2012-10-13T12:30:26-05:00 2011-12-31 310800053 CLARK SCHAEFER HACKETT CO 10100 INNOVATION DRIVE SUITE 400 DAYTON OH 45342 990 2011-01-01 310933339 THE HOSPICE OF DAYTON INC HOSP 9372564490 324 WILMINGTON AVE DAYTON OH 45420 JERRY DURST 9372564490 2012-10-12 1 KEVIN T DAVIS CPA P00039883 9372260070 2012-10-12 2011 2016-02-24 21:20:13Z KENT ANDERSON 324 WILMINGTON AVE DAYTON OH 45420 61676912 0 X HTTP://WWW.HOSPICEOFDAYTON.ORG X 1978 OH TO PROVIDE HOSPICE CARE FOR TERMINALLY ILL INDIVIDUALS 15 14 783 614 0 0 1177836 2151665 42675955 47479554 1728571 1596590 20249 356439 45602611 51584248 0 0 0 0 29258073 33991004 0 0 0 12879234 16278419 42137307 50269423 3465304 1314825 64261331 72954335 5600968 15086698 58660363 57867637 X THE HOSPICE OF DAYTON, INC. IS COMMITTED TO MAKING QUALITY HOSPICE CARE AVAILABLE AND ACCESSIBLE TO TERMINALLY ILL PERSONS AND THEIR FAMILIES, REGARDLESS OF ABILITY TO PAY, AND IN A MANNER CONSISTENT WITH THE HIGHEST HOSPICE STANDARDS. OUR COMMITMENT TO THE HOSPICE PHILOSOPHY OF CARE INCLUDES A COMPASSIONATE STAFF PLEDGED TO CONTINUOUSLY IMPROVE AND ENHANCE THE CARE WE PROVIDE, RESPECT THE PATIENTS' CHOICES OF CARE, RESPOND TO CHANGING COMMUNITY NEEDS, AND SERVE AS A RESOURCE TO OTHERS FOR IMPROVING THE AVAILABILITY OF QUALITY HOSPICE CARE. 0 0 41392342 47835993 COORDINATES A PROGRAM OF HOME, OUTPATIENT, AND INPATIENT HOSPICE CARE THAT PROVIDES PALLIATIVE CARE, SUPPORTIVE MEDICAL SERVICES, AND OTHER SUPPORT SERVICES TO TERMINALLY ILL PERSONS AND THEIR FAMILIES, REGARDLESS OF ABILITY TO PAY. 41392342 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 239 0 1 783 1 0 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X JERRY DURST 9372564490 324 WILMINGTON AVE DAYTON OH 454201891 KENT ANDERSON 40.00 X X 342917 0 4108 GARY LEROY MD 2.00 X 0 0 0 PAMELA MORRIS 2.00 X X 0 0 0 LISA HANAUER 2.00 X 0 0 0 CLAIRE RODEHAVER 2.00 X X 0 0 0 TONI SPRINKEL 2.00 X 0 0 0 LOIS SUTHERLAND 2.00 X 0 0 0 GREG TOMAN 2.00 X X 0 0 0 LARRY ZUMSTEIN 2.00 X 0 0 0 DANIEL ERLANDSON 2.00 X 0 0 0 THOMAS MANN 2.00 X X 0 0 0 PAULA MACILWAINE 2.00 X 0 0 0 RATNA PALAKODETI MD 2.00 X 0 0 0 THOMAS DUNCAN 2.00 X 0 0 0 LINDSAY M JOHNSON ESQ 2.00 X 0 0 0 JERRY DURST 40.00 X 165688 0 16622 BRENDA HUMFLEET 2.00 X 190292 0 17350 JULES SHERMAN 40.00 X 253673 0 16750 RUTH THOMSON 40.00 X 363737 0 10233 WENDY SCHMITZ 40.00 X 213899 0 5564 CHIRAG PATEL 40.00 X 249894 0 6233 RANAPREET PATEL 40.00 X 220011 0 9600 MARY MURPHY 40.00 X 184112 0 17058 2184223 0 103518 16 0 1 0 EXCELLERX 1601 CHERRY ST PHILADELPHIA PA 19102 PHARMACEUTICAL 2389456 THERAPY SUPPORT INC 2803 N OAK GROVE AVE SPRINGFIELD MO 658034976 THERAPY 1876261 KETTERING MEDICAL CENTER PO BOX 713086 COLUMBUS OH 432713086 HOSPITAL 510285 MIAMI VALLEY HOSPITAL PO BOX 713073 COLUMBUS OH 432713073 HOSPITAL 375743 ANNE M REDDY MD 8501 OLD TROY PIKE HUBER HEIGHTS OH 45424 PHYSICIAN 275455 17 2151665 2151665 PATIENT SERVICE 624100 47479554 47479554 47479554 759667 759667 10929587 10092664 836923 836923 836923 MISCELLANEOUS INCOME 900099 356439 356439 356439 51584248 47835993 0 1596590 1007400 270423 529335 207642 26839227 23997909 2598411 242907 338637 293494 41850 3293 3756863 2914445 776981 65437 2048877 1610093 411172 27612 106233 106233 1325734 5980 705486 614268 638634 181672 456962 121236 3567 117669 473410 62191 369399 41820 239268 44562 194706 1350858 1013144 337714 182994 182994 MEDICATIONS & SUPPLIES 3569148 3569148 0 0 EQUIPMENT RENTAL AND MA 2787419 1931266 856153 0 CONTRACTED SERVICES 1573125 721152 851973 0 GENERAL INPATIENT EXPEN 1261751 1261751 0 0 2648609 3511545 340043 -1202979 50269423 41392342 8877081 0 719 969 6163802 2534956 4813499 7060209 233837 47584 28982361 11209725 11623577 17772636 17611480 21457091 23814417 24080890 64261331 72954335 5259780 14656348 341188 430350 5600968 15086698 X 57102477 56303799 447886 453838 1110000 1110000 58660363 57867637 64261331 72954335 X 1314825 -2107551 X X 0 1 1 X 0 X 2524373 2637407 1444606 1177836 2151665 9935887 2524373 2637407 1444606 1177836 2151665 9935887 9935887 2109807 -2969807 460081 1728571 1596590 2925242 109120 111487 62753 20249 356439 660048 13521177 198469113 0.73480 0.78000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 22828457 1890 38869 1890 22867326 14407503 6273655 2324795 177496 22828457 7500120 6015800 1396370 504787 14407503 9640550 -2140430 7500120 0.95150 0.04850 0.00000 0 1 0 930854 930854 23415064 8911879 14503185 4523549 2249356 2274193 112894 48490 64404 17772636 BENEFICIAL INTEREST IN SUBSIDIARY FOUNDATION 22938969 DUE FROM RELATED ENTITY (HOSPICE OF DAYTON FDTN. 31-1769696) 1141921 24080890 RETIREMENT PLAN LIABILITY 430350 430350 51584248 50269423 1314825 -1670547 -437004 -2107551 -792726 52729323 -1670547 2921855 1251308 51478015 106233 106233 51584248 53522049 3358859 3358859 50163190 106233 106233 50269423 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 THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD FAIL TO BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. AS DISCUSSED ABOVE, THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES AND MANAGEMENT BELIEVES THE ORGANIZATION HAS NOT ENGAGED IN ANY ACTIVITIES THAT WOULD DISQUALIFY IT FROM TAX-EXEMPT STATUS OR INCUR A TAX OBLIGATION FOR THE YEARS ENDED DECEMBER 31, 2011 AND 2010. THE ORGANIZATION BELIEVES THEIR ESTIMATES ARE APPROPRIATE BASED ON CURRENT FACTS AND CIRCUMSTANCES. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE ORGANIZATION BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS ENDED PRIOR TO DECEMBER 31, 2008. THE ORGANIZATION'S POLICY WITH REGARD TO INTEREST AND PENALTY, IF INCURRED, IS TO RECOGNIZE INTEREST THROUGH INTEREST EXPENSE AND PENALTIES THROUGH OTHER EXPENSE. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN NET ASSETS OF BENEFICIAL INTEREST IN RELATED ENTITY (31-1769696) -437,004. PART XII, LINE 2D - OTHER ADJUSTMENTS: ELIMINATION OF NET REVENUE ACTIVITY OF SUBSIDIARY FOUNDATION 2,921,855. PART XIII, LINE 2D - OTHER ADJUSTMENTS: ELIMINATION OF NET EXPENSE ACTIVITY OF SUBSIDIARY FOUNDATION 3,358,859. PART V, LINE 4: ENDOWMENT FUNDS ARE MAINTAINED BY A RELATED ORGANIZATION, HOSPICE OF DAYTON FOUNDATION (31-1769696). ENDOWMENT FUNDS ARE MAINTAINED BY THE FOUNDATION TO SUPPORT THE HOSPICE OF DAYTON, INC., THE FOUNDATION'S PARENT ORGANIZATION. IT IS THE FOUNDATION'S OBJECTIVE TO UTILIZE CURRENT FUNDRAISING TO SUPPORT PROGRAMS OF THE HOSPICE OF DAYTON, INC., TO GROW AND PROVIDE RESERVES FOR UNFORESEEN CIRCUMSTANCES, OR TO FUND SIGNIFICANT NEW INITIATIVES. THE BENEFICIAL INTEREST IN SUBSIDIARY FOUNDATION REPORTED ON SCHEDULE D, PART IX INCLUDES THE ENDOWMENT ASSETS SHOWN ON SCHEDULE D, PART V. 0 0 0 0 0 0 0 0 0 KENT ANDERSON 272517 0 70400 0 0 0 0 0 4108 0 347025 0 0 0 JERRY DURST 143188 0 22500 0 0 0 12514 0 4108 0 182310 0 0 0 BRENDA HUMFLEET 163055 0 27237 0 0 0 13242 0 4108 0 207642 0 0 0 JULES SHERMAN 253673 0 0 0 0 0 12642 0 4108 0 270423 0 0 0 RUTH THOMSON 299166 0 64571 0 0 0 6125 0 4108 0 373970 0 0 0 WENDY SCHMITZ 213899 0 0 0 0 0 1456 0 4108 0 219463 0 0 0 CHIRAG PATEL 249894 0 0 0 0 0 2125 0 4108 0 256127 0 0 0 RANAPREET PATEL 220011 0 0 0 0 0 5492 0 4108 0 229611 0 0 0 MARY MURPHY 160112 0 24000 0 0 0 12950 0 4108 0 201170 0 0 0 SUPPLEMENTAL INFORMATION PART III FORM 990, SCHEDULE J, PART I, ITEM 4B: CONTRIBUTIONS OF $8,250 EACH WERE MADE TO 457(B) DEFERRED COMPENSATION PLANS ON BEHALF OF B. HUMFLEET, J. DURST, J. SHERMAN & M. MURPHY. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF TRUSTEES IS PROVIDED A COPY OF FORM 990 TO REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES ANNUALLY REPORTS ON ANY ACTIVITY THAT COULD GIVE RISE TO POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 A & B THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES UTILIZES LOCAL MARKET KNOWLEDGE, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE PRESIDENT/CEO. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE PRESIDENT/CEO UNDER GUIDELINES ESTABLISHED BY THE BOARD OF TRUSTEES AS PART OF THE BUDGET PROCESS. FORM 990, PART VI, SECTION C, LINE 19 HOSPICE OF DAYTON, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON RECEIPT OF A WRITTEN REQUEST FOR SUCH INFORMATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,670,547. CHANGE IN NET ASSETS OF BENEFICIAL INTEREST IN RELATED ENTITY (31-1769696) -437,004. TOTAL TO FORM 990, PART XI, LINE 5: -2,107,551. FORM 990, PART XI, LINE 2C: THE BOARD OF TRUSTEES HAS CHARGED THE FINANCE COMMITTEE WITH OVERSIGHT OF THE INDEPENDENT AUDIT. THIS PROCESS IS CONSISTENT WITH THE PRIOR YEAR. FORM 990, PART IX, LINE 24F: ALL COMPENSATION OF EMPLOYEES OF HOSPICE OF DAYTON FOUNDATION (31-1769696) IS PAID BY HOSPICE OF DAYTON, INC. AND IS ALLOCATED TO THE FOUNDATION, CONSISTING OF $441,449 OF SALARIES, $77,830 OF EMPLOYEE BENEFITS AND $27,612 OF PAYROLL TAXES. IN ADDITION, $614,268 OF FOUNDATION ACTIVITIES AND $41,820 OF FOUNDATION OCCUPANCY COSTS WERE PAID BY THE HOSPICE OF DAYTON, INC. AND ALLOCATED TO THE FOUNDATION. ALL ALLOCATIONS ARE BASED ON ACTUAL COSTS OF FOUNDATION OPERATIONS. THE TOTAL AMOUNT ALLOCATED TO THE FOUNDATION IS $1,202,979. HOSPICE OF DAYTON FOUNDATION 324 WILMINGTON AVENUE DAYTON OH 45420 311769696 TO PROVIDE FINANCIAL SUPPORT TO ITS PARENT, HOSPICE OF DAYTON OH 501(C)(3) 170(B)(1)(A)(VI) HOSPICE OF DAYTON INC 1 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 HOSPICE OF DAYTON FOUNDATION (31-1769696) C 2151665 CASH VALUE HOSPICE OF DAYTON FOUNDATION (31-1769696) L 614268 CASH VALUE HOSPICE OF DAYTON FOUNDATION (31-1769696) M 41820 CASH VALUE HOSPICE OF DAYTON FOUNDATION (31-1769696) N 546891 CASH VALUE