DEKALB COUNTY HOSPICE INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- DEKALB COUNTY HOSPICE INC (EIN 36-3164329)
- Tax period
- 2011-05-01 to 2012-04-30
- Filed
- 2012-12-17
- IRS object ID
- 201243529349300809
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-12-17T09:38:15-06:00 | Timestamp |
| Tax Period End Date | 2012-04-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 114 E EVERETT | AddressLine1 |
| City | DIXON | City |
| State | IL | State |
| ZIP Code | 61021 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-05-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363164329 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEKALB COUNTY HOSPICE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DEKA | NameControl |
| Phone | 8157563000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2727 SYCAMORE ROAD NO 1B | AddressLine1 |
| City | DEKALB | City |
| State | IL | State |
| ZIP Code | 601159204 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LOREN FOELSKE | Name |
| Title | VICE PRESIDENT - FINANCE, KHS | Title |
| Phone | 8157561521 | Phone |
| Date Signed | 2012-12-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KELLY JACKSON HARDY | Name |
| PTIN | P00747242 | PTIN |
| Phone | 8152842285 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | KEVIN P POORTEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2727 SYCAMORE ROAD NO 1B | AddressLine1 |
| City | DEKALB | City |
| State | IL | State |
| ZIP Code | 601159204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1956452 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.DEKALBCOUNTYHOSPICE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1981 | YearFormation |
| State Legal Domicile | IL | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HOSPICE SERVICES TO TERMINALLY ILL INDIVIDUALS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 28 | TotalNbrEmployees |
| Total Nbr Volunteers | 300 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 223270 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 201302 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 1480726 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 1739366 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -66940 | InvestmentIncomePriorYear |
| Investment Income Current Year | 5554 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 6125 | OtherRevenuePriorYear |
| Other Revenue Current Year | 6406 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1643181 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1952628 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1371906 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1416047 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 3615 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 685778 | OtherExpensePriorYear |
| Other Expenses Current Year | 670850 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2057684 | TotalExpensesPriorYear |
| Total Expenses Current Year | 2086897 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -414503 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -134269 | RevenuesLessExpensesCY |
| Total Assets BOY | 624699 | TotalAssetsBOY |
| Total Assets EOY | 970141 | TotalAssetsEOY |
| Total Liabilities BOY | 886642 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 676097 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -261943 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 294044 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | OUR MISSION IS TO ASSIST PEOPLE TO LIVE WITH DIGNITY AND HOPE IN WAYS THAT BEST MEET THEIR NEEDS WHILE COPING WITH END-OF-LIFE ISSUES AND TO SUPPORT GRIEVING FAMILY AND COMMUNITY MEMBERS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 2010003 | Expense |
| Revenue | 1739366 | Revenue |
| Description | ORGANIZATION PROVIDED HOSPICE SERVICES TO THE COMMUNITY. OVER 300 VOLUNTEERS PROVIDED 4,782 HOURS OF SUPPORTIVE SERVICES TO PATIENTS/FAMILIES, FUNDRAISING EFFORTS, OFFICE SUPPORT, BEREAVEMENT SERVICES, AND EQUIPMENT AND SUPPLY DELIVERY. THE TRANSITIONS PROGRAM PROVIDED EMOTIONAL SUPPORT AND CASE MANAGEMENT TO 33 TERMINALLY ILL INDIVIDUALS WITH A PROGNOSIS OF 1 YEAR OR LESS, AT NO COST TO THE CLIENT. VOLUNTEERS ARE A KEY COMPONENT TO THIS PROGRAM. OFFERED AT NO COST TO ATTENDEES, POWERFUL TOOLS FOR CAREGIVERS CLASSES ARE OFFERED 2 TIMES DURING THE YEAR, WITH 6 SESSIONS IN EACH CLASS TO PROVIDE EDUCATION AND SUPPORT TO CAREGIVERS LIVING IN THE COMMUNITY AT LARGE.MAILED AN AVERAGE OF 4,853 BEREAVEMENT CARE NEWSLETTERS 5 TIMES A YEAR. MAILED AN AVERAGE OF 285 SUPPORT MAILINGS MONTHLY TO THE NEWLY BEREAVED. MAILED 572 BOOKLETS OUT AT THE HOLIDAYS TO FAMILIES FACING FIRST HOLIDAY SEASON AFTER DEATH. 305 HOURS OF COMMUNITY CONTACT WAS PROVIDED IN THE FORM OF BEREAVEMENT GROUPS, BEREAVED PARENT CANDLE LIGHT SERVICE, MEMORIAL TEDDY BEAR WORKSHOPS, 1:1 GRIEF SUPPORT WITH COMMUNITY MEMBERS, AND CHURCH, CIVIC GROUP, NURSING HOME EDUCATION AND SUPPORT. 3.5 HOURS SPENT PROVIDING COMMUNITY EDUCATION ABOUT THE PROGRAM, SERVICES, AND GENERAL GRIEF. | Description |
| Total Program Service Expense | 2010003 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 5 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 28 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LOREN FOELSKE - VP FINANCE KHS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8157561521 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE KISH HOSPITAL DRIVE | AddressLine1 |
| City | DEKALB | City |
| State | IL | State |
| ZIP Code | 60115 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| JANICE FRITSCH | ||||||
| SEC/TREASURER | 1.00 | X | X | 0 | 0 | 0 |
| KURT SCHWEITZER | ||||||
| CHAIR | 1.00 | X | X | 0 | 0 | 0 |
| KEVIN POORTEN | ||||||
| PRESIDENT & CEO KISH. HEAL | 1.00 | X | 0 | 698961 | 102663 | |
| DR MICHAEL THORNTON | ||||||
| MEDICAL DIR. KISH. MED. AS | 1.00 | X | 0 | 0 | 0 | |
| MARVIN BARNES | ||||||
| VICE CHAIR | 1.00 | X | X | 0 | 0 | 0 |
| MARY GAWRYS | ||||||
| SEC/TREASURER THRU 6/11 | 1.00 | X | X | 0 | 0 | 0 |
| STACI HOSTE | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| KAREN MASON | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JUDY BERGESON | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| MARK HILDE | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| ELISA RUBECK | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| RUTH WALKER | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| KAREN HAGEN | ||||||
| EXECUTIVE DIRECTOR | 40.00 | X | 90827 | 0 | 21781 | |
| LOREN FOELSKE | ||||||
| VICE PRES. & CFO OF KISH H | 1.00 | X | 0 | 316761 | 41819 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 90827 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1015722 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 166263 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| HOSPICE PHARMACIA | |||||
| BOX 510818 | PHILADELPHIA | PA | 19175 | MEDICAL SERVICES | 124560 |
| KISHWAUKEE COMMUNITY HOSPITAL | |||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | MEDICAL SERVICES | 117323 |
| BETHANY HEALTHCARE | |||||
| 3298 RESOURCE PARKWAY | DEKALB | IL | 60115 | MEDICAL SERVICES | 106583 |
| KISHHEALTH SYSTEM | |||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | MANAGEMENT SERVICES | 103835 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Federated Campaigns | 16847 | FederatedCampaigns |
| Government Grants | 7128 | GovernmentGrants |
| All Other Contributions | 177327 | AllOtherContributions |
| Noncash Contributions | 4067 | NoncashContributions |
| Total Contributions | 201302 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE RE | Description |
| Business Code | 621610 | BusinessCode |
| Total Revenue Column | 1739366 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1739366 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 1739366 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5554 | TotalRevenueColumn |
| Exclusion | $5,554 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 895 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 85 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 810 | TotalRevenueColumn |
| Exclusion | $810 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 9335 | GrossIncomeGaming |
| Gaming Direct Expenses | 3739 | GamingDirectExpenses |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5596 | TotalRevenueColumn |
| Exclusion | $5,596 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1952628 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1739366 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $11,960 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 118915 | Total |
| Program Services | 118915 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 940660 | Total |
| Program Services | 940660 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50321 | Total |
| Program Services | 50321 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 231736 | Total |
| Program Services | 231736 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74415 | Total |
| Program Services | 74415 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 95322 | Total |
| Program Services | 95322 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 125 | Total |
| Management And General | 125 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2400 | Total |
| Management And General | 2400 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 107242 | Total |
| Program Services | 36488 | ProgramServices |
| Management And General | 70754 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8159 | Total |
| Program Services | 7468 | ProgramServices |
| Fundraising | 691 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 333439 | Total |
| Program Services | 330515 | ProgramServices |
| Fundraising | 2924 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58588 | Total |
| Program Services | 58588 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 55253 | Total |
| Program Services | 55253 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6087 | Total |
| Program Services | 6087 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| FLOWERS AND CONDOLENCES | 2423 | 2423 |
| MISCELLANEOUS EXPENSE | 907 | 907 |
| DUES AND LICENSES | 675 | 675 |
| EMPLOYEE RECOGNITION AN | 230 | 230 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2086897 | Total |
| Program Services | 2010003 | ProgramServices |
| Management And General | 73279 | ManagementAndGeneral |
| Fundraising | 3615 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75 | BOY |
| EOY | 75 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 203804 | BOY |
| EOY | 488456 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 284593 | BOY |
| EOY | 257618 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8316 | BOY |
| EOY | 7439 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 35581 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 35581 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 127911 | BOY |
| EOY | 216553 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 624699 | BOY |
| EOY | 970141 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 256312 | BOY |
| EOY | 264372 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 630330 | BOY |
| EOY | 411725 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 886642 | BOY |
| EOY | 676097 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -376214 | BOY |
| EOY | 169720 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 114271 | BOY |
| EOY | 124324 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -261943 | BOY |
| EOY | 294044 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 624699 | BOY |
| EOY | 970141 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -134269 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 690256 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 314619 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 203848 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 343029 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 225030 | CurrentTaxYearMinus1Year |
| Current Tax Year | 201302 | CurrentTaxYear |
| Total | 1287828 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 314619 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 203848 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 343029 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 225030 | CurrentTaxYearMinus1Year |
| Current Tax Year | 201302 | CurrentTaxYear |
| Total | 1287828 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 171856 | AmountsSubstContributorsTotal |
| Public Support Total170 | 1115972 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 6078 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 3372 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3270 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2138 | CurrentTaxYearMinus1Year |
| Current Tax Year | 5554 | CurrentTaxYear |
| Total | 20412 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 4177 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 3120 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6691 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 3348 | CurrentTaxYearMinus1Year |
| Current Tax Year | 6406 | CurrentTaxYear |
| Total | 23742 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 1331982 | TotalSupport |
| Gross Receipts From Admissions Etc | 7851656 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.83780 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.82790 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 35581 | OtherCostOrOtherBasis |
| Depreciation | 35581 | Depreciation |
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER RECEIVABLES | 103967 |
| DUE FROM RELATED ENTITIES | 219 |
| INTEREST IN NET ASSETS OF KISHHEALTH FOUNDATION | 112367 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 216553 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO RELATED ENTITIES | Description |
| Amount | $411,725 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 411725 | TotalOfAmounts |
| Total Revenue | 1952628 | TotalRevenue |
| Total Expenses | 2086897 | TotalExpenses |
| Excess Or Deficit For Year | -134269 | ExcessOrDeficitForYear |
| Other | $690,256 | OtherAmount |
| Total Adjustments | 690256 | TotalAdjustments |
| Excess Or Deficit Per FS | 555987 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 1956452 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 3824 | OtherRevenues |
| Revenue Not Rptd F990 | 3824 | RevenueNotRptdF990 |
| Revenue Subtotal | 1952628 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 1952628 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 2090721 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 3824 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 3824 | ExpensesNotRptdF990 |
| Expenses Subtotal | 2086897 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 2086897 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | CHANGE IN INTEREST IN NET ASSETS OF KISHHEALTH FOUNDATION 12,212. OTHER -11,956. CAPITAL CONTRIBUTION RECEIVED FROM KISHHEALTH SYSTEM 690,000. TOTAL TO SCHEDULE D, PART XI, LINE 8: 690,256. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENTS EXPENSES 3,824. |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENTS EXPENSES 3,824. |
| PART XI, LINE 10, EXCESS OR (DEFICIT) FOR THE YEAR PER FINANCIAL STATEMENTS: LINE 10 IDENTIFIES FINANCIAL STATEMENT INCOME AS EQUALING $555,987. FINANCIAL STATEMENT INCOME IS ACTUALLY $(134,269). THE DIFFERENCE IN THESE AMOUNTS IS REPORTED AS A CAPITAL CONTRIBUTION FROM KISHHEALTH SYSTEM IN THE AMOUNT OF $690,000. FOR FINANCIAL STATEMENT PURPOSES, THIS TRANSACTION WAS RECORDED VIA AN ENTRY TO EQUITY. THERE IS ALSO A NET ADJUSTMENT OF $256 INCLUDED IN EQUITY TO ACCOUNT FOR THE REMAINING CHANGE IN NET EQUITY. THIS ADJUSTMENT CONSISTS OF AN INCREASE IN DCH'S INTEREST IN THE INVESTMENT ASSETS OF KISHHEALTH FOUNDATION IN THE AMOUNT OF A $12,212 AND AN OTHER DECREASE IN THE AMOUNT OF $11,956. THESE ITEMS ARE INCLUDED IN THE RECONCILIATION AT PART XI AS ITS INCLUSION IS NECESSARY TO RECONCILE THE CHANGE IN THE EQUITY BALANCE, BUT ARE NOT A COMPONENT OF FINANCIAL STATEMENT INCOME. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KEVIN POORTEN | |||||||||||||
| 0 | 515921 | 0 | 183040 | 0 | 0 | 0 | 79288 | 0 | 23375 | 0 | 801624 | 0 | 0 |
| LOREN FOELSKE | |||||||||||||
| 0 | 249213 | 0 | 67548 | 0 | 0 | 0 | 19288 | 0 | 22531 | 0 | 358580 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 4B | THE ORGANIZATION'S CEO PARTICIPATES IN A NONQUALIFIED DEFERRED COMPENSATION PLAN. CONTRIBUTIONS FOR CALENDAR YEAR 2011 WERE $60,000. | |
| PART III | PART I, LINE 3: THE ORGANIZATION RELIED ON A RELATED ORGANIZATION THAT USED ONE OR MORE METHODS DESCRIBED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. | SUPPLEMENTAL INFORMATION |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| KISHHEALTH SYSTEM | |||
| COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, KHS IS PARENT COMPANY OF DCH | 95322 | KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF DEKALB COUNTY HOSPICE. THE PURPOSE OF KHS IS TO PROVIDE MANAGEMENT AND SUPPORT SERVICES TO ITS RELATED ORGANIZATIONS, ALL OF WHICH PROVIDE HEALTHCARE SERVICES. FEES PAID TO KHS ARE IN EXCHANGE FOR THESE SERVICES, INCLUDING THE ORGANIZATIONS SHARE OF COMPENSATION OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES. | 0 |
| KISHWAUKEE COMMUNITY HOSPITAL | |||
| COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, BROTHER-SISTER AFFILIATE | 117323 | KISHWAUKEE COMMUNITY HOSPITAL (KCH) IS AN AFFILIATE OF DEKALB COUNTY HOSPICE (SAME PARENT CORPORATION). KCH IS UTILIZED BY DEKALB COUNTY HOSPICE FOR MEDICAL TREATMENTS AND SUPPLIES AS WELL AS COLLECTION SERVICES. | 0 |
| KISHWAUKEE COMMUNITY HOSPITAL | |||
| COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, BROTHER-SISTER AFFILIATE | 53976 | KISHWAUKEE COMMUNITY HOSPITAL (KCH) IS AN AFFILIATE OF DEKALB COUNTY HOSPICE (SAME PARENT CORPORATION). DEKALB COUNTY HOSPICE RENTS SPACE IN THE BUILDING OWNED BY KCH. | 0 |
| KISHHEALTH SYSTEM | |||
| COMMON DIRECTORS/OFFICERS/KEY EMPLOYEES, KHS IS PARENT COMPANY OF DCH | 690000 | KISHHEALTH SYSTEM (KHS) IS THE PARENT ORGANIZATION OF DEKALB COUNTY HOSPICE. KHS TRANSFERRED FUNDS VIA AN CAPITAL CONTRIBUTION TO DCH DURING THE YEAR. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | KEVIN POORTEN AND LOREN FOELSKE ARE BOTH EMPLOYEES OF KISHEALTH SYSTEM, THE PARENT ORGANIZATION OF DEKALB COUNTY HOSPICE. MR. POORTEN IS PRESIDENT AND CEO OF KISHHEALTH SYSTEM AND SERVES AS AN EX-OFFICIO DIRECTOR FOR ALL ORGANIZATIONS RELATED TO KISHHEALTH SYSTEM. MR. FOELSKE SERVES AS THE VICE-PRESIDENT - FINANCE OF KISHHEALTH SYSTEM. | |
| FORM 990, PART VI, SECTION A, LINE 6 | KISHHEALTH SYSTEM IS THE SOLE MEMBER OF DEKALB COUNTY HOSPICE. | |
| FORM 990, PART VI, SECTION A, LINE 7A | AS THE SOLE MEMBER AND PARENT ORGANIZATION OF DEKALB COUNTY HOSPICE, KISHHEALTH SYSTEM HAS THE RIGHT TO ELECT CERTAIN MEMBERS OF THE HOSPICE GOVERNING BOARD. PER THE HOSPICE'S BYLAWS, THE VOTING TRUSTEES ARE ELECTED BY THE KHS BOARD AT EACH ANNUAL MEETING. | |
| FORM 990, PART VI, SECTION A, LINE 7B | KISHHEALTH SYSTEM (KHS) SERVES AS THE SOLE MEMBER AND PARENT ORGANIZATION OF DEKALB COUNTY HOSPICE. THE BYLAWS OF THE HOSPICE STATE THAT THE HOSPICE BOARD MAY TAKE NO ACTION PERTAINING TO THE FOLLOWING WITHOUT APPROVAL OF THE KHS BOARD: A. APPROVING THE ANNUAL OPERATING AND CAPITAL BUDGETS FOR THE HOSPICE; B. ELECTING THE MEMBERS OF THE HOSPICE'S BOARD; C. APPROVING THE STRATEGIC PLAN FOR THE HOSPICE; D. APPROVING THE DISPOSITION OF ANY ASSETS OF THE HOSPICE OTHER THAN IN THE ORDINARY COURSE OF BUSINESS OF THE HOSPICE; E. APPROVING ANY CHANGE IN MEMBERSHIP OF THE HOSPICE; F. APPROVING, EVALUATING AND/OR REMOVING THE PRESIDENT AND CEO AND REVIEWING AND APPROVING THE EMPLOYMENT CONTRACT OF THE PRESIDENT AND CEO AND ESTABLISHING COMPENSATION FOR SUCH OFFICE; G. APPROVING THE ADOPTION OF AND AMENDMENTS TO THE ORGANIZATIONAL DOCUMENTS, INCLUDING THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE HOSPICE; H. APPROVING THE ADOPTION OF A PLAN OF MERGER OR ADOPTING A PLAN OF CONSOLIDATION WITH ANOTHER CORPORATION; I. EXERCISING ALL RIGHTS THAT THE HOSPICE HAS AS A SHAREHOLDER OR MEMBER OF A SUBSIDIARY ENTITY; J. AUTHORIZING THE SALE, LEASE, EXCHANGE, OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE HOSPICE; K. AUTHORIZING THE VOLUNTARY DISSOLUTION OF THE HOSPICE OR REVOKING PROCEEDINGS THEREOF; L. ADOPTING A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF THE HOSPICE; M. APPROVING ANY AFFILIATIONS OF THE HOSPICE; N. SELECTING OF THE MEDICAL DIRECTOR OF THE HOSPICE; O. REQUIRING MINUTES OF MEETINGS, FINANCIAL RECORDS AND SUCH OTHER INFORMATION AS MAY BE NECESSARY TO PROPERTY EVALUATE THE PERFORMANCE OF THE HOSPICE; P. TRANSFERRING MONEY OR PROPERTY AMONG THE HOSPICE, KHS AND ONE OR MORE SUBSIDIARY CORPORATION; AND Q. INITIATING ACTION TO REMOVE OR REINSTATE A DIRECTOR IN ACCORDANCE WITH SECTION 4.14. SUBJECT TO THE AUTHORITY OF THE BOARD AS SET FORTH IN THIS ARTICLE IV, THE KHS BOARD MAY INITIATE AND APPROVE ANY OF THE FOREGOING ON BEHALF OF THE HOSPICE. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A DRAFT COPY OF FORM 990 IS PROVIDED TO THE GOVERNING BODY (BOARD OF DIRECTORS) AND THE GOVERANCE COMMITTEE FOR REVIEW BY THE RETURN PREPARER PRIOR TO FILING. THE ORGANIZATION'S CEO, CFO, AND OTHER MEMBERS OF THE ACCOUNTING DEPARTMENT ARE ALSO PROVIDED A COPY OF THE RETURN FOR THEIR REVIEW. THE CHAIR OF THE AUDIT COMMITTEE AND THE AUDIT COMMITTEE MEMBERS ARE ALSO PROVIDED DRAFT COPIES AND REVIEW. IF CHANGES ARE NECESSARY, THEY ARE REPORTED TO THE RETURN PREPARER AND INCORPORATED INTO THE FINAL RETURN. | |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICTS OF INTEREST ARE INVESTIGATED BY APPOINTED MEMBERS OF THE GOVERANCE COMMITTEE ON AN ONGOING BASIS. IF IT IS DETERMINED THAT AN INDIVIDUAL FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM THE INDIVIDUAL OF SUCH A BELIEF AND AFFORD HIM AN OPPORTUNITY TO EXPLAIN. AFTER SAID EXPLANATION, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION AS DEEMED NECESSARY. THE CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD ANNUALLY AND UPDATED AS NEEDED. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THROUGH THE OVERSIGHT OF THE BOARD OF DIRECTORS EXECUTIVE COMPENSATION COMMITTEE, THE KISHHEALTH SYSTEM EXECUTIVE TOTAL COMPENSATION PROGRAM WILL BE COMPETITIVELY POSITIONED IN THE MARKET PLACE OF RELEVANT ORGANIZATIONS AND FALL WITHIN THE SAFE HARBOR GUIDELINES ESTABLISHED BY THE INTERMEDIATE SANCTIONS RULES. THE EXECUTIVE COMPENSATION COMMITTEE IS MADE UP OF THREE MEMBERS OF THE BOARD OF DIRECTORS WHO MEET THE BOARD APPROVED DEFINITION OF "INDEPENDENT DIRECTORS". ANNUALLY THE EXECUTIVE COMPENSATION COMMITTEE CONTRACTS WITH SULLIVAN, COTTER AND ASSOCIATES, AN INDEPENDENT HUMAN RESOURCES CONSULTING FIRM TO PROVIDE THE COMMITTEE ANALYSIS AND COMPARABILITY DATA. USING THE SUPPLIED DATA THE COMPENSATION COMMITTEE APPROVES EACH EXECUTIVE'S TOTAL CASH COMPENSATION AND PROVIDES CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. TOTAL CASH COMPENSATION IS DEFINED AS THE SUM OF BASE SALARIES PLUS INCENTIVE AWARDS. BASED ON THE COMPARABILITY DATA AND THE PERFORMANCE OF EACH EXECUTIVE IN MEETING GOALS AND STRATEGIC OBJECTIVES, THE EXECUTIVE COMPENSATION COMMITTEE APPROVES INCREASES AND INCENTIVE AWARDS FOR EACH EXECUTIVE WITHIN THE GUIDELINES ESTABLISHED. THE EXECUTIVE COMPENSATION COMMITTEE REPORTS ON ALL COMPENSATION MATTERS TO THE FULL BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST IN WRITING TO ADMINISTRATION. | |
| FORM 990, PART VII, COLUMN (B) | AVERAGE HOURS PER WEEK FOR THE INDIVIDUALS IDENTIFIED AS OFFICER'S ARE ESTIMATES OF THE INDIVIDUALS TOTAL TIME PER WEEK UTILIZED FOR WORK RELATED TO DEKALB COUNTY HOSPICE. | DESCRIPTION OF HOURS FOR RELATED ORGANIZATIONS |
| FORM 990, PART XI, LINE 5: | CHANGE IN INTEREST IN NET ASSETS OF KISHHEALTH FOUNDATION 12,212. OTHER -11,956. CAPITAL CONTRIBUTION RECEIVED FROM KISHHEALTH SYSTEM 690,000. TOTAL TO FORM 990, PART XI, LINE 5: 690,256. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XI, LINE 2C | NO CHANGES IN THIS PROCESS WERE MADE DURING THE TAX YEAR. THE ORGANIZATION MAINTAINS AN INDEPENDENT AUDIT COMMITTEE WHICH IS RESPONSIBLE FOR OVERSIGHT OF THE AUDITED FINANCIAL STATEMENTS. THIS COMMITTEE IS ALSO RESPONSIBLE FOR THE SELECTION OF THE INDEPENDENT AUDITOR. MEMBERS OF THE AUDIT COMMITTEE ARE ALSO MEMBERS OF THE KISHHEALTH SYSTEM BOARD OF DIRECTORS. KISHEALTH SYSTEM IS THE PARENT CORPORATION OF DEKALB COUNTY HOSPICE, INC. | RESPONSIBILITY FOR OVERSIGHT OF FINANCIAL STATEMENTS |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| KISHHEALTH SYSTEM | ||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 363649080 | PARENT CORPORATION OF 501(C)(3) HEALTH SYSTEM | IL | 501(C)(3) | 11B | N/A | 0 |
| KISHHEALTH FOUNDATION | ||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 363649077 | SUPPORT OF CHARITABLE HEALTH ORGANIZATIONS | IL | 501(C)(3) | 7 | N/A | 0 |
| KISHWAUKEE COMMUNITY HOSPITAL | ||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 237087041 | HEALTHCARE SERVICES, PRIMARILY ACUTE CARE | IL | 501(C)(3) | 3 | N/A | 0 |
| VALLEY WEST COMMUNITY HOSPITAL | ||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 364244337 | HEALTHCARE SERVICES, PRIMARILY ACUTE CARE | IL | 501(C)(3) | 3 | N/A | 0 |
| COMMUNITY CARES CLINIC INC | ||||||||||
| 3100 SYCAMORE ROAD | DEKALB | IL | 60115 | 800424001 | HEALTHCARE SERVICES, PRIMARILY ACUTE CARE | IL | 501(C)(3) | 3 | N/A | 0 |
| KISHWAUKEE PHYSICIANS GROUP INC | ||||||||||
| ONE KISH HOSPITAL DRIVE | DEKALB | IL | 60115 | 651293967 | HEALTHCARE SERVICES, PRIMARILY FAMILY PRACTICE | IL | 501(C)(3) | 3 | N/A | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEALTH PROGRESS INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE KISH HOSPITAL DRIVE | AddressLine1 |
| City | DEKALB | City |
| State | IL | State |
| ZIP Code | 60115 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363824138 | EIN |
| Primary Activity | INVESTMENT IN HEALTHCARE RELATED SMALL BUSINESSES | PrimaryActivity |
| Legal Domicile State | IL | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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