APPROVED BY THE FINANCE COMMITTEE OF THE BOARD, A FULL COPY OF THE FORM 990 WAS MADE AVAILABLE TO EVERY BOARD MEMBER FOR REVIEW PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CEFFECTIVE 2006, BOARD MEMBERS, KEY EMPLOYEES, DIRECTORS AND OFFICERS SIGNED A CONFLICT OF INTEREST STATEMENT, STATING THAT THEY HAVE READ AND UNDERSTOOD THE STATEMENT. SINCE THAT TIME, ORIENTATION FOR NEW BOARD MEMBERS, KEY EMPLOYEES, OFFICERS AND DIRECTORS, INCLUDES REVIEW AND SIGNATURE OF A CONFLICT OF INTEREST STATEMENT. THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE COMPLIANCE OFFICER WITH FOLLOW-UP BY THE COMPLIANCE COMMITTEE IF ANY POTENTIAL CONFLICTS ARE IDENTIFIED.
FORM 990, PART VI, SECTION B, LINE 15EACH POSITION HAS A SALARY RANGE. COMPENSATION AT HIRE IS DETERMINED BY SEVERAL FACTORS, INCLUDING THE APPLICANT'S EXPERIENCE, EDUCATION, APPLICANT'S SALARY AT THEIR MOST RECENT EMPLOYMENT AND WHERE THE PROPOSED SALARY WOULD FALL WITHIN THE SALARY RANGE OF OTHER MEMBERS OF THE HOSPICE TEAM WHO ARE IN SIMILAR POSITIONS. INCREASES IN SALARY DURING 2011 WERE MADE DUE TO MARKET WAGE ADJUSTMENTS, OR BASED ON PERFORMANCE. IN 2011, HOSPICE DEVELOPED A PRESIDENT'S COMPENSATION POLICY. THE POLICY STIPULATED THAT INCREASES FOR THE PRESIDENT'S POSITION WOULD NEED TO BE APPROVED BY THE BOARD PRESIDENT.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST STATEMENT, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XII, LINE 2CTHE PROCESS OF SELECTING AN INDEPENDENT ACCOUNTANT AND OVERSIGHT OF THE AUDIT HAS NOT CHANGED FROM PRIOR YEAR.

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