2012-11-14T09:56:29-06:00 2011-12-31 420714325 MCGLADREY LLP 230 N ELM ST STE 1100 GREENSBORO NC 27401 990 2011-01-01 581343313 HOSPICE & PALLIATIVE CARECENTER HOSP 3367683972 101 HOSPICE LANE WINSTONSALEM NC 27103 BRIAN K PAYNE 3367683972 2012-11-12 1 ADRIENNE MCKINNEY P00819656 3362724551 2011 2016-02-24 21:20:13Z BRIAN K PAYNE 101 HOSPICE LANE WINSTONSALEM NC 27103 32435168 0 X WWW.HOSPICECARECENTER.ORG X 1978 NC HOSPICE & PALLIATIVE CARECENTER PROVIDES IN-HOME AND INPATIENT MEDICAL CARE FOR THE TERMINALLY ILL, TRAINS VOLUNTEERS TO ASSIST WITH FAMILIES OF PATIENTS, AND CONDUCTS EDUCATIONAL GRIEF SEMINARS FOR THE COMMUNITY. IN 2011, HOSPICE & PALLIATIVE CARECENTER CARED FOR 3,428 PATIENTS. 25 25 465 630 0 0 2350063 2399398 29557634 29737776 34873 -10417 145704 178941 32088274 32305698 0 156000 0 0 16997329 18827426 5000 0 1323655 11656752 12012499 28659081 30995925 3429193 1309773 26409553 25011137 5267875 2524743 21141678 22486394 X HOSPICE & PALLIATIVE CARECENTER PROVIDES COMPASSIONATE CARE FOR THOSE INDIVIDUALS LIVING WITH A LIFE-LIMITING ILLNESS AND THEIR FAMILIES, THROUGH QUALITY MEDICAL, EMOTIONAL, SPIRITUAL, AND SOCIAL SUPPORT. 0 0 16797114 22447084 HOSPICE HOMECARE - PROVIDES MEDICAL CARE FOR TERMINALLY ILL PATIENTS, FOCUSING ON IMPROVING QUALITY OF LIFE, PHYSICAL AND EMOTIONAL COMFORT, DIGNITY AND PEACE OF MIND FOR PATIENTS AND THEIR FAMILIES. SKILLED PROFESSIONALS PROVIDE IN-HOME PATIENT SERVICES, INCLUDING NURSING HOMES, ASSISTED LIVING HOMES, GROUP HOMES, REST HOMES, AND RETIREMENT COMMUNITIES, REGARDLESS OF ABILITY TO PAY.IN 2011, HOSPICE & PALLIATIVE CARECENTER PROVIDED 140,151 DAYS OF CARE TO 2,055 PATIENTS IN THIS CAPACITY. 7279417 7106094 KATE B. REYNOLDS (KBR) HOSPICE HOME - 40-BED INPATIENT FACILITY THAT PROVIDES HOSPICE PATIENTS STATE OF THE ART CARE IN A BEAUTIFUL, HOME-LIKE SETTING. HOSPICE PATIENTS RECEIVING CARE AT HOME MAY BE ADMITTED TO THE KBR HOSPICE HOME WHEN NECESSARY MEDICAL CARE IS NOT EASILY MANAGED AT HOME, OR WHEN A CAREGIVER IS IN NEED OF RESPITE.IN 2011, KATE B. REYNOLDS HOSPICE HOME PROVIDED 12,298 DAYS OF CARE TO 1,178 INPATIENTS. 259805 94407 HOME HEALTH CARE - PROGRAM FOR PATIENTS WITH SERIOUS ILLNESSES IN NEED OF INTERMITTENT SKILLED NURSING CARE. HOME HEALTH CARE PATIENTS MAY BE SEEKING AGGRESSIVE TREATMENT FOR THEIR ILLNESS, YET HAVE A SKILLED NURSING NEED WHICH REQUIRES THE SERVICES OF A REGISTERED NURSE. HOME HEALTH CARE SERVICES INCLUDE CARING FOR THE MEDICAL, SPIRITUAL, SOCIAL, AND EMOTIONAL NEEDS OF PATIENTS AND THEIR FAMILIES.IN 2011, THE HOME HEALTH PROGRAM PROVIDED 5,789 DAYS OF CARE TO 54 PATIENTS. 243702 226027 PALLIATIVE CARE SERVICES- A PROGRAM THAT PROVIDES PATIENTS WITH MEDICAL CARE FOCUSED ON THE RELIEF OF PAIN, SYMPTOMS, AND STRESS OF SERIOUS ILLNESS - REGARDLESS OF THE DIAGNOSIS. PALLIATIVE CARE SERVICES ARE PROVIDED SIMULTANEOUSLY WITH ALL OTHER MEDICAL TREATMENTS.IN 2011, THE PALLIATIVE CARE SERVICES PROGRAM PROVIDED 76,412 DAYS OF CARE TO 683 PATIENTS. 144855 0 COMPLEMENTARY THERAPIES 176110 37952 COMMUNITY PARTNERSHIP/COMMUNITY EDUCATION 275742 2003 GRIEF COUNSELING CENTER 182010 HOSPICE BEREAVEMENT SERVICES 156000 156000 THE HOSPICE FOUNDATION PROGRAM SERVICES 1178419 156000 265982 25514755 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 1 123 0 1 465 1 0 0 0 0 0 0 0 0 0 0 X 25 25 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X MONY CHAMBERS 3367683972 101 HOSPICE LANE WINSTONSALEM NC 27103 X RICHARD V BENNETT 1.00 X X 0 0 0 CHARLES H HAUSER 1.00 X X 0 0 0 MARGARET ANN HOFLER 1.00 X X 0 0 0 MICHAEL L ROBINSON 1.00 X X 0 0 0 R SCOTT BOWEN JR 1.00 X X 0 0 0 ROBERT COIL 1.00 X X 0 0 0 DALE E DRISCOLL 1.00 X X 0 0 0 PATRICIA L ADAMS MD 1.00 X 0 0 0 ELMS L ALLEN MD 1.00 X 0 0 0 ROLAND J BARRETT II MD 1.00 X 0 0 0 CANDICE BROWN 1.00 X 0 0 0 REV DAVID B HODGES 1.00 X 0 0 0 DONNY LAMBETH 1.00 X 0 0 0 A THAD LEWALLEN 1.00 X 0 0 0 JEFF LINDSAY 1.00 X 0 0 0 MARY F LYLES MD 1.00 X 0 0 0 WARD MILLER 1.00 X 0 0 0 JAMES O'NEILL 1.00 X 0 0 0 REV DR CEDRIC S RODNEY 1.00 X 0 0 0 AARON SINGLETON 1.00 X 0 0 0 JAMES N SMITH 1.00 X 0 0 0 DR PEGGY VALENTINE 1.00 X 0 0 0 EDWIN L WELCH 1.00 X 0 0 0 GORDON WILLIAMS 1.00 X 0 0 0 KENNETH P CARLSON MD 1.00 X 0 0 0 JIMMY STRICKLAND 1.00 X 0 0 0 JOANN E DAVIS 36.00 X 177566 0 15209 BRIAN K PAYNE 36.00 X 145340 0 5910 KATHERINE F CECIL 40.00 X 78780 0 8294 RICHARD C STEPHENSON 40.00 X 238288 0 21202 KAREN L CROSS 40.00 X 179677 0 20652 KIM KINSLEY 40.00 X 172192 0 9943 GENEVIEVE WROBLEWSKI 40.00 X 167070 0 11274 BRENTON SHARPE 40.00 X 152118 0 7595 1311031 0 100079 10 0 1 0 FORSYTH MEMORIAL HOSPITAL 3333 SILAS CREEK PARKWAY WINSTONSALEM NC 27103 HOSPITAL SERVICES 523613 SPRINGWOOD CARE CENTER 5755 SHATTALON DRIVE WINSTONSALEM NC 33336 SKILLED NURSING FACILITY 468664 GRACE HEALTHCARE OF WINSTON-SALEM 1900 WEST FIRST STREET WINSTONSALEM NC 27104 SKILLED NURSING FACILITY 422260 IL LONG CONSTRUCTION CO INC PO BOX 4186 WINSTONSALEM NC 27115 CONSTRUCTION 359287 NC BAPTIST HOSPITALWFUMC MEDICAL CENTER BLVD WINSTONSALEM NC 27157 HOSPITAL SERVICES 337525 14 342196 256184 1801018 87270 2399398 PATIENT SERVICE REVENU 621610 29296523 29296523 MANAGEMENT REVENUE 621610 441253 441253 29737776 15922 15922 15376 15820 25895 -444 -25895 -26339 -26339 90905 256184 87755 3150 3150 OTHER INCOME 621610 175791 175791 175791 32305698 29913567 0 -7267 156000 156000 431099 431099 15029195 13155626 1252352 621217 327423 282550 28054 16819 1927949 1369645 417093 141211 1111760 933878 122294 55588 154773 97827 56946 5904 5904 48450 48450 5129273 4577470 365270 186533 207111 68997 138114 605818 180281 294318 131219 319887 319887 667549 393805 273744 658191 612424 34479 11288 71518 71518 736590 272723 463867 133455 133455 PATIENT MEDICAL SUPPLIE 2709544 2709544 EQUIPMENT & MAINTENANCE 278014 178801 99213 EMPLOYEE PROCUREMENT 126001 126001 CONTINUING EDUCATION 88012 45767 35643 6602 72409 33529 23816 15064 30995925 25514755 4157515 1323655 8809982 6609524 42508 42742 1458075 1011601 3063202 2948661 118673 121446 195110 215959 18179225 4959110 12502737 13220115 381668 219266 459421 26409553 25011137 1829224 1934763 3360880 175308 77771 414672 5267875 2524743 X 19733493 21163734 1387185 1301660 21000 21000 21141678 22486394 26409553 25011137 X 1309773 34943 X X 0 1 1 X 0 X 1661013 2128589 4748696 2350063 2399398 13287759 1661013 2128589 4748696 2350063 2399398 13287759 538184 12749575 65613 137589 31069 34134 15922 284327 98571 165508 177819 307198 266696 1015792 14587878 133148644 0.87400 0.88960 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME SPECIAL EVENTS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 756977 756977 11778921 2108543 9670378 3714028 2380478 1333550 1929299 470089 1459210 13220115 CAPITAL LEASE OBLIGATION 414672 414672 32305698 30995925 1309773 34943 34943 1344716 32186749 -118949 -118949 32305698 0 32305698 30792851 -131556 -131556 30924407 71518 71518 30995925 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: MANAGEMENT EVALUATED HOSPICE'S TAX POSITIONS AND CONCLUDED THAT HOSPICE HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE CONSOLIDATED FINANCIAL STATEMENTS. PART XI, LINE 8 - OTHER ADJUSTMENTS: EQUITY IN INCOME OF ROWAN HOSPICE AND PALLIATIVE CARE 34,943. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASSIFICATION OF INTEREST EXPENSE -71,518. THE HOSPICE FOUNDATION REVENUE 138,713. ELIMINATIONS -221,087. EQUITY IN INCOME OF ROWAN HOSPICE AND PALLIATIVE CARE 34,943. PART XIII, LINE 2D - OTHER ADJUSTMENTS: THE HOSPICE FOUNDATION EXPENSES 89,531. ELIMINATIONS -221,087. PART XIII, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF INTEREST EXPENSE 71,518. HOSPICE HOPE RUN 142754 100299 42455 9077 2470 25 500 13866 GOLF TOURNAMENT 56987 42462 14525 2362 5411 1610 1145 7 147348 113423 33925 19450 7585 7310 16944 347089 256184 90905 30889 10055 12746 2110 31955 87755 3150 SCHEDULE G, PART II, COLUMN C, NUMBER OF EVENTS: OTHER EVENTS INCLUDED ON SCHEDULE G REPRESENT ALL FUNDRAISING EVENTS HELD BY HOSPICE & PALLIATIVE CARECENTER. OF THE SEVEN TOTAL EVENTS LISTED IN THE OTHER COLUMN, FIVE EVENTS GENERATED GROSS RECEIPTS GREATER THAN $5,000. 1 THE HOSPICE FOUNDATION 101 HOSPICE LANE WINSTONSALEM NC 27103 561823562 501(C)3 156000 ENDOWMENT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: EXPENDITURE RESPONSIBILITY X X X X 0 0 0 0 0 0 0 0 0 JOANN E DAVIS 177566 0 0 0 0 0 8947 0 6262 0 192775 0 0 0 BRIAN K PAYNE 145239 0 101 0 0 0 0 0 5910 0 151250 0 0 0 RICHARD C STEPHENSON 237187 0 1101 0 0 0 10560 0 10642 0 259490 0 0 0 KAREN L CROSS 179451 0 226 0 0 0 7942 0 12710 0 200329 0 0 0 KIM KINSLEY 172091 0 101 0 0 0 0 0 9943 0 182135 0 0 0 GENEVIEVE WROBLEWSKI 166767 0 303 0 0 0 1346 0 9928 0 178344 0 0 0 BRENTON SHARPE 151892 0 226 0 0 0 7595 0 0 0 159713 0 0 0 X 2 625 EST. FAIR MARKET VALUE X 30252 EST. FAIR MARKET VALUE X 7 15853 FMV AT DONATION DATE X 1 1000 EST. FAIR MARKET VALUE X GIFT CERTIFICATES 27 1240 FACE VALUE X SPORTS TICKETS 96 19150 EST. FAIR MARKET VALUE X VACATION STAYS 14 19150 FACE VALUE 0 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS REFERENCED IN PART I, COLUMN B IS REPRESENTATIVE OF THE NUMBER OF CONTRIBUTED ITEMS RECEIVED EXCEPT FOR PUBLICLY TRADED SECURITIES, WHICH SIGNIFIES THE NUMBER OF CONTRIBUTORS FORM 990, PART VI, SECTION B, LINE 11 THE PREPARED FORM 990 WILL BE REVIEWED BY THE GOVERNANCE BOARD FINANCE COMMITTEE, THE AGENCY CEO, THE AGENCY VP OF FINANCE & ADMINISTRATION, AND THE AGENCY CONTROLLER FOR ACCURACY AND REASONABLENESS PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED AND DISCUSSED WITH ALL EMPLOYEES AT GENERAL ORIENTATION. EMPLOYEES SIGN AN ACKNOWLEDGEMENT INDICATING THEY HAVE READ AND UNDERSTAND THE CONFLICT OF INTEREST POLICIES. IN ADDITION, MANAGERS COMPLETE TRAINING FOR POLICIES REGARDING SOLICITATION, DISTRIBUTION AND ACCESS, GIFTS AND GRATUITIES, REFERRAL OF BUSINESS, PATIENT/FAMILY LEGAL MATTERS, AND WILLS. THE CONFLICT OF INTEREST POLICY IS ALSO INCLUDED IN THE EMPLOYEE HANDBOOK. ANNUALLY, THE BOARD OF DIRECTORS MUST SIGN AN ACKNOWLEDGEMENT INDICATING THEY HAVE READ AND UNDERSTAND THE CONFLICT OF INTEREST POLICY. ALL BOARD MEMBERS WILL BE REQUIRED TO DISCLOSE ANY CONFLICT OF INTEREST AND WILL EXCUSE THEMSELVES FROM DECISION MAKING, INPUT OR VOTING RELATED TO THE CONFLICT. THEY WILL BE REQUIRED TO REPORT ANY CONFLICT TO THE BOARD OR CEO. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNING BOARD OF DIRECTORS IS RESPONSIBLE FOR DETERMINING CEO COMPENSATION. THE GOVERNING BOARD CONSULTS MARKET SURVEYS, PUBLISHED INDUSTRY STANDARDS, AND THE "HOSPICE & HOMECARE SALARY & BENEFITS REPORT." THE CEO AND THE HUMAN RESOURCES DEPARTMENT ARE JOINTLY RESPONSIBLE FOR DETERMINING ALL OTHER OFFICERS' COMPENSATION. THE PROCESS AND AIDS USED ARE THE SAME AS USED FOR DETERMINING CEO COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 HOSPICE & PALLIATIVE CARECENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND ITS FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC ONLY ON REQUEST. FORM 990, PART VII, SECTION A, COLUMN F THE ORGANIZATION, IN A FULL TRANSPARENCY POSTURE TO REPORTING, IS REPORTING ALL BENEFITS IN FULL IN COLUMN F, PART VII AND IS NOT APPLYING THE $10,000 PER ITEM EXCEPTION FOR CERTAIN BENEFITS. HOURS DEVOTED TO A RELATED ORGANIZATION FORM 990, PART VII, LINE 1A, COLUMN B: THE CHAIR AND VICE CHAIR OF HOSPICE & PALLIATIVE CARECENTER JOINTLY SERVE ON THE HOSPICE FOUNDATION AND HOSPICE & PALLIATE CARECENTER'S BOARD OF DIRECTORS. BOTH DIRECTORS DEVOTE APPROXIMATELY ONE HOUR PER WEEK TO EACH OF THE ORGANIZATIONS. THE PRESIDENT/CEO SERVES BOTH THE HOSPICE FOUNDATION AND HOSPICE & PALLIATIVE CARECENTER. THE PRESIDENT DEVOTES 40 COMBINED HOURS PER WEEK TO THE ORGANIZATIONS, 4 HOURS PER WEEK SERVING THE FOUNDATION, AND 36 HOURS PER WEEK SERVING HOSPICE & PALLIATIVE CARECENTER. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: EQUITY IN INCOME OF ROWAN HOSPICE AND PALLIATIVE CARE 34,943. TOTAL TO FORM 990, PART XI, LINE 5: 34,943. FORM 990, PART XI, LINE 2C: FINANCE COMMITTEE THE FINANCE COMMITTEE'S PROCESS OF EVALUATION HAS NOT CHANGED SINCE PRIOR YEAR. THE HOSPICE FOUNDATION 101 HOSPICE LANE WINSTONSALEM NC 27103 561823562 SUPPORT OF HOSPICE & PALLIATIVE CARECENTER NC 501(C)(3) LINE 11A, I HOSPICE & PALLIATIVE CARECENTER 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 THE HOSPICE FOUNDATION B 156000 THE HOSPICE FOUNDATION C 38944 THE HOSPICE FOUNDATION M 26143