2012-05-15T15:06:54-05:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2011-01-01 561452373 HOSPICE OF CLEVELAND COUNTY INC HOSP 7044874677 951 WENDOVER HEIGHTS DRIVE SHELBY NC 281503565 MYRA MCGINNIS 7044874677 2012-05-15 1 GREGORY W JOHNS P00535091 7049985200 2011 2016-02-24 21:20:13Z HOSPICE CLEVELAND COUNTY MYRA MCGINNIS 951 WENDOVER HEIGHTS DRIVE SHELBY NC 281503565 11220863 0 X WWW.HOSPICECARES.CC X 1984 NC HOSPICE OF CLEVELAND COUNTY PROVIDES CARE AND SUPPORT TO PATIENTS WITH A LIFE-LIMITING ILLNESS. 16 16 177 262 -2295 0 791144 398738 10320132 10725372 40682 43107 14979 37060 11166937 11204277 0 0 0 0 5343213 5886211 0 0 0 4325138 4315243 9668351 10201454 1498586 1002823 16424316 17590193 1289492 1252838 15134824 16337355 HOSPICE OF CLEVELAND COUNTY, INC. EXISTS TO PROVIDE HIGH QUALITY SKILLED COMPASSIONATE CARE AND SUPPORT FOR INDIVIDUALS WITH A LIFE-LIMITING ILLNESS, THEIR FAMILIES, AND THE COMMUNITY, REGARDLESS OF THEIR ABILITY TO PAY. 0 0 5366960 7358014 HOSPICE CLEVELAND COUNTY PROVIDES COMPREHENSIVE END OF LIFE HEALTHCARE FOR TERMINALLY ILL PATIENTS AND THEIR FAMILIES DURING THE FINAL STAGES OF ILLNESS. DURING 2011, HOSPICE CLEVELAND COUNTY PROVIDED 45,419 DAYS OF HOMECARE INCLUDING 10,965 DAYS OF NURSING HOME AND HOSPITAL INPATIENT CARE. HOSPICE CLEVELAND COUNTY SERVED 599 HOMECARE PATIENTS IN 2011. HOSPICE CLEVELAND COUNTY'S INTERDISCIPLINARY TEAMS CONSISTING OF PHYSICIANS, NURSES, HOSPICE AIDES, SOCIAL WORKERS, AND OTHER SUPPORTIVE PERSONNEL PROVIDED OVER 34,324 VISITS DURING 2011. 2708667 3066829 HOSPICE CLEVELAND COUNTY OWNS AND OPERATES TWO HOSPICE HOUSES THAT PROVIDE HOSPICE INPATIENT AND RESIDENTIAL CARE FOR TERMINALLY ILL PATIENTS DURING THE FINAL STAGES OF ILLNESS. THE WENDOVER HOSPICE HOUSE HAS 14 BEDS AND THE KINGS MOUNTAIN HOSPICE HOUSE HAS 8 BEDS. DURING 2011, HOSPICE CLEVELAND COUNTY PROVIDED 7,798 DAYS OF CARE IN THESE FACILITIES. HOSPICE CLEVELAND COUNTY SERVED 292 PATIENTS IN THE HOSPICE HOUSES IN 2011. 709577 300529 PALLIATIVE CARE CLEVELAND COUNTY PROVIDES A PROGRAM OF PAIN CONTROL, SYMPTOM MANAGEMENT AND ASSISTANCE WITH DIFFICULT DECISION MAKING. DURING 2011, PALLIATIVE CARE CLEVELAND COUNTY SERVED 946 PATIENTS. 8785204 1 1 0 1 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 32 1 1 177 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 1 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X PAM BENFIELD 7044874677 951 WENDOVER HEIGHTS DRIVE SHELBY NC 28150 DR JEFF CARLEY 1.00 X 0 0 0 DR ROBERT GOSSETT 1.00 X 0 0 0 KARLA HAYNES 1.00 X 0 0 0 DR FORREST THOMPSON 1.00 X 0 0 0 KATHY WILSON 1.00 X 0 0 0 ADRIAN CAMP 1.00 X 0 0 0 ANDREA LESLIE-FITE 1.00 X 0 0 0 JENNIE LAMBERT 1.00 X 0 0 0 EARL LUTZ 1.00 X 0 0 0 STEVE PADGETT 1.00 X 0 0 0 JT SCRUGGS 1.00 X 0 0 0 EDDIE HOLBROOK 1.00 X 0 0 0 KEN MILLER 1.00 X 0 0 0 PETE MOORE 1.00 X 0 0 0 DR MIKE RIBADENEYRA 1.00 X 0 0 0 RIT VARRIALE 1.00 X 0 0 0 DOUG SATTERFIELD 1.00 X 0 0 0 MYRA MCGINNIS 45.00 X 0 127718 35889 DR DAVID BARKER 40.50 X 163615 0 35341 DR JAMES POTTS 50.30 X 154389 0 33348 DR SANGYA PATEL 46.20 X 204851 0 44248 522855 127718 148826 4 0 1 0 CLEVELAND COUNTY HEALTHCARE SYSTEM 201 E GROVER STREET SHELBY NC 28150 MANAGEMENT SERVICES 280014 1 89751 308987 398738 PATIENT REVENUE 621610 10725372 10725372 10725372 43107 43107 52892 16586 36306 36306 DISPOSAL OF ASSET 900099 3049 3049 UNRELATED BUSINESS INC 452000 -2295 -2295 754 11204277 10725372 -2295 82462 4840836 4198410 642426 97416 84488 12928 602239 522316 79923 345720 299840 45880 38844 38844 331986 80439 251547 28085 28085 115931 53227 62704 84396 23827 60569 229949 111000 118949 171764 163354 8410 30646 18018 12628 551699 551699 51746 51746 PURCHASED SERVICES 1406195 1406195 SUPPLIES 811680 811680 BAD DEBT EXPENSES 299586 299586 PROFESSIONAL FEES 30816 30816 131920 102224 29696 10201454 8785204 1416250 0 6075486 5613953 833526 3003410 726953 529981 1080466 1017195 5328 5667 62382 71189 9980141 2639307 7627323 7340834 12852 7964 16424316 17590193 952477 880957 337015 371881 1289492 1252838 X 14407871 15609833 726953 529981 197541 15134824 16337355 16424316 17590193 X 1002823 199708 X X 0 1 1 X 0 X 366454 1180647 923415 791778 398738 3661032 366454 1180647 923415 791778 398738 3661032 324912 3336120 284653 187882 85611 40682 43107 641935 -70 -395 -2295 -2760 -2761 10608 13028 -6019 3049 17905 4318112 46280832 0.77260 0.74460 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 149 149 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE ORGANIZATION BELONGS TO THE NATIONAL HOSPICE & PALLIATIVE CARE ORGANIZATION WHICH DETERMINED THAT 3.03% OF ITS PROVIDER DUES WERE USED FOR SPECIFIC LOBBYING PURPOSES. 238989 238989 0.17000 0.83000 0 0 295737 295737 7358348 1639148 5719200 1593660 794400 799260 732396 205759 526637 7340834 ESTIMATED THIRD PARTY LIABILITY 371881 371881 11204277 10201454 1002823 2167 197541 199708 1202531 11403416 2167 326004 328171 11075245 129032 129032 11204277 10201454 0 10201454 0 10201454 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: PERMANENT ENDOWMENT FUND ($197,541) PLUS BOARD-DESIGNATED FOREVER FUND ($41,448). DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION ADOPTED THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE IMPLEMENTATION OF THIS STANDARD HAD NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2011. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN PERMANENTLY RESTRICTED NET ASSETS 197,541. PART XII, LINE 2D - OTHER ADJUSTMENTS: RELEASE FROM RESTRICTION FOR PP&E 326,004. PART XII, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED PLEDGES RECEIVED 113,404. CHANGE IN DISCOUNT ON PLEDGES RECEIVABLE 15,628. VARIOUS 42984 42984 2000 5963 4371 RAFFLE 9908 9908 4252 52892 52892 2000 5963 8623 16586 36306 X 1 1 X X X 0 0 0 1 0 0 0 0 0 MYRA MCGINNIS 0 105386 0 14650 0 7682 0 0 0 35889 0 163607 0 0 DR DAVID BARKER 162570 0 550 0 495 0 0 0 35341 0 198956 0 0 0 DR JAMES POTTS 153524 0 550 0 315 0 0 0 33348 0 187737 0 0 0 DR SANGYA PATEL 203986 0 550 0 315 0 0 0 44248 0 249099 0 0 0 PART I, LINE 1A HOSPICE OF CLEVELAND COUNTY, INC. PAYS A PORTION OF MONTHLY DUES FOR EMPLOYEES WHO CHOOSE TO JOIN THE LOCAL YMCA PROGRAM. THIS IS REPORTED AS TAXABLE FRINGE IN THE EMPLOYEES PAYROLL EARNINGS AND TAXED APPROPRIATELY. PART I, LINE 5 THE PRESIDENT/CEO, WHO IS PAID BY CRMC, RECEIVES A YEARLY BONUS BASED ON ACHIEVING A LIST OF GOALS. FORM 990, PART VI, SECTION A, LINE 3 HOSPICE OF CLEVELAND COUNTY, INC. HAS AN AGREEMENT WITH CLEVELAND REGIONAL MEDICAL CENTER TO PROVIDE MANAGEMENT SERVICES FOR DAY-TO-DAY OPERATIONS. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED EFFECTIVE JANUARY 1, 2011. THE AMENDMENT INCLUDED THE PROVISION THAT THERE SHOULD BE 17 VOTING BOARD MEMBERS. IN ADDITION, THE AMENDMENT OMITTED LANGUAGE THAT GAVE MEMBERS OR OTHER PERSONS THE AUTHORITY TO ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S PRESIDENT/CEO WILL REVIEW AND APPROVE FORM 990 AND WILL PRESENT IT TO THE FINANCE COMMITTEE BEFORE IT IS FILED. THE FINANCE COMMITTEE WILL THEN PRESENT THE PREPARED FORM 990 TO THE BOARD OF DIRECTORS FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MAINTAINS A CONFLICT OF INTEREST POLICY THAT COVERS ALL EMPLOYEES AND BOARD MEMBERS. EACH YEAR THE CONFLICT OF INTEREST POLICY IS REVIEWED AT ONE OF THE MONTHLY STAFF MEETINGS WITH ALL EMPLOYEES. SENIOR LEADERSHIP AND ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE, SIGN AND DATE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM. ALL DISCLOSURES BY BOARD MEMBERS ARE REVIEWED AND APPROVED BY THE CLEVELAND COUNTY HEATHCARE SYSTEM COMPLIANCE DIRECTOR. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION OF THE PRESIDENT/CEO AND SENIOR LEADERSHIP WAS LAST REVIEWED IN 2011. FORM 990, PART VI, SECTION C, LINE 19 REQUESTS FOR REVIEW OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS MUST BE SUBMITTED TO HOSPICE OF CLEVELAND COUNTY, INC. IN WRITING AND MUST INCLUDE THE NAME, ADDRESS, AND TELEPHONE NUMBER OF THE INDIVIDUAL OR ENTITY MAKING THE REQUEST. ALL REQUESTS ARE SUBMITTED TO THE PRESIDENT/CEO FOR APPROVAL. UPON APPROVAL, THE DOCUMENTS ARE MADE AVAILABLE WITHIN TWO WEEKS OF RECEIPT OF THE WRITTEN REQUEST. THE DOCUMENTS ARE AVAILABLE FOR REVIEW AT THE HOSPICE OF CLEVELAND COUNTY, INC. ADMINISTRATIVE OFFICE BUILDING. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,167. CHANGE IN PERMANENTLY RESTRICTED NET ASSETS 197,541. TOTAL TO FORM 990, PART XI, LINE 5: 199,708. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CLEVELAND REGIONAL MEDICAL CENTER 201 E GROVER ST SHELBY NC 28150 560654386 GOVERNMENTAL HOSPITAL NC 501(C)(3) 170(B)(1)(A)(III) N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 CLEVELAND REGIONAL MEDICAL CENTER O 72102 CLEVELAND REGIONAL MEDICAL CENTER L 280014