2012-06-27T13:52:01-05:00 2011-12-31 581941470 HOLLAND HENRY & BROMLEY LLP PO BOX 8878 SAVANNAH GA 31412 990 2011-01-01 581393820 HOSPICE SAVANNAH INC HOSP 9123552289 PO BOX 13190 SAVANNAH GA 31416 ARTHUR GNANN 9123552289 2012-06-27 1 SHANNON L BRETT P00558136 9122353410 2012-06-27 X 2011 2016-02-24 21:20:13Z ARTHUR GNANN PO BOX 13190 SAVANNAH GA 31416 14027741 0 X WWW.HOSPICESAVANNAH.ORG X 1979 GA TO PROVIDE MEDICAL SERVICES TO PATIENTS WITH TERMINAL ILLNESSES. 18 18 252 250 0 0 150858 178100 13615734 13730574 16133 30190 79569 88877 13862294 14027741 0 0 0 0 9314045 9558863 0 0 0 4907651 4754504 14221696 14313367 -359402 -285626 10393555 10227137 1491823 1611031 8901732 8616106 TO PROVIDE THE BEST SERVICES AND RESOURCES FOR THE COMMUNITY ON DYING, DEATH, GRIEF AND LOSS 0 0 11654802 13795723 THE ORGANIZATION PROVIDED CARE FOR TERMINALLY ILL PATIENTS AND THEIR FAMILIES THROUGH HOSPICE HOUSE AND HOME CARE PROGRAMS AND PROVIDED EDUCATIONAL OPPORTUNITIES ON DEATH AND DYING, GRIEF AND LOSS. GRIEF AND LOSS PROGRAM FOR PATIENTS, FAMILY MEMBERS AND THE COMMUNITY AT LARGE. 11654802 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 1 95 0 1 252 1 0 0 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 1 0 GA X ARTHUR GNANN 9123552289 PO BOX 13190 SAVANNAH GA 31416 NITA ANN KLEIN 1.00 X 0 0 0 R VINCENT MARTIN III 1.00 X 0 0 0 KACEY RATTERREE 1.00 X 0 0 0 HOLDEN HAYES 1.00 X 0 0 0 MYRA HILL 1.00 X 0 0 0 FRAN KAMINSKY 1.00 X 0 0 0 LYNN WIRTH 1.00 X 0 0 0 PAUL MEYER 1.00 X 0 0 0 FRANK SLOTIN 1.00 X 0 0 0 THEODORA T GONGAWARE MD 1.00 X 0 0 0 MARTIN GREENBURG MD 1.00 X 0 0 0 RAMON V MEGUIAR MD 1.00 X 0 0 0 KATHY MCCURRY 1.00 X 0 0 0 MARK BURNS 1.00 X 0 0 0 WILLIAM A BAKER 1.00 X 0 0 0 BRUCE BARRAGAN 1.00 X 0 0 0 KATHLEEN DELOACH BENTON 1.00 X 0 0 0 ROENIA DELOACH 1.00 X 0 0 0 DEBRA LARSON 40.00 X 105770 0 0 ARTHUR GNANN 40.00 X 99702 0 0 JUDSON HENDRY 40.00 X 98682 0 0 MONICA ANDERSON 40.00 X 95412 0 0 KELLY EROLA 40.00 X 196329 0 0 595895 0 0 2 0 1 0 BCBS PO BOX 100376 ATLANTA GA 30384 EMPLOYEE HEALTH INSURANCE 994904 HOSPICE PHARMACIA LLC PO BOX 510818 PHILADELPHIA PA 191750818 PATIENT MEDICATIONS 857589 MUTUAL OF AMERICA ROCKEFELLER CTR UNIT PO BOX 2493 NEW YORK NY 101850049 403B 619249 EDM ENTERPRISES INC BLDG 6 2600 CHAMBLEE ROAD SUITE 2 ATLANTA GA 30341 DURABLE MEDICAL EQUIPMENT 488313 BRYAN COUNTY HEALTH & REHAB 127 CARTER STREET RICHMOND HILL GA 31324 NURSING HOME 460323 5 178100 178100 PATIENT SERVICE REVENU 621610 17609011 17609011 CHARITY CARE 621610 -390296 -390296 CONTRACTUAL ADJUSTMENT 621610 -3488141 -3488141 13730574 30190 30190 53918 53918 53918 53918 MANAGEMENT FEES 561000 24000 24000 SPECIAL EVENTS 621610 10959 10959 34959 14027741 13795723 0 53918 X 595895 103073 492822 7180902 6391801 789101 1782066 1488298 293768 10098 10098 69276 50 69226 123462 123462 49047 4660 44387 53987 50344 3643 349744 256957 92787 MEDICATIONS 933388 933388 DME 566790 566790 MILEAGE, MEETINGS, CELL 385217 313158 72059 BAD DEBT 309859 309859 1903636 1236424 667212 14313367 11654802 2658565 0 2196233 2351735 1627761 1606190 25982 19916 70206 56477 10203944 4175867 6328163 6028077 145210 164742 10393555 10227137 1491323 1610531 500 500 1491823 1611031 X 8901732 8616106 8901732 8616106 10393555 10227137 -285626 0 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8559934 2652729 5907205 1644010 1523138 120872 6028077 DUE TO RELATED PARTIES 500 500 14027741 14313367 -285626 -285626 13847616 0 13847616 180125 180125 14027741 14133242 0 14133242 180125 180125 14313367 PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION TO FOUNDATION 180,125. PART XIII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION TO FOUNDATION 180,125. 1 1 X 0 0 1 1 0 0 211281 211281 0.01480 211281 211281 0.01480 664429 664429 0.04640 123362 123362 0.00860 787791 787791 0.05500 999072 999072 0.06980 1 378769 211150 12546354 12369978 176376 X 1 1 1 1 HOSPICE SAVANNAH INC

1352 EISENHOWER DRIVE SAVANNAH GA 31406

HOSPICE CARE INPATIENT UNIT HOSPICE SAVANNAH INC 1 0 1 0 0 1 X X 1 1 X 1 X 0 0 X X 0 1 2 HOSPICE SAVANNAH INC

1674 CHATHAM PARKWAY SAVANNAH GA 31405

ADMINISTRATIVE OFFICES HOSPICE SAVANNAH INC

450 MALL BLVD SUITE H SAVANNAH GA 31416

BEREAVEMENT CENTER PART I, LINE 3C: THE FOLLOWING POLICY IS USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. A FINANCE REPRESENTATIVE OR SOCIAL WORKER WILL MEET WITH THE PATIENT AND/OR RESPONSIBLE PARTY PRIOR TO PATIENT BEING ADMITTED TO COMPLETE A FINANCIAL ASSESSMENT FORM. THIS FORM DETERMINES THE LEVEL OF PAY THAT IS REQUIRED PER DAY FROM THE PATIENT OR FAMILY, DEPENDING ON THE FINANCIAL RESOURCES AVAILABLE. THE PATIENT/FAMILY WILL PROVIDE VERIFICATION AND APPROPRIATE PROOF OF RESOURCES AND COMMITMENTS.THE FINANCIAL ASSESSMENT FORM IS SIGNED BY THE PATIENT OR RESPONSIBLE PARTY AND A HOSPICE SAVANNAH REPRESENTATIVE. SIGNING THE FORM IS AN AGREEMENT TO PAY THE AMOUNT DETERMINED. REFUSAL TO PAY THE AGREED TO AMOUNT WILL RESULT IN APPROPRIATE MEASURES BEING TAKEN TO COLLECT THE FUNDS.REFUSAL TO COMPLETE AND SIGN THE FORM WILL RESULT IN THE PATIENT BEING CHARGED THE FULL RATE PER DAY.THE ORIGNIAL AGREEMENT WILL BE PLACED IN THE PATIENT'S FINANICAL CHART. THE PATIENT OR RESPONSIBLE PARTY WILL BE BILLED BI-MONTHLY BASED ON THE PER DIEM RATE ESTABLISHED USING THE FINANCIAL ASSESSMENT FORM. PART I, LINE 7: WORKSHEET 2 FROM FORM 990 INSTRUCTIONS IS USED AS COSTING METHODOLOGY. THERE WERE NO SUBSIDIZED HEALTH SERVICES. PART II: THERE WERE NO COMMUNITY BUILDING ACTIVITIES HELD IN 2011. PART III, LINE 4: WORKSHEET 2 IN THE FORM 990 INSTRUCTIONS WAS USED AS THE COSTING METHODOLOGY FOR PART III, LINE 4. PART III, LINE 8: THERE WAS NO SHORTFALL ON PART III, LINE 7. THE MEDICARE ALLOWABLE COSTS OF CARE WERE DERIVED FROM THE CMS PUBLISHED PER DIEM RATE. PART III, LINE 9B: HOSPICE'S COLLECTION POLICY IS TO SEND THREE STATEMENTS AND PAST DUE LETTERS. IF NO PAYMENT IS RECEIVED AFTER STATEMENTS AND LETTERS ARE SENT, THE ACCOUNT IS WRITTEN OFF. HOSPICE SAVANNAH, INC. PART V, SECTION B, LINE 15E: HOSPICE'S COLLECTION POLICY IS TO SEND THREE STATEMENTS AND PAST DUE LETTERS ONCE AN ACCOUNT IS DEEMED PAST DUE. IF NO PAYMENT IS RECEIVED AFTER STATEMENTS AND LETTERS ARE SENT, THE ACCOUNT IS WRITTEN OFF. HOSPICE SAVANNAH, INC. PART V, SECTION B, LINE 18D: HOSPICE SAVANNAH IS NOT A HOSPITAL AND PROVIDES HOSPICE SERVICES, NOT EMERGENCY CARE SERVICES. HOSPICE SAVANNAH, INC. PART V, SECTION B, LINE 19D: HOSPICE SAVANNAH USES A FINANCIAL ASSESSMENT FORM TO DETERMINE THE AMOUNT OWED. SEE EXPLANATION ABOVE UNDER PART I, LINE 3C FOR ADDITIONAL DETAIL. HOSPICE SAVANNAH, INC. PART V, SECTION B, LINE 21: ALL SELF PAY PATIENTS THAT DO NOT QUALIFY FOR A REDUCED RATE AFTER COMPLETING THE FINANCIAL ASSESSMENT FORM ARE CHARGED FULL PRICE. PART VI, LINE 2: HOSPICE SAVANNAH PREPARES AN ANNUAL MARKET ANALYSIS ON DEMOGRAPHICS IN THE REGION. CUSTOMER SATISFACTION SURVEYS ARE USED TO PROVIDE FEEDBACK ON EFFECTIVITY OF SERVICES PROVIDED. NHPCO AND GHPCO RESOURCES ARE USED TO TRACK TRENDS IN HOSPICE CARE AND BEST PRACTICES. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE IS DONE THROUGH THE ADMISSIONS PROCESS. THEY RECEIVE A FAMILY RESOURCE GUIDE EXPLAINING FINANCIAL OPTIONS. HOSPICE SAVANNAH ALSO ASSISTS PATIENTS WITH COMPLETING MEDICAID APPLICATIONS. PART VI, LINE 4: HOSPICE SAVANNAH SERVES A 5 COUNTY AREA IN SOUTHEAST GEORGIA. CHATHAM, BRYAN, EFFINGHAM, LIBERTY AND LONG COUNTIES ARE ALL SERVED BY HOSPICE SAVANNAH. MOST OF THE POPULATION IS IN CHATHAM COUNTY IN AN URBAN SETTING. PART VI, LINE 5: HOSPICE SAVANNAH OFFERS GRIEF AND LOSS SERVICES TO NOT ONLY HOSPICE SAVANNAH PATIENTS AND THEIR FAMILIES BUT THE COMMUNITY AT LARGE AT NO COST TO THE PARTICIPANTS. THESE SERVICES INCLUDE, BUT ARE NOT LIMITED TO, INDIVIDUAL AND GROUP COUNSELING, MASSAGE THERAPY, MUSIC THERAPY, STORYTELLING, ETC. SCHOOLS, HOSPITALS, NURSING HOMES AND WORD OF MOUTH ARE USED TO INFORM THE COMMUNITY OF THESE SERVICES. PART VI, LINE 6: N/A X 0 0 0 0 0 0 0 0 0 KELLY EROLA 196329 0 0 0 0 0 0 0 0 0 196329 0 0 0 HOLDEN HAYES CHAIRMAN OF HOSPICE AND PRESIDENT OF BANK WHERE CASH ACCOUNTS ARE HELD EMPLOYED BY BANK AND VOLUNTEERS AS BOARD MEMBER FOR HOSPICEEMPLOYED BY BANK AND VOLUNTEERS AS BOARD MEMBER FOR HOSPICE 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WILL BE REVIEWED AND APPROVED BY CEO, VP OF FINANCE AND EXECUTIVE/FINANCE COMMITTEE OF BOARD OF DIRECTORS VIA EMAIL PRIOR TO SUBMISSION TO IRS. FORM 990, PART VI, SECTION B, LINE 12C AN ACKNOWLEDGEMENT IS SIGNED BY ALL EMPLOYEES AND BOARD MEMBERS. THIS FORM IS MAINTAINED IN THE HUMAN RESOURCES DEPARTMENT. FORM 990, PART VI, SECTION B, LINE 15B HOSPICE SAVANNAH TYPICALLY UTILIZES AN OUTSIDE AGENCY TO PERFORM A COMPENSATION SURVEY. THIS SURVEY ENSURES THAT ALL SALARIES ARE COMPARABLE WITH AVERAGE GOING RATES FOR ORGANIZATIONS OF SIMILAR SIZE AND IN THE SAME INDUSTRY. ALL SALARIES ARE BASED ON RELEVANT EXPERIENCE AND EDUCATION WITHIN COMPENSATION STRUCTURE. THE COMPENSATION SURVEY IS PERFORMED EVERY TWO YEARS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST FROM THE ADMINSTRATIVE OFFICE. ALL OTHER FUNCTIONAL EXPENSES FORM 990, PART X, LINE 24F MEDICAL SUPPLIES: PROGRAM SERVICE EXPENSES 234,723. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 234,723. CONTRIBUTION TO FOUNDATION: PROGRAM SERVICE EXPENSES 180,125. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 180,125. CLEANING AND EXTERMINATING: PROGRAM SERVICE EXPENSES 146,155. MANAGEMENT AND GENERAL EXPENSES 32,325. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 178,480. UTILITIES: PROGRAM SERVICE EXPENSES 80,499. MANAGEMENT AND GENERAL EXPENSES 71,502. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 152,001. INSURANCE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 131,699. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 131,699. EQUIPMENT: PROGRAM SERVICE EXPENSES 90,729. MANAGEMENT AND GENERAL EXPENSES 17,653. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 108,382. TELEPHONE: PROGRAM SERVICE EXPENSES 143. MANAGEMENT AND GENERAL EXPENSES 98,745. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 98,888. COMPUTER: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 82,132. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 82,132. AMBULANCE: PROGRAM SERVICE EXPENSES 75,169. MANAGEMENT AND GENERAL EXPENSES 720. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 75,889. REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 53,313. MANAGEMENT AND GENERAL EXPENSES 15,666. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 68,979. FACILITY RELATED CONTRACTS: PROGRAM SERVICE EXPENSES 41,340. MANAGEMENT AND GENERAL EXPENSES 24,573. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 65,913. DIETARY AND FOOD: PROGRAM SERVICE EXPENSES 64,549. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,549. CABLE AND LINEN: PROGRAM SERVICE EXPENSES 62,665. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,665. THERAPIES: PROGRAM SERVICE EXPENSES 62,483. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,483. SECURITY EXPENSE: PROGRAM SERVICE EXPENSES 36,762. MANAGEMENT AND GENERAL EXPENSES 20,905. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 57,667. CONSULTING AND SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 7,655. MANAGEMENT AND GENERAL EXPENSES 49,216. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 56,871. DUES AND SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 9,211. MANAGEMENT AND GENERAL EXPENSES 45,685. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,896. CONTINUING EDUCATION: PROGRAM SERVICE EXPENSES 33,279. MANAGEMENT AND GENERAL EXPENSES 6,673. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,952. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 35,519. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,519. PASS THROUGHS: PROGRAM SERVICE EXPENSES 26,855. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 26,855. POSTAGE AND PRINTING: PROGRAM SERVICE EXPENSES 2,506. MANAGEMENT AND GENERAL EXPENSES 18,126. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,632. LAB AND IMAGING: PROGRAM SERVICE EXPENSES 15,184. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,184. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 1,775. MANAGEMENT AND GENERAL EXPENSES 10,900. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,675. WASTE DISPOSAL: PROGRAM SERVICE EXPENSES 6,861. MANAGEMENT AND GENERAL EXPENSES 5,173. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,034. OUTPATIENT: PROGRAM SERVICE EXPENSES 4,443. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,443. AS IN PREVIOUS YEARS, THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. OLD RIVER HOSPICE PROPERTIES LLC 24 DRAYTON STREET SUITE 712 SAVANNAH GA 31410 270888923 PROPERTY MANAGEMENT GA 2968 390707 HOSPICE SAVANNAH INC THE STEWARD CENTER FOR PALLIATIVE CARE INC POST OFFICE BOX 13190 SAVANNAH GA 31416 510545338 COUNSELING GA 501(C)(3) LINE 9 HOSPICE SAVANNAH INC 0 HOSPICE SAVANNAH FOUNDATION INC POST OFFICE BOX 13190 SAVANNAH GA 31416 582215819 FUNDING ASSISTANCE FOR HOSPICE SAVANNAH, INC. AND THE STEWARD CENTER GA 501(C)(3) LINE 11A, I N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 HOSPICE SAVANNAH FOUNDATION INC B 180125 FMV HOSPICE SAVANNAH FOUNDATION INC M 0 THE STEWARD CENTER FOR PALLIATIVE CARE INC M 0 HOSPICE SAVANNAH FOUNDATION INC N 0 THE STEWARD CENTER FOR PALLIATIVE CARE INC N 0 THE STEWARD CENTER FOR PALLIATIVE CARE INC P 95545 FMV HOSPICE SAVANNAH FOUNDATION INC P 69196 FMV